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Learning’s Luster Lost

The joys of education die easily

The New Physician March 2010

On the first day of orientation, a fellow medical student mistook me for a staff member. I wasn’t entirely sur-prised. After all, I was 11 years older than the average student in our class and I knew that flip-flops for foot-wear didn’t constitute the business-casual dress we were supposed to wear during that week of indoctrination. If I didn’t exactly look the part, I also wondered how my fellow students and I would relate to one another. When I got married, a handful of them were in middle school; many could still count their ages on their fingers.

Several weeks into the school year, in a moment of curiosity, I asked a student if two other students were dating. “Oh, Ingrid,” she replied, “it’s soooo complicated. You couldn’t possibly understand.” Sure, I thought. I had only started fumbling around in the backseats of cars with guys about 20 years ago, but she was probably right. I couldn’t possibly wrap my mind around the nature of this particular relationship. vAs orientation slid by and the girls’ blouses, pressed capris and flip-flops were replaced by T-shirts, torn jeans and flip-flops, the differences between us melted away as we just tried to pass classes.

My most flattering moments came when the occasional pale-faced student approached me to ask how I was managing to balance my family life with school. I always try to answer this question carefully, because I have to believe it is possible to sustain a marriage, raise a daughter, maintain a home and earn the grades I need to advance to the next year.

I want my fellow students to believe that they can also manage this later while practicing medicine, if their lives evolve to include spouses, children and mortgages. I point out how few adjustments I had to make com-pared to many other students in our class. My house of six years is only three songs on the iPod away from school. I didn’t have to move halfway across the country and then figure out where to get groceries, an oil change or a beer. (In truth, I don’t think the latter was much of a struggle for anyone.) I am not newly engaged, newly married, nor newly broken up, all major life changes that consume many of my fellow students. My daughter attends the same preschool she’s been attending the last two years. We simply had to ramp up the number of hours she’s there to accommodate my class schedule. We live in a close, tight-knit community. My support network is multilayered and deep. That is something not every student has when they embark on this process.

Unfortunately, I soon learned that such abundant gifts can also bring on tremendous, collective pain. It be-gan in the fall when my mother-in-law, who lives one town away, was hospitalized four times for issues related to COPD and a wayward parathyroid gland that was finally removed. In the midst of our concern over her, my brother-in-law tried to kill himself. As we processed this event, winter break and the holidays came and went. The Saturday night before I was to resume winter quarter after a two-week hiatus, I had this gnawing sense of unease. I had no idea what it stemmed from other than thinking it had to be dread of an anatomy written and practical test on the horizon. All this anxiety over anatomy?

The next night my father-in-law collapsed and died suddenly at a grocery store. I felt like I was falling off a cliff. I had never been one of the first tier of people involved in the funeral preparation for a loved one. Throughout that week, I helped my in-laws complete the initial errands in our ritual of grieving: picking out clothes for my father-in-law to be laid out in, choosing hymns for the service, and finalizing the menu for a luncheon.

Then I had to face having missed a week of school. I think even the least empathic medical student’s sto-mach would drop when contemplating what that might be like. For the next six weeks, every night was triage for the next day as I scrambled to keep pace with the current workload while making up the assignments and tests I’d missed. Finals week dawned and when I really needed my husband to be strong—to make all the meals, walk the dog, put the kid to bed—he developed an incapacitating case of gout. He was in agony and by the end of the week, we were both limping.

Spring break arrived, and those few days off were tempered by the realization that the looming specter of a bottomed-out economy was beginning to make its presence felt among my friends and family. My father reported that his retirement funds were gone and he needed to take in a roommate to make ends meet. The first one was arrested at his home for evading a felony charge in Florida after driving up to Milwaukee to find work. My mother’s employer experimented with work furloughs for four weeks to make ends meet. Our phone starting ringing with questions, as my husband is in human resources and our resident expert when it comes to unemployment and health insurance, COBRA, and penalties for 401K withdrawals. He and I were also wondering if we’d have the same questions: My husband’s employer was in the midst of laying off 10,000 workers. We have no idea, day-to-day, if he, too, will soon be standing in Depression-era souplines as caricatured in the day’s political cartoons.

I began to have trouble sleeping.

The timeframe of that year becomes hazy when I try to piece together the elements of grief that seemed to permeate every aspect of our lives. During the winter and early spring, more losses mounted. A close friend from my childhood was carrying a trisomy 13 baby, which she delivered at 25 weeks, and named him Matthew, the same name my husband and I had chosen for the baby we had lost at the start of the fifth month. Although five years had passed since the death of my first child, my friend’s loss opened up that pain anew.

Among our closest friends in our neighborhood, a grandparent was lost in one family, a parent from anoth-er. Another friend in the area lost a cousin to a traffic accident on the Tri-State Expressway. Finally, my broth-er-in-law’s girlfriend was found dead by her parents in their house. The jumble of our lives was riddled with condolence cards, flower orders, casseroles and drycleaning slips.

It became increasingly difficult to fall asleep. No one loss was incapacitating in and of itself, but the totality of the experiences of the year weighed heavily upon us. Distracted, I was not in the least myself.

And then I realized that I was experiencing another loss, otherwise undiagnosed: the loss of the love of learning. While I would never equate this loss with the experience of my mother-in-law, bereft without her hus-band of 40-plus years, it was a loss nonetheless, and one with substantial consequence. After all, my love of learning helped propel me to medical school in the first place. In the past, my studies had always been a posi-tive coping mechanism during difficult times. But the pace of a medical school curriculum for most students does not afford the luxury of enjoying the process. As a mother and a medical student, I never expected to have abundant free time, but I also never envisioned that the process might smother the joy of learning. Yes, most of us can and do slog through the subjects and pass our courses. But doesn’t that come at a cost?

It might be tempting to write off my concern as an understandable manifestation of the cluster of grief my family and friends have been experiencing. It’s perfectly reasonable, one might argue, that I might have less-than-pleasant associations with the respiratory equations and dorsal column-medial lemniscus system that I tried to memorize in the process of funeral-hopping. Nonetheless, I have a nagging suspicion that I am not the only one who feels this way.

The mission of medical schools is, in part, to educate the next generation of students to become medical practitioners. But for how long? How long do schools envision their students practicing medicine? My school and others are increasing class sizes, but will that guarantee an increase in the number of hours doctors are available to future patients in this country? How does future physician burnout factor into the curriculum? What about students who don’t end up practicing medicine at all, or who eventually look for seminars on what to do with a medical degree without having to see patients?

I can only hope that the last quarter of my first year will be my most difficult. I finished it out and passed my courses, but I never could have done it without several conversations with compassionate faculty and staff, a prescription for Lunesta, and a couple of pampering trips to the spa (my own toes are now flip-flop worthy). I want no pat on the back for finishing the year any more than I’d want someone to think less of me if I had withdrawn or been dismissed. Even the brightest and most earnest medical student can falter. What I would like is to continue the conversation—for I know I’m not the first to observe this—about what we can do to preserve students’ love of learning, a love that is not extinguished during medical school, but nurtured and amplified. My medical school can’t keep my family and loved ones safe. Nor can it macroscopically change the economy. But it can work on this one problem. I challenge all schools to do the same.

Ingrid Berg is a second-year at the Chicago College of Osteopathic Medicine.