Saying Goodbye to 2nd Year

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Many people have said that the second year of medical school is the hardest and most grueling year of all.  I’ve heard countless people tell stories of how busy, exhausting, and completely consuming 3rd year is, but it is always followed up by the statement, “But I’d take just about anything, including getting hit by bus, over 2nd year.”

To be completely honest, this was in fact one of the most challenging years of my life for reasons that extended far beyond the rigorous course work that we were faced with each and every day and the ever-looming presence of Step 1 (the exam that makes even other medical licensing exams cry themselves to sleep out of fear).

HOWEVER, I can honestly say that despite the challenges that we faced this year, I will look back on 2nd year with fond memories and a never stronger sense of the presence of God’s guiding hand in my life.  Let me take you through a quick whirlwind tour of what the end of this year was like and what made it so challenging, but I promise there’s a light at the end of the tunnel so keep reading!

From January on, the only thing that 2nd year medical students across America have on their minds is Step 1. This is the mother of all exams; it is 8 hours long and covers all of the content that we have learned in the first 2 years of medical school – anatomy, physiology, cell & molecular biology, immunology, behavioral science, biostatistics, preventive medicine, biochemistry, pharmacology, pathology, pathophysiology, psychiatry, and neurology.  Now this test wouldn’t be such a big deal if it didn’t have so much weight toward which field of medicine we will ultimately be able to enter.  It’s basically the MCAT of residencies and our scores will either make us eligible for competitive specialties like surgery, ophthalmology, radiology, or not.  The saddest part, in my opinion, is that students who may excel in those fields because of their clinical skills and passions may not have the chance to experience those professions because this exam holds so much weight in residency applications.  This was one of the things that I struggled with the most near the end of the year.  I watched countless classmates, who I know will be incredible healers struggle beneath the weight of the pressure that this exam places on students.  The tensions were certainly high and at times the morale was low, however, I can say that the silver lining through it all was learning to trust more in the fact that God has called us to this place to serve in a profession that he will placed us in.  If he has gotten us all this far, then surely he will see us through to the end.

Despite the challenges that we faced during 2nd year, I promised that there would be a light at the end of the tunnel.  Medical school is a process that is so much more than simply learning how to be a doctor; it is a process that challenges people at the very core of who they are and I can honestly say that I have enjoyed that challenge.  I’ve been stretched and forced to grow in ways that I could have never imagined.  I have been required to search for the true reasons why I chose to enter this profession.  I have made the best friends of my life because of the common struggles that we have faced together.  I have been inspired to grow in my walk with God.  I have learned more than I ever thought was possible.  And I have been humbled by the realization that I will never be able to learn everything there is to know about the workings of the human body.  Although the process has been challenging, frustrating, and seemingly impossible at times, I now stand on the other side of the first two years of medical school and can say with confidence that I wouldn’t change anything and would do it all over again in a heartbeat.

 

I would be remiss if I did not take a moment to thank the incredible people who helped make this year both meaningful and enjoyable!:

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My study buddies, Scott and Justin.  We met both years for 2 hours almost every night, 6 hours every Sunday, and ran through at least 45,000 flashcards – about 15,000 cards times a minimum of 3 repetitions. I couldn’t be more blessed or more thankful to have had them by my side through this journey.

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My fellow “Carrelers,” Keri, Krisalyn, Melissa, Stephen, James, David, Linden, Casey (not all of whom are in this picture). I spent my afternoons studying with these wonderful friends in the Study Carrels of Alumni Hall throughout 2nd year.  I have been continuously inspired by each and every one of them and have been spiritually and emotionally uplifted by each of their friendships.

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Dr. Werner, our famed professor of Pathophysiology and the Dean for Medical Student Education to whom we owe our gratitude for continuously inspiring us to never stop learning and to be the absolute best physicians we can possibly be.

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And my classmates, who I love with all my heart!  Coming to Loma Linda and joining these incredible, talented, brilliant, God-fearing, and all-around absolutely wonderful people was the best decision of my life!

I have a pager and a white coat with my name on it???

Kristina, Third Year Medical Student

First year – check. Second year – check. Step 1 – check. Orientation week – check. Tomorrow, with white coat on and pager in hand, I step onto the wards.

It’s both exciting and scary that these mile markers for medical school have passed already. For so many years I have been learning from behind a desk, and now it is time to actually do things.

As I look back on the last two years, it is pretty incredible to see how I’ve changed and been molded to face the changes of medical school. The experience has enabled me to get to know myself in a more raw and vulnerable way. I’ve discovered strengths and weaknesses that I didn’t realize during my college years. If this has only happened in the first two years, I cannot even begin to imagine the changes I will experience in the last two years!

With Step 1 (part one of three board exams that dot the path to becoming an MD) behind us, it’s so interesting to even see the changes my classmates went through in such intense stress. I saw some burning out, some are peaking just at the right time, some in a panic to get the highest score possible, and some at peace with just getting it over with. I realize that we have all come to this point in order to become physicians by mostly studying, studying, occasional OSCE…studying, studying, …and more studying. Yet this is one of the first mile markers of many that REALLY stays with us significantly into the future. I really try not to think of that too much as I wait for my score to arrive sometime in July.

Although it has been draining, I have gained some of the valuable things this year. One of the best things I have experienced is making new friendships and strengthening existing friendships like never before in my life. My friends that I have made in medical school are definitely ones that I will keep for the rest of my life. This is one thing that I have absolutely loved about second year of medical school. In college, I had a harder time getting and maintaining friendships. I’m not sure why. Maybe I spent too much time in the chemistry lab, or maybe I just wasn’t a friendly person! But this year, the hardships have made friendships stronger, and that is something that I will always treasure. Because it’s these friendships that get you through the rough times, and it’s these friendships that make the good times even MORE awesome.

Another thing I’ve really learned this year that has been VERY important for me to “turn off the chatter”. There are always people around you suggesting the newest and best resource for preparing for classes and step 1. The class nearly goes into a panic at the beginning of second year trying to find the best books and notes and flashcards and dropbox pdfs in order to succeed in classes/boards. Early on, I found that this kind of talk reallllly gets to my head. And even though I managed to turn the chatter off first year, I had to do it all over again second year. As a result, my days grew to be spent entirely at home with studying from 6am to 11am, working out, eating lunch, studying from 1pm-6pm (with an occasional 20 minute power nap thrown in), dinner break, then studying from 7pm till about 10pm. Repeat the next day. Yes, it did get a bit lonely at times, but I was MUCH more at peace and much more focused.

This past week we had orientation, which was…..interesting. We had a lot of lectures about smoking cessation, preventive medicine, ethics, and some about how to succeed on the wards. There were ups and downs in my attention span, I will admit.

Thursday night was the clinical commencement dinner for our class at Castaways restaurant. It was so awesome to see everyone in nice outfits, all done up for the occasion! But what I think I loved the most was seeing how relaxed everyone was. Seriously, I don’t think I’ve seen such relief on our faces in all my time here. Now, come our first presentation to our attendings in a few days, I don’t think that will be the case! But, I loved seeing so much happiness then.

The program consisted of a vocal rendition of “Let it go” by some of my classmates (Hans, Ben, Vincent, Jackson, Vanessa) and I along with an encouraging and educational speech given by Dr. Werner on how to succeed in third year (probably the most informative speech of all orientation week). It was an awesome evening of no studying, good food, awesome friends, and a gorgeous sunset.

So in short…third year starts tomorrow. Without a doubt, I am SO happy second year will be over and behind me. But about third year, I’m not going to even pretend like I know what is going to happen, because frankly, I have no idea! I’m sure I will miss the days that I could completely control my schedule and plan my fun activities around my studying. However, at the same time, I so appreciate the first two years of molding me into being a better doctor and a better friend. I have grown in my solitude of prayer and study this year, and now I’m ready to continue growing around patients, attendings, residents, and nurses.

And the saga continues…

Sincerely,

Kristina…now MS3

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Changes

Hayley, Fourth Year Medical StudentIn two and a half weeks the familiar faces of the class of 2014 will be lining up with hats, robes, and tassels to celebrate the completion of medical school. Many people say “medical school has flown by!” But as I think back I can remember the different years, the different flavors, the different themes. There have been so many changes – new friends, new relationships, new habits, new life directions – in both my life and in the lives of those nearest and dearest to me. I want to tell you what I remember of the four years in medical school and if you are in one of those years and feel like your life will never change, you can feel comforted knowing change is always around the corner in medical school.

First year:

New. Everything was so new. I couldn’t believe I lived somewhere where palm trees grew! Centennial complex was shiny, new, and so big! The cadaver lab was formidable. The lectures were intense – and there was tons of information to learn. Many of the subjects I had already had in college – biochemistry, anatomy, physiology – so sometimes studying felt boring. Also I wasn’t always sure why what I was learning was important. The application often evaded me. But I was a Medical Student. I had that brazen confidence of first year students. I was used to being the top in college and confident my mind could grasp anything professors cared to throw in my direction. When people asked me what I was going to be, I confidently told them I was going to be a Doctor.

Second year:

Overwhelming. First year is hard. Second year makes first year look easy. So Much Information. I felt like I was constantly drowning in a sea of pathologies I should know. Cloistering myself in the study rooms in alumni hall kept me focused… I would last there 8 or 9 hours until I got too hungry or tired or my eyes couldn’t focus anymore and then I would trudge home with my bag of books, ear buds droning Goljan, till I got home and could get out a “fun” book – something like clinical microbiology made ridiculously simple – to read while I ate something. Then out for a walk with the flashcards I had been pumping out all afternoon, then back to my bedroom to flip through some powerpoints and pathology slides. Repeat times infinity – or at least that’s what it felt like.

So many flash cards

So many flash cards

I remember one time during second year I went to the bank and needed to talk to a teller about something. While I was waiting in line I almost started crying just from the stress of being out in public and having to talk to strangers. I felt like I couldn’t even cope in society because I was so sequestered all the time. And then of course, as second year students are wont to do, I began to worry I was developing agoraphobia (which I had just recently learned about). When people asked me what I was going to be, I told them I was hoping to be a doctor someday.

Third year:

Busy. Being on a clinical rotation is much like being in a small boat tossed by the whims of the ocean. Sometimes the sailing is smooth and you can go where and when you want, but often your direction is completely out of your control – your schedule fluctuates dramatically from one week to the next as your team shifts or your rotation switches. There is really no pattern that can be established. In my scant time off I was constantly reading review books to try to prepare for the inevitable board exam at the end of each rotation. But third year is no second year. Seeing the faces of patients, understanding that the hours I had poured into learning meant something, made a huge difference to my morale during third year. I was excited to read about sarcomas because I wanted to learn more treatment options to talk about with Ms. X. I wanted to know why enterocutaneous fistulas stayed open so our team could move Mr. Y toward resolution of his large EC fistula. Everything had a lot more meaning for me. When people asked me what I was going to be, I told them I was learning to be a doctor and hoping to go into obstetrics and gynecology.

Asleep in the physician’s lounge between surgeries – instead of waking me up when the next surgery started, my attending texted me this picture.

Asleep in the physician’s lounge between surgeries – instead of waking me up when the next surgery started, my attending texted me this picture.

Fourth year:

Unique. I feel like no other year in my life will ever be quite the same as the fourth year of medical school. The first third of the year is intense – sub-I’s (sub-internships – where you attempt to play the role of an intern on your team) back-to-back, collecting letters of recommendation, the step 2 board exam, filling out the online application forms and the stress of wondering if you will receive interviews (you will – unless you completely disregard Dr. Shankel’s advice).

Then the middle third of the year is consumed with flying all over the country, evening dinners with crowds of people you don’t know, endless small talk, and always – “why do want to go into obstetrics and gynecology? Why do you want to come here?” Cities I interviewed at included the greater LA area, Palo Alto, Seattle, Portland, Minneapolis, Rochester MN, Denver, Chicago, and Boston – as you can imagine it is quite a feat to coordinate interviews especially when interviewing in specialties like OB-gyn when the program often only has 2-4 days on which they interview between October and January. Some programs just told me a day that I was going to interview.

One of my interview trail essentials – dry shampoo.

One of my interview trail essentials – dry shampoo.

When the flurries of interviews are over and the ranklist is formulated there is an interminable period of waiting. Waiting. You are aching to go to your number one, but you try to stay on okay terms with the top six on your list so you won’t burst into tears on match day.

Then match day comes. The tension is unimaginable. It is the culmination of everything you have been striving for tirelessly for the past four years. I remember the long hours in the cadaver lab first year, the even longer hours bent over pathophysiology notes during second year and the sleepless nights on surgery in third year. Did it pay off? You open the envelope and suddenly there are no more possibilities. There is just the one reality and that is your future.

And now, when people ask me what I’m going to be, I tell them I am going to be an obstetrics and gynecology resident at University of Washington next year.

Extremely happy on match day!

Extremely happy on match day!

Step1 | WSMRF | snowman

Janna, Second Year Medical StudentOne more day of tests! Then, second year will be officially 2/3 completed which means only 121 days 12 hrs and 29 minutes and 14 seconds til the looming Step 1. Step 1- it seems like the biggest test of my career. But then again, I felt that way for the SAT, MCAT, my weekly spelling tests in elementary, this set of tests I should be studying for right now, and basically every test I’ve ever taken… which means there will probably be another “biggest” test to come: Step 2?

On another note, I am excited to say I had the opportunity to present a poster and oral presentation at the WSMRF conference in Carmel, CA. There were over 20 students from my class at the conference and some of our mentors even came up like Dr. Blood. We had a great time learning from each other’s posters, attending presentations, and hanging out. It was a mini-vacation!

And, we have another mini-vacation after this test set. Our officers planned a retreat for our class at Camp Cedar Falls. I can’t wait to frolic in the snow with my classmates. Maybe we will build a snowman!

Disclaimer: I didn’t actually calculate the countdown to Step 1, but it’s around there. 🙂

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Nikoleta Brankov presenting her poster to fellow student Casey Harms.

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Michael Giang in front of captive pulmonologists.

 

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Anthony Yeo with mentor Dr. Blood.

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Me rolling up the poster.

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Olaf from Frozen. Maybe we will build a snowman at our Camp Cedar Falls retreat!

 

Peculiarities

Leanna, Fourth Year Medical Student

Being a med student.

For almost the past four years, that is how I have lived my life. The idiosyncrancies that come with that are still too numerous to count.

Peculiar situation #1: Attendicitis

Unfortunately, attendicitis is a very common, frustrating condition; most patients have it to some extent. It manifests by a patient describing his or her complaint to a student. Student then goes to attending/senior resident and presents the story. Student and attending physician make their way back to patient. Attending asks patient the same questions to clarify the details and gets AN UTTERLY OPPOSITE STORY. This of course makes the student look like a dumb, incompetent cow.

Phase 1: Attendicitis Prodrome

Me: Mr. Patient, this stomach pain, tell me a little more about it.

Mr. Patient: Like, a month ago or so. Just outta nowhere. It’s kinda all over, mostly in the middle I guess. Doesn’t hurt when I eat, thankfully. Just a generalized dull pain that comes and goes.

Me: Any associated symptoms? Nausea, vomiting, weight loss, change in your bowel movements?

Mr. Patient: Nope, I’m super healthy.

I walk out of the room and tell the details of the story to the attending. And we walk back into the patient’s room together.

Phase 2: Full-blown stage IV attendicitis

Attending: So Mr. Patient, I hear you’ve been having some stomach pain?

Mr. Patient: Yeah doc, it started about two months ago – hurts so bad I can’t even eat! I’ve lost 25lb without even trying, and I’ve been having horrible diarrhea! It’s a severe, sharp pain – here, I can point to exactly where it is. Help me doc!

Me, in the corner, wide-eyed, in a state of incredulous brooding: THE LORD IS TESTING ME.

Peculiar Situation #2: Residency Interviews

This first half of fourth year has been relaxing by most medical school standards, yet still fairly stressful as my classmates and I are applying to residency programs, at which we will spend at minimum the next three years of our lives, if not up to ten years or so.

The neat thing about applying to residencies is that it is no longer a one-way street in the sense that applying to medical school was. 99% of med school applications consisted of me trying to sell myself to the school in hopes that they would accept me. Regarding residency applications, I am now only doing that about 98%.

There are a few tips I have picked up along the interview trail.

1. Have a low threshold for laughing when your tour guide tells a joke.

Most interview sessions will include a tour led by a current resident of that institution. They’ll often try to joke with you and make small talk, and it is your job as an applicant to help them feel important and laugh at all the mildly funny things they say. However, do not neglect to be discretionary as to what is an actual joke and what is not.

Good example:
Resident tour guide: Why did the chicken cross the road? To prove to the possum that it could be done! Haha!

Medical students: Haha! Teehee! You’re so funny!

Bad example:
Resident tour guide: I once trained and ran a marathon for a cancer charity and –

Medical students: HAHAHAHA!

2. Find something individually impressive about yourself

Understandably, many of the higher, most competitive institutions attract the most intense and decorated medical students to their interviews. Sometimes, while everyone is sitting around a large table, a resident will ask all these intense and decorated medical students to “say a little neat fact about yourself.” My concept of neat little facts are things along the lines of “I kissed a real dolphin at Sea World last summer” or “I won Illinois’s pie eating contest four years in a row.” In reality, not so. Instead, this is simply an excuse for each of these students to rattle off their, ahem, humble accomplishments. For those of us without such bizarrely impressive achievements, it is sheer awkwardness. Try to have something, anything, to set yourself apart from the other applicants when these situations occur.

Student #1: I had a bit of free time during second year, so I was an ambassador from my state to Central Africa and helped to set up a new system of water purification. It decreased the child death rate by 85%. I am ashamed it did not decrease it more.

Student #2: I played for the U.S. Women’s National Volleyball team in college. Now I’m no longer that athletic, but I biked from Shanghai to Madrid over the summer while studying for Step 2.

Student #3: I was first author of seven different oncology papers this past year. Unfortunately, I was the second author on the eighth and ninth.

Student #4: I actually have a PhD in particle physics from MIT, but it wasn’t a satisfying career for me, so I went to Harvard Medical School instead.

Me: I, uh, I’m really good at parallel parking and I housetrained my rabbit last month.

Peculiar situation #3: The decomposition of the English language

Despite being homeschooled, I think I turned out fairly well. One neat thing about being homeschooled is that for some odd reason the vast majority of homeschoolers graduate high school with inordinately exceptional grammar and English skills.

Unfortunately, my time in medical school has not been good for these aforementioned skills (perhaps I overestimated them to begin with). I think we had to write one, maybe two papers in first year, and a paragraph about Patch Adams during second year. I wrote on the pathophysiology of liver disease during third year which was pretty much on the scale of The Iliad. As a fourth year the extent of my writing is in the fairly-sappy-yet-honest thank you notes I’ve written to residency programs at which I’ve interviewed.

Frankly, NO one cares about my grammar or English right now, which gives me a great excuse to mash out letters and words that to a normal human seem barely readable. Also, respectable writing takes like 584 times longer to type/text, so that is another reason it has fallen by the wayside not just among medical students but even more so among the Powerful Residents and Almighty Most Intelligent Attendings.

Example #1

Normal person version:
Can you check the vitals for the patient in bed 4B? The nurse forgot to give his beta-blocker dose. Thank you.

Homeschooled version:
Would you be amenable as to attend to the vitals for the patient in bed 4B? The diligent nursing staff has been so engaged in their duties that they inadvertently neglected to administer the patient’s beta-blocker, which is a great misfortune . Much obliged!

Medical version:
Can u chk vits on bed 4b,, forgot to give BBlokcer .TY

Example #2

Normal person version:
I think that this patient needs to be admitted to the surgery team. It looks like he has a bowel obstruction.

Homeschooled version:
I postulate that the care of this individual shall be relinquished to the surgeons in order to provide the most optimal treatment for the emergent management of this patient’s most impressive abdominal pathology. Shall we proceed now to the next patient? (best when read with an fake English accent)

Medical version:
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To celebrate being a fourth year, I got married. Here is a picture of me (the one with the white dress, in case you were unsure) and my med school compatriots. Solid gold proof that you can have a social life in medical school. My husband is not in medical school so I think that counts for even more points.

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