First-Year Journal—Part I “Lifting the Robin”

Beginning a Life in Medicine

From her first day in anatomy lab to the exploration of a Midwest city to a summer externship in the Maine woods, 27-year-old Sarah Cook shares her personal diary—and reveals the mind and heart of a first-year medical student.


“I realize that I have chosen a life that will require sacrifices. The fact is that I chose a life in medicine. This is my dream.”


Sarah Cook

MY MEDICAL EUCATION at Washington University School of Medicine officially began today! Along with many new friends and many classmates whom I have yet to meet, I participated in the Class of 2003 White Coat Ceremony on August 13, 1999.

As I entered the Eric P. Newman Education Center this morning, I could feel the energy of the first-year class. Everyone was excited about receiving his or her first white coat—a tangible symbol of the fact that we are now one step closer to being physicians. Unfortunately, I have to confess that as I entered the auditorium, the idea of the white coat didn’t really thrill me in the same way. I had already been wearing a white coat for two years as a clinical research coordinator in the Massachusetts General Hospital Cancer Center and had come to think of it as a mere layer of protection from blood and bodily fluids.

As Dr. Lefrak spoke on "Professionalism," I realized that the student oath we had written as a class in the preceding days echoed his words. I began to recognize that the white coat I would soon wear would not be like any other white coat I had worn before. This white coat represented my pledge to accept the privileges and responsibilities of a future physician, to live my life in an altruistic manner.

I received my white coat from Dr. Dodson. It felt different. It felt right.

I looked down at my ID and saw the words medical student under my picture. My journey has begun and it feels incredible.

August 19

I am beginning to feel torn. Friends and family call to catch up and ask how I am faring in St. Louis. New friends call to make plans to go to dinner, go swing dancing, go running… I have reading and studying to do. I know that I need to prioritize and balance, but that is easier said than done.

I am leaving tomorrow for the weekend. My friend Kristen is getting married on Lake George in Upstate New York. I am excited to share this special day with her and many other close friends. But, the first-year class will be going on a float trip over the weekend. I feel as though I am missing an important bonding experience.

This is pitiful—I am complaining about the fact that I have too many options! I should be grateful! I realize that I have chosen a life that will require sacrifices. The fact is that I chose a life in medicine. This is my dream.

August 23

Kristen and Dan’s wedding was beautiful, but I spent
the majority of the weekend between JFK and Albany International Airports, being bumped from one canceled flight to the next. Two nights without sleep and the frigid weather in upstate New York brought on a nasty cold.

The bonus—I couldn’t smell anything this morning. We began gross anatomy today. And then, we met our cadaver—a 92-year-old woman who died earlier this year of arterial sclerotic heart disease. We started the dissection right away. I asked if I could be the first to "cut," thinking that it would be best to jump in before fear, anxiety, or any other of the myriad of emotions that surrounded anatomy took over. Surprisingly, I did not find the first incision difficult. Maybe I had adequately prepared myself. Maybe I had distanced myself sufficiently from the notion that the body before me was a living, breathing woman just five months ago. As I reflect on the day, I wonder whether this separation is respectful or necessary.

September 1

I spent last Friday night working at the immunization drive. The clinic was packed with children needing immunizations before starting school this week. We were able to provide MMR, Polio, Hep B, Hib, DTP and Varicella vaccinations for MANY uninsured kids. I was impressed with many of the children. They were well-behaved and extremely brave as they quietly received as many as six shots! It felt good to help these children and their families.

On Saturday the first-year class went to a ropes course out by Six Flags. It was a blast!!!! We broke up into small groups and visited various stations on a low ropes course with challenges such as trust falls. Our group worked exceptionally well together.

On Sunday morning, I ran the Chubb Trail in Lone Elk Park with Rachel. Despite the heat, it was nice to run on dirt trails outside of the city. We saw a white-tailed deer and found a rope swing on the river! I spent Sunday afternoon studying and preparing for my first quiz in Molecular Foundations of Medicine.

September 11

I have been terrible about writing in this journal. My only excuse is that it is a definite indicator of how busy I’ve been!

I was relieved to have done well on my first MFM quiz. I have been working like a maniac to keep on top of everything—yes, I am still planning on making it to Sheila and Riz’s wedding! The amount of information that we have been presented with is overwhelming. I am finding that my head is spinning and I am not sleeping well as a result!

Rachel and I have been running every day. Our times are improving and we have gotten in a few long runs. We are thinking about running the Chicago Marathon in October as a training run. I think that running is allowing me to maintain some semblance of sanity.

I was selected to work on a clinical study at St. Louis Children’s Hospital screening adolescents seen in the ER. I will probably start working on that this coming week. I am really excited, but I think that I need to be careful about overextending myself.

September 30

Family practice really interests me! I think that the diversity of the field is exciting! Not to mention, I could live in a rural area much closer to decent fly-fishing! City life is not for me. It is ironic that I can feel so lonely and isolated in the middle of such a dense population, and yet feel surrounded by a caring community in the middle of nowhere.

October 2

I met my little sister, Cierrah, through the Pediatric Outreach Program (POP). She is 13 and in that stage where she wants to distance herself as much as possible from her mom and siblings. She was extremely quiet around her mom and I could really sense the tension. I am not sure that Cierrah actually wants to be involved with the program. I think that this is Mom’s choice. We’ll see how it goes.

October 9

Sheila and Riz’s wedding was beautiful. Although I am incredibly stressed by the fact that I haven’t been able to study this weekend, I know that I made the right decision in being there. This was an important memory to make. Hopefully, I will survive next week. Anatomy on Monday, MFM on Tuesday, and Histology on Thursday. I am diving in!

October 17

I survived! Mom came to St. Louis over the weekend. We had a great time and it was wonderful to relax. I am so fortunate to have a family that provides never-ending love and support.

Mom brought a present for me—actually a gift from a stranger that she met in Logan Airport in August. Mom and my stepdad, Charlie, were on their way to England, but their flight was canceled due to mechanical problems. My Mom has a gregarious personality and makes friends with strangers in a matter of minutes. Apparently, she started talking to a young guy from Maine on his way to Europe. In the course of their conversation, he pulled out a picture of himself fly-fishing with his dog. Mom told him about me and the fact that I love to fly-fish. They then discovered that this stranger and I had incredible similarities. And so, Mom pulled out her pictures. As they parted ways, the stranger reached into his bag and pulled out a fly—a Princess Di #4. He handed this to my Mom along with his e-mail address and asked her to give it to me.

October 21

Yesterday, the topic in my selective class, Ethical Issues in Clinical Research, was research involving terminally and seriously ill patients. I was pleased that my experience at the MGH Cancer Center enabled me to contribute significantly to the class. The topic did, however, bring back a flood of memories and remind me of the words that I wrote in my medical school application essay.

…"Despite all that I witness on a daily basis, I do not begin to comprehend the stalking fear of facing a terminal disease. I only know that compassion and careful thought are received as blessed gifts by a patient. In the presence of
a struggle for both future life and quality of present life, I recognize that a balance between medical technology and human dignity must be achieved. I have been privileged to observe the altruism and tender compassion of some of the finest oncologists in the world and honored to learn from my patients."

I wrote to the stranger to thank him for the fly. His name is Dave. He lives in a small town called Ashland. I don’t know why, but I feel as though I may have met my soulmate without even really meeting him. I don’t know if I will ever meet him in person, but it is fun to have a pen pal and his e-mails take me away from St. Louis to the backwoods of Maine, if only for a brief moment.

November 22

Grandma’s birthday. I miss her so much. It is hard to believe that she has been gone for almost seven years now. In celebration of her birthday, I spent the day in labor and delivery. I observed three cesarean sections. Each was different.

In the first case, mom was born with a congenital heart defect called tetralogy of fallot. We learned about this in anatomy and the effects of this birth defect were becoming clearer as we studied cardiovascular physiology. I held the mother’s hand and tried to calm her as the anesthesiologist performed an epidural. The surgery went well and a healthy baby boy made his way into the world. Mom was taken to the cardiac ICU to be observed carefully for postpartum complications associated with the stress and blood loss of delivering her son.

The second case was planned. This was mom’s third and final child—she was having her tubes tied! Dad was present and the atmosphere in the operating room was upbeat. A beautiful 10-pound baby girl was born. During the delivery, we received word that an emergency C-section would be performed in the adjacent OR in a few minutes.

The third mom had gone into labor prematurely at 28 weeks. Her amniotic fluid was infected and they had lost the baby’s heart beat. The NICU team from St. Louis Children’s Hospital had come over with special equipment to support the baby. The atmosphere was tense and mom lay alone on the operating table with a look of terror. Dad had been called, but was almost two hours away at work. I held mom’s hand and did my best to comfort her. Within moments, we heard a tiny cry from the other side of the curtain. One of the neonatologists wheeled an incubator laiden with equipment and tubes toward mom. She reached out and took the tiny hand of her 2-pound baby boy. The doctors explained that he had been unable to breathe on his own and so they had inserted a breathing tube. He was taken to the NICU at Children’s. And then, mom was alone with the steady beep of her heart monitor. Shortly after, I received an e-mail that the struggling baby had passed away. I cried.

November 28

Thanksgiving break was amazing! My friend Julie came to spend the holiday. Julie is an orphan and my family "adopted" her not long after we became roommates back in Boston. She arrived on Thanksgiving morning and we went directly to Casey and Nancy’s house to start preparing dinner. Casey’s brother and sister were both visiting too. The six of us were inseparable all weekend. We spent Friday walking around the zoo and Forest Park. On Friday night, Julie and I went to see Macey O’Parker at Mississippi Nights with Rachel and her husband, Victor. The music was great and we danced off all the weight that we had gained the day before! On Saturday morning Julie and I went to a kickboxing class before we went out to Casey and Nancy’s place to polish off the Thanksgiving leftovers. It was a great relief to not even open a book for four days; more importantly, it felt good to have created our own "family" in St. Louis.

December 8

It is the last week of class in the first half of my first year of medical school. This must be some sort of milestone! My life has become consumed with studying, particularly head and neck anatomy. Nine more days to the completion of Anatomy and Molecular Foundations of Medicine! Although the first semester has gone quickly, I can’t wait to go home for Christmas! Imagine—friends, family, two weeks without books…

December 18

I survived!!! We finished our first semester yesterday! I spent this morning at the Saturday Neighborhood Health Center, a free clinic operated by Washington University medical students. The fourth-year medical student with whom I worked and I saw two patients. Both had diagnoses of hypertension, congestive heart failure and COPD. One of the patients had a heart murmur that I was able to hear. I will follow up with these patients to make sure that they have established regular health care when I return to school in January.

January 11

The first-year class held a service of remembrance and gratitude for the individuals who had donated their bodies to our anatomy class. A candle was lit in memory of each of the cadavers that we had come to know so intimately. Dr. Conroy read a poem written by one of our cadaver donors just prior to his death. He had been a surgeon and understood what we had experienced in anatomy. More importantly, he reminded us of the lives of these heroic people who had given so much so that we could learn. He reminded us of their love, their dreams, their hope and their humanity.

January 18

I felt like today was going to be a good day. I woke up early and even got in a couple of hours of studying before class. A dusting of snow had fallen overnight and the trees sparkled with ice. When I arrived at our 8:30 Genetics class, something seemed amiss. Drs. Peck, Kahl and Whelan stood at the front of Moore Auditorium. Immediately, I assumed that someone had cheated on the take-home exam and that we were all in for a lecture on the honor system. I never imagined the weight that would be dropped on our class within the next few minutes. The worst kind of tragedy had occurred—five of our friends had been in a car accident traveling home from Chicago. Two of them, David Kawamura and Stanley Chan, had been treated and released from the hospital. But Adam El-Kishin, Danny Lee and Candice Lin had been killed. Shock swept over us and the stabbing pain erupted into tears of anguish. This didn’t make sense. How could God have taken the young lives of three amazing people? They had the potential to do so much good and it had been wasted … Nobody knew what to say or do and so we huddled together in the King Center, let the tears flow and stared out over Forest Park.

January 21

A memorial service was held tonight in the Eric P. Newman Education Center. Portraits of Adam, Candice and Danny stood before us. Each time that I had closed my eyes in the past week, I had seen their faces. Adam’s quirky grin, Candice’s gentle eyes and beautiful smile, and Danny’s youthful face that somehow portrayed an impossible number of years of wisdom. The service was beautiful and truly captured the personalities of each of our extraordinary friends. We laughed and cried and thought if only we had more time together…Leaving was the most difficult part. Somehow it felt like a final good-bye and I don’t think that anyone was ready to let go.

January 23

I wrote to Dave last week to ask about some of the National Health Service Corps sites in Maine. The summer externship application that I completed last week asks applicants to list preferences. I had simply specified rural, but I thought that I would get the inside scoop in the event that I may be given an option later. We ended up deciding that it would be easier to talk on the phone and so Dave called this afternoon. We spoke for hours! It has been incredible to get to know him without any of the usual pressures of a male-female friendship.

January 27

We had an incredible class yesterday. Two sets of parents came to talk to our class about their experiences with having children that were born prematurely with life-threatening birth defects. Their stories were terrifying and tragic, but they provided a lot of insight into the thoughts of patients and their families. I probably learned more in those two hours than I learned all of last fall.

Dr. Misler talked to us last week about facing death as a physician. His words were beautiful.

In a sense, many physicians face death daily. How does one deal with that situation? The best way I can relate that to you is to say that physicians are in the unenviable position of having to face death while trying to preserve life. But they are also in the unique position of being able to actively memorialize life as a way of mourning death, and that is by doing something that is really quite proactive. I think that is what probably sustains all of us. I don’t know whether I’ve ever shared with you the Emily Dickinson poem:

If I can stop one heart from breaking,
I shall not live in vain.

If I can ease one life’s aching or cool one pain
or lift a fallen robin to its nest again,

I shall not live in vain.

I think that is something that all of us as physicians ought to realize, part of our mission is to lift that fallen robin to its nest again.

February 14

Valentine’s Day! Dave and his black lab, Dyer, sent me an incredible bouquet of yellow roses! I have been told that yellow roses mean friendship. I am relieved that we are able to take time in developing our relationship and impressed by the fact that he is so aware of such things! His support, like that of Casey and Nancy, has made all of the difference in the world! And I am going to meet Dave face to face in March! Casey and Nancy and I are going home to Hingham on March 9. Nancy’s parents also will be flying in from South Dakota. Wow, my Mom’s little house is
going to be full!

February 23

With very mixed emotions, Cierrah and I have decided that she be paired with another POP big sis—someone who has had similar life experiences. I introduced her to my friend and classmate Rachel. It went well—Rachel really knows a lot more about Cierrah’s life and interests. They talked about music and rappers...all kinds of things that I knew nothing about. I think that Cierrah has decided that Rachel is pretty cool. Better yet, Rachel is not going to be a pushover. She was really clear about the fact that she will not tolerate some of Cierrah’s past behavior. Although I am sad about being "little sibless," I know that this is really about what is best for Cierrah.

March 1

Exciting news! I was offered a summer externship in Maine through the National Health Service Corps and the Maine Ambulatory Care Coalition. I do not know where I will be sent in Maine, but I am excited about the program. It will be a terrific opportunity to experience the life of a rural family practice physician.