Black and White: the Radiology Days

I've started a new life as a rotating medical student. I can honestly say that it's way better than sitting in lectures and studying for never-ending tests. I've gotten a taste of radiology and internal medicine so far. Here is a sample of my experience with a radiologist.

Imagine an office big enough for two people, but not much bigger. The lights are never on and the only light you see is from the black-and-white computer screens and a little crack under the door. You may be wondering, why black and white? The answer is simple: to help get better contrast in the black and white images. The whole set up of darkness is designed to get better contrast on the images. If this isn't helping you, see my handy, dandy visual aid of an emergency dispatcher's room.

Now imagine more black and white and you got it.

What did I do all day? I watched the doctor read X-ray after X-ray, CT after CT, and MRI after MRI. I was constantly amazed at how incompetent I was (something that has become a recurring theme throughout rotations). For example, he had me read a book about chest imaging. After reading, I thought I could read any chest X-ray with the best of them. I would go in the next day only to be humbled by what I would think was a normal image, only to find out that that person likely had walking pneumonia. The other thing that I was constantly amazed by was how he would catch the tiniest, most subtle finding on an imaging study. I'm talking a minuscule fleck here, a microscopic scratch there, things that I would never have seen in a million years. And he managed to notice them right away. 

Mixed in with all the sitting and watching were fluoroscopic studies where the doctor would have a patient drink some oral contrast solution and then image their esophagus, stomach, and small intestine. I got to put on a lead shield gown complete with neck protector to watch these. They were fairly interesting studies, but not my favorite thing in the world. In fact, the only time that I've been puked on by a patient was during one of these. You see, the contrast solution doesn't taste terribly great. It's not the worst thing in the world, but it tastes like you're drinking liquefied chalk (I asked to try some after the incident). Anyway, a lady was drinking some and started feeling nauseated. I was quick on my feet and grabbed a nearby trashcan for her to hurl in. In my haste to prevent chalky vomit from being spewed forth everywhere, I didn't foresee that the swivel lid would be a problem. The lady did her thing and some of it splattered off the lid and all over my hands. It was a lovely experience. The doctor later told me that I had finally been christened a health care worker by getting someone else's bodily fluids on me. Given all the gray scale I saw all day, it was only fitting that her vomit was white and some of it got on my black watch. 

Next time, I'll write about internal medicine. There will be much more color and much less vomit.

A Little Bit of Henry

Henry's getting older. He's almost a year and a half old! When he was newer, people would tell me how fun it was to watch a baby's personality develop. I wasn't entirely sure I understood that; I'm still not sure that I do, in fact. Since he's our first, I can't tell what is his personality and what is normal baby behavior. I think I'm going to take all the negative aspects (crying, clinging, dislike of long car trips, etc.) and put them in the "just a baby" category, and so that means all the positive aspects are clearly his personality and make him unique among babies...right? Unique or not, there are a few funny things about him I want to share.

At a family reunion, summer 2016

• Henry flaps his arms like a little bird when he gets excited. This happens when he sees us bringing him applesauce or when he sees me come back after having been babysat all morning. He flaps very excitedly and squeals.
• Henry has a little Buddha belly (see picture above). It's getting a little less pronounced as he gets older, but his little shape toddling around the house makes me smile. I love his shape: his big head, his pudgy wide-set legs, the curly hair, and that belly!
• He knows the words "no!" and "yeah!" but isn't quite sure what they mean, so he almost always uses them backwards. "Do you want a snack, Henry?" "Nooooo!" (reaching for the snack).
• He loves to say "Dad." Lately, he's been sticking "a" in front of his words (so it's "a ball" or "a puppy," rather than just "ball" or "puppy") and now James is "a Dad." (The best part of his new "a" fascination is that he uses it everywhere.I'll say, "Henry, let's go!" He'll say, "A go! A go!!")
• Henry is (on a small level) exploding with words. Granted, he knows only a handful, but he's picking up more all the time as we use them. He has recently mastered "button" (for belly button) but for a while he didn't get the second syllable. I remember him playing with James on the floor one evening, when he turns around, pulls up James's shirt, and sticks his finger in James's belly button, proudly calling it, "A butt!"
• Henry is pretty good at identifying his own body parts. James particularly likes it when Henry will point out his hair by lifting a single strand when we ask where his hair is, and how Henry smacks his right hip when we ask where his bum is. The belly button is especially funny, because if Henry is wearing a t-shirt, it's easy to pull up the shirt and peer down to try and find it. If he's not wearing a t-shirt, he gets quite distressed. "A but-ton! A BUT-TON!!" and frantically tries to pull his shirt up to find it. 
• He still loves to taste everything he can touch, and he loves drinking anything he can find. He's not great at normal cups or water bottles, but he is great and finding them when we hide them.
• Speaking of hiding, he will hide pacifiers, spoons, etc. when he's done with them because he knows we'll put them away if we see them around. Then when he wants one, he'll pull it out from under the couch or behind some blocks so he can have it.
• Henry is very friendly with new people. He might make a few squeaks of protest when I leave him with others, but he recovers very quickly (if he notices I've left, that is. He often doesn't) and he's happy to hang out with pretty much anybody.
• He loves babies. "A baby!" he'll say when he sees one, then grin at me and cackle. Babies are very funny to him. Sometimes he'll steal my phone and somehow turn the camera on so it's taking pictures of him. He'll stare at the screen, which is showing him, and say, "Baby!" and laugh and laugh.
• He does not love shoes, he does not love sitting still, he does not love table food (one of the daily struggles he and I fight over), and he does not love cuddling at all. He's far too busy for that, thank you very much.
• He is all about puppies. His first word was "puppy" (he says it "pup-mm") and I think he actually thinks the word means "animal," because that's how he uses it. He does love dogs, though. If we see one on a walk, he'll spend several minutes happily remembering the encounter, saying, "A pup-mm! A pup! Pup-mm!" to himself. 
• He loves James so very much. His joy when "a Dad!! DAAAAD!!" comes home is heart-melting.
• Sometimes he has so much emotion that he doesn't really know what to do with it, and so his whole body will shake a little. This happens if he's very angry (usually if we take him away from exciting but forbidden things like the toilet or trash can) or if he's very happy. This week he was by the door when James came home, and he stood there, shaking a little, yelling, "Dad! A Dad! Dad Dad Dad Daaaaad!" for quite some time, flapping his arms. He got so excited he fell over. 

Rotation's Eve

It's the night before I start my third year in which I will rotate through a bunch of different specialties, shadowing and seeing the practice of medicine as opposed to only the theory. This has been the part of school that I've always been the most excited for, but also the most nervous. It's a great big unknown; I really have no clue what to expect tomorrow. How big of a fool will I make of myself? How will I annoy the attending due to my lack of knowledge and experience? What kind of cool stuff am I going to see?

When we were visiting family during our break, Sariah and I talked to my mom about what kind of things she would like to see on the blog. One of her questions has stood out to me more than the others: what are your fears about school? As the day of my first rotation has approached, I've thought more and more about that. What am I afraid of? Maybe this won't be relatable at all, but here's a small glimpse (in bullet point form) into my anxiety.

• What if I get into my first rotation and realize that I absolutely hate practicing medicine? I can't really change careers at this point because of the insane (and I mean insane) amount of debt that I've taken.
• I'm not going to be able to handle it when I lose a patient. I don't mean in the literal sense (although that would be kind of funny, trying to find a patient that's hiding in the hospital), but I mean in the sense of I screwed up and someone died as a result. How does one cope with that?
• I'm never going to see my family again. This is a big one for me. I want to be there for my family and I don't want to miss anything (a la Aerosmith's "I don't want to miss a thing"). However, I've chosen a career that will most likely make this fear a slight reality.
• I'm going to make such a big mistake that I'll get kicked out of the hospital and subsequently fail the rotation and get kicked out of school. 
• I'll misunderstand instructions and get chewed out because I didn't hear well enough or the doctor doesn't really know how to communicate his thoughts or he assumes that I can read his mind.
• I'm worried about the unexpected expenses like car repairs. I'm going to have to do a lot of driving over the next two years. Hopefully nothing majorly bad happens to my car, but you never know.

Although only 6 bullet points, I think that that about sums up my biggest worries. Whenever I get nervous before big things like this, I remind myself that things are never as bad as you imagine. They might be close, but for the most part, this has held true for me. May the pattern continue tomorrow as I face my fears.

Oh Boards. How I Hate You So

For those that don't know, after the first two years of medical school, every student takes the first step in becoming a licensed physician. Although technically not really a board exam, that's what it's called colloquially. I just took it. It wasn't a pleasant experience.

The way to imagine this test is to think of everything that you learned throughout college. And I mean everything, even down to the smallest little details from your freshman biology class about mitosis and meiosis. Then add on top of that, two years of med school, which is roughly the equivalent of four years of undergrad in terms of credits. After studying that impossibly large amount of information, you get to take a 280 (USMLE) or 400 question (COMLEX)* test that makes sure your basic medical knowledge is there. A few weeks afterward, you get a 3 digit score that residency directors will use to judge you when applying for residency. Fun stuff.

At any rate, boards are a big deal. They're kind of like the BAR exam, but for doctors. It's a super stressful time filled with much anxiety, lots of memorizing, tons of late nights, and more anxiety thrown on top of it for good measure. So how do you tackle the beast? Honestly, that depends on how you study, but this is how I did it. I still don't know my scores yet, but I feel like I did well enough that it could work for others too.

First off, I accepted the fact that there was no way that I was going to remember everything that could be on this test. It's frankly impossible. After accepting this, I was a little relieved, but not enough to stop studying entirely.

The second thing that I did was planned out how I wanted to go about studying. I'm an active learner, which means that reading textbooks without doing something active doesn't help me a whole lot. My typical day during my dedicated study time consisted of 4 hours of "book work" in the morning, roughly 4 hours practice test questions in the afternoon, and then a couple hours of videos at the end of the day covering the information that I went over in the morning. You're probably thinking, "Wait a second. He just said that reading doesn't do it for him, yet here he is saying book work. He must not know what that means." By book work I mean that I read out of a lovely book called First Aid for an hour, then I would "test" myself by standing up at a white board and writing down everything that I remembered from my reading. I would skim through the pages to see the different topics and then write down. If I didn't remember something, I would re-read that section. Thus, it was more active and my reading time had to be focused reading. Otherwise I wouldn't remember anything when I went to write down.

As I said earlier, my afternoons were filled with practice questions. I used a couple question banks (Combank and UWorld) to test what I had learned in the morning. Both of these banks allow you to choose the topic to be tested on. For example, if I read the cardiovascular section in the morning, I would get my cardio for the day by doing cardiology questions. Doing these questions was probably the most beneficial part of my day. The benefit basically comes down to this: you don't know what you don't know. By focusing on the questions and the explanations provided by the question bank about the question, I was able to hone in on my weaknesses. It's kind of a brutal and somewhat discouraging way to learn things, but very effective. Getting your rear handed to you via questions about something you thought you knew well serves as good motivation to keep studying, but it is a little depressing. That being said, I (and all my friends) found practice questions to be extremely useful.

The last thing that I did was set aside a day to relax every week. In my case, that day was Sunday. I would go to church with my lovely wife and son, and then relax with them the rest of the day. Having that day off made the biggest difference for me. It doesn't make much sense, but having one day off every week helped recharge me and was something to look forward to at the end of the week. It was so nice not having to think about the different gene mutations in cancers or what specific diseases look like under a microscope. I even started to notice that Mondays tended to be my most effective study day. Go figure.

Anyway, this is what the last two months of my life have looked like: lots of sitting in a chair, writing on a white board, and practice questions, followed by a nice respite on Sunday.

* There are two different licensing exams based on the type of medical degree that you're pursuing. If you're an MD student, you must take the USMLE (United States Medical Licensing Exam). If you're a DO student (like me), then you must take the COMLEX (College of Osteopathic Medicine Licensing Exam) and you can choose to take the USMLE if you want to or if you're slightly masochistic like me.

Another Semester's End

I gave my finals this week. I always ask each class for their favorite and least favorite topics we studied in class and why they liked/hated it. Here are some of my favorite answers.

Least favorite and why:
-The atoms because they involve chemistry.
-Fungus. Mold because it's not a good thing.

-Learning about the human reproductive systems. I have a very weak stomach when it comes to that topic.

-Duh...male reproduction! Who cares about them? But really it was okay.
-Ions! Ugh! Just thinking about it makes me want to cringe. Seriously though, it's awful. Protons, neutrons, electrons, cations, anions...it's terrible.
-Nothing because you teached it.
-The skeletal system. There's a large amount of terms to learn and to be frank, it sucks.


Favorite topic and why:
- I loved the bones. Specifically that my whole life I had lived a lie not knowing my true ankle.
-Muscular system: because I'm familiar with the names of muscles since I have deeply studied the science of bodybuilding for the past three years.
-All of it. Please pass me.

Cincinnati!

We took the Friday and Saturday of James's spring break to go on a mini-adventure to Cincinnati! As you read, please forgive the formatting with the text and pictures here. There was a fight between blogspot and me. I've given up. Blogspot has given up. It's as good as it's going to get.

Cincinnati is only about 3.5 hours away. We loved it. Our favorite thing was a park along the river - it wasn't very busy, it was remarkably clean and friendly, and it was full of fun stuff to do!

Look at that. It's beautiful! View from Ohio looking across at Kentucky.

They also had enormous checkers you could play.

Balance and spin ball

Exercise equipment

Pigs fly in Cincinnati!

 

We also went to a store called Jungle Jim's. It's a grocery store that's about the size of Costco, but it's an international store, too! There are entire aisles dedicated to each country, and the music even changes to match the aisle you're in! The "regular" grocery store out of the international part was the Casa Bonita of grocery stores (for all you Colorado folk to compare). It is highly decorated, lots of ambiance, etc. The fish section is decorated as a wharf with shops and fish decorations swimming along, and enormous tanks with many kinds of fish swimming around to choose from and then eat. They have an entire room just for cheese. They have little mini-shops set up throughout the store for you to buy things (like sushi, stir fry, a quick BBQ brisket sandwich, etc.). It was lots of fun.

We also went to a cemetery. On a list of top things to do in Cincinnati, it was #3, so...why not go? It's filled with very impressive graves, tombstones, mausoleums, you name it. The registrar said they had over 235,000...patrons? bodies? specimens? people? Whatever your preference, there are lots here, with the earliest death date at 1840.

The grounds are quite extensive and they are very well kept. Spring was arriving around the time we were, so we got to see the magnolia trees and tulips, which are my two favorite flowers. Because of Henry's nap time and temper, we only stayed about 30 minutes, but in that time we walked past probably two dozen individual mausoleums, well over two dozen ENORMOUS obelisks, a granite gazebo with benches as headstones, and many other ornate and beautiful tombstones - and that was just walking distance from our car. Pictures really can't do it justice, so I gave up on trying to capture it and just got my favorite mausoleum instead. The place was huge! There were ponds and bridges and statues and stained glass windows...I'd be okay to be buried here. I've decided I'd like to share a mausoleum with James. Just us two - sorry, everyone who wanted to join us there. You can build a neighboring one. Or maybe we'll put a picture if you up in ours. Or you can come visit us and put your hand prints on the wall or something.

As a happy end to our adventure, we were home in time for Henry's first Easter. As you can see, he greatly enjoyed the bunny ears. But not as much as James did!

Hard and hopeful truths of being a med wife

If you recall, we originally started this blog so people could get an idea of what it's like to go to med school. We wished there had been more blogs for us to read before starting so we could get an idea of what it's like. Here are some thoughts I've had over these last few months about what it's like at times. I'm hesitant to post this, because if I knew ahead of time what it would be like, it would have been much more frightening for me. But despite it all, there is joy here. Joy and difficulty. And at times, all of these are true.

• Sometimes (especially near big tests) it feels like we're people who just happen to live in the same house as each other. Like you're just roommates but the other one doesn't ever do the dishes.
• But you didn't expect him to be doing the dishes; he's got better things to be doing. It's not the not-doing-dishes that's hard - it's that utter loss of time and closeness that make it hard. You really have to work at your relationship to keep your humor, intimacy, and personality intact.
• But sometimes you can't help but both be living your separate lives and hope they become the same life again someday.
• A professor at James's school says he and his wife got through it by remembering med school is "a short term investment for a long term benefit." I like this, and  tell myself some variation of that at least weekly. "It's not forever." "It's just three more years."  "It'll end someday." "It'll be worth it."
• At times you almost stagger under the thought of how the end isn't the end - after school there's residency, which is its own tangle of poorly paid and overworked years, and then you have to face a student loan which is worth more than the average house. And you realize that this whole "at least you'll be married to a doctor" line people try to sell you is baloney. The first half of becoming and being a doctor is miserable, and "someday you'll have money" doesn't help the "now you don't have any, and your kids don't see their dad, and there's nothing for birthdays" problem. Maybe in twenty years.
• But when your student comes home excited about something they learned, you love it. They try to explain it to you and usually can't because it's obscure and not that interesting to you, but you love, love, love it anyway.
• You know your family and friends will never truly understand what your life is right now; it's not realistic to them. And that's okay. They become desensitized to it, or might be hurt by why you still can't do whatever it is, and it stinks to hurt them. It's hard to communicate the daily weight of this, and that every single test is a very big deal, and when we do have time off, we want to spend it together first. Other things that used to be high on the priority list slip down, and family and friends notice that loss, and it's heartbreaking to contribute to that. I feel very protective of my time with James. We need it.
• Test days (at least for me) are actually wonderful. James gets the day off after his tests, and since he has nothing new to study, I know we get to have family time.
• Sometimes after test weeks, when Henry sees James on Sunday after many days of little to no visual of James, Henry is wary or afraid of James, the tall stranger. I think that's pretty hard on James, and it's hard to know we can't really change it. But as Henry gets older, it's getting better.
• On the other hand, Henry is so young he won't remember this, so it's lucky.
• You can talk for hours to anyone who'll listen about the nuances of medical school and you don't even attend. Your nuances are different from your student's, though. It gets a little old hanging around your student and his school friends - that is ALL THEY TALK ABOUT. You'd think they might for once talk about something else, like sports or video games or the weather, but those topics last for maybe ten seconds.
• However, you yourself have your own topics that are probably ALL YOU TALK ABOUT, and it makes an enormous difference to get some sort of support group for you as a spouse, too. This could be church, other student wives, coworkers, or anything. You need your life to matter, too, and I love that I have friends who are in EXACTLY the same boat as me, and they understand completely. I love it.
• The utter, crushing, financial weight of this is something I will not miss.
• I am so grateful for programs and loans and other things that help us afford to get through this.
• I never cease to be amazed at what James knows and is capable of. Not only the material they're learning (he can diagnose things! It's crazy!) but his capacity for self discipline, his ability to study effectively, his great intellectual effort, his natural skill and joy for the subject. I like to see my husband succeed at things he works hard for. 
• There is something both humbling and strengthening about these years. Knowing we're in this together, following our family's dreams, and working so hard to do this - it's the kind of thing you look back on, I suppose, and say, with great satisfaction, "We did that." For today, there is great pride in saying, "We're doing this now."
• And despite it all, I am happy. I'm with my husband (at least sometimes) and I'm with my son. It's a safe place. There's sunshine and there are friends. There is beauty in our struggle. We are adding strength to our family. All I want is to be with James and Henry, anyway, so why not here? Why not be happy with that now?

The uppercut of all semesters

This semester (the second semester of year two) has been the hardest so far for both of us. This is mostly due to condensed course work, huge board tests, and preparing for rotations (years 3 and 4).

James has to take his first huge certification test by June. Think of it as the doctor equivalent of the lawyer's bar exam. In order to give students more time dedicated to studying for that, our school finishes most (but not all) classes in early April, so they have more free time the months before the test. Because of this condensed schedule of regular classes, he has more classes per day than usual to get through than before, so each day is already much more demanding for him. He has one more week of this schedule before he's done with the bulk of classes for the semester and will instead use all his time studying for boards.

On top of that, Jame is also studying for multiple hours each day for the big board test outside of normal studying. This studying includes old notes, old lectures, study aides, and a whole lot of practice questions from question banks. A LOT of that.

The board test this year is one of three big old expensive tests for DO students (called step 1, step 2, and step 3, conveniently). There is also an equivalent series of tests for MD students. They're both difficult groups of tests, but programs don't always accept them interchangeably. He must take the DO ones since that's what he'll be, but we decided that it would be best for us and our future if he did both. the DO and MD tests. In our case, the first of each series is scheduled for the very end of May. He spends an astonishing amount of time studying each day with this combined with normal studying. That's been very hard on him and in turn on the family to never see him.

Another difficulty of this semester has been more of an emotional one: preparing for rotations for the next two years. Some schools are big enough to have their own teaching hospital, but ours is not, so our students go to one of some twenty-odd rotation sites for the next two years to learn the on-the-job side of things. We ranked the sites in order of preference, but ultimately, it's a lottery system and you go where you're assigned. We ended up getting assigned to Harlan, KY, which is about one hour from our house. It was not something we were expecting; it was definitely not one of our top preferences. We were frustrated with this assignment at first, but have since made our peace with it. It does have some benefits: we'll stay in our house so we don't have to move, I can keep my job, it's a much lower cost of living than some of the sites (e.g. Tampa), and since it's more of a rural hospital there aren't as many students so James can do more hands-on stuff. We're actually content with it now, but for a little bit there it felt like some promised adventure was taken away from us, like we were being held back in some way by not getting to move on. We're still a little nervous because we will see less of James each day because of the commute, and I'd hoped to see more of him, but we like our area! We love our landlords. Our house is perfect for us. I like my job. It'll be okay.

But really - this semester has been overwhelmingly draining for both of us. My mantra since Christmas has been, "I can do anything for six months." Now we're down to, "I can do anything for two months!" It has been such a loooong four months, though. But imagine the relief when it's over! Our calendar has a series of exclamation points written on it for the entire week after the board tests are over. That is my goal. That week will be...well, honestly, it probably won't be worth it, but it will be sweet and wonderful. And over.

Christmas, Lexington, Snow, and a Shark Hat

Christmas happened. Approximately December 25th, if I recall correctly. There were presents, meals, happy 70 degree weather. Henry didn't destroy the tree. (Score!) It was relaxing to be home together, and Hal got better at letting James comfort him instead of only his mom. (Hooray!) It was fun to fill Hal's stocking for his first Christmas. (Awwww!) Boxes and wrapping paper were greatly enjoyed for many days. (Bonus present!)



Before school started again, we went to Lexington: the horse capital of the country, nay, the world, nay, the universe!  (Or should that be "neigh"?) Sadly, on January 2nd, horses and their many attractions are apparently closed for the winter and holidays. We had fun driving past the horse farms, though, and it's just like Seabiscuit or Secretariat make it seem. One second you're in downtown, and not four minutes later you're surrounded by sprawling fields with white fences around them.

Note: This is a simulation and not a real horse.

If you're in Lexington and are unable to see horses or the Toyota factory (also tragically closed!), don't worry: Lexington is also famous for bourbon! There were dozens of upscale bars in the few square blocks we walked. It was impressive. At the visitor's center, they have different local bourbons you can puff some air into and smell. I couldn't tell much difference, but then I'm not a connoisseur. They all smelled appropriately fermented and dusty, though.

Inhale Lexington by wafting your favorite bourbon!

If you'll recall from last year, this area isn't well-equipped to handle snow. Remember that east coast blizzard a few weeks back? We didn't ever get more than 11 inches or so (all told, with melting in between storms, so it never got to be more than 8" at once at our house) but we were again "snowed in" for a week. The local school districts had even longer before they reopened. We did not get the enormous quantities of snow that, say, Washington D.C. got, but we got a fair amount for our area.

On the first day of snow, it was supposed to stop snowing at noon and then turn to rain that afternoon,which would freeze into ice overnight. So at noon on the first day we decided it was our best hope to get to the store. Our poor little 2-wheel drive Honda does great...except in snow. I think it's afraid of cold weather, frankly, and we should've just sent James in the truck, but nooo, we thought we'd make a "trip" out of it and all go together. Never, ever again. We only spun out of control once on the way there, and only got well and truly stuck on the way home at the stop sign downhill from our house. It had snowed three inches from when we left to when we returned. We only slid into one mailbox before two strangers with trucks helped tow us to the grass by our uphill driveway (no way was that happening!). The next day was the warm eye of the snowstorm, and while I was shoveling a nice old man in a bulldozer was plowing the road, and he helped dig our car out so we could get it back up the hill.

Henry remains undecided in his feelings towards snow. He was too busy staring at it to really feel much emotion towards it. We put him on a blanket atop the snow and, very uncharacteristically, he just lay there without moving, and waited patiently for us to take him back inside. He couldn't get enough time staring out the window at it, though. Despite his lack of snow, he sure was stylish in the hat I made for the occasion. Awww.

Om nom nom!

FAQs we get asked..well...frequently.

Every week or so I get a question about med school and doctors, residencies, rotations, etc. It's getting worse as 2nd year draws to a close: "Wait, he has a huge certification test already?!" "Why are you likely moving next year?" "Are they doctors when they're residents?" "Does everybody have to all this, or is your school just unusually demanding?" "Aren't you about done with that school thing yet?" "Sheesh, still not making any money, huh? Aren't you ashamed of yourself for not contributing to society yet?" (Just kidding. But seriously.)

This won't answer all of them, but this should start to shed some light on those burning questions in your souls.

Shock

Awhile ago I asked people what they wanted to read about and one of the questions was essentially, "what kind of medical culture shock have you experienced, James?" Well, I'm hear to finally answer that burning question.

Before starting school, I had very little exposure to doctors. I mean very little. We're talking in the realm of my only experience really coming from my occasional trip to the family doctor. I shadowed a little bit, but nowhere near as much as most of my classmates. The biggest shock for me was how little I actually knew about medical practice and the different specialties. I have no one to blame but myself. Even so, it was still quite a shock to meet people who already knew exactly which specialty they wanted to go into. To this day I haven't the foggiest idea what I'll go for. I'm really hoping that rotations next year will help me out in regards to that. I guess what I'm getting at is that I don't know if I can say that I've experienced any shock related to medicine. There are some things that have shocked me about medical school, so I'll talk about those.

The first thing that I'm still amazed about is the number of people in my class that smoke. I would really have thought that understanding what is going on when you inhale those toxic fumes would be a huge deterrent to smoking. Then again, I don't understand what it feels like to be addicted.

The next major thing that has surprised me about school is the insane pace. I always thought that college felt like cramming a year's worth of high school into a semester. The more I think about it, med school is like cramming a year's worth of high level college science into a semester. It's pretty crazy. Needless to say, I've had to adjust my study habits. In undergrad, I used to think that studying only from PowerPoints was dumb. It never seemed to work for me at least. I was more of the read the book kind of guy. Now I can't even imagine having the time to read from the books even if I wanted to. I was not expecting that at all. I envisioned my days being spent reading textbooks for hours on end instead of studying from PowerPoints. I will say this though: I have found a very (at least what I think to be) efficient way of getting all the information to stick in my head.

Another big shock of med school is something that they don't really tell you: the material isn't overwhelmingly difficult. What is difficult is the volume of facts and minutiae that you have to learn. That isn't to say that all of the concepts are easy, but much more manageable in terms of difficulty than I expected.

I'm sure there are other things that are shocking to me, but I can't really think of any thing else. Hopefully this shed a little more light into what it's like to enter med school.