Water usually glistens off skin; yet, here the droplets formed a dull cascade till they hit the pewter metal of the exam table. Nothing seems to shimmer in the morgue. The body, freshly washed, showed mottled skin with hues of deep purple and black. The superficial layers of skin were retracting upon themselves into cylindrical whirls. I felt the stench of the putrefying corpse weave its way through my hair and burrow into my pores. I held my breath till my vision dimmed providing myself with just enough oxygen to function. I locked my knees to avoid collapsing.
I bent my torso forward almost to the point of bowing; my feet refused to move any closer. Upon careful inspection, I noticed several tattoos. There was tattooed script hidden amid a ribbon design where the ink was seeping beyond the lettering on the left arm. Along with the mottling of the skin, the tattoo was all but illegible. Eager to prove myself valuable to the forensic pathologist, I slowly made out several of the letters of the first few words. My new puzzle distracted me from the ever-invading stench for a moment. After deciphering the first two words, the remainder of the quote flooded my thoughts: “I solemnly swear that I am up to no good.” It was the famous phrase used to activate the Marauder’s Map in the Harry Potter series. I became immobilized when I realized that this person was younger than me by several years when she died.
After gathering my thoughts, I moved to a dissection table adjacent to the cadaver, waiting for the forensic pathologist to pluck the enlarged gangrenous organs for dissection. I made serial cuts through each structure in order to identify any underlying pathology. The sights, smells and textures of decay bombarded me immediately overwhelming my senses. I allowed the adage known by most medical students — especially those in their clerkship years — to reverberate in my head. Fake it ’til you make it.
I pushed aside what invaded my senses minutes ago and ignored the beloved Harry Potter quote from my childhood. It felt for a moment as if a piece of my naïvety dissolved. I quickly changed out of my scrubs into more professional attire to meet with a surgical pathologist at a hospital in a neighboring county. Dousing myself with cologne to mask the scents of formalin and decaying flesh, I rushed to my car.
Despite my haste, the one-hour commute to the hospital consumed my lunch break. I laughed at the state of my car as I drove. It transformed from a means of transportation to a means of miscellaneous activity. It frequently served as a dining table for long commutes, as evidence by the plethora of food wrappers strewn across the floor. On other occasions, it morphed into an office, where data supplied by my phone allowed me to submit patients notes in the parking lot of hospitals when computers were not available. At times, this area has even been used as a bed, if fortunate enough, to steal a nap if I finished pre-rounding earlier than expected. I continued my day by examining slides under a microscope, driving, studying and preparing to restart this cycle the next day. All things considered, it was an enjoyable day.
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In the clerkship years of medical school, one is cast into a new environment roughly every four to six weeks. A new hospital or clinic, preceptor and possibly a different town. This relatively nomadic existence proves difficult for medical students to find their confidence, develop clinical skills or demonstrate some innate proficiency in order to impress their preceptors for the sake of their end-of-rotation evaluations. During these years, medical students often go through so much, often in silence. They deny themselves a great deal to perform at this level. The aforementioned story of my pathology rotation was ultimately a great day. No one yelled at me, berated me or placed me in an awkward situation; yet, I actively suppressed my emotions and dehumanized my work by refusing to identify the corpse as a teenage girl. My meals were quick and held nearly zero nutritional value, and I made no attempts to exercise. I also did not attempt to contact or socialize with family and friends. Worst of all, I planned to repeat this cycle with no intention of change.
In medical school, there are days that are much worse, when students are torn down and overcome with fears of their own inadequacies. On days like these, the mantra fake it ’til you make it is playing on high volume mentally. These stitched-together words are supposed to provide senses of strength and reassurance. To some extent, they do deliver this. Acknowledging the ubiquity of this adage gives perspective that someone likely more proficient and knowledgeable was once in a similar position; yet, these small moments of uttering this cliché builds, and the toxicity of this repetitiveness starts to manifest. These words reinforce a constant avoidance of medical students’ experiences and denial of their emotions. In some ways, it makes them less human.
To deny parts of one’s humanity in the beginning is simple. Unfortunately, the long-term effects are insidious. Medical students gladly find themselves in a rut and willing to repeat the same charges against their physical and mental health. With time, they realize that this mode of survival has completely affected their demeanor. At this point, preceptors, who they were once so eager to impress, ask if they are from strict military families or members of military due to their extreme stoical presentation.
In these moments when I recognize the pervasiveness of my survival tactics and dearth of my humanity, I grieve. Trapped in the anger stage of grief, I blame the culture of medicine, medical education and ornery educators. For an instant, I recite a modified axiom from a quote by Madeleine Albright, former Secretary of State: “There is a special place in hell for women who do not help other women.” However, I replace the word “women” with “physicians” or “medical staff.” The mere utterance of these words is like an ember drifting from a fire representing a small dissolution of my rage.
Medicine is a sacrifice. I knew this upon admittance into medical school. I did not know the sacrifice would be an erosion of my humanity. In what seems to be a constantly abrasive environment, it is hard to find time to process how an event may have caused an effect. It can be even harder to find time for what I once thought were necessities before medical school, such as sleep, food and sharing moments with loved ones. Acknowledging this in the constant motion of the clerkship years, I wish to end my rant with a sparkle of advice from the gleam of an experienced perspective: Nothing seems to shimmer in medical school.
Image credit: “And How and Why They Died” (CC BY-NC 2.0) by Thomas Hawk
Contributing Writer
Florida State University College of Medicine
Matthew is currently a fourth year medical student at FSU. His submitted content is narrative medicine describing the experiences of himself and his peers. Matthew continues to explore writing while hoping that his unbridled perspective will promote an internal sense of validity among his readers.