the on/off switch?

One of the biggest problems I have with med school is that I've discovered that my brain did not come equipped with an on/off switch. I've been awake now for about 28 hours straight, and I still cannot get it to shut up. It's a tad annoying that way....

I suspect this is not an uncommon problem, especially for those of us in PBL programs, and particularly during the high-pressure days before one of our big exams. On Friday, we have our first PBL exam of the semester. I'd try to correlate this to exams I took as an undergrad, perhaps like those at the end of a term...but really, there's no comparison. The amount of material we're being tested on is absolutely overwhelming. (I think I've said that before, but I don't think I can say it enough, you know?) On Friday, I'll be tested on 36 learning issues and 7 cases. What does that mean? Well, each learning issue is essentially one chapter from a textbook. This block of cases focused on cardiac, vascular, & renal physiology, so we're covering three units in Guyton's Physiology, which means all of cardiac physiology, all of vascular physiology, and all of renal physiology. That would be enough, in and of itself, but, wait, there's more: we've also got chapters from embryology, anatomy, histology, pathology, biochemistry, pharmacology, & genetics. Some of the material will overlap a little--e.g. there's a chapter in phys on lipid metabolism, as well as one in biochem--but basically we've got over 500 pages we're responsible to know. The cases, although much more interesting than just the chapters themselves, integrate much of the material, but they also challenge us in unusual ways. While most medical schools focus on one set of classes at a time (e.g., in a traditional allopathic medical school, I'd be taking lecture courses in physiology, histology, anatomy, embryo, etc, and they'd each be their own distinct entity like in undergrad), almost all of our work is done through the PBL format. It's great in the sense that we're getting clinical exposure early on in the form of learning how a medical case works, what lab results look like, how to interpret x-rays and such, etc; but it's also daunting to have to learn about all the different classes of hypertensive drugs when I feel I've only barely got a grasp on how normal kidney function works, let alone pathophysiology and treatment through pharmacology. And that's just one example of how I feel like I've been thrown in the deep end here, so to speak....

No doubt my experience right now is colored by my surgical recovery and all the time and energy that has eaten up, but I do wonder--is two years enough time to learn all the basic science needed to pass the boards and set foot in a hospital and start treating people? Sometimes it seems like sheer lunacy to me, this concept that I can learn all about the body so quickly.

Of course, it could be the precise reason as to why I seem to have lost my off switch: with this much information to incorporate, even sleep--however infrequently obtained--is permeated with thoughts of drug clearance curves, risk factors for atherosclerosis, and nagging questions about just how those kidney tubules actually work.... Anyone want to trade places for a day? I need a nap!