doc w/ pen

a journalist becomes a doctor before your eyes

s/p surgery rotation, week #1

My 6-oz. water bottle, which fits in my white coat pocket, helps keep me hydrated throughout the day. Its small volume keeps me hydrated enough that I don’t get lightheaded, but not so hydrated that I have to go to the bathroom all the time. In surgery, hydration is a delicate balance.

Medical student with a past life history significant for journalism, art, and piano, s/p* starting her surgery rotation 1 week ago, presents with aching feet and legs. The symptoms are most consistent with walking all over the hospital and standing for hours in the OR with inadequate footwear. The student does note that these symptoms have not affected her enthusiasm for the surgery rotation, and that assisting in several surgeries last week has only enhanced her desire to improve her surgical skills. Recommend the student continue to read more about the field of surgery, practice suturing and knot-tying at home, and buy shoes that are more comfortable to stand in for extended periods.

Part of writing up a patient note is including your “Assessment and Plan.” It’s just what it sounds like — a very brief synopsis of the person’s presenting symptoms, what you think the cause is (and why), and what you plan to do about it. The paragraph above is my own Assessment and Plan after 1 week of my surgery clerkship. In other words, the main issue is that my tennis shoes simply aren’t cutting it. Aside from that (and being tired from waking up at 4 a.m. — which is just a given), I’m really enjoying the rotation so far.

Of course, I did learn some lessons from my ob/gyn clerkship that have helped. Those of you who follow my story may remember my near-fainting incident during a C-section earlier this spring (see “Getting back up” from The American, the online magazine I write for every month). After that experience, which I attributed to hunger and dehydration, I now keep quick snacks, as well as an adorable 6-oz. water bottle, in my white coat pockets. They come in handy.

I’ve found several flavors of KIND bars (high protein, lower sugar) that keep me fed when there isn’t time for a real meal. String cheese is great too.

On Friday, for example, we had a lot of cases booked, and in two different rooms — eliminating the room cleaning break in between surgeries that gives you time to get something to eat or drink, and use the bathroom. It was around 4 p.m., and I hadn’t had time for lunch. I was staying late that evening too, and didn’t anticipate time to eat dinner either. At the completion of one case, as everyone readied to go to the next, I approached one of the residents.

“Do I have for a 2-minute snack?” I asked.

She looked intently at me as she quickly thought about my question, knowing we were on a tight schedule.

“Two minutes,” she replied.

Thank heavens for that packet of string cheese in my white coat pocket, which was hanging in the hallway just outside the suite of operating rooms. I ate it in three quick bites, and was indeed back in about two minutes.

The clerkship orientation I mentioned in my last blog post has also come in handy. During a laparoscopic cholecystectomy (gall bladder removal), I got to “drive” the camera for part of the procedure. I also did my best to suture closed one of the port sites used to insert the instruments. Getting that needle just where you want it is harder than it looks though, so the resident had to rescue my effort. But I’m resolved to improve.

Those were things I’d practiced (a little), and expected to try. I didn’t expect to get to help with an ulcer debridement. Debridement is the process of removing dead or damaged tissue from a wound, and in this case it was done to try to help the wound heal. After watching the resident and intern, I was allowed to snip away bits of the yellow, gooey fibrinous exudate that we wanted to eradicate. But even after we cut away as much as we could, there were little bits still stuck down, too small to remove with scissors. So we (that includes me!) used another tool.

Before we started with it, the resident picked up the handheld device, and asked me what I thought it was.

“Well, it looks like a water gun,” I told her.

She told me that’s essentially what it was — a combination water gun and suction device. It sprays a high-powered stream of water into the wound, loosening the remaining gunk, and simultaneously sucks it up.

The resident then pointed to a shield surrounding the nozzle.

“This is to keep us from getting sprayed,” she said. “Don’t spray us.”

Then after a brief demonstration, it was my turn. I considered my time with the fancy water pistol a full success: I helped clean up the dead tissue, and I avoided spraying my resident and intern in the face. Even with our eye protection, that would have been … less than ideal, to say the least.

The ulcer debridement was a procedure I had really wanted to scrub in for. Having talked so much with my mom, a hospice and palliative care nurse, about wound care, I wanted to see it in action.

Along those same lines, it was interesting for me to see bedside wound care too. Several times last week, I went along with an intern to change a dressing. The intern did most of the medical work. My main role was to distract the patient from the pain, inevitable in spite of pre-medication. So I put my palliative care hat on, glad to help ease a patient through this temporary, painful event.

More than once, an intern has apologized to me that there isn’t anything “interesting” going on for us to see. The intern was referring to the fact that some days, there are few, if any surgeries going on while us medical students are there. On the other hand, there are also days when we’re booked back-to-back, plus emergency add-on procedures. You simply never know. My response is always that (of course!) while I’m excited to scrub in for surgeries, I’m also just glad to be part of the team, helping with the little things like gathering supplies for a bedside dressing change or procedure.

It’s all part of the learning process. And that’s why I’m here.

 

*s/p, which stands for “status/post,” essentials means “after.” It’s often used in reference to procedures, such as surgeries. For example, a patient who had their gall bladder taken out 5 days ago would be referenced to as “s/p cholecystectomy 5 days ago.”

Surgery, day #1: attitude adjustment

We weren’t wearing the appropriate maroon scrubs when we went to the OR to practice how to scrub in for surgeries. So we had to don the infamous blue “bunny suit.” These disposable, zip-up onesies are only stocked in XL, so most of us looked completely ludicrous. I felt it was important to capture the ridiculosity of the moment. My friend, who had kept her iPhone handy, was kind enough to oblige.

Around the country, the medical school surgery rotation has a reputation for being one of the toughest and most grueling. The hours are long, the breaks are few, and the expectations are high.

So it was with more than a little trepidation that I approached the first day of my surgery clerkship yesterday. But after yesterday, I find myself with a changed attitude. The hours won’t be any shorter, but our day of orientation got me excited about what I’ll be seeing and learning over the next 8 weeks.

Our orientation included the obligatory lecture sessions about clerkship logistics, leadership, grading, safety, all that. But after those things were out of the way, we got to do stuff. Fun stuff.

Our orientation was held in Weill Cornell’s Skills Acquisition and Innovation Laboratory (SAIL for short). It’s a suite of rooms in the hospital designed to help surgeons, surgical residents, and medical students practice their surgical skills. And while as medical students, we obviously won’t be performing the operations, we will be assisting in some ways. Depending on the trust earned with our residents and attendings, we may be asked to do things such as insert the foley catheter (for urine), retract, hold the camera during laparoscopy, suture, and tie knots. Retracting is pretty self-explanatory, but everything else requires some knowledge.

So yesterday, we practiced. We used actual foley catheter kits (the same kind that we will see in the operating room) on both male and female mannequins. Urine passage is obviously pretty different depending on the gender, and getting a tube up there is also a little different. While inserting the foley, we worked to maintain sterile technique to reduce the risk of infection. There were also workshops on knot tying (so many knots to learn!) and suturing (so many ways to suture!). The most high-tech workshop was for laparoscopy, also known as minimally invasive surgery. That’s where they make tiny incisions and insert a camera and other instruments rather than open up the abdomen (or other part of the body) with a long incision. There were several stations to practice our hand-eye coordination. It was a lot like playing a video game. At each station, you looked up at a screen (same as you’d do during a laparoscopic procedure) while holding the camera and/or instruments with your hands. Then you had to manipulate objects with your instruments, passing tiny blocks from one hand to the other, dropping beans into a tiny hole, or untangling rope (to simulate loops of bowel), for example. These stations actually replicate an exam that surgical residents have to pass in order to graduate. After doing a few stations, I have a new respect for this kind of surgery. I did notice improvement after a few go-rounds though, so I see how these practice stations are a huge help to surgeons.

Late afternoon, we headed to the OR for a brief tutorial on scrubbing, gowning, and gloving. Since I completed my ob/gyn rotation, I’d already learned these skills, though it was a good refresher.

At the end of the day, I’d recalibrated my attitude. And I’d formulated my goals for the clerkship. I want to perform well, of course — that goes without saying. That overarching goal encompasses lots of little goals, including studying for the shelf exam, reading up on patients, being a helpful student, working hard on my patient presentations, and so on. But I also want to leave surgery with a better grasp on some of these surgical skills, particularly suturing and knot tying. We were told yesterday that it takes (literally) thousands of hours to really learn how to suture and tie knots. I don’t have thousands of hours to practice. But I also don’t need to perfect my skills to the level of a surgeon. I do, however, want to feel more comfortable doing those things, because they’re useful across the practice of medicine. So I talked at length with the doctor who runs SAIL, which is open 24/7 for us to come in and practice. I’ve now got some sutures, gloves, and other paraphernalia at home to practice with. And he told me to come back in a week or so to show him my progress. He’ll help me if I’m struggling with anything or if I’m doing something incorrectly — both of which are very likely. I know that this kind of hands-on tutoring is invaluable when learning a new skill. I’m so grateful for the help.

Along with being a writer and medical student, I’m also an artist and former pianist. I love using my hands, and know the importance of building muscle memory. So I see this as a fun (and practical) challenge.

I love a good challenge. I’m in medical school, after all.

The theme of my spring break: exploring the integration of art and nature

Today marks the beginning of a new clerkship, surgery. I’m sure I will have plenty to say about that in the coming 8 weeks. But right now, I want to write about the marvelous spring that just came to a close. Without intending this, my vacation decidedly had a theme: art, nature, and their integration. I explored this three-part theme both in New York City with a dear friend who came to visit, as well as during a brief trip to Chicago to see my family.

Taking a break to hug a tree at the Morton Arboretum.

It all started while I was in Chicago, with a visit to the Morton Arboretum. The weather was perfect for seeing this outdoor plant sanctuary, a favorite of my mom’s, and I had never been there. When my mom and I arrived, we discovered there was an origami exhibit underway. The beautiful arboretum grounds were sprinkled with immense metal sculptures, precise replications of miniature folded paper creations. We oohed and aahed as we walked around, both at the plants and the intricate folds of the sculptures, and took lots of fun photos. At the end of our visit, we stopped by the gift shop. I came across a craft kit on how to make origami flowers. It had everything you needed: instruction booklet, paper, and a DVD showing how to make the folds.

“This would be fun,” I told my mom.

Ever the supportive homeschooler, she replied, “I’ll buy it!”

An orchid bouquet that my mom and I crafted together.

So she did. We learned how to make orchids, plumerias, and leaves. I bought floral tape and wire, and we made bouquets. We found YouTube videos detailing how to make cards. We did all this not from the paper included in the kit, though — that paper was plain and boring, so we used it for practice only. But I’d left dozens of sheets of fancy paper at my mom’s apartment, the remnants of my decoupage days. They were still in her basement. I lugged them up the stairs, thankful that most art supplies find use in multiple projects.

I had so much fun that I mailed all my paper (in poster tubes) back to me in New York, and on my plane ride home checked an extra suitcase full of other art paraphernalia. Now I’ve got another way to express my creativity — one that doesn’t involve sitting in front of a screen.

I told my dad one morning a day or two later about the Morton Arboretum and our origami adventures. Along the lines of Japanese culture … he asked whether I’d ever visited the Anderson Japanese Gardens in Rockford. I hadn’t. The afternoon forecast called for rain, so we hurriedly got ready and hopped into his Corvette for the drive to Rockford. Our walk among the Japanese maples and other carefully cultivated plants was sublime.

Enjoying the falling water and beautiful foliage at Anderson Japanese Gardens in Rockford, Ill.

Posing with one of the Chihuly sculptures at the New York Botanical Garden.

Back home in New York,  a good friend of mine came for a brief visit. We headed to The Met, of course, at her request. At my suggestion, we also visited the New York Botanical Garden to see the Chihuly exhibition. I’d seen a similar show at Chicago’s Garfield Park Conservatory several years prior, and had been blown away. His immense blown glass sculptures, which have an unmistakable signature, dotted the garden’s landscape. Some stood alone; others were mixed into the actual plant beds or flowing fountains. For those of you in New York City, I highly recommend going to the botanical garden before this show ends on Oct. 29. Pay the extra few bucks to see not only the outdoor sculptures, but the indoor ones too. It’s totally worth it.

Below are additional photos of my art and nature adventures. Click on any of the photo galleries to see a slide show version with larger images.

Morton Arboretum:

My origami:

Anderson Japanese Gardens:

Beautiful blooming dogwood tree on the grounds of the Japanese garden

New York Botanical Garden / Chihuly:

Enjoying San Antonio

Posing along the lovely San Antonio River Walk

While I was in San Antonio last week, I enjoyed not only the conference I was attending, but the city too. I took several strolls along the famous San Antonio River Walk. As I discovered, you can follow the bank of the San Antonio River for several miles along a network of paths that are inset one story below the hustle and bustle of automobile traffic. For part of the River Walk, you’re surrounded by hotels, restaurants, and shops, with river taxis and tour barges whirring by. But past the commercial district, it’s all peace and quiet. On that leg of my walk, I saw more ducks than people. This was quite the change for me, coming from New York City. The place to go for “green” in NYC is Central Park. No matter when you go though, there are gobs of people there, on all the paths and lawns. I definitely enjoyed the solitude and silence I found in San Antonio. Here are some photos from my excursion on the River Walk.

Being in the Southwest, I also enjoyed the prevalence of Latino culture. As I made my way along the River Walk, I stopped for lunch at a Mexican restaurant. While waiting for my enchiladas, the table decor, a large sheet of paper protected under a layer of glass, caught my eye. At the top of the paper, the title read “Serpientes y Escalaras.” I realized this was a game board — in Spanish — for “Shoots and Ladders,” which I’d played so many times as a kid. I couldn’t resist taking pictures of the board, including the Spanish-language instructions.

All in all, it was a wonderful trip — I got to both learn and unwind. Still, it’s always good to be home.

Presenting a poster, and reigniting my passion

Posing with the poster I presented at the American Geriatrics Society’s annual meeting this past week in San Antonio.

I spent the last few days in San Antonio at the American Geriatrics Society’s annual meeting. I wasn’t just an attendee — I also presented a poster on the palliative care research I did last summer in Uganda. It was a wonderful experience to go through the process of writing and submitting an abstract, creating a poster, and then presenting my work to other medical practitioners.

Talking with people about my research, getting feedback on what we’d done in the past and hope to accomplish in the future, also reignited my passion for the project. I’m ready to dive back in and use the information we learned last summer to try to make positive change. I won’t have to wait long to do that. I will be continuing my work in Uganda during my four-month “Area of Concentration” research block next year.

The work we did last summer was a pilot project that aimed to better understand why some patients in rural Uganda do not seek medical treatment until their condition has progressed to being terminal, and therefore present for palliative care. We also hoped to learn what the patients understand about their illnesses, and what both patients and medical workers see as barriers to seeking medical care. Here is a link to a larger image of the poster I presented, detailing our results and conclusions: Understanding Illness Perceptions and Care-seeking behavior in Older, Palliative Care Patients in Rural Uganda.

One key thing we learned last summer is that poor communication from providers to patients is a factor that affects whether people seek medical care. Patients don’t trust the medical establishment because they feel belittled rather than heard or understood. So they are discouraged from seeking medical care from physicians. Instead, the patients turn to traditional healers who actually listen to their concerns. This is a problem when a patient has breast cancer, for example, and months or years of using ineffective herbal treatments means that her cancer progresses beyond the point where it can be cured. So my project for next year is to develop a multimedia educational module to teach better communication skills to medical workers. Specifically, the module will address the topic of how to deliver bad news to patients, such as a frightening diagnosis. We’ll be using film footage that was taken during palliative care home visits in rural Uganda last summer. The project has yet to be formally approved by my research committee, but so far I’ve gotten very positive initial feedback. I look forward to sharing my progress as this new project moves forward.

It truly takes a village to make a project like this possible. It’s impossible to mention everyone who played a part, but these are the key players. Thanks to my research mentor, Dr. Randi Diamond, for her hard work, dedication, and ongoing support. I also want to thank Weill Cornell’s Division of Geriatrics and Palliative Medicine for sponsoring my trip to the conference, as well as my initial research funding from the Howard Olian Endowed Scholarship in Geriatric Medicine. I also want to acknowledge those who worked with me on the project last summer. From New York: Dr. Howard Eison, Dr. Jemella Raymore, Dr. Carol Capello, Dr. Veronica LoFaso, Dr. Cary Reid, Dr. Ron Adelman, Dr. Kelly Trevino, Lauren Meador, Allison Maritza Lasky, and my fellow MSTAR/Adelman scholars. From Uganda: the St. Francis Naggalama Hospital administration, physicians, and staff; and the Naggalama Hospital Palliative Care Outreach Team.

A mystery junkie’s podcast line-up

In a previous post, I called myself a “mystery junkie.” It’s true. Crime dramas, real and fictional, are my escape. There are plenty of excellent TV shows out there, especially some of the British stuff, like “Sherlock.” But I spend so much of my time in front of a screen that lately, I’ve gotten into podcasts. Lying on my couch, eyes closed, listening to the story unfold is a perfect way to unwind after a long day.

Most of these podcasts tell true stories. I’ve found the element of the “real” provides a compelling hook. And the journalism — the reporting, writing, and audio execution — is phenomenal.

One thing I initially found daunting about the world of podcasts is that there are just so many of them. How do you know what you’ll like, what’s good? Thankfully, you can find this out pretty easily by trying an episode (most podcasts are free to download or stream) and then deciding whether to continue with the show. But in the spirit of sharing and shortcuts, here is a list of the ones I’ve found and fallen in love with. I’m also including several that I plan to try, but just haven’t gotten around to yet. Click on the name of each podcast to go to the show’s website.

Highly recommended:

Serial. This is the podcast that turned me on to podcasts. It’s from the creators of “This American Life,” so you know it’ll be good. There are two seasons. The first season explores the 1999 murder of a high school student. The description of the first episode, from the website: “It’s Baltimore, 1999. Hae Min Lee, a popular high-school senior, disappears after school one day. Six weeks later detectives arrest her classmate and ex-boyfriend, Adnan Syed, for her murder. He says he’s innocent – though he can’t exactly remember what he was doing on that January afternoon. But someone can. A classmate at Woodlawn High School says she knows where Adnan was. The trouble is, she’s nowhere to be found.” The second season is about a soldier who leaves his U.S. Army post in Afghanistan in the middle of the night. This season’s first episode description: “In the middle of the night, Pfc. Bowe Bergdahl grabs a notebook, snacks, water, some cash. Then he quietly slips off a remote U.S. Army outpost in eastern Afghanistan and into the dark, open desert. About 20 minutes later, it occurs to him: he’s in over his head.” Warning: I was literally hooked within minutes of starting the first episode. This is really good stuff. Check out the show’s website for maps, photos, and other pieces of evidence from each season. And once you’ve watched “Serial,” check out this “Saturday Night Live” sketch about the show.

S-town. The tantalizing description from the podcast’s website: “John despises his Alabama town and decides to do something about it. He asks a reporter to investigate the son of a wealthy family who’s allegedly been bragging that he got away with murder. But then someone else ends up dead, sparking a nasty feud, a hunt for hidden treasure, and an unearthing of the mysteries of one man’s life.” This podcast miniseries is from the same people who did “Serial” and “This American Life.” Also very addicting.

Criminal. From the show’s website: “Criminal is a podcast about crime. Stories of people who’ve done wrong, been wronged, or gotten caught somewhere in the middle.” Many of the shows are about bizarre crimes, like the repeated theft of milemarker 420 signs in Colorado, or an exploration of how to fake your own death. Even the shows that are about more “standard” crimes like murder all have a twist to them. Each episode, which ranges from 20 to 30 minutes, stands alone which makes this show great for shorter blocks of time.

Accused. This is a wonderful, nine-episode show that explores an unsolved murder. From the show’s website: “When Elizabeth Andes was found murdered in her Ohio apartment in 1978, police and prosecutors decided within hours it was an open-and-shut case. Two juries disagreed. The Cincinnati Enquirer investigates: Was the right guy charged, or did a killer walk free?” The newspaper also did a print version of their investigation, and includes additional videos, photos, and other exhibits on the website. Pretty cool stuff.

In the Dark. The website’s description: “For 27 years, the investigation into the abduction of Jacob Wetterling in rural Minnesota yielded no answers. Reporter Madeleine Baran reveals how law enforcement mishandled one of the most notorious child abductions in the country and how those failures fueled national anxiety about stranger danger, led to the nation’s sex-offender registries and raise questions about crime-solving effectiveness and accountability.” I’ve only listened to three of the 10 episodes, but so far they’re gripping.

Still in my queue:

Stranglers. “It’s been 50 years since 13 women were murdered in Boston … and we still don’t know who really did it.” There are 12 episodes exploring the cases.

Someone Knows Something. This Radio-Canada show has two seasons so far. The first season’s description: “What happened the day five-year-old Adrien McNaughton wandered into the woods and was never seen again? How does a family grieve for someone who may still be alive? And where might he be today? SKS host David Ridgen returns to his hometown to investigate the case.” The second season’s description: “On December 31, 1997, at a New Year’s Eve party broadcast on live TV, Sheryl Sheppard accepted a marriage proposal from her boyfriend, Michael Lavoie. Two days later, she disappeared. In Season 2 of SKS, documentarian David Ridgen joins Sheppard’s mother Odette on her search for answers.”

Real Crime Profile. From the show’s website: “Join Jim Clemente (former FBI profiler), Laura Richards (criminal behavioral analyst, former New Scotland Yard) and Lisa Zambetti (Casting director for CBS’ Criminal Minds) as they profile behavior from real criminal cases.  Real Crime Profile will take you through the gripping Steven Avery case highlighted on ‘Making A Murderer,’ the OJ Simpson Trial, and much more.” Episodes 65 and 66, incidentally, profile the main characters of the podcast “S-town” that I’ve recommended. I plan to listen to those episodes soon.

Found. This show has a unique premise: “Have you ever found a note on the ground, maybe meant for someone else? Help Davy Rothbart solve these mysteries on the FOUND Podcast, where we explore personal stories of love, loss, hope, transformation and aspiration through the lens of lost and found notes –with the power of humor and music.” There’s even an iOS app where you can see the notes.

Crimetown. Another interesting premise: a show that explores the culture of crime in different American cities. The first season’s 18 episodes explore the world of crime in Providence, Rhode Island.

Reveal. This podcast is done by the renowned nonprofit group The Center for Investigative reporting. The shows are on everything from unsolved murders, smuggling, and whistleblowing to explorations of the situation in Standing Rock.

Secrets, Crimes & Audiotape. Unlike the other podcasts I’ve listed, this weekly audio drama tells fictional stories. There are murder mysteries, tales of political intrigue, even a radio musical.

Thanks to my family, friends, and colleagues for their podcasts recommendations (mystery shows and otherwise), and helping me find a new way to relax. In the stressful world of medical school, that’s priceless.

My own unsolved mystery

I’m a mystery junkie. My favorite TV shows and podcasts all involve drama, sinister intrigue, and crook catching. Right now I’m immersed in “Accused,” a nine-episode podcast about the unsolved 1978 murder of Elizabeth Andes.

And now I have an unsolved mystery of my own.

My unsolved mystery is not at all sinister though. Quite the opposite — it’s sweet; a puzzling act of kindness that I can’t completely explain.

Allow me to present my case, and the physical evidence I’ve collected.

I don’t get much mail. Not even the junk mail senders or credit card companies have found me yet. But about two weeks ago, a nondescript, cream envelope appeared in my mailbox. It was hand addressed to me in black ballpoint pen — clearly not an advertisement — but there was no return address. Curious, I opened the envelope and found a lovely card inside. The message — “Always remember … You are doing your best” — was exactly what I needed to hear that day. I’d had a long, rough afternoon at clinic and really needed some encouragement.

I was so grateful for this surprise act of kindness. But I didn’t know whom to thank.

The card itself looks handmade, which makes me think maybe it came from someone artistic. But that’s not much to go on. So I scoured the envelope for clues. I tried to make out the blurred postmark (of course the postmark would be blurred!). I think part of it says “SUBURBAN IL,” but I’m not sure. No other revealing markings on the inside or outside. I didn’t recognize the handwriting either. This wasn’t from either of my parents, my two sisters, or the friends who send me mail from time to time. My mystery writer would have needed help finding me, though. So I could try asking my parents and sisters whether they’d recently been asked for my address.

But here’s the thing: I’m not sure I want to solve this mystery. Which surprised me at first, since I’m all about the thrill of the chase. But the fact that my mystery writer sent me this beautiful card in an envelope without a return address was no mistake. She or he wants to remain a mystery. And I want to respect that.

Since I don’t know who sent this to me, I can’t thank them directly. But just maybe, my mystery writer will see this blog post and know how much this seemingly small act meant to me, how it truly lifted my spirits when they were low. I want them to know that I keep the card on my refrigerator to remind me that I am doing my best, and also to remind me that there are so many people out there who have my back — more than I even know.

So if you’re out there, mystery writer, thank you.

Subway syncope

The view from inside a NYC subway car, where I evaluated a woman for syncope (fainting).

Sitting on the New York City subway, immersed in the world of my true crime podcast, I suddenly heard a commotion. I looked up and saw that a group of passengers had stood up and gathered in front of me, staring at the woman directly across the aisle. She was slumped over against the shoulder of the woman next to her.

I pulled off my headphones, my ears alert. What I gathered from the murmuring passengers was that the woman had suddenly passed out. In doctor-speak, she had a “syncopal episode.” She was awake now, but obviously woozy.

Usually in this sort of situation, someone with medical qualifications presents to help — a doctor, nurse, PA, paramedic. No one did so. I realized I might be the person with the most medical qualifications in the train car. That was a scary thought.

You are 9-1-1.

The words of my CPR instructor from nearly two years ago rang in my head. That was his response when one of my classmates proposed “calling 9-1-1” as the appropriate course of action in an emergency. Of course, there is some truth to both perspectives. When an emergency happens outside the hospital, you should call 9-1-1 if that’s an option. The paramedics have equipment and knowledge that you don’t. The CPR instructor’s point was, though, that in that critical moment you are the one who is actually there and can make a difference. So if you are appropriately trained, you should act.

With that in mind, I yanked my stethoscope out of my backpack, slung it around my neck, and crossed the aisle to evaluate my “patient.”

By this time, we had pulled into the next train station. Someone alerted the conductor about the emergency, so we stayed put while the paramedics were summoned. In the meantime, I conducted my initial assessment.

I explained that I was a medical student. I cradled the woman’s wrist in my hand so I could take her pulse — faint and slow, I noted. I tried to listen to her heart but it was difficult to hear anything with everyone around me talking. I decided it was more important to take her history. I asked whether this had happened to her before, if she ate or drank sufficiently that morning, whether she had any medical problems.

“Are you a nurse or something?” asked the policeman who was standing in the open doorway of the train car, watching me.

I felt a prickle go up my spine. Clearly, old-fashioned assumptions about gender roles were very much alive, even in progressive New York City in the year 2017. I doubted he would have asked a man with a stethoscope around his neck the same question. But my goal here was to practice medicine, not feminism. So I swallowed, and calmly answered.

“I’m a medical student.”

This seemed to satisfy him. He told us the paramedics were on their way. Another passenger offered to stay with the woman who’d passed out until help arrived. The two women slowly stood up and exited the train car.

Minutes later, the doors whooshed shut, and we were on our way. I sat down, my own heart still racing.

My physician preceptor told me later that morning that as the medical professional, I should have stayed until the paramedics got there. Not necessarily because this woman was going to need more intervention. But because I could better communicate her condition to the paramedics, and because I could prevent bystanders from doing something like starting CPR if she passed out again. Lesson learned for next time.

I learned a lesson about myself that morning, too — about how I respond in an emergency. Namely, that I did respond. I remembered what I’d learned over the last two years and applied it.

In medical school, we hear about how being a physician entails great responsibility. There is a standard of professionalism, and the so-called “social contract” that we’re expected to maintain. As a medical student, I didn’t expect to put that into practice — at least, not without supervision — for some time. I’m honored I had the opportunity.

Narrative medicine: my soul’s monthly nourishment

Once a month, a handful of people gathers in a small conference room on the 14th floor of New York Presbyterian Hospital’s Baker tower for an hour-long narrative medicine group. We discuss a poem or prose piece, sometimes about medicine sometimes not, then write a reflection to a related prompt. The composition of the group varies by who can come that day: librarian, doctor, social worker, medical student, chaplain. Just like our job titles, our experience with interpreting literature, with writing, and with life itself, varies. But that’s exactly what makes the group so rich. With my crazy clerkship schedule, I can’t always make it. But I know when I do, I will leave feeling refreshed, fed. Here is the poem we read last week, along with my written reflection.

“In a landscape of having to repeat”

In a landscape of having to repeat.
Noticing that she does, that he does and so on.
The underlying cause is as absent as rain.
Yet one remembers rain even in its absence and an attendant quiet.
If illusion descends or the very word you’ve been looking for.
He remembers looking at the photograph,
green and gray squares, undefined.
How perfectly ordinary someone says looking at the same thing or
I’d like to get to the bottom of that one.
When it is raining it is raining for all time and then it isn’t
and when she looked at him, as he remembers it, the landscape moved closer
than ever and she did and now he can hardly remember what it was like.
— Martha Ronk, 2004

Prompt: Write about a time you remember looking at a photograph.

When do memories begin? I think I remember being there, tell people I do. Sitting on my pink bicycle in a Minnie Mouse bathing suit, our golden retriever Jake-a-pup reclining on the lawn in the foreground. Flying high on the swingset in my dark blue jeans and the white T-shirt with the pretty blue flowers. Hanging upside down on said swingset, my face flushed red and my eyes half closed. Blowing out candles on the green-frosted caterpillar cake that my mom baked. But are they really memories? Or just pictures in a photo album?

‘No one gets a diploma alone’

Almost every day, I pass by this bus stop billboard, which is across the street from Weill Cornell Medical College.

The message — “no one gets a diploma alone” — is so true. It’s true whether you’re talking about a GED, B.S., or M.D. So every time I see this advertisement, I think of all of you.

And when I say “you,” I’m talking about a lot of people.

My family and close friends play enormously supportive roles. I wouldn’t be here without them. I can’t thank them enough. My classmates, too, play a key part.

But “you” is even broader than my family, friends, and classmates. One of the most difficult things about medical school is the pervasive feeling of isolation. So knowing that there are people across the globe reading my story — many of whom I’ve never met, and am unlikely to ever meet — that helps too.

To each one of you, for your unique contribution: thank you, from the bottom of my heart.