Chelsea Green Publishing

Chelsea Green Blog

A Life Lesson Learned In Medical School

The following article was written by Maggie Kozel, author of The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine. It appeared originally on the New York Times “Well” blog.

It was in my second year of medical school that I learned one of the most important lessons of my career: That it can be hard to distinguish truth from a perfectly good answer. Certainty was what I craved the most back then, poised as I was on the threshold of my medical career. But my first patient would cure me of certainty forever.

I had just started my physical diagnosis course and was teamed up with a classmate, Randy, for our first attempt at performing a medical history and physical exam. Our patient, admitted to the hospital with alcoholic liver disease, was dressed for company with crisp blue pajamas and a seersucker bathrobe tied neatly at the waist. He had white hair and white teeth, and his brown face was a little raw, as if he had just shaved. He looked pleased that we had dropped by.

We introduced ourselves and produced the clipboard that held our exhaustive list of questions. He remained as calm and patient as a snow-covered garden as we went through our checklists, assuring us he did not have facial pain or droopy lids, fruity-smelling breath or scrotal swelling. As I stood there perspiring, he calmly relieved us of any concern that his heart skipped beats or that pain radiated down his legs, before recalling what he could about his grandparents’ health at the turn of the previous century. An hour later, it was time for the physical exam. We worked our way down his body, looking for malformations of the earlobes, listening to his heart sounds and noting every brown spot that had come to grace this man’s surface over the previous seven decades. We managed not to miss the yellow tinge of his eyes, or the rubbery edge of his liver, which we had first tried so insistently to locate at the bottom of the rib cage but which actually extended several inches below it. A diagnosis of alcoholic hepatitis. Enlarged liver. Got it. Nothing in this world seemed as satisfying as having the puzzle pieces fit together. The mental status exam came last. Having finished our four-week psychiatry course, we felt we knew a thing or two and conspired in advance to check our patient for alcohol-related brain damage. His unfaltering performance up to this point had not settled the question for us. A supervising doctor had taught us a trick in assessing cortical function: pretend to hold up a string, and ask the patient what color it is. The patient should, of course, respond that there is no string there. If he says it is pink or orange, he is confabulating, meaning his brain cortex isn’t working so well. So with thumbs and forefingers pinched together, Randy held up an invisible string and asked this man what color it was. We waited. After some time, he gave us his considered answer: “It is the color of atmosphere.” A self-satisfied grin broke across his face. Confused, I looked over at Randy, who was now frowning at the “string” himself, as if wondering if he’d missed something. We were suddenly a couple of rudderless ships, startled into the realization that all the facts in the world couldn’t protect us from uncertainty. Sometimes, it could actually blind us to the truth. After all, the string really was the color of atmosphere. Except, of course, for the fact that there was no string. Of all the pearls that our patient offered us that day, this was the one I would carry with me throughout my career as a pediatrician, and the lesson never lost its relevance. Doctors, like anyone else, can get so comfortable with a routine that they neglect to question the questions, and we can all be misled as a result. Clinical truth has only grown more obscure since my medical school days. Throughout the 1980s and ’90s, for example, pediatricians relentlessly used antibiotics to treat the middle ear infections so common in our young patients, as we waged war against the epidemic of hearing loss and delayed language we imagined would occur if we didn’t act. But the goal was invisible. No one had ever shown that not treating the ear fluid would cause long-term language delay. It would be decades before we realized that overuse of antibiotics caused us huge problems, while the drugs accomplished very little for our patients. We had devoured answers without asking the right questions. Today, as we take on the hard work of health care reform, doctors continue to work under an avalanche of pharmaceutical marketing, malpractice threats and shortsighted health insurance strategies. Clinical approaches to conditions like obesity, for example, or mental illness or a learning disorder are hard-wired into current practice methods, even if those approaches don’t make sense. And after decades of caring for patients in a complicated health care system, I have learned that if I really cannot see the string, I need to say so. Read the article at its original source, The New York Times. Maggie Kozel’s book, The Color of Atmosphere, is available now.


Ask the Experts: Submit Your Permaculture Questions Now

Attention all growers, food-lovers, and green-living enthusiasts, we are once again celebrating Permaculture Month by putting our pioneering permaculture authors to work for you. Chelsea Green is proud to publish and distribute some of the most recognized, and award-winning, names in permaculture, and we’re making several of them available to our readers to answer any and […] Read More

Hands-On Learning: School of The New American Farmstead

This summer, twelve of our authors (plus Chelsea Green’s own President and Publisher) will be leading hands-on intensive courses at Sterling College in Craftsbury, Vermont.These workshops, classes, and certifications will inspire you, equip you with marketable skills, and provide you with new perspectives on integrated, community-centered farming and food production.Engage your SensesThe hands-on courses will […] Read More

The Occidental Arts and Ecology Center Cookbook Wins IACP Award

Chelsea Green is thrilled to have received the Food Matters Award for The Occidental Arts & Ecology Center Cookbook, by the OAEC Collective and Olivia Rathbone.The International Association of Culinary Professionals announced its 2016 IACP Award winners on April 3 during a ceremony in Los Angeles.The awards recognize the best food writing of the year, […] Read More

Recipe: Pascal Baudar’s Basic Wild Kimchi

Experiment with what you have, anything from the mustard family will work extremely well. Read More

10 Books to Curl Up With This Winter

William Wordsworth was right when he said, “Nature never did betray the heart that loved her.” Nevertheless, the cold, dark days of winter can still get the best of even Nature’s most tenderhearted admirer. What’s one to do? We here at Chelsea Green have concocted the perfect cabin fever remedy with our suggested winter reading […] Read More
Follow us
Get every new post delivered to your inbox
Join millions of other followers
Powered By WPFruits.com