As I settle into my second year of medical school, I’m confronted with the fact that I’m one-fourth of the way to an M.D. — that an entire year has passed, and unsurprisingly, all those predictions my deans made at the very beginning came to pass: time flew, we learned more than we thought we ever could, and upon close self-examination, we’re very different from how we were this time last year. I understand bits and pieces of medical jargon that, quite literally, can be a completely different language. When I pass a CVS, I think of “cardiovascular system” instead of the pharmacy. CT no longer means Connecticut; it only means the scan. And why do I have to explain what nephrology is to other people? Nephrons are clearly in the kidneys — it’s such a common term in daily lingo, after all.
The funniest thing about medical school is that despite all the studying and all the learning, I am constantly in a state of anxiety of how much I don’t know, or fear of how much I am capable of forgetting. There is always the looming, ominous presence of Step 1 lingering, followed by the fascination and fear of the wards, and of course the prospect of matching into residency as well.
At every step of my academic career, I have been nervous at some point or another. Being concerned is a natural part of the process — I believe worrying about my academic performance is partially responsible for where I am now. But being afraid academically in medical school has been an entirely different experience from before. For the first time, I am not concerned about excelling — I’m more afraid of legitimately failing, and this fear became clearest when I failed an anatomy exam. For once, this “fail” was not hyperbolic; it was a legitimate delineation that I had failed to achieve an academic baseline that I’d always expected not simply to meet, but to exceed.
In the same time span of the last year, as I was confronting very real external and internal challenges to my own intelligence, the social landscape of the United States was changing dramatically.
On August 9, 2014, unarmed black teenager Michael Brown was shot by a white police officer. This caused the re-launch of the Black Lives Matter movement, one that has become increasingly relevant as what seems to be an endless stream of cases of violence against unarmed black individuals reach national headlines: Tamir Rice, Eric Garner, Walter Scott, Freddie Gray, Eric Harris, the Charleston Emanuel African Methodist Episcopal Church shooting, Sandra Bland and many, many more. Contrary to what it may seem like, the Black Lives Matter movement and all others associated with it did not spring up overnight. Racial profiling and mass incarceration of black and brown minorities have roots in the fairly recent War on Drugs that was declared by Reagan and further exploited by Bush Sr. and Clinton. Essentially, the social landscape of the United States did not so much change as it did shift decades of simmering tensions into national spotlight; social media and an entire generation of tired youth forced these issues to finally require everyone, not just those directly involved in those communities, to examine the honestly deplorable state of racial and class relations in the United States.
In the last year, two other incidents directly concerning the medical field also came to light. The first was the release of the U.S. Senate investigation findings of the CIA interrogation tactics in December 2014. The findings showed that the CIA’s torture techniques were not only ineffective, but were also deeply misrepresented to the public and its policymakers. Additionally, the CIA paid two psychologists $81 million to develop the “enhanced interrogation” program of that included a host of techniques, of which waterboarding was the barest minimum. In response to this news, Harvard Medical professor and journalist Dr. Atul Gawande wrote a series of tweets condemning not simply the CIA torture report, but more specifically “how doctors, psychologists, and others sworn to aid human beings made the torture possible … doctors were long the medical conscience of the military. The worst occurred because government medical leaders abdicated that role.”
In a similar but less well-known vein, in June 2015, 243 doctors, nurses and other medical professionals were arrested in a national Medicare fraud that amounted to over $700 million in false billings of equipment or medications that were not needed. Many of these patients were also mentally ill and were not capable of fully understanding their situation or giving consent.
In our second-year orientation, our deans brought up the very serious topic of mental health among medical students, especially in this year where we will start studying for Step. We’re told that it is common to start questioning our choice to enter medical school and our capabilities to succeed here. We are asked to watch out for each other, to recognize any changes in our friends’ patterns that could signify depression.
And it’s easy to hear those words, to agree with them. It’s another thing entirely to really process how they can apply to you personally. Because the thing medical school truly can’t teach you is how to really deal with fear and failure in addition to the loss of faith in the profession you want to believe is supposed to be the epitome of simply “helping people.”
We belong to the profession that swears to do no harm. But what do you do when the medical community remains largely silent about the historic social and racial issues that pervade to this day? What about the current discourse about defunding Planned Parenthood; what do you do when you feel like the medical community is slowly but surely getting overtaken by the brutal dichotomy of an increasingly conservative agenda clashing with an increasingly liberal one? What do you do when the medical community itself fails to maintain the Hippocratic Oath? What happens if you see that failure personally — in your attending, on your team, in your community, or even in yourself? Do you speak up each time? Do you repeat every hashtagged name, watch every video, read every article to remind yourself that this is the world you live in, the world you want to change?
I’m going to get personal and be brutally honest. I am tired. I have questioned countless times in the past year if I belong in medical school for multiple reasons. With every new name that reminds the United States of its racial issues, I find myself reconciling the macro with the micro: social change needs to happen, but I also need to pass my exam tomorrow, because if I don’t pass, then I don’t get to be a doctor. And if I don’t get to be a doctor, then I’m not going to be in that position to enact that change. But then I think about how much I’ve changed in this past year alone and I worry: what if the doctor I become is not the doctor I ever wanted to be? What if I become so jaded that I fail to care, and I become a part of the system that fundamentally needs to change?
These are fears that medical school can’t teach away, but in reality, nothing can. “What ifs” are like post-its you can file away if you need to — they’re still present but out of sight. I know these are questions that many of my classmates and other medical students have, but despite all of the encouragement our administration gives us to talk about our emotional and mental health in medical school, we still don’t want to ask these questions aloud.
To me, med school comes in waves, academically and emotionally. There are moments where I feel like I’m not just above water; I’m in command of a ship, steering effortlessly and excited about the vastness of the unknown. Then that next big wave arrives, and I’m submerged and it’s taking everything I can to get out of bed to stay afloat. I think other people are in the water too, but I can’t be sure and I’m too stubborn to ask. But when we find others with the same struggle, we can empathize, and through empathy build a platform for community and encouragement, to openly discuss all the weights that are making it so difficult to keep our heads above water. Medical school can’t teach us how to not be afraid or be overwhelmed, but maybe we can teach each other exactly how we can just keep swimming.