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Surviving the Tough Times
Thomas Robey -- May is a tough time of year for medical education. The Step 1 board exam is looming for second year students, third years are exhausted from solid months of clinical clerkships, fourth year students are nowhere to be found, and interns, well, they're as exhausted as third year students but raised to the exhausted power (a mathematical expression). For many, this fatigue is not the running on empty, "I'm almost finished" feeling that we might expect in June, but rather an "I'm drowning, but I'm too busy to call for help" situation. Yes, not all feel this everyday -- to get this far, we have to have good coping mechanisms -- but there's a greater chance that overwhelming feelings get the best of us this time of year. (I wonder if it's by design that the medical year's most stressful time coincides with spring's unleashing of hopeful, happy and even manic episodes.)
But for those of us with real struggles to get through an understandably difficult year, it is helpful to recall why we are here. The patients we try to cure can be the very medicine we need to get through the day. In the rest of this article, I've picked out some of my more memorable patients in an effort to cheer myself, but also to jog your memories and invite accounts of your favorite patients.
There's the 8-year-old boy with Crohn's disease who drew a portrait of me. When he had unbearable pain and bloody stools, it took a day for him to warm up enough to communicate with more than head nods. Some day he will need large chunks of his intestines removed. It's too bad his overflowing heart cannot be used as donor repair tissue.
Can you remember your first delivery? Mine was a complicated Caesarian section, which made the emotions cycle extra quickly. In the end, mom and baby did just fine, and I try to draw strength from the resilience they both exhibited.
There was even the time when I delivered bad news to a patient with metastatic prostate cancer. He probably knew this was going to be the diagnosis, but had been in denial. The time he spent ignoring the problem was probably too long, but in his acknowledgement, he re-established care and is actually doing well. It has been nice to check in on his check-ups, if only via the electronic medical record.
And finally, there is the aged southern belle who could be a poster child for a "hugs not drugs" campaign. In the process of administering the Dix-Hallpike maneuver to assess canalith dizziness, we discovered that even medical professionals need hugs now and then.
These are the golden patient encounter memories that keep me looking forward. What are the stories that pull you through the difficult days?
May 2, 2008 in Thomas Robey | Permalink
Comments
Im a third year medical student who is busy preparing for the upcoming exams.Saying May is a tough time is an understatement! May truly is really hectic.One thing that keeps me going is knowing that as I study I am not only learning for myself but for others that I will be serving one day!The fear of one day making a mistake that could put someone's life at risk, is the thing that drives me as I study. I know that whatever I am feeling(fatigue,discouragement), I must weather the storm because the reward is so much more rewarding.Maybe one day someone will also draw a portrait of me, just because I was faithful in studying!
Posted by: Motshidisi Malimane | May 3, 2008 4:14:00 PM
i'm finishing up second year right now, and i just got done crying to my husband about how i'm scared for finals and boards... and third year... and the rest of my life. he said he was proud that i'm scared because of the reason behind it: i just want to be a good doctor someday. i feel a little better knowing that so many others are going through the same thing right now. thanks for the encouragement!
Posted by: stephanie | May 6, 2008 8:24:39 PM
I'm a 4th year student (technically, until I graduate next Friday!). Navigating the world of student loan deferments/payments, home buying and mortgages, hiring paperwork, W2 forms, health insurance plans, and tax sheltered annuities (etc, etc) makes me wish I was just worrying about patient care in the hospital these days. At least I'm good at that - this fiscal stuff is way over my head!
For the second years - you will pass step 1, it will be OK.
For the third years - yeah, that year really stinks, but 4th year is the light at the end of the tunnel!
For my fellow almost-graduates - this should be the most exciting time in our lives, we're realizing our dreams and have so much to look forward to.
To the poor interns - I'm sure you're exhausted, but the year of brutal initiation is almost over, and then you can move on to your chosen specialty and (hopefully) more reasonable call schedule!
Posted by: | May 6, 2008 8:40:03 PM
I am a second year medical student; everyone says May is the toughest month for medical students. I will agree. For me I am preparing for step I. At the same time I am searching for the motivation to continue when there are no patient experiences to remember. There are no drawings to explain why I should continue. In the end all second years have is a longing for the time when we will have the chance to care. The motivation for me has been family and most of all my fiancé who has endured this journey with me. To her I say thank you for listening to me at all times. Thanks to the third and fourth year students for taking the time to share their experiences, giving confidence that we too can endure. Thanks!
Posted by: Juhmal B Eastland, Indianapolis, IN | May 7, 2008 4:02:15 AM
While I was on a nephrology rotation during third year, I had the pleasure of being able to check in on a patient that had bladder cancer. His cancer was causing urinary obstruction, so he was referred to nephrology for dialysis. On one occasion, the nephrology team checked in on the patient while he was in dialysis. This particular time he was being visited by his siblings and his son. While my attending was fussing over the details of his orders, I made some non-medical remark that brought a big smile to both him and his family. Much to my surprise, his son told me that I had a 'gift for communicating'. I suppose that they had been so overwhelmed with all of the surrounding medical talk, any comic relief was welcomed. As it turns out, the patient's son is a native american artist, so he left a small, beautiful print for his father to give to me. I have that print framed and I intend on hanging it right next to my MD (which I am receiving next week), so that I always will remember that there is in fact an important, non-scientific side to Medicine that should never be abandoned. Despite the trying times that I have gone through in the past couple of years, that print brings a smile to my face each day! It reminds me daily of why I wanted to go through this arduous course to achieve my life goal of becoming a doctor. If only that family knew how much strength I have drawn from that small token of appreciation!
Posted by: Karen, Canada | May 7, 2008 8:39:04 AM
Having got a place on the Graduate Entry Programme in medicine, I am currently in my second year(equivalent 3rd year)doing clinical work. I am finding this month an increasingly stressful period and dreading the coming month which will bring us medical students even closer to exams. Like so rightly mentioned, it is very easy to lose track about why we are doing medicine, especially on days when the patients decide to be uncooperative or the consultants either just ignore you or make some scathing comments. And then there are those days when you can't seem to do anything right! I have had a few truly scary experiences with some of the members of my team which makes me doubt myself and which can also be demotivating. In this time of stress with the exams looming, a little comment can have a a negative effect! But what keeps me going, is that one day I will make a difference to people's lives as a good doctor. I saw this elderly lady who has had her leg amputated and is still optimistic and who keeps telling the consultant about "this nice trainee doctor" who takes the time to talk to her. This reminds me about why I want to be a doctor.
Posted by: Preety | May 7, 2008 8:40:44 AM
Mots Mali, I know exactly what you mean. The intellectual stimulation is a challenging motivation, but what really draws me to medicine is the personal interaction. The trust – and perhaps a little desperation – with which each patient approaches, shakes me to the core every time I experience it, and pushes me to master the otherwise impossible bounty which is modern medicine. I pause to state this, but I realize that my main motivator for learning has nothing to do with pride or grades, or class standing, but simply to fulfill my part of the relationship that I have and will have with each patient. Not excellence for excellence’s sake, but because of the immense weight of obligation you have to the patient.
Posted by: Ephraim Caangay | May 7, 2008 9:17:53 AM
Medical school is not just tough, something more! as a Final year student in a Kenyan University where Problem Based Learning is used, all the pressure is on the student. we got to be on top of evrything, something hardly achievable, but we are encouraged knowing that a better day will come and that 'pressure makes diamonds'
Posted by: Juma Sylvan | May 7, 2008 10:56:45 AM
I'M A 6TH YEAR MED STUDENT FOR HONDURAS, AND BELIEVE IT'S ALSO HARD HERE. RIGHT NOW I'M ON MY SURGERY AND UROLOGY ROTATION AND THE TOUGHEST PART IS WHEN I'M ALL NIGHT IN THE ER AND YOU SEE PEOPLE THAT COME ALMOST DYING AND WHAT'S EVEN WORST IS WHEN THERE AREN'T ANY SUPPLIES FOR YOU TO WORK WITH AND THE PATIENT DOES NOT HAVE ANY MONEY ON THEM. WHAT CHEERS ME UP IS WHEN I DO EVERYTHING I CAN TO HELP THESE PEOPLE THAT COME IN AND THEY NOTICE THAT. IT'S REALLY COMFORTING WHEN THEY BRING YOU SOMETHING AS LITTLE AS A LOLLYPOP OR A COKE AT 2AM, WHEN YOU REALLY NEED THAT TO STAY AWAKE TILL YOU LEAVE THE HOSPITAL THE NEXT DAY AT 6PM.
Posted by: Karla | May 7, 2008 2:37:18 PM
I had a 3 year-old patient once in paeds orthopaedics who had bilateral Ponsetti POPS, which he could walk on quite efficiently (try it: walking with both knees flexed, ankles in dorsiflexion: a pretty decent workout at the best of times) If this isn't impressive enough, he developed this habit of waddling over when he saw me, clinging to a leg, and not letting go til the end of the ward round.
Posted by: Linda | May 7, 2008 3:05:36 PM
Thomas's right,it's helpful to recall why are we here,struggling and sacrificing...I've always wanted to become a doc since childhood. In times of hardship,I do wondering why I choose the difficult road. Fancy about the life over the fence. However,I believe God has a plan for everyone of us,and this is mine. I'm a 4th year Med student from Malaysia. It's comforting to know Med students all around the world are going through the same thing as I am.
Posted by: Junni Keng | May 7, 2008 6:19:17 PM
I am a second year preparing to take step 1 (USMLE and COMLEX). I really never paid attention to the fact that may is one of the toughest for any medical student. But in the last few days, i have lost my car (accident), could have died in the accident, missed required class meetings and my laptop stopped working.
In someways, reading this article and the posts is a positive for me. i know am going to be alright, or better, i have to be becuase that the only choice.
thanks for the opportunity to vent!
Posted by: david | May 7, 2008 7:26:59 PM
hi every body, iam final year student, right now i am preparing for my final exam in surgery, its a bit tough and difficult subject, but what drive me to study more, is when i imagine my self in the operating room helping in saving one`s life, thats an enough reason to complete the medical journey that i started...
good luck for all.
Posted by: Hadeel Azzam | May 8, 2008 5:47:16 AM
Hi everyone,I am a second year medical student from peshawar...these days we are busy in our research assignments and preparing for stepI exams.When it all gets very tiring and frustating the only motivation that keeps me going is that someday all this sweating and tough studies will bring a smile on someones face and i will be thankful that i studied so was able to help and save a life...a reason worth continuing the medical journey thati have strated!
Posted by: ASHEE | May 9, 2008 2:03:07 AM
salam everyone, now am in 4th yr,surgical rotation, for me what push me to continue my journey is patients prayer for me, they just want to be treated by a good doctor. how beautiful is there face when they look at u and wanted u to be a great doctor.
Posted by: ALAA | May 9, 2008 3:08:25 AM
I am a 5th year medical student in New Zealand. Most recently, I have been on my general practise placement, and the most rewarding time for me is having the ability to talk to people about "personal" problems, whether it be about their heart, their family or their piles. The bond you have with the patients you work with. How they can be so greatful they bring in baking, or you can just see it in their eyes, and you know that they trust you. Even better still is the bond you have with fellow students, who share the pressures of med school, totally understand exactly what you are going through, and are always there to help when you are down, and there to laugh with you when things are good too, and conveniently ready to party with you when all the assessments are over!
Posted by: suz | May 9, 2008 3:30:24 AM
I am a final year medical student, GOING TO SIT FOR FINAL EXAM IN 2 DAYS TIME.
I have finished my theory paper last week, which i think i did not do well. But the most important part is the clinical exam 2 days later, which determine u pass or fail.
I have been suffering for past one month and another 2 more days to go......not enough sleep everyday and yet cant finish revise even only the important topics.
However, i keep telling myself, there are many ppl out there suffer more than me, i am lucky to be in medical school, preparing myself to serve the community.
Yes, i can do it!!
Posted by: miaw | May 10, 2008 5:45:57 AM
Hi, I am a medical student but still a while away from having to take my boards. I just wanted to share a quote from a man, Randy Pausch, whose story has made me see some things very differently.
When he discusses obstacles or "brick walls" to pursuing or fulfilling your dreams, he says "The brick walls are there for a reason (...) The brick walls are not there to keep us out. The brick walls are there to give us a chance to show how badly we want something."
Good luck on all of you who have exams soon.
Posted by: Quique | May 11, 2008 8:26:02 AM
am a third year med student at makerere university in uganda where we study on the problem based learning(PBL) system.clinical rotations begin in fourth year and you dont want to be left behind if you fail to jump the hurdle in the exams of MAY.what keeps me going is remembering the fact that i joined med sch. to help the people of my country and am willing to stand in any kind of situation
Posted by: mwanje geoffrey | May 12, 2008 5:12:29 AM
I am a sixth year medical Student in Peru. And as much of you I always try to look up for any chance of gold inspiration in the simple things we are rounded.
In my country the patients see a medical student as their "not yet a doctor, still a human" so we have these great oportunity to talk to them, encoureage them to figth for their health and happiness in life, I think that besides all the hard work, the level of these communication is what makes us to wake up every morning and go to them and say: These is the place where I belong to be!
Posted by: Mayita Peru | May 15, 2008 8:24:44 PM
