When I was 17, I went to the gynecologist for a Pap smear because my mom said, “Once you have sex you have to get one.” It felt like punishment, but it was also the only way I had a chance of getting birth control. I went to three different doctors and exam after exam, they kept saying I could have cancer. I did a ‘colpo’ — whatever that is. After that, they did three different procedures on me, THREE, all to take pieces of my cervix. I don’t remember what they were called or what even happened. All I remember is the pain.
There are many reasons a medical student may struggle on their obstetrics and gynecology (OBGYN) rotation. There is an obvious lack of medical knowledge or procedural skills common in all clinical rotations. But, on OBGYN, it can be especially challenging for male medical students to gain the confidence to feel comfortable talking about sensitive topics and being present for sensitive exams. (The same goes for female students in Urology.)
I entered the office of the Community Health Council of Wyandotte County, Kansas City, on a muggy, late-summer day during my family medicine rotation. The air-conditioned building boasted a large front room with sporadically placed desks, children’s books and toys, and what looked like a large food pantry. I flexed my elbows and wagged my arms to fan out the sweat from my Black body enshrouded in my white coat.
In April of 2020, I began to use the word “adjusting” on a daily basis. I was administering rapid COVID-19 tests at the Detroit Health Department and while their tests were processing, I had fifteen minutes to talk with patients about how they were adjusting to social distancing and adjusting to the media storm that occupied our screens all day.
I had developed a strong friendship with Ms. D during the rotation, and her passing became one of the first confrontations with grief that I encountered as a rising medical student.
If there is one thing I have learned, it is that what we, the medical providers, think is important may not necessarily be the priority of the patient. We want to know: why are your sugars uncontrolled? How is your diet? Have you been able to take your metformin? However, for the patient, these things are often trivial. The patient wants to know: how will I be able to afford these medications with my part-time job? How am I expected to see a specialist without insurance? Should I be going outside to exercise, or will I contract coronavirus?
Having a family, for some of us, is also non-negotiable. We want to be moms, and we have the right to pursue more than just medicine. So let us flip the script in our mind. Our mindset should not be a question: “Can I have a baby during my training?” Instead, let us decide, “I will have a baby during my training, and this is how.” Own it. Do not apologize for it.
She was a woman in her early twenties accompanied by her husband. She was a first-time expecting mother at 19 weeks gestation with twins. They had received regular prenatal care and had been doing everything as the doctor had instructed to ensure a healthy pregnancy. She made this appointment because she felt something was off, her motherly instincts already keen.
I have become, in these last six months, a twisty little ouroboros. I eat my tail because it’s all I know, and I savor my pain and confusion. I am always full and always empty and a little twitchy from all the coffee. We are one of the few medical schools in the country to push ahead early with in-person rotations during the pandemic.
Patient 15 was a fit 38-year-old female with a past medical history of dilated cardiomyopathy who presented for follow-up on her most recent echocardiogram results. Flipping through the past notes, prior echos, family histories, I was captivated. A previous echo revealed an ejection fraction of about 50% — her heart was already revealing its impending fragility. The most recent echo, just five months later, revealed an ejection fraction of 20% — her heart was failing!
In the extremely efficient and fast-paced environment of health care, the emotional needs of patients and their families may become secondary to their medical treatment plan. But emotional stressors may be directly associated with poor outcomes in regards to the healing process and overall quality of life. Thus, these needs may be addressed by face-to-face communication that allows for better patient education. Such investment of time is most rewarding when both the patient and family members have the opportunity to explain their fears and worries regarding treatment.
In the neuro intensive care unit, I took part in a meeting with my team to update a family on the status of their loved one. It was my first time in this type of meeting, especially for a patient that I was directly involved in caring for. To our team of medical professionals, he is our 51-year-old male patient with a 45-pack-year smoking history, but to his family, he’s a son, a husband and a father.