FINALS

So I have been abusing myself lately. With finals, get your minds out of the gutter. I'm not a high stress person. I don't let tests or worrying about whether some tiny detail on the coagulation pathway will determine my success in life. I think a lot of that is bull shit. On the other hand, I am a person who enjoys knowing things. I like being able to spout of pathways or the pathophysiology of a disease. My finals studying becomes a combination of learning what I want to learn and learning what will be on the test. People who try to "game" tests by figuring out what is on them and asking excessive questions to that motivation drive me crazy. We should be interested enough in the material to learn it and learn it well. We should want to be the most competent people we can be in order to help patients. I know this is idealistic and many will argue this mode of learning just doesn't work. I'll just have to disagree with those people.

I am looking forward to escaping the medicine/science world for a while after finals. I'm trying to make plans for NYC over New Years. We'll see how that works out. I won't know what to do with myself without having material to learn. I am a freak. We all are.

Turkey Day

I am tying up the last few strings for this semester as the holidays are coming around. I have issues with holidays. There some cruelty to them. Everyone is expected to act certain ways and have certain components in their life: family, friends, wealth enough for a banquet. Many don't enjoy these things. Many people are products of broken families, either by choice or by difficult circumstances. Holidays provide an impetus for many to believe their lives are wrecked. After all, if you don't enjoy the common, American rituals there must be something wrong with you, right?

I'm a big fan of constantly enjoying the people around you and the people who are important to you. We shouldn't need holidays for that. So as the holidays come, I would like to encourage those struggling. We are all one community. I hope everyone has a happy holiday that doesn't revolve around rituals that contain little meaning.

Arrhythmia

I've developed a bit of a rythm to my Sunday mornings. I wake up around 9, check email, watch something online (most likely daily show), work out, clean my room, listen to some NPR. It is the only rythm to my life. I find comfort in it for whatever reasons.

Reflecting on this, it is odd to me that I have chosen a profession in which I hope to have no rythm. As an academic physician, I hope to be pushing boundries, treating new patients, and progressing my field. This course is not at all regular among physicians. There seem to be so many routes and such disparate lifestyles to be had within medicine. Some specialties I feel to be so adverse to the things I want to do and be, all under the umbrella of medicine. I could just as easily see myself being a fisherman as being a plastic surgeon or a dermatologist.

The rythm of being a physician is an important factor to me. I don't want to spend too much time fighting insurance companies or filing for payments. Our depleted, ruined system has taken so much of the life out of working in medicine. I wonder how much more dedicated and excited caregivers would be if this was not the case. Would quality of care go up? Would costs go down?

I have a month now to get into finals rythm. Pathology last week was quite an exciting test. The time given for the test was not enough. Classmates were running from room to room to look at slides and think about what exactly leads to subendocardial infarcts. I will be using the month to study and write papers, hopefully with some coherent rythm.

Immunocompromised

Took an immuno test this morning that covered virtually all of the basis science behind immunology. Fun. Immunology actually is fun because it is very clinically relevant. Clinical case presentations go a long way to understanding the mechanisms behind immune response. One more test in a couple days on Pathology and then its cruise control until finals.

On another note, I performed my first physical examination last week. It was a bit impromptu. The physician walked me through it and held my hand at every step. It was still quite strange acting like a doctor. It felt a bit like I was being asked to go through the motions for a play rather than examining another human being for signs of disease. I did learn a lot, though. I believe becoming a practicing physician will take much repetition before I feel as though I am not a complete poser.

Switching gears: Unabashed Obamamania

My first round of mid terms have been put to rest. I have a few weeks of test freedom until the next round comes crashing in. I will be taking this time to write a couple of papers (writing this is a warm up). While I could disgust any possible readers of this blog with the exciting tales of pathology, genetics, immunology, and anatomy, I'm sure everyone is more focused on a little upcoming election.

A bit of personal history first...I was raised in two locations: Texas and rural Colorado. My father is from the panhandle of Texas; he is as white and conservative as they come. My mom is of Mexican decent and was born and raised in a border town. Our interal family dinamics, looking back on them now, are phenomonally strange. When visiting my father's side of the family it is not rare to hear blatantly racist garbage, sometimes even directed against the very race that myself and mother constitute. These events aren't offensive to me, I understand that they do not see me as a member of the groups they attack. They see me as grandson, nephew, cousin; not mexican, spic, ditch digger. I don't know how these these conflicting ideas present in their minds. For me, forgiveness and an understanding that they lack the experience with culture to understand the harm they cause rule out any anger or grudge I may harbour. I was raised primarily with these Christian, conservative ideals when it came to my politics. As I matured and explored ideas/perspectives outside of these boundries my own belief systems formed.

And this is the part where I gush about Obama. I doubt that I will ever relate to another political figure as I do to Barack Obama. I understand that this could be construed as being not different from the people who vote for a candidate on the basis of "I could sit and drink a beer with that guy", but I can't help it. Barack's speach on race after the Rev. Wright fiasco hit so close to home for me. Growing up in primarily white America, I struggled with identity. To this day, I am forced to adjust and often ignore ideas that Mexican's come in certain boxes. As though pursuing academics or not knowing how to salsa dance exclude me from my racial background. That, to me, is the most damaging feature of race. Those not in the racial majority are expected to follow cultural roles that the minority is seen to reflect. Growing up white means that you have a cultural get out of jail free card, you can pursue what interests you and what you relate to. Being a racial minority in the United States means that you are expected to be deeply anchored in that culture, work with that culture, enjoy only those cultural activities. If you do not, than you are an Oreo or worse. I am non of these things, I enjoy Spanish language and Mexican food, but I am not Catholic, I do not go out of my way to find hispanic areas of the city. I understand and empathize with the plight of immigrant and Mexican issues, but science and medicine are of much greater interest to me than those social issues. Barack explains these ideals and perspectives. I truly believe he understands the ethnic components of America. He doesn't come from a background of white and black; he sees communities in constant modes of balancing race, family, and work. He understands that we are all in this together.

In addition to this more personal reason for supporting Barack Obama, his policies are absolutely needed. Our current economic situation and the immense gap between the super rich and poor in this country should absolutely put the Republican "trickle down" economics completely to bed. The idea simply does not work and has caused a horrific amount of damage to so many Americans. Barack Obama is not an elitis, but he certainly has an elite mind. His campaign has been focused and really transcedant in these bleak political times. His health care plan is light years better than anything coming from the other side and I think he will more capably drive us away from our dependence on oil. On social issues (abortion, same-sex marriage, gun control) I will always lean to the left. I believe that the past few decades the conservative movement drove policy drastically to the right. While the free market is most certainly the best economic system, there obsolutely must exist balances in the form of regulation to keep middle and lower class Americans from slipping to the bleak level they are at right now. Ok, I have been on my soap box enough this morning. Time to get back to medicine. Get out and vote!

Autopsy

My nights have been getting later and later. I don't think this is because of overwhelming work load or stress. I'm not sure what's going on. I do find myself dwelling on things I need to do or want to do. Tonight I'm thinking about how early I have to get up to go to autopsy review. My program is one of the few in the country that still incorporates autopsy participation in the first year curriculum. We are able to do so thanks in some part to the small size of the program. Great, one may think, hours with dead bodies.

I found my first autopsy a couple of days ago to be a bit of a transforming experience. I have been in anatomy lab for a couple of months now, but this was different. A technician roughly dragged the body onto the table and began preparing. This wasn't a corpse to me. It was a person last night. A person with hope and aspirations for the future. The technician swiftly cut open the chest cavity and began loosening the upper respiratory tract from its bindings. The normal, mondane activities of this man's everyday working life was entrancing. The sites were surreal. Much in the same way I couldn't believe a live bull was chasing me through the streets of Pamplona a few months ago, I couldn't quite comprehend what I was watching. The feeling lasted around 15 minutes before the medicine and education engulfed me again. The moment summed up a lot of my more ruminant feelings about medicine. We are practitioners of the most humane profession in humankind, but must often suspend bits of our own humanity. We want nothing more than to connect at the deepest levels with patients, but our own experiences and points of view often compromise any ability to relate. Yet the overwhelming feeling I recall now in watching was that of utter empathy. That empathy is what has driven many of us to this point. We can and must do tings outside of the norm. We must tell families things that will break their hearts, and our own in the process. We must because it must be done, because these things are necessary to directly help individuals and future generations.

Testing the funny bones

Just finished an anatomy exam. Boy was that fun...Cool tricks for the family with anatomy: put strong pressure on either side of your wrists on the palm side, if you put enough pressure on the correct spots your palm will start turning white because your are cutting off the superficial and deep palmar artery arches from the ulnar and radial arteries respectively, when you release your palm will flush pink. Also, gather the guys in your family and ask them to lift up their chins. Ask which of them have scars under there chins. Turns out that around 40-60% of males have scares under there chins from falling, getting punched, or saying the wrong thing to the wrong girl.

Now I will start the process of forgetting everything I know and knocking out some brain cells. Maybe I will sneak in some reading of normal literature or thinking about some non-medicine stuff.

Anatomy

In lecture right now on biomechanics...not my thing. Anatomy is a very controversial subject in medical school. Some programs poo poo it, and some have basically eliminated it. The thought is that if you go into a specialty that requires that knowledge, you will learn it then. Can't this be said for practically any medical knowledge?

Anatomy blows at times. Long lab hours, brute force memorization, juicy remains all over, and constant smells. I like to think that my 3 month dedication to it will be worth the trouble. I certainly can't imagine med school without it. I don't know if specific knowledge of the pectineus or plantaris muscles will ever come to play in my career, but if nothing else I will have an appreciation for the physical presence that is all of us.

Studying

I am encountering my first bit of real studying since taking the MCAT. The process taking on an academic lifestyle has involved changing the fundamental way in which I think about studying. I remember the many days in which studying was much like a shitty high school job, I did it just to get by without anyone getting upset with me and in hope that at some point I could stop doing it. It's hard for me to now uderstand how that formulated. Is this an American attitude? Why do young kids become indoctrinated with the "school sucks" attitude? Why is learning about animals and the way the world works so much less exciting than who is fucking who on "the real world"?

Of course, no one likes staying in and missing out on other fun activities to hit the books, but material learned during education is truly useful and applicable. It amazes me that everyone makes that classic clame: "this will never be useful in my real life when I am working". How the fuck do you know what you are going to be doing? I hear this claim from seventh graders on up to medical students. Really, noone thinks having a broad knowledge base in many different areas doesn't make you more insightful, interesting, more able to hold a conversation?

Maybe the studying is getting to me. I'm basically on a 9am-11:30pm schedule of lecture, anatomy lab, clinics, and studying during the week with breaks for lunch, an hour for nap and dinner, and an hour or two of study breaks for random messing around. But I really don't feel as though my life is terrible. Normally I would be watching reruns or some shitty movie I've already scene 10 times on TNT. Which is really more exciting? Just food for thought. With all this being said, I'll be more than happy to endulge in a Friday night full of debauchery, drunkeness and absolutely no medicine. Back to hematopoiesis...

I'm still alive

Haven't posted in a few weeks...more a indictment of my laziness than of being overloaded or overstressed. The best thing about medical school is that studying isn't so painful as some of the studying in undergrad. No more physics, calc, random course that I really don't give a rat's ass about. No, using up valuable socializing time in the dissection lab or studying immunology is not my idea of fun, but the information really is interesting and I feel priviliged to be in the process of becoming a physician.

Yesterday was my first experience with the brachial plexus. I must say the hype is a bit much. I don't feel too intimidated by any of the structures we've gone over yet. Then I read the manual for tomorrow's lab... How many fucking muscles can there be in the forearm and hand? Talk about gross anatomy. hahahahaha, get it?

Other than studies, I've spent a bit of time at free lunches and dinners which are abundant in medical school. There was a posh dinner complete with filet mignon and free drinks last week, not too shabby. We've also been on boat cruises and an assortment of activities to get us to get drunk and bond, which I have been more than happy to do.

First week of real class

I am finishing up my first week tomorrow. Though the week hasn't been overly difficult or intimidating, my first dissection looms tomorrow. We were able to view our cadaver briefly a couple of days ago. The sight of the hands and the tattoos on our cadaver made me feel uneasy. I think the first cut will be difficult. Once entering the cavity, I think it easier to think of the dissection as simply a tool. Of course, I am not speaking from experience yet.

The coursework has been great thus far. After years of taking classes, I feel as though I am finally taking the courses I want at the level I want them. Get back to me in a month or so when I am barely treading water and wanting the tidal wave of info to stop. Some of the more interesting factoids I have learned thus far include the fact that Prostate Specific Antigen testing and Digital Rectal examines aren't as good for finding cancer as I had believed. Also, the immune system is crazy. I guess if I'm worried about any courses it's immunology and anatomy.

Otherwise, things are going well. Still adjusting to the med student life. It is a little bit odd coming back after a couple of years. I don't feel like as much of an individual right now, more a cow being hearded in different directions. The options of things to do are endless, now I just need to find the time and motivation for them. Too bad I am so shitty at setting priorities sometimes. That's all I feel like writing right now, though there is much more on my mind. My next post may be political, just a warning.

The night before

Orientation starts tomorrow. Pre orientation has allowed befriending and partying, but I'm not feeling overly prepared for tomorrow. Drinking and socializing constantly seems a strange starting point for a career traditionally regarded as stressful and isolating. Maybe the experts are wrong...It is surreal that my life as a medical student is beginning. I suppose it will still be quite a while before I feel as though I am actually becoming a physician.

I don't have anything else, mostly just wanting to mark the occasion for myself. To the general public: watch out for the new short coats in the next few days, we don't know anything.

Welcome to the jungle

Ok, so I really haven't started anything, so this is a premature post. The real jungle doesn't start for a couple of weeks. My new classmates and I have spent most of our time being lost in the city and finding places to drink. Not exactly the intense studying I've been warned of. Returning to the dorms has been awesome so far. I'm happy with my room and realize how much I have missed having no commute time. Boston seems to be a great city. In the limited time I have spent here, the local culture has been intoxicating. The sharp accents and compulsory use of the word fuck is quite charming. Today myself and some classmates were pulled over while doing community service because they thought we were soliciting the locals. The locals ooze character. Now if I could stop spending so much money on food and booze...

Everything will change

I often entertain ideas that human beings were not meant to live in the modern world we have created. This is certainly not an original notion, but it is a particularly intimate feeling for me as I pack for medical school.

Humanity has thrived due in large part to circumstances of group dynamics and family structure. Evolution has taught every living species to value group survival over all else. We are innately social beings meant to attach great meaning to our relationships. Our tv, movies, books, stories, and fabels are packed with stories of heroes sacrificing self for the greater good. I have little doubt that these thoughts of heroism encircle the thoughts of many premeds. After all, many doctors are portrayed as selfless heroes in media and motion picture.

Why then, do I feel like I the path to medical education has led to putting myself above all else in many situations? I haven't lived anywhere near any family members for over six years. My infrequent visits are often marked by the inability to relate to those so close. To many family members, I am the smart kid who they don't really know and seems a bit aloof. I am unable to discuss my job or exactly why I am doing what I am doing. I scoff at family members when they refer to how many years it will be before I get to do what I want to do. They don't seem to understand that education is what I want to do.

Now, as I finally achieve goals a lifetime in the making, I don't see many around me to celebrate with. I will not have a close friend within 300 miles. All personal relationships have ended and I feel alone. I know that I will soon be living and learning among amazing people whom will become commrades. But what of those amazing people who are now in the past? The past 6 years have been a circuit of becoming immeasurably close to people, only to lose them when it came time to chase the goals. Is this the plan? Should this be normal? Or am I caught up in archaic emotions which have become unnecessary for survival of the fittest? Does being able to disband myself from loved ones make me strong, or vapid? I am so emotionally tired.

I don't question what I want to do. I know that medicine is the career that will fulfill me. I question the methods of achieving it. I question American morals. I question myself.

Kafka often related the contridictory life of an artist in his writings. In his efforts to describe and capture the nature of humanity and his attachment to it, Kafka found himself alienated from that which he held so dear. It seems physicians often undergo the same cycle. We fight and claw to achieve the position which we believe will allow us to most closely connect whith those around us. In this process, I think many lose touch and become separated from the common man and from those around us. That being said, Kafka understood more than I ever will and contributed more than most ever will. It is this hope that I cling to, the hope of making a contribution.

Home

I am making my last stand. My last stand just happens to be letting my parents stuff me with food. I collapse into the same rut every time I come home. There's nothing I want to do at home and my parents aquire some sort of anxiety about not doing something every second that I am here. Something usually ends up being eating. I am helpless to resist. So I will be taking an extra ten pounds to school with me...just the impression I want to make on classmates and faculty.

I am certainly one of those people who loves family from afar. I miss them and wish I could play a bigger role in the lives of my family, but when I am actually around them I become frustrated. My convictions and ways of thinking are foreign to my family. I find myself going into a mental coma when I am around my family for too long. This is of no fault to them, I am just so different. I find myself chewing fucking ice or sleeping a lot. My family will always have a divergent effect from anything else in my life.

The coming reality of med school still seems far away. I am at the edge of the cliff, but I can't see it. I'm not worried, stressed or even excited. I've just accepted it as a reality that hasn't come to pass. Maybe this will change when I get on campus. I'm looking forward to meeting new people, but that isn't what I am doing med school for. Maybe I am just in a circle of denial that all of the effort and worry in getting here is over. Maybe I'm just a fucking douche. I just don't feel as though my life is about to change, even though I know it is. I've never been one for epiphanies, though. I need some inspiration, somehow I think the people who I will soon be around will provide plenty.

Rebounding

Recovering from vacation is a bitch. Not so much in the tired, worn down recovery, but in recovering from mind sets. For the past 3 weeks I have been completely free of any obligations. Facing life again is foreign and unwelcome. I find myself wanting to crawl into bed and escape. While I am fighting these things, allow me to give some perspectives from the final destinations in my trip.

Barcelona is a much more tourist friendly location than Madrid or Pamplona. The big, well-to-do shopping areas, fine dining, english friendliness make Barcelona less intimidating. The sights around the city are fantastic. Montjuic, Museums (Picasso museum being the one which grabbed my interest), olympic park, parc guell, Gaudi buildings everywhere, and the beach (which you may or may not be interested to know is topless friendly) are just a few of the attractions. The city fulfilled the daydreams I have been having about it since I was a child. Those planning a trip to Barcelona are doing themselves a great favor. I stayed at Centric Point which is a couple miles north of the beach on Passeig de Gracia. It is in a very nice part of town with a great atmosphere. I spent a rainy night playing a game of spoons with special drinking rules in the hostel bar which was very lively. One of the game participants had been in an altercation the night before and arrested. His court date was scheduled for one day after his train reservations, so he didn't believe a return trip to Spain would ever be prudent. Of course, he had to be a fucking American. Just one of the many characters from hostels.

After Barcelona I spent two days in Paris. Paris is beautiful. Every street corner seems to offer a picturesque statue with a cafe or street vendor adding life to the very old city. My days were filled with site seeing. The louvre was overwhelming. I almost felt it was too big. I spent over 5 hours there and didn't even touch an entire floor. The history and sites in Paris are remarkable, but I didn't become attached to the city like I did Madrid and Barcelona.

Finally, a train shipped me to London and Cambridge to finish my trip. I had a chance to spend a year in Cambridge attaining a masters, but didn't take it for several reasons. While I am thrilled with the directions my life is taking, I somewhat regret not living in England for the year. Being in Cambridge certainly pulled out these feelings. Small cafes and restaurants are littered amongst the ancient buildings where some of the greatest minds in human history were developed. I attended the graduation of a certain special someone while I was there. The event was as history drenched and proper as one would expect. London was as great as expected. I had spent time in London before and returning only confirmed my fondness for the city. Devouring fish and chips in a London pub is a must.

Overall, I couldn't be more pleased with my trip. There were no great tragedies, the weather always seemed to be perfect, I met some unique personalities, and spent time with a familiar personality which I greatly appreciate. Travelling from hostel to hostel is a worthwhile experience for anyone. Being in unfamiliar countries with languages you don't know can be intimidating at times, but breaking out of comfortable situations can lead to great growth. As for the cities and countries themselves, I wholeheartedly endorse all of them. Barcelona, London, and Madrid were my favorite destinations in that order.

I hope to slowly switch gears now. Thoughts of medicine and school have been fleeting, but I want to start medical school on the best foot. I needed some time for me, but my goal is to use my time helping all of us. Wow, that sounds fucking corny, but sometimes I can't help myself.

Pamplona

If anyone out there is a big fan of vomit, piss, drunken madness, danger, unnecessary risks, adrenalin rushes, people being gored, and complete release of any inhibitions I strongly recommend Pamplona during the festival de San Fermin. Bulls running through the streets, people being thrown throughout a stadium by angry animals, an amazing 24/7 street party in the entire city, unabashid drunkness, piss, trash, glass, and nameless disgusting old guys with broken noses trying to steal your drinks are just a few of the highlights from a completely undescribably few days in Pamplona.

For those wondering, yes, I did run. No, I am not crazy. There are relatively safe routes of running with the bulls. The fact is that no one has died in the running since 1996. Yes, a few are injured every day of the running. This mostly consists of the drunks and those that run without any advice. There are much more dangerous things to do in a life time and much less great experiences.

On the topic of advice. For first timers and any timers, don't try the dead man's corner on mercedes. You can't win when a 2,000 pound animal is slipping around a tight corner and your body is underneath or in front of it. My advice for first timers is to go to the straight away right after dead man's corner. The bulls tend to stay to the right after the corner, so a nice run on the left is your best chance. Let the first pack pass and run like hell to make it into the ring before the second pack catches you in the entrance. There is no such thing as a sure thing when making the run, but most "experts" agree that this is the best low risk strategy for actually running with the bulls. When the bulls get close, hug a wall or hit the ground. If you hit the ground, stay down and don't get up until you are sure that everything has passed.

There are those, or course, who run the entire course before the bulls are even let out of the corral. This is not running with the bulls, this is running through a street before the bulls come. The crowd in the ring will boo you and throw whatever trash they have because you arrived before the bulls did. If you really want to run, you have to let the bulls pass you. It is a completely surreal experience which evokes pure instinctual survival traits. Those moments are hard to come by in the modern world and that is the reason people do it.

The party seen before and after the running is great for a day, but quickly became obnoxious to me. The smell of piss and rot, drunkards constantly hastling you, and endless noise preventing sleep wore on my nerves completely. Unless this is your thing, a nice, compact two night trip is what I would advise.

Alright, time for bed. Sorry for the typos, I'm a little bit drunk in a loud hostel in Barcelona.

Vive Madrid

Madrid has been a fantastic haze. I´ll gladly pimp my hostel: Cat´s hostel. Good location and great atmosphere. The downstairs bar, from which I am writing for free, is an amalgamation of language and culture heavily drenched in giant glasses of sangria. I have met people from the states, Belgium, Australlia (winners of craziest drinkers award), England, Brazil, Singapore, Chile, Scotland, Germany, and of course Spaniards. Diverse drinking games, cheers, and dancing breaks out as the booze continue to flow. Each night i start becoming ancy to leave at around 11, but am told to wait. Living up to it´s reputation for being late, Madrid clubs become fun at around 1. Those looking for advice on Clubs/bars should look elsewhere, they are all a poisoned blur in my mind. Coming back to my bunk at god knows what time, I have slept until at least 1 everyday and usually much later. My afternoons have been spent wondering through cultural highlights and often stopping for naps. I strongly recommend el Museo de Prado, and jardines del buen retiro. Now I am going to attempt the impossible: sleeping in a mostly sober state so that I can wake up and head to the train station for Pamplona in the morning.

Euro Trashed

Hostels love to stuff 14 people to a room. This means all hours of the night and morning people are coming in and out in differing states of substance abuse. How is one to fall asleep in these conditions? I've taken to basically sleeping with a flask under my pillow and staying drunk through the night. If only my mother could see my now.

Vacation

After a 4 day music festival and watching around 3600 hours of online TV shows over the past 3 weeks, I am drained. I have basically turned into a jar of mayonnaise at this point. Work is over, school is around the corner. But these things are taking a back seat to my excitement for leaving the country today. My recently received stimulus check will be going directly to foreign tourist traps. Sorry Uncle Sam. Coming from a family which never traveled outside of the country and being a poor student my entire adult life, this is my first trip to mainland Europe. The chance to practice the spanish and see some of the places I have long held in esteem (hi Barcelona) is making my face melt with anticipation. No, really.

I am debating running with the bulls. Many I have discussed this with have an aversion towards it. I don't have a pressing urge to get gored in the ass by an angry bull. I simply think it will be a once in a lifetime event. Romantic notions of man vs. beast and story time with grandkids aside, running with the bulls could be my final expression of youthful idiocy. 7-8 years of intensive, stressful training with the lives of others in my care will likely demand greater discretion. Increasing age and likelihood of increased responsibilities would make an act like running with the bulls completely unreasonable.

All of this being said, chances are great that I will watch the running once and lose all stomach for it. Horn enemas really aren't my thing.

Lawsuits Americana

At some point a large portion of our society decided they were entitled to never face any bad luck, bad circumstance, or errors. More shockingly, many even believe that others should subvert their own blatant stupidity with detailed, ridiculous instructions and safety features. Something always has to be someone else's fault. This feeling is not only illustrated by our legal system being bloated with lawsuits, but in everyday interactions. Neighbors call the police for minor issues rather than talking it out, regulations limit what people can do and where they can go. Obviously there need to be rules, but limitless regulations will never prevent shit from happening.

This is altogether too evident in the medical profession. Shit happening has turned tragic health care mistakes into a national health care crisis. Physicians absolutely need to be held to a standard beyond any profession. Mistakes in the health field result in the most terrible of consequences. We must continue striving for the absolute best outcomes in patient health. Unfortunately, mistakes will continue to happen. No human being or machine is 100% free of errors. It is simply impossible. We will continue to hear of health care workers making mistakes which are sad and sometimes preventable in hindsight/sometimes not. What is to be done about this? According to the completely unreasonable social outlooks of many, every penny should be squeezed out of not only those directly responsible for the mishaps, but also from the institutions they are a part of. This simply must be stopped. Pain and suffering is not worth limitless resources. Obstructing the ability to give care to thousands of others because of relatively few incidents is irresponsible. How would I react if a mistake cost myself or a loved one there basic functions or life? I would be committed to assuring that any miscues were completely addressed. I would demand complete explanations. I would expect any resultant care to be completely taken care of and any previous costs removed. Other than that...Shit happens. In this setting the saying seems crude, but it does not make it any less applicable. Any malicious intent or reckless endangerment by health workers should be met with criminal punishment. The direct family of those affected by a hospital mistake should be compensated a reasonable amount for the duration of extra care, or the expected life time in cases of deaths. Under no circumstances, however, is it reasonable to award millions upon millions of dollars to individuals. This practice has made practice insurance simply ghastly and raised medical costs inordinately. These costs are passed along to consumers who must pay steeper insurance which many can't afford and have been left with no direction in cases of medical emergencies.

The Oregon Health and Science University was recently punched in the stomach by a ruling that there will be no limit placed on the amount a plaintiff can sue the university for. There malpractice insurance instantly jumped up and the university was forced to cut employees and spots from the medical school. The pain and suffering of an individual directly caused the loss of financial stability for employees at various levels and a reduction in the quality of health care and medical education. How is this the solution to errors made in medicine? How does taking resources from medical education result in better medical care? $20,000,000 is not enough for damages? There needs to be a paradigm shift.

Social Misfit

Fading in and out of sleep, I found a topic on MTV that I can't resist. The show is titled True Life: I live another life on the web. Nothing could be more fascinating. Our world contains the most educated, wealthy societies in the history of humanity and there is a significant portion of our population that doesn't see any reason to socialize with actually people. Amazing! I am guilty of participating in the system of isolation that has come into place for many. Often times I come home from work, shut my room door, and let the machines entertain me for hours on end. Over the course of a long winter my body becomes a pale, floppy product of modern evolution-the aftermath of long lab hours and media dependence.

I am exaggerating, of course. I manage to go out with friends and even catch some sun on the weekends. But there are so many who do not. Everytime I see a 25 year old who lives at home, can't hold a conversation, and is scared of their own shadow I want to light myself on fire. Educational systems need to adapt to technology. Technology is a tool, not a crutch. Your level 400 ogre dark priest is not cool. Games, IM, blogging can be partnered with educatation, working out, a job, going out late with friends, and occasionally even getting layed. There is a balance, no one thing should dominate. Sorry to get preachy. Back to being alone with the machines...

Multiple Countdowns

The time separating myself from my masochistic medical fantasies is growing slimmer. I am excited. Being out of school for the past two years, I crave the ability to release all responsibilities outside of learning. The first semester of the program I will be subjecting myself to is supposedly quite brutal. While the frustration, self-doubt, and general dismay this may cause will likely exact a toll, what else am I going to med school for? I understand that this profession which I have chosen will present enormous obstacles and daily challenges. I am prepared to make these challenges in order to be able to truly serve and use my life to progress this human world.

Alright, enough of the squishy stuff. A couple of my friends recently got off waitlists and our shared excitement for the profession has made me a bit spunky. I am going to have to hold on to these feelings when the times aren't so easy. On top of the countdown to med school, I am counting down the days to finishing at work and taking some time off. It's a bit like getting married (not that I'm married): while you are happy to have found something to spend your life doing, you want to jam in all the other experiences you can beforehand. Hopefully I'll have some success and others can follow along to see how to truly live out the final premed days.

Besides Medical School...

This afternoon, I was titillated to receive my ticket to a certain music festival that will feature the above, My Morning Jacket, among others. The neck mashing mahem is quite admirable, I believe. Thinking on my festival plans (including some plans I won't share with my mother or you) I realized how socially normal or even above average I consider myself and nearly all of my premed friends to be. Is this an aberation? I had been told for years that medicine and science were reserved for those willing to sacrifice personhood. Outside of medical TV dramas, phycisians are often seen as pale, single minded gunners who speak a different language.

Maybe we've gotten a bad rap from PhDs slaving away in the lab. Maybe there is a stigma towards those who do well in the classroom. I mean those people must be losers, right? Maybe actually getting into the clinics will drag out any socially relevant mores straight out of my little brain. There's probably a mixture of all of these influencing opinions.

I must say that fellow applicants at interviews, students I met, and future classmates at revisit blew me away. I know there is the prospect of being crushed by the system, but at this point the people who I will call my peers are absolutely superb, and not simply from a medicine point of view.

There is precedent for phycisians breaking the mold. Howard Dean and Stephen Joseph Bergman (aka Samuel Shem) are a couple of phsicians with expanded interests and influence. With the current shit shoot that is American health care and the ethical quandries in research, global health, distribution of wealth, ect., physicians should take a stronger role in areas outside the clinic.

I think med students are cool. I think we need to keep after activities beyond the biomedicine sphere. I am going to be doing my part by getting my hippy on...

Matters with the MCAT, if it matters, that is

Since I offered up a complaint filled entry about the nonsensical interview/acceptance phenomena, I should add to the application thoughts with a few opinions on the MCAT. Besides, I’m not actually a med student yet, so I have very little frame of reference from which to give medicine related advice. Your confidence in my ability to dole out solutions in clinical care should be akin to your confidence in a C student from Connecticut who claims to be a cowboy from Texas and scrapes by on his father’s name doling out solutions in American policy. I’m one of the few people who will advocate the use of the MCAT. I know the MCAT brings about dread and distaste. Premeds feel they have no control (you do), that a few points will cost them their hopes and dreams (they won’t), or that a bad score means you are unintelligent and incapable (it doesn’t).

2 out of the 3 major MCAT sections (I won’t talk about the writing section because it is just stupid) are directly related to how much and how well you study. The MCAT is measuring your ability to learn the information and synthesize it under different pressures against everyone else. If you aren’t putting forth the level of effort others are, you shouldn’t complain about a low score and its affect on applications. I truly believe that 90% of student can attain ~30 with good study habits and effort. This type of score paired with an average premed GPA (~3.5) will get you into school as long as you show some genuine interest in what you are doing outside of the classroom. The other 10% who have difficulties with the MCAT (and probably standardized tests in generally) have an obstacle to overcome—nothing more and nothing less. If you fall in this category, fight through the despair. Explain you test taking issues in an eloquent way in your application and on interviews. In your ECs, go out of your way to show depth of intellectual efforts in research or by impressing qualified mentors who can write a letter. Remember, the MCAT is a major portion of the application, but it is only 1 of 5 major portions. Make sure your other 4 sections, GPA, LORs, PS, ECs, are in top shape and YOU WILL FIND A SPOT.

As far as needing to score a huge number to get into the top schools, yes and no. For every 40 at a top school there is a 30. Top schools are looking for big time potential. High GPA and MCAT shows high ability for assimilating information, but this has to be complimented by showing the facility to get things done. It is much more frequent that an average MCAT with great accomplishments gets into the elite schools than a great MCAT and little else does.

Alright, I need to organize and finish this. Get after the MCAT: study, take a class if needed, study, do tons of practice question, study. Do everything you can! If you are still not satisfied with the result, step back from the ledge. Throw yourself on the things you can control, these things are just as important and often times more important than the dreaded test.

Application Epiphanies

I am finishing up my one and only (very gratefully) med school application cycle. The process is brutal at times. And by brutal I mean colossal-stepping-in-shit-cluster-fuck (visual interpretation at top). For myself, the entire process was inundated with anxious email and mail box checking. Where I got interviews and acceptances vs. where I didn't seemed paradoxical at times. A great interview complete with my interviewer allowing 20 minutes of shadowing time led to a waitlist. Awkward interviews filled with trivial ethics questions led to swift acceptances. If there was a pattern, I certainly didn't discern it. Various analogies can be made, including my personal favorite: comparing the application process to carrying out multiple hectic relationships. I think it works on several levels. All of us hope to find that one perfect match and hope that the object of this affection reciprocates, we go after several targets and try to spend time with each, we are attracted to superficial attributes, we get dumped and do some dumping, at various points we just want to do all of them at the same time in a strange med school orgy, at the end we hope to not have made a huge mistake, and a few of us actually may find a perfect match.

There is light at the end of the tunnel and even some opportunities for attaining skills in the application process. Answering the "Why our school?" or "What is your greatest weakness?" questions can lead to a hideous, trite BS festival. On the other hand, actually putting thought to why you are applying and what issues you will have to overcome can be good prep work. Secondaries were the overall most excruciating obligation of applying for me. Completing nearly 20 of them put a hatchet in my social life. Developing the skills of self acclamation, however, will probably be valuable at some point. Also, forcing applicants to do at least some minimal research on the schools they have applied to probably leads to better matches. Other issues seem antiquated. This is illustrated by the insistence of some schools on using paper mail. Really? Supposedly cutting edge, elite medical institutions can't use the internet? I have to read on SDN that someone living nearer to a school has received a letter and now I'm panicking every time I check the mail. It also seems that the process could be shortened. I know it is difficult putting together a class without overfilling, but an entire year from primary app completion to decisions is excessive. My hope is that the med school application process will not be static, that new ideas will continue to be fused in with existing protocols to create a better system. Let us be progressive in establishing the best possible system in identifying future physicians and training them.

I find it difficult to give advice to those applying as individual circumstances change the process. I will state that setting your heart on one place is often a road to disappointment, especially if it is a school with very competitive applicants. The fact is that there are a ton of amazing candidates applying for limited spots. There are also quite a few amazing places to study medicine. Being part of a society with the greatest accumulation of wealth in mankind's history has its benefits. One of these is that virtually every major city claims it own world class training hospital. Of the 18 or so school I applied to, I honestly believe I would have been happy at any of them. I could probably make up an applicant with the best stats/ECs who will randomly fail to make it to a few schools; that's just the nature of med school applications. Apply early, put effort into the writing, and be passionate. We need more physicians with passion. It is cliché but true that in the end where you went to med school doesn't matter. What you are doing to progress medical science and care for patients matters. Bragging about a big name school isn't going to improve the outcomes of any community. This isn't to say attending a school with a big time reputation is evil, I'm just saying that attending a big time school or any dream school isn't the point.

The application monster can be tamed. Identify the qualities that make you unique and the life experiences which have led you where you are. Organize these factors into a concise, enjoyable story that will allow others to understand your commitment to being part of the medical profession. There are infinite ways to do this. Unfortunately, this doesn't mean it is easy. There are also infinite ways to write or paint; but relatively few great works of art. This process is an art. Don't be afraid to immerse yourself in it and make the best application you can. Good luck...it's so much easier looking at it from this end.

Que pasa

The readership of this blog will likely be nil, but I think the cathartic effects of writing things down may be selfishly worthwhile. I fancied myself a writer at various points in my life until realizing I had very little talent for it. This blog will help scratch that itch. Be warned that my practices in using language are similar to my eating habits: I'll try anything and a little bit of spice livens up a meal. I am also a bit sick today and fighting off any thoughts of productivity at work, so writing a blog allows for sitting and vomiting ideas rather than pippetting in a cold room. My posts will likely be sporadic and my thoughts nearly always unorganized, but perhaps others crawling through the medical maze will scrape a valuable idea from this mess or learn from my experience.

I am 24 and will be matriculating in the fall of 2008, where this matriculation will occur is still somewhat up in the air. For those wanting the nitty-gritty, I'm sure there will be more posts. I consider myself to be a person of broad interests. While biological science has been my focus, literature and the social sciences have diverted me at several points. I carry a mixed bag of experiences as a multi-racial/multi-cultural person who has lived in quite divergent areas. I believe these characteristics to be valuable; the biomedical world could use more people with diversified interests. Where my medical path will lead is still very much an open question. Medical research has played an enormous role for me, but there are so many avenues I have not pursued. I look forward to rolling up my sleeves and mucking around in the disparate fields that physicians have open to them. As you read on, you will find that I am a very idealistic person. While my naivety may sometimes be obvious, I believe idealism to be to the core human value that leads to changes for the better. This vein of idealism will be evident throughout my blogs as I air out general ideas about the medical community, social structures, and human societies. If this isn't appealing to you, get out now. I tend to be insufferable (whiny) to people with set ideals. Those wanting a diary of events may also be disappointed at times, but I will undoubtedly use this blog to talk about personal experience as well. Having established these parameters, I hope you will read along. I'm not all business and I'm hoping there will be some fun in the blog along the way. I wanted to get this initial post in to let anyone reading know a tiny bit about me. Enjoy...