doc w/ Pen

August 18, 2015

Day 1: Orientation and My First Patient!

It’s real now. I’m officially an MS-1 (first-year medical student) at Weill Cornell Medical College. And I have the ID badge to prove it.

Yesterday marked day 1 of orientation, which continues the rest of this week with various lectures, receptions, and our white coat ceremony.

Yesterday also marked day 1 of seeing patients. Yes, that’s right! I saw a patient. My job yesterday was just to observe. But before long, I will be working as a “junior clinician” as part of Weill Cornell’s Continuity of Care program. I have a specific patient (whom I met yesterday), and will be responsible for things like attending all of her appointments, making clinic follow-up appointments, providing emotional support via phone (she gets my cell phone number), documenting all our telephone calls in the electronic medical record, and serving as a liaison to the clinic physicians if she has medical questions (I obviously can’t give any medical advice!). As I learn to do things like take a history or perform a physical exam, I will practice those skills with her. The idea is that the patient (who has some complex issues) has an advocate, someone familiar with her situation and medical history helping make sure she gets all the support she needs, and ensuring that all the necessary issues are addressed. In return, I learn about managing chronic medical conditions and interacting with a patient — skills that can’t entirely be taught in the classroom.

When I got to the clinic yesterday for the appointment, the clinic coordinator told me I was “brave” for doing this on my first day of orientation. Perhaps she’s right. But the way I look at it, that’s why I’m here — to learn how to be a doctor. No time like the present.

August 14, 2015

Confronting Fear

Do the thing you fear the most and the death of fear is certain.
– Mark Twain

This post is about climbing out of the pit of fear. Unless you’re a stepnophobic.

A dear friend, who is on her own pre-medical journey, just shared this quotation with me. It’s a good reminder as I head off into the unknown of my first year in medical school.

August 14, 2015

Embracing Change

Chicago skyline

For nearly a quarter century, the Chicago area has been my home. When I think “city,” in my mind I see a skyline like the one in the picture above. Navy Pier, Sears Tower (I’ll never be able to call it “Willis Tower”), Michigan Avenue, Art Institute, Field Museum, Millennium Park, Prudential Building, Northwestern University, University of Illinois at Chicago. And that just scratches the surface of the places I’ve worked and played over the years.

But as they say, the only constant in life is change. So I’m going to have to get used to calling another city home: New York City. Thus, this will be my skyline for at least the next four years:

New York City skyline

Clearly, there are key differences. New York City proper has more people than reside in the Chicago city limits (about 8.5 million compared to 2.7 million). There are different bodies of water, different landmarks, a different train system, different types of pizza. These differences will require adjustment on my part, of course, and there will be some uneasiness at first. I’m sure there will be days when I long for Chicago — Lake Michigan, the John Hancock Building, the El, and deep dish from Lou Malnati’s (with butter crust, of course). But I fully believe that before long, I will look lovingly at the East River and the Empire State Building. I’ll board the subway without trepidation. I may even be able to stomach New York-style pizza.

Change is scary, and it’s hard. I’m not going to pretend otherwise. But change is also good. It brings about new growth, opportunities, relationships, and interests.

The way I see it, I’m not leaving Chicago behind. I’m merely adding New York City to my repertoire.

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August 11, 2015

Study Habits for Medical School, New and Old

This is medical school.

Trying to absorb the vast quantity of information presented during medical school has been compared to drinking from a firehose. There’s simply no way to swallow it all. This means that I’ll have to prioritize information, and to maximize my time with excellent study skills. I’ve always been a good student. So I’ll be carrying over some old study habits that worked well in college and my post-bac. But I’ll also try some new methods that sound promising. It’s all based on knowing my personal learning style. Here’s my lineup:

During organic chemistry, writing out complex reactions on my dry erase board helped me understand the concepts better.

Dry erase board. I used this extensively during my post-bac for everything from organic chemistry (drawing out structures and color-coded synthesis reactions) to genetics (creating a flowchart of the transcription process from start to finish). For me, the kinesthetic component of learning is key – I need to DO something with the information, not just read it or hear it (although audio and visual learning is important for me too). Seeing things written extra large, and with multiple colors, helps me remember them even better.

Scapple. This is a new experiment. Scapple is a Mac app that allows you to make connections between ideas and concepts. I tried it out while reviewing the Krebs cycle a couple weeks ago, and really liked it (the screen shot below is part of what I created to represent the links between the different molecules, enzymes, and other players in the cycle).

The Scapple app allows you to make connections between different ideas.

Cornell note taking is a much more active process than regular note taking.

Cornell note taking method. Another experiment, this note taking method incorporates reviewing, questioning, and summarizing into the process. It’s much more active than just scribbling down what the professor is saying. That kind of active participation helps me learn and remember, which is why I’m giving this a try.

Study groups. I’ve had mixed results with these in the past, but I’ve heard that studying in groups is really recommended in medical school. So I want to try it.

I’ve made it this far, so clearly have my share of good study habits. But with the game being stepped up in medical school, I think it’s important to experiment too. There’s always room for improvement.

August 6, 2015

Learning to Live Without a Car

Knowing that cell phone service is less than certain amid skyscrapers, not to mention the threat of my battery dying, I thought buying maps would be prudent. These Streetwise maps, which are laminated, got great reviews on Amazon.com. One covers Manhattan, one covers the multitude of transit options (NYC subway, Long Island Railroad, etc.), and the other exclusively covers the Manhattan subway.

In 2003, just after graduating from college, I bought my first car. I’ve owned one ever since. My car hasn’t been my only means of transportation though – while working at the University of Illinois at Chicago, I commuted on the El (short for “elevated train”), and have often taken the train into the city rather than fight traffic and pay $30 to park. But taking the train or bus to work is different than taking the train or bus to buy groceries, which is what I will be doing while living in Manhattan. The thought is a little nerve-wracking – that there will be no trunk, no back seat, to haul stuff in. No immediate wheels. No straight shot to where I’m headed. Add to that the complexity of the New York City transit system, and it’s overwhelming. I remind myself that I survived taking the bus everywhere (and not having a car) for five months when I lived in Chile during college, and that was in a foreign country where I had to speak a foreign language. So I can certainly do it in New York. Because as foreign as NYC might seem at times, I’m still on home soil. And soon enough, NYC will come to be my home too.

I’m especially excited about the foldable subway map.

August 5, 2015

This Book’s a Keeper

Reading immunology on the front porch on a beautiful day is rather pleasant.

A few days ago, I wrote about some books I *might* be using during my first year in medical school. I already know this one is a keeper: How the Immune System Works, by Lauren Sompayrac (Wiley-Blackwell).

Before I talk about this book, let me take a step back. It’s said (by people more knowledgeable than I am) that in addition to the required basic science classes in college, there are three upper-division courses that may help you in medical school: genetics, biochemistry, and immunology. I’ve taken genetics and biochemistry, and done well in both. But immunology is a world I know nothing about. To put it bluntly: I didn’t know my neutrophils from my natural killer cells (which is embarrassing, if you know anything about the subject).

Enter Lauren Sompayrac’s book, which is a “big picture” view of immuno designed to prepare you for more a complex course by showing how parts of the immune system act and interact at a very basic level. At only 132 pages of actual chapter material, it’s a short read. The writing is entertaining, with plenty of analogies and quips thrown in. From now on, when I think of the major histocompatibility complex (MHC) – a molecule that essentially serves as a billboard to tell what’s going on either inside or outside the cell it’s attached to – I will think of a hot dog bun. (Yes, there is a photo of a hot dog bun in the book. It works.) There are also plenty of astounding facts too which keep me engaged with the general topic. (Did you know that the area covered by the mucous membranes lining our digestive, respiratory, and reporductive tracts – part of our body’s perimeter that needs defended – measures about 400 square meters? That’s two tennis courts! Immune cells have to patrol all that!)

My goal isn’t to master the immune system before medical school. That’s what medical school is for. But since I have exactly zero background in this, I want to develop a basic understanding of the players before I’m expected to know the whole playbook.

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July 31, 2015

Read All About It: Basic Science Books for Medical School

Note: This post is at the request of one of my readers, who asked me to share what books I plan to use in my first year of medical school. I will update as the year goes by to talk about what I actually used. But here’s the plan …

During undergrad, each new semester meant heading to the school bookstore, dropping a few hundred dollars, and lugging a giant stack of heavy textbooks back to my dorm or apartment.

Things have changed. First, I’m in medical school now, not undergrad. In medical school, the prevailing wisdom is that you wait for your second year classmates to tell you what you really need before buying any books. Second, the trend across the publishing world is to use eBooks on your laptop or iPad rather than giant hardback tomes. And many medical schools – Cornell included – offer access to a selection of these eBooks through the school’s library. Cornell’s top-of-the-line resources mean that I have access to a LOT of eBooks this way, so I anticipate not having to buy many titles at all. Another bonus of these eBook offerings, which are usually accessed through an institutional subscription to part of a publisher’s catalog, is that in addition to the books there are related videos and self-assessments.

I do have a list of books I plan to use as necessary, most of which I can access as eBooks. This list was developed with the help of a dear friend, Dr. Hoffheimer, who is now a third year internal medicine resident in the Detroit area. I thumbed through the books she had used, and selected those that seemed to best fit my learning style. Most of these are not traditional textbooks, but review-style books, offering a bigger picture of the concepts rather than excessive minutiae. I have these bookmarked in my web browser, ready to go.

LIR biochem In terms of the basic sciences, I found I preferred the Lippincott Williams & Wilkins series Lippincott’s Illustrated Reviews. From what I’ve seen so far (I’ve spent some time with the biochemistry title), the LIR series does a good job of giving you an overview, while also providing enough detail – but not so much that it’s overwhelming. These eBooks also offer online self-assessment, video/audio components, and a print feature (great for reading offline, if you print to PDF and throw it on the iPad). I have bookmarked the following through the LWW Health Library website. I’ve linked the titles to their Amazon.com pages if you’d like to read more about them or see customer reviews.

netter's atlas From Elsevier, I bookmarked:

From McGraw-Hill, I bookmarked three titles that I haven’t ever flipped through, but looked promising. What I like about these is that there are interactive self-assessments for each, with USMLE-style questions. So even if I don’t use the books, I’ll likely use the test prep component.

metabolism at a glance I did buy four books in advance, titles I felt confident I’d need, were worth the price, and I wanted as tangible objects instead of eBooks.

First Aid for the USMLE Step 1: Highly recommended by people I trust. And I know I’ll need to start doing USMLE-style questions pretty much right off the bat.
Neuroanatomy in Clinical Context: An Atlas of Structures, Sections, Systems, and Syndromes: Neuroanatomy has a reputation for being a tough block, and this book looks amazing. I do have access to this as an eBook, but there are some writing components that made me want to buy it in print.
Metabolism at a Glance: This large-format book puts all the pieces of metabolism (Krebs cycle etc.) together in an integrated way, rather than looking at them separately.
How the Immune System Works: This title presents a high-level view of the immune system, which should be great to have before I dive into my medical school block. I felt I needed this background since I’ve never taken an immunology course.

How many of these titles I use remains to be seen. But I felt it was important to have them bookmarked ahead of time so that if I get to a topic where I need more information, I have a trustworthy source to go to – and by “trustworthy” I don’t mean Wikipedia.

Thanks to Dr. Hoffheimer for her help in developing this list. And thanks to Varia for prompting the post.

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July 30, 2015

“This Case Is Closed”

Dear LORIEN MENHENNETT,

This email is in reference to your inquiry regarding your credit appeal. Your case number is #XXXX-XXXX. Retain this number for your reference.

Your Credit Appeal has been processed and this case is closed. Your case has been <APPROVED >.

Those words came in an e-mail this morning from the U.S. Department of Education Federal Student Aid office. My struggle to finance medical school has been so tumultuous. So when I read such nonchalant words, sent by a customer service rep named Maria at 9:14 a.m. EST, I had to reread the words several times before this realization sunk in: I’m going to medical school. Not “if my loan gets approved.” The loan just got approved. There is nothing left standing in my way. What a feeling.

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July 28, 2015

Science Marvels #1

I dove back into science yesterday. My first medical school assignment is to complete a prematriculation assessment, and since I’ve been out of school for a few years (finished my coursework in the spring of 2012), I’m brushing up on some basic concepts along the way. In doing so, I quickly rediscovered the pure joy I find in studying science. To try and share that sense of awe and wonder, I’m going to post periodic amazing science facts or concepts on my blog. Here is today’s entry.

Electron micrograph of chromosomes from Berkeley.

The Amazing Chromosome: Stretched out to its “contour” length, chromosomes range from 1.6 to 8.2 centimeters long. Yes, CENTIMETERS. This according to my medical biochemistry book. Holy cow! Question: So how do these linear segments of DNA fit in our tiny cells? Answer: They are condensed more than 8,000 fold, coiled and wrapped over and over with RNA and proteins called histones. Wow. Marvelous indeed.

July 24, 2015

Packing It Up

Time to start packing …

I packed my first three boxes today. One milestone among many over the last several days, weeks, and months – each bringing me closer to medical school. Other recent notable events:

Buying my one-way plane ticket to New York City (I leave Wednesday, August 12)
Getting my Weill Cornell mailing address, e-mail address, and campus user ID
Logging into the Cornell system for the first time
Taking a peek at my first medical school assignment: a “prematriculation assessment module” aimed to determine how much we remember from our premedical classes (scored but not graded)
Buying lots of stuff on Amazon.com for my new dormitory nest
Quitting my job
Applying for a student loan (again)

It’s been a few months since I posted here on my blog, and the last two items on that list – quitting my job and applying for a student loan – deserve explanations of their own.

Last July, I left my research lab job at Northwestern University and in August began working for the American Academy of Orthopaedic Surgeons (AAOS). This “acquisitions specialist” position brought me back to my publishing roots, though with more of an emphasis on competitive analytics and market trends. Sort of a hybrid publishing/marketing position. With research, writing, and science in my background, the job was a wonderful fit (or so I gleaned from the positive feedback from my manager and colleagues). Besides being a great job, I met some dear people and was immersed in the amazing world of surgery – a world that quickly fascinated me. But with things looking good for my student loan, I left AAOS in early June to focus on getting ready for medical school.

Ah yes, my student loan. Those of you who kept up with my story last year may remember that my 2014 student loan rejection prevented me from starting medical school last August, and threatened to keep me out of medical school entirely. The reason was my foreclosure, an adverse credit event that turned my loan application – even my appeal – into automatic denials.

That old maxim though – “if at first you don’t succeed, try, try again” – is so true. I sent dozens of faxes to politicians, journalists, and other pundits across the country. My goal was to make so much noise that someone with authority and power would listen to me, take up my case, and force the Department of Education to change its tune. It took time, but it worked, thanks to Senator Mark Kirk, a U.S. senator from my home state of Illinois. A legislative aide from Kirk’s office was on the phone with me within 48 hours of my pleading fax arriving at his office. Within a few weeks, my loan denial was reversed. The approval came too late for me to attend school last year. And I still have to reapply this year (nothing is automatic with the Department of Education, believe me). But now there is precedent for my loan being approved, and I am confident it will go through again. (It’s currently rattling around in the DOE system somewhere.)

In the meantime, I better pack up more boxes. Because in two and a half weeks, I’ll officially be in medical school.

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