Iatrogenesis: Essays on Becoming a Physician

In Their Own Words

New book written by U-M medical students reflects on what it means to become a physician

By Lauren Crawford
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Upon entering the U-M Medical School, students receive a white coat and a stethoscope, symbolizing the start of their journey to become physicians. Now, thanks to an ambitious group of their peers, incoming students will also receive something a bit unexpected: a collection of short stories reflecting on what it means to study medicine, written by those on the same path.

Iatrogenesis: Essays on Becoming a Physician “was conceived out of a recognition that these coming-of-age stories, by trainees embarking on their journey into medicine, are too often untold,” says Trisha Paul (M.D. 2018), editor-in-chief of the collection. “While this journey is singular and deeply personal, we were struck by the elements of universality in our shared experiences: whether it be reconciling a new way of seeing humans as bodies, learning to cope with the intense emotions that can arise when caring for patients, or even questioning one’s decision to pursue a career in medicine in the first place.”

Iatrogenesis is derived from the Greek root words for “physician” and “origin,” a neologism that embodies the growth — the highs and lows — that comes from attending medical school and entering into the profession of caring for others.

“It has been my great honor to serve as the editor-in-chief, as well as a writer of this collection,” says Paul. “Perhaps the most rewarding aspect of sharing our stories has been to learn how embracing our collective vulnerability not only creates a closer sense of camaraderie, but also resilience in medicine.”

Read an excerpt from Iatrogenesis below, or purchase a copy.

Yes, I Understand

By Sara McLaughlin (M.D. 2017), Ph.D.

It was a hot summer day in early August. I gathered with 170 strangers and their families for the White Coat Ceremony to celebrate our entry into medical school and the start of our medical careers. Like most of my soon-to-be classmates, I was full of excitement and anticipation. I had been accepted to the medical school of my dreams to pursue my dream career. I had returned to my hometown, which I had loved and missed. Unbeknownst to my peers, I was on the verge of becoming more than a medical student; I was 10 weeks pregnant with my first, much desired pregnancy. I looked around: Who would become my closest friends? Who would I tell first? How long did I have to wait to share my good news?

We began medical school studying Genetics. It seemed as if each lecture was directed at me and my growing belly. When we learned about rates of trisomy 21, I wondered if my baby was carrying extra chromosomes. A woman spoke to us about her decision to continue her pregnancy even though the baby likely had Down syndrome. We met her son and heard about his successes and struggles. “I just want him to find love someday,” his mom said, to a hall of damp eyes. I had no idea what I would do if the results of my genetic testing came back with news similar to hers. The year continued. I made friends. I held on to my secret.

And then the day I will never forget: August 22, my first obstetric ultrasound. Baby pops up on the screen. Bright, smooth ribs and spine, evenly spaced in geometric perfection. Limbs moving. So human. A flawless baby, like ultrasound images I had seen from friends and would come to study in the years ahead. The ultrasound technician leaves the room, and a physician enters. The appointment, which was supposed to be a joyous confirmation of the baby to come, instead becomes a blur of badness.

“We don’t see a uterus.”

“Possibly ectopic.”

The pregnancy was so far along, already 13 weeks. A ticking time-bomb. I step back and wish with all my might that this isn’t happening, but I cannot stop time or change the course of fate.

“No, you can’t fly to your cousin’s wedding. You need to go to the Emergency Department (ED), right now. I’m sorry.”

Hours later, an MRI and more ultrasounds. I email professors and classmates from my bed in the ED with vague reasons for missing meetings and assignments. I’m sent home in a daze. More diagnostic studies, more conversations, more wondering if my baby would live. More attending class and taking quizzes as if life were normal. One week later, the final verdict: a rare uterine anomaly, the doctor told me, a bicornuate uterus with one rudimentary horn, unfit to hold a pregnancy but with one growing inside. A uterine horn that almost certainly would rupture should I continue the pregnancy. So the pregnancy had to end, or my own life would be in serious danger. My rational nature and budding medical knowledge evaporated. It was all my fault. The floor dropped out from under me. My perfect baby had to die because of my horribly imperfect body. Nothing could make me feel that this wasn’t my fault. I sobbed and apologized over and over to my baby.

That fall, in Doctoring class, we discuss how to deliver bad news, to consider how the news might affect a patient. We talk about how, for a patient, bad news may split life into “Before” and “After.” Yes, I understand. I was living After and could never return to Before.

Then came the worst day of my life: the day we had to end the baby’s life. Potassium chloride injection into the little heart. Heart stops, and the worst cramps I’d ever felt start. I pick my head up, walk from the clinic to the library, and sit in front of a computer screen in a fruitless attempt to study. My husband drives me home. I assume the fetal position. I cry and cry. Then I finish studying and take an exam in a parallel universe where life is okay. Weeks later, while studying the cardiovascular system, I learn how hyperkalemia, too much potassium, can cause the heart to beat abnormally or even stop. I become nauseated. Yes, I understand.

“Emotional pain can cause or augment physical pain, I learn later.
Yes, I understand.”

Next came surgery. Removal of the faulty uterine horn and its contents. I wake up. My shoulder hurts. In anatomy, I learn that the diaphragm is controlled by the same nerves that go to the shoulder, often causing shoulder pain with diaphragm irritation. Yes, I understand. My physical pain is severe, much worse than I had expected. Emotional pain can cause or augment physical pain, I learn later. Yes, I understand.

In Doctoring class, I learn about being an empathic physician who supports patients’ emotional and physical well-being. I walk, from a morning of pretend examples and role-play, to my doctor’s office, where he puts a hand on my knee and looks me in the eye.

“We’ve been talking a lot about how you’ve been doing physically; how are you doing up here?” he asks, pointing to his head.

I break down.

He says, “This and that might be hard.”

“I thanked him for giving me, the medical student, a perfect example of the empathy and caring I would attempt to emulate for the rest of my career.”

I don’t remember what his “this and that” were, but I remember he was exactly right. I hadn’t said it, for it was too hard to say. But he knew. With a warm embrace, my tears began. I looked up and thanked him for making me, the patient, feel like it was going to be okay. At the same time, I thanked him for giving me, the medical student, a perfect example of the empathy and caring I would attempt to emulate for the rest of my career.

During the second year of medical school we learned about pathology — what can go wrong. My second year was accompanied by two more pregnancies. I was a nervous mess the whole time. In class we learned about early pregnancy problems — abortions, they’re called — of all types. Pregnancy number two ended in a spontaneous abortion, or miscarriage. With the third pregnancy, I experienced a threatened abortion: fifty percent chance of the pregnancy continuing. A jarring statistic. Yes. I understand. Somehow, I was dealt the lucky cards and the pregnancy marched ahead.

Trisomies: The first trimester screen showed an increased chance of trisomy 18. Later, during my Pediatrics rotation, when I helped take care of a baby with trisomy 18, I could barely enter his room without feeling nauseated and weak in the knees. His less-than-one-year life expectancy, his microcephaly — or abnormally small head — and all of his physical difficulties … I was overwhelmed by how all of this must pain his parents. And I was filled with emotions as if he were my child. As I stood in the boy’s room, I was unable to look him or his family in the eye. I felt powerless to this extra chromosome. Follow-up testing of my pregnancy showed no extra chromosomes. I breathed a sigh of relief. Time moved onward.

My half-sized, abnormally shaped uterus continued to expand and support my baby. He became too big to view in one screen on ultrasound.

He kicked me.

I told people.

I began to let myself hope.

I took Step 1 of the U.S. Medical Licensing Examination. I entered the wards.

And then a miracle: my beautiful and perfectly healthy baby boy was born. Another dividing line, another Before to After. A line I had come to believe I would never get to cross. I was a mom.

Now, I am an almost-physician with a toddler running around my home. My medical knowledge has expanded exponentially. I feel ready to have two extra letters affixed to my name and to claim all the responsibilities that come with them. I am a mom, and my life is full of love, amazement, and satisfaction (as well as dirty diapers and sleepless nights). The despair I have experienced along the way, however, continues to remain tangible. I remember the importance of empathy and seemingly simple acts, like a hug or check-in note. I remember how personal medicine can be. What an honor it is to care for others’ bodies and souls. Yes, I understand the importance of this work and how difficult it can be both for patient and provider. I graduate prepared to tackle this daunting task, thanks to my infinitely entwined journeys as both a student and a patient of medicine.