I think about our medical students all the time. It is quite a leap from great undergraduate or graduate student and employee to medical student. Even if you’ve been in the top 1% of all your classes before, now you are surrounded by the top 1% percent. The pressure is intense.
Where I went to medical school (I love my medical school), we were “graded on a curve” (do schools still do that?) or so we believed. This means that grades were all competitive, compared and there was a bell-shaped curve with outliers at the top and at the bottom with the bulk in the middle. So, basically, there were folks at the bottom who were failing. And we might be competing with kids who had already published their undergraduate work in major scientific publications, like Nature.
For my science requirement at Princeton, I took a summer Botany course at the University of Washington. My father had an annoying habit of teaching us and quizzing us on plants while we were growing up. This annoying habit meant that I knew half the plants we had to “key” in lab and could often leave within the first half hour without having to go through the painstaking labor of differentiating leaf, stem, petal, ovary characteristics until the flower was identified. I thought it was quite a coup.
Did I mention that I was an English major at Princeton? My track in English was the rarely opted Literature and Theater track. For the theater part of my major, I took Dance. Did I mention that Dance at that time at Princeton, was Pass/Fail only? Really, if you show up to class three times a week and move around, how can you fail? I shouldn’t belittle it too much. I created a dance show for my Senior Thesis and was the first dance student to ever win the Louis A. Sudler Award in the Arts, for artistic contribution to the campus, for our senior class.
However, these achievements prepared me poorly for the intensive and competitive scientific milieu of Medical School. I had to learn to read for facts, not story or philosophy. I had to memorize voraciously. I had to learn chemical and physical pathways and anatomy and energy cycles and pharmaceutical methods. Woe is me, we all had to and have to.
I accessed the schools tutors, formed study groups, created flash cards, experimented with different types of note taking, recorded lectures to repeat in the car while commuting.
But as challenging as that was, and I even managed to fail one core clerkship (a story for another time), residency was even harder. The time pressure was immense as well as the need for high efficiency and productivity. I had already had my first baby, who was 17 months old when I started internship.
There were no mandated work-hour restrictions yet when I was an intern. We had call no more than every 3 night, usually every 4. (My father reminds me they were on call every 2!) I’m pretty slim to begin with and I lost 9 pounds in the first 4 months of internship and bought cases of Ensure supplements for over a year to maintain weight. When I was on my surgery rotation as an intern (which was, by the way, the easiest location for the Surgery residents and considered their “cush” month) I was on the road at 4:30 AM with a burrito-rolled wrap in hand to eat as breakfast on the way. We rounded at 5:30. When I was on call, I gave myself 15 minutes for breakfast and lunch and 30 minutes for dinner. Other than that, I ran all day and all night. I visited all my patients once more before I went to bed and there were many nights when I didn’t sleep at all. I recall once going to bed at 2:00 and thinking “Oh, that’s not too bad” until I realized that I needed to get up at 4:00 and that to think that 2 hours of sleep was “not too bad” was/is ridiculous.
Time was so short that I found ways to cut around wherever I could. Skipping showers was not always an option. But fresh socks and tooth brushing was always a must before starting pre-rounding in the morning. And even when I was at home, I only buttoned half the buttons of my PJs. And I never bought shoes that couldn’t be slipped on. Some of my cohorts slept with their shoes on but I just couldn’t. So I needed shoes I could jump out of bed and be in quickly without fumbling. And they had to be supportive shoes since I was on my feet for so many hours. Merrill slip-on sneakers were my trusted companions. The vast majority of my tops were on-sale Banana Republic long-sleeve and short-sleeve nice tees that could be paired with decent pants (or scrubs) to look professional enough but not be mourned if ruined with someone else’s body fluids.
That’s how much I needed to prioritize and squeeze the potential out of every moment. Slip on shoes, on-sale tees and half buttoned pajamas.
Hang on, my students, build your flexibility, access your creativity, maintain your passion and know I believe in you. All these skills will come in handy as you face the challenge of prioritizing what needs to happen first for your patient, fashioning a way to communicate with someone to get that test or evaluation done, identifying where your limits are, and empathizing with a patient or family under stress.