Matted hair.
Tired, blue eyes.
Trembling hands.
Shallow, quick breaths.
Dry lips.
Hurting.
Terrified.
Dying.
"How are you feeling?"
"I'm okay"
I didn't know what to do or say.
So,
I reached out
Held her hands
And prayed.
Gray skin.
Matted hair. Tired, blue eyes. Trembling hands. Shallow, quick breaths. Dry lips. Hurting. Terrified. Dying. "How are you feeling?" "I'm okay" I didn't know what to do or say. So, I reached out Held her hands And prayed.
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This is a piece I wrote after my first day of gross anatomy. After my inaugural call day in the wards, it was an energizing read. It is amazing to realize how capable we are of growth, and even more great to see that we are still the same person.
It’s dark and lonely inside my apartment as I throw my backpack onto my couch. The piercing sound of my iPhone’s ringtone breaks the silence. Seeing it’s my mom (and hoping to avoid an hour long conversation about my day), I reject the call, making a mental note to call her first thing in the morning. It’s only Tuesday, I think to myself… I still have over half of the week left. My mind felt numb from the amount of information that had been thrown mercilessly my way in the first two days of medical school—‘learning how to drink from a fire hydrant’ as they called it. Now it was 11:30pm, and I had dedicated my entire day so far to attending lectures or studying at the library. It felt like the fire hydrant was winning. Just as my eyes close with the dying hope for at least a little rest, I hear my phone beep, notifying me that an email has been sent to our newly assigned first-year inboxes. Squinting my eyes, I see that a professor has emailed out a disclaimer for gross anatomy lab tomorrow. Whatever, I think as I throw my phone back onto the table and pull the covers over my face. It isn’t until I read the email the next day that the haunting idea of dissecting a human body hits me. The first thought that entered my mind was looking into the coffin at my grandfather’s funeral four years ago. It was the first death I had ever had to cope with in my young life, and I had never gotten full closure on the experience. Yet here I was… in front of a cold, steel box reminiscent of that same coffin. All of the sudden, my heart dropped. I got chills thinking of the idea that the cadaver had her own life, family, and unique lively personality. I didn’t want to pull the body up. I didn’t want to remove the towel. I didn’t want to cut into cold skin. I made every futile attempt I could to distance myself from the cadaver. Standing two feet away, I observed the dissection as I had observed many surgeries in the past, almost in denial that the body lying in front of me was lifeless. Yet somewhere within the first hour, my interest in the dissection piqued as I noticed my tank-mates having difficulty finding a minor nerve. I found myself palpating the cadaver with a natural expertise, both unintentional and exciting for me to experience. My eyes, with an attention for detail that I had acquired from years of academic challenges, would not quit until I found it. I was surprised at my own innate talent in working with the human body. From the moment I received my acceptance letter, I have always felt it was something I did not deserve. People worked hard for years to get where I had ended up straight out of college. I had convinced myself that luck had brought me to the doors of Texas A&M Health Science Center College of Medicine. Yet, in that moment in the gross anatomy lab, it felt right. That’s all that mattered. For the first time, I felt like a doctor-in-training. I belonged in this medical class, whether I chose to believe it or not. I had an undeniable natural talent, some acquired knowledge, and the drive to make it through any obstacle that may arise. By the end of the lab, I felt empowered. I wanted to connect to the same cadaver I was attempting to alienate as much as possible in the beginning of my experience. Somehow, this nameless, faceless person had given me a gift I would be forever grateful for—the ability to explore and look into the human body first hand, the motivation to become absolutely proficient in my field of study, and a newfound confidence in myself as a student of medicine. I now ache to know her name, about her life, her ailments, and what caused her to pass away, but I know it is something I may never learn. I almost feel cheated out of the essential human connection that I realized was necessary in every physician-patient relationship, being given a patient I could not even talk to. I could not express my concern, and she could not express her ailments. Yet, as I walk out of the lab, take off my lab coat, and change out of my dirty scrubs, I feel hopeful that I can share the empathy I was never able to communicate to her with all of my future patients. Why should I care?
Many say that fatigue is just a part of life as a medical student. So when I was feeling emotionally, physically, and mentally drained as a second year, I didn't think much of it. However, it quickly caught up with me. I was no longer feeling like myself anymore. As the workload began to overwhelm me, I would often spend more than 12 hours sitting at my desk alone trying to learn everything. Then, I would go to sleep exhausted and wake up to start the cycle all over again. It's important to remember that even medical students, residents, and physicians are human. Don't hold yourself to the expectations of a machine. When we don't take care of ourselves, we can't perform well and we aren't happy. Therefore, it becomes important to learn the right mechanisms to cope with (and more importantly, prevent) the fatigue we experience. Action Items for Healthcare Professionals:
People talk about work-life balance all of the time. My thought on this concept is very simple: I give 100% at work and therefore, I give 100% in my life. And vice versa. The two are too deeply interconnected to separate and it is not fair for one to take over the other. It is important for me to take care of myself in order for me to be the best possible physician for my patients. Similarly, it is imperative for me to give my all in my profession because medicine challenges me, pushes me to be a better person, and rejuvenates my spirit. Let me leave you with this: consider fatigue a blessing. I know that I am lucky to have found so many things that I am passionate about. With some healthy coping strategies and prevention measures in place to help me manage this exciting new life of mine, I'm happier than ever. Ah, psychiatry rotation! The six weeks every third year medical student looks forward to. Also known as the "psychation", this clerkship is notorious for great hours, low stress, and relatively easy content. In all honesty, I began my psychiatry rotation with these same expectations, only to be caught off-guard by brilliant teaching faculty who kept me on my toes, complex patients, and the mystical nature of the human mind. Here is a little taste of what I learned on my psychiatry clerkship:
Mental illness is real. One of the most amazing things I was able to witness is the stabilization of an acutely psychotic patient. When someone is admitted with auditory hallucinations, homicidal thoughts, and bizarre behavior, it is easy for someone to write them off as “crazy” – as if an element of their illnesses is fabricated. However, as my patients began responding to treatment, they also gained insight on their disease process. I now understand that distorted perceptions lead to a legitimate distortion of reality. I often found myself wondering how I would react if everyone told me that my reality was wrong. It wouldn’t be easy to accept. After seeing my dear patients experience the hardships of mental illness, it is clear to me that their suffering is no less real than any physical illness. Mental illness does not discriminate. Another fallacy is that mental illness is a plague of the low socioeconomic status and under-educated - that these individuals are destined to live at a lower level of functioning and intelligence. On the contrary, mental illness affects the millionaires and homeless alike, from the medical student to the high school dropout, and everyone in between. What's more, health disparities seem to be more pronounced in the diagnosis of mental illness. Silent and dangerous, inequalities in diagnosis, treatment, and other modalities of care can be combated best by choosing not to ignore them. Awareness of these health discrepancies is crucial to optimizing patient outcomes. Psychosocial issues cannot be ignored. Medicine can be hectic - nurses are desperately trying to get medications dosed to patients at the appropriate time, physicians are trying to fit in one more consult before the day is over, and supervisors are trying to ensure that time to discharge is minimized. However, we often forget that the best treatment approach is a holistic one that extends beyond medical care to encompass psychotherapy, social work, occupational therapy, and other types of treatment. It is imperative to understand the patient's home life, finances, support system, and stressors so that our treatment plans can be more effective and realistically followed through by the patient. What's the point of writing a script for antibiotics that cost $100 if the patient won't be able to afford anything more than $50? We should work together with our patients to formulate a plan that not only works best, but works best for them. Being a doctor is not only an opportunity to treat, but to heal. People with mental illness are largely disenfranchised in the world we live in – by their families, their friends, and even by healthcare providers. Yes, I said it. Even if they have good intentions, many medical professionals simply do not want to work with these patients. Some may feel caring for them is out of their scope or that they are too complicated to care for in a typical appointment time slot. However, it its core, medicine is about being a source of support and healing for a person who is suffering - even if we do not have the all of the answers or the resources to do so. My psychiatry rotation helped me develop my identity as a future physician. Being able to talk to people from all walks of life about their deepest, darkest fears has helped me cultivate a deeper understanding for the common thread that runs through all of us. It fine-tuned my ability to communicate empathy to others and handle emotionally stressful situations as a healthcare provider. Last but not least, it made me immensely thankful to be in a profession where I am able to offer compassion to others and serve their most basic human needs. This is the first post in a new series inspired by a lecture hosted by Dr. Janet Marcantonio, executive professor at Texas A&M University Mays Business School. Dr. Marcantonio is an extremely pleasant and patient woman who is truly dedicated to the success of her students. She teaches a course on individual leadership development, which has been invaluable to me. In the beginning, I would dread my mandatory weekly reflections. However, upon completion of the program, I walked away with a greater understanding of my personal leadership style and strengths. Furthermore, I have a vast array of frameworks available to me for everything from project troubleshooting to establishment of team expectations.
My posts in the "Ownership Has Its Privileges" series will be focused on a subject as it applies to the medical field. For example, today I will begin with a general discussion about issues with engagement in medicine and end by offering some advice on how healthcare professionals can take ownership of their engagement based on my experiences so far. Why should I care? Have you ever read a page, only to have forgotten what you read once finishing it? What about having a conversation with someone only to be reminded that they already told you something in a previous encounter? It happens to us all. Physicians are only human and no less susceptible to passive disengagement. Failure to remember details, confusing similar patients, and multitasking while in the patient exam room are all things that happen daily to any medical professional at some level. Unfortunately, there is a cost associated with disengagement that often goes unnoticed. These small things add up and lead to concrete failures in patient care. On the other hand, active engagement is not as easy as it seems. It requires due diligence to stay present in the moment when you are being pulled a million different ways by legitimate responsibilities. Action items for healthcare professionals:
I stole this book from my brother... I saw it sitting on his desk and figured it would be a great quick read. I appreciate the artistic, yet simple cover design. Any book with the words "Harvard Business Review" across the top at least deserves some consideration, right? Since it only took an hour to get through, this is a book I'll probably read every few months for guided reflection.
Overall Rating: 10/10 Highlights:
Critique:
Favorite Quotes:
“Hello, my name is Shraddha and I’m a third year medical student. Today, I’m working with Dr. X… is it okay if I ask you a few questions before the doctor comes in?” Not once have you said no to me.
Every time I make this request, I prepare myself for rejection. Considering everything at stake in your position (privacy, vulnerability, time), it is a mystery to me why anyone would let an inexperienced student work with them at the doctor's office. Yet without fail, every time I ask, you invite me into your examination room and personal life with a welcoming smile. You trust me… a humbling realization for me once it sinks in! It is the little things my patients do that keep me going through third year: A busy, working mother sitting patiently through my extensive, time-consuming history. A three year old giggling as I, a stranger she’s never met before, attempts to listen to her heart. A teenager confiding in me things he hasn’t even told his own parents. The most overwhelming of all of these experiences is at the conclusion of our encounter, when you say “good luck with everything”, “you’re doing great”, or even the occasional “you’re going to make a great doctor”. I am forever appreciative of your kindness, patience, openness, and confidence in my abilities. You are a constant reminder of why I chose medicine – to connect with others in a deeper, more meaningful way and to work with others to better the human condition. To my first patients – thank you. At the airport, I picked this book among a sea of other options. The cover was simple, unlike the others surrounding it. It bore a plain white background with a single impression in the middle, presumably from the piercing of a knife or similar weapon. In a black, regal font read the words "David and Goliath". Having loved the story since childhood, Gladwell's promise to deliver insight on "underdogs, misfits, and the art of battling giants" lured me in from the beginning. At just over 300 pages, it was an easy read during my layover.
Overall Rating: 6.5/10 Highlights:
Critique:
Favorite Quotes:
I am going to make a bold statement here. Are you ready for it? There is nothing wrong with healthcare providers thinking like businessmen.
I know what you’re thinking, but I feel the word “business” gets a bad reputation in medicine. We immediately associate the term with profit-hungry, egocentric individuals, a preconceived notion probably rooted in their unfair depiction in popular media. I want to challenge that perception by arguing that perhaps business and medicine are not at odds. Maybe good business practices allow physicians to focus on what matters most – delivering quality medical care. In that case, it would be advantageous for the average physician to start thinking more like a businessman. Here are four reasons why I think the business mindset isn't a bad thing:
Looking back, completing a Masters in Business Administration has been one of the most difficult things I’ve done. As a student at a top MBA program, I was surrounded by brilliant, competent, and ambitious individuals who challenged me every step of the way. The subject matter itself was also difficult, mostly because it was in stark contrast to the biochemistry and pathology that I am used to. Nonetheless, I gained the opportunity to fill a personal void. I realize I won’t be the most knowledgeable or experienced person to tackle every administrative problem I face in my career. However, when I see challenges in the clinic, I will feel empowered to identify the underlying issues and seek solutions to better serve my patients. If my patients have to wait for more than an hour to see a provider or receive suboptimal service due to the organization’s financial constraints, I refuse to let them become victims of a flawed system. As a scientist at heart, I try to gather all the facts before coming to a conclusion. After a grueling and intense nine months, here’s what I’ve found: business isn’t evil. Innovation and creativity is emphasized at the core of every discussion. There is a refreshing emphasis on long-term goals and value maximization. And yes, even financial analysts learn ethics. Business and medicine are deeply integrated in the world we operate in. I’m not arguing every physician-in-training should pursue an MBA, but maybe it’s time to take a step outside of our comfort zone and take ownership of the issues we face in the largely inefficient, unprofitable industry we operate in. Why? The answer is simple—if the healthcare system fails in the end, it’s our patients who suffer. I love writing because it is extremely challenging. Good writing involves so many elements - intrigue, simplicity, interconnectedness. It forces you to be so convicted to your thoughts that you commit to the permanence of words.
That is why I am writing this blog. Somewhere between school, family, friends, and the ongoing buzz of life, I am beginning to lose the ability to truly reflect on my experiences - a frightening realization. I fear becoming one of the doctors who treated me as a child. Intelligent, accomplished, competent, but distant. Someone who walks in a patient's room, conducts a brief interview, and formulates an accurate diagnosis - and yet cannot sense the fear of death in a patient's voice or the looming financial stress when handing over a prescription. Medicine is burdened with so many technicalities that it becomes easy to forget that each patient encounter is a unique experience. My goal is to cultivate mindful medicine through my writing and become a physician who is able to provide meaningful healing to each one of her patients. |
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