In the wee hours of a summer Saturday, a generalized tonic-clonic seizure breaches the tranquility of night for a suburban wife and mother of two. Imaging reveals frontal lobe masses with central hemorrhaging. Differential diagnosis quickly focuses on metastatic disease versus glioblastoma multiforme. Surgery a few days later confirms the latter.
A couple months later, I enter the neuro-oncology clinic for the first time. The interminable “first day” mercilessly exploits my latent anxiety about always being sharp on the job. I must focus and absolutely must be on top of my game today of all days. But there is a lot weighing heavily on my mind.
By this point, third-year clerkships and a second round of gargantuan board exams are in the books. And for my contemporaries, the light at the end of one tunnel draws nearer and nearer. Is it a train after all? Maybe it is not. The past year had been a roller coaster in the sky. Sure, there were valleys. Shelf exams challenged our self-esteem. Feelings of clinical clumsiness and general human incompetency came about early and often. But the mean altitude remained high, for the dream was finally coming to fruition. The first “Thanks, Doc” was a shocking gaffe. The dozens that followed dared to coalesce into something increasingly vivid, if still premature: validation from real patients under our increasingly real care. Random facts from random preclinical lectures spectacularly fused to yield useful clinical pearls, and tired question bank vignettes came to life before our eyes.
The familiar beasts of medical school are evolving now, morphing into docile and even splendid creatures. At long last, grades are a relic of the past. My classmates have chosen their aspired craft and submitted residency applications. They have applied for rotations across the country, and now the interview invitations are rolling into their inboxes. They are booking flights. They are embarking on long road trips. Through the power of social media, it has become one big, vicarious experience, in which everyone has something new and exciting to contribute. Upcoming vacations and other leisurely plans guiltlessly seep into conversations with a saturating and syrupy sweetness. In a few months’ time, they will rejoice and shed happy tears together over opened envelopes. A couple months after that, they will be doctors of medicine.
They are sub-interns. They are seniors once again. Realities of the present day confirm unequivocally that they belong in this sacred field. After years of hard work, with years of harder work ahead, here they finally are in the spring of their careers. They are all future once again, packaged neatly for the world before them. And the future is bright.
The attending doctor enters the room and commences the encounter with the patient, a suburban wife and mother of two status post radiation and a first cycle of chemotherapy. Uncertainty continues to dominate her future, but for the time being, she is doing as well as can be expected. There are no focal deficits at the moment, neurologically or otherwise.
When the doctor completes his examination and exhausts the patient of questions, he invites my input. I agree that the patient is doing as well as can be expected under the circumstances, and echo hope for continued response to treatment.
“So what field have you chosen?” the doctor asks me.
I respond reflexively and even crack a slight smile, my first of the day.
“I’m going into internal medicine. I just love the variety of a general medicine ward.”
“Well that’s good. I’m glad someone likes hospital work.”
The doctor chuckles and stands to bid adieu to the patient. On his way out of the room, I stand, sporting a simple college t-shirt and shorts, and shake his hand.
“Thanks for taking such great care of my mom.”
“You’re very welcome. You’re doing the right thing spending this year at home.”
Life, or perhaps destiny for the romantics among us, does not spare us during our medical training. We harden ourselves to insignificant things. We even learn to put important matters on the backburner. But our concrete facades cannot deflect the wrecking ball that the universe inevitably swings our way from time to time.
Cabin fever and preemptive guilt constitutively clash in my conscience. Intrinsic and extrinsic pressures to personify optimism contend perpetual paranoia of lullabies to false hope. A room with a view, overlooking the triumphs of my friends and colleagues for the past three years from a distance, underwhelms on most days. Sometimes it feels like my family and I are losing over here while they are winning over there. But that is not necessarily true.
A silver lining in this situation is the time I get to spend with my family. Another is the detour itself. My path has rerouted through the woods for a stretch. People do not plan to become patients. Illness diverts them from good health in varying degrees of abruptness for varying amounts of time. I will don my white coat again before too long, and from that point forward, I will be responsible for helping patients with detours of their own. Until then, I will walk this narrow footpath through the woods, seeking the empathy and credibility attainable only by someone who has been there before.
Back to June 2017 Issue of IMpact