Abstract

In lieu of an abstract, here is a brief excerpt of the content:Grieving the Loss of What Medicine Was Supposed to BeKaterina V. LiongI attended a conference this year. The timing was less than ideal because it was held the weekend before the Internal Medicine clerkship exam. But as with all things, especially during medical school, there is never a "right time" to be doing anything. It was fortunate that I attended the conference anyway because I met an incredible doctor there. She had given a talk called "The Myth of Physician Wellness," and somewhere in our lengthy discussion, she asked me this:"Have you ever considered that since entering medical school, you've never been able to stop and really grieve the loss of what you thought medicine would be?"I am writing this in the downtime during my surgery rotation, regretting that I didn't wait until I got home to fully feel the feelings of writing this because I cannot cry here in front of others. At the same time, I feel guilty spending time writing at all; I should instead be doing UWorld practice questions for my upcoming exam. I can feel it in my body, the feeling of being plugged up—I have allowed tears to leak out too many times this year.The first time was in Internal Medicine, after seeing an elderly patient with a terminal rectal cancer that was so far along you could see it grossly. The bulging mass was so obvious during the patient's digital rectal exam that the senior resident was able to take off his still-clean gloves mere seconds after putting them on. The patient had come in for abdominal pain and difficulty defacating; the [End Page E20] only management he'd been able to receive for his known cancer was multiple hospitalizations in the last few months for emergency blood transfusions when his Hemoglobin level, indicating blood loss from the cancer, got too low. As I was taught to do, I gave a summary statement: "So you're here because you had a primary care appointment for a regular checkup, but they wouldn't see you because they didn't take your insurance? And they sent you to the county hospital, but even though they take uninsured patients, you are technically insured, just under a terrible plan … so they transferred you here. Is that right?" Unfortunately, the man's sí of affirmation was enough to make me lose composure, and I had to step out to let the resident finish the interview.After that, all it takes recently for the tears to well up is for an attending to pull me aside for feedback and ask, "How is third year going for you?" or even "What do you feel you've done well?"I almost wonder if holding in tears is like constipation. In medical school, we learn that sometimes what we think is diarrhea in patients is actually constipation—the stool is so impacted that the only thing that can leak past the plug is liquid. We see the leakage and first interpret that as diarrhea. I have to wonder if people interpret the same about me—emotional lability? Or is my inability to prevent the tears from leaking out simply a product of all the plugging up I have been doing all along? My inability to properly grieve the loss of what medicine was going to be? Maybe the first step in processing that loss is identifying it:I thought medicine meant caring for patients. Why am I going through 7+ years of training if insurance companies are allowed to undermine us so easily?I thought medicine meant connecting with patients. Why am I spending 30 minutes seeing my patients and 2 hours writing notes?I thought medicine meant leadership. Why are others bypassing two-thirds of my time in training and ending up with almost the same job … but the only "leadership" left is that their liability falls on physicians?I thought one must be well to take care of others. Why are students working all day and studying all night, residents too overworked to take a lunch break, and attendings made to work while visibly sick and diaphoretic?I thought...