Med School in Two Postings: Part 2

Let's see if I can successfully encapsulate med school in a few paragraphs. (If it's entertaining enough, I promise I'll write an entire other blog about it.)

First off, I can't say enough about the medical school at The University of Chicago. Yes, they'll get some donations when I'm done with residency. They have a lot of private money, and they gave me a lot so that I could attend.

The med school at U of C (called "Pritzker" after the just-slightly-less-richer-than-the-Hilton family) is an anomaly among the rest of the University: people there are happy. The U of C itself is an old gothic set of buildings in the war zone that is the southside of Chicago, always overcast. The undergrads are sullied and no fun, and they have this incredibly apparent inferiority complex to Northwestern, up the road about a dozen miles. The law school kids are overworked and exhausted, the B-school students are too quantitative to have a personality, and everyone else in the grad school is partaking their communion from their own triumvirate of Paxil, Prozac, and Zoloft.

But the med school was a happy place. Really. The anatomy lab had windows (not at ground level of course, but could you imagine how fun that would be?) and it was well-ventilated. IT WAS PASS/FAIL ALL FOUR YEARS. Class size was small, and they had an abundance of people who had taken time off before med school like myself. Everyone was interesting, and I loved my classmates. Educating each med student costs the university a lot of money, so they had zero interest in weeding anyone out. In fact, though it was a pass/fail system, we called it "pass/pass" or "pass now/pass later," since you can remediate anything at anytime.

So let me boil down four years:

Year 1: Learn how the body is supposed to work.

Anatomy, physiology, biochemistry, ethics, history-taking, you get the idea. Anatomy was a hoot. Pritzker is a private school, so we could afford to buy more dead bodies (what a weird statement to make, eh?); thus, there were 3 or 4 people assigned per cadaver as opposed to 8 as in some places.

I'll admit, it was freaky. The only dead body I had heretofore seen was my grandmother in her casket when I was 12. And even then there was a mildly humorous component to it because her best friend showed up to the viewing wearing the exact same dress as my dead grandmother. She didn't stay long.

So we as a class walked in together to the anatomy lab. There were 30 dead bodies there to greet us, but all in bodybags. We had to unwrap them like they were Christmas presents. ("Did you get a male or female?" "Can you tell how yours died? Mine has the back of his head missing, I think he blew his brains out.") It was actually a fairly horrific sight -- they all have their heads shaved, and their hands and feet are bound together like they were kidnapped homicide victims. They've been stored vertically in giant preservative tanks, so they have that wrinkly, waterlogged appearance of a drowning victim, and they all have that tale-tale giant roped knot sticking out of the side of the neck where their internal jugulars were punctured and drained.

What they say about murder and sex is also true of human cadaver dissection: the first time you do it is the hardest (but funnest?) and it gets easier and more boring afterwards. The first day, my hand was trembling when I pierced the sternal skin with a scalpel. By the end, my lab partner and I were skinning legs and talking about our respective weekends.

The most grotesque part about it, however, is the tri-section. The pelvis is a very difficult area to learn -- it's where the upper part of the body collapses into a small space and the lower part of the body takes off. Everything becomes a microscopic, coalescing mess, and then you add in the reproductive organs to take up more space. So how do you get around this three-dimensional quandary to see what's in there? You do this: take a regular old saw, put it at the navel, then saw back and forth, back and forth, until the top half of the body is separate from the bottom half. Then you take said saw, place it where the labia meet each other at the clitoral frenulum, then saw the legs away from each other. Now pull like a wishbone. Tah-dah! You now have a body in three parts. By this time, most schools will have been done with the entire top half of the body and you chuck it into a large bin on the side of your table.

Now, lest you think this is disrespectful, it actually kind of isn't. We had a solemn "thank you" ceremony at the end of the semester to dispose of the bodies and give the ashes to the families. As gross as it is, there doesn't seem to be any alternative to educate future doctors. It's also a rite of passage into med school in my humble opinion.


Year 2: Learn how the body can get fucked up.

Year two is devoted to what can go wrong -- you learn microbiology, immunology, and pathology among other things. This might have been my most interesting year in med school because you learn about all the diseases by way of organ systems. I had no idea that there were so many ways to screw up your liver and how that will screw the rest of you over. (Yet I still get holiday cards from the folks that produce Ketel One.)

However, we were required to attend a gross pathology conference. All 104 of us filed into a small Roman-esque auditorium as though we were about to witness the Christians vs. the Lions. And though that's not exactly what happened, it was still a slaughter.

On the slab in front of us was a man who died about six hours prior to us walking in the room. With fervor and aplomb, the pathologist took his scalpel and just started cutting away, trying to lecture all the while. This was a much different experience than gross anatomy in the first year -- the cadavers then hardly looked like people. This current guy looked like he was asleep! The bone saw came out, sternal cage removed, organs hacked away and weighed, the only thing missing to make it look like a feast was being prepared was a set of Ginsu knives. I turned white, then green. The pathologist yanked out the slippery liver, and all I could think was "that liver would go well with some fava beans and a nice chianti. Fifififififififififfffff."

But the worst part was the face. The pathologist made a large incision at the base of the skull and just pulled the face right off the skull. He sawed open the head, yanked out the brain with the spinal cord still attached (it whipped right out like it was trying to get away) and then he put the man's face back on!

So of all the medical specialties from which to choose, I crossed pathology off my list first.


Year 3: Taste the six major poisons

In year 3, you rotate in various numbers of weeks in the six major specialties of medicine: surgery, internal medicine, ob/gyn, pediatrics, family practice, and psychiatry. Rather than detail specific happenings during each rotation (another blog, another time), I'll describe the gist of the personality types to be found in each major specialty; and remember, these are very gross generalizations.

Surgery: assholes with God-complexes for the most part. They only get good at what they do through repitition, so it becomes almost reflexive vocational work. (If you're my surgeon reading this, just kidding!) The field is militaristic, residents are treated very VERY poorly and not only does shit flow downhill, it also begets more shit. It's a very stressful life because you're opening up someone's body and mucking around in there, but it's gratifying in that within hours, you've fixed a major problem that was really screwing that patient up. And patients seem to LOVE their surgeons. The exception to this rule is the orthopedic surgeons: they're always nice, funny and they know that they only know bones and that's it and that's all they want to know.

Medicine: this is where the smart people go. They have to know everything about every organ system, and it's the stepping stone to where even smarter people go, like cardiology, oncology, etc. They pontificate way too much and let the surgeons walk all over them. And they hate kids.

Pediatrics: it takes an extra special person to be a pediatrician -- you have to be patient beyond belief and act like a veterinarian because the kids hate you for what you do to them. And pediatricians have to suppress the murderous rage they have for the parents. You do get to wear funny ties and play with toys though.

Ob/Gyn: I don't even want to talk about it. PTSD.

Psychiatry: crazy themselves. They're just very patient people who are sometimes entertained by psychotics who remind them that they're still (barely) sane.

Family Medicine: I'm still not totally sure what this is. You do a little of everything: kids, adults, gynecology, obstetrics, even psychiatry, but nothing emergently. I think they just write a lot of referrals to specialists who may give them kickbacks.


Year 4: Pick your poison

Now you have to decide what you're going to be when you grow up. Some fields are so competitive, that if you didn't already know you were going to specialize in that field (and how could you without rotating through it?), you're behind the curve and need to take a year off to do research and more electives in that field. Such is the case with orthopedics, neurosurgery, urology, dermatology, ophthalmology, and radiology to some extent.

You spend most of the year preparing your applications and guess what? You're paying again -- just like when you were applying to med school to begin with -- to go on interviews all over the country. Most students (including myself) took out extra loans just to afford flights and hotels on both coasts.

And then you have The Match. Nothing strikes more fear into the hearts of upper-level med students than The Match. It goes like this: you interview at x number of hospitals, these hospitals will interview y number of candidates. You put a list together in rank order of where you want to go, and the hospitals rank their interviewees. It all goes into a central computer in Washington, D.C. and one day in March, every med student in the country at the exact same time (it's timed across all time zones, how sick is that?) receives an envelope with one and only one name of the hospital where they will spend the next few years of their lives.

That just sounds stressful, doesn't it? And it brings out the worst in people. Everyone's OCD acts up and you catch them doing weird rituals to make sure they get one of their top 3 choices. In one day, you find out if you're living on the east coast, west coast, no coast, or -- eek -- that you didn't match anywhere at ALL, every student's nightmare. And it happens, especially in the competitive fields. These students have the option of taking a year off and trying again, or switching into another specialty that hasn't filled its training spots.

This is making law and business school look a lot better, no?

Fortunately, the large majority of students will end up in a program within their top five choices, and then the REAL fun of residency begins. Regular life comes to an abrupt end overnight -- your time is not your own, you lose friends, you lose money, you can do about 5% of the social things you want to do, and that includes holidays and special occasions like weddings and birthing a child. You might gain weight, you might lose weight, but you'll certainly get more grey hair if you have any hair left. Your friends from undergrad who went to law or business school will call you up and say, "hey, we're going to Aspen this weekend, want to join us?" And you'll say, "I have less than 10 bucks in my bank account and I'm on call anyway, so no thanks." Yet somehow, the vast majority of residents say they would do it all over again and still pick that same residency.

So how did I end up choosing emergency medicine for my residency and career? That'll be the next post.