Tag: medical student

Case Report

“Case Report” document’s the author’s simultaneous experiences of being a medical student and sexual assault survivor. It moves through the aftermath of the trauma living solidly in two worlds, as an insider and outsider of healthcare.

This brief story describes numerous interactions with a range of health care providers, as well as interactions that occur with friends, a pharmacist, patients, and others. By showing examples of unhelpful and helpful ways people responded to a sexual assault survivor, this story can prompt important discussions about compassionate care and social support. It also provides insight into how a provider’s own traumatic experiences inform their approach to medical care. Some of the interactions in the story are difficult to read so advance notice may be appropriate with some audiences.

The tennis partner

Abraham Verghese is a bestselling novelist (Cutting for Stone; The Covenant of Water) and this memoir is written with elegance as deep as his medical expertise as an internist. The story of his close relationship with a medical student whose life unravels through addiction gives profound insight into physicians who struggle with addiction (like anyone else, but also quite differently). His role as a teacher and mentor for medical students gives an up close view of what medical education can be: sensitive and humane, without denying how much physicians must learn under often-stressful conditions. Pre-health professions students, medical students and graduate health humanities courses committed to reading the whole book would find much to discuss about both those issues. I used Chapter 11, an extended examination of and conversation with a patient, hospitalized for various complications of being both a heroin addict and unhoused, to talk through humanistic approaches to medical care with undergraduates.

Body of Work

Anna Dovre’s story “Body of Work” is a meditation on the various ways she has encountered death through her medical education: learning to intubate on a cadaver, witnessing death in the emergency department, sitting with a hospice patient. Her essay reflects on the ways death is experienced and understood in the process of medical education and the connections and disconnections with one’s own understanding of mortality.

She starts her reflection with a description of her practice time in a cadaver lab and the physical benchmarks for competency when performing an autopsy. The following section about her time as a hospice companion juxtaposes personal experience with a discussion of clinical terms for ways and stages of dying. “To die actively means the pauses between breaths lengthen and stutter; the mind slips into unconsciousness; the skin begins to mottle into starbursts of purple and blue. To die inactively—well, that becomes a question of semantics, of philosophy.”

The story raises questions about how we honor life and make one’s last moments and after death a respectful and respected process. How can we, as the living, be more appreciative of the gift of life while caring for those around us? This quotation, “If anything, the scene on the table has become more gruesome, but perhaps that has rendered her less real, less human to me,” from after the autopsy is a stark realization that will inspire feelings and emotions in readers.

Code Switching: Gravel Against Stone

Andrew C. is a queer East Asian medical student who writes about altering his voice and pronunciation to perform what he calls “the most stereotypically masculine version of myself.” He describes having learned to do so as a child of immigrants, growing up in a suburban Georgia suburb and wanting to fit in. In the essay, he analyzes why he continues to feel the need to do so in medical school. He says he has yet to meet someone like him who is a physician, and so code-switching is required if he is to enact the implicit model of “competent physician” that is on offer to him. He writes: “I am still carrying the heavy weight of my childhood notion that to be different is to be singled out as ‘other’—and I fear that it may impact the outcome of my medical education. These vocal habits are a form of self-preservation. But when I reflect on my childhood, and my lack of exposure to queer-physician role models, I fear that I will be perpetuating the problem.”

The essay is an eloquent example of why it is so important for health care providers to come from a range of identities and social positions. It also speaks to the challenges for those providers who come from under-represented groups and why equity and inclusion require not only that we diversify, but also that we welcome and value the diversity that people bring.

The essay is brief enough to be read together in a class or workshop. It is one of several essays from a writing contest by Pulse, an online site that publishes personal narratives about health care.

No One Left to Save

Rachel Berlin recounts her experiences as a third year medical student on an internal medicine clerkship and the relationship she had with the senior resident who supervised her work, Hassan. The story touches on several themes, including the process of developing competence in diagnosis through practice with patients and interaction with a mentor, and the emotional work of learning to treat patients in a system in which you aren’t always around to learn the outcome of care and in which you don’t always have time to respond as you might wish to patients who face serious diagnoses or who are dying. An element of the story also concerns Hassan’s status as an immigrant far away from his family in an unnamed war-torn country, repeating his residency in order to qualify for a US medical license.

In my course on the role of narrative in medical practice, I teach a week on how medical students are socialized to become physicians and the role of storytelling in medical practice and socialization to medical practice. This brief personal story would be a useful companion piece to some of the anthropological research I teach.

Extremis

25 minute documentary filmed in a hospital that shows patients, families and health care professionals (Dr. Jessica Zitter, pulmonary/ER specialist and palliative care, is featured. See her book Extreme Measures: Finding a Better Path to the End of Life”) dealing with end of life moments. Talking through concrete decisions of whether to take a loved one off a ventilator in the same room where the patient lies captures the difficulty of those decisions in agonizing detail. Short enough to show in a class, might be too intense for many audiences (maybe to stimulate discussion among pre-med or medical students). Could be used with a reading like “Letting go,” by Atul Gawande, but content warnings are essential. Academy Award nominee.

Heart Sounds

In this 5 minute read, a first year medical student discusses treating a patient whose family had to overcome indifference in the ER in order for him to receive treatment. Additionally, the medical student illustrates managing the unknown when assisting a patient with an advanced and nuanced condition. The student decides that the best treatment they can provide is listening to the family’s complaints, fears, and happy moments in order to encourage them to keep believing in this patient’s future.

The story touches on cardiology as a specialty and would benefit pre-medical undergraduates as well as professional students recently starting their health profession. It highlights the importance, and difficulty, of active listening.

Fae Kayarian: Physician in Training, Poet in Progress

Fae Kayarian is a poet and medical student who began as a scribe at Harvard Medical School. She has shared her experiences through poetry in the form of an autobiography titled “Journals of a Visitor” and several stand-alone poems. Her website contains eight poems ranging in topics in medicine from her point of view as a bystander and now a student.

Generally useful for close reading of poetry. Two poems – “The Color Blue” and “It’s been six years” could interest families of patients experiencing loss and dementia. Others would be beneficial for teaching physicians and other health professionals in mentor positions. Her poetry would serve as a reminder of what it’s like to be a student and the impact that medical educators have on the future of medicine as mentors.

COVID-19 through the Eyes of a Black Medical Student

Shuaibu Ali is a medical student who reflects on how his experiences growing up in an urban environment increased his risk for various health conditions. He makes the case for the importance of personal stories from individuals from historically marginalized groups as a way of personalizing statistics on health disparities and exposing conditions that create them.

I have used this essay in an undergraduate narrative medicine practicum class to prompt discussion about the importance of hearing stories from marginalized groups and the power of story to mobilize social change.

Patients as Teachers Project

The Patients as Teachers program pairs two first year medical students with a patient to learn more about how illness affects a patient’s whole life. Students visit patients in their homes or other locations and learn about the impact of illness, patient coping and resilience, and positive and negative interactions with the health care system. The website has an archive of videos students have created about patient experience. For example, a video from 2020 interviews Jason Barup about his experience with clear cell renal carcinoma and also includes an interview with psychologist Michael Hayes, who worked with Barup through his diagnosis and treatment. The storyline puts Barup’s illness experience in the broader context of his identify as a runner. The videos could be used to provide examples of patient narratives (they cover a range of medical conditions). They can also prompt reflection on patient-provider communication and interactions with health care systems.