From the Agamemnon of Aeschylus (written c. 458 BCE)
Pathei Mathos can be translated as learning from adversary, or wisdom arises from (personal) suffering, or personal experience is the genesis of true learning.
Understood in its original context, Aeschylus expresses that wisdom arising from personal experience is more valuable than what any impersonal words, faith, or doctrine can impart to us.
I saw a patient on the ward on call recently where the patient’s complaint was some mild shortness of breath. Upon reviewing the progress notes, one of the issues low down on issues list was titled PE.
My heart skipped a beat.
Pulmonary embolus. My thoughts raced at the possibility that this patient had a recurrence. I quickly went back to see the patient but found that his story and physical exam did not quite add up to what I had imagined. I decided to go back and read the chart notes carefully again.
The more I read the notes in its reverse chronology, the less this PE sounded like a pulmonary embolus until I finally found the source, some ten pages back, buried in the middle of their already thinned chart.
Over time, a relatively benign finding had been unintentionally shortened to a grave and emergent issue by the student writer. I breathed a sigh of relief.
It was yet another reminder of how shorthands and acronyms can cause miscommunication.
For the students who have survived their foray into clerkship, congratulations for making it this far. You are only a year away from finishing your medical schooling. Here are some words of wisdom as you draw closer to the end as an undifferentiated stem cell and down the new path as a resident.
Today marks the end of my first week as a doctor. To say the least it has been exciting, interesting, but above all, scary.
I have hit the ground running here, starting my first rotation in internal medicine. The days thus far have been long, hard, and busy. Everything feels more real, more high stakes; after all, I am now the one who needs to make the decision overnight.
However, every resident feel like this when they begin practice. What I would like to share instead are some of my other experiences:
There are still two years ahead of me in this residency and much to learn, see, and do. Expect more thoughts on this transition in the future.
In the 1970s, Noel Burch described four stages of learning any new skill and it could be summarized as follows:
Everyone strives for unconscious competence. The mastery of a skill has become so complete that you can do it effortlessly. The scariest state to be in is the first stage. “You do not know what you do not know.” That can be a terrible position to be in, especially when a patient’s life is on the line.
That is why receiving feedback is so important. That is why we train for so many years, under the watchful eye of so many experts to be a master of the craft. Sometimes, in order to make that transition to the next step of our competency, it requires someone else to point out where we need help.
It still shocks me that I am only a few days away from beginning my residency. Four years have come and gone. I now have a degree and letters behind my name to show for it. This last year has presented with its own unique challenges and a lot has changed in four years. Let’s have a look back.
It was here that I first learned how to correctly use my stethoscope, how to speak with patients, and how to act like a doctor. These were my baby steps. I studied a whole host of topics, covering the broadest and biggest organ systems. It was also here that I learned anatomy and had the privilege to work with cadavers.
In many respects this was the most stressful year. While clinical work is taxing in its own right, nothing came close to the mental toll this year had on me. Studying was both a necessity and a compulsion. Easily I spent entire days sitting a library, reading, memorizing, understanding. I had never studied that much in my entire life.
This time, the stresses of clinical work were balanced between the mental and the physical. By far the most challenging year of all but also the most enjoyable. Having sat in class for the better part of my life, now I would have to do.
It was an adjustment to work in a hospital, to see volumes of patients, to do call shifts. But I adjusted and grew used to the pace of the ward. Gradually, I learned to move from knowing how, to showing how, to doing.
On top of the clinical work, I had a number of additional challenges this year. I had an all encompassing OSCE, residency applications and touring, and a licensing exam to complete. By this point, clinical rotations were not quite as overwhelming or scary as they used to be, but I still had many hard days.
The brunt of the stress this year came from the latter additions. Those three things were for all the marbles, and the consequences of missing any one of those were a constant worry. The OSCE wound up showing some of my weaknesses that I would need to improve on. The CaRMS tour would take me across the country from colder to coldest winters in Canada. The licensing exam ended up being a two-week mad dash to the finish line. For six months, the pressures mounted through these three main events.
But I eventually reached the end of my four year journey. I graduated, I was admitted to a residency program, and I passed my exam.
It has been a roller coaster ride through four years of medical school. I am happy I could document it all here in these posts. Now I start a different journey through residency and look forward to reflecting more on this new adventure.