First year of medical school:
Don’t remember much.
MD/PhD students, you know what I mean.
Learned how to use a stethoscope.
Second year of medical school:
Everything a blur except
Step 1 introduced me to my friends
melatonin, Benadryl, Ambien
And my best friend
Lunesta.
Third year of medical school:
First clerkship: Ambulatory.
First time I saw a patient by myself!
It took an hour and a half!
Attending happy?
Attending not happy.
Second clerkship: Neurology.
Oh Neuro.
So hard to “localize” my feelings about neuro.
Where is the lesion, Thomas? My attending would ask.
Because that’s very important!
Right…
Third clerkship: Pediatrics.
First time I made a patient cry.
Also the first time a patient made me cry
Actually no, just kidding.
Fourth clerkship: Internal medicine.
I matched into IM.
Enough said.
I am going to skip OB/GYN and Psych.
Seventh clerkship: Surgery
A surprisingly enjoyable clerkship
But maybe that’s because I did ophthalmology.
Just kidding. Surgery was fantastic.
Until the day I stepped on the suction cord.
Emergency medicine:
Where I learned chest pain = troponin, EKG, CXR, D-dimer, CBC, CMP, U/A, LE Doppler, abdominal U/S, troponin
Oh, and of course CTPE
Anesthesia:
For some reason I was always paired with the same resident.
She only had two weeks left before she finished residency,
So of course her favorite thing to say to me, every morning, was:
“Oh, Thomas, I can’t. I can’t. I can’t.”
And then I tell her,
“You can you can you can.”
But what I was really thinking was,
“We can’t, we can’t, we can’t.”
Time out from medical school, research year:
Wow! Look at this graph! It’s looking good!
P value? 0.06.
F**k!
All of my mice died.
I can’t, I can’t, I can’t.
Longitudinal primary care clinic:
First patient of the night!
Just going over her problem list on EPIC, I saw the following:
Asthma, HTN, HLD, morbid obesity (saw that coming), pain in LLE, GERD, depression (easy, SSRI), Diabetes type 1.5 (what?), rheumatic mitral stenosis (uh oh)
And that was only the first patient of the night! And her EPIC problem list.
Plus, she checked in at 4 p.m. for a 6 p.m. appointment.
And she’s scheduled to see me for a good, solid 15 minutes.
O.M.G.
Fourth and last year of medical school:
Beginning of my medicine sub-internship:
On my IM sub-I. I got a page! From the care coordinator, whew.
I got another page, from a nurse, saying “come to pt room N.O.W.” I grabbed my stethoscope and ran to the patient, whom I was cross-covering for the night, and whom I did not know and had never met. Nurse was now telling me, patient was blue in the face, and desatted to the 70s.
O.M.G.
The respiratory therapist was also in the room, and as soon as she saw me, she said “Patient is okay now, I gave her NTS.”
Now, I didn’t know what NTS was, but I knew it saved the patient. So I didn’t ask any questions.
I went up to the patient, and pretended to listen to her lungs even though I had no idea what I was doing or what had just happened.
Fast forward to the end of my sub-I:
I got a page. It was from a nurse. “Ms. M is not looking well, she’s very somnolent,” it says. I ran to my patient Ms. M. She had severe CHF and COPD and she was barely responding to me.
O.M.G.
But this time I knew what to do. I called my senior.
I suggested that we get an ABG immediately to check for CO2 retention which I suspected was causing her somnolence.
(Okay, I suggested a VBG and my senior said no and told me to get an ABG, but that’s not the point).
The point is, the ABG confirmed severe CO2 retention, and we treated that by transferring her to the MICU.
Towards the end of my sub-I, on that day, I thought I could do this.
I could be a good doctor.
Soon I will be sitting at Commencement,
Having traveled the long road from a mild dork
To a Medical Doctor.
To all of my amazing classmates and
The incredible, persevering medical students
About to graduate from all over the country,
Who simply refuse to not take another exam
I am going to say to you all,
We can, we can, we can.
Contributing Writer
Yale School of Medicine
Thomas is a fourth year medical student at Yale. He graduated from Columbia University in 2011 majoring in philosophy and after that taught English in rural France for a year. He will be an internal medicine intern at Stanford. He loves fantasy/science fiction and creative writing. His super far-fetched dream is to write a fantasy novel one day.