“Mr. Aster” hopped up onto the exam table, the familiar sterile paper crinkling underneath him like crispy autumn leaves. From that modest amount of activity, he was completely out of breath. A few minutes later, following a monologue of Shakespearean proportions, our patient wasn't the one left breathless.
The scene: Dayton's free clinic, Reach Out of Montgomery County, located downtown in the shadows of Miami Valley Hospital.
The cast: Mr. Aster on one side of the room, Dr. S (his physician du jour) on the other, and me, intentionally blending into the background-a wide-eyed, wide-eared and ultimately wide-mouthed medical student who just watched, learned and took mental notes-to-self.
Dr. S, whom I was shadowing that evening, noticed Mr. Aster's shortness of breath as well.
"You couldn't move from the chair to the exam table without gasping for air," she said bluntly, in a tone made of equal parts concern and displeasure.
Mr. Aster looked down at his feet, which were swollen at the ankles, as if he had not heard her. He was embarrassed.
But she continued, this time more sternly: "In all likelihood, you'll be dead in 15 years."
Now Mr. Aster looked up, his lips parting to shape a defensive response. I looked up as well. That was harsh, I thought.
But it was nothing compared to the lecture that followed, one that would have made Napoleon proud, with our no-nonsense physician performing what I later recognized to be one of the most compassionate acts possible, given her position. Mr. Aster, as you may have diagnosed by now, had every risk factor for heart disease imaginable — stunningly high blood pressure, obesity, a heavy smoking history, diabetes, and the list goes on.
He was 35 years old, but his heart had aged well beyond.
In all likelihood, at a free clinic, a physician will see any particular patient once, and never again. For all Dr. S knew, she had only 20 minutes to genuinely change Mr. Aster's future.
Certainly, Dr. S prescribed medications. She suggested some followup referrals. But Mr. Aster's situation called for something more. This was a simple moment about getting through to the patient, to treat the disease not only by fixing its symptoms, but also by addressing its causes.
Without a doubt, one of the elegant aspects of the medical profession is that moments like this happen in doctor's offices all over the world every day, multiple times a day. A physician might treat high blood pressure, or warn a patient about heart disease risk factors, hundreds or thousands of times in his or her career. But that's not the way we as medical students, as physicians, think. After all, it might be the patient's first time with chest pain.
With that mindset, we build the foundation to do special things. An otologist recently told me that a tear comes to his eye every time he sees a child hear for the first time. Another physician, an ophthalmologist, told me that there is no better feeling for him than restoring someone's sense of sight. Medicine, we realize, is simply the sum of these moments, with a physician's lifetime devoted to creating them for others.
As Dr. S made her impassioned plea to Mr. Aster on that night at the Reach Out clinic, I stood in the corner, stunned at how forthright and candid she was. And she had to be. I remember watching our patient look up, first to me and then to her, and finally, something seemed to click inside. You could see it as he exhaled, nodding to himself.
"You're right," he would later say, just before walking out the door. "No one's ever said any of that to me before."
That was the last I saw of Mr. Aster. Of course, we can't know what happened to him. But we do know that Dr. S gave it her best shot, completely involved in that moment with him as if there were nowhere else she'd rather be. As for me, I realized that sometimes, the best thing we can do for a patient is simply give them the opportunity to take control.
I continued shadowing Dr. S that evening, seeing patient after patient, and that's the way it goes. I was a first-year medical student at the time, beginning to learn what it truly means to be a doctor. You may be left breathless, but you have to catch your breath and do it all again, never complaining, because it's not about you; it's about the patient. You knock on the door, meet the next one, and no matter what, you look them in the eye and say, "Hello. I'm your doctor."
"And I'm going to take care of you today."