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This Summer Has Been About the Heart

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Sorry, I’ve been busy lately. I’m sure a lot of people have, premeds are applying for medical school right now. Newly minted MD’s just started their internship year last week. Right now, medical students are doing a variety of things with their ‘last’ summer. For myself, and many others, it’s clinical research. During the school year, I was sort of in an emotional rut. Medical school is really rewarding, but it’s also very taxing on your interpersonal relationships (with people not in medical school). For, example when my cousin died of terminal cancer I couldn’t find the time between exam blocks, less lose momentum, to fly back to California and then back to Boston while juggling exams. Instead, all I could do is use the “training” I was given on consoling families and patients over the phone — it was surprisingly effect. After a while, I just felt buried under classwork and charts to memorize, reviewing membrane potentials, memorizing what phosphorylates what, how many blocks your kid should stack by age 3, and learning just why everyone despises (and rightly so) the trigeminal nerve. My best time during the first year was spent with patients, it was the time that I felt pretty happy. So, I decided a while back that instead of lying around in my depression cave, I’d instead spend my summer with patients — to be more particular with patients who have heart problems, getting me closer to the sun (cardiovascular disease has killed many in my family).

Cardiac Inpatient

Lately, it’s been Monday-Thursday ambulatory cardiology (research), with the occasional Friday mornings tagging along with the cardiology team for their rounds on the cardiology wards — I’m the most inexperienced out of the team: a 3rd or 4th year medical student, two residents, one cardiology fellow, one attending, and a pharmacist. Rounds are a staple, especially at teaching hospitals, and it’s worth noting now that rounds will be however the person in charge allows it to be. The rounds of my experience are straight forward. Someone, a resident or medical student assigned to the patient. The person who has that patient does the presentation. The presenter will give a ‘quick’ history and feedback: chief complaint, pertinent history (health and social), details in labs/scans, and pertinent negatives (helps with differential diagnoses), most likely diagnoses, and finally management strategy. Labs and scans are brought up on computers on a cart, the attending or fellow typically asks a few more questions about things that weren’t clear, or specific findings on transthoracic echocardiogram or ECG. Finally, once everyone (the attending) is satisfied the whole team does the ceremonial hand sanitization (or the occasional sanitize then glove) and enter the patients room.

The most interesting part is that, you never know who you’ll see in the room. It might be a widowed grandfather and retired mechanic, a former nurse, a an inmate cuffed to the gurney with their guard escorts — sometimes you see the worse, people who remind you of people you know and those younger than you. Patients are remarkably tolerate of rounds, unfortunately many of them are probably used to it by now because they’re hospitalized so much. The chief complaint and history are then again discussed, this time with the patient being able to put their input in. Unfortunately, not every patient takes advantage of this period, perhaps patients don’t know medicine is moving away from paternalism and inviting the patient into the mix. I’m not really sure, but there’s a variety in patient responses and their levels of health literacy. As such, there’s always a variety of outcomes for this patients. Some outcomes are good, like being discharged on a false alarm via an occult finding. But, often it’s not very good news. The strange thing about news is that, good news is easy to comprehend for patients while bad news is typically not. You can give the exact same explanation to a patient with identical diseases, one patient will suit up to fight the big fight, some will be underwhelmed and tell you they don’t have time to sit around in the hospital bed over the weekend.

Cardiac (Ambulatory)

In contrast to the inpatient service, these patients are doing leaps and bounds better. When I see patients here, I leave my white coat and stethoscope and home. When I see patients in this capacity, we’re one on one and we speak for 30 minutes to an hour and a half (all depending on the patients verbose nature). I appreciate this time, because unfortunately I’ll never get to speak with patients for so long later when I actually am a doctor. Because of the nature of my research project, we end up really diving into their lives. In a medical setting, it’s rather astounding what people will tell you in confidence. We discuss their disease, we talk about their medications, about their living situation, their ambitions and goals. Part of my project involves a chart review (which I currently should be doing), but beforehand I tend to not look at the patients chart except to screen them for the study. This strategy only works because I do not have to worry about addressing their concerns or treatment. I like to hear from them first, before I bias my recording of their answers with my assumptions. Though, for more difficult interviews I need to pull up their chart to make sense of things on my notes mid-interview. I’ve learned some interesting things from patients:

1. Some patients confuse their lack of symptoms, thanks to treatment, as lack of disease

2. As a consequence of the first realization, some people skip their medicines intended to be taken on schedule because they “Don’t need it as much”

3. Some patients actually have no idea what they have, even if it’s been diagnosed for years

4. Patients often don’t make lifestyle modifications because the seriousness of their situation isn’t understood (e.g. some people have no idea they were hospitalized just 3 months prior due to heart failure)

5. Some patients are remarkably on top of their disease management, and it’s immediately obvious “who” does after learning who (at the same age and income level) can still make it up a flight of stairs or watching an elderly gentlemen prove his health by performing exercises

6. Some patients come with their family in tow, it’s likely a cultural thing. I like it, it can make some parts of what I need to do more difficult (getting the patient to answer without bias or outside input). It also makes some things easier, especially since some symptoms are better observed by others than by one’s self

7. People grow accustomed to not being happy, and start to find that the new normal. As a consequence, when I try to learn about the negative things in their life, they put things in relative terms, and give me a cheerful interpretation to an otherwise bad situation. A lot of them just chalk it up to getting older. Sometimes it is simply normal wear and tear, sometimes it’s just life catching up with them, and sometimes people are just unlucky

Oh yes, there’s one more cool perk about this gig, like drawings from patients:

Patient Gift

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Report on Patients and Journal Club

So, my research mentor for this project is an attending physician. My partner and I work together to update them on our progress, or lack thereof, and we make suggestions on what we can tweak on our process to make things better. I’ll take the time to say that the success and enjoyment of research is chiefly based on your team, I’m lucky my partner and my mentor became (I’d like to think) good friends and work well together. Once a week or so, we meet to discuss the research articles in our niche of cardiology. My partner and I take turns leading the hour long discussion, spending an ornate amount of time with the statistical methods and research design. Part of my scholar program requires me to help run an undergraduate version mid week, so I also help with that as well (these presentations are about 12-15 minutes each, and fortunately I don’t need to present in these anymore). The undergraduates in the program are impressive, I think there were 7,000 applicants and they selected 12 or so. I admire their ambition. Technically, I’m one of their co-mentors, though I’m not sure of how good of a job I do with that — I’m not exactly dripping with wisdom.

It was a good experience to go from ambulatory to inpatient, especially in broadening my understanding of the patients’ story on cardiac disease progression (both in physiology and seeing learning to see past their diseases).  It’s too early for me to say I’ll definitely be a cardiologist, but let’s just say it’s the leading the specialty decision race. Either way, I suppose, everyone has a heart. So, it’s going to be useful to learn these lessons now. I’ll probably forget them later, but I think it’s better to have know and have forgotten than have never known at all.

Why Medicine? — My Ridiculous Answer

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Hello All,

For premeds, applications for medical school just opened a few weeks ago. If you’re applying this cycle, or for that matter any cycle, submit your applications as soon as possible — find a balance between a high quality application and fatal perfectionism. Anyways good luck!

As for me, and how I’m using my summer, I’ve been toiling away and trying to keep busy. It’s my last summer, at least my last summer on the books. Some people take the summer off, I just didn’t for a number of reasons. For me, I’ve been so busy with medical school that I forgot why I wanted to go to medical school and who I was before it. Indeed, I even started to feel this guilt about not being the person I was originally that got me into medical school. So, I’ve taken some time to remind myself of who I was and who I am — this also means I’m taking time aside to remember, “Why Medicine?”

Stuff I’ve been up to:

1. Working with elderly atrial fibrillation/stroke risk patients with my team for our cardiology research project.

When I was still sitting on the fence about medical school or a PhD (to follow after my mentor), my grandmother died of a pulmonary embolism during surgery to remove a stent. We were really close, so this was a big setback for me. My grandmother was physically and mentally disabled, she couldn’t read nor write, nor did she have any real grasp of math. But, she was a swell lady. Before her death, she got married to my step-grandfather, who’s also mentally disabled. When she died, it was a very hard event for everyone. I, well, I was furious and distraught. I was also already an emotional wreck at the time because a friend just died from suicide just a month prior. One of the most painful things was to get into medical school and not have her come to my white coat ceremony.

In case you’re wondering about my original grandfather, I never met him on the account of him dying from a heart attack prior to my birth. So, the heart and I have some unfinished business.

2. Last week, I volunteered for the Special Olympics.

I felt like rubbish most of the year, so I needed to do something for myself, to see something of pure “good”. You see, I was so busy with school I didn’t get to do the things that got me into medial school. I sort of felt like a fraud. These kids and adults, or rather athletes, trained for months to compete. And their results were born out in the events included that included: shot-put, standing long jumps, 400 relay, and the 4 by 1, to name a few. It was actually a great competition, and I’m definitely going to try to find time to this again next year.

I met some awesome and confident athletes, they really helped motivate me to not be afraid to work harder.

3. Tomorrow morning, I’ll go with other medical students to teach high students about emergency medical procedures, and some advising about getting into medical school (from our perspective).

I’m not really sure about the details of the program, I just sort of haphazardly agreed to it because it sounded awesome. So, I’m not really sure what will happen, but learning on the fly is something we all get used to.

Why aren’t I in Hawaii for my last summer as a student?

I often find myself trying to repent by performing labors. You may wonder what is it that I want to repent. In my previous life, before blogging, was I an international jewel thief? A deadly double agent, but with a heart of gold? A Columbian drug lord? An evil water barren? No, nothing as gratuitous or even that interesting. Instead, I was just a patient most of my life. And, perhaps hypocritically, at those times [as a child till a teenager] I saw myself as a lost cause, and poor use of medical resources. My health was especially taxing on my family, my single mom maintained an unhealthy abusive relationship to ensure I had health insurance. My older brother I grew up with didn’t get the attention he needed, because the sickly child gets favor. A book smart kid, who grew up with a useless body. I really thought I was a waste back then, fortunately a few life events changed my views. Anyways, I’m now on this ridiculous quest to make my life mean something. Thus, I’m not sure if I can say that my reasons for loving to interact with patients is altruistic, I need them as much as they’ll need me — hopefully, me working on self improvement will mean they get more out of this relationship.

I’ll take a vacation when I feel I’ve earned one, and I’ve already taken a long enough vacation as a nontraditional who only later applied to medical school.

Kind of stupid, huh? I never told you my reasons would be logical. But, that’s my story, and one of the mean reasons I need to become a physician: people saving my life has to mean something, so I must invent a reason why they did. Sure, there are other factors, I want to help people, recent deaths around me, the challenge — some of these events almost broke me. However, at the heart of my motivation, I’m just trying to have a meaning [in a subjective sense].

So far, I think I’ve made a good choice in how to pay it forward and pay it back.

Research, I Missed It — Also Known as Funding Summer

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Hello,

So, I get to approach patients from a different perspective, this summer I will work with patients for research purposes. I imagine this is coming for most medical students. During the summer, we aren’t funded — as far as financial aid is considered, we just disappear off the face of the earth, then we reappear out of the blue in the fall (to their credit, this is totally feasible at a quantum level). Thus, we do things during the summer to make ends meet. Some just have pared expenses, and have enough to scrape by for the summer. Others, they return to their home state or stay with nearby relatives because it works out budget wise. Many do research projects, paid (CNA) nursing exposure program, others traveled to foreign countries on stipends, and some give an extra hand as a student doctor at satellite community clinics.

The very fortunate, they do a well deserved nothing. If you’re one of those people, please, party a little harder in my honor as I live vicariously through you. 

For myself, I think I’ve mentioned it before that I’ll start working on a cardiology project. I wanted to avoid the stress of trying to find a summer project, so I contacted the doctor I’m working with now early in the fall quarter. This may sound sort of ridiculous, but I did it early because I knew that most of the deadlines for scholarships come in February. And, it’s a lot easier to accomplish research related stuff like funding, required medical human research training (a lot of online modules and quizzes), writing a proposal etc. I’m a lazy person, so I knew I had to space these tasks out or I’d feel overwhelmed. Most projects involving people or animals will involve those steps, with the only big modification being the level or type of online ethics training they’ll need to do. There are different ethics training you can do, NIH, CITI, depending on the place you’re at. However, that CITI one is usually considered gold currency between institutions. The reason why I’m saying all of this is because I was fortunate to have a lot of my old ones roll over, because I had to do a lot of them for work before (you always use the same account for ethics training, it’s ethical!).

To back things up a bit, and to make a point, I think you should make it a point to do research only if:

1) You found/know where to find money.

Finding money is a big deal in research, no matter the purity of intent, plenty of great ideas go unfunded. Also, unless you’re helping the unfortunate, you shouldn’t be afraid to not want to eat Cup Noodles ever again when trying to raise money for the summer. In undergrad, I did a lot of free research work/labor, sometimes paid usually not. Admittedly, it was a lot of the unpaid portions that probably help catapult me into medical school. Therefore, I can entertain the argument that there’s more to research than your stipend. Indeed. And, if you can find a landlord that accepts “good spirit” as a form of payment and I’m with you. But, life is unpredictable and you can’t determine when you’ll have a random expense you didn’t see coming (in my situation, just found out my landlord is selling the house so it’s time to hit the market, again 😞.

2) The subject/purpose really matters to you.

A seminal event for me, was the death of my grandmother. She was a second mother to me. Her death was untimely. But,  who’s death is timely? She died of a pulmonary embolism during surgery to remove a stent, secondary to the stent that had built up plaque on it — in fact, these stents come with huge contraindications. Understanding that my grandmother, who grew up physically cripple and illiterate but full of spirit and love, essentially drowned in her own fluids until her heart finally failed never sat right with me. It was also the lynch pin event that sealed me to sign my soul away into medicine. For myself, I wondered what life would have been if I were a physician in training instead of chasing my curiosity. I suppose, now I feel the answer lies somewhere in between. So, I’m doing research in cardiology.

Started training and sat in several meetings to prepare for the project.

For the project, last week I had a required session for electronic health records training, the system we use is called EPIC. This is just a computer system for patient charts/hospital records, physician notes, prescriptions, surgical histories, labs etc. — part of my project involves going through a lot of charts. Boston has the most physicians per capita in the US, number two I believe is New York, and so we have a lot of hospitals and clinics. Beyond that, a lot of large hospitals have interconnected health records. So, when I’m at the community clinic I see primary care physicians using EPIC; they use it to chart and look up patient medical histories after (while) interviewing. Even while shadowing at the main hospital, EPIC is also used at the hospitals where I shadow. In other words, I will have to learn how to use it, might as well do it now.

Part of my project, or rather part of my grant, involves co-mentoring and running journal clubs for 10 undergraduates who were invited to Boston University (with free housing and a research stipend). I just saw the schedule, apparently we have a journal club meeting every week, and we’ll take them out on the town several times to seduce them into science. The rest of my days will be spent doing my project.

I won’t bore you too much with the details of my research, other than saying it’s a project in atrial fibrillation (AF). I’ll be recruiting patients, and possibly analyzing (preliminary results) extensive ECG records. So, to prepare for that the principal investigator (cardiologist) and with my research partner (fellow classmate/friend) and I, spent most of the early morning discussing AF: epidemiology, socioeconomic factors, statistics, etiology, genomics, physiology, and finally the impact on patients as people. He gave us a tour of the parts of the hospital we’ll be working. Our hospital is a medical complex, so there’s several buildings, and many floors and buildings built later than others. As such, it’s like maneuvering through a catacomb, underground dungeon included. We met several physicians, nurses, spoke to several coordinators, and many other friendly faces.

Tomorrow, I’ll help the undergraduates move into their dorms. I so rarely go to the undergraduate campus, so it’ll be an adventure. But, before that I’ll meet with my research partner and we’ll practice running the research consents past each other. We figured if we stammered through it with each other we’d better feign competence when working with patients. This weekend we’ll be spent reading the eight research papers our PI just sent us, and of course making sure to take time out for a beer.

To summarize, or distill something useful from this post:

1. If you know what you want to do have things lined up so that you may apply for grants and scholarships (scholar programs) early, it’ll remove a lot of the last minute scramble. Keep in mind that a lot of deadlines come in February of the year you start medical school, so it’s easy to miss these if you’re not aware of them.

2. Don’t be afraid of the occasional double booking of plans, as long as you don’t commit it’s okay, because some plans fall through (PI ran out of funding, or something like that). Don’t try to double dip, but do make a plan A and B. My plan A was this opportunity, my plan B was an amyloid cardiology project. I was honest with my plan B, I told them that I had plan A, and they told me to come to them if plan A fell through.

3. Don’t be afraid to apply for outside funding as well, especially since institutional money (usually as spread out as possible) won’t be given to everyone who applies. Also, I enjoyed feeling removed from the competitive pool when people were wondering who got funding and who didn’t. I applied for several scholarships and didn’t hear anything back from any (including a Tylenol grant). But, applying to medical school means being rejected by a lot of places and hopefully gaining acceptance somewhere. So, it didn’t feel that bad to hold out for help since I wasn’t facing any real deadlines yet about earning money. In the end, I received a NIH partnered with American Heart Association grant/scholar program. It’s important to say that I didn’t just solo mission, I also used the resources given to us by our school and followed tips about who to talk to when I got the chance.

So, even though I have a lot of work ahead of me, some coursework, meetings on meetings, patient screenings, and data splurges, I’m just happy I have money for both rent (including enough to search for a new place) and security that I can fly to see my parents and friends this year.

Thanks for reading!

So first year is over…

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Hey Everyone!

Sorry I’ve been away for a while, things have picked up more than I expected.

First year is over, technically, all of my lecture material is over. But, I still need to take an exam next month to finish the entire year. I’ve had the last two weeks off, and I’ve used it wisely. I said goodbye to a friend who matched in California, he was actually the person who housed me during interviews (he didn’t know me at the time). We spoke on the phone several times before that, and his personality, and thoughts about our school had a big impact on my decision to come here. Anyways, so when he invited me to Cambridge for some beers with his friends I jumped at the chance to wish him off. There, I met two of his friends, one of them a rising 4th year who I’ve seen around a lot at the hospital/campus but never interacted with; all of them very nice people. I was expecting him to talk about his residency, instead we talked about books they suggested I read: Les Miserables, A Tale of Two Cities, and also Pride & Prejudice. Then we talked about Bram Strokers Dracula, you know, before vampires were sex symbols.

Then they asked me a question I hate to be asked now, “What are your hobbies”. For once, I replied honestly to this question, “I..actually don’t remember anymore”, I responded. Then they asked me something I haven’t been asked in a long time,

“How are you doing?”

It’s funny, the difference between prefacing your conversation with the phrase, “How are you doing?”, and interjecting it later into the conversation. At the beginning of the conversation, it’s the “ice breaker” we all learned how say to be polite. Used later, it’s a genuine question.

As medical students, we soon learn not to expect to be lent an empathic ear. Many of our problems seem to pale in comparison to others. In good taste, we don’t try to garner it from our patients. We can’t explain how we feel exactly to our parents, they’d seen as not being appreciative of the opportunity given to us. When we try to vent with non medical friends, we’re reassured we’re going to be doctors anyways so it’s okay. Many of our peers within our class are too afraid to vent, some will pounce on your ‘weakness’, and castrate you for not being as dedicated as them. Well intentioned [and fundamentally correct] folks will tell you, “Just stay balanced”, then you realize you’re even failing the concept of balance. If I whine to a premed, they’ll rightly counter, “Well, at least your in medical school”. Interestingly, the only people who give a shoulder of support end up being more advanced doctors in training or physicians; they’ve been through it: no matter how you feel you need to perform well.

So, after many months of holding back how I felt about things I was able to share my feelings over some beers with upper classmates. It was a re-affirming, if not purely a cathartic experience. I told them how I felt, and what I’ve seen, and overheard. The distasteful (albeit, inadvertent) things said by classmates that haunted me, my random feelings of inadequacy (see first clause) and ‘war’ stories, and pent up stress mostly due to not being able to explain myself in earnest — things I’ve had to keep off of here because my blog is now followed by a couple of classmates, some don’t know who I am (the intrigue!)

If you’re in medical school this time of year, and you’re reading this as a first year, I’ll give you advice that those advanced students gave me:

1. Make time for yourself, or else you’ll crack.

2. Hang out with upper classmates when you can, they’re usually more chill about things as they have things in prospective.

3. The first two years of medical school are formative, but grades aren’t that big of a deal (Step 1 however…)

4. Exercise.

5. Find your hobby. (writing ✔️)

6. Know when to stay away from neurotic people.

7. Read something unrelated to medicine everyday, i.e. no more JAMA over milk and cookies.

8. Know when to stop studying, sometimes it’s just not worth it.

I’m sorry if you were hoping for a big moment of awe and reflection, or perhaps an entry on how easy I thought medical school is. My big reflection, if anything, is that I need to do a better job at taking care of myself. While I’m getting by in medical school, I’m not utterly destroying my courses so it’d be arrogant for me to toss out advice. But, what I can say is be sure to find a place where you can speak, where you can admit your flaws and not be judged.

It can be hard and tiring, pretending like you have it all together =)

Stay tuned, the next post will be less about me and more about what I’m doing as a medical student with my summer.

Understandably, you may not be able to reach out to others, so if you’ve got some pent up emotions over medical school and no where to share them then just message me, or email me doctororbust@gmail.com. Your stories will never be used in my writings, if you want to share then fine and we can work that out, we can do so anonymously to the public (obviously, confidential to me).

Forgive the wine-ladened typos/errors!

Physician Suicide, Organizational Justice and the “Cry of pain” Model: Hopelessness, Helplessness and Defeat

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doctororbust:

A great post.

Originally posted on Disrupted Physician:

They can be a terror to your mind and show you how to hold your tongue
They got mystery written all over their forehead
They kill babies in the crib and say only the good die young
They don’t believe in mercy
Judgement on them is something that you’ll never see
They can exalt you up or bring you down main route
Turn you into anything that they want you to be–Bob Dylan, Foot of Pride


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Although no reliable statistics yet exist, anecdotal reports suggest a marked rise in physician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved in the descent from suicidal ideation to suicidal…

View original 4,152 more words

Medical Training Culture — A Quick Reply

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This article is in reply to the well articulated piece Tulane MD/PhD candidate (Stiletto + Stethoscopes): http://stilettosplusstethoscopes.com/2015/03/12/loneliness-is-the-poverty-of-self-solitude-is-the-richness-of-self-may-sarton/. She made excellent points, so be sure to check it out (it’s likely better than this article).

My response to their article isn’t as polished, I’d even say my response is downright clumsy. But, for what it lacks in style and refinement hopefully you’ll  find will be brimming with honesty. And really, the purpose of this piece is merely to keep the conversation going. You my find this piece to be more acerbic and pessimistic then my usual writing, but this dialogue needs to happen. The point of this piece isn’t to scare premeds out of medical school applications, instead it’s to normalize the feelings that are politically incorrect to ever mention in front of your student body.

Understandably, human gross anatomy and the first year of medical school is a formative and seminal event for every physician in training.

But in all seriousness, how is skinning, lopping of their breast, meticulously scrapping out their fat, bisecting their genitals and dismembering a human not supposed to be a traumatizing experience in medical school? For the love of Pete, I’ve held a severed leg in my hands.

Gross Anatomy is and starting medical school is hard, and not just because of the amount of material.

Neither the less, most people get through it. I succeeded by distracting myself with the awe and appreciation that someone would give up their body for medicine as our first ‘patient’ — so that we can be a physicians. I believe an important bond is formed between our first patient and ourselves. This is mostly a bond of responsibility. Responsibility turns into guilt when we feel we didn’t hold up our end of the bargain. I mean imagine the guilt associated with knowing that someone (and their family) gave their body to you and you feel you didn’t give it your all, whether that be because of class load (30+ equivalent undergraduate units, a considerable chunk of it not being all that clinically relevant but extremely easy to test), hopefully you’re passing all of your classes, burn out and depression, or personal reasons such as ‘untimely’ deaths or illnesses of closed loved ones. Some just feel bad for “not enjoying ” like everyone else seemingly are. I’ve seen students try to express themselves, hoping to find some sympathy from their colleagues only to be shutdown for not being “into it enough“, albeit an inadvertent discouragement.  This is the first layer of guilt some of us experience, wondering if you’re worthy of what we’re tasked to do.

There was one person who I believe dealt with it in a healthy way, crying from time to time. I respected them a lot for this, for their strength. Admittedly, I learned of murmurs of others who found this person to be “weird” or “overly emotional”.

You’ll quickly learn how to stuff your emotions into the closet — hopefully, you learn when to open that closet as well.

For my first semester of medical school I struggled with the moral dilemma of visiting a recently diagnosed cousin with terminal cancer. I need not defend my actions or intentions, I selfishly decided to not travel during my midterms as I knew without a doubt she’d likely die in the interim. I find myself on the right side of history but on the wrong in morality — for this I can admit my hypocrisy as I’d never fault another student for making the same decision to stay and take their exams. Everyone, including my terminal and now deceased cousin, comforted me by telling me to stay and thus transgression was forgiven by others. It’s no secret that medical students and physicians in training miss a plethora of things: deaths, funerals, wakes, and births. I suppose the part most people don’t know is how quickly these things most be given up or put on hold, at times I wonder what things I’ll later miss or the people who think I forgot about them in their time of need.

Not everyone is a medical zombie, not everyone tries to wear a suit of armor to hide their feelings. I can’t recount the number of times people who I assumed “had it all together” confided to me nearly in tears about the stress, anxiety, and feelings of inadequacy. There’s been even a rare conversation or two when students have admitted to me about thoughts of taking their lives, or as the called it sometimes “I just want to off myself”, during the first semester but not wanting to be outed as “depressed” or lose respect. Some dropped out (once you’ve made up your mind it’s a wise decision), while others have (bravely) taken psychological medical leave with intent to return when they’re ready. Fortunately, my program recognizes mental health as a health concern not a competency one, sadly; I can’t say this is a universal policy among programs or our potential residency spots. It’s a sad day when medical students and physicians can have guilt about their own mental health status, but with uncertainty of being discriminated against we should expect physicians in training to not seek help when they need to.

You’ll quickly learn how tied your hands will be later.

At the clinic I quickly learned that a knowledgable provider prescriptions’ in no way guarantees or even implies that the patient will receive said treatment or medication. Having insurance doesn’t mean coverage. I recall one conversation a physician had with a long time patient:

Doctor: actually, there is a medicine has a 95% cure rate for your condition

Patient: OH MY GOD SIGN ME UP!

Doctor: the only problem is it costs too much and you’re insurance won’t cover it, unless you get more sick. But, then if you’re too sick they won’t cover it either… It’s typically denied, but I’ll try it anyways.

Patient: …wow, so there’s a cure and I can’t get it?….

Doctor (to me): better get ready for this kind of stuff.

It’s a bitter pill to swallow that all we learn about drugs and diseases can be overturned by a swift “denied” stamp by a clerk. However, at the end of the day a person need be blamed, and that clerk will be no where to be found. Remember not the best treatment, but the covered treatment — even if it’s an inferior treatment. And let’s face it, when it comes to billing people can incorrectly assume that doctors are behind a scheme to over bill (sometimes with deadly results) — this is despite the gradual shift away from fee-per-service and into capitation. It looks like, for now, we’ll just have to enjoy the orphaned guilt not taken up by billing. When I sit in the bus towards I hear patients lament at how incompetent and irresponsible doctors are, including blaming doctors for lobby wait times. Fortunately, I haven’t deluded myself into thinking physicians are universally respected. Clearly, when people prefer Jennifer McCartney about vaccinations over their physician something is misplaced.

Never the less, I’m not disheartened by the realities of medicine, or the culture. Though not at the pace I’d like, I see the culture changing as we speak. In fact, I feel more empowered as I slowly gain a grasp of what “we signed up for” and I’d rather be part of the fight then on the sidelines — let’s hope it stays that way. There are tone of positive things about medicine, you only need to check the rest of my blog for upbeat posts. But really, if you’re going to marry medicine you better be willing to accept the good and the ugly or you’re in for a rude awakening.

And, I’d be irresponsible if I didn’t level with you.

I LIVE!!! — And Plans for The Future

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Hello Everyone,

Sorry for the absence, medical school had me a little occupied. There are a lot of tests and competency evaluations in medical school, especially within the first couple of years — though, let’s face it medicine means a career of learning and evaluation. This post will include some details about my class load, a general synopsis of what’s going on. Another point of this post will be to talk about the summer, a critical time for students transition from first to second year in medical school.

I don’t want to freak any premeds out, but there’s a rumor that circulates quickly during the first year of medical school that you have to do certain things to even have a fighting chance at obtaining a residency later. Besides the obvious Step 1 score, there’s a lot of talk if being busy during summer “secret requirement” of residency programs later. Those with concerns aren’t just being neurotic, graduate medical education is capped and not everyone finds a residency across the country (for brevity I’m excluding this conversation to MD match system). This means that about 5% of US senior MD candidates don’t initially match, though there is another match system ironically called SOAP — this 5% could also merit another debate for another day. With that all said, the word of advice that I’ve heard from upper classmates and faculty is that you don’t need to worry about using your first summer for residency. Actually, I’m of the opinion that your number one goal during medical school, especially in the first year, is maintaining your sanity (in public at the very least). You taking off time might mean a fresher you and better you. In short, for you summer do what’s good for you.

Currently, my class load are medical courses (fun fact: we are the last class year to have this curriculum, the future classes will have a more guided lesson through medicine):

1. Physiology – we just finished circulatory and gastrointestinal. Now we’re moving onto pulmonary and renal. We will end the semester with endocrinology with a unit to itself. For neurology, we had a separate and dedicated neuroanatomy/neuroscience block earlier this winter.

2. Genetics – just finished this course. If I learned anything from this course is that when I’m a physician I will both 1) appreciate that I learned more about genetics and 2) understand that genetic counselors have a large role to play in both short term diagnosis and long term patient education. My program really explored some interesting topics such as sexuality, rare diseases, and ethical dilemmas I will later face from genetic test results.

3. Immunology – we will start this next week. I expect alphabet soup.

4. Clinical Medicine – we have clinic or hospital (or both) hours assigned to us. The first year it’s four hours per week, the second year it’s up to eight, and well the 3rd year you’re just abducted by the hospital. Right now, what you do during your hours depends on who you’re attending is. One reason why I chose this program was because of the early exposure to “doctoring” and the fact that it’s a safety net hospital system. For various reasons we’ll leave unaddressed in this post, a lot of the patients “unwanted” at other institutions are our primary patient population. We do a variety of things, from standing around to randomly helping during a procedure — they don’t call it a teaching hospital for nothing. Most of our time is spent talking with patients, taking their histories and learning more about their story. You learn a lot from patients : you learn that the cute little old grandma-eusqe patient that you like also just quit heroin for years prior, how some people writhing in pain from cancer worry more about their families than their diagnosis, or see even those embroidered with intimidating prison tattoos can still weep in the face of chronic depression and disease. I’m learning a lot about humans, it gets me through the week.

Summer Research Plans

The summer of the first year is a wonderful time. Some feel pressured to keep busy, but I don’t think that’s necessary. They’ll be plenty of time for research later and clinical experience, in fact by that time you’ll probably be more useful of a team member. So, if you’re into traveling (or vice versa, want to curl up for the summer with a book, go for it!). Some students do a lot of things during the school year and nothing during the summer. For myself, the load of medical school was enough so I’m using my summer for my ‘side goals':

1) Find something to motivate me (I’m goal orientated)

2) Raise money for summer rent and food

3) Become better (useful)

The first two are constant pursuits, the latter is the latest goal I’ve stapled onto my agenda. I think the biggest motivator right now for improvement, besides the obvious clinical applications, are my classmates. It’s really hard to overstate how awesome they are, in how they think, the questions they pose that I did not. It’s not a competition you see, I just really bask in awe at times at their individual geniuses and focuses. As such, it makes me want to work harder so I too can add something.

For myself, I’m planning to get involved in cardiology research for the summer: atrial fibrillation. The great news is that I solved my summer bill problems (and then some) with a stipend I’ll receive for it. So, this month I’m working reading up on atrial fibrillation so that I can submit my proposal. I interviewed a few weeks ago for the research grant, it had a number of steps to undertake because it’s funded through the NIH and the American Heart Association. Fortunately, I passed that phase, and all that’s left is for me to submit the proposal start working with patients that have already been screened from the hard work of another arm of the project done by others. Coincidentally, the turning point for me going into medicine was a cardiology related death of my grandmother, so I’m happy to turn my attention towards heart disease. About the timeline of the research, it’ll be conducted mostly during the summer. However, project and grant requires a longer commitment, so I’ll continue the work in my second year as well — by the way, although it’s unlikely for myself, some students with field changing results choose to take their second year off to publish etc. Though, I think the end point of this research is to add to some patient literature, so it should be an interesting trip.

In case you’re curious how to find a research position in medical school, it’s actually a lot easier than in college. Of course, the opportunities available to you will depend on what medical school you attend. Though, even if your program doesn’t have the clinical or bench research that you want to work with you can always do an externship program — though a lot of the institutions prefer to internally fund their students than others. For myself, I used the time honored tradition of just pestered a cardiologist I found with emails until we could meet. I was awarded for my persistence with an invitation to join in the summer.  When I chose my school, one of the reasons was because I already looked up some labs I thought were interesting or cool to me. My main source of healthcare has been clinical trials, I had been enrolled in them for over a decade (in fact, I’ve donated quite a few chromosomes towards the cause of pharmagenetics). So as a former patient, I have a big belief in the importance of medical research and I’m happy to be on this side of the court yard where I can hopefully have more influence.

Community Service

I need to figure out how to serve my community here in Boston. I’ve lived here for less than a year, and I’m still learning which way is north and where the food is. But, as time goes on I can’t forget that service is one of my main driving forces. I think I just have this fear of being useless, though we can probe into my sanity and self esteem in another post. Luckily for me, part of my research grant includes the requirement that I mentor and “show the ropes” to a trope of premeds who’ll receive a scholarship (from universities across the country, including Puerto Rico) to live in Boston for the summer and learn about research. I believe they’re selecting 10-12 (I’ve seen some of the list so far) people from several thousand applications, interestingly their selection criteria isn’t that different from picking medical school invites. The big goal of the program is to give a chance to those with the mental abilities but lacking opportunity — robust plants that just needed some water and sunlight. We’ll lead them through journal club discussions, and other exercises, and answer random premed questions — aka mentorship arm of the program.

At some point in the summer I’ll figure out how to take a vacation. I have very easy vacations: I go watch jazz or go to drink coffee, I’m easily satisfied. But, I think it’s important to emphasize that you can easily take the summer off during medical school and it likely wouldn’t have much impact on your residency application. But, if there’s something you just want to try or dabble in, the summer is a good time to go for it. Though, if you need to raise money for the summer, then accomplishing your goals and getting rent money is a good way to go about it. If you want more access to scholarship money then be sure to enter your medical school email into interest groups, the research or activity you’re doing might coincide with the requirements for a grant if you’re lucky.