“During my initial years as a graduate student, I certainly didn’t enjoy an unshakable sense that I had found my true calling. The beginning of doctoral training can be rough.”
So goes a recent article I read on my friend’s Facebook wall. I felt guilty for going online two days before my psychiatry exam, but I’m glad I read it.
I always tell people the story of how I got into medical school. How I was going to be an engineer all my life (a computer one, I discovered in JC) and then in the military, my vocation allowed me to immerse myself in the medical profession and it occurred to me that perhaps, “medicine is just a different kind of engineering”. That line sure impressed the interview panel and I did get in. Though, that seemed like a misunderstanding in the first two years, where they load you up with the “basic sciences” before they let you loose onto patients in the hospital.
In the first two years, nothing made sense (well, almost). It was literally Greek to me and my professor’s repeated insistence that “see, you don’t need to memorise, you just need to understand!” came across as nothing short of a lie. It isn’t downright wrong, I have realised, but you need to figure out a coherent way of reminding yourself of what you have understood. I started out at the bottom of class and somehow managed to make my way to a more acceptable, above average. I also realised that the trick really was to understand, and once you a) understand a bit of Greek and Latin and b) try to make sense of things, it a lot more fun to learn.
In my second year, it got worse in a sense. There was a crap load more content, tutors went on and on and on explaining how the immune system works, when they could have simply said, this works by a darwinian algorithm with a positive feedback loop that amplifies the appropriate signal. You can see how much geekiness that statement is loaded with. All this while, I had this sickening feeling that I was in the wrong place, everyone was better than me and that inauspicious amount (according to the Chinese) on my government bond which had a lot of fours in it, was a bad omen and I should go back to the familiar field of computers.
I have a lot less self-doubt these days. We do rotations in various hospital departments and if you draw a chart, it starts off at a medium height, then peaks much higher a few weeks into the posting when you realise the sheer scope of your ignorance. Slowly, as the exam comes closer and you’ve had more time to make sense of the subject matter, it takes a slight dip (or rise, depending on how well prepared you are). It then, at least during the exam, stabilises to a lower level.
Over time, I have come to accept some amount of self doubt as necessary for being rational and for the sake of progress. I think 100% confidence is something that generally does not exist in the sciences and although I can accept that we can assume certainty in a practical sense, we can never be 100% sure about anything and pretending to be that is either inaccurate, stupid or downright dangerous. Doubt is an interal part of the reasoning process an although you never get rid of it, I enjoy the practise of wrestling with it to come up with a final answer. As and extension of this, I have always tried to cultivate a healthy skepticism about what I’m being taught in school (one of my mentors drove this point home really well) and have tried to understand the limits of my abilities. The field of medicine has a history of falling prey to erroneous idea, but we take pride in being open to correction and improvement.
Early on, a couple of things were important in keeping me going. I realised that I came from a unique background and had a unique viewpoint which no one else had. I think I’m the only guy in class who asked “if you use Valium to treat alcohol dependence, can you use alcohol to treat Valium dependence?” That probably stunned the tutor for a minute. She probably thinks I’m a retard for asking that question, but I don’t care.
I had some really cool friends. My BFF and I would have these random speculations in class, it keeps us awake. I would say evolution, he would say design. I had these two friends in the hostel who really helped me study and understand stuff (yes idiots, I’m talking about you). We would stick to a particular accent during an evening of studying, which resembled drunk Greeks arguing rather than medics. Our exams ended later than everyone else’s so the other students in the hostel would mockingly ask us if we were studying for the next semester.
We got taught by some awesome tutors who had these vastly different personalities. This really convinced me that, because Medicine was such a big field, I could either find a nice spot where I fit in, or create one, or better still, I don’t have to fit in and that can be a strength.
Yet, one of the biggest lessons was when I was talking to my classmate in the lift one day. S/he was someone who’s at the top of his/her game. I cannot remember how the conversation went, but s/he just blurted out that s/he was worried about whether s/he was in the right place, doing the right subject and if s/he could cope. I’m confident that there are people who are sure, who, have wanted to be doctors all their lives, but I doubt these are the majority. You barely know what you are doing when you are 18, and I got lucky, even at 20, to say that I’ve made the right choice.
I have come to understand that this is the cooolest thing I could ever be doing. I’ve seen birth and death, in the same night, almost. I am looking forward to delivering babies in a few weeks. I’ve had my hands inside someone, while they were still alive. Probably saved a couple of lives already. Got bitten by a patient. Played cards with another group. Spoke to recovering drug addicts and people who were in the midst of a suicide act when they were rescued. Listened to a hundred hearts. Seen someone’s heart and breathing stop (in preparation for surgery). We had a tutorial where we discussed how to deal with a patient who feels his life being messed up “is God’s Will”. We spent an entire day talking about marijuana, booze, ecstasy, heroin. We talked about Dragons*, Angels, Pink Elephants and miniature humans running around in the wards. Next time I complain about how I can’t go partying with you, do remind me what a heck of a time I’m having.
Self doubt can be scary for some students who have had straight As since as long as they can remember. They get thrown into an uncertain, unforgiving environment, where things are not exactly black and white anymore. It’s uncomfortable, but I think that’s what makes medical school fun. I’m glad to have all these amazing classmates and I’m sure they’ll turn out fine 🙂
*Chasing the Dragon is a Euphemism for smoking heroin. Pink Elephants and Lilliputian hallucinations is what some alcohol addicts might report when they are going into withdrawal. Angel dust is a street name for a drug called PCP.