Many firsts of Many
Lessons medicine taught me about life
Telling my story
This year has been quite a year but it has been a year of many “firsts” my first c-section, my first big break up in medical school, and my first time getting to walk into a room of a sick patient and finally have something to offer. There have been many ups and down but I have learned a few lessons that I’m excited to share.
1. Surgery: “Fake It Till You Make It” is Fake: Suturing a real human for the first time
No matter how much I practiced, nothing would prepare me for the nerves I felt when my attending (the doctor who oversees trainees) finished the surgery to repair a hernia, ripped off his scrub gown, and headed to lunch telling me to “close up.” I go to the sinks to scrub in, barely remembering how to do that then approach the scrub nurse to get outfitted in the sterile garb for surgery. Looking back, it is so wild that I didn’t even know how to dry my hands and stay sterile now that I have scrubbed into a few dozen surgeries.
I debated following the old addage- fake it till you make it, pretending I knew what I was doing, and hope I didn’t break the sterile field. I opted to do the opposite. I said, “this is my first time doing this, would you mind walking me through getting scrubbed in?” Fearing she would be annoyed that this was going to take longer at the end of the case, I begged her for mercy with my eyes and I got it. She was kind and happily walked me through the whole process. When I was suturing, the surgical first assistant did the same. She painstakingly watched as I fumbled to hold the instruments and took 5x the amount of time that she would have taken to do the same thing.
In adult life and especially in medicine, I often find myself feeling like I should be amazing at everything the first time I try.
This year, I read a book called Show Your Work which reminded me that there is so much beauty in the process of learning- especially the beginner phase. You still have a passion for things, you learn fast because you have so much to learn, and you are forced to look stupid and be okay with it. After reading that book, I began applying that philosophy to my whole life. I failed harder when learning new dance moves, and I guessed wrong answers to questions from my preceptor, but the important part was that I tried and in trying, I learned.
Faking it until you make it reinforces the idea that we are supposed to be good at things when we first start and we have to fake that we aren’t just beginners. What if we romanticized the process of being new and enjoyed being a beginner? Who knows.
As a patient reminded me after doing my second prostate check, where we insert a finger into the rectum to feel the prostate, “we all have to start somewhere.”
2. Inpatient psychiatry: Be a Human First and a Doctor Second
On my first rotation, I was working in inpatient psychiatry in a hospital that was underfunded and even more understaffed. Despite being a new third year, I was thrown into the fire rather quickly. Within the first week, I was seeing patients on my own and spent most of my time chatting with them and writing notes.
There was a patient admitted on my second or third week of the rotation who left a big impression on me from the first day. She was a young girl, no older than 19 or 20 dealing with the depths of psychosis. She couldn’t share a room with other patients because all night she would yell and crumble up her food before throwing it all over the room. Most of the time she was inconsolable and by the time I got there in the morning to round, she was on the floor of the unit mumbling nonsensical words under her breath.
The first day I saw her on the unit, I was assigned to round on her so I went to go talk to her. We sat on the floor and I asked the standard questions I was taught to ask. “How are you feeling today?” “Do you have any thoughts of hurting yourself or others?” “Do you hear voices of people not in the room with us right now?” When she couldn’t answer any of these questions coherently, I decided to abandon them altogether.
I put down the clipboard and said, “Tell me what’s going on. Why are you here with us today?” She murmured some more nonsensical things but then some words started slipping through her stupor. She said, “No one believes I’m a girl. Everyone calls me by my dead name here.”
A dead name is a name that a trans person no longer identifies with which is usually the name they went by before their transition. Oftentimes, dead names are the ones we get in medical records because we use legal names. If a trans person hasn’t been able to change their name legally, chosen names may not make it into a visible place of someone’s medical file.
She told me that she uses she/her pronouns and that she goes by a different name than the one on her chart. I started finding excuses to use her chosen name in every question after that. Slowly, and only for a moment, we had a full conversation. She told me more about what happened before she was admitted, the voices she hears, and the “shadow people” that she can see everywhere. It was the calmest I’d seen her all morning.
Who is to say whether her meds started working at just that time or her brain randomly decided to take a break from psychosis at that moment? Either way, it seems important that she was finally able to hold a conversation when I acknowledged her chosen name.
One of the most important things I have learned in these past 6 months is that one of the most basic and important human needs is to be seen. We want to show up as who we are in the world and have someone acknowledge us. This semester, I have seen doctors do that by using someone’s chosen name and pronouns. I have also seen doctors do that by hearing a patient go on for 5 minutes about how they think Trump should be president again despite this physician’s known political views being the opposite.
In all these situations, one thing has happened every time. The relationship transforms from one between a provider of a service & a consumer of that service to one human seeing the other. Healthcare today feels so far from the hometown house-call doctor that medicine used to be. I have seen doctors countdown to their last patient of the day and use how fast they can see them as more of an exercise in productivity rather than a human experience.
It is the doctors that have retained their humanity in this healthcare system that have the power to make them feel better and offer them tools for healing. I am learning that those are two separate things.
It is the surgeon that changes his patients’ dressings instead of asking a nurse to do it and the OBGYN who takes 40 minutes of a hospital shift to talk about mortality with a patient who has end-stage liver and kidney disease. It is the midwife who gives her patients a “feelings talk” to remind them that choosing a c-section makes them just as good of a mother as someone who delivered vaginally and reminds them that there is still space to grieve the vaginal birth they imagined. It is this kind of care changes how their patients feel.
If there is a certain type of doctor that I am striving to become, it is one that finds a way to be human in a system that incentivizes us to be anything but that. From what I have seen so far, this is much easier said than done but I still hope to try.
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I have fallen back in love with medicine and feel incredibly privileged to have the experience of caring for other people in a way many will never experience. I have taken care of people in the depths of depression and for the birth of their first child. Medicine is such a privileged place to see the human experience and I feel lucky to be getting to do it and sharing this journey with you.
Thanks for reading, subscribing, and most importantly, sharing this space with me today and in the days to come.
