The whole of what I'm supposed
to have learned in the last four years of medical school
is summarized in the 1,400 page tome known as Toronto
Notes. I remember looking at this book eight years
ago while I was still an undergrad, relieved that I
was studying for Biology 101 rather than the scary MCCQE.
The first page of the book contains
an epigraph from Hippocrates: "Life so short, the craft
so long to learn" The sentiment undoubtedly echoes the
sentiments of all my hapless peers who've spent time
with it in dark, airless medical libraries, trying to
cram as many diseases into their memory banks as possible.
My licensing exam is only a month away, so for me, the
Hippocratic epigraph can be more accurately paraphrased
as "Exam so soon, the Toronto Notes so thick"
HITTING
THE BOOKS
Despite the intimidating quantity of information to
be learned, I'm actually happy sitting down to study
medicine. Much like the first days of medical school
when everything was so cool and I was going to be a
doctor, I feel one step closer towards that goal. Now
that I'm matched to internal medicine, that goal has
become clearer as well.
As I'm reading Toronto Notes,
I feel almost surprised to realize that I've actually
acquired some knowledge over the last four years. Whereas
in first year, I would have skipped over the lists of
differential diagnoses of particular diseases, I now
have enough background knowledge to formulate differentials
for myself. It helps to have a little bit of reassurance
because sometimes it seems like I don't know anything
at all.
SURGICAL
ROUNDABOUT
At the same time, I'm still labouring through my surgery
rotation, the final rotation of medical school. I like
surgery, but there are aspects to it that just outweigh
its interests for me: the residency is tough, the hours
are long, I'm standing all the time, I can't touch anything
in the OR — and the surgical caps mess up my hair.
This fourth year rotation isn't
much better, except that now that the residents know
I'm going into internal medicine, it's automatically
assumed that I'm not interested in surgery and I don't
get to participate as much. "Can I join you for this
hip replacement?" I ask. The surgeon asks me, "Do you
know how to scrub?" (This is the last week of my ten
weeks of surgery in medical school, I wanted to say.)
"Can I close the wound?" I ask after retracting for
four hours. "Do you know how to tie interrupted sutures?"
(I sigh.)
I considered claiming that I matched
to some surgical speciality so I'd hopefully get more
experience. Then I considered claiming that I matched
to psychiatry so maybe they'd just let me off to go
'read' in the library. Eventually, I decided that I'd
just take advantage of my last surgical experience by
selecting cases that I was actually interested in seeing
from the OR slate for my own edification. Even though
I consider surgery a physical hardship, it is still
pretty amazing stuff.
TERMINAL
DIFFERENTIATION
If I didn't want to, I would probably never step into
an OR again after this rotation. In one sense I'm sad:
a doctor just can't do everything anymore. I can't practice
nephrology and create my own AV fistulas. It's one or
the other. I can't be a gastroenterologist and resect
bowel. I can't even see children as a general internist!
I guess the world is just becoming
more specialized and people have to find a niche for
themselves as generalists become valued less and less.
Life is too short, especially when there are so many
interesting things to discover in medicine. I feel like
a pleuripotent stem cell right now at the end of medical
school, taking my first step towards some terminal differentiation.
Where will I eventually fit in in this vast healthcare
system?
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