My Study Walk

Exercise.  It’s something that is super easy to neglect in your first two years of medical school.  While I am all about trying to live a balanced lifestyle, getting exercise in is one of the easier things to push to the side when the pressure of exams and Step I is breathing down your neck.  It’s really easy to neglect certain areas of health that in actuality would really benefit our ability to study.  To some this may sound like common sense.  Now I’m not trying to sound pompous here, but if you have experienced the type of study and lifestyle a typical med student endures, you know how easy it is to forget the “little things.”

Dr. Nava Helps Us 2nd Years Remember Long Lost Anatomy…

While attending review sessions for boards, as pictured above, is very helpful, it’s only a part of my learning puzzle.  For me, the more neurons I can get firing in my brain while I study, the better I’ll remember things.  If I limit myself to simply reading, not only do I get very tired very quickly, I remember next to nothing.  Picturing a disease process, hearing what it sounds like, even associating a scent helps me recall much more information, faster.  While that may have already been obvious to others, it is something I was happy to discover.

On top of that, I have discovered that I memorize things the fastest when I walk while I study.  One of my professors back in undergrad (Dr. Steen maybe?) tried to share this with our general biology course my freshmen year.  So why did I wait until half way through my 2^nd year of medical school to try it? I have no idea! “Things I wish I had known before starting medical school…”

Just for fun, I started a pedometer on my iPhone during our last exam week, just to see how far I was actually going. Starting Sunday and running through Friday morning, I walked over 20 miles!  For me, it’s much better than sitting at a desk and letting my rear fall asleep while I try to fight the same inclination.

The Hills Overlooking Loma Linda

As Step 1 gets closer and closer, I’m bound to be walking all over creation.  Maybe I should see if I could do the entire Pacific Coast Trail before I take my big exam! Haha.  But in all seriousness, if you are someone like me who hates sitting down for long periods of time, I would strongly suggest trying the study-walk! It has done wonders for my productivity and has allowed me to retain information faster then my previous memorization techniques. If anything, I at least try to stand up and scribble all over a white board; just get those muscles moving!

Attempting to Remember All of Microbiology

With 6 weeks and 2 days left until I take Step I, the days blur together like never before.  As I focus on wrapping up classes for the year, I am growing more and more excited for what is coming.  After passing my last set of exams last Friday, I feel like there is finally a light at the end of the very long MS1/MS2 tunnel. 3 mock boards, 3 comprehensive finals, the NBME Comprehensive Basic Science Exam, and one tiny little test called USMLE Step I separate me from finally getting a taste of what it’s like to actually take care of patients. There’s still a lot of work to do, but us 2014’ers are almost there!

Meme’s are a Fad at LLU Right Now So…

Just for fun, I got on eBay for a few minutes the other day and tried to win a rather expensive jersey modeled after that of Cincinnati Reds 1st basemen Joey Votto… I ended up winning it for a mere $20! Things are looking up…

Go Reds!

43 days until USMLE Step I!

Reflections

In eight short weeks, my third year of medical school will be over. I cannot believe how fast this year has flown and how memorable it has been! Here are some reflections from each rotation:

1. Obstetrics & Gynecology

Delivering a baby was by far the most thrilling experience from this rotation. I enjoyed having the privilege of sharing such a precious moment with several families. It will not be soon forgotten. On a lighter note, I was reminded of just how “green” I was on this rotation when a baby was out of mom in a crash c-section before I could even get my second glove on. Oh well, practice makes perfect right?

2. Family Medicine

What a broad field! I truly enjoyed seeing a diverse population of patients everyday I went in to work. From 3 week old babies to elderly individuals with every medical problem in-between, it was all there. My favorite part of this rotation was the personal relationships formed. Family docs have the unique opportunity to oversee all of an individual’s care, not just one condition. I felt that this led to a closer relationship between doctor and patient, what an awesome benefit!

3. Internal Medicine

Wow, what an experience! Many medical students consider this to be the “meat & potatoes” rotation during third year where the most information is learned. I found this to be true. Although busy, the rotation was also quite fun for me both from working with great teams and from the patients I had the opportunity to follow. One patient in particular, Mr. C, was 98 years old and had served in WWI! Serving such individuals made both this rotation and the year as a whole worthwhile and reminded me of just how blessed I am to be in this profession.

4. Neurology

For this rotation I decided to have a change in pace and fly across the country to Kettering, OH. I am very glad I did! Kettering is not only a lovely city but the hospital there was also wonderful to work at. I also felt that it was a very good experience for me to branch out and see how other hospitals are run. The most memorable patient encounter from this rotation was getting to see Anton’s syndrome, a condition in which damage from a stroke renders an individual blind but having them still believe they can see. Although very sad such diseases remind me of just how intricate our bodies are made & of just how well we are at compensating after damage has occurred.

5. Psychiatry

Spending one week on the addictions unit and three weeks working with individuals battling eating disorders was by far the most memorable in this rotation. Although they may appear to be quite different I found both of these areas to be similar with the issue of “control” at their center. It was interesting to listen to the stories and to see just how much these problems can consume an individuals life. After completing this rotation I have a new respect for people fighting these diseases.

6. Surgery

Phew! This was by far the most difficult rotation for me. After completing it I can honestly say that I am not cut out for long hours in the operating room. I have a high respect for surgeons; they do amazing work. That being said, I will happily refer my patients in need of an operation to them during my medical career.

7. Pediatrics

The kids are adorable & they have such resilience! They are the best part of being on the pediatric rotation and I find that I am constantly smiling with them around me. I can’t wait to see what the rest of this rotation has in store for me.

This year has had its ups and downs but overall I am truly thankful that I am here in medical school and look forward to the opportunities that await me in the time to come.

Time Management

Hi friends. Guess what? Even though I did my Pediatrics rotation a while ago, I’ve managed to sneak my way onto another Pediatric service as part of the Neurology rotation. I so miss the fifth floor when I have to go other places. But this post is about what I do with my time when I’m not on the fifth floor.

I was whining to my fiance John last night about how it seems like I waste time and don’t get anything done – lamenting my time management skills. It seems like I get home, wind down a second, have some dinner and the next thing I know I’m supposed to go to sleep and I’ve barely had time to study.

This is the USMLE World Question Bank. We should probably hang out more than we do.

I presented a recent night as an example: I was in the hospital from 6 am to 5:30 ish, made it over to the gym for an exercise class, got home, and by the time I cleaned up and made dinner it was literally like 8 pm. And of course Criminal Minds was on and I got a little sucked in and even though I was simultaneously getting worked over by some Neurology questions it didn’t really feel like I accomplished anything.

So I was whining.

John’s response?

“So you’re saying you worked about 12 hours and went to the gym and you’re concerned because you didn’t get anything done?”

Oh. Right. I worked for 12 hours.

I think we forget sometimes that all the things we accomplish as part of the work day count too. I know I’m not alone in that – we really expect a lot of ourselves.

We expect that we should somehow be able to learn ALL the things on top of the long hours. When I don’t know the answer to a question when I’m on service I feel sad. Like it was my responsibility to find time to already have that memorized. It doesn’t matter what it is; it feels like I should know.

My ideally time-managed day from an academic perspective would probably not include anything fun because the hours of studying I would fit in would crowd out everything else. And that just doesn’t make sense.

Bottom line?

Time management = Doing your best. And when you’ve watched some TV,  took your time chopping up vegetables for dinner and gone to bed too late because you were reading something that’s not a textbook, that’s okay.

Because you work hard. And because medical school isn’t just about learning medicine – it’s a trial by fire of how to spend your time, and we’ll all make it. Right?

Here’s to Hope

They tell me that I’ll change.

They always do.

In our first two weeks of medical school, freshmen students are assigned to shadow senior students working in the hospital.  When I was a freshman, my senior student’s final comment to me was “wow, you’re really enthusiastic…that will change.”

Now as a fourth year medical student, today’s version of the story was – “intern year will change you.  You may look the same on the outside, you may portray that same bubbly, sunshine personality, but inside you’ll be different – harder, less tolerant, mean.”

They say it with confidence, they say it with authority, brooking no disagreement, allowing no doubt. Attendings, residents, nurses – they all deign to tell me my future – “there’s no way you can stay that energetic, it’s incompatible with a medical career.”  Over and over I have heard this.  As a medical student, I am supposed to listen and learn – to be guided by these wise elders.  This morning when I heard the prediction for the 100th time, like always I politely listened with a half-smile.  Yet silently my spirit roared “How DARE you smugly tell me the fate of my soul?! How DARE you justify your own insecurities about your passionless heart by attempting to degrade mine?”

In my short foray into this time-honored, traditioned society, I have been buffered and shocked by the rampant negativity that oozes through the hospital walls.  People seem to even take pride in their ability to bemoan their situation.

“Seriously? Another consult from the ED, think they managed to even do a physical exam before calling?”

“That professor has no idea what’s on boards.”

“I can’t believe we have to be here.”

“This computer system is a joke.”

By far the most common conversation in a hospital involves complaining.  Tomorrow, try something different – stop and listen to the myriad people talking at work.  The ratio of negative to positive conversations will overwhelm you.

Why is hospital culture like this? Shouldn’t a place of healing be full of warm emotions, positive thoughts, and uplifted people? Why is a “negative Nancy” the most common type of medical professional we meet?  What are we doing wrong?  These questions often come to mind during my workday.  There is no easy answer.  At the very least I know my top goal is to NEVER become that stereotypical cynical physician, and instead be the uncommon doctor with true passion for medicine.

So how do I accomplish this in such a caustic environment?  Have no doubt, even at my current bubbly baseline, it is a daily war to maintain my heart for this career.  So many physicians before me have fought this battle and lost.  How can I succeed where they have failed?

A resident who I highly respect recently told me “be careful what you say, because talk patterns become thought patterns.”  This, more than anything, is my first defense against cynicism.  It is SO easy to fall into conversation filled with complaints.  These tiny conversations seem harmless, but over the course of a lifetime they shape your soul.  Now at the end of my medical schooling, and at the cusp of residency, I am awed by the power of the spoken word.  It’s undeniable – what we say both molds and reflects what we think.

Overall I believe the best weapon against developing permanent pessimism is to be deliberate in how we react to daily adversity.  How do we respond to a floridly difficult, unpleasant patient? Do we moan about how annoying they are? Do we ruminate about how unfairly they treated us? Permit me to suggest a different response.  Instead of focusing on how unjustly that patient has treated me, I instead try to feel gratitude.  Whether or not it’s right, these difficult patients make me grateful that my life has not put me in their position.  They must be really unhappy inside, to so poorly treat the people who are trying to care for them.  When I am mistreated by an attending, I remind myself that they are but a momentary discomfort, and soon will be gone from my life.  Over and over I find myself fighting to see the positives in my life.  It is a deliberate, intentional strategy, which allows me to shine out with joy even in the little moments of the day.

I firmly believe that working as a medical professional can be a path to a life filled with meaning and passion…if we let it. Not all days are perfect, but most days I feel like I’m the luckiest girl in the world to be in my chosen career.  The patients are interesting, my skills are stretched, and I feel fulfilled.  Beyond these personal reasons, more than any other career, medicine reminds us how short and precious life is.  We deal in broken bodies, lives cut short by car collisions, by strokes, by chronic disease.  How lucky we are to be able to move our bodies without wheelchairs, to be relatively self-sufficient.  Working in the medical field reminds me daily that everything can change in a moment.  It is this acute awareness of the frailty of life, which makes me embrace life with so much abandon.  It is this knowledge that gives me joy in the workplace, even during the rough days.  To put it bluntly, life is too darn short to be grumpy.

So why am I reflecting via this venue?  Perhaps because I hope that I am not alone in this fight.  Perhaps I hope that by starting a discussion, we might nudge forth a change in the standard hospital culture.  Maybe together, we can shift the caustic paradigm.  Here’s to hope.

A new low…

My eyes narrow to focus on the words taunting me from the bright screen. My unruly brows furrow deeper, carving a marked crevice into my forehead. A Uworld question directly confronts me.  In the far recesses of my mind, I try to imagine where I saw that rare artifact of knowledge.  Was it in First Aid or my notes or did I hear that from Goljian, King of Pathology? My mind draws a blank. That seems to be happening a lot lately.  As I force myself to march forward against the onslaught of Uworld questions, I realize that my medical school knowledge is buried way too deep or I forgot where I hid it.  Either way, I lose.  Uworld always wins.

This has been my life for the last few months. Every night I do Uworld questions and read my First Aid, practicing for my upcoming duel against the great nemesis of all second year medical students:  STEP 1 (the first of three Boards exams required to complete the United States Medical Licensing Examination, or USMLE)  I will be honest. After all, I agreed to write this blog so all of you who may be interested may catch a glimpse into the highs and lows of medical school.  The months leading up to Step 1 are a definite low.  I will not pretend and say things are going great and that I am ready to slay the dragon.  No. Everyday I study for my classes and then study for Step 1 after that. 15 hours a day. Easily. Do my practice questions or tests reflect that effort?  Not even close.

Signs and Symptoms of Ingrid’s Low Point: 1.  Went to Stater Brothers on Thursday evening to buy ice cream and eat my pain away in pajamas 2.  Went to study at Olive Ave Market on Friday and realized I was wearing a shirt that I apparently already wore since there was a beverage stain right in the front and middle… 3.  Forgot to check Anthropologie’s website on Tuesday (that’s the day that they update all their sale items to their website).  This is perhaps the most troubling sign. 4.  I want to eat all the time: Kettle corn, shortbread windmill cookies and yogurt covered pretzels are my food medications at this time. 5.  My eyebrows are out of control.

In spite of all this, life is not all bad.  God has sprinkled my life with bright spots to keep me going.  First, His presence strengthens me day by day.  When I am discouraged, He keeps me going and I can rely on His promises to get me through.  My husband, Devon, has been very supportive.  He’s even taken up grocery shopping, making salads to ensure I get my 5 servings of vegetables and antioxidants, and cleaning the house for my mental health.  Last Sunday was the last day of spring break, and I took the day off from studying. Sort of. Devon and I drove down to Orange County listening to the sweet sounds of Papa G (Goljian)  playing on the sound system.  As his crooning voice explained the ins and outs of neoplastic diseases, we arrived at Bruxies to eat waffles and shop at Fashion Island. Later that afternoon, we drove to Little Saigon in Westminster and got 1 hour massages.  I felt sorry for the poor Chinese man who had to work out all my knots. All that relaxation worked up our appetites, so as we sat by the window booth watching the rain fall, a bowl of steaming lemongrass pho was placed before us. Great food and scintillating conversation with my best friend.  Thoughts of Step 1 were far away.  Perspective at last…  Ready for the last quarter of second year.

A week later, its time for church. The clock tells me I’m late.  And yet, my wayward eyebrows scream to me from the mirror.  Be on time for church or groom my eyebrows?  I decide to do the public a favor and groom the hedges.  So although I am late, all of you should thank me….You’re welcome.