Lifelong Dream

The School of Medicine welcomed its brightest and most accomplished class this semester when 148 students attended the annual White Coat Ceremony on campus Aug. 5.

The event -- a traditional rite of passage in which school administrators place white coats on incoming medical students -- marked the beginning of a "remarkable personal and professional journey that will bring the students a lifetime of joy and fulfillment," says Toni Ganzel, M.D., senior associate dean for students and academic affairs in the School of Medicine.

For at least one student, it also marked the fulfillment of a lifelong dream.

"I've wanted to go into medicine since I was in the second grade," says first-year medical student Cristina Fernandez.

"When other kids were playing with mud pies in their back yards, I was using mud to concoct medicines and pretending they were new treatments for my patients. Every poem and essay I ever wrote -- they were always about how I wanted to be a doctor, and all my coursework in high school and college was designed to prepare me for medical school.

"So when I finally had that coat placed on me during the ceremony, it was as if the culmination of my entire life had been directed toward this one moment, of being in medical school. That coat signaled an end to all my preparation, and of course the beginning of something even more challenging: four years as a medical student.

"It was a wonderful, exciting feeling. But at the same time I also felt very small. I realized like never before how much knowledge there was to learn and how much work I would have to do to become a doctor. It was intimidating in an exciting way. I knew something great was going to come out of it."

Fernandez, a Louisville native, is returning home this semester after earning an interdisciplinary bachelor's degree in philosophy, neuroscience and psychology from Washington University in St. Louis.

Even before the semester began, Fernandez and her classmates showed impressive intellect: They have the highest average college GPA and MCAT scores in UofL history -- 3.64 and 9.73, respectively.

But medical school is a challenging enterprise for anyone, Ganzel says, so university staff hosted a week of orientation activities to help students get centered before classes began.

Besides knocking out mundane tasks like posing for ID card pictures and purchasing textbooks, students had the opportunity to tour the campus, attend seminars on topics such as financial aid, and see demonstrations on clinical skills like suturing and arthroscopic surgery.

"We also met lots of great faculty like Dr. Ganzel, who was sort of our everyday cheerleader," Fernandez adds.

"The instructors and more advanced students all made sure we felt welcome here."

Fernandez was grateful for the experience, she says, but the first-year students were anxious to begin course work.

"Orientation week seemed so long, and I had butterflies in my stomach the whole time," she recalls. "We just wanted to the get the ball rolling."

When classes finally got underway, the first day was a busy one -- two hours of histology lecture, a break for lunch, one hour of gross anatomy lecture and a couple of hours in the gross anatomy dissection lab, capped off by several hours of individual study.

That last class, dissection lab, was of particular concern to Fernandez. She knew she would be meeting her very first patient - a cadaver donated to the medical school so she and her study group could learn human anatomy first-hand - and wasn't sure how she would respond.

"I was quite nervous that first day because I knew we were going to be doing dissections in the lab," Fernandez recalls. "But I actually ended up making the first dissection in my group because I wanted to take charge of the situation."

Gross anatomy, it turns out, is now her favorite class, although the material is perhaps the most challenging she will face in her first year at UofL.

"There's a huge amount of knowledge that we have to learn in order to correlate the structures we see in the gross anatomy lab with the functions and their place and orientation that we read about in our books," Fernandez says. "You just have to sit down and commit so much to memory.

"But we also realize that we'll never know a patient inside out as well as we know our cadaver," whom the students have named Frank.

"We explore every single inch of his anatomy, and that is such an amazing gift. I'm just grateful every day we're in that lab learning more about the human body."

Other subjects taught during the first semester deal with a broad range of basic sciences - embryology, neurology, histology - and cover an equally intimidating amount of material, Fernandez says.

"We really have to absorb a tremendous amount of information in a very short period of time," she says. "I knew it wouldn't be easy, but I didn't think it would be quite this challenging, either. You have to be extremely rigorous and disciplined about your study habits."

To help with this, Fernandez meets with a regular study group twice a week. Many of the group's members also form her social circle, since virtually all her life now revolves around medical school.

The reason for that is simple: There are only so many hours in the day, and Fernandez' days are packed.

On a typical day, Fernandez might wake at 6:45 a.m. and head to school in time for an 8 a.m. class. She then attends class until it's time for a one-hour lunch break, which she frequently spends by walking down to the 4th Street Live complex for Cajun food at J. Gumbo's. Then it's back to class until about 3 or 5 p.m., depending on the schedule.

After that, Fernandez stops by the Heine Brothers coffee shop on Frankfort Ave. for four to six hours' of study time.

"A lot of other medical students go there, too," she says. "It's a nice atmosphere, and I like their vanilla latte - with as much caffeine as possible!"

Around 9 o'clock, she'll return home and have a late dinner before studying into the night, sometimes until 3 a.m. ("I do that at least twice a week," she says).

This kind of schedule obviously makes time management a huge challenge.

"There really is so much to do, and I don't want to get burned out," Fernandez says. "I need to make sure I'm always fresh and motivated to study, so I can sit down and knock out five or six hours at a time."

To help clear her head, she makes time for the occasional weekend soccer match or plays the piano at home, where she lives with her mom, Anna, and dad, Rafael Fernandez, Ph.D., a professor of immunology at UofL.

"If there's something I really want to do, I have to make time to do it," she says. "But now is the time for us to learn how to balance all the things we're going to have to deal with as doctors, professionally and personally. Time management is really a critical skill, and one of our biggest challenges as students."

The school has been very helpful in fostering the skill, she says, by offering time-management classes. And faculty like Ganzel -- a practicing surgeon, wife and mother in addition to being dean of students -- also help.

"I have her as a teacher in a class called Introduction to Clinical Medicine, where we talk about clinical case studies and key issues like professionalism and ethics," Fernandez says. "I know that I and the other women in our class are excited to have her for a mentor because she really shows us that you can balance a family with a demanding and successful career while also playing an active role in the community. She is the epitome of effective time management."

Fernandez, who is of Guatemalan ancestry and speaks fluent Spanish, also hopes to squeeze in some volunteer work by serving the Hispanic community. Before college, she volunteered as a translator at University Hospital's emergency department.

"I'd like to be able to give my services at a clinic for immigrant populations in Louisville," Fernandez says. "Many of these people are pretty powerless to improve the current state of their health care, and I feel a respon-sibility to help serve them."

As Fernandez' first semester winds down, she's more confident than ever that medicine is her true calling. She's equally confident that she made the right decision in coming to UofL.

"I just really like the learning atmosphere here at Louisville," she says. "The faculty are very supportive and open to talking to you at any time about anything, and you really feel like everyone here wants you to succeed. The whole system is just so supportive."

Fernandez also appreciates the school's legendary clinical focus, which sets it apart from many medical institutions.

Although first-year students traditionally have limited opportunities for clinical experience, UofL is rewriting the rules by giving them a chance to practice patient interactions in its Standardized Patient Clinic.

The mock doctor's office employs actors who play the role of patients with scripted maladies. That allows students to conduct exams in a no-risk environment while faculty observe.

"We're really learning the very basics, like how to wash your hands or greet a patient," Fernandez says.

"But it's amazing how many things can go wrong in that interaction. You can know everything there is to know about anatomy and body structures, but if you can't say 'Hi' to a patient, you're not going to be a very good doctor. That patient-doctor connection is crucial."

The clinic, like everything else in medical school, has been "very demanding and challenging, but also exciting because we're learning so much," Fernandez says.

"Soon, I know I will be able to apply that knowledge to improve the health of people who are sick. I'm so glad I came to UofL. This is just the kind of experience I was looking for in medical school."