Students Write About Their "Firsts" in Medicine
Last fall, Academic Medicine, the journal of the Association of American Medical Colleges, put out a call to all medical students and residents for 400-word letters to the editor describing a “first” in their medical education or experience. Nearly 400 trainees across America sent in submissions, including a dozen students from the Lewis Katz School of Medicine at Temple University. A Letter by Miloni Parekh, LKSOM class of 2021, was one of those accepted and scheduled for publication in late May. Her letter, titled “It Was Already Too Late,” describes her first overnight trauma call and is linked here. Five essays from Temple receiving honorable mention, as well as one other, are published below. In all these essays, covering a wide range of firsts, the compassion, humanity and dedication of the authors shine through.
Heather R. Gochnaeur, LKSOM, class of 2020
Dear Pediatric Intensivists,
Thank you for the privilege of spending four weeks in this very special corner of the hospital. Thank you for challenging me with questions about dead space and changes in ventilator settings. Thank you for asking me to read the morning chest film and to help suction a patient’s throat. Thank you for taking time to explain to Mom and Dad why their baby needs a hole put in his neck to help him breathe.
Do you remember Emily? Do you remember her 3-month-old fingers and toes? Her beautiful baby skin? Do you remember her retinal hemorrhages? “Too numerous to count,” the report read. Do you remember her broken tibia? Do you remember the way her eyes held still?
She was my first, you see. My first neurologically devastated, broken-boned, bleeding baby girl. Shaken and beaten until she lay still, too still. I remember the first time I walked into her room. Mom and Dad sat on the couch, heads bowed, staring at the floor. I felt my morning coffee and banana rise to my throat. I wanted to scream and yell. But instead we said, “Good morning,” and we listened to her tiny beating heart, her clear lungs. We shone light in her small, still eyes and gently caressed her soft head.
I watched Emily every day. I watched her start to breathe a little more without our help, to move her arms without the sedation weighing her down. I watched the nurse place a pink bow in her hair and a stuffed bear next to her head. I still could not look Mom and Dad in the eye. I was too scared I would say something I shouldn’t. I was too scared I would lash out.
Please, Pediatric Intensivists. Would you please ask me how I feel? Would you tell me how you feel? Would you please explain how a Mom could do this? Why this happens? Would you please tell me that it’s okay to be angry and that it’s okay to be sad? Would you tell me what you do when your baby won’t stop crying and your toddler won’t eat peas and your spouse hasn’t taken out the trash in three weeks?
Emily was my first. And I pray my last.
Tyler McCardell, LKSOM class of 2021
It’s 9 P.M. on a Friday at Temple University Hospital in Philadelphia. I am a new third-year medical student assigned to the Trauma service, fumbling to put on the trauma gown and face mask to prepare for the incoming patient. It was my first weekend night on call, so I barely knew the passcode for the ER doors, let alone understand my role. Suddenly, we heard the bay doors open and someone screamed, “It’s a code!” as I see a nurse start chest compressions. Ten seconds later, the doors open again and someone else yells out, “second code, bay two!” As our team splits up, our Chief Resident gestures me to come help him with the first patient, who had been stabbed in the chest.
I nervously stepped forward as the Chief prepared for a thoracotomy. Before I could process the scene, he had the chest open and instructed: “put your hands around the heart and squeeze.” In the moment, I didn’t question, I didn’t even comprehend the gravity of what was being asked of me; I simply squeezed just like I was told. Within 60 seconds, thanks to the efforts of the entire team, the patient’s heartbeat returned, and I was relieved of my job. I stood back a few steps, looked down at the blood coating my gloves and dripping off my elbows, and it hit me. For the first time, I had held a human heart-- a living, beating, human heart -- in my hands. In that singular moment I knew that I had chosen the right field, because I had just helped to save a life.
Two weeks later, that patient walked out of Temple Hospital. This experience speaks to me as a metaphor for medical education and has set the tone for how I think about the clinical years of medical school and residency. As students, we can stand back and observe countless patient encounters, but the truly impactful and rewarding experiences will come only when we step up and do. We learn and practice now, because for the rest of our careers, patients will be relying on us to hold their hearts in our hands, both literally and figuratively.
Azam Husain, LKSOM class of 2021
The Whitest White Coat
I keep my white coat white. I’m talking Mr. Clean White. Sensodyne White. White on rice White. New Balance sneakers on a middle-aged suburban dad White.
In fact, my doctoring group makes fun of me for getting my white coat dry cleaned, but I what can I say, it’s my favorite piece of clothing. And although we all have one, all of ours are a little different.
I doubt I will ever change where I keep my pen. Or my conveniently sized White Coat clipboard. Or my stethoscope. Or my spare pen for when a patient asks to borrow one. Or even those two pins we got during the White Coat Ceremony 1…which, I should probably do something with someday.
I have practiced and prepared in this coat. It will do me well, even beyond the Sim Center. No matter how much we complain, we have to admit that Doctoring has taught us invaluable lessons. Now, on the brink of third year, it is hard to picture myself two years ago…wiping my sweaty palms on my new, pleated dress pants before shaking the SPs hand. I have come a long way. We all have.
Every time we put on that Temple white coat, we are ready: we are ready to learn, we are ready to teach, we are ready to make a difference. But we are also ready to make mistakes. And that’s okay. This year we are likely to be the most inexperienced members of the healthcare team. And just as these last two years have flown by, so too will the next two. Regardless of the impending challenges, we are ready for what’s next.
I, for one, will go from wearing my “white” white coat about once a week to almost every day. Naturally, I doubt I will be able to maintain this bleached white color. However, there is also pride in wearing an “aged” white coat. Every stain, every scuff, and every accidental pen mark will forever be linked to a memory. After all, a white coat is not meant to spend its life hanging in a locker.
This coat will travel with me across the street, and even across the state. And no matter how worn it gets, one thing will never change: this will always be my first white coat… And regardless of how “un-white” it may get, it will always be my favorite.
Hannah Roach, LKSOM class of 2023
When you think of codes on television or film, they move like lightning. Shock here, compressions there -- fast, fleeting and bright flashes of resuscitation. My first code was more like thunder. The PA went off: we could expect a code arriving in five minutes. People gathered slowly, gradually pouring in as we all got dressed in gowns, face masks, and gloves. And I stood there, awaiting the lightning strike.
There wasn’t a flash, there wasn’t a flurry of activity. There was the steady, rolling approach of the paramedics and the gurney. There was the beat of compressions and the accompanying footsteps. The doors swung open. People began to move.
I fell into place behind three nursing students, all ready with their hands interlaced. I stepped onto the step stool and began. I was brought back to playing the violin -- playing for pages without seemingly reading the music. I moved and worked and done as I had been trained to do; my thoughts were somewhere far off, hiding maybe. I could feel my knees shaking but my hands were steady enough.
During my second round of compressions I was told to stop compressions and time of death was called. If I kept my hands on longer would it have been 3:05 instead of 3:04? But I took my hands off and they were sore, and I was sweating. The other students and I asked if we were ok and we said yes. Little by little it got quieter; thunder rolled away and retreated back. The storm left behind quiet little motions: removing gloves, quiet questions.
We walked in almost a straight line back to the main desk in the ER. A patient asked me for a gown, and I got her one. I watched an IV be placed. I asked questions about diabetes. I met a very nice woman who smiled despite her being in pain.
I thought a lot about him -- my first code. The residents told me it gets easier in a way, but I don’t think I want it to. I want him to travel with me for a while. My hands feel different -- the next week my hands were held by a newborn in her first physical. My hands feel different because they worked to help him, and I know he made them stronger.
Emilie Decoppet, LKSOM class of 2021
The Sound in Between
Upon Performing the Pulmonary Exam for the First Time
I was not listening for a sound in that fraction of eternity between breathing out and breathing in – when the lungs are unburdened of air, and the body girds its forces before the next rushing of tides. And yet I heard one just the same. Not the flat hum of vastness that echoes in canyons, but the delicate percolation of living tissue. Starbursts of sound scintillating in her empty lungs, alveoli rustling tenderly in a dying breeze.
In the silence of the room I – alone – am in the sound. Such a fragile sound it is, dust motes floating in the darkness between her breastbone and her spinal cord. Surely, if I let such a sound out into the room, it would die. Suffocated by the air and the light before it was ever born. Like a bird hatched too soon, the thin membrane strangulating its desperately folded bones.
Here again, the age-old question of the scream of ancient oak falling alone in primal forest. Does the air carry the scar of where it was rent? Or did the wind have to carry it onward for millennia until human ears could harden the echoes of death into existence? No, no, in her, here, now, this sound, this quiet rushing of darkness, exists only inside solid human flesh. A reverberation between two bodies and my instrument. Her lungs the oak, my mind the mossy forest.
Suddenly – the tidal thunder of her breath sweeps back in. Closes over my head. I pull back. Pull the stethoscope away and blink into the bright air. Dazed. Emerging from a more primitive world, like a deep-sea diver surfacing above the waves, still drunk on the wonders left behind in the watery depths.
“Did you hear anything?” the patient asks. I pause and consider the world I just left. “I did.” I heard, I could have added, the sound of your existence.
• • •
Several more students from LKSOM submitted essays, and we include one here:
Ebunoluwa Olawole, LKSOM class of 2023
As an immigrant from Nigeria, I felt prepared for the new challenges in medical school because adapting to new situations has become second nature to me. Alas, I was wrong. Nothing prepared me for my first experience with a Black cadaver.
My assigned donor was a white male who became my first patient and teacher. I learned so much from him: the intricate details of the muscles of the leg; the diverse functions of the nerves in the brain; and the complicated, yet majestic body processes.
However, I had a very different experience when I saw a Black donor for the first time at another anatomy table. I stood at his table and could not move; the room became quieter. For minutes, I could not pinpoint the strangeness I felt. And then the thought came to me: He had the same shade of black as my father and suddenly the donor became real to me.
I imagined how much the Black donor must have trusted the institution, to donate his body, considering the lack of trust that exists between many African Americans and healthcare practitioners. Then I thought that while I knew nothing about this particular donor, we must have shared similar experiences based on the color of our skin, with his being much worse than mine. For instance, I imagined that he must have suffered the effects of Segregation in the 1960s in a way I never have had to experience. This reminded me of the privilege I have as a medical student in my institution.
I pondered the fact that while his skin was very different from that of my assigned White donor, the internal biological features of the two donors were the same. I asked myself why would society treat people so differently merely on the basis of skin-color, when nature had so obviously designed the human anatomy to be the same, irrespective of exterior skin-color? This fact could not have been clearer with these two donors on our anatomy table.
I am inspired by the Black donor’s trust in medicine and I am determined to work with every community I serve and find ways to improve the trust and relationship between African Americans and healthcare practitioners. My experience with the Black cadaver humanized my view during my entire anatomy course. This will be a constant reminder of the humanity in medicine throughout my medical journey.
Michael Vitez, winner of the 1997 Pulitzer Prize for Explanatory Journalism at The Philadelphia Inquirer, is the director of narrative medicine at the Lewis Katz School of Medicine at Temple University. Michael.firstname.lastname@example.org