The Little Things Do Matter

She was waiting for surgery in pre-op and as per usual I went to introduce myself. I always say the same standard lines, "Hi my name is Meagan, I'm the medical student. You probably won't remember me, but I wanted to come say hi as I'll be another face in the OR today." She, like many patients, laughed and lamented that there were many faces and she's already forgotten many of them. I'm used to remaining nameless with patients. I'm not the surgeon, I'm not their nurse attending to their every need. It's so easy to slip into the feeling you're unimportant.

She was wheeled into the OR where the staff descends and the well choreographed dance of readying the patient starts. If you've never seen this it's like a NASCAR pit crew doing 8 things to the patients body simultaneously. Many monitors are applied while the patient lies there completely helpless. This particular patient who was hard of hearing had taken out her hearing aids and I could see her eyes as they roamed the room from person to person not hearing a word that was said. They held the unmistakable look of fear. As the anesthesia staff began the process of putting her off to sleep I took her hand and held it in mine. She squeezed back. We locked eyes, I saw her smile, and despite that she couldn't see it for my mask I was returned the gesture. The next day I pre-rounded on the patient and she looked at me and said, "You said I wouldn't remember you, but I do. You were the one that held my hand in the OR. Thank you." No matter how small the gesture, as a medical student there is still room to make a difference. 

Meagan Ladell, M4

Castellano

Prior to interviewing at UT Southwestern, I had never seen a physician use an interpreter because I had only shadowed or worked with native Spanish speaking providers. I was shocked to my core when I caught a simple mistranslation. It wasn't a life or death error but it put in perspective the amount of medical errors caused by mistranslations. 

My father attended medical school in Lima, Peru, where I was born. We moved to the U.S. when my father received an offer to conduct his residency in Brooklyn, New York. He did his fellowship in Minnesota and we moved to a medically underserved area as part of the physician visa waiver program. Growing up in a border town in south Texas allowed me to become an "honorary Mexican" and attended a bilingual elementary, middle and high school. 

I love being able to speak to patients in Spanish. The first patient I ever served as an interpreter for at Southside Clinic asked me if I was from the same area of Mexico as her. She also asked me how I got my papers since she was undocumented and had just moved to the U.S. It's weird to say that looking and sounding like my patients is an honor, but it truly is. Seeing how much patients love and respect my native Spanish speaking clinical preceptor is incredibly heartwarming and inspiring. 

It terrifies me that arrogance could one day lead to my classmates to make a medical error and probably never realize it. I am extremely grateful to be here and for all of the opportunities I have. But somedays I really wish there were more students at UWSMPH that grew up speaking Spanish. Somedays I wish there were more students like me.

Paloma Reinoso, M1

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One day in outpatient neurosurgery clinic, the attending and I met with a young couple who just had their first child.  The tiny little boy was receiving a surgical consult for his sagittal suture craniosynostosis (premature sagittal suture closure).  The couple seemed hesitant at first, listening to the doctor as she explained the diagnosis, without much interruption.  The doctor then proceeded to tell the family about the two “equally efficacious but slightly different” methods of surgical treatment.  The doctor calmly rattled off the procedure, the recovery, the benefits and risks of each, using models and using language the family understood.  The doctor simplified the choice by emphasizing that the main difference between the open and laparoscopic surgeries is size of the scar versus having to wear a reshaping helmet.  The plastic surgeon was there to explain her part in this procedure, of reshaping the infant’s skull to help contour the head to a more normal shape.  Once the doctor stopped to ask for questions, and I started to think this procedure sounded more innocuous than I previously thought, the encounter takes an unusual turn: Mom cries silently while dad stares down at the little boy, wiggling around on the bench.

What was going through their heads?  We soon found out.

In pediatrics, it is really like you have two patients: the parent(s) and the child.  I’ve learned that a surprising amount of what pediatricians do is reassuring parents about what is happening to their child.  It is amazing to witness, for the vast majority, how much parents love their children.  From working in a family practice clinic and seeing adults on a regular basis, I’ve seen adults more motivated to change after they hear their smoking harms their toddler or how their diet at home contributes to their child’s obesity.  Parents do things for their children that they often wouldn’t do for themselves. 

Fear is a huge driving force.  I see it not only in pediatrics, but in all of healthcare.  People feel so powerless.  I’ve seen parents request endless tests for their child, argue with doctors that they are not doing enough to figure out what is wrong with their child, or yell at doctors that they deemed incompetent in some way.  That was fear. 

Working in neurosurgery clinic the next week, I found that the love of your children and how much you worry for their safety never abates.  After seeing a 38 year old man for a surgical consult for resection of a brain mass, his mother tells me, “If I could take that tumor from him and undergo the surgery myself, then I would.”  I guess your children will always be your little babies. 

This new mom from the story was beside herself, almost incapacitated by the decision as to which surgery to select.  She asked over and over again why there were two procedures if each were equally efficacious.  She had the doctors spell out every possible complication and asked how children that had a larger incision hid it in their hair, or how the other group minded wearing a helmet.  It seemed to me a more minor detail in comparison to greater decisions that are made in this child’s life daily, but I did not understand fully the reason for the questions.

It was later on we realized that mom also had premature fusion of her sagittal suture and underwent a large, open procedure early in infancy.  She has to keep her hair long because of the natural cowlick from the scar tissue formed along her scalp.  She sees her parents and what they are going through after hearing about their grandson undergoing the same thing their little baby girl went through so long ago.  Her father refused to come to the appointments with them because he had such intense emotions related to reliving those events.  We failed to see initially in those tears, that she recalls her photos from her first birthday party, where she was pictured in her contour helmet.  She fixated on those pictures and seemed to vow never to have her son look back on similar photos from his childhood.  She questioned how the scar would affect how he could wear his hair, as detailed as the length and the cut.  We finally saw her personal values, intensely colored by her own experience.

“Do you have kids?” “What would you do for them???” “Will he hate us later on in life if we choose one over the other?” the mother anxiously queried.  She wanted us to make the decision for her, to absolve her of her guilt if something ultimately went wrong with the treatment she picked.  I believed she would have felt every ounce of that guilt.  The doctor and everyone else in the room refused to take away their autonomy by deciding for them, even though at that point, it may have been the easier option.

She asked question upon question and the doctor answered them patiently.  Eventually, the doctor started to grow impatient, as she was growing exceedingly later in seeing her other patients.  She stayed in the room, but it could be seen that her body language was disengaged with this struggling mother.  As the doctor grew tired and her explanations less thoughtfully and carefully worded, the poor answers to the mother’s initial questions inevitably led to more worry and thus more questions.  I’ve found there is a fine line between telling a family enough information that they understand what is happening to their loved one, but not too much that it seeds fear and ultimately more anxiety.  It is far harder to “undo” harm once a patient is slapped with to a new diagnosis or exposed to some piece of medical knowledge.  It then takes twice as much work to relieve the worry in their mind.  For some of this panic, I thank the countless “resources” on the internet.   

The doctor came out of the room fuming at the “excessive amount of questions” brought up by the family.  It’s frustrating for both sides if this communication does not go as well as planned.  It is a sad time for our health care system when questions are a taxing, burdensome part of our interaction with patients.  I wish we could rejoice in questions, as it shows parents and patients are involved in their or their child’s care.  The doctor maintained her professionalism to the very end, but investment in the conversation and empathy for the mother’s feelings, were compromised. 

Going a step further, I think we all might have some trouble dealing with sorrow.  We often cannot look it in the eye.  We scramble for the tissue box upon the first glint in the corner of someone’s eye, whether it is out of discomfort with tears or out of the feeble attempt to in some way alleviate suffering.  To me it just shouts, “Wipe that up!” -- A message I would never want to send.

In reality, the tears of this mother stemmed from something even deeper.  She believed her family was recently experiencing a true streak of bad luck, including family deaths, financial trouble, and their home burning down.  The sorrow of our daily lives does not stop at the door of the hospital, but clings to us as we go about our day, and can carry over into our interactions with others, our outlook on life, and perhaps even our health outcomes.  I will always remember to tread lightly.

I’ve learned a great deal about myself over the last few weeks.  Perhaps I’m only learning more because I have yet to know what it feels like to be a parent and the potent love you feel for your children and the slight madness you feel when they are ill or injured.  I’ve loved pediatrics: the transparency and trust of children and the light and innocence they bring to clinic.  I’ve appreciated the breadth of interactions I’ve been allowed: intimate moments when a mom asks her son to leave the room so she can speak about her concerns of abuse, to seeing babies’ first days in the world, to an adorable toddler tearing apart your exam room.  I’ve enjoyed seeing people trying to do what is right so that their children can have a shot at a good life.  I love the idea and the promise of caring for the minds and bodies of our collective future.

- Anonymous, M4

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“It’s hard to say this, but we made a mistake. We actually meant to admit a different M___.”

After receiving my acceptance into medical school, I was very cautious of who I told because I am extremely superstitious. I thought I would jinx myself if I told the wrong person, and then I would receive the inevitable call from Admissions about the error they had made. This call was my biggest fear the entire summer before starting medical school. Surely, even without jinxing myself, they would discover their mistake in June, July, or most definitely before August.

“Once they give me the white coat, there’s no take-backsies, right?” This was one of my first thoughts during orientation. Looking around at my classmates, I did not feel like I belonged. How could they have picked me when everyone else around me is so much better? Ivy League graduates, scientists with dozens of first author publications, Peace Corps volunteers, and me. Am I worthy to even be studying alongside my classmates?

For the first semester, every post-exam period I wondered secretly if this was my last set of exams. Would the administration see that I was not progressing appropriately and should not even be here? Would they realize they should have taken someone off the waitlist who had better qualifications than me? Undoubtedly, there was someone more qualified than me for this spot. Someone on the waitlist had to be better at medical science with more patient and leadership experiences than me. This hypothetical person has plagued me for a long time, making me wonder if I should be here when I am so ordinary.

Feeling inadequate has been something that has afflicted me for so long throughout medical school, but I have finally come to terms with it. Besides, it is not unique to me. We have all felt like imposters at least at some point here, and it is normal.

This unworthy feeling has actually been useful for me. As a result of it, I have a desire to constantly strive for more from myself every day. It has left me more open to advice, criticism, and new information. It allows me to listen to everyone, from a medical school friend to standardized patients to the physicians we work with on a daily basis. Synthesizing all the knowledge I gain from them, I glean insight that will hopefully one day lead me towards feeling like a proper member of this community.

Truthfully, these feelings make me more productive. Nowadays, instead of worrying if I am a worthy member of my class, I worry I will lose this drive to push myself constantly. Imposter’s Syndrome is real, and it plagues all of us. Instead of hiding it, I suggest using its vulnerability to become a more insightful physician.

- Anonymous, M2

The Ultimate Gift

The pain of goodbye An only child Choked of his last breath His mother's heart breaking because his became the ultimate gift Organ by organ the life left his body Tears of grief transformed by a few short hours into tears of joy for new life Children received the fit of their mother's life saved

- Anonymous, M4

Uncertainty

I may have 20 more years Or just one. They don’t know; They don’t even have a name. I call it Hell. I am crippled. And worse: My children have had their lives stolen. Alcohol. Grades. Eloping. What will happen when I am gone? Is it worse to die? Or to be dying?

- Johnathan Fricke, M4

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I walk into the room Greet the patient She is happy, cheerful Much like me I sit down Still feeling like I’m playing dress-up "What brings you in today?" "Just here for a physical", she begins Run through the laundry lists in my head Location, quality, severity, timing, context Social history last We know all of this by heart now "Thank you for your time" Present to my preceptor We go in together Smiles all around Everyone is happy to be here, happy to help Happy to be part of my education The physical exam begins "How did the medical student do interviewing you?" Patient laughs "She did great", she says "But the question about abuse, she asked me if I had ever been abused I had to laugh at that That sort of thing doesn’t happen Not to people like me Not to people like her" I stand in the corner Trying to stay out of the way Pulse racing Smile faltering Mind darkening Straining against the clumsy stitches That no one can see In a room getting smaller and smaller Because it has It’s happened to me This patient a teacher As I step into those rooms As I shrug proudly into my white coat As I question my abilities and As I prove myself As I ask the tough questions As I learn what it means to be a physician Forever reminded You never know You would never know Looking at me I’m joyful confident present That I was once none of these things "Not to people like her" Words like bags of sand I’ll carry with me always My patient taught me Never, ever assume Because it’s happened to me.

- Anonymous, M1