Well, as a seasoned M3 (who is totally qualified to call herself this by dint of surviving almost one full week on Surgery), I have a bit of advice for those who are starting clinical rotations: it's hard.

While I admit the hours are comparable to those used to study for Step 1 a month ago, the energy (physically, mentally, and emotionally) expended during the day are far greater. From the outsider's perspective, I did not do much of anything during my study period - I sat on my couch and stared at my iPad for hours on end.

Now, I'm racing from pre-rounds to rounds on the floor, then down to the OR where I stand, maintaining the retractor in exactly the right position or even being asked to two-hand tie a knot (which makes my heart rate jump to over 100), and so on. The amount of action makes it patently obvious why there are multiple medical dramas focusing on the hospital and not on the preclinical years.

In short, I'm exhausted. I come home ready to collapse on my bed - I torture myself by prolonging sleep at least until I've showered and ate dinner - and I sleep, as my family calls it, "like a rock" (as in, like I got hit over the head by a rock). In the morning, I stumble around my apartment like a zombie, trying to collect everything I need for the day.

But, when I'm at the hospital, I don't think about any of that. I'm exhilarated. I am actually doing something to help improve other people's lives, even if my part in this better life is reasonably small. Especially on Surgery, it's easy to see the impact on people's lives.

This month, I'm rotating on the Vascular surgery service, which means that a lot of the OR cases are some form of endarterectomy. Over time, atherosclerosis causes plaque buildup in major arteries and can lead to inadequate oxygenation of important tissues. If these arteries feed the heart, the result can be a heart attack. If they are any other artery, that's where vascular surgeons come in. For example, femoral artery stenosis can lead to claudication (essentially angina in your calves, or leg pain after walking a given distance that subsides after rest) and difficulties moving from place A to place B. Or, there's carotid artery stenosis, which leads to a higher risk for stroke.

In an endarterectomy, the surgeons clamp off the vessel above and below the stenosis (usually at least 50-70%, and sometimes even 100%, of the vessel is occluded), open up the artery, take out the plaque, and close everything up. The procedure takes 2-3 hours, but what a difference it can make. People can walk farther than they have in a long time or are less likely to have a stroke. It can change their life.

And that's what I came to medical school to do.

So yes, it's hard. And yes, I'm exhausted. But, even playing a tiny part in improving someone's life makes it all worth it. It just takes time to get used to the change in my own life. No more streaming lectures for me; now I have to be up front and center. It's definitely an adjustment period, but it's a bit like starting a challenging exercise regime - my whole body is sore and I want to quit. But, when you stick with it, you become a much stronger and better person than you ever dreamed possible.