Someone asked me what the happiest day in my career thus far has been. I paused and thought for a few minutes and said, “When I got my acceptance letters to medical school.” Yes, the letters. Not the first day of school or my first patient or my first successful procedure or elective or whatever. Admission. I have a feeling the next best day will be acceptance into residency, but I’m not there yet. Now, its not that medical school isn’t great or anything. I would recommend it. Its just not quite what I expected, and it definitely was no walk in the park. I wouldn’t trade the adventure for anything, but nonetheless there are some things I wish someone had told me before starting medical school (or if they did, which for some of these is an astute possibility, I didn’t listen).
1. Not everyone in medical school is a crazy genius. You walk in to orientation and hear people talking about their summer research, considering doing their PhD or finishing their Masters and what have you. At our school, the compile this by doing a “this is the bell curve” talk in which the point out that people fail and although you all were once in the top 10% or so of your classes, some of you will be now at the bottom. If you feel stunned, have no fear, everyone does at some point. For me it was in first year biochem where everyone else around me was a biochem major. Turns out, though I struggled a bit there, other things came easier to me. Everyone has strengths and weaknesses; the beauty is that you all come out with the same general knowledge in the end.
2. Resist the urge to study your life away. Yes, studying is important and the fear of being the “stupid one” will cause you to resist this, but you can only study so much before your brains start to ooze out of your orifices (not medically proven, but I swear I have seen it!). There are people in my class who live in the library or labs for the week before an exam. Some people learn better there. Others hole up at home. I’m not saying don’t study, but practice moderation. Don’t shut down your life. Breaks sometimes help you to focus better overall. Patrick and I would take supper breaks or watch a bit of TV or hockey during the exam crunch to give me a break.
3. Relax. Counterintuitive, no? I have come to realize that I had more time in Med 1 and 2 than I used. Take advantage of breaks and free evenings or afternoons to do things you enjoy. Do things that look good on applications, but also do things that are just fun or that you want to try. Same really in Med 3 and especially 4. I have been trying to embrace the down time and decreased call volume of Med 4. In a few short months I will be an intern and this will be in the past. Embrace the sleep.
4. Do not get eaten by medical school. Yes, medical school eats people. We all have friends and family outside of medical school. I moved to a new province for med school and had to make new “not school” friends. It took time and intentional effort. I could have done better (the friends are lovely, but I could have made more of an effort). Other people feel neglected when you are all consumed with school. You need non-school people. Keep them close.
5. Stay true to yourself. It is easy to get sucked a million ways in medical school. Weeks on the wards with tired and jaded attendings can start to dull your perspective. Remember what you stand for. What you believe in. Stay connected to those things. You need to remember them in order to be the kind of person and physician you want to be, otherwise, I think its like selling out.
6. Remember the person, not the disease. NEVER label someone based on disease. I have done it. Everyone has. The hysterectomy in room 2. Jaundiced man. They have names and personalities and families and lives outside of the hospital and clinic. Those things influence their health too. Keep a perspective of what medicine is… Caring for people with diseases, not just diseases. Plus, remembering the person makes for better medicine, better care.
7. Learn from your patients. Read around your patients, but not just diseases or presentations. If they are a professional, find out more about what they do. Maybe they have some sort of interesting skill that would be good to know about. Or maybe they have done some research into something. I learned a bunch about nutrition from a cancer patient last week who took it upon himself to learn as much as he could following his diagnosis. I looked it up, he knew his stuff! Now I can use it to help someone else.
8. Applications never stop. Getting into medical school is just one step along the way. Then it is CaRMS, then fellowships, and then jobs. It never ends. Always be striving to better yourself. Keep your CV up to date (unlike me, who though organized, had failed to update it since applying for a job in Med 2).
9. Hypochondriasis will get you. When you learn about so many diseases, you are bound to be convinced you have something. And so will your friend.
10. You probably have some sort of cool physical exam finding. Disclose with caution, or everyone in your class will be checking you for nystagmus and your giant tonsils.
11. The smell of formaldehyde stays with you. It adsorbs into everything – clothing, hair, skin, books. And you may stop noticing, but others won’t.
12. The minute you get into medical school, answering “I want to be a doctor when I grow up” is no longer sufficient. Your answer then needs to include a specialty. That is usually followed up by a guilt trip about how they need more of that kind of doctor and that you should practice in community X.
13. You will have permanent spine damage from all of the books you carry. On the same tangent, you may also develop nerve damage from writing or typing or studying. I have an interesting ulnar nerve issue thanks to leaning on my elbows to study. I know at least two people with some intermittent carpal tunnel symptoms.
14. You will likely need glasses if you don’t already thanks to all that reading you are about to start doing. Mysteriously, about 10 people in my class only began needing glasses in med school. Now, all but maybe four wear glasses.
15. Your printer needs to be functional. The sheer volume you will print can take out a single forest in a year.
16. There are some things that you will memorize and forget. And memorize and forget. And memorize and forget. Then someone will ask you at rounds and you won’t remember. But then you will never forget. Except that one thing… that you will.
17. Call rooms are not glamorous. Or sound proof. And often you don’t sleep much in them. Especially if the person next door is not getting paged and snores.
18. You eat more on overnight call than you would on any other night or day. Something about not sleeping or not knowing when you can sleep makes you eat.
19. Charts have legs. You can’t see them, but when you aren’t looking, they pop out, so the chart can run away. Same goes for pens.
20. Pagers are scary things. Refer to my previous post on pagers.
21. Hospitals have mice. They come out at night. When you are peacefully trying to read in between calls.
22. You are being constantly evaluated. That is exhausting. It is impossible to be perfect at everything. And yet you try. Also, remind people to do evaluations. They forget.
23. If someone sends you home or for lunch… GO! Actually, I was told this before. But it stands repeating. Best advice ever!
24. Learn the hospital. Food, vending machines, bathrooms, phones, offices, clinics and the numbering on the floors. For one, it saves time when you have to get somewhere and two, when you wander around with a stethoscope around your neck and/or a hospital ID, people will ask you where things are. ALL. THE. TIME.
25. You can apply for more than one away elective during a single time slot. Cover your butt, some schools fill up fast and others will cancel last minute. Just makes sure to politely decline the ones you don’t accept.
26. Rotation scheduling is important, but not the end of the world. In the end, everyone does the same core rotations.
27. Ask what is expected of you if nobody tells you otherwise. Better than falling short or making more work for yourself if not necessary.
28. Tide sticks are good to have on hand. White coats are like magnets for coffee, pens, body fluids and food.
29. Befriend people. Other classmates, house staff, nurses, RTs, maintenance people, cafeteria staff… You never know when you will need their help. Or for that matter, if someday you can help them.
30. Wear sensible shoes. Hospitals generally have dress codes on this. But even appropriate shoes are not always comfy. Until you go home hardly able to walk because your feet hurt so much or your blisters bleed on the walk home enough for a stranger to point out, “uh, ma’am, you’re bleeding” (true story), you may think they are sensible. Seriously, comfy shoes rock, even if they are a bit homely. I want to be able to walk when I am old.
I could go on and on. I am sure I missed things. Let me know if there is something you wish someone had told you!