A first time for everything

I fidgeted uncomfortably, trying to hide the fact that my hands were shaking. Dr. Shepherd scrolled through the patient’s electronic medical records, leaning over with his chin in his hand. Upon discerning that this case would be the simplest possible – a middle-aged man simply at the clinic to refill his diabetes medications – he said, “OK, I’ll let you see this patient,” without even looking up.

My hair was combed neatly to the side, my short white coat starched and pressed; I was of course wearing my favorite dress shirt and tie combination. But none of that mattered as the beads of sweat forming on my forehead betrayed my inexperienced nervousness.

“Alright,” I responded tenuously.

Dr. Shepherd filled me in on the patient’s vital signs and gave me a few brief instructions. Then I was finally off – paper and pen in hand – to see the very first patient of my medical career.

My walk down the hallway to Exam Room 2 was pathetically cathartic. My mind journeyed to the cold, bumpy flights that carried me away from the comfort of my family to my undergraduate university. I thought about all the late nights I had spent studying in undergrad, both for my classes and for the MCAT. I remembered my father’s proud smile and my mother’s sweet tears when I approached them for the first time wearing my white coat just a week prior. Even with all of the preparation I had pushed myself through and all of the encouragement my family and friends had given me, I couldn’t help but feel totally and completely helpless as I stood looking dumbly at the closed door of Exam Room 2. I had been dreaming of this moment for my entire life, but now that it had finally come I had even forgotten how to open a door.

I shook my head briskly to clear my mind, gathered myself, took a deep breath, knocked, and opened the door. Sitting before me was an extremely obese man in his mid thirties. He greeted me with a short handshake and avoided eye contact. Fumbling for my place in the room, I settled on the stool sitting near the computer. This was supposed to be my place for the rest of my career, but when I sat down I felt an overwhelming sense that I was nothing more than an imposter. Remembering the brief training I had received thus far, I just sat and just looked at my patient. He was staring off into the opposite corner of the room. He fidgeted on the examination table and wrung his calloused, rough hands repeatedly. I saw in his eyes that he, too, was unbelievably nervous.

I was the first to break the awkward silence. “So, I hear from the nurse that you are here to get a refill on your medications for diabetes,” I began. He looked over at me and then back to the corner.

“Well, I guess,” he replied softly.

I began to run down the history checklist from our first “Patient, Physician and Society” lecture. In the middle of my foolish attempt to “OLDCARTS” his chief complaint of needing more diabetes medication, he looked right at me and said, “I’m not really here to refill the medicines. I’m more here to get them for the first time.”

“Oh, so you’ve never taken medications for your diabetes?” I asked. I felt sweat drip from my armpits. He wasn’t following my script, and we were now in uncharted territory.

“You see,” he continued, “I’m Native American. Whenever I get sick I just drive to the reservation in Louisiana to see our medicine man. But the problem is that I’m sick with this ‘diabetes’ and he doesn’t have anything for that. So I have to see one of you.” The disdain underlying the word “you” in his statement took me completely by surprise.

Not only did he have no idea what was going on with his body, but this – me of all people – was the first time he had ever seen a Western “physician.” Deeply rooted within him was a sense of mistrust for those who wore the white coat I so proudly flaunted just a week prior, and he was terrified. He was sick and experiencing miserable symptoms, and this entire experience had placed him far from the familiarity of his tribe and culture. To top it all off, he had come into the clinic alone.

The end of this story is laughably boring. Dr. Shepherd explained diabetes to him, started him on metformin, administered a seasonal influenza vaccine, and scheduled a follow up appointment. But my reflection on this day continues to be very meaningful to me. When I consider those few moments we spent together, what were the differences between us? We were both alone. We were both outside of our comfort zones. We both struggled and fumbled with our words. We were both out of place. We were both afraid of each other. We both assumed roles neither of us had ever filled before.

No matter how comfortable I become with the medical profession or how busy I become with grueling rounding and lecture schedules, I hope to never forget how I felt as I stood outside of Exam Room 2 on the first day of my medical career. Even though my white coat has become wrinkled and stained with afternoon coffee and various pen markings, I can always think back to this experience in order to help find the emotional common ground with my patients that is so necessary for healing to take place. What is commonplace for us can be terrifying for our patients. It makes them fidget in their seats, wring their hands, and sweat all over. It is vital to recognize this on a daily basis so we can do our job as it is meant to be done.