Further

January 8, 2016

After the last exam of our first semester of our first year, we joked that we were 1/8 there. 25% of an M done. Almost one letter in “doctor” down. The reality, of course, is that we’re further. Much further along, and much further away.

Over the last few months, we’ve seen things and done things that few others have or would even be allowed to—the kinds of things that when friends ask how med school is, you know you can’t explain. The first time our anatomy professor pulled back the sheet during prosections, my heart was racing and my knees were wobbly. A few short weeks later, I found myself leaning over the open thorax of my cadaver, wrist deep in the pericardium wrapped around the heart. Though it had stopped beating long ago, it was still a wonder, something I’ll never forget. And I noticed that my own heart had stopped racing.

The cliché that medical school is like drinking from a fire hose is true. But the real shock of it is not the amount of material rushing at you, but that before long you realize you’re drinking it in and you have been and will continue to, and somehow you’re doing alright. I’ve absorbed more information than I realized. A few days ago watching House, I picked out the right diagnosis (Cushing’s Disease) just moments before Dr. House named it. That makes me 1 for about 207 in accurate diagnoses since becoming a medical student, but I still told everyone I knew about it.

Things that used to be daunting aren’t so much anymore. One Tuesday afternoon I was shadowing an emergency medicine attending. This was my sixth session, and the ED, a place that once scared me, was just starting to feel routine. But, on this Tuesday, I’d barely arrived when a nurse hurried into the room saying, “Hey, there’s a code coming in. Cardiac arrest. One minute out.” The attending nodded, hung up his white coat, and calmly walked to the code room. I followed, not so calmly. Forty-five minutes later, after countless shocks, thousands of chest compressions, and injections of drug after drug, the patient was pronounced dead. Since seeing that, nothing else seems that terrifying, nothing else that unmanageable.

But there’s still a long, long way to go.

Another Tuesday afternoon I was shadowing a resident. As we prepared to see a patient with abdominal pain, he asked me a simple question: what could be causing the pain? I took some guesses: Stomach problems? Intestinal? Infection? “Sure,” he said, “but what kind of stomach problem? Gastritis? Diverticulitis? Cholecystitis? If an infection, what kind? Bacterial? Viral?” On that Tuesday, no one expected me to have the right answers to these questions—which was good, because I didn’t. But one day I’ll need to know the differential diagnoses, to pick them out from what seems now like infinite indistinguishable possibilities. One day, it’ll even be me running the code that I watched silently from the corner of the room.

In medical school, you find yourself on your own a lot, alone with your notes and books, your thoughts, your hopes and certainly your fears. Even with people around, the challenge of learning the flood of material is, in the end, yours alone. I chose to be here, so it’s not an option to tell myself that I can be apathetic about what I’m studying, or that it’s ok if I don’t work that hard. So I hope I can be good at this, even if sometimes it’s impossible to ignore the nagging fear that it’s too much.

Just over fourth months in and when I look back it’s hard to see where I started. Looking forward it’s even more difficult to see where I’ll be. But I’ve made it through many of the hardest firsts, and usually that’s the hardest part of all. So one day, one block, and one step (and, eventually, STEP) at a time. That’s how I got here, and that’s how I’ll keep going further.