The words by now flow off my tongue. “I’m Sarab, the fourth-year medical student” comes off in a rhythmic flow without a second thought. My position is comfortable, even simple. I am expected to be there, participate to some degree and occasionally know the right answer — I am, after all, a fourth-year post-match medical student. Having acquired a degree of medical proficiency, much of clinical work has become routine by now. So, like any good post-match fourth-year, I zone out during rounds, disappear for hours at a time and do my own thing — it’s not like anyone is depending on me. Gotta love play time.
I’ve been playing doctor for quite awhile. The thrill of wearing a white coat has subsided as the white coat has become progressively less white. I’ve been seeing patients, examining them, making plans and presenting for almost two years now and it’s all second nature. I look, think, plan and suggest. Other people watch over it and agree. I’ve done, too — and done lots. I’ve done central lines, chest tubes, intubations and more rectal exams than I’d ever want to admit. I’m part of a generation of almost physicians who will be among the best trained in history: steeped in evidence-based medicine, imbibed with humanism and passing ever more challenging standardized tests. However, my 10,000-plus clinical hours and my 15,000-plus basic science hours seem to be playtime in light of the reality that in 17 days, I’ll be the doctor.
A few months ago, I was confident that I was ready to be done — to be ‘The Doctor’ and to do it for real. Sometimes these days, I wonder if I am ready, as I consider all the things I’ve forgotten, the things I haven’t learned and how much rides on each little decision I made. Suddenly, the easy decisions I made months earlier, dosing morphine for a patient with gallstones, ordering a CT without contrast for appendicitis or deciding how to sugar-tong splint a particularly large wrist, were landmines waiting to explode.
The complacency and comfort of my current position only adds fear to the change that is to come. In a few short days, I’ll be putting an MD after my name. In a few short days, I won’t be the ignorant medical student — I’ll be the ignorant physician.
When people told me in third year and the first half of fourth year that I was playing doctor, I sputtered with rage. My identity, my beliefs and my life’s work were under threat so I responded with all the eloquence I could muster about the hard work and sacrifices we endure as medical students. I waxed poetic about how I counseled family members (with my resident in the room), did small procedures (under close supervision) and sometimes outshone the resident (during a pimping session half missed due to constant pages). Now, despite all that experience and training, I feel slight nausea and fear as I consider where I’ll be in 17 days. I’ll be doing much of the same I did as a medical student, except with the responsibility (and greater autonomy) of the resident physician.
I’ve played doctor and dreamed about the day I get to be one for a long time. In 17 days, I won’t be playing anymore. And that’s terrifying.
The Fourth-Year Faux-cisian deals with the trenches of medicine, the dirty details and the inglorious scut, as well as with the sublime and transcendent moments. The posts I write are about medicine, humanism, life, philosophy, and most of all the ruminations of a young doctor-to-be as he embarks upon the transformative journey of becoming a physician while attempting to hold onto his humanity.