Thursday, June 28, 2012

Med School's Eyes Are Way Too Big

Everyone has had those days.  When you are so voraciously hungry you are confident you will be able to put away 4 boxes of Wendy’s chicken nuggets, a chicken sandwich, a side of fries and a large frosty.  Then you get your food and by the time you’re on the 5th nugget you’re barely nibbling.  Cue the “your eyes must have been bigger than your stomach” which never made sense to me because that’s anatomically ridiculous but the gist of the story is you bit off more than you can chew, literally.

So now the title makes a little more sense, right?  I think that medical school’s eyes are far too large for my academic stomach.  Let me explain a little bit further.  The biggest shocker to me was not the difficulty of the subject matter in medical school but rather the sheer volume.  Never in my life have I had to study so many things at once.  Its like the academic wizards over in the college of medicine walked through a buffet line of classes and decided to just pile on heaping loads of biochemistry, histology, anatomy, physiology (which should be its own freaking restaurant) and all the other classes until it started to get so high they couldn’t see over the plate and then continued piling it on.  

The biggest mistake I made was underestimating when people described the volume of material, I figured I could handle it.  I did handle it, everyone does, but it is an epic shock to your system.  Here I have to warn that everyone has a very different experience and I can only speak form my own.  I have never been the type of student that holes up in the library right after class to review notes from that day or to pre-read chapters, I barely get to reading the chapters in the first place.  Medical school changed all of that. 

Study guides, those are my favorite.  I’m a study guide maker.  I’ll type up all my little notes from all my powerpoints with doodles and scribbles and bullet points and amass all of that information into a neatly stapled packet from which I can review.  And when I say review I mean just read over and over and over until I know what is going on, that’s the only way I know how to study.  Here is a little comparison, in undergrad I thought 6 page study guides were intense.  Any more than 8 pages had to be some kind of epic final exam study guide for a class that gave a cumulative final.  The first time I put one of these little guys together in med school it was like 34 pages long.  That’s not even a joke.  Its really difficult to explain that it isn’t really overwhelming, you know its what you have to do and so your mental mindset evolves and adjusts to your present circumstance.  At first you may feel a little at sea but then its fine and you just go with the flow.  

Being the kind of person that you are, utilizing the study skills that you have been have brought you as far as it has so whatever methods you have employed has obviously worked for you. Being in medical school is a shocker to the system, no doubt about it.  You will study harder than you ever have in your life, you will spend more hours sitting at a desk reviewing notes than you ever thought possible, your body will hate you for not sleeping enough because you got distracted by whatshouldwecallmedschool’s tumblr page instead of reviewing for shelf exams, but that is what its all about.  At the end of the day, you figure it out. 

Honestly, in retrospect, I can now say that it wasn’t all that bad.  In the throes of it, I was miserable, but I made it through and so did everyone else. People tend to overdramatize and act like being a medical student means you have no friends, no social life, no nothing,  I strongly disagree.  It is what you make of it so the biggest thing you can take with you to medical school is a positive attitude, as cheesy as it sounds, its so easy to get sucked into the vortex of complaints and frustration but don’t let yourself do it.  There are too many negative nancies in medical school just looking for something to leech on to and complain and whine about, FIGHT IT! You’ll be so much happier for it in the end. 

Saturday, June 23, 2012

I love the smell of formaldehyde in the morning . . .

Anatomy Lab.  The quintessential medical school class, right? I swear whenever I imagined what medical school was like the only thing I envisioned was anatomy lecture and being in cadaver lab.  I pictured myself meticulously taking notes, color coding them, filling pages and pages with drawings, diagrams and splashes of color.  My imagination took me through a journey in which an atlas served as my exact guide and I could go vessel by vessel, nerve by nerve along its course, at the end being satisfied by the specimen that I had so exactingly dissected.  I couldn’t wait to feel like a real medical student.

*          *          *

9 months later: I absolutely have come to hate some aspects of anatomy.  I hate the endless hours (I’m not exaggerating) you spend pouring over a body cleaning out fascia.  I spent a year in anatomy lab and I still don’t think I know what the hell superficial fascia is.  You know what is the worst? When you spent 2 hours carefully scraping something clean then the professor comes over and rips through it like an old cobweb.  Then you want to cry.  You know what is even worse? When it’s your turn to teach your group and you have no effing idea what is going on because your cadaver refuses to cooperate.  By the time exam time rolls around the things you dissected at the beginning have started to look more like decaying old wood than any semblance of a body.  “Oh hey look, this is the cephalic vein! Oh sorry, IT’S A FRAGMENT OF MUSCLE, NBD”

*          *          *

Rewind 8 months and 29 days (ie first day of lab). I walked into the anatomy lab locker room and was overwhelmed by the most bizarre smell I had ever encountered but shrugged it off and changed into my scrubs.  To this day I am still a little confused as to why we insist on wearing scrubs to lab, there is no rule that you can’t just wear an old pair of jammie jamz (pajamas) or some comfy sweat pants and t-shirt you never want to wear again.  For some reason I think we lump this all into our requisite wardrobial rite of passage which includes but is not limited to: scrubs, white coat, those funny shower caps for your shoes, respirators (face masks) and stethoscopes (I have no business owning one but you better believe it was one of the first things I bought. LITTMAN BABY!).  In any case I changed and feeling very important slid by ID card through the scanner outside the lab and let myself in feeling like a BAMF.

So my group and I congregate around our table and slowly lurched open the large metal hinged doors that cover the body and latched them as they swung under the table.  We hesitatingly unzipped the bag and uncovered our cadaver.  This was happening simultaneously all over the room and you know what I found to be the most shocking thing? Not the dead body in front of me or the numerous other strewn about the room but the fact that not a single one of us flinched.  This is one occasion (of a handful) when you come to realize that people who go to medical school aren’t normal. There is some kind of morbid curiosity that drives us.  But a random sample of 100 people in the same situation I can guarantee 70 – 80% of them are going to have some kind of adverse reaction ranging from mild to moderate to severe.  Med students are basically freaks of nature.
You BFF in anatomy lab

Something that you will come to have a love-hate relationship with over the course of your first year will likely be Grant’s Dissector (sometimes called Tank”s).  Essentially the only anatomy lab manual you ever need.  So here we all are standing around with our copy of Grant’s and they tell us to take out our dissection kits and start. 

That was it.

And with that I began my first year of anatomy.  Here’s a scalpel, here’s a lab manual, here’s a cadaver. GO!
*          *          *

For all the complaining and late nights and stress and a perpetually impending sense of doom associated with it in retrospect I wish I could do anatomy all over again. Why after all the b****ing? Because anatomy really is everything I dreamed it was, but it wasn’t the romanticized notion I pictured.  It wasn’t easy.  It was frustrating.  Every artery and vein and nerve didn’t always magically appear when I looked for it, sometimes they downright didn’t exist.  Sometimes instead of an abdominal aortic bifurcation you find a giant aortic aneurysm, but that’s life, right? 

I can’t believe I took for granted that incredible gift that those donor’s gave to us.  As medical students we are given an opportunity to look where very few people do, inside ourselves.  Every single cadaver that you will dissect or see or study from was at some point someone’s someone.  A mom, a dad, a brother, a sister, a grandmother, an aunt, a friend, a neighbor.  The only piece of advice I would want to pass on is to encourage some time for self reflection and I guess this doesn’t apply only to medical students but especially so because we are afforded such a tremendous opportunity and sometimes we get so caught up in what we’re doing we forget that we’re in the middle of something so much bigger than ourselves.

Don’t get me wrong though, sometimes anatomy will make you want to punch yourself in the face (then your nociceptors and c-fibers will go bananas ;) )

Thursday, June 21, 2012

Don't Call Me Bob

First history taking workshop ever.

I smoothed the creases from my clothes, made sure the hem of my pants wasn't tucked into my socks and straightened my shirt out.  Carefully taking it off the hanger and sliding it on, the pièce de résistance, my white coat.  I stood there feeling a little bit in awe of myself.  I had waited so long, it felt like my entire life for this moment to finally put on that coat in a serious capacity.  

It was the first clinical skills workshop of the year.  This was the first time I would put to use the tedious amount of instruction we had received in clinical skills plenary sessions about how to interact with a patient, what to ask, how to ask it, when to ask, how to diagnose, how to rule out one disease versus another.  I was pumped.  It was gonna be my first day of doctoring.

What I encountered could not have been further from what I had imagined.  We were all herded into a room where we proceeded to split into groups and each group was to interview two mock patients.  So here we are sitting in a large multi-purpose room in the college sitting around a "mock" patient (these were people who did suffer from the medical conditions they were describing to us but had been nice enough to subject themselves to the utter clueless-ness of M1s) who we were supposed to interview as if in a clinic setting.  There were six of us so we went around the circle (like it was a second grade sharing time) and each asked questions until we had exhausted our totally inadequate list of what information we needed to elicit from the patient. 

I went home from that experience feeling so much less like a doctor than I wanted, essentially nothing like a doctor.  That was when I realized how many eons away I was, we all were, from even being comfortable enough with ourselves in a conversation with a patient to be of any use clinically. 

One thing that struck me from that day, that I will never forget is something one of our patients shared with us.  He was an older gentleman who shared with us that for years and years he had harbored some slight resentment for his primary care physician because the young chipper doc had affectionately called him "Bob" from the very first visit.  The doctor didn't realize what a colossal misstep it had been not to ask the patient what he preferred to be called, although the patient had approached the situation with a 'grin and bear it' attitude and eventually came to like the physician there always remained that initial feeling of discontent.

It seems like such a small thing, just tell him not to call you Bob, but it isn't.  As physicians we often are in situations where the power is shifted tremendously on our side and away from the patient.  For that reason I believe it is of utmost importance to cultivate a relationship that gives the patient a loud enough voice even if the only thing they want to say is "Please, call me Robert"

A little introduction

First things first, right? Who the hell am I? Why am I writing a blog? I hope in this first post to address some questions and then delve into the nitty gritties of M1 (<-- if you don't know what that means then probably the rest of this blog will be uninteresting to you either that or you call it MS1 and now I'm judging you.

Who am I? I have just kicked off what I have been told by many is the last summer of my entire life because my first year of medical school has just ended, so to answer your question: medical student (and for the uppity follow up lurking in some of your minds: I attend an allopathic medical school in the United States in a large Urban city)

What is this blog about? This blog will help document what I have experienced in the last year which was my first year of medical school as well as into the future as I progress through the remainder of my medical education.  Although I in the future I hope to mix in some posts that are in real time as things occur--for the first year I jotted some journal entries down and hope that using the added benefit of hindsight will be able to present a more complete picture of what this year was.  That being said this is in no way meant to lump all medical school experiences into one, this is my own personal journey and I hope to share the things that I learned, my successes and failures, random thoughts I had etc.  

Why am I doing this? I wanted to consolidate all my thoughts about this year into a format I could refer back to, I want to be able to reflect back on my naivety as I progress through this and hopefully have a way of keeping myself connected to the youthful energy and passion that I brought with me in this process. 

What does the title of this blog mean? I wanted to have a title that encapsulated exactly how I felt about the academic path I have chosen.  Much like the literary character Godot and MD seems like such a highly elusive and esoteric concept to me.  Most of my life I thought that once I entered medical school I would feel different, that I would feel like a future doctor and right now I don't and thus I am waiting for MD both figuratively and literally. 

I want to thank you for sharing your time with me and I encourage each one of you to share your own stories, pointers, tips, questions and experiences as well.

Happy Reading