Thread by @TheRealDoctorT

“What you don’t have,
you don’t need it now.

What you don’t know,
you can feel it somehow.”

- “Beautiful Day” by U2

This is suddenly real. It isn’t supposed to be. I thought I was ready. Prepared.

I meet the raw intensity of a gaze filled with tears.

And I freeze. 1/

It’s 2000 and I’m full of well-meaning energy and naïveté.

I’m a first-year medical student and my short white coat is hanging in my closet, tantalizingly nearby.

I’ve wanted to go into medicine for so long, and now there’s finally light at the end of the tunnel. 2/

I go through the white coat ceremony with the rest of my class, and feel warm shivers as I solemnly recite the Hippocratic Oath.

These words that bind me to a lineage through history, good and bad.

I speak them into being, as if for the first time.

And so it begins. 3/

Every illness in my family is suddenly made my responsibility. My grandfather is in the middle of the final decline in his health, the last year of his life.

He introduces me to his visiting nurse as “my grandson, the doctor.”

I’m not a doctor, not yet. Not by a longshot. 4/

As med school progresses, I am settling into a routine of classes and exams. I’m reaching a certain comfort zone.

Hey, maybe I can do this doctor thing after all...

The next threshold comes in the form of standardized patients- trained educators who roleplay as patients. 5/

These standardized patients allow us to start working on our clinical skills, and also our ability to connect with our fellow human beings.

In these artificial scenarios lie the rudimentary beginnings of the crucial “doctor-patient relationship.”

Every encounter is taped. 6/

I feel like I’m doing well with the standardized patients, scoring well. This is why I wanted to go into medicine. To make meaningful connections, and help people, on a very basic and human level.

But I’m about to get a serious wake-up call.

A simple question. 7/

In this particular standardized patient encounter, the scenario is “giving bad news.”

The instructor tells us we have to disclose a biopsy result. The biopsy shows a very aggressive cancer with a dismal prognosis.

Our job isn’t to treat anything, just to break the news. 8/

Before we proceed with the encounter we read several articles and essays on this, as well as watch videos and have group class discussions.

I feel ready. My strategy is clear in my mind.

I got this.

I knock on the door to the exam room.

“Come in.” 9/

As I enter the room, I ignore the cameras recording me, and offer a warm smile to the standardized patient inside.

An elderly man sits before me, neatly dressed. I note the way his hands are clasped together. The way he sizes me up with his gaze.

He smiles, nervously. 10/

I’m going to try to be clear and concise, but also warm and empathic.

Simple, right? Ha.

As I sit down, I make small talk about the Boston Red Sox logo on his sweater. He laughs, and I realize something.

Everything is about to change for him. Forever.

I breathe deeply. 11/

In a detached part of my mind, I know this is an exercise. I have a safety net here. This is where I learn.

But deep down, I’m believing the reality of the scenario. My lips are dry.

I start going over the biopsy report with him, maintaining eye contact, speaking clearly. 12/

His features change as I speak, the smile fading, and his brow staring to furrow.

When I’m done, he’s silent for a long while, before asking quietly.

“Are you telling me I’m going to die?”

His eyes fill with tears. The quiet intensity of his emotion is real.

I freeze. 13/

In 1889, Sir William Osler, one of the most celebrated physicians in modern medicine, gave his farewell address to new doctors at the Pennsylvania School of Medicine.

In it, he advocated for two traits in the new physicians: imperturbability, and equanimity.

I have neither. 14/

I am silent, realizing that all this time in the classrooms hasn’t prepared me at all.

Getting grades. White coats. Ceremonies. My privileged life.

All of it, useless.

There is no currency here I can exchange, no multiple choice path to salvation.

I’m just a kid. 15/

“Doc? Does this mean I’m going to die?”

He repeats the question, and it snaps me out of my paralysis.

I don’t know where the words come from, but they find me.

I try to speak slowly, calmly, clearly. Every instinct I have screams to give hope, but I try to be unbiased. 16/

I don’t remember what I said, exactly.

But I do remember at the end, he shakes my hand, and thanks me as he picks up the clipboard on which he will write his feedback.

I step outside and feel my carefully constructed scaffolding of self-confidence begin to fall apart. 17/

I can’t do this... unless...

Unless I accept a truth:

One of two things must happen.

Either I harden my heart, to numb it, or I learn to bear the pain of its repeated breaking.

20 years later, and it’s a lesson I’m still learning.

Medicine is life, in broken portions.