Mmmm, sweet black nectar of bean.

My loftiest goal at the start of medical school was to not get addicted to coffee.

Yeah, that went real well.

I decided this after going to breakfast with a friend in residency, who, after her 3rd cup of coffee, declared "Now my caffeine headache is gone!" I could stand to do without headaches, I concluded, and set my noble goal which probably made you shake your head at my naive foolishness.

After seeing Alice admit she gave in to the aromatic stranglehold of the percolator, I can now come out and admit that my determination lasted only until about the start of 2nd year. I am clearly much weaker than Alice (but I already knew that).

I started to drink my coffee, and now I tell myself it's because I love the flavour. Once a day, then twice a day, sometimes more. I would never say that I'm addicted...just that I love the taste of a Tim Horton's (and a Starbucks if needs be). My dad only fed this wonderful addiction by supplying me with a bountiful Tim Horton's gift card...perhaps the best gift I have ever received. And, it always made a convenient excuse to rally the study buddies for a study break - "I've had enough of studying these neurology / gastrointestinal / hematopathology / whatever notes. Let's go grab a coffee."

For a time, I'll even admit I tried caffeine pills on the advice of a friend. A few people I know had resorted to this in undergrad, and I was able to abstain then, but my curiosity overcame me when I was approached in a back alley at night by a fellow medical student and was offered one of a variety of caffeine pills hidden in the inside of his overcoat. Why pay $2 for coffee when you can pay $0.15 or whatever for one of these magic pills, I thought?

Actually, the drug reference has a bit more credence to it than you might think - during our first week of orientation way back in first year, the physician support hotline sponsored a session in which a doctor and a dentist warned against the dangers of drug use, and that as professionals we weren't immune to it - and of course, one of them was adamant that his progression to cocaine and heroin had began way back in medical school, when he started trying to augment his studying using caffeine pills (and then ephedrine...and so on down the slippery slope). Never underestimate the pressure that medical students feel.

After hearing that, and admitting to myself that the pills didn't really give me that much of an extra kick (unless I took 5 or 6 at a time, which I wasn't interested in doing), I decided that paying $2.00 for the pleasure of a brew wasn't that bad.

When second-year finals were all over, though, and my coffee intake plummeted, I started getting headaches by mid-morning. At first, I chose to believe I had an aneurysm, or a massive brain tumor. No way my sacred brew of black nectar is responsible for causing me this cranial throb, I told myself. I refused to admit, until finally, after demanding numerous CT scans and MRIs (and having to fake a large number of seizures in order to get those scans...ok now I'm really exaggerating), I admitted... it was the caffeine. I was addicted.

I've already scouted out the nearest coffee sources by the hospital I'll be working at in third year, and can't wait to get back to the grind.

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What about those Canadians studying medicine overseas?

A medical school dean once told me, "Every year we turn away as many applicants as we admit, who would also make excellent doctors - our class size just isn't big enough to hold them all."

I've had the unique opportunity to spend time with a few Canadians who are attending medical school in Australia, and I've come to the conclusion that what that dean told me couldn't be more true.

The students here have all impressed me with their life experiences, their intelligence, their motivation, their accomplishments, and how friendly each and every one of them is.

In fact, if you had told me that they were students at my medical school, I would have believed you. I can't see any difference between the students here and the students in my class. They're by no means inferior, whatsoever. And while I'm basing this impression on only a limited amount of time with them, I have already spent a lot more time getting to know them than any admissions interview committee does.

I've also learned that just because a Canadian is studying medicine overseas, it doesn't necessarily mean they were denied from entering a Canadian medical school. Getting into medical school is a lengthy process, and if you don't get in on your first try, as was the case for up to half of the people in my class, the process to re-apply takes almost a year (apply in October to find out in May if you are in September's starting cohort). Rather than apply again, and sit out for another year, some of the students who learned they had been admitted in Australia considered it a logical choice to get on with their medical education right away.

In fact, in many ways I look up to the Canadian students studying here. Before I applied for medical school, I always told people my backup plan was, "If I don't get into medical school in Canada after my third time applying, I'll start applying overseas...Australia, Ireland, the Caribbean." But, to be honest, the thought of having to leave Canada to study scared me, and I wonder if I would have had the determination to apply yet again, let alone apply overseas.

The Canadians studying here, on the other hand, have given up proximity to their families, their friends, and everything familiar to them, to pursue their passion for helping people through medicine - many more sacrifices than we Canadian medical students are making.

And at the end of the road, that determination, that willingness to sacrifice, and that unbeatable passion for helping people - if that's what these students have in them, and if they put all that into how they serve their patients, well, you can't deny that's the type of doctor every patient prefers on the other end of the stethoscope.

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Was that a "click"?

A funny thing happened while I was studying yesterday. I finally felt like all these random, individual information bits I was learning in the neuro/psych block were all starting to come together... things finally 'clicked' into place.

You see, starting out the neuro/psych block feels like having to navigate a rainforest without a map. They might as well have written the entire set of notes in Latin. Every time you try to read something, you get about two sentences in before you don't know what something is. So you look it up... and... well... let me illustrate:

"Hmm, what is the 'caudate'? Oh I'll just look that up. It says here,

'part of the basal ganglia.'

Uh... okay.... better look that one up too. Basal ganglia... blazing danglia... here it is....

'large nuclei deep within the cerebral hemispheres.'

Good thing I know what cerebral means. Now... nuclei?? what's that? ok looking that up...

'a group of cell bodies and dendriates of neurons, such as the red nuclei, a part of the rubrospinal tract.'

Okay. Got it. Except... I still have no idea what the caudate is. and what is the rubrospinal tract?! Do I need to know that??"

Or it's also fun when you think you've learned something... for example, that a certain group of nerve cells ends in the thalamus of the brain... but then later on you read that they end instead in the ventral posterior lateral nucleus (VPL). Damned if you didn't already know that the VPL is a part of the thalamus.

Perhaps now you can see how excited I was to feel as though things were finally coming together.

Interestingly enough, a similar thing is happening with the entire program (not just the neuro/psych block).

It's coming to the end of two years of medical school, which means that by the end of this year we will have had units and lectures on every major body system.

At the start, it's all new, and that can be quite a challenge. Medical terms, lab tests, diseases, all of which you've never heard before. Starting out with things like cardiorespiratory is fortunately pretty straightforward, and you study those units hard, then you feel like you finally know something little about medicine.

But by the end of the two years, you start seeing things over and over. You start seeing how they relate. You start understanding how things fit together. You start doing the physical exam skills not just in a tutorial session, but also in a family practitioner's office, then in a clinical hospital setting, and learning the basis for those exams - for example shining a light into patients' eyes, tapping their knees, and asking them to say 'aah' - helps to learn the pathology and physiology that we need to know for courses outside of the clinical skills course.

One example of a disease we've seen many times now is hemochromatosis -a disesase in which the body can't get rid of iron, and so it builds up in various body tissues. It affects many different parts of the body, so we learned about its effect on the bloodstream in the blood unit, then talked about its effect on the musculoskeletal system in that block, and how it damages the liver in the gastrointestinal unit.

It's a relief to feel as though things are finally making sense, and while some students might give me flak for giving the faculty some credit, it does finally seem as though there was some method to this madness and that we might actually have learned something.

Then again, from what I have heard, that feeling of knowing anything disappears completely next year on the wards...

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Words I'd use to describe med school: Honour

There are a number of words I'd use to describe med school. This blog post is the first of a small series I'll devote to expanding upon these words.

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I've heard people joke about it before. "You know, you're lucky... as a doctor you're one of the few people who can get someone to to take their pants off for you within minutes of having met them!"

That's not necessarily always a fun thing, considering how unpleasant it is to perform a digital rectal exam on, say, a patient who has lost control of their bodily functions and hasn't showered in weeks.

But that borderline crude statement has a lot more to it than just humor.

Statements like that only scrape the surface of the depth of the honour it is to be able to practice medicine...something that we med students can occasionally tend to lose sight of when we are in the midst of 80-hour work weeks on the wards, or in our tenth 15-hour study day in a row, or when we've just been humiliated by a preceptor in front of both our colleagues and patients.

While I can use this blog to complain about finals or how much stress I'm feeling at times, I probably don't say enough that I do feel honoured to be a part of this profession.

There are so many ways in which this honour is revealed. Here are a few I can name:

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• Medicine: a profession to which people are willing to donate their bodies...their most personal possession....after they die. It's an honour to be a part of that.
  
• Medicine: a profession to which people are willing to give you a huge amount of trust just because you are a part of the profession. Depending on where you look, physicians may not be the #1 most trusted profession, yet around the world, they almost always fall in the top 10 (BBC: Doctors #1; Harris: Doctors #1; Ipsos Reid Canada: Top 5; Reader's Digest Australia: Top 10). It's an honour to be a part of that.
  
• Medicine: one of the professions in which there are so many sides and approaches to the common goal of health, and in which those various health professionals are starting to work harder to work together to achieve this goal. It's an honour to be a part of that.
  
• Medicine: one of the few reasons that a driver, though enraged by the thick of traffic, would still be willing to pull over. I've seen people grumble when a cop turns on the siren to whiz through a red light, but never when an ambulance has come through. It's an honour to be a part of that.
  
• Medicine: one of the few professions legally allowed to self-regulate by the Canadian government. It's an honour to be a part of that.
  
• Medicine: the reason why people will open up to me their deepest secrets, the greatest extremes of their emotions, their first and last moments on this earth...all because of my field of study. It's an honour to be a part of that.
  
• Medicine: one of the areas of study that thousands of the most intelligent university graduates fight for the chance to be able to enter every year. It's an honour to be a part of that.
  
• Medicine: one of the professions where you are able to call some of the most brilliant, accomplished, fascinating and devoted people your colleagues. It's an honour to be a part of that.
  
• Medicine: one of the professions with a longstanding legacy throughout centuries, and is continually looking back into its history and deep into its future to better itself for the good of the patient. It's an honour to be a part of that.

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Even if I could think of all the reasons why it's an honour to be studying medicine, I don't think all of them could be put into words.

That being said, I know I've missed some... if anyone is reading this and can think of some I've missed, I'd love to hear your thoughts in the comments!

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You know you're consumed by studying when...

I found this list in a friend's Facebook notes... and with her permission, am reproducing it here for your reading pleasure. I won't pretend that I'm coherent enough to be this creative at this point right before finals... this many 15-hour study days in a row is enough to shut down most basic cognitive functioning.

You know you're consumed by studying when...

10. You think osteoclasts are cute (white furry balls!)

9. It seems like you're studying more than breathing

8. Things that secrete mucus are mucous-secreting
(clarification for those not in our class: incorrect spelling = incorrect answer = no marks. because we don't have enough stress!)

7. Breaks consist of eating

6. You don't sleep, you nap

5. You look forward to sleeping

4. Taking a shower is a relaxing activity

3. A change of scene involves studying a different block

2. Hearing "6 days til the holidays" provokes fear, not excitedness

1. You think personal hygiene is an option, not a necessity

Okay... back to work!

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Studying Scared

What does it take to get Vitum off his butt and into study mode?

Good intention? A desire to do well?

Try fear. Plain, simple fear of failure. That's all it takes.

Unlike last year, when around this time I was enjoying how slack I thought medical school was, this year is different. Not just for me - I've noticed that a lot of people who took it easy early in the semester for the last two terms are turning up at the hospital & university study rooms on the weekends / evenings. And I've got three things that are giving me enough fear to get me studying scared this early into the semester.

1. Life around finals time sucks.

First of all, now that I've been through a year of medical school, I'm more aware of what it involves. I know how hard I had to work when last year's finals were approaching. I spent entire days and entire weeks studying with few breaks. Seeing few friends outside of med - and even friends in med - was not an option, and how the only thing that kept me going was the thought that "if I don't work my butt off, I'm gonna fail." I don't want to be going through that again come finals at the end of this term, so I'm studying now. Hopefully, as a result, around finals I'll feel a bit more prepared and the stress level will be a bit lower.

2. Finals are gonna be brutally hard.

While that should be reason enough to get my nose in the books, there's another reason. If there's any truth to what the third-year students say, my finals this year are going to be tough... much harder than last year.

That could be because for some of our units, the course directors have decided that providing us with lecture notes and lectures that cover all the topics that will be on the final are ineffective strategies for teaching physicians, and so we're expected to do a lot of reading from a variety of sources outside our lecture material. That's intimidating... as is generally the case with medicine, there's not enough time to learn everything, which means I can only hope that which I've learned is enough to get me through.

3. I don't want to fail and have to repeat second year!

In addition to those first two reasons, there's something else. There are a few people in my class this year who are repeating second year. Their reasons for doing this span a wide range - personal reasons, lots of stuff going on in their lives, MD/PhD students who are doing bits of the program at different times as their classmates, and not doing well enough academically last year.

Despite the fact that I don't know the individual reasons that these people are in my class, every time I see them around I think of the last reason. Yeah, it's hard to fail out of med school, and if I do fail a few courses I'll be able to repeat the year, but the third reason I'm getting my study on is because the last thing I want to be doing next year is repeating second year. Med school is a long time and I'm excited for the clinical part of medicine, which doesn't happen until next year. I would hate to be stuck in another year of PBL and our physician and society course.


The funny thing is, I'm sure this year will be a lot like last year in that it seems 90% of the class is scared of failing, but 99% of the class ends up passing. I think it's because we former pre-meds are used to undergrad exams, which we would routinely go into feeling like we knew all the material. Med school exams are scary because there's no way you will know all the material... and getting your 60% for a pass is much harder and requires much more knowledge and understanding than getting a 95% in undergrad.

There's a few people I've talked to that are afraid of third year. Rightly so - from all accounts 80-hour work weeks, being on call all the time, and having the stress of working with attending physicians, seeing patients, and trying to figure out where all the equipment is - let alone knowing how to use it - will be stressful enough. But I'm not even thinking about that yet. I just want to get through second year.

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By the way, Happy Thanksgiving, y'all. That's right, it's Thanksgiving weekend in Canada. (early holiday, our soaring currency, our pristine health care system...bet you want to move here now!) Seems like everybody is doing family stuff this weekend, but since school is so far from the family - and since the 'rents are coming out here in two weeks - I'll be going to a friend's house for the festive meal. He's a master in the kitchen and I'm looking forward to it.

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