simple tasks

Presentation of the second prize winner of the 2022 Gerald F. Berlin Creative Writing Prize.

What follows is Simple Tasks, second prize winner of the 2022 Gerald F. Berlin Creative Writing Prize, presented via a brief note from the author. The Gerald F. Award is given to residents. and colleagues. To learn more about the award, see “reckless act of loveWritten by Richard M. Berlin, MD.

I wrote this article on a Saturday morning’s whim, partly to put off my studies for a few more hours, but mostly to express the complex range of feelings I’ve been experiencing over the course of a year. It poured me out in less than 45 minutes. I have come to see the practice of writing as a way of addressing and healing the many challenges that arise in medical school (and outside medical school), while also honoring ceremonies. I was excited to submit this article for the Berlin Prize after the article was published on the UMass community blog, and received an amazing outpouring of praise and support from my resonant colleagues. This award not only honors the piece, but the originality of the experiences detailed in it, and I am very grateful to the Berlin family for this recognition.

simple tasks

“I was going to open it up,” he clicks, staring at me intently. I already grabbed the doorknob, but I think I hesitated for too long. The resident does not take his eyes off me as I close the door and open myself behind him, allowing him and the rest of the team as much space as possible to leave the room. The patient, a nice but talkative guy, had been talking for 15 minutes, and we were just here to ask him a brief question. It’s noon, rides late, and it’s Friday: we’re all ready to leave.

As we walked back to the elevator, the resident taught me “one of the best skills to develop as a medical student”: the ability to sense when everyone else wants to leave and open the door so they can. “This is because you guys are always in the back by the door. You need to loosen the blockage.” He rushes in front of me to ride the elevator, and I follow him, taking my position in the back.

This is the second to last rotation in my third year of medical school. The curtain was pulled from me long ago, revealing how delusional I had been promised. It turns out that that year of my bold entry into the world of clinical medicine–filled with life-changing patient encounters, and brimming with educational opportunities–was often moments like this: I forced them to do menial tasks, and was told I wasn’t doing them well enough. Hold doors, file papers, cut sewing threads, and print menus for eight months. I have been referred to by the word “child” or “student” much more than by my name. I have been ignored, childish, and humiliated. Month after month, alternation after alternation, this year has often been like death by a thousand cuts.

However, this year has also been transformative. I have given birth to children. I went through 6 hour surgeries, sidelining all my bodily needs for longer than ever. I watched a neurosurgeon pull fourteen nails out of the head of a man my age, a man who shot those nails himself in a desperate attempt to silence the voices he couldn’t stop hearing. I sat for hours with a patient in psychotic pain, begging me to believe that he was actually reading the minds of everyone in the building and that we were all in grave danger. I’ve made friends, lost friends, laughed, and cried. I got engaged to my partner four years ago, and I felt the love deepen in a way that still surprises me every day. I’ve learned, grown and changed, yet some days I feel as though I’m still where I was at the beginning of this year: in the back of the room, at the bottom of the hierarchy, I’m told that the one thing that wasn’t done well.

I think it would surprise no one to hear that medicine, with all its selflessness and service, is a field plagued by cynicism and false negative aggression. Health care worker depletion is at an all-time high. Now approaching its third year, the COVID pandemic has left the medical world frustrated. And I think it would come as no surprise to anyone to also hear that in an environment where tensions run high and the valves are short, these frustrations are often unleashed on the smallest person in the room. Part of me understands that. Spending two years in a classroom (especially a virtual one) is poor preparation for navigating the hospital ecosystem, and it often takes twenty minutes to teach us how to do something an experienced intern himself can do in five minutes. I have met and worked with many wonderful teachers and colleagues this year. But for all the good that is in this year, it doesn’t make the bad endurance any easier.

How do we deal with a problem so widespread? It seems unlikely that a permanent solution will emerge, at least while I’m still in medical school. Our current grading system—one that places great emphasis on our seniors’ self-assessments of our skills and professionalism—keeps us firmly on the lower end of the strength dynamic. Should we swear that we will never treat our students this way? Should we allow ourselves to grow in a state of exhaustion and pessimism? Should we keep going to the hospital, running bravely day by day, saving our feelings of inadequacy and frustration to our loved ones, in tearful conversations and unbearable moments? I’ve tried all of the above, but none of them seem to work the way I want them to.

Although there may not be a permanent solution, I offer one that I have found most sustainable—one for which the simple tasks of a third-year medical student have prepared me. It’s a solution that I remember the same day, in the next patient’s room. We got off the elevator to the emergency department, and went down around a small bed currently occupied by a man in his 90s. It is impossible to look at him and not notice the length of his ears. When telling his story about the fall that brought him here, he had an undeniable wit that made me smile under my mask. Although he wears the same Johnny and yellow socks with fall-resistant rubber bottoms as every patient in the hospital, he still wears his own slippers, a glimmer of identity that he’s often stripped of here. I recognize these slippers. They are LL Bean moccasins. I have a pair that looks exactly the same, which my fiancée gave me last Christmas. When those present remove them to test the man’s reactions to Achilles, she leaves them at the foot of his bed. I know these slippers. I love how comfortable they are, how warm they are, and how they help me get out of bed on the coldest mornings. If I were in this place, this unfamiliar area of ​​horns, crowded corridors, and the constant screaming of another patient down the hall, I would stick to these slippers and the little comfort they provide as often as I can.

I think of another kind of moment that I experienced over and over again this year. I remember the resident holding the hand of an elderly woman crying, filled with mortal horror at the cancer diagnosis she received just yesterday. I remember the scrubbing technique that followed me out of the hospital on my last day of surgery, having left before I had a chance to say goodbye, just so he could shake my hand and wish me all the best. I remember my classmate kneeling in front of her classmate, who had nearly passed out from exhaustion, peeling the lid of her applesauce. If death brings a thousand wounds, steadfastness is done in a thousand acts of kindness.

It is in these small moments that we are reminded of the humanity we all share, and why we all respond to medicine’s call in the first place. I twist the engagement ring on my finger. It’s like falling in love: it doesn’t take away the pain of the world, it gives you the strength to keep going in spite of it. Kindness is a pair of slippers for the soul.

When the team leaves the room, I stop at the foot of the bed. “Do you want me to wear your slippers again?” Ask the man.

“Yes, please,” he smiles, “if you don’t mind.”

I grab each moccasin, gently lower them one foot at a time, and wish him a good day before I run behind my team in the hall.

Mr. Boyden MD, class of 2023, at the University of Massachusetts Medical School.