"Restless Med Student" is now a Doctor.

In this blog you will read of my journey as a hapless student navigating through medical school and  my rewarding yet futile quest of becoming the next William Osler. Here you will find stories describing challenges that encompass both blunders and achievements- from my descent into a miserable 8-month depression after the death of my Father and nearly dropping out of medical school to being published in two peer-reviewed journals and scoring in the 99th percentile of the USMLE.  Life is darkness and light. I wish there was a way to briefly summarize this journey in a few sentences but all I can say is that... it was worth it.  

If you're a student considering pursuing this long and wearing path,

I have a few words of advice:

    1. As you gain knowledge, stay grounded

    2. Learn and re-learn because you'll forget if you don't.

    3. Grow some thick skin in the process

    4. Remind yourself why you wanted to help people through medicine.

    5. Don't pursue medicine for the $, the most important things in life aren't  things.

I'll be graduating from UCLA in a couple months and will be specializing in Internal Medicine, perhaps sub-specializing in the future. I'm happy with my decision. The journey has been demanding and sometimes marked with doubts but this was the path I choose eight years ago while watching my Dad being wheeled to an OR... damn good decision.

Lastly, I want to motivate students out there who come from an underserved background-- perhaps a recent immigrant struggling with English or someone from "the hood" with little resources and an uphill battle to success.



 Match Day: (3/16/12))

My family (five of us) came to this country when I was 9 yrs old, our family's annual income was less than $22,000 living in a one bedroom apartment for several years. I'll admit without embarrassment that we grew up with government assistance. Nothing was easy... but nothing is impossible. I worked hard and never lost focus. There's countless stories of folks who through hardwork and sheer will have beaten the odds. We are all dealt with certain cards that we must play in life, but the difference between a successful grasshopper and others is not a lack of strength or knowledge, but rather in a lack of will. In this path you will experience failures (trust me!), but success consists of navigating from failure to failure without loosing enthusiasm, so don't give up.  If you wish to read more about this topic, then I suggest this post from awhile back.

I started this blog 4 years ago with a post describing the humbling experience of starting medical school. The humbling process never stops but maybe i'll end this blog today.  Peace!

    

USMLE Step II

bulldog winning

It's been several months since I've been here but I wanted to quickly follow up on a previous entry where I posted my strategy to 'win' on the USMLE Step 2.


To be brief--- the plan worked, I scored in the 99th percentile. The key was to review First AID twice, complete the entire UWorld Qbank in tutor mode, and take one NBME practice exam. Sometimes you just have to be like the bulldog and stare down your challenges.

Good luck!

Research

"when you think of your human senses, how do you fell when knowing they are just one way of seeing the world?"

Truth is...I’m hitting a wall in my research...

Bootcamp Letters

Jumping from the Towers... My grandchildren will feel it.

At the listless age of 14, I was sent to a Marine Corps mini-bootcamp called Devilpups at Marine Corps Base, Camp Pendleton in Oceanside, California. Unlike a number of participants at the camp who were forced into participating, I had volunteered without realizing the degree of pain and humiliation I was to succumb. The reasons behind my decision laid in the belief that my late Father, a U.S. Army Korean War veteran, felt I could not endure several weeks of hell. 

Mother was hesitant to sign the waiver but after some persuasion by Dad, she signed the papers. On the day of departure, there were approximately one hundred teenagers from southern California at MCRD waiting to be picked up by rows of white buses marked with Semper Fi emblems.  We were told by staff to stand and wait for the sergeants inside the bus to exit and deliver their special welcome.   The first sergeant who came out of the white bus began hollering at the group, calling us ‘Nancy” and emphasizing how we were prohibited from looking into their eyes.

Just before I boarded the bus Dad looked at me with a dash of anticipation, as if waiting for a change of heart…  But I spit my pride and said to him, “I’ll see you in two weeks, alright.” He smiled and said “Hey, don’t drop the soap” in reference to a story he told me the day before of how Army recruits in bootcamp bathe in communal showers.

In my naïve thinking, it was a challenge I wanted to undertake mainly to impress my Dad and break a Father-Son Complex that I’d carried for years. After the first few days of bootcamp, the Drill Sergeants gave us the opportunity to write a letter to our parents. Well… twelve years later I opened this letter… this special letter brought on many, many tears.  In the letter I ramble to Dad with a foolish pride about how much I enjoyed bootcamp and how great I was being treated, I can chuckle now because those were some of the most eternal weeks of my life, LOL.

When you look back at your fleeting life, which moments will you vividly recall the most? The achievements, your contributions to society, or the little pieces of humanity you gathered along the way. The earliest memory of your beloved one. The desperation and glory of crossing a finish line or the moment when you first felt the seemingly empty satisfaction of altruism. The smell of Mom’s cooking… Bootcamp is one of mine.

United States Medical Licensing Examination (Step 2)

....Can't for the life of me understand why the National Board of Medical Examiners charges $1355 to sit and take this exam. Now that my bank account is lighter I'm more compelled to study. FYI, if you're a fellow student who will soon be taking the exam-- i'll be using the following resources and posting my score when it arrives.

• FIRST AID for the USMLE step 2CK
• USMLE World Qbank (i've been working on this sucker since the start of 3rd year)
• SIMPLE cases (internal medicine)
• Step Up to Medicine (USMLE step 2)

Year 4

So i'm nearing the end of 3rd year of med school.
Now i'm signing up for the USMLE-Step 2-CK ("Clinical Knowledge"). I'll be posting the review book(s) and Qbank's i'll be using for the exam in case anyone out there needs some guidance. The plan is ambitiously simple: Win!

On Psychiatry

The psychiatry ward is one of the most interesting places in the hospital. What makes it interesting are the patients, I was so intrigued that I began to reflect on it.

Among them was a gentleman who would stroll along the patio singing and smiling, if you spent three minutes observing him from afar you would catch him carelessly dancing and spreading his arms imitating a bird. He was fond of purple sweaters and could spend hours staring blindly at the sky as if he was urgently waiting for rain. He was docile, meek, ridiculous and stupid. This gentleman was happy-- so much that i'll admit-- he smiled and laughed more in one day than I typically smile in one week. Each day I'd spend thirty minutes charting trying to justify medical necessity, which oddly enough, became a novel habit of mine to pathologize behavior. There is little doubt in my mind he was genuinely happy. I'm slightly embarrased to admit that for a brief moment I envied it...this of course irritated me-- that someone so delusional and cognitively impaired could be so happy. 

A question has lingered since leaving the psych ward -- would I rather live a hopelessly happy and non-functional life oblivious to society’s expectations or carry-on a high functioning existence tormented with inner demons but mitigated by self-control?

During those five weeks I was taught to observe and ascribe terms to abnormal behavior and present these findings to my preceptors to demonstrate clinical skill. Initially this kind of work was interesting… but after a few short weeks I was compelled to consider some inconvenient truths. 1) psychiatry is very subjective 2) The DSM has helped to standardize and legitimize the profession, but it begs the question, who the **** sets these standards dictating normal vs abnormal behavior, anyways?

In addition to this happy, free-flying, purple-loving gentleman, there was another man who I was assigned to shadow. This man was cunningly smart and perhaps too eccentric for society's comfort.  During those five weeks on the psych wards he showed me how to synthesize methamphetamine and even clarified some of Nietche's views on absurdism and nihilism. I was equally amused by his intellect and his buffoonery. He could predict precisely what I was writing on the chart and would sometimes remind me with a smile, "don't forget to write down my new 'delusion of grandeur". He walked the wards with a swager, smiling unpretentiously and effortlessly winning the hearts and admiration of others. Even the nurses would flirt with the guy. But it all became clear to me during the last day of rotation when he cleverly stated how he was going to be discharged soon with disability insurance, how he was working the system... stickin' it up to ******

Many questions still linger. First, what causes mental illnes? Secondly, can we really say that all mental illness is organic in nature?

"You like a... cookies?"

Three months ago while driving back to my apartment I noticed an elderly Asian lady stranded in the street trying to push her broken car towards the curb. The delicate lady was sweating and smiling  which, oddly enough, reminded me of my Father...

I stopped at the corner, exited my car and crossed the intersection to push her car. During those ten minutes I was breaking a sweat and wondering what the hell she had in the damn trunk.

She was grateful and asked me if she could bake me cookies or pastries. Frankly I was irked by her offer and slowly began to walk away while saying "Oh, you're so nice, but it's not necessary thank you." She asked  where I lived and I timidly told her "around the corner" while pretending to be in a rush and walking back towards my car.  

Three months later... the sweet lady shows up at my door with cookies. She explained how grateful she was that some stranger stopped to help. She discretely thanked me, smiled, and bowed her head like Asian's sometimes do.   I placed my cynicism aside and ate those cookies. -- 'some of the best cookies i've eaten so far.

Refranes

 `Today, entrepreneurs make millions selling books and giving courses on `self-actualization' and on finding out `who you are,' but if you develop self-discipline and invest your full attention and effort in whatever you do, you will not need a course to tell you who you are. You will know.'' - Michael DeBakey, MD

"In terms of what's important everything is important, so forget the underlining 'cuz you would need a paint brush!" - Dr. Goljan, MD.

                                       “I find I’m luckier when I work harder…” -Denton Cooley, MD

"I pictured myself as a virus or a cancer cell and tried to sense what it would be like."- Jonas Salk, MD

"Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert." - Williams Osler, MD
 

                                                  "Wrong wrong wrong wrooooooong
                                                 Wrong wrong WRONG wrooooonnnngggg
                                                  You're wroooonnnnngggg!" - Dr. Cox, MD.

                                                    "Nah, I wanna do Internal Medicine
                                       and feel in accordance with the universe" - Michael G, MSIII

                               "Given one well-trained physician of the highest type he will do 
                        better work for a thousand people than ten specialists." - William Mayo, MD

The Doc's Role

Funny how our outlook changes as one becomes older.

 

During my undergrad years I held a raw and trite imagination of the heroic doctor: 'The heroic doctor' rushing into a trauma room  to literally save the dying child… rescuing the emaciated patient from the imminent brink of death by breaking open the chest and massaging the heart to restore bloodflow, etc. This 

scenario happening over and over (with the ER theme song in the background, ah).

For the past 3 weeks I've been a member of the Surgical Trauma team at a level one trauma center in Los Angeles. Oh, the things one gets to see....  from the stabbed reckless Hep C+ drunkard who decides to spit at us, to the stoic kid with multiple GSW's. It's amazing and thrilling to acutely save lives but, as contrite as it may sound, the excitement wanes as you become exhausted. Being on-call in the trauma service has led to 36hr days without any sleep. Suddenly the OR doesn't appear as exciting... Suddenly 'scrubbing in' becomes a taxing ritual...you are physically/emotionally crushed and begin to dread the next time your pager will beep. 

Perhaps one romanticizes the role of the physician/surgeon by focusing on how one saves lives every day without realizing the price the doctor pays -- time, family, and youth.Television shows are notorious for portraying the heroic physician/surgeon role, and perhaps I’m guilty of watching too many episodes of ER during my premedical years.  

The more realistic and fitting role for me, as I see it today, is that of a healer who works primarily to improve the quality of life of patients and who emphasizes prevention. This is the role which appeals most to me. To some, like my formal self, 'management and prevention' may lessen the romanticism of medicine... but i grin... Internal Medicine is sexy.

I enjoy writing poetry, but such poems are too personal to post on this blog. The following poem by T. Roethke is one which ‘stunned’ my amygdala.

In a dark time, the eye begins to see,
I meet my shadow in the deepening shade;
I hear my echo in the echoing wood--
A lord of nature weeping to a tree,
I live between the heron and the wren,
Beasts of the hill and serpents of the den.

What's madness but nobility of soul
At odds with circumstance? The day's on fire!
I know the purity of pure despair,
My shadow pinned against a sweating wall,
That place among the rocks--is it a cave,
Or winding path? The edge is what I have.

A steady storm of correspondences!
A night flowing with birds, a ragged moon,
And in broad day the midnight come again!
A man goes far to find out what he is--
Death of the self in a long, tearless night,
All natural shapes blazing unnatural light.

Dark,dark my light, and darker my desire.
My soul, like some heat-maddened summer fly,
Keeps buzzing at the sill. Which I is I?
A fallen man, I climb out of my fear.
The mind enters itself, and God the mind,
And one is One, free in the tearing wind.

A Work in Progress

Last night, someone very special to me asked a seemingly simple question: How do you see yourself?

In retrospect, rather than giving a defensive response, a simple statement such as "a work in progress" would have sufficed.           This answer will always be true, even after you've paid your dues.

Med School Secrets

Ever been pwned so hard that a nodule in your throat made it hard to swallow; dominated royally such that everyone near could hear your sphincter contract?

Not me; not yet at least.
But a hapless fellow decided, inadvertently or not, to BS a Chief Resident. Bad idea... His skin will grow two inches by next month.

The secret to succeeding during the last two years of med school is straightforward: keep a "good attitude."

Synonyms for "right attitude" include the following: being Honest, Professional, and knowing when to keep your mouth shut.

Medical Students and Professionalism ...

Most didactic sessions are interesting and engaging, however, some session one simply has to bravely 'endure'. Professionalism was the topic of today's session.


Highlights:

• One should not spend more than 15 minutes doing testicular exams
• Wear gloves for the pelvic exam
• This is not surgery; no profanity please.
• Avoid unnecessary breast exams
• Patients are not your friends...

There are plenty of anecdotal and famous cases in the media of how physicians have behaved unprofessionally or violated patient rights, so its understandable why some patients distrust physicians or have developed negative stereotypes.
In a perfect world, these sessions would not be necessary.

• oh yeah, and no "mama jokes" in the clinic:

Rating Pain (1-10)

Pondering excessively on the suffering of others seems to cloud my perspective...

In the medical setting, it behooves one to reflect on the existence of pain/suffering because it helps one empathize with patients, presumably enhancing the doctor-patient relationship. Looking at someone in the eyes with intent and expressing sympathy can open a channel of understanding and rapport. Still, no degree of empathy can amend the harsh reality: sick people suffer. As any good Samaritan, you strive to alleviate the experience of suffering-- sometimes to no avail, like standing idle before a burning at the stake.

So as [any] coward, I avoid thinking about its metaphysical origin-- I still cannot find a good reason for its existence. Considering all the meaningless reasons for the suffering of people, why should one bother to rationalize or make sense of them?

There is a box inside of me where at the end of the day, I place all these moments. I make an effort each day to close the box before returning home. As usual, the very next day this sealed box cracks open. If fortune smiles, each will say "...0/10 today.”

3 Passions

Seldom have I got an opportunity to read non-medical literature, a reality that saddens me when I recall the richness and diversity of former undergraduate work. But every so often I come across a poem or a short story that strikes a deep chord . This was the case with "Prologue" from the Autobiography of Bertrand Russell (1967):

Three passions, simple but overwhelmingly strong, have governed my life: the longing for love, the search for knowledge, and unbearable pity for the suffering of mankind. These passions, like great winds, have blown me hither and thither, in a wayward course, over a great ocean of anguish, reaching to the very verge of despair.

I have sought love, first, because it brings ecstasy - ecstasy so great that I would often have sacrificed all the rest of life for a few hours of this joy. I have sought it, next, because it relieves loneliness--that terrible loneliness in which one shivering consciousness looks over the rim of the world into the cold unfathomable lifeless abyss. I have sought it finally, because in the union of love I have seen, in a mystic miniature, the prefiguring vision of the heaven that saints and poets have imagined. This is what I sought, and though it might seem too good for human life, this is what--at last--I have found.

With equal passion I have sought knowledge. I have wished to understand the hearts of men. I have wished to know why the stars shine. And I have tried to apprehend the Pythagorean power by which number holds sway above the flux. A little of this, but not much, I have achieved.

Love and knowledge, so far as they were possible, led upward toward the heavens. But always pity brought me back to earth. Echoes of cries of pain reverberate in my heart. Children in famine, victims tortured by oppressors, helpless old people a burden to their sons, and the whole world of loneliness, poverty, and pain make a mockery of what human life should be. I long to alleviate this evil, but I cannot, and I too suffer. This has been my life. I have found it worth living, and would gladly live it again if the chance were offered me.

3rd Yr

I am scheduled to begin my Inpatient Internal Medicine clerkship today.

Some say the initial learning curve can be a tough lesson...
but I'm game.

John Wooden (October 14, 1910 – June 4, 2010)

If you look up "class" in the dictionary there is a picture of John Wooden.

Truly a great man and a great teacher.

The world has lost a great one....

Revisiting Dr. Death

You Don't Know Jack is a film starring Al Pacino as Jack Kevorkian. Besides Scarface, Attica, and The Godfather, this film is another reason why Al Pacino is one my favorite actors.

The movie is worth the time.

Jack Kevorkian: "When history looks back, it will prove what I'll die knowing."

"I will Pass. I will Match"

In the upcoming months i will be preparing for the USMLE Step 1. This beast is very good at intimidating grasshoppers but I will pray to Manny Pacquiao and Goljan to give me their powers to hammer this monster.