Tuesday, November 25th, 2014

Healing Encounters on Aisle 8

Joshua Niforatos

Frazzled and exhausted by another ten-hour day at the end of our second week of medical school, the two of us made our way from the clinic to the grocery store on a mission to get chips and dip. Looking “important” in business wear,, we bumped into a petite, middle-aged woman, whose eyes were covered by aviator sunglasses.

As we neared her, we noticed her mumbling, pleading: “Oh no, it’s coming, can you help me?”

Nobody around her stopped, and initially, neither did we. But after a few steps, we turned back.

“Is something wrong?” we asked.

“It’s coming – I think it’s coming,” she said with panic in her voice. Her dazed demeanor made it difficult to ascertain her seriousness.

“What’s coming?”

“I think I’m going to have a seizure,” she muttered as her speech became a bit less lucid.

We briefly panicked. It wasn’t that the experience of seeing a person about to seize that was distressing; rather, we were embarrassed by our lack of knowledge about how to handle this situation, especially given our new role as medical students. Given our lack of knowledge of most things medical, we did the only thing we could in this situation: we asked, “What can we do to help you?”

She slowly sat down on the floor in the middle of the aisle, slurring a few basic instructions for us in case she began to seize: turn her over on her side, hold her head in order to keep it from hitting the floor, put nothing in her mouth, and track how long the seizure lasts. Most fascinatingly, the others in the grocery store, including some people dressed in scrubs, seemed only to be concerned that the woman on the floor was blocking their path.

Over the course of the next 5 to 10 minutes, we talked with her and reassuring her that we wouldn’t leave until her friends or family arrived at the store. Unfortunately, her condition seemed to worsen quickly. None of her friends or family members arrived at the store. The incident underscored for us the importance of having a social network for chronic conditions (like seizures), something we read about in the public health literature.

The woman pleaded with us to not call an ambulance, so we offered to go to her apartment to pick up her medication while the manager of the grocery store watched over her. When we got back to the store, we found her in an upright fetal position, afraid to move. She was holding her knees to her chest very tightly and beginning to shake. She was panicking. Still clutching her knees to her chest, she managed to grasp and take two pills, washing them down with water.

After ten minutes, the stressful scene began to fade. The woman began to loosen up and a friend of hers finally arrived at the store. We all but forgot the original purpose of our trip to the grocery store. When our heartbeats returned to normal as we were left questioning what to make of this experience.

It wasn’t too long ago that most of this year’s 20,000 new medical students ceremoniously received their first white coats. The White Coat Ceremony is a milestone for those en route to becoming a physician; it marks the beginning of the process that turns bright-eyed college graduates into clinicians trusted with an individual’s most personal information and most vulnerable moments.

Becoming a doctor means learning a lot of information, answering questions like which DNA repair mechanism is non-functional in patients with xeroderma pigmentosum? — That’s actually the easy part. The difficult part comes during the non-academic moments. Socialization that occurs on the hospital wards instills the sense of responsibility and professionalism society expects of its doctors. That is what is frequently cited as the most difficult part of the journey.

While many medical students began school in late-August or early September, at the Cleveland Clinic Lerner College of Medicine, we began classes in early July. It started with a week of lectures about wearing the proper attire to school (always wear a collared shirt to class, nothing less than business attire when interacting with patients), and how to act professionally as future physicians.

Part of learning how to act professionally means being bombarded from the beginning about our role in the medical profession’s hierarchy. Medical students are at the bottom of this hierarchy, especially in the preclinical years. Of course, it’s necessary to have a hierarchy in places like an operating theater or in the clinic, but outside such places there is still a great deal medical students can do to help others before officially becoming a physician.

Our experience with the woman in the grocery store demonstrates a few important points to us. While knowledge is important, there is not much anyone can do, medically, in the absence of medication if someone is about to have a seizure. Nevertheless, we were able to engage this woman and see her as a human being in need and not someone inconveniencing our quest for appetizers. Or, to paraphrase Charles Dickens in A Christmas Carol, we saw her as a fellow-passenger to the grave, and not part of another race of creatures bound on other journeys.

Hierarchy has its place within the clinic and should be respected, but incoming medical students are often just as effective as their teachers in other areas of humanist interactions. Therefore, humanism should have no hierarchy. As we comforted and helped a woman that night just blocks away from two well-respected, and internationally-known hospitals we were given a fantastic reminder that scientific knowledge and board certification are only one component of becoming a physician.

ABOUT THE AUTHORS

Joshua Niforatos Photo cropped. jpgJoshua D. Niforatos is a first year medical student at Cleveland Clinic Lerner College of Medicine. Born and raised in the suburbs of Chicago, Joshua eventually made his way to University of New Mexico (UNM) where he earned bachelor degrees in both cultural anthropology and biology. While at UNM, he worked with immigrants at risk for Type II diabetes in the poorest parts of Albuquerque. Prior to attending CCLCM, he earned a Master of Theological Studies at Boston University School of Theology where he studied theology, anthropology, and ritual. Joshua is interested in infectious disease medicine and psychiatry, and hopes to one day teach courses at the intersection of religion and medicine while treating patients in underserved communities.

 

Alex Chaitoff CroppedAlexander Chaitoff is a first year medical student at the Cleveland Clinic Lerner College of Medicine. He is a graduate of The Ohio State University, where he studied microbiology and political science, and of the University of Sheffield, where he received his Master of Public Health as a 2013 Marshall Scholar. Interested in how social and cultural determinants affect health, Alex has spent time working for the Department of Health and Human Services, the National Health Service, and the Ohio State College of Public Health among other institutions. Alex is a co-founder and currently serves on the Board of Trustees of the 501(c)3 nonprofit organization the Pure Water Access Project.


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