JulieLeung.com: a life told in tidepools

Enoch’s post giving a damn about the patient, not the numbers linking to Victor Van Hee’s A Great Case reminded me of an experience I had had in a hospital years ago – and how it was one of the reasons why I changed my mind and chose to leave the medical program I had entered.

I wrote a comment and then Enoch invited me to reply with more details:
If she’s comfortable, I’d love to hear more from Julie about her process of choosing not to continue in medicine, since she was to be in my med school class.

It’s taken me a while to figure out how to succinctly describe all my experiences.
Here’s my try:

At 19, all I had ever wanted in life was to be a doctor. Well, that’s simplifying it a bit: I don’t remember much before age 4. Perhaps here and there as a young child, I imagined being a veterinarian or a marine biologist, even a deep sea diver.

But for at least 15 years my mind had blinders, focused solely on medical school. And in my senior year of high school I was accepted to an eight-year college-medical school continuum program, a program in liberal medical education, one I had been eyeing since kindergarten. I was ecstatic. I can still remember how I felt when I opened that letter in the mail -and I think I remember the exact date too: December 23.

Sophomore year of college I decided to use the opportunity offered me through this program to shadow a physician for a day. Two other students joined me as we took a taxi early in the morning to the huge city hospital where we met the surgery resident. We spent the day following her and her crew. I remember having a corporate-sponsored sandwich lunch in a lobby somewhere while someone tried to sell us pharmaceuticals, and watching the third-year medical student practice stitching up an older woman’s bed sores during an afternoon clinic.

But what I remember most about that day happened quickly and quietly.
At one point, the surgeon and her crew, we shadowing students included, were in the Emergency Room for a shift. A man was rolled into the room straight from the ambulance. He was an older man with gray facial hair. His clothes were tattered and I think I overheard that he had been found on the side of the street. Victim of a hit and run or something. I don’t remember many details except that people rushed around him, removing his clothes, working swiftly, then stepping away.

This man had died. He lay there, stripped of his clothes, nearly naked, legs together but arms outstretched, looking like some kind of strange Christ. It was the first time I had seen anyone die. I was shocked by the death. I was also surprised by how rapidly it all had happened: rolled into the room and then declared dead.

But what shocked me more, was how everyone reacted. Or rather didn’t react. No one said anything. The surgeon and crew walked out of the room, shift over, and onto the next project. Inside I was disturbed, feeling much distress over the situation, and the silence made me even more upset. But no one else showed any emotion. No one even asked me how I was. The other two students my age seemed calm. I felt something must be wrong with me. I must have been the only one with such feelings. I bottled it up, waiting until the end of the day, when I got home to my dorm room. There I wept.

Granted, the patient who died had been wheeled into the ER already near death and he wasn’t someone we had spent a lot of time working on. I think he was even a bum from the side of the road, literally. But it still affected me a lot. I felt that perhaps I was expected to swallow my sensitivity. I was supposed to become a doctor detached from her patients. I felt a message had been clearly telegraphed to me that day: in order to become a physician I was going to have to become much harder and less sensitive. I wasn’t sure I could do that. I wasn’t sure I could see people die and not feel anything. I felt like a part of me was going to have to die too.

This ER experience though was not the main reason why I left medicine. If it was, I probably would have gotten some counseling or struggled more to try to work through feelings. I would have tried to practice detachment.

But I had other concerns too, such as financing medical school and going into debt for the sum of $100K. After looking at the loan figures I realized I’d be paying for medical school until my own children were old enough to attend.

And children were another part of the picture. I had never planned on having kids, but then in college I began to change my mind about motherhood. If I had children, I knew, from my years as a latch key kid, that I wanted to be able to be at home with them. So at 19, when I decided I would “opt out” when the kids came, I figured that medicine would not be the best career choice. Surgery and obstetrics were the specialities that appealed to me the strongest, and I didn’t think I could do those without paying a price in many ways in my personal life.

I also had many emotional and spiritual reasons for leaving medical school, perhaps I’ll describe those in further detail in a later post. To summarize, I found myself examining my life, perhaps simply doing the obligatory collegiate navel-gazing, but also discovering new aspects about myself, now that I was living thousands of miles from family and home, and finding out more about who I was. What mattered to me. What motivated me. Who and what I believed. What choices would I make to shape my life. And while sorting through the pile of spaghetti inside me, it became clear that I needed to leave medicine, at least for a while, for my own emotional and spiritual health. At college, for the first time, I sought out spirituality, finding that for me, as I was trying to come closer to God I was growing farther away from medicine. So I left the program.

But that picture of the dead patient in the ER has stayed vivid for me all these years: his body stripped and stretched as if crucified, the lack of emotion outside but the feelings inside me strong. How I went home to my dorm room and cried. I called Ted, my-then-boyfriend, so he could help comfort me. I needed compassion. I didn’t think doctors had any, but I still did.

So when I read Enoch’s post, calling for compassion and sensitivity towards patients, something inside me resounded. He and I became friends in college, when we were both in the continuum program. If I had stayed we would have received our M.D.’s together. Now he’s practicing medicine and I’m staying at home with my kids, each of us on the path we chose many years ago. Reading his blog medmusings gives me glimpses of what I’m missing and I still have strong interests in science and medicine. Sometimes I wonder whether I’ll return to that arena in any way. But I know for now that I’m where I want to be.