It’s the first day of residency. This morning, the intern was exuberant: the white coat was starched with pride, and the stethoscope brought a new sense of prestige. In last night’s lengthy sign-out, the intern proudly asked relevant questions pertaining to patients’ diseases. The first patient on the list, Mr. F, has a complicated medical history. With an array of comorbidities, including coronary artery disease, deep vein thrombosis, peripheral artery disease with below-knee amputation, and colectomy, he was hospitalized after falling and injuring his back. Perusing his chart, words like “difficult” and “unpleasant” were frequent: “How bad could it be?” Knock on the door. “Good morning Mr. F” “Who the f*** are you?” “I am the new intern who will be taking care of you. How do you feel this morning?” No response. “Did you sleep well last night?” No response. “Your INR is not looking good, Mr. F. Have you noticed any blood from your colostomy bag?” “I am sick of you stupid questions! Why don’t you get the f*** out of my room?” Stepping out, the intern couldn’t think of any element from that brief conversation that made Mr. F retort like that. The following day, Mr. F was verbally abusive to everyone. The intern hesitates before entering the room: There is an element of fear now. Hesitantly, the Intern steps into Mr. F’s room, and the cycle of verbal abuse repeats. At that point, the intern felt helpless: The fear grows. Despite desperate tries, there was no doctor-patient relationship the intern had yearned for during those med-school days. In the chaos of emotions, the intern’s mind casts back to a fond childhood memory. The Courage, the Cowardly Dog show is the epitome of television. Courage lives in the town of Nowhere, along with two humans: Muriel and Eustace. Nowhere has one house, with these three as only inhabitants. However, they are frequently visited by monsters and otherworldly perils. Courage, in spite of his fears, fends off these monsters. For the Intern, Mr. F is a figurative monster. However, there is something more. Both the Intern and Courage are viewing these monsters from their narrow perspectives. Monsters that frequently visit Courage are actually normal human beings. But since he is a dog, he perceives these unfamiliar faces as literal monsters. In parallel, a constraint focus on diseases prohibits the intern from understanding what a patient is outside the hospital. In the 46th episode, named “The Mask,” Courage encounters a mysterious masked woman. She constantly attacks Courage because she thinks “all dogs are bad.” As the plot grows, we come to know that the masked woman is named Kitty, who, in her past, was abused by a dog. Once we know Kitty’s story, our animosity towards her is gone, and we start empathizing with her. Courage ultimately succeeds when he tries to understand the monster, instead of finding a way to defeat her. In retrospect, one wonders, how many of those monsters just needed saving than being defeated? For Courage (and we) only saw the ugly faces (masks) of those monsters. Perhaps, the intern should try to see beyond Mr. F’s mask. He has spent a better part of life suffering at the hands of the doctors. They took his leg, they took his intestine, and because of them, he is in pain every breathing second. If one peeks behind his mask, the curse words don’t hurt, and the hatred seems vindicated. In fast-paced residency, we often forget that patients are humans, many of whom have suffered long enough before becoming our unannounced guests. The intern can learn a lot from Courage: It’s OK to be scared. The intern will encounter many difficult patients in residency. In these instances, the intern should take a lesson from Courage. Courage tries to move forward and look past his fears, and so should the intern. It will be a long journey before every monster is unmasked. It took Courage 46 episodes before he was able to see the true suffering of a monster. As the intern moves further in career, it won’t matter what kind of monsters arrive, as long as the intern tries to understand, the story behind their mask of hatred. Till then, the intern should try, like Courage did. Every episode of the show ends with Courage, Muriel, and Eustace in the living room. Eustace whips out a ghastly mask to scare Courage. Courage falls prey to this act every time, even though he knows that its Eustace behind that mask. This final act parallels a key attribute of the intern’s journey. No matter how much experience we gain, we may fail to understand some of our patients. Tomorrow, Mr. F will be discharged. Perhaps, Mr. F will be like one of those preceding monsters who went unmasked. Perhaps, the intern should have tried to make him comfortable and understand him as a person, rather than only focusing on his medical conditions. The silver lining, however, is that the intern has learned an important lesson; it’s a lifelong journey to appreciate the patients rather than their diseases. The efforts may not always be successful, but the intern will keep on trying. Knock on the door. Suveen Angraal is an internal medicine physician. Source
