Thoughts From Third Year

Jennifer Chen is a third-year medical student at the University of Vermont, Larner College of Medicine.

In the following blog post, she reflects on the challenges and insights of her clerkships experiences.

Jennifer Chen

“To care for someone is to take on suffering for the honor of knowing them—to be responsible for ensuring their comfort. We go into the field of medicine, not just for the nobility of it, but also for the humanity, the sense of duty that as a human you care for your fellow humans.”

Many Firsts

As a newly minted third-year medical student, I walk into the hospital with my scrubs, stethoscope, and myriad of gadgets. I may look just like a resident, and yet I have just started. There is a clear hierarchy in medicine, of which patients often have no idea of what it means. 

The beginning of clerkships hold many firsts. Swaddling an infant for the first time and holding the stethoscope to the tiny bundle in my arms. Being called for my first Rapid Response and seeing the chaos alongside the well-coordinated team fluttering about the patient; the team secures access and pushes fluids. I find my way to the ED and see a patient on my own for an admit. It’s the feeling of finally—I am doing what I have set out to do.

Questioning My Role

And yet, there are moments that sink my heart and cause me to question my role. I take care of patients who don’t even take care of themselves. Patients who lie, patients who seem like they don’t care, patients who will fight with the team at every step, patients who waste away despite our best efforts. There are microaggressions that chip away at me, too. A patient comments on my English and asks if I “plan on going back to China.” 

During my service in a rural part of Vermont, I see children who lack access to needed health care services and learn just how much the future generations are impacted by food insecurity, substance use, domestic violence. I have gone into this field, knowing that I will have patients die… knowing that sometimes there is nothing I can do, except hold their hand as they wince, as I tell them they must stay in the hospital yet another day, and as they take their last few breaths of life. I sit in silence, listening to the attending tell the parents of a patient that their daughter will pass, and wonder what kind of universe we live in, where a parent must outlive their children.

We Have Learning To Do

On Medical Oncology, I see a cancer patient with severe hyponatremia. A sweet woman, who is trying her best to be a brave soldier, but her cancer is too far advanced and metastatic, now a grossly fungating tumor that has overtaken her body. But I am not on the team designated to treat her cancer, just the complications of it. We discuss the causes of her hyponatremia and how to treat it, a purely academic discussion of what diuretics to give while balancing her precipitously declining kidney function. But the reality is that these interventions are not likely to significantly prolong her life.

Day after day, I walk into her room and ask how she feels. I check her sodium level fluctuations and discuss her plan with the team and titrate up her pain medications. We discuss her end-of-life plan with her husband and that she will likely pass sooner than originally expected. Each day, she gradually fades away. The blinds are drawn lower and lower, she doesn’t remember who I am anymore. One day, I don’t see her on my list anymore as I pre-round. The sinking feeling in my chest is confirmed when I learn that she has passed during the night, so quickly, and yet, finally, it seems. I move on to the next patient as assigned. I don’t have time to cry/think about it. Death becomes so routine. We have learning to do. 

I Learn To Adapt, I Learn The Balance

There are times where I am overwhelmed by the cognitive overload of it all, too, and times where I feel the adrenaline of excitement surge through me. The countless decisions to be made: lab results to check, medication changes, messages to send, calling consults, updating family, writing notes, taking notes of everything I learn in the day, all of this contained in the scribbles of a folded wad of paper shoved into my back pocket.

I learn to adapt to the revolving door of patients and attendings and residents and nurses and new faces. I learn the balance of knowing when and what questions to ask—to seem eager and responsible, but not overbearing or incompetent, acutely aware of the impending evaluations each week. There is the feeling that, the more I learn, the more I still don’t know. It feels like the road ahead just stretches longer and longer, and the many patients that will fall sick or die—almost as if it must happen in order for me to learn.  

Difficulties Become Opportunities For Inspiration

And yet, bit by bit, these difficulties become opportunities for inspiration. I see the relief wash over the patient’s face as I adjust their pain medication, their understanding when I tell them why they feel short of breath and what the plan for them is. I feel the warmth of gratitude when the patient’s family member thanks me for updating them on the smallest thing. I hold the hand of a terrified woman during her thoracentesis, 70 going on 90 with metastatic cancer, her lungs full of fluid; she tells me I have a nice smile. On stroke service, I see a patient who presents with acute left sided weakness and facial droop, he is quickly diagnosed with a stroke and given thrombolytics. Within hours his symptoms improve, and by 24 hours he is nearly back to baseline. It is heart-warming to see how grateful he and his wife are, and how miraculous medicine can be. 

A Higher Purpose

In the ED, I meet countless people who try to end their life, only to discover all they have to live for, and that they are glad to be alive after all. I spend hours comforting and talking to patients and families about their lives and their various concerns in my outpatient clinic. Although I may not know the answer or what medication to give at this point in my training, I can still listen, and sometimes that’s the most powerful thing I can offer.  

The field of medicine is vast and long, and yet the challenges of the curriculum and sacrifices we make pale in comparison to the philosophy behind why we do what we do. To care for someone is to take on suffering for the honor of knowing them—to be responsible for ensuring their comfort. We go into the field of medicine, not just for the nobility of it, but also for the humanity, the sense of duty that as a human you care for your fellow humans. The sense of higher purpose is what allows me to embrace the challenges, the informative experiences that shape my burgeoning aspirations. Now, halfway through third year, I have started to become part of the team that I will one day lead.