M1 Column: Caution: Doctor-In-Training by Jeffrey Lam

The first few days of school felt like any other orientation — making new friends, talking logistics, and “orienting” ourselves. Now, six weeks later, I am making bad puns about histology, flipping through “high-yield” pictures of dead bodies, and playing doctor with hired actors. I don’t know when the switch happened, but I feel like a doctor-in-training now.

My first encounter with a standardized patient (SP) is during our first ultrasound training session. My anatomy group and I were not told that we would be working with SPs and our mentor does not introduce us to the woman lying down with jelly rubbed over her stomach. After a 5-minute ultrasound introduction, the instructor pushes the ultrasound probe into my hand and tells me to find her heart. Standing over a half-shirtless woman in a group of four, unsure whether to make small talk or get right to it, I default to nervously jabbing the probe into the patient.

This time, I am mentally prepared to talk to a “patient” and have a time to put on my I-am-somewhat-competent face. I make small-talk with the SP, and even go a little off-script. I take his pulse and respiratory rate without a hitch. I gain confidence as I wield the sphygmomanometer. I take a mental note of the pressure when I hear the first heartbeat (systolic pressure). I then take note of when the sound disappears (diastolic pressure). As I open my mouth to follow the script running through my mind, I forget the first number. I admit my mistake and sheepishly retreat.

I’m not sure whether it is the formaldehyde or the fact that I am standing in front of a dissected dead 56-year-old man’s body for the first time, but I am not feeling good. Our professor introduces us to the body and proceeds to unfurl the body like a weird puzzle. Skin. Pectoralis major. Pectoralis minor. Rib cage. Lungs. Heart. I can’t help but feel like we are disrespecting the body.

The rest of the 30-minute introduction to the body is a blur, but I remember some tips:

“Don’t be afraid to blunt force dissect.”

“Wear goggles and close your mouth when you expect splashing juice.”

“Use the button hole technique. Cut an ‘X’ into the skin. Stick a finger in and pull.”

Our anatomy professor says these things with chipper energy (a stark contrast from the other five first-year medical students behind her with nauseous faces). I feel like it will take me years of training before I can become just as enthusiastic as my professor while around these dead bodies.

Before the first lab, we decide to look at the face before we start our dissection. Our cadaver is an 85-year-old teacher — groomed white chin hairs prickling up. He chose to donate his deceased body specifically to our medical school. I don’t know why he decided to donate his body, but my guess is that he wanted to continue to teach beyond death.

Fifteen minutes later, unlike in my interactions with living patients, all my hesitations and fears are gone. I am shifting his body to see the structures better, using the button hole technique, and blunt force dissecting. My hands are inside of a dead human body, but now it just feels like any other basic science lab.

In the last month, it has been a privilege to have intimate encounters with some of my first “patients”, both living actors and decreased cadavers. I am starting to feel more “doctorly” by the day, but I’m terrified at the thought of being responsible for patients with real stakes. Each day in the last month, we have changed a little, and we have grown a lot as human beings. In the end, one of the most important things to do is reflect and not forget how quickly we are absorbing these new experiences.

 

Jeff is a first-year medical student who loves good conversation, trying new things, and thinking too much.

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