What I Learned in Medical School

What I Learned in Medical School: Personal Stories of Young Doctors

KEVIN M. TAKAKUWA
NICK RUBASHKIN
KAREN E. HERZIG
WITH A FOREWORD BY JOYCELYN ELDERS
Copyright Date: 2004
Edition: 1
Pages: 228
https://www.jstor.org/stable/10.1525/j.ctt1pnqq8
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  • Book Info
    What I Learned in Medical School
    Book Description:

    Like many an exclusive club, the medical profession subjects its prospective members to rigorous indoctrination: medical students are overloaded with work, deprived of sleep and normal human contact, drilled and tested and scheduled down to the last minute. Difficult as the regimen may be, for those who don't fit the traditional mold—white, male, middle-to-upper class, and heterosexual—medical school can be that much more harrowing. This riveting book tells the tales of a new generation of medical students—students whose varied backgrounds are far from traditional. Their stories will forever alter the way we see tomorrow's doctors. In these pages, a black teenage mother overcomes seemingly insurmountable odds, an observant Muslim dons the hijab during training, an alcoholic hides her addiction. We hear the stories of an Asian refugee, a Mexican immigrant, a closeted Christian, an oversized woman—these once unlikely students are among those who describe their medical school experiences with uncommon candor, giving a close-up look at the inflexible curriculum, the pervasive competitive culture, and the daunting obstacles that come with being "different" in medical school. Their tales of courage are by turns poignant, amusing, eye-opening—and altogether unforgettable.

    eISBN: 978-0-520-93938-7
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. FOREWORD
    (pp. xi-xiv)
    Joycelyn Elders

    When I entered the University of Arkansas in the fall of 1956, I knew that had I tried to go to medical school just ten years earlier, I would not have been admitted. At that time, blacks in the South could attend only black medical schools, of which there were two, Howard University in Washington, D.C., and Meharry Medical College in Nashville, Tennessee. Because of the limited spots, admission to these two schools was highly competitive. Besides, neither had the resources required to run a state-of-the-art academic, research-based institution. Physicians from Howard and Meharry became clinicians in cities and communities;...

  4. INTRODUCTION
    (pp. xv-xxii)

    When doctors are asked what they expected medical school to be like, they often answer with a blank stare. “I didn’t really think about it. I knew it would be hard. I just wanted to get in.” If asked what medical school was like in retrospect, they frequently say something like, “It was awful. I’m glad those days are behind me.”

    So what happens to us in medical school? Because prospective medical students are so focused on getting in and on their eventual membership in the prestigious and powerful medical profession, they are primed to be particularly susceptible to the...

  5. PART ONE LIFE AND FAMILY HISTORIES
    • [PART ONE Introduction]
      (pp. 1-8)

      The field of medicine, with its aura of mystique and importance, holds a great attraction. It is well known that many more people aspire to enter medicine than there are spaces in medical school classes. A large number of would-be doctors enter college as “premeds.” But the rigorous grading curves of a year of biology, general chemistry, physics, and organic chemistry, the core prerequisites for medical school, cause many to pursue other careers instead. The other major requirement, the Medical College Admissions Test (MCAT), is a standardized test covering biological sciences, physical sciences, reading, and writing. Besides the core prerequisite...

    • BECOMING AN AMERICAN
      (pp. 9-18)
      EDDY V. NGUYEN

      The August 1992 issue of theSmithsonianmagazine featured an article entitled “The New Saigon” by Pulitzer Prize–winning journalist Stanley Karnow. It documented the new generation of Vietnamese Americans, seventeen years after the fall of Saigon. Beneath the photo of three Vietnamese American students, a caption read, “Refugees Oanh Ha, Minh Tran, and Eddy Nguyen are all honor students at Saddleback High.” What may have been another’s claim to fame was my humiliation.

      Until recently, I would never have mentioned this to anyone. I was ashamed of the image and the caption that branded me, in a conspicuous II-point...

    • MELANIE’S STORY
      (pp. 19-22)
      MELANIE M. WATKINS

      I knew for a long time that I wanted to become a doctor. But when I became pregnant at the beginning of my senior year of high school, I thought it would be impossible. After all, most teens who become pregnant in high school drop out and never make it to college, never mind medical school and a three-year residency on top of that.

      As a pregnant teen, I felt the judgmental stares of strangers. I lost many of my friends, my boyfriend dumped me, my mother disapproved, and my relatives were disappointed. It was a lonely time.

      The loneliest...

    • PAVEMENT
      (pp. 23-30)
      NICK RUBASHKIN

      I toss and turn on the maroon velour back seat of my uncle’s white 1979 Oldsmobile. His sturdy workhorse, this car has registered more than 150,000 miles carrying him to and from his work. Whether I hang my knees over the seat or tuck them against my chest, I can’t find a position to suit my six-foot-two-inch frame. In the front seat, my uncle and cousin quietly talk above the traffic report. It’s almost 4:00 in the morning, and the report is very short because there is no traffic on the highways between the East Bay and the South Bay...

    • WHISPERS FROM THE THIRD GENERATION
      (pp. 31-36)
      PAUL M. LANTOS

      My grandfather would have seen me enter medical school had he lived another four months. A psychiatrist who practiced until his eightieth year, he had been the impetus for my medical aspirations. Like my other grandparents, Apu was a survivor of the Nazi death camps. While each of my four grandparents reacted and coped in unique ways, this grandfather sought solace in medicine. He often credited his knowledge of medicine with saving his life during the war, though we never learned exactly why he felt this way. In fact, he seldom discussed his wartime experiences.

      Anyu and Apu immigrated to...

    • BORDERLANDS
      (pp. 37-46)
      MARCIA VERENICE CASAS

      I am originally from Zacatecas, Mexico. My name is Marcia Verenice Casas, and these are my memories.

      On any given day, Latino Indians swim across rivers and hide in crowded, rotting trucks as they cross the Mexico-California border. It is a simple border, drawn in barbed wire and metal fence, separating two peoples, two cultures. Human beings risk their lives for the chance to work at Jack-in-the-Box; they risk death for the chance to wash some white guy’s BMW for a dollar tip. They risk it all for that elusive American Dream.

      I am a little girl again, and it...

    • POISON IN MY COFFEE
      (pp. 47-54)
      HEATHER GOFF

      During my first year of medical school, I took a class called Behavioral Science and Psychiatry, a required course that covered child development, drug addiction, sexuality, and psychoses. One day in class, the professor mentioned that 2 percent of the U.S. population suffers from obsessive-compulsive disorder (OCD). There was an immediate flurry from members of the class, as they quickly calculated the implications of such a statistic.

      The student next to me leaned over and whispered, “That must be wrong. Two percent? That means four people in our class have it. That’s impossible!”

      I smiled ironically. Little did he know...

  6. PART TWO SHIFTING IDENTITIES
    • [PART TWO Introduction]
      (pp. 55-62)

      Once in medical school, students face a shocking new reality. Whether by design or evolution, medical school delivers a constant barrage of information. Typically, the first two years, called the “pre-clinical” years, are devoted to lectures and laboratories covering the basic sciences. Subjects such as anatomy, biochemistry, and pathology are among the most rigorous. Others include physiology, microbiology, pharmacology, endocrinology, hematology, cardiology, pulmonology, gynecology, obstetrics, and a patient interview/physical exam course.

      Keeping up with the extremely rapid pace pushes most students beyond any limits they might have previously experienced. Lectures superficially cover incredible quantities of information. For example, a week...

    • NECESSARY ACCESSORIES
      (pp. 63-69)
      NUSHEEN AMEENUDDIN

      My starched white coat hung on a plastic hanger suspended from a gray steel bookshelf. Worn only once, two years ago at the White Coat Ceremony, an event that welcomed first-year students into the profession of medicine, the coat would now be used in a functional capacity for my first clinical experience. The rest of my ensemble had also been carefully prepared. My khaki pants were neatly pressed. As I admired them, I ran my fingers along their crisp creases, which rarely graced my daily wear. I left my loose-fitting, thigh-length black and beige dress shirt untucked so as not...

    • MEDICAL SCHOOL METAMORPHOSIS
      (pp. 70-74)
      TRESA MUIR MCNEAL

      Life has changed for me in many ways since I started medical school a year ago. I study more; I play less. And I can no longer carry on a normal conversation with people outside medical school. This change seemed to occur overnight. One day I was an average twenty-three-year-old married woman from a small Texas town; the next I was a “Medical Student.” This new label has changed how people look at me and how I look at the world in ways I never anticipated.

      Sanger, Texas, is a typical small town of six thousand, with more churches than...

    • WHY AM I IN MEDICAL SCHOOL?
      (pp. 75-79)
      KAREN C. KIM

      No one ever said it would be easy. Nonetheless, I maintain that the past several years have been an especially difficult time in which to be a medical student. I started medical school in the fall of 1999, living in the “birthplace of Silicon Valley,” as Palo Alto is known. With many of my friends from college then working for Internet startups, I sometimes felt jealous that they were out in a world where new and exciting ideas were changing the face of knowledge and communication (sometimes rather disturbingly), while here I was, stuck in a classroom. Once upon a...

    • MY SECRET LIFE
      (pp. 80-86)
      LINDA PALAFOX

      My name is Linda, and I am a third-year medical student at a well respected medical school in New York. I am also an alcoholic. You would never know that by looking at me. I am a student in good standing, comport myself in a professional manner, get along well with my colleagues, and do not embarrass myself at class functions. My path to medical school, however, has been different from that of most of my classmates. That path has most recently been laid, brick by brick, by the fellowship of Alcoholics Anonymous, but it began with my first drink....

    • FIVE POINTS OFF FOR GOING TO MEDICAL SCHOOL
      (pp. 87-91)
      RACHEL UMI LEE

      Seeing the bare trees braced against the chilly November wind, I think of the freezing cold winter that is fast approaching. This will be my second winter in New York, far away from my home in California. After living most of my life with relatively mild transitions between seasons, I must remind myself why I am here.

      For most of my classmates, getting into medical school may have been the greatest accomplishment of their lives to this point, their crowning scholastic victory over a lifetime of educational pressures and demands. I, on the other hand, have some ambivalence about being...

    • PARASYMPATHIZING
      (pp. 92-113)
      KEVIN M. TAKAKUWA

      I’m suspended in Jeanine’s brown sofa, enveloped in soft velour that caresses my arms and legs. Through the windows, I can see flowering dogwood tree branches reaching toward me, inviting me outside onto the old Washington, D.C., cobblestone streets to pay witness. I sleepily imagine stuffy statesmen wearing white pony-tailed wigs and tight-fitting, gray-tailed suits, stepping over or averting their eyes from the slaves sleeping beneath the pink arms of the dogwood. But I’m not tempted to move. Not now. Just below the window sits Jeanine, propped up, facing me, mirroring my position. She speaks softly, slowly, holding me with...

    • SOMETIMES, ALL YOU CAN DO IS LAUGH
      (pp. 114-120)
      LAINIE HOLMAN

      Medical school makes it so damn hard to keep your sense of humor. Ironically, it gives you so much new comedic material at the same time. I mean, when you think about it, having to memorize the names of all the complement fragments (you know, those funny little chemicals) is pretty funny. It’s almost as if someone designed them to be ridiculous: C4b2a? C3bBb? C3PO? R2D2? RU-SR-E-S? Who are they kidding? I half expect to see Allen Funt popping out of a bush screaming, “Smile, you’re onCandid Camera!

      And memorizing the genome of the adenovirus? I don’twantto...

    • A PRAYER FROM A CLOSETED CHRISTIAN
      (pp. 121-125)
      ANITA RAMSETTY

      Dear Lord,

      Please forgive me, for I have failed You. I look back on my three plus years of medical school, and I am ashamed. You gave Your life for me on the cross, and I have only now begun to stand up for You.

      I began medical school with every intention of staying close to You, no matter what. But it became harder as I struggled to keep up with all the material I had to learn. I fear that, in my worry, I put You second. I chose studying over church on Sunday. I could have made it...

    • SEEING WITH NEW EYES HOW AYURVEDA TRANSFORMED MY LIFE
      (pp. 126-134)
      AKILESH PALANISAMY

      In June 1999, after a year of medical school at the University of California at San Francisco, I began my study of Ayurveda, the traditional medical system of India. Ayurveda, which derives its name from a Sanskrit phrase meaning “knowledge of life,” is the oldest known system of medicine. Its principles were first recorded in the Vedas, the original Hindu scriptures, more than five thousand years ago.

      While I strongly believe in Western allopathic medicine, I am also aware of its limitations and feel that it may not meet the needs of all patients. For several years, I had been...

  7. PART THREE CONFRONTED
    • [PART THREE Introduction]
      (pp. 135-142)

      At the beginning of the nineteenth century, medicine in the United States encompassed the practices of Native American doctors, homeopaths, botanists, bonesetters, abortionists, cancer doctors, midwives, and others.¹ Women served as lay practitioners and had provided most home medical care since colonial times. Over the ensuing decades, however, and into the twentieth century, medicine evolved into a homogeneous, highly regulated, professionalized, and elite entity. Medical schools developed stricter entrance requirements, a greater emphasis on expensive scientific laboratories, and affiliations with wealthy universities; and they charged higher tuition. From the middle of the nineteenth century until the early 1960s, women constituted...

    • HOKA HEY
      (pp. 143-144)
      ROBERT “LAME BULL” MCDONALD

      I’m a Native American with dark skin and long black hair.

      I was told by my chief resident that he thought I would have trouble with my clerkship.

      He said that I stand out and that I was under the magnifying glass.

      I asked him why.

      He thought for a moment and said, “Well, for one thing, you’re older.”

      He also said it must have been difficult for me to leave an Indian community to attend college in a non-Indian community.

      He said it must be even more difficult to adjust to medical school and be in a medical community,...

    • MY NAMES
      (pp. 145-153)
      DAVID MARCUS

      My name is Tourette Disorder (TD) and Attention Deficit Hyperactivity Disorder (ADHD).¹ TD is a syndrome that can include motor tics (brief, repetitive movements), vocal tics, ADHD (inattention, disorganization, impulsivity), obsessive-compulsive thoughts and behaviors (counting, touching, cleaning), and mood disorders (anxiety and depression).

      Although I was not formally diagnosed until high school, I have had tics and symptoms of ADHD since childhood. In elementary school during the 1970s, I had a strong desire to pick putty out of the window sill over and over again until it felt right, which resulted in swats from the principal. I was forced to...

    • A CASE PRESENTATION
      (pp. 154-160)
      TISTA GHOSH

      1/8/99, 06:30

      SUBJECTIVE: Twenty-four-year-old woman presents on her first day of surgery rotation with complaints of anxiety, agitation, and apprehension

      OBJECTIVE: VS (vital signs): afebrile, tachycardic1

      Gen (general): well-nourished woman, no acute distress

      HEENT (head, ears, eyes, nose, throat): pupils

      dilated bilaterally, round and reactive to light,

      mucous membranes slightly dry

      Cor (heart): tachycardic, no murmurs appreciated2

      Abd (abdomen): hypoactive bowel sounds

      Extrem (extremities): diaphoretic3

      I had heard all about this guy. Dr. Snead, one of the top dogs in the surgery department, was notorious for both his bark and his bite when it came to medical students. His temper,...

    • UROLOGY BLUES
      (pp. 161-167)
      UGO A. EZENKWELE

      It began as a good day. The sun was just peeking over the buildings, and already I could feel the cool breeze of early fall as it made its way through the house. Just the day before, I had learned that I had received honors for my performance in my internal medicine clerkship, one of the most important and difficult clinical requirements in medical school. Months of hard work had finally paid off. My last major hurdle was the surgery clerkship; after that, the worst of medical school would be over. Just last month, I had obtained a degree in...

    • LIKE EVERYONE ELSE
      (pp. 168-176)
      KAY M. ERDWINN

      Medical school orientation. I’m elated and terrified at the same time. I sit down on a chair in the lecture hall, distracted by momentary gratitude that it’s the kind that pulls away from the table, not one of those “all-in-one” student desks. Then, like everyone else, I listen with half an ear to the dean’s speech. What I’m really doing is checking out the other people in my new class. I look around and catalog people shamelessly: she’s a science nerd, he’s here to make lots of money, he looks genuine, she could be a friend, but him—oh, Gods!...

    • DARING TO BE A DOCTOR
      (pp. 177-181)
      SIMONE C. EASTMAN-UWAN

      Every time I sign a patient’s chart on the ward, I experience a small dilemma, wondering how to identify myself. In addition to my name, I’m supposed to indicate my title. Should I really putMS 5/6after my name, meaning that I am a medical student in my fifth year out of what will be a total of six? I’m afraid that would prompt a lot of questions:

      “Why is it taking you six years, and not the regular four, to complete medical school?”

      “Are you getting another degree?”

      “Did you take time off during medical school?”

      “Did you...

    • A GRADUATION SPEECH
      (pp. 182-188)
      THAO NGUYEN

      Families, friends, faculty, and staff, the class of 2000 at the University of California at Davis School of Medicine is happy and honored to share our exhilarating and momentous day with you. We want to take this opportunity to share our triumphs and trials over the past few years and to ponder our dreams and hopes and fears as we ready ourselves for the journey ahead.

      We began our medical training full of excitement: the excitement of childhood dreams and adult ambitions realized. We had made it into medical school. We knew that we would work hard to become the...

  8. AFTERWORD
    (pp. 189-194)

    We cannot end this book without considering some solutions to the problems faced by today’s medical students. Although we realize that the struggles within medicine are connected to those of the broader society, the suggestions we offer here focus strictly on improvements within the medical education system. Some of these changes are already taking shape at different medical schools around the country, but we believe that a complete overhaul of the system, based on these ideas, will eventually be necessary to educate those who will become our best doctors.

    As we look back at medical school, we see an educational...

  9. FURTHER READING
    (pp. 195-198)
  10. CONTRIBUTORS
    (pp. 199-204)
  11. ACKNOWLEDGMENTS
    (pp. 205-208)
  12. PHOTO CREDITS
    (pp. 209-209)
  13. Back Matter
    (pp. 210-210)