The First Step

I want to write about what I think is the first big mistake I’ve made in medical school – that is to say, the first mistake that made me stand back and think, should I be doing something different? I’m not talking about mistakes like thinking I can study all of histo the morning before an exam, or setting my alarm to 6:30 PM instead of 6:30 AM. While those are certainly mistakes that I’ve made more than one time and should probably stop making, they’re not the kind that made me question whether I could be wrong about my approach to life in a broader sense.

It happened while I was shadowing one day. The patient (I’ll call her Mrs. B) was there with her husband, and they were both in their mid-30s. She was sitting in a wheelchair, with thin tubes coming out of her nostrils, connecting her lungs to the oxygen tank next to her. What struck me was how engaged she was in what the doctor was saying, and how many questions she asked about what was next. Mrs. B had a manila folder full of papers on her lap (I hate how papers fall out of those folders so easily), and would ruffle through them to point to specific items she had questions about. Every time she had to reorganize the papers in her hand, she would end up breathing heavily, her body already desperate for oxygen after the physical movement.

I have to explain that I really admire when somebody is passionate about something, whether it be my classmates discussing the research they’ll be doing over the summer, or my friends talking about how much they love to run, or even overhearing somebody raving about a new recipe they want to try. I just love seeing people light up when they talk about something they’re truly interested in, and often I get so absorbed in what they’re saying that at the end I realize I’ve contributed very little to the conversation.

Looking back, I really hope that I wasn’t just staring at Mrs. B as she talked, because I was so taken in by how lively and forward she was as a person while talking about a disease that was in the process of killing her. It was an honor for me, as a first year medical student who could only tell you where the lung was and not much else, to be able to stand quietly in a corner of the room and learn from a patient many times braver than I was. I had my hands behind my back and was struggling not to move a single inch, so as not to disturb the intense level of energy and trust that had been established in that room. I thought that if I even rolled my shoulders to get rid of the ache that was creeping in, the patient, her husband, and the physician would all look at me in dismay because I had accidentally reminded them that I was there.

But then, suddenly, I was acknowledged. Mrs. B’s husband turned to me and asked, as if I had been involved the entire time, “So do you have any questions for us? We’re both teachers, as you might be able to tell, and we know that the best way you can learn is to ask us questions.”

What an amazing pair of people! I was so surprised, and I felt embarrassed for some reason. So I said, “Oh, no, I’m really just here to learn by observing. But thank you so much!” I mentally kicked myself immediately then, and I mentally kick myself now as I write this. I want to really think about why I felt like I had done such a wrong thing, why I felt so sure that I had let everyone in the room down.

A week before this experience, I had been shadowing in Interventional Radiology, and the resident led me along a hallway with thick, glass windows on either side. The windows looked in on the operating rooms, and the resident pointed a rack of lead vests out to me. “Please feel free to put one on and enter the room. You can see the operations more clearly then, since we do smaller procedures that might be hard to see from out here.” I nodded enthusiastically and thanked him, and he left to do the important things that residents have to do. But in my head, I thought, no, I’ll stay in this hallway so I can see as many different kinds of operations as possible. There will be other opportunities where I can enter the room and learn about the procedures more in depth. During that time, I felt that I had acted reasonably, and that this was the best way that I, as a med student of less than half a year, could learn about different aspects of specialties.

However, with Mrs. B, I was once again on the other side of glass window, peering in. This time, it was one that I had constructed myself by saying no, thank you, to learning more about the patient’s experience when she had offered. I thought that I had been actively engaged in learning while standing there in the room with the physician as she spoke to her patients, and yet I was politely removed, carefully keeping a distance under the excuse that I didn’t know enough yet and was only observing. What sort of image would that leave the patients with? That here was a medical student observing them as if she were still sitting in a classroom, watching a video of a doctor speaking to patients, rather than being there in the room, in real life, finally learning from experience after all the work she had put in to get to this point.

Flash forward a few months. The first-year med students at my school recently went through a team-building exercise where we were assigned into groups of 7-8 people, and we were recorded while we discussed items we would want to bring with us on a stranded lifeboat. There were so many things to consider – should we prioritize navigation and attempt to reach land? Or would it be better to try to survive as long as possible until somebody found us? Anyway, during the discussion I loved listening to my groupmates bring up movies they’d watched (namely, Life of Pi) or books they’d read and past experiences they’d had that justified their opinions as to what we should bring. We had an engaging and fast-paced conversation and eventually reached consensus. Afterward, when we watched the recording of our session, I was shocked to find that I actually hadn’t said anything, and instead had only laughed or agreed with what people said. But I had had such an amazing time! Did I really not contribute anything to our final product? I was again disappointed in myself, and felt similarly to when I had politely refused to ask Mrs. B any questions.

What I’ve slowly realized is that now that I’ve finally made it to med school and am realizing my dreams, it’s not enough to be involved as a listener, as an observer anymore. While it’s useful to absorb through listening and learning from talented peers, amazing physicians, and brave patients, that’s just not going to cut it if I want to engage with other people, if I want to truly participate in all the wonderful opportunities we have as medical students. This isn’t an inspirational piece because it’s all easier said than done, and I feel like it’s been a long, 6-month process of even realizing that I had a lot of self-discovery to go through. But I want to use this blog to document my thoughts along this journey, so that someday, maybe I’ll look back and think, “Wow, you finally made it.” But also so that maybe someone out there who’s feeling the same way will realize that they’re not alone. We all don’t know what we’re doing (I hope), but we’ll get there!

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The First Step