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’ve heard it said that knowledge is power, and that to be forewarned is to be forearmed. I still remember getting a text from my mother when I was on my OB/GYN rotation, during the first window of time I had gotten to use the bathroom all day. I remember her texting me a picture of a CT scan of my grandfather’s lungs with the words: “What does this mean?”
I spent the first week of my outpatient experience in internal medicine working with the nurses at Hospice of the Red River Valley in Fargo, ND. Besides being incredibly nervous to begin my third year of medical school, I was anxious about what I might encounter on my week at hospice.
“Be a duck,” became my mantra throughout medical school, so much so that my mother had it printed onto a canvas and has it hanging on a wall at home in my honor. As a medical student you might think I would be more interested in having the prowess of a lioness, the elegance of an eagle, the speed of a cheetah or the energy of a dolphin. A duck, as most envision it, does not have much appeal; except, however, when swimming. The quote that led me to emulate the duck is Michael Caine’s, “Be a duck, remain calm on the surface and paddle like the dickens underneath.”
In the playbook of professionalism, / Where is room for the physician who / Reads German poetry to the dying patient / For days and days until her end?
“Please not me,” I pray earnestly. Not me. Not me. I don’t want to become the medical student-turned-resident-turned-physician who loses empathy. The one who loses compassion. The one who takes lives and near death experiences for granted, who quickly learns, as an ER attending once bluntly stated, that “everyone’s a liar.” Not me.
“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.
My alarm went off at 4 a.m. in the morning. I begrudgingly pulled myself out of bed, threw on some scrubs, and headed to the hospital. Not a car was on the road. It was the third week of my OB/GYN rotation, and I was on the infamous gynecologic oncology service.
When I enter the examining room, Mr. Jones is visibly distressed. His chest heaves as he struggles to catch his breath. I glance at his charts and make note of his chief complaint: chest pain. After a brief introduction, I fire off a barrage of well-rehearsed questions: When did the chest pain first begin? Does it radiate outwards or stay localized in one spot? Is there anything that makes the pain better or worse?
Delirium is a bread-and-butter presentation. The differential writes itself — stroke, infection, intoxication, electrolyte imbalances, shock, organ failure. The intellectual exercise this invites was practically invented for medical students, even if the final diagnosis (dehydration secondary to gastroenteritis) and its treatment (fluids) were relatively mundane.
On the first day of my psychiatry rotation I was anxious, and like most students I worried. I worried I would not have anything to say and I worried I would say too much. I worried I would say the wrong thing at the wrong time and I worried that my words would be more consequential than I ever intended them to be. I worried about my worry.