Category Archives: Pre-Med Experience

Change

Four weeks from today I will have just finished my first day of medical school orientation. To borrow from the imperturbable Donald Draper, “our biggest fears lie in anticipation.” On the surface, I know exactly what to expect–the work load, the incessant studying, the fast pace, the competition to get into top residency programs–yet what scares me the most is perhaps not knowing the person I’ll be in the end. The person I will unavoidably morph into in the process.

In, “Not An Entirely Benign Procedure, Four Years in Medical School,” Dr. Perri Klass writes,

What I would like to say, looking back, is this: medical school changed me. If you are thinking of going to medical school, or are actually in the process of doing so, know that it will change you. If you love someone who is going to medical school, expect changes. That is not a bad thing, by any means, and it could perhaps be argued that any serious training changes you. I watch medical students and residents now as they move from year to year, and I can see them learning and growing, and I can see changes which reflect growth in confidence and competence. But as these changes accrue, we lose touch to some extent with our old perspectives and even our old personalities. That’s part of the reason I think there’s value in reading the stories that were written while the training was actually happening–and it’s also part of the reason I encourage medical students now to write about their own experiences, to set down pieces of perspective that will remind them of who they were and why they wanted to do this.

Perhaps that is part of the reason I started this blog. To capture the journey. To witness, in slow motion, the change in my point of view. If you asked me today, why do you want to be a doctor? My answer is this:

1. Knowledge. I am thirsty to learn. Few things bring me greater pleasure than knowing that in four years my mind will possess (at least in some limited fashion) the content of hundreds of years of study and research on the human body. I want to know how we work. How to fix us. How to prevent disease and to stop it in its tracks. I want to have the skill of healing.

2. Challenge. I thrive on obstacles. The bigger the better. When I am pushed to perform I find happiness. I am not content simply being. The challenge of getting into medical school contained the happiest years of my life to date (this also coincided with dating and ultimately marrying my husband, so there may be some happiness overlap). I have never worked harder than I did the last three years, and I have never felt more driven–alive. I believe medicine will grant me enough challenges to last a lifetime.

3. The above two reasons are rather self-serving. So for the sake of not being too obvious, there is the great pleasure of helping people in need. That goes without saying. I want to leave, in my own way, some benefit to the world for having had me as a resident.

I wonder how my answer will change. Will I look back and recognize the ardent, eager, enthusiastic self I am today? I hope so. I have come  across many doctors who have lost the spark and motivation that brought them to medicine-replaced by cynicism, fatigue and for some, even boredom. Their passion chiseled down to complacency. They warn me, the money is not as great as they say. The politics suck. There is less emphasis on the patient–and more on paperwork and numbers. I suppose every job has its downsides, and the art is not to forget the happiness it could bring you. To not lose one’s self.

May I always be as hopeful as I am on that first day.

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The Motivation to Heal

“When did you get the call?” A hand shoots up near the back of the room. In seventh grade. And you? When I was a junior. Yes, you over there. About two years ago.

Walking into this conference room you might mistakenly believe this is some type of Pentecostal revival, but there was nothing religious about this particular event. I was here to listen to a sort of pep talk by a local family medicine practitioner/musician extraordinaire (he began his presentation with a bluesy harmonica and a soulful, toe-tapping, off-the-cuff song about personal responsibility). Dr. H was a guest speaker at the monthly staff meeting for my clinical internship. He began with a statement that I’ve since spent a lot of time dissecting:

“You don’t choose Medicine. Medicine chooses you.”

This is quite a bold idea–the thought that medicine, like some act of divine intervention, is a calling. Sure, becoming a physician is not your typical job. It requires at minimum 10 years of post-high school education and training, often closer to 15 years–and placing your patient’s health and needs above all else– before family, relationships, personal problems, sleep deprivation and vacation. Perhaps to be a good doctor, one that lives up to the sacrifice and responsibility required of the profession, one must feel a special calling to serve the sick. How else could you survive?

Indeed, research has found that doctors who view medicine as a calling are more satisfied.

I began to examine my own motives for entering the medical field. Could I think of a specific moment where I felt called to medicine. The truth of the matter is becoming a doctor is something that has interested me since I was a young kid. But how many kids play doctor growing up? Over the years, what began as a mere interest in medicine and the neat tools of the trade, grew into an inescapable feeling of somehow knowing that this is where I belonged–the only place I belong.

It’s tough to describe–but as I entered college to study Journalism, I kept having a gnawing feeling that I was studying the wrong major. I entered the University of Maryland as a sophomore, having taken mainly college coursework during my senior year of high school, which meant I only had three years before I would earn my undergraduate degree. My mind perpetually pondered if I should switch majors to biology. It seemed the universe was trying to send me similar signals. I remember one day walking to class, deep in thought weighing the pros/cons of switching to a pre-medicine major in my Junior year, only to find a flyer on my desk for the Pre-Med Society. I attended the meeting and decided to make an appointment in the Office of Health and Sciences.

The following week, as I sat waiting for my appointment, it was cancelled by the academic advisor.  Instead of speaking to someone about the educational path towards medical school acceptance, I grabbed a flyer listing the required pre-med coursework. My mind fixated on the then required calculus. I hated math. That little course was enough to dissuade me from re-scheduling the visit.

However, medicine continued to stay on my mind. In my dorm, we had weekly Greys Anatomy viewing parties (yes, this show was once watchable!). The biology, chemistry majors and me would religiously watch the show together, dreaming about life as a doctor. I was secretly jealous when they returned to their organic chemistry homework. One of the girls who used to watch with us just matched in an Internal Medicine Residency.

Although I came close to switching majors several more times, I graduated in three years and went on to graduate studies in Public Policy, focusing on International Development. My course work introduced a new concept to me– the idea that health was a fundamental human right. I spent two years studying  the idea of health– its inexplicable link to poverty, health disparities, health policy and economics, ethics, philosophy and Africa as a setting for great opportunities and needs in health.

By the time I was in my final semester of graduate school, the feeling that started as a small nagging thought–I think I want to be a doctor– ignited into a burning desire. I realized my passion for medicine and the profession was not going to go away. Instead, it kept me up at night. At a time when it became even more impractical for me to now not only switch majors, but careers, I decided to finally pursue a pre-med education.

Interestingly, around the same time as this crazy idea that I could actually become a doctor came to a boil, I became sick. Really sick, with a chronic illness that required frequent visits with cardiologists, neurologists and even emergency rooms. Whether I wanted to or not, I was around medicine all the time. It was enough to help me decide to pursue a post-bac program at night.

With each successfully completed science course, the desire to enter the medical profession grew stronger. Eventually, I could no longer think of any other alternative for my future. This was what I was meant to do. I would do whatever it took to get me to medical school.

Although there was no single “ah ha” moment to reflect on–I can’t help but feel that medicine has been a calling I simply couldn’t ignore — as much as I tried. Perhaps, medicine simply chose me. The universe, my genetics, the medical drama ER, my husband’s belief that my dream was not indeed crazy, opportunities to spend time in health clinics in Africa, my own failing health, all moved me towards where I am today–about to start my first year in medical school.

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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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