second beginning

On Monday we start on the wards, and it's what we've been anticipating excitedly and in immense fear for quite some time. But unexpectedly, a lot of things began with Survival Fair two weeks ago. I know we complain about having to wake up early for lectures, long days of workshops, and some very dry sessions on legality, privacy, sexual harassment, and so on. It is a pain, but I've also learned a lot, medically and personally and while there's a lot I'd change about it and I could use another week to wind down, it's helped me.

We haven't had as much down time as I'd thought and wanted, especially this past week with afternoons full of advanced cardiovascular life support, phlebotomy, and a clinical skills session. We've learned the steps beyond CPR in resuscitating people, which include shocking them (or not shocking, depending on what's wrong with their heart) and a handful of drugs. We learned to draw blood for cultures, how to put in an IV, how to insert a catheter. Among these procedures, some of the hardest things are little steps that require a lot of attention. For example, sterility is a huge concern, and it's kind of interesting to think about how we are trying to avoid everything that surrounds us, like slipping in between slits of rain drops. There is a certain way to put on sterile gloves, to ensure that nothing gets "dirty," and you have to be constantly aware of your hands and body and what lies in a "sterile field" and what doesn't. It's pretty cool conceptually, to think of how we negotiate our environment, but it's also exhausting and prime ground for mistakes. So I enjoy the explanations, fumble around with my own imitations of what I saw, and come home crammed and tired.

In the midst of this, I am grateful to Yale for pounding into us the personal aspects of medicine, all the issues that we're going to face as people. Even as some of the topics can first come across as superfluous or obvious, like gender discrimination and power dynamics, much of it has been helpful in thinking about how to interact with people. More specifically, how to interact such as to bring greatest benefit to patients, stick to your principles, not cause drama, and avoid frustration. This is hard.

I've heard many things that connected to me, that I know will be hard to keep in mind; I can barely recall them now after a week of so many things. A lot of it helped me with some of the feelings I had from the last entry, and made me think about what to do in conflicts to benefit people most. I also learned to think about how circumstances influence my own feelings, and to remember that most things happen out of neglect rather than bad intentions, which includes a lot of my own negative responses. Another thing emphasized is the detachment of certain behaviors and feelings from individuals; for us to seek systemic reasons for why a person might do something we perceive as unkind or unjustified. Today was particularly powerful...oops, no pun intended. Our last day of orientation was called Power Day, and it was dedicated to thinking about potential abuses of power in the health profession. We read two stories where physician-writers narrated their own experiences of taking advantage of patients' vulnerability in order to enact what they felt was best care. The day started with a fabulous keynote speaker, a woman who had been my section leader for Public Health, who talked about the power dynamics of race and ethnicity.

She was amazing in several respects. Firstly, I think the majority of the audience loved her and it's hard to sustain the attention of any group of people and make yourself relatable to a diverse number. Secondly, she read us a couple journal entries she kept back in med school, which of course inspired me to write as much as possible. The entries themselves narrated powerful (again) experiences that were unique in how they explored the medical hierarchy, the divides between people in general, and language (even though this wasn't really mentioned). The first story dealt with a doctor's use of literature to degrade a med student (the speaker), and unraveled at a slowly building pace that made it seem natural that such a thing could happen not even fully understood by the student. It ended with a sentiment that it was nice to think about literature, a part of her brain that'd been suppressed in medicine, but that in the end literature had hurt her medical learning and herself. It's a longer story that can't be done justice by summary, only by her voice, but I appreciated this thought and remind myself that stories in my head are one thing and stories in front of me are another. The second entry the speaker shared with us dealt with a med student gracefully, creatively, and humbly standing up to a doctor who failed to address a patient's language barrier. In both stories, she noted a couple things that have been, in different lights, emphasized these past weeks: these powers and responsibilities we have and will come to have carry much weight, for both a lot of good and a lot of bad. In her first story, thoughtfulness and kindness from an unexpected source saved the speaker from her superior's racism, and in the second, strength and ingenuity came from the lowest rung on the totem pole. Of course there were "adversaries" in these stories, but she, like others, have encouraged us not to see them as such, to give more room for gray. Related to this, we're encouraged to see where the problems lie within the system, not the individual. For example, why was this allowed to occur in the first place, why wasn't the speaker comfortable reaching out to anyone about it, why didn't anyone else notice anything or if they did, why did they do nothing? In the other story, the med student took it upon himself to change the system that led up to miscommunication between doctors and patients, via a simple suggestion to place simple signs on doors of patients who couldn't speak English, to refer healthcare providers to interpreter services. This systemic approach was also brought up in a session on leadership and group dynamics, wherein we talked about distinguishing when individual behavior is indeed individual and when it is a reflection of group thought.

This is not to escape personal interactions, because that's where any systemic change occurs and that's also where we live. Even before starting on the wards, and way back since starting first year, I've been amazed at how many issues we discuss because medicine deals with countless aspects of life and not necessarily just in the patient encounter, how hard a lot of this can be and what rare challenges we experience and witness others experience, and how lucky we are to continually question and start.