I spent my first two years of medical school collecting stories. I journaled about my thoughts in the anatomy lab. I wrote about what it was like to learn how to interview and examine patients, about the immense honor and privilege I felt just being able to don a white coat with a stethoscope around my neck. I wrote about the patients that touched my heart – the patient with Huntington’s Disease that reframed my perspective on death, the teenager with an undiagnosed neurodegenerative disorder that reminded me of my privilege, the elderly woman with a lymphoma that showed me the knowledge I was gaining was meaningful.
Since I spent most of these first two years studying from a textbook, I craved these stories. Each time I collected one, I tucked it away and protected it with every fiber of my still-pristine white coat, wrapped snugly around my body. It was easy to tell these stories. Each one felt so important, like an opportunity for self-discovery and personal improvement. And there was ample time and space to learn and grow.
I entered my clinical rotations of third year with excitement and eagerness about all the stories I was going to gather. After years spent listening to lectures and seven weeks spent studying 12 to 14 hours a day for USMLE STEP 1, I had finally made it to the “good part.” When I walked into my first day of my neurology rotation, still wearing a pristine white coat, I was ready.
But somehow, the stories are hard to tell now. They are vast and messy and tangled and numerous and all-encompassing – and when I sit down to write, the only thought that keeps flashing through my mind is which story do I tell first? Do I write about the stroke patient who reminded me of my grandmother? Or the immigrant child with cerebral palsy who cannot receive her spinal surgery because of a lack of health insurance? Or the mother of two young children who was just diagnosed with an incurable neurodegenerative disease? Or the man suffering from delirium whose belligerence drove his wife to tears? Or the patient who throws himself onto the floor with the hopes of sustaining a head injury that will allow him to “escape” to the hospital?
Things are complicated now. After spending hours at the hospital every day learning, studying, and trying to stay out of the way, I have found it difficult to process this new world I have been thrown into. While there is something to learn from every patient, every mistake, and every story, the takeaways are not so neat and tidy anymore. Lessons like “we need to spend more time listening to our patients” and “there are systemic challenges facing medicine” feel too shallow and too surface level – the limitations of what we can do to alleviate pain and suffering are all too real, and all too frightening.
Yet, what I’ve gathered so far is that this may be one of the biggest lessons that your third year of medical school can teach you – in the real world, medicine is messy. By choosing to practice medicine, we accept the reality that we are treating patients in an ecosystem that is complicated and largely out of our control. We choose to work with the mess that our patients bring to the hospital with them – to advocate for them to the best of our ability in spite of the resistance we encounter along the way. There may not be a “neat takeaway” or a “quick fix” for every patient, or any patient, but we can choose to shape their stories with respect and dignity.
I chose to go into medicine because I wanted to tell people’s stories, and to help shape them. I now realize how frustrated I will feel about the stories that remain untold and the stories that remain unchanged. However, I am also beginning to understand the joy I will feel when my patients tell me I made them feel acknowledged and cared for, and when I am (finally) able to correctly diagnose them and use my medical knowledge to improve their quality of life.
For me, choosing to practice medicine means acknowledging my limitations, but also my value. It means telling as many stories as possible, and holding the untold narratives just as close. And as I am beginning to understand, it means embracing the mess, and slowly but surely, learning how to mold it.
Prerana Chatty is a medical student.
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