Week 16: Reflections from Medicine

Hi friends! Apologies if you've been keeping up - I promise I've been writing every day (!!) but the second half of the block got really hectic, and I didn't have time to edit the entries in a way that'd be appropriate to share online. I do want to share some reflections on what was an absolutely incredible rotation:

It’s hard to look back on my medicine block. It feels like it’s been such a blur. Every day, we had rounds and morning report and noon conference and afternoon didactics and some attending teaching if time permitted. And in between all of that, I visited my patients and asked them questions and discovered physical exam findings and thought carefully about their labs and explained what we thought was going on and tracked their progress.

Looking back, a lot of my patients wrote too. One said that she used to read a lot but hasn’t been able to concentrate since a traumatic brain injury from when her neighbor assaulted her. Another told me about a novel he’s writing with a twist at the end, we almost had to discharge him to the street but managed to find a shelter bed in the nick of time. One of my patients writes raps I learned on my very last day, he pointed them out to me and told me what each one was about.

I’ve had a lot of patients who have been incarcerated. One police officer told my intern that we were being too nice, that our patient didn’t deserve that much kindness after what he did. Another police officer told the nursing staff that our patient is faking his pain, he’s quiet and comfortable until the medical team comes in and then he makes a show. So many patients who were living on the streets- some had made peace with it and carved out their own little corner beneath the highway to call their own. Others struggled to find their footing in this inhospitable city. Some lived in terrible conditions, with mice and cockroaches. Some lived with loving families who took meticulous care of them.

I think back fondly to the ease with which I connected with my first real patient, the way my guard was down completely. How another patient later on, who was charming and needed a dangerous amount of opiates, made my guard go back up.

How I wasn’t always present when I visited folks, how sometimes I was thinking about the next patient or the next task on my list instead of pressing them for questions I thought they might have. But at least I always came back to them, no matter the language they spoke or how altered their mental status - I circled back eventually. But I know there were times tha I should have gone back sooner.

It’s funny how all the notes I wrote, the elaborate differentials I sketched out, the phone calls I made to consulting teams, the teaching I tried to squeeze into my presentations- the things that we get graded on that I learned and grew in aren’t really what come to mind when I think back on the rotation. Not to say that they don’t matter, of course they do. Now more than ever, I realize that having a firm grasp on the pathophysiology and management plan is of utmost importance; no amount of human connection outweighs an effective assessment and plan for a patient’s long-term prognosis. I put so much work into developing these skills and I’ve grown enormously, and I want to continue honing my craft. But I could have sweat the small stuff just a little less and the overall outcome of my performance on the rotation would really have been the same.

I’ve been impressed by the review of systems and how it stars up conversations people don’t even realize they want to have. How asking where people live and who they live with can surprise you. Have they ever had this happen before, do they know what it might be? People know their bodies best. I actually heard murmurs and I felt a spleen, I found liver edges and odd distributions of neurological deficits on exam. I tracked a patient’s volume status for a week by the physical exam, listening for crackles and feeling for edema and eyeballing the biphasic JVP that slowly receded from the ear to inside the clavicle. I saw conjunctival and palmar pallor in a severely anemic patient; spider angiomata and fluid waves and asterixis and the other sequalae of cirrhosis in patients with advanced liver disease.

I love pathophysiology, learning how things work and then connecting that to tangible signs and exam findings and labs and images, and then thinking about what we can do to make them better. Seeing patients get better – it wasn’t quite as satisfying as I had hoped, and I’m still not sure why. My working explanation is that I’ve always been more of a process-focused gal rather than one who measures outcomes; if I feel like I treated someone with dignity and grace, made them feel heard and feel like they matter, maybe even feel a little connection in the moment, then I’m enormously validated. Obviously I want all our patients to get better, but when they do (or when they really don’t), it doesn’t quite hit me as personally.

Looking forward, my medicine rotation has really made me reflect on what kind of doctor I want to be. I don’t have all the answers yet. I was just watching the new episode of Chef’s Table (Ryan recommended it to me) and it was about a black woman who returns to her hometown in Georgia to open up a restaurant. The episode is a beautiful tribute to reclaiming African-American history and legacy but the featured chef talked a lot about returning to her roots to remind herself of the kind of chef she wants to be – this is pretty much a tangent but it makes me want to reflect too. I’m not too worried about the doctor stuff, that will play out over the next two years (I only have two years left what!!). But in terms of my writing, what is my voice? What am I even trying to say? I know that I like making people feel like they matter, that’s something I want my writing to do. I believe more every day in the power of optimism – which isn't a shallow positivity but rather a deep belief that we can find meaning in the midst of any pain or suffering, and that no matter what, it is always possible to treat others with dignity and grace, and that more often than not, there’s space for human connection even in unlikely circumstances. And that joy can be found anywhere if you open up to it. But I still don’t know what my creative voice is (and that’s okay, I want to enjoy figuring this out).

Y’all, I start surgery tomorrow. Last year, if you asked me which rotation I was most nervous for – it was this one hands down. This past week though, I’ve been so excited. I’ve even been looking forward to the reading. It’s amazing how much can change in a few months. I can’t wait for eight weeks of trauma surgery – promise you'll hear about some of it right here on the blog : )



xoxo,
Juhi