Beautiful Pathologies: Medical-school students sometimes get carried away by their enthusiasm for the science of disease and forget the human suffering that comes with it

AUGUST 14, 2013, 8:39 PM

Beautiful Pathologies

By NATHANIEL P. MORRIS

At our medical school, we have something called the organ transplant observation program, which allows students to shadow the doctors who transfer functional organs from deceased or living donors into the bodies of dying patients. It’s pretty great. When it’s your turn, you might go to a nearby hospital and watch surgeons put in a heart, or hop on a private plane and fly to another state to get a kidney. The program is wildly popular and often a highlight of the medical school experience. This year, over half of my class signed up as soon as the forms went online.

Getting through the red tape required to allow inexperienced first- and second-year medical students to observe these lifesaving operations always takes several months. I know, because I volunteered to help out with the setup process. Training sessions. Vaccination forms. Observation forms. Surgeon meetings. Sponsor signatures. Limited enrollment. Our class started the process in January and was not cleared until the end of April. Finally, the sign-up list was randomized and a pager was handed to the first lucky student. The waiting began.

A few weeks passed with little activity. One student was paged, but it turned out to be a false alarm. Frustrated classmates passed the beeper down the list, since you had to be constantly available and conflicts arise over time. We started questioning whether anyone would ever make it to an operating room. Then one morning in late May, someone did.

We were sitting in a pathology lecture on the differences between benign and malignant cell growth. The sleep-deprived were nodding off in the back. The future oncologists were furiously taking notes in the front. A shrill beeping rang through the auditorium — an everyday event when your teachers are practicing doctors. But this time, it did not come from the professor behind the podium. It did not come from any of the course directors sitting off to the side. It came from a student in the middle of the lecture hall, who stood up in shock and quickly gathered his things.

The entire class erupted in applause and started cheering his name. As he stumbled out the door, fiddling with the pager, excited chatter broke out.

“Do you think he’ll get to fly somewhere?”

“I hope he gets to scrub in!”

Watching all of this, our instructor searched the audience for an explanation. Amid the laughing and the clapping, a classmate shouted a description of the program. Our professor was surprised — he had thought the exiting student was about to become a father. Now aware of what had transpired, he solemnly told us that he often took care of transplant patients. And he reminded us of what we had forgotten: that someone had probably just died.

The room fell quiet. We shifted uncomfortably in our seats. Dozens of Type A medical students, we were ashamed of what we had just done.

Later that day, we found out he was right. An elderly woman had been left brain-dead by a seizure, and the student had gone with a team to retrieve her liver. She was legally dead, but because of a ventilator and other supports, her heart was still beating and the surgeons had a little more time. Still, when they opened her up, they found that her liver wasn’t healthy enough to warrant transplantation. So they packed up and drove home.

My classmates and I thought we were applauding the gift of an organ and the training of a friend. Instead, we had celebrated a seizure that ended a life and the dissection of a woman we did not know.

It’s eerie to think about that morning, the strangeness of medical students cheering the news of someone’s death. Yet these contradictions happen all the time in our education. Our lecturers say, “This is a great case,” when describing a toddler who died from a rare cancer. Or, “Look at this beautiful pathology,” when holding up the clogged heart of someone’s father. I wonder if other professions share these kinds of perverse excitements. Do human resources trainees hear of “great” instances of sexual harassment? Do law students study “beautiful” murder cases?

In medicine, a lot of our training depends on the misfortune of others. Without sick people, we cannot learn to diagnose and treat. But we sometimes forget to manage our enthusiasm for the science of disease and, in doing so, ignore the human suffering that comes with the experience of disease.

When it’s my turn to take the pager, I’ll make sure to keep that in mind. I’ll never forget the seizure that I clapped for — even as I cross my fingers, hoping to get the call.

Nathaniel P. Morris is a student at Harvard Medical School.