I had not yet guided a ‘goals of care’ discussion. This is the discussion that entails understanding a patient’s wishes regarding end of life care, and it is often in the context of determining what advanced medical interventions the patient might want. That day, my short white coat felt shorter, like it was yelling out to everyone I encountered that I had no idea what I was doing.
I was starting my surgery rotation, the second rotation of my third year, on the colorectal service. It was my first 24-hour on-call shift, which meant that my team would be responsible for multiple surgical services overnight.
I hate to say that there is something exciting about getting called in to the hospital in the middle of the night. Logically, I know that means something bad is happening to someone else, but it makes my heart beat a little faster and my adrenaline surge.
I just finished my two month surgery rotation, and as a third year medical student new to the wards, I had a steep learning curve. One of the things I learned the hard way, causing me to nearly cry during rounds, was how to properly present a patient’s history and physical examination findings.
Every time we’d ask the physical therapists to take him on a walk to get better oriented with his surroundings and see some sunlight, Mr. G. would refuse. He was a stubborn man.
I will never forget the patient who shocked my preconceived notions about health care.
They asked me how that encounter had gone, and I could feel my cheeks turn bright red. I was embarrassed that I was not able to connect with my patient.
My medical education has been a long journey to this point — a journey filled with many obstacles and detours resulting in moments of self-reflection and personal growth. One of the most important detours on my journey led to me being relocated to Riverside University Health System (RUHS) for a longitudinal care assignment.
Perhaps the single most awkward conversation that a third-year medical student can have with an attending physician is the one that begins with the attending asking, “So, what medical specialty are you interested in going into?”
I know that being a third-year medical student is like being a transplanted kidney. One starts the day in one body. School is composed of lecture halls and written exams. However, the world has shifted by the end of the day, and shockingly, one’s old body is not present.
“If I don’t get a cigarette right now, I’m going to punch someone,” he said. “Okay, I understand. One second.”
To keep breathing does not mean to go at it alone or to put up a brave front even when it feels as if the world is collapsing. To keep breathing is to always push towards the goal even when it’s hard and even when it doesn’t feel worth because it will be in the end.