Thinking Out Loud

Every medical student remembers their first rotation. Most of us anticipate that transition between the classroom to the hospital when we finally get to put everything we’ve learned from textbooks into clinical practice. In the beginning, whenever my self-doubt showed up uninvited, I’d remind myself that (at the very least) l knew how to navigate sensitive conversations with patients burdened by difficult circumstances

During my initial week of OB-GYN, I worked at the outpatient clinic where we mostly had prenatal visits and routine check-ups. On that Wednesday, one patient, in particular, was an 18-year old female who came dressed in gym clothes. Lily wore thin, round-framed glasses and had her hair picked up in a ponytail. She presented alone at 11 weeks’ gestation. I introduced myself as she sat on the exam table. Shortly after, we started discussing her medical history: Menarche was at age 13. The Gardasil vaccine was administered in May 2014. During her previous pregnancy, blood tests confirmed an RhD- status. At that time, Lily was 15 years old when she vaginally delivered her first tiny child—a 39-week stillborn girl at Kings County Hospital. I stayed nervously silent for five seconds while scribbling down this information on paper. I can’t remember if I even looked back up at her before proceeding onto the next question—When did you have your last Pap smear?

Lily sat there patiently and answered all my questions, even when each one grew seemingly longer than the next. After I observed the resident perform a physical pelvic exam, Lily thanked us and scheduled her follow-up appointment in a few weeks. We started cleaning and setting up the room before our next patient walked in. And then it hit me. Like the whiplashing wave that pulled me underwater on my first trip to Mullet Bay—I didn’t tell Lily that I was sorry for her loss; I didn’t even acknowledge the profound experience that stood out glaringly from her past. Realizing then how vulnerable she must have felt, I wish I had reached out a little further and on a more personal level. If only I hadn’t let my nerves run away from me, maybe Lily would have expressed equal parts fear and excitement over her new possibility to begin again.

But Lily had already left, and by now, she was probably standing on the humid subway platform waiting for her G train back to Queens. I was mad at how nobody deserves a false promise that big, and even madder at myself for not saying it out loud. Many people know how it is to lose something before it barely exists, but few are familiar with the strange feeling that lingers indefinitely whenever that something was half a part of yourself. The only thought that found room for itself inside my foggy head was painstakingly obvious: this is the kind of loss that untethers a person.

Because I was speaking at Lily during our interview, I managed to overlook the most essential principle of Being Human 101: When someone else is grieving, show them compassion. So simple and yet not simple at all. Sometimes it might mean noticing the colossal difference a swift sentence can make when building a connection (in real-time, not in hindsight). It can be remembering to do the one thing you swore you would never forget.

Medical school is recalling obscure names for prescription medications just as much as it is sitting with uncomfortable interpersonal dialogues or accepting when ugly situations are not hypothetical anymore. The latter (and arguably better) two years of training are filled with ephemeral moments when test grades seem almost silly or far less relevant than we once thought. Lily helped me see that problems are relative, but each is uniquely heavy in its way.

Empathy is not acquired through skillful practice or rote training. It might be inside all of us, but occasionally it gets deeply tucked away—covered up by piles of memorized mnemonics and diagnostic algorithms. There are times when overthinking can prevent us from feeling connected or being present. It takes careful attention to summon up the courage to temporarily carry the hurt of another in the midst of your own; to consciously push aside whatever currently worries you and understand a stranger’s story as yours. Because Lily was one of my first patients, I learned early on that the ability to empathize does not always happen effortlessly, and it often takes longer than five fleeting seconds.



All names and identifying information in this article have been changed to ensure patient confidentiality and privacy. *


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