What to expect while you’re… in med school

what to expect when in med schoolThis title is totally tongue in cheek, in case you couldn’t tell. It’s like those books: “What to expect when you’re expecting.”  Because it’s totally easy chop chop to cleanly categorize and itemize things you can expect from pregnancy in 1000 cute words or less.

Well, medical school is definitely not cuteness, and definitely cannot be summarized in 1000 words or less, but all med schools across the US have a similar skeleton and anatomy (get it? I know, I crack myself up too), so I thought I’d outline it.

The worst year.  This is when your spirit gets crushed. It repeats a lot of your college courses, such as biochemistry and physiology, but in more detail and with more multiple choice.  The infamous anatomy lab where you will play with the pickled people takes place this year.

First year sucks because it is a far distance away from actual medicine or actual doctoring for the most part, although you do get to take some classes that allow the medical school to advertise “early clinical exposure!” (that is what everyone looks for when applying, and after starting, tries to avoid so as to be able to concentrate on actual studying…)

Interesting classes you get to take:

  1. Introduction to clinical medicine – here, you will learn how to properly interview a patient hitting all the important points of the medical history, and how to present in rounds without sounding like a blabbering idiot. PLUS, and this is an added bonus, you learn how to be an attentive and sensitive physician. (keep an open posture, lean slightly forward, never cross your arms. Nod your head, and once in a while, say: “This must be very frustrating/difficult/painful/confusing to you. “)
  2. Human sexuality – I’m serious! We had a professor who was just perfect for teaching human sex. His name was Bernie Bernstein; he was an elderly Long Island Jewish guy in a tweed jacket and a (usually crooked) bow tie. I can’t think of what beats hearing him explain the stages of the “Female ooooogasm.”
  3. Medical ethics – this course is a brain twister. Like a tongue twister for the brain. It hurts. No answers, just philosophizing. Discuss euthanasia… discuss HIPPA… discuss Terri Schiavo (well, she wasn’t around when I was taking this course, but something similar was discussed).  Discuss discuss discuss… ad nauseum discuss.

And let’s not forget the pickled people!  I mean the cadavers.  I mean gross anatomy class.  It’s an ever consuming endeavor.  In addition to countless official hours in the lab dissecting your assigned cadaver, you will be encouraged to come in on weekends and at night to finish your dissections, get better acquainted with all the organs, and to moisten the cadaver.  Yes, because if you don’t moisten in (with warm water and a dishrag), it dries up and by the end of the year, turns into jerky.  Cadaver jerky.

You get slightly closer to what you hope to be allowed to do one day, so more interesting and relevant, but also, much more vast and voluminous. The amount of information you have to read and internalize is staggering. Really. I wouldn’t be surprised, for example, if the pathophysiology of atherosclerotic plaque formation replaces, say, your best friend’s date of birth. Or if cephalosporins, their mechanism of action, spectrum of coverage and various generations, take over the space in your brain previously occupied by your phone number and address.

This is when none of your time is actually yours; anything you do that’s not studying, is taking away from studying.

Of course, there are some people who might not have had that exact experience. In fact, I have one specific frenemy in mind. We accidentally met the summer after first year, each at a different school, and I said, expecting commiseration, although, honestly, I don’t know why I would: “So, that was overwhelming!” Her answer: “I don’t know why people say medical school is overwhelming. Whatever! I wanted to work hard! I knew I’d be working hard! And I am always done studying by 8.”

Hint: NEVER EVER say stuff like that to other medical students, or they will kill you. If not with their bare hands, then with their look of death.

Some of the fun courses you’ll take this year include:

  1. Pathology – slides and more slides
  2. pharmacology and microbiology – drugs and bugs
  3. introduction to clinical medicine – this is not a fluffy course like you had last year.  This is a hardcore learn to think like a doctor course.  This is probably the most important course you’ll take.

That might be it.  But it’s enough.

Step 1
The United States Medical Licensing Examination has 3 and a half steps. Step 1 is taken between 2nd and 3rd years, ie before you make the move into actual clinical medicine. Step 2 is taken after your clinical years and Step 3 at some point in your residency, probably after intern year. These tests are 8 hours of pure computerized hell.  When I took it, I had only gotten maybe four hours of sleep the night before, valerian root pills having failed me.  It was sweltering hot in the room, which I shared with people taking their real estate exam and beautician exam, and whathaveyou.  They were typing incessantly, which was so annoying.  Fortunately, I was given earplugs, but unfortunately, when I put them in, all I could hear was my own heartbeat.  I don’t know how I made it.

Let me digress for a few minutes. I had this friend, and she turned out to be the first of my friends to have a baby when we were still pretty young. Naturally, I was curious about how bad is it, really. I mean, when the baby comes out, your poor vagina, that’s gotta hurt like hell!!

She answered, “Oh, no way, pushing the baby out is a pleasant relief, like a good bowel movement! It the contractions that suck…”

Back to my story. Sitting at the computer taking the test is pleasantly relieving, like having a baby, or a bowel movement. The studying beforehand is what really sucks.

You’ve passed step 1! You’ve been allowed on the floor. The main job of a third-year medical student is to follow their intern around and absorb information as much as possible. They’re encouraged to ask questions, but if they do, often, it’s turned right around and they’re given an assignment.   Example:

  • student: what’s a blighted ovum?
  • intern: why don’t you look that up and tell us about it tomorrow.
  • student: Sure! Thank you for the opportunity to learn! *learns…to keep mouth shut next time*

You have to do the core rotations: Medicine, Surgery, Psychiatry, OB/GYN, Pediatrics and Family Medicine. The trouble is, unless you’re extremely good at faking interest, the rotations you don’t like are painful. Because you HAVE to look interested. The third-year medical student’s biggest sin is to not look interested. Or motivated. It’s a joke by now: “An interested and motivated individual would…”

All in all, 3rd year of med school is when they begin to brow beat you into submission and fit your square peg of a person into the round hole of the medical hierarchy.

This year is seriously nothing but a secret ploy to get us to pay more money!! You’re required to do some rotations, and usually, you’ll do ones that pertain to the actual field you’ve chosen. But you end up with up to 5 months of nothing to do. Some people (ahem, gunners) will do useful things, like research. Others (ahem, moi) eat junk food and watch Law and Order. Yet others procreate. Tons of girls had babies at this point. Probably not a bad idea – just saying.  With waiting, comes infertility.

You might sign up to teach first year medical students how to do a physical exam, and when you meet those silly guppies, you will feel like you’re too cool for school because you have learned everything there is to learn and med school has nothing to offer you any more. Beware: it’s precisely this type of hubris that will make you regret you were ever born when you’re an intern.  I’m just saying.  Remember: you know nothing, and the further you go, the less you know.

The Match
The match is a service that will literally match up residency programs with appropriate respective applicants. The AMCAS rears its ugly head. Once you’ve picked a field, secured 3 recommendation letters, and written a personal statement (My Korean grandmother didn’t understand that I wouldn’t be seeing patients. But for me, radiology is the noblest field.), you pick out the programs you want, click click click, and await interview invitations.

Interviews are more fun that the medical school interviews. For one thing, everywhere you go, you get food. Secondly, residents will try to suck up to you. Third, you get time off rotations to interview, so score!

Then, once you’ve had enough, and they’ve had enough of you, you fill out a rank list. I have known students to become literally suicidal over their rank list. Playing tricks with the list, trying to figure out if they can trick the match protocol into playing more into their favor…. But trying to guess the match protocol is like…. Trying to figure out the proverbial mysterious ways in which God works. It’s like that giant prophet from A Hitchhiker’s Guide to the Galaxy. After years and years of hard work and blinking lights, and beep beep beepy boopy boop… you get an answer. 4. How that answer came about, no one will ever know.

Match day is an exercise in restraint. Everyone gets together in the medschool auditorium. Tension is so palpable, and the air so thick, you can seriously cut it with a knife. Let’s just say, to make it through, we brought giant Nalgene water bottles filled with orange juice [and vodka]. You’re handed an envelope. Once everyone has theirs, someone says: GO! and everyone opens at the same time. The noise that follows is deafening.

Once that happens, you’re indentured for the next 3-6 year.  Get ready for a magical time in your life called “Internship” and “residency…”

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