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]

Changes

Hayley, Fourth Year Medical StudentIn two and a half weeks the familiar faces of the class of 2014 will be lining up with hats, robes, and tassels to celebrate the completion of medical school. Many people say “medical school has flown by!” But as I think back I can remember the different years, the different flavors, the different themes. There have been so many changes – new friends, new relationships, new habits, new life directions – in both my life and in the lives of those nearest and dearest to me. I want to tell you what I remember of the four years in medical school and if you are in one of those years and feel like your life will never change, you can feel comforted knowing change is always around the corner in medical school.

First year:

New. Everything was so new. I couldn’t believe I lived somewhere where palm trees grew! Centennial complex was shiny, new, and so big! The cadaver lab was formidable. The lectures were intense – and there was tons of information to learn. Many of the subjects I had already had in college – biochemistry, anatomy, physiology – so sometimes studying felt boring. Also I wasn’t always sure why what I was learning was important. The application often evaded me. But I was a Medical Student. I had that brazen confidence of first year students. I was used to being the top in college and confident my mind could grasp anything professors cared to throw in my direction. When people asked me what I was going to be, I confidently told them I was going to be a Doctor.

Second year:

Overwhelming. First year is hard. Second year makes first year look easy. So Much Information. I felt like I was constantly drowning in a sea of pathologies I should know. Cloistering myself in the study rooms in alumni hall kept me focused… I would last there 8 or 9 hours until I got too hungry or tired or my eyes couldn’t focus anymore and then I would trudge home with my bag of books, ear buds droning Goljan, till I got home and could get out a “fun” book – something like clinical microbiology made ridiculously simple – to read while I ate something. Then out for a walk with the flashcards I had been pumping out all afternoon, then back to my bedroom to flip through some powerpoints and pathology slides. Repeat times infinity – or at least that’s what it felt like.

So many flash cards

So many flash cards

I remember one time during second year I went to the bank and needed to talk to a teller about something. While I was waiting in line I almost started crying just from the stress of being out in public and having to talk to strangers. I felt like I couldn’t even cope in society because I was so sequestered all the time. And then of course, as second year students are wont to do, I began to worry I was developing agoraphobia (which I had just recently learned about). When people asked me what I was going to be, I told them I was hoping to be a doctor someday.

Third year:

Busy. Being on a clinical rotation is much like being in a small boat tossed by the whims of the ocean. Sometimes the sailing is smooth and you can go where and when you want, but often your direction is completely out of your control – your schedule fluctuates dramatically from one week to the next as your team shifts or your rotation switches. There is really no pattern that can be established. In my scant time off I was constantly reading review books to try to prepare for the inevitable board exam at the end of each rotation. But third year is no second year. Seeing the faces of patients, understanding that the hours I had poured into learning meant something, made a huge difference to my morale during third year. I was excited to read about sarcomas because I wanted to learn more treatment options to talk about with Ms. X. I wanted to know why enterocutaneous fistulas stayed open so our team could move Mr. Y toward resolution of his large EC fistula. Everything had a lot more meaning for me. When people asked me what I was going to be, I told them I was learning to be a doctor and hoping to go into obstetrics and gynecology.

Asleep in the physician’s lounge between surgeries – instead of waking me up when the next surgery started, my attending texted me this picture.

Asleep in the physician’s lounge between surgeries – instead of waking me up when the next surgery started, my attending texted me this picture.

Fourth year:

Unique. I feel like no other year in my life will ever be quite the same as the fourth year of medical school. The first third of the year is intense – sub-I’s (sub-internships – where you attempt to play the role of an intern on your team) back-to-back, collecting letters of recommendation, the step 2 board exam, filling out the online application forms and the stress of wondering if you will receive interviews (you will – unless you completely disregard Dr. Shankel’s advice).

Then the middle third of the year is consumed with flying all over the country, evening dinners with crowds of people you don’t know, endless small talk, and always – “why do want to go into obstetrics and gynecology? Why do you want to come here?” Cities I interviewed at included the greater LA area, Palo Alto, Seattle, Portland, Minneapolis, Rochester MN, Denver, Chicago, and Boston – as you can imagine it is quite a feat to coordinate interviews especially when interviewing in specialties like OB-gyn when the program often only has 2-4 days on which they interview between October and January. Some programs just told me a day that I was going to interview.

One of my interview trail essentials – dry shampoo.

One of my interview trail essentials – dry shampoo.

When the flurries of interviews are over and the ranklist is formulated there is an interminable period of waiting. Waiting. You are aching to go to your number one, but you try to stay on okay terms with the top six on your list so you won’t burst into tears on match day.

Then match day comes. The tension is unimaginable. It is the culmination of everything you have been striving for tirelessly for the past four years. I remember the long hours in the cadaver lab first year, the even longer hours bent over pathophysiology notes during second year and the sleepless nights on surgery in third year. Did it pay off? You open the envelope and suddenly there are no more possibilities. There is just the one reality and that is your future.

And now, when people ask me what I’m going to be, I tell them I am going to be an obstetrics and gynecology resident at University of Washington next year.

Extremely happy on match day!

Extremely happy on match day!

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.

Step1 | WSMRF | snowman

Janna, Second Year Medical StudentOne more day of tests! Then, second year will be officially 2/3 completed which means only 121 days 12 hrs and 29 minutes and 14 seconds til the looming Step 1. Step 1- it seems like the biggest test of my career. But then again, I felt that way for the SAT, MCAT, my weekly spelling tests in elementary, this set of tests I should be studying for right now, and basically every test I’ve ever taken… which means there will probably be another “biggest” test to come: Step 2?

On another note, I am excited to say I had the opportunity to present a poster and oral presentation at the WSMRF conference in Carmel, CA. There were over 20 students from my class at the conference and some of our mentors even came up like Dr. Blood. We had a great time learning from each other’s posters, attending presentations, and hanging out. It was a mini-vacation!

And, we have another mini-vacation after this test set. Our officers planned a retreat for our class at Camp Cedar Falls. I can’t wait to frolic in the snow with my classmates. Maybe we will build a snowman!

Disclaimer: I didn’t actually calculate the countdown to Step 1, but it’s around there. 🙂

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Nikoleta Brankov presenting her poster to fellow student Casey Harms.

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Michael Giang in front of captive pulmonologists.

 

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Anthony Yeo with mentor Dr. Blood.

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Me rolling up the poster.

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Olaf from Frozen. Maybe we will build a snowman at our Camp Cedar Falls retreat!

 

Downtime

Hayley, Fourth Year Medical Student

“Fourth year is the best year of your life,” I have been told repeatedly.

“Oh you’re a fourth year – make sure you travel and don’t study!” innumerable interns have exclaimed.

“Ahh that was the best year of my life…” senior residents reminisce fondly. First and second year medical students cling to descriptions of lazy weekends, and third years anxiously wish that they too were done with interviews, away rotations and essentially an MD.

I am not here to burst your bubble as you struggle through the first three years of medical school, but there are some realities of fourth year that nobody warned me about.

First of all, I feel like I have been diagnosed with terminal cancer. Expected date of death? July 1, 2014. With the 80 hour work week limit now in place I’m sure that residency will be manageable, but at the same time, you’ve heard the talk. I feel like I’m going to disappear into a deep, dark hole once I become Dr. Hunt and not emerge for four more years. My time is no longer going to have any semblance of being my own. And I’m going to have responsibility. It’s terrifying and exhilarating to think about at the same time. I feel overwhelmingly frustrated when nobody listens to my suggestions on the wards. But at the same time thinking of having my orders carrying weight – having the power to really help or hurt patients? That’s terrifying. So maybe my life won’t end July 1. But it is certainly going to change forever.

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Second, I’m lonely. Yes, I have all of this miraculous, beautiful, spacious, free time… to spend by myself. My friends are scattered across LA and the inland empire, intermittently on rotations or away at interviews. My husband has his job and incredibly few personal days. We have no family nearby. Yes, it was amazing and exhausting to spend the first three weekends in December flying to see my in-laws in Chicago to interview. Christmas vacation with my family in Seattle was filled with laughing, mossy hikes and scrabble games by the fire. But now here I am in LA, dutifully cooking dinner every night, making sure the carpet is vacuumed regularly, washing my hair on a routine basis… but after the exhilaration of the endless knowledge of first and second year, the stress and tension of surgery during third year, fourth year seems mundane and dull… I aimlessly read books and try to motivate myself to make it through selected texts, but by myself and without application sometimes I just find myself moving in listless circles.

Third, what are my hobbies again? Yeah, when I came into medical school I was an interesting person… I loved to paint and sketch. I dressed up in crazily creative costumes for Halloween. My favorite holiday was April fools and I tortured my college roommates mercilessly. I ran 50 miles per week with my friends. Gradually through the past four years that has all been stripped away as studying and then clinical duties nudged into my time and suddenly life became about surviving – eating, sleeping, trying to drink water. First year I gave up painting and drawing – frivolities replaced by anatomical diagrams and continuous sketching of the brachial plexus. But I clung to running as a life line, not willing to admit that I could go without that hour per day of anaerobic activity. In second year, running went. With Step 1 looming in the distance there was too much at stake and every hour became of paramount importance. So study walks and jogging with audio reviews in my ears had to satisfy my cravings. Third year even my time stopped being my own; the team you’re on owns you and med students do not take shifts – we must wait until we hear the words “you can go home now.” Not bad if the team is tuned-in, but it can lead to 16+ hour days if they forget about you. And then in the scraps of hours left, there were always review books or texts clamoring to be read.

And now we get to fourth year. What are my hobbies, again? Suddenly I have to re-learn how to use free time. And so, often I just end up running or walking and reflecting on the past years. Fourth year is a nebulous time of self-reflection and re-discovery. Every time I answered an interview question I was forced to delve into my soul and contemplate – who am I? what do I want? Do I actually fit here?

As I sit alone at home I think – what is my purpose here?

So, fourth year. Yes, a great year. Purportedly the best year of our lives. But be prepared for pockets of silence, to feel alone, to cling almost desperately to those moments of being “normal” that you may have forgotten how to experience in the past few years. Thankfully we are not actually going to die July 1, 2014, but our lives are going to change forever.

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