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Final Exam

It ended much the same way it began. On this Friday, during the last lecture of our first year of med school, we were a sea of white in West Lecture Hall. The school year was ending with one last patient presentation. As usual, the guests sat in a row of seats on stage. Over the course of two hours, we listened and learned about their experiences with our health system.

At first glance, not much had changed among us first years–most of us sat relatively attentive (for a Friday afternoon) in our seats, scribbling the occasional note.  We were just as interested in learning from patients as we had been 9 months ago. Still, our coats were nowhere near as neatly pressed as they had been in August. A good number of us had gained some weight or loss some over the months. Relationships had been gained and lost too. Overall, though, most of the changes were subtle–so subtle in fact, I probably wouldn’t have noticed myself how much we’ve grown over the past few months if I hadn’t been prompted (by current circumstance) into quiet introspection.

First year had gone by in a blink. It felt like we had been sitting through our first lecture just yesterday. And now we were almost second years. Unbelievable.

After the lecture was over, there was an immediate exodus to the Learning Resource Center. Class was over, but it wouldn’t officially be summer until we completed our last exam of the year. We had until Monday to finish it, but most people had already set their travel plans for later in the evening (myself included) and needed to get the exam out of the way quickly. Gauging that I’d need to spend another hour or two looking over the material before I tested, I took a small detour away from the computer lab portion of the LRC to the portion where several rows of study rooms lined a long corridor (studying in one of these small classrooms is much more comfortable than cramming in a computer cubicle). However, when I approached this area, I was unexpectedly greeted by a series of big red signs covering the windows of the doors. They stated in bold letters:

“M4 CCA Exam”

CCA. Comprehensive Clinical Assessment. You don’t hear much about them as a first year but I knew enough to know your CCA Exam is a big deal. You have to pass two different CCAs, the first before third year, before you are allowed on the floors and the second as a fourth year.

I considered my current level of ability when it came to giving physical exams. I’d just given my first full physical to a volunteer “patient” a week before. There’s a lot to remember, but we’re trained to perform the physical in a systematic way that helps minimize mistakes. Despite my fear of inadvertently injuring a stranger, I performed relatively well (after I remembered to go back to exam the respiratory system, which I completely overlooked on my first sweep…forgetting to check an entire body system is generally frowned upon in this business…apparently).  Still, it’s clear that each year the stakes get higher—more work, less room for mistakes, increasing responsibility. And one day, not as far away as I like to imagine, someone’s health and wellbeing will depend on the decisions I and my 169 or so classmates, make.

Yep. All in all I was glad I wasn’t an M4. I had a good 3 years before I’d have to face the stress of my final CCA exam.

With the study rooms being occupied, I ended up studying for the last few hours at one of the computer cubicles. Despite the keyboard taking up a decent chunk of available desk space, it didn’t end up being too bad. A good number of my classmates were doing the same thing—spending the last few hours of first year cramming and scanning their notes –and because of that, a pleasant air of camaraderie permeated the LRC computer area.

A few hours later, when I felt ready to take the test, I started my usual pre-quiz/exam ritual: first, I took out a pristine sheet of computer paper and numbered it. Then I set aside 2 mechanical pencils (including my lucky red one). After that, I placed a single piece of gum beside my answer sheet (don’t knock my routine…you don’t make it to med school without being at least moderately anal retentive). The remaining tasks I needed to do to complete my ritual were to go to the bathroom and on my way out, fill up my water bottle. Making my way once more out of the computer area I headed toward the other end of the LRC. On the way to the bathroom, I passed several M4s (identifiable by their scrubs and the “let’s get this over with” looks plastered on their face) and what I assumed to be several standardized patients trying to find their places. There was a lot of activity.

Pushing open the bathroom door, I went to stand behind the sole woman in line. To my surprise, she took one look at me and immediately stepped to the side.

“Oh! You can go ahead. I’m not in a rush.”

I paused for a second, thrown slightly off-balance. In my 23 years of existence, no one had ever stepped out of a bathroom line to let me go in front of them “just because”. I was completely confused—until I realized I hadn’t taken off my white coat after the patient presentation. She must have gotten the wrong idea.

“Oh no…I’m not a fourth year!” I sputtered. She clearly thought I was one of the M4s preparing to take my CCA soon. I didn’t have time to be flattered by the woman (clearly one of the standardized patients) thinking me more advanced than I actually was—I was too busy being horrified at the fleeting prospect of having to perform a complete physical for evaluation. Nope, not me. Thankfully, not yet.

“I’m just a first year,” I finished. With that, I signaled her to go ahead, just as a stall opened up. For some reason, I was relieved when she nodded briefly and then disappeared from view.

Just then, at the sinks, another woman chuckled. She’d heard the entire exchange. I’d seen her before and knew her to be one of the coordinators of the clinical training programs ran through the LRC. She shook her head as she pumped a paper towel out of the dispenser. All the while, she smiled to herself.

“That’s okay…we’ll get you next year!” She joked.

Oh boy.

I hit me that she was right…you took your first CCA as a second year–which I’d be in about 2 hours time when my final exam was over. Lovely. M2 year: twice the lecture hours, third year looming in the distance, and of course…the dreaded Board Exam….Yep, just as I’d gotten used to things, the game was going to change again. So much for predictability.

Still, deep down, I knew I’d be ready. I have my friends—and between us, the solid kind of friendship that is best formed when you struggle and grow with each other. I have my family—cheerleaders, ever-present on the sidelines urging me on at the top of my lungs (and at times calling me back from the bench). But most importantly, I have a belief that it’s not a coincidence that I am where I am, when I am.

They say medicine isn’t a job but a calling. I tend to agree; and when you get a call like this, it’s pretty difficult not answer—and to be thankful for the privilege of  being chosen—every single day. Reminding myself of all of this helps me keep my eye on the prize. All that I’ve gone through, and will go through, is for a reason.

So…Second year, huh?

Let’s see what you got.


Even though it was only the second week of the Infectious Disease sequence, people were already beginning to get a little tired of the routine. Each morning started at 8am with 2 ½ hours of lecture with a small group session following directly after. Despite the “Groundhog Day-esque” feel of our days, I, for one, had come to enjoy the predictability of my mornings. Stability of any kind isn’t easy to come by in medical school, so whenever I find some, I consider it a gift.

Seven months into the year we had completed our first “sweep” through the entire human body. Covering each body system in turn, we’d spent our time learning what happens when the body is running like it’s supposed to.

ID represented an important shift in our education. Starting with ID, and continuing second year, the focus shifts to pathology–what happens when something goes wrong in the body. Even though it was early in the sequence (it’s one of our longest at 5 weeks), I liked ID so far. In small group, we focused almost exclusively on clinical cases. We spent time going through each clinical scenario one by one and discussed potential diagnoses, treatments, and preventative measures associated with the case.

When we were first presented with these cases, I had the unmistakable feeling that I was working to solve some kind of puzzle. A word search maybe. The answer was always right there in front of you somewhere; it was just a matter of putting the clues together. This particular day’s case was no different:

“A 72-year-old man who lives in a long-term care facility and who has had an indwelling Foley catheter for several months and chronic renal failure with a creatinine of 2.1 mg/dL, develops confusion, temperature to 101.2 F, and is brought to the emergency room. On physical examination, the patient is toxic, febrile and confused. He has what appears to be CVA tenderness on the right. His urine is cloudy and shows too numerous to count (TNTC) WBCs, 5-10 RBCs, and 3+ protein. His creatinine is increased to 3.1 mg/dL and the BUN is 75 mg/dL. Urine culture is obtained and the lab tells you that the urine is growing >105 lactose-positive gram-negative bacilli.”

There was a lot of information being presented and I did my best to quickly sort through all the “clues” being given. I skimmed through the questions that followed and attempted to draw some conclusions of my own (in a minute or two, we’d go over the answers as a group).

Why did the patient develop a UTI?

Catheter probably had something to do with it.

Why do you think his creatinine is rising?

First thought: his kidney is cranky

Second thought: Acute tubular nephritis (a regurgitation from lecture).

Why did the urine grown Enterobacter cloacae instead of E. Coli?

Um…good question.

Are there any worries about which antibiotic should be prescribed because of the specific organism that has grown in culture?

Even better question.

It was clear I had a lot to learn. But even though I didn’t have all the answers, it was still exciting to work through the puzzle of the diagnosis. As we thought through causes out loud, formed differential diagnoses and reasoned out treatment strategies, I reveled in the newness of what we were doing. When you think of training to be a doctor, you don’t necessarily think about memorizing biochemical pathways or spending hundreds of hours watching lectures. No, this was different. For the first time, we were actively learning how to think like a doctor thinks.

How cool is that?

After finishing up each of the clinical cases for the day and going over some basic lab techniques, it was time to call it quits. When the day’s session officially came to a close, I lingered in the classroom a bit to talk to friends. Then packed up my things and headed home to study. And I’d do it again the next day.

Stability. It meant that tomorrow, I knew exactly where I’d be and what I’d be doing.

But here’s the thing about predictability: it’s almost always a false sense–even if we like to comfort ourselves by thinking otherwise. As for me, I had to be reminded the hard way…

It started off simple. At around 10 pm, I caught a chill. Nothing big—I just couldn’t seem to get warm for the life of me. By 10:30, I was shivering and my stomach started to feel…well, “funny” (that should be an official medical term in my opinion by the way). At first, I brushed it off, thinking of any and every alternative explanation (read: differential diagnosis) for what I was experiencing. I assumed that the early morning lectures and lack of sleep were finally catching up with me. I figured it was something I ate and I just needed to wait it out. I thought a lot of things; but I certainly didn’t think that by 1:30 am, I’d be in the emergency room.

But I would be—because by midnight I was weak, my head was swimming, and my stomach…well, I’ll spare you a particularly graphic recounting of those details, but suffice it to say that it was like every ounce of fluid in my body simultaneously decided, “Yeeaah…so…I don’t really want to be here anymore”. What can I say–I felt. Like. Hell. Still, it was a friend who urged me to go to the ER rather than a plaguing sense of self-preservation. In actuality, something made me hesitate before seeking medical care. Maybe it was a childhood fear of the doctor’s office resurfacing at inopportune time. Maybe it was the more reasonable fear that the bugs I could catch at the hospital would actually make me sicker instead of better.

Or maybe, the truth was much more complicated and uncomfortable. Maybe the truth was that somewhere in the back of my mind, I thought I shouldn’t have been sick…couldn’t have been sick. Because being sick is a patient’s job, not mine.


Othering–a process of separating your identity from the identity of another and in doing so, avoiding the stigmas associated with the “other”. Seems to me it all boils down to the creation of distance—and that distance, in and of itself, is neither good nor bad. It’s both.

We are simultaneously implored to connect with patients emotionally and to not be overly moved by emotion. We are to get close, but not too close, and as a result, we draw boundaries in the name of professionalism. We divide us from them. Sick from well. Healer from healed. The million-dollar question is, where do we learn it?

I can’t pinpoint the source, but someway, somehow, it’s being taught. Want proof? I haven’t set foot on the floors and yet already I’m beginning to learn it. Without question, there is something invisible and persistent shifting my vision. The shift is slight now—no more than a slight blurring at the edges of my perception—but it is enough to make the reality of me being a patient feel…unnatural.

In any event, it was with a weary sort of acceptance that I offered up my arm to the ER nurse so she could take my vitals. The numbers weren’t great–I was definitely sick. Afterward, she shuffled me to a small room where I’d end up spending the rest of the night. I shed my pjs and quickly changed into the oversized gown they’d provided. Swallowed by the material, I felt small…and even smaller when they hooked me into a line and filled it with a drug I hadn’t learned about yet. Some time passed, and then a doctor came in to exam me. I recognized that she was giving an abbreviated version of the abdominal physical exam. We’d practiced it just a few weeks ago. It was something recognizable—and put me oddly at ease, at least for the moment. But then she was gone, and I was left alone.

In the quiet of my room, I wondered at my situation. Just the other morning I was in class, studying, living out a normal day. I never thought that in less than 24 hours I’d be in a hospital bed. It occurred to me that most people who end up in the hospital don’t plan on getting sick. They’re living out their “normal” days too, and then illness comes along and shatters their routine out of the blue. Sometimes, forever. How’s that for unpredictable?

The night passed slowly. I had to get up a hundred or so times to run to the small bathroom at the end of the hall. Trust me when I tell you it was a torturous procession—first, I had to unhook my IV bag from its post and hold it up in the air to allow the fluid to keep flowing. Then, I had to make sure the tubing wasn’t twisted, kinked, or just plain wrapped around my person. Also, leaving my room meant seeing other human beings and I was relatively certain that they wanted to see me exposed even less than I wanted them to see me exposed. Waddling down the hallway, with one hand holding the IV bag up and the other holding my gown closed, I felt like one of those contortionists at the circus (except I didn’t have the benefit of a leotard–which by my estimation would have provided better coverage than that darn hospital gown).

By morning I was feeling much better; not 100%, but well enough to be discharged. I certainly couldn’t have been happier. I spent several days afterward recovering (from what proved to be the worst illness I’ve ever experienced) and eventually had enough energy to return to small group. For my unceremonious return to the land of the living, I was greeted with a new clinical case. I skimmed for the highlights:

“A professor who was born in India returned there to lecture for a month…12 days after returning to the U.S. he had chills and fever that progressively became higher, myalagias, anorexia, and abdominal pain. In the ER, he said that he felt awful and seemed confused. His temperature was 103 F, pulse 60…..”

Although everything in small group was the same as when I left it, I stumbled a bit before dropping into business as usual.

Today, the “puzzle-solving” would have to wait; because now, instead of focusing exclusively on the differential diagnosis, or the source of infection, or the treatment plan, my mind clung to one sole conclusion as I rescanned the patient’s awful symptoms:

…This guy must feel. Like. Hell.

Interview Day

I find it interesting, and more than a little curious, that the standard uniform for interviewing is strikingly similar to the standard uniform for funerals.

The notion came to me as I arrived at the histo-lab (turned informal meeting space) that was the site of the UMMS Interview Day lunch. Pausing to fill out a name tag for myself, I noticed that the room was already awash in muted colors. Basic black. Classic grey. Navy blue for the more intrepid. It was sort of eerie to see if I’m completely honest; most of the otherwise stately looking M0’s were only a hood or cloak away from looking like something off the Lord of the Rings (…and I’m not talking about the Elves…). Still, in stark contrast to the somber tones of their suits, the faces of the applicants trickling into the room were overwhelmingly ones of relief and good cheer. It made sense. It was Interview Day at UMMS, and they’d just survived the main event.

Before long, I spotted a familiar face–an applicant I’d met the night before at Pizza House. She, along with a few other applicants, had joined current Black Medical Association members to learn more about the group. Now she approached, smiling wide, with her newly gifted U of M tote slung casually over one arm.

As we chatted idly about her interview experience, I paused for a moment and took stock of where I was. Around me, the impeccable dress of the applicants stood in stark contrast to the jeans-and-t-shirt look of the med students. But there was something else…some understated quality, outside of dress or academic position, that separated the med students and the applicants. I struggled momentarily, unable to quite put my finger on it. And then it hit me.

These interviewees looked like they were twelve years old.

I mean it. There was something about their demeanors, the way they listened to our words with wide-eyed curiosity; the fact that each time they allowed themselves to laugh, it was in this hesitant, unsure sort of way. I’m telling you, these people were downright pre-pubescent. They had to be.

But then again, there was something about that notion that didn’t sit quite right. Afterall, we were, in all actuality, quite similar in age. Saying that they look twelve, would essentially be saying that I look twelve myself…

And that’s simply preposterous.

Hmm. It was true, though, that there was something separating us; something beyond the logistical difference that we were already in medical school and that they’d be starting up in a few months.  As I folded over the thought in my mind, more med students began to file into the room. As my peers struck up conversation with the applicants, the histo-lab became transformed by the relaxed exchanges occurring between us and them; students separated by no more than a single year in real time, but much more than that in medical time.

Medical time…

That was it! I’d thought of the concept awhile back. It’s the best way I can come up with to describe what it’s like in medical school. Time simply runs differently. Take the real time (RT) concept of the weekend for example: for those running on RT, the weekend is a time of relaxation; a time to catch your breath from the craziness of the work week, sleep, and recharge. That’s true for us on medical time, conceptually at least; in practice however, for a lot of us, Fridays, Saturdays, or Sundays are the days when we often push ourselves the hardest. Weekly flextime quizzes, which we are allowed take anywhere from Friday evening to Sunday night, are a key component of our weekend. An unabashed Sunday tester, I live for the relief that comes when I press the “submit” button on my quiz. But when you’re running on MT, any relief can be short-lived—because in medical school, the march of time doesn’t slow for anybody. The lines between evening, night, and morning blur easily (especially when you throw coffee into the mix). When you are in the thick of a sequence (we’re doing the endocrine & reproductive systems now) it feels like there was no time before that sequence (cardio what?) and that there’s no time after (what sequence are we doing next anyway?).

You don’t have to be in medical school to feel that time difference. A 20 minute call home feels short to the loved ones who recall the days when you could talk freely in the evenings. To you, it’s more than a call; it’s also the one break you’ll allow yourself for the next few hours. Like I said, the clock rarely stops when you’re on MT.

But there’s more. Seeing someone in your age range who isn’t in medical school starts to feel strange. They seem so different than you. Personally, when I see one on TV or walking around downtown, dressed in their finery–carefree, seemingly unburdened—I don’t really know who they are.

I feel it happening…whatever “it” is that turns people into doctors I mean. It starts in the “us” becoming the “them”. It starts with division, the pulling apart of yourself from the world you used to know. The interviewees seemed young that day, not because they are by real world standards, but because in our world, time is different. Soon, though, they’ll trade in those stuffy suits for scrubs and a pair of whatever-is-clean-this-week. Leaving that life, they would become us.

And time, for them, would change too.

Learning to Speak

I usually feel like an impostor when I’m wearing my white coat. This day was no different. As I walked with my classmates down the corridor, I wondered if anyone else felt that way. But then again, it didn’t particularly matter either way at this point. We were on a mission–or at least it felt like it as the ten of us trinkled into the small conference room at the end of the hall. The patient hadn’t arrived yet, nor had the physician that would be evaluating our performance. This gave us an opportunity to pause before choosing our seat. Accordingly, I lingered at the outskirts of the set of tables that formed a “U” in the center of the room. There, I surveyed the space and contemplated which spot would give me the best chance of getting out of this thing in one piece.

Seating is a delicate matter. The choice, for most people is a matter of personality and one’s own relative comfort with risk.  With ten people working together to take the history of one patient, position was everything. Think about it. You go early and it’s up to you to get the ball rolling–you have to connect to the patient, make them feel comfortable, and most importantly, get them to open up–quick. You set the tone and direction of the rest of the conversation. Getting a bad start out of the blocks spells a bad race…no doubt about it.

Being first can be nerve-wracking, but so can going near the end. Going last means you have to really be on your game. You have to take note of all the questions your classmates have already covered and take special care not to repeat the same ones. What’s more, you have to synthesize all the disjointed information you’ve recieved from the patient into a coherent narrative. His or her story might not have come out linearly but you have to make it so in your head. You have to figure out what may be relevant (“the symptoms intensify when you’re at work do they?”) and what might be less so (“your sister just got divorced? I’m sorry to hear that”). Yep, any way you slice it, the ones who sit on the extreme ends of the table are either really confident, really comfortable with risk, or just plain got there late.

Me, I’m a classic middle shooter. As far as I’m concerned, the middle chair is the sweet spot. By the time it gets to the middle person, the ball is already rolling steadily; all you really have to do is keep the momentum going. Having gotten to know the patient’s situation through the questions asked by her peers, the middle interviewer can form an more informed hypothesis about what’s going on (an extremely rudimentary hypothesizes mind you–we won’t even finish our first pass through the entire human body until sometime next May). One’s nervousness has also likely waned by that point, being overtaken by a genuine interest in solving the mystery of the illness being presented.

Hence, it was with relief that I slid into one of the seats near the curve of the “U”. It wasn’t long before the evaluator arrived, with the patient of the hour in tow. They took their seats and then the clinical evaluator began to go over what we could expect in the session. The instructions were simple enough. The “patient” was really a local actor who had been trained on the specifics of a particular illness. She would be presenting this illness to us now. We weren’t there to diagnose (at this point I probably couldn’t even diagnose a missing limb with any kind of confidence…let’s not kid ourselves) but we were there to get the story of what was going on. To do that, we’d have to listen and ask the right questions.

According to our school fight song, we are “the leaders and the best”. With not one, but TEN such individuals all working on the same case, there was no reason to doubt that success was imminent…


“Who wants to start?” the evaluator chimed.

The room fell silent as the implications of her words took form in our mind. With her calm inquiry, seating order was swiftly rendered meaningless. Plan A went out the window. As the silence stretched on, all bets were off. I thought fast.

“I’ll start.”

First interviewer. I could do this. A last minute change of plans, but still a relatively safe bet on my part. Going first meant my job was to introduce myself and make the patient feel comfortable. Connect somehow. I’ve always been a talker, and never really minded asking people about themselves. I figured I’d be okay.

Orienting toward the patient, I informed her that I was an M1 student interested in hearing about the problem that had brought her in today. I asked about her drive up and if she’d found everything okay. I then asked briefly if she was from the area before finally moving the conversation toward her medical problem. By the conclusion of my questioning time, I must say, I was feeling downright pleased with myself overall. I had successfully gotten her talking and even managed to cover a few key medical questions. Life was good.

Sadly, my self-congratulation was short-lived. After I finished my portion of the interview, the evaluator immediately gave me her feedback. While her comments were generally positive and encouraging, one query in particular caught me off guard.

“What’s the patient’s name?” She asked. I thought back–and drew a blank.

Well then.

In retrospect, I’m sure the patient had a very wonderful name. Unfortunately, it had escaped my mind to inquire about it at the time. Not the best start.

Luckily, (feeling quite humbled) I was subsequently able to relax and take in the methods of my peers. Things seemed to go well overall. Of course there was the occasional repeated question, awkward sex history moment, or brain-freeze induced silence, but nothing major…Well, unless you count the fact that with all our questions, we never actually uncovered the true source of the patient ‘s pounding headache–i.e. the massive tumor pressing against her brain (personally, I could have swore it had to do with the noise associated with her kitchen being remodeled. Turns out they just threw that in to confuse us…see what we’re up against?).

Anyway, I’m realizing more and more that being a first year medical student is a lot like being a baby. We come into this new world, and don’t know a thing. On the first day, we couldn’t even sit-up on our own: most of us had never even seen a real dead body (outside of CSI) or so much as held a scalpel. The extent of our medical knowledge was whatever made it to Grey’s Anatomy or Scrubs each week…Things change fast.

They hand us a white coat and a stethoscope on the first day, sure, but it feels premature–because even now we’re just speaking our first words. Still, I’m trusting the process. We all have to–because in another year and a half, they’re expecting us to be able to run…

Looking Ahead

Focusing so much of my energy on school, I have to admit that autumn sort of snuck up on me. But rolling down the winding roads leading out of Ann Arbor the other day gave me a moment to appreciate the scene surrounding me. All around, innumerable piles of of richly hued leaves peppered the earth. Elsewhere, others clung stubbornly to the trees despite the gentle breeze playing across the branches.  There was a slight chill in the air but not enough to be unpleasant. Everything, it seemed, was in transition.

As we rode further, the familiar crush of resturants and tidy residential areas gave way to the openness of the freeway. On our way to Detroit, the four of us chatted idly as we went along. After spending most of the morning in cardio lecture, my brain and mind welcomed the current change of pace. For one evening at least, I could take my mind off of the review work and lab prep I had to do when I got back home (the next day my team was dissecting the superior mediastinum and lungs and I wasn’t comfortable enough with the material yet). I decided that all of it would just have to wait a few hours.

The Health Equity Scholars Program is new to the University this year. Since the program is in it’s pilot year, the program was kept small. Only 10 of us comprise the inaugural cohort. The goal of the program is to facilitate our learning about and participation in health equity work. This is done primarily through monthly seminars featuring UM faculty and community leaders, site-visits to local community clinics and observation of effective programs, as well as through service work–the latter in which we were currently engaged. Today, we were returning for our second trip to the Youthville Community Center downtown. Here, we assist in a program centered on improving the eating and lifestyle habits of a group of local children from the city.

By the time we arrived at the center, the organizers were just  finishing setting-up. It wasn’t long before the children (ages 9-11), arms laden with their “Healthy Eating” binders and notebooks, began to fill the room. Once parents and children alike were settled, Dr. Leatherwood started the evening. A pediatrician in the area and the leader of the program, when she stood, the low chatter filling the space slowed to a stop.

As she launched into a description of the day’s agenda, I found myself admiring the way she handled the room. I mean, let’s not kid ourselves–10 and 11 year-old children can be tricky to handle. Between their increasing exposure to all things adult (through their peers, the media, etc.), the impending onslaught of their own physical maturation, and, in general the entity that is Justin Bieber (enough said…), it’s a wonder that any kids these days can manage to keep their head on straight. Even more difficult than getting a firm understanding of the struggles they encounter at that age is effectively communicating to them how to make their lives healthier. But that is the task Dr. Leatherwood took up some years ago, not only through medical work, but through community work as well.

Sitting near the back of the room, I was able to take in well the scene playing out before me. It was a weeknight, so there was a very good chance that Dr. Leatherwood had worked early in the day. Yet, if she had, you’d never know it. Composed and warm, she greeted the children and asked them about their homework from the previous week. She was energetic and engaged them seemingly without effort. Despite her professional dress, straight shoulders and clear, bright eyes, there remained something very approachable about her. She projected confidence and intelligence and managed to speak at a level that everyone in the room could connect to regardless of their age or experience. The whole thing was kind of magical, in the way that the everyday occurrences can often be.

Maybe it’s because Dr. Leatherwood is an African-American woman like me or the simple fact that I’m finally starting to wrap my head around how long it takes to become a stand-alone doctor–but for some reason, I found myself impacted by what I was watching. All at once I could put myself in Dr. Leatherwood’s shoes. She had the kind of career I hope for: balancing clinical work with community work. She definitely knew her stuff as well…And, bonus points, because she was a snazzy dressy to boot (that part is hard to relate to though…personally, if my overall appearance makes me more ascetically pleasing than, oh, say, a zombie and/or lagoon creature, I consider myself ahead of the curve…Med school has a way of stripping away your vanity you see).

But, alas, just as quickly as my imaginings appeared, they receeded with the reality of my circumstances. I was a first year. A lowly M1! Still trying to figure out how the lines of the hospital cafeteria work. Still cringing each time we have to flip our donor body over in the anatomy lab. Still struggling for balance between school and…well, just about everything else.

It happens again. I wonder for the millionth time since I got to med school what I’m doing here. How I got here. I suppose the “medical student” identity still hasn’t completely settled into place yet…I wonder when or if it ever will.

Seeing Dr. Leatherwood reminded me how far I still have to go, but it also gave me a glimpse toward the other side. It’s encouraging to see what could be waiting at the end of all this. As a first year, those glimpses are both rare and precious. So when you get one, you hold on to it.