Done with first year!

I just finished my last exam of the first year of medical school. That's crazy talk.

I remember the first week as if it was yesterday. I was so overwhelmed and exhausted even though in hindsight we really didn't do that much. I questioned my decision to go to medical school and seriously considered taking it all back. If the first week was so hard and everyone says it only gets worse, I couldn't comprehend how I could (or wanted to) handle the next decade of my life.

Obviously, I've stuck it out. I got used to the course load and I've (somewhat) found my people. Most importantly, I've gotten to see and do some incredible stuff.

Last week, a Parkinson's patient turned off her deep brain stimulator so I could see the untreated symptoms of her disease. The change was immediate and quite shocking.

Tomorrow, I'm going to perform physicals and clear high school students for summer and fall sports.

And next week I'm going to scrub in and assist in putting a rod into a patient's leg after it was shattered by a bullet.

Even though I'm still convinced I know nothing, I'm starting to speak the language of medicine. I recognize and make sense of diseases that were a jumble of words just several months ago. Things are starting to make sense and it's so exciting to be able to understand some of the mechanisms behind the most common medical issues.

I've also experienced the power of the white coat. Within three weeks of starting school, I was being thanked by a woman for participating in the care of her husband who had just been diagnosed with cancer. Little did she know that I had just met my preceptor 30 minutes ago and was listening to the biopsy results with the same deer-in-the-headlights look that she and the patient had. The only difference between us was the white coat on my shoulders and three weeks of anatomy, neither of which prepared me to speak with any sort of authority on her husband's condition. But that white coat made all the difference.

I've progressively become more comfortable in my role as a medical student, but seeing the change in people's reactions whenever I wear the white coat hasn't gotten any less weird. Whether it's a patient and their family treating me like an equal member of the medical team when I walk into a room, or a car stopping for me at a crosswalk instead of gunning it through the light. It all still trips me out.

All in all, it's been a wild ride and I cannot wait to see what the future will bring!

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P.S. Although I'm no longer an M1 (first year medical student, in med-speak), that doesn't mean we're off for the summer quite yet. We have one M2 block remaining before we break until August. It's apparently three weeks of torture, especially after this last block which was affectionately called "Neurocation". And neurocation I did.

Making impressions on the OR staff

Last week I managed to impress the scrub tech in a very unique way.

I went to scrub in on another ortho case.* Prior to the case starting, a few residents and I were looking at x-rays on a computer in the OR. One of them needed a pen, so I dug out my purse from its awesome hiding place to get one.

Long story short, in this particular hospital, there are no locker rooms. So there is no place to store personal belongings such as backpacks, wallets, keys, etc. The residents tend to bring them into the OR and stash them under a table in the corner of the room. By stash, I mean hide them from the OR staff and attendings. I'd been instructed to do the same, albeit a bit more stealthily since I'm even lower on the totem pole than they are.

Before I could put my purse back, I got caught red-handed.

Scrub Tech: "What is that?"
Me, panicking: "I was just getting a pen for Dr. T."
ST: "Is that a pocketbook?"
Me: "Umm..."
ST, seemingly amused: "You are the first person I have ever seen bring a pocketbook into the OR."

She had a point. I did look rather ridiculous with a cross-body shoulder bag over my hospital green scrubs standing in the middle of the OR. So even though I failed at being stealthy, at least I gave them a good laugh.

The funniest part of this is that I bought my first purse only last year. I never used them before.

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* In the fall, I got hooked up with an awesome ortho resident who has taken me under her wing and has introduced me to the wonderful world of surgery. With her, I've scrubbed in on several cases and I try to go in as often as I can. This was yet another great case. More details on this in a later post. It's been an incredible experience.

Lifting each others' spirits

We have a couple of big exams this week, essentially the medical school equivalent of finals for physiology, histology, genetics, and biochemistry. To say people are stressed out is a gross understatement. But somehow we find the time to make each other laugh.

Like most medical schools these days, ours has a group on Facebook where we share resources, reminders of important deadlines, and sometimes (nay, oftentimes) comedic relief.

On the eve of the first "final", one we've been cramming for all weekend, came a few gems from my classmates:

And another. I wish the shelf exam (med speak for "final") was this straightforward:

I'm sure the inside jokes (neural crest cells being the answer to every confusing question in embryology from way back when) and direct application to what I should be studying now made this even funnier for me than it is for you.

On a similar note, a few weeks ago I was leading a tour for applicants at the end of their interview day. One guy asked, "When was the last time you guys took yourselves seriously?" I honestly couldn't think of an answer, even though we had an exam coming up in a few days. I ended up saying that probably the first week of school was when people were last worried/stressed out/serious. After that, we got used to the pace and learned to enjoy ourselves.

With this, I hope you get an idea of the atmosphere our class creates for each other. Because of them, this year has really flown by as stress-free as medical school could actually be.

A very quick update

A reader asked today about how I was doing since I haven't posted here for a while. I figured I'd let you all know that I'm still alive and haven't forgotten about this blog. In fact, yesterday I was thinking about how I should write something. Much has happened and I'd love to share it with you all.

Anywhos, onto the very quick update. School is going well, my plan for studying has been successful, and for the most part I'm really enjoying this year.

We have a couple of big exams coming up in the next two weeks, but I should get some posts out towards the end of the month. Stay tuned!

Sweet spot

I think I've found the way to set myself up for success. We'll see if it actually works when I get the results from this Friday's test, but so far I'm very optimistic. I have two full study days left before the exam and I'm not stressed out about it, in a good way this time.

I've seen all the material and understood all the concepts. I have gone over each lecture carefully enough that I was at one point able to talk it out and teach it to (an imaginary) someone. Now I just have to commit it all to memory.

Two very long days await me, but I am ready and willing to spend them in the library. This is in stark contrast to the last couple of block exams when I just shut down in the days leading up to the exam. I had so much hanging over my head that finishing it all didn't seem possible. So I gave up.

That is not going to happen this time. I'm not scrambling, because I've seen and understood everything at least once. There is nothing I have to learn from scratch, which puts my mind at ease. I am totally capable of learning this material well with the work I've put in leading up to this week. I'm very curious to see how it all turns out.

Mostly, I wanted to share a happy post of hopeful success in case I didn't write anything else before the holidays.

Learning how to learn

Medical school has been an adjustment for me. The problem is not so much the volume of work, but rather the seemingly absent product at the end.

In my previous job, I did stuff. I put in the hours at the office and most of the time I had something to show for my time at the end of the day, week, or project. This is not the case with school and it's starting to get to me.

We're on a true pass/fail system in that my grade is registered as a Pass no matter how high above 70% I score. There are no honors, no percentage, nothing to indicate how I did in the course. All that matters is that I get above the 70% that is required to pass the class.

This system is awesome because it creates a low-stress environment and a very collaborative atmosphere within our class. People help each other out all the time and I know that if everything went to shit, I would still pass medical school.

On the other hand, I find it very hard to find the motivation to do as well on exams as I would like, because, well, who cares. It's all the same in the end. A Pass is a Pass.

But it's not. I am capable of being in the top 25% of my class.* I was up there in anatomy and I should continue to be there throughout the rest of the year. I need to learn this stuff well now so I don't have to relearn it next year when it really matters. I just cannot find the motivation to study that much, though, when all I get at the end is a percentage on a screen.

I have no problem putting in the work throughout the week to be prepared for lecture. I've turned school into an extended 9 to 5 where I go to class in the morning and prepare for the next day's lecture in the afternoons, coming home around dinner-time. I have a goal of finishing a chapter or a subject and at the end of the day, it's done.

When it comes to learning stuff for the exam, though, I completely shut down. There is no end to what I can know or the depths of my understanding. I can always do more and the goals of being done are not as clearly defined. Instead of chipping away at the work, I stop studying altogether. I think I've watched a whole season of "Survivor"** in the past three days instead of memorizing random genetic diseases.

Maybe it'd be easier if I was coming straight from undergrad or my break from school wasn't over 5 years long. Maybe I would have accepted my fate of living with my nose in a book a bit better. I really don't think that's the case and instead the problem is that my personality does not naturally fit with this way of life. I like seeing the product of my labors and I'm not good with delayed gratification, neither of which are conducive to pre-clinical studying.

Alas, my personality won't change and neither will the next year and a half of school. In fact, it's only going to get harder. So instead of accepting my lackluster grades (I was below the median in all four subjects tested last block), I'm taking a more proactive approach and learning how to do better with each exam. Mostly, I'm strengthening my motivation muscles and gaining a bit more pre-exam work ethic with each test.

Thus far, this has been successful. My downfall with the first block exam was not covering some subjects until a couple of days before the exam. That stressed me out incredibly and I just gave up on Histology. This block, I made sure to cover each lecture/subject during the week and my levels of stress were significantly lowered these last few days before the exam. The material is still really shaky, though, because I've only seen it once or twice, again adding to that dreadful feeling of being overwhelmed. To help with that, next block I plan on reviewing the material on the weekend so I don't go weeks between seeing it the first and second time.

Moral of the story is that I have to re-learn how to study so that I don't get so overwhelmed right before the test that I completely shut down. It seems pretty basic but it's been a pretty big struggle for me. Luckily, I'm getting better and I can only go up from here.

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*While we are true pass/fail, we're kinda sorta ranked. Our class is divided into quartiles based on scores and that distinction goes into our dean's letter for residency application in some sort of coded way ("Student was exceptional/satisfactory/etc.") depending on where we fall. However, this ranking is heavily skewed towards clinical grades so an exam here or there in the first or second year doesn't mean much in the grand scheme of things. This also contributes to my lack of motivation right now.

**Reality TV is my guilty pleasure. I recently discovered that I actually like "Survivor" and I have plenty of seasons to catch up on. Bad idea.

Reflections on anatomy

Our anatomy final is tomorrow and it's so surreal to think that gross anatomy is finally over. It felt like such an impossible task when we first started 11 weeks ago.

I remember stressing out about the three muscles we learned in the first week. "I have to know the arterial supply as well? How am I ever going to remember the transverse cervical artery?!" That actually happened.

Towards the end of our first block, we learned the entire leg in 4 days. That seemed ridiculous and impossible.

But now, the seasoned medical students that we are, we did the entire head and neck in under two weeks. No one batted an eye at that. It just seemed normal.

I wish I had learned some things better. The pelvis and perineum still confuse me. The details of the poop cycle are also lost on me. All in all, though, I have a pretty good grasp on how our bodies are put together and I'm okay with that.

It's not surprising that I glossed over those areas because I've never found them interesting. Similarly, it makes sense that I enjoyed learning the anatomy of certain parts of the body (muscles, lungs, and eyes) because I've been interested in that stuff for a while.

Some things surprised me, though, like really nerding out on the autonomic nervous system and cranial nerves. I don't think I'll end up in neurology, but the logic-puzzle nature of the disease processes has been really fun to work through.

I'd like to say that I'm taking it easy tonight and taking the evening off because I need to do very, very poorly on the final exam to fail the course. But like a proper over-achieving medical student, I'm not satisfied with the pass. Instead, I'll be doing more review questions until my brain tells me to stop.

Trial by fire

At School E, we get assigned a preceptor whose office we will work at throughout the year practicing taking patient histories and conducting a physical exam.

I was hoping to get someone in a surgical subspecialty such as orthopedics, ENT, or plastics. We don't do 3rd year rotations in those fields and I'd like to get some exposure to them to see if they're something I'd enjoy doing. Having a preceptor in any of those fields would kill two birds with one stone: practicing patient care and seeing what their clinics are like.

Be careful what you wish for because I did get a preceptor in a surgical subspecialty: urology.

My first experience interviewing patients will be asking them about their private part problems. This shouldn't be awkward at all.

Medical school has changed me

"We have three days before the exam. That's plenty of time to learn it all."

Words I never thought I'd say until I saw how much I can absorb in such a short amount of time.


Also, my reasons for being excited about the weekend have changed dramatically.

Before medical school:
"Let's go camping. Or take a brew tour. Or just relax in the yard."

In medical school:
"Phew. We have two full days without any new information being thrown at us. I may actually be able to catch up this weekend. Sweet!"

Mortui vivos docent - The dead teach the living

Earlier this week we started anatomy lab. I hate it.

Part of the reason is the ridiculous inefficiency of it. We have no idea what we're doing so everything takes us so freaking long.

The other, more disturbing reason is that I can't bring myself to cut into our cadaver, Ms. Judy. Her fingernails are painted bright red. She has that wonderful short, curly hair that's popular among elderly women. Her muscles are tiny and she has mild scoliosis. Today we took a chisel and hammer to her back and knocked out her spine. How is that normal?

I understand it was her intent to donate her body in death for me to learn and help the living. But I cannot get over the feeling that I'm disrespecting her and mutilating her body. I cannot separate her being from the body that is lying in front of me. Did this frail, old woman know that this was what she was signing up for?

My dislike of dissection is not necessarily a fear of death. I've seen people die. I've worked on people who are dying. The newly dead aren't a problem for me, and the same goes for patients in surgery. The work of a surgeon is helping his patient in one way or another. Ms. Judy, on the other hand, is being taken apart piece by piece in a rather crude manner. It sucks.

My lab mates, on the other hand, have been incredible. They've done all the work the last couple of days while I've stood in the background adjusting their masks, hair, and goggles. I've benefited from their work because although I have no desire to cut our cadaver, it's pretty awesome to see the structures demonstrated on a human body.

Every time I glance at Ms. Judy's beautifully manicured fingernails, I remind myself that this was her exact intent. She wanted us to take her apart so we could better understand how she is put together. She may have not known the details of what it would take for us to learn, but her end-goal was clear.

I cannot let her incredible gift go to waste, so I suck it up and do what Ms. Judy would've wanted: learn about the human body by putting my hands inside her newly exposed spine.

Responsibility

While it still hasn't hit me that I'm actually starting medical school, it's slowly starting to dawn on me that I am, sometime in the near future, going to be a doctor. That is a scary thought.

Amongst all the mingling, retreating, and picnicking, we've had a few serious talks at orientation and our White Coat ceremony about what it means to be a doctor.

Our keynote speaker described the first patient that he treated. Our dean spoke about the impact his patients' words of thanks have had on him. And our orientation included a history of the impact our medical school and its doctors have had on the surrounding community.

Every single one of these instances sent shivers down my spine. The quality of my work will no longer just affect my professional reputation or a potential bonus. A good day on the job could have tangible effects on another person's life and future, as could a bad day. I have never felt such a great sense of responsibility before and it's thrilling.

So although it still feels like I'm on vacation meeting new people in a new city and the "first day of medical school" seems very surreal, I am keenly aware of the responsibility that I will acquire once I get an MD after my name in four very short years.

I am incredibly excited, but at the same time very terrified. I'm in for a wild ride.