Match Day and Residency!

Match Day was March 15^th. This was the day when all 4^th year medical students in the country discover simultaneously where they will be pursuing their residency. For this entry, I’ll talk about my Match Day experience at Ohio State and where I’ll be doing my residency.

OSU Match Day

Since this is such a pivotal moment in medical school (arguably THE pivotal moment), friends and family are invited to quite a ceremonial affair. At some institutions they go a bit overboard, in my opinion. For instance, at some schools each student opens their envelope at a podium in front of a custom slideshow projection and announces their match to the music of their choosing. It’s… a bit much. Imagine if, amidst all this ostentatious ado, you have to mask your extreme disappointment at matching to an institution you ranked near the bottom? That’s a lot of pressure.

Fortunately, OSU’s process is more relaxed, but no less jubilant. The event took place at Mershon auditorium, and I was happy to be joined by two good friends, Chris and Erick (who happened fortuitously to be in town from San Diego visiting his family). My parents live 7 hours away, but they have made plans to be in town for commencement next month so I urged them not to drive up for this.

The ceremony started at 11:30am at which time several faculty members imparted words of wisdom and shared some statistics regarding the match at our institution. For instance, 75% of students received one of their top 3 ranked programs, 44% will remain and Ohio and 15% will stay in Columbus.

At about 11:45am we filed on stage to find our envelope and retake our seats. At exactly noon a horn blared signaling that it was time to open our envelopes simultaneously. A few intermittent shrieks of excitement blossomed into a gleeful cacophony, at the peak of which I was still fumbling to open the folded piece of paper concealing my fate. Flustered and embarrassed, I finally managed to unfold it. Here’s what I saw:

I got my first choice! I’ll be moving to Pittsburgh to be a neurology resident at UPMC—the University of Pittsburgh Medical Center. My brain was so flooded with serotonin, dopamine and endorphins that I can’t quite recall how I reacted, but I think I gasped and then laughed from relief and elation (I’ll discuss why I ranked this #1 in the next section).

Afterward there was a reception with cake, cookies, coffee etc, as well as a merchandise sale (of course). I ended up purchasing a coffee mug the read “Future Doctor” with “Future” X’ed out, and the face of Brutus Buckeye (the OSU mascot) underneath. Appropriate, though a couple months premature.

Afterward I went to lunch with Erick (Chris returned to work) at Mozart’s Café, a favorite little eatery of mine because it features live classical piano music. Finally I could relax. While there I received a call from the neurology residency program director congratulating me, and I think I somewhat effusively thanked him and expressed my delight at having matched there.

Neurology at UPMC

Countless factors contributed to ranking UPMC Neurology #1. The following are just a handful:

1. The program. I won’t go into depth about this for fear of leaving the impression that I’m somehow advertising. If you want details, then Google will come in handy. Suffice it to say the curriculum structure, robust didactics, broad training and educational opportunities will provide me with a solid academic and clinical foundation with diverse opportunities for fellowship. It’s also highly flexible, offering several tracks that allow you to customize the emphasis placed on clinical or research activities.

2. The Location. I’m thoroughly excited to move back to Pittsburgh. I was looking for a city that wasn’t too large, expensive or congested (I avoided New York, Chicago, LA and DC) but has rich culture, especially in music and performance. I also have established social connections in Pittsburgh, and my parents are relocating to the region (from Maryland) next summer. The city has changed dramatically in the past 20—even 10 years. Its economy is booming and it was named the most livable city in 2010 by Forbes.

3. The Residents and Faculty. I thoroughly enjoyed the personalities of every resident I met (two of whom are OSU alumni), and the faculty is comprised of academically impressive and highly personable individuals. The resident class size of 7 is about right for me, too. I’m certain I will enjoy working with everyone.

4. Prelim Year. As a bonus, the internal medicine preliminary year (as this is a categorical residency, thankfully) permits 4-5 elective rotations—more than I remember encountering in any other program. I think this will go far in reducing stress and rendering a more diverse experience.

The icing on the cake will be my housing situation. I will be moving into the 3^rd floor of the house owned by a good friend of mine who is on faculty at the University of Pittsburgh. The house is located such that it’s a 5 minute walk to the main hospital and only a 2 minute walk (if that) to the Veterans Affairs Hospital. The top floor includes a bedroom, a guest room, a living room, a bathroom, a kitchen and a storage room. It’s essentially a self-contained apartment, and he’s charging me next to nothing to rent it. I can’t conceive of a better living arrangement! I’ll be saving a ton of money, all the while living comfortably and within a few blocks of all the hospitals. Somebody pinch me.

At the moment I’ve in full vacation mode. I finished my Last-Medical-School-Rotation-Ever last week (ophthalmology) and spent most of my spare time filling out tons of residency paper work, getting my blood drawn, peeing in cups to prove I don’t abuse drugs, getting my TB test done etc. Now I’m “home” in Maryland visiting the family until Commencement on May 2^nd. I intend to enjoy myself thoroughly for now because come mid-June, the real horror begins…

Stay tuned.

Medical School = Almost Finished!

I am more than halfway through my 4^th and final year of medical school, and more than halfway through residency interview season. So much has happened since my last blog post that I could never adequately summarize my experiences in a single entry. Instead, I’d like to take this opportunity to discuss five things about which I am commonly asked and/or about which those unfamiliar with the medical training process can be mystifying:

(1) What happens prior to residency?

(2) What is residency?

(3) Which residency am I pursuing?

(4) What is the interview process like? and

(5) What happens between interviews, graduation and residency?

What happens prior to Residency?

Medical school is a four-year education during which time everyone receives roughly the same training nationally to establish a core medical knowledge and clinical skillset that will be refined and specialized in residency.

The first two years of med school are typically lecture-based basic science with some clinical skill education thrown in. At the end of these two years, we take the USMLE (United States Medical Licensing Exam) Step 1, the first of three rounds of boards required for medical licensing. The score for Step 1 largely determines your competitiveness as a residency candidate (see below) and thus it is common for 2^nd year medical students to spend 8 hours a day for 2 months (give or take) in preparation for this 8-hour exam.

The 3^rd year of medical school is spent in rotations at the hospitals and/or clinics. At OSU, they were divided into 6 core rotations, about 8 weeks each of Internal Medicine, Surgery, Family Medicine + Elective, OB/GYN, Neurology/Psychiatry and Pediatrics. This is largely where students discover or confirm their specialty interest, which helps plan the 4^th year.

4^th year is essentially a fine-tuning of skills and a preparation for residency. In the early part of the year, students take more in-depth and rigorous 4 week rotations (called sub-internships), begin the residency application process and take the second round of boards called the USMLE Step 2. The second third (or so) of the year is interview season (more on that below), and the final third of the year is spent in elective rotations and assembling a residency match rank list.

What is Residency?

Broadly speaking, residency is a specialized training that all medical school graduates must complete during which a doctor’s knowledge and clinical expertise are expanded and refined in a field they elect to pursue somewhere along the course of medical school. Depending on the specialty, it can range from 3 years (e.g. internal medicine) to 7 or 8 years (e.g. neurosurgery). Because surgery residencies differ a bit from medical residencies, I will restrict my discussion to the latter since I am more familiar.

The first year of residency is synonymous with “internship.” So a medical intern is a medical graduate (M.D. or D.O.) in their first year of residency. This is also referred to as a PGY-1 year (post-graduate year). Regardless of the medical specialty, it is spent in internal medicine in order to lay a firm clinical groundwork crafted from broad exposure. For those pursuing specialties other than internal medicine, this intern year is referred to as the “preliminary” or “transitional” year, but it is nearly always identical to the “categorical” year of an internal medicine intern.

The next several years are spent in the specialty of interest. As the years progress, their training wheels begin to fall off and there is less and less oversight from attending physicians (the truly autonomous docs who have completed residency).

Upon completion of residency, there are still two options: (1) Pursue a fellowship to subspecialize or (2) go straight to autonomous practice and become an attending physician.

It might be useful to note here that although resident physicians live comfortably (around 50k/year), it’s the attending physicians who make the real “doctor money.”

Which Residency am I Pursuing?

It will come as a shock to none of you that I will do my residency in neurology. However, I did have brief love affairs with dermatology and hematology/oncology, but these were before I had the neurology rotation in 3^rd year that reinforced my ardor for the field. Here is an excerpt from my personal statement (a component of the residency application) that drives the point home:

“My very first neurology patient during clerkships sparked a fascination with neuroimmunological conditions. Before I examined her, I read on the census that she was a young girl with “NMO” written in the diagnosis column. Neuromyelitis optica was not even mentioned during the first two years of lecture, so this was an exciting opportunity to investigate something new. She shared invaluable insights concerning the myriad ways her condition impacted her life and raised my consciousness to the daily struggles of patients with chronic neurological challenges. Researching NMO precipitated an enthusiastic drive for exploring related neuroimmunological conditions such as multiple sclerosis and stiffperson syndrome. I never imagined the thrill I would experience from eliciting neurological exam findings and analyzing MRI films. Enraptured by my patients’ stories and sympathetic to their struggles, I was awed by the growing assortment of available treatment options and excited by prospective managements emerging from current research and clinical trials.

The compelling features I recognized in neuroimmunology extrapolated easily to all of neurology, and before long I felt that I was truly in my element… [redacted]… I experience the neurologic exam as a pleasurable and illuminating puzzle that, with the aid of a few tools, actively engages my critical thinking skills and medical repertoire. Graceful in its refined simplicity, when combined with logic and reason it yields powerful clinical information.  Moreover, it became evident to me the enormous impact neurologists have on patients. They wield the potential to restore cognitive function and rehabilitate bodies, essentially returning normalcy to the human experience. Even for patients with debilitating neurodegenerative diseases, the neurologist is a supportive companion who offers interventions to lessen disease burden and provides comforting care.”

What is the interview process like?

The residency application includes a personal statement, multiple letters of recommendations, medical school transcript, summary of USMLE board scores, lists/descriptions of research, awards/honors, extracurricular activities, etc. It is submitted electronically via ERAS (Electronic Residency Application Service) to any residency program of interest. The residency programs may then invite you to an interview. They typically interview 10 times as many students as they have slots for residents.

The interviews themselves, which take place in the late fall and early winter, are quite fun. Although we must travel to the program at our expense, most of the time they will accommodate a night’s stay in a high-quality hotel. The night before each interview includes a free dinner at a fancy restaurant (often with bottomless wine servings), the purpose of which is to get to know the current residents. This is vital, since we will be working closely with these individuals for several years. It also provides insight regarding the affability of the social atmosphere at the institution.

The structure of interview day varies, but a typical outline might be this:

8AM: Welcome and program overview (breakfast often included)

9:30AM: Interviews with faculty

-Anywhere from 3 to 8 docs; ranging from 15 to 30min each

12:00PM: Lunch with residents and/or faculty

1:00: Tours

Afternoon: Miscellaneous things like PGY1 year overview from the department of internal medicine, dinner receptions, option additional tours

The interviews are initially intimidating, but I learned quickly that they are generally much fun. When else do we have the complete and uninterrupted attention of some of the nation’s most intelligent and talented physicians? That said, it can feel a bit like speed-dating, a sentiment which I have discovered is largely shared among applicants.

The number of programs to which one applies and the number of interviews one attends varies with the specialty of interest. For instance, it is not uncommon to apply to more than 50 programs in a very competitive specialty like dermatology, or to attend many interviews for bigger programs like internal medicine. For neurology it is recommended that one attend around 10 interviews for the average applicant in order to statistically guarantee a match (more on that next).

What Happens After Interviews, but Before Graduation?

Three main things happen.

First, and most obviously, the final clinical rotations of medical school are completed. For me this will include outpatient cardiology, ophthalmology and radiology. I think all three of these will assist me both in my intern year and my neurological training, which is why I chose the latter two as my electives.

Secondly, both residency applicants and residency programs assemble their respective rank lists for the match. To find out more about the match, you can go to www.nrmp.org but I will provide a summary:

Each applicant and residency compiles a list that ranks a program or candidate, respectively. Then the NRMP uses a sophisticated algorithm (in fact, the inventor won a Nobel prize) to fill all the available positions in a double-blind fashion while attempting to give each applicant and program their top choices. There is never a guarantee that you will get your top pick, regardless of competitiveness, thus it’s important to rank only those programs to which you’d be happy to attend. On the other hand, one must be careful to rank enough programs to avoid not being matched.

On March 15^th, otherwise known as Match Day, every 4^th year medical student and every residency program discovers, at roughly the same time, who matched where. It is a very exciting day. (Yes, that is an understatement.)

I will become a doctor on May 2^nd, and begin residency on July 1^st.

I hope that clarifies things. If you have questions, please leave a comment and I will address it there directly or alter the post. Thanks for taking the time to read this lengthy entry!

Andrew’s Demented Summer—Literally and Figuratively

Medical students only get one real summer vacation in the course of their education: the break between years 1 and 2. Hence, this is my one and only official summer vacation (of any meaningful length) for the next four years.

Oh, but there’s a catch. I’m actually working through the vast majority of the summer, principally because residency programs frown upon excessively leisurely medical professionals-to-be. In order to secure a better residency, most medical students therefore use this “break” as an opportunity to engage in salient activities pursuant to their future careers. These include finding clinical internships, working at a medically-oriented camp for underprivileged high school students, heading overseas to provide medical care in poor rural areas or becoming involved in medical research programs. Given my history of neuroscience research in affective disorders and schizophrenia, I decided upon the latter.

I received a Roessler Grant to conduct clinical research under Dr. Doug Scharre, head of the Department of Cognitive Neurology here at OSU. He developed a powerful, useful clinical screening test for mild cognitive impairment and early dementia called SAGE (Self-Administered Gerocognitive Exam). I can’t describe my work in too much detail since my research hasn’t been published yet, but essentially I am establishing normative data and performing statistical comparisons between SAGE and MMSE (Mini Mental Status Exam) scores in order to implement SAGE as a community-based screening tool.

So, what is dementia anyway, and why is a screening tool important? Dementia is an umbrella term for brain disorders that lead to persistent loss of intellectual abilities in memory, language, personality/emotion, visuospatial ability and/or cognition. Alzheimer’s Disease represents about half of all dementias, the pathophysiology of which involves accumulations of two kinds of maladaptive proteins in the brain: extracellular aggregations of an abnormally-folded protein called beta-amyloid, and intracellular (within the neuron) clumps of hyperphosphorylated tau protein. Other causes of dementia can be vascular in nature, toxic or metabolically-induced, related to depression, hydrocephalic, involve Lewy-bodies (as in Parkinson’s) or manifest from varieties of cortical degeneration.

Mild Cognitive Impairment (MCI) represents a transition state between cognitive decline associated with normal aging and dementias. There are potential benefits for the early recognition of MCI given that treatment in the beginning stages may improve the course of the disease. Many barriers prevent the detection of the early stages, such as poor insight by the patient and subtleties in cognitive impairment that are often overlooked during routine examinations. Although several highly specific and sensitive cognitive screening tests exist, they are often poorly reimbursed, time-intensive and cumbersome for healthcare personnel resources. SAGE was developed to combat these hurdles by serving as a sensitive, inexpensive, rapid and easily administered screening tool for MCI and early dementia.

70% of my job involves various forms of data entry and analysis, and the remainder includes administering SAGE in community settings and shadowing Dr. Scharre in order to become familiar with dementias in a clinical setting. Observing demented patients and witnessing Dr. Scharre’s interaction and examination is very illuminating. For instance, patients with MCI seem perfectly normal until clinical cognitive tests reveal subtle underlying deficits. As an example, an individual might give “concrete” answers to questions rather than “abstract” ones: when asked how a train and bicycle are alike they respond that they both have wheels (they are both transportation devices); or when asked how a tulip is like a rose, they note that they both have petals (the abstract answer is that they are both flowers). Probably the most common manifestation of MCI are memory impairments, but I think this subtle deterioration from abstract to concrete thought processes is the most interesting.

I took a week off from this research in order to have a “real” vacation over the 4th of July. Unfortunately, the bulk of the time spent in Maryland visiting friends and family occurred during the worst heatwave since 2006. I was hoping to get a tan, but I couldn’t tolerate even 5 minutes in the sun lest my skin fry like bacon and my blood turn to gas. I’ve resigned to staying pasty for the summer which, I suppose, is better in the long-run given my genetic predisposition toward skin cancer. Nevertheless, it was great to see the fam’ and visit with friends; I’m already wishing I were back there again. Minus the hot/humid weather and egregious traffic, it’s bliss.

I’m trying to squeeze as much leisure from this summer as I can despite my research obligations. I just finished Carl Sagan’s outstanding book, “Demon Haunted World,” and next I will read a book about Henrietta Lacks (thanks, Aunty!) and “Surely You're Joking, Mr. Feynman!” (thanks, Vania!). I’ve also found new television obsessions, including “It’s Always Sunny in Philadelphia,” “Modern Family,” “Work of Art,” and soon I will hook myself on “House” and “Six Feet Under.” There’s a month left before school starts, so I better get crackin’. I figure that if I O/D on TV now, I won’t miss it so much when I’m drowning in schoolwork. Finally, while I’m on the topic of entertainment, I’ll take this time to recommend what I believe are the two best films of the summer: “Toy Story 3” and “Inception.” If you haven’t seen them, get your ass to the theater.

Spinal Taps and Retinal Defects

As you may recall, we have “preceptorships” for which we are assigned to a community physician to shadow and/or assist once a month. Most students were assigned to internal medicine, family medicine, PCPs, cancer docs and the like—but I was assigned to an emergency medicine pediatrician. You may also recall my trepidation given my a priori disinterest—nay, aversion—to both pediatrics and emergency medicine. Yet my experience thus far has demonstrated that I am prone to misjudge my own interests. Pediatric emergency medicine is… amazing. Allow me to describe (while doing my best not to violate HIPAA) the coolest afternoon I’ve had all year.

[Note: patient demographics have been altered to protect privacy]

The fun started the second I walked into the ER. I arrived precisely on time.

“Good afternoon, as of… now!” I said to my preceptor physician.

She pointed to two large monitors behind me. “Andrew, look at those CT scans. What do you see?”

Even if I weren’t in the throes of the Neuroscience block I would have known exactly what I was seeing, because it was unmistakable.

“I see… a brain herniating through a skull with multiple fractures. How…”

“A car accident,” she said. “The poor kid won’t survive.”

What a way to start the afternoon. Soon after, we were standing at the computer while she discussed patients with one of the residents. Afterward, she started to scan the patient list to determine who to see next.

“Room 30, a 7 year-old boy has a foreign body. I want you to take a history.”

“Wait… what? Me?” I thought at first she was talking to the resident.

“Yes, you. I want you to ascertain the chief complaint and take a full history and report back to me.”

“Uhh… well, what’s the foreign body?” I asked, stunned.

She smiled, “That’s for you to find out. Have fun!”

I had never taken a history from a real patient before—just standardized ones (actors, really). However, my CAPS class trained me well and I gathered all the information I needed. A CT scan later confirmed that he fell on a piece of glass two weeks ago and it had recently become infected.

Amidst the myriad other things that occurred, I witnessed three spinal taps, two of which were performed on infants. In all three cases, viral meningitis was suspected pending the results of the CSF (cerebrospinal fluid) analysis. In order to perform the spinal tap on the 9 y/o girl, she had to be kept sedated with propofol so she wouldn’t jerk around too much when her spine was punctured. Yes, propofol—the drug on which Michael Jackson overdosed. It was a milky-white fluid pushed IV throughout the course of the lumbar puncture because it has very acute barbiturate effects. The girl regained consciousness almost immediately after the drug infusion was stopped. Why Jackson’s “doctor” was using it to help him sleep is beyond me.

Following a very successful Neuroscience 1 exam on Friday, I had an awesome weekend. It started that evening at the Olive Garden with Garrett (that is, after we drove to another location upon discovering that the one to which Garrett’s GPS directed us was boarded-up) and watching Boondock Saints before bed.

On Saturday a bunch of us went downtown to The Big Bang, a dueling piano bar. We stayed half an hour longer than anticipated because it was more fun than any of us imagined. I was particularly unenthused since I’m not a big pop-music person (somehow I doubted they would perform classical music), but once again I was wrong to pre-judge. I was at least familiar with most songs, and sang along to nearly half of them. Most of the fun and excitement results from the personalities of the performers. I think we laughed more than we sang…

Afterward we headed to a wine and cheese party hosted by med students, where I proceeded to over-sample different kinds of wine. Well, first we had to drive back downtown because Garrett forgot to sign his card out at the piano bar. You see, like me he’s scatterbrained--but much worse. I’ve lost track of the number of times he’s left important things at my house and other places (phone, keys, etc). The extent to which it’s endearing outweighs the fatigue on my ocular muscles from the exhaustive eye-rolling.

Sunday was another exciting day. After recovering from the wine, a bunch of us went to see Sarah in RENT, performed by the Emerald City Players. It was entertaining, except for a few very pitchy singers (not Sarah, of course). Then we celebrated the purchase of a new grill by hosting a BBQ at our place (officially called “OMGWTFBBQ!”). We had 20 or 25 people over, and lots of food. Good times were had.

Finally, I discovered something interesting about myself at my eye exam today. Apparently, I have a small hole in the upper corner of my left retina. They told me there’s nothing about which to be immediately concerned, but they want me back in 6 months to see if there’s any change. In the meantime, I’m to be on the lookout for any flashes of light or other bogies out of the corner of my eye. Worst case scenario? My retina will become detached. Is this likely? Fortunately, no. If the hole were a small tear there would be greater cause for concern, but unless I suffer brutal trauma to the eye it’s unlikely to become exacerbated. Normally they tell patients about a quarter of what they told me regarding this anatomical flaw, but they said since I’m a medical student I could probably handle fuller detail. I appreciate that. On the other hand, as a medical student I’m already a hypochondriac and overly concerned with slight medical maladies.

In short, I’m not terribly worried about this slight retinal defect. I am worried, however, that I won’t be able to read my music at band rehearsal tonight because my pupils are still super dilated…

A Respite for the Weary

It’s been exactly three months since my last blog post. My bad. I wrote in fits and starts but never completed any of the entries (for instance, I drafted a long-winded entry on cancer during our Neoplasia unit. Perhaps I’ll finish it and upload it post-hoc).

The truth is, school’s momentum has intensified during the past three months. I realize now that the first several months of medical school were simply a warm up—an induction for the rigors to come. Gauging by the counsel of older students, it’s clear that this epoch of our education is the most ruthless of the first two years (aside from board preparation which takes place at the conclusion of Year 2). Much of what follows is a long-winded whine about medical school stress. If you don’t wish to endure that, I suggest scrolling nearer the end (after the ***) :-)

This tyrannical academic chapter is called the “Host-Defense” block, and the low exam averages during this period highlight the duress it precipitates. Aware of this oppressive chapter in our education, the school reminded us at the onset of the block where we can seek psychological support and gave us a stern, ominous warning not to fall behind (because we’d never catch up otherwise).

What is “Host-Defense?” It’s getting hit by a train and then drowned under water beneath the weight of the sunken Titanic. That’s what it feels like, anyway. Really it’s our first in-depth exposure to truly useful, relevant, scientific and clinical medicine. Host1 was concerned with blood-related pathologies (anemias, blood cancers, immunology etc). Host2 encompassed the entire month of February and early March and was concerned primarily with bacterial infections, mycology (fungal infections), autoimmune diseases, lots and lots of pharmacology related to bacteria/fungi, and many other related domains such as sepsis. Host3 begins tomorrow and seems to encompass parasitology, STDs, viruses and other miscellaneous infectious processes. In short, Host-Defense covers what can infect you, how it infects you, how it affects you, and how you can treat it. Real medicine.

So, why’s it so hard? There are two main reasons: the impossibly large and incessant volume of information, and the peri-academic demands placed upon us during this episode.

First, the academic strain: I will try to put this in some perspective. On average, we receive three 1-hour lectures each morning, each of which consists of a powerpoint averaging 45 slides worth of information (although the slide-count can range between 30 and 80). Unless specifically told by the professor, we are responsible for everything on those slides—every last detail. In Host2, there were 40 powerpoint lectures for which we were responsible. In addition to the slides, we are given a course packet, which in Host2 consisted of 329 pages. Some of this is supplementation to the powerpoint content, but we can be held responsible for information found in the course packet which was not specifically addressed in our powerpoint-driven lectures. In essence, it’s a shitload of information.

Since we, as medical students, are better understood as “professional studiers,” this wouldn’t be such a big deal (though still formidably knee-knocking) were it not for the ancillary demands and pressures place upon us. I won’t describe them in detail, since I have done so in previous posts, but I will enumerate them (at least as they apply to me):

1. CAPS class (Clinical Assessment and Problem Solving): Our weekly 3-hour afternoon class that dicates additional assignments for us including:

a. Preceptorships (I will discuss this later in the entry)

b. Senior Partners Program assignments

c. OSCE examinations (clinical skills practicals)

d. Community Projects (for which I volunteer at Goodwill and teach Pilates, give trumpet concerts and conduct nutritional seminars)

2. The deadlines for several extra-academic projects take place during the month of February. The application for summer research scholarships demanded a significant amount of time from many students because of its exhaustive nature. Countless hours are committed to this that would be useful in preparing for the Host2 exam. Additionally, tax forms must be filled out (thanks, dad) so the FAFSA application can be completed by March 1^st. These things become a nuisance when you have over 300 pages of information to commit to memory.

3. Concert Band rehearsals and concerts. These are mostly welcome, but sometimes feel like an impediment. Often during the week of an exam (and in the two weeks leading up to the Host2 exam in particular), I would be extremely and embarrassingly out of shape for rehearsals because I couldn’t spare the time to “put horn to face,” as my dad says. As principal trumpet of the ensemble, I shouldn’t be so inconsistent in my adroitness, but I don’t have the capacity to practice for several hours a day unlike the music majors in the group. I know as lead trumpet I shouldn’t make any excuses; I take comfort knowing that this is the roughest it will get, and that my playing will be more reliable in the future.

4. Living life. I try not to be one of those medical students who studies all day every day much to the detriment of their development as an individual. I try my best to stay abreast of current affairs, stay fit by attending the gym several times a week, have an active social life that doesn’t revolve simply around studying—and I even started dating again. I want desperately both to stay in touch with “reality” and stay well-rounded.

5. Finally, I was very ill at the beginning of the block, and fell behind early. Stuck in bed trying to recover, I didn’t have the wherewithal to study and I was forced to reschedule several events, like my preceptorship.

***

This brings me to the Host2 exam. Kelsey (my splendiferous study buddy) and I worked very hard together (and had a lot of fun, per usual) preparing for this exam. It paid off. Especially considering the daunting nature and infamous reputation of this exam, I’m happy to say I scored far above the average. I hate to brag—I really do—but I worked my ass off during this particularly grueling period (certainly the most demanding of my life thus far, considering the duration of the strain). By the way, it was 110 questions and 2.5 hours long. I’m thrilled to enjoy the first free weekend I’ve had since… perhaps since winter break. And it’s sunny!! It feels as if the universe is smiling at me.

I want to talk briefly about my preceptorship. Firstly, what is it? It’s a hands-on clinical learning experience for which we’re matched with a physician with whom we meet monthly. I was assigned to work with a pediatric emergency department physician. At first I was very anxious; the two fields in which I was almost certain I didn’t want to work were pediatrics and emergency medicine. So, naturally, I got both in one. Then I realized how this could benefit me—it’s good to expose yourself to that which you consider to be most uncomfortable.

After rescheduling (owing to being sick), I worked for 9 hours in the ER of Nationwide Children’s Hospital… and had a blast. I couldn’t believe how much fun it was (aside from seeing some horrifying things). At this time I’m not certain about which I am permitted to write due to HIPAA, but suffice it to say I’m much more interested in pediatrics and emergency medicine than I was before. I also really like my preceptor. She’s an exceptional physician—great with kids, a fantastic teacher, and she asked me excellent questions (I was stunned to realize how much I knew. I guess medical school is working).

I’ll ask around to see how much detail I can describe concerning my preceptorship experiences (my next one is scheduled for this Friday), so until then I’ll hold off.

Now for something cool. I want to share one of the grossest pictures we came across in Host2. Unfortunately, I cannot reproduce the image here in full due to copyright infringement, so I had to find a weblink for it. However, it’s low resolution and has an annoying graphic on it. Hopefully you’ll get the gist.

This is mucopurulent cervicitis (pus-filled, infected cervix) colonized with Chlamydia trachomatis. This is why you should have protected sex, ideally not with strangers. Chlamydia is the most common STD, beating out both gonorrhea and syphilis.

Our un-indefatigable sink

I came home from lecture last week to discover that our smaller kitchen sink (the one connected to the garbage disposal) was clogged, and there were 6 inches of turbid coffee-ground water staring up at me.

“Oh, that’s fun,” I muttered to myself.

I won’t name names, but someone regularly dumps coffee grounds down the disposal drain despite clear and abundant warnings not to do so. Incidentally, this is the same person who just moved out of the house, leaving us to find another 4^th roommate. Figuring that the individual responsible for the clog would return to restore order to the plumbing, I left the house to study. Upon my return I noticed that the entire kitchen floor developed a lake of brown water. Apparently, after the dishwasher was run, the water attempted to drain through the disposal pipes but was promptly impeded, backing up to the dishwasher and spilling out onto the floor.

“Marvelous,” I sighed, my socks drenched with coffee water.

Long story short, the responsible individual acknowledged the mistake but failed to adopt onus for addressing the issue, leaving the rest of us to dry the floor and fix the clog. Is this the end of the world? No. Should we be indignant toward flippant disregard for personal responsibility? Yes.

It’s a good thing I find our current material both bearable and digestible, because this past week I had four concert band rehearsals and three concerts, for one of which I had to miss lecture. One of the concerts was a salute to Michael Daughtery, a talented composer, during which each band ensemble performed one or two of his compositions. On Friday there were two “Celebration Concerts,” a large-scale tandem performance of most of the musical groups that comprise the school of music.

I came across the most awesomely hideous medical entity recently. It’s called a teratoma. It results from “uniparental disomy” of the entire genome. In other words, the offspring inherit both sets of homologous chromosomes from the same parent. In the case of a teratoma, the chromosomes come entirely from the mother (if they are from the father it results in a hydatidiform mole, which is less gross). It results in a tumor consisting of tissue derived from all three germ layers, including hair, teeth, bone, and in some cases more complex organ structures (eyes and limbs). Take a gander:

Best Lecture So Far... plus some random stuff

Today I had the best lecture to date in medical school. Rather, I had the best lecturer; the content (epidemiology) isn’t terribly interesting on its own—although it’s highly important. If you’re curious what it is, here is the official definition from my lecture notes: “The study of the distribution and determinants of health related states or events in specified populations and the application of this study to the control of health problems.”

Why is my instructor so awesome? In addition to more customary lecturing skills (talented oration, lucid enumeration, logical flow etc) and his use of television examples (from Seinfeld, Southpark, Maury Povich), he illustrates principles with examples from reality that highlight patterns of magical thinking that are rampant in society. In other words, I can tell that he champions critical thinking and skepticism—subjects near and dear to my heart.

For example, to emphasize the importance of validity in evaluating a treatment strategy--despite it having high sensitivity or reliability--he called attention to the use of so-called “facilitated communication” which purports to allow communication with an autistic individual (or anyone else with limited-to-no communicative faculties) through a “trained” facilitator. You can read more about it here. Though this “skill” can sometimes appear convincing, it fails utterly under even the slightest amount of scientific scrutiny. If you want to see the damage of which this kind of pseudoscience is capable, go here. By the way, while I’m on the topic of autism, vaccines do not cause autism, nor is there any evidence whatsoever to suggest that they do.

When I have my medical degree, I plan to devote much of my energy to fighting the insidious infestation of pseudoscience masquerading as medicine running rampant in this country. This includes facilitated communication, therapeutic touch, reflexology, homeopathy, faith healing, reiki etc. For a fairly comprehensive encyclopedic entry of these and other forms of quackery, visit this site.

Alright, I’m hopping down from my soapbox now. The Cell1 exam was 2 weeks ago and I survived! To celebrate, my housemates and I hosted another brunch—and it was heaven. I think there were about a dozen people altogether, and we made a ton of food. I experimented with the scrambled eggs by adding milk and pancake mix (I remembered seeing this on the menu of an IHOP) and it made them super-ultra fluffy and delicious! I recommend this for all of your future scrambled egg endeavors.

Concert band is making my life crazy and sucking all kinds of study time from me. Not only was our first big concert the night before the Cell1 exam, but my Thanksgiving break was truncated due to rehearsals I had to attend, causing me to leave late and return early. In addition, there are two extra rehearsals this week and three more (mini) concerts. Agh! I have crap to learn, people! On the bright side, the lecture material for Cell2 is much more palatable, and studying is much more tolerable. On an even brighter side (there are three sides, OK? Get over it), my director offered me a paying gig on December 13^th, woohoo! Money! I can use that!

My dad has informed me that we’re changing the dynamics of our Sprint family plan; I will soon be getting a smartphone for the first time in my life (and I’ll finally have the capacity for internet usage and unlimited texting!). I can’t wait for my new phone. My current one is only nominally functional. It only rings/vibrates when it feels like it, so I often have missed calls/alerts. I’m planning to get the HTC Hero with Google as my new phone.

Here are some random thoughts upon which I would expound had I been updating my blog more regularly:

1) Stacy is moving out. We need a new roommate. ASAP. Pain in the butt.

2) Something is wrong with our sink drain and/or disposal unit. Annoying.

3) Obama is doing many things to disappoint me.

4) Just when I think my disgust with Sarah Palin can’t possibly intensify further, she proves me wrong.

5) I drink waaaay too much coffee.

6) All of the med students are required to render a piece of art somehow illustrating professionalism or humanism. Yes, Required. No further comment.

7) I went to the Melting Pot for the first time last week. Wow. Me gusta.

8) I love Glee. Like, a lot. Also, I recently discovered that I love Lada Gaga. Who knew?

I’ll do my best to update more often. I forget 98% of the stuff that happens to me. Perhaps I have beta amyloid plaques and neurofibrillary tangles of tau protein…