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.