Why I'm Still in Med School

As a third year student, I finally get to interact with patients. It's so strange, finally getting to do what I came here to do (except, of course, this month). I had occasion to give a tour to some interviewees last week, and it reminded me just how far I've come since I got here two and a half years ago. Ah, to be so naive, thinking medical school is all about gross anatomy and learning to be a doctor. All these kids wanted was to talk to a "real live med student" about what life is like on the inside. How busy will they be? What is gross anatomy like? What are the students like? How competitive is it here? Can we go to the gross anatomy lab? What does it feel like, to almost be a doctor?

I get that kind of question a lot. Other common questions I get when I tell people I'm in medical school: Is it like Grey's Anatomy? (Of course! I have sex in call rooms with my supervisors ALL THE TIME.) Medical school? So you're going to be a nurse? (Nurses work hard, but I'm paying an awful lot to go to school for that MD, dammit.) What is internship like? (Why are people so obsessed with interns? I guess that goes back to the first question.) What is it like, getting to see patients and treat them?

Two years ago, these questions were a little more painful for me. The first year of medical school (at my particular institution; it varies) is split in half. The first semester consists of gross anatomy, biochemistry, histology, developmental anatomy, and the first part of a course on learning how to take a history and physical (called ICM). The second semester contains physiology, immunology, neuroscience (blegh), microbiology, and the continuation of the "being a doctor" course. The first semester is physically and mentally gruelling. Lectures are held every morning from 8 to noon, gross lab MWF, histo lab T/Thur, ICM whenever they can fit it in. Week-long blocks of exams occur 3 times, with the last block running into 2 weeks of finals. The second semester has a little more free time in the afternoons, with the exception of neuro lab on Mondays, but there are 4 week-long blocks of exams plus two weeks of finals.

I did okay through the first semester of first year. I was living alone at the time, since my fiance was living in DC, so I was able to keep basically whatever hours I wanted. I made some close friends within the med school class, and we had marathon bitch sessions about the hardships of med school. I started going to the homeless clinic that December, seeing patients and trying to reconcile learning dense enzymatic pathways with "being a doctor". I did okay. I even started seeing a psychologist at the school, beginning to work out my years of depression, anxiety, and neuroses (I said "beginning", okay?? Geez!).

After Christmas, the semester started badly. I had traveled too much over the break, beginning the semester exhausted. The neuro professors emailed us over the break, giving us homework that I couldn't complete (along with a majority of the class) because I was out of town. I started thinking, why am I here in medical school? I didn't come here to learn 80 different cytokines, I didn't come here to learn every single neural pathway (especially when we don't *really* know how they work, anyway), and I didn't see how learning the delicate nuances of gas exchange across lung membranes was going to affect me as a doctor. I got more and more depressed, more and more avoidant. I quit going to school, relying instead on the school's streaming video system to race through lectures as quickly as possible. I only showed up for neuro lab, which was mandatory, and sometimes microbiology, which I inexplicably loved (and which most everyone else in my class HATED). I took spring break up to my mom's house in the mountains and slept nearly the whole week, watching CSI when I was awake; I actually took the following week off of school, renting CSI DVD's from Blockbuster one at a time (on one of those unlimited rental passes). I knew my behavior was destructive. I didn't like how I felt sitting on the couch for hours unshowered, eating frozen dinners, barely getting up to walk the dog. My whole life's direction seemed up in the air. Why was I in medical school? I wanted to be a doctor, not a biochemist, not a physiologist, not an immunologist, and certainly not a neuroscientist. I hated being in the school building. One of the few things that I did that semester that helped (aside from continuing to see my counselor) was that I continued to visit the homeless clinic. I don't remember how many times I went, perhaps 4 or 5 times, but those were the few times I felt like I was in the right place. This is why I'm here, I'd think, I just have to make it through this other bullshit.

Since I've wanted to be a doctor pretty much as long as I can remember, this existential crisis really threw me. If I weren't going to be a doctor, what would I be? There was no answer to this question. With only a few weeks left to go in the semester, I made myself a deal: if I couldn't hack it, I'd take a year off, do some research, work a part-time job, and come back in a year. That way, I allowed myself room to maneuver, so I didn't feel so trapped. I also signed up to do a couple of preceptorships over the upcoming summer, where I'd follow doctors, see patients, and try to rejuvenate.

I thought I hid all this pretty well from my classmates. I've always worked hard to hide my depression from people: the harder I've cried, the giddier I am when I see my friends later. The lower I am inside, the louder I laugh. And, to be honest, I didn't feel this bad every single minute of every single day. I may or may not have met the criteria for major depression, I'm not really sure. It was a close thing. Also, medical students are fairly notorious for "playing tough", since ego drives medicine.

Later, when I've mentioned to classmates that I had a rough semester, I've been told that I looked sad, but most people assumed it was because my fiance was so far away. Even my family assumed my unhappiness had more to do with my fiance than with depression or medical school.

After I made it through the final final, an enormous load lifted. My earlier bargain was rendered obsolete--why would I need to take a year off med school? That would just prolong the ordeal. I'd heard second year was oh so much better than first year, I had preceptorships to look forward to, and my fiance had finally been able to make plans to move to be with me.

Now, over a year later, things are much rosier. Second year was so much more clinically relevant that it passed very quickly. Even with the terror of the USMLE, and the agony of taking so many exams in so little time, I never had that crisis again. Now, my panic is thinking "how will I ever pick a specialty?" But that's for another post, since this one is already approaching War and Peace proportions. So, I feel uniquely suited to talk to interviewees, and to first and second year students about why it's rough to be a med student. I tutored many first years as a second year, and we discussed these issues over and over. I promised them it would get better, and that if they were truly in the right place it would get easier. I actually got a "referral" the other day, a first year student who was having a similar crisis. After a morning interviewing patients at the homeless clinic (using my Maxwell's), she said she felt better, like it worthwhile to be in medical school again. It gave me a warm fuzzy.