August 2007 | Back to Table of Contents

End Notes

View From the Floor

By Jessie Roske

A bump on the head and a brush with humiliation gives clarity on becoming a doctor.

I was approaching the start of my third year of medical school, spending the day on the pediatric hematology/oncology floor. I had been invited to watch what was supposed to be the aspiration and culture of an infected bone marrow biopsy site, which instead turned into a surgical debridement of granulation tissue that had formed there.

I was eager to learn; I asked informed questions and observed the procedure from as close a vantage point as I could manage. Toward the end, as the patient was being bandaged, I started to feel incredibly warm and my vision started to blur.

Wait a second. This could not be me getting ready to pass out.

I leaned against the wall and tried to breathe deeply.

I can will this away. I am tough. I am not a person who faints.

I vaguely recall hearing my head collide with the wall. When I woke up, I was lying on the floor with the attending apologizing for not having been fast enough to catch me. She was worried that I had bumped my head; all I cared about was the severe ecchymosis to my ego.

In an effort to ease my embarrassment, the other docs shared their stories: Someone’s 6-foot-4-inch, 250-pound roommate had fainted in the middle of surgery, and, naturally, no one was able to catch him. I chuckled along with everyone else, but inside I was mortified.

This could not have happened. I’d seen worse. I had survived anatomy and seen surgeries and never faltered. I wasn’t exactly battle-hardened, but I was far from fresh-off-the-farm.

Nevertheless, I’d fainted.

That night at home, I cried on my husband’s shoulder, bemoaning my luck. I explained to him that as a medical student on the ward you are unequivocally at the bottom of the totem pole, attempting to impress everyone above you. You must try to be useful and professional and ask intelligent questions and respond at least marginally coherently when asked one—all while staying out of the way. And that day, in one fell swoop, I had failed stupendously.

Later that night, as I reflected on the day’s experience, I began to think about my medical education in general. The first two years had been spent almost entirely in the classroom. They’d been long and difficult, a series of 12-hour days that tested my capacity for listening to lectures, reading, taking notes, sitting for exams, and participating in extracurriculars.

Somewhere between the sixth iteration of the TCA cycle and the hesitant identification of the nucleus ambiguus on tiny neuroanatomy slides, I had begun to wonder when medical school would start to be about medicine. Somewhere amidst nephritic and nephrotic syndromes, I had begun to wonder why I wanted to study medicine anyway. I recalled a beleaguered, embittered, and exhausted fourth-year student telling me midway through my first year that medical school was designed to beat the soul out of you. Maybe it’s true. Maybe medical school is demoralizing and dehumanizing.

I thought about why I had started the journey: “I believe that medicine offers the chance to impact individuals in a tangible way, to be an invaluable part of the community, and to observe first-hand the positive effects of one’s efforts.” I wrote those words in the personal statement on my admissions application. I thought that, believed it, and now, after two years of the medical school grind, I was bawling over an embarrassing moment on the ward.

Later, I read about the little boy at whose procedure I fainted. A late relapse of acute lymphoid leukemia with bone marrow necrosis. This is what it came down to: I got into medicine with the hope of helping kids like him. Yet somehow during the last two years, too much of my hard work had gone toward getting good test scores and not enough toward making me a good physician.
I found myself readjusting my perspective on my role as a medical student: Learn everything I can, not to impress, but for the chance to help the patient in front of me today and, if I do this medicine thing right, the one I’ll see 10 years from now.

It took two years of medical school to derail my purpose and one big fall on my ass to find it again. I know I’ll stumble again, but I’m going to try to welcome insults to my pride. After all, they give me the chance to do what I set out to do in the first place. MM

Jessie Roske is a third-year medical student at the University of Minnesota Medical School.