Hayley, Fourth Year Medical Student

“Fourth year is the best year of your life,” I have been told repeatedly.

“Oh you’re a fourth year – make sure you travel and don’t study!” innumerable interns have exclaimed.

“Ahh that was the best year of my life…” senior residents reminisce fondly. First and second year medical students cling to descriptions of lazy weekends, and third years anxiously wish that they too were done with interviews, away rotations and essentially an MD.

I am not here to burst your bubble as you struggle through the first three years of medical school, but there are some realities of fourth year that nobody warned me about.

First of all, I feel like I have been diagnosed with terminal cancer. Expected date of death? July 1, 2014. With the 80 hour work week limit now in place I’m sure that residency will be manageable, but at the same time, you’ve heard the talk. I feel like I’m going to disappear into a deep, dark hole once I become Dr. Hunt and not emerge for four more years. My time is no longer going to have any semblance of being my own. And I’m going to have responsibility. It’s terrifying and exhilarating to think about at the same time. I feel overwhelmingly frustrated when nobody listens to my suggestions on the wards. But at the same time thinking of having my orders carrying weight – having the power to really help or hurt patients? That’s terrifying. So maybe my life won’t end July 1. But it is certainly going to change forever.

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Second, I’m lonely. Yes, I have all of this miraculous, beautiful, spacious, free time… to spend by myself. My friends are scattered across LA and the inland empire, intermittently on rotations or away at interviews. My husband has his job and incredibly few personal days. We have no family nearby. Yes, it was amazing and exhausting to spend the first three weekends in December flying to see my in-laws in Chicago to interview. Christmas vacation with my family in Seattle was filled with laughing, mossy hikes and scrabble games by the fire. But now here I am in LA, dutifully cooking dinner every night, making sure the carpet is vacuumed regularly, washing my hair on a routine basis… but after the exhilaration of the endless knowledge of first and second year, the stress and tension of surgery during third year, fourth year seems mundane and dull… I aimlessly read books and try to motivate myself to make it through selected texts, but by myself and without application sometimes I just find myself moving in listless circles.

Third, what are my hobbies again? Yeah, when I came into medical school I was an interesting person… I loved to paint and sketch. I dressed up in crazily creative costumes for Halloween. My favorite holiday was April fools and I tortured my college roommates mercilessly. I ran 50 miles per week with my friends. Gradually through the past four years that has all been stripped away as studying and then clinical duties nudged into my time and suddenly life became about surviving – eating, sleeping, trying to drink water. First year I gave up painting and drawing – frivolities replaced by anatomical diagrams and continuous sketching of the brachial plexus. But I clung to running as a life line, not willing to admit that I could go without that hour per day of anaerobic activity. In second year, running went. With Step 1 looming in the distance there was too much at stake and every hour became of paramount importance. So study walks and jogging with audio reviews in my ears had to satisfy my cravings. Third year even my time stopped being my own; the team you’re on owns you and med students do not take shifts – we must wait until we hear the words “you can go home now.” Not bad if the team is tuned-in, but it can lead to 16+ hour days if they forget about you. And then in the scraps of hours left, there were always review books or texts clamoring to be read.

And now we get to fourth year. What are my hobbies, again? Suddenly I have to re-learn how to use free time. And so, often I just end up running or walking and reflecting on the past years. Fourth year is a nebulous time of self-reflection and re-discovery. Every time I answered an interview question I was forced to delve into my soul and contemplate – who am I? what do I want? Do I actually fit here?

As I sit alone at home I think – what is my purpose here?

So, fourth year. Yes, a great year. Purportedly the best year of our lives. But be prepared for pockets of silence, to feel alone, to cling almost desperately to those moments of being “normal” that you may have forgotten how to experience in the past few years. Thankfully we are not actually going to die July 1, 2014, but our lives are going to change forever.

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