Monthly Archives: March 2013

The “Dr. Carson Challenge”

I recently came across the book “Gifted Hands” by Dr. Ben Carson, MD. My NOOK reader had it on sale for $1.99 and since it received large acclaim I decided to splurge. First published in 1996, it was apparently widely popular-enough so that Cuba Gooding Jr. played Dr. Carson in a made for TV movie on TNT. The book is an autobiography of one of the most celebrated neurosurgeons in the world. Or so the description reads…

 “…he tells of his inspiring odyssey from his childhood in inner-city Detroit to his position as director of pediatric neurosurgery at Johns Hopkins Hospital at age 33. Ben Carson is a role model for anyone who attempts the seemingly impossible as he takes you into the operating room where he has saved countless lives. Filled with fascinating case histories, this is the dramatic and intimate story of Ben Carson’s struggle to beat the odds — and of the faith and genius that make him one of the greatest life-givers of the century.”

Overall, a decent read-I did however find some of the book’s events to be too “miraculous” to believe. Never mind the fact that Dr. Carson has openly debated Richard Dawkins on evolution- he does make some powerful and uplifting motivational statements. He credits much of his success to his upbringing  and the particular emphasis his mother placed on education. Although she only had a third grade education, Dr. Carson’s mother challenged him and his brother to reading two new books a week, and limited them to watching only three television programs weekly. Seems like a great goal. One that apparently many of us should take to heart.

The National Endowment for the Arts has found that reading has declined among every group of adult Americans, and for the first time in American history, less than half of the U.S. adult American population is reading literature.

As much as I love learning, I must admit, it doesn’t always come in the form of a book. I am a huge documentary film buff. And although my NOVA collection has given me a basic understanding of dark matter-apparently even when the programming is educational- the passive act of television watching doesn’t quite compare to the brain strengthening benefits of reading a book. Furthermore, recent studies at Stanford have found that it’s not just reading, but how we read that makes a difference.

By asking a test group of literary PhD candidates to read a Jane Austin novel inside of a functional magnetic resonance imaging (fMRI) machine, a Stanford researcher has found that critical, literary reading and leisure reading provide different kinds of neurological workouts, both of which constitute “truly valuable exercise of people’s brains”-See This is Your Brain on Jane Austen, and Stanford Researchers Are Taking Notes

The readers were instructed to read in two different ways: to leisurely skim a passage as they might do in a bookstore, and then to read more closely, as they would while studying for an exam.

What the researchers found was intriguing: when we read, blood flows to regions of the brain beyond the ones responsible for executive functions. Rather, it flows to areas associated with close concentration. That may not seem so odd-reading requires concentration-but they also found that critical, close reading requires a certain kind of complex cognitive function that we don’t usually employ.

Moreover, the study showed that simply by asking the readers to alter their method of reading–from “leisure” to “analytical”–they could drastically alter the patterns of neural activity and blood flow within their brains. The study could have implications in the way reading affects the brain and how we train our brains to be better at things like concentration and comprehension. [Popsci.com]

Hey, there may be something to this! In high school, I prepared for the SATs by reading the newspaper every day. I have no way of knowing if this helped or not, but I did end up scoring near 1400.

Given the indisputable benefits, I have decided to take on Dr. Carson’s challenge. (And I welcome you to join me!) Starting this week, I will aim to read two books a week in their entirety (limiting television should happen by default as I certainly won’t have time for both).

To go along with our medicine theme, my reading list will ultimately try to focus on what interests me most- disease! I have scoured the internet for lists of the top “medical” best sellers and have found the following:

1. The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee, MD

Awarded the 2011 Pulitzer Prize for general nonfiction, and it has received acclaim from critics and clinicians alike. Dr. Bruce Cheson, a hematologist and professor at Georgetown University in Washington, DC, recently gave a copy of the book to each of his fellows. “It talks not only about how we arrived at our current surgical techniques and chemotherapy, but also about the people and how important their personalities and their drive were; what they did; and how they sometimes missed things,” he explains. “I gave this book to my fellows because my feeling is, if you don’t know where you have been, you are not going to know where you are going.”

2. My Own Country: A Doctor’s Story, by Abraham Verghese, MD

The book describes the first days of the AIDS epidemic in rural Tennessee. As the epidemic begins to loom over cities such as New York and San Francisco, many patients (typically gay men, once ejected from their homes) return to Tennessee to live out the last days of their lives. Verghese’s portrait of these patients is intimate, compassionate and unforgettable.


3. Cutting for Stone, by Abraham Verghese, MD

Set in Ethiopia, this epic novel tells the story of twin brothers who grow up at a mission hospital and eventually become doctors themselves. It has appeared on several prestigious bestseller lists, including The New York Times.

 

 

 

4. The House of God, by Samuel Shem

Originally published in 1978 amid considerable controversy, this book has become a cult favorite among physicians. It offers a fictional account of a medical intern at Harvard Medical School’s Beth Israel Hospital and it satirizes the dehumanizing demands of residency. “I read House of God over and over as an intern and resident,” says Dr. John Tydings, an orthopedic surgeon in New Jersey. “I read it again after residency and thought it was one of the saddest books I ever read,” he continues. “Much is outdated but much is still painfully true.”

5. Arrowsmith, by Sinclair Lewis

Published in 1925, this book won the Pulitzer Prize the next year (though the author refused to accept it). It follows the life and evolution of Dr. Martin Arrowsmith, while providing social commentary on the state of medicine in the United States. The book has received much critical acclaim, and it is still popular among current physicians.

Side Note: My husband has asked me to first read Jack Kerouac’s On the Road and although it doesn’t fit into the “medical” category- he [my husband] has never let me down regarding good books. In any case, that makes the reading selection for this week pretty easy.

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The “non-traditional” medical school candidate

Despite growing concerns over physician shortages- the American Medical School Association estimates a shortage of 90,000 physicians by 2020-when it comes to applying to medical school it is no longer enough to have good grades, high test scores and the desire to become a doctor. Those attributes are typically standard across the board. With 50-60 applicants for every seat in a class of 100, Medical Admissions Committees want more. A lot more.

Although it varies somewhat depending on the school and how competitive their enrollment process is, most Committee’s extensive list of ideal characteristics include everything from- community service, clinical exposure, research, a heavy class load, leadership positions, special talents outside of medicine- to a generally interesting personality. With so many candidates to choose from, it’s no wonder Admission Committees have the liberty of being so selective. Given this process, I am intimidated just thinking about the caliber of people I’ll be studying with- they may, quite literally be, the most interesting people in the world.

Typically, there are two categories of students who apply to medical school. Those who are termed “traditional”- in the sense they likely majored in one of the hard sciences and then either applied in their junior year of undergraduate studies or took a year off, known as the glide year. Then there are the “non-traditional” students who didn’t decide on a career in medicine until later in life. Non-traditional students often majored in non-science subjects, attended grad school and perhaps even developed a career before having some kind of grand epiphany that made them turn to medicine. I fall into this second category. Although it is hard to tell if Admission committees agree, I happen to believe that non-traditional students make for better, and certainly more interesting candidates. They are generally more goal oriented, mature, self-confident and willing to ask tough questions- such as why?? My perspective is shared and elaborated on in this article from the New England Journal of Medicine-“From All Walks of Life: Non-traditional Medical Students and the Future of Medicine.”

My path to medicine has been anything but direct. After earning my B.A. in broadcast journalism, I took what amounted to six years “off” before applying to medical school. During that time I went to graduate school and studied international development. I began working for an international non-profit organization, starting out as an unpaid intern who had a fascination with all-things-Africa (particularly tropical diseases) and quickly moving up the ranks to a position of Program Manager, in charge of overseeing five country offices and millions of dollars in health programming.

Throughout my nearly five years with the company, I have managed to fill every page of my passport with stamps and have tried, sometimes successfully, sometimes not- to help alleviate the world’s greatest problems of poverty and poor health. I am unconvinced that the work of NGOs will save the world, but there are certainly many good people and many good programs trying. My experience has been fundamental in helping me understand health in the developing world context. As if traveling in a time machine, billions of people continue to live in pre-modern days without clean water, sanitation, vaccinations, and labor and delivery in a health care setting. Basic things like gloves, doctors and oxygen are missing. I will never forget the things I have learned during my travels. Health care in the developing setting is different- it is innovative out of necessity, portable and raw. The U.S. health care system certainly has it’s challenges, yet it falls into completely different categories from the life and death struggles of the developing world.

Looking ahead, I will likely be among the oldest students in my class. I won’t finish residency training until I am in my mid-thirties, and perhaps by then I won’t have the energy of my 25-year-old colleagues to keep up with the intense hours and lack of sleep required by residency training. Yet I would never, under any circumstances, give back the last six years.

In the past few years I have developed a thirst for knowledge I’ve never had before. I can’t imagine taking organic chemistry at 19 and doing as well as I did. I needed to grow up and to fulfill my once naive, romanticized desire of traveling to distant, exotic locales and saving the world. The health care challenges of third world countries are far too great and complex to be solved by well-intentioned humanitarians. However, I needed to find that out for myself.

Maybe because I felt the urgency of being older and knowing there was little time to waste, I approached my post-bac studies with a vigor and dedication I have never felt before. The distinct knowledge of how much I was sacrificing to attain my goal of becoming a physician was a driving force that helped me excel in every single one of my evening science classes. I am leaving a promising career, a steady pay-check and an exciting life of traveling the world and getting paid for it. Yet I am gaining the ultimate dream of medical knowledge and the ability to heal people.

At least for me, being a non-traditional student prepared me for the dedication, sacrifice and responsibility of the profession I am about to embark on. I am sure many traditional applicants will become excellent physicians who advance the field of medicine. Yet, I can’t help but advocate taking a few years off after college to explore areas of interest and learn something about the world and yourself. You never know, you may end up becoming a better, if not happier, doctor in the end.

 

woman holding baby

Vaccination time for an infant in Africa.

lab equipment

Typical lab equipment in rural Nigeria.

 

boy

Young malaria patient in Cambodia.

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What now?

As the high and excitement of achieving the improbable wears off, I am left feeling-dare I say it- bored? Over the past four years my life has been manageable only through an impressive routine of time management. Nearly every hour was accounted for: working full time for an international health non-profit, attending science classes at night, studying, MCAT prep, work trips to Africa, clinical exposure at the local underserved hospital. I had a task to fill every moment, warding off boredom and bringing on an inner happiness and fulfillment.

As my schedule now goes from one extreme to the other, I am plagued by ennui. Is it possible to go through study withdrawal? Am I actually craving exams and review problems? Like Pavlov’s dogs, I have become conditioned to learning. Salivating at the mere thought of reading assignments. Most people reading this probably think I am crazy-who dreads free time? Go watch Bravo. There are three seasons of Downton Abbey to catch up on. Read a trashy magazine. All very valid options- yet none of which seem to appease me.

With 4.5 months to go until orientation, I have resorted to embarrassing tactics of re-reading my physiology textbook, watching free biochem lectures on iTunes, listening to emergency medicine residency lectures posted online. I am a sad, sad little nerd.

Most likely, I will look back on this time- my last moments of freedom- and want to kick myself that I didn’t enjoy doing not-much-of anything more. Perhaps I will. Or perhaps something in my brain has been permanently altered. My strange state is not unheard of. I recently came across this article, which may shed some light on my new found propensity for learning.

“Intense prep for law school admission test alters brain structure”

Altered or not. I cannot wait for medical school to start and the endless hours of new knowledge to follow. Only 143 days to go.

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