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A Year Like No Other: M2 shares powerful stories from clerkship year

Posted by on Monday, July 19, 2021 in Second Year .

intro by Emma Mattson & reflection by M2 student

This summer, our M2s reached an important medical school milestone: completing their six core clerkships. Besides marking the halfway point through medical school, the end of clerkship year also signifies that you’re ready to take on increased clinical responsibilities during your Immersion Phase.

The M2 year at Vanderbilt is a year like no other, so we’re so honored to share a personal reflection from an M2 student at the end of their clerkship year.

Whether you’re just starting your medical education, studying hard for the Step exam, or preparing to apply to residencies this fall, these powerful stories will remind you of the beauty and strength of the medical calling.

Looking Back on the M2 Year

As I got ready for the last day of my second year of medical school, the widest array of experiences rushed through my mind. This year was one of the most incredible years of my life. I had the opportunity to meet, learn, help, treat, hold, and witness more than I knew existed.

I think of myself on my first day in the hospital, in the child and adolescent psychiatry inpatient unit, trying to find the words during morning rounds to ask a 13-year-old, who was admitted following a suicide attempt, if she still felt like she “no longer wanted to be alive.”

I think of the time on the neurology consult service when I was gathering the presenting complaint and history from a 25-year-old female in the emergency department, seeing the characteristic periventricular lesions that I had previously seen in my textbooks clearly displayed on her MRI, and then experiencing the emotional hardship of explaining and introducing a new diagnosis of multiple sclerosis to a patient my age, all within the span of an hour.

I think of the 45-year-old who was diagnosed with ALS, and the shock she felt receiving news regarding her poor prognosis and limited time left. I will never forget the fear I felt for the patient as I observed the fasciculations on her tongue illuminated by my pen light and the pronounced jaw jerk reflex I was able to elicit.

I think of my oncology rotation, where for the first time, I met patients one day on the service who were no longer with us when I showed up for rounds just a couple days later.

I think of the veteran I fed meals to in the VA every morning because he could not have any visitors during COVID and his fingers were so arthritic that he could not even grasp the modified utensils given to him by occupational health. I also think of his wife, who he described in the highest esteem.

I think of my time on geriatrics and palliative care, the end-of-life discussions that occurred one after the other, and the talk the fellow gave me on “signs of dying.” I will never forget what mottled skin looks like.

I think of my pediatric surgery rotation. I can still hear the popping noise during the pectus excavatum repair caused by the convex metal rod lying inches from the 17-year-old’s beating heart. I also think of the neonate in the adjacent OR taking up only 1/10th of the OR table as she lay there awaiting her pyloromyotomy.

I think of my time on the hepatobiliary service. I am still wrapping my head around the fact that I boarded a plane to assist on an organ procurement to bring back a liver for a patient on our service who had one of the highest MELD scores in the country.

I think of the 8-hour transplant where the surgeons seamlessly connected the donor and recipient vessels, and the feeling of shock I felt when I saw the extraction of the recipient’s liver that was so cirrhotic and misshapen, that I didn’t know how it could ever have come out of a human body.

I think of standing around the OR table alongside the 10 other members of the transplant team and the cardiothoracic surgeons that flew down from an outside hospital to harvest the donor’s lungs and heart. Before starting the operation, I remember the transplant coordinator reading a note from the donor’s mother about how she would “always be her little girl.” I was then able to see and appreciate the most immaculate anatomy still being perfused, with full tensile strength, by the donor’s beating heart. I remember witnessing cannulation of the aorta and holding the heart during its last limp pulsation, as we played the donor’s favorite song aloud in the OR at the request of her mother.

I think of the pediatric liver transplant I witnessed. I remember the surgery was so delayed that I decided to go up to the patient’s room in the PICU to check on the patient’s status. It was there that I learned that the anhepatic patient who was supposed to be transplanted that morning had clinically decompensated to the point where transplantation would not be possible. I witnessed the difficult decision making to ultimately move forward with transplanting the “back up” recipient while the cold ischemia time of the pediatric liver transported from California was reaching its upper limit downstairs in the OR. And, before having time to process everything I had just witnessed, I was assisting the liver transplant surgeon in the back table preparation of the donor liver, as the 13-year-old transplant recipient was requesting to “push her own propofol,” lightening the mood in the OR.

I think of the sterile paint used by the surgical oncologist to mark the breast tissue during a lumpectomy, which I then followed to the pathology lab to watch the pathologist determine if we had definitively resected the margins.

I think of inserting 17 staples in a patient’s scalp laceration during my ED elective.

I think of the first time I witnessed a human come into this world and the carefulness with which I laid the baby on the mom’s chest as far up as the umbilical cord would allow me to.

I think of how C-sections were my favorite surgery of the whole year to be a part of, because they are the only operations culminating in new life. Opening the little flap on the sterile sheet so mom could see her baby for the first time never got old.

I think of the patient I admitted while I was on the inpatient pediatrics service who unexpectedly was diagnosed with acute B-cell lymphoblastic leukemia and how life-changing that day was for their family.

I think of the patients on the inpatient pediatric cardiology service who had undergone major cardiac surgery, despite being just days old. Transitional physiology of the heart was my favorite topic I learned about in my pre-clinical year, and now I had the opportunity to auscultate and localize congenital heart murmurs in many of the patients on the service.

I think about how, during my time in the pediatric urgent care clinic, I mastered the art of optimally positioning a hysteric 2-year-old child on their parents’ lap to effectively examine their ears with an otoscope.

I think of my last two weeks of the year surrounded by the calmness of the bubble CPAP machines as I walked around the neonates secured in their isolettes, amazed at how the team was capable of delivering and caring for neonates at just 22 weeks gestational age.

I think of attending the huddle with the NICU team prior to a triplet delivery, gowning and gloving myself, receiving triplet A from the OBGYN after delayed cord clamping, and carrying him in the sterile blanket held tightly against my gown to the adjacent OR, so the other two infants could be accommodated in the delivery room.

I then think of the delivery where I was handed a pale, limp baby from the OBGYN team to place on the neonatal resuscitation table and was urgently instructed to hit the code button for the first time. I then watched as a seamlessly coordinated resuscitation of a neonate took place and the APGAR score continued to elevate.

I think of my patients, the residents, the attendings, the nurses, and the staff who helped me find my way on the first day, examine a patient, present a patient on rounds, and provided me with opportunities, chalk talks, and guidance to equip me in more ways than I could have imagined in just my second year of medical school.

This opportunity to meet, experience, work alongside, and learn from the most amazing teachers and patients on the psychiatry, neurology, medicine, surgery, OBGYN, and pediatrics services is one that I will never forget. It has instilled the deepest sense of passion within me to care for my future patients.