This article describes the experience of 3rd year almost perfectly. It's not as long as it looks.
"WORD FOR THE WARDS
An open letter to third-years
The New Physician, July-August 2009
| by Jessica Yeatermeyer, M.D. | Volume 58, Issue 5 |
Dear Rising Third-year,
You deserve a pat on the back. You’ve maneuvered through your first two years and you’re well on your way to doctorhood. Nicely done. But before you’re jettisoned into the clinic, it’s only fair that you take a minute to reflect on the incredible (read: insane) things you’ve accomplished thus far. You played “Where in the World Is Carmen San Trochanter?” with every tiny groove and bump on every bone in the body. You went spelunking through every hole—excuse me, foramen—in the skull. I mean cranium. Or is it the calvarium? One’s anatomical prowess wanes as the years go by. You carried the stench of formaldehyde home to your loved ones and talked about interesting lab dissections over pot roast and mashed potatoes. And you grew to think there’s nothing abnormal about that kind of dinner conversation.
You sat through hundreds of hours of lectures given by immunologists contorting themselves into fairly convincing antibodies, and pharmacologists cracking beer jokes. You worked your way through cleverly crafted cases about Diabetic Dan, Lead-Poisoned Lilly and Atherosclerotic Alan and all the other alliterative characters intended to keep your humanity intact. You became well-versed in the hypers and hypos and pneumos and hemos and -itides and -oses and -emias. You learned to refer to red bumps as erythematous maculopapular lesions. And you valiantly battled the boards and came out unscathed, thanks to a little First Aid and maybe some under-the-table methylphenidate. In short, you ducked and covered and summoned the will to push through.
Now you get to don your freshly pressed white coat and march into the clinical world armed with an inflated vocabulary and the admirable desire to make a difference. If you’re feeling both excited and on the verge of throwing up, then you’re right on track.
The third year of medical school is at once exhilarating and exhausting, fantastic and frustrating, and there are a number of other oxymoronically paired adjectives describing how it feels to be both overwhelmed with glee and flat-out scared shitless. Lodged in your brain you have a wealth of information, but there will be quite a few days when you will feel like you’ve been denied access to your own mind.
Don’t be alarmed. This is the nature of third year. You will get mixed up on rounds. You will mistakenly refer to potassium as vitamin K and then spend the rest of the day wondering if your attending thinks you bought your way into med school. You will know the answer to every question pimped at your colleagues and then come up short when the doc turns to you and asks where heparin comes from (hint: don’t say eBay).
You will try to present the case of John Smith, a 78-year-old man who complains of shortness of breath, and you will be cut off by your attending who tells you that you should open by saying, “He’s a 78-year-old man with a history of COPD who complains of shortness of breath.” Then a few days later you’ll present the case of Janet Jones, a 78-year-old woman with a history of COPD who presents with shortness of breath, and another attending will chastise you for giving the past medical history before the chief complaint. You will be asked if your patient is on Zosyn, and you will say, “No, he’s on piperacillin-tazobactam,” and then the whole team will stare at you while you pull out your Pharmacopeia and blush at your mistake. And you will most certainly contaminate yourself in the OR. And even if you think you didn’t, even if you know you didn’t, you won’t argue with the scrub nurse because you will never win. These things will happen.
But there will be good days, too. You will find mentors in the physicians who lead your teams, and you will find reassurance in the residents who are just a few years ahead of you and remember what it’s like to feel superfluous. You will meet nurses and ancillary staff with years of experience and invaluable tricks-of-the-trade to impart, if you’re smart enough to listen. You will get better with your hands and sharper with your mind, and you will learn how to sleep when you can and chug the caffeine when you can’t. And, if you really make yourself present and available every day, you will find that you’re not superfluous at all, that for at least one of your patients, you have been the difference between a loathsome hospital stay and a patient-centered health care experience. These things will happen. This is the nature of third year.
But it should be more than all of that, too. For the first time, you will get a glimpse of your future life, what it really means to be responsible for another person’s well-being, and perhaps for the first time you will question whether or not the practice of medicine is a responsibility you want to take on, or whether you’ll ever feel worthy of the challenge. Don’t ignore these thoughts: They’re just as important as the rest of it.
The clerkship year is as much about self-discovery as it is about intellectual advancement. It’s 12 months, six blocks, five hospitals, 40 nights on call, dozens of mentors, a handful of sympathetic classmates and innumerable encounters with patients. The common denominator is you. You have 52 weeks to decide what you want to do with your life and, more importantly, how you want to do it. Learn the medicine, but take a shot at imagining your future in the world of medicine. Talk to residents and attendings, soak up the culture of academia and venture outside of it, and try to remember why you came here in the first place. What you’ll find when it comes time to trade in your short white coat for a long one is that your medical acumen is absolutely dependent on your personal growth; one can’t evolve without the other.
So embrace your third year—all of it. It doesn’t have to be perfect. It won’t be perfect. The goal is to come out feeling that it was worthwhile and that you, in at least some small way, are better for having gone through it. This is the nature of third year. This is the nature of medicine in general. Welcome to the inside."
