Butterflies.

Morning smiles 

Like the face 

Of a newborn child 

Innocent, unknowing. 

Winter's end 

Promises 

Of a long lost friend. 

Speaks to me of comfort 

But I fear 

I have nothing to give. 

~ from Sara McLachlan "Fear"

It's the first day of March and I'm starting a new month on the inpatient service. What's extra special about this month, though, is that there are other new beginnings. This is the start of the clinical rotations for our second year medical students. Ah, new beginnings, indeed.

I saw some of them yesterday. Standing near the elevators with their  teams. Coaching themselves to get the deer-in-headlights look from out of their eyes. But I saw it. And smiled.

That look in their eyes has a little to do with fear. But mostly I think it has to do with respecting human life so much that you want to help and, of course, "first do no harm." And maybe that isn't how they're feeling.  I mean, I can only speculate based upon how I felt back then. Something tells me that not that much has changed, though.

Yeah.

A lot of us fight to help them to hold on to that. That sense of wonder, of deference, of awe.  Lord knows I fight to have it myself.

So today I woke up and thought about this list of new patients that I'd meet. I read about their problems and reviewed their electronic charts. There were things that I needed to look up because I wasn't familiar with the management or had forgotten it or somewhere in between both of those. And now that I've done that,  I'm just sort of sitting here. Letting myself feel that tiny sense of nervousness in the pit of my stomach. Not so much that it makes me deathly afraid. But just enough to remember that sense of deeply wanting to help and, of course, "first do no harm."

These are human beings. These human beings have families connected to them and lives beyond me and my overfull schedule  and my little bag of internal medicine tricks. Their problems are real ones. Not pretend ones designed for teachable moments with earnest young students or enthusiastic bedside teachers. No, not at all. They are real and exist in a continuum--not just as points on my curriculum needs.

And so.

I feel those nerves because I just hope to get it right, you know? Every single time I start a month, I let myself feel this. I dig down deep and find those butterflies that somehow get lost in repetition. Feel those same fluttering wings that I know are stirring in the guts of those novice medical students that I see standing near elevators with their nervous dispositions.

Because clinical medicine is not just about conditions like heart failure. It's about heart. One heart at a time. And though that one heart may have the same physiology as the thirteen others on my list, today that heart is relying upon me--upon us--to care as if it were the only one under our watch.

I guess that's something to have butterflies about.

***
Happy First Day on Wards.


And now playing on my mental iPod. . . ."Fear" sang live by the lovely Sarah McLachlan