Last Updated on February 7, 2020, by eNotes Editorial. Word Count: 1421
In his first year of medical school, Paul is surprised by how easy it is to get used to carving up human bodies, though one dissection exercise gives him pause: when cutting open a stomach, he sees two undigested morphine pills, suggesting that the deceased was in great pain when he died. Sometimes, others have similar realizations, such as when Paul’s seventy-four-year-old professor is surprised to find one of the cadavers died at seventy-four of pancreatic cancer.
Paul also meets his future wife, Lucy, in the first year of medical school; her sensitivity appeals to him. He recalls her weeping over the EKG of a patient who must, based on the fatal arrhythmia presented on the strip, have died:
The squiggly lines on that page were more than just lines; they were ventricular fibrillation deteriorating to asystole, and they could bring you to tears.
One of Paul’s greatest influences is the “surgeon-philosopher” Shep Nuland. Though Nuland is a lecturer at Yale during Paul’s period as a student, Paul only knows him as a reader of Nuland’s seminal work How We Die. Reading this book makes Paul realize that despite his years of medical school, he still knows little about death. “Descriptions like Nuland’s,” he writes, “convinced me that such things could be known only face-to-face.” Nuland’s description of himself as a student, unable to save a patient’s stopped heart by cutting his chest open and attempting to pump it, strikes Paul as “the true image of a doctor”: responsible and active even in the face of failure.
After finishing the first two years of medical school, Paul comes to witness death firsthand when he works the late shift in the delivery ward. Only in her twenty-third week of pregnancy, Elena Garcia is experiencing preterm labor, which the doctors hope to keep under control through drugs until her twin children are developed enough to survive outside the womb. Paul is unsure how to read the results on Elena’s monitor, so he asks the nurse for help. However, just as the nurse is teaching him, she realizes something is wrong: the twins are not doing well. An emergency C-section is their sole, slim chance for survival. Paul witnesses the operation. The twins are extremely small; their skin is see-through. The doctors offer to let Paul sew the last two stitches on Elena’s belly, but his nerves cause him to put them in unevenly, forcing Melissa, the resident doctor, to fix them.
Later that night, Paul is assigned to care for another expectant mother. This time, though, everything goes right. Paul is stunned by how different (and difficult) birth is in real life as opposed to within the clinical confines of a textbook. After he delivers the good news to the mother’s family, Paul inquires after the premature twins, only to learn that both died. Melissa does not regret performing the C-section—it was the only option that gave the twins a chance at life—and Paul learns that being a doctor does not mean one is always certain about what to do in an emergency situation.
Soon after this, Paul’s rotation in obstetrics and gynecology ends, and he moves on to surgical oncology with Mari, another medical student. Mari is chosen to assist with a Whipple operation, a complicated procedure for pancreatic cancer patients in which the abdominal organs are rearranged. When it turns out that the operation will not be necessary, Mari weeps from relief in the hallway.
In his fourth year of medical school, Paul watches as many of his classmates ultimately choose to specialize in “less demanding” areas so that they can live more comfortably and have more free time away from work. Many students even claim that they should not always place their patients’ needs before their own. Paul’s feelings about these classmates’...
(The entire section contains 1421 words.)
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