My First Patient

by Kenneth Kenigsberg 

April 29, 2011

I'd been looking forward to this event for years, ever since my idolized older brother entered medical school.  At the time, I was five years old and his action determined my path.  I knew that I would become a doctor, too.

Now, twenty years later, I was about to approach a person and announce, for the first time, that I was going to be his doctor. This patient came to me via a medical school course called, "Obtaining a history and doing a physical examination." The class consisted of four medical students and a mentor who was a practicing physician. Each student was to visit Mr. Krahnkeit, a patient in the medical ward; introduce himself, elicit the story of what brought him into the hospital and perform a complete physical examination. When finished, each had to write up his findings and present them to the class.

I had run through the drill for this momentous event many times. I rehearsed what I was going to say and what my approach would be. Before I entered the ward, I checked to see that my stethoscope was discreetly peeping out of the left pocket in my new, starched white jacket. Hidden in my right pocket was the red book of Harvard Medical School.

This guide was like the Baltimore Catechism, a book I had seen my Catholic school-mates study and that provided the answer to everything. Perhaps, my red book resembled more Mao Tse Tung's red book that told you how to deal only with all earthly doings.

The book in my jacket was also comprehensive. The history portion included questions about diseases that hadn't been seen in The United States in a century; maladies stretching back at least three generations. The guide to physical examinations included findings that no one had ever seen; for instance, "Did you see larvae crawling across the conjunctivae?" All to be answered in complete sentences with correct punctuation.

I stood beside Mr. Krahnkeit's bed and delivered my prepared speech. "Hello, Mr. Krahnkeit*, I'm Doctor Kenigsberg, and I've come to see if I can help you. I know that a few of my colleagues have already visited you, but I want to make sure that nothing has been missed or overlooked."

"Oy, veh," he delivered with a heavy groan. "Boychick, please, go avay. I'm a sick man and I can't  take no mohr. Old vons, young vons, tall vons, fat vons; all askink, pushink, pokink and doink some things it's a schande und a charpe even to tink." (Oh. what a pain. Kid, please go away. I'm a sick man and I can't take any more. Old ones, young  ones, tall ones, fat ones, all questioning, pushing, poking and doing shameful things.) Explanation, soft talk, hard talk, wheedling, coercion, promised rewards, potential disasters: nothing moved him; he remained adamant. "Genug ist genug." (Enough is enough.)

Desperate at seeing my first clinical experience go up in smoke, I pulled the curtains around his bed and leaned in close to him. "Mistah Krankheit, avou tut es dir veh?" (Mister Krahnkeit, where do you hurt?) His eyes widened, he smiled ,"Kennst Yiddish redden ?" (You speak Yiddish?) After that, we became best  friends.

He had a fantastic memory and when I asked about his illness, he recalled every sign and symptom for decades past. The history of his relatives, near and far, was encyclopedic; enough to construct a family tree. When it came to the physical exam, he was so cooperative, it was almost embarrassing. He pointed out to me where to listen on his chest to pick out a murmur that was very hard to hear. It took me hours to write up all that I had learned from Mr.Krahnkeit. There was enough data to satisfy even the red book.

When the group reassembled the following day, I was the only student who was not chap-fallen. The instructor wanted to know why the other students could get no history and weren't allowed to examine Mr. Krahnkeit, whereas I had a report over-flowing and complete. I said that it was because I had tried to understand his psyche.

*A pseudonym.

Kenneth Kenigsberg lives in Glen Cove, New York; a Gold Coast town that was the playground of the Great Gatsby and is now like a grande dame more than a little past her prime. He has spent forty years as a pediatric surgeon, eight years as a research scientist and is now entering the writing profession.

Copyright Kenneth Kenigsberg /The New Vilna Review 2011.