What do you even know?
Great question. Um. I know I’ve learned a ton. I’ve taken lots of tests?
What do you even know?
I seem to be drawing a blank at the moment. Can I look it up and get back to you?
What do you even know?
I know you’re not really supposed to ask me that. We’re all pretending that I’m a doctor here, right?
*****
At the very beginning of my clerkship year, I introduce myself to my first patient as a student doctor. I am brimming with nerves and excitement as I shake his hand. His response: “A student? What do you even know?”
I spend the next year trying to answer that question.
*****
I sit with my patient with heart failure, a middle-aged woman who feels frustrated and dismissed, confused by our lines of inquiry and her trouble breathing at night. I draw out the circuit of heart-lungs-heart-body with a pen and paper, explaining that heart problems can cause breathing problems and vice versa. She says she hopes I never change, and that as soon as I’m done my training, I should open my own practice and let her know. I carry that compliment in the pocket of my heart for months, buoyed by the feeling of being liked by a patient. I love being liked. I can make people feel taken care of! Me! With what I know!
But most of the time, patients aren’t complimenting me, and it isn’t clear to me that anyone likes me very much. I know very little in the grand scheme of medicine, and in the beginning, I feel like more of a reporter than a doctor: I am listening to patients’ stories, writing them down, and reading them aloud.
If the twin objectives of medicine are to preserve life and to mitigate suffering, I feel certain that I am not doing the first. If anyone is preserving life, it isn’t me. It is the attending or the resident, who are actually making decisions, or the nursing staff, who are doing the real caretaking. Am I helping to do the second, to mitigate suffering? How can I tell?
*****
“If you’re a good doctor, you listen to your patients.” If p, then q. Assume q is true; therefore, p. I listen to my patients. Does that make me a good doctor? The fallacy of the affirmation of the consequent, or why experiments don’t prove hypotheses; results are consistent with hypotheses. My behavior is consistent with the behavior of a good doctor. We’re all pretending that I’m a doctor here, right?
What do I even know?
*****
On my psychiatry rotation, I spend the most time with the patient I relate to most, because she is in her early thirties, like me. I see how that tendency could become a problem, but I give in to it anyway.
On the first day of her admission, I talk to her father on the phone for an hour about her childhood, history of hospitalizations, and the suicidal thoughts that brought her into our care. She is easy to talk to, charming even, and I spend every morning talking to her and every afternoon writing her progress note.
By the end of the week, she is ready to leave. She is upset about our treatment plan, feels dismissed. She isn’t getting the medication she requested. Her father is calling the hospital, threatening legal action.
What happened? Where did I go wrong?
*****
What do you even know? Put it another way: You have no idea.
And it’s true, always and irrefutably. You have no idea what it is like.
But here is another truth: On some level, I do know exactly what it is like. To be mortal. To be alone with myself, at the end of the day. To be alive right now on this earth.
What do I even know? That in many fundamental ways, we are absolutely identical. But it’s hard to see that. I know that too.
The principle of noncontradiction: a postulate cannot be true and false in the same way at the same time. I cannot have no idea and have some idea, not in the same way at the same time.
I have no idea what it is like, not in any specific way. I know exactly what it is like, in the most general way. And that general way—that “being human” way—is that enough? To bridge the gulf between us?
*****
“Well, I know a few things,” is what I really say. I am caught off guard. He has wasted no time in spotlighting my most tender fear. “But I do have a lot to learn.”
His response is so perfect, I don’t really hear it. Not until over a year later, when I read over my old journal.
“I will help you learn. I will teach you everything you need to know about being me.”
He leaves the hospital that same day, and we never get the chance to really talk. I never learn everything I need to know about being him. I don’t even remember his first name.
But I see now the generosity in that response. For him to say: I recognize your fear, and I will come meet you there. Let’s start with that.
Jennifer Wineke is an MS4 at the Perelman School of Medicine.
Images by author.
