This is part of my ongoing summer project: Stumbling Through First Year
I assumed that each little piece of information I picked up during my medical education at NCNM would be another little tool in my tool belt. Every time I learned something, I would be able to apply it to a medical context. Slowly, I’d accumulate enough knowledge to transform into a doctor. This doesn’t seem to be how it works.
On many occasions, I’ve heard that medical students are dangerous. As a seasoned, soon-to-be second year medical student, I can confidently agree. Each fact is not another tool in my tool belt. It’s more like each fact is another leak in my roof and I’m frantically trying to find buckets to capture all the water. I’m beginning to think that being a doctor is not necessarily about having the most facts, but having the most buckets.
A significant portion of my first year was spent passively listening and learning, collecting facts. I correctly answered so many multiple-choice questions that, a few times, I was almost convinced that I knew something. My delusion was regularly washed away by a class called ‘Basic Science Clinical Correlate’.
It’s definitely one of the easier courses of first year. As far as I can tell, it’s main purpose was simply to remind me that I’m dangerous and have no idea what I’m doing. We would read through a real life case study from a medical journal, and in the following class, each student would give a presentation on a certain aspect of the case.
For me, the presentation was the easy, stress-free part of the course. It was reading the case studies that ended up being the real learning experience. Each student took turns reading out loud to the rest of class. The cases were filled with every potential acronym and piece of impossible-to-pronounce medical jargon available.
Most of the professor’s time was spent correcting the group of normally articulate students who, when faced with this new and complicated medical jargon, had forgotten how to read entirely. No one was immune to this sudden inability to control the English language. It was commonplace to hear the professor say something like, “It’s pronounced ‘vagina’ not ‘VAJ-ena’.”
I got comfortable learning how to pronounce all the medical terms. It’s way better to screw it up here than to mispronounce something to a patient or medical professional. My fear and doubt came when the professor would interject with little questions.
The correct diagnosis was given at the end of the case, but the professor would often stop us at certain points to ask our thoughts. “What do these symptoms tell us? What would be included in your differential diagnosis? What do you think is going on here?” This is when I would sit as quietly and still as possible, like I was hiding from a tyrannosaurus rex.
I always had ideas, but my doubts were stronger. As the year went on, my ideas got jealous. As I learned more, they became more difficult to suppress. They fought harder and harder to come out. At first, when I heard a question, the ideas were only strong enough to give me a muscle twitch. They’d knock my pen on the floor, or make my face contort like I was about to sneeze, but they were never stronger than my doubts.
I was able to suppress them until one of the final cases of the year, when I heard the words “granuloma” and “lung” in one of the professor’s questions. I felt the idea spring to life. It started in my legs, they shook. It pushed my doubts aside and made it’s way to my chest. I held it there as tightly as I could, but it got up to my throat and with one final burst of energy, shot out.
“IS IT TUBERCULOSIS!” The words sounded like they came out of an amplified Speak and Spell waking suddenly from a nightmare. It was shaped like a question, and it was supposed to be a question, but it lacked the normal tonal inflection that most humans use when asking a question. My hands were shaking. I was breathing heavy. My heart pounding.
“No. Can anyone tell me how we know it’s not TB?” A student quickly answered, “Because the granulomas are non-caseating.”
Oh, right. A classic sign of TB is caseating granulomas, not non-caseating. I knew that. My heart slowed down, hands relaxed, breathing normalized and the class continued on. I didn’t feel stupid. I wasn’t judged. The only thing that happened was the connection of TB and caseating granulomas being permanently etched in my head. I’ll never make that mistake again.
As much as I hate being wrong, this was a solid reminder that being wrong can be the best teacher. Submitting to my constant doubts doesn’t stop the doubts, it stops the ideas. I’ll make sure to give my ideas the upper hand during second year. And by the way, it was sarcoidosis. I was way off.