My Last Clinic as a 3rd-year Student!

Wednesday (April 20th) was my last clinic as a 3rd year student. It happened to be psychiatry. One patient was a super brilliant, highly paid, very well-educated, slightly unstable man who came in because of multiple issues that cropped up once he started working full time. It was challenging for me to interview him because he engages in many dare-devilish practices that frankly scare me and that I've never really understood, and some that I've never heard of. But it was a great exercise in finding those little handles people have that allow you to empathize with anyone -- some small preference, a place they've lived, a hobby, a pet, a belief. In this case, the fact that we were both in the healthcare field was a common reference point, so that worked nicely and broke the ice.

The second one was just a check-in from a man who had previously had such serious problems with alcohol/drug abuse that he had to enter a live-in residential program and leave his family and home behind. Somehow, miraculously, he has not only stayed straight-edge but has reconciled to some degree with his wife and she brings their daughter to visit him regularly. He has been sober for two years now. He told us tearfully (although perhaps this is fortunate) that the child is too young to remember when dad lived at home. I have nothing but the utmost respect for my psychiatry attending. As I've watched him over the year, I've realized how often he sees people at the very lowest point in their lives and then guides them back to emotional, and often physical, safety.

Because I am in a longitudinal clerkship program, I have had precepting sessions with different attending physicians in the core disciplines (Internal Med, Family, OB/GYN, Pediatrics, Neurology, Surgery, Psychiatry, Emergency) all year long and at seemingly random times of day and week. We've had a couple of inpatient experiences (2 weeks on Medicine, 1 week on OB/GYN nights, 2 weeks on surgery, 4 days of cardiology), but for the most part it has been outpatient medicine.

We also carried a core patient panel of about 60 patients each in all of these disciplines, and followed them into the hospital whenever they were admitted or on labor & delivery (via really old-school clunky pagers that would go off when any of our patients checked in for any reason at any of our affiliated hospitals). It's been amazing. Frustrating, demanding, often sleepless, awe-inspiring, touching, poignant, tearful, and just absolutely incredible. Never again will I have such complete access to all the different services of a hospital. Never again will I just be able to walk into the room, explain that I'm a longitudinal student, and then participate in whatever happens that day. In my fourth year and from now on, I will carry a label. I will become not just a student, but a student going into X specialty. And then I will be an X specialty resident, then attending, and so forth. This year, I have had the honor of being taught by some of the best and brightest minds in medicine, many of whom took the trouble because I was still an 'undifferentiated student' who had not yet decided what to do.

I have had so many 'firsts' as a medical student this year. First solo delivery of a baby with my (gloved) hands. First digital rectal exam (also gloved). First solo pelvic exam (metal speculums are less uncomfortable). First time breaking the news that someone had terminal cancer. First time a parent told me, "Thank you so much for taking care of my child." First lumbar puncture. First code. First time comforting a grieving relative. First time staying up all night for two days straight.

First time cauterizing a liver in the OR. First person to see someone who had psychotic hallucinations. First time I've seen a terminally ill child. First time I've had to explain why a woman in her twenties had to have her uterus emergently removed and will never again have children -- the day after her would-have-been wedding day. First time someone said "no" when I asked if they were safe at home. First thank-you letter from a patient. First time someone explained to me that they had to choose a Christmas tree OR presents for their children this year, and so couldn't afford their seizure medication. First time I've seen a husband and wife in back-to-back appointments -- in the oncology clinic. First home visit (to a healthy and robust man in his late 70s).

The Girl in the Orange Hat (first child I delivered, held by proud mama & papa)

It's been a memorable year in such a visceral way, to experience these human beings and their stories. I remember their faces, the feel of a spine, the smell of blood, phrases they used, the sound of their coughs. I look at a patient's belly and see my own sutures holding their wound closed. I look at an infant and remember catching him or her, soaking wet and newly born. It is a huge, enormous, incredible privilege to be there when people are feeling their worst, or hear the most terrible news they ever will hear. Likewise when the wonderful things happen: miracle recoveries, successful treatments without side effects, a false alarm. The thing about our longitudinal clerkship, though, is that I've also been there for the in-betweens: the colds that drag on through the winter when a patient is immunocompromised, the thyroid medicine that's never quite right, the lady who everyone thinks is "difficult" due to a lanuage barrier. These are the daily lives of the people of this city, and it's amazing to be so involved.

The next two weeks will be calmer: we have an end-of-year course focusing on healthcare policy and planning our careers. I have more tests to look forward to, as well. I am taking Step 2 of the national licensing boards soon. Clinical Skills (CS) will be in about 2 weeks, and then I'll probably take Clinical Knowledge (CK) some time in July. CS is pass/fail, whereas CK is most certainly not. I'll be studying hard for that one! Also in the next two weeks comes apartment hunting, wedding planning, and recovering from sleep deprivation. I'm SO looking forward to the idea of a class breakfast tomorrow morning, when I'll see how everyone is doing as compared to last term.

After a year of ups and downs and struggling to glean a tiny bit of this terrible, beautiful beast that is clinical medicine, it is such a pleasure to sit here with a cup of tea and write to you, knowing that spring has finally arrived.