What Is Internal Medicine?

On internist's view of what internal medicine comprises. Or should you have had those moments of uncommon richness: the sudden intimate connection with a friend, or the birth of a child, or the irresistible impulse to thoughtfulness. (Why are they so few, these epiphanies? Is it because we get caught up with the ordinary, intending to save these special moments, yet never quite return to them? Do we get sidetracked, never to get back to that special divergence that might give life meaning?)

Medicine is no different. We have our special moments in medicine, moments laced with a sense of privilege. There is that first day in the dissection room where a mystery unfolds. The human body opens before you and you find you are not repulsed after all. It even holds your interest. But more than that. Its symmetry, its efficiency of design, its universality, and above all, its poetry, strike you as marvelous. And behind this wonder lies the realization that few can ever experience this, that you are special even to be there.

That first day in the operating room holds the same specialness and similar privilege, as you watch technology and human hands repair, re-form, and cure. There is ritual here too, and history. There is drama. There is the miraculous. Standing just so, exactly where you have been told by that severest of nurses, The O.R. Supervisor, you are careful not to touch, not to sneeze, not to move, and yet still you cannot help feeling a part of it.

There is another such moment, seldom seen these days by students of medicine, to their own loss. It is the moment of the master clinician at work—that moment of connection between patient and doctor, the moment of caring, the moment of diagnosis. These consummate physicians …