As a medical student I loved mnemonics, those acronyms, often as hard to remember as the facts themselves, that served as temporary containers for the information served up daily in such large portions they seemed in danger of spilling out of our brains. Bones and muscles, chemical bonds and hormones, antibodies and enzymes, symptoms and diseases could all be reduced to acronyms and, at least for a few hours before a test, mastered, even when the concepts themselves remained opaque. Most of my classmates had majored in the sciences and were, unlike me, right out of college and living in the dorm across the street from the hospital, not in apartments with spouses and wedding-present china. But even they admitted that, try as they might, it was impossible to remember everything. At our thirtieth reunion, I confided to a classmate who had studied biochemistry as an undergraduate that I’d spent much of our first year in medical school crying in frustration in the ladies’ room next to the lecture hall. She told me this could not have been true. Sipping a glass of white wine, her other hand tucked tightly across the chest of her cocktail dress as if protecting herself from the pain of an old wound even as we laughed about it, she said, “I was always crying in that ladies’ room and I never saw you there. In fact, I thought you had it all together, so much more mature than I was, so married.”
We spent considerable time in those days comparing ourselves unfavorably to one another. We’d all been top students in our high schools and colleges, able to learn all the material in any course. Now even the most hardworking among us could barely keep up. Except that each of us felt especially inadequate. In the middle of the night, a week before a physiology midterm during my first year, I became extremely anxious and woke my husband. “What’s wrong?” he asked. We’d met at Yale as English majors and he, like me, had completed his pre-medical requirements after college. He was now two years ahead of me in medical school and I frequently looked to him for reassurance. “Tell me,” he said, wrapping his arms around me. “The pancreas!” I cried. “I don’t understand the pancreas!”
I’m not sure why it didn’t occur to us then that we could all become excellent doctors. I think it had something to do with the fact that for the first two years of medical school our entire class sat in the same lecture hall or lab all day, five days a week. My mother intuited the effect this claustrophobic arrangement had on us. Once I called home after receiving a poor grade on an anatomy test for which the class average had been high. In a rare instance when I didn’t find one of her platitudes irritating, my mother told me that my classmates and I needn’t compete with one another; there would be plenty of room for all of us once we left the confines of medical school. Still, I, and the woman I met at the reunion, and no doubt many others in my class, felt isolated in our misery. I now know—and it took a very long time for me to appreciate this—that shame incorrectly insists on its uniqueness, invariably, just as I know that you can’t sneeze with your eyes open and that with age, everyone loses the ability to accommodate for near vision, no exceptions, two things I learned in medical school and had no difficulty remembering.
One of the first mnemonics everyone learns is for the cranial nerves, the tiny structures that allow us to see and smell and hear and stick out our tongues and smile and wink and shrug our shoulders, among other functions. There are twelve of them: Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Auditory, Glossopharyngeal, Vestibulocochlear, Accessory, and Hypoglossal. As I list them here, I rely on the nonsensical chant I learned back then: On Old Olympus Towering Tops A Finn And German Viewed A Hops. There are other versions, including: Oh, Oh, Oh, To Touch And Feel A Girl’s Vagina, AH! Many mnemonics are similarly bawdy, relics from the days when nearly all medical students were men. Memorization of the numerous and confusing carpal bones of the wrist, for example—Scaphoid, Lunatum, Triquetrum, Pisiforme, Trapezium, Trapezoid, Capitate, and Hamate—has been aided by: Some Lovers Try Positions That They Can’t Handle; She Looks Too Too Pretty To Catch Her, and Scabby Lucy Tried Pissing Hours after Copulating Two Twins. Perhaps are there new mnemonics, now that the majority of students in American medical schools are women? Scabby Lucy’s revenge.
We did have several female instructors, especially in the first two years. One was a dermatologist who taught us the trick for remembering the characteristics of melanoma, the most dangerous form of skin cancer. If you see a mole you look for ABCDE: Asymmetry, irregular Borders, more than one or uneven Color, a large Diameter, Evolving and changing. The dermatologist was young, not much older than we were, fair and freckled with red hair, exactly the coloring that puts one at risk for melanoma. I remember wondering if this dermatologist had the disease in her family. Or whether she’d had it herself. At the very end of the lecture, the dermatologist turned off the slide projector, stepped out in front of the podium, and asked that the auditorium lights be turned back on, signaling that what she was about to say would not be on the exam. Her whole affect changed. She relaxed the way an actor might, after a scene is shot. Though she still wore a starched white coat, she now seemed more like a friend, or an older sister. “Listen,” the dermatologist said, “after seeing all these photos of skin cancer, you’re going to go home and find something on your own body, and you’ll be convinced you’re dying. We call that medical student’s disease. And when this happens, I want you to call me and come right over to my office so I can reassure you.”
I think some of my classmates took the dermatologist up on her offer, but not me. I didn’t suffer from that medical student’s disease. But I did have another affliction, an even more common one, I think: the fear that I wouldn’t remember everything. That, despite all the mnemonics, all the lectures and labs and late nights, I wouldn’t know enough. That I would miss something. That I would kill someone. That I would look foolish.
Rumpus original art by Kateri Kramer.
Excerpted from Letter to a Young Female Physician: Notes from a Medical Life by Suzanne Koven. Copyright © 2021 by Suzanne Koven. Reprinted by permission, courtesy of W. W. Norton & Company.