Monday, June 20, 2011

Trigger

I'm officially a "rising MS-2," or second-year medical student.  During the last few days of school, we were asked to write a two-page reflection statement about first year.  I meant to write something original, but it proved difficult.  Nothing I was thinking seemed remotely appropriate to hand in to a person who could be writing my recommendation letter.  I didn't (and still don't) really feel anything at all right now.  I don't feel particularly learned, or empathetic, or acculturated right now.

The dorm is quiet.  Our lecture hall/study center is quiet.  In April, the former second years became third years.  They started on the wards in their respective hospitals.  They no longer spend long hours in the computer labs studying for boards or mingling with our class in common areas during lunch breaks.  They no longer live with us either; many have moved out out of the dorm to be closer to their hospitals or because they finally desired their own bathrooms.

Right now, we exist in a strange sort of orphan limbo.  The former second years are no longer in our proximate space to give advice, guidance, reassurance.  The incoming class will not be arriving until August.  Without other classes for comparison, perspective is difficult.  The changes do not become evident simply because it's the current assignment.

I am a guest editor of the AMA's ethics journal Virtual Mentor.  One of my main responsibilities is to describe a clinical situation in which the physician faces an ethical dilemma.  I write a short narrative depicting the situation--the doctor, the patient, the setting.  Then, there's what the editor in chief calls the "trigger."  There needs to be a very specific event that occurs that ignites the dilemma.  It could be a patient's question, a lab result, a colleague's comment.  A solicited author then writes commentary on my proposed situation and "trigger," using a larger ethical framework to buttress arguments.

The "trigger" in various clinical situations constitutes the backbone of the journal's cases is appealing to me on a number of levels.  It is a concrete and focused way to think about nuanced and abstract philosophical issues.  The "trigger" is unique, and yet it isn't.  Although physicians may not have experienced identical situations to the ones proposed, likenesses make the situations realistic and relevant.

What I'm missing right now is the trigger.  Perhaps it will be a former second year laughingly recalling how terrified I was before our first exam.  Perhaps it will be when an incoming first year asks me how it's possible to memorize the names and functions of nearly every muscle in the human body.  Perhaps it will even be when a patient tells me that I what I said was particularly sensitive, or knowledgeable, or clear.  What I do know is that staring at my computer screen has not been the trigger.

Out of desperation, diplomacy, and a desire to be honest, I ended up smushing together two previous blog posts as a reflection.  Both had triggers: a USPS mishap, and a late-night perusal of PubMed.  Both accurately represented thoughts from various points during the academic year.  Both (I believe) were reflective.

I'm still waiting for a trigger before I can wax poetic about the entirety of first year.  Luckily, there are no deadlines this time.

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