Read below how my anxiety resurfaced in the clinical medical school setting, disguised as trying to be the amazing medical student who always goes above and beyond for her patients.
I feel like a sand castle being stomped on by multiple individuals. I thought I only had to worry about the ocean waves which steadily rose closer to me. I was prepared to deal with the waves. But these people came out of nowhere, adding an additional layer of difficulty to my life.
I worked hard to get to where I am today, I have been listening to feedback and trying to be a better person, a better M3. All I get in response is more disgrace, how I am not good enough, and am not acting the "right way" as a medical student.
I’m trying so hard. All these new rules; I am trying to learn from what others have told me, but when I follow the suggestions I get the blame. I get the pain. I get the nightmares. I get stuck at home crying and holding a blanket close, soaking up my ocean of tears.
Today I finally learned that my anxiety has snuck back to try to destroy my life. I kept thinking that I’m done with anxiety because I am taking medications, going to therapy, and doing all the things I’m "supposed" to do. However, anxiety keeps creeping back in a new form. Apparently, all my strive to do excellent in the clinical setting was a way I was hiding my anxiety of not feeling good enough (aka imposter syndrome).
Since I had never not done “well” on the academics front (failed some medical school classes and step1), but had an extensive experience working with patients (elderly caregiver and case manager) I knew this section of my medical training was where I could shine.
Therefore, every moment that I had “down time” I tried to learn from the resident physicians, attending physicians, nurses, and case workers to understand the system which was providing care for our patients. I also took on the responsibility of doing whatever I could (with my small amount of knowledge) to assist the patients.
They needed social work; I walked directly to the social work office.
They were thirsty; I would go get them a huge hospital bucket of water.
They hadn’t heard from a family member; I would call them multiple times until I could get in touch with their family member.
Were they experiencing any emotion; I was there to listen and explain what was going on from what I knew of our plan and next steps.
I thought I was doing the right thing by not just sitting around and studying, like my peers, after we had finished rounds and writing our notes.
I was there to learn, in person, and not on my computer doing practice questions, which I did already at home.
Instead what I was doing was fostering my anxiety, like providing sticks to a campfire.
At first, unconsciously, I thought that sitting down instead of being "busy" with clinical tasks was looked down upon by my physician superiors. I thought I was being seen as lazy, worthless, and unmotivated.
However, even though I was doing these things to be a better student and person, the verbal vs final written feedback was inconsistent. In person I was praised for being energetic and going above and beyond. But, at the end of the clinical rotation I would receive written comments that I didn't know "my role," didn't appreciate the role of the team, and wasn't communicating well with my team on what I was doing and saying to our patients.
Going "above and beyond" had turned into being a negative thing, and seen by some as defiant and not respectful of the team dynamic of how the medical team functions.
At first I didn't understand this feedback, and it made me frustrated because I thought I knew how the medical team functioned because that was exactly what I was trying to learn during my "down time." However, what I didn’t understand was that I didn't understand the function of a 3rd year medical students' in regards to the rest of the medical team. The unspoken expectation of an M3, for many physicians, was for us to be seen, but not heard, unless spoken to, or asked a specific question.
After receiving this written feedback I became even more anxious of how I interacted day to day. I continued to feel that if I just sat around and studied it would show I truly was a useless medical student and not interested in helping my team. Even though, I told them that I was willing to help, and they knew I was available to help, I itched to do SOMETHING!
Every time I tried to sit and actually study in the hospital, I kept skimming through the patient charts trying to find a new result or something new to do.
This particular week I was in the General Nursery where we have to sit and wait for a mother to give birth to then evaluate the newborn.
However, if you didn't know, labor takes a LOONNNGG time. Looking at a mother's chart every 30 seconds wouldn’t change how fast the baby came out. However, I continued to click the refresh button hoping for a change...
I couldn’t focus on just studying. I was scared to be seen as ungrateful or not caring about my patients.
I learned from my previous rotations that the residents did not like me going and helping the patients, nor visiting them without being told specifically what to say and do. Over time, I learned to specifically ask permission every single time to see a patient so I wouldn't overstep my "boundaries" and "role" as a M3.
Realization: I am a good enough M3
I need to practice my anxiety management: like listening to music and breathing as I sit and wait in the resident work room. Waiting to be called upon to do something. I have already offered to help, to the point that I fear that I have become an annoyance. Which is also a trauma reaction.
My parent won’t come and berate me that "I am spoiled. I am lazy. I am ungrateful, or that I am a horrible person," and neither will the physicians I work with.
What I’m doing, acting as I am told, is good enough. I am completing the tasks of what is expected of me, offering to help, and following through with requests.
Apparently, I am a good enough M3.
Just because the system says we (medical students) are useless, we individually are not useless humans. We belong to be here. We even pay to be here! Just being present. and willing to help is enough.
According to the medical system, my only assigned job as an M3 is to develop clinical knowledge and practice clinical reasoning. This includes studying during clinic and hospital down time. If I have an idea or see something my patient might benefit from, I must let my resident physician know and then they will then decide if it is appropriate to message said team member to complete that job.
One day this will change, and I will have the privilege to decide if a patient needs support and work with my own inter-disipilinary team.
However, for now I am good enough.
I will also continue to remind myself that anxiety doesn't just go away. Medications and therapy just help me get through the day-to-day. My current expression of anxiety, comes out as busy-body with a feeling that I always have to be busy. Instead I need to remind myself to just be present in the process of my M3 medical school education.
Because I deserve to be here, and I am good enough.
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