Throughout most days of clinic rotations, I envision myself panning for gold. Just like I pretended to do as a young child. I am standing in a river that courses through a mountainside somewhere in West Virginia. It is a warm August afternoon; I roll up the pant legs of my overalls and wade into the water, which is just cold enough for you to keep noticing it. As each torrent crashes over the rock in front of me, I think of the miles and days this water endured to meet me here. I have a yellow plastic pan, cross-hatched to catch larger items from the river bed. The smaller, unimportant things fall through the cracks as I dip the pan into the water, floating with the current.
Once, I found a pebble that shimmered in the sunlight. It turned out to by pyrite, the “fool’s gold.” And although it was about the size of a dime, I felt like a millionaire. I kept it in a little jar on my bookshelf for years.
The physicians who agree to host students and partner with us in our learning process are indeed a rare breed. Physicians, especially those who work in primary care, have days of being overworked, stressed, disheartened by bureaucracy, medical non-compliance, and systemic issues not cured with a prescription. Like everyone else in the world, a doctor does not always look forward to coming to work. My training allows me to see physicians on their best days and sometimes, on their worst. It is a sobering reminder that during no part of my training or my career will I “arrive.” I have numerous times tricked myself into believing that someday I will know it all, have it all together, and be the quintessential portrait of compassion. But this myth cheapens the process and does not acknowledge the fact that we must all be evolving all the time, to become the best versions of ourselves for each other.
Through this process of learning, I also witness just how customizable the art of medicine is. While one physician may be the master of her craft, with excellent technical skills and thorough knowledge of medications, another physician may be tremendously skilled at building rapport and using clinic time to emphasize education. While one physician may revel in his perfectly healed incision from a C-section, another may celebrate (literally throw a party) for a patient with a HgbA1C below 6 percent.
A fair amount of muck and gunk gets poured into my sifter. The sand from the sound of frustration in your voice, the silt of office woes, the stones of EMR troubles and power outages — but these all can get carried away by the current. As I listen and sift, I can focus on what remains. I can hold onto the extra time spent with a mom of three to teach how to correctly use a metered dose asthma inhaler with spacer. This may prevent Forrest from returning the ER for an asthma attack. I can emphasize throughout our dialogue in evaluating a little girl for precocious puberty.
This training: I can sift and pan for gold, and place what matters into my pocket. Things to be carried throughout my ever-evolving journey to become a caring, competent physician.
Jessica Sallstrom is a medical student.
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