A medical student's narrative of lessons learned from patients in Alaska to Africa.

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	• What Patients Taught Me: A Medical Student's Journey Audrey Young Sasquatch Books, 2007 - 240 pages average customer review:based on 14 reviews view larger image
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highly recommended

The human element in medicine

In "What Patients Taught Me," author Audrey Young, M.D. describes her path in the study of medicine. Growing up in a comfortable Seattle household, she became interested in socioeconomic justice. As an undergrad at Berkeley she "wanted to be an urban doctor for neglected populations."

She chose the University of Washington Medical School, an institution with a " ... dispersed ... program to train medical students from the Pacific Northwest to practice as rural doctors." Under this program, called WWAMI for its presence in Washington, Wyoming, Alaska, Montana and Idaho, Young's medical school rotations provided an unusual amount of patient contact and responsibility.

It was her choice to spend the first year in a Seattle rotation, where she had limited patient contact while taking a heavy academic load. The following summer she began her rural training in a family practice clinic in Bethel, Alaska, where huge distances and inaccessibility of care often led to delayed treatment.

Here on the tundra, as Young learned to present a case in pertinent bullet points, she began to see the context in which patients live their lives. From a healthy youngster with a cold, to a mother with a fulminating post-partum infection, to a forty-year-old mechanic with tuberculosis, each patient was so much more than symptoms and test results.

After Alaska, Young's rotations were a mix of urban and rural. Seattle for surgery and psychiatry; Spokane for obstetrics; Pocatello, Idaho for pediatrics; back to Seattle for internal medicine where she began to long for the autonomy and open spaces of more rural rotations.

At the end of her third year Young took a difficult rotation in Swaziland, in eastern Africa. This third-world country was overrun with HIV and suffered acutely from interruptions to the supply chain due to war, poverty and political ideology.

What Patients Taught Me: A Medical Student's Journey is illustrated with story after story of patients and their diseases and social context. This is the lesson Audrey Young shares with us -- "that a doctor should understand how people live." She tells her own story beautifully, and it's an inspiring story regardless of the reader's field of interest. I would paraphrase her life lesson and say that in all our interactions, any person should strive for that same understanding.

There is a lot of medical detail in this memoir, but if that field is within your area of competency as a reader, I recommend this book to you.

Linda Bulger, 2008

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Inspirational

After reading the author's accounts of rural medicine, I've begun to strongly consider applying for a rural-based residency upon completion of medical school.

Her tone isn't as pompous as some other similar books I've read. She's very down to earth, and doesn't try to make herself sound impressive by using jargon and fancy words. I've already recommended it for friends who are looking into going into medicine. A friend gave this book to me as a gift after reading it, and I plan on doing the same!

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A medical student's narrative of lessons learned from patients in Alaska to Africa.

When one conceives of the typical American medical school student's training one usually envisions students learning core clinical sciences the first two years and then proceeding on to rotations in major, large intercity hospitals. Yet, a quick glance at the inside jacket of this personal narrative mentions places like Bethel, Alaska and South Africa - not typical locales where one would expect to see a budding young physician. The singular uniqueness of the experience initially captures one's attention and then the succinct, yet poignant prologue fully captivates one's curiosity. Audrey Young brings a clairvoyant quality to her writing and seems to realize her own experience's importance in the midst of the vastness of modern medicine. She has found one thing that unifies medicine - the patient's story - and simultaneously is cognizant of its decline. Young best describes what attracts readers to the book by saying, "Patients teach things that the wisest and most revered physicians cannot, and their lessons are in this book." (x) These lessons are the defining topics of Dr. Young's personal memoir, What Patients Taught Me.
Audrey Young describes her experiences as a developing physician enrolled at University of Washington Medical School. In preparation for medical school and the goal of becoming a practicing physician in the future, Young envisions herself as an urban doctor working in a clinic to provide much needed medical assistance to the indigent and underprivileged. After trudging through her first year of medical school, settling "into the idea that doctoring meant fixing bodies with science", and considering going to practice rural medicine, Young finally enrolls into a summer experience in the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) program. (10) The maturing medical student ventures first to Bethel, Alaska where she learns from the Yupik people the value of doctoring as caring for one's patients and living alongside one's patients as not only caretakers but neighbors as well. It is in Bethel that Young first realizes that "telling the story was the crucial first step in taking care of a patient" - a lesson that motivates all subsequent interactions and provides the framework for her memoir. (29) She concludes her experience in Bethel without knowing the outcome of a patient suspected to have either curable tuberculosis or malignant cancer - she never finds out.
Upon return returning to embark upon her second year of medical school, Young "gradually...began to function like a classroom student again and devolved into a primitive machine that ate textbooks and syllabi and spit out answers on multiple-choice exams." (39) Such harsh criticism of the traditional, rigid educational structure of lecture pervades Dr. Young's book, and instructs the reader of the dangers of making medicine simply an inhuman science without a personal component to the learning. In Spokane, she returns to a different type of classroom where her patients established the syllabi and constantly made additions and revisions. On her obstetrics rotations, Audrey Young witnesses difficult labors, complicated pregnancies, and tragic endings with one baby dying immediately after the mother held the baby born without a fully developed nervous system. Young learns to overcome her feelings of judgment of pregnant teenagers and renews her duty to care for those in need in spite of witnessing how not even the best doctors could always convince their patients to help themselves.
In the next chapter of Dr. Young's seemingly unending journey, she endeavors to Pocatello, Idaho where she completes her pediatrics rotation. In this segment of her training, Young finds herself persistently in doubt - of her motivations, her capabilities, and her desire to become a physician - but she is able to find consolation in the example set by one caring resident, Jon. Of him she writes, "I felt a surge of gratitude again for how much he'd contributed towards my clinical skills and for the glimpse he'd given me into a young physician's soul. We had been through a chapter together." (110-111) In Missoula, Montana on her next rotation these clinical skills would prove defenseless against "the capricious powers of the human body to act as it wished, regardless of what the mind hoped for." (125) Martha, a patient who had previously recovered well enough to be taken off a ventilator, quickly sinks into a coma after being resuscitated and then dies almost too quickly for any of her relatives to bid her farewell. John, another of Young's patients, decides to live a fuller life without chemotherapy, spending his time riding on top of horses instead of gurneys.
It is here where she learns from her patients valuable lessons such as the difficulty involved in adhering to an extensive drug regimen, the suffering of being misdiagnosed and treated improperly, and the vulnerability of making such important decisions as a physician. Young learns from her own inadequacy on a standardized test that she herself may make many mistakes, and that someday others might not be able to prevent her mistakes from harming her patients.
Dr. Young's next journey leads her to practice medicine in Swaziland in South Africa in an impoverished community health clinic. Here in Africa Young witnesses the inadequacy of her clinic; this clinic is a healthcare facility that does not even have penicillin to treat simple infections. In spite of a close-call with an accidental needle-stick after taking abdominal fluid from an HIV-infected patient, Audrey Young still renews her devotion to medicine and carries on by taking care of patients and working through difficult circumstances. Young recalls, "I convinced myself that to feel and to act could be entirely unrelated things, but I decided that a doctor who sees suffering must act, rejecting the choice of not acting, even when futility and risk run high." (193) The time spent in Africa, while a vastly divergent setting, still provides Young and the reader with fundamental lessons about the devoted care that an exemplary physician must impart upon his or her patients.
After returning to the United States, she continues her commitment to rural medicine by pursuing a rural internal medicine residency. She finds her niche practicing in a Seattle clinic for the indigent and teaching medical students how to interact with patients. From her writings, one can learn numerous valuable lessons from her diverse experiences. Dr. Young promotes an awareness of a different type of medicine - the type of medicine that the reader witnesses in Young's travels is not the dramatic, exciting medicine that one might see on television. It is also not the technology-driven medicine that one might envision as the future of medicine. What the reader finds in Young's account is simple patient and physician interaction. Young conveys this important message by reiterating, "I admired many of my teaching physicians as brilliant scientists and intellectuals, and for a time fancied myself in that vein. But WWAMI had imprinted upon me that doctors take care of patients, and in the end, I could not imagine a lifetime of doctoring without patients at the center." (208, emphasis added)
Dr. Young weaves an elaborate tapestry out her patients' colorful stories - they are stories of nothing short of what it means to be human. The author does not veil the patients' suffering in medical terminology or vapid euphemisms; the reader instead discovers a potent, passionate account of what physicians might be missing by not listening to patients' stories beyond the clinical manifestations of disease. The first, primary lesson of this narrative informs the reader that "almost everything important comes from the patient's story." (212) The reader witnesses the consequences of failure to take note of the patient's story in the case of Carla, whose first doctor missed the diagnosis of Crohn's disease. From this encompassing lesson, the reader also learns that medicine and health should not simply concern itself with simple clinical symptoms and treatments, but should include consideration of the patient's and the family's more fundamental needs as emotional beings. John's decision to end chemotherapy to live out his last remaining days happily and the physician's respect of this decision eloquently demonstrates the importance of medicine extending beyond physiological considerations.
Moreover, one of the perhaps more important messages that the reader can derive from Dr. Young's What Patients Taught Me is that medicine is fallible and that physicians cannot completely conquer human suffering. It is this humanly flawed aspect of medicine that makes it such an emotional experience to be a physician - to have the power to make a positive impact many times, but to lack any power against disease and illness at other times. Young concludes this statement best when she writes, "Sometimes I enter a story and find I can bring a little light and relief to human suffering." (214)

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Great book

If you are in the medical field you need to read this book. It's great to see someone who is in the medical field for the people and not the money.

If you don't pick something up from this book as to how to handle your patients, I'd be real surprised.

What Patients Taught Me : A Medical Student's Journey

It was very thoughtfully written.

It was a topic of great interest to me.

The evolution of her insight into her patients was craftfully presented.

My only negative comment concerns the less than excellent level of literary skill.

reviews: page 1, 2, 3

In this deeply human memoir, Audrey Young uses her skills as a keen observer of people and recorder of details to track her development as a doctor and, ultimately, as a person. She chronicles her experiences as a medical student in the most remote regions of the American West and Africa and it is in these remote areas where Young?s education truly begins. A baby?s rapid deterioration, a terminal cancer patient?s refusal of treatment, clinics where AIDS and tuberculosis are everyday realities from these crises the author draws the hardest lessons of all, the ones only patients can teach. Young?s graceful prose captures the immediacy and emotional complexity of lives in distress. Her quiet sensitivity and intuition, qualities that make great doctors and writers alike, shine throughout this work.

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