medical school | doc w/ Pen

December 27, 2016

What do I want to do when I “grow up”?

In a recent comment on my blog, someone posed a question to me. She asked whether I have a specialty in mind for the future. It’s a common question for medical students. So I’m used to fielding it. I think it’s worth explaining my thought process here.

The short answer is that I don’t really know what I want to do when I “grow up.” I’ll become a doctor of course, but what kind of doctor? I’m not sure yet. I think that’s the case for most medical students at my stage, pre-clerkships. We haven’t had real exposure to what doctoring is like. We’ve all shadowed various physicians, sure, and spent some time in the hospital practicing our physical exam and history-taking skills. But we’ve never been a true part of the medical team.

And that’s what clerkships are about. They’re an introduction to several medical specialties, a chance to try on the different branches of medicine, to see which one fits best. In order of my own rotations that start Feb. 13: ob/gyn, primary care (adult outpatient medicine), psychiatry, surgery, anesthesiology/critical care, neurology, internal medicine (adult inpatient medicine), and pediatrics. During clerkships at Cornell, we also get a 2-week elective block where we can try a field not represented in this list.

Part of choosing a specialty is finding the kind of medicine that interests you most. This is pretty obvious. Do you want a procedure-based specialty like general surgery or urology? Which patient population do you want to work with — kids, adults, pregnant women? Clerkships are designed to help answer questions like these.

I’ve also heard that part of choosing a specialty involves finding your kind of people. I’ve been told that different fields attract different personalities. Finding the right fit means finding where you fit in.

Clerkships still lie ahead of me. So I’m decidedly undecided at this point. My goal in the next year is to remain open minded. And there is so much overlap between the different specialties that no matter what I choose, having some experience with the other fields will benefit me — and my patients.

That’s my attitude. I hope that approaching clerkships this way will help me learn the most from each one.

3 Comments

December 26, 2016

Be in the moment

This morning, my dad’s cat Regina reminded me how important it is to just be.

I had the most incredible experience this morning. It didn’t involve leaving the house. It didn’t cost anything. I didn’t even have to change out of my pajamas. For an entire hour, I sat on the couch petting my dad’s cat Regina.

My dad’s two cats are friendly, and love attention. But neither has ever sat still that long for me. So the encounter itself was a pleasant surprise. Even more surprising, though, was how amazing it felt just to be for that time. Just to exist in the moment.

I don’t often take the time for anything like that. It always seems like there is so much to do. If I’m not doing something, anything, then surely I’m falling behind. But maybe the sense of peace I got from this simple 60 minutes is a lesson to me. A lesson that no matter how much is going on, taking even a few minutes to ground myself, for serenity’s sake, is worth it. I think this is especially important as I approach my Step 1 study period and my clerkships. During both of these experiences, I’m bound to feel more harried than ever. Which means I’m bound to need a moment of tranquility more than ever.

If only I had a purring, furry friend like Regina who could remind me of that every day. I’ll just have to remind myself.

2 Comments

December 24, 2016

Preparing for what’s next

Being unprepared is one of my worst nightmares. Literally.

The dream takes different forms. Usually, I’m at school. I discover there’s a huge test I didn’t know about (and so didn’t study for). Or there’s a big assignment due, and I completely forgot about it.

I wake up from these dreams unsettled, because in real life, I make a point of being prepared. I know that in general, there are all kinds of things that I can’t control. So the things that are within my power, I try to manage as best as I can.

Nowhere is that more true than with my upcoming clerkships. So much in that realm is out of my hands. I recognize that. But certain aspects, I can prepare for. Like having everything I need in advance.

Living in New York City without a car, shopping can be a challenge. So I’ve tried to get some of that done more conveniently (and more cheaply) while here in Chicago visiting my family.

Jeans aren’t exactly appropriate for the hospital, so I needed more professional attire. And to take a patient’s heart and respiration rates, I needed a wrist watch. Thankfully, I think I’ve gotten everything I needed. Christmas sales made it all relatively affordable — certainly more so than in New York.

I did roll my eyes when my mom explained our shopping trip to a sales clerk at the local mall:

“My daughter came all the way from New York City to go shopping here in Chicago!”

But really, she was right.

I came here to see my family, of course. That’s my main priority. But I also came here to get ready for what’s next. To get in the right mindset for studying for Step 1, and to get what I need for clerkships.

At this point, I’m prepared for what I can prepare for. And the rest? I’ll handle that as it comes.

December 17, 2016

Always more to learn

What we know is less than what we don’t know.

That’s a quote from one of our infectious disease lecturers. She was talking about viruses. But her words describe so many vantage points, including my own right now.

I’m done sitting in a classroom. Not just for the semester, but for medical school. Next semester, after I take my board exam, I go straight to the hospital to start applying all I’ve learned. And to learn so much more.

It’s been a jam-packed three semesters. I absorbed more information than I thought possible when this all began. Attending medical school is compared to drinking from a fire hose. It’s an apt analogy. What we endure is intense.

Even so, what I’ve got now is book knowledge. A tangle of facts. (And even that needs a great deal of solidifying during my five weeks of studying for boards.) Having that knowledge at my fingertips, and understanding how to use it in clinical practice — those are skills I don’t yet have. And while I know the steps of a physical exam, interpreting the findings, what they mean in the context of my patient, is something I need to practice too. I also need to listen to hundreds of hearts and lungs and bowels so I can learn what normal is — and what abnormal is. Right now, it’s all a bit of a jumble.

I have learned so, so much since starting medical school in August of 2015. But I have more to learn in the next two and a half years while I’m in the hospital. Then more yet in residency. And even more once I’m an attending physician. In medicine, the learning and growing never stop. That’s intimidating sometimes, but it’s also exciting. It keeps things interesting.

Right now though, I’m ready for my two-week winter vacation. All this learning is hard work.

3 Comments

December 14, 2016

Building trust, one patient at a time

Sneaky.

That’s what my patient called me yesterday.

He meant it as a compliment. I took it as one.

I’ll back up, and explain the context of this clinical encounter. Yesterday was our final OSCE of the semester. OSCE stands for Objective Structured Clinical Examination. That’s a long way of saying we get videotaped interacting with a standardized patient, an actor who’s trained to play a certain role and then provide us with feedback about how we did. It’s a required part of our medical school curriculum. It’s how they assess our developing clinical skills. We’ve had several OSCEs since starting medical school, but yesterday was the culmination of our three semesters thus far. Up until this point, we’d only done bits and pieces of the standard history and physical exam. This time, we had an hour for the whole thing, from the chief complaint (why are you here?) and history to a head-to-toe physical exam.

I was nervous. In part because being filmed intrinsically makes me nervous. But also because this was a lot to remember. It matters, and I wanted to do well, to take the exercise seriously. Because in a couple of months, I’ll be doing it for real.

But once I settled in with my patient, I was fine. While taking his social history, I learned he was from Chicago. So I delved into that a little more. We talked about the differences between New York and Chicago. We joked about particularities of the Upper East Side. And then I attempted to gracefully move on to the TED questions — tobacco, ethanol (alcohol), and drugs. Sexual history was next. These two groups of questions are some of the most touchy. My feeling is that if you have the time, it’s a good idea to get to know the patient a little before asking those questions. Not only that, I simply enjoy hearing other people’s stories. What is someone else’s life like? Where have they been? How do they approach the world? It’s the curious reporter in me.

And that, my patient told me, was sneaky. In a good way. We were talking about Chicago and then all of a sudden you were smoothly on to more history questions, he said. By talking about his life, he told me, I’d developed a rapport that made him feel comfortable answering those delicate questions.

Not everything went so smoothly. I have lots of room for improvement. I need to find the right balance between spending time on those life-questions and spending time on the rest of the physical exam (which I didn’t quite finish within the hour).

But I’ll get faster. I’ll become more efficient. Those are skills I can learn, and will learn as I make my way through clerkships in the hospital. That I know how to earn someone’s trust — I think that’s more important at this stage. At least for me. The rest will come.

December 13, 2016

Practice makes better

In about two months, I take the USMLE Step 1, the first of my board examinations. Yesterday, I took an abbreviated practice exam in our main lecture hall with my classmates. This was not by choice — it was a mandated exercise. And I took it begrudgingly.

I plan to study full time for five weeks for the real exam. At this point, I haven’t studied at all. What I have done, though, is plow through three semesters of medical school. While I’m in no way ready to take Step 1 now, the practice exam didn’t have the demoralizing effect I expected. First of all, I remembered more than I thought I would. That suggests that if I do apply myself during my study period, I will be ok. The level of detail required, though, reminded me how much I do have to review. And my difficulty in sitting through even an abbreviated exam reminded me that I need to build test-taking stamina to make it through the real deal.

So as much as I griped about this, I’m glad to have taken it. I know I have my work cut out for me. But I’ll be trying to work through those five weeks of studying with a mindset of calm, not panic.

December 11, 2016

Remembering how I got here, with gratitude

Living on the Upper East Side of Manhattan, you encounter a lot of wealthy people. The zip code 10065, just blocks south of where Weill Cornell Medical College is located, made number 15 on Forbes’ “America’s Most Expensive Zip Codes 2015” with a median sale price of $4.4 million. As a broke medical student though, this is not a life that I’m directly exposed to. Not usually. But recently, I was invited to dinner at a private social club. I was to meet the person who funded my summer research, including my trip to Uganda.

Having grown up writing thank you notes for even the smallest of gifts, I was excited to say “thank you” in person for making this life changing experience possible. But when I found out where we were meeting, I was also nervous. Former club members apparently included people like Eleanor Roosevelt, Pearl Buck, and Margaret Mead. What in the world did I have to wear to a place like that? Of course my fretting was for naught; everyone’s attire there was classy but not fancy, just like mine. Phew.

The food at the club was excellent, but much more meaningful was the company. At the dinner I was reminded of two things. First, how important it is to support and mentor a younger generation. That support might be financial, emotional, or otherwise. And second, how significant the experience is for both parties.

The person who provided my scholarship was thrilled to hear about my trip and my experience. And I was thrilled to share it. The money provided was a drop in the bucket to her, but meant all the world to me. I couldn’t have gone without it. I hope my gratitude came across during that short time.

I’ve had so much help to get here, and it continues to pour in. I’m grateful for all those gifts, great and small. And I fully intend to pay them back someday by paying them forward.

December 7, 2016

My brush with the ‘winged scourge’

“Shit, do I have malaria?”

That was one of my first thoughts upon returning to the United States from Uganda in late July. I remember thinking that as I was waiting in the customs line at JFK airport in New York City. I’d spent my 12-hour connecting flight from Doha, Qatar, huddled under a thin fleece blanket, shivering, my head and whole body aching. My stomach hurt. I had diarrhea. Potential signs of malaria, I knew.

This was reinforced in our parasitology presentation yesterday, the lecturer saying:

Fever + travel = malaria … until proven otherwise.

Sleeping under a mosquito net every night was part of my malaria prevention in Uganda.

While in Uganda, I had spent every night under a mosquito net. I’d religiously taken my Malarone (malaria prophylaxis) as directed. But … my mosquito repellant application had been less than diligent. The bugs weren’t really about during the day, and I was already applying a sticky layer of sunscreen. So I decided to spray myself only in the evening. Problem was, I’d be sitting out on the back porch, drinking Ugandan beer and talking with my friends, and completely forget about the DEET. So a number of mosquitoes got lucky with me. It seemed like even when I applied the spray though, it didn’t make much of a difference. But either way, I had something to fuel my paranoia. And boy, are medical school students good at being paranoid about their health.

Thankfully, I didn’t have malaria — it was probably a stomach virus. Several people I’d been traveling with got something similar. But it was scary. I plan on returning to Uganda for future research, and I certainly will be more careful with the bugs next time. Just in case. No reason to tempt fate.

I’ve always thought of malaria as mainly a travel-related illness. And these days, it is. Interestingly though, I learned in our lecture about how much of the United States was affected by malaria even into the 1940s in several Southeastern states. This was such a big deal that the U.S. government worked with Walt Disney studios to bring back the Seven Dwarves in 1943 to teach people how to knock out mosquitoes, the vectors that transmit malaria. The short film was called “The Winged Scourge,” and I found it on YouTube after hearing it briefly mentioned in our lecture. I couldn’t resist sharing the video (see the top of the page). It’s just under 10 minutes, and it’s hilarious. You’ve got the booming, ominous voice warning you of the winged villain. And then you’ve got the beloved dwarves doing their best to exterminate the critters, and of course getting into mischief along the way.

Some of the advice still holds, like eliminating standing water to get rid of places for mosquitoes to lay their eggs. Though I’d guess there are other methods to try before you lay down an oil slick on ponds to asphyxiate the larvae swimming below. Not too good for the rest of the environment.

It’s a piece of history — of public health history, and of cartoon history. As a socially conscious future physician who was raised on Disney movies, what more could you ask?

Note: If you’re curious about the history of malaria eradication in the United States, here is an interesting (and brief) explanation from the CDC.

2 Comments

December 4, 2016

Bugs and drugs

Talking to yourself is a sure-fire way to look crazy. I’ve discovered it’s also a sure-fire memory enhancer. When I was first learning Spanish, I would have conversations with myself, voicing my thoughts in Spanish rather than English. These days, I find myself muttering antibiotic treatment algorithms aloud. I (mostly) do this alone in my apartment, for everyone’s sake.

Identifying the bacteria causing an infection is sometimes trickier than it sounds.

Tomorrow is our first infectious disease exam, and there is so much to memorize. Every little bump helps. I can sum up this exam in two words:

bacteria
antibiotics

That might not sound like such a big deal. Trust me. It’s a big deal. I can prove it. I’ve included a photo of my dry erase board, which currently sports an identification tree for both the common gram positive and gram negative bacteria. (There are other bugs to know, but these are the main ones.)

The list of antibiotics to learn is also long. The list here is a screenshot from an e-mail sent by our course director, telling us what we drugs to focus on. Antibiotics are tricky though. Each one covers a slightly different spread of bacteria. I also need to know the mechanism for each drug, possible side effects, and how various bacteria can become resistant to the drug. That’s a lot of information.

Learning all these drugs — what they treat, how they work, side effects, and resistance mechanisms — is a feat.

Thankfully, my motivation for learning these bugs and drugs is high. Antibiotic therapy is something I will definitely use on a regular basis. Seeing that clinical application helps me slog through. Silly mnemonics are also a boost. Some are my own, like this one:

Ceftaroline, a fifth generation cephalosporin, is one of a few drugs with activity against MRSA. Here’s how I remember that: Ceftaroline‘s got a line on MRSA.

Here are a couple from the book I’ve been using to study, Microbiology Made Ridiculously Simple:

Carbapenems like Imipenem and Meropenem are broad spectrum antibiotics that cover all kinds of things — gram positives, gram negatives including Pseudomonas, and anaerobes. To remember the coverage of Imipenem, think of this: I’m a pen, crossing out all bacteria.
Bactrim is another antibiotic that covers all sorts of bugs. This drug’s generic name is trimethoprim/sulfamethoxazole, or TMP/SMX. You can use four of those letters, TMP/S, to remember some of Bactrim’s capabilities:
- T (Tree): respiratory tree. The drug covers all kinds of respiratory infections.
- M (Mouth): gastrointestinal tract. The drug covers many gram negative bugs that cause diarrhea.
- P (Pee): genitourinary tract. Bactrim covers UTIs and other nearby infections.
- S (Syndrome): The drug covers a devastating disease called Pneumocystis carinii pneumonia (PCP), which affects people with AIDS who have low T-cell counts.

These are stupid, but they stick. And that’s what matters. It matters for my test tomorrow, but more importantly when it comes to treating a patient who presents with one of these infections. If it takes me mumbling these mnemonics to myself and looking like an idiot to get there, I’m ok with that.

December 4, 2016

An abstract challenge

I first saw my name in print in the fall of 1999. It was my first semester of college. I had taken a journalism class because my advisor told me not to. When I fell in love with reporting and writing, my journalism TA hooked me up at the school newspaper. My first article was a feature on cider making at the local apple orchard.

That was 17 years ago. It’s still a thrill to publish — to share my written work with the world. These days, most of that takes place via this blog or the online magazine where I write a monthly column. Most of my work consists of personal essays.

But last week, I submitted a different sort of writing — a research abstract based on my work in rural Uganda this past summer. If the American Geriatrics Society (AGS) accepts my abstract, I will present a poster at the organization’s national conference in San Antonio, Texas, in May 2017.

I do have another scientific publication — a secondary authorship on a paper from the Drosophila melanogaster (fruit fly) lab where I worked for a semester while taking my medical school prerequisites. But this would be my first time as a first author. And this would be my first foray into the world of clinical research.

Acceptance here is by no means a guarantee. And my topic is somewhat outside the typical AGS fare, so I’m not holding my breath. Even if I don’t get accepted, going through the abstract writing process was still a wonderful experience. Distilling all that work into fewer than 2,650 characters was something else. That taxed even my editorial expertise.

All that said: *fingers crossed.* I’ll find out by February.

2 Comments

Tag: medical school