Take a look around a medical school around this time of year and you’ll see two very different groups of people.

The first group seems delighted to be there- happy, motivated, driven, “gunning it”, ready to go out there and save the world. For the most part, they enjoy the rigors of medical school. They’re the people with perky looks, dressed nicely, smiling and being pleasant.

Then, there’s a second group. The second group has bags under their eyes. They’re tired, cranky, a little depressed, constantly cursing at being in medical school. They walk with their heads down, their eyes seem sunken and their clothes are most often sweatpants and T-shirts. There may be coffee stains on their clothes, and as they pass out in a mound of books- drool coming out of a corner of their mouths.

The first batch, as any medical student could tell you, are first years. The second batch are second years.

First year of medical school as you walk in the door, you’re excited, driven, motivated. You’re in med school! You “gun” everything- studying for hours upon hours till exhaustion, and then once the test is done partying and drinking to oblivion. You’re excited about almost everything, you’re brand new and you want to learn- and by golly you show it!

Second years, by contrast have been through the cycle. Having been forcefed vast tracts of information every 6 weeks (on average, 120 hours of lecture total) full of arcane facts that aren’t clinically relevant and despite the school (and the block’s) stated policies of testing “big picture” stuff will still be tested. So you prepare to be able to recite Bernoulli’s equation, the resistance of a vessel, the histology of polyarteritis nodosa, or some other information that in all likelihood is never tested. That’s okay you say, we all jump through hoops. Now do it again, and again, and again. Take a weekend- sometimes between the end of one and the start of the other. At the same time, realize that you’re actually supposed to be taking care of patients in a year- so try to learn to do that as well. Then, add in the required doctoring material- some exceptionally good, some mindblowingly boring. Plus minor things, like eating, cooking, working out, laundry, showers…

The thing you learn somewhere halfway through first year is that medical school is a collection of 200ish of the smartest people you can imagine. We all went through college getting accolades, being told we were brilliant, seeing amazing grades and awesome results. Then, when you get to medical school you see the scariest thing of all. A passing score- or an average score. And then you realize that the thing you based your self worth on- your intelligence- no longer sets you apart from the herd. You’re somewhere smack in the middle. Truth be told, most people in med school are about as smart as one another. The difference is the hours people put in. Some, seeking to maintain that self worth, put in 15-18 hour days regularly- and cringe when they see a 94% on a test. Others, work hard but try to balance- and are happy with a mid 80’s grade. Still others realize the futility of the system and how irrelevant some of it is to clinical practice, and cherish having their lives- cheerfully taking the 70s-80s they get. None of those is “better” than the other- each seeks to maintain their self worth and sanity how they can.

But, if you’re in the second or third category- before too long, if you’re not careful you start completely losing your mind. So, how do you hold onto your sanity in this crazy pressure cooker of a system? Here’s my secret. I add in the things that make my life meaningful to me. (I never said it wasn’t an obvious secret…)

Most of us get addicted to something- I chose to get addicted to exercise rather than alcohol or other “helpers”. So, I work out. If I don’t, as I likely won’t be able to for much of this week, I feel the withdrawal. Medical school is such an isolating and lonely experience that I realized the value of the people in my life rather quickly. The value of a support system, people to talk to, go do things with, people to share the neurosis that medical school creates can’t be overstressed. It keeps most of my classmates holding onto the last shreds of their sanity. And for me, it lets me hold onto the last thread.

What else? I added on a masters program. Yes, I added more work to a medical school career. Clearly, I’ve gone around the bend and need to be committed. But, fact is- I was a philosophy major in college and I feel the need to think about the world we’re living in. I need to consider the why’s, the what for’s. If I don’t do that in a disciplined or a more direct way I end up asking myself the why and the what for about medical school- which is a terrible idea, trust me.

Also, I travel. I go where I can, when I can. More so, I do what I can. I have a fear of heights, so I jumped out of an airplane. This weekend, I’m going jet skiing on the Hudson River with a friend after our exam. I’m travelling to London with the same friend for New Years. I’m meeting up with my family in Hong Kong (maybe- or we may go somewhere else) after I’m done with Step 1. I’m going to take a flying lesson or two in the next few weeks. Not to mention, scuba diving, skiing, snowboarding. Med school makes my days rather boring, bland, and frankly depressing. So, I choose to inject what enjoyment I can into it- as easily as I can.

Also, one of the biggest things I’ve learnt to do as I became a second year medical student is to clean up your baggage. In my experience, every person has people in their life who demand but don’t give. People who are either too hard to hold on to, or that one just can’t help. I’ve learnt to let go easier- so that I can spend more time with the people who are really important to me. It took a close friend passing to learn that lesson.

And the last way I cope? This blog. I like to write, and I enjoy dispensing my words of narcissism, questionable wisdom, and nonsense with reckless abandon!

If you’re in med school- relax. You’ll get through it- just realize that the system’s nuts, chuckle, bitch about it to the people who you trust and who’ll listen. And then keep going. What’s that famous quote? “If you find yourself in hell, keep going?”

If you’re going to med school- the one person who you shouldn’t be asking about med school’s value is the med student who’s $100,000+ in debt, has spent a year and a half buried in a mound of textbooks away from what they came to medical school to do- practice medicine. The same med student’s “paranoid, antisocial, and weird” (Erich Segal) and that’s what medical school turns you into. At the same time, as you walk out of a class and discuss something you covered over a year ago, subconsciously the right answer will push its way out. Perhaps madness is it’s method for medical school.

And if you’re sending your loved one to medical school- don’t stress. It’s hard work, but it’s doable. Just tell them to find what they have to do to get through it and proceed to do it. Preferably nothing illegal. A medical degree is of limited use if one’s license is then suspended for criminal charges…