Letter to Noelle, First Year Medical Student

Editor’s note: In 2017, the New England Journal of Medicine featured a piece entitled “Letter to a Young Female Physician,” in which Dr. Suzanne Koven writes to her younger self at the point she would begin residency training, before embarking on a 30-year career in medicine. The value of this type of self-reflection is that the author is able to impart what they feel to be their most authentic wisdom. I hope mine can carry a connection to our peers and patients.

In four years, you will be a doctor. In that time, you will have found a sisterhood amongst a future pediatrician and psychiatrist, founded on dancing to Bollywood films in the living room between blocks learning medicine PBL-style. You will have had some of your dreams and part of your life washed away by the life-altering Hurricane Ike in Galveston, Texas. After the waves returned to the sea and the brine drained from your home and those of your friends, there will be no words, but still plenty of memories — like interpretive dancing loosely based on the circulatory anastomosis known as the Circle of Willis. These women will be your first unbranded, small group Lean In Circle and your first peer mentors. While sometimes you will not speak to them for months as everyone rotates through 24-hour calls on different cycles, they will be unconditionally your friends through the turmoil and victories of becoming a physician. Female friendship and support, you will find, will be almost as important as anything you learn while rounding.

For residency, you will move to a city culturally diverse at its core, but not in your world, the hospital. You will feel like a minority at all times, and you will struggle. You will hear about imposter syndrome – the fear of being unqualified and exposed as a fraud in your profession -- and read about it academically. But first you will experience it, occasionally feeling like a ship unmoored, looking for guidance from mentors who need you to have a specific project to guide you best, not just feelings that are difficult to articulate. You will share incredible experiences with other residents and with patients as you train to become the doctor you would most want for your family. This period in your life will actually become one of those wonderful experiences, because it will guide you toward mentoring those similarly unmoored, looking for more than help on a project: looking for help to believe that they should bother with the project at all. You will be picky with your mentorship because you will want to be authentic. You will be as interested in what experiences impacted their lives well before they donned the white coat to better understand their motivations and obstacles. You will look for each person’s own “hurricane.”

It is also in residency that you will forge more bonds with complete strangers per day by virtue of your position as the person given the privilege of deciding, bared down to its most naked truth, when they get to put their clothes back on and go home. You will spend a long time with some patients and a short time with others. You will watch people die with families so large and caring that you feel truly grateful on behalf of the one that has passed. And you will watch others die alone, sometimes the same day as a holiday, or a birthday, or a special family gathering that you couldn’t attend. This point in particular will nag you for years. You will wonder if it is worth it. But that’s when you should know that no matter what you had done for your career, you would have made sacrifices, and though you’ve got nothing to prove it, what you do does matter and it matters in a currency that cannot be inflated nor traded.

You, the pediatrician, and the psychiatrist will all be Chief Residents – medical leaders at your hospitals. That year will be a blur, with the exception of a year-long bout overcoming the need to flee when someone opens a PowerPoint or an Excel spreadsheet. That year will be part of your path to discovering what it seemed like so many knew all along: Sometimes, you just have to pick something and try it out, and fail. You should know that there is no medical equivalent of the Dalai Lama at every hospital dishing out profound meditations, but there are enough little old ladies recovering from UTI-driven encephalopathy to write volumes of books on how to become better at what you love most about medicine: connecting with another human being.

Incidentally, these elderly women also have quite a few stories of being a powerful young woman in a sexist world. You will be dealing with sexism nearly every day, but that’s one thing you already anticipated. You will sometimes have to explain to three men a day why you aren’t smiling as you walk down the hall pondering the many ways a human body can fail. Facing sexism will just give you more skills at handling humanity.

Much like the power of potluck in being assigned a roommate in college, you will have found your feminine feminist physician friend by chance in the midst of half-hearted icebreakers before your intern year. The two of you will share the frustration of being overlooked even when you pull up to the table. You will each find inner strength from hikes through the mountains, unbiased and neutral in their ancient strength, as you talk about ways to be better doctors for yourselves and for your patients. When you see little girls in the elevator, gazing at you and your white coat, asking if you know Doc McStuffins, you will say, “I’m a doctor, just like her!” so that the young girl knows that she can move past wondering ‘if’ and start dreaming about ‘when.’

And finally, as important as all other lessons, take care of yourself even as you care for others.