Views from the Back Wall

Glancing down at her wristband, I saw that we were nearly the same age. Her dark wavy hair was sprawled out across her pillow, thick-lashed eyes groggy from the Propofol. Her chest heaved up and down, controlled by the aggressive hum of the mechanical ventilator attached to her tracheostomy. She wasn’t fully conscious, but wasn’t asleep either. She was stuck somewhere in between. I couldn’t tell.

It was my first time in the ICU. While I’d become fairly familiar with the general medicine and pediatrics wards where we completed our Intro to Clinical Medicine course, as preclinical students we had generally been shielded from the acutely ill—the patient rooms that were more machine than human, where shrill alarm bells were more prevalent than the conversations of family members or the chatter of hospital staff. After all, to practice taking a history we needed a patient who could talk to us.

But there I was. I’d jumped at the opportunity to follow an attending I’d been working with on a summer research project into the ICU to watch her perform a procedure. I was eager to break away from my computer and remind myself that I had come to medical school to become a clinician, not a statistician. As we entered the room, I assumed my default position as the least experienced person in the room—pressed against the back wall. It was the only place I felt I wasn’t in the line of sight of the nurses keeping their eyes on the patient’s vitals, the anesthesiologist controlling her lines, or my attending performing the procedure. As a back row spectator with no responsibility other than to learn something new, I got to see the full picture of everything going on.

While the attending physicians were focused on the procedure, I wonder if they saw how the patient’s terrified brown eyes darted around before she drifted towards sedation. I wondered if they saw the picture taped to the back windowsill.  It must have been of her and her friends – though I hardly recognized the healthy girl from the picture laying in the hospital bed. I wondered if they saw her printed tote bags piled atop a chair, filled with trendy casual clothes and pajamas she would likely not get to wear during her stay here.

I tried to refocus my attention on the monitors, the imaging, the vitals—anything to keep me from lingering on the realization that this girl had friends who were worried about her, and parents who were kicked out of the room for this procedure to take place. As a medical student, I was stuck in a strange divide between the world of medicine and the outside world. I’ve learned the pathophysiology of many different diseases, but have not yet come to accept them as part of my daily life. Going in and seeing a procedure performed that I had only read about was certainly a valuable learning experience, but the intrusive thoughts of what this girl’s life must be like outside the hospital never ceased. My heart was racing. I squirmed, disappointed by my discomfort. Though surely it gets easier with more experience, that day was hard.

These experiences remind me of the true responsibility of studying medicine. These humbling, humanizing events are the fuel for my long journey ahead, with its litany of board exams, interviews, and impossible situations.  Because the kind of doctor I want to become is one who remembers how she felt standing along the back wall. One who remembers that the person in the bed is someone’s child. One who remembers the confusing feeling of excitement tempered with anxiety that ensued every time she entered the ICU as a student.

And even when, one day, I’m the one doing the procedure—in the back of my mind, I will still carry with me those things I saw, those things I felt.

As the spectator, I thought I saw something different from the attendings. I now realize that maybe though they didn’t show it, they saw it, too.