Wednesday, October 31, 2007

The Times That Make Us Smile

There are days I'm not sure I'm really going to make it. There are days I wonder if I'm doing the right thing. There are days I question my priorities. There are days I'm lost in my own world of stress and exams and studying.

And then there are days that remind me of things.

Some days remind me of the suffering of others out there that I might someday be able to help. Some days remind me of the humanity I see in everyone around me. Some days remind me of the limitless possibility when you put in the time and effort. Some days remind me to stop and smell the roses.

These things remind me of how grateful I am to be here.

It was innocuous enough. Just a simple little conversation with some friends in the dorm. Nothing too special. Except today I let my guard down. Today I admitted I wasn't feeling all that well. Today I stopped trying to be and do everything and I just WAS. It's hard sometimes to break out of that mold we find ourselves in as pre-meds, where everyone you look at seems to do things better than you. I've had plenty of times in the past where I have envied others or wondered why I couldn't have what they have or do what they do. In some ways it made me more self-reliant, self-contained. I didn't want to reveal weaknesses or foibles. I didn't want to let anyone in for fear they might see the things I didn't want to look at.

You come to a point where you finally realize that everyone does something better than you do. And it isn't such a bad thing. After all, it's a lot of pressure being the smartest guy in the room (or at least pretending to be). It's a lot of work trying to be a perfectionist. It's a lot of work worrying about everybody else in the whole world and how you just can't seem to measure up to them.

And today I realized it just wasn't worth it to me anymore. I can be as competitive as I want and never be satisfied. Or, I can realize that the people who truly love me will love me as much for the things I do wrong as the things I do right. They will love my failures and my attempts just as much as I love theirs.

There is no such thing as perfection. And even if there were, it'd be a pretty lonely place.

(Many thanks to H, R, L, and S for loving me just the way I am. I'm truly indebted.)

Sunday, October 21, 2007

The Cardinal Sin...

... I have committed it.

I have suddenly realized just how much time has passed since my last post. Credit for this should go equally to the ridiculous amount of metabolism information I'm currently trying to stuff into my head and the way that the passage of time is forever changed by the course of medical school. Every day seems like one of the longest of my life, and yet somehow almost 2 months of school has flown by. This whole time-relativity thing is tricky. There seems to be a convincing dearth of time for the things that I really want/need to do, but the lecture by the guy who mumbles and can speak in the longest sentences humanly possible drags on at an unbelievably slow pace.

In other words - I'm sorry for neglecting you, dear blog.

Life has gotten considerably more stressful in the last several weeks. It could be the material (biochemistry/metabolism, with its infinitely detailed mechanisms that make me think I am going insane when I confuse glycolysis, glycogenesis, and glycogenolysis). It could be my impressive procrastination. Or, it could be the fact that psychologically I have hit the proverbial "wall." In looking around at my classmates, it seems that many of us have encountered just such a fate. We as a bunch are looking more bedraggled, more worn-down, less bright-eyed and bushy-tailed. Even those consummate optimists - the ones who show up to the 8AM lecture every day - are starting to fade. They still show up for the early morning lecture, but occasionally a few minutes late and looking decidedly unenthused. And, just the other day, I caught one of them napping discreetly.

What is happening to us?

The sheer volume of details and the realization that all of this knowledge will soon leave our short-term memories due to lack of use has outweighed the novelty of being in medical school. In fact, for most of us it rarely seems like what we thought medical school would be. Sure we have an occasional clinical day here or a shadowing opportunity there, but the bulk of our lives right now is spent elbow-deep in textbooks and class notes. I'm sure this is by no means a new occurrence. Probably countless classes of students ahead of us have hit this wall head-on. And now, here we are, too.

In the last week alone, I have personally witnessed several teary emotional breakdowns with critical questions: "Why can't I do this?" "Is this really all it's cracked up to be?" "What am I doing here?"

Now, this could be due to the generally high-strung nature of medical students in general. Or, it could be a symptom of the kind of lifestyle we have to lead in this education. In truth, it could be good training for the rest of our lives when on-call hours, life-and-death situations, and ethical dilemmas far outweigh any possible angst over learning the pentose phosphate pathway.

In either case, despite what people might say (you know the ones...), this is hard work. No amount of preparation in college can honestly make you ready to deal with the onslaught of personal dilemmas and the feeling of being sub-par once you're here. There is literally more work to be done than humanly possible.

For those of us who like to be super-human, that is a difficult pill to swallow.

Friday, October 5, 2007

Ah Yes, Medical School: If Darwin Only Knew...

Ah Yes, Medical School: If Darwin Only Knew...

This is a ridiculously thorough description of the question-askers I have come to know and love in the first 6 weeks of medical school. (And by "love," of course I really mean "hate.") It's nice to know that these kind of people are ubiquitous and are really as much a part of medical school as anatomy cadavers.

In fairness, however, these poor, misguided individuals certainly do provide plenty of material for everyone else to bond over. In one class, we've developed a drinking game for how many times one particularly lost soul grabs her head and says "I'm confused." In another class, we secretly pine for the particularly rigid instructor who will put a certain someone in his place. We achieved this recently when his incessant questioning of her data led her to retort: "Well, when you've read 8,000 Cell Biology journal articles, you get a good sense of it."

Life just wouldn't be the same without these grimace-inducers. And, really, would we want it to be?

Essential Medicines

Got back this week from a conference on finding new ways to ensure the third world gets the drugs it needs at a price it can afford. Essentially, the plan is to encourage universities to negotiate into their licensing agreements on new drug compounds a clause that allows for generics to be made in poor countries. I find this to be an interesting idea and certainly valid for plenty of diseases that are rampant in third world countries but limited in the United States. However, it does seem disturbing to me that someone with HIV in Africa potentially has access to cheap anti-retroviral drugs and someone in the US does not. How do we decide who deserves our efforts the most? The cynical part of me wonders if the allure of working for drugs in the third world overshadows some of the mundane real-life dilemmas of poor people without access to healthcare in our own country. Who do we have a duty to? Who do we ultimately value the most? Even though we are taught to regard each person's life with the utmost respect and to protect all human life, realistically it isn't always possible to do so. What happens when we have to choose where to place our time, energy, and resources?

Regardless of the ethical implications, the background on this movement is fascinating. It has really picked up steam in the last year or so with mentions in prominent journals and papers, the signing of an important mission statement by notable public health superstars, and increasing progress being made at individual universities.

Check it out:

Excellent Boston Globe article from Oct. 3

Wednesday, September 26, 2007

A "Dose of Reality"...

... Maybe.

An interesting attempt by an institution-sponsored blog to show what it's "really" like in medical school. I haven't been able to read each and every entry yet, but I assume you won't hear very much about the downsides of life at UMich Med School. Nonetheless, this is a great beginning. Maybe next someone will allow some unidentified student bloggers to maintain anonymity and report on the school. After all, that's probably the only way to be sure you're getting the full story.

Michigan Med School's "Dose of Reality"

The Competitive Drive

I can hear the muffled voices through the door. “So, this ribosomal subunit binds to…” “Antibiotic resistance is caused by…” On and on. The symphony of strained medical students . The feverishness of their work echoes softly down the concrete hall. Quiet questions, exasperated sighs, groans of frustration. One might think they were trying to decipher ancient Sanskrit texts rather than the neatly typed Genetics notes. Piles of highlighters, stacks of notecards, textbooks of all shapes and sizes line the perimeter of their group like a band of soldiers guarding its post. The battle may be won tonight, but the war rages on.

The struggle always continues, but the enemy here is different. Not the struggle for knowledge or learning. - it’s the struggle to outdo everyone else. To finally feel like the top dog again. In this land of “closet gunners” and “secret overachievers” and then just plain “outright obsessive-compulsives,” the sense of competition bubbles softly under the surface of everyday life. It isn’t enough to make a 96 on the test when the top 10% of the class makes 100. The “Honors” distinction (for a 100 average) is only bestowed on those who maintain perfection, the “High Pass” (for the poor suckers with a 99) is for those who have stumbled only once or twice, potentially misreading a question or misinterpreting a statement. I have heard so much in the past several weeks about how collaborative, how supportive, how noncompetitive an environment this is. I’m not sure if it is wishful thinking or a deliberate collusion to spread misinformation. Competition exists. How could it not? A group of 100 or so of the top students in the country have gathered here. Did they get here by settling for a 95% when the teacher clearly mis-worded the question? Did they make it by taking a weekend to enjoy the sunshine rather than studying? Did they impress a committee of evaluators by deciding that second-best was good enough?

All of these qualities are admirable. To be aggressive, to be confident, to be determined and steadfast. But, they come at a price. I haven’t realized until just now what a price I have paid. I sacrificed to be here. I spent sunny afternoons and lazy weekends and long vacations in battle. I worked while others slept. Happy couples on the beach. Groups of friends playing softball. I looked at them with disdain. I would be so much better. I would be morally victorious. My struggle was worth it. Duty. Responsibility. Commitment. All virtuous words, except when taken too far. Or when obliged for the wrong reasons.

As I look around now, I realize the slippery trade-off between ambition and wholeness. In some ways, my wholeness has been stripped away. Defined for so long by what I do, I have forgotten who I am. I look now at the way we greedily follow the battleplan. How we clamor for the reinforcement of our grades, our accolades, our trophies. We don’t know any other way to be. We don’t know what else will fill us up. We, who for so long have been the best of the best, are now pitted head to head. I fear for the casualties. I fear for the hurt and wounded, the ones who lose their sense of being. For the ones who cannot bear to see anything less than perfection. There is a big, scary world out there waiting for us. One in which grades and gold stars don’t just fall from the heavens. What then?

Tuesday, September 18, 2007

It Begins...

I like school. I like people. I like making things better. Why not combine them all and go to school to learn how to make people better? Easier said than done...

Years of suffering and striving. Years of competition and stress and anxiety. And after all that, I finally made it. I'm finally here - ready to make my mark on this thing called "doctoring." I'm living the dream. Yet, just a little while ago, I stepped through a set of double doors into a hushed wood-paneled lecture hall only to find that the journey had just begun. Join me, won't you?