Each one teach one

When we were growing up in Bombay, India; my dad decided to contribute to a charity called "Each one teach one". I had always found the name fascinating because it expresses the concept of individual responsibility with such simple elegance.
The reason why I thought about the phrase again was quite different from the underlying guiding principle of this charity which extols each family to adopt a child educationally. I was playing the role of the assistant senior on the Stroke service with one of the most luminary attendings around and needless to say I got inspired. I have been looking for the perfect way to learn and teach Neurology; and it just dawned upon me now; that if we simply learned one concept from each of our patients everyday; we'd perhaps learn that concept forever. It's not like I hadn't heard of this method before and somehow in the zeal to cover at least one whole topic in its entirety the simple elegance of learning at least one concept from each of my patients somehow got lost; much to my dismay. Nevertheless, having discovered it in practice now; I feel a sense of fulfillment!
When one of my most admired attendings related to me that she absolutely loves the concept of "what did this patient teach me today" I couldn't help but confess I had fallen in love too; quite simply!

In medicine it is really better to have learnt and lost...

When I climbed up the two flights of stairs to reach the anatomy floor, the distinct pungent odour of formalin tickled my nostrils and as I looked up I found my eyes transfixed by a fresco of a human skeleton standing nonchalantly with a skeleton under his/her (I still don't know if that skeleton was a male/female :) )left hand with the words that would soon become a part of my life; "In anatomy it is better to have learnt and lost than never to have learnt at all." Obviously, I didn't realize how profound this statement was because I hadn't been confronted by anything like learning human anatomy. I later realized that no matter how much we studied in medicine not just anatomy, there were always going to be things which we would forget; things which we wouldn't use for years on end; concepts which would change everyday and life would only become more complex. I realized that a lot stuff we were studying was not going to appear on tests; would not affect patient care; would not make a difference to anyone but we studied it anyway! Then there was all that stuff which was going to make all the difference; stuff which was going to change lives and that was the kind of stuff you didn't want to ever forget. Unfortunately you realize a lot of this only in retrospect. This theme carries on to residency as well. I really wouldn't want to forget any of the stuff I am learning, reading, hearing everyday but if you don't use it; you lose it. The joy of understanding a concept and applying it probably surpasses any other; but what happens to all the other stuff? I hope I can keep learning for the joy of learning but at the same time not lose heart if I forget something but study it all over again like I will never forget!

I have a consult for you...

My beeper goes off at 3:30 pm and as I answer the page; I am hoping it's not a consult when my brain is trying get home but then the voice says, "I have a consult for you..." Hmm, why didn't you call me up earlier I wonder as I start scribbling some details. So, I go see the consult. I get paged again while I am gathering information on my consult patient and this time it's a voice from the ER and the voice says what I didn't want to hear at 5 minutes to 4; "I have an admission for you." Hmm; so here I am. I really enjoy seeing patients; they are a huge part of who I am. Then why do I feel like someone should've called a consult earlier or that I shouldn't be getting an admission so close to my time to sign off? I love what I'm doing; then why do I feel that tinge of resentment when I get paged late? Shouldn't I jump with enthusiasm at every opportunity I get for learning and applying what I have learned so far. There are a few things which I realized as I was thinking about these times...one was that when you are mentally prepared to go home or call it a day; something which upsets those plans just happens to create a little resentment; or if you had plans to do things which were part of life apart from being a physician; then you get a little upset or if you're just really tired; or if it just hasn't been your day and you want it to end sooner than later or if you just want to go home! But life as a physician will always be about those moments which can never be planned for. That is both the joy and bane of being a physician; you can have a life and you can have a life but whatever you do; the very essence of your existence will be in being a physician first. The late consults/admissions are perhaps meant to prepare us as residents for the world at large; to accustom us to the uncertainties of being called upon at any time; of having plans postponed; of having to cancel birthday celebrations; of having to miss some important moments in our families; of being there and yet not being there because you're really needed more somewhere else...
Then is it cool to feel the resentment? Nope. Obviously, it's easier said than done. Being able to maintain that eagerness to learn and the drive to give it your all irrespective of the time of day; irrespective of your situations is what being a physician is all about. Someday, I'll get there; for now my beeper can keep going off whenever I'm needed whether it's to save the world or just give my opinion; I'm in training and will take it all in my stride!

What is true learning?

The motivation for learning has changed. It had to. Every single thing I learn now can change someone's life including mine. The differentials, the treatment options, the management plans...it's a sense of ownership; a sense of responsibility beyond scores, ranks; the stuff that makes you want to make a difference, the stuff that makes the difference. There's so much and there's finite time. When there's no time to lose, how can I stop? Medicine is changing every moment but where are we headed? Prolonging life by the years but are we really adding quality to those years? What I learn today, will it be passé tomorrow? What I learn today, will it stand the test of time? What would I have to unlearn? What would I have to relearn because the human memory fails me? What will keep evolving, what will perish; wish there was some way of predicting.
Medicine is as much an art as a science. Let me not sacrifice art for science and let me not forget to objectify. Either way the more I practice the more I will learn and perfect my ways. Yes, some I will learn, and some I will forget but no matter what I will be a better person for I learned. A part of me will change perhaps forever; I guess that is what true learning is all about. Changing and learning how to change and how to be that change. Perturbing as it might be, making my peace and anticipating that my sense of peace will change too. And knowing well that I am not alone in this process, I can't be more thankful to those from whom I learn; my patients, my teachers, my books and lives...mine and that of so many others!