It was 2:21 a.m., and the pager exploded in my ear like I had forgotten to turn the volume down before plugging in my headphones. The nurses told me your heart rate was getting faster, and your oxygen was dipping lower. When I made it to your room, you were laying in urine because you were too weak to stand. Your breathing was rapid and shallow, like you were caught in a blizzard without a coat. I heard you muttering words, but I understood nothing. Your eyes looked through me as if I was a ghost. I placed my stethoscope over your lungs and analyzed the drips flowing into your veins. You were supposed to be discharged in the morning, but just like that, the unexpected happened.

In medical school, you are not trained on the unexpected. You do not learn about the patient who makes jokes in the morning, and then you are pressing on their sternum in the afternoon. The memorization and formulaic thinking soon transform into managing and coping with unexpected realities. Unexpected moments on the wards remind us that medicine is not black and white. These times take us away from the textbooks and encourage us to see the human in the patient. Not all unexpected moments are unfortunate. There is another kind of unexpected. The moments where the tables turn for the better for our patients. Like the patient with a brain hemorrhage now following commands or the septic and altered patient now asking for another cup of coffee. These joys are like a lighthouse guiding us back to our initial zeal to care for others.

Life is full of unexpected moments, some positive and others negative. Medicine is no different. These unexpected moments are opportunities to step away from the checklist and to confront the humanity in our patients and ourselves. The art of medicine is born in the unforeseen.

Nicholas Bellacicco is a neurology resident.

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