IJHC (The International Journal of Healing and Caring)

Fifteen weeks ago I returned to my fourth year of medical school from a year’s leave of absence during which I worked full-time as Director of Student Programming for the American Medical Student Association (AMSA). I carried many fears with me upon my return. My baggage was by no means light. I feared watching myself slip between my fingers as I became a watered down version of myself — a non-me, really. I feared late nights; over-friendly pharmaceutical reps; mind-numbing emotional and physical exhaustion; pimping in many forms and fashions (e.g. having to answer questions put to me by a surgeon on rounds, like “What is the blood supply to the superiomedial aspect of the inferior esophagus?” “What antibiotic was prescribed to that patient ten years ago when he had sinusitis?”); pseudo-vegetables soaked for days in butter passing as vegetarian fare; being snapped at or yelled at or ignored by attending physicians; being supervised by resident physicians, nurses and patients; being expected to do things I never was told about; not being able to read minds; not remembering any medicine after 12 months of not one single spark in those dark recesses from three dankly stored years.

Much turned out better than I had allowed myself to hope. Some things were worse. After two months of a really wonderful and completely benign core internal medicine rotation (primarily outpatient), I returned to the dreaded halls of my school’s primary teaching hospital. The basement is a classic hospital maze of white floors and gray doors, hidden exits appearing and important offices disappearing. The cement stairways perpetually smell of urine; the stiffly seated inhabitants of waiting rooms fail to mask their fear and discomfort with blaring television talk shows; the nondescript window view of the city does little to distract patients from their sterile rectangle of a room; and not a single inch of space in the whole hospital exists for a medical student to sit and chart or dictate or simply think without being in some one’s way or encroaching on their claimed territory. And people go to a place like this in search of healing?

I have to admit that there are definitely fragments of good in this place that otherwise turns my stomach. But mostly, medical students draw the disparagement of nurses and other staff, annoy the residents, and mildly amuse the distracted and often disinterested attending physicians. The morning report, which roves from room to room, appears mostly to serve the needs of an overbearing self-appointed disciplinarian pulmonologist - to vent his frustrations and angers at straggling and disoriented students and residents every morning.

I could fill pages talking about the grotesque details of the inhumanity of the medical training system and its relentless trimming of well-rounded complicated individuals into cookie-cutter doctors, who work ceaselessly without complaining as they sacrifice everything else they previously loved (including themselves). These details coat me with a sooty gray coat of despair, so I prefer to stick to my safe generalizing. (I’ve seen students expelled for telling lesser truths than I write now, labelled malcontents or unsuitable for the medical profession – as conceptualized by those who have succumbed to the numbing workaholic addictions of fighting to eradicate all diseases and to see their names on papers describing interesting cases of this illness or that variation of a medical anomaly; by those who have become human doings and have forgotten how to be human beings.) Anyway, the core of the illness ailing our system of medical education lies in the overarching philosophies and not in the fragmented details. Medical education is currently based on mastering a body of knowledge within a rigid hierarchical structure. One piece at a time is changing (I continue to hope), but we have a lot of work still to do.

How do we survive as lowly students within a broken and ailing system? We remember the blessings and the joys and the high points, and we carry those with us in our hearts and our eyes. We cry with the woman mourning the double loss of husband and dog. We offer the healing power of our hands to the couple struggling to understand their aging bodies and their empty nest (especially those of us fortunate enough to be trained in manual osteopathic medicine). We spend an extra few minutes finding a translator to explain heart catheterization to the man who doesn’t speak our primary language.

How do we survive? We share the stories that bring smiles and warmth with others. During my month of cardiology (remember the hospital I was talking about earlier?) I was blessed with three humor-filled attending physicians (and a fellow student who appreciated humor only when directed by him at others). The five of us played the game together. We skipped dull clinic hours, we pretended indignation over ignorance, we showed up late and early and needled one another, all underscored by sly smiles and dry laughter. The most senior attending — a bearded, lean man — loved the game of lose the student. You’ve seen it played, haven’t you? Medical students walk single file behind the attending. Not quite on purpose, but the halls are not wide and people, beds, food trays are creeping by as you run through the halls on the coattails of daddy (or mommy) duck.

One day, on a nondescript Wednesday, the long-legged doctor halted abruptly. Just for the fun of it, I firmly believe. Generally quick on my feet, I stopped on a dime, several inches from collision. However, my fellow student crashed full-force into me, sending me sprawling into the attending. I almost started quacking but instead settled for laughter. When we stop laughing, that is when we know we are done for.

How do we survive? We breathe and we scheme for the better system we will and indeed already are creating and we join hands with others, and most importantly we laugh.

Resources:

The Humanistic Medical Group (HuMed) is a community of students, physicians and related practitioners who honor the harmony of body, mind, and spirit. It is a forum in which we explore our goals, dreams, and potential as future physicians. HuMed offers a nourishing space to cultivate discussion, critique, and hope during our medical training, to recognize personal needs to be healthy and live balanced lives, and to share connection and friendship with like-minded people. HuMed offers opportunities to explore and foster humanism within ourselves so that love, caring, wisdom, and well-being are at the center of our professional lives and our approach to caring for people.

The student group of the American Holistic Medical Association (AHMA) (www.holisticmedicine.org) and the Humanistic Medicine (HuMed) Action Committee of the American Medical Student Association (AMSA) (http://www.amsa.org/humed/) are places where students come together to nurture one another, share stories, and dream about new models of healing. Both groups are offering retreats in 2003:

The Third National HuMed Circle of Healers retreat (with a component for residents, sponsored in conjunction with the AHMA) in California in January; and The AHMA student group will have a one-day retreat prior to its annual conference in San Diego in May.

An increasing number of physicians-in-training are finding that taking a year’s leave of absence from their education provides them with critical space for evaluation, self-reflection, and recovery of their inner joy and commitment to their chosen path. Some schools are more supportive of this hiatus than others. Many individuals also find that taking time between medical school and residency offers opportunity to ground themselves and to explore other aspects of themselves or even healing that interest them.

Mara Merritt
4th year medical student
Texas College of Osteopathic Medicine
tmerritt@hsc.unt.edu

Make Way for Ducklings

by Mara Merritt, 4th year medical student