alythe wants me to come to her town. It is a good town, and I would have friends there. There is a good program there. Two good programs, one better-funded than the other.
There is a good program here.
There is a good program, with people I enjoy working with, in the city where I will do my next rotation.
They hold out outstretched arms and beckon, wine and dine (where do you want to go for dinner?) and show off their glimmering facets. They do their best to leave behind their flaws. Don't we all?
I saw my doctor today. "Wear a crazy T-shirt under your suit," she told me. "Just relax. We like the nice ones." She used to do interviewing for the program.
In the morning I saw two patients before going to my appointment - a not-so-elderly lady, deaf, who is here because of weakness. We communicate better than I had feared. I write complicated messages. She speaks some words. "Your MRI is normal." "They didn't see any new strokes." "We're going to have the physical therapy people come see you today." She gave me an ecstatic double-thumbs-up, managed to communicate that she wanted to keep the paper for her daughter to see. I just wish we knew what was wrong with her. Her leg is weak. She can't walk - she's got 3/5 strength in it; can lift against gravity but not resistance - and we don't know why. There's no anemia to suggest a B12 deficiency, no sensory defects, a mildly decreased albumin. And that's it. M wants a carotid doppler, echocardiogram. Suppose those would be beneficial if we thought there was a stroke. With a normal MRI, it's less certain, although she's had weakness for two weeks and perhaps the obvious signs have subsided. I wish we knew.
These are the frustrating cases, O Best Beloved. She is a sweet woman, upbeat, with a remarkable lack of irritability regarding our communication limitation (her lip-reading is all right, but my speech is apparently not so clear) and a smile for me in the mornings that seems to literally brighten the room. I walk in the room and I genuinely want this woman to be better, or at the least to be able to point at an image or a lab value or a lesion and say "There. There is the thing that stole away your ability to walk."
And I cannot, for this is an inexact science for all our technology, O Best Beloved, this practice of medicine is still a practice and it will, I believe, continue to be. There is an art of healing hidden deep in the scanners and the -grams and the -graphs and the -ology, and we forget it or fail to practice it at our peril. I do not have all the answers. I never will. May I never forget it.
I would tell you about the second patient, O Best Beloved, but my resident is here and it is time to take noon changeover. Perhaps later.