Clinical, Featured, Intern Year, Internal Medicine
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Parking Lot Epiphany: My First Patient as a Physician

The following manuscript was submitted to the March 2017 s/p The Match — One Year Later Themed Writing Contest.

“Bunny!” my mom shouted from the foot of the steps, hurrying me out of bed the morning after my medical school graduation. She used the childhood nickname that came from my brother who was unable to pronounce “Dominic” as a toddler, a name that had stuck well into adulthood.

There was much to be done in preparation for a family party later that afternoon and being a new doctor did not absolve me from the responsibility of running errands with her. In truth, I didn’t feel much like a physician despite the theatrics of the previous day: I was Bunny, a 28-year-old living with my parents and sleeping in a bunk bed.

I quickly descended the stairs to eat a breakfast that was interrupted by the frenzy of a household preparing for guests. Chaos reigned between bites of banana: the vacuum moved across surfaces as if chased by a predator, bird feathers flew, cartoon-like, as cages were cleaned and, invariably, a home improvement project was just nearing its final stages in the hours before company arrived.

Escaping the shrieking vacuum cleaner, I joined my mom in her car. We savored a moment of silence, looking out onto the clear skies of a perfect spring day. I surveyed the passing landscape as I thought about having to leave to begin residency, holding close to these final images of home.

My mom, a religion teacher, attempted to solemnize the day by speaking in grandiose terms about my life’s trajectory toward this vocation. But the meaning behind her words was obscured by a confusing set of emotions: I was simultaneously proud of my accomplishment while feeling that nothing extraordinary had happened.

Together we raced around town: to the grocery store, then the liquor store. Beer bottles — good, local beers, I had insisted — clanked in the backseat as we drove to our final destination: Party America.

“Dad wanted to be sure that we had balloons,” she laughed. I smiled, feeling again like a child, riding in the passenger seat alongside my mother, happy that balloons would help commemorate this event. But my thoughts were quickly interrupted. Pulling up to the store, we found an elderly woman lying in the parking lot.

Anxiety washed over me. The oath I took the day before, in which I assumed the “rewards and responsibilities of a physician,” demanded action. And yet I felt wholly inadequate to provide care a day after graduation, still dressed in pajamas, standing in the parking lot of a party store. I could avoid the situation, remain anonymous, and carry on with my day. But my duty as a physician, albeit one less than 24 hours old, wouldn’t allow me to ignore a patient. And so I acted.

She was on her back, pressed into the asphalt, blinded by the intense sun of a shadeless parking lot. Her worried son knelt at her side and in hushed tones asked if she was in pain. I approached this scene, acutely aware of my inexperience, heart racing, voice quivering, and introduced myself: “I’m a doctor. Is there something I can do to help?”

She let out an audible sigh into the parking lot that met my ears, replacing the sound of my beating heart, and encouraging me to press forward. “Yes,” she said, “I’ve fallen out of my car and my hip hurts. I can’t get up.”

My patient was in her 80s, dressed in a carefully coordinated bright blue outfit, matching the spring sky that now illuminated her face. She smelled like my own grandmother, who died six years prior but whose perfume lingers in my memory long after. And, like my grandmother, she used laughter to dampen the gravity of the situation.

As I carefully performed a physical exam, remembering the ABCDE’s of a trauma evaluation from my recent emergency medicine rotation, I learned that she had traveled more than three hours to see a concert the night before, a gift from her son. We got lost in conversation as I asked about her night on the town and she excitedly told me about the concert and having dinner before. Assured that she was stable, I attempted to stand her up to no avail.

“What should we do?” her son asked, his soft eyes conveying a confidence in my abilities that I had not experienced before. I was wearing flip flops, my hair molded messily from my pillow, with minimal experience under my belt, but I was a doctor. And I was being called on for help.

I rendered my assessment. Worried about a hip fracture, I advised we call EMS and have her transported to the nearest emergency department for further evaluation.

The weight of the encounter settled on me. Here in a parking lot, under a Party America sign, I performed a history, physical, and developed an assessment and plan for my first patient. At that moment, the significance of my graduation dawned on me. The MD degree conferred on me the day before did not make me a physician: kneeling at the side of an elderly woman, evaluating her hip pain, and seeing her eyes light up while talking about a concert did.

I realized then that my life would never be the same. And with this epiphany, I heard a bunch of balloons rubbing together behind me, blowing wildly in the wind. My mom was carrying them. Looking down at my patient and over to her son, she exclaimed, “Can you believe he just graduated from medical school yesterday?”

I stood there, proud and humbled, and laughed.

Image creditParking lot light by Katie Chao and Ben Muessig licensed under CC BY 2.0.

Dominic Decker, MD, MS Dominic Decker, MD, MS (2 Posts)

Resident Physician Contributing Writer

Warren Alpert Medical School of Brown University

Dominic Decker is an English major at heart now training in internal medicine. He completed a master's degree in Narrative Medicine at Columbia University, attended the University of Minnesota Medical School, and is in residency at Brown University.