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.
In medical school nowadays, there is a heavy emphasis on perfecting a physician’s demeanor when interacting with patients. Classes on essential patient care focus upon the social constructs of medicine, allowing permeable medical minds to ponder over various patient-care scenarios and determine the perfect method of one’s bedside manner. I used to believe such classes were ludicrous.
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.
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.
White gloves on black skin. The fingers of my gloved hands still interlaced, still resting tensely over her sternum. Elbows still locked. Frozen in the position endlessly refined during CPR training. It turns out that blood flow is important for catheter angiography, which presents a challenge if your patient has no heartbeat. Has not had a heartbeat for 45 minutes.
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.
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.