It isn't her second life, it's her third, Elise is given a second chance at her first life after redeeming herself during her second. In her first life she had everything to be happy and made everyone miserable, the empire became a living hell. In her second life she had nothing, no family, no money, other than her studies, she was determined to save as many as possible and redeem herself from her mistakes from her 1st life.
In her third life, she is simply grateful and everyone around her sees her maturing to the woman they always wanted and deeply down believed her to be. She was loved, as she changed to meet their expectations, it was well received and praised upon.
She hesitates a lot and tends to phrase all her knowledge from modern era in a way that best fits the context she's in, to not create a reality clash that's too big.
Out of all isekais that tend to be higly repetitive, superficial, sexualize women and lack emotional momentum, this one is the most meaningful for me, as while all the others use the knowledge they have for selfish reasons, for revenge or whatever, she uses it to save people and in crucial moments, for selfless reasons. Even if it means putting herself in a tight position, she's totally committed to her cause and confident in her medical skills.
