Over lunch recently I was talking with my colleague/consumer about our history. We've been working together for almost 10 years: through nearly four years of medical school (I started late), a medicine residency, a current fellowship in academic primary care medicine; we are looking at continuing our relationship as he moves on to working as a full fledged attending.

Despite my having a free medical education, I retain only trivial things, like cranial nerve III is responsible for keeping the eyelid open and cranial nerve VII is responsible for closing the lid. How do I remember this? In medical school the instructor drew a picture of an eye on the board. Imagine the Roman numeral III as pillars holding the lid up; imagine a 7 as a hook that is pulling the lid down. I'm hoping someday I'll win the jackpot on some TV game show with this factoid.

On a chest x-ray (really, nearly any plain film), I can spot potential osteoporosis/osteopaenia a mile away. I can't find the heart to save my life, but I can tell you that the patient has thinning bones.

We were reminiscing about patients that we've seen, and what I remember about the cases vis-a-vis what he remembers. Clearly he remembers the medical detials; what sticks in my mind is usually the social story of the patient, though I remember the general medical picture. I remember the Spanish-speaking paient with the sweet family who was diagnosed with Lambert-Eaton syndrome; the elderly gay man who's partner dropped him off at the hospital and wasn't allowed to stay because he wasn't "family" and another man who brought his partner in for palliative care because of end-stage HIV disease who had PML. I remember the patient with hypothyroid and how much more sense it made to me clinically now that I've seen it, instead of talking about it in the abstract in a medical lecture. I remember the young boy of 23 who was in a bike accident and broke his neck (C-3??) and became an instant paraplegic requiring a ventilator but who was totally coherant. I remember the young black woman who was transferred from the floor to the unit because she was short of breath, who died about three hours later from a pulmonary emollism. I remember the first time I interpreted a birth and the first time I interpreted for an unsuccessful code blue (as so many are).

I have had the most amazing journey. Even on the days when I am bone weary and just want to sleep in, I remember that the worst day at my current job is probably better than the best day at any other job I could have. I learn something nearly every day--sometimes small, sometimes big; sometimes medical, sometimes social.

And despite seeing some of the ugliest sides of people and disease, I can't imagine not having the job that I have. I am incredibly fortunate in so many ways.