Middle Clinical Experiences

I spent the last days before lockdown in a rustic Wilderness State Park cabin, on the wintery tip of the Lower Peninsula, surrounded by close friends and their respiratory droplets. During the trip I developed a cold and I gargled salt water and blew my nose as we joked that I must have that Coronavirus going around. We laughed, and shared the small cabin’s oxygen, unfamiliar with terms like 'social distancing'.

I didn’t have Covid then, but it was an omen of those first few months at home. I shared in our collective low-grade yet constant paranoia that every itchy throat or headache or sneeze was the start of the Real Deal, the Big One. I took my temperature with a meat thermometer, and made toilet paper shortage contingency plans. A human mind deprived of stimulation will begin to spiral into surprising directions. They say that’s what drove an isolated prisoner in 1700’s France to invent Solitaire. After only two months of not seeing friends, and going to medical school via Zoom, my brain began to desperately hunt for spare crumbs of serotonin. I baked bread, watched movies, ran 24 miles a week and hated it, turned off screen time warnings on my devices, and drank beers alone in my apartment with my friends via webcam. To this day, I cannot remember what I used to spend my time doing before the pandemic started.

Even though most of my days are still spent on Zoom, we still have clinical shifts sometimes, interviewing patients while wearing masks and face shields that make us look like low budget astronauts. One patient in the ER burst out laughing as soon as she saw me. I crinkled my eyes as hard as I could under the helmet to show her I completely agreed that I looked ridiculous.

Every student I know is grateful for these clinical opportunities, a chance to step away from a shared screen and breakout rooms. The clinic is where we see what we learn in the classroom take on life. For example, I do not think that I will remember nephritic syndrome, blood and protein in the urine, by thinking of effaced podocytes in a glomerular basement membrane. I will remember it by the patient that told us “Doc, my piss looks like a pint of Killian’s Red Ale.”

A year ago, my friend asked me how much longer I thought the pandemic would last. Neither of us could be sure, but we agreed that surely August was the outer limit. I cannot cite any pertinent public health research we based our estimation on, but somehow it was still disappointing when August came and went. Now spring is here, and the universe seems rich with obvious metaphors about rebirth and renewal, emerging from the worst pits of the pandemic. I do not feel as if the world around me has changed dramatically since a year ago though, only that I myself am new. Some of the wounds of isolation and loneliness closed by primary intention, leaving behind neat lines where they used to be, others left to heal by themselves with thick fibrous skin left behind. After a quiet year of introspection, it seems natural to think about how the world is different now, and what the next year will bring, but instead I think about Wilderness State Park. With no light pollution there, on clear nights you can see galaxies, and the glow from the Mackinac bridge. You can stare at the lake and the sky for a long time before you worry about what comes next.

- NiCo Pigg, MS-II, MSUCHM

Pieces of Home Ania Pathak, G3, DO-PhD Program, MSUCOM

There were no almonds in our lives, but there was the watermelon we loved to share, you at your house, me at mine, after the vendedora de patilla dropped off a slice for each of us as she passed by. And there was the blue smoke of the jacaranda rising from our patios that we burned as conversation, because your father never let us meet. We pledged that not even the roar of the jaguar could keep us from each other’s arms. And it did not, though the macaw hatched fifty broods before our promise was Fulfilled.

Poetry:

Hiram Stephen Williams, M.D., M.P.H. Professor of Pediatrics Emeritus, MSUCOM

Visual Art: Blurred Beats

-Salina Halliday, OMS-IV, MSUCOM

We must accept our mood swings as they are

Mood Swings

- Lauren Bonilla, OMS-II, MSUCOM

Whether human or feline, we have to be especially kind to ourselves in times of struggle.

Emotions do not define us, they are only a temporary state of being.

Hanging On By A Thread

Sparkling between the backlit leaves of morning, gossamers sway in the breeze like bejeweled necklaces that are worthy of a missing princess or shimmering high wires waiting for acrobats even though their circus is nowhere to be found. But, on closer inspection, we just see eight-legged sailors throwing silk from the deck of the sinking ship of summer. So we shiver and look for our lifeboats as well.

- Hiram Stephen Williams, M.D., M.P.H. Professor of Pediatrics Emeritus, MSUCOM

Curious Colors

We seek precision in medical research and practice, but life often refuses to be contained by lines.

- Salina Halliday, OMS-IV, MSUCOM

Bite Size

“Don’t let my first suture be on someone’s face” I think to myself as I walk into my EM shift, going over the motions in my head to drive a needle and tie a knot. I feel confident I can do it, but god I hope it’s not on someone’s face. If the attending decides the laceration is an appropriate size for a second-year medical student, no problem. If the attending asks if I can do it, I won’t look timid just in case they can smell fear-- which they can. I practice asking where the laceration is in a manner that sounds inquisitive and not fearful; “I’m game for that laceration, but where is it?” On the way to the exam room, I will wonder if it is technically lying to say that I’ve done this before. I hope the patient doesn’t ask specifically if I have done this before on a real living human. “At least it’s not on your face,” I’ll joke-- unless it is.

The patient we see does not need stitches on her face, but she needs many stitches on her index finger- she nearly cut it clean off with an industrial saw. She is sitting upright in the bed with her finger splayed open, taking up more space than any index finger should, and she’s awake, watching it all. Meanwhile, her boyfriend is sitting in a chair with his head bowed, keeping his gaze anywhere but on her finger. He tries to make small talk and she teases him about his queasiness. Unfazed, she wants to get back to work. I relate more to the boyfriend, especially as the room starts to close in on me. The resident works to put her finger back together, like some sort of grotesque skin puzzle, and I lean against the wall. When that starts to feel like a stepping stone to the ground, I stand up. I get closer to the patient’s bed and then I step away, pacing forward and back. I ask if they know of Tommy Caldwell, the professional rock climber who lost his finger to a table saw but remained the best climber in the world somehow. Immediately I regret telling a story about someone who lost their finger, and I wonder if my poor storytelling judgement is due to my queasiness. Passing out right there doesn’t feel like it would be good for anyone present, so I sneak out to the nourishment room without a word.

In April, I wrote an essay saying that the lockdown-- then in its infancy-- was going to be good for me. I was just coming off a tough first year in medical school and I felt like some time alone, and more sleep, exercise, and homemade food would be beneficial. I planned to use the lockdown to care for myself, and when the time came, I would jump back in. When I wrote that, I could not have imagined being isolated for this long. I did not foresee the speed at which time alone transforms from a luxury into a powerful altering force on my well-being. Or that nearly a full year later, the COVID-19 pandemic would be running with more steam than ever. I didn’t foresee skipping Thanksgiving at my grandma’s house or feeling like I should seriously consider cutting back on drinking. I didn’t imagine having to wait several more months to see my girlfriend in Boston. Or feeling like a virus had the potential to ruin our relationship. I never thought I would have to remind my parents not to get too close to me, suddenly understanding how they must feel when they try to convince my grandmother that she should no longer drive. I didn’t imagine my first suture to be through a blurry face shield.

But the surprises have not all been bad. I didn’t expect to return from the nourishment room-- still queasy-- to successfully suture for the first time. I was surprised to find myself volunteering to go first. I was also surprised and relieved that the resident was supportive and instructive, and the patient was unbelievably relaxed, given both her injury and that two medical students would be performing their first ever suture on her finger. I was surprised to learn that a finger repair made me feel sick, but then I also was surprised when I pulled myself together (if only for just long enough).

This year has been a reminder of the countless challenges to come, for which I can never truly be prepared. There was no way to be prepared for this pandemic. Most of us could not even fathom something like this happening. On a smaller scale, I prepared to suture-- I read about suture technique and practiced several times on gel-- but nothing could prepare me for the real thing. The current world, and our career choice, seem ripe to produce more surprises. The only option may be to face challenges with what we are equipped with. From now on, when I encounter an unexpected finger injury, a new procedure, or even another pandemic, I’ll accept that I am as prepared as I can be, and with that realization I will find a new strength.

- Eren Sipahi, MS-II, MSUCHM

Learning to Redefine

- Pastel, charcoal

Sometimes it is okay to go outside the lines, deconstruct, re-build, and explore something new.

- Lauren Bonilla, OMS-II,

MSUCOM