First Principles in Medicine: Finding the Patient’s Story

Fourteen years ago I started my clinical rotations straight out of the classroom, eager and clueless. Two years of medical school had packed my head with the foundational sciences: anatomy, physiology, pathology, pharmacology. I could recite pathways, name disease processes on a slide, and rattle off mechanisms of action. Then I walked into actual patient care and saw how little I knew about what mattered.

My first rotation was geriatrics at the VA hospital. I still remember that first morning: the hum of equipment, the low chatter of nurses, the smell of institutional floors polished to a shine. Within an hour I met Dr. Morris, the attending who would teach me geriatrics and a good deal more.

She welcomed me, gave me a tour, and handed me two assignments. One was to read the novel Water for Elephants. The other was to watch the documentary Young@Heart. I thought it was a strange way to start a medical rotation. Weren’t there charts to review, guidelines to memorize? Dr. Morris had her reasons, and they came clear soon enough.

Water for Elephants tells the story of Jacob, a young man who endures personal tragedy and finds himself as a veterinarian for a traveling circus. His 93-year-old self narrates it from a long-term care facility. Young@Heart is a documentary about a choir of older adults in England who perform rock songs, people whose spirits refuse to be defined by their years.

Dr. Morris didn’t care whether I followed the plots. She wanted me to take in one idea: we are the same people our whole lives long. Our bodies age; inside, we stay who we’ve always been, full of plans and fears and love. My job was to look past the lab results and the imaging and the physical limits, and find the person there. To uncover their story. To honor who they were and who they are.

I’ve carried that since. It’s easy in medicine to get caught up in the churn: problem lists, treatment plans, the constant push for efficiency. Whenever I feel frustrated or disconnected, I go back to Dr. Morris’s words and those two assignments. They’ve become my first principle: find the story. When I’m struggling to connect with a patient, or stuck building a plan, it’s usually because I forgot to.

People call medicine a science, but Dr. Morris showed me it’s still an art. Behind every lab value is a person with a history and a future, someone’s parent or sibling or child. Treatments matter, but the most meaningful thing we do is help patients keep being who they are inside, and live their story as much as they can.

That first rotation shaped me as much as any since. It taught me more than geriatrics or palliative care. It taught me what it means to care for a person, the whole person and not only the body. I’m grateful for the lesson, and grateful to Dr. Morris for an education you don’t get from textbooks.

Whether you work in medicine or not, take the time to find the story. The patient, the colleague, the person across the dinner table, every one of them is carrying an inner narrative. Uncovering it is a gift. Honoring it is a bigger one.