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Things We Should’ve Been Told Going Into Medical School

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     This is reality, I thought a lot about what should be written here. And how genuine I could be without seeming too dramatic. But the truth is we go into medical school all hopeful, all dreamy and arrogant about all the things we will be at the end. But how often do we actually stop to think about the things that we will “lose” in the process.

     How many of us -including myself- went in thinking they were the smartest to ever walk into class? How many of us have been repeatedly smacked on the face by a nice piece of humble pie? How many times over and over again have we questioned whether or not we are good enough to deserve being where we are?

     Here I am approaching the end of what seems to be a very long journey, one I know I’ve learned so much in. I’ve grown so much through. And yet I feel too ignorant and too little. Too crippled by my anxiety of what comes ahead, of how much more work I need to put in order to be “something” or someone. In the light of the past 5 years of my life, and the years before it that paved my way into it, I find it only fitting to make a list about the things I wish I realized before I made a kid’s choice of going into medical school.

It isn’t as hard as they say, or is it?

     Too young, too arrogant too driven too full of ambition dreams and energy to think anything is too hard for me to grasp or deal with. I started medical school thinking I had what it takes and more, that I will swiftly and easily pass through and become the Hippocrates of my time. I also remember my first block of anatomy and every inch of my brain crumbling trying to visualize and remember the bones that make up the nasal cavity.
I remember myself tearing up for how tired and how hard it was for me to grasp cardiac physiology. I also remember how much I hated myself for dismissing pre-med physics as uninteresting and irrelevant to practice.
Fourth year, the challenge of pharmacology. Our first OSCEs (observed simulated clinical examinations) my friends and I panicking. Realizing Oh doctoring isn’t just knowledge and being book smart, but also how you translate this into your doctor-patient relationship and how you correlate it to clinical examination and findings. How in the presentation of a patient everything from the way he walks and talks to a 1mm pinpoint skin lesion (petechia) could mean something and should be correlated together? Doctoring is knowledge, observation and skill and one can’t go too far without all three.
I remember how I’ve never been more scared in my life than the minutes prior to entering my first OSCE station. Stress? No it was a whole new level of nerve wrecking. Clinical years happened and for a cynic like me it wasn’t a huge surprise to realize that all the glamor and excitement of clinical years is a lie. That we are mostly here to stand for hours to be subjected to very little learning and so much condescension from our superiors. The truth is what you first learn being in a hospital is actually attitude, adding yet another variable to what actually make a doctor. Soon enough we grew to realize that having the right attitude/ mannerism is the only way to survive the varying temperaments of our tutors/ consultants/ classmates. It is the only way to get anywhere with any patient. And the only way to get anything from anyone who works in a hospital (remember you’re a medical student that has no value nor rights so any entitlement you feel should be left somewhere else). The right attitude is the only way you have to learn anything. So, to answer the original question, no medical school is not as harder as they say.
It is way harder. Especially keeping in mind that after a long day of all of the above plus or minus a couple of things that happened through the day that added to your general frustration (you are in medical school after all) you would be expected to get home “take care of yourself” and study so you don’t fall in the big black hole of not catching up. And the truth is you will never catch up, and it is yet another thing that you have to accept.

Saving lives and the greater good.

    

    Medicine is not the only profession out there that will enable a person to help others and “save lives”. The ultraism that have always been adhered to medicine and its practitioners is a feeling that could be present in any profession or act a person chose to do with the right intentions. To avoid getting too philosophical what merit a doctor has making a clinical decision to IV a patient with some drug over a lawyer fighting for the rights of an orphan child? At the end of the day they are both saving lives.
They’re both getting paid. And what arguably differentiates the two is not what profession they practice but what intention they held at heart and how much effort they’re actually putting to fulfill their job description, here resides the true merit. And it happens to be that the job description of a doctor is to do no harm while at the same time reduce the pain and suffering of others.
The point is don’t kid yourself you don’t have to do medicine because it is the only way to help people. In fact, in a study tackling trends in hospital deaths done in 2013 a percentage of 27% deaths in ages less than 65 and a percentage of a 73% in those who are older was indicated*.
The point is during your practice you will witness so many deaths unpreventable and sometimes potentially preventable outside the very tedious hierarchy and bureaucracy of the health system.  Faced by this frustration it would sometimes feel like you’re losing more than actually saving, so going in with the right mindset and perspective is rather essential to maintain a drive that would work with death -or the possibility of it- every day and still survives.
The reality of health care is often too demoralizing. And personally speaking have I known how handtied I’d practically be faced by the system and/or disease I wouldn’t have been this eager to be where I am today.

 

Basics are always relevant.

   

     Second year, our respiratory block. Me checking my grade on the notice board and tearing after. I worked so hard for that test. I studied all the resources, I understood all the concepts. However, my grade did not reflect the quality of the understanding I thought I had. Sadly enough in medical school, and in most other fields, students are not being assessed in a way targeted to assess long term learning and critical thinking.
Please, don’t confuse this statement as a justification or an excuse to hang my short comings on. But at some point, of your college life, regardless of how hard you work you will reach a place where you’d be hit by the concrete of the education system. Where you’d realize that you have to squeeze yourself to get through it, and most importantly that it is way too rigid to expand and accommodate for your needs, skills or that little extra spark that’s unique to your intelligence. And at times you will feel at need to limit your learning just so you don’t get distracted from the scoop of your course guide.
I remember struggling at multiple occasions with grades that are lesser than satisfactory for me -coming from a 4.8 GPA this might seem too dramatic-, I remember being always too overwhelmed and overworked from how much I pushed myself to study, and most importantly I remember my friends constantly giving me advices to stop going beyond myself confusing it with “not required” details. Years after, us so close to graduation, in the midst of our clinical rotations and the same friends are constantly telling me how I’m literally shining in all rounds and with all consultants. Turns out that you could never go wrong reading too much, knowing the best you could know. Because although it feels that you don’t remember most of what you read, you’re actually priming** yourself to learn it better each time you get exposed to a piece of information. Basics are essential from the remotely irrelevant basic science of organic chemistry and physics we get swallowed in during our premedical years, to the basic medical sciences of anatomy, biochemistry and pathology we spend our basic years studying. Many people will tell you not to worry about it and just pass through, your clinical practice will be different and you won’t be needing all of this. Allow me to tell you that these people telling you these things don’t really know what they’re talking about. Medicine is defined as an applied science for a reason, because you need an integration of all basic life sciences to fully understand the human body and its diseases, and an ability to apply different fields of science to investigate and manage your future patients.
So of course, unless you’re planning to turn into a physician who manages his/her patients as if they’re Google without totally grasping the clinical situation, make every minute you spend studying count. Read. Read a lot. You will forget again and again, and it will be frustrating. But at some point you’d finally read the concept and it’d feel like an epiphany how you finally really understand it in a way that you will never forget. This is the pleasure of learning. This is what makes a good medical student. And Remember, we are medical students for life.

The unbearable lightness of a white coat.

     Once we started getting exposed to patients and spending time in the hospital I started noticing how even by doing nothing but wandering and/or being lost -and believe me as a medical student that’s 88% of what you’ll be doing- being dressed like a doctor alone -regardless of how empty of a white coat I’d still be for a very long time- people trusted me. Patients, distressed, in pain and in need would walk up to me asking me with hopeful eyes for help in most times I cannot provide.
You’d walk into patients’ rooms asking them to expose themselves for you to practice your examination techniques, and they’d do so promptly, without even questioning you for a second. More than once this year I’ve volunteered for the doctor to demonstrate some examination techniques on me for my classmates. They’re people I spent 5 years with, most of which are my friends, I’m generally very comfortable showing flesh and yet I felt so uncomfortable. Too exposed with all these eyes looking at me. Too insecure. Too uncomfortable. Imagine being sick, imagine being shy, imagine being in a state that’s already discomfort. Now imagine being in the situation of being examined by “students. Who in their right mind would so easily agree to this? It is basically someone who is so trusting.
This position, of being in health care, puts you at the service of people who have all their desperate faith in you. How heavy of a burden do you think this is, and most importantly how hard do you think it’d be to truthfully give them the best chance they’ve got against all odds being disease itself or the system? How would it feel to fail someone who believed in you, because you’re choosing a profession that has this as part of its job description? Will you be as compassionate and understanding towards your patients in 20 years the same way you are today, freshly out of school? Or would you distant yourself from the pain that brings and become one of those harsh consultants that treat their patients no better than they treat a chair, a desk or any other inanimate object? The moral struggle you’d live with every day, puts way too much weight on your shoulder than you’d assume a white piece of fabric could. And this responsibility is what you’re very naively choosing to carry, so can you carry it?

Is it worth it?

     For me; yes. Yes. A thousand times yes! Although I believe this is monologue that should be shared with my therapist and not here, but during the past few months I’ve came to the realization that the reason why I have this intense passion to the science of medicine -I genuinely feel elevated every time I learn a new concept-  is because I hate the current practice of medicine so much. Loving and hating the two faces of the same coin has an appeal to it that intrigues me. Mostly because underneath my cynicism I could still feel the little child who believes she can change something to the better. We all have that little child, and it is always lovely to poke him/her.
Every once and awhile in the midst of the overwhelming stress of being a senior student, I get moments of absolute gratitude to how much I’ve learned, and how much I’ve became. One of the perks of being in the same place -medical school- for so long is that, given the right attitude, you’d make the best friendships of your life. You will not only see how you’re becoming a doctor, but you’d watch the friends you’ve grown to love too much becoming as well and my God what a beautiful thing to be witnessed! I remember 4th year, and how much I struggled to memorize the checklist for the “jaundice” history station.
Two years after today and taking proper short history became second nature to me without even needing to look at a checklist. This transition from being absolutely clueless to having the full grasp on some skill/ concept is a blessing. It is a sign that you’ve nurtured your potential into something worthwhile. And since medicine is a very dynamic field, you’ll continue to learn for every day in your practice. You’ll witness yourself going through many knowledge shifts and that compared to the static mental environment, you’d have working in most other fields, is very rewarding. Because being in the health-care profession, again with the right attitude, is extremely thought provoking. It is the perfect stimulating environment*** for mental, social and psychological growth. lastly, romanticizing the situation would add more appeal to it as well. I remember the time a diabetic patient with repeated hyperglycemic hyperosmolar coma admissions holding my hands and kissing it for spending some time with him talking about a healthier more “socially applicable” life style for him. I remember a child running back to hug me after he is done with his examination. I remember the juice bottle a patient’s father gave me expressing his gratitude after I showed care and interest towards his sick infant.
I remember that time a patient hugged my face to her chest while I was listening for the tic of her prosthetic heart valve, and I swear the loving way she smiled as she held my cheeks softly was worth half of my life. All the prayers. The smiles. The expressed love and gratitude makes a day better. But at the end of the day are you really ready to take in all of it, the good and the bad? The light and the heavy? Because you will go into medical school and come out a totally different person.

Disclaimer: This entry is written with the young naïve perspective of a medical student. The life I am yet to live will change a lot. And so will yours.

* For more reading: https://www.cdc.gov/nchs/products/databriefs/db118.htm
**Priming (psychology): it is the implicit memory effect in which exposure to a stimulus influences response to a later stimulus.
For more reading:
https://www.psychologytoday.com/basics/priming
***Stimulating environment: an interdisciplinary atmosphere that nurtures discovery.
For more reading https://www.psychologytoday.com/blog/ienvironment/201501/environmental-stimulation-and-environmental-psychology

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