Medical School 2020, Year 2, Week 7

From our anonymous insider…

Exam week with three exams.

The main three-hour multiple-choice NBME exam consisted of 100 microbiology questions and 50 immunology and dermatology questions. Lanky Luke: “This was the hardest block since the beginning of medical school.” Several students complained about the emphasis on tropical diseases. “There must have been 10 questions on leishmaniasis. Every time I saw that as an answer, I would choose it.” Another student added, “I just felt it was not representative of what we will see on Step I. There were so few on hepatitis.” Several students reflected that they will never understand immunology. Type-A Anita: “I knew going in that I would take a hit on immunology. Oh well.”

The case-based exam asked about five hypothetical patients. It tested appropriate use of antibiotics, and classical “alarm” signs of serious imminent danger, for example, patient with sore throat who has difficulty swallowing and drooling may have epiglottitis with the potential to close off the airway. The clinical exam tested adult immunization schedules, screening guidelines, and dermatology pictures. Type-A Anita: “I know we need to know these, but I crammed the day before for immunizations and screening. I’ve already forgotten them!”

The clinical exam consisted of interviewing standardized patients (paid humans recruited from the community as actors) presenting for pneumonia. We used simulated stethoscopes to hear abnormal breath sounds. The clinical exam tested the same immunization schedules and screening guidelines as the case-based exam.

Recall that we meet three times per week for two-hour “case sessions.” Our facilitator is the redheaded hematologist/oncologist. This is the first time that our six-student group met off campus, sharing margaritas as a Mexican restaurant with our facilitator. We were joined by another case session group and their young emergency medicine facilitator.

Our heme/onc attending described the abrupt shift between fellowship and attending. “Even as a fellow, you have someone to bounce ideas off of, to confirm a diagnosis or treatment plan. It takes a little while to get confidence in yourself as an attending.” She had just returned from her first vacation since becoming an attending. “My husband forced me to go on the trip to the Dominican Republic. It was scary leaving my patients. I remember sitting on the beach with a mamajuana [local drink] and feeling completely relaxed. I realized that I had not felt relaxed since beginning my residency six years ago. And probably not since beginning medical school too!” [Hurricanes Irma and Maria passed through the D.R. a few weeks later.]

The other facilitator brought his wife, an Ob/Gyn, and their three children, the oldest aged eight. When should physicians have children? “We made an active decision not to have children during residency. My wife knows all too well that it is best to begin having children by age 35. This can be a serious constraint for women if they start medical school late. Residency is your training and you need to dedicate yourself to it.” The EM physician said he enjoys shift work. He can dedicate everything when he is there, and upon leaving the ER, “I am clear-headed and can focus on my children and wife.”

“A lot of my residents struggle if they have children,” continued the EM attending. “You will have to sacrifice something. Most of the time it means you will miss soccer games and friends’ birthdays. I find it is especially hard if their significant other is not in the medical world. Nonmedical spouses do not understand that once residents are off their 12-hour shifts, they are not done. After your shift, you hit the books. You study. The one exception is a resident I have now. He will not sacrifice his time with his children so after work he plays with his kids. When they go to bed, he hits the books. He just does not sleep and seems to functions fine thus far… I am not like that.”

After the facilitators left, Jane, Mischievous Mary, Deeva Debbie and I walked over to our favorite burgers and beer spot to work on our 100-beer card. After drinking 100 different beers at this restaurant, you are awarded with an embroidered mechanic shirt. Debbie is a a young Indian-American who dominates the class SnapChat story and Instagram. She journeyed to Portugal over the most recent break for a trip with two high school friends.

The women continued the conversation of children over beers. Debbie lamented, “I have no idea when I will be able to have children.” Mary reflected, “I now understand why my parents got divorced. My father was a internal medicine resident when they had two children. He was always gone. My mom had to everything: feed us, drive us, discipline us. She always felt like the bad guy. When my father was home, he would just want to play with us. There was just no time for my parents.” It always surprises me how many male physician lecturers in their 40s are not wearing a wedding ring. [Editor’s note: Our young medical student might want to read Real World Divorce and learn about the world of sexual and financial freedom opened up by no-fault divorce to any plaintiff suing a physician.]

After a well-deserved nap, Jane and I attended our classmate’s housewarming party. He and his wife, a marriage counselor, recently moved into a spacious new downtown loft. While people danced in the center, I talked on the sidelines with a 25-year-old classmate whose parents are Iraqi Kurds. His last trip to Iraq was in 2010, his freshman year of college.

I asked for his perspective on Iraq and the Kurdish people. “It’s hard for me to say. Everything I know is from my dad. My family was comfortably settled in the US when it happened. I just remember my father being glued to the TV during the Iraq invasion. He would cheer the U.S. army every step of the way. Saddam gassed my people.” Why has it gone so wrong for both the U.S. and Iraq? “I don’t know. It comes down to the Iraqi people as a whole were not ready for democracy.”

He is eligible to vote in the upcoming referendum on independence (held September 25, 2017; result: 93 percent in favor). “I think now is the best time for independence. We are ready. The state institutions are there and the Peshmerga will defend us against any invader — Turkey, Iran’s militias. It doesn’t matter that we are dispersed in Iraq, Syria, Turkey, and Iran. Everyone might invade us. I am concerned about the state of elections in Kurdistan. Unfortunately the only politicians come from just two families, but it is now or never. I’m voting yes for independence.”