Three years ago, before fully committing myself to the idea of going into medicine, I decided to shadow in a genetics outpatient clinic to help give me a clue of what it was about. When I met twelve-year-old Laura (not her real name), she was wearing denim overalls, white sandals, and a floppy green hat. During her evaluation, the resident I was shadowing asked her to remove them so that he could do a routine physical exam. Everything was shed except for the green hat, which she flatly refused to touch. Laura’s mother, who was in the room with us, defended her daughter’s obstinacy. “She never takes that hat off. Can’t you just do the exam with it on?”
Laura and her green hat inspired a fiction story I later wrote about a young girl’s building obsession with texture and color. Many other tidbits I had learned about her, however, never made it into the narrative. In a story, with words that I arranged, characters could behave any way I chose or undergo any experience I designed. I was able to add and subtract details to Laura’s narrative as I wanted – not necessarily to give it a happy ending, but to package it neatly, smooth out contradictions, and tie up loose ends. A twelve-year-old became a fifteen-year-old, a green hat became a red scarf, and most importantly, the doctors were able to give my character’s illness a name. By writing a fictional story about a patient, I was able to fit pieces of her medical narrative together in satisfying ways I could not do in real life.
The real Laura and her mother had already seen several doctors before us, none of whom had been able to discern what was wrong. I had encountered illness before that shadowing experience, but Laura’s case unnerved me in a way I had not felt before. In the past, illness was devastating, but I found consolation in the knowledge that at least it made some sense. A heart attack in a family member was the consequence of bad genetics and a lifetime of unhealthy eating. My grandmother’s death from Alzheimer’s disease came after a gradual deterioration through a documented series of stages. The experiences were heartbreaking, but I could not describe them as wholly unpredictable. Laura’s resistance to diagnosis or treatment, however, pierced my naïve perception of a rational medical reality. I realized while writing that piece – my first story on a patient – was that what I was trying to redress was my lack of closure. Writing enabled me to turn a vague discomfort into a feeling I could identify.
Writing, both non-fiction and fiction, remains an outlet to help me process my emotions. It was for cathartic reasons that I started this blog in the first place, and I am thankful for its ability to help me make sense of my medical school experiences. Putting experiences on paper enables me to confront my intuitions honestly. By forcing myself to articulate a web of feelings into an organized string of words, I am able to process my reactions more coherently. When closure feels to be lacking, writing enables me to keep the conversation going, even if only with myself.
In three weeks, my first year of medical school will be over. I’ve had the pleasure of meeting wonderful patients like Ms. P, Ms. L, and many others, for not every story has been publicly captured on my blog page. But by reflecting on some of my experiences through writing, I’ve come to recognize a consistent emotion of this year: frustration. Just as Laura was not able to be diagnosed or treated, Ms. L’s history of abuse could not be solved in the hospital, and Ms. P would die whether I was ready to accept it or not. I feel frustrated that the line between medical and social problems can be so blurry – and that the latter is so much more difficult to treat. I have seen things that depress me about human nature, such as bruises and suffering that result from another person’s inexplicable rage, rather than from a common enemy called illness. I am frustrated by the transience of the medical student-patient interaction – a bizarre dynamic where in an hour I can get people to open up to me about their most intimate secrets, and then I can walk out of their lives. I have become skilled at collecting information, but no better at handling it. How many times this year have I said “I don’t know”? “I’m sorry, but this is not part of my role”? First year has meant walking around the hospital focusing far more on not messing up than on actively doing good. It is easy to harbor grandiose ideas of helping people one day and feel tiny, invisible, and useless the next.
In a way, all the stories from this year have made me realize what I discovered three years ago, just in a larger sense. Things do not package neatly in the world of medicine. Making decisions with limited information, feeing that I am not doing enough, and experiencing lack of closure over a patient’s story are all things I will have to deal with on a regular basis.
It’s a strange feeling, frustration. In small doses it can be an impetus for good, but carry too much and it can be crippling. As my first year of medical school winds to a close, I think I can safely say I am at the former end of the spectrum. Feeling useless has motivated me to ask questions, to research things I do not know, and to reflect on all the aspects of medicine, scientific and humanistic, that I want to understand better. In a certain light, I am grateful for my incessant feeling of ineptitude, and for the resources and mentorship I have found here to help me grapple with it. I am exasperated, yes – but more so I am inspired. As I continue collecting patient stories over the next three years, the challenge will be staying there.