As a second year medical student, we rarely get clinical experiences into the real world. When the chance came to watch a gastroenterologist perform endoscopies, I jumped at the opportunity.
Here I was, all gowned up in the theatre. Lying in front of me was Mrs Jones (not her real name of course). She was an elderly woman referred to the clinic for both a gastroscopy as well as a colonoscopy. Previously she had went to a small hospital to receive transfusions for iron deficiency anemia. The hospital doctors then referred her to the clinic to investigate the possible cause. From her history, she didn’t have any symptoms.
After a perfectly normal gastroscopy, “What could be causing the anaemia?” the doctor asked me as she prepared for Mrs Jone’s colonoscopy.
“If we’re talking about the lower GI, I’m think that polyps and possibly colon cancers can cause anaemia.”
“Exactly. Now where would you expect to find this tumour?”
I stared blankly back at the doctor. I tried to dig through my limited pool of knowledge. After all, I was just taught about colon cancers less than 24 hours ago.
The specialist must have seen the blank look on my face and answered her own question.
“In an asymptomatic patient, it would likely be the right side.”
By now the scope was prepared and plenty of lubrication was applied. We were ready.
During the colonoscopy, I found identifying the segments of the colon quite hard compared to the upper GI as it all looked the same to me. Hmm… round tunnel with semilunar folds… round pink tunnel..
A normal colon
“Sorry doctor, could you please tell me where we are again?”
“Near the splenic flexure”
Hmm… pink round tube with… what the?!
On the monitor, the smooth round tubes of the colon disappeared. Replaced instead with a sea of small raised lumps and bumps. Polyps… and a lot of them.
Clarification: Not the real patient’s colonoscopy. I just found this online to show a close approximation of what I saw.
I was surprised. I expected polyps, but not 30 of them at once. The specialist quickly took multiple biopsies of the region, and while further investigating found a hard cancerous mass further down the colon. The scope was then withdrawn after another biopsy was made.
As I watched the procedure, I was ecstatic! I felt like the luckiest med student alive! It is unbelievably satisfying to physically see a disease that you’ve only heard other people describe. However, I also felt… uneasy.
As I watched Mrs Jones gradually recover from the anaesthetic, I realised the source of my unease. Guilt… I felt guilty!
While I was feeling excited seeing pathology come to life from textbooks, I also just witnessing a life changing moment for Mrs Jones. In those 30 minutes, we have discovered a tumour in her colon!
While the doctor continued to type reports and organise a follow up with a surgeon. I had a chance to talk to Mrs Jones in the recovery room.
“Hi, I’m a medical student”
Mrs Jones smiled and nodded “The doctor told me before the procedure. Sorry you had to see such an unpleasant thing”
I presume she meant the procedure and looking at her bowels. “No, not at all!” I replied quickly, “At this stage in my degree, I don’t see much at all. I’m deeply grateful for just the chance to be here today! Thank YOU so much for allowing me to watch.”
We then looked at each other for a few seconds in silence. All I could think of was the tumor in her colon.
“I think I’ll need to go back in. Once again, thank you!”
“You too!” and with that, I rushed back to the doctor.
As I left for the day, I happened walk by Mrs Jone’s bed. She lay there wiping tears from her eyes. The doctor must have told her the news. Although I don’t know how severe her diagnosis is, I could see how upset she was.
I didn’t know what to say to her, so I hastened my pace and left the hospital.
Of the many things I learnt that day, I realized that I’m caught between two mindsets, a clinical mind and a human mind. One that feels excited to see rare diseases and terminal illnesses in person, and another one imagining the possible pain and sadness the patient would feel when they find out the diagnosis.
These mindsets are conflicting. It makes me feel guilty for feeling joy from someone’s suffering. However I don’t want to sacrifice either. Ten years later I don’t to be a doctor who only sees patient’s suffering and forget the joy of learning and identifying diseases. Neither do I want to become a doctor who only sees patients by their disease.
I guess I’ll need to live with both… for now.