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Archives - A New Chapter

Fall 2012

A New Chapter

By: Daniel Munoz, M.D. '04
Date: September 1, 2012


A New Chapter

This column was born about 10 years ago. I was a second-year med student in the infancy of my clinical training. Still on the classroom side of the mostly mysterious world of patient care, I was filled with equal allotments of wonder and naïveté about the chance to be a bedside doctor. And, like many of my student colleagues, I embraced any opportunity to witness medicine firsthand, no matter how peripheral (or frankly, irrelevant) my involvement. The reality is that after years of lectures, homework, standardized tests, and final exams in windowless classrooms, the thirst for genuine clinical experiences is, at a very basic level, a thirst for some version of humanity. Virtually any dose will do. On a wintry afternoon during that second year of medical school, my classmate Brian and I ingested a powerful dose, when we witnessed a patient die in the intensive care unit.

So, shortly after 11 pm that night in 2002, from the kitchen table in my Charles Village apartment, I sat down and crafted an email to my buddy in London. Email was still this magical new medium, permitting warp speed delivery of messages with a mouse-click. (Back then, people wrote emails regularly exceeding 160 characters, complete with punctuation, proper grammar, and well-organized thoughts.)

Raj and I had become fast friends in college. We were now both graduate students, with an ocean between our homes and our areas of study. While he aimed to understand the nuances of international affairs, I struggled to understand the affairs of the cell. Needless to say, his email updates were usually more captivating than mine.

In a stream-of-consciousness spill of more than 3,000 words, I described what had unfolded in the hospital that day, the experience of watching a family cope with the imminent loss of their father. Equally moving was how the attending physician assuaged their grief.  After clicking “send,” I collapsed into bed. It took my message all of 15 seconds to traverse the Atlantic. Raj was enjoying his morning tea and bowl of Frosted Flakes, all while perusing the online news. His email inbox chimed. By the time I awoke, Raj’s reply was already there. His feedback was (and remains) memorable: Take out most of the adverbs, go easy on the metaphors, toss out the passive verbs, and then submit this for publication somewhere.

My first column in this magazine was that account.

Since then, I have had the regular chance to share a story with you, the readers. I hope that this page has provided you with even a fraction of the meaning that it has provided me. So much happens to a patient in the span of just a day in the hospital or in the clinic. So much happens to a medical student/resident/fellow in the span of a day. There are moments in any day that might inspire you, moments that might anger you, and moments that simply make you chuckle. This column has challenged me to do two fundamental things: 1) to first identify those reactions of inspiration, anger, or humor, and, perhaps more importantly, 2) to then reflect on their meaning. That process has evolved into an essential aspect of my medical training and (attempts at) maturation. 

I am immeasurably indebted to the two editors for whom I have written, Edith Nichols and Sue De Pasquale. They both established new dictionary definitions of patience, all while I routinely redefined the concept of the “deadline.” And they each did something considerably more valuable. They provided me with a blank canvas. They never assigned a specific topic. I have felt a freedom that has been motivating and, at times, thoroughly confusing. Their only mandate was both simple and implicit: Make sure you write more from your heart than from your brain. When at times my brain exerted more keystroke control than my heart, both had their ways of offering criticism in seemingly complimentary fashion.  

Ten years and a few dozen columns later, I now close the chapter on this space, grateful for a medium through which to share my training experiences and humbled by the opportunity to shed light on my own personal learning curve. I have considerably more gray hair and an ounce or two more of wisdom—sufficient wisdom to recognize the enormity of medical learning that still awaits me.

There is one thing that I perhaps most appreciate about this adventure in medicine. Despite the hours, despite the occasional frustrations, and despite the sacrifices required of a durable commitment to the practice of medicine, there are still those regularly occurring moments, made possible by the patients I meet, which trigger that familiar desire to tell a story.  *

After two years of a clinical cardiology fellowship at Johns Hopkins and a research fellowship at the Duke Clinical Research Institute, Dan Munoz is currently completing a final year of training and looks forward to a career in academic medicine.
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