“She has a pneumothorax. You ever placed one of these before?”
The senior resident handed me a chest tube. An intern who had been standing nearby smiled and quipped, “It’s your lucky day.”
Three weeks into my surgery rotation — my first rotation of third year — I was taking a night shift in the emergency room when paramedics wheeled Ms. P into the trauma bay, frail and bruised, hardly breathing. Oftentimes, too many individuals are involved in codes for medical students to participate much in the patient’s initial survey, so I was surprised by the resident’s offer. In that moment, I would have been tempted to agree with the intern. I couldn’t deny the excitement I felt at the opportunity to try a procedure I had only read about and observed. Wasn’t this what I’d been working toward for so long — to finally practice clinical medicine as a third year?
Yet when I looked over at Ms. P, her tiny frame overwhelmed by innumerable lines and tubes, panic and distress unavoidable in her gaze, I felt a pang of sadness and guilt. If this was a “lucky day” for me, it most certainly was not the case for her. The circumstances that proved calamitous for her were now providing me a significant opportunity in the course of my clinical training.
It was an unsettling incongruity.
In third year, the memorable “firsts” of learning clinical medicine — first IVs, first intubations — interface with the most difficult periods in the lives of patients and their families. Of the many challenges intrinsic to the transition from preclinical to clinical years, this was one that I was not particularly prepared to face.
I remember feeling elated the first time I successfully intubated a patient. My preceptors cheered me on, and the nurses in the room congratulated me. Only later in the day did the nuances of the event begin to settle in. The patient I intubated had pancreatic cancer, and it struck me that my small success, as joyous as it was for me, could not undo the patient’s grief or worry, nor could it alleviate the suffering and pain yet to come.
Prior to entering third year, upperclassmen and advisors offered tips on what’s expected of medical students on the wards, how to navigate the hospital, and how to integrate into clinical teams. But I wish I had known more about how to balance clinical learning in the context of human suffering as it evolves before me. I wish I had known more about what it means when moments of personal triumph in my training as a physician-to-be intersect with moments of unimaginable anguish for my patients. The third year means freedom from lecture halls and textbooks, but it also means navigating professional growth while remaining attuned to the raw emotion and vulnerability patients experience, minute-by-minute.
I didn’t end up placing Ms. P’s chest tube that night. The resident felt that there wasn’t enough time and decided to do it himself. I know that there will be many more opportunities for me to place my first chest tube. And when the time comes, I will cherish that milestone in my medical training — but only after remembering my patient’s vulnerability and acknowledging the privilege of learning from patients in their darkest moments.
Connie Shi is a medical student.
