Fancy Advice

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Since my last blog post, the last several weeks have been pretty ridiculous. As my third year finished up with ten weeks of surgery, USMLE Step 2, and the beginning of the residency application process, I swept immediately into fourth year ER and preventative medicine rotations, watched a person die for the first time, and have been planning my wedding (I’m getting married in two days from writing this post!). Sometimes I get all Descartes-ish and wonder if I really even exist. I’m pretty sure I do.

Anywho, now that I am a wizened old fourth year I feel as if I should give some piece of advice, and so I will. Partly because I feel obliged to – nearly every first and second year I’ve come into contact with over the past few months has a slew of questions for me and I do my best to answer them. And partly because I want to – medical school is one of the craziest tasks anyone can consider undertaking, and the better prepared you are for it, well, the better.

1. Emotions, whether positive or negative, will come.

Like I mentioned earlier, I watched a patient die just recently. I’ve seen many patients on the threshold of death’s door, patients who have passed away overnight when I came back to the hospital in the morning, but no one has gone from life to death under my hands – literally. Unfortunately, a young woman in her forties came into the ER with very mild chest pain. Other than her age, every single risk factor for a heart attack was there, and that’s just what happened. A code was called and a nurse and I rotated doing chest compressions for 45 minutes. In a solemn, surreal moment, I was handed the defibrillator paddles. The four shocks were fruitless and she was pronounced dead as I stood there, the gel for the paddles smudged on my wrist. That whole experience could be a whole blog post in its own right.

Our team went to tell the extensive group of family members; also a first for me. As I drove home that evening I had a million feelings to be sorted out: frustration that the laxity in this lady’s lifestyle had lead to a very untimely death, sorrow in imagining myself in what it would’ve liked to be one of her family members, and admiration at the efficiency, calmness, and wisdom of the ER code team.

The odd fact of the matter is that at the end of the day, you learn medical facts and intuition during your fourth year of medical school. You don’t learn how to keep your voice from cracking as you look a husband in the eye and tell him his wife didn’t make it – the senior resident in charge of that task could not even do it. There are classes that help us to have better people skills, better listening skills, etc – but unfortunately, knowing how to deal with your emotions well only comes with experience. I would be surprised if there were more than a handful of people who did not agree that some of the strongest emotions that they’ve had, whether positive or negative, were directly tied to their experience in medical school. And, medical school not only has a direct effect on your emotions, but also indirectly through the sacrifices you must learn to make with your family, friends, and hobbies, and through the rewards it offers through fulfilling some of the first steps of one of your life’s greatest dreams.

2. Surprises, whether good or bad, will come

Close to Christmas of my first year of medical school, I was experiencing a very intense week of studying for finals and finally plopped into bed around 1am. As I rearranged my sheets and turned to my side, I found myself face to face with a small, very much alive lizard in my bed. After panicking and flailing to the point of falling out of bed, I collected my senses and escorted him outside – he looked very hungry and thirsty.

3. Your first year performance does not have to dictate the rest of your time in medical school

You may have had the highest of the high grades possible in college, graduating with honors and fancy Latin words framing your name. Whatever you did to earn those grades, that now needs to be multiplied ten-fold, maybe more, to score decent grades in medical school. About halfway through my first year (jeez, that seems ages ago!) I looked at my mediocre exam scores and realized I needed to change my study pattern. First year ended; my grades were a little better. Second year; substantially better. Third year I was blessed (I mean that literally; I very honestly feel God gave me the strength to study and sacrifice in other areas of my life) with excellent scores and evaluations.

The purpose of me telling about all this isn’t to toot my own horn and show how far I’ve come, although I am proud of that. Oddly enough, in retrospect, first year was the hardest year of medical school, for it required major adjusting from pre-medical school life and adoption of a lifestyle pretty darn foreign to most 20-somethings. I want to encourage all those freshman and sophomore who are looking at the academic workload in confusion. You’re not alone. Third year eventually rolls around, and you still feel lost when you get on the wards, but with each month you start to gain more and more confidence, and at you realize that you’ve actually been learning a lot, and that what you’ve been learning has very direct and rewarding applications to the hours and hours you spend in the hospital.

Basically, don’t give up, and don’t concede to any thought that you are just not going to do as well as you hoped. Second year is drastically more interesting than first year, and third year, while still difficult, is very rewarding and has many moments of You know, I think I can actually do this. Assuming that you are studying efficiently and have a passion for what you are doing (these two assumptions are extremely important!), you have an excellent chance of not just “getting by” in medical school but actually seeing yourself as a physician eventually, and succeeding in areas in which you apply yourself.

4. Don’t believe every piece of advice you’re told, such as:

Eat whenever you can on your surgery rotation. FALSE.
Coming home at 8pm after a 16-hour day of vascular surgery greatly increases your chances of devouring 3,200 calories worth of whatever is in the fridge in less than 10 minutes. Most likely those calories will be in the form of fried foods and cookie dough. I would recommend not even having those foods in your fridge during your surgery rotation. Don’t even go into a grocery store on your way home from your surgery shift, because all of a sudden you may believe that you could eat an entire frozen pizza.

Another thing you have to watch out for is snack breaks. Free snacks in the resident room are bad news for emotionally and physically exhausted residents and med students. Nutrigrain bars may have a picture of a strawberry on them, but they are like 98% sugar.

Buy all the recommended textbooks. FALSE.
I have three text books, each weighing about 20lbs, that I have read about 16 pages from each. In addition, a vast amount of smaller textbooks scattered throughout my bookshelves as well. I know I will use them more eventually, but right now your best bets for easy to access information about medicine in general are:

  • UpToDate
  • Anything off of eMedicine
  • Review books specific to your rotation (Pre-Test and Case Files are the way to go with most, plus High Yield for OB-GYN), which have the added benefit of fitting in your white coat pocket, which your Harrison’s Principles of Internal Medicine will certainly not
  • I know some people will disagree with me in regards to buying textbooks, so I would say take each rotation and class on an individual basis, and ask the med students ahead of you which were actually used and which were not. For starters, I can tell you that you do NOT need four anatomy textbooks. Your time and money are extremely valuable – the rotations fly by quickly and more efficiently you can prepare for both practical, in-hospital questions and standardized test questions, the better.

Well, time to go get married and stuff! As fourth year is definitely a more relaxed year, hopefully I’ll be blogging much more often.

Also, here is a picture of my irresistibly cute bunny who always is up for keeping me company at the end of a long day:

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