I’ve finished with my first semester of medical school. Many of my peers have been posting pictures on social media with captions that wittingly – or unwittingly – claim they are now 1/8 doctors. It seems bizarre that in only 7 more semesters I will have MD after my name. While I have learned more than I ever could have imagined in this one semester of school, having the knowledge to be considered a fully-fledged doctor still feels distant, and at times a bit unreachable.
This semester has lived up to many of my expectations of medical school, and yet there have been challenges that I never anticipated. Going into medical school I knew that it would be hard, that the hours of studying would be long and that the sheer volume of material I would be expected to know would be enormous. I thought that a balance between work and play would be difficult, that my hobbies would need to take a back seat to my studying. All this has proven to be true, although it hasn’t been nearly as difficult as I expected it to be.
What I did not anticipate from medical school however, is the constant rising of emotions. Emotions that leave me fragile and vulnerable and at times have washed over me so unexpectedly and without warning that I find myself on the verge of tears in the middle of lecture. Many times I am unsure of what has brought these emotions on and yet, other times I find myself thinking of my sister and her cancer and that year she spent in and out of the hospital.
I’m surprised that thinking about it now suddenly feels difficult. I will be in the car, coming home from school when a whir of old memories stir in my head. My cheeks become flushed and my stomach feels heavy. I have the sudden desire to burst into tears, and find myself thinking of curling up in bed, a blanket pulled tight around me as my chest heaves up and down, forcing air into my lungs between the cries. I haven’t thought about my sister’s cancer like this since I was in high school. Of course I’ve thought of that time in our family’s life often, but it has never made my knees buckle or my stomach shake like it has this year.
* * * *
“Have you ever been to Children’s before?” the second year student asks me and two other first years when we arrive for the craft in the middle of the high ceilinged lobby.
I nod yes. “I worked here last year,” I tell her. I fail to add that my sister’s doctors are here, that she was treated in the old hospital, that in many ways I grew up within those walls.
The other girls say they’ve only been to the hospital once before. “On the tour they gave on interview day,” one explains. She tosses her hair behind her shoulder. “It seems like a really fun, nice hospital, though.”
I am acutely aware of how different my experience is from theirs. It is almost unbelievable to me that two girls from Colorado have only been in this hospital in the most superficial manner possible.
As kids begin to wander over to our craft table I am self-conscious of my own connection to them. It is just before Thanksgiving and I pick my words carefully as they sit down and begin to assemble the pre-cut out shapes to make a pumpkin teddy bear. Don’t ask what they’re doing for Thanksgiving, I warn myself. You wouldn’t have wanted to be reminded then, either. When Caitlin had to stay in the hospital for Thanksgiving, I had been devastated. Any of my friends who were so bold as to bring it up or even to suggest that eating Thanksgiving dinner crammed into a small hospital room wouldn’t be too bad, were met with snide comments and sharp, shooting eyes. I don’t want to be that person now. I am aware that my classmates, sitting right next to me, might not even realize the power of such a simple question. Surely my classmates back then hadn’t realized the sting I felt when they so casually told me that Thanksgiving in the hospital wouldn’t be horrible. “At least you’ll be with family,” one of them had said.
I cringe now with the memory. I want to reach across the table and tell the families that I understand what they are going through, but that feels insensitive too.
* * * *
I ask two friends to study with me at Children’s one afternoon when I find the library too stifling to bear. “I need somewhere colorful and at least a little removed from campus,” I tell them. They oblige me. The three of us sit with laptops open and notes splayed across three tables in the cafeteria as the lunch hour dwindles and the crowds have long since dissipated.
When we go to leave, we go through the main lobby. I point out the pinball machine, asking if they’ve ever seen it before. They both shake their heads no. “Oh, then we have to stop and look at it for a minute,” I say.
The three of us walk around the large, square, glass case watching as the balls race along the metal tracks. They are carried by a rotating conveyor belt to the top of the case, where they are released along the track. A red moving scale with a dog attached moves back and forth. The ball moves in either one of two directions depending on the way the scale tips. We follow the tracks, watching as the balls bounce down a series of stairs that are cowbells. On another part of the track a ball drops from a height of two feet, bouncing off a black, rubber pad into the mouth of a metal cat. There is a caterpillar that fills up with four or five balls before releasing them all into a circular cage where they are pushed into two holes by a gorilla and his rotating arms.
I want to tell my friends why these metal tracks are so familiar to me, but I hesitate. Instead I say: “It’s seems so much smaller here than it did in the old hospital.” And later: “I wonder how old this thing is.” I know it has to be at least 14 years old since I was twelve when I first found comfort in it.
My friend Madeline takes a video of the balls bouncing off the rubber pad into the cat’s mouth. She posts it to Instagram. As we walk out the back door of the hospital into the crisp late autumn air, I wait for a natural break in the conversation to tell them. My heart is pounding and my stomach feels tied in knots. I shouldn’t be nervous. There is nothing to be nervous about. Yet, I stumble over my words when I finally say it out loud.
“I would watch the pinballs every weekend when I came to visit my sister,” I tell them.
They nod. The conversation moves forward. I wonder if they can tell how vulnerable I feel.
Recently I re-watched a Ted Talk by Brene Brown where she speaks about vulnerability and its necessity in allowing us to love and feel loved. In that talk she says that “the original definition [of courage] was to tell the story of who you are with your whole heart.” She talks of how we so often numb our feelings of vulnerability because we are uncomfortable with being vulnerable. I try now to sit in it. Perhaps, I think, I have never allowed myself to be fully vulnerable when it comes to sharing my sister’s story. Perhaps, this is why it has never felt harder to face than now, when I am elbows deep in the science of medicine and soon will be expected to have the answers for these kids and their families.
I struggle still to have the courage to share this story with my classmates. In all honesty, I don’t know that I’ve ever fully shared this story with anyone. I speak of it openly, yet am afraid to go beyond superficial facts, whether to save myself from reliving them or to spare the listener from the details, I’m unsure.
“Did you work with Dr. Handler?” I ask my friend Kyra after she tells me she spent two days with the neurosurgery team at Children’s during our class’ clinical interlude.
“No,” she says. “But I heard about him a lot.”
“He did my sister’s surgery,” I tell her without further explanation. We split ways then, finding the rooms for our assigned small group discussions.
I am aware that I have told her a small piece of my story without giving any hint as to the rest. She must be thinking why my sister had surgery or how that surgery led me here. A small part of me wants to fill in the rest, but there is not enough time and I don’t want to face her anyway when her eyes become bogged down at the end, her brows creased and her lips slightly puckered. I don’t have the energy to tell her it’s all okay now when in reality it is and it isn’t.
“Cool,” Kyra says to me, without skipping a beat. Her curly, black hair, newly cut, bounces as she waves and departs in the opposite direction.
I’m not offended by her comment, but it strikes me. Perhaps some of the strong feelings that have struck me off guard this semester stem from this comment, or comments similar to it. We have learned about disease mechanisms and drugs that treat them, looking at Kaplan-Meir curves, an astute name for what is essentially a death curve. Each professor that has one in their presentation never fails to ask us if we have encountered this type of graph before, although they will fail to ask if we have enough knowledge to know the basic physiology of the kidney which the rest of their lecture will build from. They each carefully walk us through the step wise shape that indicates with each month less and less survivors of a disease or a treatment method. “You can tell that more people survived with Drug A than Drug B,” the professor will point with the laser to each respective curve. We talk about people as if they are simply a dot on a step-wise curve.
“I like working at Children’s,” one fourth year student says during a student panel designed for students interested in pediatrics. “You get to see a lot of really cool cases.”
The audience nods. We all want to see “really cool cases.” And yet I am uncomfortable with the word cool used in any context that relates to disease. Having cystic fibrosis or cancer or a rare genetic mutation that leads to hundreds of doctors visits throughout your childhood is not cool.
At Wapiyapi this past year I was struck speechless when a fellow volunteer made a similar comment. A few of us sat in a bedroom, the campers already in a bed and each of us in our pajamas. “These kids are so awesome,” one of the volunteers said. She sat on the bottom bunk bed, her legs splayed out and her elbow bent, the palm of her hand propping up her head. “I mean it’s so cool that some of them have G-tubes and central lines.” She paused. “I just love science and can’t wait to learn about all this stuff.” I didn’t think it was cool at all. I tried not to show my emotions.
It’s not that my classmates are insensitive or even that the professors that teach us – especially the few doctors that give lectures – are crass, it’s more the way medical education is set up. There’s not much time to talk about how these illnesses affect a human spirit. Beneath all the facts – the disease mechanism and vital signs to look for, the medications and the way they interact with the protein or DNA or cell receptor – it’s easy to forget that there’s a person and a family and a story behind all that.
I can’t ignore the human aspect of medicine for too long, though. Perhaps it is because of Caitlin—I was introduced to medicine in the most personal way possible. But perhaps it is because I also identify as a writer and thus it is my natural inclination to find the story behind all the scientific facts, to pull away the threads of humanity tucked between treatment methods and risk factors.
“The parents just look so exhausted,” my roommate Abby relays to me about her time spent in the pediatric ICU.
I nod. “Yeah, I know.”
“I mean they have this pull-out bed but I can’t imagine that it’s comfortable.”
I nod again.
“They must not be getting any sleep at all.”
I tell her how the new hospital – new to me, although it is now 10 years old – is far more comfortable. “My mom had a window seat to sleep in. She couldn’t even spread out her legs.” I tell her how my mom used to love when I came to visit on the weekends because it meant she could get a cot from one of the nurses. She’d jump up and down when they brought it in as if she were a little girl going to stay in a hotel for the first time.
I’m glad that I’ll be able to relate to my patients in this way. Yet, now, it feels starkly isolating. There have to be others in my class, I think, who are like me, who have had personal or family health crises, who have experienced the health system in an all too personal way. Yet, no one talks about it. They all hint, like I do. My mom had breast cancer. My brother has Down Syndrome. When my mom had brain surgery… I wonder if like me, they too feel that each day they are abruptly confronted by that time.
When I was applying to medical school an advisor told me that there was no way my sister’s illness didn’t influence my decision to go into medicine. “People go into medicine for one of three things,” he explained. “You’ve had a brush with death, a family member has had a brush with death, or your parent is a doctor.” I didn’t fully believe him. I argued that I didn’t even need to include my sister’s story in my personal statement.
“I don’t want it to feel that I am using her for my benefit,” I said. “It feels like exploiting her in some way. I’m not so sure she’s even the reason I want to go into medicine.”
He disagreed. “You’re not so unique,” he said. He convinced me to keep her story apart of the statement. “It doesn’t have to be a lot, but you have to include it.”
Now, I see how right he truly was. My sister’s cancer had to influence me. If she hadn’t gotten sick would I have gone into medicine? I don’t know. But what I do know is that I will use her illness and my experiences from it every single day to find the human aspects of medicine, to remind myself that a story lies behind every hospital stay, every vital sign, every drug taken or not taken.
* * * *
It wasn’t until nearly a year after my sister was in remission that my siblings and I could begin to understand the full impact of what we’d gone through. It was our second year at Wapiyapi. After the talent show, an event that was notorious for making everyone cry at the end, we found one another. We held each other like we never had before, crying into one another’s shoulders. Words weren’t needed then from any of us. We mutually understood just what Caitlin’s body had gone through, that Pierce and I had suffered silently, separated from one another, staying with different people while Caitlin was in the hospital. We understood that this had impacted all of us.
Cancer had confronted us then.
I knew that cancer and its impact on all of us would continue to appear, but I never imagined that it would be this confrontational now. I’m trying to be vulnerable, to allow these emotions to work through me just like they did that night at Wapiyapi so long ago. It’s challenging. I don’t want to feel like that thirteen-year-old girl I was then. Yet, I recognize that she is a part of me, that in fact, she is me.
I want to share her struggles, which are my struggles. I realize that by writing this now I am only sharing pieces of that story. But it’s a start. As I continue through school I want to embrace vulnerability and have the courage to share the story of who I am with my whole heart.
[Below you can find some photos from my first semester]