Coming Home

By Alyssa Brown

I left Louisville 2 years and 51 weeks ago- now I am back. When I moved to Minnesota to get my PhD, I knew that I would come back. It was always a temporary goodbye to the hospital. Graduate school was difficult in its own ways. I loved my years spent in research, but I missed the operating room and patients. I snuck back into the operating room many times over those three years; I couldn’t help myself. Now, I am back, back for my fourth year of medical school.

Two days after unloading my car and moving truck, I started a month-long acting internship in the Trauma ICU. It was my acting internship in general surgery and I barely slept the night before. I packed my tote bag with all the essentials, found my white coat, and headed in at 4:30 am. The roads were empty and quiet. I had forgotten that feeling. The silence of the mornings going into the hospital. As soon as I got to 9 West, I met my team and tried logging into the electronic medical record. I had prepared by making sure my log-in worked over the weekend, but of course, I could not log in once I got to the hospital. I spent the next 20 minutes of precious pre-rounding time on the phone with the help desk trying to get logged in. Finally, 2 minutes before rounds started, I was able to see the patient list. I felt like an idiot. It was my first day back in years, and I already felt behind. As we began to round with the team, I had a surprising happy reunion. The third-year resident was my classmate from medical school. It required some explaining for everyone else on the team to  understand why I was now a fourth-year medical student while he was a third-year resident. It was so nice to see a familiar face in the hospital. During rounds, I immediately noticed that I had forgotten many things in my time away, but I also remembered many things. So many things immediately felt familiar. The rhythm of rounds and the “ducks in a line” feeling of rounding felt so good. I kept writing things down in my little notebook to look up later.

After rounds, the intern had me tag along for a consult. It was a complicated case – a man with terminal cancer who had attempted suicide. The family decided to withdraw care and the consult ended with us pronouncing the patient’s death. It really punctuated the change from my PhD program to my MD program. In my PhD program, I was learning and doing experiments, which were stressful, but it was a very different stress from the hospital. It was not life or death for anyone involved. I could go home after a day in the lab and relax and move on. After a day in the hospital, I am often still left thinking of what I could have done differently or what I could have done better for the patientLater that afternoon, I went to see a patient by myself, and I was so nervous that I wouldn’t remember the questions to ask. The nerves faded as soon as I walked into the room. To use the overused metaphor, it was like riding a bike. I was shaky at first, but I felt occasional moments of stability and regained some confidence.

After a week, it felt like I had never left. I would wake up, throw on my scrubs, compression socks, and clogs. I still got lost like I did during third year, but I remembered how to do the basics. I tried to figure out ways to help the team, even with small tasks or jobs. I loved waking up every day to come in.

The hardest part of the transition was returning to patient care and handling the emotional toll of the Trauma ICU. We had many deaths, but we also saved  many lives. As one attending pointed out, we remember the bad ones more than the good. I had not forgotten that part of medicine, but I had had a three year break from it. I am still the black cloud that I was before. I am still trying to figure out how to distance myself some days from the emotional toll of medicine, especially with the incredibly sick patients, like the ones in the Trauma ICU. I will continue to remember the moments of light though.

The first rotation back will always be the hardest. I had forgotten so many things, but, more importantly, I remembered, like I always have, my love of surgery. I love being with patients, spending time in the operating room, and working with the team. As I move onto pediatric surgery, It feels so good to be home.

Alyssa Brown grew up in Chattanooga, TN.  She went to Centre College for a B.S. in Biology and minor in History.  She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school.  She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD.  She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences.  She just started her fourth year back at Louisville (clearly). Her thesis research is on diaphragm muscle mitochondrial function and morphology. She also participates in research projects focused on physician infertility, student mental health, and pediatric surgery. She has been a part of the AWS Blog Subcommittee and AWS Instagram Subcommittee for three years, and she has loved writing pieces for the blog over the past two years. During the pandemic, you will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” or embroidering. You can find her on Instagram @Alyssa_b_futuremdphd and on Twitter @Alyssa_B_MDPhD.

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