I'm in hell.
No, not literally, but a personal hell. This class, Pathology, is basically for all the marbles. It's a culmination of all the prep we've gone through taking other courses. It's a majority of Step I, it's medicine. It's difficult to say the least. Conceptually it can be difficult but more than that the volume in the amount of time we're given is whats really difficult. It's like getting a month's worth of an undergrad course dumped on you weekly, and thats a conservative estimate. The number of days I've woken up and become depressed over the amount I have to accomplish that day and how much I didn't accomplish the previous day are far too many. I miss my family, I miss my girlfriend, I miss my friends, I miss New York City. In fleeting and weak moments I miss the life I had before, a job I was good at, money, and time. Those moments pass and I realize how much better what I'm working towards will be, still I think like that on occasion.
Despite all this I'm still in awe. I'm still shocked at the amount I've learned this term so far and how quickly my thought processes are evolving. My ability to look at a person with an illness and to understand what the signs of the illness mean has gone from nil to something. It's not much in comparison to an actual doctor but it's something. The vocabulary and syntax of the language of medicine is filling my head and I'm beginning to understand it, barely, but one must crawl before they can walk.
It's a catch 22, which oddly enough is the name of my Pathology lab group. You love what you learn and what you're becoming, you hate the process. None of this is special or unique though, it's called growing up and even people who don't become doctors can understand that very feeling.
There are other effects this is all having on me though and I've really noticed them more lately than before. I was always told I'm a weird mix of a person. Very mature for my age yet totally immature. I understand a lot of things from the perspective of a cynical old man which stems from some of my experiences and my upbringing yet at many times I'm impulsive, brash, direct, and childish. It all depends on the day and mood I guess. Each side of that spectrum has been amplified though, as a result of stress I suspect. I'm not sure if having this mix is good. I like to think it is, I like to think you need to have both to stop from becoming too much of one or the other. Though the only one it really matters to is me and those I care about. I know there are many people who don't know me very well who observe me on any given day and make a snap judgement one way or another and one of the biggest changes I've gone through since coming here is this: I used to care about that to an extent (A lot less than most though) and now I simply don't care. When I have to be professional and political of course I can put on a game face and no can tell who I am or what I'm thinking one way or another, I had to do that a lot when I was in undergrad and working and became very good at it.
That's my Dad in me, that's his genetics and teachings. "Never let them know what you're thinking or what you know, because when it matters you can surprise them all and that is the best advantage of all. Surprise." Thats along the lines of what he always told me. That and when it came to friends, never lie. When it comes to business, be honest to those who deserve it and can be trusted. Everyone else can turn out to be an enemy at any moment and you need to make sure they're never aware of your capabilities. Some will say that to lie and manipulate under any circumstances is wrong, these people have a very black and white view of a very gray world.
For the most part though, in general conversation and around those of little consequence to me I'm simply who I am and I make no apologies for it. For the first time in my life I've actually become comfortable in my own skin and proud of who I am. My accomplishments thus far while small in size and meaning are mine and mean the world to me because each one taught me a valuable lesson thats has helped me to survive here. Some people I know from home who are thinking of medical school are reading this, and if they're curious what these lessons are:
Work hard, and after that, try to work harder.
Relax, because if you burn out you're useless. Take time for yourself.
Plan for the worst, hope for the best.
If you say you're going to fight, then fight and put your all into it. Don't half ass things and don;t say things you have no intention of doing just to say them and sound intimidating. The way it was put to me from a young age was when my father tried to teach me that carrying a gun wasn't what made him brave or a man:
"Anyone can have a gun. Having gun isn't what determines if I'm going to live or die. It's my willingness to use it. If you pull a gun on someone in a fight because you think it'll scare them away and then they pull their own, it comes down to whose more willing to go past the line and pull that trigger. The slightest bit of doubt, hesitation, you could be dead because the other guy might not have hesitated. In other words, don't hesitate when it matters. Know what you have to do, know what you're capable of, and take the action. If you don't, someone else will."
Rely on others, find some people you trust and when you need to don't be ashamed to lean on them. You can be the strongest man in the world but alone you are useless. Friends and family are what makes life worth living and what keep you balanced. If you have a good set, when you fall they will catch you. Mine have caught me many times, and to all of you reading this who have I am forever in debt to you and I can only hope I do the same for you. You know who you are.
Plan for the future, but worry about today. Plans will change, whats happening right now can't.
Don't go nuts about being the best. A's are wonderful and should be the goal but if you fall short don't hate yourself for it. Grades are not the sole indicator of who you are and how good you will be at something. Don't just get by either of course, just do your best and accept what you get. You have nothing to prove to anyone other than yourself and when you get to the end of medical school, residency, your career, life in general you won't care. Being the winner of the race is great but this race is so long and difficult that simply finishing it is a feat of great proportions. It's something to be proud of. I have a lot more to say about this topic in particular but some of it might be offensive, and so I'll refrain.
Doing the right thing is the hardest thing of all, but most often the most rewarding. Right and wrong are never clear though. I was rebel when it came to many things before coming here and even here to some extent. There's nothing wrong with that, just make sure you know your own right from wrong and are prepared to take the judgement of others whose differ. To quote one of my favorite songs "I don't know much but I do know this, with a golden heart comes a rebel fist." If you know it's right but those around you disagree, then fight for it at all costs and never betray yourself when it really matters. This is not something thats very big in the school aspect of medicine but it's been my experience and the experience I know who have done it for a long time that this is what truly separates a good doctor from a great one. There are those that do as they're told and there are those who will break the rules when they know in the heart of hearts it's the right thing to do. These are the trailblazers, the people who are ridiculed by their peers who blindly follow convention without questioning it and they take it because when the day is over they know what they did was right and maybe someone who would have died didn't. My father was a rebel in everything he did and he became known as the best in each field because he of it. It was hard in the beginning, but as time goes on and people see the results of your way of doing it, they respect you for having the courage to break the mold. I aspire to one day be able to do that.
Finally and most importantly:
KEEP PERSPECTIVE
Whenever it gets to be too much and you're overwhelmed just step back. Look at it from afar. Look at the big picture, the mosaic that is your life. The small piece you're focused on, is it that bad? Will it matter that much in comparison to the rest? Are the people around you in the same position? In medical school there will always be someone smarter than you, someone dumber than you, and someone right with you. Someone will always know more about one thing than you do, but you may know a lot more than they do about another topic. Never let things like this shake you. Just look around and realize a majority if not all of the people around you are just as scared and behind as you. You're never alone.
This went on longer than I expected it to but I needed to take a break and as I said in the beginning, I needed to get this down. I want to be able to re-read this later on and understand what I was thinking at that moment in time as well as possible. I want to be able to see how much I've grown, regressed, learned or forgotten.
The title of this post is a quote from Churchill which I find very apt for the place and time I'm in now. I'm not sure if he said this after that, but I figure it means that you have to keep going because when you're in hell the only way to get out of it is to get through it. The minute you stop pushing through it is the minute you get stuck there.
So just keep pushing, keep going.
