A medical student chronicles his struggles to maintain a healing presence To all the students who went to bed crying or woke up screaming. To all those who needed to leave their hearts at the door. I just graduated with honors from Tufts University School of Medicine, the class of 1999. I dont feel honorable, though. I have become disillusioned disgusted even by medical training and medicine as a whole. I want to help others dispel their illusions as well. Medical school is four years long. The first two years are basic science lectures, more like an extension of college. The last two years, however, third year and fourth year, involve rotations through hospitals. One of the few statements with which most physicians would agree, one doctor writes, is that the third year, the year on the wards, is the critical year in medical education. In no year of their adult lives, another contends, do students change so much as during the third year of medical school. This is my story of third year, the worst year of my life. For many students, who like me have had no prior clinical experience, third year is the first real contact with medicine, the first taste of what doctors really do, what doctors are really like. I saw medicine as a humanistic career of intimacy helping people, sharing, caring for people. But what I found was a profession that didnt even seem to care about people. No one around me seemed to question what was happening to them, to the patients, to all of us. As Michelle Harrison wrote in her book A Woman in Residence, I came to feel I had been fighting a war which no one else even knew existed. The unusual format of this book is a result of its origins. It started out as excerpts from my diary, a compilation of notes I scribbled to myself in the dark fragmented snippets, flashes of images. Disjointed and chaotic, it is a reflection of my life and mind at the time.