There is a time for sitting in classrooms. When such heady topics as congestive heart failure are abstract and intangible. Discussion veers from myocytes to cardiac output and stroke volume.

The world, through the student’s eyes, is inflamed with passion and opportunity. The reality of doctoring is a distant dream. Hope peals back layers of fear and loss of confidence. Reward is imagined as a handshake, a return to health, and gentle guidance and counseling.

And there is no better place to be.

***

There is a time for rounding in the hospital. Groups of students and pharmacists trail the blue coat tails of residency. Voices tinged with false authority scoff at the regurgitated nursery rhymes of biochemistry and pathophysiology.

Clinical reasoning becomes her majesty’s bejeweled throne. The vagaries of the heart are enumerated in clean categories: systolic and diastolic, valvular and ischemic.

The world, through the resident’s eyes, is a masterfully structured algorithm guided by skill and knowledge. An apprenticeship forged in sleepless nights and the cold, hard steel of the analytic process.

***

There is a time for taking phone calls at home. Your table is set for thanksgiving dinner.

Congestive heart failure, through the attending’s eyes, is neither about biochemistry nor algorithms. It’s about missing a night of sleep. It’s about another admission for Mr. Miller who forgot to fill his lasix prescription and then ate three servings of salt coated mashed potatoes.

And as you lay down on the stiff couch in the living room, you think about your family. They will sleep quietly in their own beds and not be bothered by the pager and cell phone tethered loosely to your pajamas.

You smile as you remember those student days with a mix of fondness and melancholy.

As your mind drifts lightly off to sleep you wonder, where has the magic gone?

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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