Familiarity

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Almost exactly one year ago, I began medical school with 199 total strangers.  The only overarching thing we had in common was that we were members of Harvard’s medical class of 2014.  There would be other connections, of course, but none were obviously apparent at the time.

The best way to cement a face, I’ve since found, is to run into that face in an entirely different context.  In the morning she’s in my small group discussion section on pharmokinetics, but at night she’s my good friend’s college roommate, reminiscing about our time in college.  I sometimes sit next to him in Social Medicine, but last Saturday we discovered we had mutual friends at our local synagogue.  Every new connection became an additional dimension to an acquaintance, a personality that only revealed itself outside the confines of a classroom.

All of this is fairly obvious to anyone who has suddenly been thrust into a new city, a new job, a new role.  You strive to build connections, to create multi-dimensional characters in your local cast.  You begin to like people more, each interaction becoming easier, with more to build on and more to anticipate.  Socializing becomes less like work and more like fun.

What I didn’t realize until second year is that this common sense insight did not only apply to people.

I’ve always heard that second year of medical school is by far the hardest academically.  ”Drinking from a firehose” is the standard cliche to describe it.  The way I’ve found myself trying to relate my baseline stress levels to those outside the medical field is, “At any given point you’re only going to know 20% of what they expect you to know.  My job is to figure out if I know the best 20%.”

One of the most difficult parts about medical school is becoming comfortable with knowing you don’t know vast amounts of information.  Sometimes your 20% does not overlap with your classmates’, and then you begin to wonder what is wrong with you, and why your brain cannot hold on to factoids like everyone else’s seems to, and what if your 20% is the useless 20%…

But back to the silver lining.

Last year, I met a lot of new molecules, a lot of new concepts, and a lot of new drugs.  It was almost as though I was walking down a crowded Boston street, stopping to chat with a few molecules or muscles, learning as much as I could in a short amount of time, and wondering if I would remember them in a month’s time.  After some polite chit-chat, I usually never heard from them again, and they left my realm of conscious awareness.

Biochemistry was crammed with minutiae, down to amino acids and molecule folds.  Amino acids make proteins, proteins make cells, cells make tissues, tissues make organs, and organs are what we held in our hands in gross anatomy.  We had zoomed out and lost touch with our old acquaintances.  In physiology, we spent one week on each organ system, racing our way through the functions and composition of the lungs, heart, kidneys, GI system, and endocrine glands.  A few months later, we met the microbes–bacteria, viruses, and parasites that lived in our organs.  First year, I met each concept once, in a specific place and within a specific context.

There was so much to memorize I couldn’t imagine how much worse second year would be.

And there is a lot more work second year.

But I’ve already met the characters.  And the new ones are usually friends of friends.

Of course, I don’t remember most of them, at least not consciously.  I find myself having to Wikipedia something I know I’ve been introduced to–and looked up–at least several times before.  I find myself hoping this time will stick.

But–and I wouldn’t believe it if I’d told this to my first year self–it’s also a lot more fun.  I’m more vested in the characters.  Now when I hear that a new drug binds to a kidney receptor I’ve already met, I not only remember the receptor better but I remember the new drug better as well.  And I find myself caring about the receptor, wondering if there are other drugs that can bind to it, or if it has a job that we haven’t yet learned about.

There’s certainly more to know, but this time I want to know it.

Last year, I met classmates in classrooms.  We would do the requisite small talk because that’s the socially acceptable way to build foundations.  Then we would drift away, meeting others.  Likewise, I met molecules in classrooms, learning names and trying desperately to fit them into a mental framework.  Within a few weeks, these would inevitably drift away as well.

It’s always nice when paths cross again.  It’s nice when you hear a big word but realize that it’s still big but not new anymore.  It’s even nice to be frustrated that this is the fifth time you’ve looked up that big word, because at least you remember looking it up, even if you don’t remember what it meant.

I recently watched the last Harry Potter movie.  Somewhere in the middle I mentally took a step back and imagined what the film would look like to someone who hadn’t spent six previous books learning the ins and outs of the fantasy world.  It would be jargon, it would be forgettable, and–worst of all–it would be boring.

Second year of medical school is a lot of things.  But it isn’t boring.  My last year self–as well as probably most of the outside world–wouldn’t quite understand why I can tolerate spending at least eight hours a day studying.  The best way I can explain it is that I’m meeting and re-meeting and re-re-meeting characters I care about.

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