CLEVELAND, Ohio — Every doctor has gone through it — the stamina-testing, information-overload experience that is medical school.
It’s a trial by fire for students who up until then have had an easy time with academics but who quickly face physical and intellectual demands so intense they have been known to trigger depression, or worse, in some students.
A new book by author Jacqueline Marino gives an insider’s look at what getting through medical school really takes – in this case, by creating a portrait of students at Case Western Reserve University Medical School.
“You have to be a brainiac, and hard-working, and even then it’s very difficult,” says Marino, 39, an assistant professor of journalism at Kent State University. “It’s a huge commitment and sacrifice, and I wanted to see what that was like.”
So she followed three students at Case’s medical school over their four-year sojourn. Marino takes readers through nights of students cramming for daunting bio-chemistry exams, days when they first faced the cadavers they’d dissect, and hours caring for patients — checking pulses, performing CPR on a dying woman, assisting in a birth.
“White Coats: Three Journeys Through An American Medical School,” started as a single magazine story by Marino, then a Cleveland magazine staffer, in 2005. Based on reader reaction to that story, and her own interest in the student’s challenges, Marino decided to follow the three students beyond the day they received the short white coats bestowed upon medical students, through their years of school and training.
The students she chose — based on their candor and willingness to open their lives to her examination — were wildly different in background, and in their views toward medical school:
• Mike Norton, a Mormon from Utah whose wife was pregnant during his first year of med school and whose father would face a dire diagnosis;
• Marleny Franco, born in the Dominican Republic and motivated to be a doctor by the health care disparities she’d seen that were based on language, race and culture;
• Millie Gentry, a statuesque half-Taiwanese young woman, who entered medical school with determination to simultaneously have a balanced life that involved part-time modeling, shopping, cooking and friends outside school.
Marino says she was drawn to the doctors for several reasons: years of watching “M*A*S*H,” “E.R.,” “Scrubs” and “Grey’s Anatomy,” and from a trip to Belgrade with a team of doctors on a medical mission just after the Bosnian War ended. The doctors awed the young journalist with their focus, skill and investment of time and emotion. She is also a fan of immersion journalism, as practiced by Tom Wolfe who followed astronauts for years to write “The Right Stuff,” and Richard Ben Cramer, who took a deep-dive look at the 1988 presidential candidates in “What It Takes.”
“I wanted to do something big that took time and investment, and I picked medical school,” Marino says, a place she herself never hungered to attend “because I don’t have that in me.”
The first year of medical school brings plenty of drama: besides the dreaded bio-chem classes, students learn that while they may grasp concepts quickly, to succeed, they must study diligently and daily.
“That’s a wake-up call,” she says. They realize quickly, in a way they haven’t before, that they, too, have limits.
It wouldn’t be possible for medical students to ever learn, or retain, everything that is thrown at them in medical school, and they are bombarded, says Marino. Plus, medicine is always changing, with new research bringing new protocols.
But as the dean of the Case medical school, Dr. Pamela Davis, told Marino, “We teach students how to think like a doctor.”
“That’s a huge deal,” says Mariono. “It doesn’t matter what the research is, or what they taught you in medical school — what matters is how to get the answers you are looking for, by thinking as a doctor does.”
Another thing the students told Marino was the powerful effect that being exposed to varied cultures and socioeconomic environments had on them.
“It’s common for students in medical school to have families who are in medicine too, so many of them are very privileged,” the author says. “When they meet a 16-year-old mother who has already lost her baby’s father to violence, they are stunned. It’s devastating to them when they first see how different some people’s lives are.”
As tough as she thought medical school would be for students, Marino found out it was even worse. “The physical stamina you have to have to get through these insane schedules is incredible,” she says. “At 2 a.m., the lights are still on at the med school, because people are always studying, alone or in groups; lectures are videotaped and students watch them over and over. And yet they can’t learn it all, because you couldn’t, not even in ten years.”
Not to mention an additional pressure: most medical students face debt of $100,000 or more upon graduation — as well as years more of residency and specialized training.
But the other thing Marino found was that the most potent lessons, and the time when students were most passionate, was when they were with patients, shadowing doctors, being present at surgery — even holding surgical retractors for 6 hours as a surgeon cut and cauterized.
“When students found doctors who were good teachers, that’s when they were most excited,” Marino said. “When a doctor took the time to explain stuff to them, that’s when they really learned – when it was hands-on.”
The three students she followed each ended up facing crises of their own: severe depression, failures and negative evaluations, major family illness, all mixed with victorious moments.
Having seen medical school close up, Marino says it has affected the way she views doctors when she is a patient.
“I question them a lot more,” she says. “Doctors are supposed to examine you and get your feedback — and that’s great if you have something like a hernia or strep throat. But medical training isn’t that great in terms of picking up unusual illnesses. I know I have to be engaged in my own care.
“But I also think of doctors more as human beings, with their own families, their own health issues. I see them as more fallible — because everyone has their personal struggles. ”