During the last week of my clinical rotation in Family Medicine, my attending advised me and the accompanying medical student that going forward, the health providers of the clinic must limit their scope of care for patients who present for annual examinations.
This period of healing set Lori on a long road that was paved with pain. She lived in chronic pain from the fistula. While her physicians delicately weighed her safety with pain relief, she learned to balance both patience and uncertainty.
As a high school volunteer in my local hospital’s oncology unit, I remember the sinking feeling in my stomach every time I saw the bright “Contact Precautions” sign on the door. I would begrudgingly don a flimsy plastic gown, fix a tight surgical mask around my ears, snap on a pair of gloves and proceed into the patient’s room.
It is morning outside, the sun barely kissing the horizon. The curtains have been drawn in an attempt to force any lick of light from the room. But one slim shard cuts through the drapes, illuminating John’s face.
Like many medical students, I was vastly underprepared for the emotional turmoil that the nature of the third year of medical school can create.
Over the next few days, workup revealed she was experiencing paraneoplastic cerebellar degeneration, a manifestation of her occult cancer. In a matter of three days, a patient who had come in for seemingly benign constipation was told she had metastatic lung cancer.
After our first week on clinical rotations, my third-year medical student colleagues laughed about the silly and awkward things that made their first days hard. Someone was shunned for bumping into the sterile field during their first operation. Someone else couldn’t figure out the scrub machines and was stuck mismatching for the day.
When I was growing up, I used to love a particular series of video games called Trauma Center. In 2010, they released a version called Trauma Team where you got to play as various medical specialists, one of whom was simply considered a “Diagnostician.” Dr. Gabriel Cunningham’s “cases” were some of the most challenging because you were presented with an array of symptoms, imaging, and lab work and started ruling in or ruling out diagnoses until you got the right answer.
It was my third day on my home dermatology elective, and I boldly volunteered to see a patient by myself. As a third-year medical student strongly considering dermatology for my future career, I had studied for weeks for this rotation, hoping to make an impression as a confident, knowledgeable and reliable doctor-in-training. Usually, medical students shadow for two weeks before seeing patients on their own, but I was eager to be more independent. This was my chance to demonstrate everything I was working toward.
“You know, not all of us can be small,” the patient, a well-appearing woman in moderate anxious distress, said as she motioned with her hands and rolled her eyes towards me. “It’s disgusting,” she added.
Third-year rotations forced me to reckon with my emotional capacity as a human and future physician. With each patient encounter, I had to decide whether my skin was too thick or too thin.
Three knocks, no answer. “Good morning Mr. Adams!” I call as I peek into his room, flicking the lights on. I am wheeling a small, flailing tablet and it unstably spins left and right, back and forth, until I park it by my patient’s bed.