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The reinvention of the HMP3 guru

I have been thinking for some time that I would like to continue writing - however everytime I sit down and put my fingers on the keyboard nothing comes. This is baffling to me because of the sheer volume of thoughts that run through my head every day - especially regarding the choice of what I want to do with the rest of my life and of course the general mental processing of the things I see and do every day as a 3rd year medical student.

So why is it that I have such trouble communicating lately? After giving it some thought, I think that perhaps it is time for a change (no political pun intended) in the way I communicate and perhaps even to whom I'm communicating. I have always told people that I feel like I morph into a new person every three years or so. Of course this is probably true - we all grow and change as we interact, sometimes not so harmoniously, with our environment. I am a different person than I was when I wrote the bulk of these entries. You are a different person than you were when you first read them.

The best way that I can serve others who may want to continue, or begin, reading this blog, is to be myself. And to be myself in an open forum, to be able to send my often tortured thoughts out into the oblivion of the internet, is probably the best favor I could do for myself as well.

Please don't get me wrong here, when I say tortured I don't necessarily mean that in a bad way. But I do have some complicated thoughts about complicated matters as we all do.

So here is my plan. I am going to rename and relaunch this blog as soon as I can. I will archive all of the old posts so that they will still be available. Then I am going to write again, because I have something to say. Actually, a lot of somethings. Until then - enjoy the new year - can you believe it's 2009 already?


Meanwhile, here are a couple of things to think about:

Best news - I finally kicked the habit on October 20th, 2008


Good news - the view from my cruise ship stateroom on Christmas day

Good news - i am getting married this year to the amazing person next to me in this pic

Bad news - What the f*** is wrong with this picture?

48 hours till D-day

As you can see, I haven't posted to this blog since last October when I was towards the beginning of 2nd year, and many, many, months away from taking the boards.

Today, I am 48 hours till d-day. Time sure did go by fast. I would like to say that I spent second year working harder than I ever have but I would be lying...

It was tough but I enjoyed myself as well - went to several conferences, became pretty political, and basically reveled in the fact that I was no longer a newbie but at the same time existing without the responsibilities of third year. Nice. But all good things must come to an end, and about five weeks ago I started studying for Step I hoping to god that I could redeem myself for slacking off so much. So we'll see about that.

I will start third year towards the end of July, with pediatrics. I can deal with that. Unfortunately I have to do surgery after that which as you may know, is not exactly my cup of tea. But I think the worst thing about third year is the fact that my time is no longer my own. I can't decide not to go to class and sleep in, and I can't decide to "just disappear" for weeks at a time. And for that matter, I actually have to show up on time or else. Ugghhh.

So I will take the boards on friday and hope for the best. I'm about as freaked out right now as I've ever been about anything....ever.

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?

Light at the end of the tunnel

Tomorrow is our last day with Bob. To tell you the truth, I don't know whether to break out the party hats or cry. I guess you could say I've had a hate/love realtionship with anatomy. There were things I loved about it (working with my group, wearing scrubs every day, learning cool clinical stuff), but there were also things I hated about it (mass of material taking the fun out of it, bisecting bob's head, and of course, head pies). To elaborate on head pies, let me just say that they are very old, very preserved, well, slices of heads for us to look at. There are about 120 0f them in our lab, and yes, I'm supposed to have examined them all by next wednesday. Hmmm.

So as I was saying, tomorrow is our last day of dissection. That's good, because there is really nothing left to dissect. Ever heard of that book "A Million Little Pieces"? Well, that's about the state that Bob is in right now. So we'll finish up tomorrow, and then study like mad until wednesday, the day we take the exams and officially finish the semester. I can't believe an entire semester has passed already. Only three and a half years to go now.....

What I really wanted to write about today is my Foundations of Clinical Medicine class. I really think VCU has a great program in this regard. It is a two year long program in which we alternate weeks between preceptor visits and small group sessions. Small group sessions (8 students) are led by a doctor and a 4th year medical student, and we learn all the things we need to learn to perform clinically, including medical history taking and physical exams. Sometimes we get standardized patients to practice on. Like today, for example, we practiced abdominal exams and head and neck exams on a standardized patient. It was really incredibly cool! It's definitely days like today that make me appreciate being a medical student. But back to the topic: My preceptor is a pediatrician and I visit her practice one day every other week. At first I simply shadowed her, but at this point I have progressed to seeing patients on my own. I interview the patient (or parent), by obtaining a chief complaint and history of the present illness. Depending on the circumstances, I may also obtain a past medical history, social history, or family history. Then I do whatever components of the physical exam I can do up to this point, including auscultation of the heart and lungs, head and neck, and abdomen. Then I present the case orally to her, after which she sees the patient and verifies (or not) my findings. Of course I don't know that I'm talking about half the time, but it is really great when I do. As an example: at one of my first sessions, she had me listen to a baby's chest who was presenting with wheezing. I didn't hear a damn thing, but of course I nodded my head that I had heard it. So you can imagine that a couple weeks ago, when I detected wheezing in a two year old all by myself, I was pretty proud. It's really amazing how you progress and improve with practice. It's not something you can follow sequentially, or in a stepwise fashion. For most of the semester I didn't feel like I was improving at all. I felt retarded and awkward most of the time. But I really was getting better all the time and just didn't see it in myself until it all clicked one day.

That being said, I will tell you that a received a near perfect score on my clinical skills exam. How awesome is that? I really really love this class. Too bad my scores are so crummy in anatomy. Can't be a shining star in everything I suppose. But perhaps if I spent less time watching TV, sleeping, and procrastinating in general, I would get better scores. Hmmm. Intriguing notion. I see a New Year's resolution in the works maybe....

But speaking of the holidays, I can't wait for next wednesday to be over so that I can start my vacation. And I'm sure you all feel the same way. Good luck on finals, and make sure you enjoy your time off!

Pictures from the AMA conference

Presenting Anshu's poster at the abstract competition (by the way, he won his division!)





Anshu, Jason, and me.

Anshu, Janelle (our pres), me, Zeina, and Jason

Med student party at Bellagio's Light

Allison and me

Startin to feel those drinks.....

Girl's afternoon out. Notice the 100 ounce margarita in the middle of the table.

Does life get any better?

Yes, it does. 100 ounce margarita AND balloon hats. Sweet.

Life equals Anatomy

So it's almost one in the morning, and I have just returned from many confusing and smelly hours in the anatomy lab. We are trying (key word there is trying) to prepare for next week's exams. Unfortunately it seems like the more I learn the more I realize how much I still don't know..... sigh.

The first day of anatomy was the first day I truly felt like a medical student. Up until then I was still on familiar ground. But nothing could have prepared me for that first day. At the very least I thought we were going to get some kind of introduction, a sort of easing in process, but no, that's not the way it happened. One minute I was nervously changing into my scrubs, and then wham, the next minute we were raising our bodies, unzipping the bag, and making that first cut.
I had never seen a real cadaver before and truthfully it looked nothing like what I expected. I do not know exactly what the preservation process is, but it definitely changes the appearance rather dramatically. In some ways, it didn't even look human anymore. Yet human it is, and for some people that can be pretty hard to deal with. The whole process seems so wrong, so invasive and disrespectful, but unfortunately it is hands down the best way to learn. It is important to remember that these people donated their bodies for whatever personal reasons, and that it is a great honor and privilege to have the opportunity to learn from them. It is a privilege that few will ever have, and I think that is one of the reasons that anatomy is considered a right of passage in medical school.

When I was interviewing, I noticed that one of the most common questions applicants asked was "how many people to a body?". An answer of six or seven was generally met with a disapproving frown, while an answer of four was met with nods of approval. The bottom line is that this is a very "trendy" question, and the people who ask it have no concept of what it really means. I guarantee that if they found themselves in a group of only four people, they would be in a world of hurt. Dissecting an entire human body is a HUGE amount of work. My group has seven people, and trust me, there is more than enough for everyone to do. Generally, we have two people cutting, two navigating, two reviewing out loud for everyone, and one "floater" walking around to see if other tables have any particularly good structures to look at. It's also nice that we can switch positions frequently so that nobody gets tired or burnt out on what they're doing.

We are in the lab every morning, and more often than not, in the evenings too. The amount of material that gets thrown at you is absolutely ridiculous. As with the other courses, we are expected to memorize something the size of a phone book about every two weeks. Our written examinations deal with more with theory and clinical correlation, and practical examinations involve identifying things on the bodies. Practicals are pretty intimidating, and not many people have taken this type of test before. We have to walk around to different stations, to the sound of a buzzer that goes off every 75 seconds, and identify whatever it is at that station that has a pin in it or a string tied around it. That willl get your blood pumping, trust me. 75 seconds is not a lot of time when you're trying to identify some random cutaneous branch of some nerve that is itself a branch off of the lateral cord of one of the anterior divisions of the brachial plexus. Did I lose you? But I'm not joking, not even in the slightest.

You will live and breathe nothing but anatomy for what seems like a very long time. You will spend countless hours stuck in the lab with your body while others are out having a good time. You and your notes and books will reek of formaldehyde, and no matter how may showers you take or how much febreze you use, you will still smell it. You may even start to doubt your own sanity. But on the upside, you will learn more in a few short weeks than some people learn in a lifetime, and you will have a lot to be proud of. The useful clinical correlations you will learn are priceless. You will suddenly understand the significance of the different positions of auscultation, you will know why an epidural is usually given at the L4-L5 space, you will understand why a fracture of the surgical neck of the humerus is so dangerous, you will know why you need to follow the clavicle inferiorly and medially in order to put in a central line......and on and on. For me, as I mentioned before, it was the first time I really knew I was in medical school.

Now there is nothing wrong or disadvantageous about going into anatomy "green". I certainly did. Many schools do not offer full body dissection courses when you are an undergrad. However, if anatomy is really your passion or if you really just want to get some exposure, I do know of a couple options. First, I do believe that Mesa College offers a gross anatomy course, or at least they used to. Second, some universities offer summer intensive courses in anatomy that you can even receive academic credit for. One I know of is at Johns Hopkins and I've heard very good things about it. In fact, here's the link: http://www.hopkinsmedicine.org/FAE/anatomyinstitute/

It's pricey, but I'm sure it would be a hell of an experience.

Anyways, I unfortunately must get back to the books. I need to pull off something of a miracle to be ready for the practical on tuesday. Sigh again...

Why being a member of the AMA is so great

Hey all! I just wanted to check in and say hello. The latest news is that I did pretty well on my first anatomy written and practical examinations. Yay! I survived!

The next entry regarding.......anatomy and stuff....will be posted early next week. If you have any specific questions you would like answered about anatomy, please leave a comment. For the moment, yours truly is heading to Las Vegas for the AMA conference. If that doesn't put me in a good mood I don't know what will. Well, that and the fact that it's paid for by my AMA chapter here at school.

Wish me luck for four aces!

All is not fair in life and medical school

"Our lives are not determined by what happens to us but by how we react to what happens, not by what life brings to us, but by the attitude we bring to life. A positive attitude causes a chain reaction of positive thoughts, events, and outcomes. It is a catalyst, a spark that creates extraordinary results."

-anonymous



Good advice, no?


Well here I am, ten weeks into my first year of medical school. Don't I just look so professional and serene in my fancy white coat???

But truth be told, it's been a rough ride so far. I left San Diego at the end of July, saying goodbye to all that has been my life for the last six years. I drove across the country with my cats, my rats, and my mom for five very very long days. Arriving in Richmond was like arriving in hell.....at first. It was so hot and humid I couldn't catch a breath for the first couple days. After that, I came home from my first orientation day to find that my kitchen had been flooded from a leaking pipe in the ceiling. I had a giant hole in my ceiling for four or five days. Then of course one of the cats got up onto the refrigerator, went into the ceiling and somehow ended up getting stuck between the wall of the bathroom and bedroom. We had to knock a hole in the bedroom wall to get him out. So yeah, life was not fun at that point. The high point of my orientation week was the white coat ceremony, during which I first recited the hippocratic oath. To finally be recognized as a medical student....well there is no way that I can describe how that felt. It was amazing. At long last I stood at the gateway to all that I had dreamt of for so long. The culmination of my application year, the joys, sorrows, and tears of the long battle had come to an end. I felt in that moment that my life, brimming with all the potential my imagination could conceive, was really just beginning.

So life in medical school began. Our first block consisted of medical biochemistry and population medicine, along with the year long Foundations of Clinical Medicine course. I settled quickly into a routine: lecture every morning, periodic sessions in the afternoon, and of course studying in the evening. I spent what free time I had talking on the phone with people back home, or attending one of many school sponsored social events (How cool is an open bar tab paid for by the medical school?). But I did start to feel the homesickness. It took a while for it to kick in that I had really moved to Richmond and now resided there. I had trouble coming to grips with the fact that I had just moved three thousand miles away from everything and everyone that I loved. Yet despite my loneliness, I persisted in my studies, enough that I sailed through the first two exams with flying colors. Alpha Omega Alpha (top 16% of the medical school class) seemed like it would be a breeze for me.

Unfortunately, just when I least expected it, things got bad. Real bad. I experienced what you would call a life shattering event. It felt like someone had just dropped a nuclear bomb on my life to be more exact. I will spare you the sordid details of my personal life, but trust me, a worse thing couldn't have happened at a worse moment. I sunk into a depression that took me places so low that you couldn't even imagine unless you've been there yourself. I stopped attending class and stayed in bed for a long time, about a month to be exact. The population medicine course had ended after the second exam, and was replaced with a human genetics course that I didn't bother to attend even once. So what about the exams you say? Well, I managed to drag myself in there on the next two exam days, and believe it or not I passed both of them. Not with flying colors, but I passed. All I can say is that I must be either extremely brilliant or extremely lucky. Maybe a little of both. But truth be told, I fully expected to fail those exams, having studied maybe all of two minutes, and I know that unconsciously I wanted to use that as an excuse to drop out. I really did seriously consider taking a year off to get my head on straight. I knew I still wanted to be a doctor, but I wondered how on earth I was going to be able to concentrate on medical school when I felt so bad inside. So what did I do?

I finally reached out. I spoke to my professors, one of the deans, and some of my classmates and new friends. I let it all out. And you know what? Every last one of them was there for me, and offered more support and encouragement than I could have hoped for. How amazing is that? I realized that while I may be far from home, I am most definitely not alone.
Slowly but surely, I have begun to get back on track. I still have plenty of moments in which I feel the despair and the sting of life's betrayals, but fortunately they are becoming less as time goes by. We have started anatomy now, and I think the thing I enjoy most about it is the time my group spends in the lab together. The comraderie and the connections that are being forged feel as nourishing and as necessary to me as water is to a thirsty animal.
The studying is not going so well, but I really can't expect everything to fall back into place right away.
So maybe the Alpha Omega Alpha thing is off the horizon, but my potential and opportunities are not. I feel pretty ok about it right now, and to quote the second year students' favorite piece of advice: "P = MD baby. P=MD".

And one more thing...... thank you to everyone who has tuned in this last year. You were an unseen, but significant source of strength and support for me. Thank you.

Six weeks to go.....

Ok people, I've made up my mind. VCU it is. I've been agonizing over this whole thing for weeks now, but pretty much came to the conclusion that I have to trust my gut. From the get-go, I've always known that I would be happier in Virginia, as strange as that sounds.
Sorry to offend any of you from LA or Orange county, but LA in general makes me sick for a variety of reasons. It is not the type of environment that I can really see myself flourishing in.
I've had an extremely pleasurable experience with VCU from the beginning, and a lot of this also comes down to the way I felt and the way I was treated throughout the application process.

I've also realized that I'm the kind of person for whom nothing is ever going to be good enough, unless I change my patterns of thinking. Here I am agonizing over this decision because I'm worried that the med school that I really want to go to isn't good enough. Give me a break. I was just flipping through some med school book at Barnes and Noble the other day, and one particular passage caught my eye. It said that if you've been accepted to a U.S. med school, ANY U.S. med school, you're already in the upper echelon of all students entering graduate school. Isn't that great? I mean, really, where do you draw the line with this stuff? Shouldn't I be exceedingly proud that I have come this far, to have actually been accepted to any school at all? I tend to forget these things, and part of that comes from the brainwashing that can happen at UCSD. I start to obsess about nothing but the rankings, the numbers, the prestige, and start to forget why I'm doing what I do in the first place. I want to be a doctor, period. And you know what? I don't really care about doing groundbreaking research, winning the Nobel Prize, performing the first total body transplant, and all that stuff. I just want to be a good and respected doctor, that's it. I know I will receive an excellent medical education wherever I go, so I'm going to go where I know I'll be happy. I have to come to terms with the fact that there's always going to be bigger fish in some other pond somewhere. That's life. What matters is what I do in my own pond. Sorry for that weird analogy, but it just came to mind for some reason.

Bottom line, I just want to get back into school. I miss it. I'm excited, scared, nervous, elated, and a thousand other things right now. I'm going out to Richmond in two weeks to attend a financial aid workshop and to find an apartment. I can't believe this is real and actually happening already, but it is. Med school, here I come!

Anyways, I also have a couple of announcements for you guys. Number one, my job is going to be up for grabs very soon. See description below if interested. Number two, I'm selling my Princeton Review MCAT prep materials (all books and tests) for $150 or Best Offer. Contact me at ascheffman@sbcglobal.net if interested in either.

Here is the job description, and keep in mind that this is a position for someone who is looking for a full-time job and wants to commit to it semi long-term. If you're just graduating and taking the year off, like I did, it may be perfect for you. If you know you are interested and want to expedite the process, send me your resume and I can get starting arranging an interview for you right away.

Inventory Coordinator
Orthopedic Surgery Center of La Jolla
Full-Time, monday-friday, 6:30-3:00
Starts at about twelve an hour, full medical/dental benefits, quarterly bonuses, gym membership reimbursement, 25 paid days off a year, and catered lunch every day.
This is overall an awesome job, it can be mind numbing sometimes but what isn't....Duties include: receiving/stocking/ordering surgical supply, chart data entry, assisting with patient moving/positioning in the OR, room turnover, etc. Personally, I have enjoyed the job immensely, and it has been a tremendous learning experience for me.

Good Luck with Finals!!!!!

So I didn't decide by the fifteenth. I lost a hundred dollars but I just couldn't do it. I suppose it is very rude of me to continue hanging on to two spots, but given that I was only notified of my USC acceptance on May 1st, it just wasn't enough time.

I'm trying to take actions to get everything sorted out. My main problem with VCU was possible complications obtaining a satisfactory residency. So I wrote to them and requested the match list. After seeing it, I feel a lot better about this concern. Of course many VCU graduates stayed in Virginia but that makes sense considering that many were from Virginia in the first place. I did see (albeit sparingly) some great places on the list including Hopkins, UCSD, UCSF, Yale, Children's of Orange County, etc. I may be so bold as to guess that the people going to California may be the people who came from California in the first place. I know that I will probably want to return to SoCal if I leave. So anyways, it looks like good residency matches from VCU are definitely doable. So that's good......
As far as USC, one of my main concerns is the support network provided by faculty and administration. In my secondary to them, I had mentioned that I was excited about their new department head of psychiatry, Dr. Carlos Pato. He has done some amazing work with the genetics of neoropsychiatric disorders. So just to test the waters a little bit, I have written to Dr. Pato and indicated that I would be thrilled to work with him as a medical student there. So we'll see if even writes back and what he has to say.

That's about all I've done so far, but it's better than nothing. I may cruise up to L.A. some weekend soon and give it all a second look. I know I don't have too much more time to decide. There is a pre-orientation thing at VCU on the 23rd of June, and that would also be the only time I would have to get an apartment.

Meanwhile, I am so frustrated with all this financial aid paperwork. Not only is there the FAFSA, but individual applications for each school, and another horribly long application at needaccess.org that Rochester and Dartmouth use. I also have to send out copies of mine and my parent's tax returns, and even provide a freaking credit report. Uggg. Does this crap ever end? Seriously.......

Hey everyone!

Sorry I've gone AWOL on you. But if I have any readers left among you, here's the latest news from the front lines......

I got accepted to USC just a couple weeks ago ( I was soooooo about to kill them for taking so long), and a couple weeks before that I got placed on the alternate list at Dartmouth. So all the news is finally in, and I can stop checking my mail and e-mail obsessively. So what's the next step?

Well, I suppose I have to choose now between USC and VCU, but to tell you the truth my heart has already made its decision. I LOVE VCU! Unfortunately, my all too analytical, scheming mind is having some trouble with that decision. I obviously know that I'll be happy at VCU, but I have to wonder if choosing the much lower ranked school will affect my future in any adverse ways. For example, and probably most importantly, my ability to obtain the residency that I want. I know I don't want to go into family practice, and I'm seriously thinking along the lines of neurosurgery so........... hhhhmmmmmm. I don't know. This really sucks. I'm barely into medical school and I'm already plotting out how and what I'm going to tackle after that. Does it ever freakin end?

I guess I do have a lot of factors to consider, and this will be a very important decision that I must make soon (May 15th?). Plus what if Dartmouth comes through for me sometime during the summer? Could I honestly say no to Dartmouth?

arrgggghhhhh!!!!!!!!!!!!!!!!!!! It hurts!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! All this spinning around in my head has got to stop. I really can't remember the last time I had to make a completely life-altering decision. What a bummer, yet a great blessing all at the same time, to even have any choice at all.

I will try to write more often, not that I will have much news to report, but at least for my own sake. However, if you are interested in the twisted inner-workings of my mind as I struggle to come to an endpoint on this, then stop by anytime.

Why don't I get a spring break?

Hey everyone!

So I got a last minute interview invitation from Drexel, and that makes six out of eighteen, or a respectable 30% return on my secondary investments. I scheduled it for April 12th, but guess what? I won't be going to it, or to New York Med for that matter, because yours truly has gotten an acceptance to medical school!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I got one of the last ten out-of-state spots at Virginia Commonwealth. I also got waitlisted at U of Rochester, which isn't too disheartning. How exciting is this people? I can officially cross the bridge and call myself a med student. How awesome! Of course I'm still hoping for USC or Dartmouth, but that news won't come for a few weeks I suppose.

I really did like Virginia Commonwealth a lot, much more than I ever expected, and that makes me completely comfortable with the idea of going there if that's what happens. I am so happy, nervous, excited, and scared, all at the same time. I am excited about the prospects of this new adventure, at the same time I am crushed to be leaving San Diego in a few months. I actually have started to get teary-eyed when I drive around seeing all the places that I have loved for the last six years. Yet.......I can't be afraid of change and what it will bring to my life. It's med school for gods sake!

But don't be surprised if you see me around campus the next quarter. I plan on taking a couple of classes after work, via UCSD extension (gotta keep the brain from liquidating you know). You may see me standing wistfully in front of Geisel, where I loved my eighth floor studying nook. Or maybe sitting cross-legged, a tear running down my cheek, in the Muir courtyard, where I did all of my serious thinking. Or even standing in front of Peterson Hall, looking a little traumatized, as I reminisce trudging through that damn O-chem sequence. Who knows? But I'll be out there.

Stay tuned for news of USC and Dartmouth. It won't be long now.........

USC interview and the onslaught of rejections...

So I had what will hopefully be my final interview last friday at USC. I have one more, at New York Med, scheduled late march, but with any luck I will have gotten an acceptance by then and I won't have to go. But USC was pretty cool actually, I liked it way better than I ever thought I would. The Health Sciences campus is about four miles away from the main campus, and it is right across the street from L.A. County Hospital. So, no, it is not technically in the ghetto per se. (Compton, Long beach, Inglewooood.......Dr. Dre anyone?) The medical school is really quite attractive and well laid out. It is also right next to the USC University Hospital, the Women's and Children's Hospital, and the Norris Cancer Center. So right there, within a three block radius, is an extremely broad range of environment, patient base, and specialty for a medical student to gain experience in. And just to mention the obvious, anyone who is interested in emergency medicine and trauma would be in absolute heaven.

But anyways, I showed up about nine (after staying in Chinatown the night before) and had my faculty interview at ten. This was the first instance in which I have not interviewed with an M.D., but rather an R.N./M.S. from the department of psychiatry and behavioral sciences. Kinda wierd, huh? But she was really great, and told me that she helps teach 3rd year clerkships in psychiatry. The interview itself went pretty flawlessly. A lot of the same old questions, which at this point my answers to are very smoothed out and clearly articulated. I had a hunch the night before that I was going to get the managed care question (I knew I couldn't escape four interviews without it coming up at least once), and of course it did come up. Luckily, she left it pretty open, and at the very least I was able to show that I'd given the issue some thought and that I'd considered the practical implications and impact it would have on my practice as a physician. Yay! So no big surprises there at least.

The tour and lunch were a nice change from what I had been experiencing at other schools. The tour wasn't too long and my feet weren't killing me at the end. A brief walk-through of LA county medical center proved a little disturbing (metal detectors and all that), but what do you expect? Even more disturbing was the fact that our 2nd year tour guides showed us the gross anatomy lab (I'm pretty sure that's illegal), complete with about forty cadavres covered in white sheets. We all stood in there, amidst these cold metal tables and buckets containing saws, retractors and god knows what else, for about five minutes while our guides blabbed on about something. I actually felt myself getting all warm and my heart speeding up! I was pretty creeped out. I'm glad to know that USC is a school that has a memorial service following completion of you-know-what. Anyways, much nicer to mention is the lunch we had, at the ooh la la "faculty club" complete with nicely dressed servers, menus, and actual silverware. So much better than the hospital cafeteria...... Too bad if I went there I'd probably never see it again.

Finally, I had my med student interview. I can't believe it , but they had me interview with a first year! It was a little awkward at first, given that this guy had no clue how to interview anybody, but we both relaxed and had a pretty smooth conversation for over an hour. I can't believe though, that a first year's opinion would have much impact on my admissions decision. But who knows I guess? It went well, so no worries. After that, I hopped in my car and went through three hours of stop and go traffic (good old interstate five never lets you down as far as that's concerned.......sigh.)

Other than that, I've had a lot of bad news. But it's to be expected at this point. I pretty much knew I wasn't going to get any more interviews this late in the game, so.......
Rejections from Stanford, UPenn, and GW came in. Also UCSD and UCSF both let me off the "hold for interview status". I guess my letters didn't work, damn it. But I know they work sometimes. I know a doctor at Scripps La Jolla who got rejected from UCSD pre-secondary, wrote an appeal, got the secondary, got rejected again post secondary, wrote an appeal, got the interview, got waitlisted, and ultimately accepted off the waitlist. So it happens, just not to me I guess. It really does hurt more to have gotten that close (i.e. hold for interview) only to ultimately get let down. Sigh. So close I could almost taste the in-state tuition. I guess it's looking like private school for me, and a hell of a lot of debt. But in the end, I have nothing to complain about. I still will (barring any disaster) most likey be attending a great medical school come fall. Either Rochester, Dartmouth, USC, or VCU. When I think about the depressing statistics of medical school acceptance, and compare that to my irresponsible behavior during much of the application season, I am so thankful that my prospects are as fruitful as they are.

So nope, nothing to complain about at all.