For Sal Joyce, a medical student in 1920s Ireland.
As they moved on to the next patient, she hoped it would be the last. She had been in the hospital all afternoon and was craving a cigarette. She knew this patient already. He was one of her fiancé’s patients. She rounded with him occasionally when she had finished her studies early, and so she was familiar with this man’s case. She thought that perhaps this would give her an edge, a chance to look smart in front of her professor and classmates, should any questions be asked of the students.
Here the students learned by example; they were to be quiet, yet astute observers. The professors began to take this man’s history. He was a good doctor – at least in the eyes of his patients and most of his students and colleagues. She did not really like or dislike him – a reflection of his feelings towards her. At least he did not single her out, as so many of her professors did.
She paid close attention to the elicited history. Triumphantly she was checkign off each of the significant points of which she already knew on her mental list. Every so often she was surprised to learn something new about this patient, something that her fiancé probably did not knwo about. But after all, he was a specialist, training in ophthootolaryngology, so she did not hold it against him. And of course, the professor’s history had gaps as well. He had not asked about her inquiries, quite important to this patient’s history, at least as far as her fiancé was concerned. But this was just a teaching exercise, so no matter.
And then the professor, after having completed his history, turned to the students and began to speak of the importance of a thorough physical exam. For some reason on that day and standing at the bedside of that patient, he chose to speak about the fundoscopic exam. He spoke about the many manifestations of systemic illness that could be seen and even diagnosed from the appearance of the fundus. That said, he began to examine the patient’s left eye. As he did, he described for the students what he saw. The narrower arteries and the wider veins, and their branching as one moved away from the disk, and the trick of following the branches backwards towards the disk. Ah, the disk – one must always scrutinize the disk for glaucomatous changes.
As he spoke she knit her brow, trying to remember which side…
And then the professor examined the right eye, again describing the vessels, the disk, and now waxing eloquently on the macula.
But she was no longer listening. Her thoughts gave way to disbelief and then disappointment and then amusement as he pronounced this gentleman’s fundoscopic exam normal and healthy. He invited the students to examine the patient at their leisure and emphasized again the importance of a thorough physical exam.
As she stepped out of the hospital, she lit a cigarette, and headed across the quadrangle towards the library, still thinking about that last patient. Of course she was not sure whether it had been the left or the right, but one of these two eyes was made of glass.