"Caught between 1st and 2nd Year" by MSIH blogger Ayal Levi

“Caught between 1st and 2ndYear”

So, by some normal measurements, 1st year has come to an end. The 3 Ps are all finished (Pathology, Pharmacology, Physiology) as is the behemoth of Microbiology. 2nd year is waiting for us after the summer. So where are we now? Some strange twilight of academia filled with an endless staircase of review? Nope, we have a trial run of 2nd year before us. A brief look at oncology, then three week segments of endocrinology and hematology. A trial run of the “system” set-up now adopted by many medical schools, whereby each topic is studied for an intense 3-4 weeks, thought of as a more academically holistic approach. Allows us to get “monk” (to paraphrase a friend of mine) on a topic, sans head shaving and stylish robes.

This window into next year got me thinking. That, and this hi-caffeine tea I found. We have entered the epilogue of 1st year. The prologue of 2ndyear. Maybe an appropriate time to reflect on lessons learned? Or maybe put eyes to the horizon and imagine next year? Or maybe take a nap, energize during the eye of the storm? Rest on those seemingly hard-earned laurels of making it through 1st year (in the classical sense). Nah.

“Betterment is perpetual labor. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are also only humans ourselves. We are distractible, weak, and given to our own concerns. Yet still, to live as a doctor is to live so that one’s life is bound up in others’ and in science and in the messy, complicated connection between the two. It is to live a life of responsibility. The question, then is notwhether one accepts the responsibility. Just by doing the work, one has. The question is, having accepted the responsibility, how one does such work well.”
-          Atul Gwande, general surgeon and associate professor at Harvard Medical School.

All italics are mine. This book arrived at my doorstep in Canada while I was home with my family. Present from a good friend. This section was taken from prologue of the book, “Better,” by Dr. Atul Gwande.

It is dangerously easy to get sucked into one’s own whirlpool of constant studying, worry, and self-reflection. There is an element of narcissism to this initial year of medical school. “I have to study,” I am so stressed,” “I have somuch work,” and so on. Aside from the opportunities that MSIH offers us to get out of the protective shell of studying and interact with actual real live patients, we spend most of our time in our own heads. Strange way to prepare for a profession that involves spending a life-time in service of others.

To paraphrase Dr. Gwande, by entering this profession we have accepted the responsibility of being forever intertwined with the people we will serve. The question now remains, how to do it better? How to do it well.

We must forever rise above our baser feelings and desires in order to pursue this ideal. Our patients will not care if we are tired. They will not care if our new puppy ate our brand-new shoes, if we have a new-born that won’t sleep through the night, or even if we lost a patient earlier in the shift. When they see us, they will expect our undivided attention, our commitment, our everything. Rightfully so.

They will expect our resilience in the face of everything that life may throw at us.

Resilience is not built in a day. Or a week. Or a month. It takes years to forge. It takes being uncomfortable, for long stretches, to build that resilience. It takes practice, practice, and then more practice.

We could wait until 3rd year, or 4th year, or residency, or fellowship in order to build that resilience. That would be a mistake.

If we want to be better now, we need to practice that resiliency as soon and as often as possible. Everybody in their own way, but learning to embrace being uncomfortable now will make the challenges we will face later at least slightly more surmountable.


More importantly, it will make us better doctors. Which, after all, is the goal.

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