A Big Challenge

The first day of each year of medical school has resulted with me in tears… and I'm not afraid to say it. Becoming a doctor is the biggest challenge I've faced. It is the hardest fight I've ever fought and the longest race I've ever run, but I guess it's supposed to be difficult. At least the beginning of third year wasn't like my first. Those first two weeks felt like someone had dropped a crystal vase on a cement floor and asked me to reconstruct it by hand. I had such idyllic dreams of my first day of medical school… walking up to the stairs of my medical school, a beaming smile in my crisp white coat. Instead, I spent six hours in the anatomy lab, and turned six shades of green when my parents served celebratory filet mignon for dinner that night. I sobbed on the phone with my uncle, a family practice physician in Columbia, South Carolina, wondering how I'd ever be successful in medical school and why I had decided this of all things was what I wanted to do. But I passed anatomy and boards, and I'll survive this part of my training too. Someday soon I'll be a doctor, who by the look of things will never again have more than twenty minutes to eat a meal. Oh well.

It's just that I had become so good at sitting through lectures and taking tests, studying for five hours straight and waking up early on Saturday mornings to go to Bill's Donuts to review question books with Mark. Now I do my best to take care of patients every day, writing notes, formulating ideas for orders and frantically reading about a diagnosis I suspect in my patient, fearing I might be asked the expected serum chemistries that would be anticipated in a patient with secondary adrenal insufficiency. The residents and attending physicians actually consider my treatment ideas and trust me to perform and communicate a well-thought-out exam. It's all a little frightening for me. On one hand, I'm so excited to be trusted with a patient's care; on the other hand, it's me we're talking about. I laugh at silly jokes and play the stereo too loud. I get lost on a regular basis, and I've lived in Dayton for almost fourteen years. I start shaking like a leaf, afraid I'll look foolish in front of twenty-five residents, when I think an attending physician might call on me in morning report. Sometimes I'm not sure I'd want me to take care of me. I tripped on the steps going to noon conference the other day and almost broke my ankle. I knocked over a potted fern at the nurse's station in my enthusiasm to give report to my team. Sometimes, I'm not sure this erratic behavior is what I'd expect out of my own doctor.

All this to say, I guess I'll grow into this doctor stuff. In fact, I'm starting to get used to being called a "student doctor." At first I just wanted to say "medical student" or "third year," but I'm starting to realize that to the two or three patients I follow in the hospital, to some degree I'm their doctor. As scary as it might be for me, I get more time to spend with my patients. I ask them more questions, and I poke them in the stomach to ask if it hurts more often than anyone else does. Mostly it's because I don't have the clinical judgement to decide when I can skip certain things and when to focus on others, but I'm still there in the room the most. And being there is sometimes the most important thing. I'll do my best to suggest the best and correct radiographic procedure for the diagnosis of metastatic liver adenocarcinoma in order to find a primary tumor, and I'll try my hardest to remember how to elicit a fluid wave in a patient with ascites, and I promise to listen if nothing else, even if it's 4:30 PM the day after an all-night call. So, I guess that in three weeks, at least I've learned to be there, because that's what people need, and that's what I would want if I became sick.

Andrew Jacques ('05)