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Patient Teachers

Turning medical students into doctors is a job that calls for scientific acumen, medical expertise, and lots of patience. And it calls for patients, too. Many students say that the most powerful lessons they learn—especially those about the importance of the human touch—are insights that they glean from patients. Here are several such sagas.

Illustrations by Chris Demarest

A uniform finding
By W. Andrew Cronin

Andy Cronin, who earned his undergraduate degree in chemistry from the U.S. Naval Academy, will graduate in June from Dartmouth's M.D.-M.B.A. program. After a transitional internship in 2009-10 at Balboa Naval Hospital in San Diego, he will serve for three years as an undersea medical officer; he then plans to enter a residency in anesthesiology.

Iwas a 21-year-old rising senior at the U.S. Naval Academy when an encounter with a 20-year-old Marine changed my career path forever. He had been shot in the neck in Afghanistan but, thanks to the commitment of his fellow soldiers, had been extricated from the battlefield under heavy fire, stabilized by medics in the combat zone, and evacuated to a military hospital, where his left carotid artery was repaired and his life saved. I worked with him for two weeks during his rehabilitation after his return to the U.S. I was amazed that this man, younger than I, who had nearly sacrificed everything for the country he believes in, was determined to return to full health so he could rejoin his unit. I hadn't yet learned about the stages of wound healing that his body was undergoing, hadn't yet mastered the neurologic tests that were being used to monitor the stroke he had suffered due to the incident. But I was able to play a meaningful role in his care simply by taking the time to listen to someone who was half a country away from his family and half a world away from his friends who were still fighting. I went home in the evening after working with him convinced that there was no greater profession than medicine.

When I first came to medical school, my excitement and passion were at an all-time high as I met a community of like-minded classmates, all in pursuit of the same goal: to become doctors. At first, my passion to provide care to patients drove me to learn as much of the science of medicine as possible. However, I gradually began to separate out the art from the science of medicine. Fortunately, a few elements of first year kept my spirit nourished—most notably the On Doctoring course, which gave us contact with patients and an opportunity

On Mr. Webber's first follow-up visit, I surprised him by wearing my Navy uniform. I even had someone take a picture of the two of us together and sent a copy of it to him, together with a note of thanks.
—Andy Cronin, DMS '09

to discuss the human side of medicine in weekly small-group sessions, as well as the community service activities we were encouraged to engage in.

But slowly I began to assign the caring, compassionate parts of me to the Thursday afternoon On Doctoring sessions, while my disciplined, driven aspects took charge the rest of the week. The more I separated science from the rest of my persona, the more studying became a chore—a forced march to get

from first year to second, then from second year to third—instead of a way to provide better care to patients.

I didn't realize how separated the art and the science had become in my mind until I met Mr. Webber on my internal medicine rotation in October of my third year. Mr. Webber was a retired Navy veteran who had been admitted for the third time to the VA Medical Center for recurrent ascites—an accumulation of fluid in the abdominal cavity. He had a reputation for having

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These five narratives were written by Dartmouth medical students upon their induction into the Gold Humanism Honor Society. A national organization with chapters at 72 of the nation's 129 medical schools, the Gold Society recognizes students for their compassion and dedication to service. For last year's Dartmouth induction ceremony, the society's newest members were asked to describe an especially meaningful encounter during their medical education. Five of the narratives prepared for that occasion have been adapted for publication here. The names of all the patients mentioned, as well as key identifying details about their cases, have been changed in order to preserve their confidentiality.

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