Throwback to Medical School Days

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A few days ago, my mother sent me a letter that I wrote to family and friends during my third year of medical school. I was 22 years old at the time and finishing up a rotation in general surgery. Reading this brought back memories.  I thought I'd share this old piece with you to offer a glimpse into the life of a medical student. 

“These past few weeks have been very enlightening. I’ve learned much about human kind, myself, and life. Surgery has been an interesting clerkship, not only because it’s been one of the most demanding, but also because it’s given me much insight into the world and culture of medicine.

Today, I spoke with Dr. D, the chief vascular resident on my general surgery rotation. She is currently in her last year of surgery residency. We chatted between seeing patients in clinic, and among the things we talked about, we talked about how an attending with a reputation for made a resident and a medical student cry the other day. She felt bad for both students and thought it was totally unnecessary for an attending to be so rude. She told me that she has changed a lot over the years in residency. Perhaps due to the heartless ways in which the people (esp those high in rank) have treated her, her colleagues, and patients. She has become jaded and trusts people less. She is less naïve about this world, she told me. This made me sad. For multiple reasons. First, it made me sad to think that others can be heartless and so emotionless to not care or be aware of other people’s feelings. Sure, they might be saving someone’s life by taking out an inflamed gallbladder or performing some other incredibly advanced surgical procedure. But if they have no heart, then what good does it really do? How can people be so selfish, heartless, and power hungry to feast off of naïve and caring people who are inspired to do good in this world? Do they realize that they are contributing to a jaded system??? The attending physician has a duty not only to his patients, but also to his students, and if he cannot perform both jobs well, he should choose just the one be does better.

My moral dilemma continues. I see myself torn between having a heart and becoming numb to the painful situations patients are in. Over the past few days, I’ve become attached to patients. I’ve seen them go through pain. I’ve seen a little girl die from being attacked by her own dog. I have seen an elderly man mangled by, not one, but two cars. I have seen the results of multiple acts of violence.

During my rotation, I have also seen incredible endovascular operations by very talented and experienced vascular surgeons. I have seen a 79 (!) year old lively, and happy man receive an incredibly complex and risky surgery, and survive! What an incredibly resilient man.

What does it take to be resilient like that? Does it take not taking things to heart too much? Or does it mean putting into life all the heart that you have?

Today, we washed a freshly amputated leg of a man who previously had necrotizing fasciitis. My duty was to hold his leg stump up so the resident could see the wound better. The patient was obviously experiencing severe phantom pain as we were washing him. My arms were sore from holding his leg stump in a weird position, and although I was trying to hold his leg up as gently as possible, I couldnt help but feel that I was contributing to his pain, and possibly doing more damage to his leg by putting so much pressure on it with my hands to keep it raised for the resident surgeon. Each scream that came from his mouth made me cringe.

I hurt with the patient. I hurt with the family. IS this a weakness? In a sense it is. It is not too much appreciated in the field of surgery, especially when it interferes with making rational decisions for the patient’s best interest. And I understand that. It makes sense. Surgeons are expected to be tough, stoic, and the surgeon who is able to be rational and non-emotional during a surgery will likely be competent. And most of the surgeons I’ve worked with are very kind to their patients, even though they do not become involved emotionally. Note: there is a big difference between being kind and becoming involved. Is becoming involved a weakness? On the other spectrum, at what point does stoicism become heartlessness? We, including the physician, are supposed to be human not robots.

With each day of medical school, I grow a little wiser. I hope to pass this wisdom on to others. At the same time, I hope to gain wisdom from the people I love, the people that I don’t feel like loving, the moments in which I am happy I am pursuing medicine, and the moments where I question whether I am meant for this career.

I hope this gives you a little insight into life as a med student…Although I haven’t had too much time to talk with you, I am thinking of you always, and am very blessed to have you all in my life. You inspire me to be better everyday!

Love, Anna”

 

As a ‘grown-up’ physician, I recognize the importance of stoicism, competence (even sometimes at the expense of emotions and feelings) and compassion. Often, ‘feeling’ too much can impede appropriate medical decisions that need to be made quickly and efficiently. Being a good doctor means exhibiting compassion for your patients, but also being their steady rock and not crumbling to pieces during moments of heartbreak.

I also understand the temptation to grow cynical with the pains of modern day health care (i.e., administrative pressures and frustrations). Our effectiveness as physicians requires that we exhibit strong emotional intelligence (which can keep (most) cynicism at bay) and that we have perfected our clinical skills through intense and often stressful training. It is also important that the physician regard patient care with utmost importance.

With the increasing awareness about physician burnout and suicide, it is also really important to address the current climate and direction of medicine - less physician autonomy and increasingly large, administratively top heavy medical institutions - which are leading to unhappy physicians (and therefore unhappy patients). If physicians continue to be dissatisfied, they will need to find a way to transform healthcare (even if that means abandoning the large, bureaucratic institutions, even when that is not considered an accepted or comfortable action to make) so that they can once again serve their patients (not administration) and regain their autonomy. I digress… I might post an article on this at another time.

Overall, I am happy I have made it through medical school, residency and fellowship, and I continue to feel privileged and honored to serve others at a time when they are most vulnerable.