The Sum of
This medical student may have looked confident with patients, but she knew that beneath the surface lurked a coward.
It was the end of my time “on the O,” my month training
on the Osler medical service at THE Johns Hopkins Hospital
(or, as I affectionately refer to it, “the Hopper”).
As is custom, my assistant chief of service (read:
the boss) sat me down for feedback. The sleepless nights,
the 80-hour work weeks, the mustered energy in the
early mornings, the hard-ball questioning during rounds,
the belligerence of patients, the struggles to come
up with inspired and inquisitive questions—all that
I had poured into this rotation now felt like a pitifully
small sack of coins in my hand, and I wondered if it
would be enough to purchase the coveted approval-prize.
What he had to say floored me.
“When I look at you,” my ACS said, “I see no fear.
On rounds and in front of patients, you have those
intangible things that are required to become a doctor,
the foremost of which is confidence.”
Wow! Me? Confident? Well, if he meant that I don't
mind speaking my mind on rounds, I guess that is sort
of true, because someone once told me that the death
of medical students is when they undermine themselves
with wishy-washy opinions and self-doubt. “Be assertive!” I
was told, “and your superiors will love you—whether
or not you are correct.”
If he meant that I'm willing to perform venipuncture
or go for the arterial stick or the lumbar puncture
at the drop of a hat, I suppose that is true. Never
mind that I'm very new at all of this; there has to
be a first time for everything, right? And I figure
that the less nervous I appear, the more confidence
the patient will have in my abilities, and the less
likely to ask me how many times I've done this in the
Freely discussing differential diagnoses, testing
and pathophysiology (with either the medical team or
the patient) is exciting, but the ACS's impression
of me may have as much to do with my background in
acting as in medical school. If I act like I've been
doing this my whole life (instead of four months),
perhaps I'll be able to convince everyone else that
I'm really not as “green” as I really am.
What my ACS could not have known, though, was the
total lack of confidence I had displayed just the night
before. On my way to a classmate's wedding, I witnessed
a terrible automobile accident. The car literally right
behind me was hit at such an angle that it flipped
over, rolled three times and finally came to a crashing
halt upside-down in the middle of Pulaski Highway.
Immediately I pulled over to the side of the road,
shocked at what I had just witnessed and uncertain
of how to proceed.
In order to fully understand the struggle that ensued
in my mind, I have to explain that for a long time
I've had a fantasy that goes something like this: One
day I'll be out in public, and someone will shout, “Is
there a doctor in the house? Someone help us please,
we need a doctor!” And on that day, instead of being
just one of the many rubber-necking spectators, I will
be that doctor. I will rush to the side of the victim
and confidently announce, “I'm a doctor. What seems
to be the trouble?”
So, at last, here I was, faced with a medical emergency
and everything inside of me wanted to jump out of the
car, high heels and all, rush to the side of that vehicle
and perform some medical intervention for the almost
certainly injured people inside. My mind raced: I'm
a medical student. I know more about medicine than
anyone else around. Shouldn't I rush to help? But I
haven't taken my emergency medicine rotation yet! I
don't really know how to stabilize a C-spine injury.
And won't it just be more hazardous if I add to the
mayhem and start running around the middle of a busy
I wrestled with myself, not knowing what to do. Torn
between my desire to be a hero and my fear of making
matters worse, I sat paralyzed in my car. In the end,
I picked up my cell phone, dialed 911, reported the
accident and drove on. Confidence? More like cowardice.
So then, which is it? Within the confines of the hospital,
I oftentimes feel ready for internship tomorrow, even
though I've only taken care of 14 patients in my young
career. Central line placement? Bring it on. Critically
ill patient in the middle of the night? No problem.
But when I leave the world of checks and double-checks,
of hierarchy and balance and the comfort of knowing
that many people are working to make sure that I don't
harm any patients, I feel more like an imposter, as
though I'm “playing doctor.”
Trouble is, in a way I am playing doctor. Every morning
I don white coat and stethoscope, and rigorously examine
patients for physical findings that I've merely read
about in a textbook. I strap on purple gloves and perform
invasive procedures that I've done maybe once or twice
before. I speak to patients as a member of the “group
of doctors” taking care of them. And yet, I'm just
a medical student, that nebulous, ill-defined position
of being somewhere between citizen and physician.
No longer a lay person, not yet a doctor, I am stuck
awkwardly in the middle, trying with all my might to
act like a physician even though I don't yet have the
legal right or responsibility to do so. But I have
to learn, don't I? And like I said before, there has
to be a first time for everything. And what good does
it do me or my patients if I am afraid of learning
things that will one day be my job?
I think my ACS had it right when he told me: “As doctors,
it's crucial that we have confidence. But we must also
always be afraid of what we can do to people. We must
be aware that we have the power to cause them great
harm with our interventions and our treatments.”
So then, I guess really I am both, confidently and
cowardly. I must walk and act with confidence because
one day somebody's life will depend upon it. But I
must also walk with the humble acknowledgment that
being a physician is an awesome privilege, an invitation
into the most intimate and vulnerable aspect of humanity.
I can never lose sight of the fact that I have incredible
power to help, but also to harm. Wielding all that
power causes me some trepidation.
But next time, I
think I'll get out of the car.
Lorrel Brown is in her third
year at the School of Medicine and comes from Santa