INNOVATION AND CHANGE
Change Originally published in Louisville Medicine , February 2010 , Volume 57 , Issue 9
In my first year of medical school , Dr . Wagner opened up the gross structure of the human body in ways not encountered prior . Dr . Willis and Dr . Anderson illustrated and brought to life the biochemical and physiologic beauty of the microscopic systems of the body . In the second year Dr . Lockwood helped spark the unavoidable hypochondriasis that comes with knowledge of the many pathologic processes that can occur within each of us . Dr . Streips implanted images of microorganisms , some necessary for human life and some deadly . Dr . Williams then injected the hundreds of foreign designer molecules into the complex dance of ligands and receptors , without providing free meals and pens .
As we moved from the theoretical realm of books and laboratories to a concrete world of patients and their suffering , we learned both new material and a new style of instruction . The clinicians who generously work in the academic environment lead by example , teach in the context of patients and lecture while walking . At this point , students begin to believe in the possibility that in the future they will graduate and become doctors .
Medical students and residents encounter many potential mentors . Every professor and attending donates his time and skills in unique ways . If lucky , a student will make an immediate or gradual connection with one or more of his instructors . A special relationship can develop when the teaching style and learning style are complementary , if not similar . A class of students shares time with most of the same basic science professors and then most of the same attendings and residents on the wards . Often the landmark encounters are those that stray from the standard curriculum .
When learning the basic ophthalmologic examination in the first year of medical school , I met Dr . Paul Rychwalski . Noticing my physiologic anisocoria in front of classmates , he invited me to his office for a few standard tests . I remember being concerned about insurance and waiting time , and then the pleasant surprise of the special treatment I received , for the first time feeling included as a peer by a physician .
Dr . Rychwalski was at the time the busiest person I had ever met . Irony trailed each of his e-mails in a proverb : “ The idle man accomplishes nothing . The perpetually busy man accomplishes little more .” Dr . Rychwalski informed me of the “ competitive ” nature of his specialty – that I could become an ophthalmologist if I worked hard in school and did well on board exams . He seemed so content – so eager to share his enthusiasm with a fresh new face . From the start I was accepted by this doctor , who likely made a larger impact on my life than I on his .
Over the next couple years I frequented the Pediatric Ophthalmology office , shadowing the residents as they completed their training . Those who have successfully visualized the fundi of an active toddler understand the patience and skill required in this specialty . I saw a window into a patient ’ s cranium – the optic nerve – and the unfortunate dull pallor that occurs with its atrophy . I examined retinal blood vessels that can actually be seen pulsating in 20 percent of the population . I learned the universal sound to make a child of any age look directly at you ( a musical sound resembling the rolling of “ rr ” in Spanish ).
In the operating room , I stared through a microscope at the operative field , captivated by the removal of a congenital cataract . I was introduced early to the warranted agitation of the surgeon who is without proper instruments . Then I saw professionalism displayed when that surgeon whose ears recently emitted smoke thanks his staff for their assistance and problem solving while a
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