Tag Archives: medicine

The New MD

I must have looked at my Match Day appointment letter about six times. Part of me half-believing that my good fortune was some kind of error and if I just read it one more time it won’t actually say that I matched at my number one program. I have never wanted anything this much in my life and to actually get it–well, it leaves me speechless. The years of studying, stress, exams, planning and sacrificing all blur together.

I’m an emergency medicine physician with my first job at my dream program. It doesn’t feel real. 

Match Day was an incredible moment. I went up to the podium with my husband and had him open the envelope. When I looked down at the letter a rush of emotion came flooding in, the culmination of all of my hopes and hard work. I was so choked up I could barely speak. I had no idea I was going to react that way, but the emotion was too overwhelming. I’m not sure I’ve ever felt such joy. Probably because I’ve never worked this hard for anything.

I am so excited to start my career and the next chapter in this journey. Residency will be yet another blur of long hours, stress, sacrifice and emotion. It is terrifying and thrilling at the same time. The thought of the experiences that are to come makes me feel so thankful. I know it is very rare to find a job that you can be this passionate about, and even rarer to have a profession that challenges and pushes you daily–whether you want it or not. I couldn’t have asked for more.

Thank you to all of you guys who have been with me throughout the process and read the blog over the years! It has been a joy sharing it with you. Since I’m not sure just how much time I’ll have for writing I am moving things over to Instagram. Feel free to follow along! MD_Maja

 

 

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A Time Like Never Before

It’s been 33 days and 3,771 practice questions since I started my dedicated board studying. Although I spent the first two weeks in an emotional state of panic, I think I’ve finally relaxed enough to enjoy this unique opportunity. During no other time in my life will I have the chance to simply review medicine and put everything I know into neat little boxes. The first two years of medical school go by in a blur. The chaotic pace really doesn’t lend itself to digesting what you are putting in your brain. It’s just facts, facts, facts–how fast can you learn these facts? With tests nearly every week you are forced to move on to the next, losing the ability to compartmentalize information and put the pieces together that make up the human machine.

These last 33 days have been exhausting–but I am finally starting to put the pieces together. Connections that I totally missed the first time around are lighting up like a giant map that had once been drafted in pencil, now replaced by glittering fiber optics. Each day I am simply filling in details.

To be honest, the excitement of what is to come in the next two years (and the rest of my life really) is the only thing that is driving me. While studying things like the approach to cricothyrotomy (gotta go through the cricothyroid membrane) my mind wanders as I imagine my first emergency intubation in the ED. I go to bed unable to sleep not because I am nervous about the exam, but because I can’t wait to start my rotations. I lay awake thinking about my future patients and colleagues. Imagining all these scenarios I’ve waited my whole life for…

In terms of exam prep, I’ve noticed that tackling Step 1 is all about pattern recognition. Once you re-learn the material you start to figure out how questions on a particular topic are going to be asked. With limited time and 8 hours of questions, beating the exam becomes as much playing their game as it is about the knowledge. Of course, you have to know the material to recognize the pattern, but once you have that down, it is kind of fun every time you recognize a question.

One source of material that isn’t talked about much is “USLME Secrets.” I have found that book to be a really great resource after I finished reviewing a particular section as way to check myself, and review some of the “golden” USLME-loves-to-ask -these-types-of-questions.

My practice score is still about 10-15 points away from my “dream” score but I feel pretty good about getting there in the next 20 days. We shall see. Right now things are falling into place–of course, there is always the danger of forgetting what you’ve already covered, so I just have to make sure I am continually reviewing.

I am very fortunate to have a loving, supportive husband who gets me enough to know that the next 20 days are 14 hours of medicine, and maybe 1 hour of making sure our house is livable. I am so grateful that he’s there to encourage me and give me the freedom to just live and breathe medicine. I really owe him once this is all done, he’s basically had a shadow of a wife. Just one of the small sacrifices of the profession. I’ll be back in 20 days, I promise!

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The Friday Rewind

Time to wrap up the work week! As a way to reflect back on the best and the worst, the new and inspiring, the mundane and the news-breaking, I am starting a weekly post simply known as– The Friday Rewind.

1. The Best of This Week:

  • Biked (and jogged) a total of 59. 7 miles, completing over 5 hours and 45 minutes of cardio-strengthening training! How do I know this? I use the convenient free ap–Map My Run–which logs all of my work-outs and  emails me a summary at the end of the week. This is a data lovers dream!

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  • After a short hiatus, my husband and I returned to our nightly ER viewing habit (the old NBC medical drama, 1994-2009). This is quality time very well spent. We are now on season 7 of 15. I love this show because they make zero attempt to explain medical terminology and expect viewers to just get it. It makes me feel good when my husband turns to me and asks, “so what is a compartment fasciotomy,” and I immediately know the answer. Finally, I know about something he doesn’t! Of course, he has a disturbingly impressive memory, and with his uncanny ability to recall medical facts like an encyclopedia is well on his way to an honorary MD. (Secretly, I think the wrong person is going to medical school–if ever given the chance, he would crush me…)
  • Only 12 weeks to go until my last day at work.
  • Only 6 weeks to go until our belated honeymoon and 11 blissful days on the beach!

2. The Worst of This Week

  • I have had an unrelenting cough for 33 days and counting. Three doctors visits, one chest x-ray, one nebulizer breathing treatment, two steroid medications, an antibiotic and an inhaler later–I am still non-the wiser to what is causing this annoyance. Coughing is one of the top five most common reasons for a doctor’s visit, with up to 40% of non-smokers having reported a chronic cough at some point in their lives. A 2006 study found that among women with an average age of 48 who had a cough lasting for six months, 39% were found to have asthma, 9% had chronic upper airway cough syndrome (commonly known as postnasal drip), and 9% had gastroesophageal reflux disease (GERD), while 11% had chronic obstructive pulmonary disease (COPD), a serious, progressive disease that includes both emphysema and bronchitis. My money is on asthma…

3. Medical Breakthrough of the Week

  • Rather than picking just one medical breakthrough of the week, I will let you in on a treasure trove of medical discoveries! The website MedPage Today (www.medpagetoday.com) is a phenomenal resource of the latest in medical developments. This is a particularly helpful tool because it summarizes medical literature into easily digestible articles–each article alerts the reader to breaking medical news, presenting that news in a context that meets their educational practice needs. Sign up for daily email alerts to stay on top of all that is new in medicine!

4. Just for Fun- The Friday Rewind Image Challenge

A 26-year-old woman presented with pain and discoloration in the fingertips of both hands on exposure to cold (Panels A and B). She had had the same symptoms every winter for the past decade. The patient’s history and physical examination revealed no signs or symptoms suggestive of systemic lupus erythematosus or scleroderma. She reported that she did not smoke. What is the diagnosis?

a) Carcinoid syndrome

b) Mastocytosis

c) Normal pregnancy

d) Radial-artery occlusion

e) Raynaud’s phenomenon

* Courtesy of The New England Journal of Medicine

The Answer: Shown in the comments section.

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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 “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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