There is this prevalent myth that third year is a cakewalk compared to the first two years.  The myth goes something like this: first two years are all schoolwork, and lots of it.  I have provided some evidence on my blog about just how much schoolwork there is in the first two years.  The myth continues by noting that in the third year, you’re out of the classroom.  It would follow that being out of the classroom would mean less “school work” type stuff, i.e. less studying.  While it is fair to say that there is less studying, there is also a lot less time to allot to studying, which pretty much equals out in terms of how stressful it all is.  I was talking with some classmates the other day, and they all said they would rather do second year over again than do third year right now simply because of the scheduling wackiness that comes with third year.  So, I would like to eradicate the Myth of Third Year Simplicity once and for all.  Even though I’m only a month into my third year, I think it’s fair to say that third year is, at the very least, equal in intensity to the first two years, and in it’s own right, it is more challenging.  

Check back soon, now that I’m not on the wards, I’m going to share some of my more resonant third year experiences.

I had the opportunity to speak with Dr. Jauhar by phone one afternoon recently.  He is a very warm and friendly man whose deliberately worded responses to my questions reflected the same kind of insight and introspection that initially attracted me to his book.   I asked him about his book, his experiences in residency, and how he decided to become a doctor.  The transcript of our conversation follows.

To hear audio from the audiobook, click here.

Med School Memoir: A lot of my readers are premeds and I think a lot of them aren’t sure if medicine is actually for them.  Could you talk a little bit about why you decided to go into medicine?  Because your path to medicine was unique, so for those who haven’t read the book, could you talk a little bit about why you went into medicine, and if you would do it again?

Dr. Jauhar: Well, I would do it again, because I found a niche that feels comfortable.  But as you probably know from the book, for a long time I struggled with being a medical student and being an intern.  I think that my path was very circuitous and my position was formed by many different motivations and thoughts.  One was that I was in graduate school doing very esoteric work, and for lack of a better word, I started just to feel lonely.  Not only was I doing work that most people didn’t understand—quantum physics—but my lab, the actual physical space, was up in the Berkeley Hills, so I wasn’t really interacting with the sorts of people who I found vibrant and interesting when I was an undergrad, which was people who were interested in arts, literature, and other various pursuits.  I was spending most of my time with physicists, and I liked them a lot, but I felt somewhat limited.  That was one issue.  Then, paired with that, there was a sense that I wasn’t contributing much to the world, or society.  What I was doing was very esoteric, and perhaps it was going to have some applications down the road, but immediately I didn’t see any tangible benefits.  Then, as you probably know from the book, my girlfriend got sick with lupus, and that really was traumatic, because I wanted to help her.  She was sick for quite a while, and she eventually got better with medications, but in the process of helping her and understanding what was going on, I delved into medicine.  I spoke with doctors, I went to medical school libraries, I started talking a lot more to my brother more about medicine, I started reading textbooks, journals, and so on.  I found that medicine had so many unknowns, and there were so many uncertainties in medicine, and that was exciting.  I was drawn to the idea, I think, of traveling a road that so many had traveled before me, as far as joining a community that had a really long tradition.  There were all these different inputs, but in the end, I decided I was going to leave Academic Physics and go to medical school.  Fortunately, I was only 26 when I started medical school, and I completed the premedical requirements when I was 24 or 25, before the end of graduate school.  It all worked out.  A lot of students today are nontraditional like me, and they do bring a lot to medicine, in terms of varied life experiences, and an ability to relate to different kinds of patients.  I think the fact that I was a little bit older, maybe a little more mature than I was when I was 20 or 21 really helped in the end.  I was very ambivalent, but in the end I got a lot more comfortable in my own skin, and now I’m reasonably contented.  You know, life isn’t perfect; it wouldn’t be if I were a lawyer or a Wall-Streeter, or whatever, but that’s more a function of my own biology than medicine.

MSM: So you think your experiences prior to med school were ultimately beneficial to you as a physician?

Dr. Jauhar: I think so.  Not in any kind of concrete way.  I don’t use my physics training explicitly, but the way I learned to think about problems logically, the fact that I was an older student, the fact that I had been through career and was late to medicine, it made me a little more committed, if for no other reason than I was older, and I didn’t have any more time to change my mind about stuff.  I think in the end it was beneficial for me, and I think that I needed to do what I did.  Eventually I found a niche writing about medicine, and practicing in a way that I believe to be fulfilling.

MSM: Flash forward a little bit from before med school to when you were an intern, since that’s what the book was about.  The entire middle section was really great—the atmosphere when you were on call in the hospital during the evenings, it seems so hectic, but it also seemed kind of exciting.  I’m guessing you don’t really have those stresses in your practice anymore.  Do you ever miss the atmosphere that you encountered as an intern?

Dr. Jauhar: Yes and no.  I don’t miss the anxiety of the sleep deprivation and the fatigue, and the overwhelming sense of responsibility—I don’t miss that!  I do miss the engagement I had with patients and the fact that so much was new.  The learning curve was really steep, and so much of what I was seeing was actually providing a lot of fodder for writing and creative pursuits.  This is a good time to start writing if you have time to write, because everything is new, and at the same time you’re on the front line.  You’re never that close to the bedside, as you are as an intern.  As an attending now, obviously I see patients at the bedside, but so much of what I rely on is what my fellows and my residents tell me.  But yeah, I miss it.  But I also miss the time.  It’s hard to disentangle what was happening in my life at that time.  I was single, no kids, I was sort of a free bird in a lot of ways.  In that sense, I was only thinking about me.  As you get on in life, you have more responsibilities to other people and other things.

MSM: You mentioned how in your residency, the new experiences provided good fodder for you to start writing.  I got a big sense that you were also writing as a way to perhaps change the culture of medicine or something like that…

Dr. Jauhar: Yeah, I initially thought I was going to set on making big changes, but in the end I learned my lesson.  Medicine is just too big of a field to transform, and like a lot of people who join a field, I ended up embracing the culture of it.  I’m probably a bit of an odd bird, still, because I write about medicine, and I practice it, and I maybe think a little bit more about things, or at least in different ways, than the run-of-the-mill doctor.  But I’m a loyal practitioner—I’m like every other doctor bemoaning reimbursement cuts and losses in salary and all those things.  I, of course, support health care reform, unlike a lot of doctors I know, but I feel the pain.

MSM: What do you think it is about the training that squashes that idealistic spirit, because I feel like that’s a common theme with many students?

Dr. Jauhar: Yeah, you see so much, and it’s hard to remain idealistic.  You get beaten down by the experience.  You can only see so much suffering and remain sensitive.  That’s part it.  And also, you’re sleep-deprived, fatigued, and that’s a big part of getting cynical, because your own body is under so much stress.

MSM: One last question, and I’ll let you go, and I appreciate it so much!  For any of my readers who might be about to start their own intern year, are there any pearls that you have for maintaining your sanity or avoiding burnout?

Dr. Jauhar: Keep a diary, and process your experiences.  Think about it, because it’s a very rewarding experience, in the end, but it doesn’t feel that way.  It’s like a boot camp of sorts, because you’re suffering, but maybe you don’t see the reward initially, but it’s there.  So process what you’re doing, think about it, be mindful of the experience, and if you can, write about it a little bit.  Keep a diary, then revisit those old experience when you get older, because it’s very rewarding.  That’s what I did, and I ended up writing a book!

My next final is behavioral science, which is tomorrow. Then just one more after that. Then… I’m gonna try and take a week off before starting on STEP 1 preparation.

Since we’re in the middle of the endocrine unit at school, my first reaction was that I have pheochromocytoma, a catecholamine-secreting tumor.  There’s no way I was having a bad dream, or am just a little over-anxious about the test coming up on Friday.  No, it’s much more likely that I have a disease that is seen in about five in a million people.

This is how I memorize my clinical correlations for the test, by the way.  I actually get the diseases we’re learning about.  It’s a bitch, but I’ve yet to find a better way.

I have a feeling that this will make pathology a very difficult class next year.

Anyway, I’ll write more about it later, but for now, I just want to share a link.  I came across an interesting article at salon.com about the shortage of primary care docs in the US.

Go check it out: Where Have You Gone, Marcus Welby?