If you could have been there the night I slammed my fist, hard, into the oak door of my dorm room and held the phone with a trembling hand while I dialed my parents, you would grasp the essence of the first year of medical school.
If you could have listened, as my mother did, to a voice choked with tears as I tried to rationalize away my fears and regain my stability, you would know how close prospective doctors can come to losing perspective.
My classmates and I at the Johns Hopkins University School of Medicine now call our first year the worst ten years of our lives. We lived a day-by-day, hour-by-hour existence punctuated with intense emotional highs and equal lows. It was round one of a four-round bout, resulting either in a knockout or an MD.
As I begin my second year, I recall three intense, memorable moments of freshman year.
Most vivid is the first day of anatomy. I remember standing at the laboratory door, surveying the sterile room filled with some thirty gauze-wrapped bodies. They didn't look real, aligned so neatly on stainless steel platforms. My eyes burned from the formaldehyde vapors as my dissection partner pointed out what seemed to be the thinner bodies.
Upperclassmen had warned us that our cadaver choice was all-important. In selecting a body to dissect over the next 14 weeks, we'd been cautioned that excessive body fat would translate into longer hours in the lab.
"Try to get a thin female," someone whispered. "It'll take a lot less time."
As we scrambled into the sea of stainless steel to claim our team's cadaver, I imagined that someone would call the whole thing off and send us home with pats on the head. But as I unwrapped layer after layer of plastic and cloth to find leathery beige skin beneath, no one told me to stop. When I pressed on the scalpel to split the chest surface, the skin seemed like just another layer of plastic. It didn't look or feel real, and it resisted more force than I thought it would. As the knife finally began to cut -- even with my partners close by -- I felt completely alone.
Confronted with our exquisite sensitivity and naivete', my classmates and I fought back. We told morbid jokes that, to an outsider, might have seemed the height of callousness. We grinned at the textbook's warning that we "guard our eyes against flying fragments of bone."
I recall how I exhausted myself with the effort to turn the unusual and dramatic into the normal and everyday. So I sawed open a dead person's skull. All in a day's work. No sweat.
Each night I left my stained jeans and surgeon's top in my locker, but I took home the stubborn stench of formaldehyde on my hands and in my hair. I wondered if this was some fraternity-like ritual meant to inflict pain to cultivate a sense of belonging.
The order to learn without questioning was so great, the workload so excessive, that forgiveness for fear or failure came as a matter of course. None of us learned the exact attachments of every muscle in the body without wondering why we spent countless hours memorizing details that would leave us even as we left the exam. We were being asked too much, and pushed too hard, and we knew it.
Even with my newly won insider status, I still felt intensely alone faced with the large, self-absorbed institution surrounding me. I wondered whether my non-medical skills were withering from disuse, whether I was losing the ability to relate to others, whether I was changing, without hope of rescue, into an unfeeling person.
I don't think that I did. In fact, I was quite sure that I hadn't -- even when anatomy ended in January. While it hurt to realize how used to cutting a human body I had become, at least it still hurt.
During the second half of the year we met our first patients, two of whom -- Mary and Adam -- I will remember always.
I sat with Mary in the emergency room where she sought help for her damaged liver. Her hair was disheveled, and the dark circles under her eyes made her appear older than her 40-odd years. Her hospital gown slid off her shoulders as she told me about her alcoholism; she scarcely had the strength to re-cover herself.
I felt humbled by how little I knew of her world. How small in comparison were the challenges I faced; how much more level my road. I strained to understand when she called alcohol her only friend. I wondered how far any of us are from losing everything to the bottle.
More than anything else, I wanted to hold her, to promise that we would make her problems ours. But I had neither the preparation nor the time. There was so much more to learn. If medical school for some confirmed how much they knew, I felt they missed the greatest lesson of all: that we must constantly keep in mind how little we know, and that we must always remember how fragile the boundary between Mary's world and our own.
Then there was Adam -- an amiable, well-educated twenty-year-old with an infectious dry wit and incisive mind.
So what kinds of pressures compelled him cut off his own hand? How terrifying to pay such a price for a moment of irrationality, to live each day with so visible a reminder of the painful place he has been.
It unsettled me to listen to Adam as part of my education. Who was I to be allowed to share such private thoughts? And would I put the insight to the best use? Would I measure up and contribute something worthy of the time and effort others were investing in me?
And invest they did. From my ethics professor who encouraged me to continue with my writing, to the dean of student affairs who lent a frequent ear to my complaints about the shortcomings of medical education. I swore that I would not be taken in by those who had caused me pain, that I would not bond to the fraternity called medicine, but already its grip has fastened. Already I read of new developments with increasing interest and wonder at the confidence of medicine's veterans in attempting new techniques of heart surgery, plastic surgery and artifical fertilization. Diagnosis elicits my deep respect, knowing how many bits of information are processed into a decision on treatment.
So I have returned -- to classrooms where I felt the pressure to achieve, to instructors who demanded too much, to what was a very painful place only a few months ago, and may be again.
But I have matured more than a year in these twelve months. I have learned to deal with stress by living with it, taking it to bed with me each night and waking up with it every morning. The two weeks of just three hours of sleep a night which brought my fist to that oak door during my first year, wouldn't today. And though I resent the means by which the medical community trained my balance, I am -- nonetheless -- steadier on my feet than ever before.
Therein lies the greatest challenge to medical education -- to cultivate self-reliance and confidence without putting at risk sensitivity and well-being. John Stuart Mill said it best: "Men are men before they are lawyers or physicians or manufacturers; and, if you make them capable and sensible men, they will make themselves capable and sensible lawyers and physicians."