The path through medical training is long and arduous. Most enter medical school with a sense of idealism and purpose. There’s been a lot written about how over time, that feeling can be tempered by the stressors of the field and exposure to some of the less glorious realities of medicine.

Some of this hardening process is necessary for survival. Experience teaches you how to deal with the loss of a patient, the reality that patients may not appreciate what you do or things may not go as smoothly as hoped despite your best efforts, and the fact that some problems don’t have easy solutions. Establishing some defense mechanisms is healthy, since you’re exposed daily to a wide roller coaster of emotions.

I remember distinctly one of my first shifts in the emergency room as a student. In one night, I saw a woman who had been struggling with infertility for almost a decade come in with nausea and find out she was pregnant, a patient with abdominal pain find out that he had widely metastatic cancer, and a homeless patient come in for a bite to eat and a dry place to sleep. There were also two codes that night, with two very different outcomes. By the end of the night, I had spoken to families who were elated and families who were devastated, had picked up tips from social workers and hospice workers, had been yelled at by a consult service, had been hugged by one patient, and had to run away from another patient who tried to hit me with his cane. I left the hospital the next morning emotionally and physically exhausted, with a slightly different view of my role as a physician than I had the night before.

Every day of your clinical rotations teaches you new and unexpected lessons, both clinically and about your role in the healthcare system. Every physician could tell you countless stories that have influenced how they practice medicine. Some of these stories chip away at our idealism and can even lead to cynicism, but hopefully there are also a proportionate number of stories that reignite passion for medicine and patient care.

I’ve always loved to write, and one thing I did during training was to journal as a way to process my thoughts. From time to time, I look back on those journal entries. Particularly when I’m frustrated with medicine, this has been invaluable in reminding me of the reasons that I went into medicine. It’s also been a wonderful way of charting my evolution as a physician. I love going back to it and reading about my perception of my first day on the wards, the first time I delivered a baby, and many other experiences. To those of you in training, I would encourage you to occasionally write down yours, both positive and negative. I guarantee you’ll treasure it later.

Nisha Mehta, M.D.

Dr. Nisha Mehta is a physician and writer with interests in physician wellness, medical education, and health policy. Follow her on Twitter @nishamehtamd or on Facebook at www.facebook.com/nishamehtamd.