I have always found fountain pens to be intoxicatingly beautiful, but I never brought myself to buy one. Partly I simply did not know where to look, partly I was also lazy. I had grown up using throwaway pens and they worked fine for me. But I was inspired to consider them more seriously when I saw my attending writing with not one but four fountain pens on the ward. “Why?” I asked him. He told me: because his hand ached at the end of a long day of writing page after page of notes; the fountain pens had put an end to all of that and they got rid of the callouses on his fingers.
I looked down at my right hand, thick callouses along the side of my three fingers. I decided it was time to get a fountain pen.
Disclosure: I was contacted by the author who provided this book to me without expense. In exchange, I was asked to provide an honest review of this book. I have no affiliation with its author, its publisher or Amazon.
Set in the late 1970s, the Reluctant Intern by Bill Yancey tells the story of Addison Wolfe, a recently graduated doctor who failed to reach his aspirations of working for NASA and instead finds himself in the rotating internship of the University Hospital in Jacksonville. The story chronicles his experience from his first day until his last as an intern.
It still shocks me that I am only a few days away from beginning my residency. Four years have come and gone. I now have a degree and letters behind my name to show for it. This last year has presented with its own unique challenges and a lot has changed in four years. Let’s have a look back.
It was here that I first learned how to correctly use my stethoscope, how to speak with patients, and how to act like a doctor. These were my baby steps. I studied a whole host of topics, covering the broadest and biggest organ systems. It was also here that I learned anatomy and had the privilege to work with cadavers.
In many respects this was the most stressful year. While clinical work is taxing in its own right, nothing came close to the mental toll this year had on me. Studying was both a necessity and a compulsion. Easily I spent entire days sitting a library, reading, memorizing, understanding. I had never studied that much in my entire life.
This time, the stresses of clinical work were balanced between the mental and the physical. By far the most challenging year of all but also the most enjoyable. Having sat in class for the better part of my life, now I would have to do.
It was an adjustment to work in a hospital, to see volumes of patients, to do call shifts. But I adjusted and grew used to the pace of the ward. Gradually, I learned to move from knowing how, to showing how, to doing.
On top of the clinical work, I had a number of additional challenges this year. I had an all encompassing OSCE, residency applications and touring, and a licensing exam to complete. By this point, clinical rotations were not quite as overwhelming or scary as they used to be, but I still had many hard days.
The brunt of the stress this year came from the latter additions. Those three things were for all the marbles, and the consequences of missing any one of those were a constant worry. The OSCE wound up showing some of my weaknesses that I would need to improve on. The CaRMS tour would take me across the country from colder to coldest winters in Canada. The licensing exam ended up being a two-week mad dash to the finish line. For six months, the pressures mounted through these three main events.
But I eventually reached the end of my four year journey. I graduated, I was admitted to a residency program, and I passed my exam.
It has been a roller coaster ride through four years of medical school. I am happy I could document it all here in these posts. Now I start a different journey through residency and look forward to reflecting more on this new adventure.
There has always existed, deeply seeded beneath the surface of my conscience the burning question: where did all of the time go? I have asked myself that many times through my medical training. Now, standing at the threshold of my last semester as a student, the question is even more relevant. What have I been up to these past few months?
And just like that, year three passes into my memory, a destination in the rearview mirror. There has been so much to see, so much to process, so much to reflect on this entire year it is difficult to know where to start. Perhaps we should go back to the beginning.
Third year has been a year of firsts thus far. I have seen and learned a great many things. It has wowed me, excited me, frustrated me, exhausted me, saddened me, and disturbed me in my every day encounters. With half the year behind me now, I would like to talk about my experience.
With two months to organize myself for the coming year, it has given me a lot of time to think about the last year. Three-eighths of the way, I gave a review of the first term of second year. Now, another term complete and having earned half my M.D. title, it feels right to write another summary.
Given that it is the largest organ by surface area, it was amusing to see dermatology condensed into a single week. I suppose once you know the ABCDEs of categorizing skin lesions, you are well equipped to handle any situation. However, sometimes lesions are vague or very similar in appearance to others. Land mine or dud? Tread carefully.
Then came the brain. Over a gruelling two month period, we explored the deepest anatomical corners of the brain, learned tracts from top to bottom, and studied behaviour and psychology. The challenges of this block were two fold. First, some of the concepts were difficult to abstract, especially understanding the relation and integration of various tracts, in itself a complex web of interactions. Secondly, due to the complexity of the brain, some concepts could not be covered without mentioning other points of interest that would be covered further in the block. It was constantly a struggle to keep up with concepts A and B, when concept B was to be further discussed a few weeks later. Only at the end of the block could we finally see the big picture.
After the struggles above, we went down into the reproduction block, a simple and easy to follow curriculum that was a welcome change of pace. This block was noteworthy for its overabundance of graphic pictures and videos and the fair warning to the ladies of our class to be weary of advanced maternal age.
The last block, following the reproductive block nicely was paediatric and adolescent development. The big talking points in this block were milestones and nutrition factoids. The key to understanding this block was to memorize the facts cold. Getting the short end of the stick, the study time for this block suffered in light of its close proximity to our final exams. We held our breath that the few factoids we tried to memorize each day would stay fresh enough in our minds for the exam.
Histology, pathology, and anatomy continued to be integrated into the curriculum wherever it applied. Anatomy in particular took centre stage for the brain, while histology was important for the skin, the brain, and for reproduction.
Family practice and clinical skills courses continued to give us exposure to the routines we would need to know for our careers.
The exams this term were again challenging. I would rank them as equal to those from last term. The questions that caused me the most difficulties were the scenario questions. Reading and digesting the information presented in the scenario took time and slowed me down to a panic. Time was of the essence and I had to work fast. I dreaded every one of these questions.
For my rural rotation, which is actually part of my third year, I have already written my thoughts on that in a prior post. Now I am just trying to get my affairs in order and enjoy the summer while I still can.
I went to two review sessions today, one for neuroanatomy and the other for gross anatomy. For the last few weeks, they have been sitting on the back burner. Tougher and more complicated material had to be prioritized. This left me anxious going in.
I was afraid to discover that I was wholly unprepared for the lab exams, one of the first on my schedule. It could be a very nasty wake up call.
Surprisingly though, I walked out of the whole four hour session feeling quite secure in my knowledge. Sure, there was the occasional gap in my knowledge but I had retained quite a bit from the months before, enough that I am sure that I could pass.
Now, I am feeling a little bit more comfortable about focusing more on my other blocks.