Monday, December 15, 2008

Shelving the Shelf

One of the most difficult things about buckling down to study for an exam, besides "not wanting to" and, my personal favorite, "crippling self-destructive tendencies," is when the exam in question is widely characterized as ridiculous, non-representative and altogether impossible to predict. Classmate upon classmate who took the surgery shelf (a timed, nationally standardized final exam of sorts which are administered at the conclusion of each rotation) has relayed their feeling of utter defeat following this exam. And again when the results arrived.

I do have one Meddie Friend who rocked the socks of her surgery shelf, but she also kicks all sorts of ass in general. I reiterate, she kicks ass. That is where she and I largely differ.

Evidently the surgery exam focuses primarily on the medical management of surgical patients which by and large is NOT what I gave my attention to these past twelve weeks. When we weren't being scutted out (e.g. "Here, run this blood to the lab," or "Hey, can you write discharge summaries for the 28 patients on our service? Today?" or "So would you mind stopping by my apartment to take my dog around the block? Here're my keys.") we as medical students were expected to be in the OR to serve as retractors and mute sounding boards for surgeons' misplaced disappointment in their lives.

Standing there watching a ten hour Whipple, willing my ankles not to roll so I wouldn't accidentally drop the small intestine into the area the surgeon was focused on, it was hard to feel I was learning about medical management. The hierarchy of medicine and the staggering capacity for arrogance within human emotion? Sure, I learned plenty about all that. But how this patient was worked up and the different approaches to evaluating their presentation? Not so much touched on, at all, ever, even though we had plenty of quality time standing there and standing there and standing there.

Now, I suppose that's where the responsible med student would make it a point to go home and read up on pancreatic neoplasms (one of the main indications for performing a Whipple), but, Dude. I've been standing in an OR for ten hours (WITH ONLY ONE PEE BREAK) and was probably awake by 4:30a this morning with the expectation of waking up that early again tomorrow. I want to go home and mainline cheese cubes before collapsing into bed.

The even more responsible med student, perhaps even the good med student, would have read about all that pancreas stuff the night BEFORE the operation. In my world that's made difficult by all the persuasive excuses my incredibly imaginative internal monologue produces railing against that possibility: You need your sleep for the big procedure tomorrow! It will probably be cancelled! Someone will surely want to scrub into the case and relieve you of its infamous horror! I bet an agent will hear you whistling Christmas tunes en route to the hospital tomorrow morning and immediately enlist your talents for the Radio City Music Hall Spectacular!

So, yes, whine-ity whine whine whine. Bottom line, I have little to no motivation to bust my buns studying for an exam I am anticipating to be a medical quagmire.

Had I learned medicine the first time around, you know, at any point in the previous two years or during my 12 week internal medicine rotation this year, I may not feel so resigned to mediocrity... or if I had any modicum of motivation I might be able to use the defeateds' complaints to better equip myself for the showdown... but that would be what the good, responsible, kick ass medical student would do. And if we've learned anything about anything, we all know that that med student I am not.

Five more days. Let's see what we can do.


  1. This quote, “crippling self-destructive tendencies,” sums me up exactly.

    These posts of yours make me incredibly grateful I did not persue a career in medicine, but it also makes me realize you're going to be an awesome physician... even if you doubt it.

  2. They actually gave you a pee break?

    Just finished the surgery shelf 1.5 hours ago and I can say that it wasn't too bad. On the other hand, I've also DONE THE ENTIRE YEAR OF CLERKSHIPS AND TAKEN 15 MILLION OTHER SHELF EXAMS before this one. You're right, really. There wasn't that much surgery on the exam.

  3. I attribute it to the age of the surgeon and his likely BPH.