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....
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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.
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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.
5.25.2008
5.22.2008
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.
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.
5.20.2008
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
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
5.19.2008
DAY 2
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.
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.
5.15.2008
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
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.
5.11.2008
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...
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...
5.10.2008
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.
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.
5.09.2008
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.
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.
5.07.2008
PATH
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.
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.
5.05.2008
Apologies
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?
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?
4.29.2008
100th post...
100 posts...I'll dedicate this post to the fact that I've pretty much finished my pre-clinical medical education. Thanks for reading.
Looking back on the past 15,454 hours (or 21 months, 4 days...not that I'm counting) of my life, I'm not all that impressed by what I've seen. I've done a lot of sitting infront of books, I've run through 70+ highlighters, I've done a lot of memorizing but not a lot of learning. Every time that I think that I've mastered a subject, I go back and the foundation has fallen out from it. I try to look at the forest, but all I see are the individual pine needles. At this point, my exams test for ability to regurgitate random minutiae from Robbins, not for understanding of the material. Understanding material and being able to regurgitate sentences from Robbins on demand are very different. For one, I don't see the utility of being able to recite the translocations responsible for 15 different hematologic malignancies, or the cell of origin of one of the 25 difference neoplasms of the ovaries in the education of someone who will be a family physician, psychiatrist or emergency physician.
There has been a lot of wasted effort in my education, on both my behalf as well on the behalf of the AAMC/LCME who have an asininely archaic idea of what medical education should be. After June 23rd about 70% of what I've been forced to learn over the past 2 years will be vaporized from my short term memory. All those little interconnected neurons in my holding medical knowledge in my hippocampus will simply rearrange some microtubules and the hours I spent slaving over the pages of Robbins will spill out of my the distance reaches of my consciousness. Two years of my life be reduced nothing more than a few distant memories of sitting my ass in front of that same crappy carrel in the dingy basement of the library with the humming of the furnace and the fluorescent lights in my ears.
You would think that I would be sad that I'm about to reduce the intimate memories of approximately 1/12th of my life down to one simple experience that I like to refer to as "The Suck." But I'm not. You see, the past 21 months have been little more than a requisite right of passage into what I've been waiting to experience: LEARNING MEDICINE! Isn't that what I've paid for thus far? Didn't I go to medical school and not "memgurgitate lots of information that you probably will never see in the course of your career for the fun of it" school?
The ironic thing is that I'll probably look back on all of this in the middle of one of my over-night call shifts on surgery or OB and long for the days where I could sleep for 8 solid hours and control my own schedule instead of being abused on the floors. But for now, I'm hopeful that seeing and experiencing the management of patients and their various disease will re-ignite my failing passion for medicine.
Looking back on the past 15,454 hours (or 21 months, 4 days...not that I'm counting) of my life, I'm not all that impressed by what I've seen. I've done a lot of sitting infront of books, I've run through 70+ highlighters, I've done a lot of memorizing but not a lot of learning. Every time that I think that I've mastered a subject, I go back and the foundation has fallen out from it. I try to look at the forest, but all I see are the individual pine needles. At this point, my exams test for ability to regurgitate random minutiae from Robbins, not for understanding of the material. Understanding material and being able to regurgitate sentences from Robbins on demand are very different. For one, I don't see the utility of being able to recite the translocations responsible for 15 different hematologic malignancies, or the cell of origin of one of the 25 difference neoplasms of the ovaries in the education of someone who will be a family physician, psychiatrist or emergency physician.
There has been a lot of wasted effort in my education, on both my behalf as well on the behalf of the AAMC/LCME who have an asininely archaic idea of what medical education should be. After June 23rd about 70% of what I've been forced to learn over the past 2 years will be vaporized from my short term memory. All those little interconnected neurons in my holding medical knowledge in my hippocampus will simply rearrange some microtubules and the hours I spent slaving over the pages of Robbins will spill out of my the distance reaches of my consciousness. Two years of my life be reduced nothing more than a few distant memories of sitting my ass in front of that same crappy carrel in the dingy basement of the library with the humming of the furnace and the fluorescent lights in my ears.
You would think that I would be sad that I'm about to reduce the intimate memories of approximately 1/12th of my life down to one simple experience that I like to refer to as "The Suck." But I'm not. You see, the past 21 months have been little more than a requisite right of passage into what I've been waiting to experience: LEARNING MEDICINE! Isn't that what I've paid for thus far? Didn't I go to medical school and not "memgurgitate lots of information that you probably will never see in the course of your career for the fun of it" school?
The ironic thing is that I'll probably look back on all of this in the middle of one of my over-night call shifts on surgery or OB and long for the days where I could sleep for 8 solid hours and control my own schedule instead of being abused on the floors. But for now, I'm hopeful that seeing and experiencing the management of patients and their various disease will re-ignite my failing passion for medicine.
4.27.2008
What it's all about
If you've read this blog with any frequency, you know that I have an soft spot in my heart for cancer stories and patients who have been through the medical ringer with their diagnosis and treatment. My heart absolutely goes out to those abandoned souls who are left hanging without a physician who will advocate for them.
We had a patient presentation session this past week from breast cancer survivors treated by one of our faculty physicians. The stories of these women were sad and at the same time absolutely appalling. Between all of the mis-diagnoses, the poor attention paid to their needs, the lack of communication and the delays between procedures, it's a wonder that these women are alive at all. It reminded me why I wanted to get into this field in the first place and brought together a lot of what doctoring is all about.
-First patient: Hypodensity in one breast was missed over a fibroadenoma in the other breast. She was cleared for hormone replacement therapy. A year later, and she had full blown carcinoma that was being fed by her estrogen replacement...though that mechanism was not completely lucid at the time. Found the doc on campus and had everything taken care of and is still here to tell the story.
-Second patient: She made me extremely sad. She felt a lump, and had a mammogram done. She was diagnosed clinically with breast cancer on that mammogram. She requested a second opinion, and was sent to another oncologist at a prestigious ivory tower institution on the East Coast with another patient's films. The oncologist picked up on it right away, and repeat films were clean. Two years later, her films were not clean and so she returned to that same ivory tower practice to find that the physician had retired and left the practice in the hands of another doc. This guy was all about fitting in as many patients as possible. He drained the patient's cystic adenomas monthly for 8 months without biopsy, until one visit he stopped getting fluid. He looked at the patient and said "I think I made a mistake. Go see the receptionist, and we'll get you in for a biopsy." He didn't have an opening until 4 months later...so she left and came to our institution and found this doc who made everything all right, after a year of weekly chemo.
-Third patient: Basically got told by a doc at a NYC Cancer Mecca that she had breast cancer, and was not presented with the full amount of information that she requested. Great doctor, crappy care. The doctor gave her info and treatment options on a need to know basis and basically told her what she was going to do. She left out of frustration and found the doc at our institution who presented the entire picture of how they were going to get through it.
---------------------
The take home message that I got out of this session was that communication is 95% of being good physician. If you're not able to communicate what is going on with the patient, how you're going to fix it and what they need to do, the patient is going to lose faith in you from the get go. Your work lies in finding and correcting the errors in physiology and anatomy of another human being!!! This is not some computer simulation or lab animal or entry in Robbins that you're dealing with, it's a person and their life and their family. You can be the most technically knowledgeable and capable individual in the field, but what takes you that extra step ahead of the rest is the simple ability to explain the situation to a very scared person, who may not be thinking rationally, and to make them understand what you're about to do.
I see so many of my colleagues lacking in this regard, and I worry for their future patients and the future of medicine.
We had a patient presentation session this past week from breast cancer survivors treated by one of our faculty physicians. The stories of these women were sad and at the same time absolutely appalling. Between all of the mis-diagnoses, the poor attention paid to their needs, the lack of communication and the delays between procedures, it's a wonder that these women are alive at all. It reminded me why I wanted to get into this field in the first place and brought together a lot of what doctoring is all about.
-First patient: Hypodensity in one breast was missed over a fibroadenoma in the other breast. She was cleared for hormone replacement therapy. A year later, and she had full blown carcinoma that was being fed by her estrogen replacement...though that mechanism was not completely lucid at the time. Found the doc on campus and had everything taken care of and is still here to tell the story.
-Second patient: She made me extremely sad. She felt a lump, and had a mammogram done. She was diagnosed clinically with breast cancer on that mammogram. She requested a second opinion, and was sent to another oncologist at a prestigious ivory tower institution on the East Coast with another patient's films. The oncologist picked up on it right away, and repeat films were clean. Two years later, her films were not clean and so she returned to that same ivory tower practice to find that the physician had retired and left the practice in the hands of another doc. This guy was all about fitting in as many patients as possible. He drained the patient's cystic adenomas monthly for 8 months without biopsy, until one visit he stopped getting fluid. He looked at the patient and said "I think I made a mistake. Go see the receptionist, and we'll get you in for a biopsy." He didn't have an opening until 4 months later...so she left and came to our institution and found this doc who made everything all right, after a year of weekly chemo.
-Third patient: Basically got told by a doc at a NYC Cancer Mecca that she had breast cancer, and was not presented with the full amount of information that she requested. Great doctor, crappy care. The doctor gave her info and treatment options on a need to know basis and basically told her what she was going to do. She left out of frustration and found the doc at our institution who presented the entire picture of how they were going to get through it.
---------------------
The take home message that I got out of this session was that communication is 95% of being good physician. If you're not able to communicate what is going on with the patient, how you're going to fix it and what they need to do, the patient is going to lose faith in you from the get go. Your work lies in finding and correcting the errors in physiology and anatomy of another human being!!! This is not some computer simulation or lab animal or entry in Robbins that you're dealing with, it's a person and their life and their family. You can be the most technically knowledgeable and capable individual in the field, but what takes you that extra step ahead of the rest is the simple ability to explain the situation to a very scared person, who may not be thinking rationally, and to make them understand what you're about to do.
I see so many of my colleagues lacking in this regard, and I worry for their future patients and the future of medicine.
4.22.2008
Progress...
Part of the reason that I've been writing less is that I've been running a bit more and doing other outside funtime activities. That has provided me with a whole bunch of good feeling endorphins, incremental gains in fitness and a dose of sanity that nothing else has been able to provide to this point. I feel better, I've cut back on coffee consumption, I'm sleeping a bit better and I have a good excuse not to study. And the dress slacks fit better now too...which is always a plus.
I took my longest run in a while this weekend -5.3 miles- which felt great and I put in my first structured speed work since high school. I think the hardest part about getting back into running is that I'm still getting used to the fact that I'm a beginner again. I can't expect my body to pound out a decent pace like I used to, and it takes a bit of mental work to realign my perceived effort level with the paces/times that I'm putting up. So far the heart rate monitor is helping out with that aspect, I know where my lactate threshold is and where I need to put my heart rate to match my perceived effort, my feet just fall in line with the rest...kind of a cool quasi-physiological way to approach things. I'm also taking time to rest, which is helping out alot with the aches that plagued me for a lot of my earlier self-directed running.
I cobbled together a half-marathon training schedule that takes me up to the race in October. I'm almost sticking to it, except when exam weeks get in the way. I just hope that Surgery doesn't completely kill my hopes of finishing the race...but we'll see!
******************
I'm getting into the home stretch with classes, and starting to get all wound up for the boards in June. The nice weather is making it increasingly difficult to lock myself in the library with my good ol' pal Robbins, but I've been fairly good thus far.
Looking back on the first two years of medical school, it's been rough. It's not that the material is difficult to understand. It's the frame of reference that's been killing me all along. I'm an active learner. I learn by doing and seeing, not by staring at piles of notes and pages of readings. There is no way to actively learn pathology or biochem or any of the pre-clinical material, really. Seeing patients with their diseases makes the material stick more than the books do. It's just been the pure grunt work of slogging through the material until enough of it sticks, and that's led to some disappointing performances for me...like all of them. I've never felt less confident about what I'm doing in my life, and to have to live with that lack of confidence is draining.
Two weeks of torture left though, then a week of reading period/exams and then it's time for me to study for the boards. I'm looking foward to board studying, because I have a schedule that I'm going to stick to and it should be plenty to get a decent score on the step 1's. I'll probably continue to sneak in a post or two a week, updating about running/studying/life in general.
I took my longest run in a while this weekend -5.3 miles- which felt great and I put in my first structured speed work since high school. I think the hardest part about getting back into running is that I'm still getting used to the fact that I'm a beginner again. I can't expect my body to pound out a decent pace like I used to, and it takes a bit of mental work to realign my perceived effort level with the paces/times that I'm putting up. So far the heart rate monitor is helping out with that aspect, I know where my lactate threshold is and where I need to put my heart rate to match my perceived effort, my feet just fall in line with the rest...kind of a cool quasi-physiological way to approach things. I'm also taking time to rest, which is helping out alot with the aches that plagued me for a lot of my earlier self-directed running.
I cobbled together a half-marathon training schedule that takes me up to the race in October. I'm almost sticking to it, except when exam weeks get in the way. I just hope that Surgery doesn't completely kill my hopes of finishing the race...but we'll see!
******************
I'm getting into the home stretch with classes, and starting to get all wound up for the boards in June. The nice weather is making it increasingly difficult to lock myself in the library with my good ol' pal Robbins, but I've been fairly good thus far.
Looking back on the first two years of medical school, it's been rough. It's not that the material is difficult to understand. It's the frame of reference that's been killing me all along. I'm an active learner. I learn by doing and seeing, not by staring at piles of notes and pages of readings. There is no way to actively learn pathology or biochem or any of the pre-clinical material, really. Seeing patients with their diseases makes the material stick more than the books do. It's just been the pure grunt work of slogging through the material until enough of it sticks, and that's led to some disappointing performances for me...like all of them. I've never felt less confident about what I'm doing in my life, and to have to live with that lack of confidence is draining.
Two weeks of torture left though, then a week of reading period/exams and then it's time for me to study for the boards. I'm looking foward to board studying, because I have a schedule that I'm going to stick to and it should be plenty to get a decent score on the step 1's. I'll probably continue to sneak in a post or two a week, updating about running/studying/life in general.
4.21.2008
Yankee Stadium Revisited
Every time I head down to the Bronx to watch a ball game I get a few too many beers into me and awesomeness ensues:
I'm generally not a well liked person within the walls of Yankee Stadium, and I'm OK with that for the most part. I understand that two of the best teams in baseball play each other 18 times a year. I know that it's going to be a 4 hour game with plenty of action. I know that I'm going to be screamed at for the entirety of those 4 hours and every portion of my life will be insulted. I usually have a few drinks so that I can appreciate the atmosphere and lower my inhibitions about yelling insults at perfect strangers and their mothers. So here's how the night went:
shouting matches with the entire train car that lead to me being escorted to another car"spirited conversations" the whole way home.
EDIT: One of my friends that was at the game sent me the following link saying that this could have easily been me. I'm not a violent person by nature so I think he was a little bit off, but check it out anyway!
I'm generally not a well liked person within the walls of Yankee Stadium, and I'm OK with that for the most part. I understand that two of the best teams in baseball play each other 18 times a year. I know that it's going to be a 4 hour game with plenty of action. I know that I'm going to be screamed at for the entirety of those 4 hours and every portion of my life will be insulted. I usually have a few drinks so that I can appreciate the atmosphere and lower my inhibitions about yelling insults at perfect strangers and their mothers. So here's how the night went:
- Within about 30 seconds of opening the car doors in the parking garage, my friend and I are booed mercilessly. So we tailgated for a while because $10.50 for a Hineken is obscene.
- On the way up to our 3rd tier seats, I stop to buy a beer for the walk up to our alcohol free seating. The beer lady looks at me and says with the thickest accent she can muster "NO, I don't serve any Red Sox fans". The other beer lady came over and poured me a beer...and she got a tip too!
- We exit the concourse onto the third tier seating. My friend and I remained standing to finish our beers, and we were greeted by an intoxicated fan's "Hey, go F--- yourself and your mother". Officer Del Reye of the NYPD had a nice chat with him and I felt a little bit safer.
- Later on, I'm waiting in line for the Men's room (only place on earth I've ever experienced this) and I get my favorite insult of the night. "Hey! You in the Sox jersey! Your penis is attached to you vagina!" I looked at the guy for a second, marveling at his stupidity, and said "I don't even know what that means." He shrugged and left...by far the best insult I've ever received because it was hilarious for everyone
EDIT: One of my friends that was at the game sent me the following link saying that this could have easily been me. I'm not a violent person by nature so I think he was a little bit off, but check it out anyway!
4.12.2008
Quotes from the rectum
Ok so I have to share this one with everyone, despite how disturbing it is to me. So I had my standard male genitourinary and rectal exam a few weeks ago, and I just keep relaying one quote to everyone that asks how it went.
So we finished up the awkward exam of the male genitals (junk or twig and two berries if you will) and perenium (the taint or grundle for the anatomically disinclined). I've plucked this guys spermatic cords about 5 times and have had my finger up into his inguinal canal to feel his hernia...crossing all sorts of boundaries that I've never crossed with another man's junk, with minimal public display of discomfort. The patient/actor/educator turns around to the three of us males in the room and says:
"Hold up your hands."
We oblige. Pointing to the large-handed former football player, he deadpan says "Ok, you've got the biggest fingers, you're going to go first and open me up."
Great way to make things comfortable and welcoming for all with that visual aid...whilst I insert my fingers into your rectum...ugh.
Thanks for that again. I'll definitely be rushing to do my requisite 10 observed rectals on my surgery rotation in July after that experience.
So we finished up the awkward exam of the male genitals (junk or twig and two berries if you will) and perenium (the taint or grundle for the anatomically disinclined). I've plucked this guys spermatic cords about 5 times and have had my finger up into his inguinal canal to feel his hernia...crossing all sorts of boundaries that I've never crossed with another man's junk, with minimal public display of discomfort. The patient/actor/educator turns around to the three of us males in the room and says:
"Hold up your hands."
We oblige. Pointing to the large-handed former football player, he deadpan says "Ok, you've got the biggest fingers, you're going to go first and open me up."
Great way to make things comfortable and welcoming for all with that visual aid...whilst I insert my fingers into your rectum...ugh.
Thanks for that again. I'll definitely be rushing to do my requisite 10 observed rectals on my surgery rotation in July after that experience.
Lack of blogging motivation
So I've kind of been out of ideas for writing lately, and for that I apologize to anyone who still regularly checks in. I've been running away from school for the past two weekends since my renal path exam and the rest of my free time is being eaten up by a stupid group project.
I'm not quite sure why as a 24 year old medical student I'm still assigned group work. Honestly, I am quite capable of working with a group to complete an assignment as well as doing it independently. I think that group science report that I did in elementary school proved that skill set. But here I am again, trying to coordinate 7 other classmates to create a paper that will live up to the nit-picky expectations of the course director. I've realized that I naturally gravitate to these types of positions where I take on the burden of getting a group of people to pull in the same direction, and usually I do ok with them. Hopefully, we can get a decent grade out of this project for all of us, I've certainly done my share. Especially with rewriting the sections assigned to the the one member of the group that struggles to write a coherent paragraph. I figured the 5 non-native english speakers would be the dead weight in the writing department, but they actually write quite well...it was one of the two native speakers that gave me trouble...figures.
******************
So I got out to my favorite spot on earth this afternoon again: Fenway Park.
There's just something about the hustle and bustle around the ball park that makes me feel invigorated. Once I'm through the ticket gates, I like to immediately descend from the overly comercialized and family friendly Yawkey Way into the dimly bowels of the stadium that has stood there, almost unchanged since 1912. It almost feels like I'm traveling back in time amidst the smokey aroma of sausage on the grill and the white noise of 37,000 people vibrating through the concrete structure. Each descent brings back floods of memories of dozens of visits before, all rushing back at once. It's similar to what I imagine seeing your life flash before your eyes is like, but you can do it whenever you like for the price of admission. There's the usual, comfortable ritual of procuring the correct overpriced mass produced American lager for my dad in appreciation for the tickets he preennially provides, of walking down the ramp past the same souvenir vendor that's always there with the same old overpriced stuff, past the nacho/pretzel and hot dog/sausage, Papa Gino's, Beer/Peanut and Ice cream stands (yes, in that exact order). Waving to the same beer guy that's always there with some clever remark while he happily pours his brews in the corner by the entrance up to our section. It's a ritual that always feels familiar and yet always exciting and new...like nothing else I've ever experienced. If you've been to Fenway and sat on the third base side of the stadium, you probably know what I mean...it's the least renovated portion of the ball park and instead of feeling like a dump, which is what I'm sure many people would think, it feels like I'm walking back into an earlier time where nothing else matters except for enjoying the home team playing the classic american game.
For me, the real magic begins as soon as I emerge from the musty underbelly of the beast into the light and fresh air and echoing sounds of the park. I like to look up at the skyline over the right field wall and scan the outfield and just take a few seconds to absorb the atmosphere, and it instantly takes me back to the first few times that I visited the stadium back in the 80's and sat on my dad's lap and ate cotton candy and watched Wade Boggs (one of my favorite childhood players) play his heart out at third base and be the RBI machine that he was. It's a great feeling. The world could be collapsing around me (as it indeed it often seems to be these days), but I wouldn't really care if I had my butt in one of those cramped old seats. It really is a special place for me and holds hundreds of amazing memories that make me feel at peace and at home.
It's quite a stark and welcome contrast to my other life in New York, where I constantly feel out of place and like something is looming over me waiting to rend my soul to it's very roots. I wish I could better express what it is that I feel in words, but it's one of those intangibles that just nags at the periphery of my consciousness. Like when you walk into a room and absolutely know that something is out of place but you're not even sure what it is or why you have that feeling, but it's there nonetheless. I guess that I just don't feel at home there in NY and it adversely affects everything I do and weighs me down. I guess that strikes at the heart of the reason that I started writing this blog in the first place...to get over that feeling of living in a place that I will never be comfortable enough to call home.
I've come to realize over the past two years that discomfort is the place where I have to learn to be comfortable through many experiences (see "Notes from the Vagina"). However, making that leap from conceptualization to actualization is more difficult than it appears on the surface.
So that's a little bit about where I'm coming from in my life at this point, and it only took 3 overpriced, mass produced American lagers at my favorite place on earth to bring it out...hopefully I'll have something less touchy-feely to write about next time, but here's where my flow of consciousness went tonight.
Peace out girl scout...
I'm not quite sure why as a 24 year old medical student I'm still assigned group work. Honestly, I am quite capable of working with a group to complete an assignment as well as doing it independently. I think that group science report that I did in elementary school proved that skill set. But here I am again, trying to coordinate 7 other classmates to create a paper that will live up to the nit-picky expectations of the course director. I've realized that I naturally gravitate to these types of positions where I take on the burden of getting a group of people to pull in the same direction, and usually I do ok with them. Hopefully, we can get a decent grade out of this project for all of us, I've certainly done my share. Especially with rewriting the sections assigned to the the one member of the group that struggles to write a coherent paragraph. I figured the 5 non-native english speakers would be the dead weight in the writing department, but they actually write quite well...it was one of the two native speakers that gave me trouble...figures.
******************
So I got out to my favorite spot on earth this afternoon again: Fenway Park.
There's just something about the hustle and bustle around the ball park that makes me feel invigorated. Once I'm through the ticket gates, I like to immediately descend from the overly comercialized and family friendly Yawkey Way into the dimly bowels of the stadium that has stood there, almost unchanged since 1912. It almost feels like I'm traveling back in time amidst the smokey aroma of sausage on the grill and the white noise of 37,000 people vibrating through the concrete structure. Each descent brings back floods of memories of dozens of visits before, all rushing back at once. It's similar to what I imagine seeing your life flash before your eyes is like, but you can do it whenever you like for the price of admission. There's the usual, comfortable ritual of procuring the correct overpriced mass produced American lager for my dad in appreciation for the tickets he preennially provides, of walking down the ramp past the same souvenir vendor that's always there with the same old overpriced stuff, past the nacho/pretzel and hot dog/sausage, Papa Gino's, Beer/Peanut and Ice cream stands (yes, in that exact order). Waving to the same beer guy that's always there with some clever remark while he happily pours his brews in the corner by the entrance up to our section. It's a ritual that always feels familiar and yet always exciting and new...like nothing else I've ever experienced. If you've been to Fenway and sat on the third base side of the stadium, you probably know what I mean...it's the least renovated portion of the ball park and instead of feeling like a dump, which is what I'm sure many people would think, it feels like I'm walking back into an earlier time where nothing else matters except for enjoying the home team playing the classic american game.
For me, the real magic begins as soon as I emerge from the musty underbelly of the beast into the light and fresh air and echoing sounds of the park. I like to look up at the skyline over the right field wall and scan the outfield and just take a few seconds to absorb the atmosphere, and it instantly takes me back to the first few times that I visited the stadium back in the 80's and sat on my dad's lap and ate cotton candy and watched Wade Boggs (one of my favorite childhood players) play his heart out at third base and be the RBI machine that he was. It's a great feeling. The world could be collapsing around me (as it indeed it often seems to be these days), but I wouldn't really care if I had my butt in one of those cramped old seats. It really is a special place for me and holds hundreds of amazing memories that make me feel at peace and at home.
It's quite a stark and welcome contrast to my other life in New York, where I constantly feel out of place and like something is looming over me waiting to rend my soul to it's very roots. I wish I could better express what it is that I feel in words, but it's one of those intangibles that just nags at the periphery of my consciousness. Like when you walk into a room and absolutely know that something is out of place but you're not even sure what it is or why you have that feeling, but it's there nonetheless. I guess that I just don't feel at home there in NY and it adversely affects everything I do and weighs me down. I guess that strikes at the heart of the reason that I started writing this blog in the first place...to get over that feeling of living in a place that I will never be comfortable enough to call home.
I've come to realize over the past two years that discomfort is the place where I have to learn to be comfortable through many experiences (see "Notes from the Vagina"). However, making that leap from conceptualization to actualization is more difficult than it appears on the surface.
So that's a little bit about where I'm coming from in my life at this point, and it only took 3 overpriced, mass produced American lagers at my favorite place on earth to bring it out...hopefully I'll have something less touchy-feely to write about next time, but here's where my flow of consciousness went tonight.
Peace out girl scout...
4.04.2008
Renal Failure...
I'm having a little trouble walking after that exam.
The combination of being flustered and under prepared for the depth of material was infuriating. I felt completely lost for about half the questions, which should get me into the "I should still be able to pass the course" range. It was renal, hepatobiliary and GI with clinical correlations and lab correlations. I could have had Robbins and Cecil open on my desk with a boarded pathologist, a nephrologist and a gastroenterologist sitting next to me for the exam whispering answers into my ear and I probably still would have struggled.
Good job course director, you have crushed my will to continue on in medicine yet again...off to to nice and easy pharm exam and then to crawl into a bottle of something alcoholic until Monday.
The combination of being flustered and under prepared for the depth of material was infuriating. I felt completely lost for about half the questions, which should get me into the "I should still be able to pass the course" range. It was renal, hepatobiliary and GI with clinical correlations and lab correlations. I could have had Robbins and Cecil open on my desk with a boarded pathologist, a nephrologist and a gastroenterologist sitting next to me for the exam whispering answers into my ear and I probably still would have struggled.
Good job course director, you have crushed my will to continue on in medicine yet again...off to to nice and easy pharm exam and then to crawl into a bottle of something alcoholic until Monday.
Ode to a Kidney...
Oh Kidney, you rend the joy within my soul.You do so much, so elegantly, without complaint.
Yet I cannot fathom the depths of your pathology.
Your glomeruli confound me.
Your tubules vex my very soul.
Your electrolytes confuse the living shit out of me.
In short kidney, you make me want to curl up into the fetal position...
I suffer from neophrogenic anxiety and acute interstitial glomerulo-I-FREAKING-HATE THE-KIDNEY-itis.
3.28.2008
New Side Bar Items
I'm going to add a few new side bar items:
-A count down until I take the boards
-A link to my Runner's world workout log for anyone that might want to follow along with that progress.
-A count down until I take the boards
-A link to my Runner's world workout log for anyone that might want to follow along with that progress.
Goals and Expectations
Most people think of their new year's resolutions in December/January and break them by February. Since I'm an amazing procrastinator, I've set a few new goals for myself over the next few months:
- Finish out the year on a strong note (ie stop slacking off!!!)
- Carry that momentum through studying for the boards (June 23rd...yikes)
- Do above average on the boards (220-230 range)
- Keep running a couple times a week to maintain sanity/health
- Go into 3rd year with a positive attitude, especially with our school's "academic mecca" surgical clerkship in July as my first rotation
- Come out with a decent grade and something positive from the experience to set the tone for familyvacation medicine and the rest of the year
- Finish a half marathon with girlfriend in October
- Help my brother do some work on his new house this summer and stay in better touch with him
- Overcome the relentless beer potomania that arises with every path study session
I'll let you know how they go.
- Finish out the year on a strong note (ie stop slacking off!!!)
- Carry that momentum through studying for the boards (June 23rd...yikes)
- Do above average on the boards (220-230 range)
- Keep running a couple times a week to maintain sanity/health
- Go into 3rd year with a positive attitude, especially with our school's "academic mecca" surgical clerkship in July as my first rotation
- Come out with a decent grade and something positive from the experience to set the tone for family
- Finish a half marathon with girlfriend in October
- Help my brother do some work on his new house this summer and stay in better touch with him
- Overcome the relentless beer potomania that arises with every path study session
I'll let you know how they go.
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