What I really think of sick people

The other day, I was listening with my stethoscope to the sound of a patient breathing. Even though I have no idea what to listen for, a doctor will occasionally ask me to “come on over and listen to this.” So I do. I blindly mimic the timing and technique with which the doctor shifts the bell of his own stethoscope first to one quadrant of the patient’s back, then to another, then another, then back to the first, then to the last, then to another. Invariably, the doctor asks, “so what’d you hear?” Usually, I say something awkwardly vague like, “sounds lungish.” Sometimes I’ll try to vocally relay what I hear, “You know, sort of, hhhhehehhh-scschchhhhhh…. Hhhhhehhhhhh-schchschshhhhhhh.” But with this patient, I could actually make out some relevant noises. “The left side,” I said, “sounds a lot less lungish than the right.”

To which the doctor replies, “you’ll usually hear quieter sounds from the left side, because the left lung has only two lobes and the right lung has three.”

News to me.

He continues, “but this man also had one of the lobes of his left lung removed due to cancer.”

To which I audibly whispered, “Awesooome.”

Now, I hope it’s clear that I don’t think cancer is awesome. Nor am I in any way glad that this patient had a piece of him wrested from its casing. I just get giddy when I encounter some medical phenomenon that I can understand. I’ve heard of lungs, I have some understanding of what they do, and I can imagine what might happen if you lost a part of your lung.

This kind of thing seems to be happening more and more frequently – I suppose that’s to be expected over the course of a medical education. Even though my first semester has focused on molecules, cells, and other things that don’t really puss, bleed, or throb, I still occasionally learn about disease. Often, the diseases we learn about are really obscure things you might only come across in the movies. We started with a case study of xeroderma pigmentosum (remember the movie The Others, with Nicole Kidman? The kids couldn't be exposed to sunlight. That’s xeroderma pigmentosum) and moved onto osteogenesis imperfecta (remember Unbreakable? Samuel Jackson’s character “Mr. Glass” had really brittle bones that always broke. That’s osteogenesis imperfecta). Last week we studied something called maple syrup urine disease, a metabolic disorder in which the afflicted individual's urine smells like maple syrup. While I haven’t seen any movies about maple syrup urine disease, I’ve mentally classified this disease as fictional for two reasons. First, if you were the first to identify a metabolic disorder, wouldn’t you come up with a less ridiculous name? Second, if this condition exists, then it’s not a disease. It’s a superpower.

On occasion, though, our curriculum covers diseases that I might come across in practice. And when I see patients with these conditions, I try my best to conceal my unmitigated joy.

“So you were recently diagnosed with Hashimoto’s Thyroiditis.” Don’t say awesome, don’t say awesome… “That’s… VERY… nice. I mean, great. Really great. Super.”

It may be even more awkward when I get excited about the diseases afflicting people I know and love. There was a moment this Thanksgiving when I was discussing a family member’s recent bout with gout.

“So I just woke up in the middle of the night, with this excruciating paint in my toe.”

“Aw…awesoooome. Had you eaten a big, proteiney dinner that night?”

“Yeah, steaks.”

“Awesooome.”

Realizing my biochemistry texts appeared to be right about the existence of gout, I mentally shifted that particular condition back into the “nonfiction” category.

I suppose my excitement about disease is more of a benefit than a liability. If I get this excited seeing how things go wrong with people, imagine how thrilled I’ll be once they tell me how to fix these things.

“So, you’re telling me that you took those pills I gave you, and now your kidneys don’t hurt at all?”

“Nope, they feel great. Thanks, Doc.”

“Uh… sure. That’s great. Really super…” Don’t say I can’t believe that worked, don’t say I can’t believe that worked… “What I mean to say is, you know, that’s totally awesome.”