A week after our final physical diagnosis exam was our last “end of block assessment” of first year, which is fancy med school terminology for “final exam.” Like our other tests in first year, it was remarkable only for how long it was (fourteen-ish hours over three days) and for how absurd some of the questions were.
For instance, one question asked us to speculate about the mechanism of action for a common psychiatric drug. Note the use of the word “speculate: the question wasn’t asking us to describe something known, like how aspirin works. No. Instead, we had to imagine how the drug works based on… well, nothing in particular.
Another question asked us to describe the “neurobiology” of a common psych/neuro disorder (I’m being intentionally vague so no one gets mad). It sounds like a good question – after all, how can you treat something common without knowing its fundamental basis in the brain?
The answer: you treat it because the treatments work, not because we understand the disease or why the treatments do what they do. Prozac? Prozac does something with serotonin, and maybe makes having sex a little weird. (No, really, that’s about the extent of our knowledge about the most prescribed psych drug of all time). Wellbutrin does like six different things in the brain and for some reason helps you stop smoking. Somehow. Also it maybe causes seizures.
So what is “neurobiology?” I guessed that they wanted to know about brain changes. Hmm. But those changes are also poorly described in science. From what I did know, some areas of the diseased brain light up more on some scans. Some areas light up less. But, crucially, no one knows what this means. It’s like showing a six year old the cockpit of a 747. There are tons of buttons, and some of them are lit up, but no one has any idea what most of them do.
All of neurology is like this. Here are a few examples:
- We have no idea what causes epilepsy, an absurdly common neurological disorder, and no idea how any of the drugs that we use to treat it work. It’s like not knowing what causes strep throat or why antibiotics fix it.
- The anti-epileptic drugs have CRAZY terrifying side effects. No one knows why. One of them, Keppra, works pretty well except in an unpredictable 10% of people who take it. Those 10% become, in the words of our lecturer, “evil.” They turn into irritable, aggressive, hateful people who are a true misery to be around. In other words, me. No one knows why.
- We have no idea why certain brain cells die in Parkinson’s Disease while others are fine.
- Migraines are still a huge mystery, as are cluster headaches.
- Adderall helps everyone, not just people with ADHD, have better focus. Again, no one knows why. In other news, I am taking bulk orders for Adderall prescriptions scheduled for 2017 delivery. Payment may be made in chocolate or duffel bags full of cash.
- Dear DEA and lawyer friends: I am kidding.
Pretty much the only thing we are good at are strokes, except that by the time you see a neurologist for stroke there’s not a lot to do except figure out where the stroke is (remember, the neuro exam is “elegant”) and hopefully head off future strokes. In some small percentage, you can repair some of the damage, but that’s more the exception than the rule.
Okay, neuro soapbox over. I guessed a lot on the test. Everyone guessed a lot on the test, which means everyone is going to be fine.
The last part of the test was multiple choice. By Friday morning, just one hundred and fifty questions stood between me and 3+ glorious weeks. After finishing my first pass through the questions, I started my review. I was halfway through my first reviewed question when SCREW IT I’M FREE AND NO LONGER CARE GOODBYE MED SCHOOL
Blindly, I hit submit and staggered out of the room. Screw reviewing. I’d just change wrong answers to wronger answers anyway. Thankfully they both count the same zero points so it wouldn’t make a difference. Freedom awaited.
For the first five days after the exam, I felt like someone had hit me over the head (an experience with which I have much experience). I forgot to do errands, because there was no imperative to do them. I woke up predictably at 6 am every day, despite a totally empty schedule, wandered around aimlessly for a couple of hours, worked out, and watched TV until the world woke up. It was glorious.
It took me nearly a week of social rehab before I remembered how to make normal, non-medical small talk again. We went out for mimosas at 11am, because we could, and I was tipsy after two.
I even caught myself a few times thinking, “what do I have to do today?” The triumphant answer was nothing – always, glorious nothing.
I now sit at home with unlimited chocolate, blueberries, other snacks, and dog at my disposal with a trip to Iceland on the horizon. Life is empty. And life is good.
Of course, in late August I start rotations. OB/GYN is up first. Prepare to be terrified.