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PATIENT TEACHERS Illustrations by Chris Demarest Turning medical students into doctors is a job that calls for scientific acumen, medical expertise, and lots of patience. And it calls for patients, too. Many students say that the most powerful lessons they learn—especially those about the importance of the human touch—are insights that they glean from patients. Here are several such sagas. younger than I, who had nearly sacrificed every- A uniform finding thing for the country he believes in, was determined By W. Andrew Cronin to return to full health so he could rejoin his unit. I hadn’t yet learned about the stages of wound heal- Andy Cronin, who earned his undergraduate degree in ing that his body was undergoing, hadn’t yet mas- chemistry from the U.S. Naval Academy, will gradu- tered the neurologic tests that were being used to ate in June from Dartmouth’s M.D.-M.B.A. program. monitor the stroke he had suffered due to the inci- After a transitional internship in 2009-10 at Balboa dent. But I was able to play a meaningful role in his Naval Hospital in San Diego, he will serve for three care simply by taking the time to listen to someone years as an undersea medical officer; he then plans to who was half a country away from his family and enter a residency in anesthesiology. half a world away from his friends who were still fighting. I went home in the evening after working was a 21-year-old rising senior at the U.S. Naval with him convinced that there was no greater pro- I Academy when an encounter with a 20-year-old fession than medicine. Marine changed my career path forever. He had When I first came to medical school, my excite- been shot in the neck in Afghanistan but, thanks ment and passion were at an all-time high as I met On Mr. Webber’s first follow-up visit, to the commitment of his fellow soldiers, had been a community of like-minded classmates, all in pur- I surprised him by wearing my Navy uniform. extricated from the battlefield under heavy fire, sta- suit of the same goal: to become doctors. At first, bilized by medics in the combat zone, and evacuat- my passion to provide care to patients drove me to I even had someone take a picture of the two of us ed to a military hospital, where his left carotid learn as much of the science of medicine as possi- artery was repaired and his life saved. I worked with ble. However, I gradually began to separate out the together and sent a copy of it to him, him for two weeks during his rehabilitation after art from the science of medicine. Fortunately, a few together with a note of thanks. his return to the U.S. I was amazed that this man, elements of first year kept my spirit nourished— most notably the On Doctoring course, which gave — Andy Cronin, DMS ’09 us contact with patients and an opportunity to dis- These five narratives were written by Dartmouth medical students upon their induction into the Gold Humanism Honor Society. A cuss the human side of medicine in weekly small- national organization with chapters at 72 of the nation’s 129 med- group sessions, as well as the community service ac- ical schools, the Gold Society recognizes students for their compas- tivities we were encouraged to engage in. sion and dedication to service. For last year’s Dartmouth induc- tion ceremony, the society’s newest members were asked to de- But slowly I began to assign the caring, compas- scribe an especially meaningful encounter during their medical ed- sionate parts of me to the Thursday afternoon On ucation. Five of the narratives prepared for that occasion have Doctoring sessions, while my disciplined, driven as- been adapted for publication here. The names of all the patients mentioned, as well as key identifying details about their cases, pects took charge the rest of the week. The more I have been changed in order to preserve their confidentiality. separated science from the rest of my persona, the 34 Dartmouth Medicine—online at dartmed.dartmouth.edu Spring 2009 Spring 2009 online at dartmed.dartmouth.edu—Dartmouth Medicine 35 more studying became a chore—a forced march to tance of their relationship in each of their lives. As rying everything I would need: Lunch, check. get from first year to second, then from second year I invested time in him, he invested time in me. He Surgery Rapid Review, check. Extra hair elastics and to third—instead of a way to provide better care to shared insights from a patient’s perspective about barrettes, check. Stethoscope, check. I spent the next few days patients. what makes a good doctor. He even requested that Next to my bag lay my carefully organized white investigating all the causes I didn’t realize how separated the art and the sci- I perform his paracentesis—a procedure to draw out coat—my name badge and beeper clipped to its ence had become in my mind until I met Mr. Web- the built-up fluid through a thin, hollow needle— lapels and its pockets filled with blank note cards, and possible treatments ber on my internal medicine rotation in October of knowing full well that I had never performed one information cards, pens, a mini flashlight, and for ascites. But even more my third year. Mr. Webber was a retired Navy vet- before. I thanked Mr. Webber for the experience, breath mints. It probably weighed 30 pounds, but I eran who had been admitted for the third time to and he told me it was an honor to be a part of my felt “loaded and ready for battle.” Finally, it was important, I spent time at the VA Medical Center for recurrent ascites—an education. time to review the notes I had taken regarding the accumulation of fluid in the abdominal cavity. He Though we continued to run lab tests and to next morning’s first patient. the end of each day getting had a reputation for having been a bit gruff, even consult with experts in gastroenterology, we were He was an elderly male and had a history of to know Mr. Webber better. mean, with previous medical students. I was deter- unable to determine the underlying cause of his as- smoking, though he’d quit some time before; he was mined to get beyond his “difficult” personality and cites. We discharged him with a plan for frequent having surgery because a nodule had been identified We traded sea stories. I find the cause of his ascites. But luckily for me, he follow-up visits, hoping that closer management of on his left lung. I flipped through my Rapid Review shared with him everything was determined to remind me of something I knew his condition would avoid any more long hospital- book in the section labeled “Lung Lesions,” so I’d but had forgotten since being in medical school. izations. The day he left for home, one of his last be ready for the inevitable questions that the med- I was learning about his “Mr. Webber, can you describe to me what has comments to me was that he’d love to have served ical student on the team gets asked. Then I scanned condition. He and his wife happened since your previous admission?” I asked. in the Navy with me and to have seen me in my the internet for a description of a thoracotomy so uniform. that I would know what was happening in the op- told me how they had met. is response came in the form of another ques- Although I had been unable to identify a cause erating room. H tion: “What is that symbol on the bottom of or cure for his problem, this latter request was one At last, I resigned myself to the fact that I would As I invested time in him, your tie?” I could fulfill. On Mr. Webber’s first follow-up vis- have to learn as I went along, and I went to bed. he invested time in me. “It’s the Naval Academy crest.” I replied quick- it, I surprised him by wearing my dress Navy uni- ly and immediately asked another question: “How form. I even had someone take a picture of the two arly the next morning, the senior resident on my — Andy Cronin ’09 soon after you went home did your ascites recur?” of us together. I had one print developed for myself, E team took me in to meet Mr. DeFelice before he Ignoring my question, he asked another: “Are to serve as a reminder of the lesson I’d learned from was rolled into the OR. He was a friendly man and you a Navy man, Mr. Cronin, because I served 21 Mr. Webber, and I sent another copy to him, to- was accompanied by his three daughters, who were years in the Navy, in both the Atlantic and Pacif- gether with a note of thanks. I thanked him for re- equally pleasant. a thoracotomy—he had a tube emerging from his ic fleets.” minding me why I had gone into medicine. I As my senior resident explained the procedure chest and was in a lot of pain. The main things I was “I am in the Navy. Thank you for your service. thanked him for reminding me that the reason for to Mr. DeFelice and his family, I stood at her side, supposed to focus on were air leaks from his chest Are you in any pain?” I kept my responses to his all my science classes was so I could better serve my watching this interaction between doctor and pa- tube and his level of pain.

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