Balancing Act

by Jennifer Li

On the last day of my internal medicine sub-internship, the attending I worked with pulled me aside, telling me firmly that one of the moments she most appreciated during our service together was when we were seeing a 22-year-old patient who was going through a vaso-occlusive sickle cell crisis. She had been admitted for pain management and workup for possible pneumonia, and I had entered the room to find her body curled tightly beneath stark white hospital sheets as she groaned in pain.

“You put a hand on her leg to comfort her,” my attending said, “and told her, ‘I'm sorry that you're in so much pain.’ It was so simple, but so empathetic. It really stayed with me.”

During college, as I was trying to plan my future, I chose to pursue medicine for many reasons, including the most common one: I wanted to help people. I wanted to help people at their most vulnerable, most dark, most helpless moments, to be the person who can offer clarity and guidance when their bodies are failing them in a way that seems nonsensical. The human body is exquisitely strong, and yet far too complicated. I wanted to help people make sense of things that did not.

My parents were never physicians. They had never even been through college in the States. When I graduated high school, they told me to do what made me happy. For me, that meant I spent my college career pursuing my love of the humanities, of Asian American literature and the history of jazz and romantic western classical music from the 19th century. I was always someone who was trying to do too much all at once, never willing to slow down. There was always more to learn, and more to explore—new research projects to take on and genres of art I had yet to discover. I was easily distracted, easily passionate, and easily interested. I was always efficient, always concerned about balance, always wanting more.

When I reached medical school, my sense of balance slowly but surely began to fall apart. It started with smaller missteps—a difficult dissection, a grueling module—but soon, I found myself closing up and shutting down. I felt like I was drifting, like my acceptance had been the fluke I feared it was all along, like maybe I was not meant for this. I was not made for the extensively mind-numbing multiple-choice exams, for the hours of silence I desperately tried to fill in the anatomy lab with Mahler symphonies and 2000s pop throwbacks, for the daily drives home I spent inexplicably crying because I felt constantly inadequate. I began to create arbitrary yardsticks in my head, goalposts I felt everyone else was reaching but me: I was never going to measure up. I was never going to be good enough.

After one of my biggest failures, I hit my lowest point. I found myself sitting at my kitchen island, staring down at my phone as my mother—this strong, beautiful woman who had immigrated across an ocean and worked over half her life to give me opportunities she did not have herself—struggled to find the right words to comfort me. I did not know why I was here anymore, pursuing a career path where I seemingly continued to keep hitting walls. It had stopped making sense. And then, quietly, she said to me, “Remember when you were eighteen?”

Three months after I turned eighteen, on a long weekend in January, I woke up with a stomachache. I was in my first year of college, fresh into second semester, still trying to fumble my way through classes and figure out where I belonged. I had grand plans for my 3-day holiday. I was going to explore this new city of mine with my friends. I was going to wrangle some familiarity into this place, my new home away from home.

They ended up taking me to the hospital instead. I can barely remember the sequence of events—all I can remember is the pain. It was the worst pain of my life, like someone was screwing a red-hot searing nail into my abdomen, over and over, to the point where I could not stop dry heaving, shaking, and crying into my hands. A constant stream of people filtered in and out of the curtains of my makeshift ER room. At some point, I surrendered responsibility of my phone because I could barely breathe or make out syllables. I felt delirious, like I was moving through water, unmoored. It was as if I had stepped outside of my physical body. People began to speak in lower, softer tones around me—tumor, I kept hearing. Mass. Surgery. I closed my eyes, blinded by the bright neon of my own leggings. My family was in the northeast, nearly a thousand miles away. I had barely started college and there were so many life events I was still waiting on, secured in the belief that I still had so much time ahead of me.

After what felt like endless scans and an excruciating pelvic examination, a woman finally sat down on my bed with me. She handed me my phone, and explained to me, carefully and concisely, what a teratoma was and what ovarian torsion meant. It was like she had pulled back the haze from the cloud of pain fogging me the entire day—I now had clarity, empathy, and an answer. “I'll be doing your surgery,” she told me. “I'm giving this to you so you can look it up for yourself, but only if you want to. I know it's scary. But you're going to be okay.”

I will always remember when I was eighteen. She and everyone else that day were doing their jobs, but that experience changed my life. I told my attending this story because whenever I walk into a patient's room, I remember that pain. I think about what it must be like to be in pain all the time, or constantly short of breath, or just unable to stop feeling absolutely terrible. I think about how unreal it must feel to be suffering and struggling to merely live and breathe in the same space as other people's normalcy.

Some days, I still do not know if I am “good” enough. I can only say that every day, I wake up and tell myself to do my very best with every single patient I meet. I will sit, for as long as it takes, with the patient who is coming to terms with the progressive metastasis of her stage IV lung cancer. I will listen to her story, to the emotional complications and ramifications with her husband and mother; I will give her my hand and break down every single part of her diagnosis, treatment, and plan with her if that is what it takes. I will tell her, time and time again, that taking care of herself matters. That slowing down matters, because life is unpredictable and taking time for ourselves is the only way we can make sense of things in a world that can be full of nonsense. I want to be someone who offers her some clarity and comfort in the dark stillness of her hospital room, even if it means carrying her story home with me and shedding tears in the solace of my own apartment over her prognosis. As future physicians, when we treat patients, we are not only treating diseases, but humans—their suffering, their fears, their aspirations, and their dreams. Finding a solution for illnesses or conditions is important, but these are the factors that affect people most tangibly: the vulnerability of being in an unfamiliar hospital bed, surrounded by strangers, waiting in uncertainty and discomfort for an answer.

Some things will never make sense. Some days, I will struggle. Some moments, I will continue to question my purpose. Ultimately, I can only do my best to work toward answers with the people I have been gifted the responsibility and care of. We are all here, working through life as humans together. And for me, my own low points serve as a reminder to help me be stronger for people during theirs. Perhaps, in a sense, that in itself is a sort of balance.

Jennifer Li
Emory University School of Medicine
Graduating Class of 2021

Back to the November 2022 issue of ACP IMpact