The seven stages of medical school

Rebecca Monks shows that Shakespeare is still relevant to medics

"All the world's a stage, And all the men and women merely players: They have their exits and their entrances; And one man in his time plays many parts, His acts being seven ages."

Your English teacher might have made you read some mushy waffle about a bloke called Romeo and told you that it was a classic from years ago. Well, the above quote is from the play "As You Like It," which was written by the same guy who produced that masterpiece: Shakespeare.

So, what has that got to do with our days at medical school? Well, not only is "all the world a stage," but so is "all of medical school" and your entire career after that. See what you think.

Stage 1

"At first the infant, Mewling and puking in the nurse's arms."

Once again, alcohol rears its ugly head. The first couple of years at medical school are spent discovering your tolerance levels (or not, as the case may be), finding out that the four legged pub crawl is full of pitfalls (mostly found on the tarmac) and that mewling and puking are much more enjoyable if you can find a kindly nurse type to mop your brow.

Stage 2

"Then the whining school boy, with his satchel, And shining morning face, creeping like snail Unwillingly to school."

The first day on the wards is a nerve wracking experience. Fresh faced with a gleaming white coat, you will inevitably find yourself in the canteen by 9.07 am as no one will have been expecting you and the consultant will be in California attending a conference. By the fourth day, the novelty of waving a stethoscope in the direction of some poor unfortunate's carotids will be fading fast and the appeal of the duvet is beginning to exert its influence over the shrill of the alarm clock.

Stage 3

"And then the lover, Sighing like furnace, with a woful ballad Made to his mistress' eyebrow."

Ah, now stage 3 is the bit that cannot be taught in a lecture theatre or by the bedside. It involves commitments in your life aside from medicine. You meet a special someone who demands some of your time. After several special someones, you may well settle down and produce offspring who also demand some of your time. Initially, you may well think "no problem," but be warned as you hurtle your way towards the top of your career tree. Medicine is a jealous lover and surgery is notorious for leaving you without a backward glance if you do not lavish it with due care and attention. It is your decision whether this degree will lead to "just a job" or a "heartfelt vocational task accomplishment programme.''

Stage 4

"Then a soldier, Full of strange oaths, and bearded like the pard, Jealous in honour, sudden and quick in quarrel, Seeking the bubble reputation Even in the cannon's mouth."

Newly graduated and absolutely scared stiff because you can remember no useful facts, but after a few--with luck minor--disasters, you allegedly learn the ropes and bravely soldier on up the old career ladder, avoiding most cannon moments with a bit of luck.

Stage 5

"And then the justice, In fair round belly with good capon lined, With eyes severe and beard of formal cut, Full of wise saws and modern instances, And so he plays his part."

Consultanthood. Those wise, oldish (well, older than 25 anyway, which seems really old right now) chaps and chapesses who have fought the good fight and have earned the reputation of being fantastically knowledgeable. Fingers crossed that we can find a specialty where the working hours allow us to play golf in the mornings and have holidays in Tuscany, Antigua, and Normandy as and when the fancy takes us. Oh, and to be suitably fulfilled and useful in our jobs as well of course.

Stage 6

"The sixth age shifts Into the lean and slippered pantaloon, With spectacles on nose and pouch on side, His youthful hose, well saved a world too wide For his shrunk shank; and his big manly voice, Turning again toward childish treble, pipes And whistles in his sound."

If consultancy is not for you you may well eventually land yourself a chair in one of the learned establishments. Professors are occasionally to be spotted on a ward round with three consultants, four specialist registrars, eight senior house officers and preregistration house officers, and 84 medical students trailing in their wake. Their preferred habitat, however, seems to be a poky little broom cupboard, surrounded by half finished pages of revolutionary theses and mouldy cups of tea.

As a general stereotype, they are incredibly focused on their work and are pretty unaware that there are other medical specialties, let alone more mundane things such as how to make a decent cup of tea or indeed, find the teabags.

Stage 7

"Last scene of all, That ends this strange eventful history, Is second childishness, and mere oblivion, Sans teeth, sans eyes, sans taste, sans everything."

Wandering around the hospital in my third year, I was struck by how invincible a white coat seems to make you. Surrounded by lots of sick people, you are a glowing picture of health that bestows caring smiles and kind words of comfort to patients and relatives as they wait to speak to a real doctor. Three years ago my granddad died of lung cancer and I was one of those relatives left with a huge sense of loss as another NHS number was wiped off the computer. We are after all, simply trying to do a job and do our best for other people who are at various stages in their part that life has given to them.

This may be a sobering thought and seem incredibly unreal now, but as we go through medical school and then head into our respective careers, it is worth occasionally finding out what everyone else is doing.

A final thought--if Shakespeare had written a medical drama, would it have been a tragedy or a comedy?

Rebecca Monks, fifth year medical student, University of Sheffield


studentBMJ 2001;09:357-398 October ISSN 0966-6494