(by Justin Peterson, PGY-3)
“Name an antibiotic,” the attending commands. I have a moment of hope as I look over to the medical student, a friend, but the hope evaporates when I see his face, one wrought not with one struggling to overcome a moment of unanticipated hesitation or tip-of-the-tongue phenomenon, but instead of fear. He does not know. In the States, we call this look, “Deer in the headlights.” I do not know the Rwandan equivalent. I do not know if the gazelle has reached the same level of metaphorical recognition for his/her response to oncoming traffic. I make a mental note to ask my friend later; for now, he has a more important question on hand.
“Name an antibiotic.” He isn’t going to get this question right, not today anyways. At face value it’s hard to be sympathetic to this student, my friend, because he’s finished five years of medical education and is hopeful to become a resident in the near future. It’s hard to be sympathetic because it’s a question most of us in medicine can answer, often before we ever enroll in our first class. And nothing seems to anger us or lead us so quickly to make assumptions about someone’s intelligence like someone not knowing what we perceive to be common knowledge.
It immediately invites the wolves in.
Earlier in the day, he proudly (and correctly) reported finding egophony on a patient that we later corroborated with a consolidation on imaging. I saw the satisfaction, the energy he got when vindicated, enough to subside the fatigue he had from long hours in the ward and even longer hours studying at night. He had flashed an emphatically strained smile, a recurrent joke of his ever since I showed him my best impersonation of risus sardonicus as a sign of tetanus. I had also taught him different physical exam signs and maneuvers for the pulmonary system just days before. He took those words to heart. Or to lungs, I suppose. But egophony wasn’t an antibiotic and wouldn’t help him here.
Earlier in the week, a patient cried out during a particularly strenuous session of physical therapy. Our ward had an attending, two residents, and half a dozen students, but it was the protagonist of this story she had asked for in her moment of weakness. Someone asked, “Why is it the student she calls for?” I knew, but kept to myself that it was the time he spent with the patients, not just asking about their chief complaints and history of present illness, but about them, their families, their stories. He talked to them like they were old family friends and just happened perchance to cross paths again. When words wouldn’t suffice, his stethoscope lay within the ears of the patients when they asked what their hearts sounded like. “Lub-dub,” or “whoosh-dub,” they would confirm, handing it back. But this kindness, this compassion, was neither a beta-lactam nor a tetracycline and would not help him here.
They say you shouldn’t judge a penguin by his/her ability to fly. They say, maybe we shouldn’t worry too much about the aspiring artist who struggles on the SAT. Sure, you say, but we’re not asking the medical student to describe the notes, body, and finish of a dry red or to compose a symphony from scratch. “It’s an antibiotic for chrissake!” we lament. “This isn’t Shakespeare!”…whatever that means.
We know in the United States that higher education is disproportionately reserved for those with privilege. Rarer is the medical student from a disadvantaged background, and we know getting in the door is not the end, a safe haven reached, but often just the beginning. We know test-taking often favors those from higher socioeconomic backgrounds, but what do we do with this knowledge? “Work harder!” we say. “Overcome centuries of systemic oppression!” is less catchy and hasn’t yet quite caught on. We’re happy to hand out lesser marks; everyone has to answer the same questions, so the tests validity must have been equal to all! We pride ourselves in teaching about the best evidence but still test people like it’s the 1920s. Good thing I saved my grandfather’s abacus. It’s from Columbia.
My friend had done his medical education in China. He told me many stories, including ones of approaching strangers on the streets to see if their kids wanted to learn English. While he knew he should be in the library, learning a crude mnemonic for the branches of the facial nerve, he was out looking to earn a meager few dollars so he could afford his next few meals. He didn’t have the same economic support some of his classmates were afforded. But his entrepreneurship wasn’t an aminoglycoside and wouldn’t help him today.
We didn’t speak of his inability to answer the question that day, but I could see the scarlet letter he carried with him as he finished the days work. Whispered pectoriloquy on effusion would’ve been deafening compared to how he talked for the rest of the day. I didn’t think much of it until we went camping together that weekend, and on the bus ride out, he asked me if I’d teach him antibiotics. For the next few hours, we covered everything I could recall, which, if recorded, would probably bar me from any ID fellowship for life. I spoke off the record. When the sun went down, we didn’t stop; he used his cell phone light to take more notes, trying to soak in every word I said. He couldn’t name an antibiotic last week, but that would be the last time such a statement would be true. He was given a test and failed, and worse yet, humiliated in front of his peers. But it was also a test on his resiliency, his dedication, and his potential, and this one he passes. With a smile, we reach the campgrounds and he closes his light blue notebook, and I can’t help but notice a small white penguin etched on the front.
“Vancomycin,” he says, and flashes his best tetany-resembling smile.