Being human is an uncomfortable affair at times. No one, perhaps, knows the state of being human better than the internist (internal medicine, my residency) who passes between managing patients in the primary care setting and the hospital setting.  As I gallop toward the end of my first year of residency, I can say with growing certainty exactly what the normal state of being human is.

Being human involves hemorrhoids, knee pain, and back pain. It involves debates (whether internal or external) about what to eat throughout every day and whether to exercise. And if exercise is on the menu, the question becomes: What kind of exercise should one do? Being human involves the occasional-to-frequent stuffy nose and nonspecific ache. It involves external stress such as work, family, and accidents as well as internal stresses like low mood (all the way to depression), anxiety, and difficulty sleeping. Being human involves getting older day by day, grumbling about this certainty, and knowing that the only alternative is death.

One role of internists (and emergency medicine doctors) is helping people sort out if their current uncomfortable state is on the normal spectrum of the human experiences or is out-of-the-ordinary enough to be life-threatening or to cause lasting impairment/injury. Take the classic question, “is my chest pain because my heart is injured?”

The answer is “maybe.” Moving the maybe to “unlikely” or “likely” a heart attack is where medical training and medical tests come in.

If you’re 20 years old and two days ago lifted the heaviest weights you’ve ever lifted and come to me with chest pain, I’ll start by pushing on your chest. If you then tell me that pushing on your chest makes the pain worse that’s enough information for me to say that your pain is likely soreness in the muscles that you worked out and does not involve your heart. To be safe, I could order some tests to confirm my hypothesis. I might not need the tests but if I see you in the emergency room, I’ll probably order them.

If you’re 60 years old and you don’t really have chest pain but, rather, mid-chest pressure as if someone is sitting on your chest…you’ve caught my attention. And if you then tell me that this chest pressure used to only occur when you mowed the lawn but now also occurs when you walk from the couch to the bathroom my concern for a blockage in the vessels that feed your heart is high. I will most definitely order some tests to explore my hypothesis.

I’ve heard hundreds of chest pain stories. With a story I can sort chest pain into categories including “likely normal life chest pain” and “likely heart chest pain.” I have exams and tests to further help me determine if the chest pain is directly related to heart injury. If I’m still concerned even after my first tests are negative, there are additional tests I can order.

One of the most satisfying aspects of being a doctor is helping people move past the uncomfortable affair of humanness so that they can maximize the joyful aspects of being human. Because being human also involves doing well. It also involves getting promoted at work and having kids. It also involves traveling and parties. It also involves loved friends and family. Being human also involves adventures and creative undertakings. It also involves feeling good and achieving goals. It also involves sitting on the pouch relaxing and glorious naps. It also involves conversations while sitting on the couch or at a café. It also involves sipping favorite beverages in favorite places on perfect evenings.

The state of being human is one of contrasts. Medicine occupies the space between the uncomfortable and joy of being a human with the aim to tip the scale back toward joy when things go awry. Medicine doesn’t have all the answers, but it outlines a system for exploring physical and mental discomforts and offers possible solutions. Part of what makes a good doctor is knowing exactly what the normal states of being human are so that we can quickly identify situations that deviate from the range of normal and intervene.