Barely three months have passed since I rounded out the first half of medical school. Those long hours of lecture, which tested my concentration and comprehension as a first-year medical student, last year grew into a comfortable routine. I was familiar with the rhythms of school, friendly with my classmates, starting to formulate more complex questions about biology and insights into medicine. I was not yet a resident (in any sense) in the medical world, but I felt like more than a tourist. I was starting to feel a belonging.
Three months later, I can barely recall that feeling. I spent the first month after my final final exam studying for Step 1 of the U.S. Medical Licensing Exam, a test that condenses two years of medical school into one seven-hour multiple-choice test; a test we must pass to continue in medical school. It was as hard as you might expect. Finishing brought relief, but little pleasure.
About a week after taking my board exam, I was back at OHSU, going through a week of preparation for the final, clinical half of medical school. This “Transition to Clerkship” taught skills that, I suspect, a lot of people would think we learn early in med school. We practiced, for the first time, inserting a breathing tube into plastic dummies. We practiced giving shots to oranges and bananas. We practiced stitching up severed pigs’ feet. We practiced starting IV lines on each other, several of us fainting in the process (I didn’t faint but came close; the photo above is my arm the evening after that class). We spent a week learning not the scientific theory of medicine but the practical techniques we will need for the rest of our careers.
The next Monday, we started working in real hospitals and doctors offices, all day, every day. This is what we came to medical school to do: To see patients, make diagnoses, order tests, propose treatments and, hopefully, help people. And after all the years of lectures and applications and exams and one big test, I go through the motions of medicine and think: What the hell am I supposed to do now?
The first two years of medical school, years of study and testing, prepared me well to study and take a big test. They did not prepare me well to use a strange medical record system, or find the lube to perform my first rectal exam in an unfamiliar office, or stop my hand from shaking while trying to suture a living human being, or navigate the needs of multiple doctors who want mutually exclusive things. I wasn’t ready for expectations unstated or unclear, schedules in constant flux, mistakes (mostly mine) and miscommunication (all around). I wasn’t ready for real life. Not that I am practicing real medicine – students are not allowed to sign any orders, write any prescriptions, make any final decisions. But we are closer than ever to real practice, going through the motions, doing real exams and proposing plans that our interns and residents and attending physicians just might consider following. I’m not a doctor, but I play one in the hospital.
When you travel somewhere for vacation, an afterglow lingers once you get back to your old life. Even as you hack your way through the 300 emails that gathered in your absence, you can close your eyes and remember the feeling of the sun on your face, the sound of waves on wet sand, the tang of salt cod cakes with oranges. You know the feeling. It fades with your tan. At best, the happy glow lasts for two weeks, and then its gone. Three months beyond my basic science classes, the glow is gone. But instead of my old life I’m in a new one, a life for which I have planned but not fully prepared. I’m not sure where to go when, what to do, where to stand. I’m a tourist again. What the hell am I supposed to do now?