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Say 'Aaah' | Doctor Files

Lessons of the Heart Are Important Too

November 27, 2000|Mark Morocco | Mark Morocco is an emergency medicine doctor at UCLA Medical Center and at Los Angeles County/Olive View Medical Center. He is also the medical technical advisor for the television show "ER."

During the second week of medical school at Hahnemann Medical College in Philadelphia, we got our white coats.

It was a big deal, a symbolic rite.

All I knew about that coat was that my arms were supposed to go in the holes under the collar. The cloth, pressed by time into a patchwork pattern of square wrinkles, smelled of plastic-wrapped eternity in basement storage somewhere. In these short coats, my fellow medical students and I looked like summer-wear hobos, wearing found jackets that we didn't belong in.

My coat had pockets inside like a magician's coat. Medical students carry lots of little books tucked into every imaginable place, probably to make up for how little we carry in our heads. There are hidden pockets inside, and the usual ones outside. One guy in my class had his aunt sew extra pockets under his coat's back flaps because he didn't think there were enough pockets for all the books he needed to carry. I think the extra weight of those books made him feel smarter. But they made him look bulky from the rear.

There is an entire industry that publishes little pocket-size books for pre-doctors. A single question from one of the real doctors prompts a hair-trigger reaction: a flurry of hands reaching into pockets like a fast-draw shootout in an old western movie.

Sometimes the little books fall from their pockets. One time a book fell and plopped onto a female patient's lap. The patient, a woman in her early 50s, smiled and said something like, "Oh, my!" My fantasy was to quick-draw a rabbit out of my coat instead of a book.

Later, I was walking by the patient's doorway. We locked eyes, so I went in. Her husband, she told me, drove a bakery truck in Delaware and she raised the kids until she could no longer walk up stairs without having to sit and rest. She was here for a mechanical heart valve to replace the now-leaky one she had been born with. And on the 10th day of my medical career, I was assigned to take her history.

Most medical students are bookworms, awkward about talking to strangers. But my mother would talk to anybody, anywhere, and as her son I kept getting sucked into doorways. It slowed the schoolwork, but the patients were more interesting than books.

The heart patient asked me about the book that earlier landed in her lap. I blushed and told her how little I knew about the book, or about medicine, and that I felt like an impostor. I also admitted that I'd tripped over one of those plastic "Caution: Wet Floor" signs on my way down the hall earlier that day. She smiled and pressed her thumb to her lips, trying not to laugh at me. My medical career, I thought, was not getting off to a very good start. I was never going to be a doctor at this rate. Maybe the coat and rabbit and I could head to Vegas.

I took her medical history, reading carefully down the cheat sheet that I'd taped to my clipboard, and then allowed myself to veer off into more regular conversation. We talked for 20 minutes while the sound of muted sirens drifted up from Broad Street, 10 floors below.

It was the first time I experienced the feeling that time can seem to stop in a hospital--rare moments when the white coats making rounds and the nurses drawing blood seem to fade, and I feel a long way from anyone. It is a wonderful time to talk, if you can find someone to talk to. The staff uniforms and the hospital gowns--and the roles they represent--are forgotten, and it is possible to know someone in an intimate way. Birth, death, pain and joy are shared. When this happens, it reminds me that medicine used to be "a calling."

So we talked, my patient and I, and she told me that she had never imagined being an open-heart surgery patient. I never imagined that medical school might not fit my own preconceptions. She was scared, and so was I. In a very short time, we were both a long way from who we had been.

I got up to leave, and she grabbed my hand. It was quiet for a moment, and I could feel her fear about tomorrow's surgery flow between us--her delicate fingers felt as if dipped in hot water. I also could feel that somehow, somehow by God, something had changed, twisted a little by degrees in the minutes that we talked, and was getting better. No scalpels, no drugs, no needles, just a bed, a stool, a few quiet minutes. I was never more surprised.

A nurse looked in and broke the spell. "Everything OK, doctor?" My patient smiled slightly and lifted her eyebrows. Doctor? I realized the nurse was talking to me.

"Yeah, it's fine. Thank you," I said. The nurse left.

"You have a nice way with people," she said. I told her about my mother. She smiled and put a hand into my coat pocket. It kind of shocked me. "Make sure you keep what she taught you in there, too."

I took that advice. Every day, I try to balance the book stuff with the human lessons learned along the way. I guess I'm trying to keep an old-style doctor's heart and a modern doctor's head. My patients seem to need both.

Sure, some do better with this new drug or that proven therapy--something from one of those little books. But the other things I now carry in my pockets, 10 years later--memories of patients, echoes of my parents, moments of sweetness, humor and humanity--sometimes seem more valuable. My coat has fewer pockets, but, boy, are they full. And I still am making room for that rabbit.

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