The man in bed 14 had a foot he would not let anyone look at.1 I was the scribe on the overnight shift at Rosemont Regional, standing behind Dr. Amadi with a laptop, and my job was to type what she said and stay out of the way. He was fifty-eight, a line cook, and he had come in because his daughter made him. The sock was stuck to the wound. Dr. Amadi asked whether she could soak it off and he said he would rather go home.
I had been scribing for eleven months by then, about nine hundred hours, and I had learned that the chart is not the visit. The chart said: diabetic, uncontrolled, three missed endocrinology appointments, nonadherent.2 What I watched was a man doing math. Dr. Amadi asked what time he had to be at work. He said four in the morning. She asked how he got there. Two buses, the first one at 3:10. The endocrinology clinic opened at eight and closed at four thirty. There was no version of his week where the appointment fit. Nobody had asked him that before, in three visits and two years of notes, and I had typed "nonadherent" into charts like his dozens of times without wondering what it cost.3
I want to be careful here, because I know how this kind of story usually goes: the applicant learns a lesson, and the patient becomes the lesson.4 He was not a lesson. He was admitted, the wound was debrided, and he lost two toes. He did not thank anybody.5 What changed in me was smaller and more useful than an epiphany. I stopped copying "nonadherent" forward from prior notes. When a physician asked me to pull up a history, I started reading the social work notes first, because that was where the bus schedules lived. That was within my job. It was not much. It was something I could actually do at two in the morning with a laptop.
The other thing I do with my time is fail at Western blots. For two years I have worked in Dr. Lindqvist's lab on a project about how a particular kinase behaves in cardiac fibroblasts after injury. For most of my first year, my blots showed nothing. Not a wrong band, nothing. I re-ran the protocol, changed the transfer time, checked the membrane, and blamed myself, which is the least useful thing a person can do with a blank membrane. It took me four months to run the obvious control, an antibody from a different lot, and the new lot lit up on the first try.6 The old lot was dead. I had wasted four months and about eleven hundred dollars of reagent by assuming the problem was my hands.
When I told Dr. Lindqvist, I expected to be embarrassed. Instead she asked me what I would do so the next person did not lose four months. I wrote a one-page reagent log, dated, with lot numbers and a positive control for every new antibody. It is not science. It is bookkeeping. It is also the reason two undergraduates after me got usable data in their first month, and the reason the manuscript we are preparing has a methods section I would sign my name to without wincing. I have come to believe that most of medicine, like most of research, is bookkeeping done carefully by someone who cares whether the next person can trust it.
My scribing shifts and my lab hours pull in the same direction, and it took me a while to see that. Both are about the gap between what is written down and what is true.7 A chart that says "nonadherent" and a membrane that says "no protein" are both confident and both wrong8, and in both cases the fix was not brilliance. It was asking one more question, running one more control, and being willing to look bad in front of someone senior to get the real answer.
I have also seen what the work does to people, and I do not want to pretend otherwise. I have watched a resident cry in a supply closet after a pediatric code and walk back out three minutes later to see the next patient.9 I have watched Dr. Amadi go eleven hours without sitting down. Nobody in that department talks about calling. They talk about the schedule, about whether the CT scanner is down again, about a patient who came back. I find that I trust that version of medicine more than the one I imagined before I started. It is not a vocation that arrives all at once. It is a set of habits that make you slightly more useful each year, if you keep them.10
I am applying because I have found the two habits I am best at, reading past the chart and running the control, and both of them belong in a physician.11 I have enough hours behind Dr. Amadi to know what the room looks like at 3 a.m., and enough months in front of a blank membrane to know what I do when nothing works. I want the training that turns those habits into judgment, and I want to be the one who asks about the buses before the sock comes off.12