Two years ago, during my second year of medical school, my classmates and I sat in cramped auditorium chairs as our instructor presented us with a clinical scenario.
We were learning about arrhythmias, and our instructor flipped through slides of different ECG patterns, asking how we would respond to each. After several less concerning ones, the slide flashed ventricular fibrillation: an irregular quivering of the heart muscle that prevents blood from pumping properly, and a frequent cause of cardiac arrest.
What would you do in this situation?
“You run." he said. "Now, there are two directions you can run." In the comfort of a classroom, facing an invisible arrest patient, we all laughed.
I was a big fan of the show Scrubs before getting to medical school, and there’s a great scene in the pilot where J. D., a brand new intern, is seen dashing down the hospital hall as his pager goes off to signal a cardiac arrest. He ends up not at the patient's bedside, but competing with fellow new intern Elliot for a hiding spot in a nearby supply closet.
Only when I reached my third year of medical school did I begin to appreciate just how realistic those feelings were. Thrust into actual hospital medicine, with real patients, from two years of classroom medicine, with mostly textbooks as our companions, I finally got a glimpse of that fear. That inclination to run away. That profound, almost paralyzing dread of doing harm in the face of acuity, uncertainty, danger.
And so I hid in my share of metaphorical supply closets. When given the choice, I admit I sometimes shied away from more complex cases in favor of ones I felt more comfortable managing. Other times I aborted procedures when a patient showed signs of discomfort or impatience, deferring instead to my more experienced resident. I was constantly torn – between a desire to help and a deep-seated fear of causing hurt.
Most of all, I indulged in that wonderful qualifier I knew I could always turn to if things got rough:
“I’ll go ask. I’m just the med student.”
But somehow, bit by bit, my confidence grew. And one day, almost without my knowledge, I was admitting a patient by myself, and the treatment plans I proposed on rounds were going mostly unchanged, and I sat by bedsides and discussed with patients what was going on with their health.
And slowly but surely, I took steps toward becoming the kind of doctor – and kind of person – I wanted to be.
Still, we were protected, and we knew it. There was always a person behind the curtain, such that even when given independence, every move we made was – overtly or clandestinely – being watched by an MD. Every medication and lab order had to be co-signed; every plan run by someone. So we got to try out our doctor training wheels, but still feel protected. Safe. We couldn’t really do harm.
In one month, the security blanket will be pulled out from under us.
In one month, our pagers will go off. And it will say some version of this: “Doctor, what next?”
The patient is complaining of shortness of breath – what do you want to do?
Her potassium came back critically high – what do you want to do?
His son is asking about his father’s prognosis – what do you want to say?
They will ask for a doctor, and I will look around and think, I’ll go get one. Wait. Me?
And yes, there will still be safeguards. But it will be different. There will be decisions that will be squarely ours, and countless instances where we will be first-line to problems that arise.
Because we’ve chosen something – even though it can be frightening, sad, and downright miserable. We’ve seen fellow human beings experience immense suffering before our eyes, known what it’s like to feel powerless to help, and witnessed as mortality reigned supreme over everything we had in our medical arsenal. We’ve felt the personal weight of our decision through every weekend spent in the hospital, every missed holiday, and every overnight shift as we buried our noses in work and watched our lives pass us by.
But we chose this path, and we chose it for a reason. We came because there is a human need, and we aspire to meet that need.
In one month, our pagers will go off, and it will say some version of: “Doctor, what next?”
May we have the wisdom to make good decisions, the self-awareness to ask for help when we need it, and the courage to do right by our patients.
May we run in the right direction.
As I graduated from medical school this week, this is also my last post for Unofficial Prognosis at the Scientific American Blog Network. I started this blog three and a half years ago, and I was thrilled when I was offered a position here at Scientific American to chronicle my thoughts and experiences as I progressed through my medical training. It’s been a privilege to share them with you.
My goal when starting this blog was inspired by an Annie Dillard quote I found through an interview with Ted Chiang. Dillard wrote: "Why do you never find anything written about that idiosyncratic thought you advert to, about your fascination with something no one else understands? Because it is up to you…. You were made and set here to give voice to this, your own astonishment.”
It’s a tall order, but I’ve always loved the sentiment. I hope something I have written here has made you consider a idea you hadn’t before. Or to think just a bit harder, or differently. Or to feel something. I hope there has been some effect.
As far as my next steps, I may be leaving Scientific American, but this is certainly not the end of my writing. The best way to stay up to date on what I’m currently working on is to follow me on Twitter. You can also visit my new website, where I have compiled all my work in one place.
To all of you who have read my blog over the past three and a half years: I deeply thank you. You are the reason I write, and your dedicated readership, thoughtful emails, and passionate comments have humbled me.
Until we meet again.