An Idaho farmer died and went to hell. Satan had the thermometer set at 90° degrees and noticed the farmer sitting on the brimstone, kicked back and relaxing. "What are you doing?", asked Satan. "This is just like a nice spring evening in Idaho", said the farmer. Satan got upset and turned the heat up to 100. The farmer still looked happy and said, "Reminds me of a summer evening in Idaho". Satan got even madder and turned the heat to 110. "I've baled hay on hotter days than this", exclaimed the farmer. Now Satan was furious! He turned the thermometer all the way the opposite direction to -25. Within minutes the ground froze and frost appeared on everything. Satan looked to see the farmer's reaction now. The farmer looked confused for a minute, then started jumping up and down cheering, "The Vandals won the WAC! The Vandals won the WAC!! (Sorry Dr. Burgess, the devil made me do it.)

Readers will be pleased to know that I am officially a 3rd year medical student, having passed my board exam, the USMLE Step 1, and moved into the second half of my medical education. I started my psychiatry clerkship in July and have been enjoying the inpatient consult service and look forward to OB/GYN in several weeks.

The second year of medical school is essentially the same as the first, except that it's more interesting and people start treating you with a modicum of respect. Ironically, the body's physiology makes more sense once the disease process is learned. This knowledge goes hand in hand with one's ability to appear smarter, so maybe that's where the respect comes from. We still had 4 hour long tests every 3rd Saturday and 2 clinical exams a year, but this time, we got to take them in the posh new medical building. This building, with cushioned chairs and 30 foot tall movie screens, made my 3rd encounter with the Krebs Cycle more like an IMAX experience and less like torture. The days of tiny, hard seats and chalk boards are behind us. Learning to appreciate alumni donations was not the only thing I learned during second year.

Lesson #1: There is a disconnect between what I know and what I understand about medicine. Second year is about the time that non-medical school friends start calling and asking for medical advice. I say, proceed at your own risk. We med students love to act like we understand medicine as we rattle off statistics about obscure diseases, but we understand very little of its application to patient care. Unfortunately, 1st and 2nd years foster an environment that promotes grade competition rather than learning, so once we get to 3rd year, our priorities are mixed up. It's a strange place to be, to have a brain full of facts but with relatively little insight into how to apply that knowledge. I believe now more than ever that medicine is a combination of science and art. As a young first or second year student the science seems the most difficult, but as one later learns in third year, it's the art that takes skill and practice.

Lesson #2: The second year of med school made me a hypochondriac, and it only gets worse during 3rd year. I'll spare you the most embarrassing details, but I will say that there was some concern about Peutz-Jaeger Syndrome when I noted a freckle on my lip. My fellow students and I could justify having the symptoms of almost any disease. To us, the zebra's hoof beats tend to drown out those of the horses.

Lesson #3: Medical school is all consuming and becomes one's way of life. The running joke is that medical students spend excess time at the grocery store because it feels to us like we're really "getting out". I find out about current events weeks after they were current. I have little to talk about outside of life at the hospital. On weekends, I look forward to going to bed early and getting 8 consecutive hours of sleep. If I ever had a social life, I don't remember what it was like. Studying was one thing, but now that I also see patients, it's even more consuming. I have learned to eat, sleep, and live medicine, which brings me to a question, rather than a lesson. How does one balance life with medicine?

It's well known that as medical students progress through medical school their capacity for altruism, compassion, and empathy seems to diminish. I will admit to seeing this change in myself. I suppose it's because I am seeing for the first time the difference between the ideal form of medicine that our professors teach us and what medicine actually is. We are taught to practice the bio-psychosocial method in order to escape medicine's paternalistic traditions, and these ideas are admirable on paper, but they are much more difficult to implement with real patients.

Sometimes, it's hard to remember that as medical professionals, we see people at their very worst. They are suffering and in pain, and in reality, who would expect them to be pleasant? Can I even make excuses for the residents after all, I'm no the nicest person when I'm sleep deprived.

I have much to learn as a student, but let me leave you with this ten cent appeal. As a new 3rd year medical student, I ask you, my reader, to remember your training, the time when you were the student. Students make dumb mistakes, but we often don't know any better. We welcome constructive criticism. We are eager to learn, but we ask that you have patience with us. We are trying to please you, the doctor, the nurse, the resident, and the patient. Sometimes we can't please everyone, least of all ourselves. We may be at the bottom of the totem pole, but I ask that you remember where you came from, how you got there, and who helped you along the way.

Catie Mohr, 3rd year medical student
University of Nebraska Medical Center