Next to my bag lay my carefully organized white coat—my name badge and beeper clipped to its lapels and its pockets filled with blank note cards, information cards, pens, a mini flashlight, and breath mints. It probably weighed 30 pounds, but I felt "loaded and ready for battle." Finally, it was time to review the notes I had taken regarding the next morning's first patient.

He was an elderly male and had a history of smoking, though he'd quit some time before; he was having surgery because a nodule had been identified on his left lung. I flipped through my Rapid Review book in the section labeled "Lung Lesions," so I'd be ready for the inevitable questions that the medical student on the team gets asked. Then I scanned the internet for a description of a thoracotomy so that I would know what was happening in the operating room.

At last, I resigned myself to the fact that I would have to learn as I went along, and I went to bed.

Early the next morning, the senior resident on my team took me in to meet Mr. DeFelice before he was rolled into the OR. He was a friendly man and was accompanied by his three daughters, who were equally pleasant.

As my senior resident explained the procedure to Mr. DeFelice and his family, I stood at her side, watching this interaction between doctor and patient. And then we were gone—off to check quickly on two other patients before we changed into scrubs and entered the OR. In the surgery locker room, I took one last quick glance at my Rapid Review, tossed it in my locker, and then prayed that I'd remember how to put on my gown and gloves.

Once the procedure was under way, though the OR was a fairly large room, I remember feeling that no matter where I

stood I was in the way. The operation itself was amazing; I remember watching the surgeon in awe of his ability to navigate the human body with such ease. I followed the nodule he'd excised from Mr. DeFelice down to the pathology lab and then returned to give the surgeon the news that it was indeed cancerous. But we'd also taken tissue samples from several of his lymph nodes, and fortunately it appeared that the cancer was still localized and that we had removed all of it.

After spending a few hours in the recovery room, Mr. DeFelice was brought

up to the ICU. Then, once he was deemed stable, he was transferred to a regular inpatient room. There, I began making daily visits to check on his progress. His was initially a typical course for a patient who has had a thoracotomy—he had a tube emerging from his chest and was in a lot of pain. The main things I was supposed to focus on were air leaks from his chest tube and his level of pain.

Unfortunately, neither problem resolved as quickly as we'd hoped. His air leak continued for 24 days, and his pain proved very difficult to manage. During the first couple of days, despite the severity of his pain, Mr. DeFelice maintained the friendly nature that I recalled from our first meeting. I enjoyed our visits every morning, even though they were brief. We talked about where he was from, and I discovered that he had been the main contractor of the elementary school that I had attended. He told me about his family, and I could tell how close they were and how devoted he was to them by the way that he spoke. His daughters visited him daily, at different times, and I would often see them in the hallway as they came and went.

I found those early morning visits, as well as rounds with my whole team, increasingly informative. But I always had to run off to that day's operations, and I'd leave feeling that my work was not complete. My presentations were getting more efficient, my plans more accurate, my notes more complete. But my first patient was still in the hospital and did not seem to be making any progress.

One of Mr. DeFelice's biggest problems was vivid hallucinations that were a side effect of his pain medication. Though we changed his medication once, we were more concerned with his ongoing air leak and so asked a consultant from the Department of Psychiatry to handle this psychiatric symptom. But it continued to