A Long Road to Medicine

A week and counting before I ship back to B-town "waiting for my real life to begin".  These last few months has taught me the limits of my body and mind, knowledge that will hopefully keep afloat during 3rd year.

For the past 3 weeks, I haven't spent less than 15hrs/day in the lab including the weekends.  Today I finally get to come home before 3am, and to celebrate I'm going to write.  :D

As I've said before, this blog is to record my thoughts while I'm going through all this stuff so I can remember the road I've walked when I look back sometime in the future.  As you can tell, I haven't really written much, but for two different reasons.  The first is obviously I haven't had time.  The second is that I'm kinda tired of the sort things I've been putting in here; its just been about what I want and... well.. what I want.  I guess in a way that portrays my desperation and anxiety but it sounds a bit whiny.  Thus, I want to change what I put in here and in turn the way I'm thinking about stuff.  In the future, it'll be more reflections about my career or anecdotes from work.

But for today, you get a rant about my work hours.

I really did it to myself.  Had I been compiling my thesis like I was suppose to, I would have realized all the experiments I could/should have done for some of the aims.  Instead, like an ass, I'm writing while trying to pull together new experiments for figures.  Perhaps most grad students know about the consequences and like me are equally as lazy to put it off toward the end?  I dunno.  All I know is that I'm writing in the mornings from 10am - 7pm and then going to lab and working to usually 3am.  Throw in 6 hours of sleep, rinse and repeat -- thats been my life for the last 3 weeks and probably will be until I finish my thesis.  I have about another 4-5 weeks before I have to submit it to the committee head (Adam) and then for the rest of April, I'll be review (once again) stuff from Step 1 while doing a few more experiments to wrap up my paper.  I move the last week of April/first week of May and prepare for my defense by the second week of May.  After the defense, I'll be working on my thesis edits and studying for my clerkship. 

I do feel rushed, but not entirely overwhelmed and not at all hopeless.  I feel like this is all feasible, so no stress yet.  Perhaps its a sign that I'm finally disciplined enough to work ahead and keep a schedule?

The party never stops!

A mirror of this blog over at Blogspot.  I kinda like it better due to the cleaner, NEJM-esque look.  I'll continue to double post as much as I can.

Its nearly been a year since I started this blog, chronicling my thoughts and troubles as I've been coming to and end with my PhD.  Just going through some of my old posts, I felt compelled to update and give closure to some cliffhangers:

• So after all that hassle with getting my 3rd year schedule together and then postponing it, I ended up not returning last year (as you can tell).  However, I'm right back at the same point again, but this year they're doing it differently.  They have "premade" schedules that you have to rank in preference; you can't arrange the blocks like before to the order you'd like.  Hopefully I'll be as lucky as I was last year with placement - we'll know in a few weeks.

• I ended up taking my Step 1's late in 2007.  Let me tell you, it was a nightmare to study for, but it's also 6 years out from the last time I even looked at a medical textbook.  I've never felt such anxiety and pressure and emotional turmoil in my life.  I'm sure it had to do with how much I built it up in my mind and the scar it left.  I ended up doing as average as I nationally can; nowhere near where I wanted to score.  But the more I studied, the more I realized that with the book(s) I was using, there was a limit to how well I could do (which I'm sure added to the already absurd amount of stress I felt).  Even if I knew the books cold, I would probably still not be near what I wanted to score.  I definitely didn't do as many questions as I should have - something I'll be doing differently next time around.  As I've belabored, perhaps this is a good thing; what I need in 3rd year is a hunger/desperation to do well, not confidence that I'm just as good.  Looking back, all the stuff about ranking schools and stuff was so silly - I'd be lucky if I can manage 2nd tier schools, let alone the top 10.  Then again, perhaps I needed it to keep sane during that ridiculous time.

• After talking to PD, I know I still have a good chance to get into a good IM program.  I just have to get my act together and do well 3rd year + own Step 2.  While this still gives me hope for medicine, what I'm afraid of is what if I end up liking Surg?  I don't know if Surg programs are as forgiving with Step 1's as IM.  Ah well.  Till the time comes, I won't sweat it.  Another bit of insight that I forgot to mention was how PD didn't really seem interested in my extra-curriculars.  He didn't even bat an eye at the NSF fellowship.  He's so focused on the fact that I'm a MD/PhD and the time it took me, I don't think if I had the clinical research fellowship, it would have made much of a difference.  "One has to wonder your focus if it took you so long," is what he said.  This leads me to believe that broader interest and more time probably isn't a good thing.  Looks like the NIH idea is out.

• Rewriting my thesis as we speak.  Its still a lot of work, but not nearly as pressed for time as last year.  I do have to submit it by the beginning of April if I want to move back to Boston and have my defense during the first week of May.  As long as I keep cranking, I'll be in good shape.

As an aside to our meeting, PD gave me a few pointers on how to Honor 3rd year clerkships:

Just got back from meeting with a Program Director (lovingly referred to as PD from hereon in) of Internal Medicine.  I want to quickly record the main points from our meeting:  

Again, more wasting time when I should be studying, thinking about things that much too early for me to worry about now.  This time, its about the type of residency I should go into, ie specialty.

Some may already know that after medical school, in order to be fully licensed to practice, we need to undertake further training and pass subsequent certification exams.  This post-graduate training (aka residency) can range from 2-8 years depending on what you're looking to do.  Most primary care fields (or those that look at your medical problem first before sending you to a specialist if needed) such as Family Med, General Internal Med, Peds are pretty short (2-4 years post-grad).  Internal Medicine subspecialties like Gastroenterology (GI), Cardiology, etc, have to match into a secondary training program (called a Fellowship) after their Internal Medicine residency, tacking on an additional 3-4 years.  Surgery is similar to Internal Medicine in that their docs also have to do a "general" residency before having the option to train in a subspecialty like CT Surg or Plastics.  There are some specialties that don't have this "general" residency and start you on a very specific track for 4-7 years such as Ophthalmology, Neurosurgery, and Emergency Medicine.

Selecting your field is equally/more important than where you get trained, since unless you want to do a second residency, you're stuck with your selected specialty for the rest of your life.  Because of that fact, I can already safely say there are some fields I know I don't want to go into.

On the No-no list already:

• Urology - they make bank, but I can't imagine looking at penises all my life.  Straight foward surg specialty, not much else to it.
• Ob/Gyn - as amazing as the birthing process is, there's no market for a male Ob/Gyny, not to mention the hours are horrible.
• Derm - extremely competitive, FANTASTIC life style (9-5, 4days a week), but not intellectually engaging at all.
• EM - protected hours (can be in the middle of the night though), high stress and based more on fast judgment medicine/triage than clinically based deductive treatment.

Ambivalent list:

• Anything Peds - I really won't know if I like working with sick kids until I actually do it.
• Oncology - interesting research-wise, not sure what the life-style and clinical aspect entail.
• ENT - no clue.

Interested list:

• Interventional Cards - spend the majority of my medical career geared toward this; my PhD was in the cardiology field, however its the longest in terms of training (8 years post-grad!!!) with moderately stressful lifestyle.  Very open for research and Internal Medicine residency provides a more complete training.
• Neurosurg - a recent interest, but other than the heart, the brain is really the only other organ that interests me (can change in the future).  Really competitive right out of medical school though; rumored to have one of the worst lifestyles (supposed 85% divorce rate!), very malignant residency.  On the other hand, it is in my opinion the most intellectually challenging field with cutting edge research.
• Orthopaedic Surg - a completely left field choice since it has very little to do with research or intellectual challenge.  Its completely procedural and physical, usually considered to be the most "jockish" of all medical specialties.  However, every things they do usually has dramatic affects on the patients.  It also has a sense of elegance due to its straight foward form-to-function approach.  The hours are like any other surg, but the pay is great.

The here's the thought:
Before heading back to medschool, try to snag both the GSR Fellowship and the other research award.  Talk with the financial aid office about all the gajillions of merit and need based awards that weren't made known to the student body before.  Try and snag 1-3 of them due to my reaching the federal lifetime maximum for Stafford loans.

Once I get back to med school, make sure to join up with AMSA and the school's Global Health Organization.  This way, I'll automatically have mentors (faculty advisors) involved with international health and medical education advocacy.  That way, when comes Jan of my 3rd year, I can begin applying for the Fogarty International Clinical Research Fellowship.  Apparently, the David L. Boren Fellowship can be applied for in conjunction to supplement the NIH/FIC funds.  If I can demonstrate adequate cultural learning, it'll be a 2-fer!

There you have it.  My boss finally "officially" asked me to stay another year.  No more head games, finally time to settle back down and git'r done.

Just submitted my abstract to American Heart Association's Scientific Sessions.  It was actually kinda fun putting it together, completely different from my previous experiences.  Yet, I have to wait and see if its accepted since, unlike other meetings, AHA only selects top 30% of the abstracts submitted.  Like the boss says, a lot of good science gets passed up at this meeting.  We'll see.