29 March 2012

A surprising statistic

I was skeptical when a doctor casually mentioned that 2% of all pregnancies are ectopic pregnancies (in which the fertilized egg is implanted somewhere other than the uterus, usually the fallopian tube). Without treatment, a common outcome is fallopian tube rupture, which jeopardizes the life of the mother. It is a serious medical concern. I shot a confused look at a fellow first-year medical student. Two percent? It seemed way too high.

I checked the literature, and the doctor was indeed correct. 2% of pregnancies are ectopic pregnancies, and ectopic pregnancies constitute 6% of pregnancy-related deaths. Why was I never aware of this? Many women I have encountered in my life have undoubtedly had ectopic pregnancies, but no one speaks of it. Illness lurks in people's lives much more than they make apparent, and my medical training is making me acutely aware of that discrepancy.

In the past few weeks, I've become increasingly aware that my medical training and white coat constitute a sort of "all-access pass." Recently I was passing through our hospital's ER on a personal errand. Upon seeing my white coat and badge, the rather aloof security guards smiled and simply waved me through the entrance to the medical bay.

In the ER, I spotted a med student I knew who happened to be rotating there. She and a resident were about to examine a patient, and on a whim I joined them. Saying little, I listened to the patient describe deeply private aspects of his life: his methamphetamine use and drinking habits, his family problems, his history of mental illness, and his hopes for the future. I watched as the medical team debated the patient's diagnosis and treatment. And after about half an hour, I went on my way. A year ago, I would have been stopped at the entrance to the ER; now, no one questioned why I was there. I am part of the club. It feels so strange.

Practicing medicine involves a tension between isolation and connection. On the one hand, I am quite estranged from people. I have so little free time that when I interact with someone, they are usually either my patient, my family, or someone in the health-care field. And yet I learn about and am witness to the most intimate aspects of random people's lives. Learning medicine is a lonely pursuit, but by accompanying people as they grapple with illness, will I become more connected to my fellow man?

So far, the answer is no. Medical school has transformed how I view people and interact with them. When I am at a party and see someone with an abnormal gait or a cold sore, I automatically start reasoning through a differential diagnosis. When I chat with my seatmate on a plane, I find the need to whitewash what I encounter in the hospital, because people understandably prefer not to hear about illness and death more than they have to. Doctor and patient do not behave as equals, and even though I am not yet a doctor, and even though the people I encounter are not my patients, I can't entirely ignore this feeling of detachment, of otherness.