doc w/ Pen

In medical school, life is not like a box of chocolates. It is like a bar of wet soap. Just when you think you’ve figured out how to reliably tell AVRT from AVNRT on an EKG … pffffft. The slippery bar flies from your hands, hits the floor, and skids across the tile, as far out of reach as possible.

There are moments like that. LOTS of them. They are insanely frustrating.

But there are also moments like this: You read a case example about a middle-age male patient who has 9/10 chest pain. Your “job” is to rule out myocardial infarction. Among other things, you pick up on the fact that his sharp pain is worse when he breathes or lies down — but sitting up and leaning forward helps. You pick up on the fact that he recently had a viral illness. Your first thought is “pericarditis.” And you were right.

Of course, this wasn’t a real person. It was a textbook case, and nothing was at stake. But still … you had the right idea. You were asking good questions and putting the pieces together to rule some diagnoses in and others out, or to change your level of suspicion.

You’re still going to drop that bar of soap. You’re going to drop it time and time again, even after you’ve graduated from medical school and become a real doctor. But those other moments — the moments when you get something right, even something really small? Those moments reveal progress. And that means you’re headed in the correct direction.

I used to hate grocery shopping. It took an emergency—like running out of half & half for my coffee—to get me to half-heartedly shove a cart around the store. And doing the dishes? Forget it! I’d let them pile a mile high. In the last month, I’ve realized that medical school changes everything. (Well, almost everything.) Grocery shopping is now a welcome break from studying, a reason to stretch my legs and enjoy some fresh (or maybe not-so-fresh) New York City air. It’s the same with dishes. Not to mention that living in a single room, there is just simply less space to spread out your mess. And for me visible mess = visceral stress. So I keep my little living space very neat and tidy. Anyone who’s ever lived with me would be shocked.

Here are some more observations I’ve made about my life as a first-year medical student on the Upper East Side of Manhattan. These are thoughts about me, medical school, and city life, as well as the intersection of these and other life threads. In no particular order, here we go …

You get used to the horns. Sort of. NYC traffic is unlike anything I’ve ever seen, and this is coming from a girl who (in Chicago) would be called a “city driver.” Non-city drivers might add less-than-nice epithets to that description. But in Chicago, you use your horn judiciously. In NYC on the other hand, horns are to traffic what commas are to sentences—periodic and normal punctuation. I think some drivers must honk out of habit, not even when anything is wrong. The first couple of weeks I was here, my heart would jump at each honk. They’re loud when you’re a pedestrian! Now they’ve begun to blend in, just part of the backdrop of city life. (A side note: earplugs are a HUGE help when sleeping here because these noises continue all night long. And living next to the hospital we get not only cars honking but ambulances whining at 2 a.m.)

New York City is insanely expensive. Everybody knows that. But I now believe that people have no idea what that really means until they try to live here. For example, I went grocery shopping today (yay! break! fun!). Yes, I am now one of those city people who walks around with a push-cart. It’s actually kind of fun, it makes me feel like I belong here. I spent $91.85 for this week’s groceries. For ONE person. That’s crazy. Everything costs more here. Sometimes it’s a nickel or a dime, sometimes $1 or $2. But it quickly adds up. The most outrageous item I saw today was a 24-oz jar of marinara sauce that cost upwards $10. For that much, I’ll just go to an Italian restaurant, thank you very much.

I am … happy. Some of you know that I am not fond of the word “happy.” I think it’s overused in our society, and has lost its meaning. So when I say “I am happy,” that really means something. “Happy” to me means a sense of contentment, belonging, satisfaction, and joy. Is medical school hard? Of course. But would I rather be doing anything else? Hell no. This is where I’m meant to be. Being here, I feel “happier” than I have in years. Which is wonderful, because the last few years have brought with them a lot of sadness and loss for me.  “Happy” is a nice change.

My background in journalism helps even more than I expected. In a part of our curriculum called “Patient Care & Physicianship,” we’re learning the intricacies of the medical interview. The subject matter is different, obviously, than interviewing a politician or an artist. But when you break it down, the medical interview is really an organized series of who-what-where-when-why-how questions combined with intense observation and genuine empathy. The first time I tried it was awkward. I tried too hard, thought too much. The second time, I sat down, relaxed, stopped thinking, and let the conversation flow. Occasionally I glanced back at the list of required follow-up items. But I found that by just talking, I got much of that information naturally. I let my journalism instincts kick in. It was like … riding a bicycle.

I love a good story. This might seem obvious from my journalism background—in fact the concept that everyone has a story is what drew me to my first career. I wasn’t expecting this reaction to be so strong though. But already, I find myself drawn to people’s stories, and more specifically to patients‘ stories. I want to know not just what hurts, why, and how can I fix it, but other more human things … what is your family life like? do you have kids, or take care of your elderly parents? what do you do for a living? and so on. It’s not about being nosy. Part of it is understanding that these sorts of things have a bearing on a patient’s physical and mental health. Part of it is getting to know the patient as a person, and not a set of signs and symptoms.

Faculty here at Weill Cornell are amazing. It seems that everyone is willing to meet with you to discuss career options, let you shadow, offer advice, etc. Not only are they willing, but they enjoy the opportunity to do so. They value their roles as educators and mentors—something that is invaluable to me as a medical student. I feel incredibly supported. I know that for any question or concern I have, I merely have to ask around and someone will be able to help me find an answer.

I am tired all the time. Talking to other former and current medical students, this is just part of the reality. I’m getting used to it. (And learning to sleep in a little on the weekends.)

Not a single one of my major fears about coming here have come true. For example, I wasted a lot of energy being fearful about what the living situation would be like (especially the grocery/cooking situation) and whether I would connect with my fellow students. In reality, things have turned out better than I could have hoped for.

In summary: medical school is tough. It’s exhausting. But it’s also incredibly rewarding, both in learning new concepts and in working with patients. I fully believe that being here at Weill Cornell, and living on the Upper East Side of Manhattan, I’m in exactly the right place, with exactly the right people (both faculty and students). As my anatomy professor, Dr. Mtui, would say: “Life is good.”

It’s real now. I’m officially an MS-1 (first-year medical student) at Weill Cornell Medical College. And I have the ID badge to prove it.

Yesterday marked day 1 of orientation, which continues the rest of this week with various lectures, receptions, and our white coat ceremony.

Yesterday also marked day 1 of seeing patients. Yes, that’s right! I saw a patient. My job yesterday was just to observe. But before long, I will be working as a “junior clinician” as part of Weill Cornell’s Continuity of Care program. I have a specific patient (whom I met yesterday), and will be responsible for things like attending all of her appointments, making clinic follow-up appointments, providing emotional support via phone (she gets my cell phone number), documenting all our telephone calls in the electronic medical record, and serving as a liaison to the clinic physicians if she has medical questions (I obviously can’t give any medical advice!). As I learn to do things like take a history or perform a physical exam, I will practice those skills with her. The idea is that the patient (who has some complex issues) has an advocate, someone familiar with her situation and medical history helping make sure she gets all the support she needs, and ensuring that all the necessary issues are addressed. In return, I learn about managing chronic medical conditions and interacting with a patient — skills that can’t entirely be taught in the classroom.

When I got to the clinic yesterday for the appointment, the clinic coordinator told me I was “brave” for doing this on my first day of orientation. Perhaps she’s right. But the way I look at it, that’s why I’m here — to learn how to be a doctor. No time like the present.