Everything I Learned in Medical School: Besides All the Book Stuff (9 page)

Chapter 21

The Match

Over 100 fourth year medical students sit together in a fancy conference room. They are surrounded by friends, family, and hospital faculty. On each table sits fancy hors d’oeuvres, glasses filled with punch, and envelopes. The students whisper to one another and have smiles on their faces which attempt to mask an obvious uneasiness. One by one, each student is called to the front to pick up his/her envelope. Students nervously eye the envelope, some twirl it around their fingers, others hold it up to the light in a futile attempt to see what is written inside. Their anxiety is well-founded, because the letter inside these envelopes will determine how often they can see their families. It will separate friends and lovers and create new relationships. It will determine how students will spend much of their remaining years of youth.

It is Match Day, and inside the envelopes are the names of the hospitals where the students will start their residencies in a few short months. Without much exception, you go where it tells you to go, case closed. At this point, you’ve put yourself at the mercy of the match process.

The process of getting into a residency program is like no process any student has ever experienced before. During high school, students apply to multiple undergraduate institutions, get replies from these institutions, and if accepted to multiple places, have the opportunity to decide which institution to attend. The same applies to medical school. But getting into residency is a completely different beast.

It all starts off with a common application that the student sends to as many residency programs as he or she desires. The student is then invited to interview with the programs that deem them qualified for a spot in their residency program. After the interview is complete, the students must turn in a “rank list”. This list consists of the programs at which the student interviewed, ranked in order of places the student would most like to go. This list is submitted electronically, and the residency programs submit similar lists of the students they interviewed, ranked according to who they considered most qualified. The computer system then takes every student list, and determines if their top ranked residency program also chose them to be part of the program. If so, the student matches at this program. If not, the computer moves to the next residency program on the student’s list and determines if this institution ranked the student high enough to offer them a spot. The residency programs only have a set number of spots. Some subspecialized programs, such as neurosurgery or dermatology, may only have 2 or 3 spots available in their institution, whereas pediatrics and medicine tend to have many more, sometimes as many as 40 to 50 spots, depending on the size of the hospital.

Everyone in the country finds out where they matched on the same day, appropriately deemed “Match Day”. It occurs in March during the last year of school, and there is typically a fancy ceremony in which everyone gets an envelope that contains the place they matched. At my school, everyone opens their envelopes at the same time, which leads to quite the spectacle as many people rejoice at matching at the program they ranked first, whereas others quietly leave the room and cry when they find out they matched at the program they ranked 6
^th
, at an institution they really didn’t want to attend. Residents could spend anywhere from three to seven years in this hospital, depending on the type of doctor they intend to become.

So what happens to the people that don’t match at any of the programs on their rank list? A few days before Match Day, they get the dreaded e-mail which tells them they haven’t matched anywhere, and a process known as “The Scramble” begins. These students work with their school’s dean to get in touch with residency programs that didn’t fill all of their open spots. The programs and students find one another, and thus, almost everyone ends up with a spot for match day. It’s obviously stressful for the student to scramble, since they have to decide on a place to spend the next 3+ years of their lives, and they have to decide quickly, usually in the course of a day, since the unfilled spots fill up quickly.

The match day itself is obviously stressful, because even though you know you have matched, you are not sure where (unless you had to scramble). I’ve always felt that opening these envelopes in front of your peers is somewhat cruel. It forces people who didn’t match at their top choice to put on a happy face for the crowd, and pretend that all is well. No one wants to let others know they didn’t match where they wanted to go. After all, we hate to admit failure of any kind. Some schools go one step further on the cruel and unusual ladder and actually have students go up in front of the entire class and one by one, they open their envelopes and announce where they matched. How traumatic would it be to open the envelope and find out you’ll be spending the next 5 years in Cold-as-crap, North Dakota at the program you ranked last. It’s hard to cover up the disappointment.

I quickly learned that a life in medicine is a life of jumping through hoops, and the hoops never seem to end. The match process is just one of these hoops.

Chapter 22

Seizures and Pools Don’t Mix

In October of 1825, a young man entered the University of Edinburgh Medical School in England. His intent was to pursue the field of medicine, as his father had. But he found the study of medicine dull and unappealing. His fascination laid in geology, and the study of life. It was not long before he set off on a five year voyage around the world that would change the course of history. On this journey, he put together a fascinating record of species the world had never before seen. The man was Charles Darwin, and the knowledge and observations made during this expedition led to the modern theory of natural selection. His theory was stated in the introduction of his work:

“
As many more individuals of each species are born than can possibly survive; and as, consequently, there is a frequently recurring struggle for existence, it follows that any being, if it vary however slightly in any manner profitable to itself, under the complex and sometimes varying conditions of life, will have a better chance of surviving, and thus be
naturally selected
. From the strong principle of inheritance, any selected variety will tend to propagate its new and modified form.”

-Charles Darwin,
On the Origin of Species,
1859.

The concept was simple…those that have favorable traits are able to survive and produce offspring. Over time, the population has more members with these traits. New species are formed when old species move to new regions where a whole new set of traits now have the advantage, or if the environment itself changes.

In college, I would think about this concept, and wonder whether it applied to humans. Are we still evolving? Is there a trait that has some genetic basis that would be considered advantageous, thereby slowly changing the makeup of the human species over hundreds and thousands of generations? My conclusion was that we were evolving, but not in the old Darwinian sense where those that are more physically capable survive. We now lived in an environment where we did not have any predators, and for the most part, despite any physical disadvantages, you still had access to the food and water necessary to ensure survival and future reproduction. My theory was that we were slowly becoming smarter. After all, those that were more intelligent were able to obtain jobs with higher income. With this income, they could provide themselves with healthcare when they were sick, eat healthier diets, and have access to recreational facilities to ensure a healthy lifestyle. Intelligent people were more likely to avoid situations that endangered their well-being, such as using illicit drugs, driving intoxicated, or speeding down the freeway on their motorcycle without a helmet. And finally, smart people were more likely to protect their offspring from danger. They could install car seats correctly, afford vaccines, and have the resources to provide for more children. Sure each of these things may only affect someone’s chances of survival by a very small fraction, but over thousands of generations, this would make a large difference, just as Darwin had observed with various other species.

My pediatric neurology rotation during the fourth year of medical school quickly debunked my theory.
During this rotation, we often saw patients that suffered from seizure disorders. Seizures are events characterized by synchronous firing of neurons in our brains that lead the body to do very different things. Most people think of seizures as events where the person collapses and starts shaking uncontrollably, as if possessed by demons. But in actuality, seizures are very diverse, and can present in a variety of ways. For example, if the neurons that control the arm start firing together, the arm starts jerking uncontrollably. If they occur in brain areas that control eye movement, you’ll often see someone with eyes that are stuck in one direction. Rare seizures that occur in areas that detect smell will manifest as funny odors to the patient. In short, a seizure can mimic anything the brain is capable of doing during its normal function. Often times, the firing of neurons will spread throughout the brain, leading to firing in multiple areas of the brain and causing what is known as a generalized seizure. These are the seizures we see on television in which the person loses consciousness and jerks uncontrollably.

Luckily for patients that suffer from seizure disorders, there are medicines that often times will completely prevent seizures. But unfortunately for some, no amount of medication can completely get rid of their seizures. During a day in the pediatric neurology clinic, I met one such patient. She was a young girl, probably 7 or 8 years old, who came in wearing a helmet. This is a bad sign in pediatric neurology. It means that the seizures are occurring so frequently that the patient needs a helmet to protect her head when she collapses from a seizure. This patient was indeed having seizures multiple times each week. During the visit, the doctor discussed changing some medications to help with control. Near the end of the visit, when the mother was almost out the door, she turned and very casually said,

“Oh, we’re planning on getting a pool this month.”

“A what?” the doctor asked, hoping the mother didn’t say what he thought she said.

“A pool. It’s getting hot outside, so the family wants a pool.”

A pool for a patient with seizures is like a hemophiliac taking up knife juggling as a hobby. Any way you slice it, not a good idea. All it takes is one seizure in the pool with no one around to kill this child. So, the doctor calmly replied,

“That’s definitely not a good idea, given your daughter’s seizures.”

“Well, it’s going to be one of those pools that sits above the ground, so she can’t really fall in.”

“Still not a good idea.”

The mother was obviously looking for approval from the doctor for this pool, but was not going to get it. I couldn’t believe they would even consider it. I truly wanted to grab the woman and just shake her. But alas, shaking people is looked down upon in medical school, and even after.

So the patient left, saying they’d think more about it, but it seemed like she was pretty set on the idea. Rather unfortunate for the daughter she was supposedly caring for.

So far, my theory of human evolution seemed on target. It only seemed logical that such a parent would have a lower probability of having her genes continually passed on. But there was one problem with my theory…sheer numbers! This mother had five children. Surely, her genes would live on for generations to come. In fact, she would go on to have more descendents than almost anyone else I know, due to the simple fact she was spitting out lots of children.

In a world where Darwin’s theory of natural selection does not apply to humans, we will undoubtedly stop evolving into more fit, more adapted creatures. Our gene pool will begin to favor those that can simply produce the largest quantity of descendants, not necessarily the most fit. Sadly, this could mean that we are indeed evolving, just in the wrong direction.

Chapter 23

A New Flavor of Chip

The anatomy lab was a constant stimulation to the senses. We would see the inner workings of the human body. We would hear lectures from leading anatomists. The smell of the formalin-preserved cadavers would flood our noses every time we stepped into the lab. And we would feel the bones, the muscles, and the organs of our cadaver as we dissected further and further. All the senses were covered…almost.

Potato chips were one of my staples during lunch break. On one occasion, I had only gotten halfway through a bag, and the rest was left unfinished, tucked away in my bookbag, and forgotten about. For three hours every other day, the bookbag was left in the locker room of the anatomy lab.

Two weeks later, while studying in the library, I came across this bag of uneaten potato chips. It’s a good feeling when you find food unexpectedly. After the first bite of the potato chips, there was a funny taste, something that was somewhat familiar, but I couldn’t quite place it. Maybe they are just a little stale, I thought, but kept eating. A few of my fellow classmates soon walked in and joined my table. Being the nice person that I am, my potato chips were placed in the middle of the table as a communal offering. One of them took the offer, and began eating a chip. He stopped mid bite, a look of horror and disgust filled his face.

“These chips taste like dead people!”

Ahh yes, so that was the familiar taste. The smell of the formalin preservative from the anatomy lab had set into my chips. The chips were left unfinished. A lesson learned – the anatomy lab lockers were not a place to store food, and when it comes to chips, stick with the BBQ flavor.