Opinion Editorials

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 affected 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.

Opinion: Something We Don’t Talk About

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This week, in America, there were three school shootings.

“I love America more than any other country in the world and, exactly for this reason, I insist on the right to criticize her perpetually.”
― James Baldwin

I can hardly believe that I just typed that, but this mass shooting would make about the 145th or 146th since the 2012 Connecticut mass shooting. Even prior to me moving out to Massachusetts, there was the Santa Barbara shootings. Having worked at several elementary schools in my past, I’m no stranger to potential shooter lock-downs — fortunately, all of them ended up being a false alarm, unfortunately that usually meant the shootings were in the local neighborhood these children had to go home to. I’m old enough to remember the first shooting rampage, Columbine, and I was sure it’d be the last. Little did I know that was just the beginning of our war on each other.

If you’re a foreign reader, a bulk of my viewership is, you might wonder why and how we allow this to go on. You ask a question that many of us, of a certain political slant, have asked our fellow countrymen and women. I wish I could give you a succinct and logical reason to why we have yet to implement any meaningful changes or policies, but I can’t.

America has a lot of things going for it, but one thing we can never forget is that we’re the land of contradictions — some would even call it the hypocritical. We are proud of our rights, especially the extremely quotable “All men are created equal”. Though, we prefer not to discuss that African Americans were denied this right by being deemed “not American, therefore have no rights“, and hence how you can have a country that proclaims freedom but operated one of the most organized and cruel slave trades in modern history. When Germans, Irish, Polish, and Jewish immigrants first came they were all met with racism wrapped in the cloak of nativism — in fact, until the Irish started to migrant here there almost was no immigration policy, it was seemingly forged to keep the ‘others’ out. Arguably, some Asian families were even here long before some of their European counterparts, however this is a minor footnote in history despite their contributions and Asians are almost always considered ‘foreign’ even though many are as American as apple pie and ice cream. Indeed, taking a chapter out of WWII strategy, some politicians profit on nativism and target those from Central & South America and Middle Eastern decent — don’t worry my Middle Eastern friends, if we’ve proven anything is that you too will get the chance to be the native against the next new group.

Though, it’s important to note that no one race has ownership of all prejudice or hate, in fact we’ve seen many nativism sympathizers of all races with my own being no exception. It would seem the best way to prove you’re a native is to hate on the newcomers. Also, it’s important to note that America holds no monopoly over racism disguised in the cloak of nativism, we just have a penchant for pretending like everything is okay-dokey. The irony is that we’re a country of immigrants who get in a hissy-fit when new immigrants come here to try to receive the same benefits their forefathers did — there the difference is that for a lost of ‘natives’ their family came when immigration wasn’t strictly enforced and now it is.

So, in the land of contradictions is it really any wonder that we’ve forsaken ourselves for the right to have a pistol?

And it would take a full dedicated article to discuss how women have been often been excluded, and heaven forbid you’re minority and a women circa the period your people were hated. We claim to care about children, but do nothing but offer prayers at the hope that someone else will take action when they’re massacred.

Therefore my reader, I apologize, I can not explain why we’re okay with nearly weekly massacres. You would assume, since we spent trillions on terrorism abroad, that we would be staunch opponents of domestic terrorism with guns. However, in yet another series of contradictions, we decided to turn a blind-eye. Really, the most logical conclusion is that if we cared enough we’d do something, since we don’t we simply don’t — I would find that a much more honest and genuine position than feigning compassion.

Many can cite Australia as a country who successfully passed sweeping gun legislation to curb mass shootings following their tragedy. Australia’s response was “never again”, we can only wonder at which massacre, perhaps the “245th” we’ll finally have the guts to take a hard look at ourselves and weigh which matters more: the idealistic argument about guns or the actual lives they’re used to take.

But, I think it’s something a country of immigrants can eventually come together to work out, as soon as we get rid of nativism and the fear of the ‘other’.

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.

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

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A great post.

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


Screen Shot 2015-04-30 at 2.55.32 AM

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 post 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.

My Dark Secret

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“Could you bring me some information on what type of degree a cook can earn to further himself in his career.

J. Smith

Hey may I wish you the very best in life, keep going, don’t let nothing get you down if it does don’t let it keep you down very long, keep faith in the lord Jesus + keep growing stronger in God’s holy word”

Before I applied to medical school I was involved in a program called Prisoner Education Program (PEP), I wrote a little about the program before in previous entries [Why I Chose to Go to Prison and All the Things I Learned in Prison]. In this program I received a folded up letter from an inmate that I still keep with me till this day. The main goal of this program was to help reduce recidivism by teaching these people life and job skills, academic counseling and tutoring. In the letter above, this person wanted to know how to become a chef. I joined this group for personal reasons, you see I grew up with only one of my brothers, and well we saw a lot and went through a lot of things together; much of it I’m not really prepared to share yet, but it’s things I stop to deal with everyday and I’m sure it’s the same for him. But, we grew up around crime and violence and death. Indeed, our drill was growing up wasn’t for fires or California earthquakes, instead it was a ‘drop to the ground’ when you hear pops because it meant a local drive by shooting. My brother and I have different fathers and we had a father figure who was likely a gang member at the time, I’m presumptive because I was too young to understand what a gang was and what it meant, who was shot to death in the same drive by drill we had come to know so often. I dreamt of the glint of his blood where the bullets had penetrated for many years, I still think about it now though I don’t remember his name any longer; recently, I learned in class that this was a form of post traumatic stress.

My mother hoped to move us away from this ‘fate’, we packed things up, and with a huge helping hand of welfare and government programs we moved to a new city, one where kids killed people in video games but not in real life. I was young, it was an effective strategy. But, for my brother I wonder if he’d seen too much by that time, because he couldn’t detangle himself from the life we once knew yet didn’t talk about with our new friends. His first brush with the law was when he was under 18, then it was just a vicious cycle after that coupled with my personal illness growing up devouring my mother’s attention of course. I’ve often wondered if things would be different, for him and I, first if we grew up in different neighborhood and if he didn’t have to compete with me for love. So, as a premed I did something odd who was soon going to apply to medical, I decided to spend much of my time in prison and get to know the population and maybe how to save and understand my brother who I’ve always looked up to and who had always protected me, read to me, taught me math and how to read, and disciplined me if I didn’t keep up with my studies.

As my brother fell into more troubles with he law and eventually kicked out of the house, I was fooled into thinking my virtues had kept me safe and out of trouble. That is until I had my first and hopefully last brush with the law taught me how little how the world can be. Despite missing many days in high school due to illness, I did pretty well in high school and got into a university; but when I graduated high school, I attended a community college because I didn’t know what I wanted to do with my life yet, my step father who was an engineer at the time encouraged me to go this direction to find myself without breaking the bank with tuition. I was sort of disappointed by the transition, but never the less I kept my grades up and started taking some introductory engineering, math and some drafting courses. I met this girl one day, who was also from my school and we went on a date that week and I drove. During the date, being naive I didn’t bring enough petty cash with me, so I stopped at a local bank in an affluent neighborhood to get money out of my bank. While walking through the parking lot I was stopped by a police car, I was told to stop and put my hands on the hood of their car. A man and a woman team then got out of the car, questioned me several times with the same question. I’d seen enough crime movies to know cops do that to see if your story will stay consistent. I told them the same basic things: I go to X school, I’m interested in engineering, where I lived and I’m on date. Things seemed pretty jovial at first, I hadn’t done anything so I had no reason to fear. Then they handcuffed me and put me in the back of their car, this was about the time people were driving by and staring at me surely wondering what a menace to society I was.

In the back of the police car, on the cold and hard plastic seats, hands crimped by the handcuffs I then asked calmly

“So, why exactly am I here and what do you think I did?” 

The police officer responded, there was a bank robbery in X city (a local city I’d never been to by the way) and you fit the description of a

“Black male, with blue jeans and a white shirt”. 

I’d always had a defiant, if not flippant response towards things, so I laughed and asked

“Isn’t that like every black guy in the city?” 

They both chuckled, and we hung out in the car for an hour or so, my date in my car not being able to see this whole ordeal the entire time. Eventually, they did receive more details and I was realized, but not before another cop driving by yelled something like “Go get some chicken BOY!” — I was returned to my car, un-cuffed and as you imagined my date was pretty much over as was my self esteem.

After that, I never told my parents or my brother, I didn’t even tell my friends really as the whole ordeal was just too embarrassing for me. My grades dropped, I fell into depression and I soon wondered why had I been trying so hard in the first place, as an honor roll high school student, if this was going to be the result in the end? I just about dropped out of college and started working, and became rather reclusive. I soon understood how it felt to be on the other side of the law, and how degrading and violating it felt. I suppose this brings the story back full circle, with how I ended up in prisons voluntarily. No, I don’t think everyone in prison is innocent (though some probably surely are). But, what I do understand now is that I don’t understand society all that much and that’s why I choose to volunteer in a prison and try to help the convicted change their lives.

When I worked with the inmates, they had a hard time understanding why I’d come and if I could ever understand them with my fancy tie and dress clothes. I then told them my dark secret, and from there we had some collegiality. I recall one man who had been in prison for some time for an offense. We decided to do mock job interviews for them, as part of their life skills course. I still recall the man who weeped at the end, and shook my hand thanking me for giving him his first job interview after I gave him his feedback. Now, my brother is out of jail and he’s heard of the program I participated in, and we have a better understanding of each other and I of myself. Though, I’m not sure what ever happened to the man who wrote me the letter, as the next week that I came to the prison we weren’t allowed in because there was a stabbing that morning. I only hope that he doesn’t think that I abandoned him and although I subscribe to no religion, I do thank him for his best wishes towards me.