October 20th, 2015
I Was Raised on a Zebra Farm
I was raised on a zebra farm. Maybe you were, too. And while that’s a whimsical place to grow up, it doesn’t reflect the real world.
Our teachers told us that hoofbeats belonged to horses, but everywhere we went they showed us zebras. Those were the medical stories we wanted to hear anyway, right? The rare and interesting, the curious and obscure. We brushed past the mundane and crowded around the specimens we knew we might never see again.
Our teaching hospital teemed with the unusual. You want to know the first disease I ever saw as a student? Exercise-induced rhabdomyolysis. I aced the diagnosis and stunned my preceptor, but that was dumb luck. ESPN had just published a story about it. You want to know the second disease I saw? Hypokalemic periodic paralysis. No help from SportsCenter on that one.
Professors and lecturers filed in and out of our classrooms and threw slides up on the walls. They loved photographs of the latest referral case, some patient who had perplexed colleagues far and wide and finally traveled to our famous hospital as a last resort. Somewhere in a cramped office, a student or a resident sat at a keyboard turning that poor person into a case study.
Sure, common things are common, but we could read about those in our common textbooks. We paid good money to learn from the best.
Before graduation I made one last attempt to tiptoe outside the magical garden of academia. I traveled to Uganda where, surely, medicine would rely on its most basic pillars. But the wards there were filled with tuberculosis, leprosy, Ebola, and tetanus (the body-locking, jaw-clenching horror I had only seen in that terrifying Charles Bell painting). These diseases were less bread-and-butter and more biblical plague.
And I wouldn’t have traded the experience for anything.
The zebras didn’t go away after graduation. The first hospital to hire me was a quaternary care center. I guess that meant it was a referral hospital’s referral hospital. I didn’t even know that was a thing.
Our ICU housed an assortment of rare lung diseases and exotic bacteria. Our DKA came packaged with thyroid storm, two-for-one. On one of my first consult shifts, I found two pheochromocytomas in the same day. I should have bought a lottery ticket.
But I eventually left the farm. I moved to a city where the population dwarfed the medical resources, where any true academic medical center was hours away, where the specialists didn’t wait with legions of trainees ready to snatch up even the most timid referrals.
And I was blindsided.
Here, in the real world, the occasional clever diagnosis won’t make you a great clinician. The problem isn’t a perplexing presentation or rare pathology. It’s diabetes and drug addiction and the crushing mass of a population more concerned with survival than health — one that doesn’t see a correlation between the two.
The zebras are gone. The world is overrun with horses.
I could be jealous of those back on the zebra farms. But perhaps that makes me part of the problem. Years ago, didn’t I write an admissions essay about how the lure of medicine was service to those who needed it the most? How the only way to create a better world was to roll up our sleeves and do the work that others wouldn’t?
Maybe it was naive to think the right path would be the most appealing one. Maybe we only like to pretend our careers are more selfless than stimulating. Or maybe that kid clinician just lost his focus along the way, mesmerized by all of those pretty stripes.
I miss it sometimes, that little tickle of excitement, the glamour and thrill of the cutting edge. And I guess the lure of the zebras will always be there.
Meanwhile, the world will still be full of horses. And I will still chase hoofbeats wherever they lead.