Tag Archives: Medical School

“Stayin’ Alive”

12 Tuesday Dec 2017

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A variation of this was published in a peer reviewed medical journal. Another walk down memory lane. My first emergency medicine journal publication, and my last publication of the end of medical school.

The paramedic’s bullet was short and to the point. “40 something year old woman. Found down, possibly after a fall. Unresponsive in the field. Bradycardic to the 40s. Protecting her airway initially, but now desating to the 80s. Barely got an IV.”

As a fourth year med student who had seen a bunch of codes, I still felt a frisson of excitement when codes came through the door. After all codes for me represented Emergency Medicine- no information, a deathly sick patient, lots of adrenalin and a healthy dose of fear.

I stood by my resident’s side as she induced and intubated the patient. As the pearly whites of her vocal cords came into view and I saw the tube go through it, we all released the breath we had subconsciously been holding. A dose of Atropine raised her heart rate and she seemed to stabilize. I walked to the door of her room pulling off my gloves as I went- I had patients to see after all.

As I pulled off the gloves, alarms began to sound. Her heart rate was beginning to drop again. My resident met my eyes, and said just one word- “Compressions.” Within seconds of her having given the order, I was at it. I had done compressions on dozens of people- and each time I did, I recalled my BLS instructor teaching us to compress to the beat of Stayin’ Alive, since the song had a beat of 100 a minute. He said it also worked with Another One Bites the Dust- a connection that was too morbid for me at the time.

So as Stayin’ Alive played in my brain, I pushed down on her breastbone, hard and fast, and I felt something pop beneath my crossed hands. I was breaking her ribs as I compressed her chest in a violent, last ditch attempt to beat her heart for her. Each time I broke ribs I found myself pausing for a moment- pausing to apologize and acknowledge the violence I was inflicting. Then, I remembered that if I didn’t do it my patient would never hear any apologies again. So I fell into my terrible cadence, in my own little world with Stayin’ Alive for a soundtrack curiously disconnected from my humanity and the sadness of the situation.

Around me there was a blur of motion. The nurses were drawing up and giving med after med. My resident was splashing betadine on the woman’s chest right next to my hands and blindly trying for a subclavian line. I momentarily felt a stab of fear as she stabbed the patient in her chest millimeters from my crossed hands, but I made sure my compresisons never faltered. The patient’s one tenuous IV blew, and suddenly there were people all around me with needles stabbing away. And through it all I was humming “Staying Alive” under my breath. Each time I lifted and dropped my shoulders, about 100 times a minute, I saw her chest lift off and drop back onto the bed, her breasts, exposed to the world, flop up and down, her head jerk up and down, and her arms lift and fall just a little. For a second her movements gave her the illusion of life- an illusion I was creating. I knew the statistics, knew that more than likely she wouldn’t survive- but as I compressed I hoped. Sweat was running down my arms as I worked, landing on her chest and mixing with her blood as I kept to my terrible cadence.

Around me the needles were ineffective. Nothing was working. The nurses, who almost never miss, were cursing in frustration as they got a line only to have it blow a second later. My resident and two attending physicians were trying to get central lines, and from their lips too came soft curses.

As my arms began to tire, one of the nurses switched with me. Her light svelte frame was perched precariously on her toes as she began the same cadence trying to beat this woman’s heart for her. It seemed like seconds later that I was switching back with the nurse. As she did her final compressions and switched with me I heard the strains of “Stayin’ Alive” fading away softly under her breath.

We worked for what seemed an eternity. My arms pushed of their own accord. Thirty minutes after we began, my attending called it. “Time of death, 1040”. I walked out of the room yet again pulling off gloves- this time slick with blood. Having gotten sufficiently desensitized after dozens of unsuccessful codes, I walked out with a sigh and a stab of sadness at the life lost. In a few months I would be an intern, and a year or two after that I’d be expected to run a code. But for the here and now I was just a medical student, and my only job was to learn. So I learned from my patient, the woman who had died. I learned yet again that I couldn’t always save my patients.

There was a chart on the rack to be seen, and I walked to the room. As I walked into the room, trying to leave my previous patient and the violence I had inflicted upon her behind me, I smiled at the next patient with Stayin’ Alive still playing in my mind. All I could hope was that perhaps this patient would.

“You Set the Tone”

05 Tuesday Dec 2017

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Another walk down memory lane, as I finished my ED months and did my medicine sub-internship. A good reminder, that when all is said and done, you do set the tone and you choose the job. I still vacillate between the emotional teflon being extra thick and it being porus enough that the insanity of work spills into my personal life. And I probably will keep doing that forever.

 

“Don’t ever say you’re sorry. See, there’s two kinds of doctors… there’s the kind that gets rid of their feelings, and the kind that keeps them. If you’re gonna keep your feelings, you’re gonna get sick from time to time – that’s just how it works. People come in here and they’re sick and dying and bleeding, and they need our help. Helping them is more important than how we feel.  But it’s still a pain the ass sometimes. Sometimes, I just want to quit and do somethin’ else.”

-Mark Greene, ER

 

I’ve realized recently that there are a few things medical school teaches you nothing about. There’s the fabled four year curriculum that all neophytes believe will make you into an educated, caring, considerate and capable physician. And then there’s the reality that most of what it is to really be a physician is learned in the “unwritten curriculum”, the curriculum you learn from watching the residents, attending’s and nurses. Handling death, seeing suffering and being unable to do anything about it, and how to handle the abuse that a day in the hospital sometimes throws at you- all of these are things you figure out on your own, and hope you’re doing right.

Today, the Match list opened. I’m going to put in my list of programs I want to go to and in March, I find out where I go. And then on July 1st, I become an Emergency Physician- terrified, marginally capable and hopefully guided as I try to take care of people. I’ve spent a lot of time recently watching season after season of ER, and I’ve come to realize something terrifying.

Three and a half years of medical school have hardened me. They’ve acted like a forge, providing tremendous heat and a constant pounding to beat out the ‘imperfections’ and to expose me to the wonders and terrors of clinical medicine. They’ve taken a humanistic person who read Wordsworth, Sarte, and Dostovesky and replaced him with someone deeply familiar with the PERC rule and the CHADS2. I’ve become capable of taking care of patients to some degree, I walk with the strut of someone comfortable with much of daily patient care. My training has helped me save a couple of lives already, and will likely be responsible for saving many more over my career. But I can’t help but wonder what I’ve lost along the way.

The last patient I did CPR on died. I had my hands poised over her sternum when time of death was called. I realized later, that when I left I walked out without a second thought as to the life that had just ended, moving on efficiently to the next task.

More than anything else that terrifies me. I’ve never been overtly or overly emotional, but recently in the hospital it’s as though I’ve developed this protective Teflon coating that blunts both the great saves and the terrible losses. I can’t imagine functioning in a busy Emergency Department without it- the fear would probably render me catatonic, but the existence of it makes me wonder if I’ve become the soulless automaton I swore I would never become- the soulless automaton so far from the physicians identified by Mark Greene and John Carter.

As my mind wanders down this tangent, I’m reminded of another patient I’d seen that same day. He was an elderly gentleman, a veteran of World War II and Vietnam. A patrician gentleman with a regal bearing, I was admitting him to the hospital for pulmonary edema. When I told him, this man who’d survived the landing on Normandy and pushed on despite seeing scores of his friends die, broke down in tears. He was terrified he was losing his independence to a disease that crept on insidiously with age. My heart broke a little inside, because he reminded me of my own grandfather, a 85 year old general who hated the hospital. So I sat with him for ten minutes just talking, and holding back tears.

I do set the tone, I do decide how I’m going to see and manage and handle the emotional onslaught contained in the walls of an Emergency Department every day. And despite how useful my emotional armor is, I think I need to continue to live in fear of it. The day I grow to like it too much, is I think the day that I should hang up my stethoscope.

May that day be far, far away.

 

Transitions: A Reflection

28 Tuesday Nov 2017

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Written a month before graduation from medical school. It reminded me of that infinite medical school wisdom, when all is said and done, P=MD.

 

I walked into the medical school today morning, smiling at being back in a place I’d not seen too much of in the last year and a half. I stopped midstride, as I saw a sea of new faces sitting in the common area. The faces I saw were young, eager, full of promise, hope and fear- clearly new first years.

It struck me then, as I began to walk more slowly through the hallowed halls that had educated me- I was officially an old man.

I recalled, four years ago, walking into the medical school for orientation. I can relive the emotions that roiled inside my chest in each moment. Eagerness, disbelief that I had made it, the confidence from college that I would be the smartest, the fear that I wouldn’t, and most of all the angst of the unknown path I was treading.

I remember walking into our big lecture hall and sitting on the left sided batch of seats- something I still do to this day. I remember sitting there just watching my peers, who in a few short months will be MDs and wondering what kind of MDs they would be. I remember seeing those same people that evening at the social event uninhibited by copious doses of alcohol and wondering all the more.

I remember the drive to do well on my tests and get that honors, the degree to which my self worth was tied up so intimately in the letter my course gave me. I recall the gnawing feeling in my gut when I didn’t get honors, or did “okay”. I smiled when I thought of the first time someone had let me do something in the hospital and how cool it felt. I remember how uncool it felt when I had to do something after my 5th surgery call night.

That walk wasn’t a long one, but my mind walked the ups and downs of the three and a half years I’ve spent here during it. I had a discussion group to run for the new first years about a book they all read. After I was done, one of them came up to me to talk. Bright eyed and bushy tailed, she reminded me of myself during first year. As I left I gave her a parting word of advice, “Don’t worry too much during med school”, I said, “It ebbs and it flows- but ride it out and you’ll be just fine.”

My journey here will end soon. In a few months I’ll be an MD. In a few more I’ll be a resident. And sometime after that maybe I’ll be a good doctor. But I know that leaving this door will also mark the next unknown path my feet will follow. And I know now that I’ll be just fine.

Emergency Medicine from the eyes of a novice

18 Sunday May 2014

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Having a week of my Emergency Medicine experience under my belt, I’m sure I totally qualify as a veteran.

With my novice eyes-here are some observations and thoughts.

1. ER Docs aren’t your family docs or internists: Just yesterday I saw a lady with a slightly elevated blood pressure who’d been sent in by her visiting nurse because she hadn’t taken her medicine and needed a checkup. Talking to the patient revealed that she needed to follow up with her PCP who she’d not been able to see in a few months, and the nurse had figured that the ER would do that for her. The thing is the ER is a place for emergency care. If you’re having a heart attack, a stroke, delivering your baby, got hit by a baseball bat you need the ER. If you need a checkup and the wait times are too long at your PCP then the ER isn’t the best place for you. Between the traumas, the people with heart attacks and strokes and all the rest you’re not going to get the care you need.

2. Emergency Medicine is based on treating or ruling out emergencies: If you’re entering your EM rotation your attending wants two things from you on the differential- the bad things that could kill you and what it probably is. They’re far more worried about your chest pain being a heart attack and ruling it out before they send you home, consequently what could likely be something benign like a strained muscle can be treated once we’re sure it’s not a heart attack.

3. Not every patient in the ED will have (or needs) a diagnosis: As gratifying as most physicians find it to get an answer they can hang their hats on, the ER is often not the place for it. You’d like to, in an ideal world, figure out what’s going on with a patient but realistically when there’s a 3.5 hour waiting and 40 patients outside in the waiting room with a couple of traumas rolling in and the guy in bed 4 actively seizing you prioritize. That ends up leaving some of the things that need to be worked up on an outpatient basis as just that- waiting to be worked up outpatient. The ER is an incredibly expensive place to receive medical care as is the hospital in general so ED physicians try to judiciously use resources.

4. Sometimes people will hate you: The ER is a busy place, and there are always people you’ll be admitting. Often when you’re admitting someone to a service the resident on staff may be flabbergasted that your history and details didn’t include a more detailed family, social or physical exam- and that’s fair from their perspective. The problem comes, from an ED perspective a lot of those questions and answers won’t change an initial management. Secondly, anyone who’s causing your already busy workload to increase is likely not going to be your favorite person. For that reason, you may have the odd consultant who doesn’t jump for joy each time you call. That’s okay though. As long as the patient ends up being cared for.

5. Emergency Medicine is heavily weighted towards management:  Something I learned the hard way in a simulation session is that EM is a heavy management specialty. The traditional paradigm is for one to get a history, do a physician, collect an assessment and make a plan. In EM- you start with a plan then you keep going. And you modify your plan as you go. It seems rather obvious but if someone is coming in with chest pain that could be a heart attack you don’t want to spend 30 minutes getting a history and physical while the guy is actively losing heart muscle. Obvious it may be- it’s often challenging to make the switch from sitting and talking before you’re touching the patient and doing things to them. That said- 1 week in I’m already beginning to talk to, examine and treat my patients simultaneously.

 

In case you were curious I’m going to go into EM. Aka:

12 medical specialty stereotypes

 

 

 

 

 

 

 

 

 

A Labor of Love

07 Wednesday May 2014

Posted by in Bioethics, Medicine, Philosophy, Writnig

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I stood in the room, gowned and gloved, waiting for the woman to push. There was a thin trickle of sweat running down my back where the bright lights of the delivery room were trained. The baby was just short of the pubic bone, nearly ready to be born.

The mother-to-be had been pushing for hours and was exhausted. We watched the strips that recorded her and her baby’s heartbeats—each time that she pushed, her heart rate spiked to more than 170 beats/min and she closed her eyes and blew the air out of her lungs as we urged her on. “Push. Push. Push.” “Breathe. Breathe. Breathe.” We continued, our implacable rhythm timed to the clockwork contractions of her uterus.

Her exhaustion had caught up with her; I could read the defeat in her eyes as she whispered to her husband, “I can’t do it.” He smiled into her eyes and whispered back quietly, “Yes, you can.” My eyes were transfixed by this private moment between husband and wife, for all intents and purposes alone in a crowded delivery room, oblivious to the five other people standing around.

My hands moved on autopilot, assessing the baby’s position, a job my eyes should have done, as well. I stood there, doing what I was supposed to by habit—this was the fourth delivery that I’d done, after all, and I was a 5-week OB veteran. I stood there watching this moment, this beautiful, private moment, and some of life’s mysteries became clearer.

It was suddenly apparent to me how much I’d given up to be the one bringing this couple’s baby into the world. The fact that I could be welcomed into this intensely intimate moment and thanked after I’d done my job attested to the value of the profession I was joining. But in this moment, I wondered, at what cost?

This couple was a few years older than I. They had been married since they were my age and were having their first child now. They were madly in love, had jobs that fulfilled them, and were bringing their first child into the world.

At that moment, I had one purpose, one raison d’être, one thing I was searching for—that obsession, that passion, was medicine. In pursuit of it, I’d given up my hours, my sleep, my financial future, my social life, and my relationships.

My family was thousands of miles away, rarely seen and always missed. My friends were languishing, with unreturned phone calls and text messages on my phone, forgotten among 14-hour shifts and minutiae that needed to be memorized for each rotation. My love life was challenged by my constant lack of time and impossibly high standards—not to mention my jealous, unforgiving mistress named medicine.

She pushed again, and I snapped back to the here and now. Her son was crowning, and my hands moved automatically. I checked for a cord around his neck, pulling him out of his mother’s womb, one arm at a time. He was born from a warm and safe womb into the cold and lonely world he would now inhabit.

I swaddled him in blankets and placed him on his mother’s chest as his parents stared at him with love, drinking in the sight of his fingers, his toes, his perfect little features. I finished my work quietly. They thanked me warmly as I left the room and ripped off my gown and gloves as I went, their eyes never having left their beautiful baby boy.

I smiled as I left their delivery room, lost in my bittersweet thoughts. I kept walking because my shift had been done 20 minutes ago. I walked to a house filled with books about medicine and the tools necessary for its practice—stethoscope and white coat among them. I walked to an empty house and an empty bed. I was on again in 9 hours.

Ann Intern Med. 2014;160(9):653. doi:10.7326/M13-2673

The Things They Carried: An MS3 Story

24 Thursday Apr 2014

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Having just finished my third year here are the things that made my life easier.

1. Comfy shoes: Try walking around the hospital on rounds for >4 hours a day and standing in one place in a pair of uncomfortable dress shoes. I dare you. I can’t even imagine how it would be in heels. Buy yourself some comfy shoes for work. I use rockports when I need to be dressed nice and a good pair of sneakers for when I’m in scrubs. Invest in them- your feet will thank you.

2. UpToDate Mobile: You can signup for an uptodate username and password at any hospital computer and download the mobile app. If you’re not familiar with uptodate it’s the best way to quickly educate yourself about relatively recent guidelines, pathophys, treatment etc. Keep it on your cellphone so you can read whenever you get a second.

3. A stethoscope belt: Stethoscopes can be heavy. Wrapped around my neck it started making me stick my neck out like a turkey. Around Thanksgiving that’s a dangerous thing to look like. A stethoscope holder may not be the most fashionable thing around, but a few days in the hospital will make a sartorial slob out of any fashionista.

4. Snacks: Keep your white coat well stocked with snacks. You may prevent a hypoglycemic coma on Surgery, OB-GYN, and Medicine.

5. A gym membership: You need to stay sane in MS3- it’s busy and you’re going to need things out of medical school you can focus on. For me that was the gym. It was my endorphin rush, my cleanser and my calmer. Do what makes you happy dude.

6. Books: Walk around with the books you might need on your rotation. They’re specific so expect a post to follow later, but a good one year round especially around Step 2 time is USMLE Step 2 Secrets.

7. Reference Guides: Everyone suggests you buy the “Green Book” (used to be Red, now is purple). It’s the Pocket Medicine series and was questionably useful on medicine. Buy it if you’re really keen.

8. A credit card in your ID holder: Your stomach will thank you when you’re in the cafeteria with 10 minutes to eat between OR cases.

9. Pens: Black for the hospital- no blue. And keep your nicer pens on the inside. An attending or resident can snag a pen and “forget” to return it…

10. Fresh socks/Undies/Toothbrush: This one should be self explanatory- but post call- these are amazing.

11. Gum: If like me you’re prone to the sleepies especially after 4-5 back to back OR cases while sitting through a fascinating lecture on the biochemistry of transplant rejection- have gum in your pocket. Or your attending WILL make fun of you.

12. Someone to complain to: We complain. That’s what we do. We complain about our lives, the slights both real and imagined that we endure and the futility of our positions. You need someone to complain to- or lots of someones. So keep friends, significant others, classmates, parents, everyone handy. You’ll need them.

This will be one of the best and worst moments of your lives. My two months on IM was the most educational experience in all of medical school. The year will transform you from a bumbling and eager to please second year into a slightly jaded, somewhat educated, rather arrogant semi-physician.

In fact I’d postulate that the bulk of your learning pre-residency happens in this year. Buckle up. It’s going to be a fun (if slightly bumpy ride!)

 

Third Year: A Survival Guide: In memes

15 Tuesday Apr 2014

Posted by in Bioethics, Medicine, Philosophy

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Third year of medical school is a different beast from anything you’ve had before. You’re going from studying the basic sciences in a laboratory to functioning as a part of a healthcare team. You’re expected to truly learn to begin to be a doctor- and by the end of it you’ll be expected to manage patients to some degree autonomously. It’s a lot of work, a lot of fun, a lot of misery and just a lot- all at once. So with that in mind here is what to expect- #whatshouldwecallmedschool style.

Third Year

(http://whatshouldwecallmedschool.tumblr.com/post/80871300029/medical-school-in-a-nutshell)

This is going to be you much of third year- sprinting around the place, going nuts and basically losing your mind. Live with it and own it.

That said, the biggest thing that worked for me in third year was confidence and trying to get comfortable. Some people and some places have this idea that medical students just sort of stand around like part of the furniture. And there are those who do that!

I’ve found that the people you work with and work for- attendings, residents, interns, nurses and above all the patients appreciate you trying to do things. So when you’re asked a question, answer it with confidence (not a question). Surgeons especially hate that. If you’re not sure, start talking about what you think is going on- typically someone will cut you off if you’re rambling. But if you see someone starting to fall over asleep you should probably stop.

Don’t be afraid to get your hands dirty and do things. In my third year, I’ve delivered babies, opened incisions, stapled heads, done ABGs and placed more Foleys than I would ever want to. The reason I got to do those while some of my colleagues didn’t is that I asked if I could!

Even when you’re on a rotation you’d NEVER ever want to go into- try to learn something.

On a psych interview

What I tried to do (most rotations) was pick one thing or one skill set I’d like to learn that I found interesting, was cool, or could help in me in my future field of choice. And then go out and try to get good at it.

So on OB, I learnt to deliver babies, and do cervical exams. The only way I got to do those is by letting my residents know that I wanted to learn and do those things, and them being nice enough to let me. But still- try!

 

Also, some residents may in general be not the most interested in teaching- that’s the luck of the draw. And that’s okay.

 

 

 

The other thing is prepare to do a good impression of a piece of furniture in some situations.

“This is my medical student”

My favorite is when you’re rounding on a team of 10 people, you all squeeze into a patient’s room and then you’re introduced in an offhand fashion as you have to half sit on the patient’s grandmothers lap.

Though seriously, people don’t really hate medical students. They know we’re learning, that in a year or two, or three we’ll have an MD or a DO after our names and need to take care of them. And most are okay with us learning on them.

It helps if you are comfortable, a little charming, and not totally creepy- a high bar I know.

It’s okay being the wall, but if you’re comfortable introducing yourself do so.

And with that we’re back to confidence. If you want third year to go well, be confident. If you’re not, fake it- till you feel confident and comfortable. The hospital is an alien environment for everyone initially, but if you want to be seen as a better medical student (and one of the most important things for anyone evaluating you is how you interact with those around you)- for two med students with the same thoughts, grades and physical appearances- confidence can make one seem a far better physician to be than the other.

 

As I round off the remainder of my surgery rotation and consequently the last rotation of third year, expect some more gems like the ones above. And if you’re interested in medicine/ in med school/reminiscing about the torture that is med school dive into #whatshouldwecallmedschool. I’ll leave you with a link to one of my favorites.

http://whatshouldwecallmedschool.tumblr.com/post/81984496130/welcome-to-third-year

 

 

 

 

It Gets Better

04 Thursday Jul 2013

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I was sitting in the coffee shop today, and I must have looked a little miserable as I kept running my hands through my hair surrounded by papers trying desperately to get work done. I guess I did, because two guys sitting a few spots away called out to me and asked if I was a third year medical student. Surprised, I looked back at them and they smiled and said, “it gets better.” They had seen the OB-GYN textbook I had lying buried under a pile of papers I was reading and working on, and figured that was the source of my apparent angst.

Funnily enough, it wasn’t. I was knee deep in a long paper on end of life ethics that was challenging to write, and hadn’t yet cracked the textbook that day.  I did, later, and it wasn’t quite as much joy as a tub of ice cream or a nice long run, but it wasn’t agony. Their conversation did give me pause though.

The first two years of medical school aren’t pleasant, no matter what school you go to. The process takes the top 5% or so of students based off their scores and grades, all typically Type A personalities and pushes them into a room together where they’re then tested and graded.

We go from being the valedictorians or the smartest people around, to being that dreadful word- average. Our psyches and our selves can hardly adjust to the change from achieving a routine 93 and being vaguely pleased to the pressing fear that this test may be the one that pushes you below 70. If it doesn’t, you then start looking for a yardstick convinced the exam must have been easy then. You go from being the person people look at and think, wow they’re smart, to feeling like an impostor who got into medical school as an elaborate cosmic joke. Sometime in the first two years, you’ll think about quitting. Maybe even every day. You’ll look at the books and the piles of lectures, and think “how can I ever learn this stuff?” You’ll go and learn to see patients and consider it totally a waste of time when you could be studying for the important stuff like enzymes that catalyze reactions. You’ll likely live your first two years in fear, dread and a caffeinated high that when you crash will lead to weekends ‘wasted’ in sleep.

It’s not a pretty picture, and to put it bluntly, the first two years of medical school are horribly rough- for some people. There are some in my class who excelled in the first two years, loved the minute details and the never ending reams of paper to read. They did very well in the first two years and likely loved it. I wasn’t one of them. I didn’t like the never ending memorization with what seemed like minimal to no usage of what we learned. In college, I’d thought I was book smart, believed it with all my being. In med school, I learnt how very wrong I was. The first two years of medical school weren’t fun for me, but they weren’t pure agony either. Like anything else, they were marked with periods of good and bad- but I will say that they make you feel like a fool often, grasping for details you missed. There were days I considered quitting, but it died pretty quickly once I remembered the debt I was in!

That said, I’m one and a third rotations into third year, and I’m rediscovering my passion for medicine and what brought me in here. I’ve been seeing people, actual human beings, not just anatomical drawings of them and the hard oak of a library desk with a blank wall beyond. I’ve even been helping them sometimes. I’ve been doing things like listening to hearts, taking histories, making diagnoses. On this rotation I may even get to deliver a baby. Some of the nurses took to calling me “Doc”, a word I’m not at all used to. When they’d ask me what to do with a patient, I’d actually feel as though my toils and my labors weren’t in vain. So, I still spend a fair amount of time with my nose in my books, I don’t have as much of a social life as I’d like, and most of my meals are spent in the company of my favorite TV show. But, it’s much better because my reading, my work, my toils are all towards a readily apparent goal. What I learn today in my readings may well help my patients tomorrow, the next week or the week after that.

So, for those of you still in the depths of the tunnel with only a faint light trickling in at the end of the tunnel, know that it does end, and you will survive. Your misery, your minimal social life, and your never ending time with the books will have purpose and meaning. Till then, I’ll leave you with this story from one of my favorite books (Blue Collar, Blue Scrubs, which I highly recommend  by the way).

There was a person (who’d later become a Mayo Clinic trained Orthopedic Surgeon) working throwing rocks. That means that someone would go through and use a jackhammer to break down huge segments of concrete and this future surgeon would go behind him lifting 100s of pounds of concrete- ass outstretched in correct lifting posture, and bending his elbows he’d throw them into a truck. His boss, when he would begin each day would call out, “I don’t want to see anything in the next twelve hours but asses and elbows!” So, for the first two years focus on keeping those asses and elbows moving. It does get better after.

How to Survive Medical School (or What I do instead of studying Cardio)

16 Tuesday Oct 2012

Posted by in Bioethics, Medicine, Travel

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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…