A Third Year’s Letter to Her Patients

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To my future patient,

There are some things I want to tell you now, from the perspective of a third year medical student. I don’t know how much I’ll change by the time we meet, but if my experience thus far is any indication, I won’t be the same person I was a decade before I met you, or even in the few years leading up to it. That’s life, I suppose. Always dynamic and ever changing. I want to write this so that you know where I’m coming from and what you mean to me. I also write this so that I can remind myself. I’m human, just like you.



Contrary to what you may believe, I did not go into this profession for the money. Heck, I will owe ~$300,000 in debt by the time I graduate medical school and have already amassed ~$20,000 in interest during the first few years of my training. I accrue ~$40 in interest a day and when I finally start making my modest residency salary next year, it will cost me over $1,000 a month if I paid only interest alone. I went into this field because it was the perfect combination of my academic interests (science, medicine, physiology) and the ability to really make a difference in people’s lives. I wanted not only to be able to identify your MI and activate the cath lab for you when you come in anxious, sweaty, and with an elephant on your chest, but to be able to hold your hand when your scan shows a return in your cancer and that unfortunately, it’s all over your abdominal organs.

To begin my training, I moved out of state for the first time in my life. I left my family, friends, a relationship, and all familiarity so that I could learn the things I needed to know to be your doctor. I spent many nights up into the wee hours of the morning learning about cellular pathways, trying to keep straight all the different class I antiarrhythmics, and determining the difference between Niemann-Pick and Tay-Sachs disease, trying to remember which one presented with hepatosplenomegaly. During the month before my first board exam, I isolated myself to a room full of books, a white board, and markers, sometimes literally sleeping on my review materials, only to wake up and do it again the next day. When non-medical school friends I met invited me out to do leisurely things, I deferred to the companionship of my First Aid for the USMLE Step I book and the USMLE World question bank.

After having a less than two week summer, spending the last month in social isolation, and suffering through the second 7 hour exam of my life, I started on the wards. This was an exciting time for me, as I was finally going to be able to practice the things I learned in textbooks. I took out an appendix my first month as a third year, recognized splitting in one of my bipolar patients, delivered more babies than I was comfortable with, was able to diagnose episcleritis from a physical exam, and inserted a catheter to remove ascitic fluid from a jaundiced man’s belly. I even circumcised a baby. It was fascinating to see many of the things I read about manifested on people, but it was also a sad realization that the heterogeneous, enhancing mass on a brain MRI meant it was someone’s actual glioblastoma or that a stroke can just come and devastate someone who had been witnessed as “fine” a few hours prior to arrival.

Life at the hospital was not quite as I expected it. I sat through an end-of-life discussion, where my patient was told that he had no further options for chemotherapy/radiation and my attending was pressuring this clearly stunned man into making a hospice decision within the span of about 15 minutes. I heard cynical remarks from people not too ahead of me in training, like when a man who said he was suicidal was dismissed as “not actually serious” and another patient was referred to as “whiny”. I witnessed my residents working their butts off and “doing all the right things”, yet still staying into later evening hours, finishing charting at home, and then waking up sometimes as early as 3 a.m. the following day to do it all over again. I often worked my tail off, too, but due to subjectivity of third year grading, ended up with lower remarks than say a classmate who played the same sport in high school as our resident or a fellow student who spent his weekends playing LOL like the attending.

Outside of the hospital, things were difficult, too. All over Facebook, high school or college classmates were posting pictures of newly bought houses, adorable photos of their children’s first recitals, and engagement notices seemed to be a weekly occurrence. Life was moving forward for everyone else around me, but mine was kind of frozen for the time being, except the rings on my tree stump continued to accumulate.




The happy, complete families, the grown up lives, the ability to spend evenings free of studying or looking up presentations were all things I was jealous of and did not have. In fact, I was starting to feel increasingly isolated from friends outside of the field. After repeatedly turning down invites to hang out or for small get togethers, people stopped trying. After spending the longest year of medical school mostly at the hospital, in my off time, I’ve just wanted to stay at home and rest. I ended up meeting a friend a year ahead of me at a different school whom I could relate to about things, but feelings ensued fast in the months leading up to him leaving, and though we really liked each other, the fates (NRMP gods) brought him to a far away place for residency. And I was devastated.

To my future patient: this has been a very disheartening week. I’ve questioned my decision to go to medical school many times this year, but more so in the past few days than ever before. I feel stressed, lonely, anxious about the future, and intermittently question my ability to handle the rigors of residency. I miss my family so much and there are so many feelings that I keep inside because I don’t want to worry my mom. She’s busy enough with my other siblings and I know she would just feel badly that she was far away and “unable to help”. The truth is that having her has provided me with more than she will ever know.

Despite all the seemingly only negative thoughts I have poured out onto the screen and the general feeling of uncertainty I possess as I enter my final year of medical school, I feel privileged to be here. After only meeting me for 15 minutes, you may tell me about your biggest life fears or admit great emotional turmoil. I can reassure a tearful you that everything will be perfectly fine when your infant comes in with a febrile seizure. I may help you figure out why you constantly get the fluorescent, swirly visual hallucinations you do or just provide you with comfort as we wait for you to recover from transverse myelitis. One thing is for certain: human beings are incredibly resilient creatures and I am amazed by the drive, optimism, and ability to handle devastating news delivered by a stranger in a white coat. Yes, medical school is hard and residency will only be harder, but I meet all you amazing people and it makes me remember why I went into this field: to help others recover from illness, teach them about disease processes, and be taught by humanity in return. When I step into your hospital room and get to talk to you about your troubles, I know that I have made the right decision.

But I’m also human and everything you feel, I can feel, too. So, if ever you see me not smiling as widely as I should be, think I’ve spent too little time at your bedside, or did not think I sufficiently explained something, please at least try to understand that I have my own life stressors and that I struggle to hold my own life together in my quest to make yours better. Please let me know that I need to be better because sometimes it gets overwhelming and I may, despite all good intention, temporarily forget. Please know that this long, arduous journey that I took off on even years before medical school started, I really did it for you.

Sincerely,

Your Doctor

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