Sometimes medical students and housestaff forget why they decided to become physicians. And then sometimes patients remind them why. A student of solace and love

I was a fourth-year medical student when I met the two patients. The rotation, a rite of passage, is the month or two during the last year of medical school when we get our first true hint of what it feels like to be a doctor. We take full responsibility for our patients and make day-to-day decisions, with close supervision by our superiors. It is also our prime introduction to "scut work." Scut work runs the gamut, and may include tracking down lab results, calling an outside doctor for a fax of a patient’s MRI scan or arranging a patient’s discharge with social workers. Scut work involves the nitty-gritty of making things happen in the hospital for patients. During the middle of the rotation, my enthusiasm started to dwindle. The scut work was draining. It was intellectually empty, and the long hours — staying up for 30 hours straight every fourth night — began to wear me down. That was, until I met these patients and, more precisely, their families.

Stephen Covey, in his 7 habits of highly effective people, reminds us in Habit 2: Begin with the end in mind. Medical students often have a difficult time remembering this. Their day to day life has great stress, and they focus often on the things that cause that stress. They start school with altruism, but we (medical educators) and the "system" often beat it out of them. Sometimes it takes a fresh look at why to place "scut work" in its proper understanding. Speaking about a spouse caring for her sick husband:

I drew inspiration from her at a time when some of my own was waning. She stayed by his side, sleeping on the hard hospital floor every night without complaints. She listened to him moan in pain all day. She made him feel less like a hospital boarder and more like a regular person — he was always clean-shaven. One morning, I walked into the room, which was perfumed with the refreshing scent of Neutrogena. She had moved him to the bedside commode and set up a makeshift bathing station. The patient smiled, looking fresh and clean and proud. The meticulous care that these patients’ families gave their loved ones was an extraordinary sight to witness. Neither patient, however, sang their caregivers’ praise. She was too tired — and could barely talk through her tracheotomy; he was too consumed by worry. Yet the caregivers kept on. They knew their loved ones appreciated and needed them. In that way, the families helped me put the thankless daily grind into perspective. In the complicated world of hospital care, every task makes a big difference, no matter how small or unrecognized. The serial phone calls down to the ultrasound department, the letter-writing to Medi-Cal for emergency insurance, this was my part. These seemingly mundane tasks could make a marked difference just as cleaning a wound or bathing a patient would.

Scut work has an undesirable connotation. This slang does communicate, but I believe it communicates the wrong idea. Caring for patients requires multiple skills. Like detective work, success occurs from a series of persistent steps. As I reread this medical student’s prose, I smile. I believe she has started to understand what it really means to become a physician.

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