Growth

I have been told, time and time again, that growth comes from the places outside your comfort zone. As I reflect back on the last two and a half years of my life, I am immensely proud of the doctor and woman I have become. Nothing about the last two and a half years has been particularly comfortable and my life looks almost nothing like the picture I had envisioned for myself in my mind. But, it is still beautiful and I am so grateful for the way it looks. Around the time the world shut down due to COVID-19, I learned that I was going to fulfill my dream of being a Pediatrician. During a time where, traditionally, a lot of unknowns are answered in a young medical career, I felt as though I had more unknowns than answers. I started out my medical career during a global pandemic. After an early graduation from medical school (via email) on April 15, 2020, I showed up the very next day to NYU Langone Long Island Hospital with a brand new N95 plastered to my face- the metal piece taking a permanent spot at the bridge of my nose- and my newly-issued pager on my waist.   

Unprecedented was the word being thrown around. And that it was. At 25 years old, I hadn’t seen much of the world and I had experienced only a fraction of the spectrum of human emotions I was about to experience. Oh, if I could tell the me I was then about the me I am now. The hospital was familiar, but different. It wasn’t the same place I rotated as a medical student, only seven months prior. I had managed to find the floor I was supposed to report to.  I was assigned my patients. My patients. I didn’t have time to wonder how I got to this point when last week I was still a medical student and now suddenly I had transitioned to doctor. Actually, my official title was “COVID-19 Junior Physician” which was plastered at the bottom of my shiny new badge. The monitors were beeping and the noise from the fans made it difficult to hear. It felt like every time I was talking, I was actually just shouting. I heard a questioning voice, “Are you the doctor taking care of this patient?” I take a moment to look around and suddenly realize the voice is talking to me, “Oh, yes I am.” “Great, I need you to reorder this Fentanyl drip, please.” “Sure,” I responded, knowing full well I had no idea how to even order Tylenol, let alone a narcotic drip. My senior resident helped me figure it out and suddenly I was presented with a smattering of information, tasks, and problems that need solving. A true baptism by fire. When I finished my first day, I changed my clothes in the white tent outside the hospital, drove home, undressed in the entry way of my apartment, and immediately hopped in the shower. I ate dinner alone, watched some TV, and went to bed. And then I did it all over again the next day and the day after that.  

Working during a global pandemic afforded me a lot of lessons that came earlier in my career  in medicine than it did for most of my colleagues. A familiarity with death I didn’t think I would experience so early in my career. But there I was, wide-eyed, shaky hands, my breath caught in my throat. My plastic gown crinkling with each movement and my face shield streaked with the remnants of the last wipe-down. My voice announcing time of death: 09:10. My patient’s nurse with tears streaming freely down her face, my gloved hand on their non-existent radial pulse, the family’s agonizing screams through the phone. I helped the nurse make the patient more presentable for when the family came. I cried in the bathroom after excusing myself from the room. I rejoined rounds so we could finished making plans for the day for the rest of my patients. An hour later I explained to my patient’s family how they died and held their hand as they cried.  

Later that day, I scoured the patient’s labs, wondering if I had missed something that could have prevented this. My attending took me aside and said, “We did everything we could, this is the way it happens.” It didn’t make me feel better, but it made me a better and more compassionate doctor. I ask for help and a second opinion freely and without hesitation. I know how it feels to do everything in your power and still not have a great outcome. And if I felt that horrible knowing I did everything I could, I don’t want to know how it will feel knowing I didn’t do everything I could.  

My first family meeting to discuss goals of care was over the phone. My patient had taken a turn for the worst over the last six hours and we needed to decide how to proceed. My patient’s daughter explained what she thought her father would want and together we decided palliative care was the best option. It was the first time I learned that sometimes doing nothing is the best thing you can do as a doctor. Especially if, in doing so, you are honoring your patient’s wishes and their ideas about how a life is best lived, even at the end. My first discussion of DNR/DNI took place in the ICU but was in-person. My patient coded at 07:35 that morning and we were able to get ROSC. However, the prognosis was poor and the likelihood we were going to be able to fix what made his heart stop in the first place was nonexistent. As I explained this to the family and sat with them, they shared more about the losses they had already experienced. They shared what made their family member special. They shared their love. We reached a decision about DNR/DNI and the family said their goodbyes. Later that night, I thought about what other job afforded someone the privilege to learn such personal things about another human being and could not think of any. My patient died an hour after I left the hospital that night. I was sad, but I knew I did right by him and honored his wishes.  

 I continue to carry these patients with me. They permeate how I practice medicine and how I approach similar situations. I try to honor them in small ways every day. They have made me a better doctor. A better person. But the immense feeling of loss and grief is not something that goes away. I have lost patients since and it never gets easier. Especially when my patients are children. I’ve cried in the bathroom at work and then wiped my tears to take care of the next patient who walks through the doors. I have sat with families as their child died. I have been part of many people’s worst days. And it is not something I take lightly. Now at 28 years old, I have experienced more than the small fraction of the spectrum of human emotion that I came into this career having experienced. Each time I think back to my initial experiences and how much I have changed and grown since then. Repeatedly facing death has made me appreciate life. And how beautiful and transient it is. Death is an inevitable part of life and we do not get to choose the way we go, but we do get to choose how we fill it while we are here.  

My transition into my medical career, though not traditional, helped shape me into the physician I am today. It made me a better person. I have grown outside the confines of my comfort zone and established new boundaries for what is comfortable. And I continue to try to push through those. I have learned that I can do hard things and still honor what I value most in life. I have learned to worry about what I can control and to approach the things I cannot with grace and humility. I have learned that I hate the word unprecedented, but I cannot think of a better word for the transition I (and many others in healthcare) went through. And although the life I am living in this very moment looks almost nothing like the picture I had envisioned in my mind, I am grateful. And it is beautiful.