The Faith of a Doctor

Learning to See Beyond the Symptoms

As a young physician, I often struggle with how I am supposed to “see” my patients. History-taking, physical examination, diagnosis, and treatment: a physician tries to see patients with a dispassionate gaze, so that he or she can sort out the modest complaint from the life-threatening one.

Looking at patients dispassionately does not come naturally. You have to learn it, and the process can be a shock. I recall the first autopsy I witnessed during medical school. All rituals have their associated vestments, and for this one I “gowned”-put on scrubs and plastic apron, safety mask, latex gloves. Entering the dissecting room, I saw an elderly African-American man lying on a steel table, his hands by his sides. He looked kind and paternal, like a sleeping grandfather. Pink, puckered suture lines ran up each leg, where the man’s hips had been replaced; his right foot was blackened and yellowed by diabetes; but his hair was well groomed, his face at ease, his hands open. He had died three hours earlier while waiting for a leg amputation.

The autopsy had all the solemnity of thieves stripping a car. As the resident pathologist greeted me warmly, her assistant moved silently about the body, opening the grandfather’s chest with a long, deep incision from the top of the sternum to the break of the hips. Within five minutes, he was cutting open the grandfather’s rib cage; within ten he was examining the organs....

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About the Author

Abraham Nussbaum, MD, is a psychiatry resident in Chapel Hill, North Carolina.