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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.

Daring to Dream
For the past three years, I worked as a rural primary-care doctor. Two months ago, I resigned to pursue further training in hospice and palliative care. My patients were the inspiration that illuminated every step of my way towards this new path.
Marly came to me for a workup of her persistently elevated liver enzymes. Together, we navigated her new diagnosis—liver cancer—and a series of failed treatments. Eventually, Marly’s thoughts turned to facing her mortality.

Northern Lights
“Let me die,” you say.
You’ve listed the reasons, presented the arguments: You’re a burden, a mere speck in a world of billions, one that will not be missed. A life that never asked to be born. Why prolong this pain?
“Please, let me die,” you say again, this time with a sob that allows no more words.
I hear you, I do.

Gift of Gratitude
We all remember our patients who die, though the first patient death really stands out from the rest. This was certainly true for me.
I was just starting the second year of my internal-medicine residency. This wasn’t the first time I’d seen someone die, but it was the first time I’d seen someone who’d been alive and well, and talking to me that morning, be dead by the afternoon–a shocking dichotomy that haunts me to this day.

Joe
You’re in the hospital again, propped in bed with pillows keeping you from listing to one side or the other, and I’m sitting on a pink pleather chair I’ve pulled up next to the bed.
We watch Dr. Phil until 4:00. I always find this show melodramatic, but you seem riveted. You want to know about these people, their lives, their lies, what they’ll do with the information unveiled to them.
When Dr. Phil signs off, I switch on the Classic Country music station, and we talk.

An Exception to the Rule
“I usually talk through the procedure as I go,” I say, pulling on a pair of blue nitrile gloves. “So you aren’t surprised by anything, so you know when to expect a sensation.”
The patient is lying on the table, eyes fixed upwards. One of the ceiling panels is illuminated with the green leafy branches of a tree—an image meant to calm and soothe, though I doubt it’s doing much for this woman.
“Or I don’t have to talk,” I tell her, arranging the instruments on my sterile tray as silently as possible. “We can be quiet or chat about other things.”

The World’s Second-Best Baklava
In 2013, as a hospitalist, I attended the annual conference of the Society of Hospital Medicine. This meant traveling from my home base in Ohio to Washington, DC, the site of that year’s conference.
The second day was winding down. Colleagues, new friends and countless strangers were scurrying to their rooms to freshen up and get ready for a night out on the town, where they’d continue to mingle, share research and professional achievements and scout out career opportunities.
IÂ had other plans, however.

Heart Sounds
At his mother’s request, or rather pestering, a forty-year-old male presented to an urgent-care center after several weeks of progressively worsening flu-like symptoms. His mother asked that the providers please check her son’s heart. They replied that there was no need and sent the man home.
His symptoms progressed, and the pair went to the ER, hoping for better results. Again, the mother asked the doctors to check her son’s heart.

Broadway Bound
Ever since his adolescent years, my son and I have had an ongoing conversation (you might call it an argument) about my habit of speaking too frankly when sharing my opinions, which I do frequently.
Or, as he puts it, I have a big mouth.