Medical school is terrifying. This is not something I feel like I am supposed to admit — or let alone feel — because it conveys insecurity. For all the learning we compress into our days as students, we operate in a constant state of not knowing. Perhaps paradoxically so, uncertainty itself seems to be guiding us down the path laid before us. It is as if we are walking with our hands stretched out in front of us, groping in darkness. Every day, we face the unfamiliar, not just in terms of knowledge, but also the larger questions of whether we are turning down roads that feel true to us.
Patient presentations are a strange sort of voyeurism. Though they resemble medical interviews in many ways — the history-taking, the assessment of emotional state and physical function — what was once a private interaction becomes a public play. What was once a conversation intended to benefit the patient becomes a performance to satisfy the curiosity of so many medical students.
I underwent my first transsphenoidal hypophysectomy, fully believing in the capabilities of my neurosurgeon, who had years of experience and training from a reputable institution, hoping that my surgery would be a success and cure me of Cushing Disease, which had turned my life upside down in its course the past half year.
Have you ever had a sinking feeling in your stomach when you are about to tell something to a patient or family member that might change their life forever? I had that feeling before speaking to the wife of my patient, Mr. Smith. It had only been one day since Mr. Smith was first admitted to the inpatient unit but regardless of how long the interaction is with a patient and their loved ones, some news is always difficult to deliver.
Patients don’t always have to let us into their rooms. As medical students, I think we don’t give enough acknowledgement or praise to the vulnerable individuals that allow flocks of medical students to bumble around their bedside. But our perceived ineptness is the last thing on the patient’s mind; a friendly face that is willing to listen to their story is just as important.
Friday afternoon psychiatry didactic sessions are a holy time among medical students. A golden weekend rapidly approaches and the afternoon, typically spent trudging through paperwork, is instead spent listening to residents talk with minimal effort required to listen. At the end of a frantic third year of rotating, sometimes it’s nice to just set the busy work down and take it all in. Granted, I’ll actually have to learn the info at some point before the test, but for one afternoon it’s nice to be passive.
With more applicants than ever, and a relatively static number of medical school and residency spots, there has been an increase in the use of metrics such as standardized test scores, GPAs and research publications to differentiate between applicants. Unfortunately, an emphasis on the unquantifiable attributes of physicians — the qualities that actually differentiate great clinicians from good ones — seems to have fallen by the wayside.
As young children growing up, we all called each other by first name. So did our parents, relatives, teachers, and anyone else we ran into that wanted a way to identify who we were. As adults, attending physicians are still called by their first names around the same group of people from childhood. However, patients and most of the clinical staff may not even know the physician’s first name. When transitioning from a senior resident to a faculty physician, some event occurs where that beloved first name is molted. After the right of passage is completed, the rookie doctor becomes a veteran doctor; free of restrictions, supervision, and a first name.
The other day, while scouring my computer for a lost document, I stumbled upon a speech I had given for my medical school’s anatomy donor recognition ceremony. It was an event held every fall, right after anatomy, during which our school’s first-year students showed their appreciation to the friends and families whose loved ones donated their bodies to science so that we could better learn the anatomy of the body. It has been a couple years since, so I decided to take another look at it.
My first rotation as a third-year medical student, I met a man who will forever influence the way I approach my patients. He had come to the hospital because of rectal bleeding and was ultimately diagnosed with colon cancer. As I got to know him, I learned that he had fought in two wars, started a successful business and was married for more than 50 years. And he was enormous, six-foot five-inches and 280 pounds, with a voice that reminded me of Lee Marshell — think Tony the Tiger and the guy who sang “You’re a Mean One, Mr. Grinch.”
On a recent visit to my parents’ home in Upstate New York, just as the snow had finished melting and our tulips were beginning to sprout, my dad and I went out for a walk. As we made our way down our driveway to the railroad-tracks-turned-walking-trail that runs through the woods near our house, we bumped into one of my dad’s patients. With a hearty grin, the middle-aged man proudly told my dad how his morning blood sugars were improving. My dad beamed, and gave him a big high five. Later, as we walked along the trail, he told me how thrilled he was to see this patient getting the exercise that would help treat his diabetes and high blood pressure.
“When I was in Laredo, I studied cello when I was in undergrad. My ultimate goal with the cello I guess “professionally” was to play cello with the Laredo Philharmonic Orchestra, which I did in April of my senior year. It was a huge deal for me. Since I was really young I always wanted to play with them — [it was] definitely my ultimate goal in music.”