Hello, welcome back to medical school. I hope you had a good vacation after taking your board exams, because guess what YOU HAVE FORGOTTEN EVERYTHING YOU ONCE KNEW ABOUT MEDICINE. It is absolutely shocking how stupid I am. Again.
(I know, I know, sorry Mom but it’s true.)
My last rotation of last year was internal medicine. When I sat for the shelf exam, I knew how to treat heart failure patients, which drugs treated regular pneumonia and which were reserved for MRSA, and where the best place to stand on rounds was to avoid getting questions thrown at you.
I no longer remember any of this.
My course this month is, as I mentioned last week, one of the “integrated science courses” we’re required to take. Every morning I do the hospital thing – pre-round, present on rounds, follow the patient, and so on – and all afternoon I’m in lectures. The course is about the slowed immune systems of people with organ transplants, undergoing chemotherapy, and the like, so the patients we follow tend to require some of the most specialized care in the hospital.
I spent last week on the transplant infectious disease service, which is actually just two really smart guys and a potentially unfortunate medical student (me).
On Day One, the first thing the attending told me was how he wanted me to present. “You have to present transplant patients just a little differently,” he says, “but it won’t be anything you aren’t used to.”
Okay. I still remembered how to present. I thought. I had already seen the patient I was supposed to present, so I’d obviously just need to tweak a thing or two. Right?
“In your first sentence, if someone had a transplant, I want to know,” he started ticking off on his fingers, “relevant past medical history, why they needed the transplant, when it was, what kind of induction immune suppression they got, any postoperative complications they had, what their maintenance medications are, how often they have biopsies to test for rejection, whether they’ve had any histopathological evidence of rejection, and the name of the primary transplant doctor managing their care.”
“Oh, and then why they are in the hospital after all that. Tell me about your patient.”
Somewhere in there, someone superglued my tongue to the roof of my mouth. I had no idea where to even begin.
I eventually unstuck myself and got started under the uncomfortable eye contact of the attending. The beginning wasn’t too bad – “Mr. Patient is a 59-year-old man with a past medical history significant for viral myocarditis requiring an orthotopic heart transplant in 2011” – before I made several cardinal mistakes no medical student should make:
- I forgot to report any kind of history besides “he started feeling bad three days ago;”
- I didn’t say anything about the pneumonia that landed the poor guy in the hospital in the first place;
- I completely forgot to present my physical exam, which included important things like “decreased breath sounds” and the unicorn finding of “tactile fremitus” which if nothing else is extremely fun to say;
- My “plan” was “keep doing what we’re doing.”
As you might imagine, my attending was not impressed. “So, you’re rusty. We’ll try again tomorrow.” He abruptly got up and left.
That afternoon I went to four hours of lecture on immunology. I can confidently say, as a mature third-year medical student with a full year of clinical medicine under my belt, that immune systems are a system that humans have. They are fascinating, poorly understood, and utilize entirely too many acronyms for things. They are also impossible to learn about because nothing makes sense, especially after four hours of lecture.
I cannot tell you much more than that, because I remember nothing from my immunology block, except that the mitochondria is the powerhouse of the cell.
Just kidding. I can tell you way more than that, including such clinically irrelevant details as “precursor MHC Class I molecules are bound on the luminal side of the endoplasmic reticulum to TAP and tapasin, only becoming freed when exposed to an endogenously processed peptide antigen,” which is a sentence that was spoken out loud this week by someone potentially named Nate in class. Although I said it, I have no idea what it means.
This knowledge has the same practical application as knowing that the development of the Greek phalanx fighting formation was a nominal driver for the rise of direct democracy, which is to say none whatsoever.
(The Greek phalanx-democracy thing is definitely more interesting, if you care to– okay, sorry, I forgot no one cares about that thing either.)
Anyway. The moral of the story is that I have forgotten everything from a mostly bare cupboard already, immunology is extremely hard,* and I maybe should not have tried so hard to erase everything from my brain after The-Test-That-Shall-Not-Be-Named this summer.
*(The fighting phalanx required that every man in the formation had strong trust in his neighbors, because without them he would be thoroughly exposed on his flank. Because of this trust, fighting in a phalanx engendered a sense of implicit unity among Greeks that was absent in their enemies, who relied more on the Braveheart-style “Forward the Light Brigade” fighting that required mostly luck and sheer numbers to avoid death or defeat. Scholars have thus theorized that the formerly absent sense of togetherness present in the Greek military led to sociocultural changes that allowed for experimentation with a more communal governance model – the Athenian direct democracy.)**
BOOM SNUCK IT IN THERE!
**This is a direct quote from a paper I once wrote, probably in the thirty minutes before it was due, because I was a liberal-arts major and got participation trophies for trying, and we did such things in college. I got an A on that paper based at least 95% on the fact that I snuck in references to both Braveheart and an Alfred Lord Tennyson poem into the same sentence.
This week I go on the kidney service to take care of renal transplant patients. Please pray to your supreme deity for me.