From the Wards

Matthew Trifan Matthew Trifan (6 Posts)

Contributing Writer Emeritus

University of Pennsylvania


Matt Trifan is a current resident of emergency medicine at Thomas Jefferson University Hospital in Philadelphia. He was a former medical student at the University of Pennsylvania. In his free time, he reads, writes, travels, and never misses a chance for brunch. He owes his life philosophy to Albert Camus and Adventure Time, equally.




The Silver Lining

We stood in the shadows, a staggered line of nurses, students and surgeons in matching blue scrubs and masks. It was the middle of the night. Our tired bodies sagged against the walls, our bloodshot eyes dancing between the clock above and the gasping life below. A young man was dying in the operating room. He lay on the cutting table with his arms splayed wide, like a martyred saint stretched upon the cross.

Racial Discrimination as an African-American Medical Student

My recent psychiatry clerkship inspired me to examine racial relations during third-year rotations. This reflection originated from a physician submitting a particularly disturbing evaluation of me. She wrote: “[The student does not] recognize and address personal limitations or behaviors that might affect their effectiveness as a physician … [The student is] defensive, rigid, intense and intrusive; unable to see nuances in human behavior that is necessary for analyses of the human psyche; lower emotional quotient than peers.” Her response left me with an open-jawed, stuporous gaze. I could not believe that she had made this kind of assessment after interacting with me in only two patient encounters for less than half a day!

After the Autopsy

I went through medical school without experiencing the death of a patient I had personally cared for. In contrast to what may be seen on the trauma service, my surgery clerkship was full of routine procedures: appendectomies and cholecystectomies, port placements, excisions of pilonidal cysts, and miscellaneous “ditzels,” as pathologists may refer to them as. Sure, I have had patients who were quite sick and did not have much time left to live. For example, I once performed a neurologic exam on a comatose teenager in the ICU, whose arteriovenous malformation had bled wildly out of control despite prior neurosurgery. But with the constant shuffling of rotations that medical students must endure, I was always in and out of patients’ lives before they had a chance to leave mine.

Occupational Physicians as Goaltenders

I recently had the opportunity to shadow a local occupational medicine physician over spring break. I arrived at his office Monday morning expecting a brief day of clinic, maybe some conversation over lunch; maybe I get lucky and he pays for my sandwich. Within minutes of meeting him, though, the physician offered to host me for the entire week on a “mini-rotation.”

Poker Face: When Patients Are Dealt Terrible Hands (2016)

Like poker, medicine has certain rules — patterns of clinical symptoms and lab findings each correlating with a specific spectrum of prognoses that vary in likelihood, the differential diagnosis. Physicians are like seasoned card players, trained to maintain composure and incorporate numerous variables into logical, calculated decisions at what seems like a “dealer’s table” of outcomes. Sometimes, we hedge our bets that the patient will self-resolve, so we elect not to treat; other times, we act conservatively with a battery of tests and pre-emptive therapy.

Managing Chronic Illness: Three Lessons Learned in Training

While I could list close to 100 lessons, I believe focusing on three of the most important ones would aid other future health professionals in managing and ultimately treating the chronic illnesses that will become even more prevalent in many of our future patients. As a disclaimer, I do not claim to be an expert on this topic, but these ideas spring from my own personal reflections.

Microcosm: A Routine Visit in Primary Care

The old woman with long silver hair sat in her wheelchair, feet propped slightly up, smiling toothless among her layers of wrinkles. She waited for me to speak, deferring her decades of matriarchy and adulthood to the stethoscope I wore so casually after just months of earnest experience. Indeed, it sat lightly on my neck today but heavily on my heart. A few more seconds passed, as I contemplated how exactly I wanted to discuss her test results and how exactly I would ask her to proceed.

Looking Back from the Wards: A Lesson from Anatomy

The other day, while scouring my computer for a lost document, I stumbled upon a speech I had given for my medical school’s anatomy donor recognition ceremony. It was an event held every fall, right after anatomy, during which our school’s first-year students showed their appreciation to the friends and families whose loved ones donated their bodies to science so that we could better learn the anatomy of the body. It has been a couple years since, so I decided to take another look at it.

The Hospital Ward: A Politically-Empty Space Filled with Tolerance

The counting of compressions permeated the air as we anxiously stood by hoping to see any sign of life. We were trying to save Adam, a young Israeli-Arab who was on our inpatient service due to complications after his hemicraniotomy. He was hospitalized for nearly four months and his vital signs never stabilized, despite our rigorous and numerous treatments.

The Beginning or the End?

The beginning of third year clerkships is an exciting time for medical students. The first step of my licensing exam was finally behind me and now I could focus on applying the knowledge into a clinical context. I had heard a lot of stories about the third year of medical school. Perhaps what stood out most were the reflections shared with me when people witnessed death for the first time. From full codes to hospice patients, something about death seemed to draw out the most intense emotions and thoughts that can change lives forever. Although I always try to do the best for my patients, I knew it was inevitable that I would come across death. I wondered what profound thoughts and reflections I would have when I experienced it for the first time. It wasn’t too long before I was called to do CPR in the emergency department and I found it did not play out as I expected.

The Cost of Hope

They’re out of place in dirty Crocs and wrinkled sweatpants. More notably, she’s wiping tears from puffy cheeks. It’s a sharp contrast to the nurses, who are too casual. One makes a remark to the other about a tangled tube. They always get that way. The other chuckles.

Dignity

My first rotation as a third-year medical student, I met a man who will forever influence the way I approach my patients. He had come to the hospital because of rectal bleeding and was ultimately diagnosed with colon cancer. As I got to know him, I learned that he had fought in two wars, started a successful business and was married for more than 50 years. And he was enormous, six-foot five-inches and 280 pounds, with a voice that reminded me of Lee Marshell — think Tony the Tiger and the guy who sang “You’re a Mean One, Mr. Grinch.”

Eric Donahue Eric Donahue (9 Posts)

Medical Student Editor

University of Washington School of Medicine


Eric serves as a medical student editor at in-Training and he attends the University of Washington - Class of 2017. In the past he has worked in EMS and international community health. As for the future, a career caring for the community is in the works. He believes writing is an essential expression of human ideas, passion and intelligence. Eric is a husband and father of three.