doc w/ pen

a journalist becomes a doctor before your eyes

Bright future? Or dark cloud?

You have a bright future in front of you
But a dark cloud over you

So stated a New York City subway ad for a student loan refinancing company. (My paraphrase, but that was the gist.)

I smiled as I read the words, sitting there on an orange plastic seat, the train clattering along. Smiled, because I could relate to the feeling. Smiled genuinely though, not in a sad, resigned way. Because while I could relate to that feeling, I no longer felt that way.

Medical school in the United States is insanely expensive. Each year at Weill Cornell Medical College, I borrow about $90,000 from the government for tuition, living expenses, health insurance, and so on. I also have loans from the two-year pre-medical program I completed — more government loans, and some private bank loans too. At the end of it all, I will owe the equivalent of a hefty mortgage. Heck, depending on where you live, I could’ve bought two houses with all these loans.

Residency is when you start having to pay things back. You’re a doctor, but not making a doctor’s salary. For the government loans, there are income-based repayment plans. But not for the private loans. I’ve had many moments of middle-of-the-night panic about this. How in the world could I afford to start paying back all this money, potentially three loan payments at once, while making around $50,000 a year?

“It will work out. It always does,” I’ve whispered to myself on more than one occasion, to still the panic.

And now I have a better idea of how it will work out.

The fact that I’m graduating in a year has forced the issue. As I’ve scrolled through psychiatry program websites and pondered my personal statement, residency — and the accompanying loan repayment — has shifted from the realm of fantasy to reality.

But I’m no financial expert. And the world of student loans is a quagmire. I’ve felt completely unprepared to figure this out on my own. So I turned to the Internet. I don’t remember my Google search terms. They were probably something desperate like this:

How do you afford medical school loans as a resident?

Bank websites came up, of course, promising special repayment deals for medical residents. I investigated, discovered that it’s possible to refinance private and/or government loans to drastically reduce monthly payments during residency. Interest continues to accumulate, of course. But you can now afford to buy groceries, pay your rent, and avoid default. Seems like a good compromise to me.

I even called one of these refinancing companies, heard their spiel, and learned that there’s really nothing for me to do until after I graduate. I can’t refinance until then, or even apply, until I have my diploma. I was glad to know about the option though, and now have it tucked away for next year.

I kept poking around the Internet though, in search of advice on how to create a more comprehensive repayment plan for myself. Or for the name of someone who could help me do that.

A website called The White Coat Investor popped up. The person who runs the site is an emergency medicine doctor who got sick of “financial professionals ripping me off.” This seemed promising. Specifically, I landed on a page titled Student Loan Advice. The page gave me some information I already knew — how complicated student loan management is. It also gave me information I didn’t have — the names of people who specialize in helping medical residents manage their student loans.

I scheduled a free consultation. A specialized financial advisor and I discussed my options (in broad strokes), what his company could do to help me, and how much they charged for their services.

After the call was over, I felt a sense of relief. More than that: pure peace.

The exact details of my plan are yet to be determined (and can’t be, not fully, until after I graduate next May). But there are doable plans, and people who can help me map them out at a price I can afford.

Rather than that dark cloud, I can now focus on my bright future.

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On this day …

I don’t normally look at the “On this day” posts on Facebook. I don’t normally spend much time on Facebook at all. But today, on a whim, I did. This came up, a 5-year-old memory:

As did another post from a dear friend exactly a year later, which I’ve copied below. If I remember correctly, the first sentence, in quotation marks, is her quoting me; the second sentence is her reaction to my words:

“Holy shit. That is an acceptance letter.”
I LOVE YOU

Discussing the MCAT on this day in 2013, and a medical school acceptance letter on this day in 2014 …

I’ve come a long way since then. I’m now discussing medical school graduation (in 13 months!) and where I will apply for my psychiatry residency (in 5 months!).

Thanks to all of you who have helped make this possible, and to all of you who have followed me on the journey. I couldn’t have done it without you.

Uganda: Learning to live with limits

So much in the United States is unlimited, like our wi-fi access. Not so in Uganda, as I was reminded after a thoughtless frenzy of downloads.

Living in a foreign country means making adjustments. To respect the conservative dress code here in Uganda, for example, I wear a skirt that falls below my knees, and cover up my sleeveless blouse with a lightweight shrug.

There are technological adjustments too. The wi-fi here at Naggalama Hospital only works three weeks out of the month. By the fourth week, they’ve used up all their data.

That’s the general principle here, for technology, and otherwise. Resources are limited.

To make sure I could access the Internet for my entire four-week stay, I have a “Uganda phone.” It’s an iPhone from the United States, but with a Uganda SIM card inside, and a Uganda phone number. When I arrived, the phone was loaded with 10 GB of data, and what’s called “airtime.” Airtime can be used to call within Uganda, any phone carrier, and also to call internationally. Airtime is not to be confused with “minutes,” which can only be used within Uganda, and only with people who share your same carrier (in my case, MTN).

I didn’t plan on doing anything crazy on the Internet while here, mostly checking e-mail and writing blog posts. But I hate using the Internet on a cell phone. So mostly what I’ve been doing is using the phone’s data to set up a hotspot for my laptop, something I’ve never done in the United States (because I never had to). I’ve been religiously keeping track of my data usage, dialing the MTN “data usage” number to find out my balance every few days. After more than a week, I hadn’t even used 1 GB. Then I checked this morning. 3.5 GB gone. Somehow, over the span of a couple of days, 2.5 GB had … disappeared. How did this happen? Was there a data monster lurking somewhere, biting into my bytes while I slept? I inventoried my Internet use over the last few days, trying to account for the missing many megabytes.

An hour later, while I ate breakfast, it dawned on me. The day before, while waiting at Masaka Hospital for someone to pick me up and drive me back to Naggalama, I’d downloaded a half-dozen audiobooks from the New York Public Library. I did it without thinking. Because at home, I’m almost always on a wi-fi network. In my apartment, at school. And when I’m using my data, I’m only checking a handful of websites, maybe Google maps, or looking at e-mails. Not exactly high data use activities.

I’d downloaded so many books — hours and hours worth — because I’m picky about my narrators. Their voices, that is. So many grate on me, rub me the wrong way, for reasons I can’t always articulate. And I can never tell by the brief sample they give you. I need 15 or 30 minutes to decide whether I want to invest myself in the story, and in the voice. My dad used to read aloud to my family every night when I was a kid, and he set a high bar, it seems.

I know streaming and downloading eats up your data like nobody’s business. I know that. But I clicked the “download” button a half-dozen times with nary a thought because that’s what I always do. In the United States, data is dispensable, limitless. Like so many things.

Not so here.

I really should have known. Because after three phone calls home, I suddenly ran out of airtime last weekend, my phone call cut off mid-sentence.

Well, I have the books now, 2.5 GB later. They’re checked out for three weeks. By then I’ll be home, back to limitless wi-fi.

Lesson learned though, for while I’m here. Hopefully …

Uganda, delivered

A “six-pack” (well, six loose bottles) of Club, a popular Ugandan beer, on my doorstep. It’s not a New England-style IPA. But as the saying goes: “When in Uganda …”

One of the things I love about New York City is that you can get just about anything delivered, with minimal or no extra charge. Groceries, alcohol, and take-out food of every ethnicity you can imagine are standard fare. I take advantage of the grocery services the most often, because I hate grocery shopping. I’d much rather someone else do it for me. I happily tack on a nice tip since they carry all my bags and boxes up the stairs to my fourth-floor walk-up apartment. (No elevator.)

To my surprise, there is grocery delivery here in Uganda, too.

Lately, I’ve gotten into craft beer. I’m pretty sure they don’t have IPAs here, but lager, yes. I’d run out of the Nile (a popular beer here) that we’d gotten in Kampala. I was told that Sandra, the housekeeper where I’m staying, could have beer brought to the guesthouse. I gave her 24,000 shillings (less than $7 USD), and about 30 minutes later, there was a guy ringing the bell at our front gate, carrying a box containing six bottles of Club (another popular Ugandan beer).

A couple of days later, I discovered we’d run out of milk. I prefer half and half for my coffee, but milk will do. I texted Sandra to bring some when she came to make lunch for us. She texted back that she’d send someone with it now. In less than 10 minutes, there was a man at the front door, carrying a little black plastic sack with two pouches of pasteurized milk inside.

Talk about service.

My first palliative care presentations in Uganda: Naggalama and Nakaseke

A group photo from an educational session I led in Nakaseke, Uganda.

Last week, I started pilot testing our curriculum, “Digital Modules for Palliative Care Education in Rural Uganda.” Through these three sessions, the participants have learned from me. And I have certainly learned from them.

Leading a palliative care educational session in Naggalama, Uganda.

I began by presenting the first module, “Basic Communication Skills in Palliative Care,” at my home base, St. Francis Naggalama Hospital. Naggalama is where I came to experience palliative care in Uganda in 2016, and where I am staying in between my forays to other rural locales.

Then I traveled to Nakaseke, a rural hospital about 2.5 hours from Naggalama. I presented the first module again, as well as the second, “Delivering Bad News.” We got lost on the way (PSA: don’t rely on Google maps in rural Uganda). And then the electricity went out during a rainstorm midway through my first presentation (but we adapted; Howard held up my laptop so people could see the videos, since we could no longer project them onto the wall). So in the end everything worked out there, too.

I’m now entering my data from our pre- and post-presentation surveys. And I’m processing the lessons learned from these three sessions. What is clear, though, is that people want this kind of teaching. They struggle with communication skills and delivering bad news just like we do in the United States, but don’t have access to the kind of educational resources we do. And they’re hungry for it.

-reading guide

The participants all wanted to keep the teaching guides that I brought for the sessions. I took this as high praise.

I got a variety of feedback from the three sessions, but one comment was constant. When asked what we could change about our printed teaching guides to make them better, I was told, “Let us keep them!” Suitcase weight limits (2 suitcases per person; 23 kg each) prevented us from bringing enough printed guides for everyone. But the message was clear, and I took it as high praise.

At Nakaseke, at the end of each session, the participants also did this amazing thing to show their appreciation where they clapped several times in unison and then threw out their hands toward me like they were showering me with thanks. It seemed like their version of a standing ovation. Below are still photos from this beautiful gesture.

Apparently, I’m pretty into the material too. I didn’t realize until I saw photos of myself (below) from the sessions how animated I can get.

This week, I travel to Masaka and Kitovu, two other rural sites. I will be presenting four times in two days – a much more grueling schedule. These sessions last 2-3 hours each, and at the end of each I’m exhausted. But after last week’s successes, I know I’m up to the challenge. I know there will be bumps in the road, too (both figurative and literal, given the quality of rural dirt roads here). But I also know it will be worth it – for them, and for me.

Lions, tigers, and … lizards?

Some time ago, I wrote a post about Ernest Hemingway’s use of the so-called “six-word story,” its explosion on the Internet, and my own attempt at a tiny tale. Good six-word stories, like Hemingway’s, convey an entire world with only a few strokes of the pen (or keyboard). Writers accomplish this by what they do say – the imagery and feelings they conjure directly – as well as what they don’t – the questions and curiosity they raise.

You want to know more. But there is no more. It’s delightfully frustrating.

Here is my second attempt at a six-word story. After you take in the words, think about your own interpretation. What do you think the backstory is? Then scroll down to find out what it’s really about.

There’s a lizard in my underwear!

 

 

 

 

So. Where did your mind rush to when you read those words?

Those of you who know me well may have guessed that like all of my writing on this blog, this, too, stems from reality.

I fail at fiction. Trust me. I’ve tried.

This is truth.

In fact, these very words flew from my mouth in a gasp (or maybe a growl?) of surprise this morning as I was about to sit down and drink my morning coffee.

I’m in rural Uganda. There’s a washing machine here, but no dryer. I’d gone out to enjoy my coffee on the back patio. Where, I discovered, my recently laundered undergarments were hanging, ruffling in the breeze. One had slipped to the brick floor of the patio. I stooped to pick it up and lay it across the bars of the metal clothes rack. As I did so, something small and black flopped out.

“A stick,” I postulated.

And then the stick moved. Darted is more like it.

I saw it in one spot, near my foot. Then a quick black blur, and my black stick was suddenly 6 inches away. And then another 6 inches. And another.

I realized my so-called “stick” had legs. I know it actually did have legs because when it paused briefly, and I counted them: Tiny. Four.

I grabbed my phone, the journalist in my dying to capture the evidence. In a stroke of pure luck, my hurried snapshot caught the critter next to an actual stick (a brown one) that was the same length as the lizard. That picture, and a picture of my left hand next to the same stick to provide scale, are below.

These two words, “lizard” and “underwear,” are words I never thought I’d hear in the same sentence. This is certainly not an autobiographical tale I ever planned to tell. Or yell. Or think! Not anywhere. Not even in Uganda, where I’ve learned that anything can happen.

In these anything-can-happen environments, people always tell you to “expect the unexpected.” But if it’s unexpected, how can you expect it?

After today, I know that you really can’t.

Home-grown exotics

A few days before leaving for rural Uganda, I had an exotic adventure right in my own backyard. I trekked out to the Bronx to visit the New York Botanical Garden, one of my favorite places in the city. It’s always a fun trip, and I walked through some of my favorite haunts, like the ornamental conifer garden. But I made this particular visit to see the annual orchid show, which would conclude while I was out of the country. This week was my last chance.

The show didn’t disappoint. I ooooohed and aaaaahed as I made my way through the greenhouse, stunned by the magnificent and many colors, shapes, and sizes. Some blooms hung in clusters from trees; some strutted in giant pots on the ground; others wound their way like strands of delicate glass beads around a gigantic frame of green bamboo-like rods, a structure which reached up for the ceiling, and for the sun.

My photos don’t do these beautiful blooms justice. But they give you a glimpse at what the show was like:

Outside, the Japanese apricot trees (below) were blooming, as were the azaleas. It was early April, too early for many of the spring bulbs, but some precocious daffodils (also below) and even a few tulips had popped up to say their spring “hello.”

All this green (and pink, orange, yellow, purple, and so on …) was so refreshing to see. It was a pleasant respite from all the concrete and steel that surrounds me on a daily basis. It was also a lovely reminder that someday, I want to have a house again, with a backyard, and my own garden.

japanese apricots

daffodils

 

The white coat

Me in my white coat: a piece of clothing that started as a costume, but over time has become a uniform — just like we were told it would at our white coat ceremony almost three years ago.

At my white coat ceremony almost three years ago, a physician gave a brief speech about this new attire we were about to don. I don’t remember his name, but I do remember, with stunning clarity, his simple premise:

When you start medical school and put on your white coat, he told us, it will seem like a costume. But eventually, as you embrace your new profession, you will come to see it as a uniform.

I’ve thought about this concept throughout medical school, tested its truth as year 1 became year 2, and then year 3. As I approach the start of year 4, I conclude the speaker was right. The first time I put on my white coat, it felt completely foreign. The first time I wore it in the hospital, to spend an afternoon observing in the burn unit, I was shocked at how my white coat and hospital ID acted as an all-access pass. With them, no one questioned my presence, even in “restricted” areas. No one, that is, except for me.

I don’t recall the precise turning point when the white coat finally felt comfortable. What I do recall is that at the start of my psychiatry clerkship, a rotation in which you don’t generally wear your white coat, I initially felt confused, almost naked, as I went about my medical student duties in the hospital. Then I knew with certainty that I had accepted the white coat as a uniform, and not a costume. It had become a part of my identity.

It was with all this in mind that I selected a date for my Step 2 Clinical Skills (CS) board exam recently.

I took my first board exam, Step 1, the February of my second year of medical school. We have to take two more board exams during our fourth year, prior to graduating. Step 2 Clinical Knowledge (CK) is a daylong multiple-choice test. Step 2 CS is a daylong series of 12 encounters with standardized patients (actors). Each encounter lasts 25 minutes. You have 15 minutes to conduct a focused history and physical exam based on the patient’s chief complaint (known as the presenting problem). You then have 10 minutes to write up your findings, top potential diagnoses, and the diagnostic tests you would order next. You are graded on a number of things, including your interviewing skills, physical exam skills, and diagnostic reasoning. The exam is pass-fail. I have to pass to get into residency — but no pressure, right?

Step 2 CS is only offered at a handful of sites throughout the country, the closest to New York City, where I live, being in Philadelphia. So it’s a bit of an ordeal. You have to take the train or bus the night before and stay in a hotel. And you need to plan for a week or two of studying first — this is not a test to go into blind or unprepared. It’s an expensive ordeal, too — $1,285 to be precise. Aside from the terrible effects a “fail” would have on your residency application, you don’t want to shell out that application fee a second time. So, you choose your date carefully.

Based on my fourth-year schedule, I had planned to take the exam in late October or early November. Sitting at my laptop, looking at the dates available, I had to make a choice. But how do you decide between a day earlier and a day later? Was there a strategy to this? There must be. I groaned (audibly, I imagine), with the weight of this decision, and the frustration of indecision.

I looked at the available dates again, more closely this time. As I did so, that speech from my white coat ceremony came back to me.

Halloween.

It was perfect. Poetic.

I would slip into my white coat to take Step 2 CS, an exam that heralds a further transition from costume to uniform, the transition from medical school to medical residency, and from medical student to medical doctor, on the holiday when millions of other people wear costumes too.

I smiled as I clicked on “October 31” as the date to take my exam, and completed my registration. I had no doubt that this was the right day. Suddenly, I had transformed a day that had so far filled me with dread into one filled with meaning.

Changing my attitude in this way won’t erase the anxiety surrounding this exam. But it will ease that anxiety. And I believe approaching the exam with this positive perspective will lift not only my spirits, but my confidence too, because what started as a costume has in fact become a uniform. And I have both been given the privilege, and earned the right, to wear it.

 

Note: This essay was first published in the online magazine The American. You can read the original version here.

28 hours later

 

IMG_3980

Some 28 hours after I left my Manhattan apartment, I arrived at the Naggalama Hospital guesthouse in rural Uganda. Having just spent some 17 hours speeding through the sky in two different airplanes, and then 3 hours loping along in a pick-up truck, and having just forced my circadian rhythm ahead by 7 hours, I felt a bit … disoriented. To say the least.

At the same time, I’d felt a rush of familiarity when our Emirates flight touched down in Entebbe, Uganda and I caught a glimpse of the brick-red Ugandan soil zooming by. And my heart immediately warmed when I saw the “Welcome to Entebbe International Airport” sign.

“It was a grueling trip to get here,” I thought to myself. “But I’m so glad to be back.”

 

“You are welcome.” (above)
This was a phrase I learned to love my first time visiting here, two years ago. I felt the same sense of welcome as I peered through my rain-splattered airplane window and saw this sign when we landed yesterday at Entebbe. I felt similarly when I caught sight of the brick-red soil you find everywhere here, also seen through my airplane window.

 

Before and after. (above)
Selfies from my cab ride to JFK airport in New York City, and more than 20 hours later on my flight from Dubai to Entebbe. Notice that initially, I’m wearing makeup. My hair is in lovely, tight ringlets. I’m wearing contact lenses. In the second photo, we’re about an hour away from touching down in Entebbe. And here, I’m wearing glasses. The makeup is long gone, and my hair quite ruffled by my attempts to sleep (every single one of them foiled). I am, however, still smiling in this second picture — mostly because even though I feel uncharacteristically exhausted and unkempt, I have in my hand a cup of fresh, French press coffee. I learned on my first trip here that I could survive without my morning coffee ritual, but that I’d be much happier with it. So I brought with me a travel French press and my own coarse-ground coffee. Highly recommended for fellow coffee connoisseurs who travel internationally.

The city speaks, if you listen

Stopping to snap a photo while heading down a busy NYC sidewalk is a very touristy thing to do. I live here, but I do it too, when what I’ve seen seems important to capture, as this window decal did. Its message — to commit; to eschew indecision — is a good reminder.

Tourists in New York City are pretty obvious. One way they often stand out is that they stop in the middle of the sidewalk (blocking the rush of pedestrian traffic) to take pictures of things that those of us who live in New York City find commonplace.

I live here. I’m no tourist. But I still find myself frequently staring in wonder as I make my way through the city. And I, too, want to record those moments of wonder. What sets me aside from so many tourists is that I do my best to step out of the pedestrian traffic, making my photo-op as unobtrusive as possible.

I probably still look like a tourist. And I’m ok with that. The moment I stop approaching my surroundings with awe, and a desire to share that awe, is the moment that I’ve lost the childhood curiosity that I both nurtured and sharpened as a journalist. The same curiosity that prompts me to ask a patient careful questions to probe her story and uncover the root of her malady.

In this post I’ve included several city photos I took recently, several signs whose messages spoke to me. Whose messages I thought might speak to some of you, too.

The photo at the top right of this blog post is from a high-rise building I passed; I don’t remember quite where. The photos below were taken on different occasions in front of Pure Barre, a fitness studio on 2nd Avenue that I pass frequently (and whose signs I’ve written about before).