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Unofficial Prognosis

Unofficial Prognosis


Perceptions and prescriptions of a medical student
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Convergence (reflections on second year)

The views expressed are those of the author and are not necessarily those of Scientific American.


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“You are a red blood cell in the left subclavian artery, on your way to the brain. What vessels will you pass through?”

One by one, the ten or so of us in the neuroanatomy lab bay recited the vessels in the Circle of Willis, answering additional questions about nerves we would pass by and parts of the brain we would supply energy for. When someone made an error, the rest of the group simultaneously mumbled the correct answer.

“I want to see everyone else mouthing it,” our instructor said. “Say it to yourself as you’re walking down the street.”

People have said that medical school is a bubble. Others prefer the term echo chamber. In many ways, it really is. I walk through campus and overhear someone on her phone explaining G protein-coupled receptors. On the way to class, two students vigorously debate the rationale for a certain stroke treatment. As I walk down the street, I find myself noticing abnormalities in strangers and thinking up differential diagnoses. I am starting to see medicine everywhere, in everyone.

It wasn’t always like this. We came to medical school as a class of 165 individuals, all with diverse personalities and interests. Some already knew exactly what they wanted to do. Psychiatry. Othropedic surgery. Oncology. Then there were our other passions. Global health, policy, ethics, creative writing, music, everything in between. In the beginning, it was those differences that we recognized and embraced. “Learn from your classmates,” was a recommendation I heard often. I did. We did. Hearing the multitude of reasons people chose to pursue the path of medicine was inspiring.

Now, regardless of those interests, the way medical school works is that we all must be trained broadly. Everyone goes through everything, and we go through it at the same time. Neurology, cardiovascular, renal. Steps of glycolysis, inborn errors of metabolism. Visualizing the optic disc. Eliciting deep tendon reflexes. Asking patients about sex. We read the same books. We recite the same words. Earlier this year, we purchased the same equipment; now we struggle how to use it.

We are sounding more and more alike because there is a specific end goal we want to reach. We look at the third and fourth years who look at the residents who look at the attendings, and we admire their knowledge, their competence, and their skills. I watch those who know more and actively ask myself: how can I be like that? What knowledge do I need to obtain, and what skills must I work on?

Because it’s only once we reach that bank of broad knowledge can we begin to diverge once again. It’s only once we know a little about a lot can we choose to learn a lot about a little.

There’s a quote I love from Milan Kundera’s Laughable Loves:

“We pass through the present with our eyes blindfolded. We are permitted merely to sense and guess at what we are actually experiencing. Only later when the cloth is untied can we glance at the past and find out what we have experienced and what meaning it has.”

In just seven months, I will be out of the classrooms and on the hospital wards. I remind myself that all the studying now is for then, for that, for the patients.

I cannot wait to see what happens when the blindfold of second year comes off.

I think many of us were concerned about losing ourselves as we became immersed in the medical school bubble. But as it’s happening, I find it’s okay. There will be a time for our personalities and differences to shine again. For now, there is excitement in joining the bubble; in becoming the same.

Ilana Yurkiewicz About the Author: Ilana Yurkiewicz is a fourth-year student at Harvard Medical School who graduated from Yale University with a B.S. in biology. She was an AAAS Mass Media Fellow, and her work has appeared in the New England Journal of Medicine, Aeon Magazine, Science Progress, The News & Observer, and The Best Science Writing Online 2013. She has an academic interest in bioethics, currently conducting ethics research at Harvard after previously interning at the Presidential Commission for the Study of Bioethical Issues. She is also interested in general internal medicine and quality and systems improvement. Follow on Twitter @ilanayurkiewicz.

The views expressed are those of the author and are not necessarily those of Scientific American.





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