“My dream is to get into medical school and become a doctor.” This line is repeated in some form or another many times during application season. Most applicants do not know how truly dreamlike the experience is, particularly during third and fourth year clinical rotations.
The first two years of medical school are consumed by learning. Though there is little classroom time the shear volume of material that we have to digest requires incredible time and energy. Much is new – anatomy lab, histopathology, complex disease mechanisms – yet the fundamental skills of being a student – studying, giving presentations, taking exams – are familiar. These first two years can feel like an extension of undergrad, and you wait desperately to get to the meat of medical school when you transition from building knowledge to developing skills. Third year is where the dream – at least for me – begins.
In dreams we can do the impossible moving freely through time and space, unbound by the confining laws of “reality.” Time takes on new character, speeding up or slowing down without regard to the passing seconds on the clock by our bed. Emotions manifest on a different scale entirely, reaching new peaks and troughs as our subconscious allows us to explore how we truly feel about something. We wake up exhilarated, relieved, or confused – sometimes in awe of the capacity of our own minds.
Third year has given me incredible opportunities to participate in the care of other human beings: Diagnose, treat, cut, console, and palliate – all of these are in the purview of clinical rotations. The breadth of clinical experience spans caring for people at all ages and stages of life and our own emotional responses to witnessing the miracle of one family welcoming a new baby and the devastation of another being stripped of a loved one. Such extremes are rarely faced in day-to-day life, but are constants in both dreams and medicine.
On a day-to-day basis, you chance slipping into your own state of altered consciousness. Sleep deprivation, stress, and the rush of new experiences all contribute. Your days include incredible highs from acquiring a new skill, clinching a diagnosis, and making a true contribution, and profound lows from making an error, not knowing an answer, or losing a patient. Then, there are the moments that you wake up – either relieved by a day off when your alarm does not rouse you before the hour of 4 or 5am, or in a panic – you have overslept, forgotten something.
The first two years of medical school are challenging in their own right – you must acquire a tremendous amount of knowledge in a short time. During the third and fourth years you must apply this knowledge to the care of real patients under the supervision of residents and watchful eyes of attending physicians. Every step you take is into uncharted territory, and – though you have the guidance of some excellent mentors along the way – each wrong step is observed. If you have ever dreamt that you were standing naked in a public space – well the third year of medical school can sometimes feel like this.
I knew going in that there would be many demanding rotations. What I did not realize was how much they would infringe on my time and mental energy outside of the hospital. With rounds on certain rotations starting at 6am (meaning prerounding at 5am) and the days sometimes ending after 10pm, there was little time family, exercise, good nutrition, or sleep. Most inpatient rotations are six days per week and on several occasions I was without a break for 15 days in a row. I was often still mentally at the hospital when I was home, distracted by a clinical question or stressed about rounds the next day. Putting it mildly I was less than good company to my husband and dogs. At my darkest moment, I woke up lodged in the bumper of the car in front of me, thankfully from a low speed in stop-and-go traffic, but with the terrifying realization that I could have totaled a human in place of my Honda. My experiences in the hospital were mostly good, but one great day delivering a baby with an attending was followed by her shaming me the next for a mistake during rounds in front of ten residents.
On the other hand, there were moments of pure bliss. I realized I wanted to be a surgeon, and one whom I idolize agreed to mentor me; I was trusted to make incisions, sew on viscera, and close skin; I accompanied the lead surgeon to tell a family that surgery had gone well; my patient grabbed my hand and thanked me for being there. There were moments when the theoretical knowledge of the first two years suddenly takes on new dimension and meaning when applied to human beings – those indescribably satisfying “clicks” of new synaptic connections forming in your own brain. Upon your consciousness settles the realization that you are becoming more skilled, knowledgeable, and capable every single day.
I am grateful for the experiences prior to medical school that helped me develop a certain level of resilience. Living in a foreign country, working for a tough boss and tougher clients, getting multiple med school rejections, going through break-ups, losing loved ones unexpectedly – the list of grit-building exercises goes on and on. The challenges I have overcome prior to medical school have helped me keep the occasional nightmares of third year in perspective.
If you choose to pursue your dream of medicine, then I encourage you to come to terms with the waking reality. Consider your own ability to rebound after a psychic challenge. Medical school, residency, fellowship – these are not static means to an end – they are part of the dream with all of its emotional swings and guaranteed terrors. That said, I will not stop going to sleep fearing a nightmare. Indeed, when I crawl under the covers and turn out my light I am hopeful that tonight I will fly.