Introspections: Imposter medicine

By Michael Dea

Scalpels are sharp. They’re precise. They’re nimble. They help save lives. They’re reliable servants to our health and prosperity. They were forged into this world with a clear mission. They simply use their sharp edges, their symmetry and their levity to do their best and engage with the moment as it comes. They accept their calling with grace, humility and precision. They don’t doubt themselves or wake up with the fear of failing like I do. They are not afraid of blood, old age or cancer. They are tools from the world that break into the vast and complex worlds of our patients’ bodies, an extra finger on an already trained hand to carve out the threat of disease. Death can’t hide from them. I respect scalpels, the work one must put in to even hold it, the years of study and practice, and their representation of how far we’ve come in medicine. At the same time, I am constantly reminded that they are only a miniscule part of the equation. In the spirit of that old adage, a tool is only as good as the surgeon wielding it.

I recall a time when a trained surgeon used this tool to make that difference in someone else’s life. During a surgical service at the International Hospital of Kampala, I met John, a young man from South Sudan who was medevacked to us with an infected gunshot wound to the abdomen. That’s when the utter reality of this profession struck me like a lightning bolt. The questions I asked myself revealed my insecurities, as they became more grounded in self-doubt and fear, instead of just mere medical curiosity. Questions like: when the time comes, would I be reliable, like a scalpel is, to make confident and quick decisions? Could I ever carry the responsibility of helping save someone like John, and put aside my self-doubt and vulnerability? Witnessing the attending physician interact with John humbled me. It reminded me that every decision I would make as a doctor could heavily impact someone else’s life. It lit a fire within my chest to become the best physician that I can be, which first means being more confident in myself and removing my doubt.

This inspiration and magic of medicine was immediately conflicted when I started medical school, where I was greeted by a mountain of challenging emotions. This included my old friend self-doubt, and a new friend, imposter syndrome. My first days of school as a first year were plagued with thoughts and feelings of not being good enough. Would I be able to get through these next four years without failing? Would I be able to perform high enough on board exams to be competitive for residency applications? I allowed these haunting questions to infiltrate my mind, like a parasite making its way into the human body to wreak havoc.

Whereas I initially envisioned a hands-on and humanitarian approach to my learning, I was greeted with the prospect of having to spend most of my time at home in front of a Zoom chat room on my computer due to the pandemic. It seemed to me like the big picture was gone, or at least missing, while we memorized details like the Krebs Cycle. In my mind, patient care was put in the backseat, the reasons why I decided to go to medical school became clouded, as grades suddenly became the most important aspect. The old saying, “fake it till you make it” never felt more true.

Here’s what I’ve come to realize: We will never learn everything in medicine, and who wants to be perfect anyway? And it’s okay to feel like an imposter. It offers me humility; I acknowledge my shortcomings and that fear of not being good enough sharpens me, like a scalpel, to tailor my learning to my weak points, while building

my strengths. In lecture, I push myself out of my comfort zone and ask those seemingly foolish questions despite the embarrassment that I imagine I might feel. I’m learning to become comfortable being uncomfortable because ultimately, that’s how I will grow as a competent physician, but also as a human being, friend, brother, son and one day, father.

The path I’m on isn’t smooth or straight. It’s not easy or short but struggling with something is the best way to learn. Last summer, as I rounded on patients at a local hospital in Nairobi, Kenya, the attending asked me what I thought should be done with a patient’s gangrene diabetic foot. I stumbled over my words, awkwardly finding a way to find a way to answer. He then turned to another student who answered as if he rehearsed the night before. His quick and concise response made me feel small, like I didn’t belong in that room – perhaps even in this field. It's only by being honest with our imperfections and finding time to understand them and reflect on them are we able to overcome doubt. The point is that the moment you stop comparing yourself to others is the moment you can become true to yourself. Imposter syndrome will never really go away, but our ability to cope with it will increase. Though this may take a lifetime to accomplish, I will take each day at a time.

Relieving a patient toward the road of recovery is a notion as old as time, and in moments of doubt and fear through the years of study, I can remind myself that at its core, medicine is about making patients feel safe during their most vulnerable states. To be true to them means being true to myself. I may not be the “smartest” doctor, but I won’t let this take away my empathy, or my ability to connect with my patients. In this profession of lifelong learning, the daily practice of empathy in pursuit of holistic, greater, more rewarding work has to be at the core of my pursuit as an aspiring physician.

Last week, I used my 11 blade and practiced on my suture kit, the way my future self might perform an appendectomy, breathing in deeply to keep my hand steady, doing everything in my power to make one straight line across. A scalpel is reliable and consistent. It doesn’t think for itself or struggle with the burden of emotion and self-doubt. It doesn’t act differently; it only does what we want it to do. But perhaps that’s a quality not seen in humans. In contrast, I am constantly changing and growing in my medical training. The rollercoaster of emotions has not ended…but until then, I’ll enjoy the ride. It’s comforting to know that my confidence, too, can be built and that maybe one day, be worthy enough to wield a scalpel. ■

Michael Dea is a second-year medical student aspiring to become a surgeon. Michael was born in San Francisco, Calif., but spent the majority of his life living in various countries in Africa including Botswana, South Africa and Uganda. He moved back to Southern California where he completed his bachelor’s and master’s degrees. Although he does not consider any one place his home, he loves living in the beautiful state of Colorado! This piece is dedicated to his parents, Monica and Randall Dea, for their continued love and support.

Critical reflective writing holds a prominent place in the Medical Humanities curriculum at Rocky Vista University, College of Osteopathic Medicine. Beginning in the first semester of Medical Ethics, students engage in critical reflection to explore their own assumptions and biases and how their values impact their practice. This submission is selected and edited by Nicole Michels, PhD, chair of the Department of Medical Humanities, and Alexis Horst, MA, writing center instructor.