The Lecture I Went to Medical School For

First off, I apologize for ending a post title with a preposition. Using "for which" just sounds so pretentious and, let's be realistic - this is a blog.

The lecture's subject was sudden death in athletes, specifically from cardiac causes. If you've read my prior entry involving the subject, you'll understand why I wanted to attend this lecture so badly. After finishing a quick one hour on the topic, I think that my thoughts and feelings describe a lot about how medical school can be.

It's odd to break something so personally important into an hour-long lecture. If you consider the precise cause of my friend's death (congenital hypertrophic cardiomyopathy - HCM), we only really spent about 10 minutes on it. Most of my thoughts were confirmed - there was probably no way to know beforehand. I thought that the lecture would be somehow vindicating, that I was on a path to righting this wrong.

The talk was actually somewhat depressing. At our current level of medical knowledge, it can best be summed up as "sometimes, shit happens". He had never complained of any symptoms, so why put an extremely healthy 21 year old through an EKG and echocardiogram? No family history even remotely suggestive of a congenital heart condition - no drownings, no fatal car wrecks, etc.

The other sad fact was that this lecture, so important to me, was "just another lecture". Minutes later, we were on to another pathology and hours later I was on another topic altogether. As much as I would love to pour myself into this disease, there isn't that much medical science to know and I have to spend my time on other topics. I learned the clinical basics and know how to recognize a possible HCM and I know about the most common treatments. I know the genetic defects (as if that helps) and the pathophysiology - that is "the disease" in detail.

I think my problem is a contradiction of ideals. I spend my time worrying about getting the science down 100%. Once I learn how to resuscitate a kid that shows up with EMS in v-tach or asystole, then I'll worry about how to tell the parents that there was nothing we could do. I believe in the physician as the scientist, a clinical being that doesn't allow emotions to cloud his or her judgment. If I didn't, I would push for every sports physical to include an EKG and echo. So I'm caught in the middle - wanting to do more, but knowing there's nothing more I can do.

For now, I can only keep doing what I'm doing - learning. A few days ago I was on my way to see a patient with an unstable cardiac rhythm. When I say "see a patient", please know that I mean literally just watching a competent physician at work. Walking to the room, I realized just how unprepared I would be if the patient coded. It was a moment of humility, it reminded me of just how little I know. It was also oddly comforting - I remembered that I don't know how to do 99% of what I'll end up doing as a physician. Best of all, I can continue working on that 1% as hard as I can - there's plenty of time for the rest.