I was scared to study the heart (literally, not metaphorically). However, doing so has turned out to be a pleasure. How? 1) I have been systematically making doodles based on Gray’s Anatomy for Students, and 2) I got to play with a ceramic heart model. In the process, I have learned important lessons both about how to study, and about overcoming the fear of failure, in med school.
Back in high school, we students — perhaps like you — were required to study the heart. It seemed hopeless to try to understand the heart’s complexities: ventricles, atria, valves, arteries, veins, blood going this way and that, back and around and inside, oxygen here and not there. The heart is not quite a cube, and not quite a regular pyramid, but something in-between and stretched in one direction, not to mention tilted forward. An average human brain like mine is not designed very well to imagine — particularly, in 3-D — a thing which has as many oddly-shaped pieces as the heart. So, when it came time again, this week, to study the heart, here at the IMS Milan, my apprehension kicked in.
I decided I would try to learn from Gray’s Anatomy for Students, which I own. This was not my first-choice textbook, because one of our professors has wisely recommended that we do not use it to prepare for our exams, because it is not detailed enough. However, until I can afford better color textbooks, Gray’s for Students will have to do.
For a good 20 minutes, I sat with Gray’s, unopened, on my desk. Rather than dare understand the heart for the second time in my life, I procrastinated, maybe in some of the same ways that you might: googling random stuff, Facebooking, having a cup of tea, and so forth. My anxiety had me in a kind of paralysis.
It then came to mind, however, what people have so often said about being a medical doctor: there is more information for you to learn than you ever possibly can. A medical school desk could legitimately contain textbooks piled indefinitely high into the sky. Mastering everything is impossible. We shall never become perfect physicians. When we actually ingest and fully process our imperfection, an emotional change comes with it. It invokes a kind of humility, wonder, and resignation. You start to feel like a person whose goal it is to swim as far out into the Pacific Ocean as possible, knowing she or he will never make it to the other side. You just jump in and start going, and see how much peace you can make with the journey.
Faith is taking the first step even when you don’t see the whole staircase.
– Martin Luther King, Jr.
Chapter three of Gray’s for Students is filled with diagrams of the heart. These are abstractions, of course, from the real organ. The artists have removed unnecessary details, added colors, and so on. As much as this helps, Gray’s‘ diagrams were, on their own, still too complicated for me in the first stages of learning. So, in my notebook, I abstracted out from the abstraction, breaking down the book diagram into its most important parts. Later, all this would come together to form a complex whole. The lesson here is that you teach yourself the material first at a level at which you can understand it — no matter how potentially embarassingly simple that level is.
See how my version of the base of the heart, on the right, has fewer details, and brighter colors, than the book’s one, on the left? My globs of fluorescent highlighter ink are hardly recognizable as a heart, but rather look like an appetizer of carrots, cucumber, and sliced beets. Nonetheless, that drawing is incredibly useful to me, because it helps me memorize the relative orientations of the atria, venae cavae, pulmonary veins, and so on.
I went on, and created an abstract from the abstract of the heart from a number of different perspectives: the base, front, and back, as well various slices across its middle. In each case, I redrew the view into a labelled cartoon which, even if hugely distilled from real life, matches my own memory. These pictures are almost like a representation of various views of the heart, as I see it in my mind’s eye, after being parsed out into pieces by my brain’s primitive, primordial cognitive processing center. I then made a set of similar diagrams, not of the heart, but of the circulatory system.
The whole process took four hours or so, and in order to get through it — to keep the anxiety at bay — I made myself as cozy as possible. I put on soothing Mozart sonatas, sat in a cushiony wrap-around chair snuggled in a blanket, and nibbled from a stack, next to the tea, of chocolates generously given to me by fellow students.
What occurred the next day — today — felt wonderful. In class, our professor gave us a giant, detailed, disassembleable ceramic heart model. As soon as it was in my hands, I was able to point out some of its parts in detail. What had previously only been a set of 2-D mental representations — what was on my paper, a 2-D surface — became 3-D in my mind. The kinesthetic input of touching a model heart tranformed the previous abstractions of abstractions into something real and detailed, and I now felt familiar with each wrinkle. I still could not label the model’s parts perfectly, of course; I was still making mistakes. However, things were much better. The feeling of understanding resembled, a bit, a toned-down version of my childhood familiarity, if you will, with the features of my mother’s face. Not only was I no longer scared of studying the heart. It felt, perhaps, a little comforting, to work with the ceramic model.
If you search around for advice about how to be a good medical student, you will find it over and over again suggested to draw as much as possible, particularly in the diagram-heavy disciplines like anatomy, embryology, and histology. The other advice you may discover, about facing a difficult subject, goes something like this: do not be afraid; take it slowly, calmly, and methodically. There may be some wisdom in both pieces of advice.
Erik Campano is a consultant to the English medical school of the University of Turin and doing a Master's degree studying artificial intelligence applications in global health at the University of Umeå, Sweden. He completed his Bachelor’s of science in Symbolic Systems at Stanford University, and then he worked for about eight years as a radio news anchor, before moving to biomedical scientific study and research at the University of Paris and Columbia University. His goal is to develop AI technologies for international emergency humanitarian aid organizations like Doctors without Borders, and to combine medicine and journalism. Erik grew up in Connecticut, and is a citizen of the United States and Germany.
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