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My Education, Our Education

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I woke up throughout the night, each time I attempted to estimate the time till sunrise using the ambient light that slowly invaded my room. I wasn’t particularly anxious about the upcoming day, instead I think it was the fear of the impending jolt from the alarm that bothered me. Or, maybe it is more so that I live with other people and I hate the idea of waking them up with me. Either way, I woke up well before my alarm to shut it off. Checked the weather, a balmy Boston 20 F (-6.7 C), awesome — it was time to start the day.

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From my bedroom window.

Today, was the start of our Renal module. However, I don’t go to class, with the exception of discussions, patient sessions, and skills sessions etc. Instead, I watch later, at my own schedule. There are lot of ways to do medical school, and to each their own. For myself, I was going to the Cardiology unit of our hospital to go on rounds. Right now, I’m doing my first conceptual pass (hopefully 1 of 2) through cardiology for STEP 1. So, I took advantage of opportunity to concurrently round on cardiology inpatients.

I’m not sure if it’s realistic to do this for each block that I review, but so far it seems like an interesting spin on things. But, I figured I’m already paying an exuberant amount in tuition, might as well get as much as I can out of the experience.

So, earlier that morning, the cardiology team was to see 16 patients; a lot of them were overnight admissions. The team consisted of two cardiology attendings, one interventional cardiology fellow, two cardiology residents, and three medical students (including myself). This amounts, to what I can only imagine from the position of the patient, as staring at people like they’re in a fishbowl. I learned a lot of things since the first time I did this in the summer: read-up before coming, bring scrape paper, penlights are worth gold, try or nothing will happen, and pee whenever allowed to (bathroom strongly suggested). However, I’m still learning a lot of things when allowed on these excursions. Through lecture, I’ve been “exposed” to the material for most organs and a myriad of drugs. However, in internal medicine those random one off facts I marked on multiple choices became patients where I needed to know about amyloidosis** subtypes AL, AA, and TTR came up, gout vs pseudo gout (and the beloved crystal birefringence question) and their drug side effects, side effects of calcium channel blockers and their indications including selectivity, was Takayasu vasculitis causing the patients chest pain, vasculitis[?] and the dermatology consult, pheocytochroma (the adernergics strike back!), which medications cause Lupus like symptoms, hypertension management (should have brushed up on JNC-8), epidemiology of chronic kidney failure (remember, it’s the first day in renal medicine), and did I say vasculitis? It was a long day, but I got a warm pat on the back, and I was asked when am I coming back? To which I replied, “Day after tomorrow”. I returned home, watched the day’s lecture that I missed, did some practice questions for boards, and read up on the things that I felt I should have known, and looked up a few things I saw that day.

That night before returning to the hospital, I wrote down a list of goals for myself so I wasn’t just hanging out and stayed aggressive about my education. The cardiology exam, at least how it’s taught here, is pretty hands on and intimate (interestingly, a lot of patients say they enjoy the attention):

  • Check for splinter hemorrhages on every “likely” patients’ fingernail beds — heard it was a thing, would like to see it myself.
  • Palpate as many pulses as I can get my hands on, especially the patients with Atrial Fibrillation or peripheral vascular disease — I was really bad at the “difficult to find” lower pulses, I need to get better at this for the future. So, I thought if I feel a ridiculous amount of pulses I’ll be someone useful in a room later.
  • When given an ECG, interpret it — I’m pretty decent, i.e. I can do the stuff they taught us in class; but, seeing a cardiologist interpret these things is magical. As an undergrad, I still remember trying to read an ECG in Physiology, I remember being blown away by even the concept of the leads. Accordingly, my favorite portion of physics was the electromagnetism section. Under the direction of a phenomenal mentor, I went onto do electrophysiology projects; there I interpreted ion channels, and gained a little confidence in looking at squiggly lines. This past summer, I had to drudge through a hundred or so ECGs to screen patients for a study. Now, thinking back it’s sort of funny, it’s not all that dissimilar than what I learned in freshman physics when I was working with circuits.
  • Appreciate as many murmurs and abnormal JVPs as possible, including appreciation of Kussmaul’s sign — I remember going through murmurs the first time, I was absolutely horrible at them. I recall going to a workshop for murmurs, a physician cardiology fellow said, “It’s really hard to appreciate the differences of the murmurs, until you hear your first one and identify it on a patient”. She was right. Though, I’m not a murmur master, I can finally tell the difference between murmurs and the maneuvers necessary to amplify them. About JVPs, when I was a premed my grandmother past away, just before she passed away I saw her grossly elevated JVP myself. Dr. Google told me what it meant, so I’m comfortable with appreciating their significance; I just want to make a habit of appreciating them (just in case).
  • Get more aggressive about checking for pitting edema, including attempting to better grade and describe its character.
  • Follow-up on critical patients to see if the presented planned for therapy had the luck of a good outcome — I could do this by doubling back after rounds, or simply hoping onto my laptop from home to check-up on patients the team is assigned to; i.e. patients I’m allowed to follow. One of my favorite patients we visited passed away, Friday night, just as the attending bitterly predicted. Some patients got better, the amyloid patient was being prepared for discharge, a few were scheduled for catherization, and one had died.
  • Pay attention to the management of the kidneys — I’m currently in Renal Medicine courses, so I should try to keep in mind that I still need to pass that exam later. Not surprisingly, there was a lot of between Renal and Cardiology Medicine: a lot of people with heart failure also have kidney problems. So, I’m paying more attention to goals of removing or adding liquid volume to patients. There’s been a good amount of overlap between class “take home points” and the stuff I see on the floor about titrating diuretics is applied to the patient I will lay hands on.
  • Be more cordial with patients, especially when I’ve heard they haven’t had visitors for a while — one of the first things you notice going in cardiology assigned patients is their cognitive decline, and sadly I’ve noticed it’s also the time where some stressed families distance themselves from the patient. A large part of the cardiology exam includes assessing patients’ cognitive level, while not discounting biases (including our own), their education level, and their health literacy.

I returned to the hospital, this time I given a locker in cardiology to keep my stuff safe I was told. The day before, I wrote down everyone’s names so I wouldn’t forget who’s who. I’m really bad with names, though great with faces — I’m trying to get better at the former — that morning I forgot to throw this on my checklist, to be better at names, but I made the update. I set off to complete my check-list, I did.

Now, I don’t ask “What the hell is that drug, and what does it do?”, I wonder to myself what’s the indication for using it and removing it off of patients medications list. I’ve seen a variety of patients, with a variety of attitudes about their situation: some of them beautiful some of them spiteful. Over these days, I heard my first tricupsid regurgitation; or rather, I appreciated my first definitive regurgitation — in fact,  I was bombarded by murmurs, so that it was no longer an exotic finding. Listening to the jumble of words and lab values for patients became less daunting of a task. I now feel less bogged down by the language of medicine and instead I’m looking forward to the transition from classroom to hospital floor. Perhaps it’s my gift for holding my bladder, given that I don’t have to do any of the heavy lifting yet, I like rounds and the complications and the piles of medications to think about. Given I was hoping to just be a doctor in the future, it’s surprising to see that previous work in data entry and another later entailed backend electronic database management come to use with the electronic health record navigation. I’m a little sad to see the skill come into play, but, I’m ready for electronic record drudgery so often bemoaned (and rightfully so, given the context).  Because the senior medical students above me were great, they were essential to my experience and learning. And as usual, from them, I’m left hoping to meet the standards they set-forth. The learning went all the way around, the residents learned how to teach better from the attendings, the attendings learned an extra tidbit from “research questions” done by others. And me, well, I learned from everyone: I have a lot more work to do, but I’m going in the right direction.

**reference: amyloidosis is actually pretty rare, but we’re a center for amyloidosis so the incidence here is high, i.e. less esoteric of a fact and not just warped medical-pimping.

Probing People and Updates

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So, I just had a test on how to use all of this stuff:

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  • one reflex hammer
  • one 128 Hz C note tuning fork
  • one 512 Hz C note tuning fork
  • one Littmann Cardiology III stethoscope
  • in the bag, there’s an ophthalmoscope and an otoscope that also check the nose should you change speculums
  • in reality, with the exception of the stethoscope and the reflex hammer, and perhaps a tuning fork I expect most things to be found in patient rooms so I don’t haul this stuff around

Next year, or rather towards the end of my 3rd year as a medical student, I’ll take STEP 2 of my board certification. You’re expected to know how to use the stuff in the above picture and show off your clinical prowess in other ways. My school year ends in less than 3 month! It’s hard to believe that in less than 3 months I’ll be heading towards the 3/4th point of finishing medical school — I pick my 3rd year rotations (including elective rotations) in a few weeks. It seemed to have taken so long to have gotten here, and yet it seems to be flying by a lot quicker than expected.

Anyways, with all that aside, to prepare for the 3rd year we performed a 250-point physical on a standardized patient. Over winter break I had illustrious dreams of practicing the physical, way before the deadline I contemplated, perfecting my craft. This didn’t happen. But, at least temporarily, I did lose the bags under my eyes. This was a small life-cycle victory for myself. I was able to practice, just the day before the exam, once with a classmate and multiple times with my partner — it’s a time consuming process, I still owe her dinners till this day to make up for it. Mike, my standardized patient was also a great person to examine. Likely well into his mid to late 50’s, Mike was well built (likely more muscular than I, not that I’m all that impressive of a norm) and a talkative native of Boston; accent included. I invited him to talk the whole time, though there are times where quiet is necessary, I find examining patients while they talk to be a lot more natural than probing them and reaching into their nether regions in stone-cold silence.  Mike told me he’s into sports, so we spoke about sports while I give him a physical from head to toe (literally). The most difficult part of the exam was that I actually don’t watch or care about sports, with the exception of the Olympics (oddly enough, I haven’t missed any for the last 12 years). I grew up in a sports loving family, if you didn’t play sports you were considered weird, I played: baseball, basketball, football, and even golf. I fell out of love with watching sports a long time ago, just quitting cold turkey. But, I know the buzz word things to talk about in sports conversation. Though, somehow, sometime later we got into a conversation about our mutual love for the smell of Christmas trees. Yes, specifically the smell, how else to test cranial nerve I?

After the exam, while emphasizing my lack of knowledge, I told him ‘off the record’ that one of his arteries was bounding more than I would like. I asked him if anyone had ever told him something like that before, he said in fact they had. The finding could have been benign, but after we spoke he agreed it’d be best if he’d go ahead and check it out. He asked for a mole check, did the basic ABCDE, and seemed like just a normal mole — apparently, others he asked were also in agreement. Besides some typical features found with aging, he was perfectly healthy except for a slightly non-malignant high blood pressure that he was concerned about because he’s historically 120/80. He cared about his health, I could appreciate that. We spoke more about that, I asked him more about his substance use, in this case coffee that he remembered drinking (2-3 cups a day). We agreed that at his next visit he’d skip the coffee and then see if he’s back to normal, then take things from their with his doctor.

It’s funny, when I started the exam, I had heard that this is just a dry-run: you just have to speed through the 250-point checklist like they’re a car at Jiffy-Lube. Instead, I was met by a man, a patient who actually was both teaching me and hoping to get a medical benefit from the examination. And for me, that felt a lot more natural: me trying to give him a benefit. I’ll try to remember that as I practice my skills with patients in the coming days.

Today, we just finished our Rheumatology unit, I enjoyed it more than I expected. It was challenging, but a fair unit. During that unit, I went back to refresh myself on medical microbiology (Sketchy Medical, First Aid and UWorld questions). Some days I’m scheduled at a local community health center, we’re farmed out to a lot of places but I was fortunate to pull one that’s easy to get to. We’re now required to have one clinic day where we see patients, where we perform a battery of histories and physical examinations. I’m looking forward to returning to clinic, it does take some time out of my study schedule but it helps to remind me of why I want to do this in the first place. Though, I prefer being in a more intensive setting, so I’m also schedule to hop onto cardiology wards this coming week the day after the health center. As such, I decided to start reviewing cardiology again in my board studying schedule this weekend. Given that I’ve rounded with this attending before, my PI (he’s an Atrial Fibrillation (AF) specialist), I’ll review the basics before I show up: drugs (their indications and side effects in regards to), certain high yield risk analysis scores like the CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk, ECGs, murmurs, etc. With the cardiology team, it’s quite large, and there’s a lot that needs to get done so I don’t expect to be called on or present. But, I feel I should at least put in the effort to understand the answer that my seniors are being politely pimped about; it does seem at least common courtesy. Knowing stuff helps me pretend I know what’s going on, it’s an important strategy.

Tuesday, we start Renal Medicine. Should be a tough course, though it’s pretty much just a down hill slide from here as long as I keep on schedule. Thus, I’m looking forward to it and the patients and experiences I’ll incidentally meet along the way.

 

Student Doctor Network and Unsafe Spaces

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If you’re a premedical student, it’s very likely you’ve heard of Student Doctor Network (SDN).  If you haven’t, just as a quick history, SDN was founded in 1999 in attempts to fill the unmet need in advising for many aspiring physicians. It sort of sounds like a lofty, if not nebulous mission, and a goal that is easily lost on the current state of “access to information”. If you’re too young to remember what Oregon Trail was, and with the current adult use of the internet being around 85-87%, it’s hard to imagine a time before the internet for context of the access to information at the time:

  • 1996: 23% of US adults went online
  • 1997: 36% of US adults went online
  • 1998: 41% of US adults went online

Pew Poll

As access to the internet was still blooming and more importantly “content”, however at that same period of time there was a large gap between those who seemed to know how to get into medical school and those that don’t. Around this time, 1999, access to the big three MCAT prep companies often meant heading to the library: Kaplan (est. 1938), The Princeton Review (est. 1981), and Examkrackers  (est. 1997,  a baby company at the time, had a 100 registered prep students). In that period, if you wanted to know information about the MCAT you had to have a buddy that took the MCAT. Didn’t have a decent advisor? Tough.

This was long before the time of Twitter, and even several years before the first global hit social media “Friendster” was founded. Indeed, if you were a premed, the days before the internet were dark times if you weren’t “in the loop”. Because of SDNs victory at being the torch in the night for some, SDN must be given credit where it’s due.

However, the experience that both enhances and perhaps detracts from the premed experience are the pre-allopathic forums. When I was still an early premed, I heard whispers of this foretold website I could visit where I could learn how to apply to medical school the “right way”. Although I had no intention to post yet, I remember being very excited, I think I made an account immediately. At the time I used the site, I was still a community college student — I hadn’t taken any of the premedical prerequisites yet (I took them all at a university I transferred to). Being no stranger to forums and message boards, I felt comfortable forum FAQs and utilizing the seemingly unknown by new users search function. Because of this I think I stayed away from what is ubiquitously and now arguably haphazardly as trolling — “trolling”, a term that has lost it’s oomph, while it used to refer strictly to the succubus like internet user destroying others’ lives for attention, it’s now used as a pejorative for any dissent against the major opinion. Though, user board nuance terms aside, over time, I found like any standard distribution: most people who post are fine, if you move far away enough from the norm, and there’s a minority of both jerks and excellent people. The more you skim, the more jerks you find, it’s merely a properly of statistics known to any populous message board — see 4chan, for gamers old gamefaqs (general discussion) and Shoryuken, and for the modern man and woman Reddit. Thus, it’s easy to just dismiss the negative experiences felt by some on SDN as “par for course”. The new movement and very ironic movement, the anti-PC police, might even want to say you still wear diapers for being flustered.

When I first found SDN I wasn’t yet sure about medicine, though only a movement held by a few with “garbage” arguments, I quickly found that there was an almost anti-underrepresented minority tide. At the time, I recognized that it wasn’t a safe space for me to mature as an young African American male with no role models around to put things into perspective. It wasn’t really until after I had already at least gained one admission spot that I felt comfortable freely perusing SDN, I thought why freely stay somewhere where you’re not welcome — instead, I did all of my MCAT/admissions prep via Google and books, and any advice I could catch along the way.

However, what lies within the “garbage” of SDN posts is a lot more insidious. Even with the most open mind, and turning a blind eye to the rampant ‘joke’ sexism and womanizing of seeming pubescent boys, it’s hard to humor the recent posts where the killing of Tamir Rice was being justified and the work of civil rights allies were mocked. When I was admitted into medical school, across the nation there were only 514 other black males also admitted across the country — around the same or less than in 1978. Though, why this stuns analyst is somewhat of a mystery. Regardless of race, unless you’re in the minority, a successfully matriculated premed’s parental income statistically will come from the upper middle class. There’s a correlation between scores, including the MCAT, and parental income/capitol. For the average American, their capitol and family net worth is based on their house ownership. From the 1930s until 1968, the federal government specifically excluded African Americans from federal home loans — delaying the amassing of family wealth. Even afterwards in 1988 and 2013, in Boston and Philadelphia respectively, suits and evidence brought forward of intentional segregation and discrimination. So, even working hard and being able to afford a house doesn’t promise being able to secure a loan. So, it’s not to say that the African American middle class (and missing African American applicants) aren’t trying, it’s more so that they’ve tried for decades and have failed to gain traction until very recently. But hey, its not reasonable to expect everyone to dive into law and socioeconomics, nor do I expect people to realize that even being a black Harvard Law professor still affords you little hope for a safe space (his own home).

With that being said, the African American community (and really many people who happen to be in the SES category) have much to gain from the free resource SDN offers. Therefore, it comes with great solace to admit that when it comes to recommending using SDN, especially if you’re a PoC, do so with great reservation. As a minority and former premed, if I had stayed on Student Doctor Network because of how discouraging the general tone was for minorities; I probably would have never applied to medical school. And really, I suppose the part that disappointed me wasn’t that there was a dissenting opinion than mine, nor did I think I was a special snow flake that needed protection. Instead, it was the disappointment of thinking that this was my potential peers that effected me. I’ll even admit in my limited experience thinking SDN was “truth”, subconsciously, this scared me off the track of pursuing medicine. Eventually, I feel in love with the “hard science” crowd, and just assumed I’d pursue a PhD. Later, though I had already been accepted into grad programs, I changed my mind and decided to apply to medical school after a mentor convinced me that I let others psyche me out — that was my own failing in not believing in myself and letting negative echoes get to me. However, in the end, SDN will eventually have to come to terms that the site where professionalism is supposed to be exemplar has members that join in the ceremonial stabbing of premed Ceaser.

And as one, I can only say in solidarity with the poll towards SDN, “Y tu Brute?”

Though, in the modern age, SDN may continue to live on with its useful archive while some premedical students continue to gravitate towards safer spaces to escape having their soul ripped out. And, what does it say when one of the most popular spring boards for premedical students doesn’t function as a safe space for people of diversity (including financial SES ORM). If this doesn’t bother you, and you benefit from the status quo, bravo to you. But, do know that some are steered away from potential opportunities because of their lack of safe space that you are so entitled to in the locker room of life. And it wouldn’t be fair to ever suggest, without evidence, that SDN steers minorities away from medicine. However, because there’s no evidence that it’s particularly helping in terms of diversity — diversity goes beyond race, and are not merely “cards to be played” —  we can only wonder what type of positive effect the forums could have had diversity were guaranteed the same “safe space” enjoyed by the majority/typical applicant.

Twitter Premed Opinin Poll of SDN Use and Value

 

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How Far We’ve Not Come

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Hello,

The year is almost over, soon we’ll be ringing in the New Year. Last year, around this time at Boston Common, I was participating in mass [national] protests in regards to the Eric Gardner incident. In the mythical age before the internet, as a child, I watched my hometown burn in reaction to video of my cousin being beaten by the police went viral — it was the first time the “minority mythos” of police brutality gained credibility with the majority.

In my day to day life, I try to avoid talking about the two R’s: religion and race. I avoid religion discussion the most, mostly because the point of arguments is to convince, and I have no interest in assailing someone to convert or see my point of view on religion. So, I have nothing to gain by arguing about it. But for race, it’s not logic that stops me from bringing it up.  Then why? Fatigue.

My mom, scarred by the Watts Riots (sparked by police violence and social unrest at systematic discrimination) and her experience growing up, she taught my brother and I about race relations early in life. I still remember the day she sat me down, I can still feel the pit in my stomach as I was certain she was going to scold me about something. But, instead, she said me:

Mom: listen, I love you. One day, you’ll meet the police and whatever they say do it. They will kill you.

My mom then went onto to explain, that which seemed as casual as explaining how to ride a bike, to me how to get arrested and beaten and how to best make it home. She made me promise to remember what she said, and made me repeat it back to her verbatim. Though at the time, I still remember being dismissive, I believed her story to be antiquated and worries anachronistically placed.

I don’t remember when I found out I was wrong about my mom’s ‘antiquated advice’, and soon I learned being a nerdy honor student didn’t protect me. Maybe it was when my brother, his friend, and I were held at gunpoint at a simple traffic stop when I was a teen. Perhaps, it was that one time where I was assaulted by an older white gentlemen that my face left bloodied after he threw a beer bottle through my car window (gouging a whole in my cheek) and the police who later interviewed while me accusing me of participating in a rival “gang fight”. If I think about it, it may have been that one incident where I was held on the suspicion of armed robbery for several hours to a city and bank I’ve never been to, to the police’s credit I did match the description of a black male in “a grey or white t-shirt and blue jeans”.

Race, and the effect it has on social constructs is no mystery to me. It’s the fatigue, the race PTSD, that makes me too fatigued to talk and no less write about race. So, I’m never very quick to jump to discuss race or else betray my own sanity. The last time someone brought it up it ended in a wounded friendship after my (nonwhite) friend (who was unfortunately rejected from medical school) told me I was “lucky” aka I won the affirmative action lottery – never mind I that compared to this person that I had better scores, letters of recommendation (their top letter was from their physician father), more community service, and extensive post graduate research. I remember being taken aback by realizing that an acquaintance, someone who was becoming my friend, would rather reinvent my narrative and remove my merit and replace it with race.

Last year, some classmates and I formed a makeshift committee, and we had a vigil to honor all of those lost by excessive police force. I was responsible for compiling a list of national victims, the list I made only had two requirements: killed by the police, and killed by the police while not armed. I wanted to avoid misreporting cases so I worked to remove names off my list as I drudged through headlines, local articles, and court cases — even making an abbreviated list was a difficult task as congress forbids the FDA to use federal money for gun violence research, and most police departments can report as little or as much as they’d like. In the end, I still had a mighty multiracial list, ranging from the young and old. The event garnered a lot of support, the administration backed us up, and as tradition holds in the civil rights movement many different backgrounds decided to be our allies.

Several weeks ago, prior to a community outreach meeting, I had dinner with a friend from another program within our institution. As we gobbled down our food, she bought up a subject she rarely talks about: race. As we ate, she probed how I felt about the protests going on. Perhaps, being a politician in my ways, I decided to offer a neutral answer because I think most answers are never that simple. She told me, as a white female, how the protest alienated her and some of her friends and why they didn’t support it — as she poised it, “We shouldn’t have to say we’re sorry or guilty for something we didn’t do”.

I saw her point of view, but I also was confused by the logic of the argument. First, it’s logical to not feel guilty about systematic discrimination when you’re not participating in it. In fact, I’d hope that the police who fight against Garner like injustice feel no guilt either. However, while discounting guilt, it’s not too much to demand enough maturity to have empathy for those who experience discrimination or mistreatment. I don’t feel any guilt about pay discrimination, because I don’t participate (though I realize that I wrongly benefit from the status quo), and I sure as hell believe pay discrimination shouldn’t exist. When my house was a foster home, kids came in who were both physically and sexually abused. We didn’t need to first come to grips with our societal “guilt” before advocating for them. When I traveled to more patriarchal countries, I recognized how I was treated better than others for no other reason than what I can scientifically reason as genitalia differences. Though, I suppose if she had went to the event that then they would have seen that the event of Eric Garner, an event where we read off of the names to honor multi-racial victims, transcended blame and instead targeted solidarity and solutions. Perhaps reflecting this, most of the participates in the protest were actually white, and I doubt any of them felt any particular guilt; instead, they were just driven by doing a social good.

What social justice movements needs are allies who fight for change, whether that be for redemption or because of virtue. And really, I find it curious that people can sit on the fence as people suffer. I’m very much against the “You’re either with us or against us” false dichotomy. But, I do believe that in terms of progress, “You either help grease the wheels or help clog them”.

No one is looking to point fingers, unless those fingers are pointed at solutions. And really, if you feel defensive about being grouped together with the oppressors remember than none ostensibly assigned you to the group but yourself — if offended, consider the noun to be a philosophical Rorschach test for you to work out yourself.

In the world where it’s totally okay to riot to celebrate a sport loss (or ironically, also a victory), it’s funny that people are up in arms about other groups having the same vigor and passion to protest their lack of rights.

Thanks for reading feel free to comment.

Life, Dermatology, And Onto Hematology

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Hello,

Happy holidays! We just finished two modules: Dermatology and Endocrinology. Right now, it’s hematology. I’m happy about the switch, Dermatology was overloaded with diseased gonads. And since I study 90% of the time in coffee shops, I can assure you that the public is very pleased about my course transition too.

“The best thing one can do when it’s raining is to let it rain”

Unfortunately, at the same time, lots of bad news was stirring during this block. An aunt past away on Thanksgiving Day, I was sent a text message a picture of us together at my college graduation. My partner’s father (Kazumi) suddenly passed away from an unknown stage IV lung cancer the night before my Dermatology exam — it was a surprise, especially for him as he literally walked his positive X-ray into the hospital just 3-weeks before his passing — with the hastiness, his finances weren’t in order, so this will be a problem later for his now widowed wife. And to top it all off received news during Endocrinology that my brother is, again, in jail.

Kazumi, although in my life for only a few years, was like another father to me. When I hard still slaving away post graduate, working for nearly nothing all while putting in 10-12 hour days, accumulating debt while I volunteered instead of throwing in the towel on building my medical school application experience, he always had one response “You’re doing great!” In fact, he backed those words up, he was essential to be being able to afford to apply to medical school. He came from a less than glamorous background, wasn’t able to go to college, but neither the less worked hard to eventually get ahead and do something for his family in Japan. He saw a little of himself in me, or at least that’s what I like to think, and he wanted to give me chances he didn’t have. So, the night before the exam when I got the Skype call that he passed, all I could do that day was knock the test out of the park in his honor: I did, beat a personal high set on the last exam.

I suppose, at a time like this, it may sound callous to focus on an exam score. But really, life never stops. This year it’s this, last year it was a death of a cousin, several years ago it was the loss of my nearly adopted sisters in a drawn-out custody battle, after that it was a suicide and another death. Yes, with age, life adds up and with it so do the statistics across the population I know. So, life won’t wait for me to get my life together before it tosses me a few million curve balls. For now, I’m staying positive and appreciating the negatives: I walk tall because my grandmother was handicapped, I’ll continue to appreciate my education because of the opportunities those before me never had. As it’s said, “The best thing one can do when it’s raining is to let it rain”, Henry Wadsworth Longfellow

Goodbye Kazumi, and I’m sad you’ll no longer be reading these posts, interacting with my tweets, no more Skype conversations, or being my #1 fan on Facebook — as it’s a constant source of laughs, I’ll never let your daughter live down that you “unfriended” her, while keeping “friending” me. As someone who was usually treated like trash in their past, thanks for treating me like gold.

 

My Podcast Interview With Accepted.com – Medical School Admissions

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Hello everyone,

A few week ago, I think a day or two before some exam, I sat down to do a podcast interview Accepted.com.

We spoke for about 45 minutes about medical school and my own medical school admissions experience.

So, if you ever wanted to hear me blabber on about medical school, here’s your chance:

Podcast Link 

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http://blog.accepted.com/2015/11/18/insight-from-a-successful-non-traditional-premed-and-now-m2-episode-129/

Exam Went Great — And Background Maintenance, Forgive the Mess!

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Hello,

So, the last time I left off on this blog I was having a happy-go-lucky the night before my Endocrinology exam. Great news, my chicken to egg ratio estimation was pretty spot on, the exam went remarkably well — in fact, it’s was my personal best since I started medical school. Academically, a  lot of things happened just at the right time to make it happen, and a lot of that is because I have a solid and dependable study partner. A lot of us live off campus, so we have many off campus study habitats. One day, we expanded the study group, did practice questions, then discussed every option either right or wrong. It doesn’t take that long to do this by yourself, because you only have your internal dialogue to contest with on topics. Add in another person, two type-A medical students, the time takes longer but you each individual gets more out of it; probably because you can’t just appease yourself any longer. Add a few more people, toss in contrasting personality types, and well you have an all day affair. But, it was well worth every minute. I think having to explain my ideas or theories of why an answer is right in front of my peers, friends with very low tolerance for BS or fluff answers, was a great measure of my understanding. Also, while working on problems I’m not so shy to just say, “I don’t get X, can you explain it to me?”, when I see people who’ve mastered a certain topic more than I — it helps that I know down to earth people who’ll easily say the same thing to me. Anyways, I’m an advocate of studying independently combined with study groups, and I mean really studying in groups not just “parallel play” studying.

Blog Maintenance

I’m on vacation for a few more days, on Monday we start Dermatology (rash city). I have a few random life things to do, apply for a state ID, register for boards, and start scouting for a new place to live for summer before clerkship starts/in between boards. But, for now, I’m going for a small victory of organizing my blog a little. I’ve gotten a few fist-shaking emails asking to make my entries easier to find and search. I’m not a web administrator, and it’s just a blog, but I’ll try to tidy things up on the backend a bit. I figured now’s a decent time, as most premeds who still visit my blog have already applied to medical school this cycle and my blog doing strange things wouldn’t adversely effect them. One of the biggest shifts will be the destruction of all the categories. My blog started just as a post to document my process through medical school, and I haphazardly added categories as the things I spoke about grew. So, I’ll be fixing the categories, with a more limited filing option to make things more logical. Also, I’ll go back and see what I can do about tags to make things easier to search. I appreciate your emails, and the fact that you bother to read and want more out of this odd social experiment that is my blog. I have about +160 articles here to work on, so give me a little time and things will hopefully be smoother!