Humanistic Care in Medical School

I do solemnly swear, by whatever each of us holds most sacred…

Medical students conclude their white coat ceremonies by reciting the Hippocratic Oath – at least, a modern and truncated form of the oath. The Hippocratic Oath symbolizes the essence of health care: a covenant between healthcare practitioners and the patients they serve. This is a sacred relationship. Patients submit to another human being, oftentimes a stranger, to heal their physical and mental ailments. Physicians reciprocate by honoring patient autonomy, justice, beneficence, and non-maleficence. Ultimately, I am now part of a community of physicians dedicated to patient healing and medical ethics.

That I will be loyal to the Profession of Medicine and just and generous to its members…

I began the first year and a half of medical school building my knowledge base. My classmates and I were getting assimilated to the community and admired our faculty members for directing our education. I saw my first ‘patient’ on the second day of medical school. It was an assignment to meet a child with autism spectrum disorder at the patient’s home. He was a brilliant teenager who struggled with social skills and emotional intelligence. He told me he had great aspirations and planned to apply to my alma mater, William and Mary. We bonded about this common interest and discussed the challenges he faced and the therapies he found beneficial. The first patient encounter of medical school was an important one; I learned that my patients teach me just as much as I can teach them.

That I will lead my life and practice my art in uprightness and honor…

My attraction to the art of medicine is the pain of the human condition and my role in its healing. I act according to what I believe is right and what the patients believe is right, serving patients to the best of my ability. Patients deserve respect and autonomy throughout this process; the patient role is one that can be vulnerable, or one that is empowered with the support of good healthcare providers.

That into whatsoever house I will enter: it shall be for the good of the sick to the utmost of my power, my holding myself far aloof from wrong, from corruption, from the tempting of others to vice…

There are certainly days that make me question whether the pursuit of medicine is worth the time, energy, and sanity. Medicine is a grueling career path, one that challenges my physical ability to stay awake, my mental ability to stay focused, and my emotional ability to stay engaged in my personal life. Enthusiasm wanes with burn-out. I understand how physicians can lose their heart (i.e. humanity) when treating countless patients, who become diagnoses rather than human beings. In those times when humanity wanes, I must stay grounded to the reasons I pursued this career path to begin with: my relationship with the patient and my dedication to healing. I enjoy supporting my community – at the hospital, in their homes, outside healthcare settings; at the same time, I am uplifted by my colleagues and patients on a daily basis.

That I will exercise my art solely for the cure of my patients, and will give no drug, perform no operation for a criminal purpose, even if solicited; far less suggest it…

I remember my first patient who died. I had been following an 85-year-old gentleman on the medicine ward. He was transferred from the ICU after a remarkable degree of recovery from a stroke complicated by intracranial hemorrhage after administration of tPA. Refusing feeding tubes, my patient was unable to swallow and aspirated on food or water with any meal he would take. He became progressively hypernatremic. This was my first patient with overt delirium, falling in and out of lucid states. He refused water, was a difficult ‘stick’, and would pull out IVs overnight even when he had family or a 1:1 sitter. I sat in with him and his family for numerous discussions. I became the main contact for my patient and his family, with the support of my residents and attending.

The patient told his daughters that he was ready to die. I held one of his daughter’s hands as she walked away from her dad crying. His family feared hospice but finally agreed that home hospice would be ideal for him, as he preferred to die at home. The last time I saw him was Friday – the last day of my inpatient Internal Medicine rotation. He told me, “I want to go outside.” I told him, “We are getting you home. You will finally get to go outside.” I got a phone call Sunday that he died at 10am, two hours before the ambulance was scheduled to take him home. My heart fell apart. I was attending my grandfather’s funeral that day and felt overwhelmed by the fragility of life. At the same time, I felt the need to celebrate the lives of two wonderful men who left behind families and friends who loved them.

That whatsoever I shall see or hear of the lives of my patients which is not fitting to be spoken, I will keep inviolably secret…

As a medical student, I have the opportunity to sit by my patients’ beds, speak with them (sometimes for hours when there was time), and learn their life stories. Being a healthcare worker is a privilege, one that I will continue to honor by valuing what my patients tell me and serving as their advocate. By learning about my patients, I gain respect for who they are as people and how that can affect their medical decisions. Part of being a physician is allowing the patient to guide treatment therapies to attain the best possible medical outcome. This journey is one that optimizes their values with respect to religion, culture, upbringing, and circumstance.

These things do I swear. Let each of us bow the head in sign of acquiescence…

I define myself by my academic contributions, compassion for people, and by my desire to change the world for the better. I want to be a doctor, but I am only beginning to understand what that entails. I am learning about pain of the human condition and what I can do to promote its healing. I am learning what it means to do what I can to help my patients and to let go of what I cannot control. I am learning to appreciate the good moments when my patients experience recovery and to reflect when it comes to poor patient outcomes. I aspire to be a physician who heals my patients – not just with my knowledge – but with a love for mankind and compassion for others that motivate me to serve my community.

And now, if I will be true to this, my oath, may good repute ever be mine.

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The Life of an MS3: Good Times and Good Riddance

USUHS fourth-years are officially done with classes/hospital rotations and have graduated this past weekend. So concludes the third year of my medical school career. Cheers to that!

My existential crisis [see last post], though ongoing, has abated in intensity. I have accepted my fate as a physician despite the occasional fantasies of retiring to a small town by the water, becoming a fiction novelist, and traveling countryside in an RV with Andrew. I signed up as the newsletter writer in Alpha Omega Alpha (AOA), so I will consider that my attempt to bridge between the worlds of medicine and humanities. It’s the little things, my friends, that keep you going.

I have lots of updates for the past year, and I will try to keep them brief. Last post, I talked about how pediatrics restored my faith in my career in medicine. That was a wonderful rotation (shout-out to Walter Reed’s pediatrics department and their fantastic program!). The entirety of the rotation, I reevaluated my life and thought, “Man, I should be a pediatrician.” Then followed Family Medicine in Offutt Air Force Base. Yes, folks. That is in Omaha, Nebraska. I have finally ventured to the real Midwest. I was lucky to go during the summertime with a lovely classmate and had the best rotation of medical school – a much-needed escape from life’s obligations at home. I learned that I love primary care and appreciate the family medicine physician mentality. For the first time on rotations, I truly felt like I fit in.

As the five weeks in Omaha continued, I saw the perks of family medicine – especially in the military. The options are endless. I can do primary care in adults AND children. My experience in pediatrics helped facilitate more positive experiences with children. Fun fact: I had never picked up a baby prior to my pediatrics rotation at Walter Reed. Now I am a diaper-changing professional. Anywho, the physicians I worked with in Omaha were fantastic. I fell in love with the field. I felt at home. Considering I always intended to be a psychiatrist, I also became very confused.

Next up, my elective! I chose addiction/substance abuse at Fort Belvoir, VA working in both inpatient rehabilitation of active duty members and in outpatient psychiatry with a methadone clinic. What a great experience where I felt involved in understanding the epidemic of addition in our nation. I worked with fantastic psychiatrists that made me feel at home in their field, despite the fact I hadn’t even rotated in my core psychiatry clerkship yet. One resident made it his mission to reaffirm my decision to pursue psychiatry considering my recent interest in family medicine. During the rotation, I definitely felt like I wanted to be a psychiatrist again (ie positive experience).

The theme of wanting to do the field I was rotating in continued (which I hear is common for those interested in family medicine). I really enjoyed my internal medicine rotation, especially the inpatient experience where I had the opportunity to work with residents and attendings who were dedicated to my betterment as a student. So much knowledge to be had. I was nerding out. Internists are definitely the Ravenclaws of medicine [Side tangent: that would make Surgery the Slytherins, Family Medicine the Gryffindors, and Pediatricians the Hufflepuffs… I need to figure out how to fit in the other specialties].

My last rotation of 2016 was psychiatry. Naturally, I was doing exactly what I wanted to be doing for my life but at a medical student level. I felt challenged and never experienced the “psych-ation” hours some students enjoy on their core clerkship. I had hoped that it would help clarify psychiatry vs. family medicine for me, but it actually made me more confused. I love psychiatry, but maybe I also love family medicine. How can I do both? I have been looking into joint residencies – there used to be an Air Force option to do family medicine/psychiatry at Andrews AFB way back. There is currently an internal medicine/psychiatry residency (5 years as opposed to the 3 years in medicine and 4 years in psychiatry) offered to Army, Navy, and Public Health Service. Unfortunately, a double-boarded position is not currently in the needs of the Air Force right now, but I am trying to sell it [wish me luck, folks]. 

So that is how I concluded my 2016 year of core clerkships (typically done during third-year for other medical schools). I am still unsure about what I want to do for my specialty, and I approached my schedule so that both psychiatry and family medicine remain on the table. 

Over winter break, I got engaged (hollaaaa) to the love of my life while on vacation in Dominican Republic. It was a beautiful trip with us and a childhood friend of mine (the one who I credit with our relationship because Andrew was originally her friend from college). We met some great people while we were there and are developing an international friend pool, which is a good deal for future travels. 

Winter break went straight into Step 1 study time. We take it later than other medical schools to make up for the fact we start in the hospital 6 months earlier. Not much to say there because not much happened. My score was pretty awesome, and I think it is because I chose to CHILL OUT for once, minus the occasional panics about how I was behind schedule and felt like I was going to fail. In case there are pre-step 1ers reading this, I’ll lay out my study plan in another post.

After Step 1, it was back to the classroom after over a year. We had 6 weeks of trainings and additional education on certain clinical topics. We got certified in BLS (basic life support), ACLS (advanced cardiac life support), and ATLS (advanced trauma life support), when only BLS is required for medical students. We had a fun military event called Gunpowder that’s a prelude to Bushmaster in September where we do military medicine scenarios like making a rope bridge to get a patient across the river, running codes, and climbing walls (or in my case, having someone help push you over a wall). My team consisted of a group of classmates I had never spoken with before, and we worked great together – made it in third place among 16 teams!

Despite the training, I felt rusty on my hospital skills and was anxious to go back. Day 1 back in the hospital was on my birthday at Madigan Army Medical Center at Fort Lewis-McChord in Washington state. Neurology was a great transition rotation because we acted as the inpatient consultation service, so I felt like I was relearning all of medicine despite our focus on neurology. I also felt like so many things were finally clicking from basic science neuroscience to clinical practice. Neurologists are definitely friendly, love what they do, and have a good lifestyle. The brain is cool, friends. I don’t understand how neurology isn’t a more competitive field!

Washington was good to me. The lodging was comfortable. My residents were awesome. My USUHS classmates were fantastic, and I met some friendly HPSPers. A couple USU folks and I traveled on weekends – to Seattle, Portland, Crystal Mountain, and Tacoma. What a beautiful state! Despite all the rain, the sun managed to shine bright on weekends.

Although I had a great time on neurology, it was nice to come home, reunite with friends and family, and NOT have homework anymore. FYI to non-USUHS folks, neurology entails 10 papers, 1 take-home quiz, and a final exam. Fun stuff.

I am currently on ophthalmology where the surgeons are happy, and I am trying to get used to a new routine. I became re-engaged in group organizations after being welcomed into Alphi Omega Alpha and the Gold Humanism Honor Societies. I am working on a curriculum project with school and have two research projects going at the same time. I am also trying to get in shape for the wedding. So it has been pretty busy since I’ve come back home. Andrew and I had an epic engagement party with local friends/family this past weekend where his family was exposed to the beautiful wonders of Persian dining. With those wonderful memories and my social quota reached, it’s time to get busy. I have a book chapter due on June 1 and my step 2 CK on June 7. Cannot say I have been studying too much for this one…so I’ll let you know what my study plan is after I figure it out myself!

Surprised you’re still reading. It’s been quite the year, so I appreciate your time as I share my experiences 🙂