Rookie Questions

School of Medicine

November 17, 2017 — Two weeks ago, I volunteered in the student-run homeless clinic in downtown San Francisco. Having arrived early, my classmates and I practiced taking blood pressures on each other. Between practice sessions, I hastily Googled “where is the brachial artery” and “dangerous blood pressure” on my smartphone.

My mind flashed back to my cadaver. She had been an 83-year-old woman, roughly the same age as my Grandma. I didn’t know my cadaver’s name and didn’t remember her cause of death, yet vividly recalled locating the brachial artery near her soggy elbow.

With this image in mind, I adjusted the blood pressure cuff on my classmate, and smiled as I took a more accurate reading. I was pleased with myself: a few weeks ago, I would have shuddered thinking about my cadaver in such an instrumental way.

Later, my classmate anxiously asked me to confirm a patient’s blood pressure. It read 180/120.

That was high enough that we called our attending physician, who suggested the patient go to urgent care or the emergency room.

Our patient was on anti-hypertensives but had been robbed a week ago. Despite being a veteran, he had been unable to access adequate mental health services and subsequently lost his home and job.

Another patient walked in, sweating profusely.

“I’m out of my suicide meds. I need some heroin too.”

Before we could ask him basic questions he left the clinic. Panicked, I asked a more experienced medical student what was typically done in such situations.

“It’s unfortunate, but we cannot give treatment to individuals who aren’t here and do not give consent.”

The joy I felt from taking blood pressure for the first time vanished. Like all rookies, first year medical students experience cycles of irrational confidence and hidden insecurity. We can be self-conscious and eager to please.

“Be yourself but …be cool!” I tell myself in the mirror every morning.

The experiences pass by so quickly, students may not have time to register their meaning. I’ve seen world class surgeons operating in the OR, replacing hips in the time it takes to buy groceries. Without batting an eye, I’ve passed by a homeless woman covered in her own feces, steps away from the same hospital.

I’ve apathetically Googled “dermatologist average salary” during 8:00 am anatomy lectures. I’ve curtly told sick patients that homeless clinic is closed, and then gone home to read articles on medical student burnout and wellbeing.

After my shift at the homeless clinic, I went to the anatomy lab. Grimacing, I covered my cadaver’s face before locating her brachial artery. I reread her cause of death and committed it to memory.

Then I left to practice taking blood pressure on my roommate. On my way home, I opened my smartphone and signed up for another shift at the homeless clinic.

Some days, I find solace in simply doing. I memorize the drugs used to treat organophosphate poisoning. I squint at histology slides and avoid calling my mom. I sign up for extra shifts at homeless clinic.

Other days, I try to confront the things I’ve left unsaid. I identify the pectoralis major on my cadaver, and notice it is a muscle which contracts during hugs. I buy a homeless man dinner, only to learn later he had no teeth.

I wonder what have I gained, and what have I lost, by studying medicine.