A Few Hours in the Life of an Internist

In my view, there are two meanings to the phrase “internal medicine.” The first is purely medical and denotes the common sense of the expression. Internal medicine consists of that specialty within the realm of physicians that is primarily concerned with diagnosing and treating diseases, typically by means of a non-surgical approach. There is nothing wrong with this meaning. It’s rather correct. Like a Sherlock Holmes of physical ailments, the physician stealthily stalks the cause of his patient’s symptoms. He uses his battery of skill and knowledge accompanied with a combination of the acute powers of deductive and inductive reasoning. Assisted by the prowess of his mastery of physical examination and the modern technology behind so many laboratory tests, the clinician shrewdly determines what is happening inside his patient. He sees what is internal.

But there is yet another meaning to the phrase, a nuance that reaches beyond the physical, plumbing the depths of far deeper and difficult illnesses than those assessed through physical diagnosis. While the internist deals with the varied bodily diseases of time and chance, he is often faced with foes of a more menacing mien, the maladies of a depressed spirit, a lonely soul, and a dissolute lifestyle. And these to only name a few! Most of what many doctors meet with in their daily practice is rooted in some problem that lies beyond the somatic sickness that the patient presents with. Thus, they deal with that which is internal – the soul and being of the patient.

As in the case of my recent preceptorship with an Internist, a woman may come for treatment regarding a lump that suddenly appeared on her abdomen, causing her pain and alarm. Now if the lump were present upon her examination in the clinic, the case would be simple. But just as quickly as it appears it also disappears. This is not the first time she has come to see her physician regarding this strange physical illness. She visited before, and the doctor had examined her, performed an MRI, and found nothing wrong. Thus, upon her return for the same complaint – the doctor knowing his patient quite well – he comprehended what she truly needed. And before he ever scrutinized her that day in the office, he wrote a prescription and delivered medication to her in the form of an unsuspecting first year medical student. Sent into the room upon the pretext of taking her history, halfway into our conversation I began to realize that the woman sitting across from me was depressed, lonely, and in need of a friend. I had taken her history. Nothing struck me as being in any way significantly physically wrong with her. And slowly, like fingers of light creeping over the morning sky, it began to dawn on me that I had been sent into the exam room not so much to find out what was wrong but to treat what was wrong; I was the treatment. I was a person to which this sorrowed and solitary soul could release some of her worries and cares, find a cheerful laugh, and meet with the bright eyes of youth. I was practicing internal medicine.

Such experiences are, I assume, a motif throughout medicine. For while we live, our physical being is integrally linked to our spiritual being, each affecting the other, much like a relationship between two individuals. Though I am one person, my one person is an intricately woven tapestry of many colors and threads. And the unraveling of one thread can transform the whole, either for better or for worse. Spiritual and physical intersect and traverse one another, crossing and braiding, looping and winding, now distinct only to be suddenly seemingly indivisible. As a tailor and mender, the physician must see the whole picture of his patient, snipping a thread here and reinforcing a seam there. He must be able to see both the physical and spiritual sufferings of his patient and to place the healing hand on both.