Journeys with Joshua: Joshua Wienczkowski walks us through med school at East Tennessee’s College of Medicine with his monthly blog updates. Get an inside look into med school down South and life as a student adcom member through the eyes of a former professional songwriter with a whole lot of clinical experience — thanks Joshua for sharing this journey with us!
I just finished my first year of medical school here in Tennessee, but summer started rolling in along the foothills of the Appalachian Mountains about a month or two ago. After being locked up in a gross anatomy lab, learning about the human body inside and out, studying for days on end, and establishing friendships and memories that will last a lifetime, I’m left with a lot more questions than answers. What happens when things go awry in someone’s health? How will I help the ill as a future physician? What kind of physician will I be? What will patients refer to me as in light of my phonetic-nightmare of a last name?
There’s something surreal about self-discovery in the medical education process that lends itself to unfolding like the magnolias beginning to bloom. In medical school, we’re constantly being evaluated through exams, papers, small group discussions, involvement in our communities, and by mentors. Just to get here, we’ve jumped through more hoops than a circus clown in their entire career. So, through its nature, we in-turn begin to evaluate and re-evaluate ourselves to assess where and how we’ve changed. My mom was a nurse for all of her working career, and has always said, “the person that leaves medical school has evolved and changed a great deal from the one that entered.” So, how have I changed in one year of medical school in pursuit of my MD?
I’m really glad you asked that question, because now is the first time I’ve had the actual time to evaluate and reflect on the topic in quite some time. I think it’s best if I tell a patient story and show how I felt and reacted in that large, machine-filled ICU room versus how I imagine I would have a year ago. To preface, all details and names have been altered to maintain the anonymity of my patients, but the story itself remains intact. I am a co-investigator on sepsis, so patients are often extremely ill by the time they reach me.
“Hi, Mr. Dempsey, my name is Joshua Wienczkowski. I’m a medical student here, and I was paged about your wife, Holly. I work on sepsis, and I’m hoping I can have some answers for you. Do you mind if we sit down and talk?” I watched him wring his camo hat with calloused hands, both dirty from days in the field, as the ventilator faithfully and rhythmically breathed for his wife beside us. Bleep bleep bleep bleep, her heart still tachycardic from the systemic bacterial infection souring her body. John’s hand reached behind his head, rubbing his leathered neck, perhaps in hopes of some comfort, “she’s been diabetic her whole life, and about 3 days ago, she broke a fever real bad and was all slurrin’ her words. I knew I…” beep beep beep, his phone alarm incessantly rang. “Now’s usually when I give her the meds ‘fore supper. I’d never seen her so bad, so I brought her in yesterday, and they got all kinda tubes in her…” John went on to tell me about their three kids at home, as he choked back the thought of raising them without Holly, his wife of 12 years. I asked about work and heard how incredibly tight money is at home. He’s been doing his best and working hard, but sometimes life isn’t always fair.
I gently asked John if he wouldn’t mind me examining his wife, because it might tell me more, “you do what you have to, doc, I just appreciate you spending the time,” he said. The aftermath of a lifetime with type II diabetes had caught up with Holly, and her severe obesity, likely caused by the disease, only contributed to risk for infections – in this case, a urinary tract infection that just wouldn’t clear, and spread like wildfire. I listened to her heart, hoping I wouldn’t hear a murmur, evidence that her tricuspid valve (all the blood from your body passes this as it goes from veins to the right atrium, past the tricuspid valve, and into the right ventricle before entering the pulmonary artery and lungs) was consumed by the invading bacteria. The forceful breaths of the ventilator hissed into my stethoscope as I listened intently while scanning her arms for track marks. Unfortunately, IV drug use is a major problem in our area, and many of my septic patients have succumbed to this anchor. They’re good people that haven’t done anything to deserve this… They waited too long because they couldn’t afford proper treatment and now she needs a new heart valve, if she survives. Couldn’t this have been prevented?
“John, I’ll pull some blood, look it over real good, and come back first thing in the mornin’ to tell you what I find, and what I think it means for your wife.”
A year ago, I don’t think I would have known the first thing about how to interact with John while his wife lay next to us on a ventilator. I’m willing to bet I would have been like a deer in headlights when I stepped into that room. Machines whirring with someone on a bed who is there, but isn’t at the same time can be overwhelming at first. A year ago, I didn’t know how to listen to him, his story, or her heart and lungs. I didn’t fully understand the implications of disease, socioeconomic status, and how tightly these two are correlated with poor overall health. Sadly, I would have likely thought Holly had gotten herself into her poor state of health, because I didn’t fully grasp how life circumstances undeniably impact health. A year ago, I didn’t know how to ask John questions in just the right way, offer support, and create the vulnerable environment that needs to exist for patients to trust sharing their darkest life details and fears. Mr. Dempsey told me they’ve never touched drugs when I asked, and I trusted him, but I’ve learned this year how much I don’t trust what drugs do to people. He was telling the truth.
In a year, and 25% done with my MD, I’ve somehow changed in an intangible way that’s still a student, still undeniably me, but beginning my personal evolution in embodying what I feel it means to be a physician. With each John and Holly I meet, a slightly evolved me steps out of that patient room.