A medical student graduates with a lack of closure [PODCAST]

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“I initially fell into the dangerous grief and shame spiral. I shoved these feelings of loss deep down and let shame bubble up. How could I legitimize my feelings when people are dying?

However, I have been working through the idea that comparative pain and its conflicting feelings do not help. To a toddler, their worst grief is not being able to see their friends at preschool graduation. To a high school senior, perhaps prom. To a college athlete, the inability to finish their senior season. To a new business owner, the shuttering of their barbershop opening. Denouncing one’s own suffering does not benefit health care workers, those who are sick, or those who have “greater” losses. A grocery store worker’s 14-hour shift does not get any easier. A nurse does not magically get a mask. So, allow yourself to feel wholeheartedly, to lament without embarrassment. Feel sad. Be scared. Yell. Have a pity party. Then, when you have a moment of strength, reach out and lift someone up (virtually for now). Together we celebrate milestones, together we grieve, and together we are strong.”

Emily Masterson is a pediatric resident.

She shares her story and discusses her KevinMD article, “A medical student about to graduate. And a lack of closure.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Emily Masterson. She’s a pediatric resident, and she wrote the KevinMD article “A medical student about to graduate. And a lack of closure.” Emily, welcome to the show.

Emily Masterson: Hi there. Thanks for having me.

Kevin Pho: So we could get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

Emily Masterson: Definitely. So I was born and raised in Gilbert, Arizona, which is a suburb of Phoenix. I attended the University of Arizona for my undergraduate degree in biomedical engineering and math, and then I went straight through to medical school at Wake Forest in North Carolina. I didn’t know anyone in the whole state before moving there, but I think it was a great decision to do my medical training there. And I just started my pediatrics internship at the University of Michigan.

Kevin Pho: Excellent. And how has your first month of internship gone?

Emily Masterson: It’s flown by. I just finished a busy inpatient service where it was, you know, waking up at 4:30 every morning, at the hospital for 12 to 13 hours a day. It flew by, but I felt like I had great support from my attendings and my upper-level residents.

Kevin Pho: And as far as you could tell, how has the pandemic affected your internship so far?

Emily Masterson: What I’ve noticed the most is that when you’re moving to a new place and you’re starting a new job, it’s all about making connections with people and getting integrated in the place that you’re moving to. And so I think that’s been a little bit of a challenge, trying, safely and being socially responsible, to meet my other co-residents and just meet new people in Ann Arbor. So there’s been a little bit of an impact there, but they’ve been very conscious about trying to get us to meet in safe ways, via Zoom and other platforms.

And then, with respect to my day-to-day in the hospital, I mean, we’re wearing masks for 12 to 13 hours a day. We’re trying to stay as socially distant in the hospital as we can. And then, you know, I just finished a pulmonology service, and so I was taking care of kids with cystic fibrosis and asthma, and these are kids that, if they were to get coronavirus, it could be very severe for them. So I think it’s coming into work each day with that little nugget of knowledge in my brain, like, “I have to be extra careful, inside and outside of the hospital, for these kiddos.”

Kevin Pho: Well, best of luck to you in your residency journey.

Emily Masterson: Thank you.

Kevin Pho: So let’s get into your KevinMD article, “A medical student about to graduate. And a lack of closure.” Now, for those who haven’t read your article, can you walk my audience through it and share the story of why you decided to write it?

Emily Masterson: Definitely. My last day of medical school, I was doing a rotation in pediatric ear, nose, and throat, or ENT, and I was in the operating room. I came in early, I was ready for the day, I looked at my patients beforehand, and the nurse said, “Oh, I don’t think you’re supposed to be here. We’re conserving PPE, and I think students aren’t allowed in the OR.” And I hadn’t heard that yet. I knew there were kind of some rumblings about, “How will this affect my rotations?” but I hadn’t heard anything too severe.

So I went and talked to some senior-level residents on the ENT service, and they said, “Yeah, you know, we have a pretty light caseload today. Maybe you should go home. You’re an essential learner, but you know, you’re not essential, just with using the PPE and everything.” And so I was like, “OK, sounds good. I’m about to match in a few days. I’ll take a shorter day.” And that was the last time I ever stepped in the hospital.

And so it was just me walking out one day thinking, “Oh, I’ll be back,” or, “I’ll see my friends,” or, “I’ll see my classmates, I’ll see my attendings and mentors.” And it was just, “All right, we’re not having classes anymore. OK, Match Day is now virtual. OK, graduation is now virtual.” And the things that I loved about North Carolina were a lot of outdoor things, or coffee shops and the gym, and suddenly all of those were closing down, and my friends were leaving to go back home with their families. So it was not quite the ending that I expected for medical school.

And so, fast-forward a few weeks, I was lucky enough to be able to stay with my parents, who live in Michigan as well, and I was just sitting in my room, reading and watching TV throughout the day to make time pass by. I have a friend who’s a nurse in a COVID unit in California, and I’m hearing her story directly from her. I’m watching everything that’s going on in the news. I’m getting firsthand accounts from my friends who are a year older and interns in the middle of the pandemic, some in New York, some in California, some of these really hard-hit cities.

And I’m feeling this sense of loss about my medical school ending, which wasn’t quite what I expected, but then I’m also trying to compare it to their loss. My friends are sacrificing many, many hours; they’re on the front lines of the pandemic. On a broader scale, people are losing their lives, people are losing their jobs, and I was really trying to reconcile with myself, “Where do my feelings fit in? I can just push this down. This isn’t that big of a deal.”

And when speaking with my friend who was a nurse, she said, “Your experience of loss is valid, and you pushing down your feelings and trying to put on a happy face all the time and saying it’s OK,” she’s like, “that’s not going to give me an extra N95 at work, or that’s not going to make my day any easier. So feel your feelings, experience that loss, and then move forward and see how you can help other people, see how you can reach out and be there for a friend or a classmate who’s also going through something similar.”

So I was writing this article and kind of thinking, “Do I have a say, or is my voice even valid in this?” I wasn’t in the hospital. I didn’t have any direct family members that were ill at the time. And so there was a lot of, “Is my perspective even valid?” In the article, I kind of discussed this, walking through the different milestones in medical education and how those weren’t there, walking through my knowledge of others’ perspectives and contrasting those with my own, and my inner turmoil of, “Is this even a valid feeling?”

And what was really nice and surprising to me was, I was so excited the article got accepted and it was published, but I still had those feelings of, “Does one of my friends even want to read this? Would anyone want to hear this?” And I reached out to just one close friend who has a blog and does a lot of writing, and I said, “You kind of inspired me to write, and this is something I wrote.” And her response was so supportive, and I thought, “OK, maybe if she thinks it’s OK, maybe I’ll share it.”

And then I was just hearing feedback from friends, family members, classmates that were close to me, and even classmates that I hadn’t had the privilege of being super close with, who were just reaching out and saying, “Thank you for sharing this article.” And so I know I have one small perspective in this bigger field of medical education and the medical profession in this time of COVID, but I was really grateful to have a platform to share this through your website.

Kevin Pho: Well, I could definitely say that your perspective is very valid. See, I’ve talked to so many fourth-year medical students, both through this podcast and through my blog, and that lack of closure is almost universal. It’s the end of such a long journey, right? You go through undergraduate training, medical school, four years, very grueling years, and just having that lack of closure, just all of a sudden, I think it’s very, very difficult to deal with.

Now, were you able to say goodbye to a lot of your colleagues in person before you each went in your different directions?

Emily Masterson: I had, kind of right before, the weekend before our school got canceled, a small get-together with some friends, and we just had dinner together. There were maybe three or four of us, and so those were my real close classmates. So I was really grateful to have that opportunity, not necessarily knowing that it would be the last time that we’d see each other. And then, as school kind of faded out and friends started leaving, we tried to find ways to meet up one-on-one, whether it was doing an outdoor activity or just FaceTiming each other. Using FaceTime and Zoom and the virtual platforms actually allowed me to say goodbye to a fair amount of people as well.

Kevin Pho: Now, there are a lot of medical students who are still in school, and we don’t know how much longer the pandemic is going to go on for, but it’s not going to end anytime soon. Now, is there anything that you learned over the last few months that you could share with your fellow medical students as they continue through medical school?

Emily Masterson: Definitely. And one of the roles that I had at Wake Forest was being an advisor for the medical students that are interested in pediatrics. So it was a little bit tricky at times when they’re looking for advice for interview season or how to set up their fourth year, and this is something that is totally unprecedented, and it’s very different from my experience as a fourth-year medical student in rotations and interviewing. And so what I usually counsel them and just advise is, you can’t plan for everything.

I know a lot of people in the medical profession love planning and like having all their ducks in a row, and I think that this pandemic and these experiences have taught me that you can’t plan everything, and just to put your best foot forward, whether it’s for interviews or rotations, and try and find a way that you can show your individuality and shine in those moments. So it’s being, I guess, comfortable with the uncomfortable, and trying to advocate for yourself, especially when things are so uncertain.

Kevin Pho: We’re talking to Emily Masterson. She’s a pediatric resident, and she wrote the KevinMD article “A medical student about to graduate. And a lack of closure.” Emily, is there anything that you know now that you wish you knew back before the pandemic started?

Emily Masterson: I think I wish I had known how important it is to reach out to people. I think something that this pandemic has really taught me is the importance of just weekly check-ins or phone calls, or just trying to stay connected with people. I think when you can travel anywhere and you have a little bit more time, I guess, you think, “Oh, I can see that person later,” or, “I’ll think about visiting them at another time.” And I think this pandemic’s really taught me to value my relationships, whether it’s just via a phone call or a video chat, to really prioritize those relationships and make time to reach out to people, because you never know who kind of needs help in a certain moment, or whether you need help and you need to reach out to someone. So I think I wish I had taken more time and effort just to reach out to people that were close to me.

Kevin Pho: Sure. And my final question: What is your take-home message that you want to share with the KevinMD audience?

Emily Masterson: I think it’s being aware of your own feelings and knowing that they are valid. It’s easy to compare yourself to others and say, “They have it way worse than me. They have it way better than me. Where do I fit in?” And I think just being aware, especially as a medical professional, of how you’re feeling, and doing weekly or daily check-ins with yourself, and really validating your own feelings, acknowledging them, and then moving forward with the next step in your education or your career, I think will make you a better learner, a better professional, and a better person.

Kevin Pho: Emily, best of luck to you in the future, and thank you so much for being on the show.

Emily Masterson: Thank you. I appreciate it.

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