Freud supposedly understood himself as a surgeon of the mind, dissecting his patients’ mental anatomy through the process of psychoanalysis. I found this comparison appealing, so when I started the psychiatry clerkship in my third year of medical school, I approached the interview in psychiatry as analogous to a surgical procedure — efficient, scripted, precise.
Mr. T did not smile at me. No, I didn’t think it was because he was mean or anything; in fact, he was polite and had quite a calming voice. But honestly, it was hard to read someone’s facial expression behind a mask — at least during the first few months of the COVID-19 outbreak.
“I’m sorry that you have to see me this way,” said Ms. A as we exited the examining room. Twenty minutes earlier, Ms. A had been laughing and cracking jokes while my attending physician and I obtained her medical history and life updates.
An anxious, 36-year-old Hispanic female lays on the exam table, her feet in stirrups. A sleeved arm juts out between her tented legs as she stares resolutely at the ceiling. I wonder if she is afraid of what the amorphous black and white structures shifting on the ultrasound monitor may reveal.
A 5-year-old African-American boy presents to the emergency department with left leg pain. His leg is exquisitely tender to palpation… If I read this vignette in the first year of medical school, I would have navigated to the multiple-choice answers to select anything related to sickle cell disease. The question writers are stating that the patient is Black, young and has a painful limb — this is not a difficult diagnosis.
A classmate of mine committed suicide a few weeks ago. Though I’ve heard the harrowing statistics about physician and trainee suicide rates, to be honest, I never expected to personally encounter such a tragedy. The small classes at my medical school allow for a strong sense of community in which we all know each other, celebrate important life milestones, and happily reconnect when we’re together after clinical rotations scatter us throughout the hospital.
The first thing I notice are his boots. He’s still in his street clothes, having just been admitted. He looks thin, emaciated — his clothes hang off him, shirt collar drooping down from his neck like peeling paint. His boots, however, seem to fit him properly. They look warm, well-worn but sturdy, like they have weathered a hundred bitter winters and could withstand a hundred more. For some reason, this comforts me.
My medical school career was complicated by more than just complex cardiac physiology or biochemical pathways. Little did I know that at the end of my second year I would go from knocking on a patient’s door during a clinical session, to sitting in an exam room myself.
Upon arriving at the room, we learn that the nurse continued trying to speak to this patient in English despite the patient’s evident inability to speak the language. Following her half-hearted attempt at “patient education,” she proceeded to lift the patient’s gown and attempts to strap on the monitors. As a result, the woman is frightened by her nurse because she is unaware of what this foreign nurse is doing to her and her unborn child. One week out from detention. She is scared. Imagine.
When the start of M3 year came along, I was ready: ready to put my First Aid book to rest, ready to be involved with patient care, ready to observe physicians in their realm of expertise and ready to find my place in the broad field of medicine. Now, halfway through the twelve months of clerkships, I ask myself, was it all I imagined it would be as an inexperienced first-year student?
The heart monitor beeped incessantly, and the pulse oximeter kept dropping to the 80s. I ran to get a nurse. He walked calmly into the room, straightened the patient’s finger and left without a word. The oxygen went back up to 98.
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.