changes

I entered the clinical year of training (third year of medical school) with trepidation.  I love the part of me that is a scientist.  I love the curious, questioning, free-spirited autonomy of graduate school and private inquiry.

I was afraid that I would become a jaded, angry, burnt-out shell of myself; that I would become insensitive to other's pain; that I would be exposed to the tragedy and farce of life and lose the happy-go-lucky part of myself - not that I've ever really been happy-go-lucky.

What I did not expect was that medicine would open doors and windows in my heart to parts of myself I had never known: the part of me that loves teamwork, the part that thrives on the intensity and adrenaline of rapid responses and codes, the part of me that is gritty, the part of me that wants to step up to the plate and be in charge even if I fail sometimes.

 * * *

I hated all the details that we had to memorize; I was more interested in physiology and pathophysiology than disease management.  But now I have a better grasp on what it is I am training to do.  I had to let go of the scientist, the part of me that I held dear, and realize that I would not be doing science for  a long time.

I had to let go of the athlete in me, because I did not have time to train to that level of physical fitness.

I had to let go of the artist and hobbyist who always had side projects going.

I had to let go of the coder and programmer when I realized that I couldn't change or improve the electronic medical record.

I had to let go of the part of me that cares about all our societal causes of disease and events happening upstream of the hospital.

I had to let go of the part of me that loves sleep and sunlight, nature and beauty.

I had to let go of the sensitive, empathetic, caring part of me that clings to the people I know and likes almost everyone I meet.

I had to let go of being a happy person, because we encounter tragedy every day.

* * * 

Instead, I have found that I love teams, and that I love the meaningful aspect of what I do.  I love the immediate gratification of the clinic where results happen in days to weeks rather than on the timescale of years.

I have learned to be impatient and to cut off my patient's feelings and conversations in order to get done what I need to do.

I have learned to do "high-yield" things first and prioritize, rather than follow the things I find interesting or fun.

I have learned to dribble out my time by the minute and resent anyone who was wasting my time.  No longer did I have the luxury to following my curiosity.

I have learned to be tough-minded and say, "Each person has to stand or fall on their own.  Helping you the way you need to be helped is not within my power.  But here, have some aspirin."

You learn how to prioritize problems.  Physicians rarely solve problems; mostly, we help "manage" them.  (How depressing is that?)  We can "bend the curve" of health so people have better health longer, but we cannot prevent death.

* * *

I've learned to watch and listen, to observe the culture of each new team and try to integrate rapidly and find out how I am supposed to behave and best contribute.

I have connected with the tough-minded part of myself, the part that gets my hands dirty and ignores the blood and body fluids spurting everywhere.

I have learned to seek and value efficiency and organization.

I am learning how to say no: "This is your problem, not mine."

I am learning to let go of perfection, as there is an infinite amount of work to be done.

* * *

I accept that I will be like the physicians I felt so hurt by as a child: people who did not have time to explain what disease or treatment was about or care about how I experienced chronic disease.

I see now that this was not their role, although I thought it should have been.

I accept that to stay sane and safe, I will probably have to do just the minimum to be safe and and take care of the medical aspect of care.  

I accept that my role is to be the body mechanic but only rarely ever act on the healing or caring aspect.

I accept that I will probably be pretty sad and tired for the next few years.

I accept that I will often be cold or impatient when my patients are hurting or sad because there is only so much time in the day.

I accept that as a medical student, I will probably get to do more healing and connecting than I ever will as a resident or attending.

I accept that in medicine, the things that are intellectually interesting and exciting are usually the most tragic for patients.

I have let go of perfection and will accept that throughout my training, it will be good enough to be "adequate."  

* * *

I will probably make mistakes that cause people harm or miss diagnoses that might result in death.

If I go into internal medicine, I will see multiple deaths per month, and I may come out with that shell of self-protection I see around many physicians, where they no longer connect with their patients.

I hope I will retain some semblance of humanity and kindness, but maybe I will let go of that for a while and just do my job and try to survive.

This makes me rather sad.  I was not wrong about what the cost of training to be a physician would be or what the responsibilities and burdens would be.

But it also opens doors to future opportunities I want to be part of.

* * *

I don't know that I would do it again, but I'm not sorry I am here.  I love hearing people's stories and gaining this overall sweeping view of life that I would not have had otherwise.  I love the knowledge I have gained about my own body and others.  I am not only living my own life, but also having the opportunity to learn firsthand from the lives and mistakes of others.