Reflections of a DC Medical Student

Hispaniola

noreply@blogger.com (DC Med Student) — Mon, 23 Jun 2008 17:18:00 +0000

Shortly, I will be traveling to the island of Hispaniola to participate in a medical mission to the poorest country in the Western Hemisphere.

Haiti has been in the news recently as it has been hard hit by the global food crisis. There have been riots in the capital city of Port-au-Prince, as well as smaller demonstrations in other parts of the country. You can watch a well produced video on the subject here.

I've been interested in visiting Haiti for a long time now, especially after reading Tracy Kidder's Mountains Beyond Mountains in 2003. Of course, I have had many reservations about making the trip. You'd be nuts to travel to a country in economic and political turmoil, right??

But, part of me feels that I would really enjoy this type of work, to use my skills where they are most needed. I want to see if this is something I could really do in the future on a more long-term basis. I also want to see the beautiful parts of Haiti that we don't see or hear enough about.

I was worried about security, but I will be traveling with physicians who are very familiar with the country, and we'll travel with armed security at all times. We'll visit 5 clinics and 2 orphanages throughout the country during the trip.

The thing I'm most concerned about now is the heat and humidity. It's currently about 100 degrees Fahrenheit with 84% humidity in Port-au-Prince. I've been told I'll never complain about D.C. summers ever again.

Step 1

noreply@blogger.com (DC Med Student) — Fri, 20 Jun 2008 07:44:00 +0000

5:46 AM
It's the morning of the day I have feared for the past couple of months. Clearly, I am so anxious about taking Step 1, that my body won't allow a full night's sleep. A couple minutes pass before I manage to get my body to sleep for another 45 minutes.

6:31 AM
There's enough light coming in through my bedroom windows to keep me from sleeping much longer. Besides, I can feel the adrenaline coursing through my body. I get out of bed, go through my morning routine, sit down at my desk (a dining table in a former life) and begin to go over some last minute notes.

7:30 AM
What to pack for lunch? PB&J on a plain bagel, two apple sauce cups, some almonds, some fig newtons, a banana, some apple juice, and some water. That should do. No, wait: spoon.

8:00 AM
Sh*t!! I have to finish getting dressed, pack my First Aid (hmm. . . security blanket?), make sure I have my admission ticket and proper ID, and then run out the door and up the street to catch the bus. Where are my keys??

8:17 AM
Knocking on the bus doors that just closed in my face. Why do metro bus drivers do that? It's not like he didn't see me running up beside the bus! Of course, the 8:22 AM bus would be early today. Better early than late, I suppose.

8:53 AM
I arrive at Prometric thirty-seven minutes before my scheduled exam time. Another "Stepper" arrives at the same time (you can just tell). Hmmm. . . he's kinda cute. He opens the door and says, "After you." And he has manners! I sign in with building security and take the stairs up one flight to the testing suite. I sign in with the front desk, put my stuff in a tiny locker, and sit in the waiting area until my name is called. Somehow I lost Mr. Manners.

9:15 AM
My name is called and I'm directed to another room where my picture is taken, and a computer is assigned to me. I can see the testing room to my left through two large windows and a glass paneled door. I receive two laminated sheets and dry-erase markers, as well as a hideous pair of orange ear muffs. I know I'm going to use the sheets to work some calculations, but there is no way I'm putting those 70's-orange, germ-crusted muffs on my head.

9:20 AM
I'm escorted into the testing room and to the cubicle where I will spend the next 8 hours. With the two dozen cameras and microphones hanging from the ceilings, I almost feel like I'm on Big Brother. Almost. I sit down, place the fugly ear muffs in a corner, set the laminated sheets and dry-erase markers to my left, enter my CIN (Candidate Identification Number) in the field beneath my picture on the monitor in front of me, I take a deep breath and . . .

5:23 PM
Time has ended. I'm kicked out of the survey section. I exhale.

-----------------------------------------------------

You know, it wasn't that bad. No really, it wasn't that bad. Of course, there are many things that I wish I would have done better in terms of preparation, but there were no surprises as far as question topics go. The questions I received on Step 1 were all on common diseases, disorders, syndromes, bacteria, viruses, etc. The biostats questions were straight forward calculations (incidence, positive predictive value, negative predictive value). There really wasn't a question that made me ask, "Where is this coming from??"

Having said all that, I know that I missed many easy questions because I did not know the details well enough. I think I spent too much time trying to learn everything, instead of concentrating on the high-yield stuff -- and knowing it well. Like, really well. I had no problem identifying the pathology, but too often, I forgot the exact mechanism. For example, I knew one patient had Factor V (five) Leiden, but I forgot that Activated Protein C in patients with this clotting disorder is unable to inactivate Factor V, which leads to the large blood clots. Yes, missing that one hurts.

My advice to all those who are about to take or will take Step 1: Use your time wisely.

First, and foremost, SKIP THE TUTORIAL. How many times have we all heard this now? And why didn't I listen? [sigh] You will add 00:14:57 to your 45 minutes of much needed break time. Do you know how hard it is to eat a PB&J bagel in 10 minutes?? Not fun.

Lastly, push yourself. Maintain the pace you nailed down while you were doing all those practice questions. I found that I spent too much time on too many questions, trying to make sure that I selected the correct answer. If you get to a question and have no clue what the answer is, mark the question, click your favorite letter and move on. If you have time, go back to it. Likewise, if you get to a question (of course, you're always reading the last line first -- this is very important and can save you from reading whole paragraphs) and you do know the answer, click it and move on. Don't reread the question or talk yourself out of the answer.

Click and move on.

Trust yourself.

Reset

noreply@blogger.com (DC Med Student) — Tue, 17 Jun 2008 07:31:00 +0000

That's right. I want a "do over." I want to start afresh. But, not really.

You see, I've been tossing and turning in bed for hours, unable to sleep, because I fear that I did not pass Step 1. Being the sleep-deprived medical student that I am, I should be sleeping soundly now that that hypertension-, palpitations-, diarrhea-inducing examination is behind me, right?

Au contraire, mon frere!

Instead of catching up on my Z's, I've been doing the whole "coulda, woulda, shoulda" thing -- with some "shouldn'ta" thrown in for good measure. I could have been more disciplined. If I had a couple more days to study, I would have been able to answer more questions -- correctly. I should have studied more. I shouldn't have been so engaged in the presidential primaries. I shouldn't have watched all those episodes of Top Chef, Hell's Kitchen, The F-Word, The Office, Grey's Anatomy, Project Runway. . .

But, alas, we can't turn back the clock. What's done is done. And, frankly, I wouldn't want to go through the misery of the past couple months ever again.

Alive

noreply@blogger.com (DC Med Student) — Wed, 02 Apr 2008 03:07:00 +0000

Wow. Over four months have passed since my last post. I apologize to all those who have stopped by looking for a new post only to be disappointed. Also, I want to say Thank You to all readers for your continued support and emails. I look forward to writing on a more regular basis once classes are over (3 more weeks!). At that time, I will have time to devote to writing again. Much has happened over the past four months that I want to document and share with you.

Second year is a beast. The schedule has been relentless. The volume of information. . . obscene.

I have eighteen days of lecture, one quiz and three exams remaining before I begin some major USMLE Step 1 studying. I will be taking the Step 1 in early/mid-June. If you're a praying person, Pray for me! Otherwise, please send positive thoughts and energy my way.

As the school year comes to a close, I am feeling very much alive. I've established a regular sleep schedule that allows me to get to class on time when I need to (and I'm much more productive), I'm feeling healthy (eating right, exercising and all that jazz), I'm getting my weekly dose of TV (ANTM and Oprah's Big Give), spring is here (the weather was gorgeous today), and I have an international medical mission to look forward to over the summer.

Again, thank you for stopping by.

Blepharospasm

noreply@blogger.com (DC Med Student) — Mon, 19 Nov 2007 02:27:00 +0000

Less than 12 hours from now, I will be taking yet another set of examinations. As usually, I am not concerned about the first, which focuses on diseases covered during small group discussions, but I am concerned about the second. The second exam tomorrow is another customized NBME exam. Though, I did well on the first customized NBME, I'm worried that the faculty "went easy" on us since it was the first one.

My gut is telling me that the faculty is going to go to the opposite extreme this time -- that they've selected the toughest questions from the available pool. My gut's telling me that I don't know the material well enough to execute another knock out performance. Then again, my lactose intolerant gut may just be cursing me for that scoop of chocolate chip cookie dough ice cream I just ate.

Why did I do that? Why??

But, I know I'm really stressed about this exam because my eyelids keep twitching. That's right, my left upper lid and, sometimes, my right lower lid have lost their mind. It's the most annoying thing I've ever experienced. Every now and then, I have to stop reading because the twitching is so out of control!

I decided to look further into this eye twitching, so I looked up "eyelid twitch" on the trusty MedlinePlus Medical Encyclopedia and discovered a great new medical term: blepharospasm. Blepharospasm is the repeated, rhythmic contraction of the eyelid muscles. It's most commonly caused by fatigue, stress and caffeine. Check, check, and check.

Apparently, it can get to the point where the eyelids actually close and then re-open, i.e., you blink. Let's hope it doesn't get to that point. I don't want the professors, or fellow classmates, thinking that I'm winking at them. Though, now I have a good excuse for when I'm in one of Dr. F's lectures. "No, I'm not winking at you. I have blepharospasm."

Recognition

noreply@blogger.com (DC Med Student) — Thu, 15 Nov 2007 08:27:00 +0000

Everyone enjoys having their hard work acknowledged. It boosts morale. That's why I think an honor and awards ceremony, like the one held by my school this week, is so important.

As medical students, we live crazy, often unhealthy, lives. It's a life full of sacrifices and one that you have to go through to truly understand and appreciate. With all the time spent in lecture and lab and small group discussions, not to mention the countless hours spent studying, it's easy to lose sight of where you're going. After listening to two distinguished speakers who have been where I am now, however, I feel reinvigorated. I can once again see where my hard work could lead if I just keep at it.

Although the ceremony ran long, as these types of events tend to do, I was pleasantly surprised by how inspirational it was. My class all but swept the awards. Watching the top 5 or so students in the 2nd, 3rd, and 4th years go up for their awards made me want to work harder so that I too could receive one of the big awards (cash prizes are nice, y'all) before I graduate. I guess it was the spark I needed to get my competitive side burning again.

Being surrounded by these amazing physicians and future physicians me realize how much I can and already have accomplished. After all, we made it to medical school and are still here. (And, I was presented with an award (sans cash, but nice plaque) in recognition of my work over the summer. ) As one of the presenters said, "You all get so blinded by the workload and exams and sleepless nights that you can't see how high you're already flying."

Pain

noreply@blogger.com (DC Med Student) — Wed, 14 Nov 2007 03:29:00 +0000

Anyone else out there suffer from chronic pain? Or experience pain on a fairly regular basis?

For well over three months now, I have been been living with pain in my hip and lower back. At first, it was just a mild pain. I was aware of it, but it didn't really bother me much. Kinda like a loud neighbor watching WWE at 1am on a weeknight. He's obnoxious, but not so annoying to make you go next door to ask him to keep it down. Lately, however, the pain has become more of a moderate pain with episodes of severe pain.

Shortly after one of my most recent exams, I made an appointment at the student clinic to see if they could tell me what was wrong. Of course, I'm thinking I have chondrosarcoma or some other ridiculous differential. After taking the history and performing the physical examination, the physician believes otherwise (shocking, I know) and sends me home with prescriptions for an anti-inflammatory and a muscle relaxant.

While I did experience some pain relief after taking the drugs, I had to stop taking them after the third day. Why? Because I kept waking up in a poodle* of drool, face down in my book, page stuck to my cheek. These drugs made me so drowsy, I couldn't get any studying done. So, they had to go. I can deal with the pain.

I blame the pain on medical school. Going through first year, you think you have it rough, but then you get to second year and realize first year was like water-skiing on glass. There seems to be no time to do anything else but study this year. I tried to stick to a healthy diet and exercise plan, but that didn't last long. I wake up, go to school and sit through lectures. Lectures end, I go home or to the library and sit and study. I go to bed, sleep in the fetal position (or at least I fall asleep that way) and my body has been in the same basic position all day. I need to recommit to exercising and eating well because I can't let my health deteriorate.

Also, I think I finally understand the wheeled backpacks. I know, scary! But, I'm just one muscle spasm away from buying one. I'll make it look good, though. I know I will.

* Just noticed that I wrote "poodle" instead of "puddle." LOL

Dr. F

noreply@blogger.com (DC Med Student) — Sat, 10 Nov 2007 17:30:00 +0000

Fetching. There isn't another professor that captures more interest than Dr. F. When he's scheduled to lecture, we all show up to listen. . . and stare.

Everyone's had their own private love affair with Dr. F at some point during the first year and a half of medical school. For some of us, that love affair has never ended. I mean, the man commands attention by simply walking into a room. For starters, the man is Fine: tall, handsome face, great smile, and fit. No one makes a long white coat look better. (Yet.)

Once you get past Dr. F's mesmerizing beauty, you realize that there's substance to match. There is just something special about someone who can engage you in a subject and lead you through a concept in a clear, logical manner. His lectures and PowerPoint presentations match or, dare I say, exceed those of Dr. A, oftentimes clarifying concepts taught poorly by other professors. He is the king of physical diagnosis, providing us with tips on how to discriminate between, say, ehrlichiosis and RMSF. And, he holds comprehensive reviews to make sure we are retaining the information he presents.

Essentially, Dr. F is our dream instructor. Our very own McDreamy, if you will.

Dating II

noreply@blogger.com (DC Med Student) — Wed, 07 Nov 2007 02:10:00 +0000

Now that fall has firmly established itself and the temperatures are consistently low, my classmates are quickly pairing up like tubulin subunits. (Wow. Did I just write that? Well, can't stop now.) I think that classmates are looking for that special someone to snuggle up with during these cold fall and winter nights. You can see these alpha-beta dimers all lined up in a row in the center of the lecture hall -- a microtubule of sorts, lectures and whispers being passed from one end of the row to the other.

It seems these intra-class daters have formed their own little club, some of them even vacationing together this upcoming holiday weekend. They are having fun together, and I wish I could join in the fun.

Dating within the class is working for a healthy number of classmates. The more I think about it, the more sense it seems to make: (1) you have the same examination schedule, (2) you understand the pressures, stresses, etc., (3) you can spend a lot of time together, even if it's spent in class and/or studying.

But what if things go wrong? That question always comes up, right?

Well, I don't know. However, class attendance has dropped precipitously, with attendance being high only for Dr. A-type professors. Therefore, if things don't work out for our intra-class daters, chances are they'll only see each other on exam days and maybe the occasional lecture. Furthermore, now that one of our exams each unit is a customized NBME exam, you really can teach yourself by reading Robbins, studying board review books, and doing practice questions through prep sites such as USMLE World.

I want to be paired up too, but I think there's a mutation at one of my dimer binding sites.

Hypochondriasis

noreply@blogger.com (DC Med Student) — Tue, 06 Nov 2007 03:41:00 +0000

When I started medical school, I told myself that I wouldn't become one of those silly medical students who believes they have every recently learned disease. HA! Who was I kidding?

As we go through the organ systems, there are moments when I'm convinced that I have at least one or two of the diseases mentioned. OK, maybe four or five.

Gee, my hip has really been hurting. I think I have chondrosarcoma. What? My x-rays show no acute pathology? Are you sure?

Gee, I seem to have some discoloration in my skin. . . acanthosis nigricans? Could it be paraneoplastic (yes, it's always cancer)?

And now that I have my stethoscope. . .

Hmm, is that an S3 gallop? No, definitely S4. Maybe I have hypertrophic cardiomyopathy? See, not having enough time to run is a good thing after all .

Hmm, did I just hear crackles? Pneumonia-- no, interstitial lung disease-- no, pneumonia.

Fall

noreply@blogger.com (DC Med Student) — Sun, 04 Nov 2007 19:29:00 +0000

Just as the trees (the deciduous ones, at least) stand naked in the fall after losing their leaves, I feel that I stand bare and exposed when the temperatures drop and the nights grow longer. I don't smile as much. I don't laugh as much. I sleep way too much (that's 7-8 hours for a med student).

Though I love fall weather and fashion (who doesn't love layers?), fall also hails the beginning of what feels like a barrage of holidays. And not just any holidays, but the most hyped holidays of the year -- holidays that you're supposed to spend with your family: Thanksgiving, Christmas, Hanukkah, Kwanzaa, etc.

My mother died on Thanksgiving eight years ago. She was the only family, flesh and blood, that I knew. Every year, the holidays just seem to remind me of how lonely I feel without her. Pair that with the isolating nature of medical school life, and it's obvious why I feel so alone during this time of year. At the core, I'm still just a child that misses their mommy.

In addition to the holidays, the material that I'm currently studying is a reminder of my mother's death. I read about and study the pathophysiology of congestive heart failure and pulmonary hypertension, I hear "cor pulmonale" and "dyspnea" and "ventricular fibrillation," and I can't help but think back to how my mother had to sleep propped up by pillows (orthopnea) and how swollen (edema) she looked the last months of her life. There's just no escaping it.

Today is All Souls' Day, so at church this morning I was again reminded of my loss. However, I was also reminded that I'm not alone in my grieving. We all experience loss during our lifetime -- it's part of being human. It was a comforting reminder.

I'm sure there are others in my class who have experienced the loss of a loved one, and it's probably just as hard for them to learn and, in a way, live through the disease or process that took their loved ones life. In fact, I'm sure there are many medical students and medical professionals who have to deal with a similar situation.

We are not alone. I am not alone.

Trick?

noreply@blogger.com (DC Med Student) — Thu, 01 Nov 2007 01:59:00 +0000

Well, it certainly wasn't a treat.

Not two hours ago, I had two police officers, with guns drawn, at my apartment door asking me to come out with my hands up.

What's your name?

DC Med Student--I'm the tenant in this apartment.

Is there anyone else in there with you?

No.

Were you aware that your door was open?

No.

At this point, my landlord shows up from upstairs and confirms my identity. Apparently, he had heard movement and something drop upstairs when he arrived home from work. He called the police and had them come over to check things out. It doesn't look like anyone was in the house, and there certainly wasn't anyone in my apartment (on the ground floor), though it was kinda weird that my door wasn't locked and fully closed. Needless to say, I haven't been able to fully concentrate on studying since the police were here, but I can't find fault with my landlord's actions.

I live in a neighborhood that is experiencing growing pains from gentrification. And, as has happened in other neighborhoods (and there are many in DC) that have or are going through gentrification, there has been an increase in crime. For example, just last month, the new corner-store across the street which I frequent, was held up at gunpoint -- the two gunmen clearly taking advantage of the fact that this corner-store didn't have bulletproof plexiglass around the counter.

I love my apartment, but lately I've been thinking that it will probably be better to move to a safer area once my lease expires next year. This time, no windows or doors with security bars.

Hope you had a happy and safe Halloween.

Order

noreply@blogger.com (DC Med Student) — Tue, 30 Oct 2007 19:42:00 +0000

I need some order in my life.

While studying this past week, I felt like I was scrambling up a gravel slope, slipping two steps back with every step forward. I had an insane amount of material to go over for my three examinations. It was impossible for me to get through all of it since I had taken some time off (mental health days) to have some fun. My preparation strategy was to first get through the "big lectures," those in a series with multiple parts, and, if I had time, I quickly reviewed the small topic lectures. I also hit First Aid for the USMLE Step 1 HARD.

I didn't like feeling so behind on my studying. The stress was too much. At times, it was paralyzing. I would just look at my long "To Do" list and my stomach would turn. Life became so disorganized. My eating habits were horrible (I haven't had so much McDonald's in years) my sleep schedule was all messed up, and I took to studying in bed, which I'd rarely, if ever, done before. But, that's how bad it was. The stress and panic had lead me to believe that staying in bed would somehow save me valuable time. I slept very little, and when I would wake up, surrounded by my laptop and books and notes, I would just continue working. Insane.

Although I didn't get through all of the material, I still think I came out with a descent grade on these exams (knock-on-wood). It's not that they were easy, but I knew enough of the major diseases and concepts to work my way through the exam. I should get my grades by the end of the week. No matter what, it was worth the good times in NYC.

For this next unit, however, I think I'm going to take the advice of the education counselors and stick to a schedule. Every day, I'll either be in class or studying from 8AM to 5PM, I'll take an hour break for dinner, then continue studying until 10PM, and finally break for the rest of the night. After 10PM, I'll either exercise or prepare meals or catch up on my favorite TV shows. Or-- I almost forgot -- I'll post a new reflection.

We'll see how well I can stick to this schedule. I'm hoping it will lessen some of the stress and cramming that comes along with studying in the days leading up to exams. I'm also hoping that it will allow for guilt-free mental health days when I need them.

NYC

noreply@blogger.com (DC Med Student) — Tue, 23 Oct 2007 22:58:00 +0000

As you know, I was feeling a bit stir-crazy the past couple of weeks, so I decided to take a little trip to the Big Apple. It was the best thing I could have done for myself.

A friend from college met me at Penn Station around 1PM on Saturday, we dropped off my bags at her place, and then hit the city. We spent the majority of the afternoon and evening at the Top of the Rock (Rockefeller Center). The sunset and views from the observation decks are gorgeous! Unfortunately, I forgot my camera, but my friend had her camera and took over 100 beautiful pictures (two shown in this post).

At 8PM, we met up with another friend from college, who treated us to dinner and a night of bar hopping with his friends. We started off at Coffee Shop (Union Square) for dinner and drinks, made our way to Merc Bar (SoHo) for more drinks, and ended the night at Pegu Club (Village/SoHo) for some of the best cocktails I've ever had.

Without realizing it, we stayed out really late. It was past 4AM by the time we left the last bar. NYC is crazy like that. There are tons of people out and about at all hours. You can't help but lose track of time. I can see how it would be very easy to stay up all night. I love New York City!

Now that I'm back in DC, the stress level is slowing rising once again. I have an exam this week and two on Monday. Yes, I've come back to reality -- I'm a med student -- and it's not pretty.

The good news is that I don't think I'm going to be as stressed as I would be had I not made the trip to see my friends. Instead of feeling like I never get to go out and have fun, I have great memories and pictures from this weekend to look back on. I can't help but smile when I think of all the great moments. It makes it easier for me to now focus my energy on studying.

I played hard all weekend and now it's time to work hard.

SNAP!

noreply@blogger.com (DC Med Student) — Sat, 20 Oct 2007 01:42:00 +0000

[WARNING: Grey's Anatomy spoiler ahead]

OK, I just finished watching last night's episode of Grey's Anatomy: The Heart of the Matter. Callie (played by Sara Ramirez) was AWESOME!! She finally let Izzie have it. It was a beautiful thing. Seriously.

You feel terrible? You took advantage -- He was your best friend -- I tried to trust you. So much, I'd convinced myself that it was all in my head -- that I was crazy -- but I wasn't, was I? And then you pulled that thing in the cafeteria today -- It's not bad enough that you humiliate me by getting in bed with my husband, you have to humiliate me at work too. George may be the one who broke his vows, but you. . . We're women, Izzie; you did this to another woman. You took something from me. You stole something from me like a petty little thief. You are the one who should be humiliated. You are the one who should be ashamed. You are the one who should. . .

[Wait for it]

Don't you dare come to me for forgiveness, you traitorous bitch.

Shots

noreply@blogger.com (DC Med Student) — Thu, 18 Oct 2007 04:35:00 +0000

I could have used a couple shots (lemon drops, preferably) before going to the student health center for Tdap and Hep B vaccinations today. I'm such a baby when it comes to shots! I get all nervous and sweaty, and I feel like I have to get to know the nurse a little better before I let her stick me.

I'm sorry, What was your name again?

Oh! Are those pictures of your family?

Those eyeglass frames are great! Are they new?

Oh, yes, I'm sorry, I'm sure you're very busy.

OK, so my arm is going to be sore for a few days with the Tdap?

I'm right-handed, so, yes, let's put that one in my left arm.

OK. . . Yes, I'm ready.

That wasn't so ba-- The other arm, right.

It's so embarrassing, but I can't help it. I can't even look at the injections! I wonder how this is going to play out when I have to administer a shot. I've yet to be in that situation, but I don't think I have a problem giving other people shots. Just keep the needles away from me.

What can I say, I like my shots in a one ounce glass, not a syringe.

Consistency

noreply@blogger.com (DC Med Student) — Tue, 16 Oct 2007 02:16:00 +0000

I received the results for one of my exams from last week. The hard work payed off -- I got the H! It will be another week or so before I get the results for the customized NBME exam, but I'm pretty sure I got the H on that one as well.

Why can't I be more consistent? Why does it seem like I'm always on some sort of roller coaster?

My wish is to find that right balance that allows me to perform well in school, yet feel like I'm still participating in life. Currently, I'm either in multi-slacking (a la Seth Rogen in Knocked Up) or crazed-gunner (a la Hermione Granger in the Harry Potter series) mode. I need to find that sweet spot -- that Tiger Woods setting.

I wish I could, but I can't study non-stop week after week because after a week or two of crazed-gunner mode, I don't want to look at anything related to medical school. And then I fall behind and I'm playing major catch up. However, crazed-gunner mode seems to be the only way for me to get grades in the Honors range.

Friends have suggested a modified crazed-gunner mode, where I still study hard, but take a break every other weekend or so. On these weekends I don't study as much, but meet up with friends and get out for a while. That way I don't feel so isolated or like I'm missing out on life. I think they may be right.

So, on Saturday, I'm off to NYC to visit a friend for the weekend. That means I'm going to have to study hard all week because I'll lose some study time on the weekend. Hopefully, having "scheduled distractions" such as this will help me to feel more balanced and to perform more consistently.

Stir-Crazy

noreply@blogger.com (DC Med Student) — Sat, 13 Oct 2007 03:41:00 +0000

I need to get out! I am so sick of my apartment, my school, the local coffeehouse (which is not so local). I need a change of scenery. I need a change of pace.

Possible getaways before winter break:

NYC next weekend
London the week of Thanksgiving
NYC next weekend

I think I'm leaning toward NYC next weekend. Heck, maybe I'll do both. I've been meaning to visit a college friend in London for 4 (5?) years now. It would be a great-crazy-fun thing to do.

Out

noreply@blogger.com (DC Med Student) — Thu, 11 Oct 2007 12:25:00 +0000

Twenty years ago today, the first National March on Washington for Lesbian and Gay Rights was held. That day is probably best remembered for the inaugural display of the NAMES Project AIDS Memorial Quilt. One year later, October 11, 1988, the first National Coming Out day was observed to celebrate the March one year earlier. I was just a toddler at time.

For me, coming out has been an ongoing process since my junior year of college. It wasn't difficult for me to accept, but I found it hard to tell that first person. How was one of my best friends going to react? The fear of rejection was strong, but I knew that if I was going to continue in these friendships, I needed to be completely honest and open. I needed to be my whole self. Thankfully, that whole process was very positive.

My experience as an LGBT medical student has been mixed. I was out on my medical school applications and was asked about an LGBT group I was involved with in undergrad during one of my interviews. Some LGBT students choose to hide this kind of information on their applications, but I decided I didn't want to be at a school that didn't want me.

Once I decided to attend my current medical school, I set up a meeting with a faculty member to address some of my concerns about being an LGBT medical student. Did the medical school have an LGBT group? What were LGBT students' experiences like during the clinical years? Was being openly LGBT going to negatively affect my medical education experience? The faculty member's advice was, "It shouldn't matter, but I would just keep it a secret -- like don't ask, don't tell."

I've had several uncomfortable experiences during lectures, where a professor will tell a joke at the expense of the LGBT community. Most in my class laugh, some have no visible response, and some, like me, have that "I can't believe they just said that" look. Do I say something then? Do I confront the professor after class? Do I send them an email telling them I thought their joke was inappropriate? I end up not saying anything because (1) I don't want to come off as hypersensitive and (2) I don't want to be singled out. I already feel like I don't really belong, so why add to that feeling.

I'm out to all of my friends at school, which was a must. I don't believe you can really know and trust someone if you're hiding something. You're always going to keep some distance, which is not what I want in my friendships. As for others in my class? Some have asked me and I've answered affirmatively, but it's not like I've made an announcement. There's no need for that.

Basically, I'm just trying to live an open, genuine, authentic life. I've been doing it since my junior year in college, 7 years ago, and I don't see why I should have to stop now.

Time

noreply@blogger.com (DC Med Student) — Wed, 10 Oct 2007 01:07:00 +0000

If there's something everyone can relate to, it's not having enough time. In medical school, I've found that there's never enough time for sleep; never enough time for exercise; never enough time for grocery shopping; never enough time for errands in general; never enough time for friends; never enough time for family; never enough time to do all the required reading; never enough time for study and review. Yet, somehow, I manage to keep up this blog. . .

Today, I barely had enough time to finish the Customized NBME Exam. We were told that the clock in the upper right hand corner of our screen would not be the official amount of time we had. They, the professors, were giving us 30 additional minutes.

Uh huh. Right.

I was so nervous about this exam, I wasn't taking any chances. I would finish the exam before the clock read 0:00:00. I was slow at first. It took me a good half hour to adjust to looking at the monitor instead of having a paper exam that I could take notes on or circle/underline "buzz words." But I picked up some time on some easy questions and finished the exam with 0:02:17 to spare.

Unfortunately, many of my classmates didn't finish before the "unofficial time" ran out. When the clock read 0:00:00, it locked them out of the exam and they could not finish. Minor technical difficulty. The professors and IT people were working over the phone with the NBME people, but they couldn't come up with a solution.

So, what happens to those who couldn't finish? It's unclear. Of course, the rumor mill is working overtime. I've heard everything from "I'm sure they'll get to finish sometime later this week" to "They'll just have to eat those points" to "They'll have to take the whole exam over again" to "Everyone is going to have to take a NEW exam."

Thanks to my mad studying, I think I did OK -- I don't want to take another exam. But bottom line: I don't have time for this . . . nonsense.

Wave

noreply@blogger.com (DC Med Student) — Sun, 07 Oct 2007 14:53:00 +0000

I lost control of bowel movement this morning. Squeeze your external anal sphincter tight and take a look at this article from CNN.com. That is one GIANT wave. Something I never want to see in real life.

And here I was, dreading my upcoming exams as if they were giant waves about to crash upon me. Chil' please! People are losing their homes, their businesses, their schools, their communities, their lives.

I will continue to work hard over the next two days and will gladly take the fourth set of second year medical school examinations. It's a privilege, not a natural disaster.

Dr. E

noreply@blogger.com (DC Med Student) — Sat, 06 Oct 2007 05:08:00 +0000

Erotic. From the moment she walked onto the stage, you knew that Dr. E was going to have some fun. She was all smiles and had a bounce in her step.

"Good morning, y'all!"

[Students half awake] Good morning.

"How many of you know about spoken-word? . . . Well, I'm a poet -- Oh, you want to hear one of my poems before we begin? OK, we're all adults here, so I can share."

Clearly, Dr. E wanted to share one of her poems with us. And, as soon as we heard the "we're all adults" line, we knew it was going to be good.

Dr. E proceeded to share with us one of her poems. I don't remember the words exactly (and I'm not about to go back to the audio), but she mentioned heat, desire, seduction, biceps, hamstrings, gastrocnemius, a king and a queen -- and I think there was something about crawling on all fours. Dr. E needs some sexual healing -- stat! (Stat. Is that word ever really used?)

The poem was hot! OK, so it really wasn't that hot -- I mean, who wants to know about their professors sexual fantasies? But, she got our attention and gave a good lecture.

And besides, nerds need love too.

NBME

noreply@blogger.com (DC Med Student) — Fri, 05 Oct 2007 04:52:00 +0000

The acronym has been thrown around a lot during my second year of medical school: "You have to study hard for your NBMEs," "Forget about the LCME, it's the NBME you should worry about."

So, what is the NBME?

The NBME is the National Board of Medical Examiners. Founded in 1915, it's the independent, not-for-profit organization that provides nationwide examinations so that medical licensing authorities have a standard they can use to judge candidates for, well, medical licensure. They're the nice folks that make second year hell. How? With administration of the USMLE (United States Medical Licensing Examination) Step 1 at the end of the second year of medical school. This sole exam determines whether you have the option of going into competitive specialties such as Plastic Surgery, Dermatology and Radiology, or are limited to a primary care specialty such as Family Medicine, Pediatrics, and Internal Medicine. Believe me, I'll be writing about Step 1 hell come April.

So, why am I bringing up the NBME now?

On Tuesday, I will be taking the first of six "Customized NBME Examinations." Beginning this school year, the NBME is offering 40 medical schools the opportunity to administer these web-based examinations to their students. My medical school choose to participate, making each Customized NBME Exam count for roughly 40% of my grade each unit. Since this has never been done before, I'm a bit nervous.

The process is as follows: (1) faculty sends NBME list of topics, (2) NBME sends faculty pool of questions related to topics, (3) faculty selects questions from pool, (4) NBME produces examination, (5) faculty reviews examination and makes any changes, (6) final examination produced. About a week later, students take the examination either in the computer lab or a lecture hall (a program has been installed on our laptops). Each student will get the same 100 or so questions, but in a unique, random order.

I'm looking at these new exams as a positive change. Clearly, the major benefit is that I will be very familiar with the format of Step 1 by the time June rolls around. I'll also be familiar with the style of questions asked on Step 1. Another clear benefit is that I won't have to deal with poorly worded questions written by faculty, or questions with multiple answers that are subsequently dropped. Also, I think it will be good for the faculty because they'll actually see what topics they should be focusing on in lecture. The pool of questions sent by the NBME will make it evident. If there are a lot of questions on Topic A and few on Topic B, but Dr. B spent most of his time on Topic B, then maybe he'll change that next year. (One can dream, can't they?)

Grades may dip on this first Customized NBME Exam because of the new online format and vignette-style questions with images and lab reports -- not to mention possible problems with computers and the internet connection -- but my hope is that overall we'll do well. And come June, when I break 240 on Step 1, I think I'll be grateful for these NBMEs.

Stay

noreply@blogger.com (DC Med Student) — Wed, 03 Oct 2007 02:56:00 +0000

One week from today, I have my second exam for the unit. Since I failed the first exam, I've been working my butt off, not just to pass this exam, but to get honors.

Around midnight last night, I decided to take a break and treat myself to some television (a.k.a abc.com episode player). I could have used some sleep, but I knew that watching the season premiers of Grey's Anatomy and Ugly Betty and the series premier of Private Practice would lift my spirits. And, for the most part, my shows didn't let me down.

[Warning: spoilers follow.] Grey's Anatomy had the weakest episode. What was up with Izzie and the deer? Stupid. Disappointing. Ugly Betty got me, though. I was like, "What? Santos didn't die at the end of last season?" But alas, at the end of the episode we find Hilda alone in her bedroom. Sadness. Private Practice was the winner. That cast is so easy on the eyes! And I just love Addison. Overall, a good TV fix.

I love the drama of the relationships on these shows. (Probably due to the lack of a relationship here.) Whenever there's a "Pick me! Choose me! Love me!" scene I always hear Bette Midler singing "Stay With Me" in my head. Throughout the seasons it could have been Izzie singing to George; Callie to George; Meredith to McDreamy; Addison to McDreamy; McSteamy to Addison; Preston to Christina; Christina to Preston; Betty to Henry; Hilda to Santos...

In case you don't know the song, I give you the Divine Miss M, Bette Midler, performing "Stay With Me." If you aren't feeling Miss M in this performance, check your pulse.

Reverence

noreply@blogger.com (DC Med Student) — Mon, 01 Oct 2007 06:15:00 +0000

Sometimes you just need to step back and look at your situation from a different perspective.

Last weekend I saw a fantastic film: In the Shadow of the Moon. I highly recommend that you go see it if you haven't already. It's a documentary about the Apollo space missions, launched by NASA between 1968 and 1972. The never-before-seen footage was amazing -- incredible!

Alongside the NASA footage were stories directly from the astronauts. I truly enjoyed watching and listening to them as they described what the experience was like for them. One of my favorite astronauts was the eloquent Jim Lovell. He was able to express with such clarity the epiphany he had in space -- that of connection to everything in existence. We're all just a bunch of atoms, after all. He added:

Just from the distance of the Moon you can hide the Earth behind your thumb, everything that you have ever known; your loved ones, your business, the problems of the Earth itself, all behind your thumb; it makes you consider how insignificant we really are; but then how fortunate we are to have this body and to be able to enjoy living here amongst the beauty of the Earth itself.

What Lovell said struck a cord in me because I had a similar experience during college. The more I learned about biochemistry and molecular biology, the more I grew in awe of Life.

[Leap]

During this Sunday's sermon, "The Practice of Reverence," Rev. H, defined reverence as "fundamentally, a deep respect; an attitude of awe and wonder and gratitude for something of high or ultimate value." As soon as he said this, I realized that this is partly what lead me to medicine.

The complexities of the body (how it develops, how its organ systems function, how it processes food, how it fights infection and disease, how it can turn against itself, etc.) are fascinating to me. I know I like to complain at times about the lack of sleep and social life during medical school, but when I really dive into the work and I'm "making the connections," I feel fortunate. I get to see and understand a whole other world that allows me to feel connected, on some level, to everyone around me. We're all the same; our bodies are all made up of the same stuff.

Rev. H, closed his sermon with the following quote by Henry David Thoreau: "Pursue some path, however narrow and crooked, in which you can walk with love and reverence." I believe that medicine is that path for me.