Reflection

I’d like to tell you about three people.

The first person, a woman approaching old age, came to talk to our class in the fall. We were studying genetic disorders and mutations; hers was BRCA1. She had had ovarian cancer not once, not twice, but three times. And breast cancer too, to top it off. She was candid and brash. She told us that the worst part was losing her hair over and over. She told us, too, about the privilege of being able to give information to her daughters to allow them to make choices that would prevent the repetition of her illnesses in their lives. She spent the last ten minutes of the lecture talking about her grandchildren.

The second was a man with a diagnosis of ALS. I was reminded that he spoke to us during our first year neuroscience course; my recollection of the first two years of medical school is already starting to blur. What I can remember clearly is how he looked sitting in a wheelchair and puffing on what looked like a large bendy straw positioned near his face, each breath otherwise requiring a full body twisting motion. Despite this, he spent the effort to speak, jumping in when his wife or son, who sat on either side of him, didn’t quite get things right. At the end of the talk, he asked us to remember that patients are never merely patients but also brothers, sons, and fathers. As he said the word “father,” he hung his head and began to sob, quietly yet terrifyingly audibly in the expansive silence of the lecture hall.

The third was a woman who, due to an autoimmune disorder, had been forced to have multiple kidney transplants. This was during the second year of medical school, and we were studying nephrology. She talked to us about facing a life-altering illness while young, in college, and trying to live a normal life. She told us about the metal taste of uremia. She had, quite possibly, the most upbeat and joyous attitude of anyone I’ve ever met. Her demeanor was so striking to our class that someone finally raised their hand and asked how she could be so happy in the face of unrelenting disease. She stated simply that she was happy because she had come downstairs that morning to find that her husband had left flowers on the table for no particular reason. So, of course, she was happy.

We are often asked to reflect on our experiences in medicine. And it’s no exaggeration to state that each day on our clinical rotations, days filled with patient care, could each be the subject of their own essays. And yet, when I sit down at the keyboard and let my mind wander, it’s these patients that I think about: folks who came to talk to us during the first two years of medical school.

They came to us when we were just on the cusp of our medical careers, when everything was shiny and new, and they came as surprising reprieves from days that were otherwise filled with lectures and case studies. I was just beginning to come to terms with the idea that I was in medical school, that I would one day be a doctor. And the fact that people might sit in front of me and my classmates and tell us about their medical problems was frightening and thrilling and somewhat hard to believe. These patients, these people, entered my life as I reconstructed and reconfigured my sense of self, and, as such, I worked them into the fabric of this new me somewhere deep and thickly intertwined. They are the seminal prototypes for all the similar patients I’ve gone on to meet. When I think of how overwhelmingly impactful changes in the chemical structure of our DNA can be, I think of the first woman and her children and grandchildren.  When I think of uremia, I think of the other woman that I’ve shared with you, and metallic taste is the easiest symptom for me to remember. When I think of ALS, I think of that man, even though I’ve since met others with his same disease. And when I think of raw suffering, I think of him, too. Their faces have become dictionary definitions for me.

I’ve thought many times about what it would be like to dissect your body’s malfunction in front of a room full of people. It makes my palms sweat. Would I set aside my closure, my comfort, my dignity to prioritize the education of a stranger? To be frank, I probably wouldn’t. Yet the immenseness of the gratitude I feel that a handful of people did just that is overwhelming. These patients, these people, did not just talk about their diseases. They shared stories of themselves that were cohesive, analytical, and probing. There were whole sections of their speeches that I encoded with perfect recall as I sat and listened in rapt wonder. Their stories were personally formative and professionally illuminating.

I’ve met many people who were good at reflecting and examining: classmates, whose parallel journeys along mine have grounded and informed me; physicians, whose mountains of experience have shaped who I hope to become; writers both in medicine and outside it who have left me with words to express what I couldn’t previously say. But of course, I’ve left the best for last: the people who came to speak with us during the first two years of medical school, people who somehow digested years of intense personal trial into stories that function as tools in my back pocket. They are the masters of reflection and it’s been a privilege to learn from them.