GUEST POST: On Transplants and Transitions Monday, December 16, 2013

Medical student Jennifer Klein (pictured here) writes: 

The view over the shoulder of the surgeon was limited. I stood on a stool and craned my neck, but still, I couldn't see. Around the operating table were five surgeons from three medical institutions working over the small surgical field of a one-month old child. When I was able to come up to the table, what I saw amazed me. The infant, a victim of child abuse, was an organ donor and my team was removing the heart.

As a third-year medical student, I was fortunate to witness every exciting and tense moment of the heart transplant process: from the surgical procedures to informing the recipient's family of a successful transplant. In the days that followed I shared with enthusiasm what I had seen. And the reaction of my friends and family was surprised me: they were in awe, but also horrified. How could I talk about something so tragic as something thrilling? How could I describe the experience as “incredible” when it was also filled with sadness? Of course the experience was emotionally wrenching. I continue to struggle with the conflicting exhilaration of the medical event and the tragedy on a human level.

But, I no longer had the same perspective as my family and friends. Sometime, I don't know when, in the course of the third or fourth year, a crossing occurs. Slowly. It’s not a run across the bridge, look back at the other side and struggle to recall the view from moments ago. Instead the clinical years of medical school are like being in the middle of the bridge, cautiously crossing the gap between layperson and physician, aware of progress but hesitant to take the next step. The view is uniquely its own.

The clinical student is far from a lay-person. The words “EF” and “CMV” have meaning. Not just definitions read in a book, but implications you’ve begun to appreciate. And even more importantly, a clinical intuition begins to develop. You can walk into a room and gauge if the patient is “sick” or “sick sick,” or better yet, you know if this is something you can handle. You can look at an EKG and tell it’s not normal, even if you can't make a diagnosis from it. And you surprise yourself when a patient asks a question and, woah, you know the answer! Yet you are far, far, from being an experienced clinician. You watch the attending accurately diagnose a patient from the doorway and think “oh my god, how did she do that?!”  And when you are asked a question that you should know from studying for Step 1, but you don't, you cross your fingers that you are skipped in the line of questioning. And when the patient asks you a question and don’t have a clue how to answer, you can easily say, “Let me get the doctor for you...”

Alas, you are somewhere in between. It can be precarious, sure. You don't always know how much you should tell the patient, how much autonomy a particular resident or attending will give you. But mostly, it affords you an amazing view of the medical system. You get where the doctor is coming from. You've studied the outcomes of a particular disease or treatment. You may have even seen another patient suffer from or fight through the same illness. You understand the frustrations in the system, the high demands on the provider's time.  But you also get it from the patients point-of-view. You can tell when the doctor is talking too fast, rushing through medical terminology that you aren't even sure that you understand. You have spent time with the patient and can tell when a family member is getting upset or when the patient seems depressed. You understand that the hospital is a confusing place and struggle, yourself, not to get lost in the hospital basement or locked in a stairwell.

Somewhere in this confusion, in this ill-defined but incredibly-defining phase, is a truly unique and special view. No one doubts that this is a period of personal and professional transition, but rarely is its magical nature mentioned. It is the place where a heart transplant is both tragic and thrilling, horrific and inspiring. It is not just a phase to get through or a brief layover point on the way to becoming “physician.” It is the unique third and fourth years of the medical school experience that are irreplaceable. So let's enjoy the view!

ABOUT OUT GUEST POST CONTRIBUTOR: Jennifer Klein graduated from Washington University in St. Louis where she studied Anthropology. She is currently a fourth-year medical student at Emory University going into pediatrics.


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