Well, Here Goes Nothing

It’s finally here.

After 13 years of K-12 schools, four years of college, and one year of pre-clinical medicine, I’m finally doing the unthinkable: stepping beyond the classroom, trading chalkboards for charts, swapping study guides for stethoscopes, and putting 18 years of learning into application at the bedside.

Well, sort of–there’s still grand rounds, morning report, and core didactics. And I’m far from done with textbooks or tests. But it’s hands-on, and it’s dynamic, and it’s the closest I’ve ever felt to actually doing anything tangible, applicable, or useful, so I’ll seize the opportunity for a little ‘hooray!’

Just one thing: I’m scared to death–tense, timid, terrified, and (D) all of the above.

In the days to come, I anticipate carefully budgeting my umms, uhhs, and I don’t knows. I expect to know all the right answers–that is, about five minutes after the question’s been asked and the resident’s moved on. I plan to stockpile the responses that are valid for almost any question; I’m told ‘cytokines’ and ‘idiopathic’ are reasonably reliable. The unshakable conviction that I’m only here because of an admissions office clerical error is back, right on cue from this time last year.

Here’s the wild part, though: even though all that’s true, and sleeping in is about to mean 8:00am, and a two-day weekend is about to be a vaguely fond memory of days past, I’m still really, really amped for this.

These next few months, there’s no telling what might happen. I might get to introduce a life into this world. I might get to reboot a heart that’s stopped beating. I might get to offer someone a word of comfort in their waning days. Even the most simple of things sound like opportunities–I might draw upon 19 years of lessons and lectures to decipher what’s making someone feel crummy, then find a way to make them feel less crummy.

It’s going to be petrifying, but profound. Terrifying, but terrific. Wild, but wonderful.

As I embark on this next chapter, then, these are my promises to myself. In the months to come, I hope to revisit these promises, to measure my personal growth against them, and to hold onto them as my compass, my ‘true north,’ of moral and intellectual character.

Start humble; stay humble. This one’s easy, especially when you don’t have the expertise or credibility to be anything but humble. As I grow in this clinical life, though, I hope to retain what it feels like to not have the answers, to speak from a place of low hierarchy. and minimal confidence.

Remember that everyone’s an educator. Even while learning to think like a doctor and do as doctors do, I hope to bear in mind that there are many things to be even better learned from my other colleagues and collaborators: from nursing, compassion and advocacy; from social work, resourcefulness and relationship-building; from environmental services, perseverance and ‘can-do’ willingness.

Seize every moment like it’s once-in-a-lifetime. This year, I’ll rotate through 100 specialties, and 99 of them won’t be my future profession. In other words, for anything I do this year, it could be the first day of the rest of my life, or the last time I ever deliver a baby or close a surgical incision. I’ll inevitably be tempted many times this year to skip a learning opportunity or cursorily participate in an educational experience–”I’m never going to need this skill.” When that happens, I hope to catch myself, to cherish everything as potentially unique, and to stay open to the moments that might unexpectedly captivate me.

Resist a reductionist view of the patient. Toward the end of first year, I knew I was overdue for a summer break when I’d catch myself tuning out of the ‘irrelevant’ parts of the patient narrative, feeling impatient with the details that weren’t pertinent to a diagnosis. As the medical student, I have the gift of being ‘non-essential’; my histories and physicals are, most likely, just educational exercises. In that context, I hope to remember that it may occasionally be more impactful to defer the review of systems to allow a patient space to reflect. I hope to remember that there’s more to patient care than a detailed differential.

Exist beyond medicineFor better or worse, medicine isn’t my all-consuming identity, my sole purpose. I’d like to think I exist beyond the hospital, in the form of values, leisurely pursuits, and relationships. Naturally, this won’t be the year I chase my dreams of seeing the world, or the year I take a step back to focus on my relationship. The hours of clerkships and the drive to study more, to know more, to perform better will be demanding, and these will come first. I hope, for my sake and for the sake of those dear to me, that this medical apprenticeship doesn’t become everything–the only thing–that I’m about.

So there it is–the manifesto of who I am now, and who I hope to become (or not become) by the conclusion of this whirlwind of a year. Preachy? A bit. Sappy? Definitely. Over-ambitious and doe-eyed? Sure, probably. Still, I know the odds are against me, and chances are high that I’ll end this year more jaded, more skeptical, and less empathetic. And maybe, just maybe, if I set my goals to an aspirational degree of virtue, goodness, and empathy .. then I’ll land somewhere in the middle, and fare just okay.

Well, here goes nothing.

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