A DOCTOR’S FIRST DUTY
Sarah Khayat
A still from Wild Strawberries (1957)
T
here is a scene from an exceptional
movie (among perspicacious movie critics whose job it is to determine
such things) that details a Swedish doctor’s
nightmare sequence. This 1957 “Wild Strawberries” is another Swedish masterpiece from
the director Ingmar Bergman. Its curmudgeonly old physician, curt and overtly pessimistic, is invited to accept an honorary degree from his alma mater. On the way, he endures an introspective
journey that sends him spiraling into a series of mini self reflections, few of which he is thrilled to be experiencing. The dream
sequence is the product of that journey. In it, he is taking an oral
exam in which he’s told to identify the organism on a slide under
a microscope. He is unable to do so, despite his background as a
bacteriologist, and he cannot also decipher the words written on
the blackboard. The examiner reminds him that these words denote a doctor’s first duty. Again, he is at a loss, visibly exasperated
by his doltishness. How could he, a practicing physician of many
decades, have forgotten something so basic? The examiner decides
to put him out of his misery and provide the answer. “The first
duty of a doctor,” he stoically and matter-of-factly reminds him,
“is to ask for forgiveness.”
donned the white coat- long enough to imply I knew something,
yet short enough to prove there was much more I didn’t; inches of
fabric as gatekeeper to the world of hospitals and clinics. I made
sure to bring my trusty legal pad and my purple finely tipped pen,
the one that didn’t bleed or smudge. I followed my preceptor’s directions to the internal medicine call room and found him waiting. There was no time for pleasantries. We exchanged hellos and
walked out of the room onto the floor.
I couldn’t have known that I would be reminded of the resonance of that statement within the year.
I greeted her, thanked her in advance for her time, and sheepishly apologized for asking questions she had no doubt been asked on
several occasions since her admission. I then began with the barrage of questions I had been in the habit of asking my Simulated
Patient, first inquiring about her initial complaint. What had you
been doing before the onset of the leg pain? She looked at me the
way I would imagine a mother giraffe looks at her calf during its
first days, stumbling about stupidly while it acquires its earth legs-
As LMC2s, we complete an observed history and physical. We
are assigned a faculty physician facilitator who coordinates with
us to figure out a time to come in and interview a patient. We were
not asked to prepare anything; we were simply to come in and
interview a patient, present, and write up a note.
I scheduled the H&P for 1 p.m. on a Saturday. After parking, I
10
LOUISVILLE MEDICINE
“So, are you ready for the case?” he asked curtly. I nodded, and
in response he shared, “We have a 49 year old woman with left leg
pain.”
“Is that it?” I asked cautiously.
“For now,” he replied.
He directed me to the patient’s room and introduced me, asking if it would be all right for me to ask her a few questions. She
nodded. The patient was reclining, but had the bed propped up at
about forty-five degrees. There was a pallor to her skin, commensurate with how long she had spent in the hospital I assumed. She
didn’t quite have that “toxic” look we’ve been told to observe, but
she was at least definitely “suboptimal.” Her gown was irregularly creased, not fresh and crisp like one newly outfitted. The bed
sheets were pulled up to her waist.