There is a place where the sidewalk ends
And before the street begins,
And there the grass grows soft and white,
And there the sun burns crimson bright,
And there the moon-bird rests from his flight
To cool in the peppermint wind.
Since entering the first clinical year of medical school, I’ve started to think a lot about endings. That is, what it means to have finally arrived at the end of something.
The accelerated curriculum adopted by our school has precipitated all sorts of awkward conversations on the wards about trunks, trees and branches. This is the first time that students have begun clinical training in their second, rather than third, year of medical school, and many attendings and residents still refer to us as M3s. For the first time, I’ve felt like the amount of experience I’ve accrued is not worthy of my title. Answering the question “So what year are you?” has been very conflicting for me. I can see the skepticism take over a patient’s face when I tell them I’m a second year. But it somehow feels worse to say I’m an M3 and have them overestimate my abilities. When we, the students, are brought face-to-face with the incompleteness of our knowledge – which happens often – we are told that time will bring experience. In high school, in college, I knew this to be true. I would wear my class year like a badge of honor: “I’m a senior now. I’ve done my time.” I point to my badge sheepishly now: “I’m a clinical student. But I’m technically an M2.” When does M2 year end for us? When does M3 begin?
Whether you are an M2 or an M3, the clinical years are just as emotionally as they are academically taxing. I have not seen a person die, but I have seen a person dying. I have watched lab values skyrocket and plummet, analytical proxies for the signs of impending death. How exactly do you define when a person has reached the end of their life? A last breath? A final beat of the heart? A silent brain? It’s a philosophical and ethical dilemma for the ages, but what frightens me the most is watching physicians make the final call. They take in the gestalt of a patient and declare that this person is not long for this world. One day, I will be the one leaving a patient’s bedside, slowly shaking my head, calling it the end.
You take on the burdens and concerns of your patients because you love them. But there are also loved ones outside of the hospital that need you, your time, your energy. Life happens outside of the wards. Things come to an end out there, too. I’ve mourned the end of friendships, relationships, the end of my parents’ marriage. Endings that are just as messy and difficult to pinpoint and define.
Soon, I’ll have to accept that as doctors, as adults, we will be the decision-makers in life. No longer are there the neat bookends of a school year to let us know that it’s time to move up and on. No longer can we rely on other people to declare what is so or not so, alive or not alive, dead or not dead. Maybe I hold on to my M2 status because it is something familiar and safe. But I also don’t see much wrong with spending a little more time in this liminal space; at the cusp of professional responsibility; where the sidewalk ends and before the street begins.