Bethany Snyder, MS3, Class of 2025
“What is going on with me?”
As part of our curriculum, all University of Kansas medical students have to stumble through simulated patient encounters. Most of them are one-offs (we treat a patient once, then never again), but one patient we see multiple times, a cis-male character named “Paul Ashton.” We first meet Paul for a generic complaint and order the appropriate labs. We see him a second time to inform him that a cancer screening marker has come back elevated. During a third visit we transition his care from hospital to home, and then in the last encounter we inform him that his cancer has returned.
Throughout these encounters, note that there are several different actors who portray Paul (we have over 200 medical students after all, one man could not do it alone), and I, myself, saw a different man play Paul each time. Despite this, during the fourth Paul encounter, I held back tears as I told him I would be there for him no matter what, whether he wanted to treat his recurrent cancer or not. I struggled to keep my voice even and my face neutral as we discussed his goals of care and his desire to stay with his grandchildren as long as possible. “What in the world?” I thought. This is a fake patient, not a real person. On top of that, it’s not like I have an attachment to a particular actor because it’s been a different man every time! For some reason, it just felt so personal and real.
Weeks later I was assigned to the inpatient oncology service on my internal medicine rotation. This was my third rotation thus far, so I wasn’t quite a novice, but I also hadn’t dealt with terminal illnesses in real patients yet. “Rick” was a patient admitted to our service for extensive blood clots in his legs. He had recently had an appointment with his outpatient oncologist, who reported that his most recent experimental chemotherapy had failed, and his metastatic disease would be terminal. This news was fresh and devastating for him and his wife. Nonetheless, I faced them with calm professionalism and frankness, not letting our conversations sink into unmitigated despair. I couldn’t understand why I was able to achieve such control with a real patient, but a simulated one had gotten under my skin.
As I mulled this situation over, I began to think about my mother, who happens to be an ER nurse with over 20 years of experience. She was a charge nurse during some of this time as well. To be quite honest, I had never understood how someone like her was able to perform that job. Reason being, it’s one that requires someone with strength and quick thinking during life-or-death scenarios, and my mom is someone who cries when she sees advertisements on TV for animal cruelty organizations. She is excitable, garrulous, sensitive, and passive. Instead, I always thought I had taken after my father: the stoic, analytical engineer. Growing up I felt closer to my father than my mother, who irritated me at times with what I felt was an overreactive personality.
But this same woman was somehow able to efficiently run an ER at the largest hospital in Kansas City. Could it be that during her work she slips into a composed persona which I have never seen at home? When surrounded by family, perhaps she doesn’t find it necessary to keep a cool demeanor; we are the ones she feels safest around. But at work, her patients and colleagues need her clear thinking and composure. I realized this is a side of my mother that I have never seen before, but it is something we might have in common. In the simulated Paul scenarios, the very fact that they weren’t real meant it was safe to let my emotions flow, so I struggled to contain them. With Rick’s genuine situation upon me, however, I had no trouble keeping them in check, because I knew this wasn’t the time to let go.
I felt guilty for underestimating my mother for so many years. It’s difficult to swallow the fact that there are sides of my mom that I have never seen. She doesn’t work in healthcare anymore, so I can’t visit her during work hours if I wanted to. Even so, now I have a greater understanding of who she is. Having my own bewildering experience with the emotional aspects of practicing medicine not only helped me learn more about myself, but it also brought me closer to my mother.
Med Intima 