Long hours, intense teaching sessions, and strict punctuality; Mark Silvert got more than he bargained for at Harvard Medical School

I remember his words to me before I left: "They do things quite differently over the pond you know. The Americans do not mess around when it comes to their medicine--early starts and long days. Enjoy yourself. It will be a great experience."

I walked out of the psychiatrist's office at a London hospital. It was December and the cold temperature was biting. I never did enjoy the winters in London. I walked down the street wondering how hard Harvard Medical School really was.

The bright lights of Boston

Good luck and goodbye

Two weeks later when I arrived at Vanderbilt Halls in Boston, an angry blizzard greeted me. I found my room and shook off the snow. A medical student, who happened to live in the room opposite me, sat me down and chatted with me for a while. I was starting to feel at home until she got up abruptly, informing me that it had been nice to meet me, and wished me luck. "I'll see you tomorrow," I said to my new neighbour. "No you probably won't. In fact you probably won't see me again, if you are only here for two months," she said. "What do you mean?" I asked. "I work pretty much all day and all night, as I am in my third year now you see," she said. I didn't but I was tired with jet lag and the early morning start was approaching fast. I accepted what seemed hyperbole to me, and went to sleep.

The radio alarm went off at 6 am. The DJ said the temperature outside was -20ºC, and I noticed the Charles River had totally frozen. I slipped on the icy pavement as I tried to locate the free bus that ferries Harvard's medical students to the towering Massachusetts General Hospital.

When I arrived at the hospital I thought that I had got off the bus at the wrong place. In front of me was a new looking skyscraper and at the foot of the tower were men and women offering to valet cars. As I was about to ask for directions to the hospital, a valet jumped in a Mercedes revealing a red sign saying "Emergency."

Founded in 1811, the Massachusetts General Hospital is the third oldest general hospital in the United States. The 868 bed world renowned medical centre offers sophisticated diagnostic and therapeutic care in virtually every specialty. I was to be part of the acute psychiatry service as an elective medical student, taking on the same responsibilities as the residents.

The acute psychiatry service provides emergency evaluations for acutely ill--or "in crises"--patients. Patients may either attend voluntarily or be sent to the service on an emergency section. The department is structured so that the patients may wait in an unsecured waiting area, in a secured waiting area, or locked in holding rooms. Patients may also be located in other parts of the emergency room and the service's doctors visit them if needed.

Key facts

• Population­ 285 million
• Capital­ Washington, DC
• Language­ English
• Currency­ US dollar
• International dialling code­+1

In a land of giants

I went to find my new workplace. Like most things in the United States, everything was big. I went behind the main desk to find a member of staff, when a giant of a person approached me asking what I was doing in the staff area. I took this six foot giant, wearing spiked rings and heavy boots, to be a security guard. I was wrong; American nurses must also be trained wrestlers, if they are to work in the emergency room.

I found the team of emergency psychiatry attendings and residents, and they introduced me to the structure of the week. Teaching started just before 8 am and lasted for 2 hours every morning. We were also encouraged to BYOD (bring your own doughnuts).

The teaching was taken seriously. Tardiness by students or junior staff was not tolerated, and after a particularly long evening exploring the sights of Boston, I arrived at 8:10 am. I was taken aside after the teaching and told how things work at Harvard medical school. My mistake was put down to a "cultural misunderstanding" by the attending consultant.

Intensive teaching

After a 24 hour shift on call, there were compulsory lectures in the Ether dome--a building where the first successful public demonstration of anaesthesia took place in 1846. The teaching was fantastic and speakers from all over the world visited. But after 24 hours on duty not even the biggest caffeine fix was able to see me through the hours. It was becoming apparent that I had got myself into something far deeper for my elective than I had imagined.

Harvard medical school

American medics are well integrated among the staff and there was never a time when I was made to feel like a useless student. By the afternoon of the second day, I was seeing patients and coming up with treatment and management plans. The clinical work was fascinating. Acutely unwell patients came in every minute of the day and I would assess them psychiatrically, examine them medically, and admit them if they were in danger of doing harm to themselves or others.

The hardest part was fighting with the insurance companies to authorise payment for the patients to get beds and treatment. It took up a contemptible amount of time. If the insurance company operator that you spoke to refused to authorise any care for your patient you could go to level 2, which was called going "doc to doc." This involved going head to head with one of the insurance companies paid doctors, whose job it was to keep patients out of hospital--no one with a conscience should go into this field after medical school.

Freedom fries and sushi

Lunch and dinner were also an interesting part of life at a US hospital. The cafeteria was almost the size of my training hospital back in London and the sushi bar had to be seen to be believed. When you are on call over night, all the food is free. French fries could keep you going through the small hours of the night. These were renamed "freedom fries" in the last few weeks of my elective because of political events.

The medical students are focused and not particularly interested in partying, but that may be due to the system. Before they join medical school, students must already have a college qualification and therefore, are a few years older.

If you are looking for bars and clubs they are to be found, but shut fairly early and Boston itself fills up and empties out depending on term dates. I found myself taking Amtrak, the US rail service, up and down the East Coast to Washington and New York on weekends for added entertainment

By the time I had finished at Harvard, I had met many interesting patients and many great consultants who provided first class teaching; worked 30 hour shifts, helped do electroconvulsive therapy; and learnt more than I could have ever dreamt of. As I sat on the plane home, I relaxed back into my seat as we flew over the ivory speckled campus. As I looked down at my halls it suddenly occurred to me that I never did see my neighbour in halls again.

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