A Letter to My Past Self

Dear Me, 

It’s the night before our first LPP shift. You’re studying like crazy, because it also happens to be the night before the first anatomy exam. You’re cramming flashcards, frantically stuffing in knowledge about upper limb MSK, and wondering if any of it will even be useful someday. (It will.) Before tonight is over, you’ll feel your head swimming with the names of tiny muscles and which nerves innervate them; you’ll call mom – and our boyfriend – in tears, convinced that it’s just impossible to know it all (because it is, and knowing it all is not the point); then your heart will sink with the anxiety of knowing that you have to somehow take this heaping pile of jumbled trivia to the bedside of real patients tomorrow. 

This seems terrifying. You imagine our preceptor asking you questions that you don’t know how to answer. You envision tripping over your words while just introducing yourself, and everyone around you silently wondering if you’re even qualified to be doing this. You’re wondering it too. Who looked at me, and really thought, ‘yeah, she’s ready for this,’ because they surely need to think again. 

Take a deep breath. Trust yourself. You’re going to do just fine on that exam, and you’re about to find yourself again tomorrow. You’re going to remember why we’re even putting ourselves through all of this. Because it’s worth it. 

Tomorrow, you’re going to surprise yourself. You’ll meet Chris, our preceptor. (It’s ok not to call him Dr. Driscoll, he really meant it when he said ‘Chris’ was fine.) He’s incredible. He knows just how to let you shine, and just where to offer support. You’ll get to see yourself shine, and for the first time in a long time, you’ll start to believe in yourself again. He remembers being in our shoes, and what it feels like to dive headfirst into this new world of differential diagnoses; questions and answers and follow-up questions; and figuring out what the heck review of systems even means. He’ll start you off easy, just ask about the cardinal seven. He’ll even rehearse it with you before you go see the patient he picked out especially for your first time, because they’re so kind and talkative. He will not throw you off the deep end. 

Time after time, you’ll continue to surprise yourself. Somewhere from deep within you – I’m still not exactly sure how – you’ll remember huge parts of the things we’ll practice in DCS. Slowly, you’ll start to ask about the past medical history, the family history, the social history, and, believe it or not, you will start to get a feel for how to review the systems. Slowly, your voice won’t shake when you introduce yourself. You’ll remember that you love talking to people and helping them feel heard. You’ll start to ask questions that you didn’t rehearse beforehand, and afterwards, Chris will tell you that those were great questions! He’ll also guide you through what you missed, but in a way that makes you hungry to learn even more. And you will. You’ll learn lots more. 

Your heart will light up when you locate a structure on a chest x-ray, when you recognize AST and ALT as liver enzymes, when you remember how to distinguish between Lambert-Eaton and Myasthenia Gravis. All those facts you cram for school will start to mean something. You’ll start to put faces behind each one, as someone you’ve talked to, diagnosed, treated, connected to. You’ll start to schedule LPP sessions after exams on purpose, because you’ll be so eager to take your new knowledge and skills out into the world. You’ll start to feel one step closer to our dream. 

I still have so much to learn. The road won’t be easy. I know I will still struggle in ways I’ve haven’t imagined yet. And I still wish sometimes I could get a letter from future-us, just to check in and say everything’s going to be okay. But for what it’s worth, I had my first LPP of the second semester earlier this week; Dr. Most said we take really good histories. 


Karishma Patel is an MS1 who is passionate about writing to process and reflect on her journey. She finds great joy in cooking for others and hiking in nature. She is currently interested in exploring Emergency Medicine.

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