The Path Into Medicine
The work came before the white coat.
I grew up in a small town in Michigan. There were 87 people in my high school graduating class. When people ask how I got into medicine, it would be easy to start with medical school, but that would skip quite a bit of the story.
For me, medicine didn't begin in a lecture hall. It started in a crumpled car early on a Sunday morning, with the smell of alcohol and gasoline and the sounds of pain. It also started in a living room where the ordinary order of a house had turned to chaos in an instant. A few minutes earlier, somebody had been drinking coffee, watching television, getting ready for work, or arguing about whose turn it was to do the dishes. Then something happened, and suddenly strangers were coming through the front door carrying oxygen and a defibrillator.
I was one of those strangers.
I earned my EMT license while I was in college and began working part time on basic life support ambulances. I was young, and there was an enormous amount I didn't know yet, but EMS teaches you some things very quickly. People don't hand you their story in chronological order. You walk into the middle of it.
Someone tells you about the chest pain. His wife remembers that he hadn't looked right since breakfast. There are prescription bottles on the kitchen counter. Somebody mentions, almost as an afterthought, that he had been complaining about indigestion for two days. Now you have to figure out which pieces matter.
That fascinated me. I wanted to know more, so I went to the Davenport Center for the Study of EMS for EMT Specialist training and then paramedic training. While attending Michigan State University, I worked advanced life support in Lansing.
College and medicine became two parts of the same life. One day I might be sitting in a classroom learning physiology; later I could be standing beside a patient trying to understand what that physiology looked like when something had actually gone wrong.
There was another lesson in those years that took me longer to appreciate. When you enter someone's home during an emergency, you see more than a medical problem. There may be a frightened spouse standing three feet away, children watching from the hallway, a dog that doesn't understand why everyone is upset, family photographs on the wall, or dinner still sitting on the table.
The patient isn't a diagnosis. The illness has interrupted a life that was already in progress before you arrived.
That stayed with me.
In 1984, while still in college, I joined the Army Reserve as a combat medic. Three years later I was commissioned through ROTC. By the time I entered medical school, I had already spent years taking care of patients in civilian EMS and military medicine.
Medical school deepened what I understood. Internship and residency changed it again. Experience added another layer. But some of the habits were already there: listen before deciding, figure out what changed, put things in the right order, notice the detail that doesn't fit the easy explanation, and don't become so attached to your first idea that you stop listening to the evidence.
More than forty years later, I still use those habits when I open a complicated medical record. Instead of walking into the middle of a living room, I may be opening the middle of a 2,000-page file. The problem is surprisingly familiar. The story is there; you just have to put it back together.
And the question underneath it is still the same one I was asking when I was young and somebody opened the front door to let us inside:
What happened here?