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Emergency Medicine News:
doi: 10.1097/01.EEM.0000441172.04253.bf
Diagnosis Deconstructed

Diagnosis Deconstructed: Deconstructing a Debt

Morchi, Ravi MD

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Dr. Morchi is the director of the Medical Screening Examination program at Harbor UCLA Medical Center and an assistant professor of emergency medicine at UCLA's David Geffen School of Medicine.

Harbor UCLA Medical Center (HUMC). Recently I realized that I am in debt. It's a large debt I cannot ever completely repay. In theory it is simple and I have known it to be true, but in practice I have not always lived it.

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I will not accept “thank you” any longer. It is not mine to receive. I am embarrassed it took me this long to appreciate.

The source. It attracts the top medical students to our hospital and makes them star physicians. It does not let go when they graduate. It sucks them back a few times each month to keep the gears of the department in motion. It takes hold of talented faculty and makes them smarter and more dedicated, and it softens their hearts. Its grip remains strong for decades. It comes through the metal detectors, waits hours, and then presents itself to us.

Our entire professional existence is built on it. Everything that we know as doctors, from physiologic principle to flow diagram and treatment algorithm, everything that makes our minds marketable, everything that goes into the two letters after our name, every bit of it comes from one place: suffering.

Harbor is built on the particularly extreme suffering that other humans have to endure. People from surrounding Los Angeles County, sicker than any I have seen elsewhere in the developed world. From their broken bodies and ailing hearts comes our entire hospital system, shaping our minds, and bringing purpose to our careers. Every accomplishment and accolade we receive is borne on the backs and bones of our less fortunate brothers and sisters.

Not just HUMC. The principle extends beyond one hospital, of course. It is everywhere in every place and in every one of us. It is the entire basis of the field of medicine. All clinical knowledge in any text in any specialty throughout the history of Western medicine was drawn from the dark experiences and grim hopelessness of someone's mother, father, child, or sibling. A person who had to suffer and die for a particular truth about the human body to be known by all. A family that had to live through a horrible and life-altering experience for us to recognize some distinct fact about how things move under the skin.

To chronicle humanity's suffering on paper is to write a medical text. To be granted the privilege of reading and understanding that pain and see it in motion is called a medical education. It is a lifelong pursuit.

Colleagues, we are in debt. On the surface it seems that a patient owes something to the doctor standing over him, something for her time and knowledge, something for her care. Thank you, doctor. But I say, step back from the scenario, and it is clear. The situation is entirely the opposite. Our patients, whether ill or worried-well, owe us nothing.

We are indebted to them. The body of souls throughout history who have hurt for us to have careers, who have agonized for us to have a job and a degree that still carries with it some nobility, who die for us to have paychecks, to put food on our table, to send our children to college.

Do they know it? Do they feel our gratitude? Do we cherish and revere medical knowledge for what it is? For the human price it costs to produce? Just how can we repay the people to whom we owe everything?

That extra CT scan I know will be negative, those additional labs for bookkeeping's sake; they do not repay. Those are just for me, my gifts to myself so I can feel good, sleep well at night, not have to worry. Another day done and another lawsuit dodged. Our patients don't feel that.

The brief blurb of medical jargon just before I discharge patients telling them that they don't have an emergent condition; they didn't understand that garble. They did not feel that.

Only a minority of us will be part of landmark research that alters the lives of thousands and repays in bulk. Repayment comes for the majority of us then at the bedside. A hand on the shoulder. A hand in their hand. Eye to eye. Simple words, basic instruction. Slow movements and deliberate interactions. We are rushed, but they should not know it. They deserve not to know it. A smile and sometimes a frown to connect. Ice chips to wet their lips. Help with a bedpan. I admit that I don't repay as well as I'd like, but I am working on it.

Palpate deeply and listen carefully across the chest. Remember you are in debt. Take socks off and examine toes. Look closely and look everywhere. The clues you find may change the life of someone to whom you owe your career. Put those socks back on and tuck the blanket in snugly around their feet. It gets cold in your department. Life itself is a terminal illness, but these things they will remember.

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* Read all of Dr. Morchi's past columns at http://bit.ly/MorchiCollection.

* Comments about this article? Write to EMN at emn@lww.com.

© 2014 by Lippincott Williams & Wilkins

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