Just tell me a story…

Anthony-Lumbad bannerI think we can all relate in the fact that we each know people who seem more adept at storytelling. They build suspense, they hold the punch line until exactly the right moment, they kill it during wedding cocktail hours. They somehow captivate attention, an unofficial prerequisite to succeed in clinical year of PA school. At least, that’s what I’ve experienced. The challenge lies in convincing the most educated person in the room to listen to the least educated: that’s right, yours truly. It’s the inherent nature of being a student and especially evident in a teaching hospital with experts at the top of their field. On morning rounds, we interview our patients looking for salient characteristics of their disease. We work through OPQRST; when was the Onset, what Provokes it, what’s the Quality, et cetera, and present our patient’s case to the attending physician. But what seems to result from 15% eagerness and 85% absolute terror, our once organized information comes out seemingly garbled and out of context as the gaze from five white coats pierces through us. Sufficiently flustered, we smear historical details, lab values, and physical exam eponyms between the patients we are managing. We ask ourselves “how is this happening to me? I took such good notes…”

At times like these, I reflect on advice I received from an emergency physician early in my clinical training: “Just tell me a story, Anthony. Two people may have the same disease, but how they got here will always be different.” After this exchange, I quickly realized how inadequate “OPQRST” is with information gathering. Based simply on pertinent positives and negatives we try to place patients into discrete categories: cardiac vs pulmonary, sick vs not sick, admit vs discharge. But in this binary outlook, I believe we start to lose sight of who our patients really are. As we ask them to change out of their clothes and into hospital gowns, we unintentionally strip away their personality and quirks that make them unique human beings. Out of efficiency, we search for patients by medical record number instead of by name. We refer to them as bed 5 or exam room 1. We orally present a patient’s “case” to our teams as if we’re defending them in trial rather than addressing their health. No wonder it’s easy to mix up the details of their hospital admission. At this point, our patients are no more memorable than the bland textbook pages where we first read about them during our didactic training.

My point is this: put down your moleskine-bound notebook, the proverbial security blanket for health professional students everywhere and speak about your patients from your interactions rather than your notes.

We have the luxury as students to spend more time with them than our attendings and preceptors do, and likely will not get to do so again for the rest of our careers. We have yet to truly face the administrative pressures of generating revenue and arguably are the providers [in training] that best knows each patient. So take advantage — shift your gaze away from Epic and actually lay eyes on the person in front of you. We have the unique power as a students to cast the initial spotlight on our patients, presenting them as the protagonist or antagonist of their own story. We engage the difficult conversations, determine DNR/DNI status, all while holding back our own biases to help guide how the metaphorical chase unfolds at potentially their darkest times. This is their autobiography and they get to choose how to write it. As one of my patients frankly put it with steadfast confidence: “If my heart stops, it stops. Don’t jump start me.

As for my own 26-month long chase, the end of this chapter is quickly approaching; seven days until graduation, three weeks until I take my licensing exam, and 2.5 months away from tramming up to “the hill” in a slightly longer white coat. Simply put, PA school has been one of the most rewarding experiences that I hope to never do again. What a joy it was to study for multiple callback exams during the soul-crushing inpatient rotation, all while piecing together a grand rounds presentation. What beautiful misery it was to have my student pager actually go off for once to scrub on an urgent surgery, as my friends trotted off to happy hour. But I digress…

Blatant sarcasm aside, the past two years have been full of invaluable moments that have shaped me for the better. Stressing over a grand rounds presentation to 90+ classmates and faculty prepared me to deliver an A-Fib presentation of similar caliber at my first job interview. Although I missed happy hour with friends, I had the rare opportunity to assist on an organ transplant surgery and witnessed first-hand the tragedy and joy juxtaposing the families involved. These moments aren’t memorable because of the guideline directed therapies I rattled off to my attendings, or correctly identifying thoracic anatomy in the OR to prove my competence. Rather, these patients are more memorable because of my interactions with them in the PACU or rounding on them on my own time on the wards, discovering what makes them unique human beings. Just as they are, I am more than just a 28 y/o otherwise healthy male with h/o asthma, PSVT s/p ablation, with no known drug allergies. I, too, have my own story to tell beyond these pertinent positives and negatives. My PA16 nickname is Coco Tones, and I will fondly miss hearing it on a regular basis. I earned by black belt in kajukenbo at age 14 because my parents believed it was a good idea to have their saxophone-playing band nerd son able to defend himself. And I’m a wannabe photographer with a shameless obsession for dogs. You will not find this information in my medical record, but they certainly influence my life and make me unique. Most pertinently however, I am an OHSU graduate hoping to survive my first job as a hospitalist Physician Assistant come October — wish me luck.

6 responses to “Just tell me a story…

  1. Such a great writer! I have enjoyed every one of your postings and hope you continue to use your talents as a writer into your new career as a Physician Assistant. Can’t wait to see your trajectory! Congratulations, Anthony – and well done.

  2. Good luck…it’s a tough job market in Oregon!! I know exactly where you live in the Bay Area!! Having a sense of humor will get you far in life.

  3. Yay! Congrats Anthony!

    So happy to see you leap from the depths of Cal Poly’s library, through PA school, to that slightly longer white coat!

    28 y/o success and wonderful human!

    Buena suerte!

  4. Whoa. Great post. Insightful post. Your message to avoid reducing people to a collection of symptoms is well taken.

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