in-Training 10-Year Anniversary, Preclinical
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Being Present in Transition

This April marked the 10-year anniversary of the founding of in-Training, and we invited all members of the in-Training family to contribute articles and other artistic works to celebrate our first decade as the premier online peer-reviewed publication by and for the medical student community.

Trisha Kaundinya, Class of 2024 at Northwestern Feinberg School of Medicine, contributes this article as an in-Training writer and featured author in our print book in-Training: 2020 In Our Words.

“Welcome, everybody, to the last module of your second year.”

I froze. There was no way. I pulled up Google calendar on my laptop in the increasingly warm lecture hall. Oh my gosh, they were right! Somehow, I had lost sight of the fact that we were just a couple of weeks away from finishing our preclinical years — I knew it was coming up soon, but had not internalized how soon it would be.

After this, our rotations on the wards and full-time interactions with real, sick, adult patients. Children. Expectant mothers. It would all start. It felt like yesterday that I recited the Declaration of Geneva virtually over Zoom to officially begin my first year during the pandemic, and now I was almost 50% there.

Instead of letting myself spiral into listing all the loose ends to tie up before beginning rotations, I turned off my laptop and tuned into the presentation.

As the module plenary started, our deans and instructors brought up that perhaps there were moments when we did not think we would make it, but now we were here.

I blinked back a tear, remembering the multitude of moments in medical school when imposter syndrome was particularly poignant. There was one moment in summer of my first year when mastery of a particular physiology concept felt insurmountable. Thoughts were racing through my head — I was second-guessing myself and all the skills that had gotten me thus far. I had called my close friend who was not in medicine, certain that I was not smart enough, savvy enough to get through. He reassured me that I was meant for this profession and could “do this,” if I stayed true to who I always had been. I had to show up for myself every day with intentionality and keep at it. I would keep “showing up” every day, and now I was here at the final preclinical plenary.

As the plenary went on, the wonderful facilitators explained that one of our final clinical skill sessions with standardized patients would focus on breaking bad news.

I remembered reporting to my assigned primary care continuity clinic for the first time in fall of my first year. I had learned how to take vital signs and begin the history-taking process just days before my first real patient visit. In that visit, a patient ended up receiving challenging news regarding exacerbation of a chronic disease. In a literal sense, the most valuable thing I was able to offer the patient was my attention and time. A curiosity to learn about their story, and a willingness to be a part of the next chapter of the story. Even though I have acquired significantly more history-taking and physical exam skills since that visit, the most valuable thing I can offer has and will remain very similar to that first visit.

The plenary continued. “You’re gonna rock this and be really ready!”

I thought back to an encounter in winter of my second year at the primary care clinic. I was expecting to see a patient for a return visit, but upon evaluation this swiftly evolved into an emergency department admission. Over the course of the patient’s extended hospital stay, I had the opportunity to check in on the patient and their family at the hospital. The patient and family’s positive reaction and gratitude that a member of their primary care team was at the hospital to see how they were doing was not one that I will ever forget. It made me feel connected to them and gave me the confidence to sit down, introduce myself to each of them, and hear their perspectives of the events of the past few days. This was one of the first moments when I felt like a part of my patient’s medical “home” and it reminds me of the importance in engaging the patient’s whole support team with intentionality and warmth.

As the plenary concluded, our mentors remarked that our potential went far and above taking tests, and that there was so much we could do to help patients.

I smiled. It was just a month ago in spring of my second year that I received a scary phone call from my mom, who stated that my grandmother’s blood pressure was steadily increasing every few hours. Other physicians in my extended family, more seasoned health care providers, chimed in about the treatments that might be helpful. While I was following the content of this group phone call, all I could focus on was the fact that this was my grandmother — what she had to say and how she felt mattered most. I took a deep breath and left the clinical conversation to ask her in Tamil about what she was experiencing and what she would like to do. She quietly expressed uncertainty and an interest in monitoring her blood pressure for a bit longer before being evaluated. I could tell that simply having the opportunity to express her thought process to someone was a significant source of relief. Her crisis was later medically managed after her blood pressure and personal level of concern continued to rise. This event made me acutely aware of the duality in being a budding medical provider during family health crises. It also highlighted the value in centering the patient perspective in a culturally humble way despite all the facts we might have at our fingertips.

A classmate of mine recently compared the journey of medical school to a “bug on a jumbo jet.” We put one foot in front of another through the long days, but the wind carries us through the seemingly short years. In just two years of preclinical training peppered with clinical exposures, I find myself leaning on so many lessons that validate the importance of being present. With my friends. With my patients. With my patients’ loved ones. With my family. With myself, whether in my daily adventures as a trainee or in my moments of thoughtful reflection through writing. As I embark on this transition, I cannot even begin to anticipate all the lessons ahead. But I hope to prioritize being present.

Trisha Kaundinya Trisha Kaundinya (4 Posts)

Contributing Writer

Northwestern University Feinberg School of Medicine

Trisha is a third-year MD and MPH student at Northwestern Feinberg School of Medicine. In 2020, she graduated from Northwestern University with a Bachelors of Science in human sciences and disorders, a Bachelors of Arts in neuroscience, and a certificate in leadership. She has worked internationally as global impact fellow and medical journalist. In the future, Trisha would like to pursue a career in academic medicine.