This was a momentous day for me, a third year medical student at State University of New York at Upstate Medical Center in Syracuse N.Y.

Today I would actually begin clinical medicine, “rounds “in the hospital.  I would don the sacred white coat upon my body and adorn myself with symbol of success- the stethoscope.  After two long years of cell biology Physiology, pharmacology, and every other  “ology”  you could imagine I was ready for the real stuff . My  first rotation- pediatrics.

In the hospital I was part of an entourage of two dozen ducklings seeking seeds of wisdom from the mouth of our mother duck, respectfully known as the “attending.”  He would stop in front of a patients room often for an hour discussing the significance of  mouth ulcerations and a particular skin rash and surprise us with the a diagnosis of Kawasaki syndrome.

It should be no surprise that rounds could last up to six hours.  About half way through the morning I unintentionally looked into a room that was not on our list. In fact our attending was discussing a case in the room just beyond where my attentions lay.

The discourse of my attending slowly faded as I peered into this room which was filled with  light and color, like a Monet painting.

A young girl of about three years old was sitting on her bed as incoming light from a window to her left reflected off her hair. With her every move sunlight seemed to dance playfully, skipping upon her short straight blond hair.

The child was staring intently at a picture book, as a woman next to her moved her lips. I presumed her to be her mother reading her child a story. The child would intermittently take the book from her mothers’ hand pointing at a character in it. It was at this moment that her mother smiled with great exuberance. A moment passed and mother’s lips moved again. This time the child, opened her mouth to receive a teaspoon of vanilla ice cream. As the child glanced toward me she revealed her soft blue eyes, as blue as Caribbean waters. My heart was already breaking  “God I thought, she is adorable.” I hope it’s not serious.”

Our entourage continued making rounds until it was time for lunch. The Varsity restaurant was the place the medical  students met the coeds of Syracuse University. It was here we collected phone numbers and got as many dates lined up  as possible. I went to lunch and completely forgot  my experience with the young child.

Three weeks later, on an overcast day, I had been to a special lecture in the basement of the hospital, a section of the hospital “off limits “to the public.   As I was leaving this area walking toward the exit out to the street, I perceived in my peripheral vision “something blond.”  Immediately a pressure gripped my chest.  When I noticed that I had just passed the morgue the pressure in my chest increased, my heart now pounding fast , my stomach in knots. “Please G-d,”  I thought.  ” Don’t  let it be!”

The morgue had two heavy steel doors that swung open, each door with a square window only about the size of a serving tray at eye level.  I looked slowly through the windows.

Her little body, yellow- white, lay on a steel table three times her size. Her blond hair still as blond and bright as three week’s ago only this time there was no sunlight playing upon it. I left quickly.

I was ashamed of myself as I went home throwing my white coat on a chair.  I sat down and wept.It took me weeks to process what had just happened. This was to be my first realization of the seriousness of this chosen field. I wasn’t some cool dude, but here to be intimate with life and death. I wondered if I was cut out for this. I kept thinking about the child’s mother.  Did her mother know this was going to happen to her? If so what was going on in her mind as she was serving her child ice cream. I was sick with grief and all I could think of was how unfair life seemed to be.

Typical night in the ER.

Gotta keep moving.

More ER patients signing in.  Abdominal pains, chest pains, asthma, lacerations,  fractures, vaginal bleeding, septic shock.

Another two ambulances rolling in.

Where’s the nurse for room 12 ?

Who’s on line 8200?

I don’t know if he ‘s a  DNR !

I really need  to visit the bathroom.

Gotta keep moving .

Three new  patients. First one , a 26 year woman  can’t  be aroused. Her urine shows, cocaine, amphetamines, opiates, and valium- take your pick of which zonked her out the most. Another one a 40 something male says “my leg hurts need pain medicines. “  His   urine shows methamphetamine. He’s in all the time,  known as a frequent  flyer.  The third a 19-year-old girl who comes in with repetitive  seizures.  In between her seizures she wakes up .”  I was doing cocaine, that’s all they gave me, I’ve never done it before.”

I know they’re  using drugs to mask their pain but the truth of the matter- I was not kind to any of them!

I just shouted commands. ” Stick out your tongue!  Lift up your arms !”  I’m testing their  brain function but at the same time venting my frustrations .  I can get away with this indiscretion. I know better -but lost it.

I make a vow to do better.

Life in the ER is staccato not  adante,  brief sentences not  flowing paragraphs.  I see in black and white not shades of gray or color.

Here’s the worst part:

Cardiac arrest,  50-year-old man  dead, couldn’t resuscitate him. We tried hard.

Wife and children  waiting in the family room

I’m a stranger, not their doctor,   no relationship!

My  job to tell them the  worst news of their life.

And after I’ve dropped this  load on them I’m pulled away, another doctor on line 8200, another ambulance rolling in. Not even allowed two minutes to mourn with them!    Next  abdominal pain, next  chest pain.

Can’t talk anymore.

Gotta  go.

Phillip  Silverstein  M.D.

One of my first life’s lessons  as a  doctor took place not  in the emergency department but through my wife’s illness as a patient in  an ICU unit.  She had a gynecological problem that  required multiple and repetitive surgeries and was now suffering with complications .

She had 103.5 temperature ,  blood pressure dropping and big pockets of pus in her abdomen. She  had been in the hospital a month by this time and was progressively getting worse. As a doctor  unfortunately I knew enough about her situation to let my imagination get the better of me.   I imagined every complication possible. I would lay awake at night and visualize pus eroding into her pelvic veins,  sending bullets of pus through her bloodstream toward all her vital organs. It was tough enough that I was working 10 hour days, visiting her morning and night often with little time to sleep. When I had time to sleep,  I couldn’t.  I was exhausted.

After she had been in the hospital six weeks she began to get worse. On one night I  looked up to God and asked him why was all this happening?  This  wasn’t the script that I had imagined, she was supposed to be getting better. After all we were good people, had done nothing wrong, always  tried to help others etc. etc.

Then the unexpected..

I began experiencing chest pain along with shortness of breath. I began to sweat as well.  ” Oh great ” I thought , “now is a great time for me to have a heart attack! Not good.”  These symptoms continued for several minutes and I was getting progressively more fearful.

About then I noticed a bible on a table near me. I opened it and began reading the Psalms. after a few minutes reading Psalm 23 , I felt less fearful and was  able to analyze my situation and my symptoms more objectively. To make a long diagnosis short , I was having an anxiety attack- something I’d never had before. Even as a doctor  I never realized  how it close it could mimic a heart attack.  I’ve never forgotten to respect patients in the ER who come in thinking they’re having a heart attack when in reality it’s an anxiety attack.

I continued reading the Psalms and within five or ten minutes I sensed a message from above. I didn’t hear a voice but within me I knew a message had been delivered. The message was simple.

“She is mine first, and yours second. You need to let her go .”

For a few moments I felt like I was in a dream and that this could not be happening.  But then I realized that the message I received was an important message. one that I needed to hear. I needed to let her go. I apologized to God for holding on to her and acknowledged that she belonged to him first and me second. The moment I apologized all my chest pain and shortness of breath went away. That next morning my wife’s temperature dropped, blood-pressure improved and she began getting better. You can call this coincidence but I think I was learning a lesson . The lesson was one of learning to “let go.” In my case I was blessed and  the script turned out to be one that I could rejoice about. My wife finally did come home  two weeks later. But I’m not sorry that I went through all that I had been through. I learned a valuable lesson about relationships and and about letting go, submitting to a higher authority. This was one of my first lessons as a doctor and one of many more ” lifes lessons” that I would learn in my career.