And it belongs here because after two years of stubbornly refusing to yield to med school, to let it define my life, I concede that in some warped twisted ways, it has led me exactly where I wanted to go.

Back in May my parents rented a house at the beach. My life was on “pause” – I had just finished step one of the board exams and in a week or so, I would be starting my third year. My goal was to absorb enough sunlight so that I wouldn’t actually look like I was spending summer in the operating room. But the more valuable hours may have been ones I spent sitting on the front porch in a rocking chair, idly drinking coffee and thinking about the woman I was becoming. I had overcome academic obstacles and panic disorder and the next big challenge (surgery) was fast approaching. I was terrified and exhilarated and I was ready.

Since then, I have performed surgery, delivered babies, and spent nights in the emergency room. I learned how to play doctor during office visits in pediatrics and family medicine. I traveled to Europe again and to Africa for the first time. I wrote up a storm. I helped organize an orchestra concert and a few lectures for the Art Therapy group. I made new friends in the community. From the start I had worried that medical school would prevent me from being the free spirit I always suspected was hidden inside. Instead these monumental steps have given me the confidence and courage to embrace the life I was born to live.

I passed out in surgery and destroyed my car, forcing me to confront the fact that as a human I am by nature imperfect, and that very fact is what makes life beautiful. I traveled back to the spot in Italy that took my breath away with each memory and I was proud of myself for being the sort of person who goes for the things I want. I had always hoped this was true but had my doubts. And most recently, the last blog entry I wrote was submitted unbeknownst to me and accepted by the following website, reminding me that when you put your heart into something, anything, you wind up somewhere you could never have imagined:

http://www.kevinmd.com/blog/2011/12/emotional-intelligence-matters-doctors-medical-students.html

Somehow by the end of 2011 the pieces fell into place. I have friends I didn’t know a year ago and a life I would never have thought possible. For the first time since starting medical school, I am starting to believe that it just might be exactly where I belong.

A popular teacher at our school recently gave a lovely talk about “emotional intelligence.” I was at once proud of my school for offering such a lecture and disturbed that it was necessary. Our schedules are flooded with lectures devoted to issues such as professionalism and emotional awareness. We’ve all heard stories about insensitive doctors with terrible bedside manner and outrageous faux pas by medical students, transmitted in whispers, and we debate whether they are urban legend or fact. It leads me to wonder, what percentage of med school students actually are as socially awkward and unaware as we are led to believe? Most of the med students I know are caring and compassionate people. We all have our limits and we can be clouded sometimes by exhaustion and frustration. But cracking under pressure now and then does not negate the fact that this is a group of uncommonly good-hearted people. So I have to wonder, where are things breaking down between that image, and the idea that we are self-centered individuals who are out of touch with reality? I suspect that only a minority fall in the latter group. It’s undeniable, however, that some young doctors grow disillusioned and forget how be human. That image is so disturbing that it is burned into the brains of those scorned and misunderstood by their doctors, and in the eyes of society, we have fallen. This is our burden to carry.

If we are denying our emotions and our humanity, perhaps it is not that we are callous individuals but that we are scared. Med students are faced with many inhuman tasks. So far during medical school I have befriended a dying woman and watched her slowly decline, dismembered a cadaver, cut into the flesh of a live human, inserted catheters, poked people with needles, performed pap smears and rectal exams, removed staples, packed seeping wounds, sewed together bleeding skin, even helped to deliver babies. When I first learned a couple of years ago that I would eventually have to do all these things, I had a panic attack. At that point I was squeamish looking into a classmate’s ears. Yet they became necessary and even routine elements of some of my classes.

Maybe it’s not just about the exhaustion and the fact that our brains are crammed with a bunch of scientific details and Latin-based vocab words. We do profound things without hesitation, without letting a glimmer of weakness pass across our faces, because we have to. It’s not an option. Thus, some degree of detachment is essential to survival. When we become pros at keeping our emotions under control, trying not to let anyone see our hands shake or sweat roll down our foreheads, it’s not a surprise that we become a little mixed up. Personally I wonder what would happen if medical schools not only offered but required routine mental health checks for their students. At this point, there is no safe place for us to admit when we feel scared, shocked, dehumanized. We are rarely reminded that acts such as assisting a surgeon and delivering a baby are not normal, they are extraordinary, and we are extraordinary for making the sacrifices and finding the strength necessary to be a part of it all. Instead we suppress these emotions and tell ourselves that if other classmates can get through without being scared, we must be weak for feeling that way. And just like that, we have lost touch with reality.

I’m ashamed to say, sometimes even I find myself asking how much emotional intelligence actually matters. The time that I spend writing and ruminating can feel self-indulgent. This was particularly true during first and second years, when memorization and the ability to sublimate bodily urges (eating, sleeping, having fun) in order to study longer were the path to an “honors” grade. Third year is more about relationships and personality and the ability to connect with others. And I am starting to see how having emotional intelligence is what makes a doctor great with patients. After seeing hundreds of patients this rotation, one after another, I am learning to see the subtle emotions that flicker across people’s faces. I am learning to detect when people are really in danger, and I have missed things the real doctor later picked up on because I failed to read these cues. One of my teachers used to say that we must learn to recognize when someone looks sick. Sounds simple but takes great perception. And usually that judgement can reveal more than a lab test or a CT scan.

Emotions play a large role in my life. Rather than hiding from them, denying them, I try to understand how the world affects me, how I handle challenges, how the people I interact with make me feel. My major decisions are based not on logic but on how I feel. I understand that this is not entirely normal. Emotions are inconvenient sometimes. They can draw you into a black hole. But that does not mean that they should be avoided completely. Delivering a baby or performing a surgery is not just “cool,” it is amazing. Miraculous. It is only when you open your heart to all emotions – the sadness, the disappointment, the wonder, the joy – that those moments become so potent.

I applaud our educators for acknowledging that emotional intelligence matters, because it does. I am glad they take time out of orientation days to remind us of its importance. I am now sending out a plea to my fellow classmates: let’s show everyone that they don’t need to. Don’t be afraid to admit to yourself or to a loved one that you have an emotion. This is not a sign of weakness, but of being human. We are set apart from plants and fungi by our beating hearts, our breathing lungs, and the ability to feel complex emotions. Celebrate this. Feel giddy when you deliver a baby or take out a cancer. Feel sad when you witness suffering. Learn to read the faces of your patients, to gauge what they are really feeling. It means nothing and sometimes, it means everything.

Last week was a test of strength. After returning to Indianapolis on Sunday after three weeks away, mail piled up and a cat already angry that I ditched her with my parents, I had to be in Muncie at 8am on Monday for the start of my Family Medicine rotation. I was not so much bothered by jet lag (rendered immune after switching back and forth from day to night shift in OB month) or the drive (it’s only an hour) but by the fact that I was not re-assimilated to home. So I commuted some nights, slept in Muncie others, did what I could to make it through the week. Sometimes med school is an exercise in fortitude even beyond the OR or the patient’s room.

This week is easier and will end with an orchestra concert. Which reminds me… a shameless advertisement: COME SEE THE IUSM ORCHESTRA! We are having a concert at 2pm on Sunday Nov. 13th. It is at the Indiana History Center, at 450 W. Ohio St. (on the canal). It’s a great study break. We are playing music from the Nutcracker so there will be something familiar. Okay, sorry for that, but I would be remiss if I didn’t at least mention it!

On to a more relevant topic. My Family Medicine rotation is fun. I am paired up with a doctor in the community and luckily he is awesome. He grew up there and has seen the same patients for many years. I love this “continuity” as they call it – seeing the same people year after year, learning about not only their health issues but also their work and hobbies and family structure. Every time he prescribes a medication or proposes a new idea, he takes into account the person’s beliefs about their healthcare, level of motivation, willingness to take medications versus modify lifestyle, even financial abilities. Decisions are personalized, which is how I believe medicine should be. There is also such a strong focus on preventative care. I enjoy surgery but so much of it is fixing things that have already occurred. Controlling someone’s diabetes, hypertension, weight before a problem occurs is satisfying. And spending a large part of the day just talking to people makes it hardly seem like work. It is exhausting sometimes for an introvert, but fun more often than not.

Many students don’t like the fact that patients don’t listen to the advice to quit smoking or lose weight or get that flu shot. They hate caring for the same conditions day after day. But I like seeing that personality come through. I can be very stubborn myself and probably respect people more for it. It becomes a challenge in this way to earn trust, to get the point across, to say things in a way that mean something. The fact that people decide whether or not to take the advice to heart makes it more fun when they do. I obviously do not possess such great communication skills yet, but it is my mission to hone them.

I haven’t decided whether or not I will be indulging the part of me that loves crafting and creating with my hands (the surgeon) or the part that loves delving into people’s ideas and emotions and helping shape them for the better (the psychiatrist or general practitioner). But family medicine is definitely on the list. Having a relationship with my patients, in some way or another, is an absolute necessity for me.

October was “vacation month”: customarily a time in third year in which students try to find the least work-intensive elective possible in order to catch a break while storing up extra vacation for fourth year. To me, however, this meant that I should actually take a break, learn something new about the world. So I went to Europe and Morocco, which has been the cause of my blogging hiatus. This should be taken as further proof that living a balanced life, even during med school, is entirely possible and in fact a great idea.

I have a friend living abroad in Madrid, and visiting her was the center of my trip. Together we decided to take a short trip to Morocco. I also wanted to revisit the farm where I volunteered last summer in Italy. This lovely plan brewed in my head for months until at the end of a particularly long day of general surgery when I decided a break was warranted. I impulsively bought a ticket to Rome. And thus began three weeks of living out of a 21-inch suitcase, sleeping in hostel rooms with seven strangers, eating whatever was brought to me because I usually had no idea what I was ordering, etc. Let me be clear: traveling by yourself to a foreign country where you barely speak the language is by no means a “vacation.” It is an adventure, I would say, because it’s fun and exciting and life-changing but it’s a lot of work. You really learn who you are in such challenging circumstances.

Rome was the beginning. I had been completely overwhelmed my first time there, and though things were no less crazy, I’ve at least picked up a little Italian and could order food, buy train tickets, etc. I saw the Vatican, wandered transfixed through the museum filled with ancient Roman art that I’m sure I have seen in Latin textbooks, admired the Sistine Chapel, gaped at St. Peter’s Basilica. I took in the ancient Forum, walking over the same stones that the Roman emperors once trodded, and admiring the remains of ancient temples. There were flowers on the spot where Julius Caesar was murdered, and I thought it inspiring that after thousands of years a man could still be admired and respected. I wandered through local markets, parks, and piazzas. I ate a picnic lunch in the shade of the Colosseum.

The farmhouse in Tuscany was no less idyllic, if a bit chillier this time around. I tended to vegetables, pulled weeds, picked saffron flowers, and even helped care for some homemade wine fermenting itself in a cellar that was once an ancient Etruscan tomb. For those of you less nerdy than I, those were the people who settled Italy even before the ancient Roman empire arose. One day we picked pumpkins, which assuaged my sadness of missing a beautiful Indiana October (my favorite month). The week was also an exercise in loneliness from leaving everyone I love behind, and guilt from leaving medicine behind for a month, quite honestly. There is much time to think and experience every emotion when you have no TV and only 2 CDs on your iPod. It felt so good, though, to be in the crisp air under the warm sun of Tuscany, to work in the dirt with my hands. As with surgery, when I am working with my hands, I feel connected to myself and whole.

After a day of travel that included a rural bus, two trains, and an airplane, I stopped over in Madrid to meet my friend, and together we flew to Marrakesh, Morocco. I have never seen chaos and peace exist together so comfortably. We stayed right off the main square, a cluttered mess of food stands offering fresh-squeezed orange juice and nuts, pottery shops, men charming snakes and carrying around monkeys to impress tourists. Stray cats roamed everywhere. All buildings were a sandy-red orange color on the outside, no more than two stories tall but for towering mosques, giving the city a cramped cluttered feel when viewed from a rooftop terrace. The insides, however, were exotic and beautiful. Courtyards with fountains and mosaics of blue and white created the illusion of the sea in the hot desert climate. A few times a day, chanting would rise up and float above the rafters, a devout prayer to the God that the people believe brought them all this wonder. For two days we wandered about, ate warm delicious lamb and couscous infused with cinnamon and spices and sweet homemade yogurt, haggled with street vendors, and hid from the sun in parks and palaces with courtyards akin to Eden.

Madrid was a classic European city, with stately buildings and wrought-iron gates, green trees scattered about, good public transportation, and smartly-dressed citizens. It has a lovely art museum and a giant public park perfect for lounging under the trees, with strains of trumpet and saxophone music drifting through. We ate three-course lunch specials at 2pm and dinner at a tapas market at 10. At all hours the city was alive with people. I love Indianapolis, but here the streets can be so dead that I sometimes wonder if there has been a zombie apocalypse. Madrid was the first place outside the United States that I could picture myself living. I had a wonderful time exploring the city and bonding with my friend, eating churros dipped in chocolate, listening to the language. I’m truly inspired to learn Spanish now; it’s a beautiful language and after a few days of struggling to be understood, I can’t imagine how my non-English speaking patients must feel in the hospital. Imagine being sick and misunderstood. I don’t think I ever got how hard that must be.

After a short daytrip to Segovia, a cute medieval Spanish town complete with an intact Roman aqueduct, I ended my trip in Barcelona. Which is not Spain, I learned. It is technically in Spain but adheres heavily to the culture of its region (Catalunya) and even has its own language, in case I wasn’t confused enough already. With its laid-back atmosphere and hoards of roaming tourists, it felt more like Disney World than a European city. It was pure vacation, rare for me, but a good end to my trip. I explored the old quarters with their Gothic-era buildings, the newer open areas with fantastical designs by Barcelona’s famous architect Gaudi, lounged in a park with musicians and lovely views, and wandered the boardwalk to the beach.

Last Friday I packed up and flew back. My luggage was lost and found. My family and cat were all happy to see me. I spent the weekend in Cincinnati and somehow made it to Muncie at 8am Monday for my Family Medicine rotation. I am exhausted after going from baking in the Spanish sun to running around seeing a new patient every 15 minutes. Quite a culture shock. But if I learned anything from my trip, it’s that I love what I do. Last summer when I traveled, I had barely made it through first year, and I wondered what I had gotten myself into. Half of me wanted to stay in Italy. Third year, things are different. I was actually excited to come home and start Family Medicine.

Medical school is a hard road to walk, but I now know that I am capable of handling it, and I am built to be a doctor. I even openly admit to people now that I am training to be a doctor, which is a brave move considering the questionable reputation that we have among the general population. No matter what criticisms of the healthcare system are thrown at me, I’m willing to defend myself because I know what kind of doctor I will be. Medicine is my calling. I could fight it, I could complain, I could question my judgement (and I have done a great deal of all three of these things, believe me) but a few months into third year, it has won me over.

So when it’s the middle of winter and I have caught the flu from a kid on my pediatrics rotation and I am bemoaning life as a medical student, threatening to pack up and flee to a beach in Southern Spain, please leave me a comment to remind me how much I missed it