“How bad is it, doc?”

I froze, stunned. I had never considered that anyone would ask me, a lowly medical student, a question so critical. Family meetings were the sort of thing attending physicians were supposed to handle. I quickly developed a healthy respect for the power of the white coat.

“Has he got much time left?”

Still frozen. They don’t teach these skills in classes. Rather, they try, but it’s utterly futile, and everyone knows it.

I didn’t want to mess this up. This woman’s face was clearly on the verge of tears. Her concern etched her 86-year-old face deeper than time had ever been able to.

“Just tell me, doc. I can take it. I’ve had this sort of talk before with him multiple times now, and heck, we know we’re a long-living family. We’ve outlived all our friends, and now we’ve just got each other. Honestly, neither of us cares if we go tomorrow or years from now. We’re just waiting to die, and it’s up to God when it happens.”

I finally found my tongue. I began to explain what had brought Mr. K to the hospital: he had become very weak due to anemia and had a fall. Fortunately, there were no broken bones, but he needed a few units of blood transfused so that his body could sufficiently circulate oxygen and nutrients. It was likely that he was continuously losing some blood through his GI tract, since he had a several-month-long history of some blood in his stools, but he didn’t want a colonoscopy since he knew his time was coming anyway. I reassured the sister that after receiving blood, Mr. K was doing much better, and while he may still be bleeding internally, he was, for the time being, stable–we had done everything we could do for him given his wishes.

The sister slowly nodded her understanding, and the concern began to fade from her face…but it didn’t completely disappear. I got the feeling that my job wasn’t done. I asked what was on her mind. She looked back at me, and after a bit of hesitation, admitted that she didn’t actually know the specifics of how things would happen if her brother passed away. She’d made arrangements with a funeral home and knew to call them once her brother passed away, but didn’t know how she herself would be contacted when it happened, or who would do it.

I quickly pulled out my notes and took down her contact information, assuring her several times that I would place it prominently in my hospital note to ensure that she was informed immediately by future doctors if anything happened to Mr. K in the hospital.

I cannot express in words how gratifying it was to watch the look of relief wash over the sister’s face, and how happy I was to see her crack a smile as she shook my hand and said, “Thank you, doc. I really appreciate it.”

She turned around, entered Mr. K’s room, and sat down in the available chair; I heard them begin to chat about childhood memories. As I stood in the hallway looking in, I couldn’t help but think for a moment that all of the hell I’d endured for med school was worth it. I’d just been granted the privilege of trust. I’d just been the person who delivered a bit of peace and comfort. And despite not having “M.D.” after my name, I’d somehow managed to muddle my way through this one.

The most exhilarating part was that for once, what I said had mattered to someone other than myself. As the medical student on the team, it’s rare to feel that anything I say is important. I often feel like I’m just repeating things said by my residents/attending, and honestly, it has yet to actually affect patient care, so I have little stake in anything other than for the sake of my grade/evaluations, which I don’t really care a whole lot about (my philosophy is that I’m here to constantly learn, not just work for a number that “defines” me). But just this once–what I said and how I said it made a real difference.

I think moments like this are what prevent me from becoming jaded. I was talking with my upper-level resident the other day, and she was telling me how frustrating it can be to know that patients frequently have diseases that can’t be reversed. But no matter how grave the medical scenario, there are shining moments where you know you touched someone’s life for the better, and those make up for all the rest of the drudgery. It’s times like this that remind me that medicine is perhaps the field where balancing between science and art is not only conducive to success, but rather, critical.

One of the major influencing factors in me joining medicine was the prolonged illness and death of a close family member, and I still remember all too well how painful it was. I know how horrible it feels to lose someone, no matter how “prepared” you are. I left the hospital on this particular day with my head held just a bit higher, feeling that just maybe, I’d been able to put a bit of positive energy into a family’s medical care.

Do medical students have paid jobs when school is in session? I would think that some would work to help pay off their tuition costs.

Yes and no. Many people do some form of work-study financial aid in school where they find jobs as librarians, TAs, research assistants, manual laborers, etc. Others arrange their own gigs, whether it’s playing in a band or tutoring the local university students or designing web pages. But honestly, many don’t do either, simply because they feel the time investment is either something they cannot afford to make if they wish to maintain their desired level of academic achievement, or they just want to use that time for self-care (social life, cooking, baking, exercise, hobbies, sleep, you get the idea). Here’s a simple decision tree to consider:

• Do you really have time to work? In other words, will you still keep up your academics, social life, sleep schedule, and exercise?
  • If no, stop. Go play some frisbee and enjoy your life as it is.
  • If yes, continue.
• Are you sure? Will you stay sane?
  • If no, stop. Go eat some chocolate and let the soothing effects take place.
  • If yes, continue.
• What are your skills?
  • If research, consider seeking a lab that allows you to work flexibly. Chances are that this will be an extremely difficult job to maintain.
  • If teaching, see if you can find an MCAT program to teach for, or a tutoring arrangement (these often pay $50+/hour), or a TA position.
  • If bartending, look for a bar that doesn’t have you doubling as the bar-back.
  • If music, try to score gigs to play around town.
  • If muscles, then consult with your anatomy lab–chances are they’ll need help from time to time moving bodies and equipment.
  • If programming, let people know you’re into code/web design/etc.
  • If art/photography, consider selling your pieces/work. Chances are you’ll have classmates who get married, and they’ll need a wedding photographer.
  • If something not on this list, be creative and come up with something.
  • If none of the above, look for a simple, non-intensive task, such as librarian. This position has the bonus of giving you study time when people aren’t bugging you about books.

Keep in mind that all of this changes from year to year, particularly once you begin clinical rotations, which are basically a full-time job in and of themselves. I think tutoring is probably the most flexible and gives the best money/hour, but do whatever floats your boat–and remember: not working while in med school is perfectly acceptable, and in many cases, a healthy thing. You really have to weigh whether the (usually minor, in the grand scheme of things) decrease in debt is worth whatever sacrifices the job(s) require.

~~~~~

“Hey Jae” is a series that publicly answers questions from pre-med students. I get these from time to time through facebook, e-mail, etc., so I figured if one person’s wondering, more likely are too. Feel free to pose a question of your own through my contact page! As always, best of luck.

1. You really have to love medicine. If I offered you $100 million to quit medicine forever, you should be able to say no without looking back. I realize that sounds absurd, but my point is: if any amount of money will sway you, chances are you’re doing this for the wrong reason. Keep things in perspective: you beat out thousands of other applicants to win your spot in your class. Why did you bother fighting for a spot that would keep you out of the money-making world for 7+ years if you’re either a) after money or b) not really passionate about it? Never forget why you applied.
2. Most of the people who enter med school are a little behind on maturity. I’m definitely guilty of this, and chances are, you are too. Think about it–most med students are hardcore nerds/smart-alecks who spent time studying when they could’ve been hanging out with their friends and learning social norms. Generally speaking, we have a bit less overall “life experience”. I’m not joking when I say I have classmates who complained about seeing penises in anatomy because they’d never seen one before and wished they’d had a gentler introduction. Take-home message: be understanding of classmates–at some point you’re going to seem immature too, and you’ll have to rely on someone to be patient with you. A healthy tolerance for drama (particularly of the romantic variety) helps.
3. You have to find new ways to study. The chances that the same study habits that carried you through college will work in med school are slim–there’s just too much material, and the first step is accepting that, honestly, there’s no way you’re going to know it all. That’s a sore spot for people who’ve been academically successful all their lives, but it’s the plain truth. So find what lets you memorize and understand the high-yield material. Above all, don’t be afraid to reach out for help!
4. Try not to piss people off. I don’t care how tempting it is–take the high road. When you enter med school, you become a professional, and you are judged as such 24/7 regardless of the situation. You just can’t afford to upset someone with more authority than you this early in your career, and for that matter, annoying your future colleagues is an obvious bad call as well. If you disagree with something, bring it up through tactful channels. Request relatively private meetings (but don’t be afraid to ask if people can come with you!), be cordial in e-mails, and re-read everything from multiple angles to make sure it can’t be taken the wrong way by someone in a bad mood. Practice good communication skills, and it’ll get you far!
5. It’s easy to forget the human aspect. Drowning in information all day, it was easy to lose sight from time to time of the fact that all this book-learning is being done for the sake of helping others. Don’t let being a social butterfly take away from your studies, but don’t be the lone wolf either! Take the extra effort to say hi to everyone, give them a hug/high-five, ask them about their day, etc. Med school’s a tough experience, and you want as much mutual support from friends as possible. Who better to understand what you’re going through than your classmates?
6. It’s hard to take care of yourself. Eat healthy. Exercise. SLEEP. Everyone tells you to do this, but shoots, it’s not easy. Hint: it helps a ton if you learn how to time-manage properly! It seems to me like medicine is ironically a field where its practitioners have to fight to find the time to practice what they preach, and as a student adjusting to a whole ‘nother city, culture, and schedule, to call it tough would be giving it rather short shrift. I guess when it comes down to it, just remember to have fun with the whole experience, or else it’ll drive you up the wall. Make time to hang out with friends, call up old pals to catch up, etc. Part of taking care of yourself is keeping your sense of humor, so remember to laugh and love life. Being a med student is a very blessed position, don’t ever forget it!
7. Open-mindedness is key. I came into med school all gung-ho about going for ER residencies, and while I’m still really in love with the field, I’m starting to consider trauma surgery too, and for 10 minutes at a time when our ophtho prof shows us a sweet operation video, I consider ophthalmology. Seeing my neurology professors lecture is like experiencing poetry in motion, and after finishing that class I’m utterly in love with neuro too. You might know what you’re interested in, and that’s great, but just remember how broad medicine is. A wonderful professor gave me this piece of advice: “When you’re on surgery, be the best surgery student you can be. When you’re on peds, be the best pediatric student you can be. And so on and so forth. It doesn’t matter how little interest you walk into a rotation with, you owe it to the patients and the rest of the team to be at your best. Besides, how are you going to figure out how much you like or dislike something without giving it a legitimate try?”
8. Hacks and resourcefulness will save time, effort, and money. Don’t wanna blow your dough on textbooks? Find out what your library carries. Interested in research? Introduce yourself to cool profs right after their lecture and then e-mail them while their memory of you is still fresh. Food budget getting tight? Search your e-mail for local events with free food. Stayed up late at school studying and don’t feel like going home? Remember where the comfy sofas and shower facilities are and keep a change of clothes at school (some deodorant helps too). Don’t want to spend $100+ repairing your cracked iPhone screen? Get the local tech nerd to do it for you with a $13 replacement off of eBay. You get the idea.
9. People will automatically trust you, and treat you differently. Family will start bombarding you with medical questions, friends will text you with ailments even though they’re thousands of miles away and you can’t even do a basic physical, and strangers will approach you with a trust that you will probably find shocking. Get used to it. Everyone sees you as a professional, and really, the best you can do as a medical student is to tell them what you know and humbly admit just how much you don’t. Don’t abuse anyone’s trust. Don’t act like you know something when you don’t, it’ll just bite you in the butt later, and the stories that go around about arrogant med students trying to show up their peers are mindblowing. If one of your classmates does this, don’t bother trying to one-up them, it’s just not worth it–they’ll usually get their comeuppance when it comes to reviews anyways.
10. MOST IMPORTANT OF ALL: teach. The word “doctor” does not mean “healer”, “provider of cures”, “surgeon”, or anything specific to the field of medicine. In Latin it means “teacher”, and its origin was the verb “docre”, which means “to teach”. The first line of the Hippocratic oath is not “Do no harm”, as popularly believed–the first line pledges honor to the person who taught the practitioner, and includes a vow to teach others. So educate yourself. Help educate your classmates. Educate your future patients. If someone asks you a question about medicine, don’t just slap it off as “something you’ll learn later”. Take the opportunity to find out, review, and follow up. Be patient. Be gentle. Remember that outside of a test scenario you’re getting asked by someone who doesn’t know the answer, and they’re genuinely curious.

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Feel free to comment and/or make suggestions!

Answer dedicated to Anna Parks, UCSF class of 2014. Best of luck, Anna, I’ll always be rooting for you.

Have you ever seen a med student with a disability (a mild physical impairment in which the student doesn’t use a wheelchair)? If so, what were others’ reactions/how were they treated?

Short answer: no, to the best of my recollection I have never seen a medical student with a physical impairment worth noting.

Long answer: this is a really, really broad and open-ended question. Honestly, I’m quite puzzled as to what to make of this and wondering what prompted the question–curiosity? fear? What’s on your mind?

If I wanted to be picky, sure, I could easily name several physical “impairments” I’ve seen med students possess: myopia, foot drop, lack of coordination, hyperreflexia, hyporeflexia, incomplete freedom of movement in certain joints, etc. Where I would draw the line between defining these impairments as a “disability” vs. “normal variability” is something I’ve never even thought about, because I’ve never really considered them to even be worth noting until now, nor have I ever seen a med student treated “differently” per se based on any of these so-called impairments.

I suppose the answer to your question, then, is that our (extremely) blunt reaction is, “We don’t give a shit. There’s a ton of stuff to learn, extracurriculars to do, sleep to chase, and we’ve all got way better things to bother with than giving a classmate crap about something so minor. Honestly, if you tell us something’s ‘wrong’ with you, our nerdiness makes us more likely to think you’re awesome because we can use you as a fantastic learning experience that we’ll remember forever.”

About the only thing a med student will shun a classmate for is the classmate’s attitude–if they’re arrogant or a jerk, then whatever, they’ll soon find themselves isolated and ignored. Some people shun others because they fancy themselves as intellectually superior. They also quickly find themselves isolated and ignored, and (hopefully) discover they weren’t so damn smart after all (at least socially). Physical “impairments”? Whatever.

I realize this might seem a bit glib, but I assure you I truthfully have yet to find a medical student who discriminates on anything other than personality. If there is a specific disability you have in mind, please, ask away, but this is the best I can answer without any further specifications.

~~~~~

“Hey Jae” is a series that publicly answers questions from pre-med students. I get these from time to time through facebook, e-mail, etc., so I figured if one person’s wondering, more likely are too. Feel free to pose a question of your own through my contact page! As always, best of luck.

(1) THINK, DAMNIT.

Allow me to wax philosophical for a minute.

When you start, do NOT immediately try to write something about yourself. I’m all for getting random thoughts and ideas down on paper, but don’t start hammering out a first draft from the get-go!

Hold your eagerness/nervousness in check and just think, damnit. This is, quite literally, an essay that can determine your future. It deserves some respectful introspective contemplation. Think about why exactly you want to spend a small fortune and nearly a decade of your life, and what you will bring to the profession. Quite frankly, if you don’t already question whether you really want to be a doctor or not, you’re either not thinking hard enough or you’re naive, neither of which improves your odds. Ignorance is not a sin, but it is one hell of an inconvenience, so let me give you this fact: over half a dozen people in my class left in the first eight months. Being accepted to medical school was what they worked for years to earn, spent thousands of dollars on–an opportunity hordes of other pre-meds would’ve been happy to take. Cogitate on that for a moment. If there is anything else you could possibly see yourself pursuing as a career, do that instead. Please?

(2) What drives you?

Start by identifying your passion(s)–what makes you tick drop everything else for the sake of making it happen? This is your hook, so don’t just reply “medicine”. What exactly about medicine makes you think its the career of your dreams? What is your vision of how you will impact medicine in 10, 20, 30 years? Dream big, and build those castles in the sky. The whole point of the admissions process is to determine whether you’ve really got what it takes to build foundations underneath them.

Please, for crying out loud, write something original. Seriously, I don’t care if it’s true:

• Don’t write about how you’ve wanted to be a doctor since you were a teenager/child/fetus. Not only is this thesis commonplace, and therefore boring, I honestly find it extremely insulting. Why? Because nothing in the world really prepares you for the emotional, physical, and mental rigors of medical school. Med school is not the heavenly ideation pre-meds often dream it is; if it was, people wouldn’t quit. If it was, people wouldn’t have mental breakdowns. If it was, the percentage of docs saying that they wouldn’t do it again (if they could go back in time) would be way lower. Honestly, it’s kind of hellish. You study more than you’ve ever studied in your life. You stress more because if you screw up, someone might actually die someday. Emotionally, something will eventually crack you as you begin to see incurable patients. The list goes on. As much as every doctor tries not to be jaded, can you see why the bright-eyed notion of “just knowing” you’ve always wanted to be a physician could be downright aggravating? Show some respect for the challenging realities of the medical profession.
• Don’t write about how you or a relative underwent a traumatic medical experience that inspired you to be a healing force in the world. I’m perfectly aware I’m touching on an emotional hotspot with this advice, and that it’s probably going to piss people off. Let’s put it this way: I did this. If I could do it again, I would do it differently. Everyone has bad medical experiences if they live long enough, so please, get over yourself (I mean that in the kindest way possible >.<). In the grand scheme of things, one physician more or less is not going to make a particularly large dent in the healthcare needs of the 6 billion+ people in the world, and if everyone who had a relative die of cancer chose medical school, the average IQ would top 130 and we wouldn’t have the shortage of healthcare providers that we do now. If you’re going to write about a medical experience, don’t make it your sole focus–weave it into the framework of how you plan to use that experience to improve healthcare.
• Don’t write that you come from a proud family of doctors and you want to follow in their footsteps. This just makes the reader think you haven’t the brains to think for yourself. I don’t care if you’ve spent hundreds of hours shadowing dozens of doctors–you’ll still sound like you’re choosing medicine because it’s what family expects you to do, instead of you really wanting it. It kills any chance you have of sounding charismatic, and instead you come off as annoyingly naive. =__=;

Basically, from the moment someone starts reading, you have about 30 seconds to impress them enough to keep reading, so don’t write on the same premise as a thousand other applicants. It’s trite, mundane, and uninteresting. If a significant part of why you want to be a physician happens to stem from a relatively common theme, fine, that’s not the end of the world–spend fewer words discussing your inspiration and quickly shift gears to specifics about you that will convince the reader they’ve got a genuinely special story in their hands. It’s your response to adversity that will make you stand out, not the fact that you’ve faced it.

(3) What have you done to fuel your passion?

So. You’ve told me what you’re really into, what gets your juices going. Maybe you’ve said you’re really interested in the evolving interface between medicine and technology. Or maybe you’re in love with the idea of joining the CDC’s crack team of epidemiologists. Or your dream is to improve the treatment of AIDS in inner city slums. Awesome! You’ve identified your mountain.

…what’ve you done to start climbing? Are you just pontificating or are you being realistic? If you don’t write about any computer science experience, epidemiology research, AIDS fundraising work, or something along those lines, my skepticism will start increasing. The medical community can be idealistic and appreciate hope, but if your personal statement and resume don’t seem to match, you can bet your readers’ bullshit alarms will start going off loud and clear.

Now, that said, a caveat: if you have extenuating circumstances that have prevented you from being able to start climbing, explain them. Put your heart into it, and appeal to your reader’s sense of compassion. True story: a student with a 28 MCAT was accepted to an extremely prestigious private medical school. On first glance at her numbers, you might wonder why they didn’t throw out her application immediately. Her statement, though, told the tale of a brave young woman who was working full time outside of class so she could support her four younger siblings. Of course she didn’t have the time to properly study for the MCAT–expensive prep books and courses were also out of the question when that money could feed a sister or brother for months. Upon acceptance, she quickly rose to the top of the class. A truly. incredible. applicant.

Second caveat: don’t repeat anything that’s said in the rest of the application. This is something I see so often, done for the sake of “emphasis”. The personal statement just becomes another resume. Fact: you’ll seem like you have nothing else in your arsenal, and at the end of the day, you’re beating a dead horse. If you’re going to write about an activity in your personal statement, don’t give away the thunder before the reader even gets there. The application process gives you so little space to squeeze in everything you want to share about your life–you don’t have the luxury of repetition. Hit the relevant high points in the extracurriculars section and then expound on those points in the essay.

(4) Unify.

I don’t want to sound like a high school English teacher, but assuming you’ve managed to intrigue the reader beyond the first five sentences and kept them furiously reading to the point where they develop nystagmus, at the end you absolutely need something to tie it all together. By the time the reader hits the end of your statement, they should have a caricature of you in their head, a distinct voice they can imagine reading the essay aloud, and the last few sentences are your one shot at combining the different elements of yourself into a complete persona. In other words, if your reader ever meets you, you want them to be saying, “You’re just like I’d imagined!” If you haven’t done this, you need to keep writing.

Loosely speaking, you utilize pathos in talking about your passions, logos in explaining how you’ve pursued them and how they’ve driven you to the field of medicine, and your ending is your biggest opportunity to show you have some legit ethos to balance it all out.

Do NOT:

• Say, “In conclusion”, or give a summary. You’re not in 5th grade anymore. Show some creativity.
• Use a cultural or cliche statement/quote to connect. First of all, this type of writing is an insult to both your and your readers’ intelligence, and second, your reader could be someone unaccustomed to your idioms–a huge chance of misinterpretation. I’ve yet to see someone pull this off, and it just makes me roll my eyes.
• Be satisfied with an essay that, when you send it out to friends/family for feedback, doesn’t elicit a “Damn, that was solid.” response from at least 2 people. “Pretty good!”, “Nice!”, “I liked it!” are not good enough; if they’re not followed by supportive criticisms, they’re actually signs you need to pick other people to read–people who aren’t afraid to jab at weaknesses in your writing.

Be brutally honest and ask yourself:

• Would I want to meet me if I read this essay?
• Do I leave the reader believing in my potential to change medicine for the better?
• Do I seem to match a stereotype, or do I really stand out as awesome?

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This post just took ~10 hours to write. If you can spare a moment, please, leave your thoughts in the comments about whether this was helpful or not. Is there anything you wish I’d touched upon? That I could write more in detail about? That I’m flat-out wrong about? Any and all thoughts are welcome!

1) Think of the patient. No, really. Think of the patient. This is so stupidly obvious, yet it’s overlooked all the time thanks to the easy boilerplate of “It’s hospital policy.” It’s amazing how many will blindly follow words on paper instead of the needs of a fellow human being. I’m thinking of a case where a pediatric patient with a terminal condition was on his deathbed. His father was a psych patient, and admittedly not entirely right upstairs, so for security reasons based on his mental condition, he was not allowed into his son’s room to spend the final hours together.

See what’s wrong with this scenario?

Someone took the general hospital rule that psych patients are not to have extended visiting hours, and denied a young boy in his final hours the gift of holding his father’s hand as he went. If this doesn’t strike you as a great injustice and move you to anger/tears, please don’t be a part of the healthcare field until it does.

Fortunately in this case, a physician intervened, and demanded that extra security be called up to the ward and the father be allowed in the room. The end result? The physician got in trouble for violating hospital policy. For thinking of the boy’s feelings. Incredible. Thank goodness for being able to rely on tenure…?

Now, with this rule, it’s a bit broad. Think of all the patients in a case. If you’ve got a pregnant mother, you’ve got two patients, particularly if she’s passed the X-week mark (dictated by your state laws) past which the fetus is considered viable. If you’ve got a pediatric patient, you’ve got to take care of the parents too. If you’ve got a man who tested positive for TB, you need to get his family in for testing and preventative therapy too. It goes on and on–cast the net wide, no matter what the law minimally requires.

2) Never stop asking questions and communicating. I don’t know where in the busy life of medicine some doctors stopped being inquisitive and became robots processing information and technicians performing a trained skill. A case came in where a developmentally mentally challenged woman gave birth to a healthy baby. Heated debate ensued about whether the baby should be given to the care of the state and foster care to give it a more competent set of parents, or whether the baby should be allowed to stay with the mother, given that the mother was competent enough to take care of herself and had managed through pregnancy without the help of the father, who was no longer in the picture.

Amidst the flying arguments which began to lean toward giving the child to foster care, a medical student went into the room, and a few short questions later, discovered that this mother apparently had an aunt who had already agreed to take care of both her and the baby once the child was born. The aunt was called, and she immediately came to the hospital.

See what went wrong in this scenario?

Not a single other person had bothered to ask the patient if there might be other family who could help. Not the attending, not the residents, not the nurses. It took a curious student to stymie the possibility of giving away a child to the mercy of the foster care system. That student saved that baby’s life by simply taking a moment to speak with the patient and wondering if there was anything else that could be done. This brings me to the next rule…

3) Be creative. Brainstorm. A large, large part of being a medical ethicist is thinking up alternative solutions. Free your mind and forget the notion of good idea/bad idea. You can always sort your thoughts in order of best-to-worst later. The test prompt for my ethics exam presented a case where a mentally challenged young man was brought in by his parents for a vasectomy after they heard that one of his classmates had impregnated another classmate the week before. They were concerned that he wouldn’t be able to control his sexual impulses and do the same. This young man clearly lacks the mental capacity to be a father, so his parents wanted to prevent the possibility altogether.

What questions are popping up here?

Sure, it’s legally kosher in a lot of states for parents to sterilize their mentally disabled children. Should it really be the first thing to come to mind, though? What about psych therapy to see if he can develop restraint? What about transferring him to an all-boys school? What about home schooling with tutors? Most importantly, if he’s really so mentally incapable, why are they leaving him unsupervised for periods of time long enough that the possibility of him impregnating someone exists?

The parents’ wishes are clearly driven by fear, and a physician that simply goes with their will and performs the procedure is one who isn’t using his/her brain. In the end, a vasectomy may indeed be called for, but hopping straight to it without giving some pause to other solutions is on par with negligence, IMHO.

4) Bend/break rules when needed. Let’s be real, we’ve all justifiably broken rules before. It happens. An interesting case was presented to us in class where a patient concerned about his sexual promiscuity wanted to be tested for HIV. He tested positive…but did not want his girlfriend to find out. The girlfriend is also your patient. The girlfriend is also pregnant. Telling her that her partner is HIV-positive is a clear breach of patient confidentiality. Turns out the law only prevents you from being sued by the man in the event that you tell his spouse, not a significant other.

Do you tell her…? Would it be any different if she wasn’t pregnant?

I would hope there is general consensus that any modern-day physician needs to be an advocate for women’s rights and tell the girlfriend that she is at risk for HIV, regardless of whether or not she’s pregnant. That said, basic respect for the patient-physician relationship calls for informing the boyfriend that you’re going to do this regardless of what he wants, and give him a chance to change his mind and deliver the bad news himself. In the event that he still refuses to budge and you tell the girlfriend, limit the confidentiality breach as much as possible–only deliver the news that her partner has HIV, and her options to protect both herself and the fetus; how her boyfriend acquired HIV is something for the pair to discuss, and it’s not something that needs to come from a doctor. Don’t be nosy.

5) Be prepared to pay for it. Self-sacrifice is a hallmark of the medical profession; whether its reputation or money, the possibility of repercussions is always there. In the above case, you might lose the man as a patient, the man might spread negative rumors about you to his cohorts and damage your business, you might get sued (although it turns out that monetary damages in this type of scenario are typically quite minimal), etc.

So do you just sit there and deal with lawsuits left and right…?

Hell no. The tenet of open communication goes a long, long way in preventing people from getting mad at you. An attending told me a methodology he follows, and it’s quite genius: whenever he absolutely needs to go against a patient’s wishes, he carefully takes the time to explain to them why exactly his medical judgment calls for it, and then he gives them the phone number of the best malpractice lawyer in the city, and quietly says that if necessary, he would be willing to defend his actions under oath in a court of law. He’s yet to be sued by a patient who he’s said this to–they get that he’s entirely serious, and that he’s focused on what’s really important, and willing to fight for it. Kinda cool, no?

1) Always put the patient first. Duh, right? This is, after all, your passion. Unless you entered medicine for the wrong reasons, you think helping people is, well…cool, and you signed up because you wanted to make it your career. That said, you soon realize after signing up that there are an unbelievably large number of things that will draw your attention away from the patient, whether it’s politics (read: fear of being fired), financial concerns, ethical dilemmas, whatever. But no matter what, you can’t ever forget: you’re treating a fellow human being. Even if someone’s 100 years old, that someone is someone’s kid. So while this rule may seem inherently obvious, just keep it in the back of your mind–use it as your compass to point you back to humanity whenever you might walk astray.

2) Look cool while doing it. Ok, so at first this rule definitely sounds a tad arrogant, but it makes sense. You wear the white coat of a professional. People hold you to ridiculously high standards whether you like it or not, and you owe it to everyone else who wears the white coat not to mess that up. And don’t just be happy with “not messing it up”–push the standard further. If you’re a surgeon, be awesome at the technical skills you’ve honed. If you’re a pediatrician, help those kids grow up strong, tall, and smart. If you’re into psychiatry, be the most understanding person your patient has ever met. And so on and so forth. Strive to be great unmatchable in your mastery of the field, and you’ll soon be described by those around you as “baller”, “legit”, “hawt”, and other such fashionable words of adoration.

3) Don’t hurt anything with a name. Surgeons have a slightly narrower pancreas-related version of this in their 3 rules, but basically, this broadly applies to your patient, your patient’s innards (we all had to pass anatomy, right?), the rest of the staff, your institution, the “doctor” title, your family, you…the list is pretty much infinite. Are sacrifices sometimes required? I suppose so. But as cliche as it might sound, it really is our ethical and professional duty to minimize sacrifices whenever possible.

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At the end of the day, we all have times when we’re tired. When life just kinda sucks. That’s natural. It’s ok. Take a deep breath, do what you need to give yourself a boost of confidence, and keep on chuggin’ away. I hope everyone who reads this finds it useful–goodness knows I’ll constantly be referring back to this whenever I’m feeling lost and need a sanity check.

Back when I first discovered the beauty of the screwdriver and its magical ability to take things apart and show me the inner workings of whatever poor piece of technology I tackled, my father gave me a piece of advice: “It doesn’t mean anything to be able to take something apart if you can’t restore it to its original whole.”

I must’ve taken apart just about everything in the house except maybe the kitchen oven and refrigerator (mainly because, well, I didn’t have the guts to stand up to my mom when she said no, and even in my foolish youth I had the wisdom not to do anything that might impede the process of food reaching my mouth). But clocks, radios, an old TV, various computers, and every other random gadget I could get my hands on fell to the sharp blade of my flathead. I was convinced I was going to be an engineer who would invent the flying car one day. At least, that’s what I told myself as I played with my Legos. This was until I took calculus.

Fast forward 15 years, and I find myself not in a machining shop, but in an anatomy lab. Working not with big power tools, but with a scalpel and some green pokey things. And the environment is just…utterly bizarre. We joke around a lot in anatomy lab. Anyone who isn’t in medical school or gone through it simply wouldn’t understand. How is it even possible to attempt humor or liveliness whilst surrounded by the presence of the dead? But in many ways–we have to, or else it would drive us mad. As if the sleep-deprived hours spent cramming the material before the lab closes for exam preparation weren’t enough, if we had to be stone-cold somber the entire time it would be unbearable. So we kid, we jibe, we toss insults back and forth about whose body has the larger penis, and so on.

But even as we complain about the havoc the smell wreaks through our first cranial nerve, even as we dehumanize an entity that is so entirely human, we remain quite aware that these cadavers are our best tool for learning ourselves–that ironically, we must learn from the dead to treat the living. Every time I mistakenly cut something I felt terrible for ruining an opportunity to learn from my donor. I imagine that maybe they’re around in spirit. I imagine that honestly, they’re probably kind of horrified at what their physical beings are subjected to. But I also imagine that somewhere amidst that shock they remember why they agreed to donate. Why they agreed to posthumously teach us for months when they could have been peacefully laid to rest for eternity. Why they agreed to an act of kindness that will ultimately impact thousands of fellow men, women and children as each of us graduates and begins a career of healing.

It bugs me that I can’t follow my father’s advice in this case. I will never be able to restore my cadaver to its whole pristine state. And while I hope this only gives us all more motivation to work to restore our future patients to their happy healthy selves, I can’t help but wish I were able to thank our donors more tangibly. I imagine that perhaps some of our donors spirits are with us now as we acknowledge and pay tribute to their incredible sacrifice. I hope they understand just how thankful we are to have been given such a privileged blessing. I will never know the identity of the person whose body I dissected, beheaded, and in many ways, due to my inexperience, mangled. I will never know whose sister, aunt, mother, grandmother, daughter I cut apart. I can only hope that my belief in a divine power is not unfounded as I pray He deliver our thanks to these generous souls for bringing us first-years to a closer understanding of God and man.

1. gunner: the most notorious of the stereotypes, the gunner is out to get perfect scores on everything, whether it’s final exams, clinics, or random questions in lecture. The gunner is somehow capable of handling all classes, half a dozen electives, reading all the latest scientific literature, conducting several research projects (and publishing), being an officer in every club, and achieving AOA, but this incredible seemingly-pristine resume is tarnished by the fact that they have no friends (hey, something has to give). Physically, they often weigh in on the extremes of the scale depending on body type–they are either insanely skinny because they don’t have time to eat or they are obese (ironic) because they don’t have time to exercise. No one has been able to verify if gunners ever sleep, but they are easily identifiable by the collective groan that goes around whenever they open their mouth to speak.

2. sniper: the sniper is a gunner who refuses to admit that s/he is a gunner. With their element of surprise, they are far more dangerous in the academic setting than their counterparts, but often equally more tolerable due to their skill at normal (if brief) social interaction. Snipers frolic about in the presence of others, hiding their positively vicious work ethic by appearing to waste time on Facebook/Gchat/etc. like everyone else, but when others are gone, 3 textbooks, 2 BRS books, 563 flash cards, an anatomy atlas, and a 24-pack of ice-cold Red Bull suddenly appear from the void as they focus on their goal of defeating the gunner. Their only tell-tale sign is the slight unhygienic odor that surrounds the hooded sweatshirt they always wear (the sweatshirt becomes their “thing”, serving to hide the fact that they were locked up at school all night studying). Some have evolved to take advantage of the advent of Axe body spray to hide even this last trace, perfecting their ninja-like cover.

3. super-chill dude/dudette (SCD): this is the person who will end up being the doctor that other doctors want to go to. The most valuable people to have around for sanity, SCDs don’t really care too much about school, as they realize classes are not more important than having a life (everyone knows preclinical grades don’t matter anyways). Always up for a good game of frisbee or a solid nap, SCDs are perfectly fine with just passing, and are the most content with life amongst their peers. Interestingly enough, their overall happiness boosts their performance greatly, much to the chagrin of the gunner/sniper, and their cheery smiles often belie the brainiac they can be when given the proper motivation.

4. drama queen/king: this particular breed of med student just doesn’t get that no one cares about their problems. Often purposely putting themselves in situations where freaking out is at least 0.000001% reasonable, they make a big deal about everything from studying to rumors about the opposite sex to how many beers they slammed at the last party. They fail to realize that the typical med student is not the type to tolerate BS, and their selfish behavior perpetuates their life of being single. Usually found chattering to anyone who’ll listen, the drama royalty are pitiable but nonetheless useful, as they are textbook cases of delusional behavior that can be studied in depth merely by asking “How’s life?”

5. boredom incarnate: even God sometimes wonders just how in the world this type of med student managed to live through more than 2 decades without picking up some ability to socialize. Not much is known about this type other than that their ability to put people to sleep by talking is unrivaled–their monotone is practically coma-inducing. It has been postulated that they are the chief source of boring medical school professors, but this has been met with much contention from the Ph.D. camp, who currently defend this title with pride.

6. English (or any non-techie) major: the source of the more physically attractive members of any given class, the non-techie majors are a very valuable addition to the dating pool, and are the most sought after for those who love medicine so much they want to marry a doctor as well as be one. Their eloquence in speaking and shockingly legible handwriting make them stand out when it comes to presentations and notes-sharing, and their earnest approach to and curiosity about science is a refreshing contrast from those who have memorized fact after fact all their lives and are sick and tired of it. Next to the SCD, these are probably the students who have kept the most sanity.

7. dumbass: to the confusion of all, at least one inevitably appears in every med school class. No one really knows how they made it into med school, but whether it was an admissions mistake or traumatic head injury that made them how they are, they are unbelievably stupid. They can’t seem to understand even the simplest concepts even when force-fed the material repeatedly, and everyone fears for their future patients. Fortunately, however, the dumbass usually does not last long, dropping out quickly and sparing everyone their inane questions/comments.

8. ghost: the ghost never comes to class, review sessions, labs, parties…anything, really. Due to their heavy reliance on streamed lectures and notes posted online, no one is quite certain that the ghost even exists except for that one person who they talked to for 30 seconds during orientation; were it not for the presence of their name on the class roster, the school wouldn’t be certain either. Commonly noted in passing conversation with a “Who’s that?”, ghosts gain almost legendary status, with claims ranging from “I hear s/he can watch recorded lectures at 5X speed” to “they sleep 8+ hours a night!”

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Now, it must be noted that most medical students fit into more than one of these categories, giving rise to mixed, sometimes bizarre breeds such as the ghost gunner. While the medical school ecosystem is a complex environment with many subspecies, these 8 categories serve to cover most of what you will find.

Did I forget a stereotype? Got comments about the ones above? Leave your thoughts below!

But wait, cry all the self-help coaches, overachievers, and med students. Perfectionism is good! It drives us to achieve, to surpass our limitations, to be all we can be! Without perfectionism, without an obsessive desire to attain the unattainable, we would have no progress, no innovation, no nothing!

Utter nonsense, my dear Type A’s. What you have fallen victim to is simply a misuse of semantics that perfectionists universally delude themselves with to justify their habits/natures. I would know–I was one, and to a certain extent, still am.

As a perfectionist in recovery, I want to first make clear the extremely important distinction between “striving for excellence” and “perfectionism”. Society and vernacular often treat them as one and the same, BUT the latter is the former taken to extremes.

Excellence is a worthy goal–the best goal, really–for not only physicians, but for anyone in any profession. One of my favorite quotes by Dr. Martin Luther King Jr. is, “If you are called to be a street sweeper, sweep streets even as Michelangelo painted, or Beethoven composed music, or Shakespeare wrote poetry. Sweep streets so well that all the hosts of heaven and earth will pause to say, ‘Here lived a great street sweeper who did his job well.’” And I think this quote does an excellent job of highlighting the key aspect of excellence that distinguishes it from perfection–excellence is possible. Striving for excellence, then, means working toward the realistic goal of attaining maximum performance from one’s capabilities.

This of course raises the question of “How do I know what my capabilities are if I don’t push myself as much as I can?” I have to concede that without motivation/drive, we would all be useless fools–but when we use this question as an excuse to excessively sacrifice other parts of our lives, that is where I draw the line between practicality and delusion.

Unhealthy sacrifice is the major hallmark of perfectionism. At some point in the pursuit of perfectionism in a field/profession/pursuit, we begin to let go of other key priorities and lose the tenet that success is a very holistic term. What do I mean by holistic? I define success as the following (in order of importance):

1. being physically fit–if you’re not alive and healthy, the rest is impossible. Duh.
2. having strong relationships with others–I think just about every overachieving academic has had at least one awkward moment in their life when they realize that after spending all that time cooped up studying, they don’t know anyone who can write them a strong letter of recommendation. I’m not saying go out and spend all your time networking, but really, if someone has this issue, it’s quite likely they don’t have very many close friends either. Let’s be real, I have classmates who are generally despised, and while everyone generally do a good job of hiding this loathing with Oscar-worthy facades, I have to wonder what they’ll eventually go through. Somewhere along the line, whether it’s through a patient (lawsuit), friend (defriended on Facebook), spouse (divorce), or whoever–their style is going to bite them in the ass.
3. hobbies–you need to know what you’re interested in, and develop them. Hobbies are, by definition, activities that give you pleasure. Everyone who has ever become famous achieved fame because they spent their life doing what they loved, whether it’s math, science, music, politics, whatever. So spend time on your hobbies–it could get you famous.
4. academic achievement–I hesitate to list this, but it IS important as a medical student. After all, without a reasonably solid knowledge base, how can one be a good doctor? I do, however, list it last. Yeah. Last. Why? Because if you really believe academic accomplishments define you to the point where it takes precedence over your health, relationships, and happiness, you are, in fact, an idiot who will probably die alone with no one to attend your funeral.

All four of these factors are key to success–succeeding in only one or a few is, in fact, being the so-called “failure at life”. Why? Because life isn’t just about being able to run a mile in <10 minutes, or having good friends, or being able to play piano/sing like a diva/drink like a champ, or rocking exams. It’s about finding the right mix of all of these abilities, and striking a holistic balance. What that balance is will be slightly different for everyone, but ignoring or downplaying one part will ultimately degrade your performance in the others. Think about it. People who only do athletics earn the reputation of being dumb jocks. People who party all the time probably aren’t doing so hot in class. People who only do their hobbies are the eccentrics that no one really wants to admit knowing. And people who do nothing but study are the gunners that probably end up gaining weight, burning out, and, statistically speaking, having the highest probability of committing suicide in the healthcare profession.

So again, I stress that balance is key. And it is un. fucking. believable how many excuses people come up with to save themselves the trouble. When’s the last time you heard a variant of “I don’t have enough time” or “I have to study” from someone? Chances are it wasn’t too long ago. And of course, sure, if it’s the week before finals, by all means, study till your brain feels fried–do what you have to do to pass. But realize that’s only a few weeks out of the whole year.

Tips for beating perfectionism:

• Make sure you have a “fuck it” point, and friends who know what it ought to be. You need to realize when you’re taking something too far, and just in case you do get caught up and don’t realize it, you need buds who will come to your rescue and save you from yourself.
• Perfectionism is the inherent belief in a limit–an unattainable one. So instead, believe that you have no limits, and work to back that up. Work hard, put in the best effort you possibly can, and learn to be happy with what you are able to accomplish each day.
• Perfectionism is usually paired with the incredibly annoying habit of being arrogant. As human beings we all want to feel validated, and when we pour time and energy into something we expect others to take notice and applaud our efforts. A bit of bragging never hurt anyone, but when this becomes a habit you just look dumb. Be humble about your accomplishments, and let them speak for you–actually, if things go well, you might find nothing is said at all in the process! (think about it–Nobel Prize winners are only notified by a brief phone call once they’ve been selected)