All names changed for privacy.
Nearly-brand-new clogs thundered off the granite flooring as I crossed beneath the architectural microphone of the lobby of the Hospital of the University of Pennsylvania. I swore I’d heard my name being called.
Standing in just the right position, directly inferior to the apex of the dome and situated in the exact location of Ravdin & Rhoades famous surgeries, the slightest noise – as faint as a scalpel’s slice – reverberates throughout the lobby. Decades ago, this was the former operating theatre of HUP, fundamental for surgical trainees prior to the days of Da Vinci-enabled 3-Dimensional recording.
That Tuesday though, it was merely a distraction as I exhaustedly carried myself home after my second twelve-hour shift on labor and delivery. All I could focus on was replaying the day’s hurried events. Scurrying behind my intern all day, I had scarcely sat down amidst the rush of participating in two Cesarean sections and three vaginal births, not to mention ultrasounding, blanket grabbing, and patient rounding in between.
“Alex, Alex!” Jacob called out across the lobby. To my surprise, it was a new father with whom I had bonded as his wife delivered their first child early that afternoon. I picked my head up, smiled and walked over. After excitedly introducing me to his mother and sister-in-law, Jacob fought back tears as he thanked me for my involvement and calming presence. Together they had welcomed their beautiful baby girl. My role had rotated between acting as a support person, grabbing supplies for the experienced residents, and after the hard part was over, assisting in delivering the placenta.
Jacob’s mom remarked, “This just has to be the most amazing part of medical school. You accompany people through the most special moments of their lives.” Even though we had spent only two hours together, I was always going to be remembered as the medical student present for the birth of their first child. His mom was right. It was an experience I’ll never forget.
Biking home that night through the blistering wind whipping across the South Street Bridge, with tears in my eyes reflecting on all it took to get here, I knew I was in for a special year.
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The first time I saw the Penn/CHOP skyline, my heart skipped a beat. Traveling to Philadelphia as a PSOM applicant, I had never seen anything like it. Two years later, I’m still exhilarated to turn left off of Spruce and bike up Civic Center Boulevard. For trainees, this is where we will learn how to care for people during the most intimate moments of their lives.
Walking up to the Hospital of Pennsylvania amidst the throngs of providers from all walks of life, it is impossible not to be inspired. The shiny buildings are fun, but it’s the people inside them who are changing the world. Earlier this fall I bumped into Nobel Laureates, took a class with one of the chief orchestrators of the Affordable Care Act, and witnessed innovative therapies on every patient floor. The aura of medical excellence here is palpable.
Yet, where I look at these buildings with awe for what is held within, to many others the hospital is but a reminder of difficult moments. Clerkships have for the first time helped contextualize how the skyline of medical architecture that ignites a sense of excitement in trainees can simultaneously hold an intense heaviness for members of the Philadelphia community. For some, they welcomed the newest member of their family, while for others those sterile walls held the hardest conversations of their lives.
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Patients come to the OB/Gyn office for a myriad of reasons. From uncomfortable bleeding and bloating to family-building and gender affirmation visits, the range of humanity across my first clerkship was vast. Perhaps it was because so many of the visits centered around bringing new life into this world, or maybe because I am still settling into the emotional psyche of medicine, but I found myself reflecting often on how even just six weeks rotating in the hospital changes a person.
The OB/Gyn clerkship is unique in that almost every week I left one team behind and started anew. We spend time with inpatient surgical & consult services, outpatient routine clinics, specialty services such as infertility, and of course the labor floor. OB/Gyns uniquely care for patients as primary care providers, specialty care providers, and in acute care moments such as delivery. A microcosm of medicine, they celebrate with patients on their best days and counsel them through some of their worst.
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Two weeks after being stopped by Jacob in the HUP lobby, I was holding the door for the attending physician and an anxious young couple, Seth and Jessica, as they entered the clinic’s ultrasound room. Jessica took a measured seat on the papered bed, and Seth paced back and forth. The journey to pregnancy had not been easy for them, and they knew painfully well that there were no guarantees. The attending placed the jellied probe on Jessica’s belly, and we held our breath as the 10-week ultrasound began.
My breath quickened as the physician scanned. A cautious smile emerged across my masked face as I stared at the fetal pole in amazement of the ultrasound’s clarity. The physician said nothing, diligently scanning. Those fifteen seconds felt like an hour as she worked from top to bottom, side to side, longitudinal and transverse views. Silently, my heart dropped as I realized why the physician was repeatedly searching the gestational sack. There was no heartbeat; the pregnancy had not made it.
The next ten minutes were a blur. The physician called in her colleague to confirm the scan as both Jessica and Seth held each other and let tears flow. I passed out tissues and shared my condolences. Inside, I was stunned; this was my first experience with death as a clerkship student. We stepped out to afford the couple time and space to process. Hard discussions about next steps would follow, but there was no rush, and little to do. The door closed.
“Are you okay? What’s going through your head?” my attending graciously asked me. We took the few minutes that followed to check-in and discuss what had just occurred. Together, we talked through the precariousness of family planning. I was still struck at how quickly the demeanor of our morning had changed. Excited conversations about the color of their nursery were abandoned for consolations that this was no one’s fault. I was grateful that we paused to reflect and acknowledge the gravity of that news. What was just one part of our morning would be a painful memory that Jessica and Seth would remember forever.
A few minutes of reflecting, and then we were back to work. “When you are ready, go see the next patient and get their history.”
One intense moment fleetingly gave way to the next routine encounter. With a smile on my face, I knocked on the door and said, “Hello, good morning! Thank you for your patience—I am sorry for the wait. My name is Alex Nisbet, and I am the medical student working in clinic today…”
– – –
Each moment in the clinical environment is substantial for the people involved. Later that morning, I helped the attending physician repeat the same ten-week ultrasound protocol and confirm the health of two different pregnancies. Both times I waited to smile, acutely aware that there were no guarantees. The moment with Jessica and Seth still burned at the forefront of my mind. The vibrancy of each moment was not lost on me nor on the couples, each celebrating the new addition to their family.
Shuffling between clinic rooms, I accompanied patients and their loved ones through the full spectrum of human emotion. Through loss and creation, physicians walk with patients in the most intimate moments of their lives. This is not just our task but our calling. The difficulty is in not letting the gravity of one moment dim the unbridled joy of the next. No patient deserves their emotions to be set in context of the room next door, yet for providers we see—and feel—the whole picture all at once.
Thus is the thrust of the physician, to be fully present with each individual and yet able to metaphorically close the door and leave each room behind us as we walk into the next. What is just another day in clinic for us may be a moment our patients will hold forever. The skyline reminds patients not of field-changing innovations, but of the gravity of the conversations and decisions held within. Patients come to the hospital because they have to, not because they want to.
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Regardless of what type of medicine I’ll eventually practice, these two moments from the first weeks of my clinical training will stick with me forever. Each time I look up at the West Pennsylvania medical skyline excited to go into work, the buildings hold new meaning for me. I now consider what a trip to 3400 Civic Center Boulevard might mean for expecting patients, children of ill parents, or partners offering strength and encouragement. To us it’s our job, our calling—to them, it’s their lives.
As I wrote in my personal statement when I applied to PSOM two years ago today, Medicine is the act of caring for patients inside the hospital so that they might live their best lives outside of it. We accompany families through their best and worst moments. It’s imperative that we care for ourselves and our colleagues so that we can fulfill our job to bring our full selves to each clinic visit, one doorway at time.
Alex Nisbet is an MS2 at the Perelman School of Medicine.
