Do you remember when you fell in love with medicine?

I do remember

Storytime

Last week, a known by-the-service patient came to the office with an exacerbation of the same problem that had been torturing her for the last couple of years. As the hypertense patient she is, the first thing I did was measure her blood pressure to rule out a possible hypertensive crisis.

Maria is an 85-year-old woman. Since I started my work in Hinton on October 2022, she had come to consult 5 or 6 times due to severe headaches. Not a single time I found her blood pressure in values that should rise concern for a hypertensive emergency. So, deep in my head, I knew this time was not about to be different. I was right. Left arm BP: 130/60 Right arm BP: 120/60.

Anyway, there was something different in her visit this time. The person who brought her to consult was not her oldest son (the one who had brought her all previous visits to our health center), but instead, was her daughter, Sandra.

Previous interviews with her son couldn’t meet my expectations looking out for substantial information. He usually left his house around 5 in the morning to work on the ranch and didn’t make it home until past 5 or 6 in the afternoon. So he didn’t know the answer to most of my questions.

The fact is, due to feeling sad and lonely, Maria was taken to Chiclayo city so her daughter could take care of her for a couple of weeks. And it was Sandra who lit the path to understanding what was wrong with Maria.

“Doctor, last time we were in my house and her headache started, she told me she couldn’t see”

I’d asked before for any episode of Amaurosis while trying to diagnose the cause behind her headache. But his son couldn’t provide any information on it.

I asked her about any episode of jaw claudication Maria may have had. She answered yes (Apparently she presented one episode while having breakfast with her daughter).

Prednisone was started on her at 1 mg/kg/day for 10 days as empiric treatment for Giant-Cell Arteritis.

Two days ago, I called to check how she was doing. They told me she felt so much better. Not only her headache had improved, but also the muscle soreness, that she had from time to time, was improving (Probably due to concomitance between GCA and Polymyalgia rheumatica). The moment they told me that, I couldn’t feel happier. Not only I relieved someone’s pain but I also made my first diagnosis of GCA

And so, I decided which topic I would be covering on the blog for this week.

A Harsh-truth

If you ask me about the exact moment when I decided to pursue a career in medicine, the truth is I wouldn’t be able to answer that question. Since I have memories of someone asking me that, the answer has always been the same, but I don’t know how that idea came to my mind and stayed there forever.

In my 3^rd year of college, in one of my first clerkships in internal medicine, I met Dr. Francisco Hidalgo, an excellent person whom I still remember fondly. He was born in Tambogrande (a small town close to Piura). But during his younger years, most students aspiring to a college career had to travel to Trujillo and apply to UNT (Universidad Nacional de Trujillo).

He told us about his original plan of studying civil engineering. And how everything turned upside down the day before the admission exam when his cousin convinced him to apply to med school because “real money was in medicine”. Long story short, he did it and made it.

Based on his own story, he told us how he never liked to hear freshman med students when they said they picked their career because they loved medicine.

“There is no way you can love something you don’t know. You may be attracted to it for many reasons, but a real love for medicine only can be born once you’re deep into it”

I realized what he said was nothing but the absolute truth. A memory of my first semester came to my mind. In a “learning methodology” class (or something like that), our teacher asked us to stand up and say it loud the reason why we wanted to become doctors. Two of the answers that were repeated the most among students were

-Because it’s my passion.

-Because I love helping those in need.

Truth is, by the second semester, at least one-third of our class was done with medicine and they left the career.

¿Where was all that passion/love that drove them into giving those answers? The thing is it never existed.

A real passion for medicine can only be born once you’ve figured out everything about it: bad things like sleepless nights, endless shifts/rounds, and a detriment to mental and physical health. But also the good ones: the eternal gratitude of those you help in moments of despair, social recognition, or economic stability.

My personal experience

There is a moment (or there will be, in case you still haven’t had yours yet) when you will get hooked. A moment when you will realize you are deeply in love with this life path you chose and only then you will feel like walking through it for the rest of your life. A moment when you’ll start to love the process with all that this entails.

For me, helping others, and relieving their pain is an incredible plus of my profession. But it is not the main reason why I never desisted on my dream.

I figured it out during my second year. In a physiology lab with Dr. Flores. We were grouped in pairs and were called for a little oral exam. We were studying the reproductive system and most of the questions were strictly about the function of the hypothalamic-pituitary-gonadal axis, hormones, and menstrual cycle.

Just before Dr. Flores let us go back to our sits, he came out with a case of a relative of his whose daughter stopped menstruating after a couple of months following a strict diet before her debut as a ballet dancer.

“Why do you think this happened to her?”- he asked.

Looking back at it now, the answer is simple. A strict diet will probably produce a diminish in BMI and therefore a reduction in body fat percentage ). Since estrogens rely on cholesterol for their synthesis, it makes a lot of sense. It is one of the hypothalamic causes of amenorrhea. But at that moment I was still having a hard time integrating my knowledge of basic sciences with clinical cases.

Anyway, at that time, I was hooked as hell on House M.D., even though I still wasn’t able to understand half the things that were said and done. So being able to answer that question just based on critical thinking made me feel like a real doctor (I felt like Dr. House, Dr. Foreman, and Dr. Chase).

So for me, that was it, my passion was born.

Understanding how the human body works, how diseases may alter its physiological processes and therefore manifest signs and symptoms in patients, and, at the same time, how different treatments can restore our body to its perfect equilibrium. That’s what still makes me fall in love with medicine every single day; what prompts me to review classes and lectures; what drives me to create and review massive amounts of flashcards; and to always look to solve clinical cases.

For you, it might be the first delivery you took care of. The first time you took a patient out of cardiopulmonary arrest after intense CPR. The first time you entered an OR. But I am sure you remember it as clearly as I do.

The moment we fell in love with medicine, it was the first day of the rest of our lives.

Sincerely, Dr. Oscar.