REFLECTIONS | Ema Arai

When I look in the mirror, I see my younger self.

She thinks before she speaks, then wonders if she thought enough about what to say. She never goes first because surely someone else wants to. At crowded house parties, when the noise becomes too much to stand, she finds the family dog. The dog never seems to mind the silence.

But her teachers do. Every year, despite different classrooms and different report cards, the same two words appear: “too quiet.” And somewhere along the way, their words became her own. The harshest critic was the one staring back at me in the mirror. Why can’t she be different? Surely the world would fit better if she were louder.

***

On the day of my medical school matriculation, I believed I had finally reached the point when the reflection would change. Doctors are extroverted. They speak first, easily filling silences and connecting with strangers. They don’t linger on details. They command a room with their presence the second they enter it.

And that was who she would become.

As I walked across the stage and shook the dean's hand, the white coat settling onto my shoulders, a smile spread across my face. Looking out at the sea of freshly minted medical students, I believed I had finally found my place.

But alas, the reflection in the mirror was unchanged. It was still my younger self, only now wearing a white coat as though she had shown up to a Halloween party disguised as a doctor. And if there were a dog at this party, this “doctor” would almost certainly be found beside it.

***

By the time clerkships began, I had stopped expecting the reflection to change. I had spent years believing that belonging meant becoming someone different. Why would medicine be any different?

Clerkship year, however, placed a new mirror in front of me.

I had little time to look in mirrors that year. There were patients to see, presentations to give, notes to write, and a seemingly endless amount of medicine to learn. Most days, I was too busy thinking about other people to consider myself.

One of those people was an older man hospitalized with heart failure. Our early morning conversations began predictably enough: How was his breathing? Was the swelling better?

Somewhere between those questions, I learned that he had been an artist and an art teacher. One day, I brought colored pencils and paper to his room. Soon the pencils were scattered across his bedside table. He took one from my hand and showed me how to draw bamboo, tilting the pencil to make one branch thick and another thin. For a while, he was an art teacher again.

Another patient returned from a colonoscopy wearing dark green scrub pants beneath a light blue pajama shirt covered in cartoon hot dogs with dachshund faces and legs. The matching pajama pants had gone missing somewhere in the endoscopy suite. He didn't seem particularly bothered. “Life happens,” he told me. But I couldn't stop thinking about the pants. Earlier that morning, he had mentioned his wife had a matching pair. They gave them to each other as anniversary presents, a fitting gift for two people who shared forty years of love and the same sense of humor. During some downtime that afternoon, I went back to the endoscopy suite. I crouched beside one gurney after another, lifting sheets and peering underneath. Eventually, beneath one of them, I spotted a familiar flash of light blue. When I returned to his room with the missing dachshund-hotdogs in hand, his face lit up.

Then there was a woman with end-stage cancer who had transitioned to comfort-focused care. She lay in bed, too frail to say much, but the fear on her face said it all. There was little I could say or do that would make the inevitable any less frightening. So, I sat beside her in silence. For most of my life, silence was criticized. Silence meant I should be speaking. Silence meant I failed to think of something to say. But sitting beside her, I realized that silence did not always need to be filled.

Somewhere over the course of that year, I began to find a place in medicine for the very qualities I had spent years trying to change. I had always preferred conversations quiet enough to notice things. In the hospital, that meant learning that beneath the heart failure was an artist who missed teaching. I had criticized myself for lingering on “insignificant” details. But sometimes, the “insignificant” was more significant than it appeared, like the way a simple pair of pajama pants signified forty years of marriage, shared humor and a life built together. And the silence I had treated as something to escape could, at the right moment, be a way of staying.

I began to understand that becoming a doctor was less about becoming someone else and more about learning to become one as myself.

***

At the end of clerkship year, I stepped out of the room of my last patient and stopped in front of a window overlooking the hospital parking lot. Outside, the day had dissolved into darkness. Against it, the glass reflected the fluorescent hospital lights and a familiar face staring back at me.

It was still my younger self.

But now, she was exactly who she was supposed to be. She was no longer searching the reflection for someone else. She did not need to become louder to grow into the white coat, or to find her place in the world.

And for the first time, I quite liked what I saw.

Ema Arai is a third-year medical student at the University of Colorado School of Medicine. Arai discovered narrative medicine during her clinical clerkships, where writing became a way to reflect on the patients and experiences that shaped her training. She is drawn to the way storytelling can capture what exists between the lines of clinical medicine. Outside of medicine, she enjoys baking and latte art, with a particular love for making desserts as beautiful as they are delicious.