Not About Me


“Write your name”, he said. I complied on a little scrap of paper. He was, after all, the senior in college who’d just gotten accepted to medical school- therefore all wise and all knowing. “Now write Dr. in front of it.” Again, I complied. “If you don’t feel a little surge of adrenalin when you see that- maybe medical school isn’t right for you” he continued. I didn’t feel shit.

Standing here in the hall of the medical school I’m going to graduate from in May, I can’t help but feel he had a point. Today is Match Day, the day I find out where I’m going to be a resident physician- and if I didn’t feel shit then, I might shit myself now.

This day marks the beginning of the end of a $250,000, four year long journey, littered with hundreds of coffee cups and not a few tears. This day, is a year of tradition and torture every senior MD candidate in the country has come to with high hopes and loosening bowels.

As much as I’d like to believe this day is all about me, it’s really not. This day is about the people who’ve brought me here.

This day is about my grandfather, the first person to say with unending hope in his eyes to his cardiologist- “he’s going to be a doctor” when my tenuous grasp of cardiac anatomy in first year let me explain what we were seeing on his bedside echo.

This day is about my parents, my unconventional Indian mother who told me to go into business school- why did I want to spend my life studying away for test after test? Mom, I wonder that to this day. It’s about my stepfather, who with my mother sacrificed and worked to get me to college and beyond.

Today is about my loving, kind, girlfriend who’s put up with hours of complaining, self-doubt and moaning from this self-absorbed, terrified medical student. She who’s lifted me up when I’m down in the dumps, and knocked me down a peg when I’m far too arrogant and cocky.

Today is about the nurse in the ED who taught me how to start an IV. When she guided me through my first successful IV, she walked out of the room and whispered to me- “Wear gloves next time, sweetie.”

Today is about my attendings and residents, the ones who put up with my fumbling histories and clumsy physicals as they attempted to educate me. The ones who pimped me mercilessly, but always kindly, about how to treat Torsades and distinguish it from Polymorphic VTach.

Most of all, today is about my patients. The first life I brought into this world, and the first life that left this world with my crossed, gloved hands on her chest- this day is about the patients I learned to practice medicine on, the patients I laughed with and cried for.

As you finish reading this, I will probably have opened my envelope. I’ll probably have shown the fateful words written on that slip of paper to my girlfriend and my parents and grandparents, FaceTiming in from across the world well past their bedtime. I’ll know where the next part of this crazy ride is taking me- and maybe I’ll be the face you’ll see when you come to the Emergency Department, introducing myself as the words I wrote on that paper- Dr. Sarab Sodhi.

 

Advertisements

Three Patients

Tags

, ,


Another publication from way back when, detailing the insanity of intern year.

 

At 0622, I walked into the resident room. I pulled on my scrubs and clipped my stethoscope, cellphone and trauma shears to my waist. A patient had joked I looked like a gunslinger from an old western. I felt more like Don Quixote, with my makeshift strapped on armor, trying to do good against all odds.

 

I walked into my shift at 0645, into the busy urban Emergency Department I called home. The night intern signed out to me. The sign out included the usual scattering of the very sick, and the very intoxicated, everyone else had gone home before dawn broke.

 

I walked up to see a new patient that EMS had just rolled in, an elderly Vietnam vet who’d fallen and couldn’t get up. He was terrified he’d broken his back. I reassured him and his wife as best I could without lying to him. Leaving, I got a call from the nurse of one of my patients. “The woman in 19 wanted to leave, is at triage.”

 

Stale alcohol wafted through the air. As I tried to make sure she was sober, she grew irate. When I asked her to walk, she huffed and took two steps to me with her middle finger raised, stopping right before she slammed into me. I went to print her discharge to a commentary telling me where I could put it.

 

I’ve been a resident in Emergency Medicine for two months now, but I’ve already begun to find those encounters blasé. As I bade her good health and walked back, the veteran called me over. He and his wife seemed terrified so I reassured them and explained what to expect as the day went on.

 

I walked over to go see my new patient and I got a call “Bed 14 wants to talk to you”. As I approached, I saw the half-naked, well built, angry looking fellow I’d been signed out and had a sinking feeling. He cursed at me with a fluency I’ve grown to expect, with his sweet, old mother sitting next to him holding his dirty shoes and clothes on her lap. “Let me go!” he spat, as I kept my distance, a muscular technician at my side. As I tried to examine him, his anger grew. He ripped off his C-collar in one mighty swipe and his blood pressure cuff in another. As he was rising from bed, security officers materialized, as if beamed down from Star Trek. Under their gentle, watchful gaze, I finished examining him and finding him sober, discharged him.

 

As my day progressed, I saw a handful more patients, dispositioning them with the eagerness and ineptitude of an August intern.

 

The veteran ended up having a compression fracture, and as I helped put him in his back brace, he thanked me effusively. As I said goodbye, he looked me in the eye and said, “I don’t know how you do it. I heard that woman curse at you, and I saw how badly that kid wanted to rip your head off. How do you do it? All this pain and suffering day in and day out would destroy me…” I smiled, shrugged my shoulders and said “It comes with the job.”

 

As I walked away I was forced to confront my flippant answer. I’m an intern, two months into residency and already I’ve lost a handful of patients. I see terrible violence every day and as I dip into and out of people’s lives I feel a faint echo of their misery. To survive as I tilt my lance at windmills, I wear a coat of emotional armor that allows me to take the hits and keep working. My armor is adaptive: titanium when I see angry, intoxicated patients and cotton when I see scared sick people.

 

Then I sign out, walk out of the Emergency Department’s bright neon lights and try to leave it all behind me. As I get home, to a loving significant other and puppy, I take a deep breath as I walk in the front door, take off the armor, piling it carefully by the door. After all, I work again tomorrow.

“Stayin’ Alive”

Tags

, , , ,


A variation of this was published in a peer reviewed medical journal. Another walk down memory lane. My first emergency medicine journal publication, and my last publication of the end of medical school.

The paramedic’s bullet was short and to the point. “40 something year old woman. Found down, possibly after a fall. Unresponsive in the field. Bradycardic to the 40s. Protecting her airway initially, but now desating to the 80s. Barely got an IV.”

As a fourth year med student who had seen a bunch of codes, I still felt a frisson of excitement when codes came through the door. After all codes for me represented Emergency Medicine- no information, a deathly sick patient, lots of adrenalin and a healthy dose of fear.

I stood by my resident’s side as she induced and intubated the patient. As the pearly whites of her vocal cords came into view and I saw the tube go through it, we all released the breath we had subconsciously been holding. A dose of Atropine raised her heart rate and she seemed to stabilize. I walked to the door of her room pulling off my gloves as I went- I had patients to see after all.

As I pulled off the gloves, alarms began to sound. Her heart rate was beginning to drop again. My resident met my eyes, and said just one word- “Compressions.” Within seconds of her having given the order, I was at it. I had done compressions on dozens of people- and each time I did, I recalled my BLS instructor teaching us to compress to the beat of Stayin’ Alive, since the song had a beat of 100 a minute. He said it also worked with Another One Bites the Dust- a connection that was too morbid for me at the time.

So as Stayin’ Alive played in my brain, I pushed down on her breastbone, hard and fast, and I felt something pop beneath my crossed hands. I was breaking her ribs as I compressed her chest in a violent, last ditch attempt to beat her heart for her. Each time I broke ribs I found myself pausing for a moment- pausing to apologize and acknowledge the violence I was inflicting. Then, I remembered that if I didn’t do it my patient would never hear any apologies again. So I fell into my terrible cadence, in my own little world with Stayin’ Alive for a soundtrack curiously disconnected from my humanity and the sadness of the situation.

Around me there was a blur of motion. The nurses were drawing up and giving med after med. My resident was splashing betadine on the woman’s chest right next to my hands and blindly trying for a subclavian line. I momentarily felt a stab of fear as she stabbed the patient in her chest millimeters from my crossed hands, but I made sure my compresisons never faltered. The patient’s one tenuous IV blew, and suddenly there were people all around me with needles stabbing away. And through it all I was humming “Staying Alive” under my breath. Each time I lifted and dropped my shoulders, about 100 times a minute, I saw her chest lift off and drop back onto the bed, her breasts, exposed to the world, flop up and down, her head jerk up and down, and her arms lift and fall just a little. For a second her movements gave her the illusion of life- an illusion I was creating. I knew the statistics, knew that more than likely she wouldn’t survive- but as I compressed I hoped. Sweat was running down my arms as I worked, landing on her chest and mixing with her blood as I kept to my terrible cadence.

Around me the needles were ineffective. Nothing was working. The nurses, who almost never miss, were cursing in frustration as they got a line only to have it blow a second later. My resident and two attending physicians were trying to get central lines, and from their lips too came soft curses.

As my arms began to tire, one of the nurses switched with me. Her light svelte frame was perched precariously on her toes as she began the same cadence trying to beat this woman’s heart for her. It seemed like seconds later that I was switching back with the nurse. As she did her final compressions and switched with me I heard the strains of “Stayin’ Alive” fading away softly under her breath.

We worked for what seemed an eternity. My arms pushed of their own accord. Thirty minutes after we began, my attending called it. “Time of death, 1040”. I walked out of the room yet again pulling off gloves- this time slick with blood. Having gotten sufficiently desensitized after dozens of unsuccessful codes, I walked out with a sigh and a stab of sadness at the life lost. In a few months I would be an intern, and a year or two after that I’d be expected to run a code. But for the here and now I was just a medical student, and my only job was to learn. So I learned from my patient, the woman who had died. I learned yet again that I couldn’t always save my patients.

There was a chart on the rack to be seen, and I walked to the room. As I walked into the room, trying to leave my previous patient and the violence I had inflicted upon her behind me, I smiled at the next patient with Stayin’ Alive still playing in my mind. All I could hope was that perhaps this patient would.

“You Set the Tone”

Tags

, , , ,


Another walk down memory lane, as I finished my ED months and did my medicine sub-internship. A good reminder, that when all is said and done, you do set the tone and you choose the job. I still vacillate between the emotional teflon being extra thick and it being porus enough that the insanity of work spills into my personal life. And I probably will keep doing that forever.

 

“Don’t ever say you’re sorry. See, there’s two kinds of doctors… there’s the kind that gets rid of their feelings, and the kind that keeps them. If you’re gonna keep your feelings, you’re gonna get sick from time to time – that’s just how it works. People come in here and they’re sick and dying and bleeding, and they need our help. Helping them is more important than how we feel.  But it’s still a pain the ass sometimes. Sometimes, I just want to quit and do somethin’ else.”

-Mark Greene, ER

 

I’ve realized recently that there are a few things medical school teaches you nothing about. There’s the fabled four year curriculum that all neophytes believe will make you into an educated, caring, considerate and capable physician. And then there’s the reality that most of what it is to really be a physician is learned in the “unwritten curriculum”, the curriculum you learn from watching the residents, attending’s and nurses. Handling death, seeing suffering and being unable to do anything about it, and how to handle the abuse that a day in the hospital sometimes throws at you- all of these are things you figure out on your own, and hope you’re doing right.

Today, the Match list opened. I’m going to put in my list of programs I want to go to and in March, I find out where I go. And then on July 1st, I become an Emergency Physician- terrified, marginally capable and hopefully guided as I try to take care of people. I’ve spent a lot of time recently watching season after season of ER, and I’ve come to realize something terrifying.

Three and a half years of medical school have hardened me. They’ve acted like a forge, providing tremendous heat and a constant pounding to beat out the ‘imperfections’ and to expose me to the wonders and terrors of clinical medicine. They’ve taken a humanistic person who read Wordsworth, Sarte, and Dostovesky and replaced him with someone deeply familiar with the PERC rule and the CHADS2. I’ve become capable of taking care of patients to some degree, I walk with the strut of someone comfortable with much of daily patient care. My training has helped me save a couple of lives already, and will likely be responsible for saving many more over my career. But I can’t help but wonder what I’ve lost along the way.

The last patient I did CPR on died. I had my hands poised over her sternum when time of death was called. I realized later, that when I left I walked out without a second thought as to the life that had just ended, moving on efficiently to the next task.

More than anything else that terrifies me. I’ve never been overtly or overly emotional, but recently in the hospital it’s as though I’ve developed this protective Teflon coating that blunts both the great saves and the terrible losses. I can’t imagine functioning in a busy Emergency Department without it- the fear would probably render me catatonic, but the existence of it makes me wonder if I’ve become the soulless automaton I swore I would never become- the soulless automaton so far from the physicians identified by Mark Greene and John Carter.

As my mind wanders down this tangent, I’m reminded of another patient I’d seen that same day. He was an elderly gentleman, a veteran of World War II and Vietnam. A patrician gentleman with a regal bearing, I was admitting him to the hospital for pulmonary edema. When I told him, this man who’d survived the landing on Normandy and pushed on despite seeing scores of his friends die, broke down in tears. He was terrified he was losing his independence to a disease that crept on insidiously with age. My heart broke a little inside, because he reminded me of my own grandfather, a 85 year old general who hated the hospital. So I sat with him for ten minutes just talking, and holding back tears.

I do set the tone, I do decide how I’m going to see and manage and handle the emotional onslaught contained in the walls of an Emergency Department every day. And despite how useful my emotional armor is, I think I need to continue to live in fear of it. The day I grow to like it too much, is I think the day that I should hang up my stethoscope.

May that day be far, far away.

 

Transitions: A Reflection

Tags

, ,


Written a month before graduation from medical school. It reminded me of that infinite medical school wisdom, when all is said and done, P=MD.

 

I walked into the medical school today morning, smiling at being back in a place I’d not seen too much of in the last year and a half. I stopped midstride, as I saw a sea of new faces sitting in the common area. The faces I saw were young, eager, full of promise, hope and fear- clearly new first years.

It struck me then, as I began to walk more slowly through the hallowed halls that had educated me- I was officially an old man.

I recalled, four years ago, walking into the medical school for orientation. I can relive the emotions that roiled inside my chest in each moment. Eagerness, disbelief that I had made it, the confidence from college that I would be the smartest, the fear that I wouldn’t, and most of all the angst of the unknown path I was treading.

I remember walking into our big lecture hall and sitting on the left sided batch of seats- something I still do to this day. I remember sitting there just watching my peers, who in a few short months will be MDs and wondering what kind of MDs they would be. I remember seeing those same people that evening at the social event uninhibited by copious doses of alcohol and wondering all the more.

I remember the drive to do well on my tests and get that honors, the degree to which my self worth was tied up so intimately in the letter my course gave me. I recall the gnawing feeling in my gut when I didn’t get honors, or did “okay”. I smiled when I thought of the first time someone had let me do something in the hospital and how cool it felt. I remember how uncool it felt when I had to do something after my 5th surgery call night.

That walk wasn’t a long one, but my mind walked the ups and downs of the three and a half years I’ve spent here during it. I had a discussion group to run for the new first years about a book they all read. After I was done, one of them came up to me to talk. Bright eyed and bushy tailed, she reminded me of myself during first year. As I left I gave her a parting word of advice, “Don’t worry too much during med school”, I said, “It ebbs and it flows- but ride it out and you’ll be just fine.”

My journey here will end soon. In a few months I’ll be an MD. In a few more I’ll be a resident. And sometime after that maybe I’ll be a good doctor. But I know that leaving this door will also mark the next unknown path my feet will follow. And I know now that I’ll be just fine.

The Step


Published 3 years and some weeks ago, as I finalized my list of applications into the match for residency. Now, I get to interview prospective residents and walk them around. Deja vu much!

I stood on the edge, and felt terror rise in my chest. I took a deep breath, and forced it down, screwed up the courage for that one step and I took it. I stepped out of an airplane door, with instructors holding onto my shoulders and hips and jumped into space at 15,000 feet. I thought the hard part was over- how wrong I was.

Today, I’m a fourth year medical student. I’ve completed four years of college with a thesis in biochemistry and philosophy each. I’ve survived the two years of classroom learning of medical school and all of my core rotations. I’ve taken all the dreaded Step exams. I’ve spent 4 dedicated months in the Emergency Room, taken care of dying patients, saved lives and had people die under my hands. I’ve intubated people, put in chest tubes, and made decisions that could save or kill people. Why then do I feel that same terror rising in my chest now?

Perhaps it’s because I’m on another precipice. I’ve submitted 23 applications for residency and I have 15 interviews scheduled. I’m deciding where I want to be for the next 3 years of my life and I’m trying to pick a place that will make me an excellent clinician, researcher, possible academic physician, and writer. Not just that, the place has to work with my significant other’s job and our plans to move in together. And I have to choose the place that will let me do that.

I hold my future in my hands, and I’m rudderless in the competing currents of each possibility. Each place gives me compelling reasons to come there, shows me visions of who I may become through them, and touts the successes of those who were in my shoes just 3 short years ago. The magnitude of this decision and its effects on my life and my future are dizzying and terrifying. Though I have a gut feeling that I will make my own luck and my own future at whichever place I end up.

As I fell from 15,000 feet with my instructors on either side I felt sheer terror. I fell at 120 miles an hour, screaming towards the earth. Fifty of the longest seconds later, and my parachute had opened somehow. My terror abated, I began to breathe again as my trembling hands reached for the cords and attempted to steer me towards where I needed to get on the ground.

Perhaps then this rising terror is from who I’ll be when the parachute opens. For as I step into the abyss I am a medical student- now bereft of responsibility and blame. A few short years later when the parachute opens I will be an attending physician sailing on my own steam. I’m stepping into the abyss in a few short months- I suppose my choice, as I step, decides who my wingmen (and women) will be when I’m free-falling with the terror rising in my throat.

Geronimo!

Exceptional


Continuing the theme of posts I’ve written in years past, this one talks about the weirdness of having a self admitted mediocre student being called exceptional. I remain, quite honestly, mediocre at many things, but somehow clinical medicine clicked with me, and allowed me to become better than mediocre. 

This post was written halfway through medical school! Enjoy!

 

It’s a lovely word, exceptional. Makes you feel all warm and fuzzy inside, gives you this idea that you’re something more, something above and beyond, raising your self image to dizzying heights.

 

It’s something I’d never heard till I got to college. Through my middle school, my report cards would read, “Can do so much better if he’d apply himself” or “Capable of so much more.” In college, I started hearing the word smart, or even gifted applied to my name. I convinced myself that I was actually just gifted, and the fact that I’d done two years of college level Biology, Physics, General and Organic Chemistry in high school had little to do with the apparent ease with which I achieved academic success. So, I coasted through college on autopilot, passed out in nearly every class with my legs sprawled out on the seat ahead of me, working through experiments, projects and exams in fractions of the time of the rest of my class, never seeing the frustration on their faces as I did these tough tasks with obvious ease. I tried to explain that I’d done it before, but I didn’t try very hard. I enjyoed the mystique the achievements gave me, enjoyed the feeling of being seen as gifted and smart, and I loved hearing from the people around me, professors, peers, and the people I taught that I was exceptional- sometimes in words, or sometimes in just the way I thought they saw me. So, I remained oblivous to the trial and the tribulation that is hard labor of the mental kind. I graduated mangna cum laude, with college and departmental honors and sundry pats on the back from the world.

 

I then moved onto medical school convinced in my little mind that it’d be the same thing as college, that I’d be able to sleep through my classes and still outshine everyone else. The first day of medical school, as they explained that we’d be dissecting on one day and studying the other, my small group was told we had a study day first. So, I floated around the library in this vast new building unsure of what the heck to do with myself. I opened my Netters, and promptly passed out with my face in it, drool leaking from my open softly snoring mouth onto those glossy perfectly drawn images of the anatomy we were to learn. The next day, during cross teach, when the other half of our group who had dissected taught us, I experienced what it’s like to feel like an idiot for the first time in my life. There were terms flying around I’d never heard of, gray structures that looked identical to my naive eye being distinguished from one another all the while I tried desperately not to throw up my breakfast. I was like a fish lost in the desert, totally out of my element. Slowly, I got the hang of it, but that first two months I learnt to feel like a fool and began to downgrade my estimate of my own intelligence. I still didn’t study, since I’d never learnt how to; hoping instead that somehow magically I’d survive. I did survive anatomy, and felt much more comfortable during Biochemistry (since that was my major in college) but my self esteem was about the lowest it’s ever been in the first two years of medical school. I’d gone from an honors student in college to an average or slightly above average medical student. The swagger and arrogance of my college years remained as a thin veneer to hide the fear and insufficiency I felt on most days, with my peers the equivalent of linebackers to my metaphorical ninety pound weakling being kicked in the face with the sand of anatomy, phyisiolgy and pathology. The sense of meaning, purpose and power I’d felt in college, the heady sense of strenght, and the knowledege of where my path was leading was replaced by a never ending gnawing self doubt that nibbled at the foundations of all of my choices, questioning why I came to medical school, what it was that I hoped to accomplish and fear that the Siphysian task of learning all this material would never end.  Nearly every day I experienced at least moments of dread, fear and anxiety, feelings that I wasn’t cut out for medicine, that I was in the wrong field. I’d heard that it would get better, but the future was so far off, with such daunting obstacles between me and it that there were days I nearly despiared of my goals.

 

Somehow, I managed. I passed my Boards, and did fairly well. I began my rotations, jumping into psychiatry where I had always done well in my boards and my classes. I found my strengths again, talking to people- a skill that had nearly atrophied in my two years of social isolation, finessing out the details of their conditions and trying to match their symptoms with this whole set of diseases I’d had stuffed into my brain over the last two years. I guess some of it stuck, because I was doing quite well by the end. The soft skills I had discounted in favor of my so called intelligence in college, of conversation skills, charm, courtesy, politeness, and reading people began to show their worth as I searched to find them under the haze of biochemistry formulae and physiology concepts. So, I started hearing the voices again (not the schizophrenic kind), those of my attending physicians and my residents, telling me that I had skills, that I could be of value in medicine and I could be a good doctor. I spoke to a resident yesterday, a self described hard ass who ‘didn’t kiss medical student’s asses’ who said the magic word to me- exceptional. She called me an exceptional medical student, not so much for my fund of knowledge, but for my abilities with people, for the confidence to ask questions and try things, and most importantly the confidence to give it a shot and be totally wrong- something I have in abundance.

 

“Becoming a Doctor”


I’m about to graduate residency in Emergency Medicine, and as I think back, I realize that I forgot completely about showing my blog and website some love. So, here we go- in memory of all the insanity that’s developed- a walk down memory lane. I’ll try to update and post frequently!
“Write your name on the paper,” he said. Since he was a senior who’d just gotten into medical school, and I was a simple sophomore who’d chosen to attend the session, I did. “Now write Dr. in front of it.” I complied. “If you’re reading that and you don’t feel anything, medicine isn’t for you,” he said. I looked at it again, my name with a Dr. in front of it. I didn’t feel a thing. I crumpled up the paper, chucked it in the trash and didn’t give it another thought. Until today that is.

In four days, I’ll get to write a Dr. in front of my name. More than that I get to call myself a doctor is the fact that I get to be one. In a few weeks when I start residency, I’ll be responsible for people’s lives. And that is terrifying!

It’s been a long journey, since my careless sophomore days. I went from being a cocky, know it all college student, patted on the head for my intellectual acumen to a terrified, foppish first year medical student who spent my first year lost and confused. I was petrified in anatomy, as I was constantly less aware than my classmates who with reckless abandon pointed out the vagus nerve, the mesenteric arteries and dismissed much of the fascia I believed was important anatomy. I drowned in the weight of neurophysiology, as I discovered that the brain was and remains a complete mystery to me. I threw up, in the hotel before I went in to take my Step 1 exam and was mortified when I barely made an average score. I spent my first years of medical school battling the terror of inadequacy, afraid I wasn’t good enough or capable enough.

But, in four days, I’ll be a doctor.

I was terrified that I was playing doctor this entire time. Mortified that my medical school experience was not enough, that I was unprepared for the next step. Then, I realized something.

I’ve diagnosed and initiated the management for dozens of diseases. I’ve read hundreds of EKGs and chest X Rays. I’ve brought life into this world with my own hands, and been there when it’s left. I’ve fought violently against death, breaking ribs as I tried to bring back a patient from the precipice. I’ve watched death softly take someone who was ready to go. I’ve cried for a patient, in the arms of my lover, after I first told someone they were going to die. I’ve violated the sanctum of the body with chest tubes and central lines in hope that someone would live.

My family, like families tend to, have introduced me as a doctor for a few months now. I’ve demurred, each time saying “I’m not a doctor yet.” Like my white coat ceremony I need something to mark the movement from a medical student to a physician and to mark the importance of the situation. I realize, however I’m not there yet. Though I’m getting my degree I have in Robert Frost’s words, miles to go before I sleep. And I’ll never be there. I’ll constantly be learning, making mistakes and fixing them, and forever humbled by the vast enterprise of medicine I’ve had the audacity to try to conquer.

I’ve been becoming a doctor for a long time now. The MD I get to put at the end of my name has been in the works for eight long, caffeine fueled, sleep deprived years. I’m going to spend the rest of my life living up to the promise it holds though- because that’s what becoming a doctor really means.

Playing Doctor


The words by now flow off my tongue. “I’m Sarab, the fourth year medical student” comes off in a rhythmic flow without a second thought. My position is comfortable, even simple. I am expected to be there, participate to some degree and occasionally know the right answer- I am after all, a medical student. So, I zone out during rounds, disappear for hours at a time and do my own thing- it’s not like anyone is depending on me. Gotta love play time.

I’ve been playing doctor for quite awhile. The thrill of wearing a white coat has subsided as the white coat has become progressively less white. I’ve been seeing patients, examining them, making plans and presenting for almost two years now and it’s all second nature. I look, think, plan and suggest. Other people watch over it and agree. The scary part is that in 70 days I’ll graduate medical school, and I won’t be able to play at being a doctor anymore. In 126 days, I’ll be a resident in Emergency Medicine.

The complacency and comfort of my current position only adds fear to the change that is to come. In a few short months, I’ll be putting an MD after my name. In a few short months, I won’t be the ignorant medical student- I’ll be the ignorant physician.

My future (hopefully) program chair said it best- the only person who should call you doctor after you graduate medical school is your mother. You learn the basics of medicine in medical school. You learn to practice it in residency. For the first few months of your residency, you’re watched like a hawk as like a newborn foal you start to find your feet, wobbling and falling a few times. You’re watched for your safety and your sanity- the sudden onslaught of responsibility and consequence to your actions can be terrifying. More importantly, you’re watched for the safety of your patients. I’ve been told that until your second year of an EM residency, you’re not really a doctor. I guess my playing days aren’t done yet.

The Evolution of a Medical Student


At this moment, I’m on the top of medical student evolutionary tree. I’m a fourth year, strutting my stuff in the hospital and casually describing intubating, sticking and poking people. A few days ago, I got to run a book discussion for the new first year medical students.

As I walked into the medical school I walked down memory lane a little. I relived the boring hours of my first years orientation and how little it oriented me to medical school. I relived the shock of my first day of anatomy, and how I was told to “go read” since my group didn’t dissect that day- but I had no idea what to read… I remember how I felt, going from a cocky, confident, relaxed college student who was big fish in his little pond to a medical student who was surrounded by people who were smarter and studied harder. I remember the feelings of inadequacy when I didn’t get an honors grade on an exam, or it seemed that my peers were so much more clued into a concept than I. I remembered feeling like I didn’t belong- that somehow I’d crept into medical school and would be discovered and laughed out.

I recalled how magically in my third year of medical school, when I was seeing actual patients my strengths came out. I could talk to people, get a good history, make a solid differential and decide how to work them up. I could explain in non-medicalese why I thought they needed something and work with them when they didn’t want it. I remember beginning to enjoy going to the hospital, feeling like I was where I could do good work, where my actions and my words meant something. I remember the first time I was called “Doctor” in the hospital and how I meekly responded, I’m just a medical student.

I remembered how in my recent Emergency Medicine rotations, I was being given great autonomy and freedom. I could confidently walk into a room of someone who was sick and make decisions to make them better. I had acquired the skills to take care of people- diagnosis, treatment and decision making. I remembered most recently when I was leaving the room of a woman who had come in with abdominal pain how she had said in parting to me, “Thank you doctor” and I had smiled in return as I walked out not correcting her.

If you told my first year self that I was going to be who I am now in a few short years I’d have reacted in disbelief. At this moment I can scarcely believe that I was once that timid, that new or that scared.

I told the new first years some of this. I doubt they believed me. But maybe in a few years when they’re looking back at their beginnings they will.

Oh, and in terms of advice for you first years, here it is. Watch “Dead Poets Society”. Then you go and carpe the hell out of that diem.