The time I thought it was tuberculosis.

Posted on by James Munro

This is part of my ongoing summer project: Stumbling Through First Year
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I assumed that each little piece of information I picked up during my medical education at NCNM would be another little tool in my tool belt.  Every time I learned something, I would be able to apply it to a medical context.  Slowly, I’d accumulate enough knowledge to transform into a doctor.  This doesn’t seem to be how it works.

On many occasions, I’ve heard that medical students are dangerous.  As a seasoned, soon-to-be second year medical student, I can confidently agree.  Each fact is not another tool in my tool belt.  It’s more like each fact is another leak in my roof and I’m frantically trying to find buckets to capture all the water.  I’m beginning to think that being a doctor is not necessarily about having the most facts, but having the most buckets.

A significant portion of my first year was spent passively listening and learning, collecting facts.  I correctly answered so many multiple-choice questions that, a few times, I was almost convinced that I knew something.  My delusion was regularly washed away by a class called ‘Basic Science Clinical Correlate’.

It’s definitely one of the easier courses of first year.  As far as I can tell, it’s main purpose was simply to remind me that I’m dangerous and have no idea what I’m doing.  We would read through a real life case study from a medical journal, and in the following class, each student would give a presentation on a certain aspect of the case.

For me, the presentation was the easy, stress-free part of the course.  It was reading the case studies that ended up being the real learning experience.  Each student took turns reading out loud to the rest of class.  The cases were filled with every potential acronym and piece of impossible-to-pronounce medical jargon available.

Most of the professor’s time was spent correcting the group of normally articulate students who, when faced with this new and complicated medical jargon, had forgotten how to read entirely.  No one was immune to this sudden inability to control the English language.  It was commonplace to hear the professor say something like, “It’s pronounced ‘vagina’ not ‘VAJ-ena’.”

I got comfortable learning how to pronounce all the medical terms.  It’s way better to screw it up here than to mispronounce something to a patient or medical professional.  My fear and doubt came when the professor would interject with little questions.

The correct diagnosis was given at the end of the case, but the professor would often stop us at certain points to ask our thoughts.  “What do these symptoms tell us?  What would be included in your differential diagnosis?  What do you think is going on here?”  This is when I would sit as quietly and still as possible, like I was hiding from a tyrannosaurus rex.

I always had ideas, but my doubts were stronger.  As the year went on, my ideas got jealous.  As I learned more, they became more difficult to suppress.  They fought harder and harder to come out.  At first, when I heard a question, the ideas were only strong enough to give me a muscle twitch.  They’d knock my pen on the floor, or make my face contort like I was about to sneeze, but they were never stronger than my doubts.

I was able to suppress them until one of the final cases of the year, when I heard the words “granuloma” and “lung” in one of the professor’s questions.  I felt the idea spring to life.  It started in my legs, they shook.  It pushed my doubts aside and made it’s way to my chest.  I held it there as tightly as I could, but it got up to my throat and with one final burst of energy, shot out.

“IS IT TUBERCULOSIS!”  The words sounded like they came out of an amplified Speak and Spell waking suddenly from a nightmare.  It was shaped like a question, and it was supposed to be a question, but it lacked the normal tonal inflection that most humans use when asking a question.  My hands were shaking.  I was breathing heavy.  My heart pounding.

“No.  Can anyone tell me how we know it’s not TB?”  A student quickly answered, “Because the granulomas are non-caseating.”

Oh, right.  A classic sign of TB is caseating granulomas, not non-caseating.  I knew that.  My heart slowed down, hands relaxed, breathing normalized and the class continued on.  I didn’t feel stupid.  I wasn’t judged.  The only thing that happened was the connection of TB and caseating granulomas being permanently etched in my head.  I’ll never make that mistake again.

As much as I hate being wrong, this was a solid reminder that being wrong can be the best teacher.  Submitting to my constant doubts doesn’t stop the doubts, it stops the ideas.  I’ll make sure to give my ideas the upper hand during second year.  And by the way, it was sarcoidosis.  I was way off.

69 thoughts on “The time I thought it was tuberculosis.”

  2. Haha wow! M myself a second proff medical student now heading to d third… Bt if u knew tht much in proff one u guys are taught all this much earlier … We were taught about caseating n non caseating granulomas a wee bit later

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  3. Medicine sounds Greek to me..thanks to medical science for being there 🙂 And hats of to professionals for that wonderful pronunciation and ability to learn this science. Good luck for your further studies!

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  9. I loved your analogy of trying to remember all the medical information to a leaking roof! And I completely understand the whole idea vs. doubt battle in your mind. But hey, each time you get it wrong, you never forget the answer! Good luck with the rest of your med school journey!

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  10. Ah, such is life in med school! We all have our humbling (and humiliating) moments, so don’t you worry. If you were in my country, you could guess TB for every question and you’d probably be right. I enjoyed this post – good work!

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    1. Thank you for the support! I just spent some time reading through your blog and I LOVE it! My favorite part is the post on coronary artery disease followed immediately by the post on Harry Potter. Haha! A nice balance.

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  11. I love this! I’m in my first year of university and have made the mistake of shouting out the wrong answers twice already. I often feel like I’m stumbling my way through my course, just trying to figure out what I’m saying and doing. Basically, I can relate. Thanks for sharing, and good luck!

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  12. Terrific article. If I was still in the classroom, I would share this with my students. You are absolutely correct. Being wrong IS a fantastic teacher.

    Also, who doesn’t know how to pronounce “vagina”???

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  15. I gather there is a plethora of info to digest in med school. And to think that it’s only the beginning…. I guess it will be nice to reflect on the early years and remain humble, and thankful to your patients for what they will have taught you…all the best with your career!

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  17. Something that all med students might find helpful is to study a bit of the laboratory side. This can be especially helpful when doing a differential diagnosis for a particularly difficult case. As a Laboratory Professional I find that a lot of docs aren’t as well versed in what testing is appropriate for what symptoms as I thought they would be. Good luck on your journey through school!!

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  19. My Pulmonologist took a mucus sample from me, some time ago. After sending to the lab and 2 months passing they came back and said they thought it was TB, and wanted to start me on a rigorous treatment plan of antibiotics. I told them Im Sulfite Sensitive and cant take antibiotics. They retested and diagnosed me with Myco-bacteria Lentiflavium . Needless to say I cured myself with Silver Hydrosol, taken orally and in a nebulizer it took several months and almost a year till all the spots on the lung went away. Just wanted to comment. I know the medical community frowns on cures like this. But it worked for me in a Nano Particle Form.

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    1. I don’t think anyone should frown on a cure that works for someone. I’m happy to hear that you were able to fully recover. Thanks so much for sharing your story.

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  22. What a great title, followed by a very interesting post. I especially liked and could relate to the paragraph that starts with “I always had ideas, but my doubts were stronger.” You describe that crossover time from novice to proficiency in a way that I could relate too. Thank you for starting my day off thoughtfully.

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  23. This is just so VALID. I loved your writing, how you managed to indite everything you went through in such an engaging way. I am currently an undergrad student at a university in India, and I plan to pursue Med School in USA once I graduate. I’ll be grateful to you if you can provide me with little knowledge about how can I convert my far fetched dream into reality. I know about MCAT, is that it? That’s the only criterion for selection? And if you know anything about 100% fellowships awarded to international students please let me know! Thanks already. 🙂

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  24. I enjoyed your post. It was interesting to know how medical students experience learning all that you need to know plus it was done in a fun way. Thanks

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  28. Hahaha. You know, it’s not so bad that you think you were half a doctor because you remember all the facts. All I do is watch Greys anatomy and House M.D and think of myself as some kinda wiz!

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  31. BUAHAHAHA. I can relate to those false light bulb moments. And the most embarrassing part is that you are so absolutely sure about your answer at that moment, you are ready to believe that the professor/teacher is wrong.
    Way to go, Doc! =D

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  32. Most humor blogs don’t make me laugh out loud, and here you are with a thoughtful piece, making me spit water at my computer screen because of the Speak and Spell.

    I think writing helps things “stick” in the brain too – I write to cement ideas that would otherwise just flutter away.

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  33. Hahaha wait till you get to final year. Especially psych. I’m almost certain of my self diagnosed disorder- a dash of OCD, a pinch of paranoia and a decent helping of ADD, with shades of Seasonal affective and/or Borderline personality disorder.

    Pretty sure I have an ulcer too. And bronchitis. Hmm….

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  34. Hi James! Thanks for writing this! I thought it was hilarious because I often say “I have no idea” when asked a question. It’s like I stop thinking in these situations… It’s weird. I have no idea how I’ll get through clinicals.

    But I thought “hiding from a tyrannosaurus rex” was a particularly hilarious statement! I remember once a vet I was working for asked me “What bone is this?” on a bird. I just remember replying “I have no idea”. Obviously it was the humerus, but it’s like I don’t think out of lack of confidence. Anyways, I enjoyed it! I hope you’re enjoying a lighter workload for the summer!

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