Reflections on Year 1

I can officially say I survived my first year of medical school, miraculously without failing any exams as I had expected. I can't help but look back on the person that I was before starting medical school and who I am now. I have to say I feel like I have both grown a lot and barely changed. I walk away from my first year with an immense and exponentially growing body of knowledge, and yet I still feel like I know nothing. In spite of a greater acceptance of my own inevitable demise after having held the hand of many a dead, I still feel unprepared for watching life leave this world. Deep in my heart I know I have found my career path and where my passions lie, yet I still feel lost and unsure that I am up for the challenge.

In the wake of everything in the news today, the fear surrounding the uncertainty of our collective future is at the forefront of my thoughts. From shootings to radical political decisions, globally I am scared.  I am scared for the world and I am scared for myself as a budding young professional; what kind of life can I expect to live? But of all the fears I have, the thought of being thrust into the medical world, already riddled with uncertainty, feels the least frightening of them all. Many of the "bad habits" picked up by society are even more pronounced in medicine; the need to be perfect and free of mistakes, to work long hours and show an almost altruistic level of devotion to your career, forgoing personal care. I had always made a deal with myself that if I couldn't take care of myself both in medical school and as a future physician, that I would quit, and that deal is still in place.

During our end of year wrap-up, my class unanimously agreed that finding a reasonable work life balance was the most challenging thing about medical school, and we were warned that it only gets harder as time goes on. Personally, I feel that this challenge stems from a fear failure; that if we need to take time off because we are going through a rough time or fail an exam because of a break up that we have somehow failed as people. In medicine, there is a culture that failure is not acceptable.  We are often held to unreasonable standards of perfection, and expected to maintain our grades and commitments to the medical community when we are hurting. There is less stigma about taking time off to grieve a loss in other careers, why is there so much stigma around this in medicine? What a beautiful irony we live in where we are expected to care for others by failing to care for ourselves.

We need to change our medical culture to be more tolerant of failure because, contrary to popular belief, we are not superheroes. We fail exams, we fail at relationships, and unfortunately we do make mistakes that can potentially have devastating consequences for other people. But collectively shaming individuals for being human, even by omission of support for people struggling, is not the right way to prevent mistakes. We need a system that is supportive of self-care, promotes growth from failure by helping us to learn from our mistakes, and has many safeguards in place to prevent tragedy in the face of human error.

With all of this in mind, I pledge to start off my second year by promoting vulnerability, and open and honest communication with classmates, using myself as a guinea pig. I promise to openly ask for help when I need it, support when I feel down, time off when I find it hard to function, and encourage others to do the same to hopefully start creating the culture of medicine that I want to work in. 

Invisible Disease

Yesterday I stood in the shoes of my patients. Although for a short period of time, it was a firm reminder of what some people struggle with everyday. Invisible disease is pervasive in our society, it is everywhere, and yet because it is invisible, it is nowhere. We as humans are flawed in that sometimes when we can't see something, we don't believe it is there. But for the person experiencing it, it is all too real.

I suffer from chronic knee issues from an overuse biking injury, worsened by having congenital flat feet. Most days, I keep it well controlled (thank you orthotics), but some days the pain makes it harder to walk. In and out of physio for years, I've never been able to be completely pain free. I never walk 100% pain free but I can usually get up to 95%. However, I can rarely stand for long periods of time without pain (I have trouble in the anatomy lab and yes this is something that worries me for clerkship). Yesterday, I needed to hop a bus go to the other end of the city and I knew that ride would take about 45 minutes. I tried to arrive at the bus stop 15 minutes early to guarantee a seat but the line was already stretching around the corner. When I boarded the bus, all the seats were full. After a few minutes of standing the pain began to escalate. I knew I wouldn't last the whole ride so I just kicked aside some of the dirt, sat down on the bus floor,  and just rubbed my knees to help alleviate the pain.To my surprise, the people around me just stared at me with this look of repulsion. No one seemed to be asking themselves "Is she okay?", but more like "Eww how can she sit on the floor, that is disgusting, what a weirdo". They averted my eyes when I tried to make eye contact, and of course no one offered me a seat (and after those looks, I didn't dare ask for one). Thankfully after 25 minutes a seat opened up, but this experience had me reflecting on how different this situation would have been if I had had a bandage around my knees or crutches.

While I sat on the floor I honestly felt a little humiliated, like I was less than human. All because of how people looked at me. Sadly, this is the kind of thing that people with invisible illness encounter everyday, sometimes many times a day. The moral of the story is something that Disney movies and cliches have been trying to teach us for years: you cannot judge a book by its cover. You cannot tell if a person is sick or suffering just by looking at them. Many people have become experts at hiding their invisible illnesses to further avoid unpleasant experiences like the one above. This may be especially true for people suffering from mental illness, which is even more stigmatized in our society than physical illnesses (this will probably get its own blog post at some point).

So the next time you see a young person taking an elevator up one floor, or someone who looks able-bodied using handicap parking, or someone who is asking for more time off work for mental health reasons when they look "fine" don't judge them. Yes there is always the possibility that they are lazy or "scamming the system", but those people make  up a small percentage of society. Step back for a minute and give them the benefit of the doubt, because there may be more going on than you realize.