Wild Zones

At one point in my life I spent a lot of time mowing the lawn. We had a decently-sized area with terrain ranging from wide, flat spaces to steep hills and washed-out depressions. The ride-on mower was the closest I got to having a four-wheeler, so the chore wasn’t all bad. Even so, during the height of the summer, the grass had to be cut weekly, essentially pre-booking my Sunday mornings.

One area of the yard was especially treacherous––water runoff had formed a rocky stream bed, sycamore trees hid branches beneath bark pieces and wide leaves, and there were two wells to be avoided. This Wild Zone wasn’t highly visible compared to the rest of the yard, making it possible to leave that area for the next week’s mowing.

Each time I shifted the task to the right on my calendar, it became easier to do it again the following week. Eventually it had been postponed so many times it became part of the landscape. Nature continued to reclaim the Wild Zone, increasing the difficulty of the task and the inertia associated with completing it. And so the grass grew tall and went to seed, rippling with the breeze even as it concealed all manner of organic debris.

Containing the most egregious parts of the Wild Zone was easy enough: I mowed close to the edge and tossed stray branches further inward. Nevertheless, ulterior consequences of such a region are much harder to manage, encroaching into other areas in sinister ways. My dog began returning to house with dozens of ticks, mosquitoes diminished the enjoyment of the rest of the yard, thorns and locust saplings obstructed the wells.

This simply could not continue. I pulled on thick jeans and a hoodie despite the summer heat. I added safety goggles and tucked my earmuffs awkwardly beneath my hood. Thus armored, I adjusted the mower and plowed into the miniature wilderness. Almost immediately, I heard the telltale grind-snapping of a branch being destroyed by the blades, followed closely by stray pieces of wood and chipped rocks smacking into my face. Thorns pulled at my sweatshirt and snared my ankles, digging into skin. Disturbed insects rose to mix with the vast quantities of dust and pollen already filling the air.

This is a rather roundabout way of describing my life of late. It’s easy to carry on with the imperative parts, doing what is absolutely necessary to keep things moving forward. Dealing with the rest of it, however, requires initiative; it doesn’t have to be finished immediately, even if it should. And so life moves onward, visibly well-maintained while the more hidden, personal areas grow wild and unkempt.

Mowing the Wild Zone was every bit as difficult as I had imagined, but it had to be done. Similarly, as exhausting as it may be to continue “hanging in there,” it’s not enough. It isn’t fulfilling to merely keep pace with existence. There is a limit to how much of oneself can be sacrificed before the tangled undergrowth begins to choke even the non-negotiable tasks.

Take the extra time to truly focus on a loved one, to do something creative, to enjoy the outdoors is vital. Not mowing edges or tossing the branches farther in, but applying the same professional focus to whatever represents “the rest of life.” We ignore these things at our peril. For sure, isn’t easy to set aside the urgent to take care of something important. It’s hard to overpower the inertia and plow through the stress in pursuit of fulfillment.

That’s what it takes.

Leave the Rest up to Him.

It’s only been a week and a half into medical school. I already feel out of shape, out of sleep, and out of energy. Yes, it’s true, the only kind of change I truly enjoy is the sort that rattles around in my pockets. But that’s the short-term talking. When I take a step back from the pixelation of long study hours, empty coffee mugs, and questionable bouts of motivation, the bigger picture allows me to press on. And yet, removal from the urgency of the moment—fluttering up far enough for an aerial view—takes time. Specifically, time off. I’m not a robot. I’m not a Cullen. I get tired and my eyes glaze over. I get moody and eat too much chocolate. I coop myself up inside and hold grudges when the sun shines too cheerily. I, like every other human being alive, have tipping points and require breaks.

Considering Sabbath through the lens of a student, I liken time away from the books to the process of exercise. Maybe it’s my soul’s deep-seeded ploy to trick my body into athleticism (so far, no luck). But maybe it’s just a little bit more. Physically speaking, there are limits to how much stress the body can handle before it breaks down and risks injury. Too much work in too little time can be a recipe for disaster. Yes, the body must be broken in order to be built back up, but it is a process of micro-tears. It is not a battering, or pummeling, or a high-speed ramming into a brick wall. I realize as well as anyone that doing too little too slowly is a laughable stab at progress. But Rome wasn’t built in a day. That doesn’t mean Rome wasn’t built. Or that it wasn’t magnificent, powerful, and demanding of respect.

I think God invented dusk to help us find the beauty of rest; the twilight of Sabbath. He took day and night and warmth fading into cool, wrapped them up in early moonglow and cricket chirps, then tucked it all between the edges of the day. He intentionally put a pause button on the remote of transition. He knows exactly what we need and supplies it all with the contingency of choice.

I’m not Seventh-day Adventist and I don’t have a 24 hour time slot reserved as Sabbath. But I think my personal celebration is umbrellaed under the same context of a dedicated day to rest and reflection. Jesus is my Sabbath. Jesus is where I rest. Sabbath, for me, is a place that lives outside of time. It is my freedom from the Law, my release from bogs of routine, my heart being held in the hands that wove the world. There is beauty in the resting; light in the dimming of Earth’s tangles. And so, this is my toast to not worrying about tomorrow—it frets enough when left to its own devices. Here’s to slowing down, to looking up, and to letting God take care of the rest.

My Growing Experience

Stories. We each have one of our own, a unique journey full of ups and downs, good times and bad, triumphs and failures.  That’s one of the things I really like about this blog the school of medicine hosts; seeing the vastly different viewpoints of my peers and being able to contribute myself. Everyone’s experiences are different, and collectively they provide a really interesting look into what it’s like to attend medical school.  It’s been fun reading posts from the new bloggers, and after a little time off this summer, I myself am looking forward to continue telling my story. Season 2, if you will. A lot has changed over the summer, and while some people would think I’m out of my mind for being so candid, the following is just another story from a larger book that my journey through medical school has been creating. Strap yourselves in; this will be one of my longer posts!

Why am I here? Why am I attending medical school?

When I last blogged, I was neck deep in preparing for MS2 final exams and Step 1. Life was crazy and seemed to be an endless cycle of studying, integrating, practicing, studying, integrating, practicing. My sophomore year of medical school was difficult, stressful, overwhelming, and just plain hard work, but at the same time, it was fascinating! The only thing that kept me from going crazy over the huge wealth of information I was expected to know, was that I LOVED it.  Sure there were parts here and there that I didn’t find as interesting as others, but for the most part I really liked the curriculum.

Photo on 5-3-12 at 2.41 AM #2Desperately Trying to Keep Up by Memorizing Drug Facts Off of an iPad

Now as plenty of medical students will probably tell you, I struggled a lot adjusting to the increased workload of second year, trying once again to figure out the proper way to study. My strategies from 1st year didn’t seem to be working the same way as they had before, and so I had to figure out a way to assimilate and use even more information in a shorter amount of time then ever before. While 1st year felt more like an exercise in memorizing and regurgitating information, 2nd year involved a lot more integration across the sciences. For me, it required a different way of thinking. Unfortunately, when I attempted to survive the first round of 2nd year exams, I fell flat on my face. I knew something had to change; I did terribly! So after re-evaluating and discussing new methods with some of my professors, I made some big changes and tried again.  I started doing MUCH better.  But with that huge hole I had dug myself at the beginning of the year, it was going to take a lot of work to bring myself back up into a comfortable place. I’ll spare you the details, but in the end I made some of my best scores in all of medical school… but unfortunately, I was not able to restore two of my classes to above the lowest margin of passing.  And so despite all my hard, hard work over the course of the year, I failed two classes. According to school policy, with two classes falling short of standards, I will have to repeat the entire sophomore curriculum on the basis of only a few points.

After learning I was going to have to repeat my second year of medical school, I went through an entire range of emotions.  Anger, sorrow, embarrassment, confusion, despair, and many others put me on a weird sort of roller coaster as I tried to figure out how this happened.  Without trying to sound arrogant, I asked the question one always does in this sort of situation: why? Why did this happen to me? I got all A’s in college. I was the President of my undergrad’s Pre-Medical Society. I rocked my MCAT. I was accepted to Loma Linda early in the morning of the very first day they do acceptances… why? How could I have possibly failed? I felt like I had let down my professors, my classmates, my fiancé, my parents, myself… even God.  I felt the unquestionable call into this field of study, and so with God directing me into the practice of medicine, how could I have failed?

I wrestled with that question until I realized I had a decision to make. I could whine and complain, blame others for what happened, mope around, feel sorry for myself… OR… I could pick myself up, dust off some of the debris, and go again. Obviously it’s not ideal.  I doubt anyone would want to spend more time in medical school then necessary. But what’s one more year compared to the several decades I am going to have practicing medicine, especially if it makes me a better doctor? In 20 years no one is going to ask whether I had to repeat a year or not. So instead of dwelling on the bad, I choose to see the good.  I get to go through second year knowing now what I wish I would have known before. I’ll be that much better a doctor because of it.  If I spend this year strengthening my competency as a professional instead of moping around feeling stuck, it will be time well spent.

I’ve always learned quickly by making mistakes, and with that said, I would be foolish not to name a few in the hopes that someone can learn from them as I have.  To some, these might seem like common sense, but for me they are little things that can be easily over looked in pursuit of an MD:

1. Hit the ground running: It’s so easy to fall into the trap of staying on summer break for “just one more day.” While it may seem harmless to ease back in to studying, that is really a bad idea.  Because for every little bit you get behind, you have to catch back up, and trust me, it is impossible to catch up in medical school. So while it may be tempting to start off slow and build up a study tolerance, that mentality should be avoided at all costs. There is never “just one more day” of break.

2. Study with other people: Some of you might not know of any other way to study, but I tried doing my second year completely alone.  I locked myself up in my bedroom, slaving away for hours and hours in front of a desk.  Not only is this super boring, someone with a brain like mine can’t handle hours upon hours like that.  While studying does involve a lot of personal devotion, I saw a lot of my classmates making a social experience out of it.  I tried this way too late. Not only does it help give you and your group (or study buddy) more accountability, it can even give studying a few laughs. Just make sure laughing isn’t the only thing you are doing.

3. Study walk everything in: I talked about this in a previous blog post, but for those of you that missed it, taking your notes and walking all over creation while you go over the material really helps.  I’m not one to sit around for a long time, and I wish I had started doing this earlier in the school year.  Just the simple act of walking really seemed to boost my memory, and subsequently my scores. Plus it feels good to just move!

4. Get help when you need it: I can’t stress this one enough.  I was always the one doing tutoring in undergrad, so it was really hard for me to admit that there were certain subjects I needed extra help in.  Take microbiology for example.  That class is a lot, and I mean a LOT of detail that requires memorization. For some reason, I couldn’t wrap my head around the seemingly simple concepts.  I really regret this, but it took me until halfway through the winter quarter to ask for help.  I got hooked up with a really great tutor who provided me with some tips and tricks for memorizing the tiny details of microbiology, and my grades in that class skyrocketed.  In fact I scored over 98% on my last final of the year! Asking for a tutor is not admitting you aren’t smart enough for med school, it’s simply tapping into another resource to help you succeed.  The med school here wants us to do well, so we should take advantage of every type of help offered.

5. Come back from break two or three days early: I was definitely one of those students who reported back from vacation at the last possible minute.  This carried over from undergrad into medical school.  The only thing is, in undergrad, you don’t have to worry as much about getting back to real life.  After returning from a break during medical school, I would spend the next few afternoons taking care of laundry, grocery shopping, and getting my apartment back into order.  Studying was put on the back burner for a couple days while I got my life back in order, and I only spent probably half the time I needed to be studying.  And like I said in #1, even that small setback can put one on a constant need to catch up. So in the future I’m going to cut my break as short as I need to in order to make sure I’m settled back in before I start studying again.  The smaller the amount of distractions, the better!

6. Don’t memorize every little detail: Medical school throws a whole lot of information after you, and it is impossible to learn it all. That’s right, it is impossible to learn everything.  Maybe it was a habit, maybe it was a compulsion, but I felt the need to read every sentence and try to learn every last tidbit. So instead of learning 70% of my material really well, I probably ended up learning 100% poorly. I would usually find exam weeks quickly approaching, having had spent so much time making study guides or flash cards of every last fact, that I would quickly be running out of time to finish it all.  A panicked cramming would ensue that left me without the preparation I needed, not to mention not being able to look over the early material one more time.  Second year is about integrating and finding what big pictures are important, not memorizing tiny facts and insignificant trivia. It’s something I’m still working on, and hopefully will perfect quickly into my second go around.

Those are just a few of the more important things I have learned.  Even with some of those poor habits, I almost did succeed in passing my second year of medical school.  But I feel a second run through of everything will be good for me in every way.  I can avoid doing poorly on my first round of exams and work on solidifying the rest of the school year. It will be important to avoid the trap of feeling like I know it already and don’t need to study as much. I mean, I feel as though I have a pretty good grasp on a lot of it, but like I described above, there is still room for improvement.

It’s going to be a little weird at first.  I am really going to miss the class of 2014 and all the relationships I formed throughout the last two years. I wish them all well as they go about their clinical rotations and am excited to rejoin them in that setting soon.  It will feel strange working with an entirely new group of people, and I hope they will accept me as one of their own as I once again find myself in Alumni Hall, working hard and joking nervously about the looming USMLE Step I exam that will happen next summer. I’m not worried, but change feels funny at first. I’ve had tremendous support from my family, friends, and wife; more support then I could have ever imagined. I know everything is going to be ok.

I began this blog post with a question: why am I here? Why am I attending medical school? Well duh, it’s so I can become a doctor! So maybe I have gone about this whole medical school thing with the wrong idea.  I’ve been studying so I can do well on tests and advance to the next level.  A mentor of mine recently gave me one of the best pieces of advice I’ve heard since starting medical school. Don’t study to do well on tests.  Study to become a better doctor and the rest will fall into place. I’m interested in mostly everything I have been studying, so why not focus on that instead of stressing about the exams? Study to become a better doctor and the rest will fall into place. Shouldn’t that be the main point of studying in the first place?

So instead of taking Step 1 and jumping into MS3 clincial rotations, I suddenly found myself experiencing a surprise summer break.  What did I do with all the extra time? Well, simply things like become scuba certified, get married, win the final showcase on the Price is Right with my fiancé (now wife). Nothing major… more on that later… welcome to Season 2! 🙂

Screen Shot 2012-06-19 at 8.56.56 PMDid that Really Just Happen?!

My Study Walk

Ryan B., Second Year Medical StudentExercise.  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.”

IMG_1423Dr. 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 2nd 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.

IMG_1275The 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!

IMG_1375Attempting 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!

BYAAAAAMeme’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… 🙂

IMG_1404Go Reds!

43 days until USMLE Step I!

Time Management

Kari, Third Year Medical StudentHi 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?