MD Class of 2012 Blog


Saturday, October 23, 2010

3rd year

3rd year is what I’ve been waiting for. Going to the classroom, studying in the library, not interacting with patients (ie the focus of the first 2 years of med school) was not what I signed up for, but it was and will always be a necessary evil. The light at the end of the tunnel is 3rd year. You get the opportunity to try out all the major specialties, you don’t have the burden of responsibility because you can’t write orders or prescribe medications, and residents are always double-checking your work, and you don’t quite have to worry about getting into a residency program yet. It’s great.

Being a 3rd year medical student like being an awkward teenager starting high school: You don’t quite know how to fit in, you’re trying to become more independent without overstepping your bounds, and you get lost easily in a new environment. Remember what it was like to be a teenager? At times you do very “grown up things”—learn to drive a car, vote for the first time, take care of making dinners some nights, for example. Yet while you’re testing out your boundaries, you still get reprimanded, you still live in your parents’ home, and you likely are not making enough money to support yourself, so you still have to play by your parents rules.

Life on the wards is very similar. As a medical student, we just learned all this medicine during our first two years so we feel like we know a lot, but at the same time, compared to the nurses/interns/residents/attendings, we know so little. We walk into rooms at 5 in the morning to talk to patients, take their histories, do physical exams, answer questions we know the answers to, write notes in the chart. A few minutes later, the nurse/intern/resident/attending do the exact same thing. These activities are very “grown-up” yet there’s that constant feeling of not knowing if you’re doing the right thing, or that you’re playing pretend since everything you do is done again, and usually better. It’s easy to get reprimanded, easy to get lost or feel lost, and we still have to play by the rules.

It’s pretend, but at the same time, medicine is a field where you’re always making an impact on someone’s life whether you want to or not. We have the remarkable privilege to ask patients intimate questions, perform physical examinations, and to our astonishment at times, patients let us. As “in-between doctors” we have the unique ability and time to translate what is happening to patients throughout their hospital course, and why things are happening the way they’re happening. Though it may seem from our vantage point that the white coat, stethoscope and scrubs feel awkward and like we’re playing pretend, many patients do not feel that way. To them, we’re just another health care provider waking them from sleep to ask them if they have chest pain, shortness of breath or if they’ve farted yet. The best part about it, is that your real responsibility is to try on the shoes of each specialty and learn without danger to the patient. It’s awkward, but it’s the best thing ever.

Monday, February 8, 2010

A Strange Time

It’s a weird time right now. We’re all trying to balance studying for school and studying for the boards, while figuring out what we might be interested in doing for the rest of our lives, and trying to be a human and have a life at the same time. Funny thing is: everyone says that med school is the easiest time of all our training.

You would think that school studying and boards studying is the same. In some ways yes, and in many other ways no. For me, school studying is learning all the intricacies that specialists in their field want us to know, and boards studying is pattern recognition. School studying is staring at packets of notes and PowerPoint slides, and boards studying is doing questions from a Q bank that make you feel like you haven’t learned anything in the past 1.5 years.

One of my colleagues and I joke when we see each other in the dark isolated recesses of the BioMed basement that we’re like monkeys: trained to memorize and spit out information. We’re all a little neurotic the way we study. Some like their packets stapled, some need them unstapled. Some highlight every word in the notes packet as they read, and then highlight them again in a different color when they read it again—rinse and repeat. Some (me for example) write and draw diagrams on the whiteboard and erase them—rinse and repeat. Still others put things on Post-it notes and put them all over their bathrooms and kitchens (imagine walking into that house). Unless you’re in it, or have done it, this all seems CRAZY. The relief/justification/satisfaction comes when we see patients, and we recall that sticky note with the differential next to the toothpaste to the left of the shaving cream, or that drug that’s highlighted in 5 different colors to the point that it’s almost illegible, and we’re able to help a real, living person.

This weekend, I took a break. It was all getting a little too nutso, and let’s be real, it was way more fun snowboarding on Saturday, watching the Saints win the Superbowl with friends (the commercials were terrible this year), and watching a couple movies on Netflix. It’d be great to be as smart as House, know the diagnosis right off the bat and just mess with your team because you can. It’d also be amazing to be one of those doctors (What are they anyways? It seems like they must be quadruple boarded in interventional radiology, surgery, internal medicine and infectious disease, while doing lab stuff on the side). Maybe it was endless studying that made House into the ridiculously brilliant jerk he is on TV. If that’s the case, I think I’d rather not know as much, and be a friendlier doctor. Don’t people say 70% of medicine is being able to talk to and relate to your patient?

For now, I have some ideas what I want to do, or rather, what I think I don’t want to do, but little experience to base it on. The experience is coming though, and I’m pumped. For now, it’s continuing to be a monkey, memorize and spit out facts, and recognize patterns. The satisfaction’s just on the horizon. A few more months, and we’ll be working long hours in the hospital—probably wishing we were back studying, in control of our own schedules.

-Ed Cheung

Saturday, January 2, 2010

The Boards

It’s hard to imagine that we will be starting our rotations in the hospital in May. The time that we’ve spent in the classroom and in the library studying has made it seem like ages since we started our medical education, when in reality, it’s only been a year and a half. There’s so much that still needs to be learned, but when I reflect back on where I was in August of 2008, I’m amazed at where I am now, and a little terrified of where I need to be before I start on the wards. The ominous first step of the medical licensing boards is fast approaching: something that is constantly on my mind, and on the minds of many of my classmates.

Someone once told me that studying for the boards is the best/worst thing you’ll never want to do again. That sounds pretty accurate. Though I’m not looking forward to the “intense 6 week study period” that we have, I’m excited for the outcome. This is a period of time when second years synthesize all of the information we’ve learned so far into something that’s usable. It’s our time to organize the vast amount of knowledge we’ve learned (and forgotten already), and package it into a usable form. The thought of being able to think of a McDonald’s #1 and the number of things a 2nd year student could tell you about what happens to that as it passes through our body astounds me. It’s incredible that after only a year and a half, most 2nd year students can tell you the gross anatomical route the food will take down our body, the innervations, blood supply and musculature of those structures how it’s absorbed and digested, what enzymes and chemical mediators are involved, and the different interactions between organ systems from a gross to a cellular to an enzymatic (sometimes even genetic) level. The more I learn, the more I want to know (though it always seems like there’s too much to know before a test). The more I learn, the more I realize I still have to learn. It all seems so daunting, but it’s both inspirational and comforting to know, that practicing physicians have all gone through a period of time like this in the past and have made it through.

4 months of crazy studying, and then the wards—the part of medical school that I’ve been looking forward to the most.

The interesting thing that I’ve heard from many people in medicine, during different times in their careers is that you’re always looking forward to the next step. 1st and 2nd year med students look forward to their 3rd and 4th years when they’ll be rotating, 3rd and 4th years look forward to residency when they’ll have more responsibility, and residents look forward to finally finishing their training and becoming an independent doctor. It’s sometimes hard to enjoy the moment, but I think it’s important to always remember how fortunate we are to be going into such a wonderful career. Each struggle / obstacle along the way is just one more step in the right direction.


-Ed Cheung

Buzzwords

Have you ever played the game when one person says a word, and the other person says the first word / thing that comes to mind? It’s often seen in movies when people are getting psychological tests done. Given that a lot of test taking is recognizing key words and answering questions based on what the right answer should be, it’d be really interesting to see how a medical student would score on one of those tests.

Thus far, we’ve studied cardiology and renal this year. I was thinking about how funny it would be to compare medical student “buzzword results” to those of “normal people.” Last week during small group, bread and butter came up, and the first thing that came to mind wasn’t breakfast or English tea, but pericarditis (because we’ve been told multiple times that pericarditis looks like bread and butter on the gross level).

As medical students and future physicians, we’re encouraged to sharpen our observational and deductive reasoning skills—after all, isn’t that how clinicians diagnose patients? What’s the most common cause of hypertension in a 76 year old man with high blood sugar? You put hypertension, an elderly man and high blood sugar together, and I spit out diabetes and nodular glomerulonephritis. As future clinicians, these buzzwords will rule our lives.

For me, I sometimes find myself so entrenched in medical school that I forget what it’s like to think about anything other than medicine. Since we recently studied renal, I’ve noticed that my thought pattern has changed. Usually when people feel the urge to urinate, they think of where the nearest bathroom is. Last week, I found myself tracing the nerve pathway of my detrusor muscle in my bladder back to my brain which was causing me to realize that I needed to pee. As I was relieving myself, it wasn’t the normal satisfaction that comes with peeing that was occupying my thoughts, but I found myself thinking about the pathway of urine from the glomerulus in my kidney all the way to the urinal cake in the bottom of the urinal.
Like most of my “problems” in medical school, I turned to my medical school friends to see if they had any similar experiences or if I truly should see a psychiatrist / psychologist to discuss my inability to separate medicine from every day life. The responses I got back varied from, “Whoa, you might want to chill out a little,” to “Oh my gosh, I last night I had a dream me rafting down a urine stream in a giant nephron last night!”

Reflecting on the variation of responses from various friends and family members, the same conclusion I get from everything else comes to the surface. Balance: it’s something everyone strives for, and few truly achieve. Many people in this world yearn for normalcy at one point or another in their lives. The truly successful are those who can achieve it at some extent.
This summer, during my cross-country bike trip, my good friend Jake gave me a piece of advice about balance. He said that the happiest people he knows who are established in whatever field that might be—law, medicine, business, art—have balanced lives. When he asked them about how they achieved balance in their lives, they said that they didn’t sacrifice the things that made them happy during their training. Prioritizing “balance” from the beginning will make it easier to maintain balance later on in life. This is the true test in medical school. Yes, our renal test was 41 pages, 3.5 hours and 120 questions long—a pretty serious test by anyone’s standards—but the true test, is achieving balance in the face of the behemoth of knowledge we’re required to learn.

My hope is that I can achieve this balance in life so that words like bread and butter bring to mind English breakfast tea and biscuits when I’m not studying instead of pericarditis.

-Ed Cheung