Just Like The Very First Time

There are moments as a teacher when I'm conscious that I'm trotting out the same exact phrase my Professor used with me years ago. It's an eerie feeling, as if my old mentor is not just in the room, but in my shoes, using me as his mouthpiece. It happened yesterday when I was  at the bedside, showing my students how to feel a patient's spleen which happened to be quite enlarged. 

Anyone can feel a big liver. Sitting as it does under  the right lower ribs, the liver when it enlarges isn't shy and makes itself known to even the most amateurish of probers. But the swollen spleen is more elusive.  It is set back deep in the belly, under the left rib cage; it has to be three times its normal size to be felt, and even then it often lacks a distinct edge and is easily missed by the inexperienced examiner. 

As a student I couldn't convince myself that I'd felt the spleen, even when it was known to be massively enlarged.  I began to doubt myself. One day my teacher, his hands on the patient's belly, had me lay my fingers over his fingers. Then he slid his fingers out from under mine, instructing me not to budge. "Don't try to palpate the spleen, but instead let the spleen come and palpate your fingers! Don't dig! There is no gold there." As the patient took a deep breath, her diaphragm contracted and pushed the spleen down and my waiting fingers felt a gentle nudge, like a whale bumping into a boat. Let the spleen come to your fingers! It was a brilliant pearl of his own invention. For me it was an extraordinary moment, a breakthrough. It was as if he'd put himself in my shoes, anticipated the difficulty and also shared mydelight in success.

I was around my mentor for two more years, enough to hear him trot out Don't dig! There is no gold several more times to other students. I was disappointed at first, as if such repetition took away from what I had felt to be a unique, brilliant moment, one that was somehow mine and his alone.

It's taken all these years, for me to understand how special a teacher he is.  Every single time he said the phrase, he did so with such intensity, enthusiasm, as if it were the very first time those words came out of his lips. It wasn't. . .  but the point is, he knew that for me it was the very first time.

Perhaps that's the secret of being a good teacher, and it is why I aspire to be like him. I have to keep in mind that as repetitive as my teaching can seem to my ears, for the student, it is the very first time. And therefore I have to make sure that I bring my all to what might be a seminal moment for the student.

The reward of course is what I saw yesterday as I guided my student's fingers to feel the spleen. When she looked up I knew she'd felt it. Perhaps one day, she will say to a young medical student, "Let the spleen palpate your fingers, and not the other way around. Don't dig, there is no gold." And then the chain will remain unbroken.

Let me hear from you teachers and students out there, but I'll contend that that is as close as we get to immortality.

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Abraham Verghese is an author, physician and med school professor. He is the author of Cutting for Stone and his writing has appeared in many major publications. More

Abraham Verghese is a physician and writer. His third book and first novel, Cutting for Stone, was published by Knopf in 2009. He is also known for two acclaimed non-fiction works, My Own Country, which was based on his experiences working with persons living with HIV in Johnson City, Tennessee; that book was a finalist for the National Book Critics Circle award and was made into a movie. He followed that with The Tennis Partner, also a New York Times notable book and a national bestseller. His writing has appeared in The Atlantic, The New Yorker, The New York Times , The New York Times Magazine, Sports Illustrated, and The Wall Street Journal as well as many medical journals. Verghese is board-certified in internal medicine, pulmonary medicine and infectious diseases. He attended the Iowa Writers Workshop at the University of Iowa where he earned his MFA. He currently practices and teaches at Stanford University School of Medicine where he is a tenured Professor and Senior Associate Chair for the Theory and Practice of Medicine in the Department of Internal Medicine.

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