Double Vision

I clutched a little nervously at my sleeves, exchanging frequent glances with the other student as we waited for the attending to pull up the patient’s records. We are student observers in the hospital and no two days are the same. What would happen today? Something always did. There is something indescribably exciting about rounds, like reading a brilliant book for the first time. And with shadowing, every time is a different story; you just need to be there for it. My feverish energy could also have been due to the two large iced lattes I had quickly downed on my way to the hospital. Rounds start early, but it’s a small price to pay for the experience.

“She’s a new admission?” The attending was asking the nurse practitioner – NP for short.

“Just came in, complaints of blurry and double vision, she’s getting an MRI this morning.”

“But only in one eye? It could be a nerve problem.”

“Not sure, I guess we still have to figure it out.”

“It could be a sixth nerve palsy. Do you remember what the sixth nerve does?” the attending asked us.

We certainly didn’t know, and waited eagerly for the answer.

Essentially, this is what he said: when you look left or right, both of your eyes move in that direction. The sixth nerve acts like a sort of pulley that draws your right eye to the right or your left eye to the left. It sounded fascinating, and I made a mental note to Google the sixth nerve as soon as I got out.

The patient smiled at us as we came in, including my friend and me in her welcome. I smiled back; I always worry that a patient will ask why I’m there. What is my purpose on the team? Our attendings always introduce us, letting the patients know we are there to learn, asking them if it would be alright if we observe. We hadn’t been denied before, but I often wonder how they feel about being a subject of teaching. It’s a huge gift that our thank yous, whenever we leave a room, don’t seem to cover.

“Mrs B, could you do me favour and follow my finger? With just your eyes?”

I watched the attending move his finger before the patient’s face. Her eyes moved left in tandem, but when they meant to follow his finger to the right, only the left eye made the full turn. I saw the attending give an infinitesimal nod to the nurse practitioner.

When we left the room, the NP said, “It looks like a classic sixth nerve palsy. That was a pretty good test in there.”

“So, if the MRI is clear, can we have her go home, and handle this as an outpatient case?”

“It’s been going on for a while and she still functions alright, but it would be a disaster if she was going down some stairs and accidentally looked through that eye.”

“Yeah, we definitely don’t want that. Let’s have someone from Physical Therapy come in and take a look.”

The attending turned to us, and said, “See, that’s why it’s good to have more than one set of eyes on a case.”

My experiences while shadowing have proven this to be true. I’ve learned that the practice of medicine is not a solitary one. Instead, it is a network of people who make up the treatment team, each one an intrinsic, invaluable part of the web.

I recently had the opportunity to go the American Society of Clinical Oncology conference where a physician, Dr. Michael E. Porter, spoke about healthcare, patient outcomes and the varying roles of healthcare providers in achieving those outcomes. One thing in particular that he said struck me: “We have to be part of the team that jointly accepts the responsibility for all aspects of care.” It was a clear argument for cohesiveness in the clinical team, where each person is a vital member.

Today I saw, that while the physician did take unquestionable leadership of the team, he needed the support of the nurse practitioners. And the ultimate assessment of the patient was only complete with the additional reports from the consulting specialists. The care of the patient was only as whole as the work of all members of the team: the hospitalist who had completed her admission, the phlebotomists who had completed her lab work, the MRI technicians who had completed her scan, the radiologist who had read it. The medical team is built on a foundation of trust and an understanding that one person cannot do it all.

I couldn’t resist wondering what it will be like to play such a role, to be part of the team that takes responsibility for a patient’s care. I am lucky to see, so early in my medical journey, how such a team functions. It puts secondary application essays that inquire about teamwork into perspective; I’ve seen, in medicine, that being able to work in a team is essential.