Tuesday, June 5, 2012

Second Year of Medical School

Second year of medical school....rumored by some to be the most intense year of medical school and indisputably a challenging, busy year.  That perhaps explains, while not entirely excusing, my lengthy blog silence.  Still, I have to say--I (mostly) loved second year, and I am tremendously excited to begin clinicals in July. 

Second year falls in a steady rhythm: four weeks of consistent class and studying with the ability to take a night off here and there, to visit friends in the area, followed by two weeks of class and more intense studying and slightly rising blood pressure, and finally, two weeks of nine-plus hour study days and four exams, where the light of day is barely seen (with a few pauses when sanity is needed).  Then, the cycle begins again.  Really, I prefer it to the first year schedule of exams every two weeks.  Sure, there are about three weeks that are way more insane than any time in first year, but the stress ebbs and flows.  There is recovery time, less guilt when an afternoon is taken off for ice cream or a walk or to hang out with friends.  If first year told you everything about how the body works and where all its parts are located, second year told you everything that could go wrong and how to treat it.  The analogy of flinging mud at walls hoping some sticks is fairly accurate, but I did love the material.  It felt much more clinically relevant and tangible.  I do remember some of it too; for instance, I can probably tell you how to treat hypertension, recognize bipolar disorder, take a much better health history, and tell you what to expect with heart failure.  Most pharmacology no longer sounds like a foreign language, and Microsoft Word has even learned how to speak it :) 

What are some of the lessons of second year?

(1) Boards are omnipresent and awful.  Sorry to begin the list with a downer, but anyone who has been to medical school knows that Step 1 of the medical boards is kind of an obsession throughout second year.  Professors are known to indicate parts of lectures that are "often on the boards."  Bits of information are added specifically for that purpose.  Talk scatters about "q-banks" (series of questions and explanations), "First Aid" (tells you almost everything you need to know for boards), "DIT" (one of the online prep classes).  Having studied for them since October and taken them nearly two weeks ago now, I can say it is seven hours of brain drain for which I paid nearly $1200, but finishing is definitely an accomplishment, my span of knowledge is more, and I just keep my fingers crossed for a good score.

(2) Many patients really do respect you as a physician.  During fourth quarter physical diagnosis, which took me and a partner to a hospital in the area, we had the wife of a patient shoo a visitor away for a few minutes because,  "the doctors are here right now."  Even with the short white coats and stethoscopes and reflex hammers that feel much more awkward than natural in our hands, with a mouth that stammers out history questions and fingers that furiously scribble answers for fear of forgetting anything, minds that search desperately to remember what to ask if the patient has had a stroke or diabetes and frequently forgets to ask about medication allergies, we are viewed as authorities.  It's certainly terrifying to know and humbling, but empowering too.  It is like a flash vision of the future, where we really will be doctors, exuding confidence and actually knowing some of the answers.  I had a moment in ambulatory care in the first semester, where we go and shadow a primary care physician in the area, when I was able to follow up with a patient.  She'd been someone I expected to be difficult when I met her, with several physical and psychological problems, but she and I ended up connecting.  I talked with her for a half an hour, gathering relevant history and advising for weight loss.  I left with an encouraging smile, and was blown away when three weeks later, she came in again and remembered my name.  When I saw her with my preceptor, she acknowledged to have followed some of my diet advice, and she hadn't gained any weight in the time in between.  I was blown away.  A patient actually followed my advice?  It made my month.

(3) Coffee really does work.  This is not to say I am addicted--I am working really hard to keep my consumption to a minimum.  And no, I still don't like the taste of coffee--I have to have cafe au lait or a latte or anything that is at least half milk.  I have discovered, however, that on days where I have not gotten nearly enough sleep and I find my eyes getting heavy or my mind stalling over the same five words, the caffeine in coffee does bring me that needed burst of energy and helps me to focus more.  Whether the effect is psychological or not, I haven't tested, but it does work.  That being said, I can't do more than a medium, ever.  Sometimes even with that, if I am not sufficiently sleepy, I can feel the caffeine in my blood like tiny bubbles, and it feels as though everything is going on warp speed.  It's all a matter of spacing and planning :) 

(4) There's something for everyone.  Well, mostly at least.  My favorite module of the year was viruses.  That something essentially non-living to be so destructive and so elusive of nearly all medications just blows my mind.  I have quite a bit of respect for these little particles as pathogens!  My friend meanwhile far preferred bacteria to viruses.  Others loved cardiology, neurology.  It will be interesting to see how all my classmates and I like our rotations next year and what we all end up going into. 

(5) Medicine is truly a calling and privilege.  Though or patient interaction was mostly minimal this year, every one reminded me why I love medicine and why plugging through these didactic years is SO worth it.  Just being able to hear fragments of people's stories and to sit in a room with them and figure out how to connect with them on a very human level is powerful.  I admire the strength I see in most of the patients, how one can be a 49-year-old former addict and now diabetic with ulcers on 20 medications and still light up when she talked about her grandchildren, or how one can be depressed with multiple ailments and exhaustion written on her face yet find the energy to joke with us.  There truly is nothing else I would want to do with my life. 

For those who stuck with this very long entry, thanks :)  I will try and be much, much better with writing this year.  I leave tonight for Cambodia, where I will spend three weeks working in a hospital in Siem Reap (where the temples of Angkor Wat are) doing what is essentially a rotation.  It was time to try something more clinical for me.  When I come back, rotations start and I will begin with OB/gyn at Washington Hospital Center for six weeks.  Blessings and love to all!

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