This is part of a series about extraordinary experiences in personal health. Share yours at firstname.lastname@example.org.
I stared out the window of a friend's car on my way to clinical placements that would mark the finale to a grinding first year of medical school. I should have felt excitement, but instead I felt dread. I wasn't sure medicine was for me any more.
Before becoming a medical student, I had completed a PhD in epidemiology and biostatistics. My days were spent in front of a monitor, reading about genetic disorders and staring at strings of As, Cs, Ts and Gs that may look like gibberish to some, but told me stories about the people I studied. I wondered about the lives of the people whose genes stared back at me. How did the disease change their lives? I wanted to make a real difference.
In medical school, my enthusiasm was crushed by six hours of classes a day, biweekly exams and constantly being put on the spot among peers and superiors. Knowing the right answer no longer meant praise, it became the expectation, usually accompanied by a barely perceivable nod from the tutor. The rigour was meant to prepare us to be good doctors for our patients. But during the little time I spent with patients, I heard a lot of disappointment. They told me about doctors who were too busy to listen to their complaints, too arrogant to hear their explanations and too jaded to explain diagnoses.
When I arrived for my first day of work in Port Dover, Ont., a small town 140 kilometres outside Toronto, the attending physician gave me a list of patients to see on my own. I went in to my first patient's room, trying to remember all the clinical skills I had learned; ask about the chief complaint… details on when and where…PQRST…past medical history…wait, did I have to do a physical exam unsupervised? Should I ask?
"Hi …?" the patient asked. I realized I had been standing in her room blankly. I snapped out of uncomfortable and scared med-student mode and tried my best to mimic a confident junior doctor.
The patient – a young mother of three – had recently visited the emergency room. After learning that her work hours had been cut and negotiating with her ex-husband for custody of their children, she started to feel dizzy and her chest felt heavy. She couldn't breathe, her heart was racing. She felt nauseous. As she tried to call 911, she fell down and her vision blurred. Thankfully, her husband heard the fall and called for help. In the ambulance, she regained consciousness and described saliva coming out of her mouth involuntarily.
Was she having a seizure? She didn't describe any involuntary movements or focal neurological symptoms. Heart attack?
In the emergency room, her doctor, just as concerned about a heart attack as she was, ordered blood work and an ECG. The results were negative.
That makes sense, she is young… no cardiac history… no risk factors. A panic attack, perhaps?
This is where her story ended. She was disappointed and confused with the lack of explanation given to her. Evidently, she was told that she was having a panic attack (Ah-hah!) and asked to follow-up with her family doctor. By this time, she was close to tears.
I felt ill prepared to comfort her. So, I thought about what I would want in this moment. I began to talk to her about her life. What were her worries? How did she cope with stress? Had something changed to make her feel this way? The longer I talked to her, the more at ease she seemed. I then tried to explain why her panic attack felt so real. Stress and anxiety, I told her, ignites an evolutionary response to danger. That same response protected our ancestors from enemies and helped during hunting. But when activated by stress, the symptoms can also be distressing.
I wished I could continue talking to her, but there were more patients I was meant to see. I apologized for having to end the conversation, but when she said she was grateful for the time I spent with her, I was relieved and overwhelmingly happy. I had actually, in a very real, albeit small way, made a difference to her.
And by reminding me of my purpose she, in turn, had made all the difference for me.
Zahra Sohani is a medical student at the University of Toronto