Mr. K had been admitted with dehydration and malnutrition secondary to diarrhea in the setting of HIV. During his stay, he developed refeeding syndrome. When the resulting electrolyte imbalances paved the way for cardiac arrhythmias, he coded twice in the ICU. The care team managed to bring him back each time, but not without consequence; the brutality of numerous cycles of CPR left him with multiple rib fractures, inflicting him with sharp pain every breath.
You don’t have to sit in silence and painfully nod along with an attending’s racist, misogynistic lectures because you’re their medical student. You don’t need to pick the skin off your cuticles to stop yourself from replying. You don’t need to learn how to hide your grimaces behind your mask because you know you’ll have to listen to them attack your identity for the next several weeks.
Each morning, Mr. E had a new concern — too hot, too cold, too dizzy, too stiff. He was admitted for what seemed to be a straightforward heart failure exacerbation, but his echocardiography showed severe hypertrophy in both sides of his heart that the cardiologists described as “concerning for infiltrative cardiomyopathy.”
There were seven of us standing around the table as the attending surgeon debrided the infected fascia. The vascular surgeon came in the room and barked at us to identify the structures before us. “What’s that artery?” he interrogated us. “I’ll give you a hint,” he said, “there’s a deep and a superficial.” We named the sural nerve and iliotibialis band and the great saphenous vein. As we clamored around the table, I suddenly thought of the Rembrandt painting: The Anatomy Lesson of Dr. Nicolaes Tulp.
Until recently, vulnerability meant weakness, allowing oneself to fall behind without a chance for recovery. Courage, on the other hand, had the opposite meaning: betting all my chips on prevailing at any cost.
I knew I moved through these spaces easily for many reasons, but being White is a big one that needs to be said out loud. And when you look and feel more comfortable in a space, it is easier to perform “well,” or to sound confident. This is directly related to what academic medicine characterizes as “objective” evaluations of students, and there is data to support this.
“Could you please hand Eric the needle driver?” As the scrub tech loaded up that blessed golden tool, I knew that I had just ascended within the realm of surgery.
I commented to the resident how satisfied the attending would be with the efficiency of his work. He just laughed and said “look” as he gestured down to his list of patients. I saw the name, and a sense of dread sank in during the rest of the silent walk down the hall.
Our patients deserve to have their battles acknowledged. That means believing your patients when they implore, “I am trying” and appreciating that we may encounter people at different phases of recovery.
“There’s a great neuro exam in room 5147,” my resident said as I dropped my bag in the call room. “Why don’t you go check it out?” I clutched my reflex hammer in one hand and googled the components of a neuro exam with the other as I headed towards the stairwell.
A hospital bed rolled in. It was Marvin. His last walk. On rounds we would say, “Twenty-two-year-old with gunshot wound to the head. Waiting for organ donation.”
Doing my elective at Klerksdorp-Tshepong (K/T) Hospital Complex in my hometown of Klerksdorp gave me the opportunity to become familiar with the health system, the medical personnel and health-related issues that are prevalent in my community. It also allowed me to draw comparisons between my home country of South Africa and the United Kingdom, where I have undertaken the clinical years of my medical degree.