And I thought first year was hard...

How could I possibly begin to describe the last four months? Succinctly, I hope, as I don't really have all night to finish this post. So...lets see..

Summer: Good. Did the Summer Institute for Medical Students at the Betty Ford Center. Incredible and inspiring experience. It's important every once in a while to reaffirm the things the drew you to medicine in the first place. After my internship I spend some quality time with my best bud in San Diego- you know, the beach, gaslamp quarter, shopping, waterfront dining etc. How totally wonderful to be back in San Diego after a whole year! After that my fiance and I meet in San Francisco to see his dad in a play (The Imaginary Invalid by Moliere-totally awesome). A few days after I leave San Diego, and after spending hours helping my friend rewrite her personal statement, I find out that she got into Tufts School of Medicine off the wait list! I am so ridiculously excited that my best friend in the whole world is coming to the east coast, and immediately make plans to attend her white coat ceremony in Boston. At the ceremony, when the Tufts class of 2011 stands up to take their hippocratic oath, other physicians in the audience are invited to reaffirm theirs as well. A lightbulb flashes in my head when I realize that that means me too, and how proud I am to be counted among those in this profession. I stand up and recite my oath for the second time; In one year I have changed so much, learned so much, and feel so blessed to be standing where I am at that moment.

July 30th: 2nd year begins and I quickly find out that there is not going to be an "easing in" period. Things start out fast and don't let up. I realize that I was actually supposed to remember all the clinical skills I learned last year when, during the second week, there is a "surprise" examination consisting of a complete history and physical on a standardized patient. There are more workshops than ever: advanced interviewing, heart sounds, ophthalmologic, "careers in medicine", resulting in virtually no free afternoons. I start my clinical rotation for the year in family medicine, finding out that there is more to life than otitis media and URI's (I did pediatrics last year). I manage to keep my head on straight and ace pharmacology and pathogenesis. Then microbiology comes and I quickly lose ground. Try as I might, I could not manage to memorize five bazillion bacteria, viruses, parasites, and fungi, along with all of the therapeutic drugs, and keep it in my head all at the same time. I barely survived. To make things even more complicated, I have found myself as the E.R. Shadowing Coordinator, President of the Psych Society, and the chapter delegate to the AMA. Don't get me wrong, I love extracurriculars, but at this point any time I had for myself is virtually nil. I can't even manage to get a haircut. And here is the worst part: I have to take the Step I boards next summer, meaning that I start reviewing...um...now. I buy a used set of board review books off someone in the class of '09. I flip through them and wonder how on earth I will ever put all of this information in my head. I am experiencing severe test anxiety ten months before the test. In a self-perpetuating cycle, my anxiety leads to lack of focus, major mood swings, erratic studying patterns, and falling asleep in class, which of course, begets more anxiety.

Perhaps I exaggerate slightly, but damn, this sucks. However, I don't suppose that I would wish myself anywhere else right now. It's still worth it. Despite the longer hours, I think that second year is, at the very least, more interesting. We are on an organ based system now, learning disease concepts and pathophysiology rather than just the basic science. We just started hematology/oncology, which I really should get back to studying...

I definitely feel like more of a student-doctor, more so than just a student. I've gotten to the point that I can examine my fiance when he gets sick, pronouncing that he has lower left lobar crackling and diffuse petechiae in the oropharynx. That's gotta mean something.

Guru Out!!!

I write to you on my last night as a first year medical student. Although I must be brief (neuroscience be damned), I thought that this would be a good moment to share. At this moment it is not the coffee, red bull, or Starbucks double shots that are keeping me going, but the pure excitement and drive to put this year in the PAST and to look towards the future. All in all it's been one hell of a year.

There's a part of me that wonders how I made it through. Then there's another part that knows I deserve it somehow. Despite frequent challenges and what I would describe as an incredibly miserable adjustment period, I managed to keep pushing myself and pulling myself together throughout the year. But barely. So many times I have thought, "this is too hard....there's no way this is worth it......I'm too burned out......I have nothing left".

Then I would become conscious to the fact that there is still that motivated, relentless, and frequently annoying pre-med inside of me. That person never gave up. That person knew what she wanted and worked harder than she ever had in her life to get it. I remember her. I admire her. I want to be more like her. And then somehow I would find the courage to do whatever I had to do. Funny how we backslide, isn't it?

I see this journey as being very cyclic. I have moved up a level, yet somehow I am starting at the beginning again. I am finding myself, what motivates me, what gets me through to the end of the day, and figuring out what I want next and how I'm going to take steps to get it. Believe it or not, in two years time I will be filling out residency applications, getting letters of recommendation, and traveling to interviews. Sound familiar? How painfully so....

But I do believe that when the next step comes I will be ready for it. Just as I was once a shy, awkward, and hopeful pre-med sitting in Adele's office looking for direction, I started medical school scared, awkward, and clueless. But I came into my own and blossomed at UCSD, and I have no reason to think that that will not happen here. I know I sure did learn a lot this year, and that is definitely not restricted to academics.

I am looking forward very much to second year. Although I know the workload will become even more demanding (if you can believe that), I know I am better prepared for it. I know what to expect, I know what is expected from me, and I know what it takes to deliver. I think things will become much smoother, maybe even less painful. I will be leading the Emergency Medicine Student Association as well, which I am thrilled about.

So anyways, have a great summer and don't forget to tune in next year for the continuing saga of SECOND YEAR...oh yeah......





ANSWERS SECTION (to questions previously asked in comments sections)

1. Match day occurs each year on March 15th, and represents what amounts to a giant computer spitting out the names and places where 4th years will be going to residency. Basically, at the beginning of 4th year you will fill out applications, send in letters of rec, and attend interviews. After interviews, a student must rank-order his or her choices based on preference. Meanwhile, the hospital/residency program also rank orders candidates based on their preference. All of this information is fed into the computer program, which creates matches. For example, if you rank a program 1st and they also ranked you very high, you will probably match. Maybe not so if you ranked them high but they ranked you low. Get it? Remember, not everyone will match (unfortunate). Also, there is an "early match" for some very competitive specialties (neurosurgery, anyone?), the purpose of which is to give those students a second chance to match in something else if they don't get the competitive specialty.

2. Along the same lines, dermatology is increasingly becoming very competitive, and I think it totally makes sense to wonder why. But I suscribe to the theory that it is due to increasing numbers of women in medicine that are committed to having satisfying family lives (i.e. having children and actually spending time with them) as well as careers. I mean think about it.....who has a dermatology emergency at three in the morning? So shorter, more flexible hours, no call, and you still make the big bucks as a specialist. What I'm basically saying is that you can have your cake and eat it too. Theoretically.

3. After first year you will get about two months off before second year. While first year tends to deal with "normal systems", second year tends to revolve around "when systems go bad" (i.e. pathophysiology and diagnosis). After second year, you will have to study for your Step I boards, about a month or so, which will leave you about three weeks to actually take the exam and "vacation" before third year rotations start. Third year puts you in the hospital with patients, where yes, you will supposedly apply what you have learned. This will be tested not only by your work with patients, but also by shelf exams and merciless pimping by your attendings :)

Oh yeah, and you don't get a break at all, it's twelve months :)

Flowers sometimes grow in the strangest places

Hello.

Man, am I tired. My last histology exam is in a few hours and I have crammed and crammed...till I could cram no more. I can only hope it's enough. Life has been interesting the past few weeks. Just when I finally felt like I was getting the hang of this med school thing, life decided to bring forth yet another challenge. Probably the most difficult decision I made to date this year, I arranged to leave school for a little while to go home. Right after spring break, I found out that my mother had been hospitalized. It took me all of two days to realize that I needed, and that she needed, me to be there. I couldn't find one person at school, students nor faculty, that said I should stay either. The overlying principle was simple: family always comes first. After I arranged for my leave, I took the first flight out to Arizona and the rest is history. The last couple weeks were more stressful than med school could ever be, being that the situation was so deeply personal. I also worked harder during this time period than I usually do in med school. The hospital was about eighty miles away from my sorry little rural hometown, and my stepdad, grandmother, and I, drove there every single day to see her. All day I would do the things my mom usually does around the house (including taking care of what I would call a miniature zoo), cook meals, run errands, and try to keep up with my studies. Every evening was spent traveling, visiting, and traveling again. What a routine....and how mentally and physically exhausting. The good news is that my mom is doing much better. She was discharged from the hospital after about two and a half weeks, and I flew home a couple days after that. I wasn't ready to go, but I had already missed too much school. Any longer and I might have jeopardized getting promoted. sigh.

I have my histo exam today, and my last physiology and immunology exams on Friday. I've pretty much missed the entire immunology course, so I don't yet know how I'm going to pull that off. The exams that I missed, the fourth physiology and first immunology, along with the second clinical skills exam, will be made up later. Yes, I get to stay in school now and make up exams after everyone else is done for the summer. sigh.

It was worth it though. A decision I will not regret. Things that you choose to do, or not to do, for your family are decisions that maybe you can make only once. When the moment is gone, it's gone. Make a decision against your heart, against your instinct, and it's possible that you could end up regretting it for the rest of your life. That's why it is so critically important to keep things in perspective. I believe that family always, always, comes first. I know that there are some schools of thought out there, and some med schools for that matter, that would decidedly disagree with me. I can only express my gratitude that I am not in that kind of place. I have decided that I love my school, and that I love my class. The support, the flexibility, the many offers of academic help, and the prayers that went out for my family, touched my heart deeply and gave me strength. What I've learned: Even out of sad and unfortunate events, there is joy to be had and wisdom to be gained. I learned something valuable about my school and, perhaps for the first time ever, I learned the true meaning of having really good friends. I also learned a lot about myself, who I am becoming as I mature, and most importantly, I learned that something a hell of a lot stronger than superglue holds my family together.

A long time ago (okay only last summer but it seems like a long time ago), I made a decision based on a gut instinct. The decision to attend the school where I now reside. If you've been following my blog for that long, you know that I went through some serious anguish and misery making that decision. How much simpler it would have been if I had just went with my gut and not lamented over the technicalities of it all. My feeling, or instinct, stemmed not from a ranking, or a curriculum, state-of-the-art laboratories or any of those things that seem so trivial now, but from an impression I had of the people. I had a feeling that they would be there when I needed them. The reality of things is that bad stuff can and will happen, and you never know when. The majority of med students I have spoken with have had to leave school at one time or another for serious family or personal reasons. If and when that time comes, I think you would want to know that you are surrounded by understanding and support. It makes it a lot easier at any rate, to make the right decision and feel good about it.

These last six weeks of MS-1 are going to be utter hell for me. I don't know how I'm going to get any sleep whatsoever. What once looked like the home stretch is suddenly filled with tortuous loops and hairpin turns, but I suppose I'll get through it somehow. I always do.

One piece of great news: I got a full scholarship to the Summer Institute at the Betty Ford Center. Soooooo awesome.

Will try not to leave you hanging for too long. Despite my very acute lack of time, I find writing in this blog very calming. Till next time.

Meeting Patch Adams M.D.

Although I am in the middle of cramming renal and GI physiology, I decided to take a few hours off tonight to go see Dr. Patch Adams. He happens to be an MCV/VCU alumnus if you didn't know that already. You may have seen the movie and noted what a beautiful campus he attended. Unfortunately that was not MCV, that was UVA. Apparently the MCV campus was too urban and slovenly to be featured in the movie (but hey it's home, right?). Admittedly, UVA does have a gorgeous campus, however I would argue that we practice medicine waaaayyyyy better.

Anyway, it was definitley worth my time. It was without a doubt one of the most provocative, creative, and inspiring talks I have ever heard. I decided to purchase both of his books ( yikes! when will I have time to read them?) and yes, that is me and Dr. Patch Adams pretending to pick our noses. Maybe laughter is the best medicine. I was laughing so hard taking this picture that I forgot all about the upcoming exams.

Now for a little Q&A. Maybe I can actually stay on top of it this time.

1) You bet your ass I was Phi Beta Kappa

2) Don't take too seriously what I said about the competitiveness of med students. Yes, everyone wants to do well, some more so than others. However, at least in my school, this is not a curved system. By acing an exam, I am not preventing anyone else from also acing an exam. It's not like the first day of Ochem when they tell you that only ten percent of the class can get A's. Here, if everyone aces the exam then everyone gets honors. That being said, there is still an element of competition in that, inevitably, there will be a rank order. Depending on specialty preference and other various reasons, class rank may be very important to some people. But it is not to the extent that they would actively try to push others down (UCSD pre-med courses, anyone?). Everyone is very friendly, very helpful, and very cooperative. Many people choose to study in groups, and additionally, parts of the curriculum are done in small groups. For my team based learning sessions in biochemistry, we got a group and an indiviual quiz grade. This is also done in my Foundations of Clinical Medicine group. I have not encountered one soul who was unwilling to help me with anything I needed. From what I can tell, my class is like a mini-community and is very close-knit, protective, and supportive of its members. I have no doubt that lifelong friendships are being formed. As far as professors go, most are willing to bend over backwards to help you achieve your goals and support you in anything you want to do. As one attending put it to me, "You're in the club now", and that is so true. When I failed an exam, I was called in the very next day by the course director, who wanted to express her concern and see if there was any way she could be of assistance to me. Bottom line: Med schools don't choose people that they think can't make it. If they have chosen you, it means that they believe in you, and that they will do everything in their power to facilitate your journey.

3) I feel overwhelmed every day of my life and that is no joke. There is never enough time to get it all done, let alone do other things that I want to do. How do I deal with it? I try to go to bed every night knowing that I made the most out of my day. That's all I can do. I have bad days, good days, and average days, but every once in a while I get one of those supremely satisfying, inspiring, and rewarding days. Those are the ones that I live for. Although the workload oftem seems to require superhuman powers, just remember that you are human. Do the best you can do, and chances are, that will see you through.

Yes, I'm still here....

Hey all!

Sorry I haven't been keep you up to speed......there's just never enough time in the day.

So when we last left off I was just finishing anatomy, and I'm glad and sorry at the same time that it's over. Now we're back in the lecture hall four hours a day and to be completely honest with you I sleep through at least half of it. It was a lot more fun being in the lab even if it was smelly. Since the break, we have completed blocks in Embryology and Behavioral Sciences I, and have started Physiology and Histology. Behavioral Sciences was great, and given my psych background, I got 100% in it without even studying. Yay, at least I'm good at something!!!

Histology is so ridiculously boring that I can't stay awake in it to save my life. The good news is that in this great age of digital media, we don't have to spend hours looking at slides on the microscope. Everything I need to know, for the practical exam at least, is right here on my handy dandy CD-ROM. The class itself is not very difficult, it's just totally mind numbing.
Then there's physiology, and that is a whole different ball game. I used to like physiology in undergrad, but here they just suck all the fun out of it by making it so damn complicated. Trust me on this one: You're only getting half the story in undergrad physio. Believe it or not, I actually failed the first exam and that was definitely a wake up call. Luckily it was not because I'm stupid (I'm definitely not.....magna cum laude.....hahaha), but because I slacked off and underestimated the time I needed to put in. The sheer volume of the material was half my problem. But a lot of it is conceptually very difficult as well. Our second unit on cardiovascular physiology pretty much blew everyone's mind. But luckily I stuck with the program, put in the hours and passed the exam (barely). That brings me to the lesson of the day:

If you are one of those people who study twice a quarter and still get straight A+'s, congratulations. I'm sure that you will graduate with honors and that your parents will be very proud. Unfortunately, the people who are getting A-'s and have better study habits are going to kick your ass in medical school. You have two options. 1)Start working on your study habits now
or 2) Prepare to be very humbled

If you can't tell by now, I was obviously the first type. I came out of undergrad thinking that I was the greatest thing since the advent of microchips ("No, I don't have to study...I'm just naturally brilliant...."). But alas, medical school is full of brilliant people. If you want to shine, you really have to work at it. Currently, I'd say that I'm somewhere in the bottom quartile of my class. Ouch. In order to improve my standing, my study habits are going to have to improve.... a lot. If you're like me, do yourself a favor and start working on them now.

The highlight of my year thus far has been the six week elective I did in anesthesiology. Only one other student and myself were accepted to this elective (yeah, my grades aren't great but at least I shine clinically!), so it was very personalized attention from the attendings and very awesome. One day we got to participate in this airway management lab, where I learned various intubation techniques (on simulation manequins of course), including oral and nasal fiber optic intubation and bronchoscopy. Those fiber optic scopes are seriously the coolest things ever!!! I feel so honored, as a first year medical student, to have been allowed to play with fifteen thousand dollar toys....
Another day we were let loose in the emergency room to practice starting I.V.'s. I feel sorry for some of the people we had to stick three times, but in our defense they were difficult cases. Seriously, it was so much fun. Why can't all of medical school be so fun?

It's been a lot of ups and downs, mostly downs at some points, but my gut always tells me to hang in there and to stick with it. As much as I hate it sometimes, I know that there is nothing else that I want to do with my life. Three people in my class have already dropped out. I can only reason that they had enough doubts about medicine as a career that leaving became a feasible option for them. Although I've been to hell and back this year, personally as well as academically, I have enough faith in what I'm doing that I'm still here. I'm glad. I'm really glad.

By the way, I've been procrastinating for two whole hours now. Time to dive back in to the exciting world of the kidney. Sigh.

Q&A

To briefly (or not so briefly) address a common question.....

Yes, The people in medical school are ridiculously competitive no matter what anyone says. You have to remember that pretty much everyone who successfuly makes it in is an overachieving, driven perfectionist. That being said, maybe it's not so much that they're competing against each other, but that they're competing against themselves. Or both. Probably both. The averages in my class are ridiculously high because a lot of people are just unrelenting gunners. They piss me off sometimes, and make me look bad just because I want to have a life and be a doctor. And I'm not saying my grades are all that bad either. I got an 85 in biochemistry and that was actually below average if you can believe that.

But the important thing to remember is that it's your choice. If having a life is important to you, then you can have it and that's ok. But don't expect to be in the top of your class if you make that choice. There are people out there who are willing to study twelve hours a day. But also take into consideration what kind of specialty you think you might be interested in. Due to the competitiveness of some specialties, you may need to be one of those people who does nothing but study. Since I am personally interested in emergency medicine, psychiatry, and anesthesiology, I feel comfortable making the choice to have a life and knowing that that I probably won't be at the top of the class. I don't need to be. In each of those three specialties, there is pretty much a residency spot for any U.S. medical graduate who wants one.

Based on my research so far, the most competitive specialties are plastic surgery, orthopedic surgery, general surgery, and dermatology. For most other specialties, there are actually very high match rates. If you are interested in learning more about different specialties and statistics on match rates, check out http://www.careersinmedicine.org. Look to the right hand side of the home page at "Charting Outcomes in the Match". This website is awesome, and extremely helpful, for now and after you're in med school. Check it out!

Also, since somebody really wanted to know, the lowest GPA I've heard of that successfully got into medical school was 3.3. But, really, when you take all the variables into consideration, who knows? Bottom line: Don't think you're golden if you have a 4.0, and don't sell yourself short or give up if you have a GPA in the lower range. I got into med school with a 27 MCAT, during a year when only 40% of applicants got in. How do you explain that?