Sorry for the delay, I had to #GJWW5...

Dear B:

Congratulations!!!  You’re pre-med.   

I hated it when I told doctors that I wanted to be one of them, and all I heard were negative comments about the grind or how the pay has gone down or you never see your family...I’m not saying those things aren’t sometimes true.  But I think it’s awesome that you want to be a member of our club.   

Your CV (curriculum vitae—for some reason medicine is still Latin and uses this instead of resume) is impressive.  You are in the group of Pre-med students who know that this is what she wants and have taken all the right steps to get there.    

My wife was one of you.   I was not.  We ended up in the same specialty, the same residency, in the same place, for totally different reasons.  And we both had a thorough education. And sometimes even fun in the process. 

First, know that you are a select group...of nerds.  All of you.  There will be some in your med school class who will strive to be the more popular--  but know that you wouldn’t be there if you completely lacked nerdish tendencies.  The cool kids go into business something, make a bajillion dollars and travel.  They get to start retirement funds before the age of 25.  The ultra nerds are future engineers.  They shushed us when we studied in their lounge space in the Chem E building.  They will also run the world, get a 4 year degree and a 6 figure salary before you can legally do your job without supervision.  

And, if you think that this isn’t a letter to you, know that we all address one another by our last names.  And that “strong work” is high praise.  

At GJWW5, we had the joy of watching Sarah McLaughlin perform.  She said something like this (not in quotes because I was listening, not taking notes):

I didn’t do it for the financial rewards.  Don’t get me wrong, those were great.  But it was for the connection with you all, the joy from doing what I love... 

I think that’s a great way to approach any career or big life choice.  You don’t do it for the money, even if that’s a nice perk.  You do it because you love it, you can’t imagine any other calling.  

Because it is a calling.   

I’m not going to lie.  It’s pretty cool the first time you and your classmates get to walk around calling each other “Doctor.”  “Doctor.”  “Doctor.”  Like Chevy Chase in the movie Fletch.  (you are waaaay too young for that reference.  Ask your mom.)  But for real.   Especially as twentysomethings, the idea that we were going to be given this title and the responsibility that accompanies it—whoa.  If you aren’t overwhelmed by it, at least a little, you’re not paying attention.  On the other hand, if you’re like one of my classmates who routinely skirted the rules and barely made it by, and then declares: “that could be MY HAND on somebody’s aorta in the OR,”  it’s hard to take you seriously.  Because in the same breath you’ve told us how to run a check writing scam and skirt the IRS.  (true story, also fortunately quite rare.) 

When I decided to really pursue English Major Who Goes to Medical School, I was told some nuggets over and over again.  Some of them were complete urban legends, like I couldn’t get into medical school without a letter of recommendation from someone in the club, an actual doctor.   (I did shake down a couple for letters, but I doubt that was the deciding factor.) 

Some of them were useful, and I think are still today, even though it’s no longer the early 90’s.  Judging by your CV, you already know these.  I’m sharing them for the students who were like me, late to the game: 

• Believe it or not, the MCAT will not be the hardest test you will take.  It is only the beginning. 

• The real reason med schools care if you did something other than academics in college isn’t because they want a huge list of volunteer shifts.  It’s because the education never ends, and the outside demands only increase once the education workload seems manageable.  They are looking for someone who has figured out how to balance the learning/schooling and living the life you want, while still participating in some sort of obligations outside your selfish pursuits.  Because you will be asked to give more and more and more of your time and energy.  Every cause will be worthy.  Every need bigger than your own.      

• When you are on clinical rotations, 2 to 6 weeks in a particular specialty, you should approach it as though THAT one is your answer to what do you want to do; on Urology, you want to be a urologist.  If you do an advanced elective in GYN/ONC or cardiothoracic surgery, you want to be a surgeon at the very least, and if you aren’t embracing a surgical subspecialty with extra training, it will show.   You are living it anyway, so throw yourself all in.  You want to know the cranial nerves and the tendons of the hand, and the Glasgow Coma Scale and the muscles of the pelvic floor and how to tie a surgeon’s knot.  Besides, how do you know you don’t until you really give it a go? 

• Anyone who tries to talk you into their specialty as a medical student (“You’d be a great internal medicine resident/surgeon/pediatrician!”)  is looking at your potential for success in their residency program, not what field is the best for you and your life both inside and outside of medicine.   It also means that you have successfully fulfilled your role as urologist/internist/neurologist for the rotation.   Even if you went home every night and said, “I’m NEVER doing this again.” 

• Similarly: “You’d be perfect to lead this group, (or be chief of staff or department chair, or residency coordinator, or run journal club...)”  Any ask that starts like this means that you would indeed be good at it, but you would also be good for the people around you in the group.   Because you have your poop in a reasonable group and aren’t an asshole.  Or nobody else wants the job, but someone has to do it.  You don’t have to do any job just because someone says you’d be good at it.  If nobody wants to do it though, you need to rotate it.   

• I know this is old school.  Deal with it, and just try it out.  Get yourself a pack of 3 x 5 inch index cards, and use them to jot notes about what you don’t know, want to look up, need to review.  Yes, technology and cell phones and voice recognition.  I know.  I was dazzled by the use of palm pilots when choosing residency.   And these are great adjuncts.  But there is something about the learning when you put pen to paper, use your tiny handwriting, and look at it again later that tapping and swiping cannot replicate.  Also, you are clearly not doing the Wordle or on Insta when you are writing on an index card with a pen...

• Have a backup plan.  Major in what you love, not because you think it will look good on an application.  There are lots of ways to have a career caring for people, and there are lots of careers that make a difference that don’t involve blood and vomit and unpredictable hours.   And you never know when you will get a Clive.  (If you are new here, we named my brain tumor Clive).  If medicine defines you, then who are you if you cannot practice?  Who are you when the tragic outcome occurs?   

• Medicine will always take more of whatever you give it: your time, yourself, your soul.    

As med students, we used to encourage one another with such witticisms as “S equals MD” (translation: a passing grade is all you need to be a doctor, you don’t have to knock it out of the park in every subject) or “What do you call the person who graduated last in their medical school class?”  “Doctor.”  There’s some truth to this.  We should try to do our best, but we cannot learn everything.  And that’s okay.   

Congrats again.  Strong work.