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Transitioning to the Clinical Years: Be A Duck

“Be a duck,” became my mantra throughout medical school, so much so that my mother had it printed onto a canvas and has it hanging on a wall at home in my honor. As a medical student you might think I would be more interested in having the prowess of a lioness, the elegance of an eagle, the speed of a cheetah or the energy of a dolphin. A duck, as most envision it, does not have much appeal; except, however, when swimming. The quote that led me to emulate the duck is Michael Caine’s, “Be a duck, remain calm on the surface and paddle like the dickens underneath.”

Just picture the creature, awkward as it may be, waddling alongside a pond, but once in the water, gliding on the surface. Submerge your view into the pond to see the intensity of its counter-current circulation powering those legs back and forth, propelling the duck forward. The act appears so different with this change of perspective. As a new third year student I “waddled” into my first rotation and after a few months, both patients and mentors complimented my glide.

On my medicine rotation during third year, my team was paged to the emergency department for an admission.

To give some context, as you may be new to this, oftentimes (in my limited experience) when the inpatient team is paged to the ED for an admission, the resident reviews a long checklist of questions in the electronic medical record while the medical student whizzes through history-taking. Only then do they two-step out to have the medical student present the case to the attending physician with occasional interjections from the resident. Finally, the attending engages in a brief conversation with the patient to review either party’s unanswered questions and discuss the plan. The reset button is tapped and it starts all over again for the next patient. A great duck, my attending in this story, trained me with a different method.

We arrived in the ED, the patient’s name tickling my mind. The attending quickly recognized the patient as an elderly woman with a complex rheumatologic disease whom we’d cared for a few weeks prior. He entered the room with the team and gave a hearty hello with a proper handshake and reintroductions. Rather than starting with the classic, “What brings you in today?” he began with questions I had not heard before, “Are you comfortable, dear? Warm enough? Would you like an extra blanket? Can we get you something to drink?” With her response he rose from his chair and left the room. I quickly followed him, trailing behind his abrupt departure, and in a moment we returned with a blanket and a beverage for our patient. She was grateful, after hours in the ED, to be warm with quenched thirst before beginning our conversation.

This is merely a glimpse into this attending’s approach. What he exemplified, and I hope to emulate, was that he was gliding on the surface as he engaged patients, staff and trainees, but paddled furiously to generate differentials, complete paperwork on time, work on systems improvement, follow up on cases, stay current with literature, teach and more. He also believed, as I always have, that some of the earliest lessons learned in life are some of the greatest lessons to learn in medicine; that is: to remember the manners your mother taught you.

Treat everyone with respect, be friendly and approachable, bring positive energy, get to know your support staff and nurses and genuinely greet those who clean the linens, transport your patients or bring them food. Every single individual at the hospital is essential to patient care. The more friends you have in a hospital, the better equipped you will be to serve your patients — and the more people who will help you learn to glide through this incredibly complex and overwhelming system. Do all of this while calm on the surface, but paddle like the dickens underneath: study hard, exercise, eat well, map out concepts, prepare for rounds, do your assignments, be there for your loved ones and cherish your classmates. Your short white coat is a symbol for everyone to know that you are a novice and that you are working hard to stay vertical some days, never mind become the brightest clinician you can be. Be like a duck, but don’t frazzle your feathers.

Vivienne Meljen Vivienne Meljen (3 Posts)

Contributing Writer

The Geisel School of Medicine at Dartmouth

Vivienne T. Meljen is a fourth-year medical student at the Geisel School of Medicine at Dartmouth ('17) and a graduate of The University of Scranton ('13). She will soon be beginning her residency in Obstetrics and Gynecology at Duke University Medical Center. She is a 2013 Truman Scholar and National Health Service Corps Scholar interested in working with medically underserved populations. Vivienne first learned about Narrative Medicine through an English course in college and is taking strides to begin to share her stories. She takes pride in her education and work as a physician-to-be as well as spending time with her family and enjoying outdoor action sports any time of year and anywhere. Follow her on Twitter: @StethoscopeOn