Learnings

Leanna, Fourth Year Medical Student

In the past several weeks I’ve matched to USC’s internal medicine program, graduated medical school, and now am preparing for residency (i.e. filled out 100+ pages of paperwork and bought Pocket Medicine and new shoes). The things I learned about medicine, becoming a doctor, myself, and life during these last four years of medical school are far too many to confine to a blog post, but I’ll note some of the more entertaining and blog-able ones here.

MSI: First year – year of the basic sciences:

I learned that my new best friends would likely be the ones who made art projects with me, art projects with the titles of “Cell Lineage Cupcakes” and “Sandcastle Nephron: a beach study in the functional unit of the kidney”.

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I learned that in order to get decent grades in medical school you had to make huge sacrifices in all other realms of life, sacrifices that I did not have to make in undergrad and at first had a hard time making during this transition.

I learned that from the moment you tell someone, I’m studying to be a doctor, inevitably one of the next questions would be – Oh good, can you check this out for me and tell me if it’s anything serious? Or, sometimes his or her next odd question was, You mean, like a nurse?

Conclusion: I had no life, and far fewer friends than I was used to, but I was okay with it.

MSII: Second year – year of pathology/pathophysiology

I learned all the different ways a person can die (there are a lot).

I learned that pathophysiology is best studied as a group, with cookies.

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I learned that when a professor says, “This concept will be on Step 1”, the entire class wakes up and poises ready with their pencils/iPad note-taking software.

I learned that I could walk around the Drayson Center track for up to three hours at a time while listening to audio lectures.

I learned that while listening to audio lectures at Drayson Center track I ran the risk of getting hit in the head by a stray soccer ball [I learned this lesson twice].

I learned that some of the Step 1 study books had the stupidest study tips, such as, “Just remember the simple acronym AINBIBYXDYAHTGUVI for all the causes of liver failure and you’ll never forget ‘em!”

I learned that the best friends I made in first year were indeed still my best friends and fellow soldiers in the war against overwhelming exams and boards.

MSIII: Third year – year of clinical rotations and the beginning of the hospital hierarchy

I learned that all residents can be bribed, whether they are conscious of it or not – sometimes with food, sometimes with compliments.

I learned that the diseases that in prior years were confined to pages and chapters were infinitely more fascinating when seen up close in a living, hopefully breathing human being.

I learned to act quickly and seriously with the pregnant woman with a life-threatening lupus flare and for the man with a rupturing abdominal aneurysm, and how to lean towards empathy instead of apathy for the patient complaining of non-descript fatigue.

I learned that I loved internal medicine and family medicine and neurology and wilderness medicine and psychiatry and endocrinology and emergency medicine and cardiology and gynecology and critical care and pediatrics.

I learned that Hour #1 of a hernia repair and abdominal adhesion lysis surgery is fascinating, but Hour #9 is not (note that surgery did not make my aforementioned list of rotations and specialties that I love).

I learned that surgeons, upon finding out that I was moderately intelligent and strongly considering primary care as a career, had no inhibition when it came to constantly telling me that it would be a waste of my mind to go into primary care. And this was discouraging.

I learned that there was no possible way to describe my joy and relief with ending my surgery rotation other than this picture:

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I learned that a benevolent neurologist who lets multiple students practice the opthalmoscopic exam (imagine the Death Star killer beam that destroyed Alderaan in a single blast being emblazoned onto your retinas) on her, is a saint and I hope the Vatican City or the Catholic Church or whatever recognizes her as such eventually.

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I learned that as much as I liked doing rotations at White Memorial Medical Center, doing several months’ of rotations there instead of in Loma Linda distanced me from my fellow classmates and disintegrated what little social life I had.

Without a doubt I learned the most during third year. And as I looked back at the beginning of third year compared to the end of third year, I realized that maybe, just maybe, I was actually getting the hang of this doctor thing.

MSIV: Fourth year – year of marketing yourself to residencies and awkward spare time.

I learned that I would have a very hard time choosing between internal medicine and family medicine.

I learned that I loved diversity, puzzle-solving, variety, primary care, and hospitalist medicine, and because of that finally chose internal medicine as my residency path.

I learned that I would have A LOT of time off. What is time off? What do I do with it? Should I study? Should I sleep? Should I go to a pound and adopt another rabbit? Should I read War and Peace? I’ll bake some cupcakes.

I learned how to better practice grace and patience when a family member or friend tells me that they don’t “believe” in Western medicine and prefer only “natural” routes [Hint: arsenic, cyanide, and a variety of lethal mushroom are all “natural”…this could be a topic for a whole different post].

I learned how to be a wife, and in that taking on my husband’s last name of Wise, being called “Dr. Wise” sets quite a high threshold of excellence to which I will be held. Sometimes I wish his last name was Dumb, so that I could be Dr. Dumb and not too much would be expected of me.

I learned on the residency trail that an emphatic “Nope!” is a perfectly acceptable answer when asked if I have plans for specializing after residency.

I learned that Match Day is like a combination of eHarmony, the football draft, the Harry Potter sorting hat, and that part of the Hunger Games when teenagers are chosen to go fight to the death. The last comparison is the most accurate.

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I learned that I liked sushi.

I learned that graduation and all the festivities involved was going to feel extraordinarily surreal, almost joke-like. I’m – graduating? What?

I learned that graduation would be horribly bittersweet as the incredible people I’ve met over the last four years would be leaving to go their separate ways around the country.

In retrospect, I learned that all our well-meaning deans and administrators were morbidly incorrect when they told us during first year, Before you know it, the next four years will fly by and you’ll be graduating! No no no, the years creeped by like a elderly arthritic sloth pulling a wagon full of turtles. With slugs and snails and all other slow things cheering him on.

I learned of all the beautiful hiking trails in the immediate LA area and experienced many of them for myself, some of which for the first time.

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On May 22rd, 2014, I learned that I had officially completed all the requirements for my M.D., and May 25th, I walked with my best friends to receive my doctorate of medicine.

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I learned that the most fierce and profound last four years of academics have brought me to a point where I am entrusted with the well-being of others.

I learned that as a doctor, I am swearing to be a life-long observer, innovator, and of course, insatiable learner. My future patients are my new teachers, the exams will be based on the degree of my patients’ health and wellness, and the hospital and clinics are my full-time classrooms.

A deep gratitude to Loma Linda University for setting me on this path of learning, and to my God for sustaining me with so many blessings, and His promises for my future.

[For any folks who are interested, I plan to be blogging at wisemd.wordpress.com during residency]

Questions

Leanna, Fourth Year Medical StudentThere have been some questions asked of me and statements said to me, especially during third year, that I’ve had to think long and hard about answering, making sure I didn’t say anything too weird or inappropriate.

1) “You must be so smart!”

At first, before med school even began, I may have actually secretly agreed with this well-intentioned compliment. I did decently on the MCAT and got interviews and acceptance to some great med schools – thus, in my mind’s eye, I imagined continuing my strong undergrad performance in medical school. Wrong. I cannot even begin to describe what a shock it was, realizing how different undergrad and medical school were. Not that my undergrad education didn’t prepare me well, but medical school demanded 500% more effort to simply pass. As I alluded to in an earlier post, I eventually realized how to change up my study habits and outlook about halfway through first year. Essentially, any decent grades or exam scores I have received since that point I can attribute solely to hard work.

Of course, having some degree of natural intelligence/sound reasoning is quite helpful too, but I passionately believe that medical school is still 90% extraordinarily hard work – hard work that entails ongoing sacrifices of a social life, normal emotional life, and even a little of your soul (I might be kidding about that last one – or maybe not). “Balance” is a great idea and a term that is thrown around a lot, but the “balanced” life of a solid medical student is skewed heavily towards his/her school and away from nearly everything else that a normal twenty-something year old experiences.

First and second year demand incessant studying. Take a day off if you are convicted in that regard, but the other 6 days of the week must be devoted to school. If they aren’t, you will fall drastically behind, or even fail. You will log onto Facebook and see friends and family incessantly posting pictures of hiking, traveling, shopping, – things that are now reserved to Christmas break or the rare full weekend off. What the heck did you do with your free time before you started medical school? During third year, and maybe even a rotation or two of fourth year, you will be waking up when it is pitch black and coming home when it is pitch black. Someone will ask, isn’t it really hot in Loma Linda right now? And you won’t know because you’re inside the hospital all day, on inhumanely long shifts. To receive honors on a third year rotation requires that you pass the respective board with flying colors (implying that you’ve been studying every moment of downtime you have – while eating, in the bathroom, grocery shopping, while on the treadmill), that you have consistently given 110% hard work on the rotation, especially when being watched by residents and attendings, and that you have done all the additional “if-you-want-to-receive-honors” requirements, such as writing pathophysiology papers and scoring well on quizzes. Third year is not a year of rest; it is all the mental demands of first and second year now coupled with performance and application based on that material.

My sheer hope is that this in no way comes across as a pity party. I want to simply dispel the notion that medical school requires of one to be placed on a pedestal; no, it is being an extraordinarily focused and devoted student for four straight years that will get you to graduation. Like I mentioned, intelligence still plays some part, but at least in my case (and I know many who would agree with me), the energy that keeps me going has little to do with intelligence but everything to do with raw diligence and perseverance, driven by a passionate thought of there is no other career in my life that I would rather be doing (honestly though, being a stunt women would be really awesome).

2) You speak Spanish?

Usually, I am tempted to say that I do – well, that my Spanish skills are decent, and if we are not looking for an in-depth conversation, I can get by. Unfortunately, trying to instantaneously translate as a patient is talking to me can be quite tricky.

Recently, in fact, I was in GI clinic and listening to a conversation between the doctor and the patient (both of whom are native Spanish speakers), while trying to translate in my head.

Doc: So how are you feeling?

Patient: Fine; I am thankful to God for the blue horses, and my family’s legs

Doc: Excellent. It appears to me and to you that to me that you appear to want to see results of the scopes.

Patient: Yes. Give protection and truth.

Doc: Everything is breakfast.

Patient: Why is running cancer?

Doc: Cancer is a low probability [YES. Got that one]

Patient: Next year we repeat the trip to the small shoe store?

Doc: No, in three years we repeat scope and tears from the sky, along with stomachs and arms.

Patient: I am confluent with you doctor. God bless you and your beetles.

This may be a slight exaggeration, but have it be known that I greatly look forward to refining my Spanish during the rest of my career, because I really need to do so.

3) So Women’s Health clinic went well today?
YEEEEEAAAAAH I’M THE PAP SMEAR QUEEN YO! (Note: This is never, ever, ever an acceptable Facebook status)

4) How do you do it all, remembering and retaining all that medical information?
Comfort food (Garlic and butter croutons during the week; frozen yogurt on the weekends),
Friends (someone to pat you on the back and remind you that your life has a small bit of inherent meaning to it. Regardless of the fact that your surgery attending’s main goal is to pulverize any self-worth that you have),
Exercise (cardio step classes set to mash-ups of Eminem/Justin Bieber – a mega dose of inspiration)
Incessant studying (see question #1. Do have any idea of how many times I have had to focus on my portable pharmacology flash card set while standing in line at the grocery store, and resist the temptation to read the tabloids’ headlines of Paris Hilton’s set of quintuplet love children with Bigfoot? Many times)

5) Tell me about one of the greatest challenges that you had during medical school (naturally this question is asked quite a few times by my interviewers during the residency interview season)
Well, off the top of my head one of the greatest challenges I’ve faced during medical school was on my surgery rotation. I was on a two-week block of vascular surgery and was waking up at 3:45am to make sure that saw all my patients in time, updated the list in time, began my notes in time, and providing offerings to the gods of vascular surgery – the vascular fellows and attendings.

Anyway, by the time rounds were underway around 8am or so, I was famished, starving, nearly emaciated. On this particular day, I had eaten blueberries and a junky little 90-calorie Special K bar that morning. Naturally I was desperate for food, anything. And as luck would have it, the first patient my team and I saw that morning was sitting up in bed, eating a tasty, mouth-watering meal straight off of the gourmet Loma Linda VA Hospital breakfast menu. Pancakes and no-sugar-added maple syrup, with a cranberry juice box and a link of dry sausage. I couldn’t help my staring – the food was right there in front of me, at that delectable lukewarm room temperature I so craved.

It wasn’t long before the patient caught me staring, my eyes glazed over as I the thoughts of eating one of those little silver dollar pancakes ran through my mind. I want that. I want that pancake. Please. Give. It. To. Me.

“You want this pancake?”

The patient was asking me this. What? No. No. How did he know? Was it the shrieking sound of my stomach over the beeping med-surg monitors? Possibly. That wild hungry look of a castaway lost at sea for a month? Perhaps. Did he know that I had been up since the wee hours of the morning running off of a Special K strawberry breakfast bar? Eh…I suppose so, if he had excellent intuition.

Nevertheless, I was in a major dilemma. Do I accept this patient’s kindhearted gesture and cram the pancake in my mouth while we are debriefing with the attending about the care of the patient? Or do I refuse this offer that may potentially save my life and prevent a fatal hypoglycemic episode in order to save face with the vascular team and prevent myself from going down in Loma Linda VA history as The Girl Who Ate The Pancake?

Fortunately for my reputation, and unfortunately for my stomach, I found a happy medium of gently, kindly refusing the patient’s offer and asking him to please enjoy his entire meal for me (in my mind, it was like YEAH YOU GO AHEAD AND EAT THOSE PANCAKES RIGHT IN FRONT OF ME, BUDDY) while I paid attention to what was going on in the discussion of the patient’s recovery and prognosis.

That afternoon I got a huge Caeser salad and curly fries, and at the end of the rotation I received an excellent letter of recommendation from the surgery clerkship director. So, I think my self-control paid off and I am a better person because of it.

Peculiarities

Leanna, Fourth Year Medical Student

Being a med student.

For almost the past four years, that is how I have lived my life. The idiosyncrancies that come with that are still too numerous to count.

Peculiar situation #1: Attendicitis

Unfortunately, attendicitis is a very common, frustrating condition; most patients have it to some extent. It manifests by a patient describing his or her complaint to a student. Student then goes to attending/senior resident and presents the story. Student and attending physician make their way back to patient. Attending asks patient the same questions to clarify the details and gets AN UTTERLY OPPOSITE STORY. This of course makes the student look like a dumb, incompetent cow.

Phase 1: Attendicitis Prodrome

Me: Mr. Patient, this stomach pain, tell me a little more about it.

Mr. Patient: Like, a month ago or so. Just outta nowhere. It’s kinda all over, mostly in the middle I guess. Doesn’t hurt when I eat, thankfully. Just a generalized dull pain that comes and goes.

Me: Any associated symptoms? Nausea, vomiting, weight loss, change in your bowel movements?

Mr. Patient: Nope, I’m super healthy.

I walk out of the room and tell the details of the story to the attending. And we walk back into the patient’s room together.

Phase 2: Full-blown stage IV attendicitis

Attending: So Mr. Patient, I hear you’ve been having some stomach pain?

Mr. Patient: Yeah doc, it started about two months ago – hurts so bad I can’t even eat! I’ve lost 25lb without even trying, and I’ve been having horrible diarrhea! It’s a severe, sharp pain – here, I can point to exactly where it is. Help me doc!

Me, in the corner, wide-eyed, in a state of incredulous brooding: THE LORD IS TESTING ME.

Peculiar Situation #2: Residency Interviews

This first half of fourth year has been relaxing by most medical school standards, yet still fairly stressful as my classmates and I are applying to residency programs, at which we will spend at minimum the next three years of our lives, if not up to ten years or so.

The neat thing about applying to residencies is that it is no longer a one-way street in the sense that applying to medical school was. 99% of med school applications consisted of me trying to sell myself to the school in hopes that they would accept me. Regarding residency applications, I am now only doing that about 98%.

There are a few tips I have picked up along the interview trail.

1. Have a low threshold for laughing when your tour guide tells a joke.

Most interview sessions will include a tour led by a current resident of that institution. They’ll often try to joke with you and make small talk, and it is your job as an applicant to help them feel important and laugh at all the mildly funny things they say. However, do not neglect to be discretionary as to what is an actual joke and what is not.

Good example:
Resident tour guide: Why did the chicken cross the road? To prove to the possum that it could be done! Haha!

Medical students: Haha! Teehee! You’re so funny!

Bad example:
Resident tour guide: I once trained and ran a marathon for a cancer charity and -

Medical students: HAHAHAHA!

2. Find something individually impressive about yourself

Understandably, many of the higher, most competitive institutions attract the most intense and decorated medical students to their interviews. Sometimes, while everyone is sitting around a large table, a resident will ask all these intense and decorated medical students to “say a little neat fact about yourself.” My concept of neat little facts are things along the lines of “I kissed a real dolphin at Sea World last summer” or “I won Illinois’s pie eating contest four years in a row.” In reality, not so. Instead, this is simply an excuse for each of these students to rattle off their, ahem, humble accomplishments. For those of us without such bizarrely impressive achievements, it is sheer awkwardness. Try to have something, anything, to set yourself apart from the other applicants when these situations occur.

Student #1: I had a bit of free time during second year, so I was an ambassador from my state to Central Africa and helped to set up a new system of water purification. It decreased the child death rate by 85%. I am ashamed it did not decrease it more.

Student #2: I played for the U.S. Women’s National Volleyball team in college. Now I’m no longer that athletic, but I biked from Shanghai to Madrid over the summer while studying for Step 2.

Student #3: I was first author of seven different oncology papers this past year. Unfortunately, I was the second author on the eighth and ninth.

Student #4: I actually have a PhD in particle physics from MIT, but it wasn’t a satisfying career for me, so I went to Harvard Medical School instead.

Me: I, uh, I’m really good at parallel parking and I housetrained my rabbit last month.

Peculiar situation #3: The decomposition of the English language

Despite being homeschooled, I think I turned out fairly well. One neat thing about being homeschooled is that for some odd reason the vast majority of homeschoolers graduate high school with inordinately exceptional grammar and English skills.

Unfortunately, my time in medical school has not been good for these aforementioned skills (perhaps I overestimated them to begin with). I think we had to write one, maybe two papers in first year, and a paragraph about Patch Adams during second year. I wrote on the pathophysiology of liver disease during third year which was pretty much on the scale of The Iliad. As a fourth year the extent of my writing is in the fairly-sappy-yet-honest thank you notes I’ve written to residency programs at which I’ve interviewed.

Frankly, NO one cares about my grammar or English right now, which gives me a great excuse to mash out letters and words that to a normal human seem barely readable. Also, respectable writing takes like 584 times longer to type/text, so that is another reason it has fallen by the wayside not just among medical students but even more so among the Powerful Residents and Almighty Most Intelligent Attendings.

Example #1

Normal person version:
Can you check the vitals for the patient in bed 4B? The nurse forgot to give his beta-blocker dose. Thank you.

Homeschooled version:
Would you be amenable as to attend to the vitals for the patient in bed 4B? The diligent nursing staff has been so engaged in their duties that they inadvertently neglected to administer the patient’s beta-blocker, which is a great misfortune . Much obliged!

Medical version:
Can u chk vits on bed 4b,, forgot to give BBlokcer .TY

Example #2

Normal person version:
I think that this patient needs to be admitted to the surgery team. It looks like he has a bowel obstruction.

Homeschooled version:
I postulate that the care of this individual shall be relinquished to the surgeons in order to provide the most optimal treatment for the emergent management of this patient’s most impressive abdominal pathology. Shall we proceed now to the next patient? (best when read with an fake English accent)

Medical version:
page surrgery/

To celebrate being a fourth year, I got married. Here is a picture of me (the one with the white dress, in case you were unsure) and my med school compatriots. Solid gold proof that you can have a social life in medical school. My husband is not in medical school so I think that counts for even more points.

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Fancy Advice

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Since my last blog post, the last several weeks have been pretty ridiculous. As my third year finished up with ten weeks of surgery, USMLE Step 2, and the beginning of the residency application process, I swept immediately into fourth year ER and preventative medicine rotations, watched a person die for the first time, and have been planning my wedding (I’m getting married in two days from writing this post!). Sometimes I get all Descartes-ish and wonder if I really even exist. I’m pretty sure I do.

Anywho, now that I am a wizened old fourth year I feel as if I should give some piece of advice, and so I will. Partly because I feel obliged to – nearly every first and second year I’ve come into contact with over the past few months has a slew of questions for me and I do my best to answer them. And partly because I want to – medical school is one of the craziest tasks anyone can consider undertaking, and the better prepared you are for it, well, the better.

1. Emotions, whether positive or negative, will come.

Like I mentioned earlier, I watched a patient die just recently. I’ve seen many patients on the threshold of death’s door, patients who have passed away overnight when I came back to the hospital in the morning, but no one has gone from life to death under my hands – literally. Unfortunately, a young woman in her forties came into the ER with very mild chest pain. Other than her age, every single risk factor for a heart attack was there, and that’s just what happened. A code was called and a nurse and I rotated doing chest compressions for 45 minutes. In a solemn, surreal moment, I was handed the defibrillator paddles. The four shocks were fruitless and she was pronounced dead as I stood there, the gel for the paddles smudged on my wrist. That whole experience could be a whole blog post in its own right.

Our team went to tell the extensive group of family members; also a first for me. As I drove home that evening I had a million feelings to be sorted out: frustration that the laxity in this lady’s lifestyle had lead to a very untimely death, sorrow in imagining myself in what it would’ve liked to be one of her family members, and admiration at the efficiency, calmness, and wisdom of the ER code team.

The odd fact of the matter is that at the end of the day, you learn medical facts and intuition during your fourth year of medical school. You don’t learn how to keep your voice from cracking as you look a husband in the eye and tell him his wife didn’t make it – the senior resident in charge of that task could not even do it. There are classes that help us to have better people skills, better listening skills, etc – but unfortunately, knowing how to deal with your emotions well only comes with experience. I would be surprised if there were more than a handful of people who did not agree that some of the strongest emotions that they’ve had, whether positive or negative, were directly tied to their experience in medical school. And, medical school not only has a direct effect on your emotions, but also indirectly through the sacrifices you must learn to make with your family, friends, and hobbies, and through the rewards it offers through fulfilling some of the first steps of one of your life’s greatest dreams.

2. Surprises, whether good or bad, will come

Close to Christmas of my first year of medical school, I was experiencing a very intense week of studying for finals and finally plopped into bed around 1am. As I rearranged my sheets and turned to my side, I found myself face to face with a small, very much alive lizard in my bed. After panicking and flailing to the point of falling out of bed, I collected my senses and escorted him outside – he looked very hungry and thirsty.

3. Your first year performance does not have to dictate the rest of your time in medical school

You may have had the highest of the high grades possible in college, graduating with honors and fancy Latin words framing your name. Whatever you did to earn those grades, that now needs to be multiplied ten-fold, maybe more, to score decent grades in medical school. About halfway through my first year (jeez, that seems ages ago!) I looked at my mediocre exam scores and realized I needed to change my study pattern. First year ended; my grades were a little better. Second year; substantially better. Third year I was blessed (I mean that literally; I very honestly feel God gave me the strength to study and sacrifice in other areas of my life) with excellent scores and evaluations.

The purpose of me telling about all this isn’t to toot my own horn and show how far I’ve come, although I am proud of that. Oddly enough, in retrospect, first year was the hardest year of medical school, for it required major adjusting from pre-medical school life and adoption of a lifestyle pretty darn foreign to most 20-somethings. I want to encourage all those freshman and sophomore who are looking at the academic workload in confusion. You’re not alone. Third year eventually rolls around, and you still feel lost when you get on the wards, but with each month you start to gain more and more confidence, and at you realize that you’ve actually been learning a lot, and that what you’ve been learning has very direct and rewarding applications to the hours and hours you spend in the hospital.

Basically, don’t give up, and don’t concede to any thought that you are just not going to do as well as you hoped. Second year is drastically more interesting than first year, and third year, while still difficult, is very rewarding and has many moments of You know, I think I can actually do this. Assuming that you are studying efficiently and have a passion for what you are doing (these two assumptions are extremely important!), you have an excellent chance of not just “getting by” in medical school but actually seeing yourself as a physician eventually, and succeeding in areas in which you apply yourself.

4. Don’t believe every piece of advice you’re told, such as:

Eat whenever you can on your surgery rotation. FALSE.
Coming home at 8pm after a 16-hour day of vascular surgery greatly increases your chances of devouring 3,200 calories worth of whatever is in the fridge in less than 10 minutes. Most likely those calories will be in the form of fried foods and cookie dough. I would recommend not even having those foods in your fridge during your surgery rotation. Don’t even go into a grocery store on your way home from your surgery shift, because all of a sudden you may believe that you could eat an entire frozen pizza.

Another thing you have to watch out for is snack breaks. Free snacks in the resident room are bad news for emotionally and physically exhausted residents and med students. Nutrigrain bars may have a picture of a strawberry on them, but they are like 98% sugar.

Buy all the recommended textbooks. FALSE.
I have three text books, each weighing about 20lbs, that I have read about 16 pages from each. In addition, a vast amount of smaller textbooks scattered throughout my bookshelves as well. I know I will use them more eventually, but right now your best bets for easy to access information about medicine in general are:

  • UpToDate
  • Anything off of eMedicine
  • Review books specific to your rotation (Pre-Test and Case Files are the way to go with most, plus High Yield for OB-GYN), which have the added benefit of fitting in your white coat pocket, which your Harrison’s Principles of Internal Medicine will certainly not
  • I know some people will disagree with me in regards to buying textbooks, so I would say take each rotation and class on an individual basis, and ask the med students ahead of you which were actually used and which were not. For starters, I can tell you that you do NOT need four anatomy textbooks. Your time and money are extremely valuable – the rotations fly by quickly and more efficiently you can prepare for both practical, in-hospital questions and standardized test questions, the better.

Well, time to go get married and stuff! As fourth year is definitely a more relaxed year, hopefully I’ll be blogging much more often.

Also, here is a picture of my irresistibly cute bunny who always is up for keeping me company at the end of a long day:

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Oddness

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There are a lot of peculiar aspects to being in medical school. Here’s just a sampling of a few interesting ones I’ve dealt with during this past year.

#1
As you would imagine, being in medicine exposes you to quite the realm of diseases. And although I wouldn’t totally say that I am a hypochondriac, I will for the point of this blog post. So yes, sometimes I am a hypochondriac. Since starting medical school, I have 100% believed that at one point or another I have one, two, or seven of the following:

Mitral valve prolapse
Multiple sclerosis
Lupus
Scleroderma
Trigeminal neuralgia
Rhabdomyolysis
Anemia
Generalized anxiety disorder
Restless leg syndrome
Hypothyroidism
Psychogenic polydipsia (compulsive water drinking)
Vascularsurgeonophobia (fear of vascular surgeons)
Ungodlyhourophobia (fear of getting up at 3:15am for vascular surgery)
Highcholesterolophobia (fear of ever needing vascular surgery)
Mad cow disease (just kidding)

Thank you medical school, thank you for exposing me to all of these different ways in which our bodies can stall and begin to shut down. I’ve cried wolf so many times to my family that at this point they just give a gracious nod and tell me to go see a doctor, which of course I never do. But now, thankfully, all of these aforementioned fears last only a week or so, until the symptoms (real or imaginary) subside. Except the vascular surgeon fear; I think that will stick with me until the day I die.

#2
Pharmaceutical representatives (aka drug reps) are known for being attractive, sociable, extroverted, smooth-talking people. For example, while on surgery, a male-dominated field, I’ve noticed that the drug reps are gorgeous, flawless women that look and act like they model swimsuits on the side. Just saying, that’s what I’ve noticed. Overall, the general picture of drug reps isn’t a particular positive one; like everything though, I’m sure there are some exceptions, and someone needs to do the job.

Back to third year. Here I am, an innocent, clueless little third year tagging along with my doctor while on allergy/immunology. Apparently it’s Wednesday, and we have drug reps coming to sell us their product, and, naturally, bring us food to convince us to buy their product. A sampling of an interaction between myself and one of the [male] drug reps:

Drug rep: [peering at my name badge] Wow, what a last name – It’s BEAUTIFUL! What is your ethnicity?

Me: [warily] I’m Armenian.

Drug rep: [enthusiastically] AWESOME! That is so cool? Are you from there? Do you speak the language still? That’s like the Kardashians, right? How FUN!

Me: [exasperated by the comparison to the Kardashians] Um, no, I only speak English and a little Spanish.

Drug rep: SPANISH! GREAT! How smart of you! Now, tell me, because your name ends in I-A-N instead of Y-A-N, that means you’re from the West Coast, and not the East Coast, right?

Me: No, it sorta has to do with the area from which my ancestors immigrated.

Drug rep: Oh my bad! Well hey there, what year resident are you? Which attending do you work with?

Me: I’m a med student.

Drug rep: Just GREAT! Good for you! Well, you enjoy our lunch here; I am so glad to have met you and talked with YOU! You’re going to be an EXCELLENT doctor and I hope to see you when you come back to work here! You have a WONDERFUL DAY NOW!

Me: Thanks.

At this point I realized that it must be horrendously exhausting and socially draining to be a drug rep. I’m still not sure if he was inordinately invested in me was because my attending was standing right next to me or because he was interested in me. Regardless, the Mexican food they brought was tasty. And free.

#3
Hey, by the way, as of finishing this blog post, I am a FOURTH YEAR MEDICAL STUDENT! Yay for me. Fourth year is renowned to be one of the most laid-back and fun years, and since you are scheduling your own rotations that often have great relevance to your expected specialty, it’s just a fun year academically speaking too. Hopefully I will have the time and energy to blog more as well. And I get to get married, which is a colossal bonus.

To celebrate the end of third year and the beginning of the fourth and final year, my fiancée, Nick, took me out to Mongolian BBQ, one of my favorite cuisines. As we were looking over the menu, the server brought out a soup with a very peculiar, jelly-like consistency, and although I had indeed seen and sampled this soup before, Nick and I had a conversation somewhat along these lines (after the server had left, of course):

Me [dramatically, with despair]: Oh no. Look at this. I can’t eat this soup.

Nick: What, why?

Me [high-pitched whisper]: It looks like MUCUS. It looks like the sputum from a chronic smoker. And sputum means spit!

Nick: Leeeeeeaaaaaannnnnnna. Don’t say that. It’s just soup. And you’re the one who doesn’t mind being up to your elbows in someone’s guts while you’re operating. And the fact that watching a childbirth doesn’t bother you either – how can you not deal with this soup?

Me: I’m fine with dealing with sickness and bodily fluids as long as my food doesn’t resemble it.

Nick: Well, okay, at least you’re human then.

[five minutes later, as I am finally enjoying the slightly gelatinous soup)

Nick: How’s the mucus?

At that point I had to push the bowl away from me and call it quits. Somehow I have a stomach of steel as I watch blood spurt in vascular surgery or am called on to assist with an exploratory laporatomy for a perforated bowel. I can assist with trauma calls and perform invasive exams on patients without flinching. I can drive a suture needle through skin, give shots, and cut umbilical cords. But this soup, this soup was way too much to deal with right now. Thankfully, the rest of my meal was an A+ for both taste and consistency.

Hopefully this will provide you with a little glimpse of the mind and life of a third-now-fourth year medical student. As I look back over the different rotations of last year I realize that each has quite a large share of its own bizarre little idiosyncrancies – hopefully this upcoming year will give me more time to write about these things. Something tells me I am never going to be bored while practicing medicine!