To ME, teetering on the cusp of adulthood, he seemed old -- 47. He had heart disease, I'd read in the surgeon's chart notes, and had been admitted for coronary bypass surgery. My job as a medical student was to follow the interns and residents and do yet another preoperative physical examination. The patient had been kind enough to allow one more person to take up his time.
I introduced myself and shook his hand, then, feigning confidence, pulled a chair next to his bed and brought out my folded pages of questions from the starched pocket of my short, white coat. Taking a deep breath, I began the classic sequence of interrogation, following a recipe refined by years of medical tradition. This included the "chief complaint" (the reason for being in the hospital), "past medical history" (the story behind the reason), "review of systems" (a checklist for health or disease in each organ system from head to toe), and "social history" (personal and life factors that could contribute to illness).
From our conversation, I learned that he'd had his first heart attack while in his early 40s. His family history and trim physique hinted that genes, not lifestyle, were the probable culprits. His father had died at a young age of a suspected heart attack, as had too many of his older male relatives. Despite my patient's advanced coronary artery disease, his general health was fairly good. To my unpracticed eye, he looked more robust than I expected for his age.
He had no children but had been married for many years. He was a businessman, rather successful, and looking forward to returning to work as soon as possible. He was excited about tomorrow's surgery, he said, and hoped it would give him a new lease on life after years of fearing a second heart attack.
I put down my pen and slipped my notes back in my pocket. "I just have to do a quick physical exam . . . "
Clutching my new, shiny black bag, I stood up self-consciously and tried to pretend that I was confident of my next moves. I had rehearsed doing physical examinations on my fellow classmates and drafted friends, but I was terrified that I would stumble in my first "live" performance. My biggest fear of public humiliation was that I would diligently complete all the necessary steps of the examination of the chest and heart and then notice I had failed to insert the earpieces of my stethoscope into my ears.
