My first ring of rotations was a hard one. I started out with Internal Medicine, Neurology, and Psych thinking that because I had done well on my step exams these clinical experiences wouldn’t be too difficult. Boy, I was very wrong. The world of clinical medicine for a fresh pre-clinical student was like a new world, Pandora from Avatar if you will. You arrive in this new world seeking refuge from the drudgery that is the classroom, books, and the dreaded step 1 back on Earth hoping for a new and brighter future. The world is as beautiful as you expect but if you are caught unaware this new place could swallow you whole. Your uppers explain the rules to you. “You are not in preclinical anymore. You are on the wards, ladies and gentlemen. Respect that fact every second of every day. If there is a Hell, you might wanna go there for some R & R after a tour on the wards…If you wish to survive, you need to cultivate a strong, mental aptitude. You got to obey the rules: Ward rules. Rule number one…”

The interesting part of medicine is that the rules can change depending on the Ward you’re in. This is where many mistakes can be made. I found myself making a big one on the first day of my acute coronary syndrome rotation. I had known the basic gist of pertinent information and presentations from my past two rotations but I was still new to what would be pertinent to this rotation. I made the mistake of not pre-rounding on the heart monitor overnight on a new patient. What made it worse was that I didn’t have a chance to discuss my findings and plan with the intern over this patient. It was something very simple but I still had forgotten to do. When it came to my turn to present I reported a normal cardiac physical exam finding when in fact the patient was in Afib from overnight. The attending, as well as the team, were very surprised and had asked me what I had seen on the heart monitor. I answered I must have missed it and tried to regroup but the intern was already taking over the presentation because this new finding was essential to next steps within the plan. I felt very silly…to say the least. I felt incompetent. I felt that I had blown my first impression. And in fact, I did. No matter how much I improved over that rotation I still kept that mistake with me and I believe it decreased my overall confidence. It most likely showed through my presentations and my evaluations reflected that.

It was a hard pill to swallow, especially coming from such high expectations in Part 1. However, I think it was a necessary one. I had always had trouble with confidence in myself with public speaking and this was what my nightmares were made of. Yet, from this experience with failure, at least failure in my eyes, I was able to really reflect on my presentation style, how to be a better clinician overall, and how to be more confident in myself. Through this, I learned to think more critically, become more efficient, look more deeply, and re-check myself for logic and clarity. I had decided I wasn’t going to let my fear of public speaking control me anymore and now in my second ring, I can move through presentations in a succinct and organized manner with a style that is all my own. I have grown tremendously, and I couldn’t be happier with my development of my clinical skills.

Despite learning curve that is third year I remain most proud of my interactions with patients. On several occasions I have had the opportunity to delve into my patients lives. For example, I met an older African American woman who was Bipolar, that had been off her medications for 2 months and had become suicidal due to an extreme physical illness.  I saw a woman that could have been my mother in not only look but in demeanor.

We began speaking more about her family and she began to tell me stories about how things were going wrong in that area of life. I then began speaking to her about similar family issues that I’ve had in my own and I think it was then that she warmed up to me. We spent a long time discussing our families and how having a mom just being there sometimes makes things ok. All the while I started to notice her smile, laugh and warm up even more to me.  We then started on the topic of religion and she told me all about her issues with her pastor, not being able to make it to church, her history of being Jehovah’s witness to becoming Baptist, and her love for Jesus.  I was surprised by my personal reaction to this conversation because I usually contain myself more when speaking to patients about religion but I felt that the rapport that we had built would allow me to speak more freely. As she told me more about her religious background, I began to speak encouragement into her through scripture that had come to mind as well as remind her of how much Jesus loves her. It was by the end of our conversation that I had noticed a stark difference to the person I had only just met a few hours ago. We ended the conversation with prayer and she thanked me with the biggest smile on her face. Later in the day, she sent a nurse for me to come to see her. She had started a gratitude book and had begun filling it with prayers and things she was grateful for. She asked me to fill it with a word of encouragement and I was humbled to even do so. I filled it out and by the end, it was time for me to leave. I did not see her again but our last encounter made me hopeful that she had found some semblance of peace and remembrance of God’s purpose for her being here.

There have been many changes I have seen in myself from the beginning of medical school to now. Taking the time to reflect on these small changes have made a few things more apparent to me. Although they may be minor, I think they are the beginning steps of a what I’ve always dreamed of being, a Physician. First, let me start off by saying that doing what’s best for the patient is what we all signed up for when we decided to become doctors, at least most of us anyway. We are then taught the best way of gaining information from those patients to help them. This includes approaching the care of patients as a cooperative endeavor, integrating patients’ concerns, and ensuring their health needs are addressed.