"What is your hand on?" the surgeon asked, her question punctuated by the whirr of the ventilator wheezing away in the chilly operating room.
I stood there for a moment, quietly, just trying to get a sense of where my hand was in the first place. In reality, I knew just where my hand was. It wasn’t a trick question and it wasn’t particularly hard to answer. Part of me, though, just didn’t allow the realization to sink in. So, I stood there, searching for something more, something other than what my fingers obviously felt.
My mind stretched back to anatomy and embryology at the very beginning of the year for answers. Last August, everything, everyone, was new. My white coat was freshly white, uncreased, neatly kept, gleaming with my newly minted nametag - “Roheet Kakaday, Medical Student”. I had achieved the dream, but the promise had yet to be fulfilled.
The first time I entered the anatomy lab, a chill ran down my body - the kind you get when you’re about to do something really significant. It was cold, like the operating room I was in now, and lives lived lay in front of us, waiting for us to learn. I learned and, soon, everything I saw became an anatomical problem. Short of breath? Probably a pulmonary abnormality. Patient has unilateral leg pain? Probably a pinched nerve between the piriformis and gemellus. Patient can’t move her arm? Brachial plexus neuropathy. As it turned out, some of that knowledge actually came in handy.
A few months later, all of that was complicated by biochemistry, by far one of my more challenging courses. Cycles, pathways, histologies, and reactions galore mucked up my once pristine anatomical differentials. Now, not only could it be a neuropathy, but, perhaps, an error in metabolism? Is she getting enough vitamins and amino acid precursors? What’s her diet like? The factors to consider multiplied ten fold.
Then, along came physiology. Coming from an engineering background, where overviews take precedence over details, the homeostatic control systems of the body were a breath of fresh air relative to memorizing minutiae. Now, however, the differential became even more complex - could the neuropathy be because of a chemical imbalance? Hormonal dysfunction? The factors to consider grew again.
Finally, immunology and infections hit with one last volume of information. Bacterial, fungal, viral, and parasitic etiologies ran amok in my differentials. Could it be an infection? Could it be cancer? Could it be an autoimmune disease? The factors, now, were astounding in number.
In the background, I started a company, won some awards, became an advisor for Stanford University’s Medicine X, was approached by entrepreneurs to collaborate on my electronic health record idea, joined a research team, started co-hosting a podcast on medical innovation, and more. The funny thing is, there is yet more in the pipeline.
Looking back on the year, it was incredible to think I did these things and finished medical school in one piece. None of it would be possible without the incredible support of friends, family, and folks on the Internet, like you, who would reach out to me.
At the end of the first year of medical school, the facts I have learned (and, let’s be honest, forgotten) is staggering. Indeed, the responsibility of managing that burden of knowledge is daunting. In the same vein, it’s still what keeps medical school exciting; the intellectual challenge is what motivates many of us medical students and the satisfaction of helping another is what helps keep us going.
If anything, I can say I have a basis now, a basic platform upon which to further build a clinical career, an idea with which to piece together the puzzle of human disease. That is incredible in and of itself.
"Mmmm?" the surgeon prompted me again.
Snapped out of my brief lapse, I found myself back in the operating room. I looked into the open chest my hand had disappeared into. My fingers felt it - thump, thump, thump - and there was no need to even think.
It was, to some degree, instinctual now.
"It’s the left ventricle…" I let that hover for a moment, "My hand is on the heart." It’s slick surface thumped and slid across my fingers, frozen in awe.
My wide-eyed amazement slowly sunk into the corners of the OR and the surgeon resumed working. As phenomenal as that was, I realized that this will be my new normal. This will be my everyday.
And that is incredibly exciting.
Excellent piece by the lovely Roheet.
Medicine still remains the most incredible, wonderful thing in the world to me. :) We’re so incredibly lucky to get to do what we do every day.