So much more than a robot.

HEY. I realize that it has been a good long while since I’ve posted anything. Second year is insane! But because I didn’t want to deprive you of my incredible prose (lol), I carved out a little time to try to get out what’s been on my heart lately.

Can we talk about perfection for a second? This is something that I feel pressure to achieve every. single. day. There is a pervasive culture of perfection in our society, so imagine all of that funneled down into the culture of a bunch of overachieving, type A med students who spend a lot of time together. Our worth and our success and our value is in large part determined by how closely we achieve perfection, and that can mess with your head. I see it in our professors, I see it in my classmates, I see it in myself. We all want to be perfect, no matter what. And thinking about this has raised a lot of questions for me – is this important? Is this necessary? Is this healthy? Is this human?

Is this important?
I actually think it is. Medicine is a field that necessitates attention to detail, and the well-being and lives of our patients often ride on our ability to achieve perfection. Small mistakes can have devastating consequences, just like small adjustments can have drastic benefits. It is so important for us to pay attention to everything – they teach us this: how to watch body language, how to pick up on subtle clues that could be easily overlooked, how to ask the right questions and do the appropriate tests and perform the correct exam. If we miss a step or don’t ask a certain question or interpret lab values wrong, the end result isn’t always great. This is why medical students are allowed to do very little on the wards, and why, once we graduate with our M.D.s, we all still have a minimum of three years of training left (COOL).

Is this necessary?
NOOOOO. (One more time for the people in the back: NO). It’s just not. Think about the kinds of people that med school typically attracts. I don’t have to look any further than the mirror to see a stereotypical med student: driven, perfectionistic, a little (or a lot) type A, persistent. This is who we are. These are the kind of people that go into medicine. Internally exerted pressure for perfectionism is already a part of many of us. Externally exerted pressure for perfectionism is unlikely to change ever. So what gives? I think we need to be more gentle with ourselves. I think we need to assert the fact that medical school is a world of unattainable perfection: we will never know everything. Not now, not ever. In these last few months, life has thrown me some major curve balls, curve balls that have made me feel like one of the only things I have control over is my performance in school. Even so, I have continued to learn how incredibly important it is to be gentle with myself. It’s okay to take a walk and clear my head. It’s okay to take a night off from staring at my computer. It’s OKAY. It’s okay to want to be the very best I can be, while still giving myself space to breathe, still loving myself when I make mistakes, still allowing myself to be human.

Is this healthy?
I think competition can be really healthy, and so by deduction striving to not make errors or mistakes is an inherently good thing, and can also be healthy. But, for example, I’ve watched myself and others beat themselves up over getting one question wrong on a quiz. We are learning much of this information for the very first time, and at a ridiculously speedy pace, and somehow getting all but one question right isn’t good enough for us. This can be healthy in that it motivates it, it pushes us to work hard, so that when that question pops back up again, either on an exam or in actual patient care, we get it right. However, this is also, in a very real way, SO unhealthy. I have been so frustrated with myself for getting that one question wrong, when in reality, me learning from that mistake or misunderstanding is what’s ultimately going to make me a better doctor.

Is this human?
Second year is kind of a brutal year in med school. Step 1 looms closer every day, the blocks get shorter and faster with no breaks in between, and the senioritis/desire to not be in a classroom anymore gets super real super fast. This year is draining and exhausting and, to a certain extent, dehumanizing. I feel like a robot approximately 79% of the time, and I have to remind myself on a very regular basis that I am not a machine but a human being. It is so easy for me to see why the rates of depression and anxiety and other mental illnesses are so high among medical students – we are human beings attempting to operate like machines, all while trying to outcompete all the other human beings acting as machines. Med school can be really quite enjoyable, but there is also a dark side to med school, a side that we try to ignore a lot of the time, a side that we deal with because one day this is all going to be SO worth it. Interestingly, med school has taught me more about humanity than any other experience in my life so far, but this same experience has also been the biggest threat to my humanity. I have learned more than I thought possible about suffering, vulnerability, humility, empathy, and healing since starting med school. Concurrently, I have learned more than I thought possible about working yourself past your limits, about being so test-focused that we forget all about why we are here, about depriving myself of basic human needs – exercise, rest, human interaction – so that one day I can champion the benefits of exercise, rest, and human interaction to my patients. The irony of all of this has not been lost on me, and sometimes it amuses me to no end, while other days it can be rather discouraging. In the end, I think med school tries really hard to take the human out of us, while simultaneously bringing out the most human parts of each of us.

If I’ve learned one thing in the last almost 2 years (WHOA that’s gone fast), it’s that I will never be perfect. I think a lot of us (including myself) often view physicians as gods who can do no wrong, but when we get right down to it, we’re just as human as the patients in front of us, and reminding ourselves of our humanity, in the midst of trying to achieve perfection, makes all of this much simpler:

I am a human who will, one day, finish a long, arduous road of extensive training, and I’m here to do my best to make you healthy again or to keep you healthy. And if I can’t do that, I will do my best to make whatever life is left in you the very best it can be.

I am a human, and so I won’t promise perfection because to do that would be to put myself on a pedestal above you, my patient, to claim that I am superhuman when you are not.

I am a human, and I will be authentic, I will be real, I will work as hard as I can to serve you well, and I will make sure that your humanity, just like mine, isn’t lost in the middle of disease and chaos and illness and fear.

I am a human who will champion you right on through all of my strengths and all of my shortcomings.

I am a human who will never give up on you, because you will make me better at my job.

In order to do all of that, I’m going to be working hard forever – now as a medical student, in the rest of my training, and as a full-fledged attending. That’s what I signed up for, and that’s what I’m showing up for. But sometimes we can all use a good reminder that this isn’t about us, and we need to shift our focus. My #1 goal in life should never be my ability to achieve perfection – it should be serving my patients well, and while that ALWAYS includes precision and critical thinking and teamwork so that we can get as close to perfection as possible, it also necessitates realizing my errors, acknowledging my mistakes, and retaining a very, very strong sense of humility in a profession that can easily replace that humility with pride. In my opinion, there is much more danger to my patients in me exuding pride – believing that I am perfect – than in me embracing humility – knowing that I am not. I will come much closer to perfection through humility than I will ever be able to through pride.

Here’s to replacing studying to achieve perfection on exams with studying to achieve healthy patients and saved lives. Here’s to replacing stress with determination. Here’s to being something more than robots, something better: humans. Here’s to working hard to achieve the highest bar of all: not one of perfection, but one of service.

And with that, back to work.

“So what brings you in today?”

“So what brings you in today?

That is a heavy sentence. A loaded sentence. Patients share with us their most impactful, most heart-wrenching, most difficult struggles in response to that question. And yet, we say it so casually, as if we inherently deserve, by some magical property afforded us by our white coats, to hear this answer. As if we don’t realize that asking that question requires that our patients place a level of trust in us that they may not place in anyone else in the world. This question cuts straight to the heart, it gets right to the root of everything the patient is carrying with them.

“So what brings you in today?”

As I sat on the little swivel chair, I watched as the patient sitting in front of me recounted her reasons for coming to clinic. Her voice trembled. She wiped her hands on the front of her hospital gown. She averted eye contact. She told her story to a total stranger.

“So what brings you in today?”

The toddler ran from me, hiding behind his dad’s knee. He was absolutely terrified of me. “It’s not you…he’s scared of the white coats that everyone wears,” his dad relayed. As I shrugged it off my shoulders, he said to his child, “See, she’s not scary! She’s just like you and me!” The toddler slowly crept out from behind his father.

Medical school has a lot to do with appearance. We are taught to be professional at all times, and this professionalism extends into every area of our lives. We dress professionally, with appropriate makeup, hair-styling, spiffy clothing, and clean shoes. We act professionally, leaving our entire lives at the doors to patient rooms so we can serve them better. We address our superiors with the utmost respect, regardless of the level of respect we are shown as lowly medical students with the short white coats. I’m a lecture-goer (all our lectures are recorded so it’s not a requirement), and I think it’s a sign of respect to the professors to actually be awake if I’m going to go to lecture, and so I get my butt out of bed way too early in the morning in order to be semi-functional and attentive by the time 8 am rolls around. We are strongly discouraged from drinking too much when we go out, being publicly disruptive, or in any way reflecting negatively on the school and the medical profession. We are essentially required to lead exceptionally healthy lifestyles so that we can advocate for our patients without being hypocrites. Professionalism in medical school doesn’t end when you go home for the night, when you go out of town on vacation, or when you’re having a crappy day. It is a 24/7 requirement.

This has led me to think a lot about how patients perceive me. We make such a big deal about how we come off to others, all for the sole idea that if we appear, act, and speak professionally, patients will put more trust in us as they navigate the scariest situations of their lives, when we ask that loaded question at the beginning of every patient encounter. We are taught that physicians are meant to build exceedingly intimate workplace relationships with patients, that them literally putting their lives in our hands is not meant to be taken lightly, nor does it come without a given amount of time to build trust, confidentiality, and respect. And all of this is absolutely true. But how much of our professionalism is to prove our competence, be it warranted or not? How much of it is to demonstrate to patients that we, being mere humans ourselves, can do something to save their lives or help them be healthier?

I specifically wonder about how this manifests in how medical students are taught to leave our lives at the door of the clinic or hospital or wherever we’re seeing patients on any given day. For the sake of their health, we are not afforded the same privilege of bringing our baggage and emotions and issues into the patient room; our job is to help patients navigate their baggage and emotions and issues, not our own. Ever. Not for a second. I fully invest and believe in that idea, that my job has nothing to do with me and everything to do with them. But as I think about my future practice and what patients will know about me as we build that doctor-patient relationship, I wonder how protecting this trust is possible if, every single day, I’m putting on a face for them. Of course I am there to help patients be healthy in all areas of their lives, but personally, I think that that end is not fully possible if I am not authentic and appropriately vulnerable with my patients as the encounter warrants.

I have had, at best, limited interactions with patients so far, as my time is primarily taken up by lectures and studying endlessly. But as I consider these interactions, I am again reminded of what my goal as a physician will ultimately be when it comes to building trust and productive, protected, professional relationships.

Do I leave all of who I am at the door, or will I bring my life into the room, either consciously or unconsciously?

Can patients sense when something is going wrong in my own life?

Could a patient grappling with a new diagnosis of breast cancer understand that me averting my eyes wasn’t because I didn’t care, but because my mom had been diagnosed with breast cancer not long before, and this was my way of coping in that moment?

Do the patients I have seen who disclose to me things they are too scared to share with anyone else realize that my eyelids blinking much too quickly is not simply because their stories are tragic, traumatizing, and terrible, but also because I’m sharing fully and wholly in their pain?

When we deliver bad news to our patients, do they know that it weighs on us when we go home that night? When we deliver happy news to our patients, do they know that our smiles could not be more genuine?

In my few, naïve experiences thus far, I have come to firmly believe that there is a time and place for bringing our worlds into the exam room with patients. After all, we are just as human as the person sitting before us. Our white coats grant us no super powers. Our big words don’t make us mighty. At the end of the day, we are humans treating humans, and if a patient is suffering, maybe what they need isn’t just a physician, a medical student, or a healthcare professional, but also a human being meeting them right where they’re at, entering into that space of grief or pain or shock right alongside them.

If I have to tell someone that his or her beloved family member has just passed away, it might foster trust for that individual simply to know that I, as a fellow human, have seen grief up close, that everyone’s grieving process looks different, that I am here for them now, after just destroying them with this news, and in the future, as they work through what their loss means.

If I’m discussing the frustrations of recurrent running injuries with a patient, perhaps putting aside my desire to just fix everything RIGHT NOW and taking a few moments to simply hear out their frustrations will be far and above a more productive use of time than anything else. As a fellow sufferer of recurrent running injuries, it means so much to not have them pushed aside as if they are unimportant or minor, or to not have pages and pages of generic muscle stretches unceremoniously shoved in my face with no further conversation on the topic and an “on to the next thing” approach. Addressing their immediate concerns, including ones that don’t fall conveniently under an ICD-10 code, compromises no clinical excellence; in fact, it will likely make me better able to focus my advice.

If a patient starts to cry and I feel tears creep into my own eyes, there may be situations where it is better for the patient’s healing process for me simply to acknowledge that their story or situation is resonating with me; conversely, there will, without a doubt, be many a time when not letting on to the patient if and how their sadness is affecting me is the absolute best way to proceed, but I have a hard time believing this holds true 100% of the time. I know people who, when something goes wrong, need someone to hold things together and put on a strong front; I know others who, when something goes wrong, need someone to tell them that it’s okay to respond however they’re responding, and to cry with them or laugh with them or be angry with them. Does this mean I’m supposed to be a hot mess in front of patients? Absolutely not. That would be unprofessional. But I think there can be value in patients knowing that we’re right there with them in their pain. This is where our intuitions as healthcare providers will be so, so important: not every patient will benefit from our emotional distance, and making this distinction should be part of creating our own sense of professionalism.

When I consider the most difficult, most challenging, saddest, most heartbreaking experiences in my life and in the lives of those very close to me, it becomes very obvious that it is these experiences that will make me a compassionate, empathetic, warm physician. My good days and good seasons in life, although wonderful in their own right, are not what have shaped me and formed me and molded me so significantly. No, it is the seasons, the experiences, the moments I wish I could forget that led me to medical school, and that will define how I help patients navigate those seasons, experiences, and moments they want to forget. It is these experiences that will afford me authenticity and, hopefully, an ability to create a safe space for patients and their families. If the experiences in my life that beat me to the ground, that crushed my heart, that took away my control, that left me feeling helpless, are to be of any good, it will be because I use them, whether my patients are aware of it or not, to relate to, understand, and put myself in their shoes, so that I can be of better service to them.

Maybe professionalism isn’t shutting my entire life in a box when I get to the clinic or hospital. Maybe professionalism is realizing that there is a time and place to acknowledge our own humanity, to come alongside patients in the midst of their hardship in the most authentic ways we can, if only so they know that we, as their healthcare providers, are and will always be in their corner. Maybe professionalism is asking that question – “so what brings you in today?” – and being ready to address their concerns with an entire library of knowledge crammed into our brains, with sincerity, with honesty, and, above all else, with humanity.

Staying grounded.

A few weeks ago, we finished our first exam of second year, and it was then that I wrote the first part of this blog post. I didn’t publish it then for reasons that will be apparent as you read, but turns out two more weeks of second year gave me some insight, and I was able to finish this post. So here you go:

Two weeks ago: “I write this after an inspirational bout of lying on my bed, staring at the ceiling, too tired to sleep, anticipating one of those nasty colds that seem to come around every time my stress level drops suddenly. There are things I should be doing – pre-reading for tomorrow, perhaps, or making edits on a manuscript – but all I can do is stare into space, waiting for the last molecules of adrenaline to say sayonara and slowly contemplating whether my best first move towards an extremely productive afternoon would be to take a nap, eat something, or watch Netflix.

We’re two weeks in to our second year, and this scene took place upon my arrival home from our first exam of the year. It was a stressful two weeks. Specifically, our stress levels went from marathoning-Netflix-and-haven’t-moved-in-hours to puppy-being-told-not-to-eat-the-treat-put-on-his-nose in a matter of days, and all of a sudden an exam was looming much too close in our futures.

Coming out of a pretty sweet summer, I was 100% not at all prepared for this. And in my desperate efforts to JUST STAY CALM amidst SOAP notes and drug names and pathology slides and afternoon lectures and all the highs and lows of these first few weeks, I felt less like I was standing on my own two feet and more like I was tumbling. Constantly.

See, second year is a slightly different animal than first year. While my study strategy and work ethic hasn’t changed from last year, we’re now on a graded system (instead of pass/fail), which has, sadly, slightly changed the vibe from “we can all pass” to “we can all pass, but how the person sitting next to me does might impact my grade.” Add to that the constant murmurings about Step 1, and you’ve just created 175 people who are more stressed out than last year all in the same room. Awesome.

So in the midst of all of that chaos, I found myself wondering how to make sure I don’t get swept away in a current that already seems so strong. As I thought about this, I was flooded by a myriad of questions:

How can I remember what I came to medical school for when it seems all we do is stare at Powerpoint slides and read page after page of information?

How can I preserve my sense of self-worth and value when our worth as a medical student is so often based on a number?

How can I feel energized about the profession of medicine when the extent of my study breaks is calling my parents, eating dinner standing in my kitchen, or biking to the coffee shop down the street?

How can I sincerely bask in the joy that comes with the privilege I have as a medical student when the alarm clock goes off too soon, when 10:00 pm (my bedtime because I am internally 90 years old) comes much too quickly, when the hours I have in the day seem to be so disjointed from the hours I need?

I knew I needed answers to these questions, because being jaded as a 23-year old doesn’t sound like a great way to live life. And as I contemplated how to stand my ground in a world that feels like it’s constantly shifting, I found my answer.”

 

Today: It’s funny. Sometimes I start writing blog posts and have absolutely not one shred of foresight about where it’s going to end up. That’s how this blog post (and many other posts) went; I often find out how I’m going to close it out along the way. This one, though, hit a major roadblock. I got to the final paragraph, typed the words “I found my answer” and just stopped typing. I wanted to have an answer, I racked my brain for an answer for the last two weeks while the draft sat open on my computer, and came up with nothing.

Nada.

Zilch.

Zero.

And then, in a moment of clarity among the non-clarity that is the renal block, I understood that, quite simply, I don’t have an answer. Truth be told, I sometimes feel like I have a pretty solid grip on this whole medical school thing, and other days I have no clue how to handle medical school.

Medical students don’t like to not have an answer. In Guatemala, they trained us to throw out wrong answers for the sake of having an answer to give, rather than not having an answer at all. Having no answer is not how we operate. It’s wildly uncomfortable.

But here I am, trying to navigate a challenging, incredibly busy, emotional second year, and I don’t know the answers to the questions I posed to myself a few weeks ago. And while I wasn’t okay with admitting that then, I find that today I am okay with that.

Because medical school is full of professors asking us questions and us staring back, completely bewildered (I promise we figure it out eventually).

Because not having answers to these tough questions has nothing to do with my competency as a future physician.

Because the science side of medicine has an answer for everything, but the art side of medicine doesn’t always operate that way.

Because medicine is full of questions that simply do not have answers.

These questions that I contemplated after my exam will soon evolve into other questions, questions that hearken to the art side of medicine rather than the science side, questions like “why did my child die before me, doctor?” and “what if I can’t pay for this life-saving treatment?” and “why me?” and they’ll be waiting for answers from me. And then, just like now, I may have to tell them that I don’t have a good answer. Because medicine is more complicated than throwing treatments and medications and diagnoses at patients and waiting for results.

Medicine is people. And if I’m not comfortable with admitting to myself that I don’t have all the answers, how will I ever be able to admit it to my patients, to their families when they ask me these questions?

I have this obnoxiously long Spotify playlist that I listen to while I study, and I heard this lyric the other day that seems to sum all of this up:

“The ground beneath my feet is starting to trust me.”

Regardless of whether I feel like I’ve got this down or I feel clueless, regardless of whether I have wrong answers or right answers, regardless of the fact that this second year has felt like I’m walking on unsteady ground, every single day I learn a little bit more about how to trust my abilities, my instincts, my competency, my intuition, my knowledge, my relationships with patients, my feet carrying me over whatever ground is beneath me.

And so, no matter what lies ahead, tomorrow I’ll take another step.

Street dogs, dolor de cabeza, and a steep uphill climb.

I did my research. I read articles. I completed assignments. I braced myself. I thought I was ready. But I never could have been adequately prepared for what Guatemala had in store for me. I’m writing this on a plane heading for the United States, and as I re-enter a nation of such privilege, I find it foolish that I could have ever thought that I knew what I was getting myself into.

Guatemala was the first third world country I have ever set foot in, and to simply say that many live in poverty would be a severe understatement. We landed in Guatemala City after a night of traveling, mediocre airplane food, and little sleep, and essentially stumbled our way through customs and out of the airport. In my short stay in the capital city, I didn’t find myself particularly struck by my surroundings. Sure, it was different than my neighborhood back home, but at the end of the day, it was just another big city.

Early the next morning, we squished into large vans and tried to get comfortable for the bumpy three hour journey to the rural town of San Lucas, our home for the next two weeks. I remember immediately realizing that there were no seatbelts, and although we traveled by car every single day during our time in Guatemala, I saw not one seatbelt the entire time (sorry mom). As the Guatemalan midday heat set in and we got further and further from Guatemala City, this new world started to change before my eyes. New smells, a lack of speed limits, and houses built with sticks, bricks, and, if you were lucky, with an aluminum roof, emerged. Men carrying who knows how many pounds of firewood on their backs walked precariously on the edge of the road, and women in colorful skirts tended to open fires. Dogs and chickens wandered the streets at liberty, and roosters were calling for morning even though it was almost noon. We quickly learned that the typical mode of driving is to floor it, and then slam on the brakes right before the speed bumps that were way too common for our liking. We made it to San Lucas unscathed, settled into our hotel, which judging by the number of children around was in the safest part of town, and hung out at the hotel’s pool, which I quickly noticed was overlooked by the humble stone and wood abodes of some of the locals. Thus on day one, I found myself uncomfortable, my privilege sitting like a lump in my throat, a pit in my stomach.

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Days were spent hosting mobile clinics in various villages surrounding the hub that is San Lucas. Some villages were high up in the mountains, nestled among volcanoes, the air chilly enough to need a jacket. Others were a trek downhill, and in these villages I found myself wiping away sweat constantly, sorely dehydrated and lightheaded by the end of the day. Residents of these communities would sometimes line the streets waiting for us to arrive; this was their only chance at healthcare for months, or potentially years. Every morning, we arrived at a new village amidst children’s shouts of “gringos!”, armed with our varying degrees of Spanish fluency and lack of fluency of any indigenous language whatsoever, boxes of commonly needed medications, wide eyes, bags of sandwiches for lunch, and good intentions. We often set up shop in a one roomed building with a roof but open walls, seeing patients in stations that were never far enough apart to create any semblance of privacy. The days passed quickly, without warning, as we saw patients in teams, struggling to learn on the spot how to present to the physicians, helping to decide on treatments, and sending patients on their way with, perhaps, a little bit of ibuprofen or some vitamins. We often ate lunch on the run, shoving tomato and cheese sandwiches down our throats, noting every day that we, unlike so many of the people we were serving, never went a day without someone making sure we were fed adequately. In rare moments of calm, we taught kids how to use our stethoscopes or played soccer with them in the cobblestone streets, sought out any available bathroom facilities, fought a losing battle with staying hydrated, and practiced our Spanish or Kaqchikel.

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Our weekend off was spent adventuring. On Saturday we decided to climb a volcano, something I was really looking forward to. As luck would have it, a slight obstacle was thrown into these plans, as I came down with an unpleasant level of GI distress on Friday night, leaving me exhausted, weak, and woozy when my alarm blared Taylor Swift at 5:30 am Saturday morning. Not wanting to miss out on climbing a volcano, I took some Zofram, drank some water, and clambered into the bed of a pickup truck with 23 other people (don’t ask me how we got that many people onto the truck, I still can’t wrap my head around it) for the 40 minute ride to Santiago, where we caught a boat to San Pedro and then a tuk-tuk (the Guatemalan version of a taxi) up to the nature reserve. I somehow made it this far without my GI system revolting, but had absolutely no food in my stomach as we began our climb.

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Now, I’ve done my fair share of hiking, and I’m in pretty good shape, but as it turns out, climbing a volcano is hard work (I would venture so far to say that it was harder than running a marathon). We literally walked straight uphill for four hours, gaining almost a mile in altitude to get to the peak, me still unable to keep more than a banana down. It was only by sheer spite that I managed to climb the equivalent of 434 flights of stairs across 12 miles when I was fighting nausea, dizziness, and muscle weakness unlike anything I’ve ever felt before. I made it to the top, bracing myself for spectacular views down into the volcano and over the beautiful Guatemalan landscape.

Instead, here’s what I saw.

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While it was cool to be above/in the clouds, I think it’s obvious that we were disappointed that we couldn’t see more. Regardless, now I get to say I climbed a volcano, swung on a vine over a drop off, and made it back home that night in one piece, albeit with calves that were sore for days.

Luckily for me, Sunday was much more subdued. We took a boat to some other villages on the lake to go shopping and enjoy the weather. We returned with time to see the Corpus Christi festivities and get some ice cream, and just like that, the weekend was over. IMG_9505.JPG
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Our second week of clinic passed much like the first, except with less stumbling over patient presentations, less “um…” when asked what we thought what the diagnosis was, less really bad pronunciations of drug names, and better balance in the back of the pickup trucks that carried us to and from the villages every day. Friday came without warning, and I suddenly found myself packing up my things, not ready to leave but nonetheless looking forward to sleeping in my own bed and being away from the scarily large bugs that populate Guatemala, but with entirely conflicting emotions over my experience. At times, I felt like we were doing so much for people, connecting diabetic patients to long-term continuity care, solving skin conditions with a tube of cream, being an ear for some of the most heartbreaking and empowering stories I’ve ever heard; at other times, I knew how inadequate 30 tabs of ibuprofen would be for someone’s headaches when they can’t get enough clean water to stay hydrated, or how useless an inhaler is for a child living in a household that uses an open fire to cook meals. How much were we really helping? Were we joining part of a sustainable system or simply medical voluntourists?

I wrestled with these questions my entire time there, and as I learned more about the healthcare system in Guatemala, the San Lucas Mission that we worked with, and the culture I had immersed myself in, I am convinced that our trip was not only ethical but that we were able to be the resource that the communities we visited would not have otherwise. Defining ourselves as a resource can take many different forms, and while the primary purpose of our clinics were to treat patients as best we could, I think we did the most good not by dispensing meds or diagnosing disease, but rather by simply listening. I heard stories of trial, of victory, of frustration, stories that broke my heart to pieces and stories that made my heart full. I heard stories that put my hardships to shame and stories that reminded me of humanity’s common thread. I heard stories that kept me up at night, stories that brought me to tears, stories that inspired me to get up the next morning, ready for a new day. I heard stories that I will carry with me for the rest of my life, stories that will make me a better physician, and I feel nothing but humility at the idea that these patients would confide so much in someone who looks different, who doesn’t understand their cultural customs, who doesn’t share a first language with them, who they met five minutes ago. I am privileged to be on the receiving end of these stories, because they have changed how I view the world and how I will treat my future patients. I stepped foot in Guatemala hoping to make a difference, but this experience has given me more than I could ever provide to the people I had the opportunity to interact with. And now, as I return home, to my sidewalked neighborhood, clean running water, freedom to walk outside after dark without significant fear, extraordinary living conditions, seatbelts, and food security, I vow not to forget, not to push away, not to ignore what I have seen and heard and been a part of for the last two weeks. I will be uncomfortable with how privileged I am, I will struggle with the injustices I witnessed, I will fail to understand why equity is so hard to come by, I will remember the stories I was invited to hear, and I will let all of that shape me into a physician I could not be otherwise.

So I step back onto United States soil honored to have been changed by the short two weeks I spent in Guatemala, crossing my fingers that I didn’t contract Zika, but with eyes that are now better equipped to see what my future patients need from me, with ears that want nothing more than to really hear the stories that travel through them, with hands that are just as willing to play marbles in the dirt with little kids outside of clinic as they are to hold the hand of their mother who is struggling to make ends meet, with feet that will walk to the ends of the earth to help make healthcare accessible to all, and with a heart that has been softened by the hard edges of life in Guatemala. I will be a better physician because of this experience, and while I don’t know where my future career will take me, Guatemala, I sure hope it involves you.

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All for the adventure.

I have been fortunate to have had the opportunity to travel widely in my 22 years. Travel has been a part of my life since a very, very young age, and it’s something I have carried with me into adulthood. It is near and dear to me, and I am 100% convinced that in an increasingly global society, we have an obligation to learn how to be global citizens, how to appreciate cultures totally foreign to our own, to learn about other worldviews, to forget where we were born and embrace where we are at in a given moment. These are things that can only be learned and built and created through travel, through immersion.

But sometimes travel doesn’t go as planned. Sometimes travel seems so much more stressful than it’s worth. Sometimes you find yourself fleetingly wishing you had stayed at home, where everything is comfortable and safe and easy.

I was thinking about this as I curled up on a dirty, uncomfortable, surely bacteria-infested airport floor a few weeks ago, after 1200 flights out of the Denver airport were canceled due to the most intense blizzard I have ever seen (and I’m from Wisconsin).

Let me back up, though. Leading up to me attempting to sleep in a crowded airport was a 10-hour journey through a whiteout blizzard, during which time we were firsthand witnesses of a crash and saw at least 200 cars in the ditch. We had 70 miles to go, from Estes Park to the Denver International Airport. The first 25 miles or so was uneventful, but before we had time to even realize what was happening, we drove straight into an insane blizzard that dropped an estimated 3 inches/hour over the Denver metro area, totaling over 24 inches.

There were several problems with driving into a blizzard in a rental car (luckily, one with 4-wheel drive) in an unfamiliar state, the largest being that the snow was falling so quickly that exits were invisible. We could sometimes see signs hanging in the air, delineating exit this or exit that, but it was impossible to see where the road diverged. This meant that we were trapped on an expressway. There was no way to leave unless you saw tire tracks heading down an exit ramp from some brave soul who had given it a shot. We took the first of these tire tracks that we found and ended up at a Subway that was about to close, but let us in regardless. We spent approximately three hours there waiting for the blizzard to pass and attempting to reschedule our now canceled flight. In the middle of all of this, my elderly phone decided to turn itself off and not turn back on for several hours.

Once the blizzard seemed to have moved on, we tried again, only to drive straight into the blizzard once more (none of us thought to check a weather radar…), which had somehow worsened. We soon realized that this was not at all safe, and found some tire tracks leading to an exit, only to be stopped a quarter mile later by police attempting to remove about 12 cars from the ditch around this exit ramp. In what just might be the most terrifying 15 minutes of my entire life, I backed up on an exit ramp (being led by a police car, thank goodness), with two of my classmates’ heads stuck out the car windows to direct me away from the snowbanks on either side of the tire tracks created by the police car. We re-entered the expressway, my mind pushing away the thought that three of my dear classmates’ lives, in addition to my own, were in the sole care of my very shaky hands.

By what can only be called divine intervention, we found another open exit and the only open diner in the entire metro area (I don’t think I’m exaggerating when I say that), a diner that very graciously let us stay two hours past closing until the blizzard had passed for good, and sent us on our way with free pie. We were then able to safely make it to the airport, rebook our flights, and find a cozy patch of floor to lie awake on for the next few hours.

While my parents would probably beg to differ, this is an experience we will remember for the rest of our lives, and for that reason, I wouldn’t change a thing. I then started thinking about other traveling mishaps I’ve had:

-temporarily losing my dad in the Mexico City airport

-countless sprints through the airport to catch connecting flights

-thinking the Louvre was much closer than it really was, deciding to walk there, and arriving 15 minutes before closing time

-getting hopelessly lost in the Chicago subway system and ending up in a part of the city that was frankly terrifying to a 15 year old white girl

-getting sick on a plane when I was maybe 2 or 3 years old (I apologize profusely to the poor lady sitting next to me)

-the sailing trip where the boat felt like it was about to flip the entire day

-the day I swam into a herd (is that the right word?) of jellyfish in the morning and my brother was chased by sharks that afternoon

-getting to spend a little extra time in Argentina when a volcano eruption caused ash to obscure visibility so much that the airports closed for awhile

-a backpacking trip complete with tornadoes touching down in the area

-getting lost in the mountains on this same trip to Denver and then getting unlost and then lost again before finding our way back to the main trail

 

Do we ever remember the times when travel went smoothly? Do we ever think back on a trip with a knowing smile when nothing happened that pushed us out of our comfort zones or got our adrenaline rushing? The countless number of times I have driven to the airport, moved quietly through security, sat on my plane for a few hours, and landed without incident are not the times I remember (although they are greatly, greatly appreciated). Where do the stories come from, the things we’ll tell our friends and future grandchildren, the things that will cause your mom to hug you extra close when you make it safely home, the things that you joke about for years, the things that teach you that the world is messy and chaotic and that that’s okay? They come from things like this terrifying drive through a record-breaking blizzard in Denver.

And (of course), I find that this relates very clearly to med school. We are so goal-oriented here that we’re always looking forward, always looking behind, always trying to find ways to improve, always searching for things that will make us more competitive residency applicants. How often do we just appreciate the moment we’re at right now? How often do we look around us, at the insanity and chaos that defines medical school, and tell ourselves that that’s okay, that that’s just part of the journey? Not nearly enough. We wish away the busy schedules and the erratic sleep patterns and the droopy eyelids and the hours and hours spent with our noses in books. But do we remember the smooth sailing? Five years from now, I’ll remember not the normal days, but all the ups and downs. I’ll remember the crazy exam weeks when we were all sleep-deprived and hanging on by a thread. I’ll remember the innumerable IHOP trips at all hours of the day and the run when I got lost after my phone died and getting on the wrong bus and dragging ourselves into anatomy lab on the weekends. I’ll remember that one really hard dissection we did, and then one that ended by holding a brain in my awestruck hands. I’ll remember the night I stayed up way too late attempting to learn immunology by literally holding my eyelids open. I’ll remember the night before the immunology exam, when it all finally clicked. I’ll remember the panic attacks and nervous breakdowns and the people who loved me anyways. I’ll remember the standardized patients that let me blind them repeatedly with the ophthalmoscope as we very clumsily learned how to do eye exams. I’ll remember my very first exam block, when I had car problems the day before exams started and I spent a good part of the day completely unnerved. These are the things that we’ll look back on and think, “look how far we’ve come.”

Do I wish med school was smooth sailing all the way through? Of course I do. That would make life significantly easier. But since that’s not possible, I might as well appreciate the lessons learned and the memories made from the chaos. After all, it’s in those moments where we really learn about ourselves and learn about the world. It’s in those moments that we remember that this life is about going on an adventure and not about losing ourselves in the apparent sameness of the days that stretch out ahead of us in the middle of a block. It’s in those moments that we realize that med school is a lot like driving straight into a blizzard; it’s terrifying and really hard and frenzied a lot of the time, but when the storm clears and you can breathe again, you see that you’re still on the right path, even though you can’t always see the road. It’s in those moments that we appreciate how good it feels to embark on a brand new adventure, and how good it feels to return safely home.

So I’m on to the next adventure.

Fake smiles and hitting the wall

Quick backstory that I promise is relevant:

When I ran my marathon in 2014, I planned out every second of my race. I read articles about how to run each and every one of those 26.2 miles, I compared strategies on pacing, I considered how and when to refuel during my hours of running, I thought about how I would handle any number of different problems that could arise before, during, and after the race. I thought I knew exactly how that race would go, down to the step.

If you haven’t already figured out where I’m going with this, let it be known that this race went NOTHING like I thought I would. I didn’t realize that my body would essentially shift into survival mode, and my carefully laid-out plan for when to eat something or my strategy for running the turns meant absolutely nothing. All that mattered was reaching that finish line, one way or another. But I even expected in the back of my mind that this sort of thing might happen.

What I didn’t even think to expect was ending up on the race course alone. One of my teammates pulled ahead early in the race, and another dropped back a few miles later, and before we knew it, all three of us were very much alone on the course, something none of us ever thought to plan for.

It was less than a mile after running alone that I hit the wall. At mile 12, when I expecting to hit it around mile 19 or 20. I had no idea what to do, only that I was alone and felt so isolated from the runners around me because the support system that all three of us were expecting to have the entirety of the race was suddenly disbanded. It was in the middle of mile 12 that I caught up to a pacing group, and at a loss for what else to do (my legs felt like literal bricks) I decided to join them. I stopped thinking about the race, I stopped over-analyzing every step, I stopped racking my brain for any information I had on how to get my second wind. I just ran. I let the pacing group leader take over, so all I had to do now was breathe and put one foot ahead of the other.

At one point, the pacing lead had us all paste fake smiles on our faces, because apparently that actually makes you feel happier. Me, being somewhat of a cynic, thought this was stupid. But I did it anyways because by this point (it was mile 20 now and even though I was past my “wall”, I was still 20 miles in with the scary knowledge that I still had 6.2 miles to go and a 5-mile long hill to run up) I honestly don’t think I was thinking straight. So I plastered the stupidest grin I could muster on my face, and I kept running.

And it worked. The ache in my legs lessened, the burn in my lungs seemed less fiery, and my overall exhaustion became just a little bit less overwhelming. That fake smile meant that every next step I took brought me closer to the finish line, and my smile at the finish line could not have been more real.

 

Now back to present day:

We just finished another block, arguably the toughest block yet. As I sit here writing this a few hours after walking out of my last exam, I find myself completely drained, completely exhausted, but with a sense of pride, because I made it to this finish line of the many finish lines we strive for in med school. This block in particular taught me two very important things, two lessons that I previously learned on race day that have now come back around:

  1. 1. If you’re not careful, medical school can be dangerously isolating. At the heart of medical school is knowing that we’re all in this together, but when you haven’t talked to another human being in hours because you’ve been in your little corner of the library all afternoon, that alone is enough to make you feel like the only person you have is yourself. Add into this our insane schedule this semester, courses moving faster than ever before, “winter” making it less desirable to actually go outside, and about a thousand different opinions on the right way to study and all of a sudden people you used to see every day, you go weeks without seeing. During this week of exams, I think I saw my roommate once in three days, in an encounter that lasted approximately 12 seconds. We live together, and we have gone days without having an actual conversation. Just like I felt alone on that racecourse surrounded by hundreds of people, there were moments this block when I felt alone surrounded by 174 classmates (and I’m an extrovert, so this was a new feeling for me). This block reminded me of the simple fact that we are designed for community and that community can take many different forms, whether that be studying together, taking a walk with someone, remembering to text friends back in Minneapolis or Marshfield or elsewhere, and essentially making sure that I don’t let medical school win the battle of isolating us all from each other. I’ve learned that when life is at its busiest, community becomes even more important.
  1. That stupid fake smile thing works in med school too. No, I didn’t walk around with a fake smile on my face during all of exam week. That would have been a great way to fulfill lesson #1. But when I hit the med school “wall”: when neuro got so overwhelming I could hardly function, or when physio learning objectives stretched on and on without an end in sight, or when anatomy reminded me that I will never know every little thing there is to know about the human body, I was reminded of my race. And when I felt like I couldn’t take another step, that fake smile gave me just enough energy to pick up my foot and move forward. Just a little bit at a time. That’s all it takes.

So as we begin a new block, with what I’m sure will bring new victories and new challenges, I’ll remember the simple power of a fake smile to give me the courage to just keep running. And so I walk away from this grueling block with bags under my eyes, fatigue filling my bones, my brain in dire need of some good rest, stiff muscles and sore eyes, but with a very real smile (thanks cranial nerve VII) plastered across my face.

6 months ago today.

6 months ago today, I woke up with the sun.

Running shoes kicked off my feet and into the corner.

Cereal clattering into a bowl, the sound chaotic.

Restless hands filling a water bottle.

Same routine, different destination.

 

6 months ago today, I walked through the front doors.

A lump in my throat, a stomach buzzing with butterflies, clammy hands dried on my dress.

Stones dangling from earlobes, eyelids dusted, hair brushed twelve times.

My backpack hanging from my shoulders, holding only a notebook and a pen and empty space.

Waiting expectantly, dreams years in the making finally like cloth between our fingers.

 

6 months ago today, I sat down in an unfamiliar lecture hall.

Suddenly privy to private stories.

Spoken aloud instead of whispered behind closed doors.

Proclaimed to inspire instead of hushed to protect.

Tears blinked back at stories of heartbreak and stories of healing.

 

6 months ago today, everything was brand new.

Turning a white coat over my hands.

Putting stethoscope buds in our ears the wrong way.

Smiling for the camera.

Introductions, introductions, introductions.

 

6 months ago today, I had innocent eyes, innocent ears that have since been filled with unforgettable moments.

A new mom in early labor.

A nearly comatose patient fading before me, rescued.

I think you may want to consider hospice.

Can I see your wrists?

 

6 months ago today, I came home exhausted, apprehensive, incredulous, joyful.

Exhaustion dwarfed by the achy eyelids in the hours following an exam block.

Apprehension that cannot compare to “anyone who knows how to do CPR, get in line.”

Incredulity that has since been minimized by the complexity of the human body.

Joy that could never measure up to a shaky, thin-skinned hand grasping my fingers, cloudy eyes set on mine: “so you’re going to be a doctor, too?”

 

Yes.

 

6 months ago today, I was called a medical student for the very first time.

Ready or not, here we go.

Whiteboards, colored pens, modules upon modules, coffee cups upon coffee cups.

“No, Mom and Dad, I’m sorry, I can’t come home this weekend…”

Wait, how do you pronounce that?

 

6 months ago today, weights were set in front of me, a scale towering before me.

24 fleeting hours, the to-do list lengthening faster than my pen can scratch them out.

Ropes tugging from every direction.

Learning to find my balance.

“Mom and Dad, I’m on my way home.”

 

6 months ago today, I took another step.

A brand new journey with nervous laughter tickling my throat.

Greeting an unfamiliar world with outstretched arms, trembling fingers.

Peaceful blues hidden in a canvas of chaos.

And all I can do is smile.