MSIII: Bring Your Own Chair

Six weeks ago, I made my official entry into hospital life. I put on my short white coat, stethoscope around my neck, and headed into Children’s Hospital Los Angeles, having no idea what to expect. My first week was also the interns’ first week, so I got to witness firsthand the impossible transition between being a medical student one week and a doctor the next. Spoiler: there was not a day when no interns cried.

The first thing that stood out to me was the incredibly intense work culture. I didn’t know that so many people could act like it is completely normal to work for 12 hours at a time without so much as a ten minute break. I arrived each day at 5:30 am, and when I’d get dismissed around 5 or 6 pm, the interns would look at me longingly and tell me to enjoy seeing the sun. There is no such thing as a lunch break. Everybody works furiously until 1:30 or 2 pm, then we go and grab food from the cafeteria and bring it upstairs, right back up to our work stations.

Every sixth day, I worked a 17-hour night shift. I felt very doctor-y, running around the hospital all night, admitting patients with my intern. For the patients I admitted, I was the first person to talk to them at length since they had arrived in the hospital, and I was the one waking them up every day before 6 in the morning to talk and examine them. When it came time for rounds at 9 am, I’d make a presentation to the medical team (nurse, three interns, senior resident, attending), patient, and patient’s parents. It was the first time I got to follow the same set of patients day after day. 

At 3 am one crazy night, after holding down a particularly squirmy, screaming toddler to jam a tongue depressor and a flashlight in his mouth to look at his throat until he threw up on me (out of defeat or protest, who knows), I stepped into the hallway with my intern. She looked at me and said, “Why am I here right now? I love kids, but I could have made so many other choices and been happy. I could have been a teacher. I’m so tired. I hate my life.”

Perhaps that will be me in two years. I really think working every sixth night indefinitely, and working from 5 am until 9 pm on all the other days, with an average of one day off per week (which means you could get stuck working 12 days in a row), will kill me, too. I understand why there are so many tears. I’m sure I would have cried trying to do all the work they had to do every day, knowing that getting tired will only slow you down, so you won’t get to leave until late at night, but no matter what time you leave you have to get up at 4 am and come back so you can start over the next day.

Before this gets too dark, I want you to know that some parts of it are good. My psychological state is much better than it was two months ago. Working with people in the hospital is far less depressing than silently studying alone for 10 hours in my room all day. An overwhelming majority of the pediatricians I have worked with have been nothing but supportive and eager to teach. It just seems that as a group of people, doctors have taken it upon themselves to remove all non-essential elements of human interaction. Thus, because I am a third year medical student and my value to the medical team is extremely low by definition, my presence is often ignored completely. It’s not personal.

Being a third year medical student is the most awkward thing I’ve ever experienced. Janhavi used to tell me that when you’re a third year, you become very aware that third years drag down the hospital, and that it’s no one’s fault, but that it sucks for everyone. I don’t know how to do anything, so I always have to be shown. My notes need to be proofread, my patient plans modified, my physical exams double-checked. It’s a giant amount of work to teach an MSIII (medical student III: that’s my title now) to be a doctor.

After my three weeks of inpatient life at CHLA, I transitioned to outpatient clinic life at the county hospital. I have a much less active role in clinic, often just shadowing. Sometimes even being the shadow of a doctor is difficult. More than once I lagged behind the group by ten seconds, taking off my disposable gown, mask, and gloves while saying goodbye to the patient, only to step into the hallway and realize that the entire team of doctors had evaporated. Poof.

I have become very good at looking busy while standing idly in the middle of a hallway. I’ll be with a couple residents, waiting for the attending, and they’ll sit down at computer stations to write their patient notes. There are no extra chairs, and I can’t go study somewhere else because no one would think to come grab me, so I just stand by, trying not to hover but not to get ditched either. I tally the minutes of awkward loitering I have accumulated over the past few weeks.

There is a palpable hierarchy. As medical students, we are advised to only answer questions that are asked directly to us, even if a question is posed to a small group. You don’t want to come off as a know-it-all, or to make the residents look bad. Quizzing medical students is everyone’s favorite activity. It’s called pimping. It makes up a large part of the interaction I have with doctors throughout the day. It can be used to assess a baseline level of knowledge on a subject, or just for the general entertainment of the doctors. I was in a lecture the other day, in a small conference room with about 15 doctors. I was sitting on the floor next to a bookshelf, since it is an unspoken rule that medical students are the first category of people to sit on the floor when the chairs run out. Halfway through the lecture, the professor pointed to the bookshelf and said, “I saw a medical student back there somewhere. Medical student! What is the molecular weight of albumin? This should be common knowledge.” I don’t know.

 
Finding somewhere to sit is one of my most frequent problems. In bigger conferences, the designated area for medical students is at the very back of the ballroom. Even though I arrive early, I look at the empty 50 seats and realize that there won’t be one for me. I put my stuff down and go chair hunting. When I find one that looks stealable, I start the trek back to the conference room, carrying my chair. People stream steadily into the conference, 2 minutes late, 5 minutes late, 10 minutes late. I can feel someone hovering right behind my chair at 8:15. I turn around and ask the doctor if she’d like my seat. “Sure, thank you,” she says. So I sit on the floor in the back of the ballroom, leaning against the wall, unable to see well. I find this ironic since I am the one who knows the least out of anyone in attendance, and I am in desperate need of teaching. Even if I had carried ten more chairs to this meeting though, I’d still be sitting right here.

Step 1: A Horror Story

Step One—two words that will send shivers of terror down any medical student’s spine. Ever since the first week of medical school, I have been hearing tales of how crazy it makes people go, how soul-crushing the process is. On the surface, it’s just an exam. Step 1 is just the first in the series of medical board exams, but it is the one with the highest stakes. It is the exam that largely determines what kind of doctor you can be after medical school. The higher of a score you get, the more options you will have in terms of your specialty. Score low and you might not get to choose at all. It’s a very big deal.

A friend of mine told me that by the end of studying, she became convinced that she had lymphoma, so she went to the doctor and demanded a full workup. Another friend told me that I was going to be so busy studying that I wouldn’t even be able to go to the grocery store or buy more highlighters, so I should buy as much of everything as possible every time I went to the store. Another casually tried to warn me that I might feel like I was going to die. At the time, I laughed it off. I thought, “Oh, people in med school are so neurotic and high strung, I’m sure it’s not that big a deal. It’s just studying for a test.”

I started my 11 weeks of studying with plenty of optimism and motivation. I wrote a blog post telling my friends how to love studying. I find that hilarious now.

Quite simply, I underestimated how terrible it would feel to study for at least ten hours per day, for weeks and weeks and weeks. We were advised to take at least half a day, but no more than one full day, off of studying per week. I was doing ok with studying for the first month or two, slowly becoming more miserable, but still just chugging right along. My psychological state gradually worsened though. I started having trouble sleeping. My appetite changed such that I wouldn’t really feel like eating until I was starving, and then when I finally ate I’d feel queasy. At least once per day I’d notice a baseline level of slight nausea. I became a lot more apathetic, with a slight but ever-present sense of impending doom. I am significantly less happy than I used to be.

My alarm has been set at 5 am every day for months now, and as soon as I get up every minute is on the clock. Either I’m studying until the timer goes off, or I’m on a break until the timer goes off, until studying is done for the day. When I’m done, I am exhausted and have no energy or motivation to do anything. I get in bed and don’t even feel like watching TV. I just scroll through instagram until I’m bored of it, then do a guided meditation using an app on my phone to try and put myself to sleep. And this day seems to repeat over and over and over again. I still go to CrossFit every other night, and study with my friends here and there though, so it’s not like things are 100% bad 100% of the time. Still.

I was taking my rest days as scheduled until 20 days ago, when I scored horrifyingly low on a practice exam. As if I weren’t stressed out enough already, I realized that if I wanted to make it to my older brother’s wedding and get to have a break before starting third year, I’d have to intensify my studying. I’d have to work the hardest I ever had for 20 days on end. So I did.

This study season has made me crave normalcy more than anything else. I just want…Saturday. I am sad because the weekend does not exist right now, and I am sad because my work schedule is going to be very intense for a long time, starting now. The weekend has been cancelled, starting now, for six years. Maybe that’s a bit of an exaggeration, but it’s also not. I just wish I could wake up slowly, make pancakes with Jono, go to CrossFit, then spend the day lounging around. I wish I could be normal.

This is the first time I have truly resented medicine. It feels like some sort of sick game where you work as hard as you can, just to be promoted to the next level, where you have to work even harder until you move up again to work harder still. At the same time, I love it. I find it interesting and stimulating and challenging and rewarding. It is definitely what I want to do with my life, and I feel lucky to have the opportunity to do it. I just didn’t fully grasp until now that doing medicine would mean only doing medicine. It looks like it’s going to be hard to find that work-life balance. I have a lot of years to try and work on it, I guess.

There has been a lot of talk these days about mental health in medical school and residency. During my first week of medical school, the student health center gave us a presentation telling us that 50% of us would have issues with depression and anxiety during med school. Last year, a faculty member killed himself. Just this month, a boy in the grade above me. I am starting to see how dark medicine is on the inside. Feeling so burnt out after just a few months of studying makes me see how people would develop serious depression from doing real doctor things—with all the pressure, responsibility, and sleep deprivation that comes with them. No wonder it happens to so many people.

On the brighter side of things, I made it to the end of study season. Step 1 is tomorrow. Today I’m just relaxing and taking a break. Studying is over. I would expect myself to feel more anxious, but I think I already used it up somewhere along the way. I have accepted that my study to-do list will rest unfinished. I did not learn everything. I’m sure I could study full-time for another month, or another six months, and still not feel comfortable with all of the information. So I guess it’s just time to do it. Thank goodness.

How to Love Studying

Friends and family, it’s been another two months since my last post already, oh my! I hope everyone is doing well. I have arrived at a very important time in my life: Study Season. It’s not just any study season (most seasons are study seasons), but this is the study season. The time has come for me (and all the other second year medical students) to study for my first board exam, and it happens to be the one whose score determines what kind of doctor I am eligible to apply to be. It is one of the most critical exams I will ever take.

The volume of testable material is quite amazing. Imagine learning as much new material as you possibly can handle all day, every day, for a year and a half, then trying to remember it all at once. Zillions of diseases and their symptoms, why they happen, what sorts of cells you’d see under a microscope, what sorts of drugs you might use to treat them, how those drugs work, and what other effects those drugs might have. Not to mention the details of how the body works when it’s in perfect health…

So, naturally, people are freaking out.

The official recommendation is to study for about ten hours per day for ten weeks, with up to one day off per week. I was anxiously telling my mom about it, and she said, “Well, if I had to pick anyone to study so much, I’d pick you. You’re really good at it, and you like it.”

And when she said it, I realized she was right. I certainly have had a lot of practice with studying over the years, and I genuinely do find it fun and interesting. I guess out of anyone, I am least likely to be upset about having to study so much.

And so it began. I made a study schedule, and I shifted my sleep schedule so I could start my days at 5 am. My main activities include studying, sleeping, working out, cooking, and chit chatting with Jono. It’s only been a couple weeks, but I feel really good so far. It’s hard work, but every day I am impressed with how much it is possible to learn in a day. I am excited about learning more things, and it is deeply satisfying to have information from different body systems come together and make sense. I have 65 days remaining until my exam.

People often ask me for advice about work/study-life balance, so I thought I’d organize some tips that have helped me become my most productive self while still loving my life and my studies. The main goal of all of this is to get your body and mind into an ideal state for learning. A big part of that is to help yourself enjoy studying, so that you can do it for longer without burnout.

  1. Sleep should be your top priority. You can’t expect your brain to be able to learn and retain endless trivia all day unless it is well-rested. Even if you’re sleeping six hours per night and feeling fine, the studies show that you make fewer mistakes on a full night’s sleep. Go to bed on-time so that you can sleep for at least 8 hours.
  2. Consistency is key. If you want to wake up early and be able to focus right from the get-go, you want to be in a predictable pattern. After going to bed early and getting up early for a couple weeks now, I wake up without an alarm around 5 am and my body is ready to wake up and start learning. If it is at all possible, go to bed and wake up at the same time every single day, including rest days.
  3. Work without distraction. I cannot stress this enough. Do not waste your energy trying to concentrate in an environment where your attention is being shifted in different directions. Answering text messages or even just passively listening to other people’s conversations during studying is a waste of limited brainpower and attention.
  4. Cluster administrative tasks together. Set aside time for emails (or research, ughhh), and choose this block of time to be one with lower productivity. For me, this would be before bed, after I have finished studying for the day. Again, you want to avoid spending 10 – 15 minutes on an email, multiple times per day, switching your attention back to studying each time. Get non-studying administrative items done all at once.
  5. Nourish your body by eating real foods and exercising. How can you expect your body to feel energized and perform well if you put junk into it? I know you think you don’t have time for cooking, but you can make the time to prepare meals ahead once every three or four days. If you can dream it, you can do it.
  6. Don’t force it. I believe that studying does not have to be painful. You don’t have to meet your goals every single day. You will have more stamina in the long run if you find a way to study (mostly) when it feels right. If you are in a bad mood or just hating it, take a break for half an hour and come back to it. Often when I am feeling mentally fatigued, I take a nap. When I return to the books an hour later, I feel like a brand new person.
  7. …but if you must force yourself to go on, just take it one set at a time. Just like in the gym, breaking your work into manageable sets makes all the difference. Work for 25 distraction-free minutes, then take a five minute break. Just keep doing that set over and over until the work is done.
  8. Don’t compare yourself to other people, and try not to take on their anxieties. This test is about you. You already know how to study. Of course there are people around you that know more than you, about literally every single topic. This is medical school life. Just keep on doing your thing.
  9. Make peace with your sacrifices. Your goal is to become the smartest you have ever been, in a relatively short amount of time. This is not going to come for free, and you are not going to be able to keep up every single one of your hobbies and relationships and leisure activities this season. It’s ok. Most things will be there when you have time to get back to them.
  10. Lastly, remember why you are doing this. Appreciate the fact that that the content you are studying is fascinating, and has real-life applications. This is an opportunity to show yourself what you are made of—to show yourself how driven, focused, and powerful you can be.

Friends, now is the time. Go get ‘em.

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A Trip to the Coroner

At this stage in med school, I’d say that I’m pretty comfortable with dead bodies. After spending countless afternoons down in the basement with my group over the past couple years working on our cadaver dissections, the morbid jokes just keep getting funnier.

Until yesterday.

Just a note—if you don’t want to read a very graphic description of an autopsy, you should maybe skip this post…

Yesterday, eleven of my classmates and I went on a field trip to the Los Angeles County Coroner’s Office, right down the street from our school. When we arrived, we had a quick briefing. We learned that this coroner’s office is the only one that does autopsies in Los Angeles County, and that about 20 bodies arrive each day. We learned that in order to be qualified to perform autopsies, you have to go to med school, specialize in pathology, then train in forensic pathology. We then moved into another room to be briefed by another pathologist, who was going to let us watch him perform an autopsy.

A large, sixty-something man with a thick accent sat us down around a round table in his office. He asked each of us what kind of doctor we plan to be, then told us about his path to coroner-hood. He said that when he was in medical school, his mentor had told him that his bedside manner was awful, and that he’d need to choose a specialty where he wouldn’t interact with patients.

Then he took us into a supply room, where we were given entire outfits to wear over our scrubs: plastic gown, thigh-high plastic leg and foot covers, thick gloves, head cover, respirator mask, and face shield. Without further ado, we were led through a hallway, which was probably the point in the day when everyone’s eyes first started to open wider and wider.

There were dead bodies on tables lining the hallway. Some were covered in plastic, some were naked and fresh-looking. There wasn’t much time to ogle before we were led into an autopsy room—a sterile-looking room with windows panelling two walls, with a naked, dead body lying face up on the table.

That was the guy whose autopsy we’d be witnessing. He had died two days ago, of “accidental / natural causes,” according to the preliminary report. Perhaps the autopsy would uncover something more specific. He was middle-aged, and so normal-looking. He wasn’t like the specimens we work with in anatomy lab—he didn’t look so pale, preserved, old, hard—he didn’t look so dead. He looked like someone you may have nodded to when walking on the street three days ago. Maybe you did.

Then the slashing began. The pathologist made quick cuts diagonally down his chest, and vertically down his center, so that the cuts would not be visible at the guy’s funeral, he explained. The deep cuts revealed bright colors—red muscles, orange fat, cream-colored bone. The pathologist’s assistant grabbed hedge cutters (or something) and swiftly cut each rib, removing the front plate of the body and placing it on top of the guy’s legs. He cut an artery in the neck and used a metal ladle to scoop out some of the oozing blood, transferring it to an empty glass jar. The whole thing took about 20 seconds.

We all just stood there, crowded around the body, silent and shocked, admiring the shiny, vibrant organs inside that were now in direct view: the lungs, liver, and intestines, in a way we had never seen them before.

For the next couple hours, the pathologist cut out each organ, one by one, to present to us. He would hold an organ, quiz us about it, then toss it into a hanging scale just like one you’d see in the produce section. He’d grab a whiteboard marker and scrawl the mass of the organ onto the wall, then scoop it out with a paper towel and pass it around to us. Pretty soon there was blood everywhere—all over the table, dripping from each organ onto the floor as we passed it around, on the wall, on our gowns, on the specimen jars, on the whiteboard markers, all over the body and the face. The central body cavity was wide open, with all of the organs strewn about on the table.

“See the diaphragm? Look how thin it is. Feel it. Now look at this iliopsoas muscle. Look how big it is. Can you live without the iliopsoas? Yes. Can you live without the diaphragm? Absolutely not. So take that as a metaphor. Life is not about size or status. It’s not about what you have. It’s about what you do, your function. I know as medical students you are at the bottom of the food chain. You feel small. I remember that; I was there once too. But I want you to remember that old bald guy at the coroner’s office and keep going. Remember that I told you that size doesn’t matter.”

Then they brought in the electric saw.

“Time to see the brain!” he kookily exclaimed. His assistant used a scalpel to free the skin from the skullbones, then folded the scalp down over the face, so that when you looked at the face all you’d see was the inside of the scalp. They plugged the saw in and went to town. Not two minutes after the unforgettable smell of bone dust hit my nose, we were passing around the skull cap and the brain.

He pulled over a big cutting board and started slicing the jelly-like brain into one-inch slices. The slices squished around on the cutting board, eventually being reduced to a mushy blob. He pointed out the arteries of the brain, showing us small plaques indicative of diseased vessels. He put the skull cap back on and peeled the scalp back over the head, rendering the face outside-out again.

“See? Good as new,” he said. No one at this guy’s funeral would be able to tell that his brain was missing.

One by one, he sliced up the other organs too to show us the insides of the insides. Once he finished all the cross-sections, he said, “Okay, that’s it. I won’t make you guys stay for clean up. I’m going to collect some more samples, clean and stitch this guy up, send him off to the mortuary, and do my paperwork. Thank you for coming. Goodbye!”
It was one of the most fascinating and horrifying things I have ever seen.

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How A Year of Medical School Has Changed Me

The three semesters that I’ve been in medical school so far seem both short and long. This winter holiday has been a wonderful break from constant studying, and has allowed me to realize that I am changing. I’m somehow different than I was before this whirlwind started.

The life I live now is a strange one. I spend my days studying, either in the library or in a café or at home. I wear earplugs to block out sound, and close my eyes as I go over pathways and sets of facts in my head. I wear earplugs everywhere—school, gym, café, home. The world feels too loud. I treasure silence.

I’ve become a worse listener. Not only do I forget things that people tell me, but it takes a more active effort for me to actually listen when people tell me about their lives. When I finish phone calls with long-distance friends, I have to jot down some notes from the conversation so that I don’t immediately forget. It feels as if there is no more space in my brain for things I am not studying. I think about other people less than I used to. It makes me feel self-absorbed, and like a bad friend.

I have no sense of time. My daily activities are the same most days: study, exercise, research, sleep, coffee dates with Jono—in no particular order. I never ever know what day it is, and I only find out about Mondays when someone asks me at the gym how my weekend was.

It feels like people speak slowly now. I’m fully used to listening to lecture videos at double speed, and I cannot stand the pace of normal lecture. I avoid going to live lecture, even if the professor will not be recording the session. I completely understand why many professors think students these days are lazy and entitled. I think it’s more than that though. When attending a lecture in person, there is no guarantee that the hour is going to be the best use of my study time. When watching a lecture at home, I am free to pause and look something up, draw a quick chart, make flashcards, or abandon the lecture in favor of another resource that is more concise.

I am getting spread thinner and thinner, and time with family and friends is sacred. My free time continues to shrink. There is not enough time for all of the very important (and busy!) people in my life, and this break made me sad because I realized I only got to see some of my very best friends for a coffee date each. I am very grateful for the one hour or one day every once in a while I get to spend with my special people.

I’m still overwhelmed by medical school, although much less so than I was one year ago. The amount of information I am to learn every day (and more miraculously, retain indefinitely) is incredible. I tell myself that all I can ask myself to do is end up much smarter at night than I was in the morning, every single day.

After reading this post, it seems that I may be slowly transforming into a robot. Perhaps that’s just the way it is. Perhaps it’s even good for me. Who knows.

 

Meatless Monday: Your 2016 Resolution?

Hello, my friends and family! It’s been a long time. Welcome to 2016. I hope you are rested and full of fire at the start of this new year.

Today is my blog’s third birthday, and I’d like to celebrate by making a shameless plug for Meatless Mondays. It won’t hurt a bit.

The idea is that you don’t eat meat one day per week, in order to reduce your carbon footprint and make an effort to save the planet.

Here are some jarring points from a 2014 Huffington Post article, which is based off of a study of the contribution of farm animal production to climate change, as well as a report from the Food and Agriculture Organization of the United Nations.

  • Animal agriculture contributes about 18 percent of the gases that cause climate change. This means that animal agriculture is responsible for producing more climate change per year than the entire transportation sector.
  • “It takes around 15 pounds of grain to make one pound of beef – which can feed a couple people for a few hours. In comparison, 13 pounds of grain fed to humans directly can feed 13 people for most of the day.”
  • With the drought in California, we have been working hard to limit our water use. However, 90% of the water in California goes to agriculture. It is important that this water be spent well—on crops and products that use the water efficiently and responsibly. Meat is one of the least efficient things you can grow given a gallon of water.

I don’t mean to be a grinch, but if you really want to do this for the planet, you shouldn’t eat fish either. We’re in the midst of a worldwide overfishing crisis too.

I’ve been practicing flexible environmental vegetarianism since my freshman year of college. I currently eat meat about twice per month, and enjoy the perks of flexibility. I’m not asking you to do anything crazy. In fact, I’m not even directly asking you do anything at all. I just wanted you to know that this is something that I care deeply about, and that it is a cause that you can support, even once per week, without upending your life.

Are you looking for a way to be powerful in 2016? In eating less meat, you will be making a gesture to show that you care about the environmental impact of your actions. You will be voting with you dollar, your fork, and your words (it only works if you tell someone about it once in a while)—that you want to change our food culture to one that is more responsible and sustainable. Basically, you want to get more out for what you put in. That’s my daily definition of power.

Let me know if you decide to try it. I’ll cheer you on. I wish you peace, focus, and health this year, no matter what you eat on Mondays.

 

Love,

Alexa

 

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Calling the Dead

This semester, for my research project, I’m studying the long-term health outcomes of people who have had different types of surgeries to treat esophageal cancer. In the beginning, I thought the project would be an easy review of old charts—a project where I could just view patients’ medical records on my computer and analyze the data. After a few weeks though, my PI (principal investigator, or research boss) said it would be a more interesting study if I conducted some standardized health surveys by phone, as well as asked some open-ended questions about the patients’ fears of cancer recurrence and their general feelings about the types of surgeries they had undergone.

The final survey totaled 111 questions that I was supposed to ask each patient, ranging from questions of difficulty swallowing to heartburn to constipation to depression to social relations to sexual functioning to anxieties about whether the cancer would return. It was an intimidating list, and I wondered how I would make time for it in the midst of all of my other studying. I decided to set aside two hours a day to call patients for the study. I’d go home, make a cup of tea, get in my pajamas, and ask away.

Most of the patients in the study are in their 80s, and looking through their charts, I guessed that quite a few of them would be dead by now. Many patients had had their surgeries more than five years ago, and had not been in for any more office visits since. My PI said I had to reach everyone, and if a patient was dead, she wanted me to speak to the family about when and how the patient had died. That part seemed particularly daunting to me. I didn’t want to call the loved ones of patients who had recently died (and for many of them I was not sure whether they would be alive or dead) and ask them for the dirty deets.

In the beginning it was awkward and uncomfortable, and I dreaded it. I had no idea how difficult it was going to be to get people to answer the phone. Sometimes I’d call 40 numbers in a row, without a single answer. I had dreams about the phone endlessly ringing. Sometimes people would answer and say they’d do my surveys another time, then not answer my next 20 consecutive calls. I wanted to give up after trying each number seven times, but my PI laughed. She told me that this was the nature of phone surveys, and that I should be calling each patient at least three times per day. She said I needed to be relentless and aggressive, and that I should never give up. She fits the profile of a surgeon—she never sleeps, is constantly juggling six projects at once, and is so focused that her gaze could pierce right through you.

Every time a patient agreed to do the survey, we’d spend an hour on the phone together. Sometimes, flustered family members would ask who I was, again, and why I wanted to know details about a family member who had died. “Why can’t you doctors just leave me alone? He’s dead, ok? I’m trying to go on with my life, but I keep getting rude interruptions like this. What do you want from me?” I caused some upset in this process, and for that I am truly sorry.

More often though, I was touched by kindness and candor, and was caught off-guard by how much people opened up to me on the phone. They told me so much about their lives (I mean, I guess I was literally asking one hundred questions in a row about it, but the sharing went so far beyond the survey questions), and asked about mine. If I wasn’t careful, more than an hour would fly by. They spilled stories and secrets of love and loss, reflected, asked me for advice, and gave me words of wisdom. I wondered, why me? Is it because I was calling from a doctor’s office? Or just because I was the only one who had asked about their problems?

It broke my heart to cut them off and tell them I had to go back to studying for med school, and at least a handful told me that they hadn’t talked to anyone about those problems (or deaths) in a long time. It was even harder to tell them no, I was sorry, but I couldn’t call them again next week just to chat. I stopped to wonder if that was true. Was I just being cold, or could I make the time to call them back later and be friends? After thinking for a little longer, I think the answer is no, I actually don’t have time for that. I already struggle to keep up with my existing friends and family. There are many people who I want to call and write more, but don’t have the mental energy for it. My social circles are at capacity, and the thought of having any more people in my life makes me anxious. I can’t handle any more friends.

It took me about two months of calls to finish the project. All in all, I found it to be uplifting. I heard so many stories of resilience, of changing perspectives, and of hope for something better. It made me realize how close death is, for everyone. Everyone will die. Half of men and one third of women will get cancer. You must appreciate your health, because it won’t last forever. Be wonderful to your body, and to the people that you love.