The morning that we met was one most medical students eagerly anticipate as they embark on the journey that is medical education. Excitedly I put on my first set of scrubs, elated to look like a “real” doctor. Beneath my external façade however, I was masking an underlying feeling of anxiety.
I come from a family of repeaters. We repeat the questions that had unsatisfactory answers, the jokes that got particularly good receptions, the requests willfully ignored, but most of all, we repeat the stories.
“I know that this is quite upsetting for you, especially since you have been worried about your exam for several weeks.” I took a deep breath and continued hesitantly. I allowed the silence to settle as I racked my brain, trying to remember the SPIKES protocol.
I awoke to a phone ringing frantically, must have been a Whatsapp call. My father yelling from downstairs, “He passed.” And my mother, opening my bedroom door before my eyes had fully opened, stood there with her cellphone out, lips quivering, and eyes searching, “He’s gone.” My grandfather had passed away.
I recently returned from a medical outreach trip I went on with other students from my school. We traveled to the state of Gujrat in India and treated patients from a very rural population. Medical outreach trips are an excellent experience for medical students still in their pre-clinical years because they allow you to see firsthand the information you are learning and apply skills you have been taught.
One such opportunity was presented to me the same week of my acceptance phone call earlier this spring: a fully-funded trip to a previously unattended region of Nicaragua with a volunteer medical brigade. It was led by physicians from my institution looking to recruit our entering first-year medical school class to help lead the trip.
A frail elderly gentleman was wheeled in on a stretcher and left alone. His paper-thin skin lay gently across his delicate frame like fine linens. His mouth lay agape. His slightly yellowed sclera framed the piercing gray eyes cast upward at the harsh fluorescent lighting. He didn’t blink. He didn’t cry for help. He awaited the inevitable on a stretcher in a hallway of a fully occupied emergency department. I was confused and scared at the apparent lack of treatment he was receiving. There was no crash cart prepared for him. He wasn’t attached to telemetry. He didn’t have a nasal cannula. He lay in bed alone — in waiting.
Everyone at the nursing station turned silent and looked at the nurse who had delivered the news. I looked at her in disbelief, my brain struggling through a fog of confusion and surprise. I squinted at my patient list trying to remember who was the patient in 1152. Recognition finally hit and I remembered the little old lady that we saw during rounds two hours ago.
Being a premedical student is largely about the numbers — your MCAT score, your rank in your graduating college class, whether that subpar performance in organic chemistry will lethally impact your medical school application. If you’re anything like me, your time as a premed was spent encapsulated in a crippling and disorienting world of anxiety. I remember scanning Internet posts to confirm just how underwhelming my application to medical school was in comparison to those of other “more qualified” students. I read of students who had managed to four-oh all their prerequisite classes while achieving a perfect score on the MCAT and maintaining an enviable balance of humility and self-confidence, and I was understandably daunted.
Peering around the door anxiously, my eyes connected once again with the receptionist. After receiving her knowing glance, I once again stepped away from the doorway. It was 9:02 a.m. My first experience shadowing a pediatrician and interviewing patients was slated to begin promptly at 9 a.m.
It is a muggy Tuesday evening. Because it is Florida and it is summer, the impending storm promises no relief from the sticky heaviness that infuses the air. A line winds through the parking lot of a nondescript building. Children play under tents that offer paltry shade to their exhausted parents as they give their names to the students manning the reception table.
Seeing this dialog box, which pops up on the hospital’s electronic health record program, is never a surprise. On the list of patients whose charts I’m supposed to review for my summer research project, the deceased ones are highlighted in grey, setting them apart from the otherwise black-and-white list of names and medical record numbers.