After I dumped out all the boxes I got a shot from above to show the mass, but there was no perspective, and it doesn’t look all that impressive.

So I stacked it up next to the biggest textbook I could find, Robbins & Cotran Pathologic Basis of Disease, which is a massive tome that stands ~11 inches tall and weighs about 7 pounds.

As you can plainly see, my mound of flashcards dwarfs Robbins in every dimension.  This is two years worth of med school.

I spent about thirty minutes removing all the binder clips, paperclips, and rubber bands from all my piles of flashcards.

And in the end, it all winds up in the garbage.  Oh well, I won’t be sorry to see it all go.  My study room is far less cluttered now.

Tomorrow I begin my preparation for Step 1.

Pathology–Path was a course that I expected to really like.  I thought I would learn a lot about how diseases affect the body.  Since I have always been interested in disease processes–for instance, in undergrad classes, I was always way more interested in clinical correlations that taught about how the basic sciences we were learning affected human health than by the actual science itself–I figured that I would really enjoy path.  The reality of Pathology class, however, is that you spend about 20% of your time learning about disease processes and the remaining 80% memorizing what Pathology tissue slides look like.  This aspect of the class is basically tantamount to learning how to differentiate between a thousand different kinds of cancer under the microscope, and if you’re not interested in going into Pathology as a career, it doesn’t feel terribly useful.  So, in this regard, the course is basically the beefed up, angry, diseased, sequel to Histology class (which I did not enjoy.)  Nonetheless, that 20% where we actually learned about disease processes was really interesting to me, and I think path might have been my favorite class.

Pharmacology–I was a Chemistry major in undergrad, and so I had a feeling that Pharm would end up being one of my best and most enjoyable classes.  Despite the fact that there were hundreds of drugs to memorize and it could be quite difficult to keep everything straight, the class was, for the most part, straightforward.  So long as you are able to memorize tons of information (as with everything else in med school), this class is not terribly difficult, conceptually speaking.  In many ways it Pharmacology is just applied physiology–if you understand Physiology, Pharmacology shouldn’t be terribly difficult as long as you can keep all the drugs straight.

Microbiology–This was one class that I expected to like, but ended up being a little disappointed in.  I have always been interested in infectious diseases, so I figured that Microbiology would be right up my alley.  However, it turned out that I don’t really care about the virulence factors for bacteria as much as is required to really enjoy this class.  While I think it’s obviously necessary to know all the bugs that cause common illnesses, I found it terribly boring to have to memorize dozens of protein names like M protein, Streptolysin, and Leukocidin, when knowing full well that knowing these protein names will likely not affect the way I practice medicine in the future.  Nontheless, this is the type of thing you have to put up with in med school: learning stuff because it’s there to be learned.  I’m not trying to complain, however, because overall I did enjoy the class more than most of the others.

Behavioral Sciences–I had anticipated that I would enjoy this class.  And to be honest, it was nice to not have 1000 things to memorize every week, as is the case in Path, Pharm, and Micro, but Behavioral Science ended up being a lot less interesting to me than I had anticipated.  Maybe it’s because I felt like it was largely rehashing a lot of stuff I learned a long time ago–I took AP Psychology in high school, and I’d say that there was about a good 50%-70% overlap between that and Behavioral Sciences–but I found the class rather uninteresting most of the time.  I suppose if you’ve never learned about people with Schizophrenia or Bipolar Disorder and all that stuff before, Behavioral Sciences could be very interesting.  I’ve known about it for a long time, so the course felt like old news to me.

Genetics–If you’re like me and you hate memorizing useless trivia, you’ll hate Genetics about as much as I did.  One’s brain can only retain so many chromosomal translocations and gene names before he or she becomes engulfed rage and bloodlust for the sadistic professors who are making him learn the pointless material.

ICM-2–So, this class suffered a lot from poorly written exam questions and a lot of disorganization at my school, so I pretty much hated everything about it except for my preceptorship where I had the opportunity to work closely with an attending physician in the department of Internal Medicine.  That whole experience was great, but it only constituted a very small fraction of the actual class.  Otherwise, ICM is a bit of a misnomer, as there is very little “clinical” about Intro to Clinical Medicine.  A more correct name would be “Intro to the Theoretical Practice of Medicine Wherein You Consider Overly-Simplified Medical Situations and are Judged Harshly and Very Subjectively by Your Superiors, Who Likely Despise You,” AKA “ITPMWYCOSMSJHVSYSWLDY.”  Come to think of it, ICM does roll of the tongue a bit better.

Ethics–Wow, I was really, really wrong about this class.  I thought it would be thought provoking.  With a few exceptions, it was just a giant waste of time, considering that it was the only class that had mandatory attendance all year long.  There’s nothing more sadistic than taking ~150 people who are all stressed and in need of studying, and forcing them to congregate in a room two days before a giant test to listen to a lecture on the ethics of intersexual gender identity from a guy who is so boring he actually yawns at his own lecture.

Overall–The second year of medical school has a bad reputation for being difficult.  And I feel the reputation is well-earned.  I remember at the end of the first year, someone told me that second year was going to be even more difficult than first year was.  I thought they had to be crazy or just plain wrong.  I mean, the first year had Gross Anatomy, which is hard, and obnoxious as hell–surely second year had nothing that could be so bad.

And that is true.  Sort of.

No single class in second year is actually all that bad.  It’s the sum of all the classes combined that makes it so difficult.  The classes come at you so fast, and throw so much information at you all at once that it is very easy to get overwhelmed.  I witnessed several of my classmates who excelled during first year having a difficult time keeping up with the grueling pace of second year.  Second year is tough.  I’m glad it’s over.  But on the upside, it was, to me at least, infinitely more interesting than first year.  While first year was basically just a bunch of science classes telling you about the human body, second year is when you start knowing doctor-like things.

I’m still a long way from being a competent physician, but I know so much more about it now than I did a year ago.  I can thank second year for that.  I remember volunteering at a free clinic last year and knowing essentially nothing about how to treat a common disease like gout or hypertension.  The physician I was working with just looked at me like “why are you even here?”  I felt useless.  Flash forward to a year later–now when I volunteer there, I get mistaken for someone who actually knows what they’re doing.  It’s a big difference, and it wouldn’t have been possible without the difficulties of second year.

Second year is a lot of work, but in the end, there is a reward.  During second year, you work hard to convert information on a page into knowledge that you own.  The reward is that in third year, you can finally use all that knowledge you spent so long learning.  To some people, that may not sound like much of a reward, but to me, well, I’m actually quite excited to put my knowledge to use.

Up next, Step One.  More to come on that shortly.

Reviewing pathology yesterday, I had one of those moments where I panicked and thought there was no way I could retain all the information.  The thing about Path that makes it difficult for me is all the little details that must be remembered.  If you want to pass the class, it’s enough to remember that Burkitt’s Lymphoma is a form of lymphoma that commonly invades the jaw or the ileo-cecal area.  If you want to do well in the class, you have to also remember that it’s associated with c-myc translocation which puts it next to the IGH gene.  The most common translocation is t(8;14)(q24;q32).  You’d be well advised to also remember the lesser translocations if you can.  (I can’t.)  Finally, you also have to remember that the endemic and sporadic forms are associated with the Epstein-Barr virus, whereas the immunodeficiency form is associated with HIV.  If it were just one disease process that you had to worry about, it wouldn’t be that tough.  But there are hundreds of diseases to be familiar with.  For some reason, I am actually really good at understanding how diseases work from a systemic perspective, and I usually have no trouble remembering what a disease does.  Where I have trouble is remembering the tons of genetic minutiae to be memorized, the never-ending supply of trivia that goes with each disease.

Long story short, I had a “firehose” moment yesterday.  They always say med school is like drinking from a firehose.  I always thought that was an exaggeration, but I definitely felt that way yesterday.  Perhaps, then, it’s no surprise that when I woke up this morning, one of the first things I thought about was this video clip from the old but great UHF.

“Yes, I have three children,” she said. Before I could even ask my follow-up question, she answered it for me, “three live births, and 36 abortions.” As much as I tried to keep a straight face, I’m sure my eyes lit up like a slot machine that has just hit a jackpot.  ”Okay…” I said, not knowing how to appropriately respond to such a statement.  It’s not my place to judge, and after all, this woman, who had obviously had a rough life from what I gathered in other parts of her history, had been judged enough as it was.  But at the same time, it’s very difficult to not react to something as out of the ordinary as her claims of 36 abortions were.  But she was, for the moment, my patient, and it was my job to ask her questions and figure out what was wrong with her.  Judging her past decisions would not serve to achieve that goal, and if anything, would only undermine it.

When I later presented her case to my attending, he had a similar reaction as me.  ”36?  That’s a new record for me,” he said.

In other news, man, the anxiety is killing me right now.  I woke up super early with an anxiety dream that ranks up there in its intensity and vividness with a dream I had last year that led me to (mis)diagnose myself with pheochromocytoma.  The dream was really bizarre and doesn’t really make much sense, but it involved my loved ones leaving me to (more or less) live with skanky rednecks and work in the sex trade.  There was also another, unrelated dream where I had voluminous diarrhea for an extended period of time, not unlike the toilet scene in Dumb and Dumber. I’m going to attribute that to reviewing E. coli, Salmonella, and Shigella right before bed last night.

So yeah, obviously the stress is getting to me and messing with my head a little bit, but it’s nothing I can’t handle.  While the stress of finals this year is pretty intense, it still can’t compete with the stress I had last year when my family was pretty much falling apart around me as I was transitioning into med school, so I really can’t complain.  I mean, if the most stressful my life gets is spending most of the day with my face buried in Harpavat’s Microcards and First Aid, then I should consider myself lucky!  On that note, I had my first NBME final recently and let me just say that of all the review materials I looked at, I was amazed at how spot on First Aid was.  While First Aid isn’t as in-depth as other review sources, everything I saw on my Pharmacology NBME was in First Aid.  It might have been the first NBME I’ve ever taken where I felt like I had seen everything on the exam.  That’s not to say that I was fluent in 100% of the information, but I wasn’t surprised by anything.  I’m definitely going to incorporate First Aid into my studying for the rest of my NBMEs.

But not for me.  I had my time in the library, the overnights packed in with my classmates.  Those nights often seemed a little more like social time and less like study time.  So I have retreated to the quiet solitude of my house, studying in a dirty little room cluttered with textbooks, review books, and a mountain of flash cards.  It gets lonely studying by yourself for 12 or 14 hour stretches at a time, but in the end I hope it will all be worth it when my grades reflect all the hard work I’ve put in.

So we’ve completed our coursework for the year.  It’s now time to take our finals.  Our finals consist of standardized national exams that not only allow us to measure ourselves against the other medical students in the country, but also allow our school to compare itself to other schools.  Sometimes this comparison is favorable.  Other times, not so much.  Additionally, these standardized exams allow us a good chunk of time to review for the next big hurdle in our training, USMLE STEP ONE.  But I’m not worried about Step 1 today.  Today I’m only worried about reviewing all the pharmacology, microbiology, pathology, behavioral sciences, and ICM that I’ve learned since the beginning of the school year.  Piece of cake, right?

The stress of finals is unreal.  My grade in every single class depends on my performance in these weeks.  If I get sick, if a tragedy befalls my family, if I simply fail to prepare well enough, my grades will undoubtedly fall from good to lackluster.  If, on the other hand, I manage to stay motivated and prepare as hard as I know I need to, if I can maintain my positive outlook, and if I can set aside all the multitude of temptations (I’m looking at you, PS3 and reddit.com) that beckon me with their sweet promise of momentary distraction from the dull texts like Goljan’s Rapid Review of Pathology and First Aid for the USMLE Step 1, then I might actually manage to finish this year proud of my achievements.

For now, I will just keep on keepin’ on.  I have many hours of studying left before I’m “done,” though as soon as I’m “done,” I will have another set of obstacles to overcome.

Step 1 is just around the corner.

But still, for now…

I know I sound dark and dreary, but I’m actually optimistic.  I only have one block left, and then I’m done with classes for second year.  And while I’ve never been the type of person to wish my short time on Earth to speed by any faster than it already does, I am very excited to be done with second year and begin third year.

On a side note, we recently completed our endocrine block.  Every disease is hyper-this and hypo-that.  I couldn’t help but be reminded of this classic skit from SNL while studying for this block.

Let me set the scene for you.  After making something like 1200 flashcards, and trying to learn more information than can possibly stay in my brain, I was understandably stressed out.  I spent much of last week walking around so tightly wound that if someone walked up behind me and tapped me on the shoulder without warning me first, I probably would have shrieked in terror, spun around, and punched them in the face.  I’m not bragging here–just trying to explain how uptight I was from the stress of the looming exam.

So, as if the stress of the test wasn’t bad enough, they added another highly stressful event to the mix.  This so-called “Professionalism Clinic.”  The basic premise behind the professionalism clinic was that we will be expected to retain our composure in even the most stressful situations, and in order to prepare us for such situations, they would test us on them ahead of time.

The scenarios in our professionalism clinic included “Angry Patient,” who was, as the name implied, an angry old man who immediately started yelling at me the second I walked in the door, and “Sad Patient,” whose name was slightly misleading, because she wasn’t really sad until I told her she had cancer.  Now, the patients were not patients at all, but actors, as you might expect, and the scenarios were obviously contrived.  Once I actually got into the room, it was fairly easy to deal with the pressure of being yelled at or comforting the sad lady with breast cancer.

But the real stress of this event wasn’t encountered in the clinic.  No.  It was encountered in the days leading up to the event, just knowing I was going to have to go to this stupid clinic and get yelled at.  By a fake patient.  For NO REAL REASON.  I still get angry just thinking about it.  I understand what the course planner for ICM was thinking.  Something along the lines of: “medical school and the medical profession is a stressful, so we’ll prepare the students for that stress now.”  Well, I don’t think they succeeded in preparing us for anything.  They just allowed us to walk around with added stress before an exam.  Thanks for that.

Here’s why I object to this whole exercise–it is artificial, and unlike the other stressful, artificial clinical scenarios we encounter like the breast exam and genitourinary exam, this one has no objective standards for successful completion.  Basically, we have to go into a room and act with another actor.  No real emotions are being displayed by these people, and thus no real emotions are being conveyed by the students.  Just anger at having to waste our time a day or so before a big test on getting yelled at and having our stress levels go up that much further.

Sometimes I feel like medical school is just a big indoctrination into a culture of masochists who constantly compete with one another to see how much bullshit they can endure.  The thinking seems to be something along the lines of, “well it was shitty when I was in school, so it might as well be shitty for you too.”  As I have no tolerance for enduring bullshit, I’m not incredibly fond of this aspect of medical school.

Seriously?

You’re looking at my ridiculous flashcard collection. Those aren’t my accumulated flashcards from throughout med school. No. Those are my flashcards FOR THIS TEST.  WTF?

The cards in the box are what I feel relatively confident I know. The stack next to the box is the stuff I need to learn in the next 48 hours. Looks like I have my work cut out for me.

Last year I did well by making flashcards for every little fact or funtoid I could possibly need for the test. (I tend to learn well by flashcards, sue me.)

The problem here, as you might be able to see, is that I’ve reached the point of diminishing returns.  Hell, I reached that point, blew past it at ludicrous speed, and left it spinning behind me like a cartoon road sign.  I slammed on my brakes somewhere around the point of futility, and came skidding to a halt at the point of absurdity.   See, it wasn’t always like this.  Last year, I might have a couple hundred flashcards per test.  That might sound like a lot, but it’s actually very do-able.  I’m estimating my current collection here at somewhere around 1200.  That isn’t gonna work.  I can’t even carry them all around with me.

The main reason for this dramatic increase in flashcards is largely because we’ve started Pharm, and there is a LOT of memorization for that class. But still, I’m obviously gonna have to re-evaluate my study methods for the next test. This is ridiculous. With this many flashcards, I don’t even have time to review them all enough times, let alone actually LEARN them.

6:45 Awakened by alarm clock.  Hit snooze.

6:48 Awakened by alarm clock.  Hit snooze.

6:51 Awakened by alarm clock.  Find the strength to open eyes, put feet on floor.   Drink coffee.  Shower, shave, brush teeth.  All that boring morning ritual stuff.

7:45 Arrive at school.  Drink more coffee.  Pre-read for morning lectures.  This usually involves highlighting words from the syllabus that appear important.  Remind yourself to figure out what they mean.  But not now.  Later.  Drink more coffee.

8:45 Migrate to the classroom.  Chat with friends.  Be chummy with people you don’t like sheerly because you have to.

9:00 Lecture.  Try to focus on the lecturer instead of the dude in front of you playing flash games on his laptop.  Drink more coffee.

9:20 Nudge your buddy sitting next to you when the dude who’s always 20 minutes late comes in wearing the exact same clothes he’s worn for the last month.  Consider consulting the Guinness Book of World Records to determine the record for “longest time spent wearing an ugly shirt.”

9:50 Break time.  Chat with whoever is sitting next to you.  Watch stupid cat videos on the internet.

10:00 Lecture.  Try to focus on lecturer.  Instead, read failblog over the shoulder of the guy in front of you.  Drink more coffee.

10:50 Break.  Chat, go get more coffee.  Listen to that one whiny dude in class who always complains about how he couldn’t understand the lecturer on account of his/her foreign accent and/or blazing pace with which he/she went through the material.

11:00 Lecture.  Fight urge to check email fifteen times.  Drink more coffee.  Check email fifteen times.

11:50 Lunch time.  Since you now live on student loans, you can’t afford to eat out all the time anymore.  (This lesson may not be learned until after your first semester, when you run out of money in October and have to scrape by until January.)  Instead, you now bring your lunch almost every day.  It’s usually the same.  A boring sandwich, some carrot sticks, maybe some yogurt or an apple.  Your lunch is so healthy for a couple reasons–one, you can’t really afford anything better, and two, you’ve heard a lot about high cholesterol/hypertension/diabetes in the last year.  You want to avoid this, but you still wish you were eating a burrito or something significantly more awesome.

12:30 Check your e-mail, drink more coffee.  Consider pre-reading for the next lecture.  Watch stupid videos on youtube instead.

1:00 Lecture.  Despite your best efforts, you will, almost assuredly, faze out almost immediately and retain next to nothing from the lecture.  Every few minutes you catch yourself falling asleep and look around to make sure no one caught you napping.  Look over to see people pointing and smirking.  Drink more coffee.

1:50 Break.  At this point, after all the coffee you’ve had, you may have to sneak off to a secluded bathroom somewhere on campus to take a dump.  This is quite possibly the most anxiety-provoking event of your day.

2:00 If you’re lucky, you’re done with classes.  If not, you have to go back and try to focus on another lecture. Why is it that the lecturer for the last afternoon class is always the guy trying to be “cool” by cramming his lecture full of stupid puns and filling his powerpoint full of “funny” pictures as old as the internet?  Cue instantrimshot.com and prepare to deny any culpability.

2:50 Freedom!  At this point, there are a couple options.  Either

• go home and zone out in front of the TV for an hour
• go to the gym to work on your sweet biceps, if you’re like me and like to keep your immaculately toned body immaculately toned.
• go home and begin studying.  (aka: go home, open a book, and watch TV for an hour with an open book on your lap.)

3:50 Check e-mail.  Browse reddit.com.  Tell yourself that you’ll begin studying again at 4:00.

4:45 Realize you’ve been surfing the internet way too long.  Tell yourself you’ll begin studying again at 5:00.

5:00 Realize you’re getting hungry.  Tell yourself you’ll eat dinner and then start studying again at 5:30.

5:10 Eat dinner (probably something from a box or the freezer, despite your good intentions.)

5:30 Sit down in front of the TV, tell yourself you “need to digest” for a bit, then you’ll start studying again at 6:00.

6:00 Realize that there is a good House, MD rerun on.  Tell yourself it will be good for your education to watch it, and that you’ll start studying again at 7:00.

7:00 Open up textbook.  Attempt to read.  Get caught up in thinking about how you really need to get good grades in order to get a good residency.  Search google for doctor’s salaries.  Realize that the dude in your class who you really don’t like is probably doing way better than you, and he’s going to make a lot more money than you if you don’t study and get a better residency than him.

7:30 Get frustrated that you’ll never make good enough grades to get into a really high-prestige residency slot.  Search google for med school study tips.

8:00 Actually begin studying.

9:00 Still studying.

10:00 Yup, still studying.

11:00 Notice the time, realize it’s time for bed.  Wonder why your eyes hurt and you’re always so tired.

So, that’s it, to my best approximation from what I can gather from my life and what I hear my classmates tell me.  (Okay, I’m exaggerating somewhat–I actually do spend quite a bit more time in the evening studying than that…)  Still, I’d like to hear from any other med students to see roughly how well this correlates to their daily routine.

This afternoon was suture lab.  I used to be a vegetarian, so I don’t have a ton of experience with mangled dead animal parts, and consequently, I had a slight worry that this might be difficult for me.  But honestly, after gross lab, I’m glad to find that there’s really nothing relating to dead things that can gross me out.

At one point, I was working on my subcuticular suture, when a big jet of blood shot out of one end of the pig’s foot.  I was pretty intently focused on getting my stitches right, and it startled the crap out of me.  Otherwise, it was a pretty uneventful, though enjoyable lab.

I have to say though, it’s little things like this that get me really excited for things to come.  In between studying for pharmacology (not fun) and studying for immunology (really not fun), and studying for all the other classes (equally not fun) we get these little brief respites from the classwork to see what is in store for us next year.  It’s like a little flicker of light glimmering from the end of this long tunnel they call the M2 year.