Spring Break!

This week has been spring break, which translates to a week and a half of uninterrupted study time.  With my fiancé in Mexico for the past three days, you'd think I would get in a ton of study time.  Well, it's good to make plans.  Work has gotten done, but there have definitely been a few days were instead of working the 10 hours a day I intended, the hours add up more to a modest 5.  One day I spent the entire time on the couch watching House.  It turns out that the house writers in season 1 LOVE vasculitis…. apparently its in the differential for everything.  Also caught a pretty blazing error in the first season, they refer to Toxoplasma (Toxoplasma gondii) as a fungus.  It most definitely is not a fungus, and in fact is a protozoa that spreads through cat feces.  It's generally not a problem unless you are pregnant or immunosuppressed.

In other news, my mom, brother, and sister (who flew in from Oregon) are driving up from DC for my bridal shower/bachelorette party tomorrow.  I decided to put them both in the same day because 1) I couldn't afford to lose two study weekend this close to finals/Step I and 2) My sister/maid of honor lives in Oregon and I wanted her to be able to attend both without breaking the bank of air fare.  Because the wedding is so close to my Step I date (5 days after), I couldn't put the events in the wedding week due to fear of being massively hungover on my wedding day.

Home Stretch

It's almost April. I have 11 weeks and 3 days until I take Step I.  I'm in that strange place where I really want time to slow down because I have so much stuff to do between now and then, but I also want time to continue to go by quickly because I can feel the familiar twinge of burn out.  Second year has been rough. First year, I was extremely good at school. I was near the top of my class in all classes except biochem and I still felt that excited twinge of competition that drove me to succeed and perform well on my exams. Now I'm just tired.  All I want to do is pass. I've been dragging all year.  I'd like to say its because I've been distracted by the wedding but I really haven't.  I'm just exhausted, and sick of sitting in a chair memorizing information, 80% of which I will most likely forget and never use in my career.  There are days when the only thing preventing me from quitting is my massive student loan debt.

All of that said, I'm really excited to start third year.  I know the hours will be long for some rotations,  but I do best when I actually get to interact with people.  I love interacting and building relationships with patients.  I recognize the relationship building is limited in 3rd year because of the rotation schedule, but even getting to see the same person a few times and working with them is really what I look forward to. This is probably why I'm leaning more toward OB/GYN and less toward surgery.  I do enjoy operating- the precision, the physicality, the ability to actually be able to "do something" for a patient.  I also really like building relationships.  Enter OB/GYN a nice blend of the two.  It's also a relatively positive specialty.  But I digress.... All of this is literally MONTHS away. Now at the end of second year it feels almost like the light at the end of the tunnel that just keeps moving.

The highlight of my week was picking my "grid" for the order of my rotations next year. Basically we  rank various orders of rotations by preference then some computer algorithm tries to give everyone their highest ranked choice.  In the next step, we will pick WHERE we rotate. Which I'm also very excited for. Anything that involves looking forward is exciting. Anything that involves doing the work I still need to do to get there is torture.

Sensitive

We learn the "sensitive" exams in the second year at my med school.  By "sensitive exams" I mean Male GU (kidneys, penis, testicles, hernia, and rectal exams) and female breast and gyn exam (speculum, bimanual, and rectal-vaginal exam).  The way it works is that we go to a clinical site where several professionals act as highly trained standardized patients (SPs).  They first demonstrate these exams, and then talk us through doing the exams on themselves.  To a non-medical person, it probably sounds kind of odd, but it was one of the most valuable experiences I've had in my medical school career.  The SPs not only teach us the mechanics of how to perform the exam, but help us to develop our technique of sensitively explaining what is going on in the exam and avoiding any pitfalls like saying "I'm now going to feel your breast" (as opposed to "I'm not going to examine your breast") and help us to learn how to make the patient feel as comfortable as humanly possible.

A few weeks ago, I had just learned the male GU exam and was later telling a few non-medical friends about it while we were visiting (I would never divulge any of the details, but just shared that I had learned the exam, how it was taught, and what a great learning experience it was).  I was genuinely really proud of myself for having gotten through that hurdle, and was excited to share my experience because it was such a major part of my education.  While I didn't expect them to want to hear all of the details (which I wouldn't share anyway out of respect to my SP), I was surprised by their response.  They were a bit disgusted and shocked (in a really negative way) to hear that there were people who would voluntarily submit themselves to the experience of being an SP.  Now I know that there are things in medicine that most people would rather not hear about, but I was really disappointed in their reaction.  I have so so much respect for the SPs who were our teachers and am so incredibly grateful for what they did for my education.  These are people who are incredibly comfortable in their bodies, are extremely knowledgable, and who must work tirelessly to develop their teaching skills.  They truly deserve nothing but the highest level of respect and gratitude from anyone who has ever been on the receiving end of one of these exams.  The fact that anyone could feel differently (even if they are a little weirded out) completely blows my mind.  I think they were also uncomfortable with how comfortable I was with the whole experience, which also defys logic.  Does anyone honestly think that physicians who perform those exams are uncomfortable while performing them?  That would be a disaster, and a disservice to the patent.  I left the conversation feeling offended and frustrated that none of them respected or recognized the significance of the experience.

Today, I learned how to do the GYN exam.  The woman who taught us was amazing.  She was so incredibly thorough in working with us on every aspect of the exam, from how we place our body relative to the patient to how to describe what we see and feel during the exam.  Words can't express how grateful I am to have had her at my teacher.  I left the experience more confident in my current interest to pursue OB/GYN as my specialty.  I like the challenge of making a patient comfortable in a situation that is incredibly uncomfortable for most.  There is a certain level of frankness coupled with warmth that you have to find, and that suits me, I think.

We are doing the lottery for our 3rd year rotations this month, and I should know the order and where all of my rotations will be by the end of the month.  I'm definitely going to make sure OB/GYN is in the middle so I can do my best and hopefully get a good letter for residency applications.

Grownup Clothes: On The Waist:Ass Problem and Being Poor

I realized recently that I would need to start stocking up on adult clothes so that by the time third year starts, I'll have more than one pair of work pants.

My problem is this: in all of my previous professions, I've never needed to wear "work" attire.  Let's take a look:
1) Medical assistant- scrubs
2) Yoga instructor- yoga pants (which I have worn as dress pants in a pinch)
3) Dancer- booty shorts, sports bra and tank top + sweat pants
4) Contortionist- whatever combination of costume/body paint/elaborate head piece I was supplied with

The first two years of med school, at least at my school, I could get away with wearing pretty much any of the items listed above (except for the contortion outfit… that would get some looks).  Because as a med student, I'm poor, buying work clothes has been a pretty low priority because they are expensive. If one is wearing business clothes, it's generally assumed that the wearer has a job and is not, in fact, making negative money.

My plan for next year is to buy a bunch of black pants, shirts that work with black pants, and a pair of black Dansko clogs.  This will streamline my ability to get dressed in the morning (which is going to be absolutely necessary during rotations where I'm expected to show up at work before the sun does.)

Yesterday I started this wardrobe mission by purchasing my first and only pair of work-appropriate black pants.  This was easier said than done.  I am thin and tall, but my ass is one size larger than my waist.  The ass problem is a direct result of over a decade of dancing/yogaing, and while I generally like my muscular booty, it hampers my ability to find pants.

I went to Express, Gap, and J.Crew with no luck.  Finally, I went to Banana Republic, defeated, almost ready to go up to the food court and eat my feelings (probably further contributing to the waist/ass ratio problem).  I walked in and told the sales associate what I needed: a pair of pants that would fit both my ass and waist, were a little stretchy, machine washable, and would work with a pair of Danskos.  She knew exactly what I needed: The Sloane Black Trousers.  Technically they are dry clean only, but in looking at the fabric content, I don't see why they can't be washed normally.  Great success!!

Beer O'Clock

It's the night before the night before an exam at about one in the morning.  My brain hurts- you know that feeling when you've been forcing yourself to learn for so long that you start to have a physical sensation inside your skull?  I'm not tired due to the cappuccino I made fore myself around 7.  The sum of this is that I'm too tired to study, but too awake to go to bed.  The solution? Beer.  Beer and maybe one more hour spent learning about the endocrine system is the answer.  Sometimes you just have to know when to indulge.

Welcome to Crazy Town, It's been a while

Well I started this thinking I'd actually have time to keep it up!!  Wrong.  Actually, if I wrote as much as I thought about writing, I'd probably have a pretty significant set of entries.

MS1 is over, last summer is over, MS2 is almost half over, and we are getting married in June!  The last tidbit was actually what made me pick up the computer again and have another go at this.

When we got engaged, I turned to the blogosphere to see if I could find some experiences of people who had gone before me in this whole conquer MS2, take the boards, plan a wedding thing.  Turns out there wasn't much there.  After watching 2 friends at med school go through the wedding planning thing during MS1, I was a little terrified.  It seemed to take up a lot of their time and mental energy and frankly, at least at our school, you have even less of those precious commodities in second year than in first.

What I have learned is this: weddings are only as stressful as you make them.  Now, I'm not going to sit here and lie and say that our wedding planning has been perfectly zen, but I think, overall, it has been pretty low stress because I've approached wedding planning like a triage.  Take care of worst, most potentially disastrous things first, take care of less pressing things later, and if it's dead, move on.  I think the last part is the most crucial.  I will elaborate on these points over the next few days but will start with number 3:

If it's dead, move on- My Venue Saga

In wedding planning, whether you are a medical student or not, there will be things that are completely out of your control, and no matter how hard you wish, there is no way you can change the outcome.  Stressing about these things is wasted energy, so recognize that it's a bummer then let it go.

The best example would be our venue hunt.  At first, we had this grand idea to have a huge wedding up at my fiancé's family's property in upstate New York.  We were going to have a giant tent, I was going to walk across the bridge that is next to the waterfall into a chapel of trees then we would have a lovely dinner and would dance the night away under a giant tent.  Here's what killed that one: Problem #1: Wedding in New York, even if it is upstate are super expensive.  Problem #2: Portapotties.  Now, I love camping and roughing it as much as the next girl, but there was no way in hell I was going to have honey buckets at my wedding.  I understand that there are super lavish portable bathrooms but that brings us back to item number 1.  There were many other smaller issues: lodging, transportation, land improvements…. but really, the straw that broke the camel's back was the honey bucket situation. Solution?  Kill the whole idea, and have a wedding at a vineyard in Virginia (where my family is from).  Why a vineyard?  My family are southern WASPs so they love wine, my fiancé's family come from an Irish Catholic lineage so they like wine ergo, the wedding should be at a vineyard.  Not ideal, fiancé and I have only been to Virginia together twice, but the price is right, and more importantly, it's where my mom is so when I tap out of planning, she will be in her comfort zone when she has to pick up the pieces.

So then we started looking for a venue.  This was in my first week of MS2, so late July/early August, planning a wedding for June 14 the following year.  No bigs, just another day in You-Are-A-Crazy-Person Town.  Then came Problem number 3: b*%ches plan weddings hella early!  I called my dream venue to ask about the date and here is how that went:

Me (M): Hi, I was hoping to book your venue for my wedding on June 14?

Wedding Consultant (WC): yes, you are so lucky.  This is our last date in June we have available.

M: Great!  Let me just put that in my calendar: Super Nice Virginia Vineyard, June 14, 2014.

WC: Oh, I'm sorry, I thought you meant 2015.  2014 has been booked for the past 10 months (she said with a nasty hit of "oh child, bless your poor ignorant little heart")

M: Oh, ok.  Thank's for your help. (I said with a hint of "Seriously!  WTF!  Who plans their f*%king wedding 2 years in advance?!?)

So that happened.  It was dead, move on.  The above scenario more or less happened with all but one vineyard that I contacted.  It turned out I really did get the last day in June they had available.  At least it was 2014.  Problem was, I wasn't totally in love with the space and felt sad for a while (by a while, I mean about a day, but this was before an exam so time perception gets messed up). This was when I had to sit myself down and examine the options:

Option 1: Cancel the "meh" venue and book the wedding for June 2016 (because let's face it, I'm not going to have time for a wedding in third year, or the beginning of 4th year.)

Option 2: Get over it, get excited about getting married, and learn to love the venue.

That's it.  Those were the options.  It was June 14 or wait 2 more years (we are getting married right after I take the boards, right before I start 3rd year).  If I wasn't in medical school (but I am) or my parents were loaded (they aren't) or if we were willing to do a small destination wedding (we weren't) then there would be plenty of other options but given the situation, the "meh" venue was the best I could do under the circumstances.  Ruminating and being disappointed and trying to find another viable option were a wast of time and energy.  Yes, if I wasn't in med school, I probably could have gone down to Virginia, driving around to a bunch of different places, and maybe, have found something else.  This would have taken time I didn't have and prolonged the find a venue stress for longer than necessary only to maybe reveal another option.  Absolutely not worth it.  Meh venue is fine by me.  The beautiful dream venue is dead.  Move on.  That's exactly what we did.

Today, about 3 months after booking the venue, I have managed to find other things I love- my dress, my caterer, my wedding planner, my rehearsal dinner space, oh yeah, and my fiancé!  You know what? It'll be great.  The venue is the shell for the wedding, and it's still a beautiful venue and the price is right.   Honestly, in retrospect, there probably isn't a huge significant difference between the venue we picked and my dream venue.  The space is different, but the only person comparing the spaces is me, and the place we chose, has many wonderful features.  So there you have it.

The key is this: Be happy about the things that are good, let go of the things that are disappointing and can't be changed, and find the positives in everything.

 

Med School, The analogy

Someone in my class posted this video on our facebook page as an analogy to how we feel trying to learn all this content.  Couldn't help but share:

MS1, day 1

Today was the official first day of classes at med school.  I think we were all expecting an easy day with course introductions, lab protocol instructions and the like.  The beginning of the day was pretty relaxed.  We started out spending 30 minutes hearing about histology, then went upstairs to meet our "first patients."  I was surprised as I was quite nervous in the moments before they removed the shroud even though I have seen 3 dissected cadavers and countless surgeries.  After lunch we had 2 hours of anatomy lecture.  The first lecture was pretty low key.... just basic anatomical terms.  The second lecture was where the pace picked up.  We learned a lot of material in one short hour.  It was the most fascinating, engaging lecture I have ever attended.  Our professor is awesome.  Even so, everyone was in a bit of a daze at the end, and my brain was more than fried.  My plans for an easy, low key weekend are shot, and I will definitely be spending the weekend in library.

Here we go.....

Shock and Awe

Two weeks ago, I found out I got my dream gap-year job: I was going to be a full time research assistant for a prominent surgeon at Hospital for Special Surgery.  For a pre-med with dreams of ortho, this is the most ideal job ever.  I would get to watch surgeries, I would do research, and I would get to network with some of the best orthopedic surgeons in the country.

A week and 6 days ago, I found out I was accepted to medical school.  After about 24 hours of deliberating, freaking out, and generally trying to convince myself that this was, in fact, reality, I accepted my position at New York Medical College, and informed my no-longer-future employers of my regrets.  

It is amazing how one e-mail can change the entire trajectory of an entire year.  I was in the middle of re-applying to medical school, and luckily, had only spent money on my primary application.  Mike and I had accepted the reality of continuing to live in a studio apartment for another year, and I was going to work full-time and finish my master's degree in exercise physiology.  We were going to take leisurely weekend trips upstate, and spend the year completing little projects that would ultimately lead us to entry into this next phase of our lives.  Now, we have signed a paper stating that we will be out of our Upper West Side apartment by August, we are looking for a home in the suburbs, and I will be a medical student in less than a week.  It feels sort of like walking across a nice bridge, knowing that you will get to the icy river after a leisurely hike, and when you get there, you are aware of the steps you will take to ease yourself into the frigid waters for a nice refreshing swim. Then a gust of wind pushes you off the bridge and you land in the water, reeling from the impact, and your partner has nothing to do but jump in after you.

All of this said, I am thrilled with the turn of events.  

Study like a runner not a ballet dancer

This round, I've been trying to think about preparing for the MCAT the same way I would train for a marathon.  The problem is I know almost nothing about training for marathons.  I do know that academics and athletics share common features: in order to do well, you must put in the work; overtraining can lead to reduced performance and burnout, and you need to take active rests.  Even though I've been an athlete for most of my life, I did not learn any of this in my years of ballet training.  In fact most ballet dancers (and teachers) are kind of idiots when it comes to smart training as the notion of extremes without logical reason is passed on generation to generation.  In my years of idiocy, I failed to recognize things like two technique classes in a day are not necessarily better than one (your ankle hurts? maybe you need to take even more technique classes! 6 per week just isn't enough), taking a break might actually enhance performance every once in a while (but if I take a week off, it'll take a month to get back what I lost!), and eating will benefit your training (I'm hungry, but if I eat the sandwich, then I'll get fat).  In my undergraduate studies, I went with my ballet dancer mentality of "more is always better" even though, like in ballet, this theory was never actually demonstrated to work, except in rare cases.  I failed to recognize that there is a threshold that anyone reaches and once you surpass that threshold the only way to go is down where you eventually crash and burn in a pile of burnout.  Taking a rest, stopping to recover for half a day, and admitting that I needed to cut back was not hard core, and clearly, only hard core people win.

My folly was to fail to recognize that smart people are actually the people who win.  What I have learned in graduate school, is that you must train in cycles, that there need to be active rest periods, and that one needs to plan so that peak performance occurs when it counts.  (Thank you exercise physiology course work) So, after a very long tangent, we come by to my attempt to approach my MCAT studying like one would approach a marathon: gradually increasing with variations along the way with efforts culminating in peak performance.  In addition to this overall approach, I've recognized that cross training is also important.  When I was dancing, I did Pilates and later, yoga (I never said I was a complete fool).  For the MCAT, well, I also do yoga.  The problem with academia is one can get trapped in this mindset of "I can't lose that hour, I need it for studying!!"  Often, this thought comes after 3 hours of being largely unproductive, except for maybe in updating my facebook status a bunch of times and watching videos of cute puppies on youtube.  For anyone, if this starts to happen, it's much better to take an hour, get some exercise (or eat ice cream, I don't know, to each his own).  In my case, yoga is perfect cross training for academics.  I physically get exercise, I stretch out all the parts that start to hurt after 6 hours of not leaving the couch except to pee and eat, and, most importantly, I take my mind to a place of calm focus.  For an hour I decisively do not think except for maybe the occasional "you want us to hold that for how long?!" or "action potential...gah... shut up brain...... downward dog..... the equation for volta....shhhh.....baby cobra...."

In summary, this method has appeared to work.  It still takes a level of discipline and hard-coreness (After all, the hour study break isn't beneficial if it turns into a half day study break) but it is much more manageable.  Rather than hopping between extremes of intense study marathons and drunken binges, as per college, or doing nothing but studying or working all the time (even though studying often consisted of looking at one page for a really long time and thinking about how much I didn't want to be studying), a la last year's MCAT disaster, I am trying to combine an effort walk the middle path (yes, I'm using honkey yoga language, I'm a yoga instructor, what do you expect) with the sensibility of a runner doing smart training.

I told you so!!!!!

It's funny. I was thinking a lot today about the things I wish I had known the first time around applying to medical school and taking the pre-reqs, except most of the things I came up with I did know at the time but was too lazy or stubborn to follow the advice of some other person writing about what they wish they would have known..... and so the cycle repeats. So here is what I kind of already knew but wish I had known:

1) It's much better to take your time and do well than to rush and do poorly.

I think this applies to pretty much every freshman pre-med, post-bac, and person who decided half way through college they wanted to be a doctor. For me, this applied less to courses, and more to my extra curricular activities. I was so focused on having an amazing resume, that I didn't leave time for the studying, and ended up crazy and with less than a 4.0. For freshman, bio and chem together are HARD, even after you have been in college for a while. I don't know what nut job thought it would be a good idea to make a bunch of 18 year olds who are living in a new place, adjusting to washing their own clothes, discovering the joys of fake IDs and no curfews, and have no nagging parent for the first time ever take two classes that can essentially decide their fate in the medical school application process in three or more years. Chill out freshmen! Drink beer, sleep in on a tuesday, and learn that febreeze does not equal clean laundry before you put this burden on yourselves! Post-bacs, school is an adjustment. If you haven't been in school for a while, it doesn't hurt to ease back in with a math class or something before diving in head first with no arm floaties after not having seen water for years.

2) Use your MCAT books to study for your pre-reqs.

Many people get into their pre-req classes and get super confused about something at some point. The MCAT prep books are nice because they break things down and simplify them. I cannot tell you how many times, while studying for the MCAT, I thought to myself, "oooohhhhhhhhh that's what they meant!!! Well why didn't someone just say so!." Looking at the simplified content in the MCAT book then learning the more complex information in the text book would have made my life so so so much easier. Also, looking at MCAT questions while you are taking the courses gets you ahead of the game with your MCAT prep.

3) Do not take the MCAT unless you are ready to take the MCAT

I actually did follow this advice last year and am glad I did. As I got closer to the test date I paid AAMC $70 to move the date one month back, worth every penny. This year I thought ahead and didn't register until after I had mentally pushed back my date. Trust me, you most likely will not stick to your study plan and you should secretly plan at least two weeks of flex time (sort of like when you set your alarm clock to be five minutes fast so that when you wake up dazed and confused, you trick yourself into getting up ten minutes earlier).

4) Studying for the MCAT is like training for a marathon (I think, I've never actually trained for a marathon, but from what I understand about training for marathons, the MCAT is like training for a marathon) you mustn't peak too early

This is EXACTLY what happened last year. I peaked too early then watched my scores slip in my practice tests. The last two practice exams I took actually predicted my score perfectly, I just wish I could have hung with the scores 2-4 tests prior. I think what happens is you lose steam and focus. This is just a theory, but it makes total sense. I'll let you know what happens this time around.

5) Don't waste your money on Kaplan

Kaplan is great if you have absolutely no discipline, but if you have no self discipline, maybe medical school isn't the wisest choice. The forums on sites like student doctor network and mom md have great information. Use them. Instead of spending thousands of dollars on a course, spend 500 on several different books, test them out, and find a book that works with your learning style. I personally, like ExamKrackers. Focus more on the content and your basic test taking skills and less on the super strategies that the prep companies sell. Strategy is good, but not if it is so complicated, you have to spend extra time learning the strategy.

6) You have enough time to exercise. The half hour once a day won't kill you.

This is super super important. If you need to save time, save it in ways like not watching as much tv, going home an hour earlier than you normally would from a party, not drinking too much at parties so you don't lose a day to a hangover, ordering food, studying on the train..... Exercise is not the area to cut. First, you don't want to be one of those people who gets fat during their MCAT prep (and then can't fit into your post-college graduation suit when you have your first med school interview then almost cry when you are at JCrew and can't figure out if the skirt the next size up fits you properly...). Also, the MCAT is 5+ hours long. It takes a certain amount of body strength to not fall over after sitting in a hard chair for many many hours.

7) Turn your AMCAS in JUNE FIRST!!!!

Most medical schools have some form of rolling admission, so you want them to see your application first. Enough said.

8) Treat your time completing your secondary applications the same way you treat studying: with high high priority.

If you are on family vacation, pretend like the MCAT or a big final is in one week (Yes, the beach is nice but you'll be back. Cape Cod is ideal for this practice. Remember, you're better off inside than on the bay side. The water is too cold and there are no waves. Really, you are saving yourself great disappointment by staying indoors and slaving away on your computer. Use your sacrifice to guilt your fellow travelers into bringing you lobster, and drink heavily in the evenings. Hangovers may prevent you from retaining information while studying, but they don't prevent you from laying on the couch and writing awkward essays over and over again. In fact, a hangover might be further motivation to stay indoors as the sun will make you feel like a vampire, not the sexy kind that sparkles, but the kind that feels like a knife in being jammed into his eye when the sun comes out.). If you are on vacation some place super awesome, too bad, you should still work on those secondaries. Remember statement 7.

8) Never give up hope

Just when you think you are doomed to failure, you may be surprised. Don't stop sending update letters, and making sure your application is complete just because you haven't heard anything. You never know. I almost peed my pants when I saw my interview invite in January. Clearly, surprises are no good, especially when your apartment (and a change of clothes)is 45 minutes away by subway. Always be a hoping.

9) Have a backup plan

Not everyone gets in their first time and that's ok. Have a plan for what you will do if you don't get in. If that is grad school, go ahead and apply (even if you've had a thousand med school interviews), if it's getting a job, start networking and honing your resume. You don't want to panic when May comes around and you have no idea what you are going to do with yourself for the next year. Have a backup plan that you love, then waiting another year for application success won't seem so bad, and if you do get into med school then who cares about that ole back up plan. Toss it!