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Surgery

A few months back I had this dream. Nothing but water all around– I was walking on a rickety boardwalk, wearing my light blue surgery scrubs. I could taste the sea. The ocean spray on my face. My body was haggard. It was with my last ounce of strength that I moved my legs. I lifted my hands, they floated there for a moment, the breeze kissing my fingertips. I felt free. 

I imagined finishing 8 weeks of surgery would feel just like that–a release perfectly timed with my last bit of strength. So many mornings waking up at 5 am I cursed the path I had chosen. Cranky that I could not crawl back into my warm bed (it would sit empty for another 18 hours) instead I was off to the hospital. When you are in the thick of it–that release is all you can think of. Now that I made it–mostly what I feel is nostalgia.  It is funny how quickly you forget the tired mornings and late nights. All I remember now are the exhilarating highs.

Surgery was the most fun I’ve had in medical school.

I will not be a surgeon. I am going into Emergency Medicine and knowing that this rotation will likely be the only time that I’ll be spending in the OR, made it that much more exciting. I transformed from a clueless 3rd year med student, hands shaky, stupidly holding my needle driver like scissors…to a confident, somewhat less-clueless surgical student. By the end of two months I was able to read ventilator settings, remove chest tubes, tie knots, close a surgical wound nice enough to have the ultimate of critics–the scrub nurse–utter the words “beautiful.” I could prepare for rounds in 30 minutes flat, knowing every lab, urine output, nutritional status, vital sign and Flowtrack indicator for my patients. This training came at an incredible price. I stayed late. Studied even later. And walked around for 8 weeks sore as hell.

I will never forget the cases I came across. Terrible calamities. Now part of my training forever. A stabbing in the middle of the night. Gun shot wounds. Flesh eating bacteria. Total body burns. Fulminant sepsis. Amputations. Tumor in the heart. Every day I felt lucky to have the privilege of being in that OR.

Of all the specialties surgery will always have a special place in my heart. It was the only one that gave me pause. Ultimately, it is not right for me, but this rotation will be one I won’t soon forget.

 

 

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My Life as a Heart Surgeon

Ever wondered what it’s like to be a heart surgeon? Since my last blog post, I’ve gotten a chance to find out. I am doing my surgical rotation on the Cardiothoracic service. I haven’t settled on how I feel about it. Over the last two weeks I’ve gone from absolutely dreading it…to pure enjoyment.

My team is small. Just myself, my resident (R3) and our attending–the only cardiothoracic surgeon at our institution. Partly out of necessity since my  first morning I’ve been pushed into the role of “acting” sub-I/junior resident. At first having such high expectations thrust upon a meager 3rd year med student was terrifying. I felt as if I was failing at every step (and I was). My confidence crumbled as my inadequacies were brilliantly pointed out every morning. This was my first introduction to intensive care medicine. I knew nothing about management of drains, chest tubes, cardiac output monitors, ventilation settings, etc. I stared wide-eyed during am rounds as I had never even heard of most of the things my resident asked me to do. She pushed me at every opportunity. She knew exactly how uncomfortable she was making me. And she did it with just that purpose. Here was a person who was interested in seeing me grow. She was dedicated to my education.

So often as medical students we are given an easy pass…don’t know something, well that’s ok, you are “just” a med student. Not on this team. Every time I didn’t know something, I looked it up, wrote it down in my handy mini moleskin notebook and burned it into my brain. The embarrassment alone was enough not to let me forget it. Nothing was ever overtly said, but not knowing the answer to something is unacceptable to me (I put a lot of pressure on myself to be the best I can). I feel so lucky to have my resident on our team. She pushed me out of my comfort zone–in the process, I face-planted. Only to get up feeling like I actually can be a resident next year. Every day, I am starting to feel more comfortable about the non-theoretical medicine stuff. Like what meds we actually use to replete mag, how much do you give? When is it time to take out a blake? What CVP are you comfortable with? What are extubation criteria? How to remove a chest tube without giving your patient a pneumothorax. Nitty gritty medicine, you don’t want to waste time intern year having to look-up. After a 6-7 hour open operation our patients are fragile; their kidneys do funny things, their hearts get funny rhythms and there are a million reasons why we manage them in the ICU. With each passing day I’ve grown less terrified about how it all works.

As in most surgical specialties the days can be long. Really, really long. My record was starting the day at 4:30 am and not getting home until midnight after two long open heart surgeries. At the end of that day my feet felt like I just climbed Kilimanjaro. (Hint: I ordered compression stockings for rush delivery that night). I am in awe of our CT surgeon who is a mythical creature. He works like a machine. Never needing to use the bathroom. Barely eating and always up for adding on an additional heart case no matter how late in the afternoon the consult is. Heart surgery requires such a person. I have convinced myself that for 4 weeks I can assume the role of a machine, but not a day longer than that.

The surgeries themselves are amazing. Who doesn’t want to spend the day staring at a human heart. Stopping it. Then bringing it back to life again. Heart surgery is surprisingly formulaic and now having done 7 or so surgeries I can start to anticipate the next move. I know where to suction, how close to cut the suture, when to retract, when it’s my turn to step in and help with opening the thoracic cavity or what closure suture to use. Now that I know what I am doing, I enjoy the OR very much.

I didn’t know what to expect starting this rotation. I have been pleasantly surprised at how much it has challenged me. My resident is an amazing mentor. She’s found the exact style of learning that will take me to the next level of my training. A combination of uncomfortable pressure with the generous reward and satisfaction of knowing something I failed at before. If I can make it through this, who knows what else I’ll be able to accomplish.

Sometimes you have have to fail at something to learn.

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Turning 30

As the youngest in the family it feels strange hitting the big 3-0. My entire life I always wanted to be older. I wanted to be able to do the things my sister, who is 5 1/2 years my senior was doing. It all began when I was 4, she knew how to read, so I decided I would need to know how to do that too. When I was 10, she was going on dates, so naturally, I needed to tag along on those too. And when I was in college, she was out making her own money, so I definitely needed a real job. I raced through my twenties.

Never satisfied, I crammed as much as I could into the last 10 years and looking back–that really wasn’t such a bad idea. All in all, it was a great decade. By 23, I had finished graduate school and was working as a program manager, which meant getting to travel around the world, keeping my wanderlust at bay.  By 21, I had met and started dating the man I would marry. The kind of guy who watched Titanic and wondered when he would meet the Rose to his Jack. A perfect match to my zany nature, who wasn’t phased (or too impressed) by my endless need to do more–which is exactly what I need to keep doing more. By 25, I had moved 3,000 miles to start our lives on the West Coast and by 27, I was embarking on my first year of medical school. Now at 29 and 362 days, I own my first house and I am months away from starting my final year of med school.

My twenties meant growing as a person. Luckily, my husband and I grew along side each other. Evolving into two people who deep down really just like each other. Our dreams have evolved from dreaming of a wonderful wedding day, medical school acceptance, great job offer, awesome apartment, awesome house…to now one day, a healthy baby and retirement in a Mountain cabin…or Mexico.

My life is still just as hectic as it’s always been. I am continually searching for the next challenge (enter my Surgery rotation which starts on Monday) but I do feel more stable. Perhaps because of medicine I am more logical, concrete–less emotional. I am exactly where I wanted to be by 30: to have a passion I work for every day and a partner to share it with.

As you age, your perception of what’s “old” seems to continue inching forward–a self-preservation mechanism, I guess. I’m still the youngest, which also helps. And so true to form, being 30 just really doesn’t feel that old. I still love staying up late (maybe not at a crowded, late night happy hour) but Netflix marathons are totally things I’ll lose sleep for. I still work-out (ok, so the last time I ran a marathon was 2005) but I am still the same weight I was in high school! I love hanging out with my girlfriends (yes, we recently spent exactly 6 seconds in a college bar before hailing a ride to the ritzy wine bar in the posh financial district) but at least we are still doing girl-talk over cocktails and I can still wear the hell out of my suede pumps. Sure, things may look a bit more refined. But that is just what happens with age.

The best part of entering my 3rd decade–you don’t have to waste any more time figuring out who you are and what you want–because you are already there (that’s what my 20s were for and all those random life de-tours). Knowing exactly what you want is half the battle. And that is probably what excites me the most about my 30s. The “go after it” decade.

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Psych Rotation, how my own well-being improved and why that speaks to the medical profession

Third year of med school can be a grind: Long, relentless hours. No time to study, let alone take care of yourself. Rotations that just keep coming with nothing but a “golden”, rotation-free weekend in between. That is, until you get to your psychiatry rotation. Some have even called it psych-cation. So is the psychiatry rotation the vacation of 3rd year?

The answer is…not quite, but close. In comparison to inpatient medicine and my neurology clerkships, psych has been a welcome change of pace. My hours are 8 am to 5 pm, with a workload that can include maybe 2 or 3 new patients a day. I am currently on psych consult service, meaning I get called when a psychiatric patient comes through the ED doors or a hospitalized patient requires a psychiatric evaluation. As you can imagine, patient loads can ebb and flow. For unknown reasons, psych patients rarely show up at 7am to the Emergency Department, but combine a full-moon, a pleasant Friday night and our service can get pretty busy.

Being able to sleep 8 hours at night and come home around 5pm with enough energy to go on a nice jog has done wonders for my mood and my marriage. Because we have lulls throughout the day I can get my studying in while I am on service and that leaves my evenings free to do something I haven’t done since 3rd year began…relax. My husband is shocked to suddenly have me hanging around the house with free time. I’ve been so busy previously, his go-to answer anytime our friends call was “Maja is at the hospital.” Now, here I am asking if he’s up for a movie or binge watching TV shows–on a Tuesday night!

On a personal level, having this extra time to re-connect, even if for just a few hours a night is super important. I find us laughing more, talking about meaningful things (you know, going beyond the logistics of who is making dinner) and waking up smiling. So without trying, my psych rotation is improving my marriage and mental and physical health.

The hours of 3rd year had began taking their toll on my health by making me too tired to work-out. It turns out walking around the hospital and eating free cookies do not make a healthy routine. And de-conditioning is pretty much the worst thing you can do for POTS. Sorry folks, nothing can replace the heart benefits of a good cardio work-out. Luckily, I am back at it, logging some miles with my running shoes.

It wasn’t until I had time to slow down that I looked back to notice the unsustainable pace I was moving at. Of course when you have the time it’s easy to say here’s all the things I need to be doing to stay healthy– it’s when you are in the thick of it, sleeping 5 hours, feeling overworked and burnt out that your focus turns simply to surviving–who has time for the other stuff? So therein lies the dilemma.

My hope is that all the healthy choices I’ve been making in the last 2 weeks will continue as I move into my Ob/gyn rotation…at least those are my intentions. This slow down in my schedule has got me thinking a lot about how exhausting the other weeks felt at times. As a medical student we are lucky in the sense that those hours are fleeting and we can move on to more humane rotations (enter Psych). But as a resident those hours– the daily grind– it becomes your life.

For decades medicine has asked of us to become super-humans. The humans who need only a few hours of sleep, who can see the worst in people, who can face death and tragedy, who look in the face of hopeless situations and “fix them”, who can continue to log work hours when others are at home with their family….all with a smile and understanding heart. Thankfully my generation is seeing the ridiculousness of the above, no one can be that superhuman indefinitely–not without a cost. I won’t go into the depressing statistics of physician depression and suicide, or the abysmally low satisfaction rates. All I know is that a culture shift is way over due.

I don’t have the answer but I do hope that we can incorporate more balance into our profession. After all, physicians who are healthy and happy are more empathetic, productive and innovative, and more likely to stay in the field (just look at this wonderful research Stanford is doing). Somehow we must find a way to sustain the enthusiasm and dedication seen in medical students throughout our careers. The future of our field depends on it.

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For those who asked: My Step 1 Study Methods

Now that I have my results back I feel more comfortable blogging about the methods I used to study for the exam. Major disclaimer: this is a sample size of 1 person and in the end you really have to do what works best for you personally. I wouldn’t go out and try some new study techniques you have never used before. Stick to what you know works well for YOU. That being said, here is what I did. In the end I scored above average and was happy with my performance.

My test day: May 4th

My first official day studying: March 13th

I really didn’t study much specifically for Step 1 before March. I focused on my MS2 classes and did well on all the shelves leading up to the end of the year which got me honors in all my classes except for one and also laid a solid foundation for Step 1. I did use the UWorld question bank to study for shelves so I had already gone through about 40% of the Q bank.

Resources I used and my opinion on them:

Uworld Question bank: Absolutely the best resource you will use. Start using the questions as soon as possible and repeat questions many many many times.

Kaplan: I purchased their review course and stopped using this about mid-way through my dedicated studying. Not sure if it was that helpful. Just another way to see the same information. If you like Kaplan, use it, but nothing new that helped me on the exam came ONLY from Kaplan.

Pathoma: This is why I honored Path. I continued to re-read my Pathoma and watch some videos during dedicated studying. It is essential for pathology.

First Aid: Whether you like it or not this book has ALMOST everything you need to score incredibly well on the exam. If you can focus on anything just make sure you know everything in this book. I had only a handful of questions on the exam that could not have been answered by looking up First Aid but otherwise it was pretty spot on.

Behavioral Science Review Book: Probably worth going through a quick review book like BRS. You will notice once you start taking the NBME practice exams that you are getting really easy BS questions wrong simply because you don’t know how Step 1 wants you to answer them. These will be easy points so prepare for them! Don’t ignore Behavioral Science or the statistics stuff. Also, go over things like the stages of clinical trials.

SketchyMicro: This is why I honored Micro. A really fun and easy way to remember microbiology stuff.

NBME practice exams: These are ESSENTIAL. I took 4 NBME exams and 2 UWorld practice exams. My 2nd UWorld practice exam was about 10 points higher than my actual score, which is what I have heard from a couple of people. The best predictor, in my own experience were the NBMEs. I scored 2 points higher than my best one and almost 20 points higher than my first NBME practice exam that I took 2 weeks into studying. When you buy them spend the extra $10 and get the version that lets you see which questions you got wrong.

My Daily Schedule:

Before you begin studying it is essential that you make a plan for yourself. For me, I did my review by organ system so I would review all the pharm, path and physio within each of those. I gave myself between 3-4 days for each organ. In that time I completed every UWorld question for that topic and read that specific section in First Aid at least once or twice.

AM: I would start with 1 or 2 question blocks in UWorld. If it was day 1 of a new organ system I did tutor mode and would just spend time reading the answers. Otherwise I would do the questions then go through and read each answer at the end. I took notes on things that I had forgotten and then reviewed those notes every couple days.

PM: I read First Aid. I read Pathoma. I did more question blocks.

There is no magic secret to Step 1 studying. Literally just spend 10 hours a day either doing questions or reading First Aid and you will be fine. Periodically (I did every Saturday) take a practice exam to make sure your score is continuing to go up. Remember to review information you have already gone over. Do this by doing random question blocks, question blocks with missed questions. question blocks with marked questions and re-read your notes as much as you can. The key is repetition.

A few things I wish I had done differently:

-Probably not wasted my time with Kaplan, I would have done just fine with out it

-Started UWorld questions even earlier

-Reviewed my notes more often

-Been more relaxed in general; my anxiety was through the roof and that was not conducive to studying

-Made sure I really knew the biochem pathways: THEY WILL COME UP!

-Been conscious of trying to eliminate stupid mistakes- these will be what brings your score down from your absolute possible maximum. I know I made MANY stupid mistakes. Not sure if you can avoid them, but try!

-Don’t use too many resources. If you give yourself too much to do or cover this will backfire. Pick 3 or 4 (max) essentials and stick to those. You have to use First Aid and Uworld- KNOW THESE WELL. Other than that, you can pick 1 or 2 more things that will help you in your weaker areas.

-Enjoy it! This is your time to put everything together. Somewhere mid-way through everything will come together and things will just click. It’s really awesome when that happens and you may actually enjoy this nice time you have to learn medicine.

Good luck!!!

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My Step 1 Experience

I’ve hesitated writing about Step 1 mainly because I didn’t want to think about it. It’s over now. What’s done is done. I wish I could say that after 7 weeks of dutiful studying, thousands and thousands of practice questions, multiple practice exams and nothing else in my life– I conquered it. What I feel happened was just the opposite. I walked out feeling like someone just punched me in the stomach.

Over the last two months I’ve had a singular purpose driving me–to do incredibly well on this exam. There wasn’t a single moment when I slacked off, gave up or strayed from my self-prescribed study schedule. I knew this material. I did nothing but study. Over time, as my knowledge base grew I improved my practice exam scores from a 223 to a 252. In terms of studying, I don’t think there is anything I could have done differently. The problem, it turned out, was something I completely failed to prepare for-I was my own worst enemy.

I may have written elsewhere on the blog but when it comes to long, important standardized exams my brain very consistently decides to turn on me. In the comfort of my house, with absolutely nothing to lose, I am able to answer questions with such ease. But being in the exam, everything changed. I let my nerves and the exhausting process leading up to the exam get the best of me. I just didn’t feel sharp. Anxiety is obviously no excuse to not perform to your true potential, so I feel incredibly disappointed in myself and all the work I put in. Instead of eliminating the handful of stupid mistakes I was making on practice exams, I multiplied them. I keep having flashbacks, like some kind of PTSD, of questions I answered incorrectly. Easy questions that my brain has known the answer to for months. Of course, when it counts, like some kind of zombie I picked the exact opposite of the correct one.

I know that feeling like you failed Step 1 is what everybody feels. It’s natural that after 8 hours of questions your brain will focus only on the ones you were unsure of and remember the questions you blanked on, omitting the easy ones you breezed right through. So yeah, that makes me feel a little better. But I also know that my question count of incorrect items is getting high, it seems I am constantly remembering questions and wanting to kick myself for what I put. I have no idea what to expect.

The only thing I know is that no matter what happened with this exam, it was just one moment in time. It doesn’t erase any of the successes I’ve had in medical school up to now or have any bearing on how I’ll do in clerkships. It feels like I had a bad day, but in the end I won’t know anything until I get my score back. I am already looking forward to everything I will learn once rotations start. I am just trying not to lose sight of why I am here. These last 7 weeks I’ve learned so much and created a truly solid foundation of medical knowledge for myself. Whether my exam score shows that or not, I am not sure. What I am sure of is how much I love learning and how that has been consistently shown in my performance in the last 2 years, and hopefully will translate to success on the wards.

3rd year here I come!

Also, I know that several of my readers would love to have a detailed break-down of the study schedule I used and tips and tricks. I’ve jotted down some notes and will get this information out to you once I’ve processed this whole ordeal. It has been so stressful not only on me, but on my husband and family. I think the most frustrating thing of all is feeling like I just wasted so much potential. I definitely need a good week or two to recover. Thankfully, I have family visiting and an exciting trip planned with my husband to help me put this exam behind me.

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Update #2

Time for another update: First, I wanted to thank all my wonderful blog readers for the encouragement and comments. I was in a pretty low place last week and hearing how other people felt similarly during their Step 1 prep helped tremendously. Sometimes all a girl needs is a little commiseration.

It has been 18 days and I am pretty amazed at how much material I have been able to cover. I’ve reviewed Biochem, Biostats, Respiratory, Cardiology, Neurology, Immunology and half of Reproductive. Within those I’ve covered the relevant pharm, physio, micro, anatomy and embryology. I’ve also done 2,080 practice questions (yes, I keep a spreadsheet and I kind of can’t believe that is the total so far). I took my first Step 1 self assessment this weekend…and with 34 days before my exam date….it was actually a reasonable score. That took so much pressure off me. I could have done a cartwheel if I was more flexible.

Taking that practice exam was a real turning point because it allowed the release of a giant amount of anxiety. Mainly from the unknown. Up until then I had no idea if the 12-14 hours I was spending per day studying was doing anything. Having that small cushion of comfort has transformed the whole experience for me. I am working my ass off but now I think it may just work. I found something crucial I was missing last week–confidence. Now that I believe in my own methods, I am actually having fun.

Doing practice questions and getting them right–is fun. So much more fun when you know the material. Reading First Aid and saying, yes, I remember that–is fun. I started by tackling my worst topics: neuro, biochem, cardio. At first, the process was frustrating and exhausting because there was so much I needed to review. But once you get through it and a foundational layer of information forms you can actually begin to enjoy the information. It is medicine after all! And if you know anything about me, you know that I am obsessed with medicine. I was so far in the weeds I forgot that I actually like learning this stuff.

Update #2 is much more upbeat. Hooray, I am no longer despondent! I still have a hell of a lot of work ahead of me, but knowing that if I just keep at it, I can do this, is enough to get me through the day. My very long, long day.

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Everyday I am studying

As I mentioned in my last post, my classes for MS2 year are done! Last week I had my final combined regular exam and all that is left are a series of shelf exams before we disappear to some dark, lonely corner to study for our Step 1 exam. I alluded to the fact that buying a house threw me completely off course in terms of my regular study methods. As a result, because I was packing/unpacking and playing decorator instead of dutifully reviewing new material I had to resort to Emergency Plan B!

What is Emergency Plan B? Well, it is what is colloquially known as the “all nighter” or in med school the “two-or-three nighter.” A marathon of studying and reviewing that eliminates sleep and replaces it with chocolate covered espresso beans, pots of coffee and high carb snacks.  This plan is to be used sparingly and only in extreme circumstances. Yes, staying up for 2-3 nights with minimal sleep gives you the time you need to learn the content –but it comes at a price. The information I just last week knew well enough to score at the top of my class is leaking out of my brain faster than a subarachnoid hemorrhage. Not to mention my mental and physical health took a huge hit. Then there are the mood swings that come with feeling like the living-dead. Unfortunately for him, it was my poor husband who had to deal with my irrational self. So, my dear readers, avoid Emergency Plan B if you can. Do the right thing and study every night.

In other news, I had my first oral presentation at an Innovations in Medical Education conference this weekend. I felt honored to be among the three other presenters who had really inspiring ideas. I am talking REALLY awesome, big ideas. For example, check out this website http://www.2minutemedicine.com. It is an indispensable site for those in the medical field who are pressed for time and need to make sense of the 1,000s of medical studies that come out monthly. A medical student from Harvard (now attending physician) came up with a solution by having doctors write a brief synopsis and rate the validity of the study.

I think that is the best thing about attending conferences- the renewed sense of limitless possibilities you get. Hearing what other people have worked on inspires me to innovate. If medicine in and of itself isn’t awesome enough, there is the added advantage of room for improvement. Medicine changes so much and to have the ability to be part of that is incredible. I feel so lucky to attend a medical school that embraces change and in fact encourages all of us to explore technology and how it can better the field. This weekend I will be presenting at the American Academy of Emergency Medicine (AAEM) conference in Austin, which I am sure will be just as exciting!

My life has been a series of lessons learned and lucky breaks recently, so please learn from my mistakes and don’t procrastinate. You might get lucky and ace that exam, but in the long run it’s a recipe for disaster. Also, don’t accept the status quo, there are so many people out there pushing for change–get inspired!

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From medical student to student doctor

Today marks our LAST day of classroom instruction. Let me repeat that, we are done sitting in classes…forever. It feels unreal to think that I have now amassed everything I need to know to pass my first board exam. And by amassed, I literally mean that somewhere among the thousands of pages of power point notes is everything that I need to know for my board exam. The unthinkable task of consolidating that information and transferring it into my long term memory bank is what the next 10+ weeks are for.

I took for granted the luxury of having days with just one or two 50 minute classes and the rest of the afternoon to run my errands and study until the late hours of the night. What awaits us next are 70 hour weeks in the hospital. Our schedules will no longer be malleable to our liking. Gone are the days of choosing not to go to your morning class because you can always watch it online later. We will be at the hospital when we’re tired, sleep deprived and under the weather. Yes, MS3 year is the first day of the rest of our lives.

The final two years of medical school are much less school and much more training. We will be set loose on the wards. Standardized patients will be replaced by human beings. All of the pneumonics, “triads” of symptoms and “pathognomonic hallmarks” will be brought to life in a rude awakening that the maladies that we blindly memorized were for the sole purpose of reducing suffering. What gets lost along the way as we struggle to pile on more and more information is that all of these disorders have a person attached to them. A thinking, feeling person that reminds us of our grandmother, our neighbor, our mothers. We begin to develop something that can never be taught in a textbook, the ability to comfort. One of my favorite quotes regarding our profession is the following:

To cure sometimes.

To relieve often.

To comfort always.

Medicine is an imperfect science. Despite our many advancements, more often than not we are unable to cure. And as frustrating as that is, our job turns to doing the best we can. The next two years will be about learning how to navigate the options-because there will be many and with no clear indication. We will learn how to make the best choices for our patient. The real reason you go to a doctor is because you need someone to guide you. The choices we make regarding our health are individual. There is no textbook patient and no textbook treatment. The clinical years are about synthesizing textbook information with the reality of medical practice. We have so much left to learn and I can’t wait for this next phase in our education!

The only thing left between me and my training years are 5 exams and my boards. Not too bad considering everything we’ve already gone through to date.

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The Crash

I have been riding my bike to campus since the beginning of MS1 year. According to the pedometer affixed to my bike handles, I’ve covered almost 800 miles. Some days it feels exhilarating to start my morning by listening to Pandora and cruising along a scenic bike path. Other days I am groggy and tired, but I do it anyway. The path itself is nestled along a ravine, with sightings of snow white egrets and other beautiful birds I can hardly identify. It winds up and down, finally dropping me off just a few hundred yards from campus. I take this path every day. It gets my heart rate up, my blood moving and clears my head before every exam.

Yesterday, just as I had asked it to do 100 times, the path did just that, cleared my head before our NBME Medical Microbiology Shelf (a cumulative final exam taken by all medical students across the country). I walked into that exam feeling like I could not be better prepared. Having completed 3 question banks of microbiology questions, my favorite topic of all things learned so far, I didn’t expect to find anything THAT surprising. I was certain some rendition of the questions would surely have been covered in one of the 700 practice questions I went over. Well, the answer to that was a resounding–WRONG. The exam had a level of minutiae I was not expecting. Although I knew the majority of questions, the curveballs killed my confidence and threw me off. Feeling defeated, I grabbed my bike and pedaled home.

My day continued to deteriorate from there. As I pedaled against  a strong gust of Santa Ana wind my foot slipped and the next thing I know I am crashing off my bike head first. My helmet hit the ground, followed by my hip shoulder and wrist, all of which dragged across the bike path with just enough force to give me major road rash and tear a hole in my favorite jeans. What just happened? I couldn’t move my arm with ease so I called my husband to pick me up. The perfect humiliating ending to my already dreadful day.

My first crash. I got it out of the way. I also got my first Step 1 test run out of the way, and things need a lot of improving. Most of which are my nerves. My first exam question was something I was not expecting, it was so specific my brain started the exam in a panic. My thoughts raced. I know everything about this disease, but I forgot to memorize a minute detail and now I can’t believe they are asking about it! I began to get nervous that the whole exam would be like this. Before I knew it, my palms started sweating ( I am sitting there thinking, my god I am sweating on a mouse! Why am I sweating on this mouse?!). It took me a good 15 minutes to recover. I feel that all the questions I saw in the meantime suffered. The funny thing is, in the end when I went home and looked up the answer, I actually got that first question right. I was my own worst enemy. Herein lies my downfall. All of the hard work I put into studying and knowing the answers can be abruptly wasted if I let my nerves get the best of me. Luckily, seeing my weakness and realizing it is the first step to conquering it– I hope. I only get one shot at Step 1 and I cannot afford to waste it. My biggest fear as I approach my first licensing exam and ticket to the residency of my dreams (ie. staying in California) is that I freeze and that the two years of dutiful studying will all be wasted, never to be represented in that one little number that matters.

Also, please wear a helmet. If I wasn’t wearing mine, I would be writing this from a hospital bed or worse. Just wear one.

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The Thrill and other things to strive for

I recently had the exciting privilege of having one of my blog posts published on a popular website. Although I have written many things over the years, the idea of mass consumption of my thoughts was predictably nerve-racking. Perhaps all writers feel that certain excitement admixed with the nervousness of impending judgement. The unexpected thrill I felt to see my name on the computer screen brought back a flood of memories, taking me back to my first semester in journalism school.

I still remember the first time I saw my name in print. My first big story, which appeared on the cover of The Diamondback. It was 2004 and I was an inexperienced, naive, fresh-out-of-high school, yet incredibly eager journalism student. For reasons I no longer recollect, I landed the job of interviewing Morgan Spurlock, famed Super Size Me guy. In my best Dianne Sawyer impersonation, I cut right to the chase and asked Mr. Spurlock the type of question that was on the minds of all our college readers: how has his sex life improved since he stopped eating McDonald’s ever day? I think he mentioned something about his wife being much happier. The details of the evening are a bit foggy. I will however, never forget the feeling of a deadline. I hurriedly typed my portion of the co-written story, and in movie-like fashion sent it off to the editor just minutes before our midnight deadline. I went to bed that night feeling alive. Up until that point, there had been nothing more thrilling than waking up in the morning and walking down the college mall to see hundreds of students reading the Diamondback. They were reading my words. Perhaps most never bothered to look at the small italic line with my name on it, but the feeling of accomplishment and contribution, however trivial, stayed with me to this day.

Although in the end, I was not cut out to be a journalist, I learned what it was that makes me feel alive. It is the pressure of a timely response. The necessity of a quick decision. Being up when most people are comfortably at home sleeping. Not being afraid to put myself out there. And most important of all, making a contribution to someone’s day. Whether it is relieving their pain, giving them peace of mind or actually saving their life. The best way I can describe how I feel when I step foot inside the hospital is-alive. Most people work to live, but I can honestly say that being in medical school has been the happiest experience of my life. I live for it. Especially this year, as we finally commit to memory the endless differential diagnoses that exist, the limitless things that can go wrong with us. Medicine is the perfect combination of challenge and reward. I feel humbled to have the privilege of ensuring someone’s well-being.

I challenge all of you to find that something that makes you feel alive, that evokes the perfect mixture of nervous excitement. For many it is nothing nearly as all encompassing as a medical career, whatever it is, let us never stop striving for more.

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Long Overdue Update

To my wonderful followers and fellow blog readers I apologize for the neglect my blog has gotten in recent weeks. Second year is in full swing and as predicted I’m finally settling into a comfortable rhythm. My daily routine is still pretty much study, study, study. By all accounts, my old addiction is back. As I’ve noted previously in other posts when you start juicing your brain with knowledge, after a while, something “clicks” and it can’t seem to get enough. There are many times throughout the week when if left to my own devices I would stay up all night reading and furiously implementing my self-prescribed study methods. Luckily, my husband reigns me in around midnight and tells me to come to bed like a normal person. There are times however when I lay in bed actually sad that I can’t do more practice questions or read just a few more pages.

I am not sure what comes over me when it comes to medicine but the topics fascinate me so much it’s not even work most of the time. Hours go by and I barely notice. This is unfortunately the opposite of what happens to me when I am attending our required lectures. In a regrettable mismatch of circadian rhythms, my mind usually doesn’t start working at 100% until the early evening hours, so having to sit through lectures (no matter how interesting the content) puts me to sleep. However, a recent rule change means we now only have to physically attend 50% of our lectures–a dream come true for self-guided learners such as myself!

Aside from my marathon study sessions, hours filled with drugs, bacteria, symptoms and differential diagnoses, I am continuing with various research projects. One of my abstracts was recently accepted for a scientific conference in October, which was very exciting and fueled my enthusiasm for further projects. As a journalism undergraduate major I had zero interest in doing research, so I am now making up for lost time. Ironically, my research project is about introducing a Flipped Classroom (i.e. podcasts!) model for Residency education, which included filming hours of educational videos in my once perfected “broadcast” voice. Making videos has always been one of my favorite hobbies and here I am making them in medicine–which is pretty much the perfect combination. I hope that my first documentary film–“Mega Rippers”-a story about Maryland surfers–is certainly not my last! I can only improve from that title.

In more personal news, my husband and I are in the process of buying our first home, which is thrilling! We can’t wait for our move in date in January. Over the past 7+ years we’ve lived in apartments and condos of various comfort. Our first place together was a run down graduate housing complex, which had a stove that rocked back and forth when you cooked (reminiscent of trying to cook on a boat), a flood that destroyed our mattress leading us to sleep on a floor and a cockroach problem–finding a two inch cockroach on your shoulder was the final straw for us. Thinking back to those times we can only laugh. I met my husband when I was 21 and have lived through most of my 20s with him. Expectantly we have both matured tremendously over the years. We are building our life together, literally from the ground up!

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A day in the life of a first year med student

Yesterday was just a typical day in my life as a medical student–of course when you are a first year, the typical can quickly turn into monumentous milestones.

7:40 am: My husband’s alarm goes off. I have decided to “sleep in” today by skipping my 8 am anatomy lecture. Given these early morning lectures go against my innate productivity curve, leading to 5% retention of material and 95% bleary-eyed sleepiness, my day is much better served sleeping in for an extra 30 minutes and then studying the material at home in the morning. I definitely need every second of those extra 30 minutes as my husband and I stayed up past midnight watching a Killer Whale documentary (the night before was Blackfish; we have kind of a theme going this week). Given how little we get to see each other, at the time, hanging out and watching movies seems like a much better idea than sleeping–however I tend to regret this in the morning when I wake up exhausted– further adding to my decision not to get up for my very early lecture.

8:00 am: Make my daily cup of instant coffee ( I should really upgrade to something better) and prepare a few breakfast/lunch snacks for my husband to take to work. Although I am busy medical student, I find time to do nice wifely things like making sure my husband is not hungry throughout the day.

8:15 am: See my husband off to work and settle in at my desk to do some anatomy reviewing. I feel almost caught up.

9:30 am: Re-watch my anatomy lecture on the posterior triangle of the neck, which happens to be the dissection I am going into lab today to learn up close and personal.

10:15 am: Bike to anatomy lab. My 4-mile trek is particularly tough today because I ended up biking back and forth to campus twice yesterday (16 miles) and now my muscles are not happy with me.

10:45 am: Change into my disgusting anatomy scrubs. I was just in the lab last night for an anatomy review session and didn’t have a chance to do laundry in the last 10 hours. I swore I would never be THIS person, but here I am wearing the same scrubs twice in two days. Don’t judge me. I didn’t touch anything!

11:00 am: Listen to groups of my classmates present their neck dissection to me. I leave feeling like I have a pretty good sense of the structures in the neck–there were some great teachers this time, including a memorable platapus mnemonic to help us remember the function of the platsyma muscle: platysma sounds like platapus, and platapus are sad looking creatures; so naturally the platysma muscle works by pulling down the lower lip and angle of the mouth in the expression of melancholy. Brilliant!

11:40 am: Bike home. My 8 mile round-trip commute doubles as my work-out for the day.

12:00 pm: Take a quick post “work-out”, post-anatomy shower and get ready for the rest of my day. Have a quick lunch. Check my email. Put on some professional clothing and make-up since I know I’ll be seeing patients later.

12:45 pm: Leave for campus, this time in my car since I am headed to the hospital right after my last class.

1: 00 pm: Neuroscience lecture on the meninges.

2:00 pm: I have an Ob/Gyn shadowing shift set up with a fantastic resident I met during an interest group dinner. I am meeting her at a hospital about 25 miles away.

2: 30 pm: To my surprise there is no traffic so I get to the hospital early. I meet my resident and we start our day by grabbing a quick cup of coffee. First thing I notice is that the cafeteria here has a better selection than the main University hospital. This is a vitally important point.

3: 30 pm: Labor and delivery is relatively quite. We have a couple patients in active labor, but active labor can take hours. While we wait for something to happen I end up getting loads of golden information from the 3rd year med student, learning everything I need to know about the best rotations, traps to avoid and how to survive. The key is hiding lots of food in your white coat pockets it seems.

4:00 pm: There is a new pregnant patient admitted to the hospital. The 3rd year and I go to her room and do a thorough exam and interview and present our patient to the resident.

5:00 pm: The resident and I go to check in on one of our active labor patients when the pager goes off–our patient in the other room is ready to deliver!

5: 30 pm: My first monumental milestone. I get to see my very first vaginal delivery. I am in awe. I tell the parents I will remember them and their adorable little girl for the rest of my life.

7: 00pm: This is the time when the residents switch over to the night shift. Although the med student and the resident I was with are winding down, I decide to stick around since the OR is getting prepped for a C-section and I don’t want to pass up the opportunity to see that–another first.

8: 15pm: I get invited by the attending to join the C-section. I was expecting to “observe”–I thought my job would be mainly to stand in the far corner in the non-sterile field, you know, somewhere behind the husband who’s holding his wife’s hand. But no– I am instructed to scrub in! Another amazing first.

8: 20 pm: The scrub nurse asks my glove size and I get to say for the first time in my life, “6. 5, please”. I come out with scrubbed hands and the nurse pats them down and helps me put on my two sets of surgical gloves and gown.

8: 30 pm: I am instructed to go stand next to the surgeon. It is just me and two attendings. My very first surgery. The next thing I know, I hear, “you’re on doctor,” and I have a retractor in my hand. I do the best damn retracting job I can. The whole time I am in the surgery–just any other day for the two surgeons–I am screaming with excitement inside! This is the coolest thing I have ever done in my entire life. The culmination of my monumentous experience was being taught how to close the surgical incision and even putting in some sutures. My first surgical close.

9: 30 pm: I realize that I haven’t eaten since lunch and I’m starving. I drive home feeling amazing. I can’t wait to tell my husband about my monumental, typical day.

10:00 pm: Have dinner. Shower. Pick out another ocean documentary and fall asleep by 12: 30 am. Ready to do it all again.

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R&R

For the first time in a long time I woke up this morning with absolutely zero looming-exam anxiety. Constant examinations were so common to me that the lack of them is now what feels strange. I am coming down from my high–all of the endorphins and hormones that are released in the days leading up to and in the process of taking multiple three hour exams are slowly metabolizing away. My stress cleanse.

Speaking of hormones, I recently met with what I thought was supposed to be an introduction to alternative medicine techniques that might be able to complement my POTS treatment. However, as I began explaining my symptoms to a world renowned electrophysiology cardiologist MD/PhD-turned-alternative medicine expert who also happens to work at my medical school — he asked if I had ever been checked for a pheochromocytoma. A pheo!? We just learned about this in our endocrine section. This type of adrenal medulla tumor is highly unlikely (we are talking one in a million here) but I agreed to indulge him and check for it. It is a simple 24-hour urine test. Except you have to do a 3 day caffeine cleanse. I am barely on day two and already having withdrawals! I would kill for a cup of coffee or a soda right now. Heck, I’ll even settle for some hot tea, but no, that is banned as well. Interestingly, my do not eat list also includes avocados, tomatoes, eggplant, bananas, walnuts and plums. There goes my typical daily meal!

I think I’ll use my required cleanse as a jumping off point to just re-group this week. When we get back from spring break the only thing remaining between me and the end of first year is a neuroscience course and the rest of anatomy and genetics. I want to finish out strong! This week is all about rest and relaxation–since hanging out at the hospital is relaxing and fun–I am throwing that into the mix. Spending Tuesday night with a shift in the Emergency Department is the best R&R I could think of.

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In Memorium

On Christmas Eve, while I was wrapped in the warmth of family and laughter, traditions old and new, hours spent at the table in conversation–in the darkest of contrasts, a bright spark extinguished in the world. My dear friend and mentor died that same day after a long and courageous battle with cancer.

I met Anne when I was just 22 years old. At the time, she was our Nigeria country program director and she came into our HQ office for a regular visit. Although she barely knew me, she had such warmth about her she instantly made you feel like you were old friends. Anne had the rare ability to make others feel comfortable in their own skin. Her overflowing positive energy was infectious. Somehow she convinced my boss that it was a good idea to send me to Nigeria to train her staff. I still remember how confident she was that my background in journalism was just what her staff needed. Anne gave me my first chance to prove myself.

In Nigeria, Anne welcomed me into her home. Something about working in the field quickly blurs the line between colleague and new family member. We not only worked together, but we spent the evenings going on walks around Abuja, swimming laps in her pool and watching taped episodes of MI-5, a BBC show Anne loved. Anne was able to bring out the best in people. I gained confidence on that trip and returned to our HQ feeling like I had much to offer our organization. Anne was not the only one who noticed and I quickly moved into a management position– thanks very much in part to the opportunity Anne gave me.

Although Anne eventually moved to a position at our organization based in the US, we had the pleasure of going to Nigeria together again in 2010. I will never forget those trips and the memories of Anne jogging in Makurdi with me, haggling for road side tomatoes, and yelling at a chef who served her a raw chicken–his only explanation “I was in a haste.” Anne and I joined forces on many projects, sometimes working 10 and 12 hour days on a proposal. As frustrating and difficult as things got, Anne always had a positive spin on everything. Every conversation began and ended with laughter. Anne was one of the most genuine and loving people I have ever come across. In developing my management style I aimed to emulate Anne’s effortless ability to take things in stride, find the humor in just about everything and believe in people.

It is difficult to accept that she is gone. I will never forget the lessons she taught me. Anne was a rare find among people. I feel privileged to have worked with her. As brief as those five years were, they shaped me professionally and personally.

In reflecting on this holiday season, something felt different–I think the change was an overwhelming sense of gratitude. Living far away from my family, consumed by the task of medical school, I savored every moment I had with them. For the first time since embarking on this grand challenge I actually didn’t feel the urge to study. I lived in the moment and enjoyed every morsel of time with family, friends and my husband. In the end, these moments are what matters.

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