Winding Down

I saw my last patient as a medical student on Wednesday last week. I'm going out on a two week rotation in pathology (so I'm not quite finished yet), but I have seen my last live patient as a medical student. As I approach graduation, I have some time to reflect on the experiences that have defined the last four years of my life. If I had to guess how all of this would end four years ago, the only thing I know is that I would have been off the mark, possibly about 180 degrees.

Four years isn't that long, and it seems that every four year cycle in my life takes just a little bit less time than the one before. Yet, the changes in my own life are profound. I've more than doubled the size of my family, changed career trajectory, watched people die, been exposed to tuberculosis (fortunately never became positive myself), and I'm ending the whole thing off with a move from a hot steamy flat metropolis to a small cold mountain town. I would have never guessed it, but I couldn't be happier in the end with how it all worked out.

It's strange how a few years in medicine changes your perspective. I suspect that this was uniquely exacerbated in my case by my near omnipresence in a large county hospital and level I trauma center. There was once a point in my life where being cursed at in spanish by a drunk guy who showed up at my door via helicopter with numerous pieces of long bone protruding through the skin would have been a bit odd. Now it really feels far too normal. In fact, I started this journey by dissecting apart a decaying corpse. I watched my wife lie in the same beds on the same wings of the hospital where I rounded on some of the nameless, nearly faceless, morass and prayed to God that someone who knew more than me was watching. I watched my son go into full respiratory arrest and drop his O2 saturation to 19% after extubating himself in the ICU. The second time I saw it, it seemed eerily normal. As those close to me suffered, I was still bombarded by strokes, gunshots, heart attacks, cancers, and more. I feel as though I ought to be suffering from some sort of post-traumatic stress syndrome. Yet, it all feels quite normal. It's as though it was meant to be the way it was, and I've made peace with the whole thing in a way in which I'm starting to forget how disturbing it all once was.

It's not that I'm jaded. I'm not. I appreciate the gravity of what I'm seeing and what I saw. Some of my patients still tug on my heartstrings in a way that makes me reflect on the meaning of it all. It's just that I'm used to it. I guess that this is one of the successes of my training.

I have also learned such an incredible amount, that I can no longer remember what it's like to not know some of it. I've picked up some amazing skills. I can safely pull fluid out of a swollen belly or out of an infected spinal cord. I am comfortable closing relatively complex lacerations and stab wounds. I feel comfortable assisting a surgeon in those which are even more complex. I actually know what all of those weird numbers written between strangely constructed lines mean, and I can identify whether they signify a problem. I've had to hold the hands of patients when I was in the unfortunate position of telling them that the problem those numbers signified was severe. I've also picked up and distributed this data in English and Spanish. I've also done so with written notes, through interpreters, impromptu sign language, and sometimes I've had nothing to go by but old notes on an indigent comatose patient with no family to be found.

Different people come out of this experience with extremely different perspectives. People enter medicine for a variety of reasons (save the world, make money, love science, etc...). People's expectations for medical school are all over the place and rarely on the mark. There is no consensus on the quality or value of this education. I have classmates that would take any offer of student loan repayment and take a job at Starbucks over another day in the hospital.

I am one of the people who would absolutely do it all over again. If I knew what I know before medical school, I would still absolutely sign up and do it all over again. The experience is incredible. The extraordinary becomes ordinary. Even with all of the paperwork, beauracracy, physical strain, and student debt, there are still very few other fields where everyday is part of an epic struggle between life and death. It's not all exciting, not all of your patients are good people, and it seems like all of the problems of society have been dumped down upon the decaying structure where you spend 80+ hours a week, but the upside is incredible. Every encounter brings a true window into someone's life. People trust you, often because they have no choice. Whether that patients are sitting in a clinic for some medication adjustment or flailing, screaming, naked and bleeding, in the trauma bay, they have at that moment put some portion of their lives into your hands. It is an awesome responsibility. I do not regret taking it.

I'm looking forward to the next step. While the location is quite different, much of the struggle will be the same. I will continue to compete in this epic struggle as long as the patients continue to bring me something worth fighting for. When I speak with my next patient, it won't be as a med student (or student doctor, or trainee, or whatever). I will introduce myself as Dr. Miami, and the title will be appropriate. I've earned it, and I never intend to lose it.