I once imagined a career in medicine to be something like kayaking the ocean: tiring work, requiring powerful strokes to stay above water. But after completing nearly two years of medical school, I now know that there are countless ways to get dragged under the surface and pulled out of your kayak to the cold, dark depths below. When that happens it is easy to lose sight of what brought you to the profession and to lose confidence in your ability to make it back up to the surface.
This is a story of how one patient guided me to the bright world above.
*****
Sitting in the middle of our windowless hospital team room during our state’s 3rd COVID surge, I was sweating profusely under a surgical mask and protective goggles, with damp stains surely visible on my light blue scrubs. I realized I had just under five minutes to finish preparing my presentation before internal medicine rounds started. I tried to calm myself, reminding myself that I am still in training, and no one expects me to be perfect. When the full team gathered around me, I took a deep breath and started presenting with a shaky voice.
“Mrs. C is a 68-year-old woman with a history of diabetes and hypertension who presents today with a complicated medical course...”
Meeting Mrs. C for the first time, I was struck by her clear discomfort as she lay in the hospital bed. She had undergone three major surgeries in the last month. Severely deconditioned by her prolonged hospital stay, she relied on the nursing team to assist with almost every bodily function. The day I met her, she was getting her abdominal wound repacked. The silver nitrate used to reduce bleeding caused her intense pain. I moved closer to her bed, reaching for her trembling hand. As the surgical resident applied the silver nitrate, I told her to squeeze my hand as tightly as she needed.
“Let’s take a deep breath in 1, 2, 3, 4, 5…. And out 5, 4, 3, 2, 1…”
Syncing our breaths together, pulling air deeper and deeper into our lungs, I felt both of our bodies calm down.
A few days later, I was getting peppered with questions from fellow team members while presenting Mrs. C’s lab values. My face blushed deep red when I gave a wrong answer to a pathophysiology question. I closed my eyes for a moment and pictured myself sinking down under the water’s surface, down to the place where my feelings of inadequacy and self-doubt abounded. I stayed in this low place as I moved mechanically throughout the rest of the day.
Finally, it was time to make the best phone call of the day: my afternoon update to Mrs. C’s husband.
“Hello?” he answered with his usual booming voice, the sounds of their grandchildren chattering in the background. “How’s my wife doing?”
I smiled and started to fill him in on the latest updates of her physical therapy progress and changes to her diabetes management. He asked questions about how long-acting insulin worked and I did my best to answer them. Some self-confidence returned as I pictured myself zooming up toward the light.
When I went to check on Mrs. C later that afternoon, she leaned in and motioned to my mask. “Can you just take that thing off for a second? I want to see your face!” She said with a mischievous look.
I hesitated, then pulled my mask down. I smiled shyly at Mrs. C. She returned a kind smile back. The air felt good on my bare face. I felt more like myself.
One of the necessary features of medical training includes continuous feedback on your performance. After leaving a lengthy feedback session with my senior resident, I walked down the hall realizing the magnitude of what I had yet to learn. As I approached Mrs. C’s room, sounds of commotion emitted from it. Imagining the worst, I quickly opened her door and was surprised to find Mrs. C working with a physical therapist and sitting up with a huge grin on her face.
“Kirin, look at me! I’m sitting up! Can you believe it? Can you take a picture?” She had tears of joy sparkling in her eyes. This was her first time up from bed in over a month, and this was the ultimate type of success to measure.
After four weeks of inpatient medicine, my time on the rotation was coming to a close. I made my way to Mrs. C’s room for one last time and explained that she would soon have a new medical student working with her. She started crying. This time, tears of gratitude, as she explained the comfort that my presence brought her. I wanted to tell her about the grounding presence and healing she had brought me over the past month but could not find the words.
The following Monday, I was leaving the geriatrics outpatient clinic on a sunny afternoon and heading to my car when I heard my phone buzz with a new email alert. It was an email from the intern who took over Mrs. C’s care. Heart pounding, I quickly skimmed it: “She is making huge improvement and was even able to walk today! She will be discharged tomorrow. She wanted to make sure you knew.” I felt a grin spread over my face and the stress of the day faded away. Driving home, I rolled down the window and gulped in the fresh air, feeling sunlight warm my bare arm. I reveled in the joy of working with patients.
It’s commonly known that patients rely on providers to care for them; now I understood that we equally need our patients. Mrs. C guided me back to my kayak and helped me climb aboard. For it is from our patients that we find the light.
Acknowledgements
The author thanks Joel D. Howell, MD, PhD, for critical revision of an earlier draft of this manuscript.
Declarations
Conflict of Interest
The author declares that she does not have a conflict of interest.
Footnotes
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