Opinion

A PIECE OF MY MIND Kevin J. Kovatch, MD Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Corresponding Author: Kevin J. Kovatch, MD (kovatch @upenn.edu). Section Editor: Roxanne K. Young, Associate Senior Editor.

Graduation Gift I graduated medical school on a Sunday. On Monday, with the newly earned letters MD adorning the end of my name, I accompanied two friends to their doctor’s appointment at the institution where I trained. These friends happened to have graduated from a neighboring medical school just two days earlier, so as three new 20-some-year-old physicians entered an outpatient appointment, we humored one another by addressing each other only as “Doctor.” I was there primarily for moral support (and to help with directions), but my new professional colleagues were there for the same appointment, at the same time, with the same surgeons. That day I couldn’t help thinking back to my classmate’s graduation speech given just a day earlier, a masterfully delivered speech about the great humanity she had seen personally in our fellow classmates over the last four years. Examples ranged from working together on rounds, to providing bedsheets for indigent patients, to visiting fellow classmates in the emergency department. Teamwork? Humanity? Sure. However, these examples simply pale in comparison to the love and camaraderie between these two classmates I am writing about, who I am honored to call my close friends. They met in their first week of classes, when they were paired as anatomy dissection partners, as dictated by alphabetical order. They received their first white coats and walked at graduation in the same alphabetical way, side-by-side. One, a fiercely loyal friend who was involved in almost every club the school had to offer, and more than likely started the club herself: The surgically minded type who would stay in the anatomy lab the longest even though she was balancing on crutches due to a recent gymnastics injury. She would later gladly teach you about her ensuing radial nerve compression syndrome. The other, a sweet, always-smiling type who could beat you to any punch line and had a mind like a steel trap: The kind who might leave lab early to go home and play with her pets and read Game of Thrones, neither of which would affect her grade in the slightest. This one would have the misfortune to suffer acutely worsening kidney failure during her final year of medical school, at some point along a stressful 21-program residency interview trail that would (assuming we could get that many interviews) probably cripple most of us who had no underlying medical problems to begin with. Some four years later, they would have their first appointment together with the transplant nephrologist: Nephrologist: [Unknowingly to donor] It’s nice to meet you. [To recipient] What’s happening with your donor? Recipient: Actually, this is my donor with me today.

Nephrologist: Wow. Then it’s more than nice to meet you. It’s an honor! Any medical student knows that a live organ donor is significantly better than a cadaveric donor on any day of the week. A live donation boasts a shorter waiting period, less chance of rejection, longer life expectancy, and a better overall prognosis. Any medical student also knows the interesting fact that organ donors, on average, live longer than the rest of the general population. However, no medical student will tell you that fact without immediately following with the same line: “But that’s biased because you have to be healthy to be an organ donor!” Long story short, it is a huge sacrifice to donate an organ: the kind of huge that your parents might be pretty uncomfortable with at your pre-op visit. Surgeon: I just want to make sure everyone is comfortable with this. Donor’s Father: Of course I am not comfortable with this. Surgeon: Oh! Well, it’s very important that everyone is in agreement before we do the procedure. We can wait … Donor’s Father: No. I am not comfortable, but we are all in agreement. She is an adult and we completely support her decisions. Most medical students don’t know what it’s like to be on a demanding inpatient rotation while on peritoneal dialysis. In fact, most of us complain that we are only sleeping six hours per night, nonetheless that we are woken up every 90 minutes by a new cycle of dialysis under those very same conditions, while simultaneously battling double-digit creatinines, single-digit hemoglobins, and systolic blood pressures straddling 200 mm Hg. Surgeon to Recipient: How are you feeling most days? By now, I think you’ve probably forgotten what it feels like to have a normal amount of energy, and to feel “good.” Surgeon to Parents: Almost everyone stops working when their kidneys fail. It is remarkable for your daughter to finish medical school under these circumstances. We write about these stories in our personal statements for medical school admission: They inspire us to practice medicine, but rarely do we experience them firsthand as the patient. We talk about these patient stories at our residency interviews, but the patients are almost never our close friends. We sometimes even exaggerate the impact of a patient interaction to make the learned lessons, in retrospect, seem more meaningful. Seeing my two friends together on the surgical floor after the operation enters the small handful of things I have seen in the hospital that brought me to literal tears.

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JAMA October 1, 2014 Volume 312, Number 13

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Opinion A Piece of My Mind

These girls won a class-voted superlative award for “Most likely to be friends forever” long before graduation or any one of their classmates knew about the great exchange. They were also both independently named to the Gold Humanism Society long before the word “transplant” left any physician’s mouth. In fact, this text will likely be the first time most people hear their story. Recipient: She had the donor paperwork at her apartment before I even had the chance to ask her. I really wanted to tell our administration what she is doing for me. I wish she could be recognized with an award at graduation for this. The commitment they have to one another is bigger than that of a couple’s match, though the donor compatibility results were received just about the time of Match Day. The commitment here is an outstanding act of generosity between two friends who spent just four years together and, with the start of residency, will be lucky to see each other more than a few times each year moving forward. It speaks to the friendships made in medical school, the bonding done during trying times, and the personalities of the people who choose a medical career in the first place: This type of commitment is the self-proclaimed reason why this particular transplant surgeon has been in this game for more than 40 years. Additional Contributions: Thanks to Peter L. Abt, MD; Jeffrey S. Berns, MD; Melanie Blohm, MD; Hilary D. Bollman, MD; Joel D. Glickman, MD; and Ali Naji, MD, PhD, for inspiring this story and kindly reviewing an earlier version of the manuscript.

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In medicine, we consider it an honor to care for each patient who places trust for his or her health in our hands. This particular transplant team will have the unique privilege of training the young woman who they also had the privilege of treating, and she will certainly feel indebted to the team. Surgeon: We think you are going to do very well with the surgery. Here is my personal cell number. Let me know if you need anything at all. We look forward to having you here for residency! Recipient: Thank you! I promise I will take all of your consults once this is all over and I’m back on the floors! The three of us are starting residencies in three different specialties, in three different cities, none closer than 500 miles apart. This is unfortunately the nature of the residency match, where friendships are all too commonly stretched over miles and miles of country. The friends we make—our future colleagues—are our greatest gifts from medical school. We look to them for support, and they inspire us: The newest generation of physicians will make that perfectly clear in social media and online blog posts. Parts of our closest classmates certainly stay with us even as we move away to start the rest of our careers … for some of us in a more literal sense than others.

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for the Disclosure of Potential Conflicts of Interest and none were reported.

JAMA October 1, 2014 Volume 312, Number 13

Copyright 2014 American Medical Association. All rights reserved.

Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/13/2015

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A piece of my mind. Graduation gift.

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