The more things change, the more they stay the same...

I took the long weekend off and got a chance to see my brother graduate from High School, my aunts that I hadn't seen for about 18 months and one of my college buddies get married. It's kind of strange how some people's perception of you changes once the find out that you're in medical school.

Several of my family members ask the obligatory health questions "what's wrong? what should I do?"...like I've actually learned anything medical this year. I do my best to explain that I can only point to body parts and call them by their proper names, tell you what they do, where their blood supply should come from and what part of the CNS they're controlled by...but that's it. Is it that hard understand that we don't learn any medicine in the first two years of medical school?

It's always interesting to meet new people though, because you never know if you're going to get the stories about their great-aunt's heroic battle with hemorrhoids or the nth degree about what your medical training entails. The icing on the cake comes when they are people that you've seen for years at various functions, that all of a sudden want to get closer to you. Instead of being the college kid/what's-his-face's kid, you're now "THE DOCTOR". It's as if by matriculating you've undergone some super-natural metamorphosis whereby you've become a full human being worthy of their attention. Unfortunately, I'm still the same 20-something I was at last year's bbq or wedding-related thingy, I haven't changed that much, save for the grey hairs, bigger bags under the eyes and $60k of debt.

It was also weird to be back at my high school for the graduation 6 years after my own graduation...ah, nostalgia. I could clearly remember the hours I had spent there for drama productions, awards and the obligatory first Friday masses. Except for a couple coats of paint, the auditorium was exactly the same. It still had the exact same smell of dusty seats mixed with the musk of the resident bus driver that lived behind the stage (gross). At the same time I felt so far removed from the chubby little 14 year old that wandered into that place, and I was reminded of exactly how far I've come since those 4 years at MHS.

When I saw my friends at the wedding, though, it was if we hadn't missed a beat. We keep up as much as we can, there wasn't very much to catch up on...they're basically the same as they were 2 years ago when we graduated. Fortunately, they still treat me the same as always. No medical discussions, no sudden onset of reverence due to school, and thankfully the same amount of ridiculousness that I need to keep me grounded. They remind me of who I really am., which sometimes gets lost in the midst of Med school.

It was weird mix of pride and jealousy watching J-man walk down the aisle with his bride, but I can only wish him and his wife the best. They've both grown greatly since college and I have high expectations for their life together...

Psychotic Patients

I had the distinct pleasure of interviewing a schtizophrenic patient last week. Let me tell you, it was a trip.

So we learn how to conduct a psych interview in our first year, but in learning the parts of the interview, you're lead to assume that the patient will be cooperative, forthcoming with his history and somewhat talkitive. Talking to someone who is a) schitzophrenic, b) heavily medicated and c) not really understanding why they're talking to you is not exactly the best learning situation. The psych faculty also did a crappy job of introducing techniques in dealing with different interviewing situations, making my interview with a patient in the grips of the negative symptoms of schitzophrenia EXTREMELY difficult.

Here's a little taste of the interview:
Me: Could you explain to me why you're here?
Psychotic Gangsta Guy: I dunno. [pause] My mom says I need to take my medicine
Me: What medications are you on?
PGG: I dunno
Me: Do you know what your medications are for?
PGG: I dunno...[pauses, stares off into space]...they make me tired, so I don't like to take them
Me: Do you remember when you took them last?
PGG: I dunno...
Me: Days, weeks, months?
PGG: I dunno...
Me: [getting a bit flustered, but remainging calm] Ok, so lets go back for a minute, could you tell me who brought you to the hospital?
PGG: The police
Me: Why were the police involved?
PGG: My mom called them?
Me: Why???????
PGG: I dunno...[staring at the wall behind me]...because she wants me to take my medicine... because of what I was saying to her
Me: What did you say that caused her to call the police?
PGG: I dunno...
Me: What were you doing before your mom called the police?
PGG: Chillin' on the porch
Me: Did the police tell you why they were bringing you to the emergency room?
PGG: Cause my mom called...[long pause, then with a smirk]...and they told me I had a bat in my hand

Needless to say, after another painful 15 minutes of questions, the patient finally gave me enough pieces of the puzzle to tell that he was schitzophrenic, off his meds (depakote and an anti-psychotic), and sitting on the porch holding a bat in his hand because he was scared shitless that the police were coming to get him and that he was hearing people talking about him.

Then, after the patient leaves, the Psychiatrist running the session tells us that sometimes the best way to deal with a patient with negative schitzophrenic symptoms is to sit there in the silent pauses until they give you an answer. Great, buddy, thanks for sharing that little nugget before hand...

Convocation of Thanks

We had our Convocation of Thanks ceremony for the familes of our Anatomy Cadaver donors. It was a nice little ceremony that brought a sense of closure for the families and helped them remember their loved one. It also re-cemented my sense of accomplishment for the year. Here's the reflection that I read:

Saying thank you…

Death is one of the few universal experiences of life. It is a time when most typically take time to say goodbye to their families, celebrate their lives, find peace in what is happening, and prepare to meet what awaits them after death. In addition to all of that, you thought about me while you were saying goodbye and made the incredible gift of your body.

When I think about it now, I will never truly have the chance to know you. I will never hear the stories of the sights that your blue eyes saw, nor the many lands where your feet trod. You’ll never be able to share with me the works your hands wrought, nor the thoughts your mind shaped. I’ll never know the children you held in your arms, or the love you held in your heart. I will never even know your name.

We spent a lot of time together in the anatomy lab, and I came to know you very intimately. You taught me things that I could not have learned from anyone else and that knowledge will go on to help countless others. If you could only know the profound impact that you have had on me and the mark that your gift will leave on the world, you would be doubly proud of your decision. I am forever in your debt.

I may not be able to properly thank you for all that you have given me, but in remembering your gift and celebrating it with your family today, we can honor it.

Thank you.

Post exam weeks are sweet

I always have a strange feeling the day after an exam. Some may call it a "hangover" from the massive quantities of alcohol that I consumed post-exam. Other's may call it the feeling of being completely aimless. After over a week of hard-core studying before the exam I'm left to wonder what to do with my "free time". There's like two lectures to study, I'm still cathcing up on sleep from the week of falling asleep dreaming of the extra-pyramidal motor system and the various interactions of psych drugs. I've still got mandatory crap to do on campus, so as much as I would like to disappear into the woods for a week or so with my backpack, my dog and a good book, I can't.

The week after exams are some of the most fun times that I've had in med school. Everyone breathes a collective sigh of "Thank God that's over..." and comes out from the crappy fluorescent lights of the library and socializes again. At the BBQ's and parties, I'm reminded of what good friends I've met here and the fact that we're enduring the pain in the ass that is medical education, together.

I guess that I've breathed the same sigh, subconsciously. I was in a pretty bad mood for the past week or so (as evidenced by my previous posts), but now I'm starting to feel relatively like myself again. I guess part of the change in mood comes from realizing that the first two years of med school are completely what you make out of them. They can be a gut-wrenching struggle where you live in the classroom/library and never see the light of day or it can be your full time 9-5 "job" with occasional weekends of work around exam time. I'm trying to take the latter approach, and see how it works for me on this last set of exams, so I won't end up having to cram as much before exams as I have all year.

4 weeks and 5 exams to summer.

Exams weeks blow

It's Satudrday night/Sunday morning and campus is quiet. Lights are still on in the apartments, which is not all that much later than usual. But there is one marked difference: the deathly silence. No music blaring from the building across the street, no drunk people screaming outside the door, no laughter...just the suburban night.

There really is nothing like the feeling of exam week in medical school. It's the time when all of your choices over the past few weeks come back to bite you in the ass...like that time that I decided to play beruit until 2 in the morning instead of studying two days after the last exam, or that time that I decided to go grocery shopping instead of studying, or that time that I decided to go to my friend's engagement party instead of studying, or that time that I slept...yeah that was bad and lazy of me.

And if it's not bad enough that I have to deal with my own personal level of stress, it seems like the 200 or so people that I'm in constant contact/confinement (choose your term) with are also just as stressed out. The combo of sleep deprivation, insecurity and caffeine/nicotine/whatever that kid is snorting off his desk just creates an air of tension. This can either erupt as some pretty funny sleep deprived moments or as snippy annoying interactions.

I guess there's a certain comfort in knowing that you're completely screwed...wish me luck

More of why med school blows hard...

This past weekend I headed home to attend my best friend's engagement party. He lives in SanFran now and flew all the way back MA to celebrate with those that won't be able to make it out to the wedding in July. I'll be in the wedding, but I felt like I should go home and drag my parents to see him. I've actually been best friends with him since we were in Kindergarten, and we're 23 now. It's a surreal feeling because it seems like just yesterday we were playing basketball in his driveway or facing off against each other in Little League. I've still got an image of him in my head as a 10 year old, not a budding CFA candidate with a wife and a house of his own. I vividly remember him calling me three years ago when he got engaged and how shocked I was, and now he's actually going to have the wedding. It's causing a whole new level of backlash with how I'm feeling.

When he first told me about this weekend, he prefaced his invitation with "I assume that you're going to be too busy with school, BUT..." Those words stirred something inside of me that was sort of a mix of disgust, self-loathing and disappointment. Who the hell would miss something like this because of school? Am I becoming one of those people? What else in my life am I going to miss because of this career? At the same time, was the scary voice saying "STUDY. You must STUDY". Thankfully I managed to ignore that for some time, but it's about a week before Neuro and Behavioral exams, so there's a decent amount of stress now to catch up for slacking off all weekend.

Anyway, I found myself comparing my life to his on the ride back to school (3 hours). I came to the realization that I was basically putting pretty much EVERYTHING but medical school into a holding pattern. Many of my friends are in successful jobs where they work their 40-50 hours/week and take home well in excess of $60k/year, or they're engaged/married and buying houses and having kids and going away on weekends and seeing their friends and family. I swore that I would never let med school consume who I am at the onset of M1. I've since realized that it's not realistic to expect to have a normal, let alone flourishing, social life while in medical school and that everything personal comes at the price of my performance.

There are only a few other people that can relate to the feeling of isolation that this can breed: law students, deployed military personnel, clergy that have taken a vow of silence and prisoners of conscience. I mean seriously, I've been cloistered away in a library, lecture hall or clinic for the better part of a year. Besides a quick spring break and christmas at home I've basically studied... AND IT ONLY GETS WORSE from here!

I've also developed an innate and unnatural sense of guilt when I take a weekend to go home/away. My notes and books have made several trips, even to other countries, all in the name of medical education. It is certainly not natural or healthy to feel guilty about taking personal/family time, yet that is the ingrained culture of medical school. It seems that my entire existence has been whittled down to the pretense that "I have to study."

I guess that I never realized that the inner voice driving me to study, could be heard so loudly by others. I'm afraid that I'm becoming something that I don't want to be... a workaholic who is absolutely no fun to be around and has no defining features beyond his occupation.

Rebirth of the Blog

So...I started this blog back in July thinking that I would have time to sit here and spill my thoughts to the world while in medical school. You see, the problem is that I'm really not having thoughts that would be interesting to anyone and it is frustrating. I wish that I had cool stories of how I was being abused in school or of patients I've seen but there's just nothing. And blogs about nothing are frankly pretty boring. But I've hit an all new level of needing to vent. Therefore, I digress...back to the ranting

Medical school blows hard. There's no other way to put it. Sure on the surface it looks like it could be fun: Avoid getting a job by hanging out in college for another 4 years, and come out on the other side with a guaranteed six figure paycheck. Mom and Dad are happy, friends are impressed, women are flocking (NOT). But underneath the glossy patina of "Grey's Anatomy" and "ER" and any conception that I previously had of medical training, lies the truth: Medical training is nothing more than an indoctrination into the dysfunctional world of being a physician.

Medical education is currently run on a system that was developed in the 1890's and that has worked fine since then...why fix what ain't broke, eh? We sit in didactic lecture after didactic lecture and learn "basic science" for the first two years of school, and then in the second two years we learn the art of diagnosis by the Socratic method. If that weren't enough we then get to enter residency, where we have the pleasure of making $8-10/hr for 3-7 years...after 8 years of post-secondary education. Residents at John's Hopkins back at the conception of residency who were young and single, essentially lived at the hospital (ie hotel for sick people) and worked at the slow pace of medicine back in the day. Fast foward to 2007 where physicians are forced to see 30+ patients per day to keep their practices afloat and you've got a VERY different story.

Still not convinced that it sucks? Ok, consider the growth of biomedical research/knowledge since the 1950's for instance. It has been EXPONENTIAL. Yet the medical education system has not really been reformed since then. Think about it, DNA was determined to be genetic material in the 40's, DNA's structure was solved in 1953...now extrapolate the exponential growth of knowledge to the point that we have today in 2007. It is phenomenal to think about the amount of shit that I have to keep in my head just to get through the day of lecture. I've heard stories of basic science professors apologizing to their students for the level of detail that we now have to learn. In what other profession do you have to deal with that???

So combine the scholastic rigors of dragging your arse through knee deep science, with the isolation from family, friends and the outside world that has to be endured on top of it. I have honestly never felt as alone as I do right now. I'm surrounded by classmates who understand exactly what is going on, but no one else. I see the same 200 people day in and out, we have the same conversations, we eat at the same places, do the same things...I feel like I'm Bill Murray in Ground Hog Day. Sure, the lecture topics change, the weather changes, the date on my Treo changes, but not my routine. Class from 9-12, Lab/Clinic/more class in the afternoon, study at night for a few hours, sleep.

And that's where the indoctrination comes into play. You see medical school is regulated by a bunch of crusty old physicians that seem to think that the demands placed upon them in their training should be placed upon new generations of physicians. They had their entire life analyzed just to be accepted to medical school, and so should we. They jumped through flaming hoops of bullshit classes, so shall we. They suffered through 2 years of Pre-clinical science, so will we. They suffered through living at the hospital and paying to working more that 80 hours a week in the post clinical years, so will we. They were paid $40k/year for their residency training, and so will we. Only difference is that we'll pay about 10x what they did to get the same degree thanks to educational inflation.

At some point there is going to be a massive exodus of quality of applicants to medical school in favor of fields with much less bull-shit to deal with. I think there needs to be a serious re-structuring of the medical education system if we are going to continue to draw a high caliber of students to our arena but more on that at a later date.