Growing Pains

Photo by Scott Webb on Unsplash.

Photo by Jed Villejo on Unsplash.

By Emma Spence, Meds 2021 
Last year, my parents finally made the decision to downsize from their family-of-five home to a more suitably sized condo for empty nesters. Helping them move, we sifted through decades of memories that were wrapped neatly into boxes or got tossed into donation bins. The hardest thing to leave behind though, was not a piece of furniture or a parcel of photos, but rather a strip of doorframe trim leading into our kitchen. The kitchen was the centre of our home, that warmly welcomed friends and strangers alike over the years. Countless times the doorframe was walked past without a glance. Yet for me it was the hardest thing to leave behind, for on it was etched the pencil markings that followed the growth of my brothers and myself (a few stuffed animals too) over the years.  However reluctant we had become, on visits home from university or new homes with partners, our father would still line us up on that doorframe for a reference – even though my 6’6” brother could hardly fit through the door anymore. Tied up in these ever-fainter etchings was a testament of our growth, a written proof that no matter where, who, or how we were in that moment, we had come so far from those lowest markings.
         
The peds-savvy know that by five months of age a baby has doubled in length. Wild, isn’t it? From the time we are born, such importance is tied to this concept of growth. But what happens when annual pencil markings begin to crowd and overlap and when these standard measures aren’t enough to convey our development anymore?
           

So much of childhood, academics, finances, etc. are measured according to a common upward trajectory. Let’s frame this in a context relevant to all of us medical students. Particularly in the pre-clerkship years of medical school, we all learn the same material, at the same time, with the same exams and assessments of our progress at the end of the day. This can make it easy to have a sense of what you should know and where you stand. Come a certain point, however, most notably upon starting clerkship, this common path suddenly diverges in (a yellow wood…just kidding) multiple different directions. All these paths may lead to the same end-point eventually, but without 99 classmates moving alongside you anymore, how can you know that you’re moving in the right direction, at the right pace, or that you’ll actually end up in the right place? The fact of the matter is, it is really hard to be certain of these things. Wherever your path begins you will need to have a little trust that if you put in the miles, your route will eventually land you in the right spot – with all the same wonderful knowledge as your classmates.

Underlying this transition from pre-clerkship to clerkship is a shift in growth from a common upward and linear climb, to an individual expansion in any number of directions. The growth trajectory remains upward – accumulating knowledge, skills and experiences. However, rate and order of learning will vary widely based on things like sequence of core rotations, different preceptors and residents, how quickly we strike a balance between work and life, and  so many other factors both within and beyond our control. If we were to chart our progress through clerkship, some days might look like a failure to thrive, and others might really feel like a growth spurt. Just remember that even on days when the only question you get right is your name, you are growing. On days when you learn a new skill or get to show off something you have been practicing, you are growing. On days when you feel like you are underperforming, the fact that you have that awareness means you are growing. And, just like during puberty, it is normal to have some growing pains. We must take heart in knowing that whatever path we are on, we will eventually all get to where we need to go.

Having said that, not all growth is painful. Growth also comes from hugs from a patient, suggesting the right diagnosis, or finding time to see friends, family or reading your favourite book. Welcome these moments warmly and continue to seek out the positives even on the toughest of days.

Importantly, too, remember that not all pain means growth. Regardless of where we are at in our training, if we are feeling overwhelmed or run down, we must be kind to ourselves, to each other and try to connect with our support networks. There are people who care and who are there for you, whether these individuals are family, friends, partners, your class wellness representative, a counselor or others. Try to reach out and remember to keep an eye on those around us to offer a kind word.

In summary, come a certain point in medicine, our development switches from common and clearly directed progress, to self-regulated and multi-dimensional expansion. We may not be able to measure our growth with pencil markings on adoorframe anymore, but the growth we now have the privilege of experiencing goes beyond what the eye can see. Medical school allows us to grow intellectually and emotionally, in skills and in character. Pre-clerkship is a great opportunity to practice what becomes necessary in clerkship and beyond – focusing on our own growth and learning independent of comparisons to others. Take heart in knowing that while we may not always enjoy the growing pains, it would be much more painful to always remain the same.