It’s midnight and I have a headache. I’ve been staring at my bright computer screen all day and my eyes are bloodshot. My lower back is sore from sitting at my kitchen table for the entire day. Yes, the entire day. I have finally traded the caffeinated beverages for a glass of Makers Mark on the rocks, poured from a glass decanter inscribed with the phrase, “So it goes.” Fitting.

This morning, I woke up, brewed some coffee and sat down. Cracked open Functions and Disorders of the Immune System: Third Edition and read for two straight hours. One coffee lead to another. And another. I became so stimulated that I had no appetite.

I read. I watched lectures from my computer because in the beauty of the social media age, lectures are streamed online. For breakfast I ingested the minutia of various fungal infections. Tinea cruris is a fungal infection of the groin. You don’t want that evil on your hands, I mean scrotum. I drank more coffee.

Noon. Then for lunch I dug into a lecture on a variety of anti-fungal medications to treat the aforementioned infections. Then I dissected a chapter on “Congenital and Acquired Immune Deficiencies”.

3 pm. The only times I stood up were to take a piss. And brew more coffee. The only times I diverted my attention away from studying were to scour the internet on the latest election scandals of our demonic rulers. Fuck em. More reading. More notes. At five I finally realized that I hadn’t eaten yet, due to a combination of my body’s stimulation and my obligatory obsession with medical school.

I cranked out another hour of studying until I decided that I needed to consume food. Didn’t have time to cook. At least that’s what I told myself. Ordered chicken & broccoli from a Chinese joint down the road. The only time I left my apartment today was during my 10 minute round trip to pick up my take out order. The only human I physically spoke to today was the old Chinese woman behind the register with hardly comprehensible English.

I came back, ate, surfed the web, then started studying again. 10 pm. Darkness. I would have completely forgotten that it was Friday if it weren’t for the fact that I received several texts from friends asking me to come out and drink. Everyone was somewhere. At the bars. At a concert. Hanging with family. In good company. I’m isolated behind a computer in my single apartment. This time last year I’d be wasted off my ass with my buddies, reveling in the splendor of youth. But now, I’ve spent my entire day studying, from the moment I woke up until the moment I started writing this.

But don’t feel sorry for me. I’m happy as ever. No, really.

See, I may not be drinking now, but at this time last week I was surrounded by close friends at a college house party with kegs and girls and music and all that, drunk and happy. Tomorrow I’ll do the same thing I did today, but last Saturday I was shotgunning beers all day, dressed up as a safari explorer while my girl was dressed as a sexy tiger.

Ebb and flow, baby. Yin and Yang. Work hard, play hard. That sorta thing.

So, How Hard is Medical School?

So when someone asks me, “how hard is medical school”, sometimes I really don’t know what to say. Do I complain nonstop and act like many other intolerably pretentious med students? That’s not me. There’s the bad, and there’s the good.

Lets start with the bad: Man, you better believe its really hard. Every week in medical school is like finals week in undergrad. It’s almost incomprehensible to those who haven’t done it. Unless you’re some kind of freak, you can’t learn everything. There’s simply too much information. Too little time. Some explain it as “trying to drink water from a firehose”. Hyperbole. But it maintains some accuracy.

Here’s a valid statement – it isn’t that most of the material itself is inherently difficult to grasp, but rather the fact that the volume of information is overwhelming. For instance, if I were to tell you that you had to memorize 25 antibiotics – names, class, structure method of action, diseases they’re used to treat, side effects, and so on… you’d be panicking.

Cefotoxin

• Class: Second generation cephalosporin.
• Structure: Beta-Lactam
• Method of Action: Disrupt peptidoglycan formation of bacterial cell wall
• Treats: Gram(+) rods and some Gram(-) rods. B. fragilis, serratia
• Side Effects: rash, hypotension, GI disruption, pancytopenia

Now do that for 25 other drugs. Got it? Greaatttt. That’s one lecture. There will be around 3-4 others that day, each densely packed with their own flavor of medicine. As well as every day. Also, don’t forget to do those non-lecture readings about beneficence in ethics and epidemiology. If you’re lazy and fuck off for a day, you will have double the amount to memorize tomorrow.

And when exam day comes, it will be four hours long, and rote memorization will prove useless. No, instead of asking something nice and polite such as, “what is the method of action of Cefotoxin”, they will give you symptoms and lab tests, from which you will have to deduce which of the myriad of bacterial infections the patient has, diagnose the mystery disease, and then after they’re done fucking with you they’ll ask, what is the structure of the drug used to treat this infection?

For example you may see something like this:

Patient is a 56 year old white male who presents with fever and nausea. Temperature is 103.5, B/P is 150/95. The man is diabetic and currently taking an ACE-Inhibitor. The pathogen was determined to be a gram-negative aerobe and empirical antibiotic treatment was started. Four days later, the patient has gross hematuria and elevated BUN. Which antibiotic likely caused this problem?

• A. Ceftriaxone
• B. Amoxicillin
• C. Gentamicin
• D. Clarithromycin
• E. Penicillin G

You’d have to first understand which antibiotics are indicated for gram-negative bacteria. Then, because of the diabetes and subsequent renal issues, you’d need to know which of these drugs are nephrotoxic. Then you’d arrive at C. Gentamicin, because it is an aminoglycoside.

It seems convoluted and difficult and confusing. But here’s the real truth: It sounds terrible, but it’s really not that bad. Reading that as a non-medical student may seem daunting, but you’ll realize over time that questions with clinical vignettes all have several clues that point you toward the correct answer. The questions are usually never straightforward, meaning you have to know your shit (class, drug names, M.o.A., side effects, etc) to get it right.

This is how I put it – when you were seven years old, you’d look at a 600 page novel and think it’s impossible. When you’re in the eighth grade, you’ll look at a barbell with 375 pounds on it and say, “there’s no way I’ll ever be able deadlift that”. When you were in freshman high school basic math, you’d look at calculus 3 problems and think it was some foreign language reserved for savant-level geniuses. I think you get my point. You adapt, you learn, and you grow.

Imagine telling yourself as that eight year old that you’d one day read that 400 page novel for pleasure. Or that you’d lift those weights because you actually wanted to. (I don’t think example applies for the calculus, but whatever).

If you had told me a year ago today, while I was ripping shots of cheap whiskey with my buddies in a shitty college house, that I’d be studying for 12+ hours on Friday, I’d call you insane.

But the reality is, you have no idea what you are capable of until you’re pushed to go further. You don’t need to be a genius to go through medical school. Hell, I’m almost certain that I’m half retarded. Two weekends ago I got my car towed and accidentally set my dumpster into a roaring flame while I was drunk. And here I am.

It’s funny. When you grow up being forced to go to school from six years old until eighteen, every single damn day from 8 am to 3 pm, you begin to loathe academics and the word “book” becomes synonymous with waterboarding. It’s a prison. Then you go through college, where you’re told that you finally have the chance to explore your mind and enrich your conscience with thought-provoking academia. They lied. The only time in college you explore your mind is the first time your buddy convinces you to drop acid. Instead, you were sentenced to four more years of boring classes for your major and mandatory liberal arts courses taught by some whack-job professor pushing their own social agenda.

I got sick of it. By the end, I despised studying. Maybe 10% of the biology material was relevant to my career. And don’t get me started on the degree-requirement humanities bullshit. By the end, I hated school again.

Then I got here. And what do you know. Everything clicked.

Now that I’m finally here, after the years and years of monotonously irrelevant force-fed drivel, I am finally learning about what I love. For me, that happens to be the human body and all of its intricacies. I will someday be the guy that someone comes to when they’re don’t know what that rash is on their penis. I will cure that gotdamn rash. And I take pride in that.

I take pride in what I’m learning. And suddenly, its not so horrible. It’s hard, but I wouldn’t have it any other way.

So at this point, we’ve hopefully established that its very hard, there is a frightening amount of information you must memorize, but that if you’re in medical school because you actually want to be here and you love what you learn, it ain’t so bad.

However, here’s the kicker: medical school is pass/fail. You need a 72.5% on an exam to pass. If you fail three exams, you get the choice to remediate a year (I’d rather swallow a scorpion), or you get the boot.

Now, you can study for a minimum of a few hours a day and pass your exams with a low score, graduate and become a doctor. That’s fine, BUT, if you want to get into a competitive specialty (surgeries, radiology, dermatology, etc), you have to finish top of the class, obviously meaning you have to study like a maniac to outsmart a bunch of neurotic nerds. So if you’re gunning for a top specialty, med school becomes harder.

Therefore, the difficulty of medical school is relative to your goals.

In the first two years of medical school, yes it is critical to do well in your classes, but ultimately, every day you study, you are studying for one exam – Boards; Step 1  USMLE or COMLEX (D.O.). Your board score, not your grades, is the measure of how well you did and medical school, and the decider of which specialties you’ll be competitive for. If you want to be a primary care doctor or a pediatrician, simply passing and average scores should suffice. However, if your dream is to be an Orthopedic Surgeon, you better score above the 90th percentile on the exam, meaning that you need to absolutely master the material you are taught in your first and second years.

But, it is not all about “who studied more” when it comes to success in medical school. One aspect that I’m still adjusting to and figuring out, is how to study effectively. With so many books, lectures, journal articles, and other sorts of resources to learn from, deciding what to study and for how long is the key to success. And again, the beauty of the era we live in, is that there are countless outside resources to help. Foreign lecturer with a thick accent was hard to understand? Download a PDF of the book. Seemingly complex topic like  the coagulation pathway feels overwhelming? There’s a Youtube video out there to make it simple. If hard work beats talent, smart work beats hard work.

You have to allocate your time wisely. As I said previously, the volume of information is what is overwhelming, so you must choose carefully which areas you need to spend time in, by focusing on high yield questions and topics. Slowly but surely, I, along with my colleagues, are starting to develop a sixth sense for what information will likely be tested on.

Where do I fit into this? I want to finish at the top of my class, land a top specialty, all the while still enjoying my 20’s the way any low-20’s former collegiate degenerate would. Balance is key. And with my limited medical knowledge, I believe it’s very important to adhere to a strict drinking regimen to keep to mind limber. And so far, all is going according to plan. I spend one weekend getting taking shots and gulping beers all day surrounded by friends, and the next I lock in so I can crush my exams the following week.

There are highs and lows.

Some days you’ll loathe having your face buried in books and computers. Other days you’ll feel privileged that you have the opportunity to do so.

Occasionally you’ll miss your friends and your old life. Then you realize that the new people you’ve met are pretty awesome in their own right.

One week you’ll feel like an braindead idiot. A week later you feel like Dr. House.

Some days you’ll want to quit. Some days you’ll think it’s hell. Other days you’ll think that you’ve never been happier.

You’ll spend days on end studying from sunrise til you fall asleep. But you’ll also never taste a beer sweeter than the first after that exam.

I need another drink.