On a crisp March afternoon in downtown Memphis, hundreds of cars descend upon Central Station. Inside, tables covered with white cloths and printed programs are filling up one by one. The crowd of more than 200 is composed mostly of 20-somethings, with the occasional set of parents or grandparents thrown in for good measure.
A man in a suit taps a microphone, commanding the room's attention. A hush falls over the crowd, though the nervous energy is almost palpable. One by one, he calls the names of 155 men and women, who walk to the podium to accept an envelope. When all names have been called and all envelopes delivered, he steps to the microphone yet again.
"Ladies and gentlemen, open those envelopes!"
In an instant, the room explodes with noise. Excited shouts ricochet off the station's walls as people hug, high five, and compare envelopes. Confetti guns shoot colorful bursts into the air as cell phones light up to share the news. The mood is jubilant, save for the few still seated and quiet. One young woman cries quietly into her hands as a friend consoles her.
The envelope recipients are medical school students from the University of Tennessee Health Science Center, and they've been working for this moment for the four most grueling years of their lives. This is the moment they find out where their lives as doctors will begin -- what city, what hospital they'll call home. This is Match Day, and for these 155 students, it's both an ending and a beginning.
Each year, thousands of hopefuls apply to medical schools across the country. Their reasons are as different as the students themselves, but the experiences these young men and women share during this period are eerily common. Six med students provided us with an inside look at what no prep course or college counselor can tell you about what it takes to make it in the competitive world of medicine.
Two Years of Hell
For Beth Lyons, a Nashville native and UT Knoxville graduate, med school came after a few years working as a tech in a nursing home and at Vanderbilt University Hospital. With her undergrad degree in exercise science, she had the prerequisites necessary to take the MCAT, the national medical school entrance exam, which she passed with flying colors in 2002. "I'd already experienced some of the real dirty work dealing with patients, and I still liked health care. I gave it one shot and here I am."
Lyons would soon meet classmates Ben Mauck, Adam Cartwright, Andy Shull, Casey Chollet, and Ashley Ermenc (wife of editorial contributor Drew Ermenc). Though each traveled very different paths to arrive at UT in 2002, over the next four years, they became part of something much bigger, and much more challenging, than they knew possible.
"Nothing prepares you for medical school. Nothing," says Cartwright. It's a sentiment all six agree with, for various reasons.
When med students arrive on campus the first day of the first year, they've already done plenty of prep work to get there. In addition to having the required 90 hours of prerequisite math and science courses, they've studied for -- and passed -- the MCAT.
Then, the real test begins.
"The first two years of med school are nothing but studying," explains Mauck. "In-tense, hours-on-end studying. The amount of material you've got to conquer is immense, and your life revolves around those books," he explains. If students want to pass the first block of tests, they'd better have hunkered down with the material for a good eight to 15 hours a day, seven days a week. "If you can't do that," says Shull, "you might as well give it up."
That first year serves as a wake-up call to most students, who are used to being at the top of their class. Med school attracts the best and brightest, but at the end of the day, even the best and brightest must be divided again. For many, it's an unfamiliar, unsettling feeling. "It humbled me right away," says Chollet, who had sailed through college with excellent grades and minimal effort. "After the first set of exams I cried every day. I knew I was failing, and I'd never failed before."
The key to success, all agree, is finding a routine that works. Some students find that going to every lecture and class helps, while others skip lectures on material they understand to bone up on that they don't. Life revolves around reading, memorizing, studying. "Before med school, I'd ask myself how many hours I needed to study to pass," says Cartwright. "Here, you have to say how many hours can I afford to sleep, and how many minutes can I allow myself for meals in that 24 hours?" In the world of a first-year med student, every hour is precious, and every decision crucial. Discipline is a must.
Not everyone can handle the pressure.
"We lost several people from our class," says Lyons. "But UT is great about giving students time off to handle personal problems or family emergencies. People are going to have things happen that they have to take care of, through no fault of their own. So we might lose a few students, but each year we'll also gain a few who've taken time off and are coming back."
Not everyone comes back, though. "People do have meltdowns," says Shull, who was part of an anonymous peer-to-peer counseling program on campus called Audience of One. Students who need help with problems of any kind, from emotional to substance abuse, can call fellow students with the promise of anonymity. Sometimes, Shull says, people just need to talk.
The saving grace for many students is the sense of unity that the class develops. For two years, students are put through the exact same thing. No one's load is any heavier to bear than another's, and at the end of the day, what they have to try to keep in mind is they chose to be there.
At the end of those two years, students take the Step One Test, easily the most important test of the four-year period. "The results of that test, which covers pretty much everything you studied for two years, determine where you'll get your residency," says Chollet. "It's key to success."
After the Step One Test, says Cartwright, life begins again.
The Halfway Mark
During years three and four of med school, students begin clinical rotations, meaning they work in real hospitals with real patients. For the first time in two long years, books and endless hours of study give way to human contact. For Mauck, it was the first time he felt as though he might really be a doctor someday.
"The learning curve is so exponential in the beginning, but it all comes together -- starts making sense -- at this point," he explains.
For Chollet, the timing couldn't have been better. Burned out after two years of intense work but not willing to give up at the halfway mark, seeing patients and getting some real-world experience was exactly the break she needed. "For the first time, my future as a doctor became real to me," she says.
The first day in the hospital, though a welcome relief from the confines of the library, is thrilling, but intimidating as hell.
"I felt like the biggest fraud in the world," recalls Shull. "Here I am walking down the hall in my white coat -- which is so damn stiff and clean it won't even move and is practically glowing in the dark, and if someone had asked me the simplest thing, like where the cafeteria was, I wouldn't have been able to tell them," he smiles. "For me, it was the most incredible combination of fear and excitement I'd ever felt," adds Mauck.
It's easy to forget that you're still two years away from being a doctor, says Ermenc. "You completely overestimate your importance in that setting. You're at the bottom of the rung as a junior intern, and you've got an intern, a resident, and a doctor all above you in rank. You're there to draw blood, to talk to the patients and get information, and to do the prep work. That's it at first," she says. "Even still, you're always worried in the back of your mind that you're going to do something stupid and kill someone.
And while the newness of face-to-face contact is seductive, it doesn't take long for the realities of illness, disease, and death to set in. It's this time, says Lyons, that you learn the most important human aspects of medicine.
"You've got to have empathy for everyone," she explains. "Even though it's frustrating to see people who haven't given the first thought to taking care of themselves, you can't show it. You can't look disgusted with them. It's your job to care for them no matter what."
Each has an experience, or several, that will stay with them forever.
For Cartwright, it was seeing two teenaged boys airlifted to The Med after the meth lab the two were in exploded, taking most of their faces with it. "Here are 14- and 15-year-old boys, and because of one stupid mistake, one choice they made, their lives will never be the same. There's no way to fix what that explosion of chemicals had done to their faces."
For Lyons, frustration nearly took over after she saw the same woman three times in the same month. "She came in with crack-induced heart attacks within weeks of each other," says Lyons, shaking her head. "And at some point, you have to tell yourself that all you can do is keep them alive, you're not going to correct a lifetime of mistakes and bad choices in one day. That's just the reality."
The incredibly addictive street drug also played a role in one of Ermenc's more harrowing experiences. "One of my first one-on-one consultations was with a crack-addicted prostitute. We ran some tests on her, and when the results came back, I saw that she was HIV-positive," says Ermenc. "I took a deep breath and walked into her room, and to have to say those words to someone was the hardest thing I'd done. She cried -- god, she cried so hard. I sat down for a long time with her and told her about several programs offered around town, and in the end, she agreed to check them out."
Ermenc left the patient feeling as though she'd really helped her take the first step in turning her life around. A nurse who overheard the exchange beckoned Ermenc over to the desk and handed her a stack of records. "I flipped though chart after chart on this same woman. She'd been tested before, gotten her results, gotten T-cell work done and even received some meds. She knew the entire time she was HIV-positive and lied to my face. She let me go through all of that, and to this day, I'll never know why. That day changed me. I became more jaded . . . ."
Chollet's first patient was a schizophrenic being held in The Med's "201," where prisoners are kept during treatment. "I approach the door flanked by two huge guards. I'm screaming at the man, 'And what seems to be the problem today, sir?' at the top of my lungs, and the whole time he's going crazy in there, screaming obscenities back at me. I remember thinking that he could kill me in a heartbeat if he wanted to," recalls Chollet. "That was a hazing, pure and simple."
The most critical factor to keep in mind when seeing a patient for the first time, all agree, is to "assume nothing." In other words, don't assume that the young man with the baggy jeans wearing gang colors is suffering from some sort of drug reaction, when in fact he's got pneumonia, and don't assume that a sweet, blue-haired woman from the suburbs isn't on meth. "One of my professors used to tell us that even if our grandmothers came in, we needed to run a drug test and check for STDs," laughs Cartwright. While amusing, it's good advice, as Chollet discovered when a 55-year-old woman came in one evening complaining of abdominal pain.
"She was pregnant," says Chollet, with the slightest shrug of her shoulders. "But nothing surprises me anymore."
And while it helps -- is necessary, in fact, to keep one's sense of humor intact -- med students understand all too well that death is a very real part of their lives now. No matter how old or sick a patient is, it's never easy to see, and even harder to explain to the family.
"When it's time to talk to the family about their loved one, you can't stay in doctor mode," says Cartwright. "At least not in the way you speak. You've got to remember that to most people, the words you're so used to throwing around might as well be a foreign language." And how do they handle it when the family asks for advice on what actions to take? "All you can do is explain very simply, but very clearly, that if you do this , then this might happen," says Cartwright. "Leave no room for interpretation. I've found that statistics are the easiest way to relate to people the chances of a certain procedure being successful. Most people can grasp the numbers part of it."
After a year of working at various hospitals and clinics, helping with any and every type of patient and condition, third- and fourth-year students are able to weed out the things they enjoy, and the things they never want to do again. And the research begins. What hospital has the best program for what will become your specialty? And can you live happily in that city? Complicating matters even more, can your spouse or partner?
Five of the six students interviewed got married during med school, and two started families. When the time comes, your family has got to be willing to live where the job takes you, a huge part of the decision-making process for these future docs.
Once the hospitals with appropriate programs are identified, students fly out for interviews and tours. If the hospital is a good fit, it's added to the student's list. The process continues, and second interviews are requested and granted. Hospital hopefuls create a wish list, ranking their top three choices for internships, with a few fallbacks as well. At the same time, hospitals are making their lists. In the end, a computer matches the lists to ensure that the highest number of matches are made. For three long weeks after those lists are turned in, students wait. Families wait. Realtors are on stand-by, ready to help sell a home here and find a new one . . . somewhere.
Match Day finally comes, after what seems like the longest wait of their lives. Whether you matched with one of your top three or not, it's an incredibly emotional experience. "It feels as though until that moment, everything in your life was on hold, just suspended in time," says Chollet. "After Match Day, you can finally take a breath."
As these six grads begin making preparations for their new lives -- all are going their separate ways -- they do so knowing that they're entering a world for which they might not be entirely prepared. Since working while in med school, or "moonlighting," is forbidden, for most, it's been at least four years since they've earned a single dime. Life has been budgeting for months at a time with a single loan check, and feeling "guilty about something as extravagant as ordering a pizza," says Chollet. Most will leave school anywhere from $150,000 to $250,000 in debt. If they marry another med student, or in Chollet's case, a law student, they'll see that figure double: "It's so surreal, looking at the amount of debt you've accrued. I know what it means to see that 30-year loan amount staring back at me, but it still isn't yet real."
That doesn't mean these grads will have a bit of trouble purchasing cars or homes, even with exponential debt on their reports. "I can walk into any bank right now, and they'd give me whatever I asked for. Any of us could," says Lyons. "We're considered incredibly low-risk to the banks, because they know we'll soon have a guaranteed earning power of six figures."
By the time this article hits newsstands, all but one of them will be gone, ready to begin their lives as doctors, and each has his own concerns about the future. It's been a long road, but they're prepared by what they've learned, both in the classroom and in the field. "I grew up thinking I wanted to be a lawyer, and I'd change the world that way," muses Ermenc. "When I decided to go this route instead, I knew I might not change the world, but I could change lives, one patient at a time."