Traffic Stop Reflections on DCE

Half-past eleven on a Thursday morning, and I’m stuck in traffic on I-275. Typical Tampa.  

Sandwich in one hand, the other on the steering wheel, I’m mentally untangling the last couple of hours. Day one of our Doctoring Clinical Experience doesn’t seem like much to sort through. I listened to exactly one patient’s heart and had a very pleasant conversation with another before the attending turned my classmate and me loose. Yet here I am stifling tears while scarfing down my sandwich, trying not to dent the bumper of the car in front of me.  

Mr. “Goals-of-Care-Discussion” kicked off the day. The actual discussion had happened the day before, but expressing my interest in palliative medicine got me into his hospital room. Surrounded by a flurry of nurses, physical therapists, and awkward, gawking medical students, he lay flat on his back, an image of disease run rampant. His blank stare was fixed on the ceiling in the aftermath of a decision to forego further treatment in favor of comfort care. The very kind attending motioned for us to listen to his heart, to practice our skills. I leaned in, stethoscope cocked, a perfunctory introduction rolling off my tongue. “Hi, I’m Madeline, first-year medical student here to listen to your heart.”  

“Okay, dear.” His raspy response from dry, cracking lips was tinged with a sigh and sent my gut twisting. Discomfort bombarded this man from all sides. Scary-high calcium levels made his comprehension fuzzy while a giant ball of angry metastatic tumor cells slowly devoured his right shoulder. And here I was, one more person to prod and poke and listen for a heartbeat I could barely detect over the bustle in the room. My internal monologue chided: This is how I learn; this is part of medical training. I didn’t know becoming a doctor would sometimes feel like causing pain for the sake of education.  

A hurried “thank you, sir,” and I turned from his bedside, guilt nipping my heels as I exited the room. Thank you, sir, for enduring my untrained stethoscope on your chest, an invasion of your final moments on this earth.  

Ten steps back to the nurses’ station and our attending sent us off to chat with Mrs. “Nice-and-Cooperative-and-Won’t-Bite-Your-Head-Off.” Her chart wove a sad tale of metastatic breast cancer unresponsive to treatment. But her countenance, her poise, the way she carried her headscarf like a crown atop her hairless scalp, told another story. All the rage and depression and bitterness in the world would have been justified by the cells steamrolling through her brain and bones. Yet she radiated contentment. Not resignation, for she spoke ardently of fighting for her body and her future. Rather, her calm strength suggested acceptance of an entire life derailed. Hope wafted like incense between every word of the story she told from her diagnosis until that day. Sometimes life is beautiful, and sometimes you get cancer—embracing both realities is not impossible. 

I was thankful for the mask hiding my mouth, which hung slightly open in wonder and disbelief while she spoke. She was only fifteen years my senior. Were I in her hospital socks, I would wear out the ceiling asking for a reason to justify such tragedy. But I was the healthy one, standing there in my short white coat, forgetting the attending’s instructions to listen to the patient’s heart because my brain was frantically searching for something to offer this cancer-ridden sunburst of a person. A facepalm-worthy platitude was all I could muster. “I hope you feel better soon!”  

Now, I’m driving my perfectly cancer-free self to a medical school that will teach me how to be a doctor. I will shove a hundred billion facts about every nook and cranny of the human body into my brain and take a lot of exams to prove it all stuck. I will learn how to diagnose and treat and competently interpret scientific research articles (maybe, fingers crossed). But at the end of this very long learning marathon, what will I know of the sick? What will I know about suffering? What will I know of engaging the anguish of disease without losing my own emotional keel?  

My tingling tear ducts blur mid-day traffic in response to a wave of overwhelm. And then, I breathe. Take a bite of my chicken sandwich. Feel the steering wheel under my fingers. I do not have all the answers right now, and that is okay. I am not the person I want to be yet, and that is a blessing. For I am becoming, and in this space, there is so much room to grow and learn and live.  

Today, I am thankful for ridiculous traffic, for the extra time to think. Tiny shoots of my healing philosophy are meeting the sunlight. I will not be crushed by the weight of sickness but be moved by it and with it. I will protect the human right to a dignified death and infuse my diagnostic acumen with hope. I am becoming—forming and discovering my professional identity—at 11:30am on I-275.