Resident Physician Columnist
University of Texas Health Science Center at Tyler
Srijna is an internal medicine resident physician at UT Health Northeast.
consci/o- [in medical terminology: a connection deep to a state of understanding]
All physicians are taught to communicate with a fundamental language of healing and justice. This column is a collection of reflections on how I learned this fundamental language and an homage to the teachers who taught me.
With just a few months left of residency, I’ve started to pay a lot more attention to what is going on around me. I’m realizing what a unique perspective we have as housestaff physicians. The best way for me to explain what I mean is with this story of one particularly busy shift in the ER.
Residency is hard. Anyone who tells you differently needs a stat GI consult because they’re full of it. You will be tired physically, mentally, and emotionally, regardless of what specialty you enter.
From the moment I set foot in the hospital as an intern on June 24, 2016 at 4:55 a.m. to the present as I write this reflection, my life feels as though it were playing in fast forward. It is hard to believe Match Day was almost a year ago.
March 18, 2016. I had been anticipating this day for months and I could not believe that it had finally arrived. I woke up that morning, sat on my couch, and began to journal as I do pretty much every day.
“Daddy, time to wake up! It is morning time!” I open my eyes to our four-year-old daughter at the foot of the bed smiling, her hair meticulously braided. I get up and wake her younger brother from his crib and carry him downstairs. The baby is still sleeping.
“Bunny!” my mom shouted from the foot of the steps, hurrying me out of bed the morning after my medical school graduation. She used the childhood nickname that came from my brother who was unable to pronounce “Dominic” as a toddler, a name that had stuck well into adulthood.
The word “gestalt” is thrown around constantly during medical school, residency, and beyond. Although never specifically taught, we all develop an idea of what gestalt means — impression, clinical intuition, gut feeling, something we are meant to develop over time.
I knew what was coming before it happened. She was looking up at the ring of white coats encircling her hospital bed, eyes darting from side to side to follow the sequence of their voices when suddenly, her lower lip began to quiver. And with her quivering lip, her breaths came faster and she sucked in deep gulps of air between her pleading questions. But soon the pack was headed on to the next patient on rounds. She was left alone, and the tears rolled freely.
I was one of only eight African-American students in my medical school class of 214, and now I am a part of the less than four percent of African-American physicians in this country. My personal and professional experiences have further invigorated my passionate interest in public health and to explore effective strategies to reduce health disparities for minority populations in the United States.
As we discharge another patient from the intensive care unit, we celebrate a job well done. “Can you believe how far she’s come in the past few weeks?” or “I didn’t think he would be able to go home so soon.” With the use of modern technological advancements, we are able to bypass the heart and lungs of patients, and push the limits of life to as early as 22 weeks gestation.
She was talking to another attending when I recognized her voice from around the corner. As a third-year medical student, I wanted to look busy, so I moved briskly, avoiding eye contact, trying to make it seem as if I were headed somewhere important.
One of the most poignant and gut-wrenching examples I’ve witnessed of the interplay between the social determinants of health and clinical practice arises in a particular patient population: those who suffer from addiction.
Fellow Physician Contributing Writer
Medical College of Wisconsin
Dr. Mark Kaeppler is a cardiology fellow at the Medical College of Wisconsin.
