Free Everything I Learned in Medical School: Besides All the Book Stuff by Sujay M. Kansagra Md Page A

couldn’t be contained.
    “So he’s fine?”
    “Yes, back to his normal self.”
    And just then, out from the bathroom ran a Cody I had never seen before. Healthy, full of energy, and a normal 9 year old.
    “Cody, oh my god, it’s so good to see you.” I felt like giving him a big bear hug, but tried to maintain my professional composure. He looked at me for a second, slightly perplexed. And then…
    “Do I know you?”
    In the one month I had been seeing Cody everyday, he had been in a coma. He had only seen me briefly when he was first admitted to the hospital before he got really sick. So, it came as no surprise that he had no idea who I was. It was awkward feeling so close to a person and caring so much about their well-being, and yet they have no idea who you are.
    Both of these encounters left me wondering about the level of emotional investment we as physicians should make in our patients. There is an important balance between caring about patients, and being distant enough to protect your sanity when things go wrong or patients die. But in the end, it seems that the rewards of medicine come from seeing those you care about get better, and that true care can only come when you are invested fully in your patients. Even if the patients forget you (or have no idea who you are), I still think we owe it to them to be emotionally invested in their well-being. And if at some point down the road that means becoming upset with the loss of a patient, that’s okay.

Chapter 17
    Awkward Moments
     
     
     
     
    In 1966, an anthropologist named Edward Hall introduced the term proxemics. Proxemics is the study of spatial relationships between humans or other animals as they relate to various social contexts. Simply put, it is the study of personal space. For humans, when we interact with each other, there are social norms for how close you should be to another person, and based on your culture, social status, population density, and many other factors, each of us has some differences in what we consider appropriate. For the average American, it is thought that people begin feeling uncomfortable when someone is within 24 inches on each side, within 27 inches in front, or within about 16 inches behind them, excluding intimate relationships of course. In the doctor’s office, there is a completely different set of social norms, one in which a doctor is allowed to enter the patient’s personal space, and then examine, poke, prod, and listen to a patient’s body. While this deviation from typical social norms is usually not considered the least bit unusual for a patient or experienced doctor, someone entering the medical field sees and feels it all too clear. Every doctor-in-training has to adjust to this newly found permission to enter the personal space of complete strangers. Listening to the heart, examining the abdomen, and looking into ears may seem routine, but for a new medical student, feelings of self-consciousness and inadequacy are the rule rather than the exception. But with practice, one develops a comfort level quickly with the routine exam. Soon the student is deftly moving from one part of the examine to the next with comfort and flow, holding instruments like a stethoscope and tongue depressor with a confident and steady hand. Unfortunately, there are a few areas of the examination that are not routine, and not as easy to develop a comfort with. Most medical schools provide focused learning sessions for these particular physical exam areas. For us, these came during our first and second year. Each particular session pushed the limits of what we were comfortable with, all in an attempt to teach us how to properly examine the human body and get acquainted with invading the most personal parts of a patient’s personal space.
    The first session was held by a group of women’s health advocates. They went around and taught students the basics of the breast exam. That’s right, this group would go from school to