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Letter to Myself as a Third-Year Medical Student

At most medical schools, the first two years are spent in lectures, labs and classroom learning. The third year is when students begin rotating on various clinical teams in the hospital and clinics, finally seeing patients as part of a large educational medical team. As I moved through pediatrics, ob/gyn, surgery and other core rotations during my third year, I took notes at the times when I felt out of place or discouraged. These memories became the basis of this letter to myself–a letter I wish that I could have read that year.

When you’re practicing suturing on your surgery rotation, and the surgeon tells you that you need to go find a smaller pair of gloves, it’s okay to inform him that you’re wearing the smallest gloves the hospital carries.

Sometimes, when you’re seeing patients in preparation for daily rounds, you’ll get absorbed in conversation with a family and completely forget to do a physical exam. That’s okay. You’re not the worst medical student ever for this slip. You can go back and do it later.

On pediatrics, the intern supervising you will notice a concerning bruise on your infant patient’s thigh. Forgive yourself for not noticing it in the dark room while you pre-rounded before dawn. You were trying to be gentle and unobtrusive. Slowly, you will learn that “gentle” and “unobtrusive” are not always valued approaches in inpatient medicine.

When your senior resident instructs you, “Don’t waste your time on a patient with dementia,” disregard him and go spoon-feed the patient his yogurt like you planned.

You will learn the hard way in the ICU that when the resident asks you to summarize a goals-of-care conference that you observed, she is not interested in the piano recitals and the family wedding coming up. She will interrupt: “Does Cardiology want to start the pressors?”

When your attending advises you to spend less time listening to a patient’s feelings, it’s okay if you just nod and move on. (Because what does a med student know, after all?)

You may feel like you chose the wrong field, the wrong role, the wrong career.

And then, soon, I promise, you will find yourself holding the hand of a ninety-two-year-old patient approaching her death. You will be the doctor who listens to her when it matters—when she states that she wants no more treatment. You’ll lead a care conference and learn about the grandchildren’s upcoming recitals and graduations—because they are important.

One day, at the end of a clinic visit, you’ll gently and unobtrusively invite the patient’s wife to join you to go over the treatment plan. The wife will nod gratefully and say that you’re the first caregiver ever to include her.

In clinic, you will encourage a patient to write about her experience, and invite her to share. Months later, she will read you a sonnet she wrote about her illness, and she will tell you that writing and sharing her poetry healed her in ways medications have not.

As a resident, you’ll choose to spend a slow afternoon in the room of a man with dementia who won’t remember that you were there. Your notes are done for the day, and no one will look for you or tell you that you’re wasting your time. You know that you’re not, because you enjoy listening to him tell his memories of his life.

In these moments, you will know that you chose the right field, the right role, the right career.

Rebecca Grossman-Kahn is a psychiatry resident in Minneapolis. She has published essays in Intima, The New England Journal of Medicine and The Examined Life Journal. She leads the Stanford Pegasus Physicians corresponding writers group. “I am an avid journaler, and this essay arose from notes I took on the highs and lows of clinical training through medical school and residency.”

Comments

13 thoughts on “Letter to Myself as a Third-Year Medical Student”

  1. Just gorgeous. Thank you for writing, with such eloquence and grace, this much needed piece. This should be required reading for all medical students (and attendings…). And I wish I’d had this when I was a medical student, 40 years ago. I’ve tried to impart these thoughts to the generations of medical students and residents I’ve both treated and supervised; unfortunately, times have not changed enough that they are no longer needed. Sending tremendous gratitude for your work.

  2. Henry Schneiderman

    As the others have said, this is a wonderful and much-needed reflection. You embody and espouse what is most ancient, noblest, enduring and therapeutic in our calling. Please continue to fight the good fight for humane care of human beings, even when it feels that all the path is upstream. Now with more power as a resident, you role-model for a subset of students and housestaff may your positive impact extend further

  3. Dear Dr. Grossman-Kahn,
    This was so beautiful. It brought back memories of tears in the bathroom during residency internship after being berated by an attending for not having the “right order” on my presentation at rounds. In caring for humans sometimes I wondered back then if I had to become less of one. Leaning into our humanity us the most important tool we have. Thank you for reminding us of this.

  4. As a Hospice Chaplain, I applaud you. Thank you for taking time to do what matters most…listening. It is here in this sacred place where you hear the heartbeat of your patient and their families. I pray you pass this presence on to all the new residents you have contact with over the years and that you may never loose the beauty of a still presence.

    Chaplain Kathleen

  5. “ You may feel like you chose the wrong field, the wrong role, the wrong career.”

    This inquiry arises often, especially after a long day of outpatient family medicine trying to see patients, stay on top of the EMR inbasket, and cover a colleague.

    This letter reminds me that one patient, one meaningful connection with colleagues, and/or staff can remind me of the vulnerability in our profession. It’s often secondary or tertiary to the medical jargon.

    Thanks for poignant reminder.

  6. Rebecca, I cried reading this because it is a reflection on what medicine has become. The focus on getting tasks done and finishing EMR notes when what really matters the most is the caring and compassionate focus we should be giving our patients. As a Palliative Care Physician, I am blessed to be able to ask patients what they value the most, hold their hand, and hear about their lives. It has taught me that this is just as important as the medicines we give or the tests we order, and honestly doesn’t take much time to do. I hope as a psychiatrist ( I encourage you to do so) that you can continue to emphasize the importance of an empathic ear and a kind heart and share that with medical students, residents, and attendings. We all need to be reminded of what truly matters to most patients: their humanity and dignity.

  7. I wish I had had this letter when I was a third year student! I wish it were mandatory reading for all students at the beginning of their clerkships – to remind them of the humanity of medicine, the beauty and the power in those small moments, and how much we learn from our patients.

  8. Medicine is the ultimate tale. Of elation when a heart resumes its metronome, when a baby inspires, when, in its final movement, eyes close forever… and there we are…but who cares for us? …who is there for the caregivers, to give us care when our pancreas shatters in grief, when we doubt, when we face error? I only wish someone would have been there for me when I fell apart, when my soul splattered so long ago, when i bounced hard on the black asphalt on the road of medical practice. Blessings to you, young resident…

  9. Theresa Mutzig-Erwin, DO

    Dear Dr. Grossman-Kahn,

    This was an exquisite piece of writing that transported me back to my own medical school rotations, internship, and residency days. Each short paragraph summed up such a broad range of experience within a rotation.

    While I do feel bittersweet that in a few decades, medical training hasn’t evolved as much as I would hope; I am greatly encouraged that your generation of physicians still has some pockets of caring, empathetic, and humane people.

  10. Dear Rebecca, I just read your piece to my husband, a family doc for decades. He has a keen mind and a big heart like yourself and he teared up when he heard your words because he too remembers his years as a medical student, sometimes wondering why he chose this career. His patients now send him love letters, there lives having been changed because of him and the compassionate care he has humbly given them. I am a somatic therapist, and a poet. After 40 years in our respective fields, I would say that the first few minutes of interaction with a patient or client will shape the meaning of that relationship going forward—*any* form of healing, including a graceful death. You are a rare one indeed—a medical student with a poet’s heart and mind. Thank you so much for warming our hearts with your own. I trust that some day your patients will be sending you love letters too.

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