Submitted by Elle Flanagan
Submitted by Elle Flanagan
Lewis Katz School of Medicine, Class of 2019
The other day I had my groceries delivered to my house for the first time. I share a townhouse with three other female med students, two M2s and one M1. One of my absolutely amazing and super put-together roommates signed our whole house up for Peapod delivery grocery service. I sat at my laptop with the plethora of food options before me. I was overwhelmed in the most wonderful way.
Normally, my shopping goes like this: I walk around the edge of the overly-priced Center City grocery store until I start to struggle under the weight of the packed basket. I never buy liquids, I never buy bulky items, and I never buy pickles. Something that most of my med school friends don’t know about me is that I love pickles. LOVE them! I can eat a whole jar in one sitting. I firmly believe that pickles have the highest ratio of tastiness to calories of any food in existence, and I even own a happy cartoon pickle eraser. But I never buy them, because they come with all their vinegar-tasty goodness in a glass jar. It’s just too heavy when you add in all my normal stackums and various ingredients I need for my boyfriend to make me dinner. My trapezius muscles could not handle my groceries plus a full glass jar of pickles. I know this because even with my basic bags I end up stopping 3 or 4 times on my way home to rest while I pretend to check my cell phone.
But when I got my groceries delivered to my door for the first time, I could enjoy pickles without having to haul them 6 blocks. And they were magnificent!
I know this seems super silly, and I know there are some smarty-pants, cooking show buffs that thought “cucumber” was the obvious answer to my question, “What’s in a pickle?” But, the point of this question is that I had to give up a lot to go to med school.
Can we just take a mental second to recognize all the things we have had to give up to get here and stay here? I had to give up seeing my grandparent every weekend for Sunday morning coffee, I had to give up going to all my sister’s dance recitals and watching her grow up into a teenager, and I had to give up theatre and singing every day to instead focus on studying. Honestly, I really loathed the fact that I had to give up all those things. Giving up these things I love left me with little empty pieces that I filled with spunky anger and child-like bitterness.
It’s not that giving up pickles was such a sacrifice, but it’s what pickles represent. Giving up one of your favorite foods is like giving up a part of yourself. And leaving home and giving up my singing talent definitely felt like losing a part of myself.
For the first years out there, don’t get scared because making sacrifices and changing yourself sucks, but the great thing is that those parts of you never go away.
I still go home and visit my family and call my mom everyday, I have started singing again in the acapella group and even in the shower, and I still love pickles. And the weird thing I learned from this whole experience is I finally know what “enjoy the little things” means. I used to HATE that phrase. I thought “enjoy the little things” meant “enjoy the ONLY things.” But the little things you enjoy, like getting a snapchat video from your Nana, singing at graduation, or having roommates who help you feed yourself aren’t little things at all. They are symbols for the people in your life and the parts of yourself that you have learned to appreciate more and more as you grow up.
(photo credit: Tanja Brandt)
She was the worst patient in our study. Temperamental, demanding, and an inveterate absconder, our patient had turned a straightforward clinical trial into an exercise in patience. By the third time she had cancelled on her scheduled visit at the last minute, my partner and I had all but given up hope on this patient. Mind you, this is a pretty common phenomenon for a study conducted with Temple’s patient population; our study was riddled with patients who signed up for the study during their regular check up, and later dodged our calls when we tried to follow up with them to schedule their first visit. Such cases were starting to impair the power of our study, so we instituted a new policy of doing weekly calls, in the vain hope that we could keep our patients from crossing into the shadowy realm of the “no show” patient. In keeping with this policy, I called the aforementioned absentee patient and scheduled yet another visit, all the while resigning myself to the likelihood that she wouldn’t show up that day.
Surprisingly enough, she actually came in for her study visit that time – 4th time’s the charm? – but her arrival didn’t make me feel much better about my prospects. Any communication with this patient was frequently punctuated by her loud interruptions and general complaints about the study setup (“If I had known y’all would make me come out here for an hour and a half, I wouldn’t have signed up for this study”…even though we had made that point clear when we first consented her for the study and with every follow up call after). Nevertheless, I put on my best Doctoring smile and tried to remind myself that I was speaking to a person with her own struggles, not just a difficult patient.
Knowing of the blood lab’s lethargic pace and my patient’s inclination to walk out off our study, I figured it’d be best if I tried to distract her with a steady stream of small talk. The light conversation eventually transitioned to stories from her childhood, how she married her childhood sweetheart, and the lifetime of challenges they overcame together. Suddenly, I was no longer trying to see the person within the patient, but actually seeing her, learning about her, and identifying with her struggles. I guess at some level, she recognized this change in me and started responding in turn. At some point in our conversation, she sighed deeply and said, “You know, I’m sorry for the way I’ve been talking lately. They’ve got me on these pills and they just make me so damn sleepy. And my husband can tell you, I get cranky when I’m sleepy.” I assured her it was okay, and that I’m all too familiar with how grumpy my sister gets when she’s sleepy, which prompted her to smile back at me. “You know, I really am gonna try and make it through this study. I know I complain a lot, but this is something I gotta do for my diabetes, and y’all are just trying to help me with that.”
This is a message we’ve heard time and time again, but it bears repeating: medicine is a fast-paced world in which we are encouraged to get to the point. Whether we’re focusing on high yield material to prep for Step 1 or molding our patient interview to focus on our differential diagnosis, we are constantly cutting out the details. Brevity is a necessary feature in the world of medicine, where there’s ever more to learn and doctors are constantly pushed to fit more patients into their schedule. We just have to make sure we don’t cut out the human being when we leave out the details. For example, I recently visited a patient described as, “69 year-old morbidly obese, African American female who presents with syncope.” While the patient fit the above description, she was also a dedicated daughter who neglected her own health while caring for her bedridden mother for the past 15 years. These and many such other cases remind us that a diagnosis may call upon our scientific knowledge, but real treatment demands our humanity.
Like I said, this is a lesson that we’ve heard ad nausem, literally from the first day of class. Still, to see that lesson come to life, to see how I could use that understanding to convert a “difficult” patient into a patient who is eager to participate in her care, well, that made all the difference.
All patient details are fictionalized so as to protect the identity of the patient.
Last year I wrote a piece for in-Training about political activism and med school. Its main thrust was to drum up excitement about SNaHP’s activities during primary season. While that campaign and my own organizing work has shifted since then, the frame of med school as a journey of flattening socialization still feels true for me, and that was what most stood out to my friends who read the piece. I think a blog for health profession students and by health profession students is a good step towards livening up our discussions (while still being kind and respectful). I want to comment briefly on how I hope to approach all this. As a second year I feel a bit more empowered to find ways for my politics to show up in the way I approach medical culture. I hope it’s a generative process, but even if it doesn’t go the way I imagine, I’ll try to explain why I think it’s so necessary to at least give it an earnest effort.
I used to love school because in undergrad I was surrounded by some intense young people that challenged my biases and instilled in me a strong impulse towards critique. Not surprisingly, medical school is a bit less inclined towards discussion. In the first two years at least, a lot of the content is pretty black and white. You’d have to be really confident to challenge what a microbiologist thinks about some cell surface receptor they’ve been studying for at least a decade longer than you.
However, receptors are pretty marginal when it comes to the art of medicine, so it feels disappointing that this deference to authority and expertise so easily seeps into other parts of our experience. When potentially controversial discussions do come up, there seems to be a layer of self-censorship and tension which keeps them from being meaningful. Medical school does not necessarily teach you how to be a decent person, how to wage political campaigns, what it’s like to be a poor person in North Philly, or how to have real relationships with people who are different from you. A lot of these things we might figure out from our own life experience outside medicine. In the absence of structures for collectively envisioning what medicine should look like by the time we’re responsible for it, we have vetted buzzwords like “Professionalism” and “Patient-Centered” to fill the vacuum with ideas that are not especially specific or grounded.
In the past I’ve just thrown my hands up: “That’s just how medicine is, we can make change by other means.” I’ve had more than a few conversations with others who feel the same, at Temple and elsewhere, and am beginning to think that this is a losing attitude. Even as our profit-driven healthcare system enters yet another stage of crisis (for which our patients will continue to pay the price), doctors continue to have a ton of symbolic and political power. This year I hope some of us can dig into the hard work of figuring out how to responsibly wield that power. It has a lot of potential to reduce the harm and inequity which literally surrounds the building where we spend a lot of time ignoring it. While lecture and Doctoring are of course necessary and foundational, I doubt they will ever provide space for the more difficult conversations we need to be having. We need to make that space ourselves. I think politics and culture change within medicine are inextricably linked. I wrote in slightly more practical terms about my approach to this here.
*featured picture shows the Put People First PA (https://www.putpeoplefirstpa.org/) campaign taking action outside the Independence Blue Cross building during the 2016 Democratic National Convention in Philadelphia
As students of the health sciences, we are learning what it takes to make it in our chosen professions. In the course of this lifelong lesson, we learn to prioritize our education above all else; the rest, we relegate the margins.
The purpose of this blog, therefore, is to take a moment to step away from the beat of medical academia, and into the margins.
Here, you can reflect on those moments you previously pushed aside, whether it was to step into the next patient’s room or to finish studying for tomorrow’s exam. In this forum of shared experiences, you will find that your journey to career actualization is both deeply personal, but also universal.