“It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.” — Charles Darwin
There is a girl in my class who always asks the smart questions. She and I were talking after class.
Me: Hot damn! Always asking them fabulous smart sounding questions lil lady!”
Her: Well, I have studied this before.
Me: Oh phew, thank god. Cuz I have no idea what is going on. Want to teach me all the things?
Her: Heck yea! If you will teach me about culture…and how to dance…and…the world.
Me: I got you there! That’s more my strength for sure.
Her: Wouldn’t it be great if we could just combine ourselves? It would be the perfect person!
We both laugh. Partly because we are silly, but mostly because that is the actual the dream both of us are trying to find. How to be good at it all.
There is this fun new thing many medical schools are trying to do: embrace and incorporate the humanities. There are a few ways they are doing this. One is by incorporating the social sciences into their natural science based curriculum. This harkens back to the olden days when medicine was not defined as “the science or practice of the diagnosis, treatment, and prevention of disease,” but as the art form of healing. Some schools have medical humanities electives involving drawing, theatre, or writing classes. Others have joined the narrative medicine movement started at Columbia University, with student-run publications, lunchtime literary clubs, and lecturer series. Each offers a forum to discuss the importance of personal narratives in both the diagnostic and healing process.
Here at Tulane there is a program called Foundations in Medicine. It offers biweekly class involving shadowing doctors, simulation exercises on plastic dummy patients, roleplaying sessions with standardized patients (whose outside identities are an eclectic array of professional actors, historic tour guides, bike carriers and the like), ethics discussions, and personal journaling exercises. Essentially, they are our doctoring classes, trying to teach compassion, empathy, and most importantly, how to be a good listener. We even have a group called Students Against Right Brain Atrophy, which, as its name indicates, encourages a variety of art forms. Furthermore, our performance is not measured by grades but by a pass/fail system in hopes to eliminate an aggressively competitive atmospheres.
They other way medical schools are embracing the humanities is through their admissions process. No longer are the top candidates 21 year-olds with the best grades and MCAT scores. Now the ideal medical student has a lil bit of it all. Such as a pre-med who majored in the social sciences, has traveled the world, worked in the non-medical field as well as is published on scientific papers, a trained EMT, who is also an award-winning quilt maker, or olympic contestant, or has some other form of creative mastery. It is someone who is well-rounded; someone who is competent and driven, yet gentle and kind. A woman who worked in admissions for a long time at UCSF described it to me this way: it is the person you would trust to care for your mother or would want sitting by your child’s bedside.
As a former Humanities student, a dancer, and a hard-core crafter, I have been thrilled about these changes happening in medical education. They offer a breath of life and lightness into the daunting seriousness of this field. Our school encourages us with lectures about the mental health resources available, how to look out for one another, where to report concerns, while also highlighting the importance of maintaining our identities and sense of self. I’ve been enthusiastically applauding these efforts and truly believe they are meant with the best of intentions.
But as I continue to nod in agreement each time the term “Self Care” is thrown about, my neck is starting to get sore. It has become the catch-all phrase whose meaning seems to fade with each use. Its utterance has come to stand for what it means to evoke, it has replaced the very action of caring for our selves.
In medical school, Self Care embodies the expectation of being able to do it all: balancing our rigorous studies, clinic volunteering, interest groups meetings, and personal hobbies, alongside maintaining relationships, exercising, eating well, and sleeping 8 hours a night. All this while our inbox is flooded with invitations to more lunches, talks, and social events than hours in the week allow for. None of these things are required of us per se. Yet we put the demands on ourselves. Because as much as some of us (me, myself, and I) try our darnedest to hide it with our laid-back affect, let’s face it, all medical students are some degree of neurotic.
And don’t get me wrong, these are all great problems to have. The opportunities are endless and to have them offered and encouraged as much as they are is a blessing. It is all done with good intentions and the data to back it up: new studies show that a well-balanced person makes the best physician. But that is the catch. Now with the b-word dropped into the equation, it sets off the perfectionist’s alarm. So we get to work, tweaking the scales back and forth in search of this best-making equilibrium. We make schedules so perfectly crafted that even our moments to pause for thoughtful self-reflection are planned—ten-minute meditations in the morning, gratitude journaling before bed, self-love chants during teeth brushing. If calculated correctly, all this should result in our true happiness and utter appreciation of our new-found medical profession.
The problem with this of course is that stress and emotions don’t follow rules or timelines. They don’t stick to calendars nor are confined to hourly block schedules. They are mercurial in presentation and their timing can be alarming. They don’t ask when they can come out, where they are coming from, nor how long they plan on sticking around. They range in their presentation and are rarely logical, for it is not in their nature. Recently, I’ve been finding myself stumbling into emotions that were not supposed to be there. They always surprise me, for I hadn’t planned for them.
They often come on my bike rides, the rare moments of the day when my mind gets to breathe from the hyper-organized timeline I have it running on. As much as I work to manage my emotions, these moments seem to tell me otherwise. Not just that I am, in fact, stressed or anxious, but that the coping tools I have always relied on, no longer seem to work in this new context.
So when people ask if medical school is hard, the unsurprising answer is always yes. But what makes it hard is not just the endless amount of information we are supposed to understand and remember. With time, discipline, and repetition, this is challenging, but doable. What I find makes it so hard is a matter of identity. It is the challenge of merging an old life with this new one, of figuring out what to hold onto, what to let go of, and accepting that I only have two hands with which to do so. It is trying to redefine what Self Care means in this new phase of life when nearly all the variables have changed. And most importantly, it is having the patience to let myself figure out the answer. An endless work in progress.
So as I am about to enter my twenty-eighth year of life, here is a toast to change…life’s only constant!