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“It was the best of times, it was the worst of times…”

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Charles Dickens began his classic “A Tale of Two Cities” with that iconic phrase, and I can think of no better way to summarize the beginning of my medical school experience. It truly has been the best of times, but at other times has felt like the worst. Medical school is turning out to be everything I thought it’d be and more – in some great ways and some difficult ones.

Though I may seem ambivalent about my experience, make no mistake – these have absolutely been the greatest eight weeks of my life. My White Coat Ceremony was a particularly unforgettable moment. Words cannot describe what it felt like to finally be able to wear my white coat for the first time. To most people, it may appear nothing more than a piece of uncomfortable white fabric that seems made to fit everyone and no one at the same time. However, for those of us who spent long nights in undergraduate libraries longing for the privilege of owning one, it is almost sacred. It represents our official acceptance onto the pathway of the profession of our dreams. It seemed to mean even more to my family than it did to me! It was so gratifying to see my family swell with pride, and I am eternally grateful to have been able to share that moment with them.

Interviewing my first patient was an equally amazing experience though it was profoundly humbling. There I was, in a real patient interview room, with my professor and my classmate watching, trying my hardest to remember what exactly I was supposed to be asking this very real patient. Even as I was hoping that I was asking my patient the right questions, I was praying that he wouldn’t ask me any questions because I’d most likely have no idea how to answer them. In that moment, I was confronted by just how much I didn’t know. Yet that realization was inspiring in itself because I realized that I’m actually being trained to become a physician. I was intensely focused on making it to medical school while I was in college, but in some way I didn’t fully comprehend that making it to medical school would mean I’d become a real-live doctor. These patient experiences have helped that I’m not just a student anymore – I’m a physician in training.

While this truly has been the greatest time of my life (for more reasons than I can fit in one blog post), I would be remiss if I did not admit that it also been the greatest challenge I’ve ever experienced. I had often heard that medical school makes college feel like middle school, and I always thought that folks were exaggerating. They weren’t. The volume of information that I’ve been asked to master has often been overwhelming and I have struggled to adjust to the pace of learning. Within the first two weeks of class, I found myself doubting that I have what it takes to make it and genuinely wondering whether or not I deserve to be in medical school. These feelings are compounded by the fact that many of my classmates seem to have been born speaking biochemistry. I expected medical school to be mentally challenging, but I underestimated the emotional and even physical challenges that I would experience. Ironically, I’ve learned that everyone thinks they’re the only one that doesn’t have it all together. We find support in each other when we feel overwhelmed. I genuinely feel like I have the most amazing classmates in the world. If I wasn’t among a group of such kind, supportive, caring people, I’m really not sure how I’d cope.

Life in medical school has been a whirlwind. There have been amazing highs, but there have been difficult lows. Through it all, one thing is for sure: it is an honor and a privilege to have this opportunity and I am committed to making the most of it.

Elorm and his parents

Elorm and his parents

sim center banner

Saving the Simulation Patient

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Since starting medical school, sitting in an auditorium and learning from lectures has been a mainstay of my preclinical education. Although I gain a lot from the lectures as an auditory learner, I have enjoyed being able to go beyond the traditional classroom through various small group sessions that have been incorporated into the curriculum. I have been able to learn in a more interactive setting as I practice history taking, physical exam skills, and differential diagnosis brainstorming and go through pathology cases with my classmates. Nevertheless, my most unique small group experience has been the human patient simulation experience in my pharmacology course.

In the human patient simulation experience, I worked with five of my classmates to determine the cause of our patient’s drug overdose and to administer the appropriate treatment. Before going into the session we had assigned roles for each person such as lead physician, secondary physicians, pharmacist, laboratory specialist, and reporter. By doing so, we ensured that each team member could contribute to the patient’s care in a meaningful way.

Walking into one of the rooms at the Center for Human Simulation and Patient Safety was like entering a typical hospital room. I noticed the gowned patient in the bed, the vitals monitor, and assorted medical equipment. Although our patient was a mannequin, he could blink, breathe, produce a pulse in various parts of his body, and even talk! My team and I initially took the relevant vital signs, including blood pressure, heart rate, respiration rate, pupil size, and abdominal activity. Consequently, we noticed that his heart rate was significantly increased and his pupils were dilated. Yet, these vital signs were not enough to figure out what was going on. We asked questions to probe more deeply about his symptoms, and found out that he was experiencing dry mouth, weird dreams, and had eaten some mysterious flowers from his friend Jimmy. After discussing the different possibilities, we thought that the patient’s symptoms could be attributed to atropine, most likely found in the flowers that he ate. With three minutes to spare, we administered the antidote to atropine poisoning and the patient’s adverse symptoms began to reverse.

By working together, my team and I were able to pool our collective pharmacology knowledge and apply it in a clinically relevant way. It may not have been a real patient, but the simulated scenario taught me the importance of collaboration and teamwork in establishing an effective care plan for a patient. The lessons from this pharmacology simulation experience have been valuable and I hope to do more simulations in the future.

Welcome to Ghana sign

Legacy of Literacy

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As I count down the last few weeks before medical school begins, I am enjoying an extended period of self-reflection. I have been using this time to consider what the opportunity to attend medical school means to me. This is a short question with a very long and multifaceted answer, and over the course of this year I will share several aspects of that answer from my heart. In this entry I will attempt to explain what it means for me specifically as the son of Ghanaian immigrants and as a Black man in America.

My parents were born into poverty in rural Ghana, West Africa. The childhood experiences that they share with me are so incredible that they almost seem embellished. For example, my mother tells stories of growing up without shoes. She describes times when her father, who was the captain of an international freight ship, would visit her and bring shoes from abroad. Not being accustomed to wearing shoes, she would hang the gifts up on her wall as trophies for her friends to admire. Once they had finished inspecting these foreign treasures, they would all run back outside —barefoot—to tend to much more important matters such as neighborhood games. My father tells of nights spent sharing one room with his eight siblings on a straw mat. They burned old tires each night, the fumes from which were effective in repelling the biting ants that sought to wreak havoc upon them as they slept. In the morning they would wake up and blow out the tire soot that had collected in their nostrils overnight.

When considering their humble beginnings, I marvel at what my parents have accomplished. My father went on to earn a Ph.D. and is now a tenured professor at the Rutgers University School of Criminal Justice. My mother became a CPA and is now an audit specialist with the United States Department of Defense. The key to their ascension was their relentless pursuit of education. My mother grew up at a time when women were discouraged and sometimes prohibited from pursuing higher education, yet she saw education as a vehicle for upward mobility and refused to be denied it. My father saw education as a means of escape and an opportunity to provide a better life for his family and defied tall odds to seize that opportunity.

In addition to reflecting on my family’s journey, I also find myself reflecting on what it means for me, a Black man in America, to have this opportunity. Though my parents were the first in my family to live in America, my story does not start with their immigration 20 years ago. As a Black man in this country, my story extends as far back as the enslavement of the first Africans. Since slavery, African Americans have established a legacy of pursuing education despite great opposition. Frederick Douglass, a former slave who became literate, desired to learn to read as early as age six. Like many slaves, he perceived a link between literacy and freedom. When his master learned of his efforts he commanded Douglass to abandon his pursuit, maintaining that, “A [Black person] should know nothing but to obey his master—to do as he is told to do1.”

As African Americans sought formal education after the abolition of slavery, many Whites became hostile to the radical idea of educating former slaves. Particularly in the South, African Americans were severely punished for seeking education. Their schools were burned, schoolchildren were beaten and shot at, and teachers were murdered. Yet and still, African Americans valued the prospect of education and have insistently pursued it despite great challenges – from slavery, through the Civil Rights era, and even today, as systemic obstacles continue to limit the range of educational opportunities for many poor communities of color.

I am the product of a long legacy of educational pursuits, both as an African and as an African American. I have inherited that legacy and am now responsible for carrying it forward. I am not alone – many of my colleagues have inherited the same legacy. In many ways, we are the fulfillment of dreams dreamt by many generations gone by. In the 1800s, young African American men were beaten and sometimes murdered as a reward for daring to desire education. In 2013, I stand as a Black man on the doorstep of one of our society’s most esteemed professions. In the 1970s, two young Africans found sustenance in visions of the life that an education could provide them and their families. Today, their son stands as a realization of those visions. Of course, many thousands of Africans and African Americans have completed medical school before me, several will complete this journey with me, and many millions more will follow us. I am by no means unique among them and I do not esteem myself more highly than any of them. Instead, I find myself humbled by what this opportunity means in light of my historical narrative and inspired by the responsibility to add to that narrative.

1 “Self Taught: African American Education in Slavery and Freedom.” (2005). Williams, Heather Andrea.

Remote area medical (RAM) tent

RAM Clinic 2013: Volunteering with Rural Underserved Populations

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The above photo was taken at the Remote Area Medical expedition in Wise, VA.

My second year of medical school started in mid-July and it’s been a busy two weeks! We have already finished the pathogenesis course and we are now in the midst of pharmacology. Even with the intense workload and other school matters, I took the opportunity to travel outside of my comfort zone and volunteered at the Remote Area Medical (RAM) expedition in Wise, Virginia during my first weekend back at school.

RAM is an organization founded by Stan Brock that has coordinated mobile medical clinics in the US and abroad, providing free dental, vision, and medical services to thousands of uninsured or underinsured individuals since 1985. I have always had an interest in health care disparities and the medically underserved in urban areas, but college introduced me to the health care crisis of rural America. Through a course called “Healthy Appalachia,” I learned about life in Southwest Virginia, from the coal dependence and rich Appalachian culture to the health problems and the three-day long RAM clinics each year that provide critical health care to inhabitants of Virginia and other surrounding states.

Although I have lived in Virginia my entire life, I had never ventured to Southwest Virginia before my first RAM trip. The six and a half hour drive from Richmond, Virginia to Wise, Virginia took me deep into the countryside with the beautiful Appalachian Mountains along the horizon. It surprised that despite the mileage and proximity to Kentucky and Tennessee, we were still in Virginia.

Once we arrived at the Wise fairgrounds where the clinic was taking place, it was almost like stepping into an outdoor hospital. There were mobile units for ENT, audiology, women’s health, mammography, and x-rays. Large tents covered dental care and general medical services, while smaller tents housed dermatology and orthopedics. In the smaller makeshift barns, there was a full-service pharmacy and vision services with free eyeglasses being made on-site.

In my role as a volunteer, I was able to listen to patients’ stories and gain an understanding of their health problems in the context of the socioeconomic obstacles that they face on a daily basis. Each day of the clinic, I met patients who had been up at four o’clock that morning, so that they would be one of the first hundred in line for the opening of the clinic at six o’clock. I talked to patients about different chronic conditions, such as hypertension, diabetes, and obesity. Nevertheless, hearing some of the stories and seeing some of the medical conditions broke my heart at moments. With access to a primary care physician, the pain of a broken bone that did not heal correctly, the inability to read a book, the chronicity of arthritis in one’s joints, among other complaints, may have been resolved sooner so that these patients could return to having the best quality of life possible. Yet, by the end of the clinic, I realized that my efforts and the endeavors of all the RAM volunteers were worthwhile and at times, potentially life-saving. We were able to provide preventive care and other specialty services in over 3000 patient encounters, giving people health care they would have otherwise gone without. It was my first RAM expedition, but I do hope to return in the future. Most importantly, this clinic has helped me reaffirm my passion for helping the medically underserved, which is something that will enable me to persevere through the long year of challenging, but interesting, courses.

Monument at Treblinka Concentration Camp

Treblinka

The above photo is from the  Treblinka Concentration Camp.

As I write these words, I hang suspended over the Atlantic Ocean, hurtling in excess of 500 miles per hour roughly off the coast of Norway. Soft white clouds lie between my plane and the rippling blue water, as if to form a protective cushion in case the plane’s engines should fail. I am on a return voyage from Warsaw, Poland where I spent the entire month of June participating in the Humanity in Action Fellowship (HIA).

Humanity in Action is a non-profit international educational organization. HIA educates, inspires and connects a global network of students, young professionals and established leaders committed to promoting human rights, diversity and active citizenship—in their own communities and around the world. The Humanity in Action Fellowship brings together international groups of university students to explore national histories of discrimination and resistance, as well as to consider potential solutions to some of today’s most challenging issues can be considered and discussed. The programs are also intended to instill a responsibility among Fellows to recognize and address the need to protect minorities and promote human rights—in their own communities and around the world.

The reasons for my decision to pursue the HIA Fellowship were much the same as the reasons for my decision to pursue a career in medicine. Like many aspiring health professionals, I aim to use the skills and expertise I gain over the course of my medical education to improve the quality of life of marginalized populations. However, I recognized that the traditional medical education framework does not provide as much space as I need for investigating issues of human rights, minority rights, discrimination, and systemic marginalization. This is not to say that the system is at fault. Its primary objectives are to teach the diagnosis and treatment of human disease and to teach the art of the doctor-patient relationship, and it functions remarkably on both fronts. Moreover, curriculum reform has brought discussions about class, race, sexual orientation, gender bias, and discrimination to medical schools across the country. Still, though, I pursued HIA as an opportunity to gain an intense human rights education that would supplement my medical training both now as a Summer Fellow and for the length of my career through the Senior Fellows network.

Naturally, the first questions I will be asked upon my return are: “How was it? What did you learn?” (Most likely followed by: “So what did you get me?!”) There is no short answer to those questions. I could write for hours about lessons learned during my experience in Warsaw and indeed I have for my personal blog. Here, I will briefly share the reflection that I think is most useful for future physicians.

One morning, we traveled on a site visit to a small village in northeast Poland called Treblinka. It is a serene location, littered with small cottages that stand modestly, yet proudly – just as the folks who inhabit them. Most houses are accompanied by large piles of firewood, and some display satellite dishes that connect families to the images of bustling city life. The calming sounds of the surrounding forest are only rarely interrupted by the crunching of vehicle tires along gravel roads. Today, it is a picturesque countryside that seems recreated from a postcard. In 1942, it was the location of a Nazi extermination camp where hundreds of thousands of human beings were murdered.

During World War II, Jews and other targeted populations (Roma, LGBTQ, disabled) were brought to Treblinka in shipments using the same train cars used to transport cattle. They were fooled by the Nazis into thinking that they were heading to find work. Upon arrival at the train station in Treblinka, they were asked to remove their clothes to have a shower. Given that they had just traveled for days in a dirty train, this was a welcome invitation. When they entered the showering chamber, doors locked around them. An old diesel engine came to life, pumping exhaust into the chamber. Within twenty minutes, every lung was filled with carbon monoxide and every heartbeat was silenced. The total time elapsed from arrival at Treblinka to death by carbon monoxide poisoning was as little as two hours. Victims were exterminated at a rate of up to 2,000 per day.

As a future physician, the most sobering fact that I learned that day was that the ruthlessly efficient technique of mass genocide employed at the Treblinka extermination site was designed in large part by physicians. I imagine that those physicians, like most of us, embarked on their career journeys with noble aspirations. They sought knowledge for the purpose of alleviating disease and suffering. They gained the skills and expertise necessary to manipulate the human body for better – and for worse. In a 12-month period between 1942 and 1943, the same knowledge that allowed them to save human lives was used to devise a system that robbed 900,000 innocent people of their lives.

Their story is a lesson to all of us about the power of medicine. Upon entering this profession, we will vow to do no harm — yet we will undoubtedly have opportunities to break that vow. We will become armed with incredible knowledge. Society will confer power, influence, and authority upon us. True, we may never participate in such explicitly destructive systems as the Nazi genocide system, but we may yet do harm all the same – especially when choosing otherwise comes at a cost to us. We may choose to discriminate against patients based on any number of characteristics. We may lend our support to policies that disadvantage certain populations. We may ignore opportunities to improve access and quality of health care for those that need it most. As physicians – indeed, as humans – we are equally capable of choosing to good or to do harm. May we always have the courage to make the correct choice.

The Anatomy Lesson of Dr. Tulp, Rembrandt van Rijn

Good Bye

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Today I am saying my final goodbye to the person who donated his body so that I may learn something about human anatomy. It is a somber moment for me. Over the past 7 weeks, I have been able to get to know my donor’s body on a very intimate level. I have viewed nearly every muscle, artery, vein, and nerve that he had. I have learned about the way the human body works through him. I’ve been able to hold his brain in my hands, see the way tightening a muscle helped him make a fist, and watch the vagus nerve creep from the brain to every portion of his torso. There were times when it was unpleasant. There were times where it felt invasive. There were times, like when we performed the pelvic dissection or the sagittal cross-section of the head, that I wondered whether or not I should be doing this. All of that being said, it has been a truly special experience.

Because this time has been so special to me and because I have gotten to know my donor’s body so well, I wish I knew who this person was. I wish I knew his name. What did he do for a living? Did he have children? …grandchildren? …great grand children?  Was he a war veteran? Was he from Massachusetts? I wish I knew anything about him, anything. The only things I know are things I learned from dissection, like the fact that he had, and probably died from, metastatic cancer. I could imagine the many surgeries that he underwent. I imagined his day-to-day pain levels due to his massively dilated colon, blocked urinary tract, and other complex issues. I wondered how he suffered, if the last part of his life was comfortable, and how his family was affected by his suffering. For me, not knowing who he was or what he meant to other people makes it that much more difficult to say goodbye. How does one say a meaningful goodbye to a person he only knows superficially? I feel so close to him because I know what his liver looks like, but I feel so distant because I just recently learned his age, which is the only thing of any substance I really know about him.

So, today I will say goodbye to my donor, who I will not give a false name to (like Mr. X), nor will I arbitrarily assign any other attribute to. I will just thank him for his amazing gift to me and my group. I will thank him for his contribution to medicine. I will give thanks to his family and friends. I will take a moment, a moment with just me and him. I will try my best to do his donation justice. So, thank you, sir. Thank you for your gift t me. I wish you and your family well. I will never forget you.

Tutorial Group

Learning in Med School

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In medical school, learning takes on an entirely new personality and philosophy. It becomes more important. In fact, I would argue that long-term learning becomes paramount. While this is certainly similar for other professional degrees, what’s different is that once we hit the wards, the learning curve involves people’s lives. This makes learning in medical school is a lot different than learning calculus or physics because of the ways in which we must learn and study. Further, it’s different because of the sheer volume of information out there, which is not particularly well synthesized into bite-sized chunks. Thus, we learn what our professors think is “most important” and ignore the things that are merely “important.” So, then how do we gain confidence that we have the skills to put the pieces of the diagnoses and treatment puzzle together? At Harvard (and many other schools), the answer is something we call tutorial.

Tutorial, sometimes called small group learning, is a significant segment of every course we take. In my anatomy course, for instance, for every hour of traditional didactic lecture, we have about 50 minutes of regular tutorial, 1.5 hours of cadaver dissection (in small groups), and 1 hour of histology lab (again in small groups). Thus, the vast majority of our learning is in small groups, where we learn by doing. The key to this process is that the students do virtually all of the teaching and analysis. The “tutors,” professors, say very little during the discussion unless they are asked questions directly. Even then, they often redirect to the group. We go through real medical cases, wherein we have to come up with a complete differential diagnosis and subsequent treatment plan. What’s truly amazing is that as a group of eight or nine first-year medical students, we typically have the collective knowledge to solve most cases that we are given. Integration of the information into real cases is so important for solidifying understanding and promoting long-term learning.

We also use tutorial as half of the class time in our social medicine course, as we do in many of our courses. In this course, we might focus on social determinants of disease or on patient adherence to treatment regimens. One week, we were even tasked with designing a new health care system in a developing country. We come up with creative solutions to complex problems. This reinforces the idea that regardless of the innumerable barriers to health care treatment success, we have what it takes to devise solutions and deliver care. In any case, I feel I’m learning what it takes to be the kind of physician I want to be—well-rounded, compassionate, and thoughtful.

Despite the never ending databases of medical literature, we will learn what we need to learn. Participating in these small group tutorials makes me extremely confident in that. It is true that the biggest strength of any medical school is the student body. Learning from these people only makes sense in the inherently collaborative nature of our profession. One day, we will be making big decisions, and medical school will prepare us for that. As the days pass, we get better – I get better.

Woman with an Apple

Being Female in America: A Risk Factor

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In my time here at HMS, I have had the pleasure of interacting with all kinds of people. I’ve of course interacted with my excellent colleagues, brilliant professors, trusted advisors, and a few living legends; however, no one has touched me like the patients I’ve spoken with while in clinic, my patient-doctor class, and in various other settings. These people are truly my greatest teachers. The lessons they teach me are often accompanied with a hodgepodge of emotions that make them so memorable. These are lessons one cannot learn from any textbook, case-study, or didactic lecture because they are taught by patients and reinforced by the feelings that arise when witnessing human suffering with my own eyes and ears. These experiences change me. They make me more aware. I want to share, with her permission, a small anecdote from one such person who touched my life in an everlasting way. I shall call her Mrs. L. (That has no relation to her actual name).

Mrs. L is a woman from the northeastern United States. She holds a doctoral degree and suffers from anorexia nervosa. This disease disproportionately affects young women, which is well documented in the literature. She has suffered from this debilitating disease since early adolescence. She is in extremely poor physical health because of her illness. Looking at her is emotional for me because she is severely emaciated, weighing far less than 70 lbs. There is little flesh covering her bones, making them very distinct and identifiable through her skin. There was one story she told to a classmate of mine, who was actually asking the questions, that I’ve been thinking about ever since. She told a story of an experience she had while acting as a pre-teen model where she had gained a few pounds since her previous weigh-in. Mrs. L goes on to explain that she was chastised because of this sudden gain. She remembers thinking to herself, “I’m twelve; am I supposed to weigh XX lbs. forever?” She then remarked on the fact that she weighs exactly XX lbs. today.

Mrs. L, like many other women who suffer from disease, is a victim of acts of verbal and societal violence. This is not something she did; it is something that was done to her. Diseases like anorexia bring up all kinds of questions of whom/what is responsible, who/what is to blame, and what can be done about it. In my opinion, our society has substantial culpability in Mrs. L’s suffering. Modeling agents are only a reflection of society. Things like Photoshop further exacerbate the situation by presenting an unattainable form of “beauty” as a standard. As Jean Kilbourne pointed out, Cindy Crawford even once stated, “I wish I looked like Cindy Crawford.” As part of society, I too share some of this responsibility. This both saddens and angers me, especially because I see where this societal view manifests itself in my own perception of female beauty.

To better understand my role in this, I took an online implicit association test (IAT) to see if I had an implicit bias against people who are classified as obese. As I suspected, I do. And per the results of Harvard’s Project Implicit, so do the overwhelming majority of people who took such a test. I understand that our personal biases can affect the quality of care we deliver. So, what do I do about it? After some reflection and deep thought, I came up with little or nothing I could do that would truly impact the way society views beauty in women or the ways that this ideology negatively affects women’s health. However, I have committed myself to being hyperaware of my biases and being extremely vigilant in ensuring that they never affect the quality of care I provide. This is only a small and very personal step in the right direction. This is not going to help people like Mrs. L or future Mrs. L’s for that matter. I suppose I could join an advocacy group, but are they even effective? How do we address the pressures that young girls feel to fit a certain mold? Is education an affective tool? Is it even possible to change this in a meaningful way? I don’t know, but I hope someone figures it out so that I can stop being part of the problem and start being part of the solution.

HMS Lecture Hall

The Transition

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Medical school has a way of changing the way a person operates. The culture just grabs you, snatches you up, and holds you very close until you succumb to its demands…You study! You study hard! It’s kind of weird the way it happens though. It’s not like most of us make the conscious decision to spend our Saturdays in the library. It’s an involuntary reaction that is akin to a reflex or a yawn. You can’t stop it. It controls you; the culture controls you. Everyone around you is studying. There is so much information. None of us know all of it, but we feel that we are supposed to. Furthermore, we want to. Thus, we find ourselves, as I did last Saturday night, studying at 2 a.m. Sunday morning continuing our 15 hour Saturday study marathons. After six or seven hours of sleep, we’ll wake up and start the entire process over again. This process would continue every day thereafter, until the culmination of MCM (biochemistry and cell biology)—the final exam on Friday.

HMS Library 

That morning I slept little, the bare minimum to keep my neurons firing —about 2 hours. I walked into the exam at 8:30 feeling very uncomfortable. This was a feeling I was not accustomed to in an exam setting. I have never felt that I wasn’t prepared for an exam until Friday. There was just so much to know and so little time to learn. Thus, I tried, day in and day out, to get this stuff filed away in my brain in some order that I would be able to access later. I watched virtually every lecture for a second time. I reviewed all of my notes. I read two separate textbooks. Still, I had trouble remembering what bcr-abl stood for or how exactly nucleotide metabolism integrated with the other topics. I felt overwhelmed for about 30 seconds right before the exam, but I took a deep breath and walked reluctantly into that auditorium, #2 pencil in hand.

Although it may not seem like it, making this transition was relatively easy because it’s not as if I actually had a choice in the matter. I think the hardest part is coming to terms with the fact that I have little option but to study. As young medical students, we must think about this stuff day and night if we want to have any shot at speaking intelligently about it on the wards in two years. In fact, just this morning I woke up thinking about the biochemical pathways by which adrenaline relaxes certain muscles, while increasing the contractility of others in our fight or flight response. And just like that, with the mention of it while writing this blog, I’ve been sidetracked for the last five minutes thinking about those pathways all over again. It’s absolutely amazing how medicine has a way of permeating every aspect of my life, as it has many others who have gone before me. I suspect it will be the same for those that follow.

Panoramic view of Harvard Medical School

Deciding What to Learn

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Here I am, week 6 of medical school. Intro to the Profession is becoming a fond but distant memory. The Molecular and Cellular Basis of Medicine course, or MCM (what we call biochemistry), will come to an end in just a week and a half. Then, I will spend the next 5 weeks learning as much about human anatomy as I can. I’m starting to get the feeling that this medical school thing is going to be finished before I can take a breath, before I am completely comfortable with my level of knowledge. That feeling is somewhat overwhelming. As a physician, I will have people’s lives in my hands, but the word “hands” is only a metaphor, and an overly simplistic one at that. I wish being responsible for a person’s life was as simple as just holding on to a ball, an egg, or even a delicate flower, never letting it drop… never breaking it. However, the fact is that IT’S NOT! It’s not simple at all. The idea is supposed to be that I study cell signaling today so that I may save someone’s life or health 20 years from now. Is that a long time to remember something? Maybe, but that is not the problem for me. The problem is that I’m still not even close to comfortable with my level of knowledge on cell signaling, and we finished talking about many of those pathways last week. Now, I have new things to learn. So, it’s time to move on.

I probably don’t need to explicitly iterate this, but medical school is extremely fast-paced. The current body of medical knowledge is simply overwhelming to a young, and very green, 1st year medical student. A simple PubMed search for “diabetes” yields 414,545 peer-reviewed journal articles, which would literally take me 10 lifetimes to fully understand. When doing a search for the word “cell,” the results yielded a whopping 4.79 million articles! How in the world am I going to acquire the knowledge I need? How can I distinguish the absolutely essential information from the merely very important, or that from the somewhat important, or the somewhat important from the rarely relevant, which someday may prove to be essential for any one of my many patients? What may not seem important to even the most reputable experts, whom I have the distinct honor of learning from daily, may prove to be vital to saving my patient’s life in the future. I understand that my professors have to filter out the “less important” stuff (and I’m sure they’d love to teach it), but the fact is that it’s all important, or it could be. However, they only have four years to teach us. So, the question becomes what do I learn? How can I cope with my inadequate level of knowledge? How will I be able to do that in 20 years?

I can tell you that I have no clue what the answers to my questions are. I have no cure for my self-doubt. It’s absolutely frightening! This medicine thing is an extremely imperfect science loaded with judgment calls made considering only one’s own, and often biased, knowledge of statistical likelihoods. What happens to the small percentage of the people who aren’t within the norm? And to those people who have illnesses with mechanisms that I did not deem worthy of my effort to learn? They die. They become permanently disabled. They suffer immense pain. Am I okay with that? Does it just come with the territory? I don’t know, and I probably never will. What I do know is that now—the second month of medical school— is the time for me to start becoming somewhat comfortable with my very limited knowledge. I’m trying very hard, but so far, it seems to be am exercise in futility. I’m afraid my conscience may do me more harm than good. I hope that in my career I will be able to cope with the guilt associated with having a limited knowledge of the human body, despite there being an abundance of information out there. I will try to do the best that I can, but I am only a human being with a very limited capacity for storing information. That is a truth that continues to haunt me.