October 06, 2002
a new life

There are times where, in the span of a few months, you experience seismic changes in your life. I finished the Ph.D. on 8 August, amidst much turmoil not related to my work. It was a rush to the finish so that I could start the late August-September block of medical school.

One week, I'm waking up at 7.00 in the morning, and going to lab in jeans, now I'm throwing on a tie and arriving at the hospital shortly after 4.00. My SICU rotation was my baptism back into clinical life, and for that month, my life centered around one floor and 16 beds.

The texture of my life is so different now that I'm not quite sure I have a handle on it. Even as an attending, you're able to maintain some distance and perspective about medical science, but at the intern/resident level, it's really life in the trenches. Every moment of your life is devoted to the day-to-day minutiae of managing the patients on the floor. This is the system that stems directly from Osler, you start as an apprentice, and slowly work your way, as years progress to a wide and comprehensive knowledge of how to care for your patients.

I have a lot to learn, not even because I've been away from clinical training for so long, but by the simple fact that I'm just a 4th year med student, many months short of an MD and many years short of Board certification.

Interestingly enough, I remember a great deal. The biggest difference is that knowledge acquision is different in science than it is in clinical medicine. At the med student and resident level, there's no substitute for just knowing. And just knowing is essentially memorizing. When you're confronted with an acute heart attack, you don't have time to logically think through the physiology of thrombus formation, tissue necrosis, and the effect of these things on electrical conduction in the heart. There fifteen things you have to do, and you simply must know them and do them. In an abstract you can lessen the load of clinical knowledge by leavening it with understanding the physiologic/molecular/anatomic features involved. Still, there is no way that you'll know that the half-life of pre-albumin is 3-6 days unless someone's told you so.

In science, however, the mode is knowledge creation, and your time is devoted to rolling back the margins of what we don't know and generating something new (that hopefully the clinicians will have to memorize one day).

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Posted by erich at October 06, 2002 05:08 PM
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