FIRE & ICE
It has been a very long and difficult two months friends, and it feels so good to finally be able to sit and reflect on it. I try so hard not to write retrospectively about long periods to preserve details and raw emotion, but internal medicine demanded every part of me and then some. I have to say again and again, thank you to everyone that has ever taken even a moment to click on this site, read any piece, follow updates on social media, and/or reach out to me with comments, encouragement, or questions. I’ll never forget what it felt like to finally make this outlet real and any response or interaction from you keeps me inspired, uplifted and aware of why I’ve always wanted to do this… why I needed to do this.
So thank you, thank you, thank you!!!
I’ve been struggling to figure out exactly what in the last two months I’d really like to share… what I feel I need to share for me and what could be useful/beneficial to others. So much happened to me, around me and in front of me and I want to communicate it clearly & hopefully a little more orderly than some of my other emotional reflections, haha. If you’ve seen my last update on social media, then you know the Internal Medicine clerkship was as amazing as it was stressful. It was fire & ice, baby. It was the ultimate obstacle and the ultimate prize.
For anyone that is curious about what exactly we do on the Internal Medicine rotation, here is a quick rundown: IM (internal medicine) is general medicine, full body medicine. These are your “hospital stay” doctors, your critical care (ICU) doctors, and your specialists (heart doctor, GI doctor, neurologist, kidney doctor etc.)… So regarding medical students, this is where I got my first real opportunity to practice “doctoring”. We took on patients that we were expected to follow, know the ins and outs of their story, complaints, and care plan…as well as write their notes. It was real responsibility & accountability for people, and it was incredible to finally be involved in that way.
Now, let’s see where to begin…. Most of the more dynamic experiences happened a month into the rotation. But briefly I’ll tell you the best thing about the first few weeks and that was my first patient. It was the beginning, so I was still figuring out exactly what I needed to do and how, but I had decided I was going to take point on Mr.H’s care. I couldn’t have asked for a better introduction into this rotation, a better individual to learn from not just medically but generally. His condition and his care took many leaps, turns detours during his stay which kept me on my toes academically…but also emotionally. This was an elderly man that was and had been healthy all his life until this visit. He was witty, charming, talkative, curious and incredibly polite. I had the privilege and pleasure of getting to know him and the majority of his family while attending to his health. I reported to his wife and other concerned relatives as often as I could with updates and explanations and did my best to look into any questions they had. I’m very grateful for that experience and it just further fueled my love for geriatric care.
[I don’t think I’ve written much or anything about that, so for those who don’t know… geriatric healthcare is a major passion of mine, an area of healthcare I want to be able to impact/contribute to. But I’ll dive into that another time.]
Fast forward some….
I enjoyed my rotation overall. I really did. I was very fortunate in the residents I worked and learned with. That being said, a part of the learning, any learning experience is about recognizing both the things you admire/like/want to practice AND things you do not. As a student, the moments in which you find yourself uncomfortable or downright upset are WORTH CONTEMPLATING, WORTH REFLECTING ON, WORTH COMMUNICATING. One of the hardest things to witness is a doctor allow their own cynicism to alter how they both DISCUSS AND TREAT patients.
There were multiple instances where I listened to jokes being made about patients regarding why they came to the hospital and their circumstances, judgments about their character and habits… I watched this happen in meetings. I watched it happen an inch away from the patient’s open door. It’s absolutely unacceptable. The weakest, most vulnerable among us come to the hospital. I don’t care if you have face tattoos. I don’t care if you shoot up every day. I don’t care if this is your fiftieth visit. I don’t have any business invalidating your current visit on sight. That is not my job. I also have no business openly disrespecting or making fun of your condition. Also NOT MY JOB. Quality care stops as soon as you allow stereotypes, stigmas, and even certain medical statistics to rule out your own compassion and efforts. Historically, people in the greatest need, those in capable of advocating for themselves…the mentally/physically handicapped, the addicts, the poor, those with criminal history, immigrants, the elderly, and more have been treated so poorly. Yes, stereotypes and social stigmas exist but they CAN’T have a place in healthcare. They can’t dictate the diligence and commitment with which a physician practices healthcare.
There is too much authority and trust placed in that title and an increased amount of vulnerability in the whatever situation brings someone to your clinic or hospital in the first place. I had a lot of practice holding my composure in rooms where these sort of conversations happened. This is one of many issues I’ve had but definitely one of the most bothersome and also one of the most prevalent. And there is a great impact experiencing things like this has. You remember more in most instances the negative experiences, the things you don’t want to do or be. I never want to use someone’s current condition or circumstance as an excuse to make predictions about their character or future, and then use those predictions and judgments as an excuse to care less.
Internal Medicine surprised me. It surprised me by being exactly everything I thought it would be, everything I believed were reasons I wouldn’t like it, fit in or do well enough in it… BUT also being such a valuable and intriguing experience. It was the most I’ve learned, the most challenged I’ve been, the most anxious I’ve been, and the most interested/engaged I’ve been. Truth time… I’ve never thought of myself as the kind of smart that internal medicine seems to require or that the people in it are. I know I’m not dumb but I have academic insecurities just like I have physical ones… and I just never saw myself being good in this arena or feeling good about it. I was fully prepared to try my hardest in this rotation, struggle through it, and not really think about it again. What happened instead, was the opposite. The difficulty and demanding nature of the information and skills I needed to learn (and practice) fueled the greatest stress/anxiety I’ve ever known AND the greatest determination to know it and use it for the patients I was following.
Having the opportunity to see patients and have a say in their care made me want to know anything and everything I could to give them the best care and advocacy. I was practicing being the kind of doctor I want to be while learning more about how to be that doctor. After seeing a few patients of my own, I found myself wanting to really master the skills and info more and more, wanting to really consider practicing this kind of medicine. The residents I worked with were incredible. They let me take on as much as I wanted and thought I could handle, they listened and taught, and were so encouraging. I have my favorite few attendings, each who practiced in very unique ways but I found such valuable habits in each of them that I want & hope to incorporate. I did two weeks in Rheumatology for a subspecialty and had the best time. I learned so much and am still reading immunology and rheumatology books. It was so interesting and the doctor I worked with was not only a great teacher/eager to teach, but funny and compassionate.
Despite enjoying this rotation, the physicians, the learning, the patients, these last 8 weeks were spent worrying a lot. The last 3 weeks were especially hard on mentally and physically. I was so nervous about the assessments and the exam at the end and not my usual healthy “I care” anxiety. It was a distracting amount of anxiety, enough to make studying or reviewing difficult. It was strange and uncomfortable. I was losing sleep in the last week leading to the test. I can’t say for sure if it was rational or irrational. All I know is that it was real.
And what I’m about to say may not be for everyone, but it’s the truth, my truth. There was a lot of “me things” that were neglected or took a back seat to this rotation, writing, exercise, my faith… I did not have relief from my anxiety until I remembered God. I was wide awake on the verge of a panic attack at the time I told myself I’d be going to bed, the night before the big exam. I texted my mom and she sent me two scriptures and some loving words. I mediated on those scriptures…saying them out loud over and over, breathing deeply and slowly to bring my heart rate down. Then I prayed. One prayer, an honest and vulnerable request for peace and rest, and I went to bed..
I don’t know how things went yet… but I know I did the best I could. I was a little shaken when it was over, but I had and have peace. Even more now that I am home with my family and my fur babies. No matter what, I earned this break…No matter what, I am where I’m supposed to be pursuing my dream…No matter what God is good.
The holidays are here, friends. I am so thankful for you, thankful for your support and patience. You are loved, significant, worthy and capable of following your dreams. Please hold on to your passions and joy. Always share your love and truths. Never forget your purpose, what you’re grateful for, or how to be human. Continue to be uplifted & uplift others. Happy holidays!
The Third Voice