I am a monster.

Or so I think as I relegate myself the darkest place on the internet: the comments section. Here, among the semi-anonymous maze of haters, trolls, religious zealots and the self-righteous, I find myself with my fingers hovering over the keyboard.

You see, NPR recently posted an interesting article about medical students’ depictions of attending physicians and other supervisors for a ‘Comics in Medicine’ class taught at the Penn State College of Medicine. The students’ comics and artistic renderings are hilariously funny, but the point of the article is that the majority of students drew their attendings as monsters.

It’s not hard for me to understand why this is the case. Medical students often feel stressed, worried, or tired, and sometimes they feel berated by the doctors training them. The ‘Comics in Medicine’ class offers an outlet for students’ frustrations, but it also provides insight into how doctors are trained. Many physicians remember feeling horrible during their training, yet instead of promoting change, they treat newer physicians just as horribly and only perpetuate the cycle of abuse. It’s ironic that medicine, a profession which extols health and wellness, should inflict such misery on those within it.

I’m paraphrasing, but as I read through the comments beneath the article a physician from Pennsylvania implies that maybe schools are taking the wrong medical students, and those in training just need to suck it up. (I’m sure no medical student has ever drawn that guy as a monster). I want to call him out. I type a scathing comment. I re-read it over and over, impressed by my razor-sharp wit and vicious rhetoric. Then I delete it and go downstairs to make coffee.
It was such a rush, the notion of belittling someone on the Internet, and that scared me. I can see it’s a powerfully thrilling experience.

I suppose I’m especially aware of the impact of Internet comments at the moment, because a while ago an article I posted on KevinMD got a nasty comment from a doctor in Utah. The discussion was on Doximity—a kind of doctors-only LinkedIn. As I am not a doctor, I wasn’t allowed to see the comments section. I found out about his comment, which criticized my work ethic (I have three master’s degrees, screw you), through a flood of supportive emails from doctors all over the country.
“Don’t worry about that doctor from Utah,” one reply read, “We’re handling him.”
Another from an endocrinologist in New York read, “Your insights are superb, and I’ll be forwarding your URL to my current (and future) students.”

Some doctors sent me helpful links and access codes to e-books they had written. Most offered kind words of support, food, encouragement and coffee—should I ever be in their neck of the woods.

I have seen the best of the best during my medical training and some monsters, too. I don’t want to be one. If it means forgoing feeling powerful and smart all of the time, then I’ll take it—it’s better to actually be smart and influential as opposed to just feeling that way. It’s hard to show love and patience, especially to people that probably deserve getting called out. But I’ll try to make a different choice and find other, more positive methods of discussion. We all have a little monster inside us. It interrupts, tears other people down, and uses self-righteous quips that feel satisfying for a moment before they turn to ash in your mouth.
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Let’s be doctors who are kind and loving, even when it is difficult to do so. Let’s be the way forward. Let’s stand up for a better way to train doctors. To the good ones remaining: you inspire us to show empathy, understanding and love. You give us the strength to ignore those who are not as courageous, but rather more like monsters, belittling their colleagues instead of helping implement change.

May they be relegated to the comments section.

Fiona Scott, UC Davis School of Medicine
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This article has been edited for publication on WhiteCoated.com. For the original article in its entirety, please see the submitter’s blog. For the NPR article mentioned, please see “Medical Students See Their Mentors As Marauding Monsters”.

I want to talk about people who throughout this year have treated you badly, who may have wronged you or ignored you, those people who only seem to remember your name when they need something or want to ask you ridic questions in front of large groups. At some point this year, maybe this week, you were not treated with kindness and mercy and grace and humility, but with anger and frustration and fear and dare I say even malice.

I was recounting to my doctoring group this evening that emphatically these people should step on a lego. No doubt. Being anything less than gracious and kind and respectful to our fellow human beings isn’t how we should be treating each other, seeing how short human lives are and stuff. Ironic that in a hospital (a building which sees death on a daily basis) we should forget this fact. So after a frustrating day attempting to interact with the most type A-e-ist of type A people (who just want to break off the tip of the A and stab you in the eye with it), I was really having fun thinking about how karma will smite them and how I’d like to give them a piece of my mind (theoretically that is).

But then I got home, carrying a fresh bunch of daffodils Emilie got for me. I took a shower, I put on clean pajamas, I sang along to Tale as Old as Time and curled up in bed with a new book by my favorite author Anne Lamott (or St. Anne as I like to call her). I thumb through the first pages and it reads; “Mercy means that we soften ever so slightly, so that we don’t have to condemn others for being total sh*ts, although they may be that, (okay: are)….Kindness toward others and radical kindness to ourselves buy us a shot at a warm and generous heart, which is the greatest prize of all.” Dammit. I’m so screwed. I don’t feel like being merciful or kind to people who make me and my friends feel bad. I’m just not that mature. And I doubt that these people will know or care that I have softened my heart towards them, or dare I say forgiven them for being wrong, for being rude, for being mean, for using their power to belittle instead of lift up, they were wrong and I want justice. Justice I say.

As I type this, I am reminded of two things. #1: I have been so very undeserving of the mercy and forgiveness others have granted me in my life. And so very grateful that I have crossed paths with lovely, kind people who say in spite of my mistakes, in spite of being rude and self-centered and lazy and dumb, that they still love me, still think I’m okay and the biggest gift of all is their forgiveness and forget-y-ness of my messy interpretation of what it means to be human. Thanks. Thing #2: I am reminded of an 83 year old real estate agent from Terre Haute, Indiana. Her name is Eva Mozes Kor, a survivor of medical experimentation in a concentration camp at the hands of Dr. Mengele—a Nazi doctor conducting “research” under the name of the Max Planck Institute. Eva lost her entire family during the Holocaust and was very nearly killed herself. Eva came into the public eye when she announced that she forgave Dr. Mengele for what he did to her and her family. She issued a written statement of forgiveness to the Planck Institute and was featured in a documentary about her choice entitled, “Forgiving Dr. Mengele.” (Netflix it, its amazing). Her decision to forgive shocked a lot of people and actually upset a great many in the Jewish community who believe that the Holocaust is unforgivable. I can’t disagree with them, but Eva explained that she decided to forgive Mengele for her benefit, not for his. You go girl.

Don’t worry, I’m not trying to compare WWII or Hitler to being treated like crap on a rotation. My point is, that if Eva can soften her heart against the war crimes and human rights abuses that were committed against her– then I guess I can forgive the people that were mean and rude and ignored me. I guess I’ll work on it anyway, not for their benefit, but for my own.
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So dearest fellow human beings–wherever you are–who have been rude and mean and unkind. I forgive you. I know you could have done better. We all can try to do a little better—even me. What do you say we chalk this one up to life eh? Our very precious, way too short, beautiful-in-spite-of-everything life. My daffodils remind me that spring is coming. And my calendar reminds me that there are two weeks left in this rotation. And my heart…well it reminds me what love and forgiveness feel like. I guess its starting to soften it just a little.

​Fiona Scott, UC Davis School of Medicine

Once upon a time, there was a beautiful princess, who had decided to go on a long journey. She had been told about what lay at the end of a long and winding path. It was all of the good things the princess had been wanting; happiness, joy, satisfaction, riches, success and the ability to cure the sick. The princess prepared for the trip for many years. She had heard of others who had made the long journey and asked them what it was like. She read books about the road she was to travel along and slowly she gathered everything she needed to make the trek. The princess knew that she was very lucky that the King and Queen were able to help her. For the path the princess chose had many trolls who lived under bridges who would demand payment for her to pass. Finally, the princess set on her way.

It was sunny and although the road was cobble stoned and bumpy, when she stumbled, she always managed to catch herself. There were many other princes and princesses walking with her. And this helped the princess to not feel so alone, for she would have certainly been afraid without them.

As the path wore on, she grew tired. Some of the princes and princesses that had started on the journey weren’t with her anymore. Some walked slower, some walked faster and some had taken different roads altogether. Along the way the princess was tested. Sometimes she had to stay up many nights in a row without sleeping. And other times she had to walk in the pouring rain and the blistering sun. She met all sorts of creatures along the way. Some were kind and tried to help her. They would say nice things to her and encourage her to keep going. But others were mean and made her feel afraid. Sometimes a strange beast wearing all blue robes and a mask, would test the princess by making her stand very still for hours without eating or drinking or moving. The princess hated this creature the most. But the princess kept walking. She walked uphill, and downhill. She walked on straight paths and narrow, twisted ones. Sometimes the path was paved with stone, and other times it was dirt. And sometimes it was mud.

One day, she came to a rope bridge lashed together between two high cliffs over a river. She wondered what would happen if she fell into the water. But she did not fall, for the other princes and princesses held her when she felt unsteady. Finally, the path was straight again. It was sunny and warm and the road was paved with golden bricks. “This is easy,” she thought. “I’m almost there.” But then the path broke into six equal parts. The princess didn’t know which one to take. She stood in the same spot for a year. She asked the birds of the sky what the paths looked like from above and the fish in the stream what they looked like from below. But the princess wasn’t sure. The paths all looked different, but one didn’t look any better or worse than the other.
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After a year of waiting, and asking every passing creature, the princess picked one. She still wasn’t sure she picked the right one. But the path she chose became hers. And it lead her to many of the things she was hoping to find, like happiness and love and joy and the ability to cure the sick. The other princes and princesses chose their paths too. For some, their paths crossed a lot and some never did again. The journey made them older, and gave them more grey hairs and wrinkles. They were all less rich than they were before. And more tired. For they had faced monsters, and stayed up many nights in a row, and walked uphill and walked downhill, in the pouring rain and the blistering sun. But they found what they were looking for….and they all lived happily ever after.

​Fiona Scott, UC Davis School of Medicine

Fiona Scott, UC Davis SOM

Once upon a time, there was a beautiful princess, who had decided to go on a long journey. She had been told about what lay at the end of a long and winding path. It was all of the good things the princess had been wanting; happiness, joy, satisfaction, riches, success and the ability to cure the sick. The princess prepared for the trip for many years. She had heard of others who had made the long journey and asked them what it was like. She read books about the road she was to travel along and slowly she gathered everything she needed to make the trek. The princess knew that she was very lucky that the King and Queen were able to help her. For the path the princess chose had many trolls who lived under bridges who would demand payment for her to pass. Finally, the princess set on her way.

It was sunny and although the road was cobble stoned and bumpy, when she stumbled, she always managed to catch herself. There were many other princes and princesses walking with her. And this helped the princess to not feel so alone, for she would have certainly been afraid without them.

As the path wore on, she grew tired. Some of the princes and princesses that had started on the journey weren’t with her anymore. Some walked slower, some walked faster and some had taken different roads altogether. Along the way the princess was tested. Sometimes she had to stay up many nights in a row without sleeping. And other times she had to walk in the pouring rain and the blistering sun. She met all sorts of creatures along the way. Some were kind and tried to help her. They would say nice things to her and encourage her to keep going. But others were mean and made her feel afraid. Sometimes a strange beast wearing all blue robes and a mask, would test the princess by making her stand very still for hours without eating or drinking or moving. The princess hated this creature the most. But the princess kept walking. She walked uphill, and downhill. She walked on straight paths and narrow, twisted ones. Sometimes the path was paved with stone, and other times it was dirt. And sometimes it was mud.

One day, she came to a rope bridge lashed together between two high cliffs over a river. She wondered what would happen if she fell into the water. But she did not fall, for the other princes and princesses held her when she felt unsteady. Finally, the path was straight again. It was sunny and warm and the road was paved with golden bricks. “This is easy,” she thought. “I’m almost there.” But then the path broke into six equal parts. The princess didn’t know which one to take. She stood in the same spot for a year. She asked the birds of the sky what the paths looked like from above and the fish in the stream what they looked like from below. But the princess wasn’t sure. The paths all looked different, but one didn’t look any better or worse than the other.
​
After a year of waiting, and asking every passing creature, the princess picked one. She still wasn’t sure she picked the right one. But the path she chose became hers. And it lead her to many of the things she was hoping to find, like happiness and love and joy and the ability to cure the sick. The other princes and princesses chose their paths too. For some, their paths crossed a lot and some never did again. The journey made them older, and gave them more grey hairs and wrinkles. They were all less rich than they were before. And more tired. For they had faced monsters, and stayed up many nights in a row, and walked uphill and walked downhill, in the pouring rain and the blistering sun. But they found what they were looking for….and they all lived happily ever after.

When you saw that first slice through a cadaver, you felt something. It showed. I felt it, too.

When you set up your first IV, your hands shook. You tried to hide it, but I saw.

When you held the sick child in your arms, your heart despaired. I knew because mine did the same.

When you witnessed your first death, your face gave nothing away. Neither did mine. You probably broke, as I did, but you didn’t tell.

I held the sorrow just like you. But I won’t tell.

I’ll keep it buried in my heart. Just like you.

With every prick, every cut, every child, every life, I’ll feel the same. So will you.

But with every prick, every cut, every child, every life, I’ll hide. So will you.

And slowly, but surely, I’ll forget that you feel the same.
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And slowly, but surely, I’ll believe that I’m the only one feeling this way. Just like you.
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Posted by ​Robin Kuriakose

Erica Romano

What do I want to be when I grow up?

It’s a question we’ve all asked ourselves, or been asked by others, at some point. Kids attempt to answer it by using their imaginations, ‘playing pretend’ and taking on various personas (complete with elaborate costumes and props).

I think kids often imitate the people whom they admire or perceive as heroes: police officers, firefighters, veterinarians, detectives, teachers, doctors, etc. There are plenty of other (highly entertaining) examples (Kid President, anyone?), but you get the idea. Children play games as a way to understand complex adult roles, and they pick up on observable social and cultural cues from the people, places, and things around them.

The same was true of my own childhood. By the time I was six years old I had two younger siblings, so my go-to ‘play pretend’ careers were those in which I felt validated when I received positive attention from my parents and other adults. I loved pretending to be a veterinarian and caring for (or at least attempting to care for) my dog and cat. I was drawn to the notion of becoming a vet because, at my level of understanding, I could appreciate that the men and women in this field were intelligent, caring, and they were vitally important in my world, ensuring that my pets were healthy, happy, and able to withstand the (entirely loving) chokehold hugs their overzealous kid-owners might bestow. So, my response to ‘What do you want to be?’ was an obvious one: a veterinarian. I loved animals, and I was also pretty good at bandaging injuries, which may or may not have been motivated by attempts to avoid getting in trouble if one of my little sisters got injured during a game of hide-and-seek.

Throughout high school I became more interested in the medical field, and as I began college I anticipated this was likely the start of what would be an eight-year journey to become a doctor. But what I didn’t know was that I was dedicating my time, money, and mind to pursuing a career in more than just science and medicine.

Out of curiosity, I looked up the definition for ‘doctor’ in the Merriam-Webster online dictionary. The entry is succinct and straightfoward:

doctor: noun | doc·tor | ˈdäk-tər

a person who is skilled in the science of medicine : a person who is trained and licensed to treat sick and injured people.

That’s the simplified definition. Scrolling down, there are multiple entries, separated by numbers to distinguish one from another: “an eminent theologian…a sound explorer of doctrine”, “a learned or authoritative teacher”, “a person skilled or specializing in healing arts”, “a person who restores, repairs, or fine-tunes things”.

I think a doctor is all these things, and the concept of who is a doctor and what they do is a dynamic one, dependent upon individual perspective–whether in the eyes of patients, friends and family, colleagues, and so on.
So here is my perspective about what it means to be a doctor:

Doctors are teachers. Their patients are their students; doctors teach them about the design of the human body, the normal and the abnormal. No one doctor’s teaching style is the same, just as a patient’s manner of learning differs between individuals. Patients come from all sorts of backgrounds and levels of education, so flexibility is key.

Doctors are students. The pursuit of education lasts indefinitely, even in the absence of a formal institution or classroom setting. The prospect of encountering new challenges and perpetually seeking to improve myself is what makes the medical field exciting.  paradigm of thought, reinforce an already accepted scientific belief, or turn knowledge on its head and render it obsolete. We read and study, we take tests (a lot of tests), and we keep our certifications current. Our superiors and our peers are our professors. We can learn from textbooks and journals, or from personal experiences in hospital wards and clinics. We observe methods of doctor-patient communication and surgical techniques, and we commit them to memory.

Doctors are counselors, personal trainers, mechanics. Chest pain? Arthritic flare-ups? Cardiologists and rheumatologists might as well be firefighters, diagnosing and battling pathophysiologic blazes within the human body. Doctors have to be good detectives, too, in the process of developing a differential diagnosis and identifying the correct one before tailoring management strategies to an individual patient.

Doctors are artists and historians. They are immersed in the beauty and complexity of the arts just as much as they are in science. The human body is a glorious canvas requiring the critical eye of a clinician who discerns connections and truth beyond the surface. Surgeons are conductors of great orchestras comprised of steady hands and pristine instruments. My mom often reminds me, “It’s called the art of medicine for a reason”.

There’s not always a solution, or if there is, it may not offer a rewarding sense of closure, because medicine is full of variables: the uniqueness of the patient and their circumstances, location, timing, the doctor’s own strengths and limitations. It’s unrealistic to expect one surgeon to precisely replicate a skill of another surgeon. Sometimes there’s no guarantee medicine will prevail–the poignancy of human suffering is art, too, in its own way, and though not always comforting, it makes us better for having experienced it. We learn from our shortcomings as much as we do our victories.

My point is that there’s no clear-cut, detailed job description of a doctor; there are, in fact, many facets to the profession. Some of these roles are pronounced than others depending on the situation, and perhaps on the physician themselves, but I believe doctors are in the unique position of fulfilling the roles of more than one job throughout their lives, or even in the span of a single office visit. Ours is a versatile profession, and at times, it is this versatility that contributes to doctors feeling overwhelmed, exhausted, or disillusioned with the decision to enter the medical field in the first place.
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The phenomenon of burnout can happen suddenly in a moment of immense stress, or it can eat away at a person’s stamina gradually until there’s little memory of why they chose this profession in the first place. I’ve seen kids demonstrate unshakable resilience when they set their hearts and minds to protecting something in which they believe, and I think we could use a little more child-like spirit when facing obstacles in our adult lives. Maybe we just need a moment to reflect and recall our answers–our dreams, passions, and goals–the last time we considered, “What do I want to be when I grow up?”

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Katharine Lawrence, NYU

We traveled by school bus for two days to reach the health center. The roads from the capital, originally wide and paved and bustling with urban life, had gradually given way to dirt and dust and mud. We waited our turn on long single lanes as caravans of eighteen-wheelers passed by us in clouds of fuel exhaust and deep red dust. The trucks were laden with cargo, long planks of cedarwood and teak, stock animals piled on top of one another, cows and sheep and goats. Some were trees of bodies, men and women and children in bright colors pressed to one another and swaying precariously in the rusty truckbeds, en route to further reaches. Eventually, the rich green fields of tea and wheat and roses gave way to untamed brush; the further we went, the more our bright yellow school bus became an oddity.

Children collected on the sides of the road to watch us pass as we drove north. When we arrived at the hospital the gates of the building were still closed. Along the length of the metal fence a line of people waited patiently for the doors to open. Some smoked, others chatted. A few played dice to pass the time. Many looked ill, and moved as little as possible as the African sun began to climb over the distant mountains. Others were waiting, not for medical care, but for the arrival of the food trucks; oversized, overpowered blue tanker trucks that arrived on a weekly basis with supplies of grain, mullet, cassava, and other items from the capital.

A thick cement fence encircled the hospital facility, its walls topped with spikes of forbidding rusted metal. Just as we were beginning to perspire in the mid-morning heat, a young woman in an immaculate white nurse’s uniform arrived at the hospital gate. Opening the large padlock with an ancient-looking key, she guided us into the main auditorium of the hospital. Her name was lost in a whisper and a shy, flashing smile; she looked no more than fifteen, but as a nurse in the hospital she already knew far more about illness and death than we did.

There was no electricity in the hospital. There hadn’t been for months. We were told with some embarrassment by the administrator that, yes, the municipal government had allocated funds for the gas generator last year; there had been an inaugural ceremony, and the mayor himself had attended. The trouble, it seemed, was that the funding did not cover the copper wiring required to connect the generator to the hospital. The mayor had promised additional funding, but it had yet to materialize, and the hospital had no authorization or funds to spare. It was estimated the piping would cost 25 US dollars.

In the corner of the storage room beyond the auditorium, an ancient autoclave was cleaning speculums and other metal instruments; the heat for the device was supplied by a small wood fire, which crackled beneath the metal container and filled the room with a thin smoke.

There was a bright side, though. In the dark of a lightless hospital, in the absence of a humming, spewing gas generator, the housing shed for the equipment had become a quiet residence for local fauna. Among the goats and chickens, we were informed, had been discovered a surprise – a great crowned crane. The administrator spoke in hushed, almost conspiratorial tones, inviting us to crowd around him in the auditorium like children in a classroom. There had not been a crowned crane in this place for a generation; the last bird had been a gift of the old dictator to a local matriarch, a rumored lover. Many took the bird’s arrival as a sign; of what depended on who was whispering the tale, and what side of the war they had been on before.
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Beyond the gate of the hospital, women in brightly colored polyester dresses lined up in front of a newly arrived food truck; shifting fifty pound bags of rice on their shoulders and heads, they set their faces and began the long walk home.

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Katharine Lawrence, NYU

I know nothing about football culture. It was difficult enough for me to understand the reason for the argument, much less the cause of violence. The social worker let us know that legally this did not constitute a domestic violence case. The technicality was that they had a child together. Two, actually. A distant, perfunctory relationship built up around the shared blood. He, the father: paid his child support, saw his children as allowed, and kept his distance. She, the mother: diligently adopted the mantle of single motherhood with love and relentlessness. She supported her children in school, at home, and in their extracurriculars. She worried about her son’s blood sugar, although he did not have diabetes. She has plastic plugs in her electrical outlets, even though her children are now teenagers. She has a hurricane emergency evacuation plan taped to the walls in every room of her small house. She buried a key to the house in the backyard, just in case. But she did not like football for her son.

Football, for many kids in South Florida, is a godsend. It’s better than grades, extracurriculars, or minimum wage part-time jobs. In a world of shrinking options, football is hope for families. But football is not perfect. It can be dangerous, in more ways than one. The future it promises is tenuous and fragile, and certainly not universal. Attainability is both its strength and its most heartbreaking weakness. She was trapped between violence and concussions. Football was the cause of it all.
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He confronted them on the lawn, a rectangular swath of crabgrass and rocks. Our son, he shouted, is going to play football. She determinedly opened the door and stepped out to meet him in the heat, leave my boy alone. Later in court, he claimed that he had not raised his hand to her. In the ED, the X-rays showed no broken bones; weeks later, when the headaches didn’t subside, an MRI was ordered, and post-concussive syndrome was diagnosed. In the end, no further action was taken on the case. This was how I learned about football. She shared her story in bits and pieces, a little more at every out-patient visit. We built our relationship in the back of the mobile health clinic, where I poked and prodded, checked her teeth, counseled her on cervical cancer screening, and encouraged proper diabetic footwear. Although she never directly accused him of domestic violence – I don’t see him anymore, he knows not to come around – the possibility remains, according to the police, and perhaps in the back of her mind as well. So I went home and read, the diligent medical student, on domestic violence, trauma, and football. I learned to ask her about this in different ways, and gauged by her reaction how far I was from being a proficient interviewer. My patient was patient with me, and taught me how to be a doctor.

I love our hospital. It’s big and white. It’s where I met mommy and daddy.

I love our hospital because I got a cold one day, and we went there. A nice man in white smiled at me and told me that I’ll be alright in no time. I got better after some time. I like him.
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Mommy says he’s a doctor. She says that doctors take care of people who are sick, so they can go home and have fun with their family.

I want to have fun with my little brother. I got him at the hospital. The nice doctor says I cannot take him home yet. So my little brother lives at the hospital. Every day, I go there and play with him. Every night, I pray to God to send him home. Mommy says that I can play more when he comes home. She and Daddy pray, too.
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I also pray to become a doctor. I want to go to the hospital and make people better. Especially little kids. So they can go home and play with their sisters and brothers.