Tag Archives: Medicine

Hey Doctor!

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I got in the hospital elevator. One person was already in it – a maintenance guy by his uniform and the fact that he had a ladder in hand. Before I’d decided if I was going to say “hello,” he declared joyfully “Hey doctor!”

I glanced down at my badged (“doctor” was written on it in capitalized black letters on a yellow background larger than anything else on the badge). I looked around the elevator…yep just me and him…he was definitely talking to me. I said, “Hi!”

“Did you have to look at your badge?” he asked in a voice cracked in the way voices are when a laugh is bubbling up. We both burst into laughter.

I’ve been a practicing doctor for 5 weeks. While I feel ready and excited to be a doctor, the title is still new and I’m learning the role. Some patients and non-doctors take the title seriously and some don’t; however, when you ARE a medical doctor, the title comes with some weight as you know exactly what responsibility is behind it.

As part of my residency training, I work in a primary care clinic where I have a group of patients for whom I’m their sole primary care doctor for the duration of my residency. This means I’ll see them when they have a new issue and I’ll also manage their health maintenance. Primary care is about tackling health challenges before they become health issues and preventing people from experiencing life-threatening events and worsening health if possible. It’s arguably the most important part of the healthcare system even though it gets the least recognition, compensation, and emphasis in our corporate/profit-focused US healthcare system.

My first week as a primary care doctor I ordered a cholesterol panel (a blood test) for one of my patients. They had obesity and chronic pain. They hadn’t had their cholesterol checked before and at their age and BMI (body mass index) I wanted to see if we needed to start a cholesterol-lowering medication to reduce their risk of heart disease. During our appointment, the patient and I had a lovely conversation about their life and the changes they’d made to improve their health. I was inspired by them because it was clear that they were motivated and dedicated to their health – they had made diet changes and were finding ways to fit exercise into their routine despite having housing insecurity and struggling to make ends meet. 

The cholesterol panel came back several hours after the patient’s appointment had ended. I looked at the numbers and panicked. How do I interpret these numbers? I asked myself. This patient was relying on me to evaluate their lab results and provide recommendations on lifestyle and medication use. It was a big burden. I read some medical resources then, based on what I read, decided that their cholesterol was okay given their other heart risk factors. They didn’t need to start a new medication. I sent them a letter with the normal result.

Even after I sent the patient a letter about their cholesterol, panic lingered in my toes. Had I interpreted the results correctly? Would I need to call them back and tell them I was wrong, and we needed to do something different? Had a missed an opportunity to help them protect their heart?

Over the next week I researched more about cholesterol panels and then talked to my supervising doctor about the topic. In the end, I confirmed that I had made the right decision for this patient. I also learned there is a calculator I should use to determine patients’ risk of heart disease and the benefit of starting a cholesterol-lowering medication.

Soon interpreting cholesterol panels will be easy and fast. But the first time I did it for a real patient (a real person) was exciting and nerve-wracking. Just like being called “doctor” in the elevator this week required a little extra processing to realize that I was the doctor being referenced. I know I won’t have to check my badge for much longer to confirm my profession. I’m excited to grow into the person who can respond without pause to “hey doctor!”

This Is How I Started Residency

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Starting residency was like a flash flood. Beginning from the first day, I was overtaken with more work than I knew what to do with. As a new doctor in a new healthcare system, I found myself equally challenged by creating care plans for my patients (like deciding which medications to prescribe them) and implementing the plans my supervising doctors and I devised (like ordering medications in the computer system). I completed tasks more slowly than I imagined possible. My patients were well cared for because I was part of a team, but my work hours lengthened in a way that the saying “burn the candle on both ends” was created to describe.

All of us headed to residency (regardless of specialty) are warned that it will be challenging. Each person experiences different challenges and different low points. Residency is hard for everyone because the hours are long and there’s a lot to learn. So, when my work hours exploded like water through a broken dam, I wasn’t surprised. I was surprised by how my program responded.

As my hours lengthened to a point where I was exhausted and just barely surviving, my chief residents stepped in to help me develop ways to become more efficient. Senior residents observed me throughout a shift and offered advice on how I could streamline my workflow. People on my team and other teams helped take some tasks off my plate so I could focus on learning the computer system better and on writing patient care notes quicker. I was given a little extra time off to catch up on sleep because I was on track to work far more hours than permitted by the national governing body that oversees US residency programs.

At first the extra help and attention made me feel like a failure. I tried to keep my spirits up because I’ve struggled to overcome big obstacles before; I always learned more from those experiences than I did from experiences where I didn’t struggle. Similarly, past experiences have shown me that it’s okay to accept help. Still, I wondered if I was going to learn enough or as quickly as I should if people helped me more than some of my peers. I wondered if I’d get better at being a doctor.

On my extra time off I reviewed my senior residents’ feedback. I reorganized my view of the electronic health record system to make it easier to access all the information I knew was important. I took time to recharge. When I returned to work, I was still a new doctor. I hadn’t changed much from the days prior. Yet, I found myself checking things off my to-do list without the help I’d required before my recharge day. With a little more sleep behind me, I was able to see how much I’d learned in my previous days of working – something I hadn’t noticed when I was exhausted.

As I reflect on my first two weeks of residency, I don’t look at them fondly. I do think that I’m a tiny bit better at being a doctor now than I was two weeks ago. I appreciate my past self for prioritizing a work culture of support and collaboration when applying to residency. I know that there are many hard days to come before residency is over. However, my experience during these first weeks made me confident that I will be able to overcome future hard patches when they come – not completely alone, instead, with a program supporting me as I find my path forward. Feeling like my residency program genuinely wants to help me become the best physician I can be gives me confidence in the residency training process and makes me excited for who I’ll become by the end of it.

This is how I started residency. The future will tell how I end residency.

Bones on the Trail

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Each year, July 1st is the infamous day when new doctors who just graduated from medical school (called “interns”) start taking care of patients for the first time as physicians. This year I’m among these new doctors. It’ a momentous day for the interns because it’s a huge milestone and a huge transition. Some words that come to mind in anticipation of the experience are “excited,” “terrified,” “happy,” and “ready.”

I’ve been mulling over what I think about starting residency. As I’ve reflected, a story from a hike I did in New Mexico came to mind. I think it captures my mixed feelings of starting this phase of the Doctorhood Quest.

New Mexico, June, 30, 2021

My partner and I arrived at our lodging place in the late afternoon so we had just enough time for a short hike but not so much time that we could dillydally. We looked up some nearby trailheads and settled on one just down the road. We were staying in a flat valley lined by near mountains on one side and far-off mountains on the other. It was spring so even though there was no mistaking that we were deep within the New Mexico desert, the shrubs were as green as they could be. The cactuses were blooming.

We started off walking across the flat valley floor following a road through the shrubs. We stopped often to take pictures of the desert flowers that lined our path and kept a lookout for elk because there were many in the area. We laughed and joked and chatted as we often do when hiking. Our mood ranged from jolly to ecstatic. The beige and browns of the dirt and rocks contrasted against the blue sky; sage-green shrubs and cactuses; and yellows, pinks, reds, and purples of the flowers.

The road neared the bottom of the mountains and narrowed to a wide footpath. We didn’t know the trail, but we had a GPS map and a general sense of the trail’s course. We were timing ourselves to ensure we turned around with time to get back to our car before complete darkness. We knew before starting that we wouldn’t be able summit if we wanted to be home by sunset. It was our first hike together in New Mexico, the western US states, and mountain lion country.

We wanted to have fun while also exercising caution. We’d learn later that trip exactly how scary things can be in the big mountains, but that would be a lesson learned on a different hike. We were experienced hikers, but we’d primarily hiked in New England and never in the western US (except as children under our parents’ watchful eye). The short mountains of the northeast are different beasts than the giants of the US west.

As the trail narrowed, we entered the woods and left behind the shrubs and flowers of the open desert. We soon crossed a small stream. There, on the far side of the stream was an elk carcass in the middle of the trail – it was mostly skeleton, almost picked clean. We paused and became quiet. The bones were a reminder that there were big predators in these woods. We debated if we should continue and decided we would. We stayed loud and watched our surroundings more carefully than before. We were especially attentive to our timing and made sure we got back to our car before darkness fell.

We had the skills and knowledge foundation to successfully complete the hike. The difference was the terrain and responsibility/higher stakes that came with a more complex hiking environment. Hiking in new, more intense territory isn’t such a bad analogy to becoming a resident after being a student – just like with hiking, as a resident I’ll draw on previous skills and knowledge as I take on more responsibility and learn more about my craft.

Yes, I Can

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I listened to a song about a job interview that went poorly on repeat while I struggled to complete a new workout that I’d written for myself that day. Perhaps the song about the interview resonated with me because I was in my own transition or, perhaps, I just liked the beat. The workout would have been easy for certain versions of my past self. However, recently I’d led a life that didn’t involve intense workouts like this one and, so, the workout was challenging me. “Back to the beginning,” I thought.

I couldn’t ignore the metaphor of my physical fitness and learning medicine because the parallel captured the sentiment I’d been hoping to write about as a reflection of what, exactly, medical school had been like in a broad sense. I’ve had a few months between finishing my medical school classes and starting residency. It’s been a time of celebration and doing things I didn’t have time for during school and won’t have time for during residency. I’ve also taken time to reflect on my medical school experience. “What exactly was the utility of medical school?” I’ve asked myself often during these months of the happy stillness between.

You can guess what medical school was like on a superficial level – it was school. I spent hours studying and hours listening to people instruct me on all kinds of things. I spent more hours practicing skills as varied as suturing cuts shut in the operating room to writing patient medical notes. I attended lectures, engaged in simulated patient interactions, and I worked with real patients and physicians in real hospitals and clinics. I took written exams of various lengths that were proctored by various organizations. Through these actions I learned how the body works and breaks and how we try to make bodies function better with medications and interventions like surgery.

Yet, while learning about the body and how to improve health was the backbone of my medical school learning, it wasn’t the heart of it. The heart of medical school was the exercise of continually starting at the bottom, a place of not knowing much, and climbing to some place of better understanding. Medical school is a lot like the process of doing a hard workout after not working out for a long time and being unable to finish it, then engaging in a few weeks of intent and thoughtful exercise, and finally being able to do the original workout and more.

Medical school taught me that I can learn anything with time and effort. The hardest concepts can be cracked. The first year, I struggled to understand how the body worked. The second year, I expanded my knowledge from how the body worked to how it can go wrong and what we can do about it. Then, years three and four, I learned more about how different specialties in medicine address different diseases and injuries. Each year built on the year prior and then expanded beyond what I knew to things I didn’t yet know. Each time the curriculum expanded I felt like I was starting over. Much like starting in the beginner exercise class and working my way to the advanced class…repeatedly.

I bet you’ve had the experience of riding the rollercoaster of being excellent then falling to subpar and then, through sheer will, climbing to a place of excellence again. And if you have experience doing that in any area of life, then you can imagine what medical school is like. Because it’s just like that. Every month or so you start at the bottom of one area of medicine and climb to the top just to fall again and start the process all over in a different area of medicine.

Medical school is an exercise in being mediocre with a drive to be extraordinary. Each lesson helps move your personal dial from mediocre to better, but there’s a catch. Medicine is founded in science and research and, as such, it’s forever expanding and changing as we (humans) learn more. And so, there is no possible way to ever know everything. To be a physician is to be forever learning while also mastering the knowledge that you explored before. There is no end to medicine, no time when you can’t get better.

Medical school taught me that I can learn anything while I can’t know everything. It taught me not to be intimidated by an obviously hard road, but to take it one step at a time just like I take my plank exercises after a long time not engaging my core. Medical school taught me that experts are built with time and effort. It also taught me that experts remain humble and equally aware of the things they know and the things they don’t know. Medical school taught me that I can do whatever it is I choose to do if I’m willing to put in the effort. The heart of medical school for me was learning that when faced with a challenge to think “yes, I can” instead of “maybe it’ll work out.”

What do you want to be when you grow up?

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“What do you want to be when you grow up?” one of my Paraguayan friends, who used to be my student, asked during my last visit to Paraguay.

I paused a moment before answering. I was surprised by the question because he and I don’t often talk about abstract things and because I’ve been feeling awfully grown up recently. “A doctor,” I said.

“That’s it? You don’t want to be a diplomat or someone rich or famous?” my friend asked.

“Nope,” I said.

“Oh, that’s cool,” my friend said. The conversation continued as I asked him about what he wanted to be when he grew up and we discussed more details of what I hope to do as a doctor.

I graduated from medical school on May 21, 2023. I received my resident medical license yesterday. I’m officially an MD! All that remains between me and practicing independently as a physician is residency (and fellowship if I further specialize).

People like to say “it’s hard to believe” when they achieve a particularly hard goal like graduating from medical school. But, let me tell you the truth, I don’t find it hard to believe that I graduated medical school. Why? Because I was there every minute that I studied at my desk and learned how to care for patients in the clinic and hospital. I read every test question and picked an answer. I showed up on time, managed my email inbox, pestered school administrators to get answers, and did voluntary projects to expand my learning beyond the medical school curriculum.

Becoming a MD is a lot of work; I did the work to earn my degree. Becoming an MD is also an amazing quest. I was excited when my patients were cured, I was humbled that so many people allowed me to take part in their journey to death or to better health, and I loved uncovering the mysteries of how the body works and what medicine can do. I’m grateful for every person who helped me along the way – from my family who cheered me on to the patients who let me care for them, from my classmates who struggled and soared beside me to the numerous physicians who taught me. I did the work, but becoming an MD takes a village. There were many people in my village who were my heroes and who guided and supported me as I journeyed through medical school.

The last months of medical school left me feeling awfully grown up. Grown up in the tiring kind of way. My friend’s question helped remind me how much growing is left. And how, somehow, I’m lucky enough to be growing while building my dream. Next stop on the Doctorhood Quest, residency!   

6 Pieces of Advice for Just-Starting Third Year Medical Students

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Now that I know where I’m headed for residency and recently worked with some just-starting 3rd year medical students as a teaching assistant, I feel ready to offer a few practices that helped me through my 3rd and 4th years of medical school. Years 3-4 of medical school are clinical practice years and years 1-2 are academic years, so the transition between the 2nd and 3rd year is challenging for most students.

My survival tidbits aren’t profound, but survival isn’t that profound either.

In no particular order:

  1. Use a sunrise light alarm clock. You’ll be surprised how waking to light transforms even the grimmest before-sunrise wakeups.
  2. Have a pump-up song and listen to it as you arrive at the hospital each morning. Switch up the song as frequently (or infrequently) as needed to ensure it helps you put on your game face…every…single…time…you…enter…the…hospital.
  3. Work hard, do all your work and beyond, and then strive to leave if you aren’t needed. Of course, only leave if you’re done with your work and it won’t compromise your grade or learning. I call this practicing self-dismissal. You’ll have plenty of time to be in the hospital at all hours during residency and at least you’ll be meagerly paid then, so go home when you’re done during medical school.
  4. Fight for moments to eat if they aren’t given. Try to eat all the food groups, just like you teach your patients to do. I know eating properly seems impossible at times, but anemia and other diet doldrums will make learning harder.
  5. Periodically take a moment to remember why you went into medicine in the first place – it can be a literal moment. This is most important during those periods when you aren’t sure you will survive. You will survive and there’s a reason you went to medical school so try to remember it.
  6. During the busiest rotations you can’t sleep enough, see friends, exercise enough, and study… so pick the two most important ones each busy rotation. It doesn’t have to be the same two each rotation. Know that there are slower rotations where you can do all these things, but sometimes you simply can’t have it all.

That’s it. You got this.

Waiting Impatiently

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The gray of New England spring hung low as I traveled home from the airport. In short time, March would deliver the snow-rain I know the month for in the region where I grew up. I learned that the cold and gray, which can span 9 months out of the year here, was not for me when I left New England the first time. I stayed away for almost a decade until a desire deeper than my love of sun brought back to the state my parents chose for us so long ago, Vermont. I wanted to become a doctor. Medical school takes a forest of strong trees by your side – it takes a lot of willpower on your part coupled with family and friends to complete. Something made me pause when my medical school acceptances gave me the option to leave New England again. I didn’t leave then, choosing to stay close to my parents, my siblings, and my new Vermont friends. My compromise was a plan to move to southern New England, Connecticut, for the second half of medical school because my school had a clinical campus there and it suited me better than their Vermont campus.

I think the choice to stay close to family worked. As I write this, I’m waiting impatiently because in a few long days I learn where I’m headed for residency and, unless I’m gravely mistaken, I’ll leave New England once again. As a side adventure during the Doctorhood Quest, I scooped up a New England-grown husband. I often wonder if understanding the winters here is an important thing he and I have in common or if it’s just everything else that makes us a good match. I’ve also gotten to see my parents and sister more during medical school than in the almost decade leading up to it. I have good friends who saw me through the worst days as a medical student. I’ve come to call my Connecticut town home, even if the designation is fleeting.

This March’s late rain and snow squall isn’t unique to this region at this time of year – though it would seem other places where snow is unusual are getting slammed, weather patterns are becoming more and more confusing as climate change forges on. And while my roots are familiar with the snow and the cold, a few days ago I returned from 7 weeks in Puerto Rico so the coldness and gray is particularly unpleasant this week. It stands out to me how miserable March is here as I look out my window over my flowering orchids and assorted houseplants, many of which grow as weeds in Puerto Rico. It was at the ripe age of 18 that I learned how much I love the sun and living in sunny places even though I require sunblock, shade trees, hats, and other sun protection to enjoy the sun without turning into a lobster.

On Monday this week, I and many medical students across the country found out we matched into residency. And now, in a typical medical school approach of drawing things out longer than is reasonable and with no efficiency and minimal logic, we are all waiting until Friday until we learn the magic WHERE we matched. The day we learn where we will go for residency is called Match Day. Transitioning from medical school to residency is a boring process that makes little sense, so don’t ask about it. Just know that this week is moving at half the speed of any other week these past 4 years and that my excitement for Friday’s discovery is exploding. My excitement even makes the cold and gray outside acceptable though not welcome. Residency is the next and the last phase of the Doctorhood Quest before I am a doctor. I could, of course, continue onto fellowship after residency but that would be to further specialize. Residency will give me the skills needed to practice as an independent generalist in internal medicine (in my case, those pursuing other medical paths might finish residency as surgeons, psychiatrists, or neurologists to name a few areas of medicine that can start after residency).

I’m excited for what’s to come. I made a picture frame for taking pictures at my Match Day party with “Adventure Awaits!!!” written on it. Perhaps you get the Up reference. The picture frame is a party feature that’s a throwback to my Paraguay days. Paraguayans know how to throw a good party. At my Match Day party, there will be an ice cream cake, food, a banner, and streamers. And, of course, I’ll celebrate with my family. I’ve been working towards this day, the day I get into residency, for 10 years. It’s hard to believe I’m here, but it feels real. I can’t wait for it to be Friday, March 17 aka Match Day 2023.

I Don’t Think That Thought Process Means What You Think It Means*

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One day on rounds (the time when physicians, residents, and students discuss the day’s plan for each patient they’re caring for) I commented on a patient’s amazing carpenter veins (colloquial term for veins on the back of the forearm which tend to be prominent in people who work with their hands). Having once put in IVs for a living, it’s hard to shake my deep appreciation for a good vein when I see one. The physician leading the team and a resident both stopped and asked, “What do you know about carpenters?” They asked this as if I couldn’t possibly know anything about people who are carpenters. It was a joking question which is common in medicine when calling out someone’s knowledge gap.

I was completely dumbstruck by their assertion that I couldn’t have interacted with many carpenters in my life. After a long pause, I mumbled something about having put in IVs as part of my work before medical school where I had many carpenter patients with these veins. I was confused because sometimes I forgot that many people assume all med students have no experience outside of university classrooms and have doctor parents, or at least white-collar parents. If I had been less taken aback, I would have told them I know a lot about carpenters in a happy, matter-of-fact tone.

My father is a carpenter. My stepfather and mother don’t call themselves carpenters but they both do a lot of carpentry as part of their regular lives and as part of their work. I, myself, have helped build houses, furniture, and theater sets. In fact, one of the more memorable childhood photos of me depicts an elementary-aged me hammering a bolt into some floor beams. In double fact, my first work was in carpentry helping my parents build our house and working on paid building projects. Which is to say, short of being a carpenter, I feel confident calling myself an expert in what the life of a carpenter is like (without even mentioning all the carpenters I’ve cared for as patients since I started working in healthcare as an EMT years before medical school).

As humans we make many assumptions because it helps us organize the world – for better or for worse. Physicians are trained to come to quick conclusions and identify disease patterns almost as quickly as their patients decide if they like their new doctor or not. This is why your doctor will often only ask four questions before they decide how to investigate your knee pain – their experience has taught them how best to understand medical situations and make a strategy for those situations in a 15-minute appointment. Obviously, there are many medical situations where more than 4 questions are needed, but I say this as an example of how physicians are trained to make even more assumptions than the average person already does.

Often, the assumptions physicians make about medical symptoms are helpful because they lead to quick recognition of life-threatening medical conditions so they can be addressed in time to save someone’s life or allow the physician to develop a reasonable method for exploring the situation further in the confines of an overburdened, short-for-time system like the US medical system. But, as we all hopefully know, assumptions are dangerous when they come to making conclusions about whole persons. Note the difference between assumptions about symptoms versus about people. It’s assumptions about people that lead to biases.

It’s assumptions that play a role in the dark side of healthcare – like black people having their pain undertreated or receiving inferior medical treatment and transpeople receiving poor medical care (Google these if you want to know more, there’s plenty of data. There are also numerous other examples of disparities in health stemming from biases and assumptions about people).

Now, the assumption that I, a medical student, hadn’t interacted with carpenters before was erroneous on the part of my supervising physician and resident, but it doesn’t compare to disparities in care secondary to biases and assumptions. I brought those up in the previous paragraph to illustrate some of the ways assumptions infiltrate medicine beyond what I experienced and beyond their helpfulness in identifying diseases quickly.

What my situation does show is that the mental picture that many people in the US (including physicians themselves) have of who US doctors are is a bit out-of-date. There was a time when almost all doctors were white men, and many were from doctor families. And, today, the percentage of white male physicians is still greater than the percentage of white males in the population. And, separate category, there are still many medical students who have doctor parents or white-collar parents. Yet, while this is true, it is also true that things have changed a lot in medicine.

Today, there are more women than men enrolled in US medical schools. There is also a growing contingency of doctors and medical students who aren’t Caucasian (check out this article). There is also a growing percentage of medical students who will be the first doctors in their families (check out this article and this data)

There was a time when most physicians became physicians without ever leaving school – they’d pass from high school to college to medical school to residency. Today, the average age of people starting medical school is 24, which means that they took 1-2 years off from school somewhere along the pipeline. And that’s the average, meaning a significant portion of people starting medical school are older than 24; people like me, I was 29.

All this is to say that who medical students are now is different from what most of our older patients and seasoned physicians have seen most of their lives. For example, as the carpenter story suggests, my teaching physicians thought I was naiver than I am and had a different background than I do. As a different example, as a female medical student my older patients (mostly the men) think I’m a nurse. I find this particularly ironic and amusing because my husband is a nurse; he has no interest in being a doctor and he is a far better nurse than I ever would or could be given my nature.

Looking at the modern world of medicine and the medical world we want for our future, it’s time to check our assumptions about medical students and reevaluate who they are because their backgrounds may surprise you. And to disclose one of my biases, I think the diversifying of the physician force is awesome and, perhaps more doomsday, the only way we’ll solve many of the medical profession’s problems.

*Attempted The Princess Bride reference, not sorry because Inigo Montoya summarizes my thoughts more often than I would like to admit

Remembering

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I don’t remember them because their case was sad, though it was. Nor do I remember them because their case was complex or unique. I remember them because they were a DJ even though they were well beyond middle age. Who knew you could be a DJ when you were that old? Well, I learned after meeting them that you could be.

I learned of their DJ career when I met them briefly after their first stroke. The stroke was thrombotic (caused by a clot that blocked a blood vessel in the brain). Their balance was severely affected, but they were doing well, despite the stroke. There was no way to predict if they’d get their coordination back, but there was hope that they would recover if they made it past the first couple of days after their first stroke without another stroke. There’s the highest risk of another stroke in the days following a stroke.

When I saw them days later, they were not well. Their stroke had converted from thrombotic to hemorrhagic (caused by bleeding in the brain) and they could no longer speak, had limited movement, and were unaware of the world. I was struck by their deterioration. Lost in my reflection on how much the patient had changed and who they were before their brain filled with blood, I included the fact that they were a DJ in my report to the physician supervising me. I think the physician was looking for a focused medical history, but I slipped in the patient’s profession anyway. The physician teaching me paused and then said, “It’s good to get to know something about your patients as people.” It was the physician’s way of giving me positive feedback, but I found myself thinking, that would seem to go without saying.

As I continue my training, I’ve come to understand why this physician pointed out the importance of knowing patients as people: It’s easy to only ask questions related to diagnosis when you’re crunched for time and are actively thinking about what next tests, exams, medications, and treatments you should do to help the patient with their medical concern. Which is to say, the more responsibilities I have as an aspiring physician, the harder it becomes to emphasize getting to know patients beyond their medical conditions.

And, yet, when I do and can learn a tidbit about people’s lives (pets, careers, grandchildren, or whatever they bring up about their life), I’m always grateful I did. Grateful because it helps me remember each patient’s story and because it reminds me why I do medicine in the first place – to help people.

Medicine is awesome because uncovering diseases and making treatment plans involves solving complex puzzles. But the coolness of solving medical challenges is not enough to get me through all the terrible aspects of working in healthcare. My patients do keep me coming back even after the worst days on the job. Even though our interactions are brief, my patients and I have the potential to learn and achieve so much together. And, without a doubt, every patient is a person with an amazing story that I’m excited to hear a tiny bit about.

The “seasoned” DJ will never be a DJ again. This makes me even more glad that my last memory of them included them as a DJ, not just an ICU (intensive care unit) patient with a likely life-ending stroke. I think they’d have preferred to be remembered as a DJ (something they were very proud of) rather than a sick person. I know, if I were dying in the hospital, I’d want the last people to see me to know something about who I had been before I got sick.

Back In the Operating Room

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The patient was undergoing emergency surgery for an aortic dissection (when blood gets between the layers of an artery wall) with an aneurysm (dilation/ballooning out). The aorta is the largest artery in the body. It comes off the top of the heart and then travels through the chest and abdomen until it splits into two big arteries that feed the legs. It has many branches along its path. Because this patient’s dissection and aneurysm were close to their heart, without surgery the dissection could spread and damage their heart. Further, if the aneurysm wasn’t fixed and then ruptured, the patient would likely bleed to death.

Conducting this surgery was one surgeon and one physician’s assistant (PA); they were supported by an anesthesiologist, a resident anesthesiologist, 3-5 nurses, and 1-3 surgical techs. Surgeries are always a team effort. This surgery was complicated, the stakes were high, and bad outcomes were more likely than for many other surgeries (but without surgery death was almost certain). For the first 6 or so hours of the surgery the surgeon and PA worked without a break – no water, no bathroom, and no food. After the most time-sensitive part of the surgery was done, the surgeon sipped some water through a straw that a nurse carefully threaded behind his mask. The nurse joked that he was like a gerbil – no one argued with that analogy.

In all, the surgery would take about 11 hours. As the surgeon was finishing up his work, he looked around the room and thanked each person there for their help. He then looked up at me. I’d been watching the surgery for the better part of 8 hours. “What are you? A resident?” the surgeon asked.

“No, a medical student,” I said.

“God bless you,” the surgeon said. He paused. “My son is a third-year resident. I tell him to remember that you’re not supposed to enjoy residency.” The surgeon paused again. “But I still say I would never have wanted to do anything else.”

This surgeon had started working as a surgeon at this hospital when I was 8 years old. Assuming he’d done about 8 years of training to become a cardiothoracic surgeon and that he’d spent his entire career at this one hospital, he’d been operating about as long as I’d been alive.

I reflected on his sense of fulfilment in being a surgeon. I wondered if I’d end up liking my path in medicine as much as he liked his. I wondered if it was possible to enjoy one’s path in medicine as much these days as it was when he started.

~

Medicine has changed a lot in the 30+ years I’ve been alive. We’ve made lots of amazing advancements, but health disparities remain staggering. Work conditions are variable hospital to hospital and clinic to clinic. I love medicine, but I can’t ignore how strained our healthcare system was before the COVID pandemic and how much worse it has become even after the COVID vaccine reached the US public. I also know that my path in medicine will be quite different than that of a surgeon.

I am pursuing a medical career that does not involve surgery or procedures and, therefore, is not a hospital money-maker in our current healthcare system. Money gives power even in healthcare, as such, I’ll neither have the high pay nor inherent influence on hospital administration that surgeons do. All physician roles have amazing components and are important for patient care however to say each physician’s place in the system is the same is not simplification, it’s erroneous. I’ve come to feel the differences between physician types more thoroughly as each new step of my doctorhood quest unfolds.

As I wrap up my time as a medical student, I’ve been reflecting on what I’ve learned and seen in healthcare so far and where I want to end up as a physician. As a student, I’ve seen more parts of the patient care system than I will in any other capacity during the doctorhood quest. I’ve participated in countless conversations throughout the inpatient and outpatient healthcare settings. I’ve been a fly on the wall for even more conversations than I’ve participated in. From insurance navigation nightmares to cool medical cases, from nurse-to-patient ratios to supply chain issues I’ve come to understand that healthcare is a complex group sport where the field and rules change based on geographic location (because of geography itself, demographic composition, and regional laws), insurance status, medical society guidelines, government funding, hospital and/or clinic revenue generation, supply chains, ability to hire healthcare professionals, and many other factors.

I start residency in about 6 months. At that point, I’ll continue to learn what I need to know to be an independent physician. After 3 years, I could graduate residency to work as a hospitalist or primary care physician or I could continue my training to further specialize. I’m excited and hopeful about these rapidly approaching adventures. I wonder what I’ll tell a medical student about my journey 30 years from now. I dream that my message will be as positive as this surgeon’s message was to me.