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Catching Threads at the End of Preclinical

Perhaps, this story begins with pre-med classes, interview trails, years of toil and strife: different pathways that led my classmates and me to cramped cars in Dewey lot, long hours in Chilcott and Zoom-athons. Our preclinical years — neither ordinary nor as I imagined — came with milestones, a pioneering curriculum, and cascading stresses. These years have been both unwarily beautiful, extraordinarily difficult. Some may lament in the words of Dickens: “It was the best of times, it was the worst times.” But I feel it was the age of retiring pithy aphorisms, as there are no tropes but infinite feelings that fairly describe the life this time has transpired.

Time will only tell what sense, if any, I will make of these years. For now, in the solitude of my bedroom, amid our last preclinical classes, I think of the stories my classmates and I share:

Of morning classes in Vail, long afternoons with our anatomy donors — our first patients — and then breakout rooms on Zoom. Unfamiliar faces with unknown names becoming beloved friends. Our checklists and mnemonics: OLDCARTS, VINDICATE and more. The festering of self-doubt and imposition of imposter syndrome, and then a slow reawakening of confidence.

Knowing nothing about medicine, yet knowing so much about pheochromocytomas. Hearing at first the lub/dub of a stranger’s heart, and hearing, at last, the story they tell. Realizing the privilege that it is to care for a neighbor, a stranger. Finding diastole in walks around Occom Pond, skiing on Winslow and swimming in the Connecticut. Unraveling oneself from tangles of loneliness, witnessing brilliance in classmates’ social histories. Sharing inner triumphs and the silence we hold for trauma and tragedy we bear quietly or openly. Watching photo reels of smiles fade into pictures of sunsets and empty forest trails.

The death of loved ones, the birth of loved ones. The falling in and out of love with another, ideas, or even career possibilities. Of personal growth and failures, often untold. Loud conversations between classes, now text messages with exclamations. Thursday nights at Ramunto’s, Zoom galleries finally unmasked, sometimes unmuted.

Knowing the rampage of a virus, knowing the hurt of a public health crisis. Knowing that Black lives matter today, tomorrow, forever. Wondering how these experiences could not convince a nation that anything else than universal health care is unacceptable; anything less than justice and equity is intolerable.

I don’t wish to romanticize these entropic, chaotic years. I teeter between objectivity and sentimentality in the words I choose. I try to find feelings in the numbness and desensitization that comes with the chronic pain accrued by collective and individual trauma and grief that comes with the waves of injustice, sickness, disunity and death. In psychiatry, we learned of a mature defense: suppress as opposed to repress our worries. However, even the strongest breakwaters can crumble in the weight of tsunamis. Turning off the news momentarily and tuning out my worries to focus on studying always felt like a band-aid reprieve. In the meantime, the weight of it all grew. And the moment I looked back to what was happening around me, I was inundated.

I learn from and lean on friends and communities who inspire me about what I can do and who remind me there are always rest-stops on the endless highway, sunlight on frigid days, laughter that breaks the silence, kindness that grows in desolation. I live in the reality that I can count my blessings and simultaneously understand that there will always be work to be done. Many have been through a lot, in more ways than they let on — this time has been exhausting. It has been tough to be human. This time has shown us too what living requires.

In these coming months, the paths of my classmates and mine will yet again diverge from Dewey lot, as we pursue our passions and as clinical rotations cast us across the nation from Maine to Alaska. What the future holds for us has yet to be witnessed; as Dr. Lisa Sanders promises, “In medicine, uncertainty is the water we swim in.” Maybe we will find that these troubling times have taught us profound, painful, and grey lessons and we will be stronger for it in the decades to come. For now, let me write not just of nostalgia for the things that never happened and the things that did. Let me also remember hope. Across some languages, a word for hope is understood as one for charity and work. That makes sense to me. I find it easier to be pessimistic and nihilistic. To be hopeful requires hard work and generosity.

I hope my classmates, communities, and I all dance far more often with health than sickness. I pray that soon the last hospital bed holds the last patient with COVID. I hope justice and truth prevail. I hope we hold onto what we carry: the love of friends and family, a resilience tried and true, bravery unbridled and faith that we will persevere among the challenges life affords. I hope that after long days of caring for others, we care for ourselves and call a friend, a loved one, a therapist — and remember how far we’ve come. We have been patients, and we will be patients, even as we care for patients.

Despite toil, stress and loneliness, I hope I never lose sight of my blessings and the crowd of people rooting for me — the people I thanked when I first donned my white coat, the communities I’ve grown and the people I remember as I write. I’ll always be grateful for them and the privileges I hold. I hope to look back in these coming years and remember how this story began: how my classmates, communities and I persevered and tried to handle pain and failure with dignity, kindness, and humility. How I pressed on not because I have to be a physician above all else, but because something in me made it clear I want to be a physician despite all else.

I chose, and I continue to choose to trust that something.

Featured image courtesy of the author.

Amal Cheema Amal Cheema (4 Posts)

Contributing Writer

Geisel School of Medicine

Amal is a writer and medical student at the Geisel School of Medicine at Dartmouth, class of 2024. She graduated from Wellesley College with a Bachelor of Arts in biochemistry and political science in 2017. Prior to medical school, she pursued a Thomas J. Watson Fellowship and a post-baccalaureate in biomedical ethics. Outside of class, you can usually find her writing, reading, baking, or adventuring in the outdoors.