I walked into the hospital on the first day of my internal medicine rotation determined to conquer the notoriously demanding two months ahead of me. Since I was now halfway through my clerkship year, I felt better prepared for the inevitable challenges and frustrations that came with perpetually being on the steep end of the hospital learning curve. I headed to the Cardiac Care Unit as I was kicking off my rotation with two weeks on the cardiology service. I dropped my bag in the on-call room littered with shoes, coats and half-empty coffee cups — remnants from busy residents gulping down as much caffeine as their scalding mouths could handle before rushing off to see their patients before rounds. I put on my white coat, making sure it was adequately armed for the ensuing battle — quick medical references, stethoscope, three pens, a notepad, granola bars and some cash. I would have put a collapsible tent and GPS device right in next to my pocket-sized dermatome chart if there were room. I checked my cell phone to send off any last minute texts before going into radio silence for the next 10 hours, and I headed into the field.
Rounds began without ceremony for the rest of the team members, while I celebrated my own personal victory of correctly identifying my senior resident and making it to rounds in a timely fashion. We made our way through patient updates, vitals, new labs and study results. The attending focused on keeping his patients healthy, while I focused on looking focused. As the adrenaline from the morning was wearing off and I found my mind wandering to what I was going to eat for lunch, the drone of numbers from endless echo reports was punctuated by commotion from the patient room next to us. Our huddle quickly disbanded to respond to the panicked family members and the patient whose gown was newly soaked with bright red blood. A code call mobilized the floor into action, and the subsequent flurry reminded me of the marginally organized chaos of the New York Stock Exchange at 9:30am. The family members had been promptly escorted from the room, while a resident began chest compressions amidst a frenzied crowd of staff, monitors, and medical supplies. I watched from the periphery as the collection of doctors and nurses methodically executed their well-formulated algorithm that saved so many lives before that day. I watched from the periphery as they were unable to control the bleeding, and a young woman died.
As the frantic chaos gave way to somber defeat, I felt out of place. It was the first time I had witnessed a death, and I didn’t know how to react. Walking away seemed callous, disrespectful to the event that had just transpired; on the other hand, an emotional reaction would have been unprofessional and a bad impression to give the team on my first day. When rounds resumed, I was grateful for the opportunity to have some time to process it all. As we moved down the hallway towards our next patient, however, I was bothered with myself. Not because I had just experienced an emotional, heartbreaking scene, but because that’s what it should have been. I wish I had wanted to run and call a friend, or escape to the bathroom for a few solitary moments to gather my thoughts. Instead the reprieve afforded by rounds just meant my mind wandered right back to the inconsequential, selfish wonderings that typically kept me occupied when I felt disconnected . . . otherwise known as lunch.
Over the following weeks, I continued to be unsettled by my reaction, or lack thereof, to my morbid welcome into the field of internal medicine. I found it was easy for me to be empathetic when I was face to face with the patient, taking the time to hear their stories and responding in a way so they knew I had heard them. Then the second I left the hospital, my mind was occupied with how I would manage my time between studying and marathon training. I worried about looming exams, paying for groceries, squeezing in workouts so I didn’t fall out of shape. My preoccupations were minimal compared to the patients who were fighting for their lives in the hospital, some without families to encourage recovery or even homes to welcome them back. Some days I felt like a wolf in sheep’s clothing, graciously offering to help with any patient need, while selfishly wishing I could tend to only my own.
My thoughts encouraged me to revisit the reasons I initially decided to become a doctor, not because I ever questioned my decision, but because I wanted to reconnect with the moral compass that was guiding my professional development – and make sure it wasn’t pointing in the wrong direction. I knew I went into medicine because I liked science, I liked people, and I liked to work with my hands. I always felt fortunate that my interests aligned with a profession of public service so that I could help others while simultaneously fulfilling my own goals. I felt bad for those who were inclined towards subjects like accounting. Or art. Yet despite this arrogant self-regard, I was hesitant to adopt the idea of medicine being a ‘noble profession’, a line that we heard over and over during our indoctrination into medical school. I thought it was a dangerous idea, and I never wanted to think of myself as superior to the patient I was treating; they would be employing my services as a medical professional the same way I may need to employ theirs for car insurance. At the end of the day we were just two people, helping one another.
As I approached the end of my rotation, my search for a resolution slowly surrendered to the stress of the upcoming exam. One of my last patients was an older woman recovering from a devastating stroke that had left the right side of her body paralyzed. On my last day, I went in to say goodbye and wish her luck on her recovery. I was humbled when she said she would miss me because I was the only one who made her happy in the morning – the only one who didn’t make her feel discouraged about her new disability. The comment shocked me more than the code on the first morning in the cardiac unit, and when I left the hospital that day, I felt more satisfaction than I had the whole rotation. It didn’t matter to her that she didn’t elicit my deepest sympathies or occupy my thoughts when I was out of the hospital – all that mattered was that I was supportive when I was with her, and happy when she smiled. On the way home I delighted in how a small comment from a sweet old lady could quiet the self-doubt that had been nagging at me for weeks. I didn’t have to worry that I wasn’t a model for selflessness–maybe all that mattered for the time being was that medicine made me happy, and that meant I could make others happy when I was doing it. The enjoyment I got from connecting with the patients was a good place to start. I was amused that I could find so much satisfaction in such a simple answer, and as I approached my apartment I thought about what I was going to eat for dinner that night.