Patient zero: Finding confidence as a first-year medical student

“Go check on the patient in room ten. She has alcohol-induced cirrhosis and is on the transplant list.”

My preceptor’s words caught me off guard as I had been waiting with bated breath to see my first patient. So many hypotheticals had run through my mind: What if my patient didn’t want to see me? What if I say something wrong? What if I don’t know what to do?

I texted a few friends, partly to distract my own mind, but more importantly to ask for prayers. It may seem extreme, but in that moment, I felt like the next hour would either validate God’s call on my life to pursue medicine or reveal a sobering overestimation of my own capabilities. Maybe I’m not as good with patients as I had thought. Surely a good doctor can’t be scared to see patients. So why am I? What had happened to my eagerness earlier?

phone-stethoscope

There’s no time to dwell on the matter. I pop up from my seat and straighten out my new white coat, sleeves loosely hanging over my arms. Had it not been for the fresh look on my face, my long tail might suggest that I was a resident or an attending (little do people know that I had faced limited sizing options).

I grab my notepad and line up some pens in my front pocket. I don’t know why I pat down my stethoscope. While it would later serve as an important tool, for now, it’s just a prop. Simply put, I was more concerned about ‘playing doctor’ because I believed that was all I could offer.

I walk over to the patient’s room. As I motioned under the hand sanitizer dispenser, I take a deep breath and one more glance over my notes before knocking on the door. And just as we practiced in class, I begin: “Hi, Ms. F. My name is Kevin Jiang. I’m a first-year medical student working with Dr. X. If it’s alright with you, I will be taking your patient history.”

In the next twenty minutes, I was so humbled by how much trust Ms. F had put in me. She knew I had recently started medical school, yet she didn’t hold back. She so willingly told her story. She so fearlessly bared her emotions of pain, sadness, and frustration. She unabashedly shared details about herself commonly reserved for the privacy of family and friends. In learning what ailed her, I got a peek into the inner workings of her daily life and, for better or worse, the life she’s lived. All she wanted was to get it back.

I couldn’t believe how fast twenty minutes went by. For a moment, I had forgotten I was the medical student conducting a patient history for the first time and instead envisioned myself as her primary provider. Of course I fumbled my words at times, and there were periods of silence when I was figuring out what to say next.

Sometimes, I didn’t understand what she was talking about. I had never heard of a ‘paracentesis’ before. I didn’t even know how to spell her medications. Perhaps she could sense my confusion. But I imagine that from her perspective, she appreciated any help I could offer in the delivery of her healthcare.

It turns out that Ms. F had been experiencing classic symptoms of hepatic encephalopathy. After conducting a few abdominal exams and inquiring into her current prescriptions, my preceptor adjusted her sedative medications accordingly. And with that, he sent her on her way.

I know not all patients will be like Ms. F, and it’s the mark of a good physician to provide quality care indiscriminately. But for that day, she sparked the confidence I needed to continue forward in this eventful journey we call medicine. She provided a context for my medical education.

Later that week, I caught up with some old college friends. As I shared my newfound knowledge of musculoskeletal anatomy, I started to sound like a medical student – something so distinct from my college self just a few months before. I know I have a long way to go. But before long, I will be a doctor and that to me is something I can’t even begin to fathom.

-By Kevin Jiang, first-year medical student at Baylor College of Medicine

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