Medical school is a fragmented, intimate experience

His face was four inches away from mine.  I tried not to blink as he shined the ophthalmoscope’s light into my left eye and stared into my pupil as though it were the most interesting thing in the world.  He frowned, placed his hand on my head, and used his thumb to pry my eyelid higher.  He maneuvered for about 45 more seconds while I sat stone still, and then, suddenly, his face broke into a grin.  ”I see it,” he announced.  ”I definitely see it.”

And then, completely awestruck, “Wow.”

I was my classmate’s first visualization of the optic disc.

Our opthamology instructor previously had shown us dozens of images of the inside of the eye, some normal, some frighteningly abnormal.  ”Before I say anything else,” he began, “the first thing I want you to notice is how beautiful the eye is.”

Indeed it was.  Snaking along the back of the eye were tiny red delicate blood vessels, converging to become thicker until they crossed over the optic disc.  The optic disc, a pale yellow standout among the redder hues, is unique because it is the only part of the central nervous system that we can non-invasively see.

When my classmate saw my optic disc, he saw a piece of me that no one had ever seen before.  He saw my central nervous system.

Later that night, I friended him on Facebook.

It’s not surprising that medical school is an intimate experience.  When we learned to test for reflexes, I unabashedly hit my partner’s forearm until it bruised.  When studying for my microbiology final, I and a few others sat in the computer lab eating and complaining, finally shuffling out together at 1 am.   When I interviewed my first patient in the hospital, my partner watched me stumble over the most basic questions–and later told my preceptor he thought I did a great job.

What has been surprising is the complete lack of continuity among these experiences.  I have parents, I have a sister, I have a best friend, I have close friends in my class, I have had the significant other.  These people see me as a person with a complete set of experiences.  They have seen me at my highs and lows and middles, they have listened and re-listened to my secrets and fears, they have offered me unconditional support.

But–still–no matter how hard I try to paint a scene with words, they remain several degrees of separation away.  They see my world through my eyes, their sense of vision stemming from my words.

Then there are my classmates who have seen me on the front lines, seeing a side of me that deals with the emotional or bizarre or just plain new.  But–oddly–for each experience, it is a different and sometimes unfamiliar person who shares it with me.  I am used to creating memories with those closest to me, but in medical school, when the assignments are as random as the patient encounters, no such coherency exists.  The thread of experiences continues but it is broken.  I am the only witness to the whole.

I recently sat on a panel to give advice to first year students.  One of my classmates stressed the importance of finding a mentor.  She was lucky and had found someone she could completely confide in.  Her mentor knew her professional aspirations, her personal goals, and her progress in achieving them.  Sitting next to her, I felt a little less lucky.

“I don’t have one mentor who is my be-all and end-all for every issue I have,” I told the audience.  ”I’m interested in ethics, and I have a professor who I respect and can talk to about that.  For writing, I have mentors hundreds of miles away.  My faculty adviser knows the most about my personal issues.

“In short, I guess I don’t have a single mentor.  And I think that’s okay too.”  I wanted to believe my words.  But I admitted to myself that it would be a heck of a lot more convenient to have just the one.

My other experiences in medical school, some intimate beyond words, have been similarly fragmented.

I went to an Alcoholics Anonymous meeting with two of my classmates one night as part of an assignment.  We walked back slowly in the darkness, discussing, avoiding each other’s eyes.  In that moment, all three of us felt that it was just a bit of fortune that separated us from those whom we had met that night.  We were grateful.  We were empathetic.  We had changed.

During anatomy, I was partnered with three different classmates.  Together, we explored every cavity of our cadaver’s body.  We made off-color jokes.  We retracted skin and guided each other’s cuts.  We held the lungs in our hands and marveled.  We scraped the skin off the face and sawed through the skull and disengaged ourselves to do so.  Six weeks later, we had changed.

This year, during a psychiatry clinic, three different classmates and I interviewed a woman with paranoid schizophrenia.  Talking to someone with an illness in the brain is an entirely different experience from talking to someone with an illness anywhere else.  Her story involved violence, abuse, homelessness, isolation, and denial.  The narrator herself, by definition, was unreliable–to the point of ironically insisting that paranoia was the wrong diagnosis.  It was sad.  She was sad.  We were sad.  It was worse than sad.  We had changed.

I am changing, more than I had imagined.  I am grateful that I have classmates who are changing with me, sharing experiences that I can’t do justice with words when I am talking to those closest to me outside medicine.  I am grateful that our paths converge, if only briefly, for those intense moments.  I wonder how they perceive those moments, as time eventually blurs the details.  I’m sure that my classmates have stories of their own: their individual journeys at their individual paces.  I’ve heard some of them.  But in my story, I am the only one who can put the fragmented pieces together.

Sometimes the story is lonely.  Sometimes it’s exhilarating.  But, ultimately–convenience be damned–it’s mine and mine alone to make sense of.

Shara Yurkiewicz is a medical student who blogs at This May Hurt a Bit.

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  • Jon Sasenick

    I’m in MS1 right now, and I know exactly what you’re talking about (more in terms of peers than with relationship with faculty…though I imagine that to change in the future). I’m also in osteopathic school, so I feel like the person-to-person connection is even higher. We learn osteopathic manipulative medicine (OMM), or the manipulation of soft tissue, bones, and joints to promote circulation, lymphatic flow, and heal joint pain. In OMM lab, we’re randomly assigned a partner (that shifts every month) and practice everything on each other. This can range from deep tissue myofascial release (aka deep tissue massage techniques) to pubic tubercle palpation, to ischial tuberosity spreads. We’re basically obligated to teach, feel, massage, contort, etc. each other, often to someone you’ve never had any interaction with. It can be awkward at times, but I think we do it for a reason. Doctors need to be comfortable in close, often potentially awkward situations. Might as well start teaching it early?

  • http://www.facebook.com/profile.php?id=769935315 Jen Madeline

    Great reflection!  I’ve had a similar experience but have not been able to put my feelings about it in words like this…. your article definitely rang true for me.