Sage Advice

When I was little and people asked me what I wanted to be when I grew up I said "a doctor".

It wasn't until I started medical school that I realized how non-specific of an answer I was actually giving people.  Doctor.  Internist (I didn't even totally understand what that meant until M1 year)? Pediatrician? Surgeon? Pathologist? Orthopod? Psychiatrist? Family doc? Not to mention advanced fellowship training . . . cardiologist? intensive care doc? allergist? neonatologist?

The list is literally endless.

I've always had an inkling about what I thought I wanted to do.  I wanted to be a pediatrician--or so I thought.  It then occurred to me that this was likely because for the first 18 years of my life, literally from birth to adulthood that was the only physician I had ever seen.  Naturally thats what I thought I wanted.

When I started medical school I thought it was imperative to keep an open mind, there are fields of medicine that exist out there that I have yet to even discover as potential careers.  As a medical student prior to clerkship years how can you possibly already know what you want? Granted there may be those few who since birth have known what their one true passion is, what about the rest of us?

I'm itching to start my clinical years and put the pre-clinical years and step 1 behind me and forage ahead into the world of medicine.

I had the opportunity to spend some time shadowing in the NICU (neonatal intensive care unit) and struck up conversation with one of the Neonatology fellows.  One of my favorite questions to ask of people above me in the totem pole is "When you were in my shoes, what was one thing you wish you had known?"  He gave me one of the best single lines of advice I think I have received in all of medical school thus far

"Don't look at the fellows or the residents, we are all exhausted.  Look at the attendings.  Could you see yourself doing what they do for the rest of your life? Do you like them?"

So simple and in some ways so incredibly obvious.  I hadn't really considered things from that perspective, the one that lumps medical students in with residents and fellows.  Really its just a extension of the education spectrum.  They're still in the grind, they've got their eyes on the same prize as us.  Being a real doctor.

Maybe though when I finally reach attending status I'll be able to look back and chuckle and realize its not all that different on the other side.  Until then I've got my eyes peeled.

May The Odds Be Ever In Your Favor

PAUSE: STUDY. EAT. SLEEP. RINSE. REPEAT x 30

REWIND: My alarm was blaring, it was 5:30, I needed to get up. I felt around my nightstand for my glasses and grappled to put them on my face. Todays the big day. I trudged my way to the bathroom and took a quick shower--a burst of hot water propelled me further into wakefulness.

As I got dressed my mind was racing. It was racing with all of the last minute things I forgot to look up. I quickly ran to my desk and flipped to the equation section of First Aid. Waves of panic washed over me in a rhythmic beat. Clearance. Loading Dose. Maintenance dose. Renal Plasma Flow. Glomerular filtration rate. Inulin. PAH. As I scribbled those down to look over on the ride to the testing center my mind came to a screeching halt and starting leading me down another corridor of confusion. P450 inducers? What were they? Phenytoin, Rifampin. P450 inhibitors? Grapefruit juice. There are more, where is my mnemonic? I raced to the page where I knew I had scribbled a helpful note in the corner. Glancing over the list a momentary sense of relief, I knew them.

Flipping through the pages of first aid at every turn I felt like I was sinking. Did I remember the material? I don't know. My roommate was somewhere in the background packing a lunch and calmly getting ready. I'm not that person. I can't stay calm in those last moments and hand the reigns over to fate, not just yet. I believe in cramming till the 11th hour. Some people say you know what you know. I whole heartedly disagree. How many times on an exam are you searching for just that one little tidbit? Sometimes I find that little tidbit floating in the ether of my mind because I happened to see it as I unceremoniously shoved my notes into my bag before entering the exam room.

The exam itself was quite a marathon but in all honesty I don't even know where the time went. Not to say that I was completely rushed and racing the clock, but it didn't feel quite as long as I was expecting. It was tiring and long and at certain points I felt downright bored.

I did what I could to prepare, based on what I had seen and heard. Uworld? FA? Goljan? Pathoma? Pharmcards? Microcards? CMMRS? Rapid review path? So many resources and so little time.

The step 1 was like no other exam I have ever taken, I don't even know how many questions I answered with 100% confidence. I hesitate to share my study plan until I receive my score.

I set my goals high at the start of all of this, I walked away from that exam hoping, begging and pleading the universe for a pass.  Walking out of that exam felt very much like the end of the road for some of my hopes and dreams but nobody walks out of that feeling like a million bucks.

Stepping out of my testing center and onto the busy sidewalk I was again struck by the realization that it was only my life that had been on pause for the last month.

I'm really hoping that somehow Effie Trinket's words ring true for me, but until then I'll be holding my breathe. (I apologize for the Hunger Games reference, but I had to, I can't say taking the step 1 is all that different than being thrown into the arena)

For now I'm shifting my focus to gearing up for clerkships.  Ready to hit PLAY again.

Into The Wild

Studying for the step 1 has to be the most daunting academic challenge I've ever had to overcome.

I'm finding that the stress of it has as much to do with the grueling hours spent and sheer quantity of material as it does the finality of the whole thing.

If I mess this up then I've essentially ruined any shot at being a successful doctor, a good doctor.  Thats how it feels.

Similar to any standardized test in the past I am confident that at some point in my life I will look back on it and chuckle--vaguely remembering my score +/- 20 points because thats how little it will matter.

That thing is starting to happen where I'm violently oscillating between having too much time and too little all in the matter of hours. (clearly one of the stages of studying for me, for more check out this prior post: Note To (Future) Self

Times like these are a testament to the resilience of the human body and brain or more accurately, plasticity.  A month ago--studying for finals--more than 4 hours of studying felt like too much.  Anything less than 12 hours feels sub-par right now.  Oddly there aren't enough hours in the day for what I've set out to accomplish, everyday I'm surprised by how much I intended to do that remains unchecked on my to do list.

There is something to be said for slipping outside for a few minutes and getting some fresh air and a reminder that the earth is still spinning, people are still living their everyday lives even though it feels like mine has come to a standstill.

A Lot of People Go To College for Seven Years

Don't we all wish it only took seven years?

Thank you!

Elated to have been chosen as one of the Top 30 Healthcare Blogs of 2012 over at Top Masters in Healthcare

Also check out this feature over at The Goldberg Files: Frustration in Medical School.

Thanks everyone for the positive feedback and stay tuned for more of my ramblings that delve into the highs and lows of preping for step 1.

Note To (Future) Self

As a student I often find myself wondering how a professor or an attending could have the expectations that they do for us.  I am particularly perturbed by this because I know for a fact that at one point they were in my very shoes.  How then could they have forgotten how it feels to be on the other side?  I am writing this post in hopes that my future self will stay connected to this, to remind myself as I trek through this journey where it all began:

***

The test is in 3 days, no big deal.  Study.  Flip through notes. Eat. Where did the day go? Dinner. Yawn. Two more days. Sleep.

Two days.  Geez.  I'm getting a little concerned that I'm going to know too much for this test.  Seriously, 48 hours to cover this material? Thats more than enough. TV break.  Review notes. Sleep

One day. Oh my god.  What happened? I had three days, now theres 24 hours.  If I sleep four hours that gives me 20 hours to review.  Theres about five sections.  Four hours per section.  That doesn't seem like enough.  I start frantically flipping through the pages of the text book realizing five minutes in that I have absorbed nothing.  I'm just flipping.  Where is the day going? Its already 1 pm.  I woke up at 7.  By now I should have finished reviewing half the material.  I start counting: 1 pm, 2 pm, 3 pm . . . . 11 pm, 12 am, 1 am.  Thats twelve hours.

Okay good. 12 hours, that should be enough.

Somehow its 8 pm.  I've managed to eat my way through a bag of candy and 3 cans of soda.  All of a sudden totally irrelevant, menail tasks became high priority.  I absolutely had to reorganize the bathroom drawer.  It was happening before I could stop and I had to finish.  Its okay, I've gone through most of the material.

There is an ebb and flow to the panic and serenity.  A little dance, my heart rate fluctuates between tachycardia and bradycardia.  One second its beating in my ears as I see the minutes of sleep slowly slipping away as the night grows closer and my pile of work remains the same.  Another I feel on top of the world, envisioning a 99%.  High pass for me.  Stress. Relax.

Finally I decide I need some sleep.  I'm not one of those people who can pull an all-nighter.  I need a little shut eye.  I drift off to sleep with a page of notes clutched in my fist.

The clanging of my cell phone awakens me from a non restorative sleep and I bound out of bed as the panic washes over me again.  Two hours.  Theres only two hours left.  Is any of this actually going to stick in my brain now? Should I just stop? No.  I know these little details I can't remember, if I can just come up with a way to remember them.  Some mneomonic: krazy kittens gurgling the night.  There is no way I'm going to remember all of this minutia, there is no way they're going to ask about that.

As I reach the exam room the stress reaches its zenith as I pick up bits and pieces of other peoples conversations.  Every so often I heard a tidbit that I don't know and a fresh wave of panic washes over my body.  Its too late now--I'll just have to guess if that comes up on the test.

"You may begin"

I hate that feeling.  The on where you remember where the answer is.  Its on the bottom right corner of the 3rd page, you highlighted it and scribbled a note next to it.  Thats all you know.

Thats the worst.  When you feel like you should have studied just a little bit more.  If you could have just pushed yourself a little bit harder.  Then you wouldn't be sitting here with an exam in front of you and absolutely having to guess on questions.

Somehow your body goes into exam mode, you just start churning out answers.  The test taking monster inside you takes over.  Process of elimination and educated guesses slowly dilutes down to sheer dumb luck and guessing.

The walk home from the exam is awful.  First you have to escape the group of students bickering about question #68.  How do they even remember? I don't want to know.  I jam my earbuds in my ears and high tail it out of there.

On my walk home I pull out my slightly crumpled study guide and race to the bottom of the 3rd page, where I highlighted and scribbled a note.  IL-10.  Thats what it was.  How could I not remember? There's something wrong with me.

What if somehow I literally answered every question wrong? Statistically pretty unlikely but even at 25% would be awful.  What if I fail? What am I going to do? I thought I studied, I thought I knew the material.

I hope they post grades soon.

3 days later . . . .pass. Phew.  Wasn't so bad was it?

***

Panic. Fear. Pressure. Self doubt. Confusion. Restlessness. Sheer exhaustion. Those are all a part of this temporary condition but the fact of the matter is to us, at that particular moment they are all too real.

I understand that some of this is a part of the package.  Medical school is a grueling undertaking I juts wish more attendings and professors could take a second to reflect on what it felt like to be where we were--just to ease the pain for us a little bit.

They say "be the change you wish to see".  Someone check in with me in 20 years and see how thats going.

Comic Relief I

Some of my classmates can't resist the urge to already be appending an MD to the end of their names--this is how I feel about it.


Have any burning questions about med school? About classes, life, professors, family, lectures? Anything at all feel free to post a comment or shoot an e-mail at WaitingForMD15@gmail.com