Disclaimer: This poem represents my own personal reflections as I initially navigated the tensions and forces of medical education and sought to process them. In no way does it represent a criticism of the faculty or students of Perelman, whom I truly love and appreciate more than I can convey and many of whom have helped me think through the phenomena I articulate below. Where the words below are sharp, please consider them the publicized inner musings of someone who sees a problem in his own perception.
Transcript:
In West Philadelphia, bright and clean
Where I first laid my eyes upon the machine
Its pieces, though legion, work synchronously
And all do their job, to desensitize me
I wanted this machine. I fought to get in.
And now that I’m here, I’ve been branded with “Penn”
A stamp agnostic to where I’ve been
But guaranteeing the medical-grade product I’ll be at the end
So what is this machine that’s captured my fascination
To the point that I’d write a poem about its tangling pervasions
All in the name of preparing me for patients
This machine is none other than medical education
It’s a robot of sorts, with levers and gears
Some lectures over there, some labs over here
It’s a vetted process, to form some magic between my two ears
To allay my fears, make my mind clear, and form me into a process-reviewed peer
With that goal in mind, it’s not an all-bad story
I wanted this profession, not just for its glory
But to delve the depths of its systems, from aches to H. Pylori
And part of that is learning not to get woozy at the gory
See, the process of medical education
Entails not only the learning of information
Not just the memorizing of clinical situations and presentations
Not just biochemical explanations, memorization of innervation, muscles of mastication, or somatic hypermutation
Not just the pathways of intoxication, vicissitudes of vaccination, senses of sedation, or influences of inflammation
No, it’s much deeper, a new mindset formation
Driven by diligent preparation
Enabling a new lens of observation
The medical gaze
To be honest with y’all, I want this gaze still
I long to see trauma, yet remain calm and chill
I want to fly through an H&P, seamlessly diagnosing the ill
As I hone my Bayesian differential skills
But I had to pause the video of the cadaver’s face until
I had come to terms with the collision of anatomy and personhood at 1x
I still get lightheaded with blood, if it runs a bit too much
And the STD lecture nearly cost me my lunch
I want the medical gaze, hoping I can be cool in the clutch
So I desensitize my senses, in hopes that I lose touch
I look until I see a person no more
Only foramina, nerves, and more mangled gore
Dehumanize to leave all those emotions at the door
The proverbial firehose fills my mouth’s muscled floor
I turn the speed to 2x so I can watch even more.
Over time, my emotions succumb to the temptation
My knowledge grows in this education
While my passion undergoes an ablation
This exposure purports to be immunization
Inoculation with sterile suffocation
No gastroenteritis while I practice regurgitation
Emotions stopped up, like constipation
ESR, sentiments drop out like sedimentation
Low energy state, I need phosphorylation
“Care, but careful of internalization”
Give birth to apathy without ovulation
Left breathless from absence of inspiration
Forgive the ardent alliteration,
but my point is to illustrate the potential intellectual temptation
In a rush, patience is not a virtue, but they can be simply a standardized simulation
The anatomists didn’t even flinch at the cadaver’s castration
No cap, I ate sloppy joe’s while watching its decapitation
I fear that the machine is not just the process anymore
It’s the way I’m trained to think, desensitized to the person before me
I see, as I study, the cadaver on my screen simply becomes another machine
I look within and realize, the point of medical education
Is deeper than memorization of information
But also deeper than simply formation and preparation of observation
It’s for me and you to become cogs in this whole machination
Allow me to demonstrate
Wake up a bit late, but camera on by 8, who cares if I ate, there’s too much on my plate
Small group begins, pathology slides commence, eyes glaze and then, regurgitation commence
The others know the terms, I feel a slight panic inside. I’ve felt it before, ever so subtle, I take it in stride.
I resolve to work harder, so much for going on a walk this afternoon, I know what I must do.
Wait, why?
Why do I respond to every instance of not knowing an answer as if it were a personal moral failure only to be remedied by working harder?
Is this how burnout culture is built? Burn up or burn out
I’m not driven by grades, but by conditioning
There’s an intrinsic motivation, but it’s a repulsion from perceived inadequacy, not a drive for really seeing
The system is built for speed, not stamina.
Bradykinesia as my soul’s decrementing movements lose pace over time.
I know I’m supposed to take care of myself, but I feel so behind the material right before my eyes.
Maybe wellness can wait until after lunch.
I think I get why the 4th years keep telling us they wish they hadn’t studied so much.
The gaze moves to brain and behavior; I notice another issue
There’s a certain dehumanization that makes mind into tissue
No one ever means for us to dehumanize, it’s just the way it came to be
Lifelong narratives reduced to the Epic snapshot screen, pathos reduced to pathophysiology
Seizures shift from seismic waves within the psyches of souls to seismic waves on an EEG
Pathological persons paraded before our screens like a circus of the odd to gawk and see
Mothers’ quirks are paraded before us for their fascinating neurological traits
A little boy is “Gower’s sign” and a girl “Trendelenburg gait”
Medical students balk at the sight of a man
Whose essential tremor means he can’t hold his wife’s hand
Absence, please pronounce it correctly, but don’t feel the pain
Of lifelong learning impairments that will forever scar and mar these kids’ brains
Ophthalmological procedures on video, pupils crane to see
Giggles spurt from a dry sense of humor as the aqueous humor trickles from a scalpel’s injury
“If the patient’s awake, can they see all this?” I ask
“I don’t know” comes the reply. “I never thought to ask what they see” is implied
It’s not the first time our profession has failed to recognize people for who they are inside
Maybe our patients aren’t the ones who are blind
William Osler, the great physician-philosopher, once spoke of an “Aequanimitas” to medical students right here at Penn
Our great medical philosopher told our predecessors the most desired quality is one which is imperturbable until the end
He praised a “coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril, immobility, impassiveness”
He told them to cultivate “a judicious measure of obtuseness” and “a callousness which thinks only of the good to be effected”
Never admit indecision or worry, he warned, or you will lose the confidence of patients
These are direct quotes from the man we claim as medicine’s humanistic inspiration
Osler’s philosophy has won out the day
His call to stoicism, a strategic hard-heartedness, has prevailed and is here to stay
It permeates the values medical education conveys
But I wonder if to be a healer, one must be wounded in the patient’s place
I wonder if seeing, doesn’t start with the medical gaze
What if it starts instead with entering the very malaise
We’ve sought to dispassionately observe and control in emotionally detached ways
So I propose a solution, though not a panacea
It’s not a novel proposal, nor a new idea
The problem is not the machine outside me, but in what we all see
We all need to suffer a medical gaze palsy
I’ve localized the lesion within me and the treatment is simple
Medical reform starts right between my own two temples
Equanimity is admirable, but not above compassion
I propose it’s possible to thrive off of our passion
Not sever it as a liability, but driving us to a mechanism of action
Let’s praise compassion’s kinetics rather than lamenting its interactions
So train me, faculty, and hone my differential
Teach me resilience and critical thinking, that I might merit this two-letter credential
I don’t approach this profession arrogantly, but honored and reverential
I just challenge the notion that leaving my emotion at the door is essential
Greater love has no man than this, to lay down his life for his friends
I enlisted here to die to self, and in the process make amends
For a history of failure to see through another’s lens
I want to dismantle this machine, and then begin again
So, let’s re-write this story, and start it at the end
“In West Philadelphia, I met a real person here at Penn”
Chip Chambers is an MS1 at the Perelman School of Medicine.
Image by Tracy Du, an MS1 at the Perelman School of Medicine.
