Careers in Medicine
A Third-Year
Student in Clinical Clerkships
Dena Rifkin
Rifkin is a medical student in her 4th year at the Yale School of Medicine.
I am neither a doctor nor a layperson. I can sometimes diagnose, occasionally treat, and rarely understand. Take a picture of me now and you will see a person caught in the act of transformation: a girl trying on her mother's favorite dress, or tromping around in high-heeled shoes three sizes too big. I am on the inside now, as I realize when I hear myself saying that someone has "syncoped" instead of "fainted" or had a "CVA" instead of a "stroke". But I'm still an outsider, learning a new language and new rituals.
The third year in medical school is known as the first "clinical year", which means that for the first time in our book-bound lives my classmates and I will learn on the job instead of in the classroom. We spend the year caring for patients while moving from specialty to specialty each month: pediatrics, obstetrics, surgery, internal medicine, and psychiatry. It is a whirlwind tour through the hospital and its clinics, encompassing fields of medicine so different that I find it hard to believe that the basic training is the same for all.
I am glad to be on the wards, to have finished the often-dry basic science part of medical education. I like the "hard" sciences -- my undergraduate degree is in computer science -- but I chose medicine so that I could work with people. And being on the wards means seeing people, sick people, every day.
Slowly, I grow used to seeing sickness, to seeing faces as pale as the hospital pillows on which they rest. This is the first step to becoming a doctor, the statistical reality of working in a place where the illnesses and often the tragedy of life are concentrated. Cancer, car accidents, infection, congenital disease all become part of everyday life for me as I move through each ward of the hospital.This, I realize, is not normal, in the everyday life sense of normal I knew before clinical rotations began.
One thing you lose, immersed in the hospital for twelve months, is your sense of shock. I realized this the first time I saw someone die in the hospital. A woman on our service collapsed one morning just after we saw her on rounds. Of course, patients do not simply die in a hospital; instead, they "code", meaning that they stop breathing or their hearts stop beating and an alert is sounded. Emergency personnel come running, and vigorous resuscitation efforts ensue. I watched from the doorway as five or six doctors and that many nurses worked steadily for half an hour to restore a pulse. Finally, the effort was called off, and we all drifted away from the woman, some staying to clean up needles and tubing from the floor. I felt sad but not surprised by this death, the first one I had ever seen, even though we had just told the woman she was healed and ready to go home. I ate breakfast just as I did each morning after rounds. After all, people die in the hospital, I thought. I am just one of the witnesses.
The clinical years of medical school are built around month-long "rotations" in different specialties; you may never be a psychiatrist or a pediatrician or a radiologist, but you catch a four-week glimpse of these different lives during your clinical rotations.
For two months of the year, I am a surgeon. I enter into the ritual; the scrubbing followed by the gowning followed by the gloving. We move around the room with the sparseness and fluidity of a tribal dance, draping the patient with blue cloths, hovering over the table to assist the surgeon at his task. I spend hours staring into abdomens and pelvic cavities, at exposed kidneys and undulating bowels.Sometimes I meet the patient before surgery, sometimes after, sometimes I only see the patient in the operating room, open to the air. I am often bored, often uncomfortable, craning my neck to see or pulling steadily to retract the skin. Once we opened a patient's abdomen for a simple gallbladder removal and found cancer scattered like loose tea all throughout. We "closed" her again without touching anything, like children who have accidentally discovered something terribly bad in a forbidden closet. Another time we removed a colon tumor and the surgeon stretched her hand up to feel the liver. "Feel this," she said, taking my hand. I ran my fingers across the liver and felt a bump beneath my fingers. "Metastasis," said the surgeon, reading fates like Braille type beneath her touch.