Tag Archives: communication

Intention: Humanity

I’ve heard that at the beginning of a yoga session, people may set an intention to guide that period of time and help it translate into life as a whole.  While I haven’t formally done yoga before, I really like the idea of setting intentions.

In past years, I’ve picked a word or phrase to help guide the year in lieu of writing out a list of January resolutions (which I never seem to look at again anyways).  This year, I set an intention to be curious about life and each new experience it brings.  I was in the tentative first few weeks of a new relationship as 2016 rolled in, and my goal of embracing curiosity helped me to keep my heart open to the day-by-day unfolding of what has now become a beautiful part of my life.

IMG_2361

I’m finding that sometimes life can knock the wind out of you, and other times it can give you wings to fly.  The relationship that started with curiosity has been an incredibly wonderful instance of the latter.

Time has been moving quickly, and now I’m exactly 30 days away from starting my first clinical rotation.  The idea of setting an intention is coming up again, this time because I’ve spent a portion of the past two days thinking about what it means to be a compassionate medical caregiver.  I’ve also been spending a good deal of time pondering how on earth I’m going to manage being a clinical student.  I’m 26 now, and I can see that I’ve grown a lot (especially in the past year), but I’m still trying to figure out who I am.  So perhaps part of this is a cry from my soul to reaffirm who I am, to reconnect with the reasons I am in medicine.

IMG_2409

I’ve decided I want to set an official intention for my clinical years.  I already have one (hopefully) realistic goal for clinics: walk into my rotation on Day 1 with my head up, get along well with my team, learn from the mistakes I make, connect with the patients I’m assigned to follow, and walk out the door at the end of the day with my head still up.

As the lyrics go, chin up buttercup.

I also want to have a broader intention for my full 16 months of clerkships.  I think I’m starting to sort that out as I try to chart the courses of the rivers draining into the cognitive and emotional depths of who I am.  What are the reasons at the core of why I want to be a physician?  Why am I doing this?  What is going to get me out of bed every day for the next several decades?

It reminds me of when I was in the throes of applying to medical school several years ago, asking the same question–why medicine?–as I agonized over my AMCAS application form and the ensuing secondary essay questions. I actually went back to some of those essays today, blowing dust from the computer files.  It was like opening a time capsule and reliving the tense anticipation of applying to medical school: waiting for a secondary application invitation…waiting for an interview…waiting on pins-and-needles for an acceptance.

IMG_2365

Are my reasons still the same as they were when I was a 22-year old student fresh out of undergrad?  I believe they are, at their core, although they’ve evolved and grown with the passage of time.

Sitting down with my journal, I parsed out four reasons why I am in medicine:

  1. When I’m able to bring a moment of compassionate connection into a hospital room or patient interaction, I feel like my soul has been nourished (and hope the feeling is mutual with the person I’ve connected with).
  2. I enjoy being able to share information; it’s gratifying and gives me the sense that I’m contributing something to other’s lives.
  3. Medicine is full of stories if I stop to pay attention and listen to them.  I want to learn people’s stories and give them the space to share them, if they want to.  This ties in to reason #1.
  4. Learning engages my mind and makes me feel incredibly happy and alive.  The medical field is one of lifelong learning.  This leads to reason #2.

Ultimately, I found that everything can be reduced to the following: (1) I find compassionate connection with other humans to be deeply satisfying and meaningful and (2) I enjoy the personal growth and sense of contribution to society that comes from learning new information, thinking critically, and teaching others.

So these are the bare-bones reasons of why I am in medicine.  Medicine is an environment where compassion and information-sharing can be practiced on a daily basis, and it positions me at a time point in peoples’ lives where this is especially needed.  I personally found, when undergoing a minor (but painful) medical procedure recently, the only two things I cared about were whether I trusted my provider (i.e. whether I felt he cared about and respected me as a person) and whether he was competent (i.e. could do everything efficiency and effectively).  I know everyone has unique priorities when interacting with the medical team, but I feel that trust and competency would likely show up as common themes.  And those are words I’d like to be able to be applied to me.

I actually feel a bit vulnerable sharing all this on my blog, because it gets down to why I’m doing what I’m doing.  And of course, there’s always the question, is it enough?  Are my reasons good enough?  And am I?  I have to believe that I am, and that I can do this.  I may not become the absolute best at what I do, but I will try my absolute best.

So my intention for the next year and a half?  To be compassionate, to pay attention to people’s stories, to accept that I’ll make mistakes, and to do what I can to learn from them.

In a word?

Humanity.

IMG_2993

Patient-Physician

Yesterday, I performed my first rectal exam.

We began our Project Prepare sessions this week, which is a training program to teach us how to perform the male and female genitourinary exams in a sensitive and skilled manner. This was a big milestone for me, as I’ve been anticipating this day with some apprehension for about a year now. I remember one of my Practice of Medicine TA’s telling me about Project Prepare when he was a student in it last fall, and although I knew I would have my own turn in the program this year, time flew by faster than I expected.

So here I was on a Wednesday afternoon, about to learn how to perform the male breast, GU and rectal exam.

I had been told that the educators in the program are fantastic teachers, but I hadn’t realized just how amazing they would be until I met my trainer. The Project Prepare educators are people who have dedicated themselves to teaching these exams on their own bodies, and they are truly incredible. Because of them, what could have been a very discomforting experience ended up being one of the most amazing educational moments I’ve had yet. (Here is a San Francisco Chronicle article from 2003 on Project Prepare.)

I entered the simulated exam room with my three classmates, feeling as on-edge as if I was the one about to get a GU exam instead of the one learning to give it. Our instructor quickly set me at ease with his warm and genuine manner, though, as he explained that he would be modeling for us the same sort of communication we would be using with our future patients.

It really was a whole-hearted experience for me.  Here, I was the vulnerable one, uncertain about what was about to happen, while he was the calm one with years of experience. The dynamics were immediately appreciable; his approach to the encounter made all the difference.

That afternoon, I felt that I was the patient seeing a doctor, rather than a medical student seeing a patient. Now that I’ve been in medical school for a year, I’ve begun seeing more distinction between the identities within me—I am both patient and physician-student. At times, I feel a tension between these pieces of myself.   I believe this tension is not a bad thing, for it reveals an effort to maintain multiple perspectives, but it makes me think. In some sense, we all have this tension within us, although it may be defined by different parameters for different people. It is the same tension within the mother who is also an employee, the son who is also a husband, and the sister who is also a student.

This multifaceted dynamic within me is something that I have to accept as part of living within two worlds—or rather, within multiple hemispheres of the sphere of humanity. Even as I write this, I am a bit hesitant to admit this. This isn’t a struggle that I wanted to have, but it is one that I expected. Our Project Prepare session threw it into new light for me, and it has made me think of it again.

As I sat across from the one who was both my patient and teacher, I keenly felt the importance of bringing compassion and warmth into an encounter. If I can be as help my patients relax as well as my teacher helped me to, I will be very satisfied.

Over the course of the following three hours, we learned how to examine the breast tissue and the surrounding lymph nodes (although breast cancer is rare in males, it can still occur and is essential to screen for). Step by step, we practiced the genital examination and learned how to properly word our dialogue to minimize unease or apprehension. We checked for inguinal hernias and learned how to properly set up for the rectal exam.

As we neared the end of the session, it was my turn to do the digital rectal exam. I had already filed the nail on my dominant index finger to a down hairline crescent of white (we were provided with nail clippers and emery boards earlier in the session to get our nails as short and smooth as possible), and so I coated my gloved finger with lubricant up to the main knuckle.

The rectal exam was actually the most amazing part of the experience for me. Using the pad of my fingertip, I defined the contours of the prostate gland as I swept my finger across it, feeling for any abnormal textures or lumps. I had a sense of awe at examining that which I could not see, like trying to read Braille written within our bodies.

Like trying to find shapes in the spaces between the clouds when looking at the sky.

Morning clouds
Morning clouds
IMG_1863
Afternoon sunlight and fall foliage at LKSC

I found it a bit funny how the day ended for me—I was participating in a poetry reading at the Cantor Center’s new Anderson Collection that evening, so I went almost straight from practicing the genitourinary exam to reading poetry at the event. It was a wonderful time; members of the Pegasus Physician Writers at Stanford shared original pieces of poetry inspired by the art collection, and the St. Lawrence String Quartet gave a stirring performance of Benjamin Britten’s Second String Quartet in Three Movements.

In a way, this odd juxtaposition of prostates and poetry seemed almost fitting to me. In Project Prepare, I looked again at my identity as a medical student within the greater world, which I relate to in part through writing. Creative writing is what helps me process the struggles of life, and I like to think that it will help me to better relate to my patients since it reminds me that everyone’s life is a story. We all have backstories, and we are all read as sentences and paragraphs, sometimes even as chapters.

Oftentimes, there are multiple storylines that run through our lives.

I am a patient.

I am a student-doctor.

I am human.

Pulse

September 11, 2013

This evening, I listened with my stethoscope for the first time.

I have been waiting for the perfect moment ever since I received it a few weeks ago, and I felt that this evening was finally the time.  I had my first patient encounter today for my baseline assessment, which gave me the opportunity to meet with a standardized patient (a person portraying an actual patient).  It was both an eye-opening and humbling experience, and it drove home just how much I have to learn.  Thankfully, that is what medical school is about—the continual process of learning and doing our best to make each day a little better than the one before. 

I felt that it was symbolic for me to use my stethoscope for the first time on the day I met my first patient.  I have taken anatomy for nearly three weeks, have made it through my first quiz in Molecular Foundations of Medicine and can now name most of the coronary arteries, but today brought into sharp focus the fact that I am a physician-in-training.

Since today was a baseline experience, I had really no idea what to do once I entered the simulated exam room.  I did know that I needed to wash my hands with the sanitizing foam.  (Thanks to the generosity of the automatic foam dispenser, I was faced with the conundrum of drying my hands while trying to introduce myself.  Somehow, wiping my hands on my white coat didn’t seem suitable, so I settled for vigorously rubbing them together.)  I also remembered to introduce myself with my full name and indicate that I am a first-year medical student, but as I sat down, I realized how much I didn’t know.  What questions do you ask?  How do you follow up those questions?   

What do you do when you end up completely tongue-tied?

Yes, that happened to me.  My mind went blank about half a minute into the conversation, and I couldn’t think of what to say next.  Bewildered, I picked myself up after a few moments and kept going, realizing just how far I had to go.

So much to learn…

Today’s baseline encounter has been a very valuable experience, and one that will frame my studies in the coming months.  I know that with time and practice, I will gain the knowledge I need to ask the right questions, but I’m also thankful for this experience because it helped me to see what patient interactions can look like when I don’t come in with much of an agenda.  I hope to gain the structure and skills I need to effectively communicate and gather the information I need, but I also hope to preserve some of the emotions I felt today.  They anchor me in humanity.

I arrived home under a sky that looked like the ocean.  Swaths of coral clouds banked against the pale blue expanse, sea foam on the waves.  The air was beginning to take on the lightest chill.

After dinner, I sat down and lifted my stethoscope from its box.  Outwardly, the moment didn’t appear ceremonious, but it meant a lot to me.  I placed the diaphragm of the stethoscope against my shirt, just to the left of my sternum.  According to my anatomy lecture this week, this location—the left sternal edge of the second costal cartilage—was the best place to hear my pulmonary valve.  This is where deoxygenated blood rushes to my lungs, extracting life from every breath.

I heard nothing.

Since I knew I was still alive, I decided that it was a technical issue on my part and flipped the chestpiece over to its other side.  Instantly, the rhythmic thud flooded my ears with all the intensity and wonder of hearing the ocean within a shell.

I was startled by how amazing it felt to hear my heartbeat.  In anatomy dissections this week, I peered into the chambers of the heart, felt around the valves, and compared the thickness of the muscle in the left and right ventricles.  As fascinating as this was, hearing the living pulse of my heart was like glimpsing a vibrant painting after seeing the preliminary sketches. 

I rotated the chestpiece so that I could use the diaphragm to listen and began methodically working my way through the four positions on my chest, hearing a discordant roar in my ears as the diaphragm brushed the folds of my shirt.  Every sound was enormously amplified, and I could hear my fingers on the chestpiece rim as I located the four landmark points we learned in anatomy.

Second costal cartilage, along the left sternal border…the pulmonary valve.

Second costal cartilage, along the right sternal border…the aortic valve.

Xiphisternum…the tricuspid valve.

Fifth intercostal space, along the midclavicular line…the mitral valve.

I cannot yet identify the different types of sounds I heard this evening, other than the lub-dub that marks the rhythm of systole and diastole, but I know that with time I will learn.  Just like how I will learn the steps to gathering my patient’s history, and how I will learn to communicate gracefully and with confidence.

But in this moment, I know I can listen.