May – Bright-eyed and fresh from the books, I start my first rotation on internal medicine. I stay at the hospital until 11 p.m. to get a good history of my first patient. It is three pages long. I come in on weekends to practice writing notes. I find out that a patient is witness to child abuse and file a mandatory report. I pat myself on the back. My intern pats me on the back.
Early June – I am no longer as bright eyed in the morning. My notes are down to a page. I feel more comfortable “redirecting” a patient during an interview. I look forward to primary care and to leaving my house after the sun comes up.
Late June – My hero, a resident named Brian, effectively councils a Spanish-speaking patient with multiple conditions at the clinic. He asks about her beliefs and her concerns. He teaches back.
Two days later – I watch Brian interact with another patient with diabetes. He bitches about her “non-compliance” in the staff room. I watch resident after attending fall from hero status in my mind.
July – I write Brian an email to commend him and to say, “I am terrified of losing that desire to connect to and understand patients because of time and routine and cynicism.” He advises me to do something that I love to avoid burn out. I realize that everyone has good days and bad days.
August – I am thrilled to start neurology. I find a new hero in an attending who explains epilepsy to a 20-year-old patient who had signed out against medical advice from two other hospitals. The patient agrees to start a seizure medication.
September – Psychiatry. I am told by my attending that I care too much. I face an existential crisis. Another attending tells me that it’s okay to care. I start to develop confidence in my own approach.
October – I leave the house hours before the sun is up. My notes are down to two inches and my patient interviews down to under five minutes. I am on surgery. I am not surprised when I hear derogatory comments on rounds. My friend Kanchi tells me that she is shocked when she sees an attending care about a patient. I realize that I cannot remember the last time I saw someone care. We talk about what it means to “care” versus “to care.” We wonder whether we have reduced an emotion to a task on a checklist.
November – I feel numb during a lecture on cultural sensitivity, something that had been my Kool-Aid of choice during study abroad in college. I scrub. I tie knots. I call my grandparents on my way home. I fall asleep on the phone with my boyfriend. I wake up and do it all again.
Six and a half months into my third year of medical school, I watch myself change and change back and change again. It depends on the day, it depends on my environment, and it depends on the feedback I get from the people who know me the best.
When “caring for” patients will eventually be my job, I want that job to fulfill me in a way that lets me best “care about” those that I love—something that I am finding to be most valuable to me over the years. I have yet to understand the difference between types of “care,” but I’m keeping my eyes open.