This is a transcript of a brief talk Dr. Colin Knight gave at the end of his fellowship in 2007. All graduating chiefs and fellows were to speak about their “most memorable case.” Some gave academic presentations, Dr. Knight’s was more personal. Here is part two of the talk. If you missed part one, see it here.
I remember the first time I saw a wound explored and closed. In an effort to conform to the mold of the ideal applicant to medical school, I was volunteering in our local emergency room the summer after my freshman year in college. A two-year-old had a complex laceration of the forehead and the local plastic surgeon came by the ER to close the wound. He seemed to have been on a date since he had a dressed-up woman in tow who waited for him at the nurse’s station. I watched with fascination as he soothed the child, helped the nurses papoose the baby, and commenced numbing the wound. When he began running his finger under the flush of the child’s forehead, my parasympathetic system kicked in. Breaking out in a cold sweat and feeling dizzy, I rapidly found a chair and watched the rest of the procedure from its safety; albeit with some embarrassment. How would I ever be able to do this myself?
I remember the first time I cut living human flesh. I started my third year of medical school in late June on the neurosurgery service. My clerkship was in the era where it was it was rare for an attending surgeon to come to the operating room. The residents performed most cases with supervision from afar. Since it was very close to the end of the medical year, the residents were generous to eager students like me. For example, I would assist the neurosurgery intern on simpler cases like shunts. On craniotomies, the residents would allow me and other students to make burr holes into skulls and sew skin. On my first weekend on call, a young woman came to the ER with severe back pain. She was two weeks postpartum and it turned out that she had a large lumbar abscess from the epidural catheter that had comforted her during her delivery. Since there was a possibility of extension of the abscess into her epidural space, even though she had no neurologic deficit, the case fell to us. I helped the intern take her to the OR. When she was positioned, prepped, and draped, he handed me the scalpel. With a pronounced tremor due to fear (or perhaps a little from an enjoyable night at the bars on the Charlottesville corner the night before), I grasped the blade and timidly scratched at her skin. Egged on by the intern, I gained some confidence and plunged the blade into her angry flesh. The warm, creamy pus that exuded from the wound gave me a satisfaction that rapidly started me thinking about a career as a surgeon. My first night of call on the medical service six months later, however, was what finalized that decision.
I think there are several things that make a case memorable: an unusual presentation of a common disease; a common presentation of an uncommon disease; tragedy, of course, lends itself to memory. For me, though, I think the relationship you have with the patient is what really makes a case unforgettable. It is difficult with the constant changing of services as a resident to develop these long-term relationships, but practice as a primary care doctor and and fellowship have allowed me to have such contacts with patients.
Check back for part three of Dr. Colin Knight’s Most Memorable Case.