The torrent of medical education, sea glass or sand?
A second letter to my son, the medical student

By Tracey Delaplain, MD

Before you started your first year I cautioned you that “medical school will change you so you must guard the ideals you hold sacred”. I have watched you change in your first two years much like a piece of new glass thrown into the ocean being tumbled and polished by the torrent of medical academia. All first year students start out as a shiny piece of new glass, none of us knowing what will be left of us at the end of our training. I wonder if you will become a weathered, beautiful piece of sea glass or will nothing but sand remain of the original glass that is you. You study, you rant, and you test yourself against and with the currents. Sometimes you excel, sometimes you just endure. Sometimes the glass just drifts with the tide, sometimes it tumbles against the rocks. It’s surprising to me that you don’t always fight the current. You’ve learned a little bit about flowing with the tide yet I admire your conviction to stand firm against a prevailing current when you know you are right. The luster of you, the idealistic first year student has become duller but the promise of the finished sea glass washed up ashore at hooding is evident every time I see you with a patient. I see glimpses of who you are becoming and it looks very much like a physician. Not finished but exquisitely different, rough edged glass with a frosted patina starting to form.

The deepest chips around your edges have come not from the sleepless study nights or the pressure of your first boards but from the reality that everyone in medicine is not benevolent. I advised you two years ago, to “choose mentors who express the compassion and empathy that you feel now, the summer before medical school”. Many of your faculty have forgotten that teaching and healing are an honor and a privilege. I know this realization scrapes you but it shouldn’t touch your center. You will always be buffeted by physicians and fellow students whom you don’t respect or understand. It's even possible that you will become one of those physicians whom you see imperfections in now. Wisdom often shows us that not all differences are flaws. I am confident however that the empathy and compassion that is you will be protected at your core, while the surface will be battered and inevitably polished.

Physicians need to be receptive to change because many forces, like the tides, are out of our control. You will be transformed a little bit by each patient encounter. In my life these changes have been the best. Patients teach me every day and I never know whether an encounter will polish or chip me. Yet in some moments, we just need to drift untouched. You will learn how to drift in your third and fourth years. We drift when we are tired, frustrated or overwhelmed. Sometimes doing nothing is the right answer. Sometimes the glass just bounces along the bottom unscathed.

The art of medicine at its best is controlled chaos so you will spend most of your life being weathered by the currents. The sea glass is transformed by the tumult, to become a unique weathered piece of art. You must change to become a physician. The physician like the glass is always a work in progress. Always a student, always a teacher, always anticipating some turbulence. We hope for more polish than chips in our profession, so there is something of our core and not just sand left in the end. Learn to find balance between the tumult and the drift. Protect your clear center. Forgive the chips and flaws in your colleagues and yourself. Our profession is complex and wonderful. Physicians are just people with unique strengths and weaknesses. Remember that the most beautiful mosaics are formed from the oddest shapes and most diverse textures. Put your signature on the art of medicine but surround yourself with more sea glass than sand, more character than flaws.

Previously published in Blood and Thunder at The University of Oklahoma School of Medicine 2012 Edition.