It is past 2 a.m. and I spent the better part of 12 hours studying today. I am a medical student. I am writing this to offer a perspective, even at this hour. Recently, I have been asked how I am doing, and I am grateful for the undoubtedly well-intentioned question. But it is a difficult question to answer, sometimes changing drastically by the day. Since medical school started a month ago, I have learned that nothing can predict the quality of your day except perhaps the quality of the lectures you watch at double-speed each evening as you study incessantly.
From the outside, it is impossible to imagine a reality in which your life revolves completely around studying. Explaining it would be akin to explaining the distance between Earth and Pluto; it is not only difficult to explain but nearly impossible to imagine. Sadly, medical students are misunderstood on a fundamental level, in a manner that arguably cannot be reconciled by those outside the medical system.
Undoubtedly this sounds melodramatic, and you are probably thinking: “this must be an exaggeration. How bad could it really be? I had to study a lot during undergraduate and graduate school too.” I certainly would not fault anyone for such thoughts, but it also compels me to elaborate on my point. In doing so, my desire is not to undermine anyone else’s viewpoint, but instead to describe my own. So here it is: someone outside the culture of medicine is not capable of understanding what medical students endure on a daily basis. Working the brain at such high capacity near-endlessly every day creates a level of exhaustion that is hard to describe, but I would like to make an attempt at doing so.
Think about the things that you dislike doing. Assemble a mental list of the most annoying, cumbersome and inconvenient tasks that speckle your daily regimen. The tasks may involve an aspect of your job, cleaning, doing laundry…the options are virtually limitless. Since medical school began, the tasks on my own list, which I once so fervently avoided, have become my main source of enjoyment. The activities I once viewed as hurdles, like exercising and washing dishes, have become the high points of my days.
Based on this, you might infer that my life has become completely miserable, but that is not quite accurate. It would be more correct to say that my life has become extremely monotonous. Every day, I spend six hours in classes. Then I go home and I spend eight hours studying. The time spent studying in one single day equates to — and probably exceeds — the time spent studying over a period of several weeks in college, with the same material covered in a pitiful handful of hours. Nothing can prepare students for the sheer volume of information with which we are presented regularly or the utter mental exhaustion that seeps in every night.
Imagine, then, that you now look forward to your former miseries. You wake up early and spend half your day focusing on extremely dense, confusing lectures. The moment you get home, you immediately start studying because you do not want to get behind. Let me rephrase: you cannot get behind, because if you do, you could not possibly dream of catching up. You would have to simply omit a section from your learning, and the more you omit, the higher the odds grow that you will not pass your exam.
The running joke among classmates is “C’s get degrees,” but you have lost all confidence in your ability to get a “C.” You look forward to the weekends only because you can catch up on everything you could not study during regular business hours. You realize that you know nothing about most of your medical school friends because all you ever talk about is school. On the other hand, you have nothing to talk about to your older friends either, because they cannot possibly understand the joy you felt when you finally understood PFK1’s regulation of glycolytic flux through PFK2 and insulin. If that sentence flew completely over your head, then you have experienced how students often feel during lectures. You eventually realize that you just are not sure what to talk about to either old friends or new ones.
If you decide to take some restorative time for yourself, you will quickly discover that no activity exists that will allow you to ignore your recently acquired, but very compelling, Medical School Conscience (MSC). The MSC is just one of many acronymic evils in medical school that will haunt you as you confront an endless onslaught of capital letters you must commit to memory.
When you finally take your first exam, it will be perhaps the single most demoralizing event of your life. Countless hours spent studying will feel like an utter waste as you stare at the questions, unable to decipher most of the convoluted words and phrases. You will wonder how you could possibly know so little when you worked so hard. Your MSC will pervasively send you into a mid-exam panic, whispering in your head: “you can’t pass this, and you can’t become a doctor if you can’t pass.“ But somehow you will scrape by, afford yourself a moment to sob with relief, and then, unthinkable as it is, restart the process to prepare for your next exam.
That tiny, nagging voice in the back of your head, the MSC — which has somehow become the prevailing voice of reason in your thoughts after just one month — never goes away, even when you try to do something you enjoy. If you must get up at night to use the bathroom, chances are high that the first thought the MSC will grace you with while urinating is essential fructosuria, and that the next thoughts in line are: “I have to get through five lectures today to catch up. That is about eight hours of work. Do I have any homework due today? When am I going to study those clinical correlates? When am I going to the anatomy lab?“
And then the ever-present MSC will ignite an unwelcome spark of panic, mid-stream, in the pit of your stomach as you question whether it is possible to get through all your work that day. If you get too behind, it tells you: “you won’t pass your exams.“ Then your heart will pound, and you will try to calm yourself so you can sleep. When sleep is not forthcoming in light of all your unfinished work, you will resolve to make sacrifices for a few days. You convince yourself it is a fair trade and that you can skip out on sleep, food and exercise for just a little while. But you do not know that those days will become weeks and months and that you will eventually lose a part of yourself. You will someday realize after it becomes irretrievable, that this part, small as it may have seemed at the time, was what you were bartering away all along. Inevitably, you will wonder whether the loss was worth it.
Motivation may become sparse, but the ultimate motivator, the fear of failure, will be ever-present. This fear looms over the head of every single medical student. We are all driven. We despise the idea of failure. Our entire lives, we have been confident that we would not fail, because we have always felt absolutely assured that the right amount of effort would see us through any task. Moreover, we have known with unshakeable certainty that we were capable of producing the right amount of effort for the task, effort that would allow us to scale any mountain.
As new medical students though, our certainty fails us. Medical school is Mount Everest, and we are inexperienced climbers. We are filled with doubt every day — nearly every waking moment and even when we dream. We look around the room when we are confused, wondering if our neighbors feel the same way or if they sense the shadow of the mountain threatening to crush us. We waste precious time fearing that we will not make the cut, fearing that we are inadequate and fearing that we are the mistake in a lecture hall full of people.
Words cannot erase the stress of medical school, but still, some words can help maintain perspective. Always believe that you can rely on your driven nature as a fallback in the face of struggle and never lose sight of why you are here. Sooner than you think, you will deliver a baby into a sobbing mother’s arms, suture a wound on a terrified child, scrub in to assist with surgeries and help your patients through their scariest moments. When failure looms menacingly, recall that you are one of a precious few who will have these experiences during their lifetime. Lastly, and probably most importantly, learn to ignore your MSC and enjoy yourself once in a while.
This piece was inspired by my experiences during my first year of medical school, where I struggled immensely and even failed my first exam. I also observed the struggles of many of my classmates. This essay was written as an homage to students for overcoming the challenges medical school presents early on.