The New Kid

By Daniel Kronenberg, MS4

As with all writing published on Stories in Medicine, locations and names in this piece have been changed.

Anyone who has been a third year medical student will tell you how difficult it can be. Very little in the first two years of medical school can prepare you for the long hours, finding energy to study after coming home, not knowing much about the specialty  you are rotating through, not understanding how you are evaluated, finding time to eat. Did I mention not knowing anything?

Being a fourth-year sub-intern adds new challenges. After a month or two on the wards, you may have grown comfortable with the workflow and may even know a thing or two about your specialty. However, “with great power [kinda] comes great[er] responsibility.” You are now expected to function at the level of an intern, managing the care of your own personal group of patients. You must follow up on labs, images, culture sensitivities, outside hospital records. You might hold the consult pager for your service and be “first-to-call” for the patients you are assigned.

Now imagine being a sub-intern on an away rotation. Suddenly you are not only painfully inept and often ineffectual in your nascent career choice. Now you don’t even know where the bathrooms are. No longer do the nurses vaguely remember you and let you know how your patients did overnight. Imagine you just stumbled through rapid-fire rounds and you have been assigned to a case starting in 15 minutes. How will you get scrubs before the case? Where can you change? Where are the ORs?

These are the kinds of thoughts that swirled in my head long before the plane ride. Maybe it was not the best mindset to have going into a new rotation but what medical student doesn’t perseverate about the details? My mentor back home once said, “Any surgeon who isn’t a little worried all the time is probably a sociopath.”

Yet what I found during my sojourn away from my medical school for nearly five weeks, was actually very reminiscent of home.

Day one on Monday morning was a “morbidity and mortality” report-style grand rounds. Assembled in the conference room were faculty and residents of various years. There were also three other visiting fourth-year medical students. I smiled and made pleasantries but the blood left my hands and a lump hung in my throat. We were asked to stand and introduce ourselves to the group. They spoke the names of impressive home institutions. The carnage of a Mad Max-like battle royale between us played out in my head. It didn’t end well for me. The girl from the prestigious school in Philadelphia was too quick with her flamethrower.

I shook it off and introduced myself. The residents came to meet us after the meeting. They were an intimidating but smiling bunch. “Welcome! Welcome! We’ll talk more later in the week about expectations. You all have cases to go to,” one of the chiefs said. Then they showed us where to get scrubs, where to change and where the ORs were.

From then on, the rotation played out much like my sub-internship back home. I woke up at 4:00 every morning and I left the hospital at 7:00 in the evening. I read up on my patients, and studied for clinics. I assisted in the OR, and sewed up the skin when we were done.  To be sure, I got lost. A lot. However, I eventually found the bathrooms. Some of the nurses started to vaguely recognize my face. I found the break room where the free peanut butter-and-jelly sandwiches were and scarfed them down in-between marathon cases. I held my patients’ hands when I introduced myself in pre-op, and apologized for tapping on their sore bellies days later on the floor.

I was surprised how quickly I began to feel at home. The faculty didn’t seem interested in trying to break me down to make their own students look good. They wanted to teach me and help me grow, even though I might not end up as “one of them.” The residents were familiar with feeling foreign on away rotations. They strove to set me up for success and bought me lunch on a number of occasions. They spoke often of why they love their city and why I would too. And instead of chain-sawing each other’s heads off, the other sub-interns and I grew close. We shared cases and secrets about attending idiosyncrasies. We spent time together outside of work, joking about the arduous journey ahead and confessing how impressed and humbled we were with one another.

In the end are we just interchangeable parts, like Lego blocks? Could we be happy at any number of places? Maybe, I thought, as the sun came up over the last day of the rotation. I found myself falling for the place. Somehow it made me feel guilty: my medical school had ushered me in behind the curtain into the secret world of medicine. Could I simply pick up and move elsewhere? What about all the sweat, blood and tears–not all my own–that had gone into making me a fourth-year medical student?\

I thought long about this. Perhaps the answer is that if you work hard, and feel passionate about what you are doing and the people you do it for, “home” can be anywhere. My first away rotation was instrumental for a number of reasons and I did learn some truths. I got to meet very inspirational people and I was exposed to procedures I had not seen before. Most importantly, it took a lot of the fear out of the prospect of moving away somewhere unfamiliar  for residency at the end of medical school.

As fate would have it, a couple days after the rotation ended, a total solar eclipse would be passing through the region I was staying. The best man at my upcoming wedding had recently started graduate school at a university literally within the path of totality. I joined him, his classmates, and nearly 500 students and families stretched on picnic blankets that bright morning. People lounged and gazed upward, enthralled with the slowly disappearing sun.

As totality neared, a pall swept over the now silent, grassy quad. The daylight faded, the crickets began to chirp, and the temperature dropped 20 degrees. My heart was pounding as the last sliver of sun was obscured. We threw off our eclipse-viewing glasses nearly in unison. I heard a collective gasp from the crowd. It took a moment for my eyes to adjust but once they did, stars and planets replaced blue sky and white clouds.

And then I saw it. Where the sun once was in the morning sky, was a solid black disc. Surrounding the eclipse was the scintillating, white corona, the sun’s normally invisible atmosphere and fiery bursts of solar flares. In that single minute I was overcome with both the awe and eeriness of an eclipse. I couldn’t help but think that shimmering black hole in the sky was a metaphor for the future: full of uncertainty, and potential beauty, until we experience it for ourselves, it will always be a mystery.

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Killer Heels

By Lillia Cherkasskiy, MS4

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Alex was about 5’2’’, including her endless parade of dangerous-looking heels, which she drove determinately into the floors of the busy hospital where she was a resident. I never saw her take the elevator, even when she needed to get to the 10th floor in 2 minutes and we were walking with a group of colleagues, including some with legs as long as she was tall.

As a team leader, she was stern but fair. Always the first person to arrive at the hospital and the last to leave, she expected nothing less from the rest of us. Her pride in her work and leadership was palpable and I could tell that she had worked hard to get to where she was.

Over time, I learned that she immigrated to the US as a teenager with her parents, who poured their last dollars into getting her the education that would support her ambitions to be a world-class doctor. She worked her way through college and medical school as well, mostly at minimum wage jobs, and graduated nearly debt-free.

I saw her as a competent and accomplished leader who always put her patients first. Sometimes, however, I could see how some of her patients viewed her, and it broke my heart. To them, she was Dr. Ethnic Barbie, fiercely stomping around the hospital in her too-tall heels and her too-long white coat with elbows that did not quite bend enough to get the job done.

Day after day, I watched patients talk down to her. They asked her to go get their “real” doctor, to fill their water glasses, and to give them a sponge bath. She would laugh as if they had made a funny joke and then proceed to treat them. As far as I could tell, she never became upset or said a single unkind word about any of her patients. Only a few times over the whole month did I see her shoulders start to slump after particularly vicious onslaughts of sexism and racism. I cannot begin to imagine the endless compassion she must have for her patients that gives her the strength to treat them all with such kindness. As I move through my training, I often find myself wondering what she would do if she were in my shoes.

Her first order of business would surely be trading my Dansko’s for some killer heels.