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The med student and the machine

In this Stanford Medicine Unplugged post, Orly Farber reflects on how medical students can try to be like machines, temporarily, but remain very human.

After reading another student's Scope post, I began to notice how often medical students refer to one another as "machines." We do so in a judgmental tone that ends with the smallest squeak of jealousy. "He's a total machine" is both an insult and a statement of admiration. It's also a question: How does he do it all?

No one wants to be a complete machine, especially not in a profession that centers around human touch. But baked into that idiom is the idea that a student is productive and efficient, and maybe even able to transcend some basic human needs. Machines don't tire. They don't eat. They definitely don't feel.

Machines just perform.

As a second-year getting ready to take the first Step exam and start rotations, I'm climbing up the giant wall that separates the pre-clinical from clinical years, and I'm trying to imagine what sorts of machines roam around on the other side.

On the pre-clinical front, I've seen students -- myself included -- who, on average, have the highest degrees of empathy, but at the same time, can work themselves into a machine-like trance. We spend hours and hours every day often alone at our desks, flipping through flashcards and question banks, memorizing medical facts largely in the absence of medical experience.

During the one day a week that us second-years are set loose in the hospital, to see just one patient each, I find myself so desperate to flex my humanity that I often forget that I have to perform diagnostic skills too. I'll spend an hour listening to a patient's story and walk out to realize that I neglected to test their reflexes. Then, as if punishing myself for this humanoid lapse, I'll return to the library and try to function a little more like a studious robot, synthesizing information as efficiently as I can.

On the clinical side, I imagine I'll wrestle with a different type of machine, a machine that operates not in a silo of its own learning, but in a beeping, bustling hospital, where the pressure to perform is much more visible. I picture myself in that space, wanting to be a human in the eyes of patients, and perhaps wanting to be a bit of a machine -- accurate and tireless -- in the eyes of residents and attendings.

But last week I was reminded of what it feels like to operate as a total machine, when it isn't a choice, but rather, a reflex.

As I was going to sleep late on Monday night, I got a text from my mom: My grandmother had died. I called home in tears, and then tossed and turned for the rest of the night. The next morning, I woke up with a pounding headache, but I washed my face and made my way to campus. There, I watched pharmacology lectures on double-speed, taught immunology to my first-year peers, and entered the hospital for an afternoon of clinical practice. I got home, studied more, went to see some friends, and didn't tell anyone that I had just lost someone I loved.

Machines don't feel and, for a few days, neither did I. I didn't have the time or the space to process so I retreated into a numbing work mode.

I got through each day of the week -- a blur of rainy bike rides, damp socks, meetings, labs, and one horribly-timed lecture on the neurologic condition that, over the course of a couple weeks, took my grandmother's life. I studied and studied -- separating the clinical facts from the person affected by them -- and only when I made it to Friday did I finally turn off the switch and collapse.

Here I am now, fully human again, feeling loss against a backdrop of worries about making my way up and over the great wall. I feel sad and stressed, and I'm sharing this both to process and to remind myself: I'm a terrible machine.

As I prepare to start my dedicated study period -- months where I'm only responsible for preparing for a single exam -- and then roll into clerkships where my responsibilities will shift to components of patient care, I want to work hard and remain resilient. But I am not made of steel and wires. I am so very human: exhaustible, prone to errors, and filled with emotions. For me, acting like a machine is more of a symptom than an ideal state.

So, the next time I look at a classmate, at a friend, and instead see a machine, I'll fight the impulse to look on with a degree of envy. I won't ask: How does she do it all? Instead, I'll pause and ask: Is the med student behind this machine doing alright?

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Orly Farber, a second-year medical student, is from Washington, D.C. She graduated from UChicago in 2015 and spent the following two years in an allergy lab at the National Institutes of Health. While Orly's heart remains in Chicago, her body is thrilled to be in the Bay Area! She loves running, hiking, rock climbing, baking bread, and tending to her plants -- fully embracing the West Coast lifestyle.

Photo by Franck V.

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