Interview Trail - Part 1: First Impressions

H DeVos Children's Hospital 2 by ~dharvell on deviantART

I hope everyone's had a happy holiday so far and looking forward to the New Year!  Almost as soon as 2013 starts, I hit the interview trail again.  But before that, some first impressions on Part 1.  There are things I've come to realize that are personally important to me when choosing a residency program, as I'll be stuck where I match for at least the next 3 years.  So in no particular order:

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1. Location

Location, location, location.  This is huge.  More so than I initially thought.  You want to be in a city and an area of the country you can see yourself living in for the next 3+ years.  Weather and geography are major filters for many people.  Some people really want to live on the west coast, or the east coast, or NYC in particular (not entirely sure why . . . no one can survive there on a resident's salary).  Others, like me, cast a wide net over huge swathes of the country to see what might fit best.

2. Hospital

The hospital you'll be working in is very important.  Is it old?  Recently renovated?  New?  Does it have readily accessible computers?  Does it use an EMR (electronic medical record)?  Are there good ancillary staff (nurses, pharmacists, etc)?  What is the patient demographic?  One of my filters is that I only chose free-standing children's hospitals because I felt that I'd get the best pediatric training at those tertiary referral centers.  Also, children's hospitals are all so colorful and friendly!  Adult hospitals are dull and depressing in comparison (particularly the VA).

3. Residents

You'll be working up to 80 hours/week with your co-residents.  You'll interact with them more than you do your friends or family.  They will become your family.  What kind of residents are at the program?  Do you mesh and fit in with them?  What kind of person are you?  While everyone in pediatrics is universally nice, I can definitely see myself fitting in with the residents at some programs more than others.

4. Curriculum

The ACGME dictates the fundamental curriculum for all residents.  The money is in the details.  Some programs are well designed, with a ward structure that residents are happy with, and a ton of flexibility to explore interests.  Other programs are rigid or else in so much flux it makes one anxious.  I've definitely come across some interesting and innovative ward structures.  Also the size of the program can be important.  There are small (1-9 residents) programs, medium (10-19 residents) programs, large (20-29 residents) program, and ginormous (30+ residents) programs.  In what environment might you thrive?  Does it matter to you at all?

5. Benefits

A residency is a job, and it behooves the applicant to have some inkling of the benefits.  How much do they pay their residents?  Does the hospital cover medical/dental insurance, or do the residents pay a portion out of pocket?  Amount of vacation/sick leave?  Is there free parking?  IS THERE FREE FOOD?!  I didn't realize how important the latter was to me until I encountered a program that did not feed its residents.  All the applicants looked at each other and were like, "What is this? An adult program?"

6. Gestalt

At the end of the day, trust your gut instinct about a program after you've visited it.  Some of my friends have created Excel spreadsheets to "objectively" score programs to determine their rank order list.  But the gestalt of a place trumps all that.  I've walked away from programs feeling very good about them - they treated the applicants well, I enjoyed my interactions with residents and faculty, they gave a nice tour of the hospital, they answered all our questions and more - whatever it might be, it's definitely a good sign when you walk away from a program feeling really good.  I've also walked away from programs where I'm like "Hmm . . . not sure what to think about this place" or "I really can't seem myself working here."

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I'm only in the middle of mine.  I've heard from many other applicants that after about the 4th one they're just like, "Okay, I'm tired of this now.  Everything's blurring together."  But here I am after my 6th one and I'm still excited to go on my remaining 5 interviews and each hospital stands out fresh in my mind (we'll see if that changes later, lol).

I think the reason why is because I listened to my advisor's advice (that's what they're for, right?).  And he said that I'll get competent training anywhere because the ACGME demands it, so it's more about how I feel about the place.  Thus I try to explore the city a bit the day before the interview and really feel out the residents and see what makes them tick and whether I "belong."

Residency interviews are so much better (and more fun) than med school interviews (at least for pediatrics/internal medicine - not as much for surgery I've heard).  You are selected for an interview because they want you there.  The interviews are mostly a get-to-know-you and to convince you to go there.  To be honest, it's weird to be complimented and feel wanted, that what you've done outside the classroom and outside rotations mattered.  I can't even count how many times I've been told that the whole process favors the applicant (as long as the applicant isn't a dick).

P.S. The hospital in the picture above is very nice on the inside.  And the people are amazing.

Let The Journey Begin

And so it soon begins, the traveling across the country to visit and interview at residency programs.  And then to create a rank list from my most preferred to least preferred programs.  And finally, letting the Match dictate where I'll end up for the next 3 years of my life.

One interview down, nine more to go.  First to southern California, then to Michigan, then to Philadelphia, then Delaware, and then Chicago.  I didn't get interview invites at several programs I really wanted to have the opportunity to interview at (i.e. Kaiser North in Oakland, CA, UCSF, U of MI, UW-Madison, DC programs), but no matter; 10 interviews is plenty to match.  According to NRMP statistics, I only "need" to rank about 8 programs to virtually guarantee myself matching somewhere.

You may wonder what "matching" means.  Basically, I get interview invitations from residency programs that I send my application to.  Of the programs I interview, I create a rank list of which programs I most to least want to end up at.  Meanwhile, the programs create a similar rank list of which med students they want as residents from most to least desirable.  Then each party submits their list to NRMP and through some computer alchemy, it matches applicant and program.  This is a binding contract, so wherever the match dictates, the applicant must go for residency.  I've heard that the process favors the applicants, insofar as most applicants get one of their top 3 choices or so.

Still, it's a daunting thing.  I've come to accept that I'm almost a second-tier applicant and hence am out of the running for many of the more competitive residency programs.  And that's unfortunate but whatever.  I'm hoping to fall in love with a few programs, as people keep saying will happen.  We shall see.

Let the journey begin!  But first to finish packing . . .

Redefining the Republicans?

As we all know, President Obama won re-election and Democrats solidified their majority in the Senate, with the House of Representatives still Republican dominant.  And as much as I dislike politics, I couldn't help but read some post-election commentaries, such as this, "Christian Right Fails to Sway Voters on Issues."

The current Republican party is so far to their end of the extreme it's no wonder that they failed to win the election.  This got me thinking.  What is meant by "conservative" and what is meant by "traditional?"  These in and of themselves aren't sinister terms that should be tabooed.  Indeed, many people may consider themselves conservative or traditional but still be alienated by the current gestalt of the Republicans.

Economics

I've read that Republicans tend to favor market forces and believe in individual responsibility.  These are things that many people can rally behind.  They are less in favor of government hand-outs and give-me's, and as such are likely to be more restrictive on social safety nets for the poor or disenfranchised.  Still people can rally behind that notion when they believe they shouldn't "rely" on the government to pull themselves up or have seen others abuse the system.

Taxes
Republicans generally are in favor of less taxes on (preferably) everyone, but the current Republicans want tax cuts for the wealthy to a fault. Wealth is really a matter of perspective.  How much does one need to live comfortably?  How much does one need to enjoy life?  Yes, money is hard-earned, but taxes exist for a reason and without them, many things in society would simply cease to function.

Health Care
Republicans are united against "Obamacare."  Fine, I get that.  It's not a perfect bill.  But if you're going to attempt to repeal it, you better have a viable alternative ready to go as soon as it's gone, because the status quo isn't benefiting anyone.  Is health care a right?  Is it a basic right?  A civil right?  Is it a privilege?  Is access to health care a right?  These are philosophical questions that our society must determine.

Abortion
Alright, Republicans are generally anti-abortion.  Fine.  But I take issue when they say they're "pro-life."  They are not pro-life.  If you're going to oppose abortion, you better set up a support system for the children and mothers whose lives are affected.  If you're going to oppose abortion, you must make it okay for a single mom without a high school degree to give birth.  This takes investment, time, infrastructure, and of course money.  If you're truly pro-life, you'd campaign to have all kids vaccinated.  You'd campaign to have every child be in programs such as Head Start and Birth to Three.  You'd campaign to help single parents find jobs or tax credits for education.  You'd campaign to offer prenatal care at Planned Parenthood, not cut its funding across the board.  This is truly pro-life.  But it all costs money, and where does that come from?  Taxes.

Family
Republicans are pro-family.  But really, aren't we all?  Their problem is that they haven't kept up with what a "family" can be these days.  Yes, a family may be the nuclear family of parents and children.  But it can also be an extended family, where one lives with aunts, uncles, and/or grandparents too.  It can be a single parent home.  It can be a gay or lesbian couple.  All studies suggest that it matters less what kind of structure the family consists of, and more the love and care provided by that family.

LGBT
Republicans are against LGBT rights at large, but particularly gay marriage.  It doesn't hold much water with me from a legal perspective.  There is a difference between a civil marriage and a religious marriage.  Churches and other places of worship may refuse to consecrate a gay marriage, but that doesn't mean that the state should refuse as well.  In America where we profess to be open, accepting, and tolerant of all religions - where we believe in separation of church and state - where is all that here?  The same arguments made against gay marriage is exactly the same arguments made against interracial marriage several decades ago.

Minorities
The Republican party has a dearth of minority representation, and it has so far made little to no attempt to attract minorities.  It's really a shame.  Many African-Americans, Asian-Americans, and Latino-Americans likely agree with the Republican's economic stances and their sentiments about family.  Yet the Republicans have managed to alienate all of these groups.  Immigration reform, if done well, would begin to sway some Asians and particularly Latinos to the Republicans.

Environment
Republicans should be truer to the word "conservative" when it comes to environment.  The US has one of the greatest natural resources on the planet, and while it's something that we should tap into, it's also something that we should protect and cherish.  Investment into alternative energy would definitely open up job opportunities and drive innovation.

Education
There's a distinctly anti-education sentiment in the Republican party these days.  I do believe everyone should have the opportunity to attend college/university if so inclined.  I do believe we should invest in recruiting more people to become teachers, and to hold schools accountable (to a degree, this a very complex topic sufficient for its own post).  Teachers and their unions shouldn't be made out to be the bad guys.  It's not easy being a teacher.  If the Republicans don't do something to advance education, the US will continue to slide further and further behind.

Anyway, this post is long enough.  The point I wanted to make is that the Republican party, at its core and true to its moderate members, is not a bad thing.  But they've drifted so far from where they should be that they've become hypocritical.  Perhaps this election has kicked their butts sufficiently to see that what they're doing isn't working and will never work.

And this is a nice article to end on, "The Great Experiment."

Solitude

I am a single man - an individual -
undaunted by public displays of affection,
unshaken by the pairing and coupling of others.
These symbiotic relations have made them weak,
their freedoms restrained, their hearts softened.
Who needs that?

I can, at a whim, drive to nowhere
and gaze at the light of the stars,
observing the music of the heavens.
I would take in the awe and majesty
of the universe unfurled around me,
and know the meaning of life.

I can hike into the woods
and embrace the beauty of nature -
the sound of crunching leaves, the fires of autumn,
the soundscapes of brooks and creatures.
I would be one with the breath of the trees,
and know peace and solace.

I can lay on the warm sands of the beach
and listen to the rhythms of the rolling waves.
I would dig my toes into the sand,
feel the wind and sun on my face -
close my eyes, inhale deep,
and know relaxation.

I can stay in on a cold winter day
and bake a warm pie while sipping hot tea.
I would curl under a blanket on the couch,
watching the snow falling ever so gently.
I am content and satisfied,
as this is comfort.

I run on my own schedule,
my time is mine, my thoughts and actions are mine.
I need no reminding of the pairing and coupling
that defines the life-course of others.
I am a single man - an individual -
and I with nothing more than to share it with you.

Check & Check

Step 2 CK: check. (Did 20 points better than on Step 1, woot!)

Step 2 CS: check.

Letters of recommendation: check.

ERAS application: check.

Schedule my first few residency interviews: check.

Haven't actually gotten a residency interview invitation in a while now, and it's making me nervous.  I applied to 29 programs, which most people have told me is overkill for pediatrics (on average, people applying to pediatrics apply to about 15-20 programs).  I really need to hear from more programs NOW.

I'm on pediatric anesthesia right now.  For the past month I've been on my vacation month (for another post), so coming back to starting at 6:30am is a bit of a shift.  It's been a good experience so far.  I like getting the opportunity and practice of putting IV's in babies and kids, as well as manage the airway.  I like being able to see a diversity of pediatric surgeries because I can migrate from OR to OR each day and see something totally different than if I were just on one surgical service.  Everyone I've interacted with has been very nice and (usually) patient with me.

But I have to say, some people have got to stop trying to make me question why I want to do pediatrics.  Yes, I will be making about 1/4 to 1/3 of your salary.  No, it's definitely not for the money, that's abundantly clear.  I'm well aware that I'll be making among the bottom salaries as far as physicians go.  That said, I will make more money than both my parents' salaries combined.  And I see absolutely no need to "upgrade" my lifestyle.  Yes, I will come out with far more debt than both my parents, but I don't doubt that I'll have the ability to pay it off (annoying rough as that may potentially be).

Anyway, there were some cases I've seen that have definitely reaffirmed some of the reasons why I choose to pursue pediatrics (for another post).  And who knows, if I get bored or burnt out, pediatric anesthesiology might be an option, as it seems almost 1/3 to 1/2 of the staff peds anesthesiologists here apparently started off as pediatricians.  Hmm . . . I must pick their brains on this.

Re-examine

Re-examine by ~Meow2puchiko on deviantART

On Saturday I went to a friend's wedding.  It's the 6th wedding I've been to in the last 5 years.  It was a small, intimate, outdoor wedding of family and close friends.  Though the forecast threatened scattered thunderstorms, the weather couldn't have been more perfect.

I sat (as I usually do) next to friends I knew in undergrad - some of them married, many of us single.  My friend sitting next to me remarked, "Every time I come to a wedding, I feel like I have to re-examine the course of my life."  And I sympathize with him 100%.  It seems like friend after friend has been getting married, and where am I?  Where are the rest of us?  Even if it's not entirely true, it feels as though we're lagging behind in "life progress."  It's rather unsettling at times.  I'm so far from marriage that I can't even see it in the distant horizon.

At least my other friends (married couple) spoke the truth that as we get older, our dating pool only increases (formula: minimum age of dating partner = 1/2 your age + 7).
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The following day I met up with another friend (also married) on my way back from the wedding.  We chatted for a while on politics and catching up and all that.  He always relished my medical stories, especially the gory ones, haha.  His wife was a trooper too with my descriptions.

After a while when it was time for me to go, he gave me the location of his brother's grave, the same brother I had considered one of my closest (and longest) friends.  It felt strange driving to his grave.  I found it rather easily.

There I stood on the road, looking between two small stone walls along rows of graves.  The sun was bright, the sky blue, and the trees and grass green.  At the far end stood a statue of Martin Luther.  And there I saw his sign, a temporary placement for his headstone not yet finished.  Standing at the foot of his grave, I could see it was a recent-ish burial as the grass had not fully grown in the spot.  I had brought no gifts, no tokens.  I saw a single black feather and placed that under the sign.

And I began to say my last words.  It was weird, talking to no one but the breeze.  I wasn't even sure of what to say, my ramblings barely coherent even to myself.  And then I teared up as I admitted that I was bi, something I never got around to telling him while he was still alive.  The words choked, stuck in my throat as I said, "I know I never told you, but I thought you should know . . . I'm bi, probably more gay than straight but I'm working on figuring it out.  I know you would've been okay with it, you would've helped me figure it out in your own way, but there's no way to know now, eh?"

It was awkward, but what does that say?  What does that mean?  That even now, even talking to no one but the air, those words would be so damn hard to say?  I suppose I really haven't changed too much since the beginning of this blog.  I don't see an endpoint.

Having too much time makes idle thoughts wander, too much time to re-examine and yet still do nothing.

Treatise on a Cultural Truth

The Truth by ~-nightm4r3- on deviantART

I wish to begin a discourse, a treatise, on a cultural truth.  That what we believe is true, correct, and accurate may not hold true across all peoples.  Given the same data and knowledge, we may reach very different conclusions - each with its own merits.  Warning: this post is rather long.

Early last week, the American Academy of Pediatrics (AAP) revised their position on infant male circumcision, stating:

"New scientific evidence shows the health benefits of newborn male circumcision outweigh the risks of the procedure, but the benefits are not great enough to recommend routine circumcision for all newborn boys."

It is a shift from the AAP's neutral stance that had been reaffirmed since 1999.  The statement was revised by a committee that had reviewed the medical literature on the subject for the past decade.  This is in stark contrast to a German court in Cologne that essentially banned non-medically indicated circumcision, and you can read my thoughts in my post here.  To me this contrast highlights one of the age-old questions: "What is truth?"  Is truth objective or subjective?  Is it an immutable reality or something malleable to our perspectives?

The BBC News wrote a nicely balanced article, Circumcision, the ultimate parenting dilemma, comparing and contrasting how the US and Europe have approached this topic, looking at the same medical literature, and coming to polar conclusions.  Whereas the AAP has move more "pro-circumcision," the Royal Dutch Medical Association maintains its neutrality (if not slightly "anti-circumcision") stance.  At the end of the day, despite the science and the medicine, it would appear that the decision is decided upon a cultural truth.

Around the same time as the AAP's new guidelines, Dr. Tobian et al. - the same Dr. Tobian of Johns Hopkins who conducted one of the African trials that linked circumcision status to lower HIV infection rate - released an article titled: "Costs and Effectiveness of Neonatal Male Circumcision."  Instantly news stations ate up that press release, with news titles such as:

LA Times: As circumcision declines, health costs will go up, study says

AFP News: Fewer circumcisions could cost the US billions: study

TIME: If circumcision rates keep falling, health costs and infections will spike

CNN: Decline in circumcisions could cost billions

All worded rather strongly with words such as "will go up" or "will spike," suggesting an objective immutable truth to the study.  So what did the study report?  It says that if the US infant male circumcision rate continues to fall and fell to 10% (the approximate rate in Europe), the following could occur:

Lifetime health care costs per man: increase by $407

Lifetime health care costs per woman: increase by $43

Net expenditure for the US health care system per year: increase by $505 million, reflecting an increase of $313 per male circumcision not done

Net expenditure for the US health care system over 10 years: increase by over $4.4 billion

Lifetime prevalence of HIV for men: increase by 12.2%

Lifetime prevalence of HPV for men: increase by 29.1%

Lifetime prevalence of HSV-2 for men: increase by 19.8%

Lifetime prevalence of Infant urinary tract infections (UTIs) for men: increase by 211.8%

Lifetime prevalence of bacterial vaginosis for women: increase by 51.2%
Lifetime prevalence of trichomoniasis for women: increase by 51.2%
Lifetime prevalence of HPV for women: 12.9-18.3%

Those are big numbers, fighting numbers.  But they are potentially misleading numbers.  First of all the calculations based off of prevalence is, in my opinion, disingenuous.  Prevalence is the total number of people in the population with the disease at a given time.  The incidence rate is the number of new people contracting the disease within a time period.  The prevalence for a disease such as HIV, HPV (genital warts or cervical/anal cancer), or HSV-2 (herpes) will always be higher than the incidence rate.  Why?  Because people are living longer with those diseases, and they're considered "chronic," so the prevalence will always increase even if the incidence rate falls.

Second, the study fails to compare/contrast incidence rates between the US and Europe.  It instead falls on relying on data from the African trails on HIV and other sexually transmitted infections (STIs).  When Tobian was interviewed and asked about comparing the US to Europe, the article states:

"It is too difficult a comparison because "we have very different racial and socioeconomic backgrounds and different transmission dynamics," he said."

Wait a second there.  Tobian et al. used data from Africa, where racial and socioeconomic backgrounds and transmission dynamics are clearly more different compared to the US than Europe compared to the US.  Didn't he just invalidate his study, in some sense?  So what is the comparison between the US and Europe?

Utilizing the European Centers for Disease Prevention and Control (ECDC) and the US Centers for Disease Prevention and Control (CDC) data, we can see the following:

Chlamydia:

Europe (overall): 143 cases per 100,000 people (2000) to 332 cases per 100,000 people (2009)

US: 405.3 cases per 100,000 people (2009) to 426 cases per 100,000 people (2010)

Gonorrhea:

Europe (overall): 16.8 cases per 100,000 people (2000) to 11.7 cases per 100,000 people (2009)

US: 98.1 cases per 100,000 people (2009) to 100.8 cases per 100,000 people (2010)

HIV:

Europe (overall): 6.6 cases per 100,000 (2004) to 7.8 cases per 100,000 (2010)

US: 16.3 cases per 100,000 (2010) - CDC's website wasn't too user-friendly for finding info

HPV and herpes aren't tracked as closely and are difficult to track because of a latent asymptomatic phase.  But the US CDC cases seem to be overall steadily trending up, though herpes appears to actually have had a steep decline in the past 2-3 years.

As you can see, the US has higher incidence rates of all STIs, including HIV, compared to Europe.  At first glance, most of the STI rates in the US are either stable or slowly trending up at a rather consistent pace since the 1960s or so.  As infant male circumcision rates have decreased since the 1980s, one would expect to see a quicker pace of increase starting in about 1995-2000 or so (when the first cohort of more uncircumcised males reached age 15 or so).

It's true that Tobian et al.'s study is true utilizing the data he used.  But with additional data, different data, I reached a different truth.  What I see is that:

1. the rates of STIs in Europe (on the whole, individual countries vary) are lower than in the US - and we should figure out why before resorting to cutting off a part of the human body.
2. the velocity of increase in rates of STIs in the US aren't speeding up as the years progress, which should theoretically correspond to a decrease in infant male circumcision rates over the last 30-40 years if Tobian's assertion is correct.
3. despite an estimated 211.8% increase in male UTIs in Tobian et al.'s study, the rate of UTIs in baby boys is still at about 1% or less (a lower rate than for females at any age).
4. despite an estimated increase in HPV among both men and women in Tobian et al.'s study, there is now a vaccine for HPV that he likely didn't factor in (a vaccine, might I add, that has been recently FDA-approved for use in men as well).

So we must sometimes evaluate what we deem as "truth."  Even if we look at the same object we may still see it differently.  Culture can shape our truths and to evaluate our truths we must sometimes not evaluate the data, the science, the medicine, but rather the culture with which those truths are framed.  Below are some well-written challenges against the culture truth of infant male circumcision in the US:

Our Bodies, Our Choice: Circumcision is Not a Joke

Why Do We Still Circumcise Boys?

Why I Didn't Circumcision My Sons

The First Lady with Grace

I just got done watching the first night of the 2012 National Democratic Convention.  I was floored by Michelle Obama's speech bringing the first night to a close.  I'm also rather floored that it's already posted in its entirety on YouTube for you all to replay.

I believe it connected with many Americans in a very personal way.  It highlighted the struggles to improve one's station in life and that though it may not be realized in one's own life, it can happen through one's children or one's children's children.  It's not dissimilar to the story of my own family, immigrating from Hong Kong in search of a better life.  How my mom's family lived together in one apartment and I was cared for by all family members when I was born.  How my parents, grandparents, and uncles began on food stamps.  How my family worked its butt off to allow me, my brothers, and my cousins to be where we are today.

She tactfully touched upon all the social issues that President Obama has in some way championed - women's rights, healthcare reform, gay rights and marriage, and support for veterans.  She humanized him in a way that only she would be able to do.  She gracefully didn't lampoon the Republicans, something very refreshing to see.  It's easy to see why she's the most popular woman in the US.

I do agree with the news commentator on the TV - the Democrats have the social issues in hand, lock and step, but they need to refocus a good portion of the remaining nights of the Convention on the economic issues.  True, the economy has recovered and is growing, albeit slowly.  But they still need to bring that to the forefront.

Another Step Taken

Another step by ~F1rstcl4ssn00b on deviantART

Step 1: check.

Step 2 CK: check.

Check off each step taken towards my medical license.  Hopefully I passed Step 2 CK, but I won't definitively know for almost a month.  Blah.  I shudder to think about retaking that 9-hour long test (not to mention how much it costs!).  With some luck, I did markedly better on Step 2 CK than on Step 1 last year.

Steps left to go: Step 2 CS and Step 3.  After that, it's just the re-certification exams every 10 years to be board certified.  Yay.  Endless testing.  -_-

But for the moment, I have a short window of freedom (and a short vacation coming up!).  So I'm going to enjoy this while it lasts.  Alas I also have to work on ERAS applications for residency programs.

Oddly Chaotic

M4 year has been oddly chaotic.  Where to even begin?

1.  I finished my peds sub-I last month.  The last week and a half were awesome and really renewed my desire to pursue peds.  While on night float it was just me, a senior resident, the nurses, and the attending physician that I rarely saw or talked to.  I liked the smaller team structure and I enjoyed interacting more closely with the nurses and got the opportunity to know all the patients on the service a bit better.  I also became really efficient literally overnight and that efficiency carried over when I returned to the day shift.  Unfortunately I'm still worried that my comparatively poor performance the first 3 weeks caused irreparable damage to my grade and comments, which could pose an issue later when I interview for residency programs.

2.  I'm taking USMLE Step 2 CK at the end of this month.  I'm so not ready!!  I keep hearing that most people do better on Step 2 CK than on Step 1, and I desperately hope that's true because I didn't do nearly as well on Step 1 as I had expected.  :-/  Must study study study!!!

3.  I'm working on my ERAS application to pediatric residency programs.  I'm partway through but I honestly expected to be mostly done by now.  I just haven't had the energy to dedicate sufficient time towards it.  There's so many little things to do and complete!  And I have to really do some introspection into what kinds of programs are a good fit for me.  Ugh.

4.  I have to touch base with all my writers for letters of recommendation.  In addition I need a letter from the Chair of Pediatrics.  Fortunately, in an oddly deus ex machina fashion, that bit worked out far better than I could've dreamed.  So now I'm just waiting for one letter writer to get back to me as to when he can meet with me to finalize things.

5.  I went out on a date with this guy a couple weeks back (he considered it a date, I thought we were just hanging out having brunch - clearly I suck at such things).  He's about my age, is a good conversationalist, is witty.  We've been flirting a little bit back and forth via the app we first chatted on (he has limited texts, so I avoid texting him too much).  Hopefully there may be more?

6.  Last month I visited a friend in a city about an hour west of me.  It was a lot of fun.  I also ended up (unintentionally?) jacking him off . . . while his boyfriend was out of town.  Oops.

So yeah.  Oddly chaotic beginning to what's supposed to be the best year of medical school.  But these first few months are death.

Hardest Month . . .

Precocious Patient by ~ThirstyEye on deviantART

M3 year has flown by.  Sometimes I still can't believe I an M4 now and on my pediatrics sub-internship.  This is by far my most difficult month of med school yet, more so than even surgery.  I literally act as a functional intern on one of the pediatrics ward teams, except all my orders have to be verified by my senior resident.

There are rewarding moments.  There are moments and areas that I feel I shine at.  But all that is overshadowed by this constant anxious feeling that I'm not doing enough, or not doing things the right way, or not thinking fast enough.  It's terrifying.  Being the one responsible for a child's care in the hospital is daunting.  It's not that I don't basically know what to do, it's that I'm unable to instantly anticipate all possible (worst) outcomes and prepare for it.

I'm able to prioritize tasks fairly easily, to do what needs to be done, but I can't prioritize my thoughts as quickly when someone asks me a question or I'm asked to present a patient.  The information is there, but it's not organized the way I (later) type it up and it's unfiltered because I just ramble all the information - pertinent and non-pertinent.  I don't know why I'm getting flustered and blanking.

I'm now 2 weeks in to the rotation, about half-way done.  And I feel like I haven't significantly improved despite working my ass off.  Today was the worst day.  I showed up and was instantly handed 5 patients I didn't know, didn't have sufficient time to read through their chart, and on top of that I was the one admitting a new patient and had to do her whole work-up.  I was a mess and constantly second-guessing everything I said the whole day after that.  It took me way longer to catch up than it should.

Words can't express how defeated I feel right now.  How stupid I feel.  How slow I feel.  How not cut out for this I feel.  Maybe I should consider switching fields.  This was not how I expected to start M4 year, and definitely not how I expected this month to go.

When the Courts Intervene

These days the news are filled with stories of various laws, bills, and practices brought before the Courts system.  It must be difficult to be a judge, to sit in a position of logic when so many of the arguments brought forth are ones of emotion.  And when it may at first appear that the Courts overstep their boundaries, the reaction can be explosive.

In Germany, a curious ruling was made by a Cologne court: German Ruling Against Circumcising Boys Draws Criticism.  Of course Jews and Muslims are up in arms over this, believing the court overstepped its jurisdiction and invaded religious space.  The court basically ruled (paraphrased) that the child has the fundamental right to bodily integrity and must be able to consent to the procedure if it's not done for medically indicated reasons.  It sounds logical enough.

Now the vast majority of circumcisions are done in infancy or early childhood, when the child cannot of course consent.  By Jewish tradition it happens on the 8th day of life.  Muslim tradition, as I understand it, varies a bit - it could be in infancy or all the way in adolescence (when the child would be able to consent).

So the argument come back, does the child's fundamental right to bodily integrity trump the parents' rights to parent?  To dictate the child's religion?  This is a gray zone, to be sure, and I'm not sure why male circumcision gets such a pass (from a logical standpoint).  Courts have ruled previously that a parent may not tattoo their child.  Courts have ruled that female circumcision (aka female genital cutting/mutilation or FGM) is illegal.  Are those necessarily drastically different?  Tattooing inflicts a permanent mark on the child, but doesn't remove any part of his/her body.  Female circumcision exists on a spectrum - the most "benign" being a simple prick to draw blood from the clitoral hood (or removal of the clitoral hood) to practices way more extreme.

One medical body considered allowing physicians to perform the most benign on the FGM spectrum (pricking the clitoral hood to draw a few drops of blood, symbolically of female circumcision) to assuage parents who come from a culture that practices that, and to ensure they don't take their baby girls to a practitioner who'd do something way more extreme.  That consideration was met with a furious backlash and promptly retracted.  But we're allowed to do more than that to baby boys.  I mean, really now?

For the purposes of this post I'm ignoring the potential medical benefits/risks of male circumcision because the research on that waffles all the time, and whatever potential medical benefits that may be gained are easily achieved with other means (e.g. using a condom, good hygiene, etc).  But these procedures, because they are surgical in nature, do come with very real risks.  In an old Jewish tradition (fortunately not practiced by most - I think - Jews these days), the mohel sucks the blood away from the circumcision wound with his mouth.  This is obviously not sanitary and is against all medical standards.  How 11 New York City Babies Contracted Herpes Through Circumcision.  That's one of the complications of that particular practice.  Now in normal healthy older children and adults, herpes is annoying but nothing more really.  In babies, because their immune systems are next to none, a herpes infection can be deadly.

And when public health officials try to intervene to limit/stop these practices, religious backlash is again furious as they claim they can self-regulate.  Clearly not always.  Circumcision, as my ob/gyn attending once said, has a "narrow therapeutic window."  It's not a difficult procedure to perform, but when you mess up, you mess up big time and you can destroy that kid's life.  That's not a burden I'd like to carry.

If at this point you may think I'm bashing religion, I assure you I'm not.  But when a religion requires modification to a person's body, particularly to a person who cannot consent, there are at least standards that must be met.  I'm in full support of medical/public health/legal bodies regulating such practices to ensure minimal harm.  The Cologne court in Germany may have gone too far, but the issue they bring up is valid: does the parents' rights trump the child's right to bodily integrity?  What if the child grew up and wish he (or she) wasn't circumcised?  What consolation is there then?

On my ob/gyn rotation I met a young first-time mother who asked me, as she was in the last stages of labor, whether her son would get circumcised right after birth.  I tried my best to mask my shock.  I said that the baby must first be observed for at least 12+ hours to ensure he's healthy enough.  I told her if she wished it to be done, it'd happen the following morning.  She asked me again if it'd be done right after he was born.  I reiterated myself.  Her friend suggested she could just leave him uncircumcised, that there's nothing wrong with that - I agreed and said most of the world's men are uncircumcised and the vast majority of them have no health problems because of it.  She considered this for a full 3 seconds before asking me that question again.  I changed the topic, exchanged some polite words, and left.  This mother, in my opinion, shouldn't have had the right to make that snap decision for her son without full consideration of the potential risks/benefits.

Thoughts?  Should logic rule over emotion and tradition?  Did that German court go too far, or simply conform to laws regarding other somewhat similar practices?  Whose rights should respected first?

Here's one last article, food for thought: Circumcision's Deadly Fault Line: Rationality vs. the Metzitzah B'Peh.

Ending with the Crazies

Ya know, I could say how I've been busy and whatnot.  But that'd be a lie this time.  I've just been lazy.  The year has been winding down for some time and I just couldn't be bothered, lol.  And as it is, I end the year with the crazies (aka, psychiatry).

It actually wasn't a bad rotation.  Spent 2 weeks on child/adolescent psych, 1 week on eating disorders, and 1 week on adult psych.  As the director of the place told us several times, "Most of these patients ain't dumb, they ain't crazy, they just have had crazy things happen in their lives and couldn't handle it, and that's why they're here."  On about day 3 I realized how true his words rang.

The vast majority of psychiatric patients I saw aren't crazy.  Most of them aren't schizophrenic, they don't hear voices other people don't hear, they don't see things other people don't see, they aren't foaming at the mouth or anything (that said, the couple of schizophrenics who weren't taking their medications really were sometimes kinda scary crazy).  Most of the people I saw actually had mood disorders - anxiety, depression, irritability, etc.

The best way I can describe most patients' situations is that crazy things happen in their lives - a kid is witness to domestic violence or is abused (verbally, physically, emotionally, and/or sexually), a teen feels out of control when her parents divorce and start restricting her eating, an adult couldn't handle the pain from multiple surgeries and turns to drugs - and their minds just can't take it.  Something inside breaks and they snap.  These people try to resolve things and find an outlet for the trauma of their minds and find themselves repeatedly bashing their heads against a proverbial wall.

And when they're at their lowest, when there's not much further down to go, they come to us at an inpatient psychiatric hospital.  Here we control the environment, take the responsibility out of their hands for a time, talk to them, counsel them, prescribe medications.  And these medications often work (it may take some fiddling around to find the right drug and dose for the right person, but it works out more often than not).  They kind of reset the imbalance in the brain and allow people to think clearer, calmer, and more rationally.  They smooth out the edges of emotions so one doesn't soar as high or dip as low.

Mental health.  It's a real thing.  Sometimes all one needs is some counseling, and sometimes it requires medication.  In that regard, it's not really any different than diabetes or hypertension.

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Oh yeah, I'm 3/4 of an MD now!  :-D  Unfortunately the other aspects of my life have been less interesting than the things I witness when I'm in the hospital.  Still a few things here and there worth blogging about in posts to come.

Oh yeah, PPACA (aka, Obamacare) survived the Supreme Court ruling.  Thoughts?  Also for another post, lol.

The Past Few Months

It's been a while since I last blogged.  I could easily claim that I've been busy (which I have), but it's just as much my fault for being lazy.  Blogger has changed in this interval time (I kinda like the old version better, lol).  I've seen and learned a lot these past few months in the various rotations I've circulated through.  Each month presented a different slice of medicine.

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Family Medicine

Truthfully, this was easily one of my favorite rotations.  I worked in a clinic with a preceptor, no residents on site, and I got to do a lot.  It was almost like a continuation from outpatient pediatrics the month prior and I loved it.

Family medicine is the "jack of all trades, master of none" field insofar as it sees the full spectrum of ages and patients, and can do a little bit of everything but is unable to narrow down into most sub-specialties (e.g. cardiology, pulmonology, etc).  But you see the bread-and-butter of everyday illnesses and do things like lance boils, freeze warts, do a little physical therapy, and things like that.

But the one thing I most took away from family medicine was my preceptor's outlook on life.  He spent his career nurturing his perfect work-life balance, and it was something he reiterated to me over and over again.  He didn't mind earning a little less money than the other physicians in the practice because the flip side was that he got to spend more time with his family and kids.  It all comes down to priorities.

One life philosophy that was parroted by his son one day is, "Have a good day, or not.  The choice is yours."  And he told that to more patients than I could count that month.
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Pediatric Infectious Diseases

Peds ID was something I was almost certain I would do coming into med school.  My background almost perfectly set me up for it - a year of public health, focus in genetics and molecular biology, interest in HIV/AIDS, etc.

But then something curious happened.  I loved outpatient pediatrics.  I loved family medicine.  I loved pediatric rheumatology.  I could no longer choose or peg myself down for something so narrow as pediatric infectious diseases with a focus in HIV/AIDS.  I found myself wanted to become more general.

That said, I still enjoyed the month.  I got to know my patients in the hospital (they didn't always know me, several of them being babies or else mentally handicapped).  I got to understand the work-up for an infectious etiology.  And every Wednesday at the weekly conference where all the staff physicians in peds ID got together to discuss the treatment plans for all the patients on service, they would all go at each other.  It was one of the most entertaining, and intellectually stimulating, things to sit through.  I was entertained, anyway.

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Perioperative Medicine

Aka, anesthesiology (with bits of trauma and emergency medicine tossed in).  I knew I'd like this rotation.  I liked doing things with my hands and doing small procedures (not surgeries though).  I didn't expect to love it but I did.

In anesthesiology, you put patients to sleep in the OR (operating room), keep them alive throughout the surgery, monitor pain, and wake them up.  Your job is one of the most important jobs because you are directly responsible for someone's life.  You control every aspect of their physiology - their breathing, their heart rate, their muscles (via paralysis), and their consciousness.  My resident asked me, "Who is in the best position to kill the patient?  The surgeon?  No, it's us, the anesthesiologist.  Without us the patient can't breathe.  And if we make a mistake with a medication, the patient may never wake up."

There was a sense of immediate gratification and power in anesthesiology.  I got to put in several peripheral IVs (didn't miss a single one I'm proud to say).  I really liked putting in IVs . . . I got to monitor and chart the patient's course in the OR.  I got to breathe for patients.  I attempted to intubate a few (intubation is quite difficult for me, grrr).  I got to help prep and push drugs that slowed a person's heart rate down when it got too high, or boost a person's blood pressure when it dipped too low, or reinforce paralysis when a person began to twitch in the middle of surgery (always under the direct watchful eye of a physician, of course).

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Obstetrics/Gynecology

I . . . didn't really like ob/gyn. I mean, it was okay.  Not as brutal as surgery.  I just don't think I could stand women and pregnant women all day.  The vast majority of the residents are women as well!  That said, I did like participating in vaginal deliveries.  Got to catch a couple babies too!  They're just as slippery as you'd imagine.

The one thing I REALLY disliked about ob/gyn is that you spend almost zero time with the baby once it's out of the womb.  You hand the baby off to the nurse or the neonatologist and don't bat an eye at it again.  I found myself lingering more at the baby's side than the mom's.  Yeah . . . it's a sign.  Babies are so cute (even right after they're born and are all slimy and malformed-looking)!!

One other thing - you don't truly appreciate blood loss until this rotation.  In surgery you think you've seen someone bleed during surgery.  Just wait until a birth or better yet, a C-section.  A woman is expected to lose one liter of blood during that procedure - one liter!  The vast majority of women do just fine afterwards though, because their bodies have spent the better part of up to 9 months prepping for that loss.  Still though . . .

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Neurology/Psychiatry

Well I just finished neurology and will be starting psychiatry tomorrow.  Neurology was okay.  I was on an awesome team with great residents and good attendings who taught quite a bit.  But I saw a very small slice of neurology as I was on the neurovascular (aka, stroke) team.

We saw many patients with strokes or suspected strokes.  The neurological deficits are interesting to see when they're there.  What's nice to know is that most people recover and do just fine after a relatively small stroke.  It's the large ones that really take out half your body that're devastating.  There were a few devastating strokes on our service in our short time there.

So public service announcement: exercise some, eat healthy, take your blood pressure/high cholesterol medication if you need them, do not smoke.  A stroke is a scary thing to have happen to you, especially when you're young (less than 65 years old).  There are a lot of things we can do to reduce that risk.

A Sudden Farewell

At around 10pm on May 1st, one of my closest friends committed suicide.

I learned that fact from his older brother on Facebook.  There were and are no words that adequately describe my shock.  There are so many questions left unanswered.  What warning signs there were (if any) were subtle.  But this much I do know.

My friend, who had a promising career in directing/acting, went to Los Angeles in December to seek career opportunities and to "find himself."  From piecing together snippets of conversations from several of his friends, his brother was able to figure out that his mental state had begun to decline.  While in isolation each of the conversations he had with people were nothing out of the ordinary, together they may have foreshadowed this event.  In fact, even earlier on May 1st he had lengthy and rather ordinary conversations with people, including his brother.  Such is the curse of hindsight.

I have promised his brother not to say much more, at least not until after the funeral.  I have an unfinished document sitting on my laptop that I had meant to send him - a document that he will never be able to receive.  We didn't talk too much these days, because of our very busy schedules and the distances that separated us.  But he was a friend I had known practically my entire life.

My last memory of him was at his brother's wedding back in September.  Although it has been months and I wasn't able to talk to him and say another goodbye, it was good seeing him back then and he shall remain in my good memories.

Farewell, my friend.  You will be missed.

The Truth of the Matter

About a week ago, I was having lunch with some friends (most of them in med school with me). I can't recall how, but we arrived on the topic of "conventional" vs "alternative" medicine.

We had all read at least some excerpt of Anne Fadiman's book, The Spirit Catches You And You Fall Down. It's a biography of a Hmong girl who develops seizures and about the divide between Hmong culture and and Western medicine culture. Interestingly, my friend and I took away very different messages from the book.

He cited a quote from a surgeon towards the end of the book saying to the effect, "Western medicine works" and claims Fadiman ignores that fact and moves on. He believed that all of the alternative medicine and cultural beliefs of the Hmong in the book were essentially crap and that Western medicine was the one true solution to the girl's seizures, and that everything else got in the way. Western medicine is the only thing that works. I disagreed on two points: 1.) it doesn't really matter if Western medicine is superior or not if the patient doesn't want to take it, 2.) not all alternative medicine is necessarily crap - a lot is just unproven medicine.
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1. The truth of the matter is, patients don't always think highly of doctors. It's our fault, really. Doctors can be so dismissive and so readily "reduce" patients to numbers, diseases, and organs. We can appear cold and disengaged. It doesn't matter if Western medicine is the only thing that works - if patients don't take the medicine we give them, the effect of our medicine is zero. We must negotiate without patients, we must compromise with our patients, we must work with our patients to get them the best medical care possible.

There's a great article written on KevinMD.com (a great medicine/health blog) titled, Stop the Us versus Them mentality in medicine, that speaks very well to this point.

2. The truth of the matter is, not all alternative medicine is crap. A little over decade ago, acupuncture was scoffed at as a sham and now it's routinely used as an adjunct to treat pain and some other conditions. Though the research on acupuncture can be argued as not being the most rigorous and powerful out there, it did demonstrate real potential. Garlic has some medicinal properties and so does St. John's wort.

Herbal medicines and teas can augment or interfere with the effects of our conventional drugs. It behooves us to know what these herbals may do, so we may advise patients accordingly. More research needs to be done. There a lot more alternative medicine out there than research is able to elucidate its true effects. There's a lot of untapped potential that needs to be refined into a product that can reliably and safely work - to disregard it all as "for hippies" or "essentially placebo" is a disservice to patients and the spirit of science and medicine.
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Another friend at lunch remarked, "Do you know what alternative medicine that's proven to work is called? Medicine." I disagree somewhat. There's a difference between the word "alternative" and "integrative and complementary." Not too long ago research showed that a tablespoon of honey in a cup of hot water helped temporarily relieve symptoms of sore throat and cough. But these things alone usually can't suffice, and hence are integrative and complementary. Alternative implies a divergence from conventional medicine.

This article, The Believers, that my friend sent me yesterday unsettles me a little. It may seem hypocritical of me to say that, given what I've argued above. But I am by training a scientist. I acknowledge that there is a world outside what research has touched (because if research has touched it all, there would be no further research). I believe that many alternative therapies warrant further scientific research to see if it truly works or not.

Anyway, the truth of the matter is, we shouldn't dismiss alternative medicine so readily because we don't always have proof it doesn't work. Also, if we dismiss it so readily, patients may take offense and refuse to take the medicines we prescribe. And if they don't take our medicines, that have research backing that they work, then what's the end effect? Oh yeah, nothing.

Return from Unexpected Hiatus

Wow, hard to believe it's been a month since I last posted anything here! Also kind of hard to believe that I haven't been blogging about all the things I've seen and done the last 3 months (and there's oh so much to tell). Didn't mean to not post . . . oops.

Days have become long again, now that I'm on ob/gyn. It's an abomination to wake up and be at the hospital before dawn. Thankfully, the break of dawn is slowly creeping earlier and earlier in the day such that by the time I get to the hospital, the cracks of daylight begin to alight the horizon.

But before I get back into my day to day, week to week, month to month recount, there are 2 things I came across on Facebook recently.

On Being Gay in Medicine: A Leading Harvard Pediatrician's Story
This is an amazingly written (albeit long) article. The author recalls how when he was in med school, you had to stay closeted otherwise your career can be ruined at a whim. It's almost weird reading about that and about how much things have changed. Things are getting better, but there's always some room for improvement. I think this article resonated with many people, gay/bi/straight/otherwise.

It Gets Better at Brigham Young University

This is a really touching YouTube vid I saw posted. Very well done (albeit long-ish) and very moving. It's not secret that BYU is among the least LGBT-friendly campuses in the nation, but it's reassuring to know that even there things are changing for the better. Definitely worth watching the whole thing.

Chosen Path

This post is actually 2 weeks later than when I made my decision, but it has to be written nonetheless.

I've decided that I will not return and finish my MPH.

It's not like I'm necessarily giving up on getting an MPH (eventually), it's just not what I'm looking for in my career at this time. I may end up getting an MPH as a part of a preventive medicine or ID fellowship, if/when that time comes. I may end up coming full circle and return to some lab work, but not now and not in the near future.

And I've decided this for the reasons I wrote in my previous post. The words that clarified my decision came from my M4 advisor, who told me:

"I'm going to tell you what I tell residents who're deciding whether to do a fellowship or not. A fellowship, like your MPH, requires you to give it your all and your total dedication. If you're going back and forth now, ask yourself: is this really what you want? Or is your doubt telling you something?"

Those words shone in my mind like a sun burning up morning fog. I've made my decision. And I'm at peace with it.

Uncertain Crossroads

Crossroads by ~Nadja18 on deviantART

Last week my application for re-admission to complete my MPH (Master's in Public Health) was approved. Initially I was ecstatic because I had been talking about this moment for over a year, about how I loved/valued the program, etc. Now for the past week or so, I'm not so sure - I've been getting some cold feet and doubting whether I will actually go back and finish what I started. The conviction which I had held for the past 1-2 years is gone. And it all hinges on "uncertainty."

I am uncertain that:
1. I will get funding to finish my MPH (I do NOT want to tack on any more to my growing student loan debt).
2. I really need to finish my MPH to do what I want to do.
3. I still want to do what I had originally set out to do when I began med school.

Here's how those primary uncertainties are being addressed at the moment. 1.) I stand a fairly decent chance of getting funding via teaching undergrad courses as a grad student. It was reassuring that the professor I taught for was very willing to write me a letter of recommendation and remembers me so well. 2.) I do not need to finish my MPH to do what I want to do. Would it be useful? Perhaps, but it depends on what I end up doing. Which brings me to, 3.) Without even realizing, I've changed. I had set out to be the so-called "triple threat," that is the doctor who sees patients, does research, and teaches students. Now I'm not so keen on the research bit, haha. Also I had set out to do ID (infectious diseases), and while that's still on my career list, I've begun to shift away towards primary care or another specialty like rheumatology.

My MPH degree is very specific towards a particularly ID-oriented skill set. With my degree I would be better equipped to understand infectious diseases, conduct laboratory "bench" research, and create surveillance programs relating to infectious diseases and the agents to treat them. And prior to med school, that was one aspect I had wanted out of my career. Now I don't know.

Now a few things are certain and have remained certain (if not strengthened) over the past several years: 1.) I want my career to be clinically focused on treating patients. 2.) I want my career to have a public health/community engagement component. 3.) I want to teach students (doesn't have to be med students). 4.) I want a good work-life balance. None of those require an MPH - or more specifically, my focused MPH program.

So I'm in a bind. Will I regret later down the road for not having finished my MPH? If I get my MPH and never end up going into an ID field, will I feel like I "wasted" a year? I can see myself going either way, and neither road is superior to the other (not really, anyway). I can convince myself to go either way and I've been changing my mind on almost a daily basis for the past week. Ugh.

Talking to one attending physician who basically does what my MPH would prep me to do, he asked me, "What do you want to do?" And I said either peds or something within peds, like peds ID. And he emphatically said that I did not need an MPH to do peds or peds ID, and it wouldn't necessarily help me that much. What matters most is not how many letters I had after my name (so long as I had letters at all); what matters most is talent, hard work, and good networking. That said, if there's something I wanted to do within medicine that requires an MPH (or practically requires it), then I should definitely get it.

Anyway, what do you all think? I've talked to so many friends and several faculty, and I keep ping-ponging between the two options. I can't delay my commitment too much longer, have to make a final decision soon!

The Importance of Caring

Several days ago I came across this article, The foundation of medicine is care. Like many words in healthcare, "care" has become overused (right up there with "professionalism"). What does it even mean anymore?

We adhere to standards of care - the set of questions, actions, labs, imaging, etc that we do to diagnose a patient's problems and provide adequate treatment. We provide care to patients, to help them when they request it of us. None of this necessitates that we care about our patients. As the article argues (and I agree), this last kind of care is the most important.

Today, a distraught parent explained her daughter's "history of present illness" to the physician I am working with this week. In trying to get an accurate picture of her daughter's current illness, he asked the mom question after question to make sure he had the story right. The mom got frustrated because she's had to explain the whole thing for who knows how many times and she felt like he wasn't listening - such is the perils of an academic teaching hospital, you must tell the same story at least 3 times (and often more). The mom became so frustrated that she broke down. She was the first person I met who said how horrible this hospital was, how no one seemed to care enough to get the story right or talk to each other so that everyone's on the same page. She's not entirely wrong. Our hospital system is set up in a rather fragmented way. We provide the same standard of care (if not better) than most other hospitals, we provide good care for our patients. But we, as a system, didn't care about the patient.

Inpatient medicine is very different from outpatient medicine. In the outpatient setting, I felt that every physician actually cared for his/her patients on a personal level. I had a . . . heated discussion with my roommate about a month back. He asked me why I cared so much, why I get so worked up over a patient encounter. Really, I couldn't help it. By actually caring about my patients, not just for them, I feel like I am able to do more and am willing to try harder for them.

He didn't share my same views. For him, once he met the standard of care, he need not go further. If he couldn't get a patient to comply, then he is perfectly satisfied to give up and walk away from the situation. While in some scenarios this is indeed the correct course of action, I felt that it would be a disservice to our patients if we gave up every time they gave us even the slightest hint of grief.

Anyway, just some thoughts.

Privilege & Entitlement

"The moral test of government is how it treats those who are in the dawn of life, the children; those who are at the twilight of life, the aged; and those in the shadow of life, the sick, the needy, and the handicapped."

I came across that quote in this article, Addressing the needs of the disadvantaged in our health system. The words themselves struck me and the article is well worth a read (it's by a med student).

I linked that article to a friend and she shot it down as overly idealistic because people will find a way to take advantage of and manipulate the system. Then people will begin to feel entitled to the help from the government and stop trying as hard to pull themselves out of whatever situation they find themselves in. The public health aspect of me balked. She turned it back on me and remarked that I probably felt more entitled than her, and that her boyfriend almost certainly feels more entitled than either of us. I was confused. She stated that I must feel entitled to be paired with good physicians as my clinical teachers and that I expect certain things to happen or else. I was taken aback. This then became a philosophical discourse of sorts.

I have never really felt entitled to much past high school. I learned very quickly that things in life must, more often than not, be earned. I have never felt a sense of entitlement in med school. Whether or not I am paired with a good physician or not is purely luck (that said, I've been pretty lucky lately).

Every moment I have time to give pause I am filled by a sense of privilege. Truly, being a doctor is a privilege and one of the highest out there. In how many other professions can you ask someone to take off their clothes and allow you to touch them in ways that would otherwise get you arrested? In how many other professions will someone come to you and ask you to cut them open and do what you will inside them without getting sent to jail? In how many other professions can you ask someone about the whole "sex, drugs, and rock-and-roll" without getting them arrested?

I am aware that every time I walk into a patient room, I have mere seconds to earn their trust. It's an interaction that takes place within a few seconds' time, but it is so critical. With adults, this is an introduction and a shaking of hands. With kids, this is more subtle but can be sensed by the look in their eyes (and whether they give you a high-five or fist-pound). With newborns, it's a settling back into a calm. I am motivated by a sense of awe for the practice of medicine. For patients to allow me to listen to their stories, to examine them physically, to place trust in my words (as a M3 med student), to consent to have me assist in their surgeries and be elbow deep into their abdomens - I'm not sure words can express the sense of gratitude and privilege one can feel.

Unfortunately for many of my peers, the rigors of the training and the complexities of the patients out of our control have jaded them. To quote Dr. Walcott in the movie, Patch Adams:

"Our job is to rigorously and ruthlessly train the humanity out of you and make you into something better. We're gonna make doctors out of you."

In a profession that deals with humanity, how have we allowed it to smother out our own humanity? It's a curious thing. I would be lying if I said I haven't had my moments when I wondered why I even bother to help some patients, knowing that they will not or cannot help themselves. I would be lying if I said I haven't ever been pissed at a patient when things took a turn for the worst.

But thinking back to WHY I'm here in the first place brings me around full circle and sustains me. Everyone has a reason for going to med school, some of them better and nobler than others. I believe those who hold onto their reasons and do not lose sight of it are best able to make it through without become (as) jaded.

Well, this post has been rather long and I'm not sure it makes a whole lot of sense. I'll have more to say after my exam on Monday. Eep!

Happy New Year 2012!

Hey everyone, Happy New Year 2012! I know I'm a day late, blah blah blah, but Happy New Year nonetheless. May 2012 be fulfilling and rewarding; and for those of you who had a crappy 2011, may 2012 be much much better.

Already at least one blogger started 2012 off on a bad foot. Please go over to Landyn's blog, Stuck In The Middle, and offer him your best wishes and any help you may be able to provide. He's in a really bad spot right now and could use our support.
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On a completely 180-degree note, I've got more answers to questions from Well I gotta say, Being gay is . . . (now re-named to "Normally Gay").

1. What is your favorite trait about yourself? It can be physical or character-wise.
Hmm, a tough one. My best character trait is that I'm extremely hardworking and dedicated when I need to be, sometimes almost to a fault. My best physical trait . . . my eyebrows I guess?

2. Describe your perfect man.
This is a tad tough, haha. Originally I had separated this into 2 categories: "requirements" and "pluses." Then I came to the realization that I could give a little more on the requirements and some of the pluses are really more important. So here's just a laundry list below (in no particular order, and the question did specify "perfect" man, after all):

- Beautiful eyes. I find eyes really attractive. The color isn't important, though I find green and hazel eyes particularly mesmerizing.
- Cute face with a cute smile. This is very subjective and no one face fits this description. It may be a clean-shaven face on one guy or with stubbles on another, it just depends.
- Reasonably in shape. Not too thin, not fat (a little overweight is fine), is pretty toned, not too muscle-y.
- Height -2 inches to +6 inches from my height. That'd give a range of about 5'5" to 6'1".
- Age -6 to +6 from my age. That'd give a range of 19 to 31.
- Non-smoker, non-alcoholic, non-drug user. This really is a deal-breaker. Though, I could make an exception for very occasional marijuana use . . .
- Intelligent and can hold a decent conversation. Now, I don't need a doctor or someone with a PhD (pluses though that may be, haha), but an undergrad education is pretty much a must.
- Someone who can consistently get me to smile and do things I otherwise might be hesitant to do. Really, I need someone who can put me at ease when I get too tense.
- Someone who is honest, loyal, keeps promises, and likes to cuddle.
- Is a good cook. Food is definitely one route to my heart, lol.
- Plays a musical instrument and/or speaks a foreign language.
- Likes to travel.
- Is fairly neat & organized. I flit back and forth between being a neat freak and OCD organized and somewhat lax about it all. But I don't want to clean up after a slob.
- Has an "average" to "slightly above average" dick size. That'd give a range of about 5" to 7" or so. Also, not so thick that I'd choke.
- Is uncircumcised. Honestly this is pretty low down, but it is a plus.

3. Last song you listened to?
It'd probably be this: "How to Save a Life" (with Alex Goot)


Before that, it'd be this song: Gravity - by Jason Chan.

4. Favorite thing which is green?
Until recently I would've said my 2 philodendron plants. But I recently-ish bought an "olive green" messenger bag that I really like. :-)

5. Would you ever participate in an orgy?
Umm, no. Three-way, probably.