What happened isn’t important. What is important is that I am sitting in a cramped hospital office space asking a man why he feels that he needs to leave while in the midst of withdrawal and go to Hawaii. He is young, only five or so years older than me, and lanky, splayed out in his chair in such a way that his limbs appear jumbled and knotted. I need a fresh start, he says. How am I supposed to stop using here. Everything and everyone that made me use is here.
How can he recover here, indeed.
During my lunch break I locate a phone number and request an appointment. We don’t have anything except for the resident clinic, says the woman on the other end of the line. Would that work? The late September sun burns on my face. Sure, I say. Not a big deal. Everyone needs to learn. Why not on me.
—
I started medical school as a shell. Not of a former self—to say so would be predicated on the idea that I knew who I once was—but at the very least, something at once hardened and at risk of crumbling. To say this out loud would mean that it was true. So I didn’t.
During my first year there was a lecture about adverse childhood events. What they say: when children experience this, they become adults with that. What I hear: children who experience this do not become doctors. They become patients. You cannot have both.
I was certainly a child. But lucky for me, I am very good at compartmentalization.
—
That evening I receive a call from a number I don’t know. It is the head of the department: I am not going to be seen by residents. That is inappropriate, she says. Medical students should not be seen by residents. There is something about the way she says it – inappropriate – that makes me think I should have known better. A doctor would have. I feel a familiar unsettlement in my stomach. I hear her kids playing in the background. Silverware clatters. We have an attending who will fit you in. She’ll call you.
In my first appointment I am asked what brings me in. If you don’t take care of yourself, how can you take care of anyone else? I say. Haha. My new doctor humors my desire to be an insider. She uses words from my textbooks to describe me. I start to cry and I cannot stop.
On rounds, my patient reiterates his plan. He is just waiting for his VA benefits check to clear, and then he is leaving this place.
—
My next months are spent in two worlds. During the day I am a student doctor suturing in the emergency department and fumbling through pediatric neuro exams. In the evenings I make my body as small as possible in my therapist’s office to balance the words spilling into the air with increasing abandon. At home I do flashcards to learn medicine and worksheets to unlearn PTSD.
I am very good at compartmentalization. But the problem with compartmentalization is that the hollow pockets you create so easily become enshrined. Your mind becomes a museum of your own making. Ever the groundskeeper, you patrol its hallowed halls, dusting off the permanent collection of your trauma to keep it from oozing out into your world.
—
It doesn’t take long for the edges to start to blur.
At first I don’t believe it. I know too much. I can interrogate my own progress too well, resist treatment models predicated on subconscious buy-in too strongly. But I stop taking off my scrubs before I go to appointments. I am not transported to a dark room when I see myself in the practice questions for my boards.
—
Months pass. There is a pandemic now and my virtual lecturers sing the praises of video visits that allow you to get a look at little pieces of patients’ lives. I wonder what my therapist thinks of my apartment; if it looks like that of a healing person.
More months pass. I graduate from the program in my kitchen. I am sitting in the same place when I match into residency.
My patient makes it to Hawaii. His fresh start.
—
I am here to tell you that you can be both.
Sophia Yapalater is an MS4 at the Perelman School of Medicine.
Image by Andy Revell, a CDY5 at the Perelman School of Medicine.
