30 June 2013

The Luckiest

I wrote this in the middle of my fourth year of medical school, before taking a year off to go to New York for an MFA in poetry.

August 2011

It’s said in many ways.
Absence makes the heart grow fonder.
Nostalgia in looking back.
Selective memory.
And, per Ben Folds, “The Luckiest.”

This usually refers to, I think, people/place/thing. Certainly people. Certainly place. Time period. Self at a different stage of life.

It’s not usually used in reference to career.

It’s now been three days since I was an active medical student.
And I miss it. A significant lot.

I can’t wait to be a doctor.

Before I started med school, I couldn’t believe how lucky I was to get to go to medical school. I’ve had a lot of privilege in my life. This is one of the greatest, most amazing, most incredulous ones.
What I’ve done, what I’m doing, what I will be doing.
I was let into this hallowed profession – in some places, hallowed, darkened halls – in which I get to learn all about the body. Get to. And I get to interact with people in the most intimate way, at their most vulnerable – they trust me, let me in. I have to earn that trust.
Starting, and before starting, I didn’t understand that sacred trust. It’s something I continue to learn, every day. And I am amazed.

After a day with patients, last week – any day – I left the hospital exhilarated. Exhausted. Beaten down, burnt out at times. But exhilarated.
I will have no days this amazing as a writer. Or as anything else.
I am unbelievably, incredibly lucky. I get to do this. They let me in.

When I graduate from medical school, I will have been thinking about becoming a doctor for about 17 years.

I am the luckiest.

When I hear about people studying for the MCAT, my first question – reaction – is why. It’s partly that I’m still not sure if I would do this again; there are other things I could have been very happy doing, and I wouldn’t have known, exactly, what becoming a physician means. Why. This is too damn hard if you don’t love it. Too hard. Not worth it. Become a lawyer, go into business, science, anything, anything, anything that is intellectually challenging/prestigious/hard/will make you money. Whatever the motivation is. This is too much work if you don’t love what you’re doing.

Perhaps I’m already nostalgic, but that’s why it’s important to write this now – so I remember, have it to read again, on the inevitable terrible days and nights.

get to be a physician. I get to have patients.

When doing procedures that are uncomfortable/ painful. . . I give patients license to do whatever they want. Whatever helps, I say. Swearing. Call me names, I say – it’s nothing I haven’t heard before. And it won’t hurt my feelings - promise. It’s definitely not personal. You can talk on the phone. Whatever. . . If I’m holding a patient’s hand during a procedure that someone else is performing, I joke about breaking my hand. Go ahead, I say.

The unbelievable, unbelievable, incredible privilege.

It began with cadavers.
No, before that. It began with getting in. Before that. The opportunity to do pre-med at a ‘very good’ university, with a lot of support, and enough liberty to really have time to focus on classes. Which goes back to high school, etc.

I was in the school bookstore today and I almost started tearing up, looking at the stethoscopes. Mine is coming with me to writing school. It’s part of me, at this point – it’s an extension of my ears, another way to augment my senses. And it hangs so naturally around my neck that I once picked up someone else’s stethoscope – same color – thinking it was mine, and didn’t notice I was wearing two until someone pointed it out.

I get to have a stethoscope. Mine. I get to listen to the inside of the body. And with this training, I learn to interpret what I hear. Sounds and silences. The natural unwinding of this caduceus. At one point, I thought I’d lost it – left it in a clinic, somewhere. (I know people who have lost them/had them stolen). And it wasn’t just the frustration/annoyance of having to spend money on another one.

It was the thought of losing mine. I can keep this one for the rest of my career. I’ve gotten to know it. In mine, there are still a few grains of sand around the bell from the time I put it in a bag I’d just taken to the beach…
If I don’t use it, as a writer, it’ll hang on the wall.

The early med students walk around in clean white coats (I remember being told that was how we were recognizable), and the stethoscopes look a little awkward. The scrubs are almost a status thing, at that point – a little bit in awe of getting to wear them. (Getting to). And now… well, nothing used in that context stays white, and bleach barely works. The stethoscope that I used to wind carefully into a little bag, the one my sphygmomanometer (blood pressure cuff) came in – now goes around my neck, winds into a pocket, gets dropped into my bag. It isn’t fragile. And it’s mine.

I get to be a doctor.

I can’t imagine any job as incredible as this one.

This morning, talking about this with a med school friend –I, starry-eyed, was waxing poetic. I know it. And I’m trying to not forget the hours of exhaustion, “scut” (busy + mundane + worse at times) work, being grilled on the spot and judged on absolutely everything you do in a day, subjectively. And being graded just on that. And test scores. I got into this business for my patients. I want to be a good doctor for my patients. That’s the point and it comes back to that, it should always come down to that.

No matter what else is going on in the day – getting yelled at by an attending for something out of your control that you had no idea about – you get to be alone in a room with a patient. I do. And there are the patients who scream and throw things (more often, on psychiatry). There are the patients whose affects are so disturbing that you really hope the drug test comes back positive, to give you an explanation…There are the patients perseverating on things you really don’t need to know about and you have limited time and the story isn’t making sense and they’re ranting about things in the clinic or the health care system or life in general that are out of your control but they’re somehow being put on you. . .
There’s that.

There isn’t anything that doesn’t happen.
There isn’t a person, or a “type” of person, who doesn’t get sick and need to go to the doctor at some point. (Or they show up in the county hospital ER, or they need primary care but are marginally housed. . .) Or needs primary care/preventative medicine, which is generally not covered at all.

In the room with a patient, I am focused on that patient, and – the point is what the point is. I want to be a good doctor for my patients. And that’s most of what I have to think about, in those moments. That’s what I’m doing.

And I do it every day. Now, it could be a dozen times in a day. Different people, different stories, different ways lives are affected by the exact same pathophysiologic disease. But I have to do something different. The treatment might be the same, the procedure might be the same, but the way in which I approach it, talk about it, take time explaining (or not, as patient preference dictates) changes. The way I sit. The way I talk. What I talk about. Tone, volume, rhythm, posture, eye contact/facial expression – it’s not an act, it’s a mirror, and it’s finding how to be what your patient needs in that moment. Learning how to do that. You’re not changing yourself – you’re accessing all of yourself in different ways. You use the patient’s language and metaphors.
And then there is the science, some of which is supposed to become second nature. Pattern recognition and understanding the underlying conditions, the physiology, what is going on in this body at this time.

I get to do all of this.

I am trusted by the physicians around me – my colleagues –  and by my patients. I get to go in, alone, and do all of this. And it’s the trust on both sides that helps me need to do it right, or as “right” as I can with the training I have.

There are the times I’m frustrated with the thing (or the patient). The vein is rolling or they have no veins left… the cervix is wayyy anterior and it’s hard to find/access. The tonsils are large and obstructing the intubation. The heart sounds are muffled. The patient will not get the concept of taking a deep breath (“in through your mouth, out through your mouth). And I still have difficulty (a lot) finding the optic disk…

For now, I get to take time as a writer – a writer who misses medicine and patients and remains involved, in ways –

But I still can’t imagine a job as good as this one (perspective).
There are days I left my internal medicine clinic almost skipping across the parking lot. My patient’s blood pressure was better. Another one’s insomnia was improving. Another was seriously keeping track of his blood sugars. Another brought his three-year-old in to meet me (not all the same day).

My job. My future job, my future, and the present/future job of so many wonderful people I know. We – no, they – no, we – are going to be incredible doctors for these patients, because that’s the “why” in this privileged position.

Lucky, lucky patients?

Luckiest – us.


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