Contributing Writer Emeritus
University of Kansas Medical School
I am a 4th year medical student at the University of Kansas Medical School. I am planning on pursuing a residency in Psychiatry and then hopefully a fellowship in Child and Adolescent Psychiatry.
She had survived an avalanche and was now lying face down in the debris. Longstanding ischemic brain disease had triggered a seizure. The seizure stunned the heart causing a cardiomyopathy. The cardiomyopathy, unfortunately, exacerbated her chronic obstructive pulmonary disease (COPD). As her oxygen saturation dropped, she was intubated and mechanically ventilated. She was now agitated, restrained and delirious.
“You need to come in to the E.D. ASAP.” A new patient was admitted at 2 a.m. and requested for a crisis counselor. Back in 2009 when I was volunteering in New York City, unlike with cases of sexual assault, survivors of domestic violence had to specifically request for the presence of an advocate. This woman, I’ll call her Sadie, had already taken the first courageous step to seek help.
“The baby’s out,” shouts one of the labor & delivery residents as her hands firmly grab and pull the baby’s shoulders with the mother’s final push. A nurse holding the mother’s leg during the delivery walks over to the pediatric team and whispers, “cleft lip,” as if the baby had committed a crime. Instantly, we fall silent.
“To most physicians my illness is a routine incident in their rounds, while for me it’s the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity.” –Anatole Broyard. When I first encountered Broyard’s quote, it resonated with me on a personal level, as I was reminded of an incident that occurred on my surgical rotation.
She was a petite, otherwise well-appearing woman, apprehensively sitting at the edge of the examination table. Hoping to mask my nervousness about this first, intimate patient encounter, I inquired about the reason for her visit. She told me that she was here to discuss a hysterectomy. She shakily explained her two-year history of heavy, painful menstrual bleeding. She hoped that the hysterectomy would be her saving grace. The insistence on this procedure made me suspicious of stirring waters beneath calm surfaces, so I probed further.
Today was my most challenging day of clinical work yet, but it had nothing to do with charting, the number of patients, or the attending on shift. Instead, today was about experiencing humanity and embracing the emotion of caring for others in their most trying moments. As a third-year medical student on my second rotation, I have not lost a patient, seen a code, or experienced serious trauma. I have not had to cope with loss yet. I recognize my innocence and realize that it must change eventually. That process began today.
Last Saturday evening I was on the admitting team in Orange County. We got a call about a hematology/oncology admission that we would later pass off to another team in the morning. We were told “fever with an ANC <500.” That admit, was Ronaldo, a young male with acute lymphocytic leukemia.
It is one thing to be a doctor and another to be a patient. It is a radically different thing to be a medical student paired by your medical school to a physician who is your “patient-partner.” Sounds like a word salad, but that is where I found myself as a first-year medical student at The Geisel School of Medicine of Dartmouth a few weeks after moving to New Hampshire, weeks before I would receive my white coat, months before I would have any clear idea of what the medical world is really like.
I arrived at the neuro ICU at 5:30 a.m. to read up on my new patient before rounds. The resident on duty the day before had accepted a transfer at 7:00 p.m. and documented the following in his note: Mr. X is a 72-year-old male with a past medical history of severe bilateral carotid artery stenosis who had a devastating right MCA ischemic stroke at home this morning, confirmed by CT at an outlying hospital.
“He’s had enough, you don’t want to put him through any more.” Dr. Acharya’s soft jowls folded into a cool smile, as though he hadn’t thought of acids unfiltered by failing kidneys. I dug my fingernails into my palms. Glancing at the bed where my grandfather lay, I watched his bare, gray skin grip the scar that split his ribcage in two. Behind his parted eyelids were unfocused blue eyes, glazed with whitish film. He hardly knew we were there — hovering over him — deciding whether he would have a chance to live and suffer, or whether he would suffer and die.
One of the things that I have struggled with most in medical school is depression. Not learning to recognize, diagnose or treat it, but actually dealing with the effects of this condition. I soon realized that this problem is much bigger than myself, and needs to be talked about openly. This is my story.
Sian Tsuei, a recent fourth-year matcher out of the University of British Columbia Faculty of Medicine in Canada, gives us his expert advice on succeeding in medical school and beyond.
Medical Student Editor
University of Nebraska College of Medicine
The product of small town Nebraska and many evenings enjoying good reads, Chris Deans currently resides in Omaha, NE where he attends the University of Nebraska College of Medicine. He received his undergraduate degrees in Biological Sciences and Philosophy from University of Nebraska at Kearney after also spending time at the University of Northern Colorado. A child at heart, Chris enjoys late night frozen yogurt dates with his wife, long hikes in the Rockies, and camp fire shenanigans with friends.
