A Respite for the Weary

It’s been exactly three months since my last blog post. My bad. I wrote in fits and starts but never completed any of the entries (for instance, I drafted a long-winded entry on cancer during our Neoplasia unit. Perhaps I’ll finish it and upload it post-hoc).

The truth is, school’s momentum has intensified during the past three months. I realize now that the first several months of medical school were simply a warm up—an induction for the rigors to come. Gauging by the counsel of older students, it’s clear that this epoch of our education is the most ruthless of the first two years (aside from board preparation which takes place at the conclusion of Year 2). Much of what follows is a long-winded whine about medical school stress. If you don’t wish to endure that, I suggest scrolling nearer the end (after the ***) :-)

This tyrannical academic chapter is called the “Host-Defense” block, and the low exam averages during this period highlight the duress it precipitates. Aware of this oppressive chapter in our education, the school reminded us at the onset of the block where we can seek psychological support and gave us a stern, ominous warning not to fall behind (because we’d never catch up otherwise).

What is “Host-Defense?” It’s getting hit by a train and then drowned under water beneath the weight of the sunken Titanic. That’s what it feels like, anyway. Really it’s our first in-depth exposure to truly useful, relevant, scientific and clinical medicine. Host1 was concerned with blood-related pathologies (anemias, blood cancers, immunology etc). Host2 encompassed the entire month of February and early March and was concerned primarily with bacterial infections, mycology (fungal infections), autoimmune diseases, lots and lots of pharmacology related to bacteria/fungi, and many other related domains such as sepsis. Host3 begins tomorrow and seems to encompass parasitology, STDs, viruses and other miscellaneous infectious processes. In short, Host-Defense covers what can infect you, how it infects you, how it affects you, and how you can treat it. Real medicine.

So, why’s it so hard? There are two main reasons: the impossibly large and incessant volume of information, and the peri-academic demands placed upon us during this episode.

First, the academic strain: I will try to put this in some perspective. On average, we receive three 1-hour lectures each morning, each of which consists of a powerpoint averaging 45 slides worth of information (although the slide-count can range between 30 and 80). Unless specifically told by the professor, we are responsible for everything on those slides—every last detail. In Host2, there were 40 powerpoint lectures for which we were responsible. In addition to the slides, we are given a course packet, which in Host2 consisted of 329 pages. Some of this is supplementation to the powerpoint content, but we can be held responsible for information found in the course packet which was not specifically addressed in our powerpoint-driven lectures. In essence, it’s a shitload of information.

Since we, as medical students, are better understood as “professional studiers,” this wouldn’t be such a big deal (though still formidably knee-knocking) were it not for the ancillary demands and pressures place upon us. I won’t describe them in detail, since I have done so in previous posts, but I will enumerate them (at least as they apply to me):

1. CAPS class (Clinical Assessment and Problem Solving): Our weekly 3-hour afternoon class that dicates additional assignments for us including:

a. Preceptorships (I will discuss this later in the entry)

b. Senior Partners Program assignments

c. OSCE examinations (clinical skills practicals)

d. Community Projects (for which I volunteer at Goodwill and teach Pilates, give trumpet concerts and conduct nutritional seminars)

2. The deadlines for several extra-academic projects take place during the month of February. The application for summer research scholarships demanded a significant amount of time from many students because of its exhaustive nature. Countless hours are committed to this that would be useful in preparing for the Host2 exam. Additionally, tax forms must be filled out (thanks, dad) so the FAFSA application can be completed by March 1^st. These things become a nuisance when you have over 300 pages of information to commit to memory.

3. Concert Band rehearsals and concerts. These are mostly welcome, but sometimes feel like an impediment. Often during the week of an exam (and in the two weeks leading up to the Host2 exam in particular), I would be extremely and embarrassingly out of shape for rehearsals because I couldn’t spare the time to “put horn to face,” as my dad says. As principal trumpet of the ensemble, I shouldn’t be so inconsistent in my adroitness, but I don’t have the capacity to practice for several hours a day unlike the music majors in the group. I know as lead trumpet I shouldn’t make any excuses; I take comfort knowing that this is the roughest it will get, and that my playing will be more reliable in the future.

4. Living life. I try not to be one of those medical students who studies all day every day much to the detriment of their development as an individual. I try my best to stay abreast of current affairs, stay fit by attending the gym several times a week, have an active social life that doesn’t revolve simply around studying—and I even started dating again. I want desperately both to stay in touch with “reality” and stay well-rounded.

5. Finally, I was very ill at the beginning of the block, and fell behind early. Stuck in bed trying to recover, I didn’t have the wherewithal to study and I was forced to reschedule several events, like my preceptorship.

***

This brings me to the Host2 exam. Kelsey (my splendiferous study buddy) and I worked very hard together (and had a lot of fun, per usual) preparing for this exam. It paid off. Especially considering the daunting nature and infamous reputation of this exam, I’m happy to say I scored far above the average. I hate to brag—I really do—but I worked my ass off during this particularly grueling period (certainly the most demanding of my life thus far, considering the duration of the strain). By the way, it was 110 questions and 2.5 hours long. I’m thrilled to enjoy the first free weekend I’ve had since… perhaps since winter break. And it’s sunny!! It feels as if the universe is smiling at me.

I want to talk briefly about my preceptorship. Firstly, what is it? It’s a hands-on clinical learning experience for which we’re matched with a physician with whom we meet monthly. I was assigned to work with a pediatric emergency department physician. At first I was very anxious; the two fields in which I was almost certain I didn’t want to work were pediatrics and emergency medicine. So, naturally, I got both in one. Then I realized how this could benefit me—it’s good to expose yourself to that which you consider to be most uncomfortable.

After rescheduling (owing to being sick), I worked for 9 hours in the ER of Nationwide Children’s Hospital… and had a blast. I couldn’t believe how much fun it was (aside from seeing some horrifying things). At this time I’m not certain about which I am permitted to write due to HIPAA, but suffice it to say I’m much more interested in pediatrics and emergency medicine than I was before. I also really like my preceptor. She’s an exceptional physician—great with kids, a fantastic teacher, and she asked me excellent questions (I was stunned to realize how much I knew. I guess medical school is working).

I’ll ask around to see how much detail I can describe concerning my preceptorship experiences (my next one is scheduled for this Friday), so until then I’ll hold off.

Now for something cool. I want to share one of the grossest pictures we came across in Host2. Unfortunately, I cannot reproduce the image here in full due to copyright infringement, so I had to find a weblink for it. However, it’s low resolution and has an annoying graphic on it. Hopefully you’ll get the gist.

This is mucopurulent cervicitis (pus-filled, infected cervix) colonized with Chlamydia trachomatis. This is why you should have protected sex, ideally not with strangers. Chlamydia is the most common STD, beating out both gonorrhea and syphilis.