I was recently asked about my favorite class in medical school. At Stanford, the courses can be do diverse from day to day that it would be hard to really characterize one as being my favorite. Overall I love the courses, and even when there elements I don’t like, I often understand the importance and value to those experiences later on. However, I can comment on the single lecture which was the major turning point in my education, and when the whole experience “got real”.
When I was first accepted to medical school, it was a bit surreal, as something that I had wanted and worked toward for a while which involved a huge amount of uncertainty was actually going to happen. It is worth mentioning something about the way medical education works in the US. Getting accepted to medical school is by far the hardest part. Once you are accepted to a highly ranked program (like Stanford), it is very difficult to actually fail out. It’s like enlisting in the Marines and going into bootcamp, once they have you in the program, they invest a lot into you and although parts of it very stressful, brutal and demanding, they shape and remold you into a physician. You just have to keep forging ahead during the process.
I received my acceptance letter and packet on Thanksgiving morning, which is very early in the application cycle, so I had almost a full year to ruminate on the fact that I was starting medical school the following August. I read a lot about medicine, read biographies/memoirs of physicians, went to internal medicine grand rounds in Weds mornings, even go to start going to neuropathology brain cutting sessions. Once you’re accepted to medical school, even before you start, you’re in the club and start getting access to physicians as teachers. I could learn about new things that interested me at a leisurely pace. It almost felt like a time to be self congratulatory, and that I was being rewarded for hard work. It was a sort of warm, happy period.
Before we started classes, the school arrange lots of group activities and fancy dinners where I got to meet my new colleagues. There were ceremonies where we were presented with white coats and stethoscopes in front of our families. We got to meet famous, important people, were assigned prestigious faculty as our mentors, and just generally treated like little princelings and princesses of the medical establishment.
One the first day of classes, we started a molecular biology and biochemistry course, it’s called “Molecular Foundations”, which also goes by the somewhat unfortunate moniker of “MoFo”. It was the first day, and we were all collected and intently paying attention, trying to take notes and figure out what sort of note taking and study style we wanted to adopt. One of the professors, Gilbert Chu, spoke the first day. As aside he’s an amazing professor, and much could be written about him beyond his Wikipedia entry; indeed, my colleague, Michelle Nguyen has written on her experiences shadowing him in the magazine H&P. However, what is important to know is that in addition to being very active in basic science and teaching, he is a practicing oncologist.
It was during the second hour of his lecture on our first day of classes that Dr. Chu got a call on his cell phone while he was discussing DNA replication, and he politely told us he had to take the call. He went to the corner to speak into the phone briefly. When he returned to the front of the class, he had become much more serious and told us that one of his patients, whom he had been treating for a while, had just died. He took that time to talk to us about that fact that as an oncologist at a major academic and tertiary care center like Stanford, he typically only sees patients whose cancer has not responded well to treatment. It was important he told us, to never tell a patient “there is nothing more we can do for you”, even when there is nothing that medical science has that can delay death, we can always try to relieve suffering and that the patient still needs a doctor, even just to bear witness and give support in a difficult time. It is important to remember that physicians are experts on a number of topics, many of while involve healing patients when they have an illness, but another aspect that they unfortunately gain expertise with is death, and often that is an expertise that can help a patient and their family when death looms close, just helping them to understand the process and helping to guide the patient in their final months, days, moments.
That’s when it got real. After years of sitting in classrooms, learning science; years doing research, and publishing papers; years volunteering in clinics talking to patients, now it was essential to learn and pay attention to what this man was teaching. It wasn’t about paying attention to it because it was interesting, which it certainly was; it wasn’t about listening because I wanted to get a good grade on the exam, which I did want to do; it was about learning as much as I could because someday actual people were going to be depending on me to make the right decisions in their healthcare and relying on me to give the best advice possible. It was up to me to work as hard I could, because it was going to matter, lives were at stake. It got real.