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For me, hepatitis B booster shots feel pretty much as pleasant as being sucker punched in the arm. You can imagine that it didn’t inspire much elation when I scrolled through my calendar to see, spelled out in big red letters, a reminder for “Hep B #3.”

Now, as I reflect, this reminder feels like a victory of sorts.

When you are told during medical school orientation that you must be re-immunized for hepatitis B, you are sent to undergo a three-dose course: zero months, one month, six months. I remember making those appointments while standing next to a shaded window, looking out into the brutish heat of an August in Providence. I remember thinking that six months felt so far away. I remember that earlier that day, I had found an empty classroom and cried with heaving shoulders into my hands. I remember feeling alone, and small, and mistaken.

And I remember wondering, on that fifth day of medical school, if I would make it as far as February. If I would still be a medical student when the time came for the third dose of that blasted hepatitis B booster.

I never understood how I could succinctly answer the question, “How is medical school going?” It is inevitable that people ask, but whenever posed with this question, I always mentally react with sarcastic commentary. “How is medical school going? Well here, let me give you a genuine, concise answer in one sentence and less than 43.7 seconds.”

I am continually stuck when posed with this inquiry. It feels disingenuous to use the noncommittal, easy stock answer that’s void of any real substance, but the real one is too winding and whiny to offer up casually.

The truth? The transition to medical school has been incredibly hard for me. I am still unsure if this is where I want to be.

I feel separated from the disciplines I was, and am, incredibly passionate about. I no longer get excited for class the way I did when I was in college taking seminars on racial politics, the construction of scientific knowledge, gender fluidity and medical anthropology. I miss reading ideas and synthesizing my own. I feel uninvested in our material — the science of it feels so detached from the politics and realities of the world. I miss books and discussion and critique; I miss critically questioning what is presented as fact. I think our preclinical education often misses the bigger picture, forgets how medical authority operates, leaves little room to work though the impossible questions of ethics and context and humanity. I am frustrated with a curriculum that relies so heavily on the biomedical framework. I often feel shabby and insecure in all sorts of academic and social ways. I constantly feel that dimensions of my individuality are being flattened by the demands of assessments third and fourth years tell me do not matter anyway.

This curriculum feels displaced from what I pictured a career in medicine would look like. Especially in these preclinical years, our schooling is at once directly tied to becoming a physician, and yet so separated from doctoring. There are also times, scary times, when I realize I have no idea what this career will actually look like as a real profession — that I do not indeed know what I am working towards. People tell me I will have to wait for the wards to know. I worry that when I get there, it will not be what I hoped.

It does not help that surveys show 90 percent of physicians wouldn’t recommend this profession for their children.

There is also the new, overwhelming cognizance that there is an infinite amount of knowledge and preparation involved in medical training. There is no end. There is no clear point of termination, and as such, it is up to you to decide where to draw the line of academic sufficiency.

We are told to “be your own guide.” This is a reminder meant to provide comfort that your decisions will be right for you, but it is also terrifying. Being your own guide, having autonomy with intention, means simultaneously accepting culpability for anything that goes wrong. It is stressful for me to decide, day in day out, how to optimize my work-life balance. I am young and stupid. I don’t love trying to make important decisions about my future while I indeed feel, young and stupid.

Medical school has been incredibly stressful for me because it constantly backs you into a corner and forces you to figure out what kind of student and person you want to be, all very quickly. It is an encroaching force that I have to remember to actively push back against as it invades larger and larger portions of my mind, my time and my space. It demands that you decide what is important — to decide what parts of your being you will allow to go to the wayside when you have an infinite number of facts to memorize, an infinite number of ways you “should be” advancing your career. It asks you to balance personal desire and need with the looming pressure of accepting responsibility for the well-being of others. I think oftentimes, this pressure forces us to strip ourselves of the little luxuries that contribute so much more to our identity than the term “medical student.” We embrace this title with arms weighed down by books and expectation, and in doing so, we often lose others. We are runners and singers, readers and writers, painters, dreamers, and significant others. But when there are infinite facts to learn, there is less time to run and sing, fewer hours to read and write, diminished capacity to paint and dream and love.

And then there is also this point of guilt: How dare I sit here and criticize and complain about an incredible opportunity that people quite literally dream about. How do I negotiate the idea of finding difficulty in this experience while remaining humble and grateful for the privilege afforded to me by this institution? It also seems useless to worry about having too little time, when I am told over and over that I will never again have the freedom first year allows.

A dear friend recently told me that she thought I was brave for voicing my doubts about medical school openly. This shocked me. I hadn’t realized that it was something worth hiding.

Looking back, I suppose I felt early on that there was some shame attached to my doubt. I realize, now, that this notion is toxic, and only served to deepen loneliness and isolation in a place that does not necessarily need to feel lonely and isolated.

Few people are absent doubt in medical school. As I’ve been more open with my insecurity, I’ve found more support, more normalcy, and more validation in my beliefs and fears. I’ve found people who feel the same. These are people I cherish, am indebted to, and care for deeply. I am grateful for the amazing community of peers I have found in my time in medical school — Providence and beyond.

As difficult a transition as matriculating to medical school has been, as much as my doubts are still present, I look back on the fall of 2014 with a lot of joy. Indeed, there were soaring levels of insecurity, creeping levels of worthlessness, and feelings of displacement, but as a whole, my first semester of medical school feels light instead of dark. It is a good place to be, even if I am unsure it is the right place to be.

This is not a well-articulated piece. I have tried to edit sparsely because I don’t think this message needs to be sterilized, primped and polished. It certainly has no intention of convincing anyone of anything. It exists purely because I believe validation is one of the most powerful forces in this world.

If you disagree with everything that has been said above, great. I hope this rambly, disjointed reflection has allowed you to feel more situated and confident that medical school is where you are meant to be. If anything I have written resonates with you, spectacular. Know that you are not alone. If you are ever in Providence, come over and drink wine-colored beverages with me on my couch. We can blast Beyonce’s “I Was Here” and have some sort of cathartic bonding experience. This is one part of life I will not allow medical school to compromise.

I still wonder what the rest of medical school will hold. What I do know is that when I get punched again by that hepatitis B booster, I will have at least one reason to smile.

I made it to six months.

Cheers to that.

Jennifer Tsai Jennifer Tsai (11 Posts)

Writer-in-Training and in-Training Staff Member

Warren Alpert Medical School of Brown University

The white coat is a scary, scary thing, and I'm still trying to figure out if I should have one. If you like screaming about ethnic rage, dance, or the woes of medical education, we should probably do some of those fun activities that friends do.

I have few answers, many questions. Dialogue is huge. Feel free to email with questions and comments!

  • R Redman

    I love this piece! Thank you for sharing this reflection. And thank you for the (mutual) validation.

  • JR

    Well said. And very well articulated. I am about to begin 3rd year and sometimes feel as though my soul is being smashed through a potato dicer. I’ve certainly lost
    the capacity to fluently engage in cross-discipline banter over beers. I’m just hoping all of the starchy stickiness remains intact so I can stick back together on the other side.

  • Jake

    Wow this perfectly sums up my feelings. So how do you not get the urge to just drop out and try something new? Are you filled with regret? I just hope once I start interacting with patients I feel better about everything I’ve done slash am doing.

  • Sarab

    I’m walking out of fourth year, alive and into a residency in 2 months and 1 day.

    I’ll tell you the words a random fourth year told me when I sat there looking despondent as I studied for Step 1 in a coffee shop. ‘It gets better.’

    I hated first year, felt lost, scared, stupid, inadequate and incapable a bunch of the time. Second year was a little better, it felt more clinical. Like you, I felt like half my brain was dying (I was a Philosophy major in college) but luckily I joined the inaugural class of the Masters in Bioethics program.

    Third year was busy and lots of learning but it felt much more right. I was actually learning and taking care of patients! And fourth year, is heaven. You’re in the specialty you chose for months on end learning tons, you do some amazingly cool electives, you interview, you think, you feel again and you can digest that roller coaster ride you’re just getting off and see how it all came together.

    I can’t tell you if medical schools for you- that’s your decision. But I can tell you what that fourth year said to me is true, ‘It gets better’.