Day 11

Now I don't want to sound too positive here, since there have been karmic rebound effects when I have done so in the past. After locking my books in the library for the weekend, I've realized that my answers actually reflect my knowledge when I'm not completely freaking exhausted taking the questions at the end of a day of studying. I caught myself blatantly not reading questions and blankly staring at the screen...it was pretty awesome.

Since that realization, I've had a string of better performances in a row and have even managed to do(slightly) better than the Kaplan averages a few times, which is marginally positive news to me...we'll see if I can keep up the positive trend!

Anyway, I've been tagged by Dragonfly for a meme.

7 songs I like right now:

O Fortuna
- Carmina Burana, Carl Orff: I sang it in college and it's been in that series of Gatorade commercials during the Celts games...it sometimes pops into my head.

School's Out for Summer- Alice Cooper: Because it's almost summer and I'm not stuck in NY going to mandatory classes...even though I'll be spending most of my summer stealing the free AC in OR.

Son of a Sailor-
Jimmy Buffett: just an awesome song...

RHCP: One of my all time favorite bands, just saw the video on You Tube a few days ago and it's a good song.

Damn it Feels Good to Be a Gangster- Geto Boys: Makes me want to commit violent acts against office equipment...and it gets stuck in my head sometimes despite the fact that I don't know most of the lyrics.

Boston- Augustana: They did a pretty sweet live acoustic version on NPR this weekend that you can stream for free along with some of their new stuff. I liked it before it was all over TV too.

The Bluegrass Sessions- Bela Fleck and the Flecktones: Banjo music rocks...

And pretty much anything by Altan or Danu...I've been getting into Celtic music lately because it's subdued enough to put on in the background while I study.


Day 8....I'm a dumbass

I had a rather unproductive day reviewing pharmacology yesterday, and decided to pack it in early and finish up my daily QBank questions at home. I neatly stacked my books up and put them on the shelf of my reserved carrel in the library, plunked the lappy into it's case and took my nice little walk home through the center of town. I did my questions, had some dinner and went for a run.

I was laying in bed watching the Celts game and I all of a sudden had a sinking feeling. In the nexus of time that is studying for the boards, I failed to remember that it's Memorial Day weekend and that the library is closed until TUESDAY, locked up tight with my books inside. Smooth move DUMBASS. Now I'm stuck with only a copy of HY Neuro and a BRS Biochem, royally screwing up my schedule. Oh well, looks like I'm taking my catch-up day a bit early and starting Neuro 2 weeks before I planned on it.

On a more annoying note, QBank is still kicking my ass. I had one bright day of performance where I almost broke 60%, and then dipped back down to the depths of craptastic with my worst performance to date. Not to make excuses, but the GF did have the TV on in the background, and I was pretty tired at that point too. How I can study for an entire week and do worse than taking the exam cold, I'll never understand. At least there's still a month of studying left....

On the bright side, I had a nice run down a new road yesterday. The route follows the river through the outskirts of town and turns into a quiet pine-lined dirt road and ends at a pretty sweet steel-truss bridge (my great grandfather was a bridge engineer...it's in the blood) leading to the downtown of the next village across the river. I was feeling great on the way out, but kind of wanted to toss my cookies a various points on the way back.

I'll have to post some pictures of my new favorite running routes...having a nice view makes the run more tolerable.

UPDATE: So about 2 hours after posting the above, I somehow bounced up to my highest performance yet. This yo-yo performance is pretty aggravating...I just hope I can drag both extremes up.


Day 5...

According to QBank, 5 days of moderately intense studying has apparently made me less knowledgable. The first 3 days of studying, I was where I thought I should be in relation to my previous assessments. I even started to show an upward trend (as much of a trend as you can see with 3 points). I was able make a good number of the diagnoses from the description and when I could't I was using the questions to answer the questions, which is usually sound test taking strategy.

However, days 4 and 5 have kicked my ass and squashed my budding self confidence. If I had to pull something positive out of this mess, I'm consistently getting the vast majority of the initial diagnoses correct, which means that I have some vague idea of what's going on. The bad news is that the vaguely worded questions combined with the 2-5 step jumps in logic that Kaplan likes to toss into the mix are tripping me up. I'm kicking myself for not learning things in an integrated fashion during my courses...looks like it's time to do so now!!! That and I've forgotten most of anatomy as it relates to pathological conditions.

Innervation? Forget about it!

The inguinal canal? Yeah some stuff goes through it and there's a couple of rings...not good enough!

Brachial plexus? Roots, Trunks, Divisions, Cords, Branches (randy travis drinks cold beer)...you want me to know what they do and where they go AND DERMATOMES??? Crap!

Well I'm going back to snuggle in the cold, pages of my First Aid and Step 1 Secrets. To all of ya'll out there studying...good luck.


Learning something new...

I'm sitting here reading one of my "less-reputable" Step 1 review books and I get to the following case presentation:

34 yo obese woman complains of muscle aches "all over" and increasing fatigue over the past 6 months. Despite sleeping 8-10 hours per night, she feels more tired in the morning than when she went to bed. She admits to a long history of anxiety and depression but is adamant that the aches are real. PE is remarkable for tenderness at 14 0f 18 trigger points, lab, biopsy and EMG studies are all negative.

I was completely stumped at what this phantom illness was...until I read the answer: Fibromyalgia



Biochem is an absolute slog...even for someone who was once considering it as a career choice. It's surprising how much of it is sitting in the recesses of my mind looking somewhat familiar...but there's still a whole bunch that is completely gone.

I'm quickly falling back into a bad habit where I pretty much find any excuse not to pay attention to what's open in front of me...especially when my laptop is within arms reach. I'm going to have to start leaving the lappy in it's case with the battery and charger hidden in the next county until I get bored enough of reading/highliting/noting to do some questions.

Overall, I'm getting the feeling that First Aid isn't quite enough for many topics that QBank is tossing at me,it is REALLY just the bare bones of the topics/diseases. To make matters even more confusing, QBank also seems a bit more in depth than the NBME exams that I've taken at school...the two step logic jump that Kaplan is asking for is quite a leap at times. For example, the question will give a fairly in depth clinical presentation and ask where the chromosomal abnormality is, or clinical scenario and ask what drug should be given. They bash you over the head with the clinical presentation, but then make the second step slightly harder. I found the NBME's to be slightly less picky in the answers they give.

But for day two of torture, I'm ok with how things are going overall, I'm just hoping to see an upward trend in QBank over the next week or so.


A simple plan

So I have "successfully" completed second year...hooray! Instead of feeling a sense of accomplishment or relief, I'm feeling a sense of a lot of impending work over the next 5 weeks. You'll notice my OCD schedule above. I tailored it to where I'm weak...Heme/Onc, Cardio, Neuro and Renal (even though I did well on the NBME in Renal, I just lack all self confidence after the in-house exam that I took).

My class took a practice NBME exam a few weeks ago. I was in the 190's without studying at all. In fact, I was barely awake while I was taking it so I'm not too concerned with passing. My approach is more about getting the material to be fresh, making up for my weaknesses, and solidifying the big picture so that I can have a gut reaction with the questions that I'm still tentative on. I'm usually pretty good on standardized exams (SAT/MCAT) so hopefully those skills will carry on over.

Here's the breakdown for my strategy:
  • 5 weeks
    • 8-10 hours of studying per day. AM Run/Breakfast, Lunch and Dinner breaks and done at 9PM regardless of where I am.
    • 1 catch-up/NBME/chill day tossed in each week to retain my sanity and show how I'm progressing. I'm only doing the first 4 NBME exams. 5&6 have been released, but I think that doing more towards the beginning will just stress me out.
  • Green is Subject Based:
    • Biochem, Behavioral, Micro, General Path, and Pharm...clustered towards the beginning because they're the basis of path.
  • Orange is system based:
    • First Aid is my systems based approach as a guiding outline
    • HY Anatomy and Physiology for each system to refresh myself on the basics of how it works, innervation, etc.
    • Rapid Review and BRS for the Pathology of each system
    • Organizing notes placed into FA
    • Pharm reviewed with the relevant pathology
  • 50 RANDOMIZED Kaplan QBank questions per day
Oh yeah, I'll be studying in VT with the girlfriend who is taking the MA Bar in July...it will be nice to spend some quality time with her before she goes out into the real working world of environmental law somewhere between Bangor, ME and Washington, DC. Hopefully we'll motivate each other and I won't end up sleeping in my tent two weeks into this when we both get stressed out and start tripping over each other in her tiny apartment.

I'll definitely be posting about my progress, at least once a week. For now though, I have to go get a hair cut, do some laundry and get the rest of my affairs in order before I leave for VT.


A call to action?

Alot of what I have been reading lately has gotten me a bit annoyed at the medical profession as a whole. Everyone from the media to the bloggers to the AMA to the PRESIDENT has been whining about the state of medicine today...perhaps we should try doing something about it.

There is a lot of negativity in the medical community over the current state of affairs. The field is being torn apart between the interests of the patients, the government, the insurance companies, the bureaucrats, the media, the physicians, the administrators and the pharmaceutical companies. Even within the individual components there are an infinite number of directions being pulled. It seems like every part of the medical world is pulling in a different direction in an attempt to topple one of the few human enterprises that has helped the world progress out of the dark ages in upon itself.

It's like one of those stupid vector problems from high school physics: the ultimate sum of the directions that everyone is pulling is 0...there is no direction, there is no movement. We have reached an absolute balance point where something needs to be done, but nobody knows which direction to push the damned thing because we're too busy trying to reconcile the millions of individual components that have created the mess in the first place.

And so we sit around in complacency, scratching our heads and bemoaning the fact that something needs to be done. We throw around half-baked ideas of government run medicine or completely free market medicine or Doc-in-a-box medicine and hope that someone has enough momentum to tip the damned thing in the right direction. Meanwhile, the problem just sits there getting more entangled as it is pulled in more directions.

We call it a health care crisis, but no one seems to be doing anything about it. A crisis implies a need for action...and to my 24 years of memory medicine has been in a state of crisis since the first Clinton administration (I was in 3rd grade by the way). We need a leader to take on this mess, cut it down to the basic issues (of how to provide health care for those in need/transfer money from recipient to providers/cut out the rest of the BS) and plow the solution through the steaming piles of divisive political BS that have hampered the progress of this country.

We predict a disastrous future without action to prepare for it...we need to prepare! Maybe it's time that we (as decent, rational, free thinking, American human beings) do something...


Reasons not to go to medical school

The Lone Coyote posted an interesting article the other day from Forbes that has gotten me thinking about my choices over the past few years and the state of medicine...did I actually know what I was getting into?

I thought that I knew what was up a few years ago when I started my pre-medical education. Do well in college, pad your resume with research and medical related stuff. Apply, get accepted and spend 2 years of studying your life away in the library followed by 2 years of being nearly purposeless in the hospital. Do some scut, apply for residency and get a job. Great, grand wonderful...piece of cake I would think to myself.

Then you get to a point where you've put in 8 years of higher education at your own expense and people call you Doctor. But you're paid less than burger flipping wages for 3-6 years of 30 hour shifts and night swing coverage while being to be one of the most productive members of the staff, bouncing around between services, all the while jumping through hoops to keep everyone happy so you don't get fired from your indentured servitude. Not too bad, I can do that.

Now you're 30-35 years old and just finally for the first time cut free from the bonds of the medical education system and expected to tackle the immense task of building a practice or desperately launching yourself into academia. You'll be paying off loans into your 50's and you're probably going to end up divorced 2 or 3 times with a couple different kids who hate you. You're going to be sued, you're going to kill 3 patients (on average). Whatever, that's like decades from now...not my concern.

Boy was I naive thinking that was all there was to it...

You build up a perfect little image of your future. I can distinctly remember thinking about all the cool things I would do, but I never really thought about what the nitty-gritty of being a doctor would be all about. I knew there would be missed soccer games/dance recitals/school plays/birthday parties...that comes with the territory. I observed a couple of shifts at UMass in college and pictured myself as one of the ER docs flying around in their Chopper. I worked at Children's Hospital and I saw myself becoming a surgeon and doing cool Pediatric operations like you see on TV. I sprained my ankle pretty badly and went to an orthopod's office and saw myself in a sports medicine practice dealing with sprained ankles and scheduling rehab for athletes. I still can see myself doing a lot of things...I must be delusional!

Soon I'm going to be pulling my head out of my books and getting to learn the practice of medicine for myself. I'm going to see it in all of it's horrific glory...and for better or worse, I'm financially destined to continue to this path to being a doctor.


Done with path

I've been laying in bed for the past few hours in the grips of insomnia. I haven't really been thinking about anything in particular, but I haven't been not thinking either.

I cannot believe that I am almost finished with the first two years of medical school. It has not been at all what I expected it to be. I came in with delusions of grandeur, ready to save the world and be passionate about everything that I learned. I was excited to escape the hum-drum rhythm of the working world, but I realize now that I miss having that rhythm in my life. I do not, however, miss sitting on the Mass Pike in traffic. I especially miss the sense of purpose that having a place to be in the morning gives me. I've been really bad about going to class this semester, not having anywhere that I absolutely had to be made me feel somewhat useless and didn't really give me the incentive to get out of bed in the morning raring to go.

I am looking forward to third year and all of the ridiculous new requirements it will bring. I think that I'll finally have a sense of my life moving forward again, that I'm ticking off the boxes that I need to get out of NY and into a career. Second year was an absolute slog for me, partially because I have made it so in my mind and partially because of the drawn out nature of our schedule. I think that having a new service to work on every few weeks, seeing new people every day, having someone tell me what to do and where to be will at least give me a reason to get out of bed in the morning, if nothing else. I'm also looking forward to the subjective grading scheme, where how hard I work has a bearing on how I perform. It seemed no matter how hard I worked this year that I always ended up in the same spot on the curve.

I think the greatest sense of accomplishment from second year comes when I look at the tattered, over-highlighted pages of my copy of Robbins. I read that damned book cover to cover, and while how much I retained is another story, I knew enough of all of it at some point to pass the course. That's a pretty cool feeling, that passes as soon as I realize the number of hours I spent hunched over a desk in the library.

Anyway, 2 more exams and then it's onto board studying. For anyone that's interested, I passed the in-house path exam and I'll be waiting with baited breath for the shelf results in 2 weeks. I'm off to try to sleep now...hopefully I'll get some shut-eye.



Pathology ends tomorrow after two exams (in house mid-term and an NBME shelf)...I'm counting down the minutes (approximately 960 as of midnight).

It's been a struggle and I have some issues with how the course was run. Overall, I feel like I have a fairly solid basis for taking on the boards successfully in about 46 days...but that's another issue...I still have to make it out of this semester in one academic piece.

Catch ya on the flip side.



Increasingly, I find myself apologizing for being a medical student. It has gotten to the point where my reflex is to give a detailed schedule out through September and an account of what I'll be doing so people don't think that I'm blowing them off...I really am that busy and not going to be in town or free until September! It could be Mother's Day (Sorry Mom!) or my brother moving into his new house (Sorry Bro), or my friends marriage that falls in the middle of my surgery rotation (Sorry Guys! Enjoy my gift!) or my girlfriend's graduation ball (Sorry Hun), but it's always the same story...I have school, I cant get away. Yes, I have to study for a straight week before my exams, no I'm not stupid. Yes I have to study for 6 weeks straight for the boards, it determines a big chunk of my career. No I can't go to Vegas with you because I have to work 60 hours that week, I'm probably staying late most nights and I'm probably on overnight call that Saturday too...yeah, I'll see you at Christmas too.

One of my friends has been in town for work on and off for the past few months and I've turned down his invites for drinks a few times now. He's VERY understanding of the whole thing, but I'm just wondering when understanding runs out like it has with so many others...

What other career can you rack up $260k of debt and lose your personal life all before your first sub-minimal wage paycheck?