I never understood the appeal of people who liked to be “low key” or exist under the radar. As a lifelong social butterfly, the spotlight was always a more natural setting for me. I thrived in environments where I was visible, putting my skills on open display and receiving opportunities to grow, whether through praise and encouragement or constructive feedback.
However, there were, at times, circumstances where I had finite say in my visibility. My innate ability to deafen an audience with my singing meant that playing the lead role in my sixth grade production of Grease was not in the cards. Despite my best efforts to strain my vocal cords into the correct pitch, I was relegated to the role of Marty. While this role did have a musical number, the number did not involve singing. For the first time, I struggled with the inability to use what I felt to be my greatest asset. Until this point, I had perceived my voice as a tool that helped me reach my goals, not a limiting factor. I was not used to remaining silent, nor was I used to playing a secondary role. Needless to say, I was not a fan of either one.
I wanted to minimize how often I encountered this feeling, so I did my best to immerse myself in settings where I knew I had ample opportunities to be a vocal and visible leader. This led me to appreciate medicine, as I saw the way a physician’s role was like the quarterback of a football team: leading a coordinated effort to carry out the playbook of care, anticipating unforeseen circumstances and facilitating a recovery when the outcomes seem bleak. As a natural extrovert, my loquacious nature inclined me toward the idea of a career built on talking to people all day. My relentless determination and outgoing nature made my career choice easy. I knew that becoming a physician would give me the platform to grow into the leader that I aspired to be.
My understanding of the reality of pursuing a career as a physician was shattered when I started my third year of medical school. When I entered the double doors of the hospital, I was no longer the main character of my day. Instead, my attending’s patients became the highest priority and feedback transitioned to how I could improve to better serve them. Further, as the person with the least training in the room, my presence was frequently less relevant to the delivery of care. I was there as a physician’s shadow: observing, absorbing and documenting behind the scenes. At times, I even followed them a little too closely – without thought – straight into the bathroom. I had spent the last two years thriving in the light of didactic education, but now I was subjected to the exact thing that I had worked all these years to avoid: working in the shadows.
This disquieting feeling was particularly exaggerated on my surgery rotation. Entering the operating room felt like what I imagine babies feel as they acclimate to the newness of the world. I was awed by the bright light, overwhelmed by the rules and etiquette of the space and scared but simultaneously enthralled by the new opportunities I was getting. If I had felt that I was in the shadows on the wards, working in the OR felt as though I was existing in the dark.
The last time I had been in the OR was as a patient rather than a member of the medical team. I had to undergo surgery during the height of the COVID-19 pandemic. At the time, patients’ family members or loved ones could not sit with them until they were being wheeled into surgery. On the morning of my surgery, I was dropped off at the hospital doors to navigate the uncertainty and fear on my own. With how busy everyone seemed and my own desire to not be a burden, I kept these feelings to myself. I tried my best to remain stoic despite my overwhelming stress manifesting as stress eczema, or “streszema” as I like to call it. I was rolled back, woken up and wheeled out of the hospital alone.
Now armed with the perspective of both patient and medical staff, I was more cognizant of the non-verbal communication that patients made with their eyes and gestures as they were laid on the operating table. I was particularly attuned to these cues on my pediatric surgery rotation, where some of my littlest patients openly expressed their fears through cries and others concealed them with stiffened bodies and silence. I could hear the echoes of their thoughts through their watering eyes and grimaces saying “I’m scared,” “I wish my mom was here” and “what is happening right now?”
With the luxury of experience on my side, I saw an opportunity to step into the role of a person that I needed when I was the one on the operating table. Instead of settling into the role of a passive bystander there to learn by way of observation, I volunteered to be a more active player on the team. I asked about their lives and hobbies to distract them, played a Bluey or Baby Shark video while they were getting acclimated and held their hand as they were induced and extubated. I hoped that these actions communicated sentiments like “everything is okay,” “we care for you” and “you are not alone” to our patients, while silently communicating to my team “I am happy to help however I can.”
In my initial months as a shadow while on rotations, I felt stripped of my power when my voice did not have a place or carry weight in my environment. What I did not realize is that this abrupt change forced me into a position that broadened and honed my skills of observation, advocacy and non-verbal communication. My perspective shifted from seeing my voice as the only way to share my thoughts to understanding that a thoughtful gesture can hold the same power to communicate, comfort and support.
For me, being a shadow is no longer a limitation but a superpower.
Image credit: In the shadows (CC BY-NC-ND 2.0) by Salfaro94
Contributing Writer
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Rachel is a third year medical student at Florida International University in Miami, FL class of 2025. In 2020, she graduated from University of California, San Diego with a Bachelor of Science general biology and Bachelor of Arts in global health. In 2021, she graduated from the University of California, San Diego with a Master's of arts in global health. She enjoys reading, collecting sneakers, and going to the beach in her free time. After graduating medical school, Rachel would like to pursue a career in Surgery.