Subinternship

I am finding myself standing in the shoes of my past residents and attendings, reliving moments where I saw them shine in patient care or grit their teeth and get down to the business of accomplishing a difficult task. For example, I recently sat down with one of my disgruntled patients to explain why we needed to subject her to a variety of tests despite her discomfort and desire to shorten her hospital stay. I saw myself following the example of my Surgery chief resident, a charismatic physician who took the time to clearly and deliberately lay out the options for each patient despite the constant time pressures. As the day to day tasks of medical management in the hospital pile up, I find myself resorting to the methods my Medicine residents used to keep track of patients and their many needs; it’s amazing how much information can fit on an index card with the help of a fine point pen and a little micrographia.

Furthermore, as I delve deeper into my responsibilities as an acting first year resident, I find myself staying at the hospital longer, past required hours, to see my patients and make sure they are well. After all, they are my patients.

Big Man on Campus

Now that I am one week into my senior year of medical school, I can say with some confidence that feels quite different from my experiences as a (lowly) third year medical student. It is a great pleasure to work with third year students: not only is it enjoyable to teach and feel like one is helping someone else, but it is also gratifying to see how far we have come in developing clinical skills and a nascent ability to survive Medicine. The emphasis changes from surviving the wards (and the requisite clerkship exams for each specialty) to thriving as a young doctor. I am currently spending four weeks on a sub-internship, a trial where the fourth year medical student takes on the role of a first year resident with matching responsibilities, in my field of choice: Neurology. Clinical instructors often use the acronym “RIME” to represent the four stages of a medical student’s evolution: reporter, interpreter, manager, and educator. Most of a third year medical student’s responsibilities and expectations involve accurate reporting of history, physical examination findings, and laboratory and imaging findings as well as the development of clinical diagnosis skills (interpretation). Now, as a fourth year and a sub-I, I’m taking on more responsibilities as a manager (making treatment decisions and requesting studies) and an educator (teaching students, and occasionally residents, with less experience in a particular area).

On a personal note, I’m enjoying revisiting my field of interest after a one year absence and solidifying my fund of knowledge. I’m more confident now in my examination skills, assessments, and gut feeling. I’m also developing confidence and comfort in the notion that sometimes I know more than an intern and sometimes second-year residents: they’re not necessarily far from my present state of knowledge. Maybe next time I’ll even be confident enough when I hear someone with more experience than me ask “Which side?” when discussing an anterior communicating artery aneurysm to respond, “What do you mean? There’s only one.”

Speeding to the End

Five more days of my third year of medical school – it couldn’t come sooner. As much as I have learned from and enjoyed something from each clerkship this year, I feel more than ready to move beyond this introductory stage. If nothing else, I will be happy to not have to study for any more NBME “Shelf” exams. Instead, I can focus on each rotation as driven by my self-directed interest and the needs of my patients.

One thing I’ve become acutely aware of in recent days is that I tend to let myself be exposed to the suffering of my patients on medical, emotional, and social levels: I try to engage this suffering and ease it while assisting with their medical care. In other words, on a daily basis, I’m chest-deep in the troubles faced by the poor, the disadvantaged, and the disenfranchised. On the other hand, I also work alongside a privileged class: the highly-trained physicians who direct the medical care of these patients. In the space between, it’s hard not to listen to and sympathize with a wide and disparate variety of opinions and sentiments. And in witnessing the extent and depth of the suffering, it gives me pause whenever I feel I have something to complain about or when I hear others complain.