Demolition

There’s a George Ezra lyric that goes: “you may think that he’s a demolition expert when he’s finished with your self-esteem.”

I can’t think of a single better way to describe the process of medical school. You get  accepted and you feel AMAZING. I mean, medical school is very competitive to get into, and this means that you are pretty much a part of the top percent of people as far as intelligence goes (don’t mind me tooting my own horn over here).

Then you get here and you are reminded that even the top 5% has to have someone on the bottom. Nothing makes a smart kid feel stupid like being surrounded by a boat load of  smarter kids.

No matter how many exams you pass or OSCE’s you sail through, the next hurdle never fails to have you leaving feeling like the dumbest person on the face of the planet. Entering 3rd year of medical school steps up this game to a whole new level.

There’s this process known as “pimping” that is hard to explain in any other way than that it is the feeling of shear terror when an Attending physician turns to you and says something like “What is the mechanism of action of human placental lactogen in the context of gestational diabetes?” or when you’re in a surgery and the surgeon points to a small string like structure and asks “What vessel is this?” Usually followed by frozen silence, an attempted answer, and then a deep sigh of disappointment or if you’re really lucky, a verbal beatdown about how you should know this.

It’s horrifying. I’ve definitely had nightmares about some of these episodes after they happened.

However, I will forever remember everything about human placental lactogen because of the moment when I didn’t.

An attending physician friend of mine once said to me: We’re not cooking breakfast here.

How true is that. When we screw up – be it medical students, nurses, residents, or even the big bad attendings themselves – it doesn’t just result in burnt eggs or funny tasting pancakes. These are real lives we’re dealing with. People with families, stories, hobbies, hopes, fears, and dreams who entrust all these things on us.

So yes, if I don’t know the relationship of the uterine artery and the ureter, someone can die. If I show up in surgery without knowing the past medical and surgical history of a patient, someone can die. If I don’t understand that a diabetic experiencing hypoglycemic episodes in the late stages of pregnancy can be caused by uteroplacental insufficiency (resulting in decreased HPL production and decreased insulin resistance), someone can die.

Sometimes we medical students require reminders that despite everything we have learned, we don’t know nearly enough for this responsibility. There are moments when being yelled at for being unprepared is the correct outcome, because someday when we are the ones holding the scalpel there will be no one there to be prepared for us.

So maybe a little loss of self esteem isn’t the worst thing – at least not when the alternative is someone losing their life.

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