beeeeep

The other day we were given beepers. Since we became med students in the fall of 2007 we have visited the hospital weekly to interview patients, learning how to do a history and physical. In a few months we're going to do it not for practice but for real. People will beep us in order to do so. My beeper was much smaller than I expected. Everyone else's were small too, but I don't know what they expected.

In anticipation of the beeper's use, they sat us down today and kind of told us what our third year will entail. In one year we are to do the following "rotations," not necessarily in the following order:

Internal Medicine (8 weeks of inpatient care, 4 weeks of outpatient care)
Surgery (4 weeks of general, 4 weeks of subspecialties)
Anesthesiology (2 weeks)
Emergency Medicine (2 weeks)
Pediatrics (8 weeks)
Obstetrics & Gynecology (6 weeks)
Psychiatry (6 weeks)
Clinical Neuroscience (4 weeks)

We were told that we would be faced with three major changes during this transition from book learning to patient care: we are required to be there, to dress appropriately, and to get grades. Seeing as how I don't go to class, glean much joy from bright accessories, and have stopped taking our voluntary self-assessments, these are big changes for me indeed. But none of those came to mind when faced with a beeper and eighteen pages of logistics about just choosing the order of our rotations.

We're constantly being told not to stress. Don't stress about getting the highest score on the Boards. Don't stress about planning the order of your rotations. Don't stress about controlling your life to get the best residency after graduation. Don't stress about getting poor grades on rotations because you don't know something. These are legitimate concerns that we'll all face when being pimped by an intimidating superior with a million times your knowledge and experience, and I am sure I will be stressed. It seems to me, though, that in the midst of all this reassurance about our performance as students who are responsible for their own futures, I worry most about my performance as a person who is now responsible for others.

Sometimes that thought hits me so hard, especially during all these rites and milestones we have that make this field different than others for me. I find it difficult sometimes to convey our experience in medicine so far, and we haven't even experienced it. I felt a lot during our white coat ceremony, but what it was I can't even say. I just know it was supposed to be a marker for something. During the dinner where we received our beepers and thanked the mentors who have guided us through patient interviews since we started, we were made aware that this is a point of moving on. Combined with all the patients we've met; the science we've learned; the non-science of ethics, insurance, professionalism, social issues, and so on we've been exposed to--medicine has become all-consuming, and while that can be inevitably hard, it's made me think much harder about reasons.

In the past, getting to certain places was about a sort of validation of what came before. Getting into college bundled up accomplishments up until then into a neat package. Getting there was also a means to go elsewhere. I wanted Harvard simply because to my 18 year old self it meant a new coast and possibilities and possibilities. Medical school followed a similar thought process, where my college experience was tied up in an application to medical school. Even as each individual thing I did or learned had its own value for me independent of what it meant for school, to explain it to someone else I had to frame everything in terms of getting here. And I wanted to get here, in order to go somewhere else good afterwards. In between the markers of acceptance and graduation, I had an incredible time and learned so much wherever I was, but that can get lost amidst the bookends.

Now, while we may stress because the Boards and rotations are to lead us somewhere, the concern for me lies in making the present worthwhile regardless of where it takes me. I doubt the people who will let us learn about them at their most vulnerable will care much where we go for residency after school or the kind of career we'll lead. I'm not immune to caring about these things (I would like to be in a path that will fulfill my reasons for going into medicine, in a location I like and with people I love), but harder and more important than achieving them, I would like to do well by the people we've been waiting to care for, in the moment we meet them and not for anything before or after.