It ended much the same way it began. On this Friday, during the last lecture of our first year of med school, we were a sea of white in West Lecture Hall. The school year was ending with one last patient presentation. As usual, the guests sat in a row of seats on stage. Over the course of two hours, we listened and learned about their experiences with our health system.

At first glance, not much had changed among us first years--most of us sat relatively attentive (for a Friday afternoon) in our seats, scribbling the occasional note.  We were just as interested in learning from patients as we had been 9 months ago. Still, our coats were nowhere near as neatly pressed as they had been in August. A good number of us had gained some weight or loss some over the months. Relationships had been gained and lost too. Overall, though, most of the changes were subtle--so subtle in fact, I probably wouldn't have noticed myself how much we've grown over the past few months if I hadn't been prompted (by current circumstance) into quiet introspection.

First year had gone by in a blink. It felt like we had been sitting through our first lecture just yesterday. And now we were almost second years. Unbelievable.

After the lecture was over, there was an immediate exodus to the Learning Resource Center. Class was over, but it wouldn't officially be summer until we completed our last exam of the year. We had until Monday to finish it, but most people had already set their travel plans for later in the evening (myself included) and needed to get the exam out of the way quickly. Gauging that I'd need to spend another hour or two looking over the material before I tested, I took a small detour away from the computer lab portion of the LRC to the portion where several rows of study rooms lined a long corridor (studying in one of these small classrooms is much more comfortable than cramming in a computer cubicle). However, when I approached this area, I was unexpectedly greeted by a series of big red signs covering the windows of the doors. They stated in bold letters:

"M4 CCA Exam"

CCA. Comprehensive Clinical Assessment. You don't hear much about them as a first year but I knew enough to know your CCA Exam is a big deal. You have to pass two different CCAs, the first before third year, before you are allowed on the floors and the second as a fourth year.

I considered my current level of ability when it came to giving physical exams. I'd just given my first full physical to a volunteer "patient" a week before. There's a lot to remember, but we're trained to perform the physical in a systematic way that helps minimize mistakes. Despite my fear of inadvertently injuring a stranger, I performed relatively well (after I remembered to go back to exam the respiratory system, which I completely overlooked on my first sweep…forgetting to check an entire body system is generally frowned upon in this business…apparently).  Still, it's clear that each year the stakes get higher—more work, less room for mistakes, increasing responsibility. And one day, not as far away as I like to imagine, someone's health and wellbeing will depend on the decisions I and my 169 or so classmates, make.

Yep. All in all I was glad I wasn't an M4. I had a good 3 years before I'd have to face the stress of my final CCA exam.

With the study rooms being occupied, I ended up studying for the last few hours at one of the computer cubicles. Despite the keyboard taking up a decent chunk of available desk space, it didn't end up being too bad. A good number of my classmates were doing the same thing—spending the last few hours of first year cramming and scanning their notes –and because of that, a pleasant air of camaraderie permeated the LRC computer area.

A few hours later, when I felt ready to take the test, I started my usual pre-quiz/exam ritual: first, I took out a pristine sheet of computer paper and numbered it. Then I set aside 2 mechanical pencils (including my lucky red one). After that, I placed a single piece of gum beside my answer sheet (don't knock my routine…you don't make it to med school without being at least moderately anal retentive). The remaining tasks I needed to do to complete my ritual were to go to the bathroom and on my way out, fill up my water bottle. Making my way once more out of the computer area I headed toward the other end of the LRC. On the way to the bathroom, I passed several M4s (identifiable by their scrubs and the "let's get this over with" looks plastered on their face) and what I assumed to be several standardized patients trying to find their places. There was a lot of activity.

Pushing open the bathroom door, I went to stand behind the sole woman in line. To my surprise, she took one look at me and immediately stepped to the side.

"Oh! You can go ahead. I'm not in a rush."

I paused for a second, thrown slightly off-balance. In my 23 years of existence, no one had ever stepped out of a bathroom line to let me go in front of them "just because". I was completely confused—until I realized I hadn't taken off my white coat after the patient presentation. She must have gotten the wrong idea.

"Oh no…I'm not a fourth year!" I sputtered. She clearly thought I was one of the M4s preparing to take my CCA soon. I didn't have time to be flattered by the woman (clearly one of the standardized patients) thinking me more advanced than I actually was—I was too busy being horrified at the fleeting prospect of having to perform a complete physical for evaluation. Nope, not me. Thankfully, not yet.

"I'm just a first year," I finished. With that, I signaled her to go ahead, just as a stall opened up. For some reason, I was relieved when she nodded briefly and then disappeared from view.

Just then, at the sinks, another woman chuckled. She'd heard the entire exchange. I'd seen her before and knew her to be one of the coordinators of the clinical training programs ran through the LRC. She shook her head as she pumped a paper towel out of the dispenser. All the while, she smiled to herself.

"That's okay…we'll get you next year!" She joked.

Oh boy.

I hit me that she was right…you took your first CCA as a second year--which I'd be in about 2 hours time when my final exam was over. Lovely. M2 year: twice the lecture hours, third year looming in the distance, and of course…the dreaded Board Exam….Yep, just as I'd gotten used to things, the game was going to change again. So much for predictability.

Still, deep down, I knew I'd be ready. I have my friends—and between us, the solid kind of friendship that is best formed when you struggle and grow with each other. I have my family—cheerleaders, ever-present on the sidelines urging me on at the top of my lungs (and at times calling me back from the bench). But most importantly, I have a belief that it's not a coincidence that I am where I am, when I am.

They say medicine isn't a job but a calling. I tend to agree; and when you get a call like this, it's pretty difficult not answer—and to be thankful for the privilege of  being chosen—every single day. Reminding myself of all of this helps me keep my eye on the prize. All that I've gone through, and will go through, is for a reason.

So…Second year, huh?

Let's see what you got.