End Game

I've recently had to change my entire outlook on life. For the first six weeks of medical school, half of the first quarter, I was enraged that anyone would ever expect a person to learn so much… unimportant information. I hesitate to say unimportant, but that's exactly how I felt. Fortunately, I recently had an epiphany. 

It happened in Biochemistry, which is probably the second or third most pure rote memorization course we have. One of our main biochemistry professors even has a study question website with "ByRote" as part of its URL. I suppose rote memorization isn't bad, per se, but my entire life I have been taught that real intelligence is critical thinking. (Incidentally, this same Biochemistry professor also informed our class in his first lecture hour that Wisdom comes from facts, implying that we would someday be thinking critically, so he seems very well intentioned as opposed to some who seem to be lecturing in a vacuum and not a nearly empty auditorium.)

Anyway, this week in biochemistry we began learning about heme metabolism. Thankfully, the physiology of blood is really straightforward from a chemical point of view, so it's ability to be understood is less "by rote" and more by the greatness of Chemistry. During the first lecture hour, our professor mentioned P450, and it hit me:

The reason I'm learning everything right now, the reason why the amount of information I'm processing feels like it could kill me, the reason why I'm suffocating under lecture notes and text books… it's because this is the last time I will actually be learning this stuff. This is graduate school. This is the end game. 

It's taken me until the third month of medical school to realize that this will be the end of my heavily structured learning.

I've learned about cytochrome P450 once or twice before. In fact, during my last semester at Colgate University, I wrote an entire paper on how one could use the gene that codes for cytochrome P450 to determine how a population of Lake Michigan fish had evolved in response to manmade pollutants. And yet, despite writing an entire paper, do you know how much I knew about cytochrome P450 in undergrad? Nothing--besides the fact that the gene coding for it is under heavy selection in fish that live in the Hudson river. Now I know almost everything about P450 that would ever be relevant to anyone caring to know… Like a really curious patient. 

I don't know when this would ever be necessary, but let's say a teenager comes in who is currently enrolled in AP biology and has recently started drinking. Let's say she asks me about why drinking is bad, and I take a look at her chart, and notice that she's anemic. I could easily tell her:

"Listen Maggie, your body as it is doesn't produce enough hemoglobin to carry oxygen around. If you start drinking, your liver will need to up-regulate its production of cytochrome P450 to process the alcohol. P450 is derived from the heme protein, which constitutes hemoglobin. Your liver will preferentially up-regulate P450 in favor of hemoglobin. You will be weak and drunk if you drink excessively all the time. Do you want that?" (For the record, I'm not entirely sure that this would have any visible affects on Maggie, but it's true in theory, so it's true enough for a moral lesson.)

"Also, you may want to have sex at your age, and you might think alcohol is the best way to go about doing that, but you should probably wait until you're old enough to make smart decisions. Because even though you may be ready for sex, are you ready for teen pregnancy? Also, Maggie, there's only a 12% chance you will marry the first guy you have sex with, FYI, so be wary." (Maybe I'll be a cool doctor who makes up statistics. I don't know.)

I accept that I will have to learn everything now. But it really is terrifying and exciting to finally be learning the minutia of all the things you've learned superficially, several times in the past. It also doesn't help that I am in graduate school for human-centered medicine, a field that is studied much more intensely and is weighed down with a lot more information than the academic field of deep sea mussels, if only because humans are a highly self-involved species that neither wants or needs to care about the deep sea mussel. Every day it seems I read something and my understanding shifts, snapping into place, and I feel several different little things from all the science classes I've ever taken in my entire life--from fourth grade to evolutionary biology--correcting themselves and informing me a little bit more about how humans work. It's amazing. I think with a little more practice, this feeling may turn into wisdom. And for that, I am finally very excited.