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Trainee, Know Thyself

I’ve been taught a great deal in med school and in grad school. The intricacies of anatomy; cancer signalling pathways; how to take a patient history; the list goes on. Yet I have never been taught how to evaluate myself. Am I stressed? Am I angry? How has my mood affected those I love? Self-awareness is necessary for all professionals, including physicians. And given its exclusion from the curriculum, trainees must find ways to learn self-awareness on their own time.

At IUSM, student interest groups help explore this issue. For instance, the Spirit of Medicine SIG discusses individual emotions through the lens of literature. However, these meetings are not long enough or frequent enough to completely flesh out these ideas. Therefore, we students must develop our own emotional barometer, lest our feelings surprise and overwhelm us unwittingly.

I want to share with you one such moment of self-revelation. A subtle event that made me aware of my own stress and frustration; feelings I buried and ignored the more that they grew.

I study Juvenile Myelomonocytic Leukemia in a mouse model. My mice develop a disease that resembles JMML and has well defined features. However, as I treat my mice these features change. The disease may abate, accelerate, or evolve altogether. Therefore, I need for perform a thorough workup of each sick mouse to find the underlying cause. I take a history and physical (I review previous status notes, I weigh the mice, observe their activity, breathing, posture, etc.) I run routine lab tests (CBC with differential) take biopsies for histology (H&E, Giemsa, and IHC), and finally I perform a cellular analysis of bone marrow, spleen, and peripheral blood to identify the presence of malignant cells and/or skewing of the normal distribution of hematopoietic lineages. In short, each mouse gets the royal treatment.

These diagnosis tests take about 10 hours and must be performed as soon as possible, no later than 48 hours after presentation. Diagnosis days, therefore, are inherently frustrating. They are long days. Previously scheduled experiments must be postponed. Small errors can undermine the whole analysis. Two weeks ago I had a typical diagnosis day: I arrived early and anxious. I ran through my steps: weighing, blood analysis, imaging, bone marrow and spleen biopsies, cell isolation, antigen staining, freezing cells, all with extensive note-taking. I left late, relieved and drained. The next day was long too: I did that day’s planned experiments as well as those I postponed from the previous day.

Yet, my emotions did not register. I accepted the weight on my shoulders as a graduate student’s due. Who was I to complain about my workload? Did I not apply for this position? Did I not design these experiments myself?

This past weekend my parents visited me from Toronto. We ate, we chatted, we brawled. We toured city parks, visited museums and the symphony, and worked on my garden and plumbing. As they left this Tuesday, I felt sublime: at ease and with a deep sense of rightness.

On Wednesday a mouse got sick. Thursday was diagnosis day. I braced for the weight on my shoulders. I arrived early, but my mood was different. I was calm, not anxious. I ran through my steps with joy: I chatted with others in the lab and made time for a sit-down lunch. I did the work diligently, but I wasn’t paralyzed with a fear of making a mistake. The day still lastrf 10+ hours, but I left the lab fulfilled, not drained.

It was only through the lens of my parents’ visit that I realized how stressed I had previously been during diagnosis days. I can only imagine how my mood may have appeared to others: dark, stormy, brusque. How many of my colleagues did I inadvertently distance by my behaviour? What opportunities may I have forsaken by my demeanour? Yet at the time I had been completely unaware.

I am very fortunate to have a loving family who relieves me of the emotional burdens—burdens of which I myself am often ignorant. Yet I know I cannot rely on them to visit me every time I am in need of self-reflection. I hope that through open discussions with my colleagues – be it at Spirit of Medicine, other SIGs, or informal meetings – that we can help one another raise the issue of our self-awareness. In this manner perhaps peer mentorship can fill the hole in our curriculum and help me to know myself.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.

Stefan Tarnawsky

MS4 MD/PhD Student. Going into Internal Medicine; interested in Heme/Onc. Bread baker, bonsai artist, aspiring astronomer.