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I don’t remember precisely when my classmates and I began to suspect that the School of Medicine was engaged in a secret, carefully engineered plan to test our will and our worth.

I do recall that the conspiracy-theorist vibe peaked in the first half of the second semester, when our schedules were packed so tightly that we could not help but perceive a calculated exercise to push us to the very limits of physical and psycho-logical endurance. We seethed with frustration at compulsory yet seemingly superfluous activities—lectures on the U.S. health care system, summer research presentations, hepatitis B vaccinations—that subtracted from the precious hours we needed for studying. The administration, we half-seriously muttered among ourselves, was deliberately stripping us of our time and our autonomy in an attempt to make us feel even more challenged than we already were by the relentless crush of schoolwork.

We were, of course, deluded.

In our defense, we were stressed and often sleep-deprived. We were stretching our minds to contain absurd quantities of information delivered at the speed of light. And most important, we had not quite absorbed what it really means tocommit one’s life, one’s whole life, to medicine. We had just begun to learn a lot of things.

As Emory’s School of Medicine once again considers a revision of its undergraduate medical school curriculum, it is perhaps informative to view the medical school experience through the wide eyes and slightly shell-shocked perspective of the first-year student — the M1.
     As an M1 during the 2003-–2004 academic year, I quickly discovered that the foremost obsession of medical students is not, contrary to expectation, grades. It is time.
     “See, if I sleep for seven hours and it takes a total of two hours to eat and shower and stuff,” a friend said as we were heading into the weekend before an exam, “that leaves a whole 15 hours to study. That’s reasonable, right?”
     I didn’t immediately respond because I was calculating how many lectures I could memorize in 15 hours and considering whether another half hour could be shaved from meals and hygiene.
     And yet I perceived myself as not working as hard as I could—or should.
     “I don’t really study that much,” I told friends outside medical school. My husband rolled his eyes.
     My fellow M1s and I had come to count the hours as a miser counts his hoard of coins. We talked constantly about time: how much we spent in class, how much we spent studying, how much we got to sleep. Even our extracurricular and leisure activities were conducted in the shadow of the giant clock that seemed to rule our lives. And like misers, we resented having to relinquish so much as a single minute, especially if we questioned the value of what we got in return.
     We measured all of our classes by this yardstick. If attending a particular professor’s lectures sparked your interest and/or contributed significantly to your assimilation of the material (and your ability to spit it back out come exam time), then it was worth the hour spent in class. Otherwise, it was better to skip and study the transcript. Over the course of the year, even the most die-hard class attendees converted to this practice. By April, our classroom looked embarrassingly empty some mornings. At least we felt guilty about skipping. Sometimes.

Our favorite topic of conversation in the anatomy lab was whether we should have to endure anatomy lab.
     While the dissection of human cadavers long has been a core element of medical education, some schools, such as the University of California, San Francisco, no longer require medical students to perform their own dissections.
     The reasons for this shift are diverse. One of the more compelling points is that M1s haven’t yet acquired the knowledge and skills to make the most of cadaver dissection, and it would be better to offer dissection as an elective for third- or fourth-year students planning to specialize in fields such as surgery.
     At Emory, M1s currently spend the fall semester rotating through the cadaver lab, with each student performing one of every three dissections.
     It’s a chicken-and-egg argument, to some extent. Many argue that dissection is the best way for first-year students to build a framework on which to hang their studies in physiology, cell biology, and neuroscience. Certainly dissection served additional purposes: it instilled in us an appreciation for the variation and complexity of the human body and the fragility of life. As we worked with these bodies entrusted to us, we caught a glimpse of the not-too-distant future, when the living would place themselves in our hands.
     It was harder to keep up an appreciative attitude, however, when our heads ached from the preservative fumes and our hands cramped from inexpertly gripping forceps and scalpel for hours on end.
     In the chilly reek of the lab, where we averaged 40 hours per week when it was our turn to dissect—and this on top of five other courses—we debated the time value of what we were doing. How much of the value of anatomy lab, we asked each other, lay in its role as a rite of passage for cocky young medical students?
     “Look,” said a classmate at the table next to mine as I struggled to isolate the delicate blood vessels of my cadaver’s hand, “it does take an incredible amount of time. But there’s no way you’ll ever forget that nerve you spent three hours trying to find.”
     I had to admit she was right. And most of us ultimately concluded that dissection was indeed invaluable. But every last one of us was thoroughly glad it was over.

I don’t mean to give the impression that grades weren’t important to us. As an older medical student nearly a decade out of college, I had believed myself to be well past the days of gunning for high marks. As it turned out, I wasn’t. I just didn’t want to be obvious about it.
     No one did. Very few people were overtly competitive. Most of us, myself included, competed with our own impossible expectations of ourselves. This was partly because we soon realized that we didn’t need to beat each other. We needed to beat the professors.
     As the year progressed and we developed a sort of combat mentality regarding schoolwork, what little competitiveness had existed initially within the class waned and was replaced by a back-slapping, “Go-get-’em tiger” supportiveness. We taught each other, shared our notes, and swapped personal theories, mostly unfounded, about questions that were certain to appear on the exam.
     “Listen, the one thing you have to remember is that the umbilicus is at T10,” a friend confidently said right before an exam, referring to the fact that the navel is commonly located at the level of the 10th thoracic vertebra.
     “You’ll be fine if you just remember four words: relative afferent pupillary defect,” someone else assured me on another occasion.
     And yet again: “If you remember nothing else, know the difference between atrial fibrillation and atrial flutter.”
     What I soon realized, though, was that there was no trick, no ultimate crib sheet. Every scrap of information, even words in barely legible two-point type on handouts, was fair game. And although we griped about the outrageously picky questions of our professors, we understood in our hearts that everything was fair game because life wasn’t fair, and we wouldn’t be able to dictate what kinds of diseases our patients got and what specific set of symptoms they had. If I wanted to be a doctor, it was my responsibility to learn everything I could.
     And there was a lot to learn. With so many facts to be learned and regurgitated, I became a highly efficient memorization machine. Eyes closed, reciting in rapid-fire sotto voce the muscles of the forearm, the components of the electrocardiogram, the causes of jaundice, I looked and sounded like some kind of religious devotee chanting prayers. And you can bet I was praying. I prayed to the gods of the M1 pantheon: Anatomy, Physiology, Biochemistry, Cell Biology, Genetics, and Neuroscience, with a special plea to St. Jude, the patron saint of hopeless causes. I prayed I wouldn’t fail and have to drop out and skulk back to my old job in disgrace. I prayed that the faculty would take pity on us. I prayed that my memory would come through for me. I knew all the material, in theory; I just had to remember it.
     Just remember. Just remember. Just remember.
     I started to forget things. My locker combination. My cell phone number. Whether I had taken the chicken out of the freezer that morning.
     At last, the year ended, and I was able to resume, temporarily at least, some semblance of my pre-medical school life. I slept eight, even nine hours at night. I read fiction in my free time. I actually had free time. My recuperation was so successful that I found myself, against all expectations, looking forward to my second year.
     Looking back now on my first year, I continue to be amazed by the extraordinary amount of information I learned. More amazing to me is how much more I have to learn before I can begin to call myself a doctor. At least I now know I can do it.




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