I came across a photo on social media of some classmates that appeared almost identical to another one I had seen months ago — beaming medical students crowded together against a brick wall of a campus apartment. Déjà vu. But there was one difference. Nearly all the students in this picture were white, whereas all the students in the older picture were non-white.
The dispatcher called in to the emergency department (ED) to alert us that someone had collapsed in the parking lot of the hospital. The emergency medical services swiftly brought the patient in and our team surrounded him, placing lines and drawing blood. In the midst of treating him, I learned that Jones* had just been released from prison where he had remained sober after years of heroin abuse.
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.
For better or worse, I have always partaken in escapism in one form or another. “Escapism,” defined as the practice of avoiding a difficult reality by immersing oneself in distraction or entertainment, is a concept that rose in popularity in the 1930s as a natural reaction to the Great Depression of the previous decade. Although I did not know it at the time, I have been practicing escapism since 2000 BC (before COVID). As the eldest daughter of immigrants who were new to the continent and busy building a life from scratch, I would get lost in stories from a very young age. I had little in the way of friends and even less of an interest in being popular, so naturally I was drawn to books to fill that emotional void; novels were the way to my heart — fantasy and fiction, oh my!
On July 27, 2020, I began the first day of orientation week at the Medical College of Georgia (MCG). After over four years of living in Atlanta, the initial 25-minute drive from home to school threw me back to my high school days of having to wake up at six o’clock in the morning. The entire first week was a bit of a blur, and I do not remember much aside from getting my stethoscope and helping draft a class oath.
Presenteeism does not simply exist for seasoned providers; it seeps down the medical training pipeline and perhaps poses the greatest threat to trainees at the start of their careers. The fear of missing out as the “beginner on the team” can be paralyzing when there is so much important knowledge beyond us. Such pressure persists longitudinally, too, as trainees at every level fear that taking time off will appear as a lack of dedication to clinical education or will result in lower performance evaluations.
To understand the issue surrounding assessments, we must understand that it has become increasingly challenging to train physicians suited to face contemporary changes. To future physicians who have access to a repository of ever-expanding information on their smartphones, being tested on ‘high-yield’ minutia serves little purpose. Being able to think critically (and perhaps even imaginatively) in order to make sense of that information for patient care is what counts. And thus, no matter how standardized an examination is, lack of contextual reference renders it futile.
We have seen our classmates’ faces, memorized each other’s hometowns and politely chuckled at every “fun fact” introduction despite having heard it countless times. Some of us have admitted to writing down random facts about others as we hear them, hoping to review them later and somehow kindle more profound relationships than the pandemic naturally allows. We virtually contact each other later with a random sentiment trying to relate to someone’s favorite sports team or vacation place.
Improvement is at the core of who physicians are. If we do not strive to be better versions of ourselves, then we are doing a disservice to our patients who deserve good care. However, in order for medical students and physicians to pursue such a lifelong career of learning, we need to decidedly put aside this idea that we can ever be “perfect.” Medical professionals can never be, as Merriam-Webster defines the word, “entirely without fault or defect.”
Having a family, for some of us, is also non-negotiable. We want to be moms, and we have the right to pursue more than just medicine. So let us flip the script in our mind. Our mindset should not be a question: “Can I have a baby during my training?” Instead, let us decide, “I will have a baby during my training, and this is how.” Own it. Do not apologize for it.
None of us pictured beginning medical school in a pandemic. Most of us are still in shock we were admitted to medical school owing to severe imposter syndrome. Despite the exceedingly virtual nature of the fall semester — as of now, our only in-person activities are optional anatomy labs — we have hitherto made the most of this experience. Undeterred by the inability to partake in many in-person activities as a class, we are fostering meaningful relationships with our peers online and in person.
A few years ago, I found CrossFit. Since then, I have spent a large share of my free time training and improving my health and fitness. As with any sport, there was a large learning curve. However, as I trained, my mind and body adapted. I made strides both athletically and mentally that I never thought were possible. I never imagined that this preparation and development would translate to a seemingly opposing task: medical school.