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After residency: There is so much more to learn

Alexis Drutchas, MD
Physician
June 5, 2015
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The room hung silent when he was done speaking. It was Monday afternoon and I had just barely woken up from sleeping off my overnight shift in the ICU. A few days prior the poet laureate of Rhode Island, Rick Benjamin, asked me to join a poetry seminar he hosts weekly at a local assisted living community. Despite the ache as I lay my head down that morning, I set my alarm knowing it would be worth it. He recited one of my favorite Mary Oliver poems in which she asks, “What is it you plan to do with your one wild and precious life?” This profound query was then reframed as Rick asked each of us, “If you were speaking to someone younger whom you love, what would you tell them you have done to make your life wild and precious?”

I sat there in contemplation as I glanced around the room at the many storied faces around me. There were men and women in their seventh decade up to those in their late 90s. Each of these individuals had lived through World War II, Sputnik, and the Great Leap Forward. There were some who could write with ease, and others who struggled with every move of their pen, fighting tremor and memory loss. I sat there feeling apprehensive of what I, at my comparatively young age, could possibly offer to someone younger than me. This question continues to feel particularly poignant with my residency graduation right around the corner. What have all of these years meant and what have I held onto throughout? My little brother, Jake, came to mind, and the words I had been trying to find started to pour out.

Jake was seven years behind me when he was born on a calm Libra day. My sister and I showed up at the hospital wearing blue, holding blue cupcakes. Most mornings I would hear him rustling or crying through the wall we shared. I would tiptoe over creaking pine boards, quietly lift him up, and we would be together in the early light until our family woke up. Last spring I watched him walk across the college stage — oh, do the years go by. As he was making his way through college, I was finishing medical school and starting residency. What can I offer him that he doesn’t already know? He can pass his economics test with hardly a moment of study whereas I would be in the library for days. As for savoring life’s wild and precious moments, my journey through residency has shed a particular light.

Over the last three years, I have been present for a raw spectrum of human experience. Yet unlike medical school, residency not only compels you to observe these, but to truly be a part of your patients’ lives and experiences, all with the backdrop of exhaustion and doubt riding along the way. It is a true roller coaster of emotions. I have held a newborn during her very first breath of life, and I have written comfort measures only orders and held my patient’s hand at the very end. These past three years I have learned how to diagnose, how to care for and treat my patients, and there continues to be more to learn. But what has it meant to bear witness to this humanity? What lessons will I take with me after I turn in my Memorial Hospital badge?

Wild and precious

The other night I was working through the midnight hours into the early morning with a patient in the ICU. Just as the burning in my eyes and deep exhaustion were setting in, I happened to look up and out the fourth-floor window. I tell you, amid the beeps of IV lines, the press of ventilators, and the looming dark in the hallway, there was the most gorgeous sunrise climbing over the river that wraps around the hospital’s edge. And that same night, in a hurry to get my patient’s admission history so that I could finish my note and write orders, I noticed a hint of the most wonderful accent while we were talking, one that I could not pinpoint. I decided to slow down and took a detour to ask about her childhood. To my astonishment, she said she grew up in the Congo when it was still under Belgian rule. She lived there straight through the revolution until she was kicked out. While we were talking, a strand of her silvery hair fell over her forehead and covered her eyes. She was chilled, wrapped in blankets, and I carefully moved this strand of hair behind her ear like my mom used to do for me.

As I sat there in Rick’s class, writing next to those with much more life lived than I, I no longer remembered that burning in my tired eyes or the hunger in the pit of my stomach. I no longer remembered if I was at work for 24 or 28 hours. I did, however, remember the lavender tone that rose with the sun over the Seekonk River, and my surprise in this beauty. I did remember the look in my patient’s eye when I tucked her in, and she closed her eyes safe and sound despite the fear and the cold. I remembered the smell of freshly ground coffee beans when I got home, the sweet, syrupy aroma poured into my favorite cup lingering through my apartment. I could still feel the bright red strawberry that had finally ripened on my porch, and the satisfaction of knowing I grew it on my own. I still remember all of these things; the slowed-down moments I took with me.

So I write you and my little brother this as I sit on the brink of graduating residency, after three years of training not only in doctoring, but in the astonishing veracity of life, its beautiful elations and its deeply felt sorrows. Write a list of what you want to do, your ambitions, your missions, your truths—and hope to live out maybe one or two. The days, they will pass by. If there is anything that I have learned in my daily work, time and time again, it is just how short and unpredictable it all is. Those in Rick’s class with me were in their late years, writing lessons learned to grandchildren of their own. Did they foresee the history they have lived through? Are they what they hoped they would become when they were my age, and does that even matter now if they can say they have truly lived despite it all?

No matter what the day brings, the inevitable trials and tribulations, there is time to slow down, make moments precious, to take notice of the bright life all around us. The darkness of loss is inevitable, but there is always an invitation for joy. Everyone you meet has a truly incredible story if you take the time to ask, and every day something beautiful happens; a newborn first opens her eyes, a family fight is reconciled, a life ends with meaning, a meal is shared with those you love, a gorgeous sun rises over the river’s edge. Jake went from a crib in the next room to his college stage in what feels like a blink of an eye. But do you know what I remember? The stillness when I picked him up, and he would stop crying. Waiting for the rest of the family to wake in the early morning light.

Alexis Drutchas is a family medicine resident.  This article originally appeared in Brown Medical Magazine.

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After residency: There is so much more to learn
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