We’re Not in Tutorial Anymore

Photo by Graham Ramsay Nicole Martin

As a graduating medical student with some spring vacation time, I’ve been thinking about the journey I’ve made over the past four years. For me and many of my New Pathway classmates, the beginning of med school was hardly different from college. We would dutifully show up for 8:30 a.m. lectures or, taking advantage of our extensive online resources, enjoy some extra shuteye. Later in the morning, we’d go to tutorial, then use our spare time to do research, volunteer in the community, or engage in a little retail therapy. We had plenty of time to study the basic science behind medical innovation, to pore over the biochemical pathways that were altered by the latest designer drugs.

We saw patients once or twice a week, so we had an excuse to do two of the things that I like best: get dressed up and talk to people. But overall, we were sheltered from the world of clinical medicine. In my personal experience, the real transition from student to physician-in-training occurred at the beginning of third year, when the following ideas became evident. 1) I possessed no useful medical knowledge. 2) Though only a med student, I was paradoxically expected to know “everything” about each patient I admitted. 3) I could no longer wear high heels.

Now, you may think that the first two realizations were more difficult than the third. However, it’s worth noting that I’m pretty short. Not to mention that we HMSers are highly skilled at expounding on topics we’ve had less than 24 hours to research. UpToDate and Medline supplied the meat and potatoes of my wards presentations, with Google providing the occasional side dish. By garnishing with a few Harvardian words such as “gestalt” and “milieu,” I could convince virtually anyone that I had mastered my cases. To kick it up a notch, I’d mention the latest randomized controlled trials I’d read. But the pièce de résistance of any wards talk was—drumroll, please—the handout. While I used it as a crib sheet, my team members pored enthusiastically over the flowcharts and diagrams I had garnered from online journals. This was a true win–win situation, a rare occurrence in clinical medicine.

As I look over the contents of my hard drive from the past two years, I don’t remember half of what I actually wrote on those handouts, but I take comfort that I could find the information if I needed it again. And maybe there’s a market for, shall we say, “learning modules” authored by a Harvard medical student. Or at least, I can give them to other students so they’ll look good on rounds.

Dream Job
While every med student is a frequent passenger on the information superhighway, it wasn’t until I hit the wards that I appreciated the intensely physical nature of our work. Sure, I always knew I’d be examining patients and assisting in procedures, but I didn’t know the true meaning of the word “fatigue” until I stayed awake for 30 consecutive hours during my advanced medicine rotations. The all-nighters I pulled in college couldn’t compare—sitting in front of my computer with a bag of Doritos and hammering out a 10-page paper seemed like a cakewalk in relation to postcall rounds. As I shuffled through my patient notes and tried to remember all the relevant data to present to the attending, I could hardly keep my eyes open, let alone wax poetic on the causes of syncope.

On the call nights when I did get to lie down, my dreams were filled with obsessive, fruitless ruminations about my cases. Motivated by lab values, EKG tracings, and checklists running through my brain, I ran around my nightmare hospital, but I never got anything done. Only after I had made it through rounds and turned over my responsibilities to a teammate could I sleep peacefully. And even then, as I lay in bed at home, I often thought I heard a cardiac monitor beeping in the next room.

I’ve long since accepted the fact that my life is dominated by my call schedule. Things could be worse, I’m apt to remind myself—I’ll be a resident during the 80-hour-a-week era, and Harvard’s internal medicine programs are committed to enforcing the guidelines. But the sheer amount of time we spend in the hospital doesn’t fully account for the intensity of our profession.

One Step at a Time
One afternoon this past March, my transition to doctordom became complete. At the MGH neurology department’s noon conference, I was eating lunch while half sitting on a countertop, balanced on my right foot. I happened to be wearing my favorite shoes, a pair of dark red pumps. I had decided that I didn’t care if I couldn’t sit in a chair, because real doctors could stand for hours on end. Of course, my nonchalance backfired, and I felt a ker-thunk as my heel snapped off. True to my training, I immediately generated a differential diagnosis. Either the heels were simply too high for someone who spent all day on her feet, or I needed to cut back on the free food. Whichever the case, I could say one thing for sure: Nicole, you’re not in tutorial anymore.

Hoping that no one had noticed my sudden loss of height, I swallowed my pride, limped to the gift shop, and purchased a pair of Merrells. As I toted my red shoes away in a plastic bag, I felt a little sheepish. I garnered sympathy from my roommate Yanerys, who loved those pumps as much as I did. One of the medicine residents, after a laughing fit, applauded my new choice of footwear. I’m going to be in the trenches as an intern, and I’ll need both traction and stability.

From here on out, my classmates and I will be faced with hard work—and lots of it. There won’t be anyone else to do our scut jobs. No longer will we be dismissed early to go home and read. We’ll be the interns who field the incessant pages about surgical dressings and bowel regimens. When we take the Hippocratic oath on June 8, we’ll pledge to devote ourselves to the service of our patients. As much as we may want to click our heels and be whisked back to medical school when the going gets rough, we’ll have to summon our courage, brains, and heart to help us forge ahead. It may take me a while to adjust, but at least my toes will be comfortable.

—Nicole Martin is a fourth-year medical student at HMS, who will soon begin her residency in internal medicine at Massachusetts General Hospital.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

top