I was miserable.

The blaring of the alarm clock radio startled me from my sleep. It’s 4:30 am already, and this is the 7th straight day in a row of waking up early to go into the hospital. It’s Sunday morning, and I don’t get a day off until this upcoming Saturday. Like a ritual with witchcraft and candles, I do my daily countdown until my next day off.

Usually we round a little bit later on the weekends, but today is special. We have a heavier patient load than usual. I don’t get to look forward to knocking off at noon, either. Today is our “long call” day, so I’ll be working until 7 pm. The dead of the morning is deafening. Through the silence my cat meows to let me know it’s inappropriate to be up at this hour. He knows more about this charade than he lets on.

I look over and my wife is fast asleep. If only I could continue to lie there with her. She looks so peaceful. I fight the temptation to lie back down and jump in the shower.

With fresh scrubs on, I walk out the door and to the car. Damn it, I forgot to warm the car up. It’s freezing outside, so I take out my drivers license and scrape the ice from the windshield. “What have I gotten myself into?” I think to myself.

“Ahh, fuck it.”

I see the Sunday newspapers lying in the driveways of the houses in my neighborhood. I know that in a few hours, most of my neighbors will be waking up. They’ll dash outside to retrieve the paper and then sit reading it while drinking coffee. Later on, they’ll spend some quality time with their significant other. Perhaps they’ll watch a movie together or go out for brunch. God, how I miss those days.

I won’t be doing any of those things, though. Fetching vitals, dealing with old people who just want to die, and the scent of hospital food is what my day has set out for me. Sundays make me want to puke. If only I could be a normal person again. I would do anything for that.

In a few hours my wife will also be waking up. One of two days of the week where we can spend significant time together, and I’m stuck at the hospital all day. I curse myself for ever going to medical school in the first place, and then I curse my wife for talking me out of quitting school. She doesn’t really know what it’s like. She thinks it’s just a regular job with long hours, but I know different.

On my drive to the hospital, I note that there’s no traffic out at this time of the morning. I know that this is going to be the highlight of my day. No people, only the stray white of headlights glaring in my sleep deprived eyes. It’s not human, and I am relieved. Humanism makes me sick, the way they force it on you. It’s always about the patient. What about us? Where do we come in? I spend my days feeling ill.

I arrive at the hospital. The walls are made up of little green tiles. It reminds me of the bathroom in my Grandma’s house. The fluorescent lights shining on the green tiles in contrast to the dark of the morning is depressing. They are extensions of these depressing halls. Little green extensions.

There is one other student on this rotation, and she’s already there as I arrive. She’s there every day before I am. Am I a slacker? Probably so. I wait until the last minute to come into this hell hole every day. She’s enthusiastic, and seems to love what this mess is all about. Just like every day, I take a minute to ponder why she loves this shit so much. I never ask. I guess I don’t really care that much. I take that minute to put off starting my pre-rounds.

I do my work and watch the clock at the same time. Nobody really talks to me much, outside of the normal medical babble. They know I hate this, they can see the depression in my face. I hate the very thing that they do to put food on the table. I think they resent me for that. I don’t care, though. At this time of the day I would rather not talk.

I laugh to myself as I think about what my Grandma will be having for lunch today. The whole family will be there just like every Sunday. As I check my pockets to make sure I have enough change for a pack of crackers and a Coke from the vending machine, I think about the green tiles in my Grandma’s bathroom.

I always hated Sundays the most.

Note: The following post was a recollection of the thoughts and feelings going through my mind as a junior medical student on my internal medicine rotation on one cold Sunday morning in January. I still remember them like it was yesterday. As you can probably tell, it was a rather dark time of my life. I no longer feel like this since I am thoroughly happy with the outcome of my decisions not to enter medicine. I never passed those feelings down to this blog while I was feeling them at the time.

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What I’m listening to: Jeckyll and Hyde: Freefall (Extended Mix)

The following is a guest contribution from GeekDoc.

It’s a bitter sweet time of year for med school hopefuls. Those who are applying find out whether or not they’ll be going to medical school in the fall. Tears of happiness, tears of joy, tears caused by your disappointed mother throwing her shoe at you for getting a 29O instead of a 45T on your MCAT., become a normal part of your everyday life. I just wanted to reach out to my friends and say, I know what you’re going through; I feel your pain. I wish someone had explained the process in terms that I’d understand. Hopefully this will act as a beacon of “truthiness” for future pre-meds.

For Future Applicants:

The application process is every bit the dog-and-pony show that you imagine it to be. It starts with a four year struggle to out pace every hardcore science geek on their own turf. You spend every waking minute trying to distinguish between Cys and Trans, E and Z, Cocci and Baccili, only to realize that 100 of your peers will probably know this better than you come test day.

The lucky few who do manage to maintain their sanity while spending every waking minute studying, lose it when they realize that they have to write several essays demonstrating how they did not spend every waking minute of the last few years studying, but rather took the time to “help people”

And isn’t that why we all wanted to become physicians in the first place? To help people? And by people, I mean people other than your mom and dad who will probably spend the next few years introducing you to their friends as “this is my Son (or daughter)….the doctor”.

For the few who manage to be talented enough to strike a balance between spending every waking minute studying, and delivering children in a refugee camp in sub-Saharan Africa to compensate for that A- you got in Organic Chemistry, may be lucky enough to be invited to an interview. It’s the interview that people long for, a chance to set themselves apart by professing their undying love for the school, medicine, and if need be, their interviewer.

If your act strikes the right chord with the right people, you may be part of the small group who receive a big matte yellow envelope in the mail, screaming “Congratulations, You’ve Been Accepted!!!”.

So, my friends, don’t worry to much about the application process, we all go through it. Think of it as a right of passage, a chance to become part of the medical brotherhood. It’s a necessary evil, a show that we all take part in.

One of the things that annoys me most about medical school (aside from the soul-murdering, nasty, vagina-laden OB/Gyn) is the fact that so much of your time is inflexibly dictated to you. I generally mean via lectures, but it can be a whole variety of time-draining nonsense that I’m not going to go into. Lectures, meetings, training sessions, and more.

You’re supposed to be here at exactly 6AM and then there at 7:30AM and don’t forget yonder at 10:00AM, but on Wednesdays you go to hither at noon. On the 30th at 1PM you go to thither, so don’t dare forget and don’t be late or Dr. Pompous Tightass will get his panties all in a bunch and exercise his “love of teaching” by pimping you into oblivion. And don’t forget all of your regular responsibilities! Make sure those colostomy bags are squeaky clean! Oh, by the way, you’re a professional. This means late arrivals are unacceptable and you’ll naturally be held to an unattainably high standard.

All of this horseshit is most apparent during 3rd year, generally because time is already so hard to come by. They just seem to make it harder on you by making you do as much as possible on a daily basis. 1st and 2nd, luckily, have a lot of lecture time that is optional. At least, for many schools. I pity those of you who have attendance policies during the preclinical years. Luckily 4th year is a slacker year, hopefully even for evil schools with attendance policies. But I digress.

Back on point, I fully realize the world is busy, life is busy, and many careers (professional ones especially) are hustle and bustle with very little time to spare. That’s kind of the nature of things. “Overworked people run the world,” is a quote I’ve probably botched. That said, it still seems like during medical school they could make it a little less complicated, less stressful, and more effective. Jumping through hoops doesn’t make you a good physician…it makes you a good medical student. That is, you know how the system of medical education works, and thus you can effectively navigate through the hoops. And when you’re not jumping through hoops you can actually try to become a good physician. (If that’s your bag.)

Since we have Shelf Exams and three Step Exams (I say four, with the addition of Step 2 CS), shouldn’t these exams be enough to make sure one has a basal degree of competence? Why force all of the nonsense down our throats? I mean, do we really need to be forced to attend lectures during our Surgery rotation when we’re half asleep after a 6-hour GI surgery from the call night before? Where’s the sensibility and flexibility?

I suppose it’s the LCME’s fault. In fact, I bet they have a secret ruleset for pimping.

A medical student needs X hours of hardcore pimping during Surgery in order to be demeaned effectively enough to achieve the core competency of self-realization of retractor bitch status.

Screw being a retractor bitch, screw the LCME, and screw all of the nonsense. Give us time to blink!

While not as intense as Step 1, studying for the Step 2 board exam can still get you worked up into a frenzy. Here are five sure-fire tips that will increase your score.

1. Take Your Time
You’ve probably heard the saying “2 months for Step 1, 2 weeks for Step 2, and a number two pencil for Step 3.” Take caution with this. You’ll need more than 2 weeks of studying if you expect to beat the mean on Step 2. I think it’s safe to start studying at least one month ahead of time. Give yourself more time if it has always taken you longer to digest the information. Not only will you not be rushed, but you’ll have more confidence going into the exam.

2. First Aid for Step 2
First Aid for Step 2 is one of the best resources available. You probably used the First Aid series for Step 1, and the Step 2 book is just as good. You’ll have all of the high-yield information at your fingertips, and learning all of the information presented in this book should be one of your first priorities. Consider going through book multiple times. For your first read through the book, focus on learning information that you haven’t yet mastered. Each subsequent time you go through the book, you’ll get faster. Just make sure to keep on top of all of the information and before you know it you’ll have the information down cold.

3. Crush Step 2
Having only one study resource is shooting yourself in the foot. Each book you read will emphasize different material, and this will be beneficial to you as you prepare for the test. After completing First Aid for Step 2, thoroughly read your Crush Step 2 resource. The information in Crush is presented more in a textbook format, so you’ll find it refreshing while reading through it. This will minimize study burnout.

4. Step 2 Secrets
As a final resource, pick up a copy of Step II Secrets. After completing First Aid for Step 2 and Crush Step 2, Secrets will be more of a review than anything else. And this is just what the book is designed to do. The information presented in Step 2 Secrets is in a basic question format. It asks a question in bold, and then has the answer right under it. Cover up the answers and see what you can answer on your own. If you get stuck, review the answer until you’ve got it. There’s also a Top 100 secrets chapter at the end of the book, perfect for last minute review days before the exam.

5. USMLE World vs. Kaplan QBank
There are pretty much two choices when it comes time to decide on which question database you’re going to use: Kaplan Q-Bank and USMLE World. After talking with many people who prepared for the Step 2 exam, most say that USMLE World is the better choice. Not only will a one month subscription save you $60 ($90 versus $150), but the questions in World are much more difficult than the Kaplan Q-Bank questions (based on feedback that I received). If you master these questions, you’ll be prepared for exam day and will more than likely be happy with your score. If money isn’t an issue, give yourself more time and complete both question databases.

While going through questions, set up blocks in sets of 46 in timed mode. This will create identical examination conditions. Do not go through blocks with less than 46 questions or in tutor mode. You need to be used to what you’ll experience on test day, and mimicking testing conditions is best way to do it. Try to complete the entire database, whether you do USMLE World alone or both World and Kaplan Q-Bank.

Immediately after finishing blocks, make sure to take this time to review not only the questions you got wrong, but also the questions you answered correctly. Some of your correct answers will be guesses, so you need to refresh your knowledge on what the question is asking. Reviewing right after you finish the block ensures that the information is still fresh, and you can reason more easily why you answered a question in a particular way.

Finally, take notes in the margins of your First Aid for Step II book as you review. Days or a week before your exam, go back through you First Aid and review major points in the margin as well as you own notes.

Follow these steps and I’m willing to bet that you’ll be pretty happy with your Step II score. You’ll be less stressed to boot.