Going from the classroom to the hospital can easily be boiled down: white socks and black socks. I came to a realization yesterday that I now have an incredible surplus of white socks at my disposal, while my black sock supply just keeps depleting. I’ve gone from a student, wearing messy clothes in the library, seen only by my peers, to a professional, seen only by my team and my patients. It’s very yin and very yang: the intellectual pursuits of the first two years; the practical, hands-on management of the last two. The goals are very different: first came memorization of detailed facts and pathways. Now comes dealing with a real human.
The two are without a doubt complimentary, but the two require incredibly different thought processes. In preclinical, you’re looking at disease with 20/20 hindsight: you’re memorizing the symptoms, the complications, the treatments, and the physiology. Here’s the disease, what are the symptoms? In clinical work, you’re looking at… the patient. He or she comes to you with a couple symptoms, you try to ask questions to get a couple more hints, and then try to use that information to figure out the disease. Here are the symptoms, what is the disease?
This week has really felt like the honeymoon has ended. The excitement and eager anxiety has started to slow; I’m no longer completely new to the routine. I’m expected by now to be able to contribute to the team without major goofs. It actually feels like… a job. It’s harder to wake up in the mornings, I’m requiring more coffee. My awe of the human body has started to subside. (It’s a necessary evil, says the boyfriend. Otherwise we’d never get anything done, and our patients would wait endlessly while we marvel at cirrhotic livers and sebaceous gland cysts.)
One of the most challenging and humbling parts of clerkships is how often I find myself having to say “I don’t know.” On anything from things that I do know but can’t recall on the spot, to things I truly have no clue about. Some things are even obvious but I’m just nervous thinking on my feet. I stall, turn beet red, try to answer, and then after several attempts, give up. It’s a life skill that’s really important to learn as a physician: I’ve always strived to be a know-it-all (the good kind, I swear!), recalling stupid little details just to feel like I’ve studied hard, filled my head with knowledge, and done my part. I’ve always been pretty successful at getting the answers right, understanding the material, and being on top of my game. But practicing medicine has as much to do with experience as with knowledge, and right now my experience reserve is running on empty. In the end, it’s the second half of the phrase that’s more important: “I don’t know, but I can find out.”