one year down...

Today was the end of the first year of medical school for me. A microbiology exam was the last of it, an exam for which I crammed in an algorithm of bugs on dishes which I intend to forget by next week. But on the other hand, I learned about the differences between the bacteria that cause bloody diarrhea and the bacteria that cause secretory diarrhea, and I don’t think that before medical school I really knew the difference. I mean, before medical school, diarrhea is diarrhea, mostly.
I’m still stunned by my perennial ignorance–I couldn’t even begin to take care of someone, and there’s so much of what I was supposed to learn this year that I either don’t remember or never learned in the first place. I got by. I did a little better than average on some tests, a little below average on others, way below on some others. Nothing disastrous; the worst was what’s called a “marginal pass.” The teacher wrote me a note telling me that it was clear that I didn’t know any embryology–part of the test–and that I would have to study it for the boards; it doesn’t affect my transcript, in which my small group leader had nice things to say about me. In a pass-fail system, a “pass” is a “pass”; as Ellen Rothman writes in White Coat, there is no “super-pass.” Still, that sort of thing is discouraging. And last week I wrote a draft of an essay that was partly about all the cool stuff I knew about breathing that I didn’t know before, and then sent it off to a teacher of mine for factchecking; for the second draft in a row, some of the “cool stuff” I supposedly “knew” was just blatantly wrong. This sort of thing discourages me so much–that just when I think I know something, I don’t; and there’s so much that I know I don’t know.
Inexplicably panicked about the microbiology exam and feeling humiliated by the stupid commentary I’d written and got wrong again, I went into a room, closed the door and felt like I wanted to cry. I gave it a shot; a lot of my women friends say crying is cathartic, and I felt like I needed some catharsis. I couldn’t really get any traction on the crying, though, so after a minute of resting my head on the table, buried in my arms, I gave it up. Maybe that was the catharsis. I sat up, gathered my thoughts, sniffed the air and realized I should probably move.
I got my things together, found a good room to sit in that didn’t smell like the cadavers upstairs, turned on some Internet radio of KCRW from LA, and memorized a simplified algorithm of the bugs and diagnostic tests, cribbed from First Aid for the Boards–a diagram/decision tree that took a couple hours to understand and memorize after weeks of dreading it. By the end of the evening I realized I was going to do fine on the test (I did fine this morning, I assume), and when I got to bed, I couldn’t sleep–because I was excited about what would come next–going to South Africa to work with an AIDS organization there.
And thinking about that, it’s incredible what I know. It’s incredible what I’ve learned, how I’ve learned to think and talk, how I’ve learned to learn, how much my view of the world and my body and the bodies of people around me have changed. Even more so since my post-bac classes started. It’s not that I’m a different person; in some ways, medical school has allowed me to remember some of who I was when I started this process, and had started to forget.
Yesterday I had my head on a table, trying to cry but not even managing to accomplish that, feeling totally useless and stupid. Today I finished the test in plenty of time, gave hugs to my friends outside, went and hung out in a pub for a while with a big crowd of students, walked with my study partners to the bookstore to go get the workbook we are supposed to read through during part of the summer. Today, I was happy and confident.
When I look back on medical school for the year, that’s what it’s been like; one day feeling like I’m not made for this, another day impressed with myself for what I’ve done and confident about my future. One day humiliated and depressed and defeated; the next, optimistic and excited about what’s next.
A year is done. Three or four more to go, depending on how I do it; and more training after that. A life of learning for the foreseeable future. It’s not easy, but I told myself when I started this that the worst thing about my life beforehand was boredom. One thing I can say for sure after a year of this: I’m never bored.

First of all, congratulations on completing year 1!!!
Second of all, thank you for sharing your thoughts and feelings with us. I know that as we each progress through medical school, it will be good to know that others are feeling the same things and having the same doubts and fears that we feel.
And you make it feel almost like I'm in the room with you.
Thanks again!! Now go out and enjoy your summer and keep your enthusiasm going strong!

Great Work Joe!
In my life, near failure has made me a success. I remember that during my first year of law school I had a good bit of trouble with a writing class. In fact, I could have been the worst writer in the class. I was embarrassed and felt terribly inadequate. (probably shed a few tears)
Looking back, I now fondly recall that time. I can honestly say that I learned alot about myself in those dark hours. Eventually, I graduated near the top of my class and went on to do U.S. Supreme Court work-betcha my writing teacher could not have foreseen that.
Nothing breeds desire like failure or fear thereof!

Joe, your beautiful description of the ups and downs of school in just a few days were a better picture of my week than anything I could have written! On Tuesday a resident bawled me out, along with the other students in my group… and then, for good measure, I was informed individually of the ways in which I am a failure in this rotation. Now, I’m used to not knowing all the stuff I’m supposed to know - O.R. pimping is always a huge stressor for me - but on this particular day I was accused of shirking patient care responsibilities and packing attitude about it. I still do not know what I actually said or did that could have possibly led to that conclusion, because what I allegedly said/did is so out of character for me that I honestly have no idea what really happened. I was left confused and saddened - I felt my integrity was questioned, and I was shaken to my core. Like you, I tried to cry and could not.
But then today I was in the OR with a supportive physician who gave me a wealth of positive feedback. Hearing I was planning on family practice, she beamed: “You are just the right kind of person for it! You will do great!” During the surgery, she directed me with, “Dr. Renard, give us a little more traction… great, thank you.” It wasn’t an ego trip to hear myself referred to as “Doctor” so much as an affirmation that yes, this is where I belong. The atmosphere was especially collegial. Later, I worked on another case with another attending who directed me in (minor) parts of the procedure. I felt trusted, valued, respected by both these physicians.
These experiences helped to re-ground me, in the same way that your micro studying and successful exam-taking helped you to view your medical career from the glass-half-full perspective. I’ve generally been able to give myself good positive feedback, but when knocked off balance it can be hard to maintain that perspective. That’s probably the “group lesson” here - in medical school you’ll often be your own harshest critic (although others’ criticisms will certainly sting), so try to also be your own best cheering section.

I agree with Mary. Once again, you have said so well how I felt when the end of my first year came a few weeks ago. Congrats on making it through the first year and enjoy yourself in Africa!!

Hi Folks,
When I was reading Joe’s passage, I was right back at the end of first year studying Micro with him. He couldn’t have captured what I felt any better. Joe is truly a gifted writer and observer of the world. We are so fortunate to have him as a contributor to OPM. The people of South Africa are going to be fortunate to have him join the fight against HIV and AIDS on their team.
For many people in this country, HIV has become a chronic disease. It has left the front pages of our newspapers only to be replaced by fear of SARS. For most of the people of South Africa and Africa, HIV is a death sentence. The drugs are out there only to be just out of reach. I can’t imagine that.
Congratulations to Tara and Joe for getting through that first year. You both are going to be so amazed at how much you are going to build upon that foundation that you started this year. You both are going to be amazing physicians! Enjoy the summer, you both have earned it. smile.gif

Congratulations Joe! Thanks for your wonderful and candid post. You are indeed a gifted writer.
I wish you all the best! Have a great summer. smile.gif

It's done! Finally, first year is done. I can't believe it. A few weeks ago, I was reading Joe's post with great jealousy, but as of 30 minutes ago, the Pharmacology exam from hell is done, and so am I. The summer session has been incredibly intense, but it has been pretty amazing, too, and all the classes have had more clinical relevance (radiology, pharmacology, clinical skills), so it has given me a taste of what I have to look forward to. I can't believe how many friends I've made- and now, after a picnic in an hour or so- we'll all be going our own ways for 7 weeks. I can't imagine what it will be like when I wake up tomorrow, and don't have to think about, or do, anything school related. I can actually read a book that doesn't mention a disease anywhere in it. I can sit on the patio and now wonder if it's wasting time.
One down… if the next three are anything like it, it's gonna be quite a ride.
Sleep-deprived, but happy, Epidoc