Hospitals are not cheery places.

I keep hearing that ICM (Introduction to Clinical Medicine, or hospital visits) are the best part of *insert students name here*'s Medicine experience. While I think it certainly is necessary and is useful to build up communication and clinical skills (later on), I don't always agree that ICMs are the best part. Today was a rather shell-shocking day; an elderly man was gaunt and straining to exhale due to progressed emphysema, hard of hearing and generally in a poor state. In the next few minutes of our interview we were introduced to his life as a result of decades of smoking. It's not like we aren't aware of the dangers of smoking, or the possible consequences and risks; but more the fact that it confronted us here, right then and now when we were just expecting to practice our history-taking and interview skills. His condition was such that he could not work, mow the lawn, do most housework, and look after his wife; confined to sedentary activity and struggling with every breath, he remarked that he felt suicidal. When he said that, we were all stunned; 6 first year medical students meeting a man in whom hope did not exist and despair reigned. And this reminded me of what we were here to do, but also, it reminded me of what we couldn't do; when all we can do is really give painkillers and pretty much pray for a painless death. In PBLs and other ICM interviews we have encountered a few chronic diseases, and its nice to be a doctor and be able to make someone get better, but with specialities like Pallative Care I wonder how they get through every day intact. Our patient re-iterated "don't smoke" and its a fair warning, considering his personal testimony, and all I can think of is how he hopes to stop others from going through what he is right now. Whilst cases generally make me motivated to study harder (in light of an application for that knowledge later on), this one just hit me and hasn't had any positive effect so far, except for this reflection. Much food for thought.