Monthly Archives: July 2025

The Process of Learning Medicine Works

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I started my last year of residency on July 1, 2025. In the doctorhood quest, the days pass slowly while the years pass quickly. As time marches onward, I sometimes forget how far I’ve journeyed on my own doctorhood quest until an experience reminds me of where I’ve been.

This July I was reminded of where I’ve been when I had the opportunity to work with new third-year medical students. The third year of medical school is when future doctors start their clinical training – in other words, they leave the library and the classroom to enter the clinic and hospital. The third year of medical is a dramatic transition from learning theory to applying it.

I surprised myself this July as I answered third-year medical student question after question. No question was too hard – I could either answer by reaching into my mind or by easily referencing the resources I’ve come to consider my external brain. Not only did the answers come easily but so did the process. It was once hard for me to sort through patient data and make sense of it. It isn’t anymore. Work that felt overwhelming years ago – reviewing data, seeing patients, writing notes, and pitching medical ideas – is now second nature. Of course, I don’t know everything there is to know about medicine. I never will, which is one reason I love medicine. But, these days, it’s easy to identify gaps in my knowledge and easier to know where to find the answer. I know when to ask a colleague vs. ask a specialist vs. look the answer up myself.

I was a third-year medical student about 4 years ago. Now I supervise medical students of all levels. When I coach my students on how to improve the way they present patient information in verbal and written form, I’m reminded of how these things once were hard for me. As I help students review a new consult or a new admission, their questions and hesitancies remind me that I too once had the same uncertainties. These days when I work with medical students, it’s obvious to me that the process of learning medicine (student, then resident, then independent doctor) works. My own experience is a testament to that. I can’t wait to see what medical knowledge and healthcare wherewithal I’ll have after another 4 years of being a doctor. Stay tuned.

The Bitterness of Slow Declines

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They were miserable. It was obvious from the silence they kept as their spouse explained everything that had happened since our previous appointment. It was obvious from the frown on their face and the apathy in their voice. It was obvious because no matter how many things I mentioned that I knew they liked, they didn’t smile or brighten once.

They weren’t excited about their new hearing aids which enabled them to hear birds again. In fact, they often didn’t bother turning the hearing aids on, per their spouse’s report. They were afraid to go outside for fear of falling. They couldn’t change a lightbulb because they felt weak and dizzy.

They had once been the person everyone in the family relied on to fix things. They had once been the advice giver. They had once been able to keep up with even the most social of butterflies. They had once been independent – free to run errands and tend their lawn without supervision. And now, they were none of those things.

The patient had tried therapy. We were always optimizing their medical conditions to keep them as healthy and functional as possible. The thought of starting another medication to help with depression was suffocating for both the patient and I because they were already on many medications. What was left?

Everyone who lives a long time eventually slows down. Some slow down and then die before developing medical problems that cause them to visit doctors and hospitals often. Others find that their social calendars fill with doctors’ appointments. Either way, or somewhere in-between, the transition from independent and fast to reliant and slow is hard. It’s an identity shift and a lifestyle change. The bitterness of slow declines is that they don’t ask permission. The body marches along, making changes that upend everything that came before, without giving time for the person undergoing the changes to accept or adjust to them.

I knew the patient was suffering and, yet, I didn’t have much to offer. I wanted to see the patient through this phase. Was it the last phase of their life? Probably. How long would this phase last? It could last days, or it could last years. It was impossible to tell. Almost the only thing I could do was acknowledge their misery. Call it what it was. I referred them to doctors who specialize in caring for the elderly. Perhaps those doctors had a secret for helping this patient. I hoped they did. Perhaps it was a secret I, too, would uncover.

At the very least, I stood witness. I knew who the patient was and who they had been. I acknowledged their struggle. At that appointment and the previous and the next, I listened to my patient for no other reason than to ensure that they felt heard. Listening wouldn’t change their situation, but sometimes the only thing I can offer as a doctor is a listening ear. And sometimes, that’s enough to help my patients make it through until our next appointment. Occasionally, it’s enough to make my patients feel better. Such situations remind me that medicine isn’t always about medicine, sometimes it’s about being human.

Spying on Birds

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A flash of color. A movement out at the edge of my peripheral vision. A song so sweet it lingers in the mind after it’s done. These are the taunts of the birds as I try to spot them. Brown. Gray. Yellow. White. Black. Sometimes bright colors. Blue. Green. Red. Orange.

Birding, the act of watching birds, can be passive or active. In the passive form one simply observes birds that flit or swore on the path of one’s normal travels. In the active form the purpose is to see birds, discover their hiding places, and learn their names.

Growing up my mom liked birds and knew the names of most of the ones we saw in our rural home. My mom’s side of the family was a bird-loving side. As such, bird names – blue jay, cardinal, chickadee, hairy woodpecker, osprey, red-tailed hawk, wood duck, mallard, etc. – were part of my normal vocabulary. Just like, I imagine, brands or celebrities’ names were part of the vocabulary of other children. I didn’t know it was unique to know birds by name until I moved away for college. There I found myself on an urban campus where I wasn’t convinced that some of my colleagues could identify a live chicken.

Life unfolded. I stayed urban for a time. Then I moved abroad where there was too much to learn to also learn new birds. And then the doctorhood quest took off like an ultramarathon – slow and steady but always busy in its own way. Fast forward. I found myself in Virginia. Virginia and Vermont share many birds. And some of the birds Vermont sees only in the summer Virginia sees at other times of year. As I wandered the forest and wetland trails on my days off from residency, I started to notice the birds again. Somehow, having spent 10 years learning other things and more than that away from my childhood home, the birds I knew as a child resurfaced. Old knowledge was not lost despite filling my brain with an additional zillion factoids on medicine and the human body. Birds. I still know the song of the hermit thrush – Vermont’s state bird. I remembered the nuthatch and the tufted titmouse.

I have a good partnership. My spouse likes to take pictures of birds and I’m good at spotting them. My binoculars are my superpower. The only challenge is that when one starts actively spying on birds it’s hard to stop. My spouse and I now seek out birds on our vacations. I find myself toiling over bird books and using Merlin Bird ID.

Birding escalates. It starts with just trying to see birds. Then it’s about naming them. Then it’s about finding rare birds and memorizing new bird names. A harmless pastime. Another excuse to be outside. Another reason to love wild places. Another reason to also learn about the trees and plants that birds, themselves, adore. What fun it is to go on a walk and be able to name the birds, trees, and plants I see. Almost everyone used to be able to do that. Now it’s a dying art. Funny how the world changes. It’s never too late to circle back on the knowledge we once had. It’s never too late to learn something new. Just ask the birds migrating on ancestral routes and adapting to new cityscapes. They’re experts in learning.