To be a first year medical student is to come face to face with a potent mixture of your emotions flavored by those of your peers. Classmates who were always the top of their class are now somehow ordinary – bad grades, poor test scores are somehow a reflection of yourself as a person – your character intellectual and social is constantly judged and compared to “the mean”. In addition, there is a more pressing and terrifying elephant looming in the room. Soon, you will be responsible for peoples lives. On a level that few ever have been before – and unfortunately (at least for the first year medical student) your knowledge will be the only thing that you may be able to fall back on. Sir William Osler, the “father” of modern medicine once said that “We miss more by not seeing than by not knowing” a quote that I’ve always taken to mean, slow down and look at your patient, in my current situation patient = exam. Unfortunately, it seems that by not seeing things in my first two years, I’m missing things that I will need to know in my next two years. And in the next two years, I will be missing things that I need to know then. These insecurities come to the fore when discussing what is wrong with patients, especially with such a small knowledge base. Medical students are afraid of not knowing, so they memorize, it’s a basic instinct for most of us. But by memorizing, you lose the ability to actually learn the material, to “see” it so to speak. You don’t typically memorize the subtleties of relationships. You don’t actually grasp the material until to take great pains to commit it to your learned, long term memory. Which takes weeks of repetition. Unfortunately we don’t get weeks of repetition, we get days.
Days would be fine if the list of facts, terms, and relationships between those facts and terms was on the order of tens…but it’s on the order of hundreds. Some wise people said that medical school is like trying to drink out of a fire hose – I would take it a few steps further…more like trying to drink a thick milkshake out of a fire hose with a straw…You get covered in milkshake (knowledge), you actually ingest and digest very little… So with this seemingly small base of knowledge that I’m taking into my next years, I’m going to have to be observant and LOOK. Listen to my patients, it almost makes the Medicine, Patients, and Society course that I’m taking seem that much more important – even though they don’t do it any justice with the level they teach at.
So on we continue to march into this strange land, where you are the pilot and autopilot means crashing into the ground. You know the patients that you see will teach you, you know that the doctors you work with will teach you. You know that you will teach yourself. It seems like it’s time to cram as much knowledge into my brain as possible, but will that really work? Who knows…
This is an interesting feeling, intellectual inadequacy. Perhaps it is the point of the first two years – to show you that you don’t know a ton, to show you that you will always have to work hard, to reinforce a lifetime of study, to drive home the fact that you are inheriting a profession that practices – performs – but doesn’t build. We don’t build healthy bodies, we try to steer them that way, but ultimately it’s up to the patient and whatever the hell nature has decided. The closest feeling I have to describe it is the powerlessness of being completely lost in a smoky building. You might hear the outside world, you might not. Either way it doesn’t always help to orient you to what’s happening. The only difference is we have time – although not much. So you start telling yourself that it is important to use your time wisely…Suddenly textbooks are weighed against lectures, sleep is weighed against eating. Time is a double edged sword to be swung in a manner that cuts with every stroke. You start to get the hint that this is the way it will always be…You worry about new things
New things like what one might ask. Like a family. Cats, pet food, dogs, small children, medium children, large children, teenagers, and suddenly grandchildren. You wonder what effect your career will have on you as a parent, on you as a spouse, partner, friend. You being to hope that you are talented enough to make it work. There are so many things that aren’t taught in class – they are learned on the job. The apprenticeship begins and everyone is frightened. Family is scared that they will never see the soon to be sworn physician. Patients are worried that his view is too myopic, his hands unsteady, his demeanor uncaring and undignified. And finally he or she worries that all of the above will be true – and that there will be no way to realistically reconcile the myriad forces that seem to tug at you, without becoming one of those grumpy freaks of nature that can breeze along on 2.5 hours of sleep a day.
So as the pressure on the fire hose becomes even greater, as the demands grow even more discordant, and as the sleep becomes even more measured the student physician new to this apprenticeship questions…questions his fears, hopes, dreams, knowledge, insecurities, and yes…he questions medicine.
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