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In One Ear, Not Out the Other

Kalvin Nash '18
Kalvin Nash '18

My pre-health advisor at Hamilton College, Leslie Bell, encouraged thoughtful reflection which is a skill that continues to serve me today as a second-year medical student at Johns Hopkins School of Medicine. At a scheduled meeting in my junior year, Leslie and I spoke about my campus jobs, activities, and clubs. In addition to being a student, I was also a Jitneydriver, events staff member, and student researcher in a computational lab. She asked me, “What have you learned through these opportunities?” and I realized, there and then, that prior to this meeting I had not yet seriously reflected on my professional and academic experiences. My meeting with Leslie prompted me to consider more thoughtfully what I could learn through new experiences or how they could promote my future development. 

Now, I reflect during participation in activities and work to draw meaning and new understanding about myself. I reflect on what I learn at the close of each new experience and  assess its meaning and value. By thinking critically about my experiences in this way, I learned to take ownership of the development of my core competencies. Leslie’s question facilitated my adaptation of a reflective way of thinking. 

As a medical professional in training, there is a specific case in which Leslie’s advice was crucial and enhanced my experience. A 74-year-old female patient presents with thin pink scaly plaques and cigarette paper wrinkling affecting 70% of her torso and extremities. Because of her history of present illness (HPI) and clinical presentation, the attending physician moved to rule out parapsoriasis, psoriasis, eczema, and cutaneous T-cell lymphomas, such as mycosis fungoides, by performing two biopsies at affected areas of her lower extremities. Despite my confusion due to my unfamiliarity with cutaneous lymphomas, I was engrossed by it all as I began to discover the potential for learning inherent to such a difficult clinical case.

Within two days, the clinic received the patient’s inconclusive pathology report which revealed that the specimens were consistent with cutaneous T-cell lymphoma but required clinicopathologic correlation. Calmly, my preceptor explained that cutaneous T-cell lymphoma is difficult to clinch. Despite all our best efforts in performing additional biopsies, we found time and time again that all pathology reports were nondiagnostic. Updating the patient on the status of her biopsy results represented a particular challenge for me. It was heartbreaking to hear the disappointment in her voice as she acknowledged my report during our phone calls. This cycle of biopsying and reporting inconclusive pathology reports continued for another three months before a diagnosis was landed. By this time, I had drawn the patient’s blood, spoken directly with her primary care physician on the status of her condition, and taken medical photographs of the affected areas several times.

At this point, the patient and I had formed a strong working relationship because of our extensive correspondence and face-to-face interactions. With reflection, I discovered that the reason my time with this patient so deeply impacted me was because of my growing emotional investment in the patient’s wellbeing. This discovery is the hallmark of my medical training during my gap years because it was my first true taste of physician-hood. I was humbled and simultaneously empowered by the opportunity to assist this patient as she dealt with what we thought were mycosis fungoides. Through coordinating the patient’s visits and treatment plan under the dictation of the attending physician, I experienced firsthand the responsibilities that come with managing a patient. As emotionally and intellectually taxing as this case was for me, it was also incredibly rewarding. The several cumulative hours that I have spent engaging with the patient in-person and over the telephone redefined my thoughts on patient-physician relationships. I learned the importance of lending emotional support to others even if I do not know them well which has shaped and will continue to shape my interactions with people inside and outside of medicine.

For this reason, my advice is twofold. Think critically as you speak with your advisors. Interpret and internalize their words because they are here to support you and mean to ease your professional journey. I also encourage you, like Leslie did for me, to think about what you can learn from every experience you have. Do not allow yourself to passively perform your delegated tasks. Introspect and come to a better understanding of who you are and how you may serve those around you. If you are interested in medicine, like me, you may be surprised to learn how early ownership of your career goals lends to a more successful transition to clinician-hood.

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