On being a medical student – and a human being

StudentSpeak is pleased to present this guest post by Sophia “Sophie” Davis, MS1. Sophie is a first-year medical student in the OHSU School of Medicine’s YOUR M.D. curriculum. She is also participating in the American Medical Association meeting at OHSU April 13-14 to share innovative ideas on transforming medical education.

For a moment, my attention was drawn away from the patient and towards the exchanges between attending and resident physicians—the transfer of surgical instruments, hushed instructions, and steadying assurances. The hand in mine tightened and pulled my body closer to the operating table. “Please, keep talking to me.” It was the dark vulnerability of fear in her eyes that broke me, dissolved my desire to join the two physicians at the foot of the table.

And so I held her hand—just slightly smaller than mine—and was drawn fully into the realm of the patient. I was absorbed with the task of monitoring every flicker of expression on her face. The moment we would stop talking, her body would tighten. When the procedure was finished, she let go of my hand and thanked me, adding that she could not have faced the experience without my company. What she could not have known was the flood of gratitude that I felt towards her. It is a rare privilege to be welcomed and needed by another person in a moment of vulnerability. The explicit trust and expression of human connection were exceptional gifts.

This experience was a meaningful reminder of the shifting role I currently occupy. As a first-year medical student, I constantly teeter somewhere between the realms of patient and physician. At times, I presume the role of physician-in-training. My stethoscope becomes my prop and my white coat my costume. I try my best to embody the mannerisms of my mentors and to ask the questions that I have rehearsed in my mind.

At other times, when the gaps in my knowledge distance me from my instructors, I am drawn further into the realm of the patient. Uneasiness and pain are clearer than the markings of disease. In these moments, the suffering of a fellow human being registers more coherently than the words of my physician mentors.

I often wonder when the weight of knowledge and experience will ground me in the realm of the physician. As I evolve into that role, what will be left in me of this acute sensitivity to the vulnerability and suffering of patients? Will the burnout and empathy fatigue that are so often considered the collateral damage of medical education dislodge this almost desperate impulse to comfort and connect?

Humility is often suggested as an antidote to the apathy and drain of medical work. I like the notion of humility; it has a certain appealing earthiness. But is humility—the grounding of our ego—the thing that preserves this sensitivity to the suffering of others? Certainly, humility reminds us that we are each fallible and in need of abundant wisdom to balance our hubris. But I do not believe that this is the enduring quality that draws us to other human beings and compels us to serve and heal. Indeed, humility is a quality that must be nurtured, learned, even forced. For many of us, it is neither innate nor compulsive.  When our bodies are exhausted and our minds are drained, the thing that will enable us to repeatedly extend ourselves must be innately and inextricably tied to the fact that we are human. I think this thing is, quite simply, or perhaps not so simply, humanism.

Humanism in medicine is an amorphous, enigmatic thing and therefore hard to guard. But I think it fundamentally rests on the fact that we are each inescapably exposed to suffering and pain. It is one human experience that recognizes no boundaries or barriers. It is the birthplace of vulnerability but also of hope. I believe it is this bitter side of our humanity that endows each of us with the ability and innate predisposition to recognize the suffering and pain of others.

I suppose the question, then, is how to foster this humanism over the next four years and into my career as a physician. The expression of humanism, it seems, demands a certain rawness of emotion and witness to our own vulnerability and the vulnerability of those around us. Since the beginning of medical school, I have become increasingly guarded against anything that threatens my tenuous balance of eat, sleep, study, and (sometimes) play. Perhaps this is the purview of humility then. Perhaps it is humility that can remove me from my silo and remind me that no combination of routine, ritual or superstition can safeguard me from the fact that I am as vulnerable to pain and grief as the person next to me. Perhaps some day when I am a physician, it will also be humility that will enable me to accept that, at times, I may not have the answer, right tool or clear path forward for a patient. In those moments, I hope I will have the courage to simply be sincere, vulnerable, and, most importantly, human.

In the context of medical education, I believe a person’s humility has as much to do with his or her disposition as it does with the medical culture in which the student is indoctrinated. When I sit in my clinical skills labs and listen to my classmates speak about the range of emotions that they witness in the clinical setting—pain, suffering, hope, confusion, comfort—I am reminded that we are learning in an environment that values such honesty, perceptiveness and vulnerability. When I hear our physician-instructors share stories from their own practices, I am encouraged by their commitment to the art as well as the science of medicine. Whether in the form of our courses on ethics, narrative medicine, clinical skills, and even science skills, we are prompted to think critically, but also humbly, about our obligations to the individuals and communities we will serve. I hope that over the next four years, each of us students will not only develop the skills and knowledge of the physician, but also embody our institution’s dedication to creativity, integrity, and humanism.