Courage

I met a man with ALS today. That's Amyotrophic Lateral Sclerosis, or Lou Gehrig's Disease. It causes progressive demyelination of your lower motor neurons; bit by bit, you lose the ability to use your muscles and they weaken and atrophy, though your mind remains completely unaffected. It is irreversible. And fatal.

We just finished a section on neurology, got to meet some "real" patients in the Clinical Skills Center today (as opposed to the actors who we usually see there). Each had a different type of neurological problem: cerebellar atrophy, myasthenia gravis, Parkinson's disease, Guillain-Barre syndrome, stroke. Learning from these patients really made the information stick. I know I have read that treatments for Parkinson's can actually give patients dyskinesia (involuntary movements), but I will never forget seeing the woman today who, having taken her medication an hour earlier, had exchanged the slow shuffling gait and other movement difficulties of Parkinson's for the constant tic-like motion in her arms and legs.

Then we entered the last room, and were instructed to do a motor exam on the man sitting in front of us, who appeared to be approximately 50. His arms were strong - normal biceps and triceps - but his fingers were weaker in comparison. His thighs showed normal strength, but his lower legs and feet did not; he could not push down on the student's hand with his foot, or lift up his foot at all. The physician in the room mentioned that, normally, a good way to test strength in all the leg muscles is to have the patient stand up and then do a squat, but that this was not an option in this patient. Oh no, I thought. I think I know what this is. Please, please let me be wrong.

No such luck. The patient told us that he started noticing weakness and cramping in his legs about 18 months ago. He now has a diagnosis of ALS, and the loss of muscle control continues spreading up his legs and is beginning to affect his hands and wrists.

He told us his story calmly, and got a kick out of the fact that he knew the steps of the motor exam better than we did, as he has been examined by so many neurologists at so many different institutions. He was incredibly generous to allow group after group of students to practice their skills on him. If he saw pity or distress on our faces, he did not show it. In his case, it is not just the clinical findings but his courage and grace that I will remember.

Mega Marathon

Things change during second year. The general structure in most medical schools is that students spend the first year learning how the body is laid out and how it works normally, and then study what can go wrong and how we go about treating it during the second year. An even bigger change than the shift in focus is the approach to testing that my school uses for second-year students. Instead of taking a course, having a few days to study, and then taking a final exam, we take several courses in a row (ranging from 2-4 weeks in length), and then take a series of four exams, all within a few days. Usually the exams consist of two finals for courses, and one exam each for pharmacology and nutrition, courses which run throughout the year. There are five sets of these delightful exam blocks throughout the year. We call them "megas."

The first megas of the year took place over Halloween weekend. That's right, the tests are administered over weekends. They are all given online, and we are allowed to take them at any time and place we would like, as we are bound by the school's honor code to take them honestly anytime within the four days that they are available on the school's testing website. This is both an added convenience and a challenge; yes, one can take them in your pajamas sitting on the futon in your living room, and you can take them in any order, but it can be difficult to set your own deadlines for each in order to leave time to study for the next one.

The first set of megas is rumored to be the hardest. I think this is due to the fact that we don't know what to expect and that it included a month-long course in microbiology (with approximately 150 bacteria/viruses/fungi/protozoa to master), a month-long course in hematology (which can be fairly difficult) and the largest chunk of pharmacology to be tested one one exam. It was an incredibly intense experience, with a week of nonstop studying balanced between several subjects.

In frustration one night, I turned to Tay and finally found the words to truly express what this experience is like: They [professors, administrators, and anyone else who is not currently in medical school but is trying to give advice about it] say that medical school is like a marathon rather than a sprint, that it's a long-term effort, that you must take it slow and steady. But here's the problem: you have to do this marathon at a sprinter's pace! You must go at breakneck speed, only you must keep it up for all 26.2 miles!

Ironically, just a few days later, I picked up Tay's November issue of Men's Health magazine and read an interview with Jason Bateman, whom we had recently seen in Couples Retreat. (The film was hilarious, by the way.) He talks about running and says "Marathons are good training goals. And on the day, you might elect not to wake up at %^&$ing 6 in the morning and go run 26 miles. But you've got 5 months of training behind you, which is nice." Normally I would balk at the idea of not following through with the performance for which you have prepared so diligently, be it athletic or academic. But then I used this idea to further develop the metaphor I had applied to megas, and it dawned on me that, even if a test doesn't go as brilliantly as I had hoped, what really counts for the future is the work that I put into learning the information and the new knowledge that I acquired along the way. Even when going at breakneck speed.