It was just shy of 5 a.m., and I had never felt more useless in my life. I stood in front of a closed patient door, dreading the moment I would have to knock.

“Good morning,” I practiced under my breath. “How are you feeling today? I’m the medical student.” I always hated saying this last part. One of these days, someone was bound to ask what business I had, as neither a doctor nor nurse, waking them up at this ridiculous hour. And I would have no answer.

I was a third-year medical student on surgery rotation, in the hospital for no reason other than my own learning. Unfortunately, it seemed that the only time anyone could spare for this learning was at an hour when both patient and student would prefer to be asleep. In the past, hospitals relied on students to manage patients during busy hours, but thanks to tightened safety standards and structural changes, they now functioned perfectly well without our help. So we came in before the day shift and rounded on patients for our own learning. Shortly after, the residents would repeat the same motions — questions, physical exam — as we stood silently by the door. After dawn, the attending physician would repeat the visit yet again. Only then might these disturbances finally amount to some good for the patient.

I looked at my watch: 5:15, too late to keep stalling. I glanced at the scrap of paper to be extra sure I had the right room. Triple checked that my stethoscope was still there. Finally, I held my breath and knocked.

“Mr. Allen?” I asked as I stepped timidly into the dark room. I heard a grunt from the bed. “Good morning. I’m a medical student on, um, your surgery team. How did you sleep?” In the dim light, I could see him open an eye. Plainly, it meant, you have some gall to ask me that.

“Fine,” he snorted.

“How is your pain on a scale of one to 10?” I recited.

“Eight,” he muttered.

“Oh, well, um, I’m sorry to hear that. I’ll be sure to mention it to the team,” I stuttered, scribbling on a crumpled paper. “Have you passed gas?”

“No.”

“Nausea or belly pain?”

“No.” He turned his head toward the wall.

“Great, um, so can I examine you?”

“If you have to.”

I decided that was as much enthusiasm as I deserved and went to douse my hands in sanitizer. Stethoscope on bare chest, hands pressed on a warm belly, a quick glance at the tubes draining his surgical site.

“Thank you very much,” I chirped, pulling his sheets back up. “I’ll be back with the team later.” Another grunt. I scurried out of the room with relief. The encounter lasted less than six minutes.

Later, I would report my findings to the senior resident, who would stare at her nails looking bored. She would ask me what his sodium was yesterday (I didn’t know), what color the drainage was (I had been too scared to turn on the light), and whether the incision was oozing (the nurse told me not to touch it). I would stare at my shoes until it was over.

On it went for eight weeks. Mornings were spent dashing in and out of sleepy patients’ rooms, fumbling over questions on rounds. Some afternoons, I sat in the resident room wondering if I was allowed to study or if doing so would earn me a “disengaged” stamp on an evaluation. Other days, I followed residents into surgery and waited to be offered a retractor or suture to snip, shifting back and forth on sore feet. Unlike residents, students had no job or responsibilities. Far from being liberating, however, our lack of duties left us feeling dully incompetent, as if we were nothing more than annoying shadows.

I could have gotten used to being a shadow if not for the fact that we still received grades. Evaluations flowed in constantly, some from faculty we had worked with for a week, others from those we had never met. Some were encouraging, some astonishingly scathing for minor faults. The evaluations left the distinct feeling of always being judged. The problem was that, with no real job description, we never quite knew what we were being judged for.

As the weeks wore on, I paused less and less before knocking on the patient’s door each morning. I stopped saying sorry for waking them up. My visits dwindled from six minutes to five then three. By then, I understood which lab results to know by heart, knew the options for IV pain medication, and could present a patient without looking at the script. One might have mistaken this change for newfound competence, but all I had learned was how to avoid being scolded. In the process, I had become too tired to apologize anymore.

One morning, a new group of students arrived, blurry eyed on their first morning of surgery rotation. At rounds, they stuttered and stared at their shoes. “I wasn’t quite this bad, was I?” I thought as I inched closer to the residents. I saw the new students look up at me, pleading for a show of kindness. I looked away.

Be nice to medical students, I tell my future self. Remember how it felt to be a self-conscious shadow in the hospital. But already, I can feel myself slipping, an effortless fall from the judged to the judging. The infinitely apologetic medical student graduates into a belittled resident who then emerges as a brutish attending physician. By then, I hope I will still remember how it felt to stand at that patient door, hours before dawn, too scared to knock. My kindness depends on it.

What do you remember about being a medical student on the wards? Share in the comments.

Valerie Chen is an ob/gyn resident at Mayo Clinic. Her interests include medical education and women’s health innovation. She plans to pursue fellowship in reproductive endocrinology and infertility after graduation.

All names have been changed for privacy.

Illustration by April Brust