Preclinical
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A First-Year Flashback


“Good afternoon, Ms. C, I’m plus-one today,” Dr. B. said as he opened the door to GREEN 9, still finishing his knock. “This is Christopher, a second-year medical student working with me.”

I froze in the doorway behind him. My eyes widened as my stomach slipped down into my pelvis.

Second year? Could that be?

It felt wrong. It threw off my whole identity. “I’m just a first-year,” had been my motto for the past twelve months. It was so comfortable, so safe and so void of expectations. This single-word change to my introduction carried with it an entire year’s worth of experiences all of which needed to be applied to the patient sitting in front of me. But what knowledge did I have? What had I learned?

I watched as Dr. B. shut the door trying to savor every millisecond before Ms. C. became fully aware of the swindle taking place in front of her.

When I was a child, I read a thought experiment about an astronaut falling into the center of a black hole. The piece explained that the gravitational power of a black hole is so strong that even photons get trapped in an endless orbit around it, eternally flowing as a homogeneous river of light. The idea was that as this astronaut fell, being exponentially compressed by the gravity around him, he would cross through this circulating river of light. For an instant, he would be able to watch the entire history of the universe playing concurrently before his eyes.

As the gap of light through the closing doorway slowly narrowed, I realized what it must feel like to fall into that black hole. The gravity of my responsibility — the role I was expected to play in a patient’s life — began to compress me from all directions. Before the final slit of light petered into nothingness, my first year in medical school flashed before me narrated by the words of my mentors.

July, MS1

“Medicine is a language. You all will spend much of your time here learning how to be native speakers. But don’t be surprised when you hear a string of sentences and can only pick out the prepositions. Trust the system, it will come with time.”
–Advice from one of my mentors

“What about that rash pattern made you suspect contact dermatitis over something infectious?” I asked, struggling to keep up with Dr. B. as he floated down the hall to the next room.

“The distribution is the main indicator, the way it streaked across his thigh showed it clearly wasn’t dermatomal. And then with something like varicella, I’d expect…” I lost the rest of what Dr. B. said as I tried to pull the file in my brain for dermatomal — ‘404 not found’.“Sorry, what do you mean by dermatomal?”

Dr. B looked surprised.

“Haven’t you done this yet? If it were something like herpes zoster, colloquially known as shingles, you’d see the distribution along a specific dermatome.”

Dermatome. Dermatomal. Duh. Of all the things to ask a stupid question about, I waste it on a suffix.

December, MS1

“You simply can’t learn this stuff by reading it alone. You have to explain it! I don’t know how anyone can think they are going to understand these concepts if they sit by themselves and just read it. You’ll never know where your gaps are if you don’t try to explain things.”
A quote by one of my cardiology mentors

“Oh! Speaking of Jessica’s birth,” my mother said, “Your father and I had a medical question, and we thought, we have to ask Chris!”

“Shoot,” I said, hubris dripping from my ears.

“Why is it an emergency when the umbilical cord is wrapped around newborns’ necks? Like, aren’t they still getting oxygen from the mother at that point? We couldn’t figure out why it was so urgent.”

I almost scoffed at my mother’s question, but then thought better of sounding too condescending. She’s not in medical school; after all, she doesn’t know any better.

“You know, that’s a great question! You’re really thinking critically there, Mom. It’s an emergency because the placenta is the site of gas exchange and … Hmm, I see your point there. Well, the real issue is that during the transition to extra-uterine life the ductus arteriosus … Wait — scratch that, it must be because the fetal hemoglobin has a higher affinity for oxygen so that would … Uh, surfactant…” Oh dear.

April, MS1

There’s no difference in intelligence between you all and the physicians lecturing in front of you. We are not any smarter than you. If anything, with the rise in competition for getting into medical school, you all are objectively smarter than us. Experience is the only difference between a physician you admire and yourself. Years and years of experience; seeing the same things repeatedly, making mistakes, and making connections. And in the end, the only way to have experience is to have experience. There’s no expediting it. So learn everything you can now, but understand that the physician intuition is something that will come, and can only come, with an open awareness and considerable time.
–A quote from one of my mentors in gastroenterology

“Look” Dr. B. said under his breath.

I spun my head around only to catch just a few seconds of the patient who caught Dr. B’s eye before he disappeared around the corner toward the clinic rooms. The boy was walking with stiff legs swinging them laterally to clear the floor without bending his knees. His gait was several steps behind his mother, and he had a clear expression of concentration as he tried to keep up with her. By the looks of him, it didn’t seem to be a dramatization.

“That’s the boy with joint pain you mentioned? The one we’re seeing next?”

Dr. B nodded, still staring intensely through the wall.

“So what does that tell you?” I asked.

“I’m not sure yet,” Dr. B. said as he resumed back down the hall at his usual clip. “But we’ll definitely want to take our time when we see him.”

I looked down at my notepad, which was already littered with scribbles of drugs and disorders that I intended to look up later. This seemed like something important … something that I should write down and learn to do myself. But what was I supposed to write? What did I just witness? Where was that on my history and physical rubric?

Does the student:

1. Wash his/her hands before the patient encounter?

  • Performed Correctly
  • Performed Incorrectly
  • Not performed

2. Introduce himself/herself in a friendly manner?

  • Performed Correctly
  • Performed Incorrectly
  • Not performed

3. Notice the gait of his/her patient and begin forming a differential?

  • Performed Correctly
  • Performed Incorrectly
  • Not performed

July, MS2

When I was in medical school, the most intimidating thing to me was the sheer vastness of it all. It felt like I had to know everything, and there was no way I was going to be able to learn it all. What I learned was that medicine is a territory with defined borders. Those borders aren’t clear to you now, leaving what looks like an infinite landscape ahead of you. But know that your knowledge as a physician is contained, and therefore is absolutely achievable.
–A quote from one of my mentors in endocrinology

I heard the door softly click shut, and the reel of my first-year puttered out as I returned to the beige clinic room. Feeling rattled by the pressure of my newfound title and riddled with self-doubt, I turned to Ms. C. I was sure that the fear was evident in my eyes. I bumbled through a history forgetting relevant questions and missing key points for follow-up. I was awkward as I asked about drug use and sexual history. I observed the tip of my otoscope shaking as I held it to her ear. I felt uncomfortable as I held my stethoscope on her chest and was not sure what to do with my other hand.

But that’s when I heard it.

Diastole. The silence between the dub and the lub. Over the past twelve months, I had learned to map and describe the various murmurs in that space. I had memorized the valve disorders associated with them. I had heard diastole, the time when the ventricles are filled with blood, on recordings, on a simulation dummy, and on myself. However, I had never appreciated it on a patient. That little space — which had always been overshadowed in my ear by the cacophony of my internal dialogue, along with a sprinkling of crepitus from my shaking fingers — now shined through with a brilliant clarity.

Never in my life had a silence been so moving.

“Ms. C, everything sounds completely normal. But is it alright with you if I listen just a little longer?”

Ms. C smiled and nodded. “Of course,” she said. “You’re learning.”

Christopher Arthur Christopher Arthur (1 Posts)

Writer-in-Training

Emory University School of Medicine


Christopher is a member of the Class of 2021 at Emory University School of Medicine. He enjoys hiking, playing guitar, and bicycle commuting. Christopher grew up in Virginia where he majored in Psychology at the College of William & Mary. Prior to medical school, he spent time working in Seattle and enjoying the beautiful Pacific Northwest. His interests in medicine include aging, palliative care, and the practice of empathy.