Asheville, North Carolina, United States (Spring 2016)
An 89-year-old who laughs me off when I suggest that he should use his cane more often, telling me he does not want to look like an old man. A Ukrainian immigrant whose dying mother and traumatic childhood might explain why no doctor has been able to find a biological basis for her fainting spells. A bedridden older woman who cannot quite keep herself covered as she flirts mercilessly with her surgeon, introducing him to me as her “young boyfriend”.
In medicine, we have the privilege of seeing people at their most vulnerable. That is a trope repeated so often that I gagged a bit writing that phrase: it is a justification for the strict standards of professionalism that dictate our conduct in the clinic, our appearance, and the choices we make in our personal lives. Although the fact that I resent my short white coat and mourned the day when I sacrificed my funky haircut for a tamer hairstyle, every choice I have made for medical school is a choice I would make again —any day— in a heartbeat.
The schizoaffective man with a piercing stare, who saw Jesus in the mirror. The woman with “type 3 diabetes” whose sugars spike every time she is around electromagnetic radiation, who hugged me the morning after surgery when I told her the ostomy bag was not permanent. The retired classics professor who refuses to accept how much his mind has faded, quoting Virgil to deflect our questions about what he did yesterday or how long he has been married.
Some of those choices were the hardest I have ever made, but in return, sometimes I get to hear stories that no one else has ever heard. A woman tells me that her greatest fear for her pregnancy is the bulimic urges that she can never quite escape. A patient describes the time she woke up during surgery – paralyzed, unable to feel pain, yet acutely aware that gloved hands were reaching deep into her abdomen. By making people feel safe as they share their secrets, medicine allows patients to drop the unspoken boundaries that make us all strangers. Hearing people reveal their hopes of recovery, fears of disability and dreams for their children allows me, for just a moment, to see people’s lives through their eyes, rather than my own. When I walk down the street these days, I find myself thinking about the people I pass, wondering about the stories they hold to themselves.
The geriatric man whose dentures were lost during the frantic efforts to resuscitate him, whose recovery from his stroke was so profound that he told me (with toothless gums and a southern drawl) about the deer he hit while joyriding with his girlfriend. The way a dying man’s legs flail as his chest is rhythmically compressed. The shiver that passes through a woman’s body as the paralytic agent takes hold, softening her for the impending seizure of electroconvulsive therapy.
What I find harder to convey is how these vulnerable moments happen. These visits, with all their beauty and laughter and tears, are fenced into strict time limits— and before you know it, you are on to the next patient. The man who fell off a bridge, gasping into consciousness as the doctors reset his fractured leg. Next patient. A man with half-finished tattoos who tried to hang himself a month ago. Next patient. Sometimes the story is not finished when you leave the room, and you have to be content knowing that the diagnosis you delivered is the end of your role, but just the beginning of a story you won’t be privy to. Some days the events wash over me; on others I return home with hollow eyes, wondering what the hell just happened.
A teenager who was perfectly healthy last week who lies on his side, anesthetized, for the bone marrow biopsy that will determine his chemotherapy regimen. The older woman who during her husband’s post-op visit jumped into the conversation to name the day (“Tuesday!”) when she and her husband could start having sex again. The pregnant woman with too much pressure in her skull, who has to decide whether to endure the debilitating headaches and the threat of blindness or expose her baby to the radiation needed to drain the excess fluid. The comatose woman with no one to wish her goodbye.
There are days where I feel like I have lived all these stories alongside the patients who experience them. I have lived through childbirth, psychosis, trauma, dementia. I’ve come to terms with the way bodies break down over time. I have seen lifelong marriages between people who still flirt in the doctor’s office. Medicine allows me to forget my problems by seeing them dwarfed by someone else’s— but at times, I find myself lost, living another person’s story because it is so much more compelling than my own. As my former identity as a carefree twenty-something in San Francisco fades into memory, I have come to realize that who I am today – a medical student in North Carolina – is who I truly am.
Invitations to parties back in San Francisco, which will always be thousands of miles away. Pictures of weddings I had to skip. Realizing how deeply in love a close friend is with someone I have never met. Phone calls with friends who summarize six months of their lives in a few minutes. Phone calls with friends that do not happen anymore. Childbirth announcements and engagements and breakdowns and crises that I hear about through Facebook, or not at all. The purpose of medicine, as I see it, is to help people attain the physical and mental health they need to live the life they want – and as my life in the hospital starts to feel more real than my life outside of it, I have begun to wonder whether I fit into that equation. The world is turning around me, and I stand still.
So, let me pause here. I wrote this a few weeks ago and almost deleted it. It was too much, I thought. I wrote it when I was having a rough day, like the kind of day where you wake up and realize that you do not have many friends in the area, that you never had time to form any form of community. The kind of day where you realize that it does not even matter, your time in Asheville is nearly over, and that with interviews and residency it will be a long time before you can call a place home. The kind of day where you have to tell yet another friend that you are not coming to San Francisco for New Year’s, and no it wasn’t because of school but because I could not handle it, because it is too painful to see the way friendships fall apart, that I’d rather live with the memory of how things were than the knowledge of how things are today, the kind of day where you wish you were in the hospital because you wouldn’t have time to think about all this, but instead, you’re in an empty café on rainy Sunday afternoon, listening to Philip Glass and writing this essay, alone. These sentiments are too melodramatic to share, I thought, this essay was too self-pitying— and who am I to feel sorry for myself when my patients have problems so much bigger than mine.
But this morning I woke up happy and went on an incredible run, and as I looked out over the ocean from the top of a hill I realized this: healthcare providers are a part of these patients’ stories, and denying their experience— as small as their role may be— is an omission, an oversimplification of the plot. Orchestras need an audience. Actors need a backstage crew. So to wrap up, I am trying to reconcile some conflicting sentiments: The challenge of maintaining my identity in the face of a training path that demands— and deserves— everything that I have to give. The balance between recognizing the validity of my struggles yet respecting, each day, the suffering that dwarfs my own. There are no easy answers here. But for now, I am going to own my feelings because they are real. Doctors bleed too. And that’s my story.
Margot Hedlin is a third-year medical student at UNC Chapel Hill. She is doing her clinical rotations in Asheville, North Carolina, and she intends to pursue a residency in internal medicine. In her free time, she enjoys hiking up mountains, biking on back country roads, and reading outside on languid summer afternoons.