I Have Been Neutered!

Each year the University of Texas Health Science Center at San Antonio (UTHSCSA) solicits its new fourth year medical student class for words of advice for the beginning third year medical students as they start their first year of clinical rotations. The ensuing publication, appropriately titled Letters to a Third Year, is then shared with everyone who's willing to take one home with them. As I had a good deal of time and a message I felt that needed to be shared with the world I wrote my own letter. Attached below is how it reads in the book:

Dearest, Largely Unknown Third Years,

You have all probably heard now from various friends, family, and faculty about the joys and perils awaiting you in your third year of medicine: the stress, the excitement, the lack of sleep, the novelty, etc. etc. etc. You’ve probably also heard now about how third year will affect you as a person. How you’ll learn so much finally practical knowledge. How you’ll begin to develop confidence in yourself as a novice clinician. How you’ll develop a taste of the variety that medicine has to offer. How you’ll run faster and jump higher. All this is true, and I don’t mean to detract from any of it. What I felt was not conveyed to us – or to me at the very least – was something completely different.

Somewhere near the end of your first clinical year – or earlier if you’re particularly introspective – you’ll look at yourself and you’ll realize, “medical school has changed me.” Despite your best efforts to remain a caring and ethical medical student – volunteering a little bit here, resisting those accursedly friendly drug reps there – it’s a challenging battle. There’s just too much change, too much stress, too many demands, and, simply, too much to adjust to. Perhaps some may resist this inevitable decline, but even if you deal in a healthy and positive manner to what comes at you, not regressing, splitting, or repressing, you’ll change in many ways for the worse.

This is not to say that third year will totally change you. Hopefully the medical school application process successfully filtered all those types out, but you will certainly be a little bit more “short-tempered.” You’ll find yourself a little more inpatient in the car, a little less graceful with the errors of others, a little less generous with what you have, a little less inclined to call back a friend if its no big thing, and a little more likely to put yourself ahead of those you care about. Not only in stressful situations does this apply. Yes you’ll be irritable after a long night of scrubbing debris out of the wounds of an unconscious patient in the ER, but everyone knows that, accepts that, and it’s nothing particularly telling of one’s character.

All of this said, I do not mean to be a negative. Go out eat, drink, and be merry. Even during the worst of times – even during the controlled chaos of general surgery – you’ll still be able to find time to enjoy yourselves and still remain much the same charming person you always were. Instead I’d like only to issue a small advisory. Like all of life third year will have its ups and downs, and for some it may even means new highs and new lows. Some of you will do just fine, and some of you, despite my melodramatic introduction, will even likely with little effort become better human beings. The majority, however, I’d be willing to bet will be made just a little worse for wear. Use this then as an opportunity. The injury to character obviously need not be a lasting thing. Instead it can be the first uncomfortable stages of durable personal change – a forge, a crucible, a whetstone, whatever metaphor you want to use. Sometimes to become better we must first identify what is especially in need of improvement. The first step in this process often involves insight, however, and so I write you all briefly to encourage self-reflection. To those unobservant, such as myself, these changes can go unnoticed till you have to work to undo what’s been done, but with a little bit of honesty and vigilance a rough year can be made a stepping stone for greater personal development.

Go Spurs Go,
Scott Crabtree
MS3

Sucks doesn't it? Yep, pretty crappy. I think the word "change" occurs 20 different times there. They also apparently had enough time to switch out most my adjectives with the first synonym that came to mind but not enough time to edit my "MS3" which was obviously a mistake as all the letters were supposed to be written by fourth years. Some changes, as you'll shortly see, I truly didn't even understand. Seems the guy began to simply eliminate any words that didn't fit his fancy. Here's how it originally read:

Dearest, Largely Unknown Third Years,

You have all probably heard now from various friends, family, and faculty about the joys and perils awaiting you in your third year of medicine: the stress, the excitement, the lack of sleep, the novelty, etc. etc. etc. You’ve probably also heard now about how third year will affect you as a person. How you’ll learn so much finally practical knowledge. How you’ll begin to develop confidence in yourself as a novice clinician. How you’ll develop a taste of the variety that medicine has to offer. How you’ll run faster and jump higher. All this is true, and I don’t mean to detract from any of it. What I felt was not conveyed to us – or to me at the very least – was something completely different. It seems to me that while the third year of medicine changes you in a lot of ways, it also makes you more of a jerk.

Somewhere near the end of your first clinical year – or earlier if you’re particularly introspective – you’ll look at yourself and you’ll realize, “medical school has ruined me.” Despite your best efforts to remain a caring and ethical medical student drone – volunteering a little bit here, resisting those accursedly friendly drug reps there – it’s a losing battle. There’s just too much change, too much stress, too many demands, and, simply, too much to adjust to. Perhaps some may resist this inevitable decline, but even if you deal in a healthy and positive manner to what comes at you, not regressing, splitting, or repressing, you’ll change in many ways for the worse.

This is not to say that third year will make you into a jerk, hopefully the medical school application process successfully filtered all those types out, but you will certainly be a little bit more “jerkish.” You’ll find yourself a little more inpatient in the car, a little less graceful with the errors of others, a little less generous with what you have, a little less inclined to call back a friend if its no big thing, and a little more likely to put yourself ahead of those you care about. Not only in stressful situations does this apply, mind you. Yes you’ll be irritable after a long night of scrubbing debris out of the wounds of an unconscious patient in the ER, but everyone knows that, accepts that, and it’s nothing particularly telling of one’s character. This change is deeper as even fully rested after a short day reclining on the inpatient psych wards you’ll still not be quite the humanitarian you used to be.

All of this said, I do not mean to be a Debbie Downer. Go out eat, drink, and be merry. Even during the worst of times – even during the controlled chaos and narcissism of general surgery – you’ll still be able to find time to enjoy yourselves and still remain much the same charming person you always were. Instead I’d like only to issue a small advisory. Like all of life third year will have its ups and downs, and for some it may even means new highs and new lows, but it will also be very subtly abrasive. Some of you will do just fine nevertheless, and some of you, despite my melodramatic introduction, will even likely with little effort become better human beings. The majority, however, I’d be willing to bet will be made just a little worse for wear. Use this then as an opportunity. The injury to character obviously need not be a lasting thing. Instead it can be the first uncomfortable stages of durable personal change – a forge, a crucible, a whetstone, whatever metaphor you want to use. Sometimes to become better we must first identify what is especially in need of improvement. The first step in this process often involves insight, however, and so I write you all briefly to encourage self-reflection. To those unobservant, such as myself, these changes can go unnoticed till you have to work to undo what’s been done, but with a little bit of honesty and vigilance a perhaps unavoidably rough year can be made a stepping stone for greater personal development.

Go Spurs Go,
Scott Crabtree

Obviously not a stellar work of fiction in its original state either, but certainly a whole lot better than the piece of garbage currently with my name attached now in the hands of a few hundred people. Thankfully I'd gamble 90% don't bother to read more than an entry or two, but regardless, what the heck UTHSCSA? In the age of medical ethics and informed consent could you not even consent me to your terrible neutering of my entry? Argh. I emailed one of the many deans who headed this up to complain and advise they not follow the same algorithm for strangling the style and character in their letters next year so we shall see how it goes. I imagine, like so many things in school and life, that I am simply wasting my time.

Fight the Power!