Boonshoft Blogs

The busy-ness of fourth year continued into the second semester. For the first two months, I completed rotations in adult nephrology, pediatric radiology, ENT, and Ophthalmology. These proved useful rotations in allowing me to more fully understand the scope of these practices (ENT was the most surprising and the most fun!). The goal of these rotations was to soak in as much information and broaden my scope of knowledge, one specialty at a time, as I might not have the chance to complete specific rotations in them during residency.

In the midst of these rotations, I completed my last residency interviews, constantly pondered, and finally submitted my rank list. A three-week waiting game to Match Day (the day medical students find out their residency program/location) then ensued. The day was surreal, the emotions ran high, and it was definitely one of the most intense days of my life from the countdown (the day of or from the last four years :P) to mentally processing the results afterward. I matched into Internal Medicine-Pediatrics (Med-Peds) and can’t wait for this next phase of training!

During Match month, I began my Emergency Medicine (EM) clerkship, which I loved. The residents were great to work with and I really enjoyed the acuity and being the first person to see the patient. This rotation helped direct my thinking and thought process in ways I was not used to. I learned that in the ER the goal is to rule out life-threatening illness, stabilize the patient (to eventually go home or to be admitted), rather than try to seek a definitive diagnosis.

Once EM ended, I headed to Lebanon for two weeks to visit my extended family. The weather was wonderful, the food was excellent, and the adventures were endless. I can’t wait to go back again! Upon getting back from my trip, I immediately started my general pediatrics sub-internship. Long days followed (11.5 hours each day), but I thoroughly enjoyed this rotation. It helped better prepare me for residency and I learned how to manage my time more efficiently as more responsibility came with this experience. The last day of this rotation marked my last day of medical school, which is so hard to believe because the time has flown by so quickly.

Graduation is in 10 days. Sometimes when asking others how they are doing they reply with a drawn out, “Livin’ the dream.” When I think back to the last four years of medical school, I can’t help but think, “I am literally living my dream.” My 5-year-old dream of becoming a doctor will soon become my reality. I will continue to cherish the lessons learned, friends made, patients met, experiences and growth during my time in medical school. Despite the ups and downs, these were some of the best four years of my life and I wouldn’t have it any other way. Medical school is definitely not a journey to be taken alone. Words can’t express how appreciative and thankful I am for all of the support from my family, friends, and the Boonshoft School of Medicine for helping me reach this point.

Next stop…Residency!

Rank lists have officially been submitted. Match Day is just a few short weeks away. I wanted to make a quick post about my thoughts on the interview season. First and foremost, the interview process is a game, But I will touch on this a bit later. 

Going into the application cycle, I was honest with myself and knew I would not have my choice as to where I wanted to go. Ideally, I wanted to end up back on the East Coast closer to my family, but my overarching goal like most was to MATCH. I also knew that a community (Independent Academic Center) program was more my fit. You must be honest with yourself and be realistic. I applied to a lot of programs. Applications were submitted in September and from there it was a waiting game. The first few interviews I got were exciting. It put the wheels in motion that this is really happening. The process of determining where I will end up for the next few years was starting. It was surreal at first. After my first few scheduled interviews, I hit a lull. It was almost the end of October now and I had only a handful of interviews. Now the pessimist in me was taking over. Is this it? Am I going to match? What’s the worst-case scenario? I met with some faculty who reassured me that there was still time in the interview season. Nonetheless I was nervous. I started reaching out to schools. Looking back, I wish I had done this earlier, but I made a lot of phone calls and emails. Reaching out to schools definitely works. Maybe not right away, but they keep you in mind. I ended up with 10-14 interviews. I feel like I was approached by multiple people, both classmates and other applicants, each trying to determine how many interviews I had. I was guilty of it too. I feel like it's more of a way to determine if you’re on the “right track” as far as the number of interviews. But, looking back, I don’t care how many interviews people ended up with.

Overall, the interview season was a lot of fun. Aside from the fact that it was super expensive, and I was somewhat tired of traveling by the end. I couldn’t imagine how it must have been for those doing more than 15 interviews. Just the traveling and cost becomes very repetitive. But it was nice to meet new people on the trail. Each had their own story that brought them to this point. I like hearing those stories. I find it very interesting. Then comes the interview day. The program is trying their best to sell you, and I was trying to determine If I could see myself there for the next five years. Some places I vibed with a lot. At others, I quickly realized that it was not the place for me. I also realized that programs started to blur together as the season went on. So, keep detailed notes on each program. I realized that a lot of programs has the same lecture. Great training, early operating, etc. This was all true, after all they are all ACGME accredited. The biggest thing that moved placed up and down my list was how well I got along with the faculty and residents.

I mentioned earlier the process is a game and here is my explanation. Every program tried to sell you. Sometimes fabricating information or even giving you false information. One place I went to was giving me statistics from 2014 because they were better than 2015 and 2016. Your ranked alongside everyone else and most places it’s around 30-60. So your 15 interactions with four to six faculty members will shape where you fall. It comes down to did you say something they liked? It is all super subjective. Also sometimes it hard to judge how interviews go, especially when they ask silly standardized questions. The worst one I got was, “If I asked your best friends to name three qualities about you that you DO NOT agree with, what would they be.” → I was like seriously? Anyhow moving on. Like I said, it is all a game. When it came time to make my rank list, I felt that I knew my top three and bottom three very easily. Everything in between was a bit more difficult. But I was able to talk with friends and family to finally formulate a list that I am happy with. Here’s to Match Day.

I think I may have been rambling, but I wanted to finish this post with some key points I learned as the interview trail moved along. I hope someone may find these useful.

1. Be honest with yourself. What is realistic for you based on your scores and grades?

2. I was told to apply to 1/3 of schools you overqualified for, 1/3 that you would be competitive for, and 1/3 of programs were reach programs. I think this is a good idea, but my situation as above was different. That is why I applied to more programs. I applied very broad.

3. Trust the process and don’t compare yourself to everyone else. My brother always tells me to "do you" and not worry about others! That’s what interviews are for.

4. If you’re not getting interviews by end of middle/end of October, consider reaching out to schools you're very interested in. There were some schools that I reached out to and got an interview opportunity the next day. It works. But do it earlier rather than later. By the time I sent emails and calls to schools in early November, many had already filled their spots.

5. Open a credit card with an airline. Get all the bonus miles.

6. Enjoy the interview dinner. Ask questions, get to know people. It’s a free meal, so order dessert. The dinners can sometimes prove to be more important than the interview itself. Also, look at how residents interact. Do they seem like they are friends, or does it look like they don’t see each other often? Do they hang out often? Pick their brains.

7. Interview day. Just be yourself. Prepare questions to ask. Don’t be Boring. ← Boring is the worst.

8. Spend 15-20 minutes the night before your interview or dinner to do some recon on the school.

9. Guys. Always bring an extra shirt and tie.

10. Keep a running list of each program. What you liked and didn’t like. Also, after your interview, as soon as you get out of the doors take a deep breath and reflect how that program made you feel. Good? Bad? Happy? Concerned? I found this helped me a lot personally.

11. When making your list, run any questions or concerns through multiple people. For me my friends/family helped to clear the fog when trying to decide between where to rank programs.

12. Reach out to your top programs letting them know you will be ranking them highly. Don’t do it for all of them as program directors talk. As far as surgery goes, programs I reached out do did not all respond, however I’ve heard on the grape vine, that programs do move people based on this. Take it with a grain of salt.

13. Just as these programs are ranking you, you are ranking them. So, choose places where you can really fit in. Places that will support you. People who will genuinely help you. Someplace you can really see yourself thriving.

14. If programs reach out to you, always respond. I have heard horror stories.

15. Figure out what matters most to you. Is it location? Academic vs. community? Post-residency opportunities? For example, for me having an interest in trauma helped me make some decisions.

16. When talking about interviews and programs realize your classmates may not be in the same situation you are. Just be mindful.

17. Take lots of naps. Watch a lot of Netflix. Enjoy the time off. Make plans to travel somewhere! Looking forward to what the Match will bring. Best of luck to all my classmates, friends, and those around the nation who are applying. I hope we all end up where we want to be.

Currently 3 a.m. on nights in the ICU. The commotion has settled, leaving the beeping of monitors echoing the halls. It is almost peaceful. An opportunity to take a nap. Nights like this are ones to take advantage of, knowing that things can become chaotic in an instant.

This rotation has been one of my more enjoyable ones. While the patients are unfortunately more critical, each provides a learning opportunity. I am constantly reminded of how little I know. While I am sure the 3rd year version of myself has come a long way, there is still so much to study. However, I will say that through the first few years of medical school I was studying mainly because I had to, in that there was an exam that I had to prepare for. Now I find myself looking up concepts or reading guidelines in fear of not knowing and being unprepared as a resident. As a medical student, our jobs are to absorb as much as we can and try to be helpful in the process. However, 9 months from now all that will change. For I will be required to make decisions that will influence the care of a patient and, while it will be exciting to be finished with medical school, it is simultaneously terrifying. To give some perspective, let me provide an example. I was reading about how a patient who was involved in a trauma who came into a hospital. He was triaged and had multiple CT scans performed. A critical result of a superior femoral artery occlusion in the right leg was found. While the radiologist noted this finding in the report, the intern resident was also notified of the finding with a phone call. For whatever reason, this was not properly communicated to the rest of the team. Hours went by before the vascular team was consulted and, after taking the patient to the OR, there was concern that the leg may not be salvageable. Such instances like this where a single miscommunication can lead to such drastic effects is frightening. I can only hope not to make such mistakes, but also realize that mistakes are inevitable. I asked an attending of mine, “Were you terrified as an intern?” She replied, “Everyday, and even my first year as an attending I was scared almost every day.” It provided some reassurance and perhaps the “fear” is necessary. It will ensure to me I'm grounded as a physician and always remember that this field is truly one of lifelong learning.

While I have learned a ton, this ICU rotation has also been depressing at times. Most of our patients are post trauma and, while it is sad to see anyone in critical condition, for some their stories are particularly more emotional. Nobody expects to be involved in a trauma and trauma patients usually have no idea what happened to them, sometimes being a day or two before they wake up and realize they are in a hospital. I want to share a story that particularly resonated with me. A mid-20's male came in with a traumatic brain injury after being involved in an unhelmeted motorcycle crash. His injuries were confined to his head. Brain bleeds and serious skull fractures. Seeing him initially, I knew his prognosis was likely going to be poor. Then came having to tell his loved ones the state of his condition. He lived here away from his parents whom were in another state. It is difficult delivering such news to families but not nearly as heartbreaking as being on the receiving end of such phone-calls. Unfortunately, this patient’s condition did not improve. A man just around my age with kids and a family who two days ago was going about his day was now brain dead. Leaving his family the heart-wrenching decision to withdraw care and let him go peacefully, all of which could have been prevented with a helmet. His story, family and parents all repeating in my head. Absolutely saddening. It serves as a reminder how lucky we are and that every day is truly a gift. I drive more slowly now, always put my seatbelt on first and continue to be thankful for every day. Sorry for the sad story :(

I have been writing away for an hour now. Time to wrap this up. These past few months flew by (I feel like I say that in every one of my posts). I took Step 2, did an away rotation back home in Virginia and, most importantly, submitted my application for residency. Probably the single most important application I have ever submitted. In competition with every other student applying for general surgery, I can only hope that the eyes that read over my application find something of interest and give me an interview. I am looking forward to the interview trail. It will be exciting to visit other schools and try to find the best fit for me. Who knows what my Match envelope will hold in March. To be honest, the application process is a game. We spend hours writing about our accomplishments, volunteering, research, places we have worked, and of course our personal statement. The overarching goal being how well can you describe yourself, appeal to the reader, and do they find something among all those words to want to meet you personally. I feel someone reading my application will probably get under a 30% feel of who I am as a person. I suppose that’s where scores come in. A numerical filter to give you an edge or disadvantage depending on how well you do. Nonetheless, these next few months are going to be exciting. Only a few months away from achieving the goal I set for myself as a kid. A dream which is now on the horizon of coming true.

I completed my final rotation of third year with Obstetrics/Gynecology (Ob/Gyn), which felt, by far, the quickest clerkship of the year, perhaps due to the fast-paced nature of the field. I’ve enjoyed aspects of all my rotations this past year, and pleasantly found Ob/Gyn to be a wonderful mix of all the rotations combined. I found it rewarding to spend two months on services dedicated to women’s health. 

My experience began with two-weeks on the Gynecology-Oncology service. Having just finished surgery, I felt comfortable in the OR; however, about 95% of the surgeries were robotic, a contrast to my prior rotation. I saw first-hand how satisfying this sub-specialty can be through its impactful improvement in the health of women, yet also witnessed the difficult conversations and heartbreaking nature of this field.

I then moved on to a private practice for two weeks, a great experience from the hours, to the learning, to the patient interactions. Jumping from gynecology to obstetrics throughout the day kept things interesting and interactive, and allowed me to see the integrative aspects of both fields side by side. Sometimes in the morning we’d be delivering babies and doing hysterectomies, and then in the afternoon we’d be in the office managing acute, follow-up, and emergency visits. There was never a dull moment given the daily flexibility and action.

Following outpatient, I headed to Labor and Delivery (L&D) for one month. As a high school student, I had the opportunity to observe a few deliveries through a program at my school, which were defining moments in confirming my desire to go to medical school. As a result, I had been particularly looking forward to this rotation since first year, and found it both humbling and just as fascinating, if not more, to experience it on the other side as a medical student.

When L&D got busy, it got busy and intense. It was often a mix of emotions in one day from the happy, sad, and in-between. The opportunity to assist in births was the highlight of the rotation and partaking in those moments were truly beautiful experiences. I saw a lot of high-risk situations necessitating immediate action and saw how different teams effectively worked together to manage and coordinate care for both mother and baby during those stressful, vulnerable times. Overall, I got to dabble in various aspects of Ob/Gyn and had a great time!

Last, but not least, on to…The Final Year! :)

Let me briefly paint the scene for you. I am sitting at a charging station. Across from me is a Tax and Duty Free shop with ladies makeup, perfume, and a large assortment of men’s cologne. Somewhat like a large Sephora except a larger variety of items for men. I only make this analogy because my sister always drags me to Sephora when I am home to buy her stuff. I did not bother going in because I know all the items are likely out of my budget. I have finally come to spring break and I am traveling to Pakistan for a week. Super excited. I haven’t been in about 3years, just prior to beginning medical school. My cousin is getting married and my whole family is getting together. Some relatives I have not seen in about 10 years. So I am eager to have a reunion. I have been marinating at O’hare international Airport in Chicago since about 12 noon today. To put things in perspective its currently 8pm. My flight boards in an hour. ☹

I know I have not made a post in quite some time. Partially because nothing significant has been going on. I have been making my way through my third-year clerkships. After each one I planned on discussing how I felt and bring up any interesting moments I had. Clearly that did not happen. However, I am hoping to doing better going forward. But to give you all a quick 880-word synopsis.

 I started off my year with pediatrics. There was something special about taking care of children. Taking the care out of a parents hands often left them feeling helpless. But to bring their children back to good health (majority of the time) was very rewarding. I loved taking part in the healthcare of children, however, I found that I enjoyed kids too much to see them sick. I rather take part in wrestling and having tea parties when kids are happy and healthy, not then they have RSV or some other illness that turns their smile upside down. Next up surgery. I loved it. It is a true privilege to take a stranger and place a 14inch incision into their abdomen. Slice out a few feet of their colon. Anastomose the ends, and stich them back up. I found myself not minding having to wake up at 4:30 and come back home at 6pm. I didn’t realize I went through the whole day with a few crackers and a couple cups of coffee. I was busy, but having a ton of fun. While in trauma there was a patient that came in after being struck by a car. The Reescalation involved a femoral line, two chest tubes, and eventually and open thoracotomy in the ER bay followed by a few hour-long surgery. (all I did was scissors off the clothes and do compressions; don’t be confused). I got to scrub in the surgery and milked every moment of it. Trying to absorb everything that was going on. By now you probably like “Sal is totally down for surgery.” Not necessarily. Even though I had a blast I still had people constantly telling me how bad the lifestyle is. How miserable residency is and how stressful is it on one’s personal life. My brother is a pulmonary critical care fellow in D.C so I wanted to see what internal medicine had to offer.

I never planned on OB/GYN but nonetheless I really enjoyed it. Coming off surgery I didn’t enjoy the gynecology aspect of specially per-se, being that the surgeries just weren’t as exciting as those I saw on the general surgery service. But, being able to participate in bringing a life into the world during obstetrics was very humbling. Something I will remember forever.  I helped in 2 deliveries, and become a placenta abstraction pro by the end of my rotation (by pro I mean.....I “caught” like 5-6 placentas).

I chimed in the New year and began my internal rotation. This is what I was waiting to experience. Would I Like and proceed to follow in by brother footsteps, who was a pulmonary critical care fellow? I knew that the work schedule was not very demanding. Aftercall, 2 Weeks on, 2 Weeks off was pretty appealing. However, I did not really enjoy it. I found myself exhausted after writing a note. Including every aspect of a patients past medical history was tiring. Easily 3-4x longer than what I was writing in surgery. However, the information was very important. Managing diabetes, heart failure, electrolytes, and acute coronary syndrome where all important conditions that I would need to know about no matter what.

I decided to delve back into the thought of surgery. I met with one of the female surgeons whom I had worked with during my 4 week of general surgery. She was a boss to put simply. Not only was she a female in a male dominant profession, she also had children, hit the gym, and really seemed to have the work life balance figured out. She told me that my lifestyle is what I wanted to make it and you can tailor your career to what you want. Weather that be more hours or less. More intense stuff or just bread and butter cholecystectomy’s. This dwelled on this for a while. While continuing to write long notes on internal medicine I realized that I had not had as much fun or enthusiasm as I did when was on my surgical rotation. I loved critical care but I could also get that throughout surgery. I also really liked trauma. If I wanted to pursue that it would only be 1-2 years of fellowship. Yes, internal may have a more laid back lifestyle, but I realized I would miss the OR. Without getting into all the other details I realized that surgery was the “Wright” Choice for me. I quickly met with my advisors and got things squared away for my 4^th year schedule. Now when I warch greys or read some information of “Life as a surgeon” I cannot help but smile. I am excited to pursue a career as a surgeon and now wonder why I ever thought anything different.

Trying to figure out what I want to do with my life as really been the only significant thing going on in my these past few months. NOW, If you have read this far. I really want to commend you for sticking through me ranting on about my life decisions. SNAP! They just called my flight, it is time to board. Finally, a step closer to the motherland. I will be sure to update you all on my trip once I get back. Until then thanks for reading.

Sal-Money 

What a semester it has been - I’ve officially completed half of 3^rd year! After internal medicine came family medicine (FM) and then psychiatry. The transition felt particularly smooth because internal medicine (IM) laid the foundation for all to come, which allowed me to fine tune and add to my expanding medical knowledge in my subsequent rotations.

Although quite similar, unique differences between IM and FM definitely stood out. The biggest change was the 100% outpatient experience in family, as compared to the almost 100% hospital experience in IM. My placement was at the FQHC outpatient residency site, where I had the opportunity to work one-on-one alongside most of the FM residents. Although working with a different resident each day presented its own challenges, I enjoyed this method because I learned how to approach the same medical problem or procedure through different angles and styles.

I found the fun and rewarding aspects of FM to be continuity of care. I saw several of the same patients get better over a few weeks, and patients we admitted to the hospital directly from outpatient, I happened to see the next day on a one-day FM inpatient rotation.

FM has quite a few procedural aspects and I was fortunate to have attendings and residents who encouraged my participation so I could get the full hands-on-experience. Pelvic exams, suspicious mole and skin tag removals, and giving flu shots pushed me out of my comfort zone but in the end made me more comfortable in how to perform them. Although fast paced, family medicine highlighted the importance of getting to know and understand patients beyond their medical problems and into the social realms, which is something I value and want to integrate into my future medical career no matter which specialty I end up going into.

Family Medicine gave me a slight preview into mental health and was a nice segue into my third rotation...psychiatry! I enjoyed it quite a bit, and was lucky to experience the inpatient, consultation, and outpatient aspects of this field. My favorite was inpatient as I found it tremendously rewarding, intriguing, and exciting. I appreciated the amount of time I had to converse with patients (sometimes two hours!) which helped me get to know and help them better over several days. It was quite remarkable to see patients improve over a period of days to weeks via inpatient group activities, interventions, and medication adjustments. The psychiatry rotation further reinforced that taking care of and healing the mind enhances every aspect of one’s life, both medical and non-medical alike.

Three rotations down, and three more to go!

On to Pediatrics! 

Someone once told me, “Second year goes by like the snap of a finger.” It couldn’t have been truer. Many things happened in so little time. Challenges, obstacles, enjoyable, fun moments, and lots of learning pretty much sum it up for me.

Below are some things I learned during my second year of medical school:

1. Everything makes more sense. Even your notes from first year (so use them!)
2. Sometimes things don’t work out the way you want them to or don’t work out at all. It’s OK. Learn from it and be better next time.
3. Family and friends will seek you out even more for questions and concerns. You will “try” to answer them by flipping through your textbooks as you chat on the phone and end up diagnosing them with things they don’t actually have.
4. Seek help. Seek advice. Seek mentorship. Don’t be afraid to do so.
5. Put yourself out there and get out of your comfort zone.
6. You WILL have time, especially if you continue working on time management.
7. It’s more enjoyable than first year.
8. Be involved in extracurricular activities you’re passionate about because time is limited and you want to spend it well.
9. Find what you’re interested in outside of studying and don’t be afraid to try new things.
10. Make time for your health. It really makes a difference.
11. Keep moving and don’t look back.
12. Try not to overly worry about the things you can’t control/wait until it’s time to do so.
13. Agonizing over STEP 1 is not necessary because as you are studying for your main classes you’re technically studying for STEP 1! Turns out the third years were right when they said it was too soon to start freaking out about STEP 1 at the beginning of second year… 3 months before the school year ends and study period starts is a different story though :P 
14. It will be over before you know it. Literally. And you will think to yourself “I guess it really wasn’t that bad after all.”

After spending two years in the clinical setting seeing new patients almost daily, one thing continues to hold true: some patients stick with me. This theme is one I've heard about throughout all of medical school. Attendings tell stories of conversations with a patient from 30 years ago that they still remember, and many of my more humanistic teachers have told me to try to remember the patients that seem to mean something more to me. This post is for some of those patients, in hopes that I continue to reflect on them, their stories, and the lessons they taught me.  

Most recently, I met a female patient with a ten year history of IV heroin use but had been clean from heroin for 3 years. If you have been living under a rock and have not yet heard, opiate abuse, including heroin abuse, is a huge problem across the country and especially in Ohio right now. I've seen many patients with complications from their IV drug use so far, but I'd never had the chance to sit down with someone and understand why they used it. To a certain extent, I understand using mind-altering substances. If caffeine were illegal, I'm sure most of us would all still use it for that wide-awake feeling it can provide on a dreary, tired day. I've never quite been able to understand, though, how someone gets from drinking, smoking, or snorting a substance, to using a syringe to inject that substance into their veins.

When I had a free minute, I went to that patient's room and asked her if she would mind sharing her story with me. She told me that she first got into opiates after dealing with some chronic back pain. She was unable to afford her prescription opiates and learned by word of mouth that heroin was a much cheaper and more accessible source. She began buying and snorting the drug, but over time she required more and more heroin to get the pain-alleviating, and now also mind-altering, affect that she desired. So, she started injecting. She told me that the next 10 years were a blur of trying to protect her children from her behavior, but being unable to really do so. Of injecting again and again because the withdrawal was so severe she literally felt like she was dying. Of how her husband, who also became an IV heroin user, would make sure she always had a little bit of leftover heroin so she didn't have to get withdrawals as bad as his. Funnily enough, I don’t even remember why or how she stopped using, other than knowing she stopped cold turkey and hasn't looked back in 3 years. I most remember two things from our conversation: the patient never thought she would inject heroin, and she was thrilled at the chance to share her story. She told me she wished she could stop other people from using heroin, but that she couldn't get people interested enough to listen. I told her that her story had me listening closely, and that I would try to remember it whenever I had a patient who did IV drugs-or any drugs for that matter. When I left her room, two things stayed with me. Firstly, no one sets out in life to be a drug addict. No one. Secondly, sometimes what helps a patient most is someone willing to listen to their story. Ultimately, we're all just people living in this world. No matter what we look like, where we're from, or what we've gone through, we just want someone to care about our story.

The memory of another patient sits with me. I was working in the ED when an older gentleman came in via ambulance, severely ill. He was violently shaking and non-stop vomiting. When I walked into the room, the patient had just vomited on my resident's arm, who was holding the patient's vomit basin since the patient was shaking too hard to hold it himself. I quickly grabbed gloves and grabbed the vomit basin, trying to ignore my own increasing nausea as the man vomited over and over again into the basin I was holding. As I mentally counted down the hours and minutes left until the end of my shift and wondered whether I, too, was going to vomit, a break in the emesis occurred. I looked at the man and began to wipe his face as he suddenly said, smiling through puke-stained lips, "You're a pretty thing to look at." My resident and I glanced at each other, then erupted in laughter as the man smiled and began vomiting again. This was a man who was likely dying, and who likely knew it, but chose to find a bright moment in his dark situation. I hope in as dire circumstances as his, I, too, would be able to find the light.

I met the last patient I wish to remember here while doing a hematology/oncology rotation. I had met a variety of patients who were battling cancer, but this man stands out beyond the rest. He had been battling lymphoma for more than a decade and was in the office after his neck mass, which had been stable for a couple years, began rapidly growing. The moment I realized how sick he was was the moment I asked him which medications he was currently taking. He began listing medication after medication, knowing both brand names and generic names. After he listed a variety of complicated chemotherapy agents, he added, "Oh, and I'm taking that metoprolol for my heart, too." He pronounced the world mee-toe-PRO-lol, rather than meh-TOP-roh-lol, as it is correctly pronounced. To this day I clearly remember this man, with a huge, cancerous neck mass and years of being seen by far too many doctors, repeating, "Mee-toe-PRO-lol." I left that room brought to tears by the fact that this man, sitting in the chair, reciting medication after medication better than I could, knew all too much about cancer and medicine in general. For the first time in my medical student life, I realized that medical knowledge isn't always a good thing.

These three patients in particular stand out so clearly in my memory because of the lessons they taught me, both individually and as a collective. Ultimately, I recall these memories (even the memory of nearly being puked on) with fondness because it was in these experiences that I was able to see life through the eyes of my patients. Attempting to understand the perspective of others and learning to appreciate what life has taught them molds me into an empathetic physician and a better human in general. The bonding conversation with an older woman, the painful memory of seeing a man battle a horrible disease, and the disturbing recollection of watching death take hold on a vomiting gentleman all share one similarity: appreciating the perspective of each patient brought meaning to me as a physician-in-training. Relating to patients as fellow human beings, as individuals with pasts and stories to share, allows me to feel more like a participant in their life rather than a stranger in a white coat. This empathy brings me personal and professional fulfillment, and I am overwhelmed with gratitude that my patients share their lives with me. 

Four years ago during medical school orientation, one of my new teachers told my entire class to write ourselves a letter. In that letter we should tell ourselves why we wanted to pursue a career in medicine, and also how we identified ourselves. "Write down the things you like doing for fun. Your hobbies, your goals, how you handle stress, things like that." I remember rolling my eyes at the teacher’s kum-bay-yah mentality and promptly ignoring him, choosing instead to focus on the assigned, not recommended, class work. What I didn't expect was regretting that I had never taken the time to write that letter.

Somewhere during my second year of medical school, I lost myself. Apparently this is something that happens to most med students. Administration warned us and our families before medical school began that we students would likely find ourselves more burned out and tired in medical school than at any other time in our lives thus far. They were right. The business and stress of my daily life forced the "me" out of myself, replacing it with stamina, drive, and required priorities. At one point during second year, I went over 3 months without a single weekend "off." I had a test or quiz every single Monday for 3 months of consecutive Mondays, so for 3 months of weekends all I did was study and sleep. When every moment of your day could be and should be dedicated to studying, something changes. Personal enjoyments get replaced by an added hour of study time. Being stressed became my baseline. My hobbies turned into sleeping, showering, and exercising, the three best ways I learned how to deal with stress. I finished second year proud, accomplished, and learned, but also empty, confused, and burned out.

I spent the following two years, the second half of medical school, rebuilding the "me" that I lost. No longer "working" (studying) 16-18 hours a day, I finally had time for simple things, like watching TV, exploring Dayton, and cooking. Eighty-hour workweeks seemed hectic but still left adequate time for interests and activities outside of medicine. As I slowly rediscovered things I enjoyed in life, I couldn't help but reflect on who I was before the hell of the first 2 years of medical school. What did I like to do? What would I have written in that letter? I remembered that prior to medical school I liked to read, dance, watch indie films, travel, and explore new cities. I remembered that I went into medical school because I wanted to understand exactly how the human body works. I remembered I stressed about everything, planned everything, and worried constantly. While the woman entering medical school and I have many similarities, we also now have many differences.

Claire today is a planner who loves food and films and yearns for deep relationships and memorable experiences. I enjoy medicine in part because I now (somewhat) understand the miracle of the human body. But much has changed. I'm no longer the stressful worrier I once was. After surviving the stresses of medical school, it takes A LOT to phase me. This change is one that has definitely been for the better; peace comes much easier to me now than before. I still am a "planner," but to a less exorbitant degree: I understand and accept that the future is unknown for every single one of us, and there is little we can do other than accept that. On the more disheartening side of changes, I find it difficult to get excited about reading. I've loved reading my entire life, but now I see books and immediately associate long hours of studying, stress, and frustration with them. I hope I’ll soon become interested in reading for leisure again. Travel still excites and motivates me, but I've remained quite Dayton-centered over the last four years. This is largely due to financial restrictions (aka I'm a broke med student), but I'm hoping to re-discover this passion as I begin earning a salary. Shockingly, I've found that I now love to exercise. In college exercising was a task I didn't particularly enjoy but did occasionally for my health. Now, I look forward to exercise because I understand how stress-relieving it is, and, moreover, how rare it is to be able to commit time that is totally selfish in its intent. Exercising only helps me, my physical and mental health. I love it for that.

Beyond changes in personal traits, my appreciation for medicine has changed. I used to scoff at humanistic physicians who emphasized cheesy rituals like writing letters to themselves and talking about "the profession" of medicine. Now, I understand that humanism is why I'm here. At some point during my stress-filled and exhausting time in medical school, I began to appreciate the fact that life gets hard. Some days, all my effort was spent simply surviving the day. During my clinical years, I saw an even greater struggle in my patients. I saw patients who were powerless against horrible diseases, who felt isolated in a strange and scary environment, and whose stress outweighed anything I had ever experienced. Through my own stress and exhaustion, I was better able to understand the experiences of my patients. I grasped the reality of hardship, and I remembered that the love my friends and family showed me was enough to get me through my worst days. I harnessed my own compassion and applied it to my patients. I began taking time in the mornings to ask how my patients were doing and what they were looking forward to that day. I allowed my patients to vent their frustrations to me, even when they and I both knew nothing could be done to fix the cause of their upset. I started to treat my patients with empathy and love. Rather than causing me to feel more stressed or more tired, my compassion for my patients rejuvenated me. The simple act of loving others made me feel like I was treating more than a medical condition; rather, I was embracing the hardships of life and addressing them the best way I knew how. Learning to love my patients helped to heal my burn-out and restored my faith and joy in medicine itself.

After years of stress and hard work, I now know that by embracing the humanistic aspect of medicine, doctoring transforms from a demanding job to a fulfilling profession. By taking the time to think about our patients as other humans living the shared human experience, by appreciating their journeys and stories, and by reflecting on the difficulties we personally encounter in this work-driven, remarkable field, we can begin to learn why we made the sacrifices we did and understand that those sacrifices are greater than ourselves.

I was an undergraduate visitor at a medical school. One morning walking across campus I looked up and noticed my sidewalk was coming to an intersection and I was inevitably going to come across a man in a white coat. I did what any introvert would do, I slowed down to let him get to the intersection first and I looked down to avoid eye contact. If I walked slowly enough, I figured we would avoid walking past each other and could happily continue on our separate ways. Imagine my surprise when the man stood waiting for me at the intersection, smiling. Of course, he was a neurosurgeon. Of course, he wanted to know what I planned to do with my life. I told him my story and explained that I was confused about my future plans. I shouldn’t be confused he told me. He could tell exactly what I really wanted to do and encouraged I should do it. Before leaving me the stranger looked at me, pointed to his head and said, “the brain is the most mystical organ. It is the only organ that can transgress two realms, the Earth and one day God’s realm.” Pointing to the sky, he continued “He gave us this gift, our brain, and I never cease to be amazed by the wonderful things I can do through medicine.” He smiled and then he walked away and we went our separate ways.

Six weeks of M2-done! Already flying by like summer did. My summer between M1 and M2 was perhaps the busiest, yet the most educational “vacation” I’ve ever had. I spent six weeks of my summer completing my required electives-the first two weeks spent doing a pediatric GI rotation at Dayton Children’s and the last four weeks spent doing a family medicine rotation in my hometown. Each clinical experience had its unique aspects and I learned so much by being in two incredibly different, yet sometimes-similar environments. It was refreshing to learn outside of the classroom and rewarding to see many of things I learned during first year applied in the clinic. However, it has been even more powerful when my summer experiences have started to come into play during second year and I’m able to tie in what I’m learning to what I observed during shadowing. 

My schedule completely flipped when I started my GI elective because I spent around 8-9 hour days at the hospital, which had a different feel to it than the routine of go to class and study all day. Surprisingly, my exhaustion levels reached maximum capacity than during the normal school year because I wasn’t accustomed to the demands of clinical practice, but I felt like I got a glimpse of what typical days would like in the future—fast, busy, long, yet exciting and worthwhile.  I had the opportunity to observe most of the pediatric GI specialists and each of their unique approaches to patient care. I enjoyed the variety that the field of GI provides—from consults, to physical exams and follow-ups, to being in the OR doing colonoscopies… you really never get bored! I valued the opportunity to listen to the dialogue between the physician, parents, and children and the process in which one comes up with a diagnosis, and follow-up care thereafter.  One of my favorite experiences included the time when a GI physician let me get a glimpse of third year. I had the opportunity of having an in-depth talk with a parent about her child’s symptoms, collect all the relevant information and then summarize my findings to the physician and try to come up with a diagnosis before he went in to see them. Feelings of nervousness and excitement ran through me because this was my first time interviewing a non-standardized patient, but it was nice to use my ICM interviewing skills in a real setting!

After finishing up my GI elective, two days later my AHEC family medicine rotation began. I worked at an integrative health care clinic in Ann Arbor, which immersed me into a very unique and different approach to medicine—to the extent that I hope to apply some of the techniques and strategies that I learned here into my future medical practice.

The clinic uses an integrative approach by combining both traditional and alternative medicine to provide patients with more options and guidance. An integrative approach seeks to understand multiple factors from different bodily perspectives that could cause the said symptoms; therefore spending more time with patients is critical to improving their well-being to understand everything that is going on to connect the pieces. For many new and returning patients, we spent a minimum of 30-45 minutes discussing health concerns with them. I had many patients express to me how appreciative and full of gratitude they were to have a doctor spend this much time with them.

This experience showed me how an integrative approach can benefit some patients immensely as it provides them with more personalized choices geared toward their health when other traditional therapies do not seem to work for them. Thus, having the opportunity to see first-hand how this gives patients the benefit of attaining more health care perspectives and options by integrating conventional and alternative medicine to maximize their health care taught me that there is more than one correct way to practice medicine when balanced correctly. Further, I valued the give-and-take relationship between doctor and patient that I saw during my time at the clinic. This patient-centered approach further underscored the importance of allowing patients to a be a part of their health care conversation, allowing more information to be gathered to make patients more comfortable with their health care choices.

Many lessons taught, many things seen, and much more knowledge and facts gained this short summer than I would’ve thought possible!

It is difficult to grasp that in just over two weeks I will be starting my second year of medical school. There are still times where I still cannot believe that I made it to medical school and managed to complete first year. As I sit on my deck, enjoying the last few weeks of what will probably be my last summer, I figured now would be as good a time as any to reflect on the past year

I remember getting my white coat fitted during my interview, not knowing if I would ever actually wear it. Then came white coat ceremony and just like that it was official. I was the proud owner of that white coat and my journey to a career in medicine began. I knew what I was getting myself into, I have an older brother who is now a physician and he forewarned me of the long nights, constant studying and slowly decreasing social life. For the most part that is how it started with anatomy. Anatomy was much like learning a new language, but this language was both written and pronounced in English. I knew how to pronounce all the words I read, however was familiar with none of them. I had my fair share of long nights listening to video recordings and then spending quality time in lab. In the end I overcame the anatomy hurdle and each class after was just another hurdle that needed to be jumped. What “worked” in one class may not have worked for another. I found myself having more free time throughout the year. I am confident that my study skills improved with each class, but I also realized the importance of keeping myself “Healthy”. Making sure to eat right, hit the gym, and enjoy myself every now and again.

Also I need to mention that none of medical school could have been done without the friends I have made while in school. I think it is interesting how complete strangers can become the best of friends in such a short period of time. My friends kept me going when things got difficult and we always supported one another. We studied hard and partied harder. While I have my close knit group of friends like everyone else, I enjoy the remainder of my classmates and hope to continue to build friendships.

Well time to wrap up this post. First year has now come to an end. I still can’t believe the amount of information that I have learned throughout this first year. Given that I have forgotten many things, it is still crazy to think how far I have come and how much I have grown. If I can offer any advice to future first year students it is that

1)      Medical school is Doable---> Everyone before you has made it out alive. Take it a day at a time...it goes by super fast!

2)      Keep your sanity---> Find ways to relax or else the stress will eat you!!

3)      Go outside of your comfort zone--> Make new friends, meet new people

4)      Put in the effort and treat it like a full-time job--> A job that pays you nothing and charges you interest instead

5)      Remain Humble---> Don’t forget everything you have accomplished to get here and everything that you will accomplish in the months/years to come.

All in all I conquered first year, went on an epic spring break trip to NOLA, saw Drake in concert….TWICE and experienced Peru over the summer. Despite the schoolwork I have had one unforgettable year. Second year is here….time to stock up on highlighters.

As I reflect back on my first year of medical school, I can’t believe how fast it flew by. From various experiences, opportunities, knowledge gained, and individuals I’ve met, this was by far the most transforming year of my life. Every moment is still so vivid, clear in my mind, yet such a blur because all year it felt as if I was riding a high-speed train that has now suddenly come to a halt—until M2 year that is! BSOM provides its students with so many unique opportunities and I’m so glad I had the chance to experience many of these things to enrich my medical school experience during year one.

Below are some things I learned during my first year of medical school:

1. Take it one day at a time. Immersion in each moment will allow focus on one thing at a time and reduce the feeling of being overwhelmed. Be present in the moment no matter what you are doing and don’t think about what is coming next/what you have to do after until it’s time to do so.
2. Don’t be afraid to change study habits from one class to another or even during a class because each class is different and requires a unique approach.
3. You can and will do it even when you think you can’t. Other people know you can do it when you think you can’t. Believe in yourself. You will amaze and surprise yourself each and everyday.
4. Every minute is precious—use time wisely. Seize every free minute, hour, day, weekend, to visit or call family and friends, do something fun, go to the gym, watch a movie, relax, sleep, etc. Sense of time changes in medical school. The days are long but the weeks are fast. Time never stops. Use each moment to your advantage.
5. Just go for it. Studying comes first, but that doesn’t mean life has to stop. Go to events, conferences, and meetings…anything that interests you because these are the things you will remember.
6. Inquire! You won’t know if you don’t ask! Talk to older students to get advice and tips for each new class and medical school in general because that will give you some direction into what to expect and new ways to approach learning.
7. Stay on top of the material and don’t get behind, because playing catch up is hard to do. It’s possible to get through the material. Try to learn the material well the first time and when reviewing, because in the end we’ll be using this information for life. Don’t give up when something doesn’t make sense and make sure you spend time on what confuses you—don’t ignore it.
8. Build relationships for now and for later.
9. Ask for help and don’t be afraid to do so, especially when facing problems, or trying to make decisions. Talk to family, friends, and advisors for advice and second opinions. Find at least one mentor you can rely on. You don’t get through medical school alone. People want you to succeed—don’t be afraid to seek advice and share your emotions and feelings when it’s sometimes easier to just ignore the problem and bottle it in.
10. Just breathe and medical on.

About a year ago I caught a flight midway across the country with only my carry on, a checked bag, and $1,400 dollars in my bank account. With friends and family left behind in CA and no permanent place to stay in Ohio I engaged on the most epic adveture of my life, medical school. Despite all the sleepless nights and the overwhelming feeling of "I have not studied enough" I would not trade it for the world. The Boonshoft School of Medicine has been like a secret gem that I was lucky enough to discover and I know with certainty that I could not be at a better medical school. One year down, three to go. M2 here we go!

Wow! I know I say this all too often but where does the time go? I am currently about to start my last rotation of third year in a few days and have no idea how that happened. The past year has honestly seemed like one giant blur. Was it yesterday I was aimlessly walking around the halls of Miami Valley Hospital looking for a patient’s room? It sure seems like it!

I just finished my surgery clerkship. For any of you that read my blog regularly you probably know I am interested in surgery. Well…I have some news for all of you. I am still interested in surgery! It was great to actually be working hands on and I really felt like I had an immediate impact on my patient’s lives. You really get immediate results with surgery (most of the time). Even though the hours were rough, it was probably the most fun I have had during my third year of medical school.

I started out at a physician-owned surgical hospital in Springfield, OH. It was a bit of a drive but it was incredibly fun. There were no residents at this location. That’s right! It was just me and the surgeon scrubbed into every case. When you are the only one scrubbed in besides the surgeon you get to do a lot more than just retract (a fancy word for holding a metal device to move tissue out of the way) and suction (blood, water, and even feces). I was what they would call “first-assist” on every surgery. None of the surgeries were very complex but I was getting to do something that I greatly enjoyed. If you are interested in surgery and come to Wright State I recommend doing a rotation there!

The second half of the rotation I was on trauma. While putting in an average of 65 hours a week sounds like a terrible time I was actually enjoying it. The hardest part for me was the down time when nothing was going on (and we were supposed to be studying). However, it is hard to study when you are in a surgery for 7 hours (yes that happened during this rotation but it still isn’t the longest surgery I have been in) and answering trauma calls every hour or so. While I definitely enjoyed the surgery aspect of this part of the rotation I do not think I am interest in trauma surgery. Cardiothoracic surgery is where it’s at and that is still my number one interest.

Only one more rotation to go until the end of third year. What??!?! I’m still working on finalizing my schedule for fourth year. Less than a year until Match Day where I find out where I live for my residency training! A little more than a year until I am a graduate of the Wright State University Boonshoft School of Medicine! Sometimes it feels like one big dream. As always feel free to contact me with any questions! Talk to you again in a few weeks!

Although my goal in this blog is to provide the perspective of a first year medical student, I realize that it is already March, and that almost three-fourths of my first year is already over. How quickly time passes is a cliché idea, but I have personally never felt it to be more true than I do this year. It truly seems like the weeks and months since acceptance to medical school, convocation, and beginning the first class to now have been artificially put on double speed (much like I do with many of my professors’ lectures…but that’s a different story). I simply can’t believe how quickly this year has passed.

And yet, so much has happened that I feel like a different person, in many ways, than I was last July. Besides all the “active” learning that has taken place – the textbooks read, notes written, classes attended, skills practiced, tests taken – there has been a certain amount of passive learning as well, as there is in all stages of life. Simply being immersed in the world of medicine has opened my mind to concepts and value systems previously foreign to me. Part of my goal in writing, especially this blog, is to sort through the complex ideas presented in medical school, as much for my benefit as for those who may stumble upon my ramblings.

So far, what I love most about medicine is its place in the world; it is the crux of my education so far, and is sufficiently challenging, but is also an obviously worthwhile pursuit. It is founded upon research and evidence and is rooted squarely in the biological sciences; yet it is the point where the sciences must meet humanity. It is not enough to study constantly or live in a lab or the library; we must learn to interact with people of all backgrounds, must learn to have a gentle touch, must learn to listen attentively and speak kindly. This first year of medical school so far has stretched me because it has forced me to improve both sides of myself. I look forward to learning more over the course of this long and exciting journey.

I’m back after six weeks of the Family Medicine rotation. Although it was relatively short, I learned so much! It is great to get some one-on-one time with a physician, something I felt was lacking during my rotation in Internal Medicine. There was a lot of outside work for this rotation but it all added to the learning experience. I definitely think having internal medicine before this was helpful, and I believe that family medicine will be even more helpful in my future rotations. I could sit here and tell you all about the rotation, but there are some other topics on my mind (and they only give me so many words to use).

Since the last time I wrote a blog our school has lost a great mentor and teacher. Dr. Elder was the teacher of our Principles of Disease course during our first year. She really went out of her way to teach us topics on microbiology and many of us felt like this was the first time we started to learn something relevant to medicine. I think the thing I will always remember about her is the way she could come up with these creative songs for remembering different antibiotics or pathogens (you try rhyming with staphylococcus aureus). At the end of our second year, our class had an award ceremony where we awarded her with the Lifetime Achievement Award. It was an honor to be able to give that to her and she even provided us with one last song! Dr. Elder was also part of the IRB at Wright State and I often went to her with questions regarding this. I remember one time asking her if I needed to make an amendment to my protocol and submit it to the IRB. She basically said, “No. Don’t worry about it. I’m the IRB chair so if there are any issues it can come back to me.” I think I speak on behalf of all of Wright State, my fellow classmates especially, when I say it was an honor and a privilege to have Dr. Elder as a teacher and a mentor.

If any of you have ever read my profile you will see I am from a small town called Lawrenceburg, Indiana. Well, to be honest, not a lot of news comes out of my town. However, recently there has been a story circulating the internet and television news about a girl named Lauren Hill who has been battling a rare form of pediatric brain cancer called DIPG.  She has started a “Layup for Lauren” challenge similar to the ice bucket challenge for ALS. She has played in her first (and we are not going to call it her last) NCAA college basketball game. She is on her own Wheaties box. She has been on the copy of a videogame. She has even received messages from Lebron James and other celebrities.  I am not listing all of this to commend her on being famous. No, the point here goes much deeper. DIPG is a cancer that mainly affects young children. Children too young to have a voice for themselves. What Lauren has accomplished is spreading the word on a tumor for which relatively little research exists. I think her goal on starting this whole ordeal has been to increase awareness and raise money for DIPG research. I can assure you she has done that, and she makes me proud to be from Lawrenceburg, Indiana. If you would like to donate to DIPG research in Lauren’s name please go to The Cure Starts Now Foundation website.

Next up for me is my Psychiatry rotation. I am kind of excited because I have never really interacted with these types of patients before.  It is another six-week rotation so I will see you again around the end of the year (where does the time go???). As always feel free to email me at bree.2@wright.edu with any questions you may have about Dayton, Wright State, or medical school in general!

My oh my how I missed Dayton, Ohio and as a non-native, I never thought I’d say that. I am exhausted, it has been a long three months and it is SO good to be back. There are so many things that I missed. Yes, I missed my truck, my bed, my bathroom with a lightbulb that I’ve been putting off changing…but I also missed that Chinese buffet place down the street with that lo mein I always get, scenic drives to Yellow Springs when I need a pick me up and fresh air and people wearing T-shirts saying “Raider Up!”

Peace, Love and welcome me back with open arms,

Sarita

Ps. Happy belated birthday to me. I came home to presents in the mail, who doesn’t love presents? (It’s rude to ask a woman’s age.)

Pps. And now, time for an extended nap. 

I am currently three months into my third year and all I can think about is how different this year is compared to last year. Whenever I have these introspective moments, of course I want to share them with you (This way, I get to look incredibly deep and pensive.). Trouble is, I updated you very little on MS2, so let's get that established first: studystudysleepeatstudystudyspringbreakstudystudystudySTEPONE. Aaaand that about sums it up!

Ok but seriously, I tried very hard to write a post about second year once I had finished my classes but struggled with reflecting on such a big year so close to its fall-out. MS2 was the most challenging year of my life. Wow, it’s crazy to read that so definitively, but it is absolutely true: the course load and pressure of the year prevented me from really feeling very human; I spent at least 15 hours a day studying for my classes, mostly studying alone (with the exception of my faithful cat Scarlet, of course); I had a quiz nearly weekly and a test every 1-4 weeks. If that doesn’t seem overwhelming enough, on top of studying for regular classes, I had to cram in as much Step 1 studying throughout the year as I could*. Turns out sedentary, near-solitary confinement coupled with lots of stress can wear you down, and all that alone time and anxiety is something I’m still recovering from. However, all this in mind, I feel incredibly blessed that no major crises (other than school-related ones) occurred last year. I say no major crises occurred for a reason: I know many of my classmates struggled with family issues, health issues, and financial issues on top of the overwhelming work load, and I feel incredibly lucky that school was my major focus and that the real world provided few distractors otherwise. I have such immense respect for my peers knowing we all got through that challenging year together in spite of all the obstacles we encountered.

*Did reading the words “Step 1” strike you to the core with terror, anxiety, and weird excitement? No? Well then, let me explain (insert evil laughter here). At the end of MS2, all medical students take Step 1, which is an eight-hour (yup, you read that right) exam that serves as a final for the first two years of medical school. Passing the exam is required to continue your medical education, and the score you get on that exam correlates to the type and quality of residency for which each student is competitive. In summary: it's a super important final over the foundation of medicine. NOW do you feel a bit more terrified? Good, then I’ve explained it adequately.

I will remember a lot of stress, anxiety, and sleepless nights from MS2. But with bad usually comes good, and what I will also remember with pride is how much I learned every single day. To go from basically no knowledge regarding an organ system to understanding its physiology and pathologies in a matter of weeks is truly impressive. I also hope I'll never forget how much I surprised myself last year: when the going got tough, I got going. And in spite of all the times I wanted to give up, I never, ever did. That is something I'll always be proud of.

So, enough about the past. Let’s discuss the now, aka life as an upperclassmen: it's awesome. I mean, I hoped it would be considering that I finally get work with patients and physicians and see all the things I've been studying for 2 years, but LAWD is it amazing. My first rotation was in pediatrics, and now I'm in surgery. I'm loving the constant stimulation, the hands-on learning, and the interactions with other humans (no offense, Scarlet). Every single day I’m reminded how the hard work from the last two years was definitely, definitely worth it, and every single day all I want to do is keep learning. As of right now, I’m not 100% certain which part of medicine I like best-for now, I’m relaxing and enjoying the ride. I can't wait until the day that I decide what I want to be when I grow up. Let's both just keep our fingers crossed that that day comes sooner rather than later!

Being in this city by myself, I was tempted to go through the motions of just walking to the hospital everyday, working hard, walking home every night…then 9pm sleep time. (1. Yes, I have the same bedtime as elementary school children 2. The Scandal season premiere is in a few weeks and it will come on past my bedtime *sigh*.)

While I enjoy me, myself and I time, I told myself that traveling to these places is about a lot more than just showing that I’m hard working. Girl, experience things, meet people, meet the city. Netflix won’t get jealous. (Or will it?)

Well, there might be something to this ‘being outgoing’ thing. I’ve managed to meet a bunch of other medical students (even some from Ohio) doing surgical subspecialty rotations. I must say it’s been rather nice to have like minded people to talk with, especially since we can submit our applications in ERAS soon (September 15th, burned into my brain like my birthday)…what’s not been so nice is unsuccessfully trying to navigate public transportation. (“I give up, I’m calling the cab company.”)

Peace, Love and I really miss my truck,

Sarita

Medical students occupy a very strange space, especially 4th year students. You navigate this uncomfortable space where you want to show initiative and interest and you genuinely want to learn, especially by doing…BUT you also risk coming across too aggressive or even more mortifying: annoying to the more senior team members. You risk getting/doing something very wrong even with the greatest of intentions. I understand that mistakes are bound to be made; they’re a critical part of the learning process, however when you feel like your 4th year is one long audition for residency, you tend to think of ‘mistakes’ in less understanding terms.

Maybe everyone doesn’t struggle with this, but I tend to have lengthy internal dialogues about everything: “should I ask the scrub tech for the scissors to cut now?” “What if I accidentally cut their knot?” (By the way, cutting a surgeon’s knot is one of my nightmares). “Should I ask to grab that retractor?” Mind you, these thoughts don’t paralyze me into inaction, I grab a mean retractor but as students we’re always analyzing our seniors’ response to us, asking for feedback and criticism to better ourselves…wait, I bet this is isn’t unique to just medical students, but you know what I mean.

I have these moments of hesitation because I have had mixed results: I’ve had residents say, “just grab the retractor if you want to, help is always appreciated”. Tried that, sometimes I’m met with a “thanks’, other times ‘nope, I’ll do it myself’ which invariably leads me to think “OMG, does the attending not like the way I retract!? How can I retract better?!”...I’m exaggerating…a little.

I’ve had others say “just ask” which is a much more natural approach for me (#TeamPolite) and I’ve been met with a “don’t ask, just take it…surgeons just DO” for every “sure, thanks for asking”. I’ve even had some “If I wanted you to take it, would have asked you to take it.”…always nice. I use all these words to say, it’s actually quite silly of me to take mental inventory like this. Since I’m dealing with multiple personalities, there’s probably no reliable algorithm…different strokes for different folks. (You know I enjoy a good cliché every now and then.)

As a student you are usually the least knowledgeable and experienced member of the team, BUT you still know SOME things, know how to do SOME things and you want to learn more, want to do more than just observe. Respect this and at the end of the day, no one can fault you for showing initiative, however small your gesture (as long as you’re not being obnoxious about it.) right?

Peace, Love and Overthinkers Unite,

Sarita

Ps. Gearing up for my second away rotation, wish me luck friends.

Pps. I would have made the title “More savings, more doing” as I heard it in a Home Depot commercial, but it didn’t quite fit… although saving is good advice.

Yesterday I had the opportunity to observe a robotic surgery that took a loooong time (by the end I had to decide which was more important: finding food or finding a bathroom) because the procedure itself was just a long one and partly because the attending working the case was still a bit new to robotics. Two fellows were scrubbed in with her who were a lot more familiar as they were more recently trained in the technology and I could see them providing her with direction and instruction even though she is several years their professional senior.

Afterward the attending said to me "there's no room for ego in this profession".

Peace, love and lifelong learning,

Sarita

Ps. I chose to get food first

Last week Friday, I took my final shelf examination for my third year of medical school. As Murphy’s Law exists, I decided not to really exhale until I had received my Pediatric Shelf Exam passing results.
I really would like to sit here and write something that can tie my third year experience into a neat literary bow but that just seems like such a tall order right now: so many experiences to recount, so little creativity.

This past Monday we welcomed the former second year students to their clinical years at the Student Clinicians Ceremony and I had the privilege of saying a few words in recognition of one of the Interns I had the real pleasure of working with during my Pediatrics rotation for the resident Humanism and Excellence in Teaching Award. I’m just going to leave my little speech here, I think that will have to do as far as bow tying goes:

“Disclaimer: I’ve been known to be a little dramatic…I’ve tried to tone it down but apologies in advance.
I am very tempted to stand here and make mediocre puns about Dr. Shannon Golden’s name being golden and how she happens to also be that in both appearance and demeanor…but I will do my best to spare you.

I got to my very last third year rotation, Pediatrics and thought: YES, the kids and I are going to have so much fun…then I thought oooh, one month of sick kids in the hospital and another month of not so sick kids in the clinic, eh maybe they’re not going to have as much fun. Also, while third year is amazing and you have the privilege of taking care of people in one of their more vulnerable states, it can get to be quite difficult knowing that as a medical student, you are at the absolute bottom of the food chain and some team members see you only as the person lengthening their work day. I was definitely feeling this weight when I got to Peds. Then I met Dr. Golden at Dayton Children’s Hospital and it did not feel quite as heavy and I didn’t feel like as much of a burden.

In my experience, you come across three main types of residents: those that ignore students completely (and from a student perspective, sometimes flying under the radar is not a terrible thing), those that acknowledge your existence by asking you random questions here and there and enquiring if your note is finished 5 seconds after rounds had ended (spoiler alert: mine never was) and those that make an effort to make the student feel like an actual member of the treatment team and this is where Dr. Golden comes in. While sometimes during the year I felt like…an extra…just the medical student, in general, I’ve had the opportunity to work with some pretty great residents but rounding off the year with Dr. Golden was a treat. It was very new and strange to me when she would ask each of us which patients we wanted to see in the morning or suggest interesting cases based on the specialties we hoped to pursue…it was even stranger when before rounding but after we went to see said patient she sought US out to talk about OUR observations, OUR assessment and OUR plan. She was open to answering any questions and brainstorming WITH me and not just leaving me to fend for myself in front of the attending with a haphazard plan during rounds but even more importantly, not just telling me what to say during my presentation so that I didn’t embarrass myself in front of the attending, but I also, didn’t gain as much education-wise since the presentation wasn’t fully my own. Furthermore, she gave daily feedback whether it was on your note or your interaction with a patient, she let you know that you and your work were not unnoticed.  Dr. Toussaint and Dr. Taylor, the clerkship directors kept talking to us about active learning and its merits and I can say that Dr. Golden definitely facilitated that on the wards...so much more fun than TBLs. Why was this such a big deal for me: first of all, I learned the hard way that some residents do not want to be bothered before rounds, spending time with the medical student is time not spent elsewhere (but students understand, residents are under extreme pressure and intern year seems scary) and secondly, I felt useful, to both the team and the patient.

All I’ve talked about thus far is how Dr. Golden treated me like I was a person but also it was refreshing to see her treat EVERYONE this way…consistently, not just medical students and not just at the caffeinated beginning of the day (to be fair, the Pediatrics day started a lot later than the Surgery and Obstetrics day so she had an advantage in the morning grumpiness department). She seemed to be such a pleasant light on the team, a light with difficult patients and a golden light (sorry, I really could not help it) with parents of difficult patients. She was a great example of what it means to be a conscientious resident physician and that’s why she deserves this…she deserves to know that we appreciate her. ”

In the end, Dr. Golden was not able to make it to the event so it was a little awkward. Additionally, I have a fear of public speaking so throughout the entire time on stage I suffered palpitations and wondered why I had volunteered to participate, but it’s good to push yourself out of your comfort zone from time to time, right? I am also avoiding photos since I don’t want to see pictures of myself looking scared while wearing red lipstick, something tells me that isn’t an attractive combination.

Peace, Love and one year closer,

Sarita

Ps. I am going to be out of the Dayton area for a few weeks trying to rock out at an away rotation. Added bonus: my baby sister is in the country visiting from Trinidad, and my away rotation is in the same location as my other sister…three Metzger sisters reunited…and yes, you guessed it, it does feel so good.

Wow! That is the only way I can describe the last month or two of my second year of medical school. I’ll try to describe it to you as best I can, but it all still seems like one huge blur. It went by so fast and I apologize in advance if I forget to mention something.

Once we returned from spring break we had three classes that lasted for two weeks each. The best analogy for these classes I can think of is that if you imagine second year as a 2-mile race, these courses are the final lap. You are tired and don’t know if you can go on and finish the race. You don’t know why you are even running in the first place. However, you know that it will all be worth it once you finish. (Side note: I was a cross-country runner in high school, hence the running reference).

The three courses were endocrine, reproduction, and digestion. I would say there was not much of a difference between the courses except for the fact that endocrine had a quiz almost every day. While this may seem stressful, I really think it helped in learning the material. Other than that the only major stressful item for each course was the exam. The exam was worth around 80% of our grade for each of these classes. Talk about stressful!

Following the digestive exam we had approximately three days to study for a term final. This consisted of questions based on all the courses we had taken during the second semester of second year (cardio – digestion). Three days does not seem like much (and I assure you it is not), but sometimes you have to work with what you are given. Lots of practice questions later, I completed the exam.

Now comes the part that I am sure you are all wondering about: the dreaded Step 1 exam of second year. For those who are not familiar with it, it is a test of a medical student’s cumulative knowledge over the first two years of medical school. You didn’t think they would just let you learn all this stuff and then move on to seeing patients, did you?

I took my test on June 9 and had an entire month to study. While it was hard to find the motivation to keep going at times, other days I saw the light at the end of the tunnel. I am going to briefly tell you how I studied for Step 1, but keep in mind everyone learns differently and this in no way guarantees you will get your dream score.

My first resource for studying was Pathoma. Pathoma consists of a series of video lectures about various pathology topics. It is a must have for all of second year so I would recommend purchasing this around July so that you can use it all year (including during your Step 1 studying). If I remember correctly our school got a discount so make sure you have the code for that before you go off buying it on your own.

First Aid is probably a book everyone is familiar with and I would highly recommend using it throughout medical school. The things in it are pertinent to first and second year. However, it is important to not use First Aid as your only study source. I liked to use it to review things I had learned in lecture and found it to be a great tool for solidifying my knowledge. Another thing to remember is that there will be things in First Aid that you do not learn in lecture and there will be things you learn in lecture that will not be in First Aid. Again, don’t rely solely on this book.

Finally, everyone needs a good question bank. I found Kaplan to be useful during the school year. The weekend before a test I would do all of the questions that were pertinent to that particular subject. While studying for Step 1 I mainly used the UWorld QBank. I cannot say enough amazing things about UWorld. This is not a question bank I would recommend using during the school year, but it is a must have for when you seriously begin studying for Step 1.

Before I knew it my second year of medical school and Step 1 exam were a part of the past. I am incredibly excited to begin seeing patients and doing more active learning in the hospitals. My first rotation is in internal medicine and I am looking forward to it. It seems like yesterday I was walking into White Hall for my first lecture and though I will not be attending the building as frequently now, it will always have a special place in my left and right ventricles.

As always feel free to contact me with any questions you have about anything you may have read or may have just been contemplating. If this all seems overwhelming at first then that is a good thing! Medical school is not easy, but I assure you that you can do it. Don’t ever give up! If you find yourself in Anatomy next year and wonder how you will ever learn all of the arteries or all of the parts of the heart feel free to contact me. I, along with everyone else at the Wright State University Boonshoft School of Medicine, want to see you succeed!

During orientation the clerkship director warned us that they expected some of us to get sick. I’m in the middle of my fourth week and I’m sick…again. Despite the hand washing and mask wearing, my immune system was just not ready; I write this post while coughing and sneezing. My senior resident asked me jokingly last night if I was allergic to them; in reply, I just sniffled and excused myself to go blow my nose. It’s difficult to mouth breathe and talk simultaneously.

While trying to listen to a little girl’s lungs, she told me my eyes reminded her of Lucy. Her mother later let me know that Lucy is her puppy…I’ve never seen a puppy with sparse eyebrows, snazzy winged eyeliner and eyelashes brought to you by Maybelline and M.A.C. but then again I have never met Lucy so who knows.

Terms like “cute little chunk-monster” are not uncommon and you will find yourself using them.

That high pitched baby-talk voice that adults adopt when around children is extremely difficult to avoid, I found myself doing it way too often.

If you don’t have a pen-light handy, you’re doing something very very wrong.

I was expecting runny noses but I never knew there was so much constipation in the pediatric population. Then again, I guess I wasn’t too big of a fan of fibre rich foods when I was that age either.
The Pediatrics rotation is like the Disney World of clerkships; everyone is so cheerful, there are lots bright colors, diapers, apple juice, singing and dancing. I think I mentioned before that tap dancing may not have been appropriate during my earlier rotations but I don’t think anyone would bat an eyelid if I broke out into some Broadway worthy choreography at the Children’s hospital…in fact last week, my team’s interns said that we the students could leave for the evening, but only after doing a dance…cha cha slide.

You will encounter obviously neglected babies, your heart will break.

Sometimes you will encounter a twenty-something year old patient in the children’s hospital. While interviewing them you have to keep in mind an awkward blend of your routine adult and pediatric history questions…you have to ask them about recreational drug use, safe sex practices and alcohol consumption…but you can’t forget to ask about their birth history.

Peace, Love and “will you let me take a quick listen to your belly? I want to see if I can hear what you had for lunch…oh my! Did you eat a racecar?”

Sarita

I tend to worry about everything and with applying to and waiting for responses from away rotations, thinking about my fourth year schedule and then there’s matching, which I am not going to stop wailing about any time soon, I might as well be giving out personal invites to wrinkles on behalf of my twenty-something face. How do all these med students out there stay motivated, not cranky and wrinkle free?

I am sure they are going to tell me things like their faith, friends, family…Facebook (teehee). Medical school can be terribly isolating, especially in the clinical years where you’re separated from the majority of your classmates so you have no idea what they’re up to unless they actively seek you out and vice versa. At this very moment, everyone I know could be at the best party of the century and if no one thinks to send me a text, I would never know, right? Even if you have a roommate and you guys are ‘besties fo’ lyfe’ you’re on different schedules. Unless both of you make an effort to say “hey what’s up?” once an eon, it’s very easy to just end up having the same address as that person instead and being real friends. You can imagine how much harder it is to keep in touch with people who don’t share a kitchen with you, who don’t live in the same apartment complex…or state…or country.

I like to think that every student laments at the disconnect from time to time. Sometimes you want someone to talk to, sometimes you want to talk about non-medical school things….but then, for myself, I realize I literally have nothing else to talk about…except maybe if I watch an episode of Scandal. But then I always watched it a day late because it came on past my bedtime and everyone has finished talking about Mellie and Olivia Pope’s hair by then. It’s hard out here for introverts who need to be in dreamland by 10 pm.

I find that it’s the little (some even downright tiny) things that act like pick me ups:  like when a senior resident notorious for breathing fire introduces you to her patient as “my doctor in training” instead of not bothering to introduce you at all, as is her known usual, or when you get a whole four pimp questions right in a row (You’re a genius until they ask an epidemiology question…“Ummm, 5-10%?”) Or when your friend in Maryland who you haven’t spoken to in months calls out of the blue and says they thought of you randomly and you both indulge happy college memories that may or may not have actually been that happy at the time. Or when your baby sister sends you a random ridiculous ‘selfie’, when your neighbor invites you over for a much needed chat/vent session or even that sea green nail polish you rock on the weekends. (What? Trust me, it looks cool.)

Peace, Love and “she called me a future doctor” *squeals annoyingly with excitement*,

Sarita

Ps. I’m only two weeks into my Pediatrics rotation and I am not one of those lucky people that gets through their inpatient month illness-free. Yay for rest and keeping hydrated.
Pps. Sick babies :(

Somehow, before this gynecology/oncology rotation, I had managed to avoid cancer patients. I’ve said ICUs are my least favorite place, well cancer is my least favorite diagnosis. (I suppose saying it is your favorite would be strange….even for the most soulless of human beings.)

Today is my final day of this service and I am glad that I had the exposure but I think two weeks was enough. I met so many women in various stages of their cancer journey. Let’s just say it would be hard for me to write a light, joking blog post about them.

Diagnosis: Dr. L spoke about the possibility of her having ovarian cancer and she just sat there, brown eyes unblinking, silent, flat affect; her husband cried. I sat there with my heart breaking wondering if it was ok to offer a man a box of tissues. Would that just embarrass him? Then I felt silly because if that were me, the last thing on my mind right now would be personal embarrassment, I would have a wife I needed to support emotionally.

Intra-op: “Her colon looks amazing, no mets at all. I was hoping I wouldn’t have to resect any of it”. I continued to retract and pondered his usage of the word ‘amazing’.

Post-op: “Did he get everything out?” eyes only half open, coming out of her anesthesia induced afternoon siesta. Nurse: “he said it was one of the best jobs he had ever done”. She smiled then reached for her head…I knew it was to make sure her purple knit cap was still there. My resident told me that after 7 cycles of chemotherapy, she was very self-conscious about her hair loss and allowed only the doctors to see her bare-headed. She stayed in the hospital for one week after her surgery, I remember writing in my “post-op day #7” note that I was concerned about her mood, she was not as talkative or cheerful as she usually was; no number of brightly colored balloons and flowers in a hospital room could change the fact that it’s still a hospital room and you receive scheduled pain medications…the stuff you can’t just waltz into CVS and buy on a whim. Even the strong willed, like this dear woman, have days where it is difficult to smile.

4 week follow up after surgery: “I would rather not use the term ‘cancer free’ but things are looking pretty good, surgery went well and you look great”. Then my resident recommended she go to a cancer treatment center for pelvic radiation and chemotherapy. Her response: “I really hate my body”. “Mom, please don’t say that” but her daughter could only look at the floor as she spoke. So many sighs. All I could do was give thanks that no one in the room had tried to make eye contact with me and think about my classmate who is interested in palliative care, a brave, brave man.

Peace, Love and cancer: fascinating and frightening,

Sarita

On Family Medicine, my very first rotation, I remember lamenting to anyone that didn’t roll their eyes at me, that patients don’t bother to listen to your advice so why do they bother coming to the doctor at all. What’s the point of the physician even giving advice? Ok, you’re diabetic you are told over and over to eat better, work out, monitor your blood sugar, why don’t you? Do you WANT to die?

Oh to be young, self righteous and completely hypocritical.

I talk to strangers about exercise but the last time I had something even sort of resembling a regular exercise regimen (and by ‘regular’ I mean putting my running pants on more than twice a week; whether or not any sort of running was actually involved each time is a confession for another day) was at least 4 months ago. I drone about healthy eating and portion control; I eat fairly alright myself but the occasional slice of pie does find its way into my life and one of the reasons I want Summer to come is so I can feel less silly about eating ice-cream. Nevertheless, broccoli and I are good friends. Portion control is a completely different story. I can honestly say I live life as though it is one big buffet. What is portion control?

Then there are the body image issues. I know I am extremely sensitive to comments about my weight/appearance, I think MOST people are given the image conscious society we’ve createdit’s one thing for a young girl to endure her family commenting about her weight, it’s quite another to hear things like ‘overweight’, ‘BMI’ and ‘adipose tissue’ from a stranger in a white coat. (Yes, I am aware that some patients develop close relationships with their primary doctors so they’re no longer ‘strangers’ but don’t pretend you don’t get my point.)

My thinking has matured some since Family Medicine (a little less young and a little less self righteous) but now I have a new problem: I am told over and over not to “kill the patient with kindness” If I need to punch them in the back to check for costovertebral angle tenderness then so be it. (Kidding, kidding KIDDING, I promise I do not punch patientsor anyone for that matter. Violence is never the answer.) If they are obese, they need to be told so and counseled appropriately. If they smoke, they need to be told that they are actively killing themselves and offered alternatives on the journey to quitting, etc. etc. I get it, I really do. I know going to the doctor’s isn’t always the most pleasant experience for the patient (which is part of the reason why so many avoid the experience altogether. After all, who really needs to go to the doctor anyway? Physicians are just pill pushers who can’t shut up about the risk of cancer, right? Sigh. The things patients tell me.) Sometimes they need to be told things that are difficult to hear, we all do from time to time. I also know that part of the success in these ventures is the repetition; hearing something over and over contributes to a person’s motivation to change. However, it will never be ‘easy’ for me to talk to a 21 year old young woman about her weight, it will never be easy for me telling someone I recommend they stick themselves every day. I have seen patients cry at the mere mention of the word ‘Insulin’. I know if that ever happened to me, I would go through the stages of grieving and probably get stuck in the denial stage. Lifestyle changes are difficult for anyone who chooses to call herself/himself a member of the human race. (I suppose it would be difficult even for those who chose not to call themselves such.) Either way, let me never lose my patience and sensitivity.

Peace, Love and in solidarity with patients,

Sarita

In the fall of 2007, my foreign travels began when I first went under the bridge on West 3rd Street near Cleveland Browns Stadium. Beneath the busy highway, a man named “Jack” lived on an old, torn mattress. His camp, which smelled of brandy and cigarettes, was cluttered with empty potato chip bags, bottles, and other scraps that had been carelessly scattered by “Jack” and the rodents that he lived with.  But in striking contrast to the mess, next to his bedding was a neatly organized library of at least a hundred books. “Jack” spent most of his days reading.  Classic to contemporary, his book stacks did not discriminate: I remember seeing Lorna Doone sandwiched between Twilight and Harry Potter.

Besides the books, the strangest thing about “Jack” was his hospitality.  I had never imagined a person in such extreme poverty being so engaging and friendly.  The first thing I ever heard him say was, “How are my favorite John Carroll University students? Anyone want one of these Ensure drinks? A nurse dropped a box off for me today and I’ll never finish them all.” How could I not accept his offer?  I drank one.

As we served “Jack” a dinner and gave him a blanket, I got my first exposure to his storytelling.  While eating the chicken breast and mashed potatoes, he gave a riveting oral summary of The Di Vinci Code, and somehow related it to his opinions on global politics. When we were finally ready to leave “Jack” and visit other Cleveland camp sites, Brendan, the leader of our homeless outreach group, gave him a framed picture featuring “Jack” with a few of the John Carroll students.  “Jack”, doting over the picture, placed it right above his mattress on the bridge beam.

For years at John Carroll, I traveled to exotic places like “Jack’s” camp as a member of the homeless outreach group, “The St. Benedict Joseph Labre Project” (often abbreviated “Labre”).  On Friday nights, in two vans filled with food, blankets, clothing, and hygiene items, we visited the homeless on street corners, underneath bridges, and within abandoned structures.  While befriending the homeless, I learned the details of some of their most intimate problems. “Jack” suffered from paranoid schizophrenia. At times his illness would become noticeable: “The federal government is trying to shut Labre down because you guys are coming to visit me,” he once said.  After statements like these, the conversation was sometimes hard, except I knew that I had to step into his world and try to see things from his point of view.

By seeing some of the darkest and poorest parts of Cleveland, I discovered the city’s greatest beauty, the kind souls that live in its shadows.  So although I have no global travel experience, it would be wrong to say that I have never visited foreign places. “Jack’s” camp was probably more exotic and colorful than the hotels, beaches, and restaurants that many American vacationers venture to when they travel across oceans. I had the privilege to explore foreign worlds, experience unique sub-cultures, and collect many strange and beautiful stories.

This summer I am traveling to Swaziland, a country in southern Africa, to do a medical school elective at a clinic run by the Luke Commission medical team.  I shall assist with their efforts to provide primary care and HIV/AIDs services to the people of Swaziland, who are burdened with one of highest HIV/AIDs rates in the world.  Since I have never lived anywhere other than Cleveland before coming to Dayton for medical school, a month in Africa will be a great adventure. I plan to continue this blog in the fall with a follow-up entry discussing my experience in Swaziland. After learning so much from traveling around in my own backyard, I can only imagine the new experiences that I will have and the “Jacks” that I will meet in the wilderness of Southern Africa.

“Good afternoon, Ms. Starflight. My name is Samantha Miller, and I am a student doctor working with Dr. Singh. I know you have answered so many questions in the past few hours, but do you mind if I ask you a few more?” Haha, ‘Starflight’, what an alias? How can these people be so uninhibited?..."

For more on this story, see: This Is Not About You, a piece posted by Sarita Metzger on in-Training, an online magazine for medical students.

These past two and a half weeks of OB have taught me that I find vaginal births absolutely MAGICAL…I had never actually witnessed one before and I imagined the whole affair would just be gruesome and bloody. I suppose ‘magical’ and ‘gruesome’ don’t necessarily have to be mutually exclusive, but that’s not where I am going with this. Call me a sap (actually no, please don’t call me that), call me a traditionalist, but part of the magic for me is the aspect of love. I love it when the father of the baby, the baby’s grandmother, god-mother, great aunt Nellie etc. etc. are all in the room waiting for baby to enter the world. The love and support in the air is SO palpable and I find it absolutely amazing.

There was this Turkish lady who came to us in labor last week… all by her lonesome. She said her husband was at work, she wanted to surprise her mother so hadn’t even told her that she was heading to the hospital and her sister would be by the hospital later with some clean clothing and pizza. (She said pizza and I didn’t ask any more questions.) This woman was the one sweating, obviously in pain but trying to remain composed, refusing an epidural… like a STOIC ROCKSTAR and asking the resident if it was time for her to push yet. Then there was me, the lowly med student just feeling privileged enough to be in the room and trying not to be annoying/get in anyone’s way. SHE seemed perfectly ok with the situation so why did MY heart fall?

During the birth she reached out to me and I grabbed her hand with my gloved hand and told her to hold as tight as she needed. My gloves were dirty and the attending gave me a strange look. Yes, I know, I know. I know I broke sterility but I didn’t plan on touching anything draped in blue again, I moved out of my resident’s way and I felt like I did the right thing.

…Then I texted my father “OMG, I just saw someone give birth and it was GREAT!!” I imagined him smiling but thinking: I have such a cliché for a firstborn.

Peace, Love and just hold a hand,

Sarita

Let me begin by saying that I apologize for not posting in so long. The last few months have been intense. We have had several two-week courses where the final exam in that course was our entire grade. Yes, you read that correctly. I said two weeks. I have food in my refrigerator that has been around longer than some of these classes.  Time sure has gone by quickly. It seems like just yesterday I was moving into my apartment the weekend before my first class at Wright State.

Without a doubt it was a difficult time and second year is much harder than first year. However, a recent conversation I overheard on one of my flights to see my wife really got me to appreciate the fact that I am pursuing my dream of becoming a physician.

The conversation between two girls about my age went a little something like this:

Girl 1: Oh what do you do in (city)?

Girl 2: I’m in nursing school.

Girl 1: Oh that’s awesome. Why did you choose to go to nursing school?

Girl 2: Well, I thought about going to medical school but I did not want to go to school for that long.

Let’s stop here. It is well known that medical school requires a lot of extra schooling. In fact, you will probably be learning throughout your entire life as a physician (unfortunately I cannot speak from experience on this yet so ask me again in 50 years). And trust me, while you are taking exams every 2 weeks, trying to have a social life, and just trying to be involved in extracurricular activities it may seem that there is no light at the end of the tunnel. However, I can assure you there is.

Looking back at myself I knew nothing about Rocky Mountain spotted fever or how Imatinib works. I entered medical school with a relatively clean slate ready to absorb whatever knowledge came my way. Here I am 1.5 years later and I am astonished at all of the things I have learned. I overheard one of our professors mentioning how many new words we have learned since beginning medical school (it is somewhere in the 1000s) and I was astonished. It seemed impossible in the beginning but now I can have everyday conversations about how Imatinib blocks a receptor tyrosine kinase. That sounded a lot more awesome in my head but you get the idea.

My advice to anyone (including this girl if I would have met her in time) is to not let time factor into your decision to come to medical school. As a medical student you will constantly be experiencing delayed gratification, but if you truly love the things you are learning (as many of my classmates and I do) it will all work out in the end. There may be times you feel like giving up (totally normal) but the key is that you and all of your classmates are in this together. If you have any questions about what medical school life is like or need some encouragement because you don’t know how you will ever be able to make it through all the things I describe in this blog please do not hesitate to email me at bree.2@wright.edu. Happy holidays!

There was an article published on The Opinion Pages of the New York Times recently entitled “Medicine’s Search for Meaning.” Normally I’m not a huge fan of reading online articles but this one grabbed my attention because the Boonshoft School of Medicine was in it. Who else was in this article you ask? Have you ever heard of Harvard? Yes, that Harvard.

Last year as a first year medical student I took a voluntary course called Healer’s Art. I had heard from people who took it the year before that it was a course about sharing your feelings with others and talking about the difficult aspects of being a doctor. I’m not a person to talk about my feelings often, but all my friends were taking the course so I thought I would give it a shot. As it turns out, there was much more to it than that.

The article says, “Great doctors don’t just diagnose diseases, prescribe medications and treat patients; they bring the full spectrum of their human capabilities to the compassionate care of others.” A powerful statement when you think about it. As physicians we are so much more than a scientist. In healer’s art we learned about treating our patients with compassion and being able to relate to them through a concept of a wounded healer. I’m sure many of us have been to a physician where we just felt like a number or a science project. I’m sure I don’t need to ask if you returned.

On the other hand there are many doctors who sit down and talk to their patients as human beings. They ask questions that other doctors wouldn’t just because it has nothing to do with diabetes. They introduce themselves as John Smith not as Dr. Smith. They see their patient as an equal, not as a customer.

Taking this class has allowed me to see good and bad examples of the previous statement from the Times. I’ve shadowed physicians who don’t always see their patients (they let their assistants see them unless it is a new patient) and I’ve shadowed physicians who must see every patient and share stories about recent fishing trips. I’ve met doctors who volunteer their time to treat a patient outside of their normal 9am-5pm schedules. I’ve also seen physicians who watched the clock ticking at 4:55pm and headed out the door at 5pm on the dot.

Healer’s Art is a great step towards creating a more compassionate and caring physician. The class is offered to first year students here at Wright State. However, there are many schools that do not offer the course. I remember something our Associate Dean Dr. Gary Leroy said the first day of orientation at Wright State. It was something along the lines of “Our students may not average as high as other schools on the boards, but I guarantee you one thing. We outcompete other schools when it comes to real life experiences in the clinic.” I am not bashing other schools and neither was he. I think the point is that there is much more to being a physician than being able to recite Virchow’s triad.

Guys. This post isn’t very medical school related, but I needed to document this summer and this feeling. I figured you’d forgive me for writing a post like this. Right? Thanks, you’re the best.

Summer and I have a very tumultuous relationship. By tumultuous I mean that, until very recently, it was my least favorite season. I used to hate the heat, hate how dry everything was, and hate how my summer birthday was always casually ignored because I wasn’t around my school friends. The past few years, namely since my stress level has drastically increased, I’ve started to love how ALIVE summer feels. I love the thunderstorms, how early it gets light outside, how the heat feels like a release. This summer, though, is one for the books.

This summer hasn’t been flashy by any means. I haven’t traveled abroad like I have in the past. I haven’t been saving lives on medical mission trips, or researching cures for cancer. Instead, I’ve spent more time lazing around than I think I have since eighth grade. I’ve been reading constantly, sleeping forever, and spending every second possible with my family. I’ve been sweating to death in hot yoga, in my parent’s garden, and on runs in the trail behind my house. I’ve seen movie after movie and spent hours on the couch at the apartment of my two best friends. And I’ve loved virtually every second.

For the first time in a long time, I feel sure of myself. Sure of my beliefs, my mentality, my everything. I’ve never been more myself than I am at this very instant. I am more excited about living, less stressed about the future. I feel confident, empowered, certain of my decisions and my priorities. And guys, it’s a really good feeling.

After four years in undergrad constantly worrying if I could get into medical school, worrying that I was going to be at the right place at the right time, rushing and stressing and fruitlessly planning everything, this sense of calm assuredness is the hugest blessing I’ve ever felt. I only wish I could have gotten here 23 years sooner. But I’m going to hold onto this feeling as long as I can and hope it can get me through the rough year ahead.

I thank my first year of medical school, God, new and old relationships, yoga, and especially my family for guiding me into adulthood. Today, in this moment, I feel vast, brilliant, powerful, young, wise, beautiful. I hope you join me here too.

I wonder how many other essays exist out there that start with this next sentence: medical school is hard. Typical, I know, but I will not lie to you, I will not sugar coat things, I will tell you how it really is. It is hard. But I’ll tell you what, you know that fabled light at the end of the tunnel? It’s there.

As I am finishing up my first year of med school, I am almost surprised to emerge in one piece. After countless hours of lecture, studying, and memorization of seemingly endless details about the intricate workings of the human body; after praying for “just a passing grade” when a few years ago a B wasn’t good enough; after sacrificing time with family, friends, and loved ones; after a few minor breakdowns and many tears – I can honestly say that I can’t wait for next year. More importantly, I can’t wait for third and fourth year, residency, and my future career.

Despite the struggles we all faced as MS1s, there were moments I experienced that reminded me why I am putting myself through what is possibly the greatest challenge I have experienced thus far in my life. Like tiny beacons, they happened in the most unexpected circumstances to push me through a tough year. We all have these moments, each one unique to the person experiencing it, and I want to share with you some of mine.

While practicing physical examination skills on a veteran in the inpatient ward of the hospital, fumbling with your new, large, clunky otoscope, he leans in to reassure you that you will make a great doctor – you have warm hands.

While shadowing in labor and delivery, tagging along with the MS3 on duty that night diligently answering all of your queries (thanks Ashley!), you head in to an emergency C-section to witness your first birth – and get to be one of the first people to welcome this new healthy baby boy into the world.

While conducting a volunteer patient interview, practicing how to best communicate with patients and ask all the important questions, learning to do the very basics of our chosen profession – Ms. C thanks you for being so attentive, kind, easy to talk to, and making her feel comfortable (even when you have to ask a 76 year old about her sex life).

While shadowing in hospice care, visiting people in various stages of the ends of their lives, talking to those who still can, sitting and just being with those who can’t, your social worker tells you that Mr. G asked where you were last week – you brightened his day enough to make an impression, just by listening and smiling.

While in New Orleans on the spring break trip, working with homeless HIV/AIDS patients at a transitional home, you are entrusted with a life story: he served in the army, studied psychology in college, and knows five languages – by opening your mind and your heart to the triumphs and suffering of others, you have been rewarded.

While sitting in the audience at the OB/GYN residency panel, listening to four amazing women talk about their chosen field, how they got there, and what they are most looking forward to – and realizing you wish you were in their seats, because more than anything you want to do that too.

Peers and patients alike will open up to you, should you only earn their trust and respect. The kindness of others, through shared wisdom, friendship, and kind words, will be an unheralded source of strength and support. You will be privy to so many secrets and be a part of some very special moments. You will be astounded by the perseverance of the human spirit, both in the hospital and the classroom. Take advantage of the opportunities presented to you, talk to everyone, and make each conversation count.

You will work hard and lose sleep. At times, you will be frustrated and angry. But you will seek the good, and do it. You will immerse yourself into learning and enlightenment, and be guided by your teachers, your mentors, and your peers. You will succeed, and be justly rewarded. I am only (almost!) through my first year, but I can promise you this: it is hard, and it is all worth it.

I apologize in advance for such a short entry but a lot has happened since I last updated my blog. I could go on and on about the happenings at Wright State but I will give you a couple of examples. While sitting here reminiscing I am reminded that right now I am four weeks away from being done with my first year in medical school. Where did the time go? Sure, a lot of it was spent studying but there were so many more things that went on this year.

The Boonshoft School of Medicine Talent Show took place a few weeks ago. It was such a fun event and I recommend going next year if you are an incoming student. You can check out all the acts and more here: http://bit.ly/10Lwr1R.

The intramural softball team that I participated in wrapped up its season. Intramurals are such a fun way to relieve the daily stress of studying. If you are interested in flag football, soccer, basketball, softball, or even water polo I recommend you come to Wright State! Be warned though, my class is quite athletic so you will probably end up getting second place to us in any sport you try to participate in.

The research symposium hosted over 50 posters of students in our medical school who are doing research! Topics ranged from academic medicine to basic science research. Prizes were awarded for the top posters in each category. This was a great way to meet faculty as well since many of them served as judges for the event. There are a ton of research opportunities here at Wright State. If you are interested in research you will easily be able to find someone to work with or you can even start your own project!

These are just a few of the many stress-relieving activities that have happened since I last posted. If you have any questions please feel free to contact me or any of the other bloggers. At the Wright State University Boonshoft School of Medicine there is more to medical school than studying!

While most of you are probably already on or about to begin your summer vacation, we here at Boonshoft are still reminiscing over our spring break. About a month ago, over half of my class (about sixty students) went on a spring break road trip to New Orleans, Louisiana.

The timing of our spring break and vacation was impeccable: we had just finished a two and a half month class called Cells, Tissues, and Organ Systems (CaTOS for short). This class was…brutal. Our second exam covered over 1100 pages of material and the final (yes, cumulative, FML) was over almost 2000 pages. Needless to say, we all basically looked like pale, unhappy zombies walking out of that final: some fun in the sun (and on Bourbon Street) was exactly what we needed.

The NOLA trip is one that is organized entirely by our school. It’s a service trip that runs Monday-Friday of our spring break. Our class is split into groups of three and put into three different service projects on a first-come, first-served basis. I was lucky* enough to get into the smallest service group, at a site just outside the French Quarter called Project Lazarus. Project Laz is a halfway-home for people who are HIV+. Basically, if you are living in New Orleans with HIV and find yourself with nowhere safe to live, you can be accepted into this house (I believe there is a sort of referral/application process). While the residents live in the house, they participate in programming like book clubs, therapy groups, addiction counseling if they need it, and earn an income that is put into a savings account. While no residents are ever forced to leave the house, most spend a few months there, then move out on their own. It’s a really cool project, and the residents and workers there are super incredible and kind.

*When I say lucky, I mean incredibly well-planned. There were only twelve slots to be in this group and sixty med students trying to get into it. I refreshed my email every thirty seconds for, like, ten minutes and had “Project Lazarus” saved into my copy-paste. Sorry for being such a nerd but this project was too cool to act calm and collected.

While working at Project Lazarus, our group helped create a composting system for the house, tore down an old shed, cleaned one of their facilities and socialized with the residents. Obvi, socializing with the residents was the best part (but it was definitely nice to be outside in warm weather no matter what we were doing). The residents loved talking to us about our career aspirations, telling us about their past, and discussing their favorite festivals and Bourbon Street memories. They also gave us tons of food, restaurant, band, and drink recommendations and begged us to tell them if anything embarrassing had happened the night prior. They were so great.

The service work was definitely a highlight of the trip, but it was also nice that we had every evening to spend doing whatever we wanted. My group ate so much good food-like, SO MUCH FOOD-and spent a lot of our evenings at jazz clubs on Frenchman Street. (I loved the oysters and the gumbo, but my favorite meals were at a West African/Nigerian restaurant. If you have never eaten West African food, go get some. STAT. You’re welcome in advance.) I also got to go on a haunted tour which was awesome and definitely terrifying.

It was wonderful that our school planned such a cool, fun, but relaxing service trip for us after the most intense medical school class so far. Spending so much time with so many of my classmates was incredible: I loved getting to hang out with people I usually only see in class. And of course, being in one of the most fun cities in America doing work for an amazing project made it all even better.

This year I had the most love-filled Valentine’s Day of my life. Please keep reading: I will not be boring you with tales of dozens of long-stemmed red roses, a romantic dinner, or other inappropriate things. I actually spent February 14 in the Labor and Delivery Ward of Miami Valley Hospital. No, I did not bear any children of my own, but I did get to watch four other people deliver babies.

The OB/GYN Club here at Boonshoft set up a wonderful shadowing opportunity that allowed one medical student at a time to spend about five hours in L&D at Miami Valley. Although I haven’t the slightest idea what I’d like to specialize in when I’m a grown up MD, I couldn’t miss the opportunity to witness the miracle of childbirth. In the days leading up to my shadowing, my two main hopes were that 1. it would be a busy night so I could actually see a delivery and 2. that the medical students and residents wouldn’t think I was a huge loser for voluntarily spending my Valentine’s Day in the hospital. I shouldn’t have worried though*: the minute I arrived (it only took me one secretary, one janitor, and two nurses to find the resident’s lounge), I was ushered into a C-section. Literally seconds after I arrived, the attending pulled a baby out of a uterus. Like, I walked in and BOOM! there was the baby. It was insane.

*Please note that I did not mention whether or not the residents/medical students thought I was a loser for spending VDay shadowing. They probably did even though they didn’t show it because, I mean, come on, even I felt kind of lame.

I wasn’t sure how I would react to seeing a delivery; I didn’t know if I would think it was cool or gross, if I would get emotional or be unimpressed. Even after only being in that OR for five seconds, it was impossible to not be moved by what I had witnessed. When the attending delivered the baby, my jaw dropped. Once the baby started crying, my eyes filled with tears. I just stood there in shock, in awe that I was one of the first people in the world to see this little human. It was absolutely incredible.

The rest of the evening did not disappoint. I was able to see two vaginal live deliveries, another C-section, and watch blood clots get scooped out of a uterus via ultrasound (the last one was mildly gross but super cool). The team I was with was incredible. The intern answered all my questions and let me watch everything I could possibly watch. The attending on service made sure I could see every aspect of one of the vaginal deliveries I witnessed. The MSIII working with the team, incidentally also named Claire, taught me so much and was very patient with my childish excitement. It was honestly the best shadowing experience I have ever had.

One thing I cannot help but mention about Boonshoft is that virtually every physician I have met or shadowed thus far is incredibly excited to teach. Their love for their jobs is made apparent in their enthusiasm for working with students. I have learned so much from so many physicians here already, largely because they earnestly love educating. It’s so rewarding to learn from individuals who view you as anything but a nuisance (because, in actuality, medical students can definitely be just that, especially when they are freaking out in a busy L&D ward about how cool moms are).

I’m so glad I got to spend my Valentine’s Day doing something incredible. Medical school can change your priorities when it comes to what you find meaningful. I wouldn’t change my night spent in L&D for a thousand romantic dinners. Probably.

So a lot has happened since I last wrote a blog over a month ago. I’ve gone to tons of club meetings (who doesn’t enjoy free food?), completed CaTOS, and even learned first-hand why it is important to warm a stethoscope before placing it on a patient’s chest or abdomen. As I sit here on spring break (yes, you get a spring break in medical school) watching college basketball, I find it is a good time to reflect and share my thoughts with you. Apologies in advance if there are any grammatical errors but I have not used my brain since my CaTOS final 5 days ago.

One piece of advice I would give to anyone entering medical school is to make time for yourself to continue to do the things you love to do. If you are someone who doesn’t normally study non-stop all day do not change that just because you are in medical school. Don’t get me wrong. You will probably have to study much more in medical school than you did during undergrad but that does not mean you cannot have a life. If you see your classmates studying all day at school it might be a little intimidating. I know it was for me. What you need to remember, though, is that everyone learns differently. For me, that means studying but never missing an episode of the Walking Dead or Dexter on Sunday evenings.

You may also think that you are alone and the only one who has fears about the upcoming exam over 1,400 pages of notes. I assure you that EVERYONE feels that way. If you are accepted to Wright State you will have the opportunity to take a class called Healer’s Art. The class meets in small groups once a week for six weeks. You will talk to your classmates about some very deep stuff. I used to think everyone else was so confident with their studies before I took this class. However, I learned I was not alone and made some friends in the process.

The final piece of advice I have for you is to go to as many club meetings as you can. You do not have to be president of seven organizations, have three research projects going on, and work a part-time job while in medical school. That is not the point I am trying to make. What I am saying is that you should go to these meetings to open up your eyes to new fields you may not have had an interest in before (or to change your mind about the ones you WERE interested in). There are organizations for every specialty and attending is also a great way to meet faculty. If that is not enough incentive for you, these meetings usually occur around dinnertime and have free food such as Chipotle and pizza.

I know my blog can be comical at times (at least I hope) but these points of advice should be taken seriously. You are going to feel like you are going insane sometimes. However, all of these things should help you maintain your sanity when you just want to give up looking at the difference between simple columnar ciliated versus simple columnar non-ciliated epithelium at two in the morning.

When you think about the Middle East and Persian Gulf, war, political conflict, violence, and the brave work of the men and women of the U.S. military enter the imagination. However, there are also thousands of years of rich cultural heritage and areas of wealth, stability, extraordinary generosity, and innovation that get drowned out by the noise. During the summer of 2012, three of my classmates and I traveled to Oman—southeast of Saudi Arabia—through a formalized exchange at Boonshoft. We did observational rotations at Sultan Qaboos University Hospital near Muscat, and had our perspectives on the region opened and enlightened in ways we could never have imagined. For three weeks, I was learning from physicians in hematology and general surgery; and every afternoon and on weekends (which are Thursday and Friday there), we were exposed to the region and culture through student ambassadors from Sultan Qaboos University with truly hyperbolic generosity. I did this as part of a requirement for the international health track that the school has set up for us; I would venture that one third or more of my class traveled last summer--from Nepal and Vietnam, to Jamaica and Native American reservations.

While in the Middle East, I had the opportunity to visit Dubai, the glass city growing in the desert like the land of Oz; and Jordan, where the Dead Sea, Sea of Galilee, Red Sea, Roman ruins, Petra, and Wadi Rum were a collision of ancient and modern, and evidence of some of the regional turmoil was seeping just barely into its borders (especially north toward Syria). One of the Ph.D. students at Wright State University is from Irbid, Jordan and I visited his family there—in fact, his brother has come to Dayton for an elective that started this week at Kettering and I am looking forward to seeing him and hearing his impressions of the U.S.!

The other piece that had summer 2012 on my mind was a Middle Eastern meal that I had over the weekend. Last Sunday in Dayton was the Day of Caring, a fundraiser to help combat homelessness and hunger that happens annually at schools, churches, and community organizations. Ralla, one of my classmates, helped to set up sites at both Boonshoft School of Medicine and the Miami Valley School; the former serving a pancake breakfast, the latter serving food from the Middle East. It was a great moment to look back at that phenomenal opportunity to travel, and to remember through the tactile, sensory experience of eating; that trip seems so far away from studying for our renal course, it is like reflecting on a dream.

So you are interested in coming to Wright State for medical school? Either that or you are one of my family members reading this blog for proof that I am actually doing something productive. Whichever the case may be, let me start by saying that I have never blogged before so I am not really sure where to go from here. I might ramble on about things unrelated to school. Some things you might find funny, others you may not. Regardless, I will try my best to give you a mental image of what life has been like for my classmates and I since starting medical school (with the hopes of not scaring you away). If you have any questions about anything (medical school, life, why we drive on parkways and park on driveways) feel free to email me at bree.2@wright.edu.

Medical school started with Human Development. A two week course devoted to…human development. The exam for this class will be the only time you have to write an essay. Nothing too serious so don’t freak out if you are not an English major. I assure you most of my classmates are not (although some are). Go to class and you will be fine. Next comes anatomy.

During Human Structure you can expect to spend late nights in the cadaver lab with your classmates trying to find the inferior mesenteric artery or learning the brachial plexus. There will come a point (usually after about 3 hours in the lab) when everything that is said becomes “humerus.” See what I did there? That is when it’s time to go home for the night.

Your next class is MBM or the Molecular Basis of Medicine. You are going to have several professors for this class but the notes are a great supplement for the lectures. If you want to shadow, take guitar lessons, learn to cook, or build a rocket ship, do it during MBM. You will have more free time during MBM than in any other course as a first year.

When the New Year comes you will start CaTOS, which is referred to as Cells, Tissues, and Organ Systems NOT Cells and Tissues, Organ Systems. I guess CTaOS didn’t have the same ring to it. You will put in a lot of time during this course but I feel like it is the most rewarding course we have taken so far. You are going to be amazed at how much you will learn in this class. I mean how cool is it to be able to look at a tissue section under a microscope and recite approximately 20 facts about said tissue?

When I decided to come to Wright State one of the main reasons was because of the atmosphere. All the other schools I had interviewed at seemed so competitive. Wright State was the complete opposite. Your classmates and the faculty definitely care about your success. If you aren’t getting something then anyone will help you out. If you just want someone to cry with after a week of non-stop studying I’m sure someone would oblige you as well.

That’s all I have for now. Once again feel free to email me and I will try to come up with a witty (but serious) response to your question.

As everything goes blazing by, class after class, it’s easy to lose sight of what is actually happening. Maybe that sounds obvious, but writing about it seems like a great time to pause and look over what’s all going on.

Next Monday, our respiratory course will be over. So let me remember this short time, and these people that I am here with, right now, because it’s so transient and we’ll all be tossed to the wind in a few years — careers and the “real world” beyond the protective walls of White Hall and Dayton and Boonshoft.

I know one day I will think back to things like this: I arrived at school for what I assumed would be an 8 a.m. start-time this past week. We were having a question session about respiratory tract neoplasia, but I misread the schedule and found an empty lecture hall until a 10:30 start-time. I know my classmate Brian arrives at school early — he always has the closest parking spot and his small car is hard to miss — so I sent a text and eventually found my way to the ICM room he was in (the ICM rooms are basically study rooms, but they’re used for our Friday Introduction to Clinical Medicine course, so that’s why we call them that). Brian was looking over material for later, so we sat for a while studying. At some point Nikki came and joined us. There was idle chatter and occasional distraction, but that’s the best sometimes, especially for me since I almost always just study at home.

Brian and Nikki are two of the four other people that were in my Team-Based Learning (TBL) group during the MS1 year. In TBL, we had a flag next to our team number so we have always called it “Team France.” The five of us really got along well and we continue to get things for each other’s birthdays and bug each other when a group might be useful to cross-check something instead of going straight to the professor or the online class message board. The year has been busy, and I haven’t felt as reliant on the group for anything compared to last year, but it’s really comforting to have that backup.

Last weekend my dad was in town from Maryland; it’s always refreshing to have a visitor — though I’m always conflicted by feeling like I’ll fall behind if I don’t put in my time on the books, at the risk of not being a good host. I’m sure I’ll write about him again later, he and my mom are both among my heroes. Uncommonly good food, hiking in John Bryan State Park, and a short visit in Columbus with my brother were perfect to enjoy some decent weather and break the winter doldrums.

Hopefully this respiratory exam goes well. I have so much physiology to look back over! I’m sure I’ll have a chance to deconstruct it all next time.

I love to express myself and create…but for some reason I’ve never blogged before. I’m an avid tweeter. So I’ve already told myself to imagine this is a just an extension of my iPhone with one twist (there’s always a twist!) of not being constrained to 140 characters (freeeeedommmmm)… so let’s begin this journey together…

It’s the second semester of second year (see what I did there?) and I’m ecstatic, thrilled, anxious, scared, and determined all at once. Just today I was telling my classmate that we’re rounding the corner of the track and I can almost see the finish line. I like to look at med school as 2 parts. The first part is the first 2 years where we do our “book learning” and the latter the “clinical learning.” And boy oh boy can I see the finish line to the “book learning.”  But before I make it there is DUM DUM DUMMMMMMMMMMM…the dreaded BOARDS aka Step 1! (insert evil sinister laugh). So let’s go back to my track analogy and I imagine Step 1 like this…(bubble appears over my head and everything in the room gets hazy)…I’m in my Boonshoft School of Medicine green and gold track suit (looking sharp as a tack) running full speed…I can taste the sweet victory about being done with part 1 of med school and all of a sudden this hideous man jumps out of the stands and gets in my way. I’m like “Hey man what are you doing?! I’m trying to finish this race.” The more I try to dodge him the more he darts in front of me and blocks me from my goal. Talk about frustration. That was then (for the most part).

To be honest I was terrified about this year in August when we began, but how I’ve been wrong about everything so far. The moment when all of this changed is when I decided not to think about Step 1. I know that sounds impossible but I decided to just not even allow myself to get worked up about this exam. At least not right now. Some people work well under pressure, but that’s not me. At all. I’m more of a cool vibrations, let’s take one day at a time type of girl. And today is about Respiratory Pathology. And that’s it. If I just focus on that today and tomorrow on whatever tomorrow presents then I’ll maintain my sanity (rule #1: At all times maintain your cool). If there’s nothing I’ve learned best in my past 24 years of life is that I do my best work when I stay calm and collected. So until I’m proven otherwise that’s exactly what I’m going to do.

Don’t get me wrong…some days as much as I try to stay calm…my mind wanders to the same scenario on the track…me rounding the corner and this obstacle in my way, but now luckily I guess I’ll have this first post to refer to and laugh about how I just shared my the bizarre inner workings of my mind with all of you good people (aka strangers) lol.

Until next time, Enjoy!

Hey readers! I’m Claire Dolan, a (lowly) first-year medical student at Boonshoft School of Medicine at WSU. I’m just going to go ahead and preface this post (and all my future posts) by saying that you and I are both going to enjoy my blog better if we agree to think I’m funny.

Now that that’s settled, we can begin.

This month marks my sixth month of medical school. Six months at Boonshoft means I’ve dissected a cadaver, learned how to take vitals, memorized the Citric Acid Cycle (for the billionth time)(How do I still not know that thing?!), and heard families talk about how genetic disorders have changed their lives. Six months at Boonshoft also means I’ve developed a sincere love for the instant coffee machine in White Hall, found a group of friends who are a lot like me, cartwheeled through the atrium on late Saturday study nights, and become an expert at finding free food at meetings.

About a year and six months ago, I was a very stressed undergraduate at The Ohio State University, positively freaking out about where I was going to be in a year. As a classic pre-med (read: Type-A, OCD person), I was terrified not knowing where, or even IF, I would be going to medical school. Eventually, I interviewed at three different schools, one of which was Boonshoft. During my six hours here, I pretty much fell in love. I was honestly shocked-I had never really heard of BSOM and applied just knowing it was one of those Ohio schools you apply to. I never expected to actually like a medical school, I just wanted to get into one! At Boonshoft, I got the feeling that the administration was sincerely proud of my accomplishments and that they really wanted me to succeed. (I got this vibe after my interviewer blatantly told me, “You’re an awesome applicant. Congratulations on all your hard work!” Who says that during a med school interview?! Someone from Boonshoft, that’s who.) Once I was accepted here, I rejected interview offers from two other schools because I knew here is where I’d be happiest.

Now, six months into my medical education, I can honestly, sincerely, in a non-propaganda way say that I’m thrilled with my decision. Moving from Columbus (aka the greatest city in Ohio) to a suburb of Dayton (…) was a bit of an adjustment, but I’ve come to love it here. Not worrying about getting towed or fighting hours of traffic is incredible. The education I am getting at school is amazing. Our professors are incredible and genuinely love interacting with us, our physicians beg us to shadow them, our administrators hand-deliver our course packets well before every new class beings, and we students are seriously (SERIOUSLY) not competitive with each other (Try to name another medical school where a student would email his outline of 1,000 pages of material to the entire class voluntarily. I dare you.). Sorry for being a walking billboard, BUT I LOVE IT HERE.

Sure guys, medical school is hard. In these past six months, I’ve been expected to memorize more than 300 pages of solid, dense text in a week. I’ve been so busy that I haven’t had time to shower, let alone shave my legs (Apologies to my clinical skills partner during that lower extremity exam class.). I’ve gone DAYS without seeing the sun. I’ve had those moments the night before the test where I start laughing and end up crying (TMI? Probably.). And apparently it’s all going to get much, much harder. But I love my school, and it’s a lot easier to deal with sleep deprivation and caffeine jitters when you can call your classmates your friends and when the admissions committee gives you their leftover food.

I held the photo in my hands and squinted. Like an X-ray, it was black and white.

But instead of analyzing lung fields or the cardiac silhouette, I found myself looking at a photo of a young man at a rodeo, riding a bucking horse and appearing to thoroughly enjoy the attention from a capacity crowd.

Depicting a scene that was part sport, part theater, the photo itself seemed to be at least a half-century old.

"You're probably wondering why I handed you this picture," said Dr. M., the physician at the Veterans Affairs (VA) Medical Center who meets with medical students such as myself every morning.

"Tell me what you see."

Feeling uncomfortable, I looked at the photo closely, searching desperately for clues, signs of illness that the man (or the horse) might have. Perhaps, I began to wonder, I was missing something obvious.

So, logically, I counted the man's arms and legs. Start with the basics.

Both legs were present, as were his arms and hands-one used to grasp the horse's reins, and the other raised in the air, either to maintain his balance or to tip his cowboy hat to acknowledge the adoring crowd.

Really, I thought, he seemed to be having a grand old time...

On more traditional mornings, Dr. M. shows my classmates and me radiology images of patients, challenging us to find something abnormal-a small fracture on an X-ray, perhaps, or a hidden tumor on a CT scan.

It's all part of what is informally known in medical education as "pimping"—a version of the Socratic method of teaching—designed to put residents and medical students on the spot, always in front of our peers and sometimes even in front of our own patients.

Its purpose is less to make the medical students feel inadequate and more to make us learn and remember something useful.

More importantly, it's to demand that we always strive to know everything about our patients, from their liver enzyme levels to their current living situation, from their vital signs to their personal histories.

At the VA Medical Center, the personal histories come from patients who include former soldiers, Air Force pilots, Naval officers and the like. Some fought decades ago in World War II, while others more recently, in Vietnam or Afghanistan.

My first patient at the VA, a former soldier, was suffering from Hepatitis C. After seeing him every morning for several days, he was ready to be discharged from the hospital.

"My family is coming to see me later today," he said during our morning chat. "I would like it if you could stop by and tell them about my condition."

Indeed, that afternoon I met the patient's family, including his parents, and was grateful to get a glimpse into the patient's life beyond the hospital walls, an impression of what his life might have been like years ago, growing up in Dayton and hoping to nobly serve the country.

He had a kind and caring family, and though he was sick now, it was clear that the past was filled with better days...

I continued to gaze at the ragged photo in my hand, unable to find anything wrong with the mysterious man on the horse.

"He looks healthy, doesn't he?" asked Dr. M. at last.

I nodded. And mercifully, the answer was revealed.

"This is a gentleman who was here in the hospital recently and was very ill," said Dr. M. "I wanted to show this to you as a reminder that these patients at the VA weren't always old and sick."

I looked up, as did the other medical students—realizing that, although we had been duped to some degree, we had become so trained to look for disease that we had missed recognizing something far more important: good health.

Indeed, by the time we see patients, they usually are sick. Many times, they're elderly as well. But knowing everything about them means seeing more than a snapshot-knowing where they have come from, what their lives were like before meeting us in the hospital.

Hopefully, if we do that, we can take better care of them-and perhaps more importantly, help them feel young again, too.

For the last two weeks, I have chosen to visit this hospital room, this patient, first.

I enter, and the calming sense of early morning quiet is quickly broken by the ongoing sounds of a breathing machine—a device that allows my 25-year-old patient with Down syndrome, “John,” to sleep through the night.

Beside him, as always, lies his mother, who has slept on a makeshift bed by her son’s side for 14 consecutive nights.

As always, I begin my morning routine in this room, and I do so with a combined sense of hope and dread—hoping that John will be well enough to go home, but dreading that I wilI have to tell him, again, that he’s “not quite ready yet.”

Standing in almost complete darkness, I look at John and squint at the oxygen settings of his breathing machine.

Two weeks ago, he was admitted to the hospital with right-sided heart failure, a condition that had developed secondary to heart complications related to Down syndrome. He is also diagnosed with obstructive sleep apnea—a condition that, in John’s case, increases pressures in the vessels that transmit blood from his heart to his lungs.

Now, he requires supplemental oxygen to breathe, 24 hours a day.

But he looks better, healthier, than when I first met him. He struggles much less in his effort to take deep breaths, or to sit up in his bed. His legs are no longer swollen with fluid backing up from his heart.

He seems calm.

I take a deep breath myself, and apologetically, I wake them.

“I’m sorry,” I say—always my first words to them in the morning. “I’d like to see how John is doing today.”

“It’s okay,” says his mother. “I think he’s doing better.”

John wakes up as well, and as he has done so for so many mornings, he smiles underneath his breathing mask and extends his hand.

“Good morning,” he says, earnestly clasping his other hand over our handshake. “Can I go home yet?”

“I hope so,” I reply cautiously, knowing that for days on end, our collective hope has merely translated into another night’s sleep in this room for John and his mother.

Still, they have remained—above all else—patient, understanding the notion that extra days in the hospital now may save them the grief of an unwanted return trip in the future.

For most of us, breathing is a subconscious process, driven by a coordinated effort between the brainstem, the lungs, and the chemical composition of our blood. It is a process we undoubtedly take for granted.

Our goal for John, of course, is for him to breathe without struggling to do so. If we reach that goal, we can help John reach his own goals—one of which he mentions to me every morning.

“I’d really like to go home so I can see my dog,” he says, his voice often cracking and his eyes welling up as he describes his dog to me, each day as if for the first time.

“I know,” I reply. “Let’s see if we can make that happen.”

After morning rounds—during which I discuss John’s progress with the rest of his medical team —I return to John’s room. He is sitting up in bed, his exhausted mother still by his side.

I realize that, for two weeks, I have spent more time with John and his mother than with my own family and closest friends.

And for the first time, my sense of dread upon walking into the room gives way to anticipation.

I tell them the good news—that, although John will require oxygen at home, he is stable enough to leave. Tonight, they can at last sleep in their own beds.

John, perhaps appropriately, says nothing in return. He simply smiles and sighs—out of relief, I’m sure, and with the thought of seeing his dog again.

It is, without question, the deepest breath I have seen him take in two weeks.

The next morning, purely out of habit, I visit John’s hospital room first, almost walking in and expecting to see him lying in the dark, with his mother next to him.

Now, the room is unoccupied. The window shades are up, and there is no sound of a breathing machine.

I simply stand in the doorway—still unsure why I have chosen to visit this room first every day, but aware that perhaps part of the reason is for this moment, when I know that John is breathing okay.

And I don’t have to wake him up to ask.

In Greek, stéthos means “chest” and skopé means “examine.” And from the Mediterranean to the far side of the Atlantic, from its invention in 1816 to modern times, the stethoscope has become perhaps the most recognizable symbol of the medical profession in the world.

Simply walk into a hospital, and you'll see physicians and medical students with their stethoscopes tucked into a pocket of their white coats-amidst sheets of papers, penlights and reflex hammers.
Often, we wear them around our necks like gaudy pieces of jewelry. In our defense, it's a comfortable location, and besides, that's what the doctors on television do.

When we use it, the stethoscope transmits sounds from inside the body. It's a simple but impressive instrument that somewhat magically allows us to hear a malfunctioning heart valve or detect the presence of a defect in the heart wall.

It lets us take a journey through the skin and chest wall, into the patient's lungs, and it can warn us about the possibility of narrow blood vessels, among other things.

But the stethoscope isn't what we use to actually listen to the other human being in the room. We rely most of all on our ears, which we use-by training, yes, but by human nature most of all-every moment we are with a patient.

One could, in fact, argue with ease that our ears are the most important diagnostic tool we have at our disposal-more useful and more meaningful than X-rays, blood tests and blood pressure cuffs.
After all, with our ears, we listen to our patients' stories, long before we put on the stethoscope to listen to their hearts.

Recalling William Osler's frequently quoted observation-"The good physician treats the disease; the great physician treats the patient who has the disease"-the difference between "good" and "great" may simply depend on our willingness and ability to use those two appendages on the sides of our heads.

With them, we learn not only the history of the patient's present illness, but we provide the patient with an outlet to share any deep concerns, worries, and feelings. Just like the rest of us, patients need an opportunity to share their stories-medical or otherwise-and that's why, in my experience, the patient does most of the talking.

Soon after beginning my third-year clinical rotations this August, I met a patient who came to the office with a sore throat. But the visit focused very little on the sore throat and very much on the mounting stress in her life-from losing her job to caring full-time for a family member recently diagnosed with Stage 4 cancer.

There are many more solutions for a short-term sore throat than for long-term stress. There's no question about that. But at least she was able to tell me her story, and all I needed to use for those 20 minutes were the great "medical devices" that all humans have, and that are used by physicians all around the world for listening to patients.

Ultimately, as I walked out of the room, the patient — her throat probably still sore but her mind, I hope, more at ease-offered one last sentence for me.

“Thank you so much, for listening.”

My stethoscope, of course, had never left its comfortable location, securely draped around my neck.

It was an unseasonably warm Tuesday afternoon in early December. Outside, the temperature had climbed to over 50 degrees. Inside, meanwhile, 100 second-year medical students filled an auditorium to listen to a physician's lecture-a routine occurrence, typically not worth mentioning.

Except, we discovered, this particular physician doesn't practice medicine anymore. He's now a patient instead.

Why? CTG.

CTG. A mere three letters. This column alone contains more than 1,000 times as many. Our genetic code-the personalized Rosetta Stone within each of us-contains letters too. Over three billion of them. And in one seemingly inconspicuous spot, on one tiny chromosome, a repetition of gene bases represented by the letters CTG results in a disease called myotonic dystrophy. While the disease is not necessarily terminal, it is incurable and degenerative.

In this case, the disease's mid-life onset and progression-with muscle wasting, an inability to relax muscles, vision problems, and even difficulty eating-led our guest, Dr. M, to halt his medical career long before he ever would have planned.

All because of three letters.

Certainly, at one point or another, all physicians experience the medical profession from the perspective of a patient. But most of us won't have to face a cruel genetic disease that can take away our ability to practice medicine. That's what had happened to our guest, though, and every student in the room-myself included-listened intently. Perhaps we were particularly captivated on that warm December day because not long ago, the patient in front of us had sat exactly where we did.

Dr. M told us he had learned the exact number of CTG repetitions in his DNA that had caused his ailment, and he described his pure relief when he found out that his son had not inherited the disease. After all, he had a 50 percent chance of doing so, and anything can happen when you flip a coin.

We can only wonder if Dr. M dwells much on the past, thinking of the years he spent training and the relatively brief time he was able to care for patients. F. Scott Fitzgerald's famous final line of The Great Gatsby-"So we beat on, boats against the current, borne back ceaselessly into the past"-describes that feeling, when we look to the past because our hope for the future has been compromised.

Still, the quote seems to insist that we move on, that we keep rowing, and whether our boat is with or against the current might be irrelevant, especially for a patient. And that may be the most memorable lesson from that afternoon-even though the physician's medical career had ended, he had gained a perspective that allowed him to continue being a doctor in the truest sense of the word.

"Doctor," after all, means "teacher" in Latin.

I can assure you, Dr. M had our full attention that afternoon. And he taught. At times, his story was inspirational. But he also described his devastation and bitter disappointment with brutal honesty.

By a rough estimate, my classmates and I may care for a combined 20 million patients over the next 50 years. That's 20 million mini-lessons within the ongoing education that defines this profession. Sometimes we will teach those lessons, and perhaps more often, we will learn-from other physicians and, most powerfully, from patients as well.

This time, we were able to learn from both at once. It was just one of many upcoming lessons, but I suspect it may prove to be one of the more memorable. Because of Dr. M's connection to us, of course, and his ability to show us two perspectives at once, his willingness to sit in front of 100 pairs of curious eyes, and his memorable sense of humor, which showed us his belief in always fighting against the current.

So, it turned out we weren't only lucky because it was a rare warm day in December.

Thanks to our guest, we were fortunate, most of all, to be inside.

“Mr. Aster” hopped up onto the exam table, the familiar sterile paper crinkling underneath him like crispy autumn leaves. From that modest amount of activity, he was completely out of breath. A few minutes later, following a monologue of Shakespearean proportions, our patient wasn't the one left breathless.

I was.

The scene: Dayton's free clinic, Reach Out of Montgomery County, located downtown in the shadows of Miami Valley Hospital.

The cast: Mr. Aster on one side of the room, Dr. S (his physician du jour) on the other, and me, intentionally blending into the background-a wide-eyed, wide-eared and ultimately wide-mouthed medical student who just watched, learned and took mental notes-to-self.

Dr. S, whom I was shadowing that evening, noticed Mr. Aster's shortness of breath as well.

"You couldn't move from the chair to the exam table without gasping for air," she said bluntly, in a tone made of equal parts concern and displeasure.

Mr. Aster looked down at his feet, which were swollen at the ankles, as if he had not heard her. He was embarrassed.

But she continued, this time more sternly: "In all likelihood, you'll be dead in 15 years."

Now Mr. Aster looked up, his lips parting to shape a defensive response. I looked up as well. That was harsh, I thought.

But it was nothing compared to the lecture that followed, one that would have made Napoleon proud, with our no-nonsense physician performing what I later recognized to be one of the most compassionate acts possible, given her position. Mr. Aster, as you may have diagnosed by now, had every risk factor for heart disease imaginable — stunningly high blood pressure, obesity, a heavy smoking history, diabetes, and the list goes on.

He was 35 years old, but his heart had aged well beyond.

In all likelihood, at a free clinic, a physician will see any particular patient once, and never again. For all Dr. S knew, she had only 20 minutes to genuinely change Mr. Aster's future.

No pressure.

Certainly, Dr. S prescribed medications. She suggested some followup referrals. But Mr. Aster's situation called for something more. This was a simple moment about getting through to the patient, to treat the disease not only by fixing its symptoms, but also by addressing its causes.

Without a doubt, one of the elegant aspects of the medical profession is that moments like this happen in doctor's offices all over the world every day, multiple times a day. A physician might treat high blood pressure, or warn a patient about heart disease risk factors, hundreds or thousands of times in his or her career. But that's not the way we as medical students, as physicians, think. After all, it might be the patient's first time with chest pain.

With that mindset, we build the foundation to do special things. An otologist recently told me that a tear comes to his eye every time he sees a child hear for the first time. Another physician, an ophthalmologist, told me that there is no better feeling for him than restoring someone's sense of sight. Medicine, we realize, is simply the sum of these moments, with a physician's lifetime devoted to creating them for others.

As Dr. S made her impassioned plea to Mr. Aster on that night at the Reach Out clinic, I stood in the corner, stunned at how forthright and candid she was. And she had to be. I remember watching our patient look up, first to me and then to her, and finally, something seemed to click inside. You could see it as he exhaled, nodding to himself.

"You're right," he would later say, just before walking out the door. "No one's ever said any of that to me before."

That was the last I saw of Mr. Aster. Of course, we can't know what happened to him. But we do know that Dr. S gave it her best shot, completely involved in that moment with him as if there were nowhere else she'd rather be. As for me, I realized that sometimes, the best thing we can do for a patient is simply give them the opportunity to take control.

I continued shadowing Dr. S that evening, seeing patient after patient, and that's the way it goes. I was a first-year medical student at the time, beginning to learn what it truly means to be a doctor. You may be left breathless, but you have to catch your breath and do it all again, never complaining, because it's not about you; it's about the patient. You knock on the door, meet the next one, and no matter what, you look them in the eye and say, "Hello. I'm your doctor."

"And I'm going to take care of you today."

"It doesn't change. It always just hangs there in the sky."

I ignore the patient's comment for a moment as I look down at my notes, making sure I haven't forgotten any important questions. Beyond the wide windows before us, trees sway back and forth, and I wonder how many lives they have witnessed come to an end as they continue to reach toward the sky.

“You could not step twice into the same river; for other waters are ever flowing on to you.
— “Heraclitus, (c. 535 – 475 B.C.E.)

"Do you have any history of diabetes, high blood pressure, COPD, cancer, heart failure—"

It is only after he interrupts me that I realize my fingers are counting the possible flaws brought upon him by time, lifestyle, or genetics, like so many bullet points on a checklist.

"No," he says. "Been healthy all my life."

"Until now?"

"Yeah."

He looks back outside toward the sky, his eyes fixed upon a point far from his predicament. A single star, clearly visible, twinkles back at him. He has told many of us at the hospital that he feels strangely at ease with his fate, knowing that these burning fires-running on helium and hydrogen, light years away, untouchable, unchangeable-will continue without him.

"That's the three sisters," he points out. "They're part of-"

"Orion's belt," I say.

"So you know a little astronomy?"

"I grew up in the country," I answer without looking up. "I would take my telescope out into the fields and try to find my way from one side of the horizon to the other, each constellation leading to the next."

"How often do you go now?" he asks.

"Oh, wow," I say, flipping through the chart, checking a box here, writing an order there. "I haven't been out in over a decade. Just lost interest, I guess."

He turns grim now, looking outside again.

"You should get back into it. Things change down here. Wars end, nations fall, but the stars, they're always there."

"Yes, they're very lovely," I say, finally looking up. "Now, how long have you been on chemotherapy?"

The weeks pass, and his fever starts subtly, a small spike here or there. We react aggressively, but despite our efforts, his condition slowly deteriorates. I come to visit after I've ended my rotation one night. He is in isolation for his low blood cell count. I don the mask, gown, and gloves, thinking how ironic that the closer to death he comes, the more impersonal we have to become. Upon his bedside table are books of Hubble telescope pictures, astronomy reference manuals, and a laptop whose screen shows the Pleiades, a young, open star cluster in the Taurus constellation, which is visible to the naked eye on a clear night. He is gaunt and sallow, his eyes still staring out into the night sky.

"Been out enjoying the spring view?" he asks.

"No, mostly working. I haven't had a chance," I answer.

"Well, not much to see in the city. Too much light. I wish I could get out into a dark sky, take in the view."

"Hopefully you'll be able to soon," I answer, but I know it is unlikely.

As I say goodbye, he scribbles down the titles of a couple of books on astronomy and astrophysics that he says I'll enjoy. His pen runs out of ink during the last title. He swears, and I reach into my coat pocket for another. I walk out of the room with the completed list and muse about the pen. As much writing as I do, I've always wondered which pen will be my last. When I buy a pack of pens, I wonder if I'll run out of time before one of them runs out of ink. With that in mind, I never get angry over a dying pen; I'm thankful that I've outlasted another one.

Three days later, he passes away at home. Sometime after that, perhaps two or three months later, one of the nurses mentions him and his infatuation with the stars.

"He was always saying how they never change," she says. "I guess that's a good thing to hang onto."

I look up from my chart.

"Unfortunately, they do." I tell her. "The Pleiades star cluster he kept referring to is supposed to disperse in another 250 million years. What we see in the sky today is not necessarily what our descendants will see long from now."

She looks down to the floor. "That's really sad. It seems like there's nothing constant to hold onto in the universe, then."

"Well, sure there is," I say. "The constant is change. How boring would life be if nothing changed, and how meaningful is each moment because it does."

The cold air penetrates, knife-like, into the spaces my gloves can’t cover. I pull my coat together at the bottom of my neck as the wind whips across my face. I look up and see that only a few more feet remain to the door of the restaurant.

The sight of that door fills me with the same feelings, perhaps, that a small island would give a weary sailor, tired from months of floating across the sea. I pull the door open with my free hand, noting the bells clanging, reminding me I am knee-deep in the season of cheer and goodwill toward man.

The hostess looks up and asks, “Reservation?”

“No. Meeting someone. Will just sit at the bar,” I say as I pass by.

Few people are here this evening. I see a few couples, eyes locked together while bags of presents sit at their feet. An older gentleman sits at the end of the bar, his eyes turned towards the televisions.
It is unbearably evident he has nowhere else to be.

I find several seats standing lonely in the middle of the bar. Taking off my coat, scarf and gloves, I seat myself on a stool and order a beer. Months of call and long hours at the clinic and hospital have begun to take their toll.

It has been some time since I’ve sat down with my friend for a chat. It has also been a long time since I’ve had time to reflect on anything that has happened over the past several years.

Taking a drink, I look up from the glass and notice my friend coming in from the chill air of this bleak winter night.

After an hour of catching up, watching a game on the TV sitting high above the bar, and poking fun at each other, he asks me what’s bothering me.

“Just tired, I guess.”

“Marathon runners are tired,” he says. “You look depressed.”

“Maybe just a little. You have these expectations of how it’s supposed to be, treating patients,” I confess. “Things just aren’t what I thought they would be.”

“Things never are.”

“What I thought was this homogenous population of experts is more like a hodgepodge of educated tailors, each one with a different talent, each one with a different amount of ability and knowledge.”

“Well,” my friend says, “a doctorate does not a smart person make. Intelligent, maybe, but not necessarily smart.”

“And the politics,” I continue. “It always feels like a losing battle.”

“Well, your humanity still appears intact. You know, everyone faces cold and horrible situations with no honorable outcome. The compassionate person meets these, while the selfish person runs from them. You knew that when you started wearing that albatross around your neck years ago.”

“When you’re young,” I tell him, “you feel like it’s a phase, that at some point the storm will let up and you’ll be in calmer waters. Sometimes it feels like the storm will never end.”

“Life isn’t simple,” he says. “It’s not supposed to be. If you go through your whole life following one set of rules, you’re living as if you were following a large truck through snow on a forgotten country road. Eventually you need to either pass or pull over.”

“Or crash.” I smile at him. “I think I’m hopeful. I just don’t think I’m happy, I guess.”

“Well, I gotta get home.” My friend stands and puts on his coat, scarf, and gloves. “I’ll get this, okay?” He pays quickly.

As my friend makes his way to the end of the bar and the door of the restaurant, before going into the deep cold of the December night, he turns back toward me.

“I would rather be hopeful than happy, and I would rather be content than hopeful.”

He smiles and walks out the door. After he leaves I stare into the glass in front of me for a long while before I smile back at my reflection. I finish my drink, put my coat, scarf, and gloves on.

The bartender walks by and comments, “That’s a pretty good quote.”

“What quote?”

“You know. About hope, and happiness and whatnot.”

“I know. It’s one of my friend’s favorites,” I say, gesturing to the door.

The bartender, looking puzzled, asks, “What friend?”

I stop for a moment. Staring at the bar in front of me, I notice only one glass. From a look of confusion, I break a slight smile and pay the bill.

“Happy New Year,” says the bartender as I make my way toward the door.

“I hope so,” I say, and I break out through the door and into the cold night, smiling.

We're taught in medical school and residency that our responsibility to our patients often supersedes all others in times of crisis, but "crisis" is a vague term. In reality, crisis tends to be defined by those moving through an experience. A young asthmatic needing intubation will very likely recover, although family members may well believe they're facing a terminal situation. An elderly grandfather hospitalized multiple times in several months for the same worsening heart failure may have few good options for treatment, despite his family shrugging off another of grandpa's "episodes." We are creatures of habit, and habit breeds apathy.

It's fifteen hours since I've slept or eaten. The on-call period is long and arduous but a great teacher. The two pagers on my hip start beeping at the same time. I call one number, and a nurse says that a 67-year-old woman admitted for diabetic ulcer is complaining of heartburn. At the second number, I'm told a 40-year-old has a sudden onset of shortness of breath following orthopedic surgery. I go to see him first.

The patient, his left leg bandaged at the knee, is breathing deeply. My heart sinks, and I fear he has a pulmonary embolus. His vitals are more concerning: tachycardia, tachypnea. When I speak to the patient, he tells me he has severe anxiety, and "No one's giving me my anxiety pill." I order a chest CAT scan with contrast. Thirty minutes later, the patient is back in his room complaining about how small the CAT scan machine was, and he is very claustrophobic. I'm sitting at the computer screen checking the scan. The final read: no pulmonary embolism, normal lung. I give the patient some Ativan, his shortness of breath subsides, and he sleeps comfortably for the rest of the night.

I then move on to the 67-year-old with heartburn. The patient looks my grandmother, and countertransference occurs-I can't help but feel an immediate emotional connection.

"My heartburn is acting up really bad," she says.

"What does it feel like?" I ask.

"An elephant sitting on my chest-"

"STAT EKG!"

Thirty minutes later, I'm calling the cardiologist about what I suspect to be a myocardial infarction. The patient goes to heart catheterization, does well, and eventually goes home. Despite this good outcome, I don't feel well. I can't sleep. Tonight, I chose the wrong patient to see first. What if other calls had suddenly occurred? What if she hadn't described her symptom so perfectly? What if the outcome had been poor? We can live our whole lives wondering "What if?" but put simply and succinctly, medicine is not perfect. Like everyone else in life, physicians try, but we do not always succeed. Even the most seasoned attending in any specialty makes mistakes sometimes, and if we don't remember that, we won't be able to function.

Calls about heartburn happen often, and habit breeds apathy.

I sign out and give my summary of the night to the senior resident. After noon conference, I walk down to my car and climb in. I'm so very tired, but I couldn't sleep even if I were lying on a California king. The drive home is long and full of more stoplights than I feel entitled to. Coming home fatigued and sleep deprived has become a routine, a habit. In our apartment, my wife Sarah turns to me and smiles, our son in her arms.

"Daddy's home," she says.

I pick up my son and hold him close. He looks at me, his face blank, and then, as if by magic, he smiles. He doesn't need any words. That smile says more than words ever could. I kiss my wife and excuse myself to get some rest, as I always do after a night on call.

"I thought we could get a Christmas tree on your day off," she says.

"OK," I say, moving to the bedroom. I think, I hope I never get used to this habit.

"And we still need to get a Christmas present for…"

She walks into our bedroom, but I'm already passed out on the bed. She closes the door, and so I sleep deeply.

The scrubs I’m wearing are hanging damp and heavy. My limp hand is starting to go numb from the squeeze my wife is placing upon it.

The obstetrician, her forehead drenched in sweat, yells for more light and to for my wife to push harder. The monitor starts to show the baby’s heart rate falling more frequently into gullies and canyons, dropping off.

My wife’s blood pressure suddenly surges, her eyes roll back into her head, and she starts seizing. My mind races with the possibilities.

“Oh God,” I think, “it’s eclampsia.”

Her neck stiffens, and I fear aneurysmal rupture. The obstetrician calls for the nurses to start rolling her into the operating room. As we move down the hall, my hand is now squeezing hers, which hangs limp, lifeless.

Tears stream down my face, and a nurse stops me as they take my wife into the OR.

“We’ll do everything we can,” she said. “Please stay here.”

My mind reels. My hopes surge for the best outcome, but the physician in my mind whispers to me, “They’re gone.”

I sit up, and my head falls into my hands as I reorient after the nightmare. My eyes move to the baby monitor on the bedside table. The red lights jump with each of my son’s cries. He’s been teething for three days now, each ivory challenge presenting itself at night. At least, that’s what I hope it is, and not something sinister.

My wife moans, “Can you get him tonight?”

I get up from the bed, my back aching. “This is what happens when you turn 30,” I mutter.

I climb toward the nursery. Standing there in the crib, my son has tears streaming down his face. He sees me towering over him and outstretches his arms. I pick him up, and he buries his face into my neck, breathes deep and stops crying. I rub his back gently as we rock.

Earlier, my wife had asked me about giving him some ibuprofen. I refused, fearful of an allergic reaction, something I have had the unpleasant experience of seeing firsthand. Now, sitting there with him at 3 a.m., I think I might have been too hasty.

Over a year ago, I remember a visit to the obstetrician at 30-something weeks. I sat there while he asked my wife all the regular questions about swelling, nausea and weight gain. Afterward, he turned to me and spoke the only four words he said to me that day: “Don’t treat your wife.”

I appreciated his advice but never thought much of it.

Our pregnancy and delivery went as smoothly as any other. When we got home from the hospital, however, the worry began and never left. Every cough or sneeze became a rare, incurable condition in my mind.

At six months, my son developed mucus and blood in the stool. I feared the worst. After a visit to the pediatrician, we cut out dairy from his and (much to her chagrin) my wife’s diet, and his symptoms resolved. Just a milk allergy. Since starting a family, I have seen how this knowledge of all that can go wrong, all the terrifying diagnoses sneak into your mind with each symptom. These “zebras” are driven into our minds to make us into vigilant diagnosticians, but this enlightenment becomes a curse. The fear of horrible diseases befalling those you love is always in the back of your mind.

My son is sleeping now. I stand, move quietly to his crib, and lay him down amongst the soft liner with images of farm animals. The sound of rain outside lulls him asleep. I rub his back for a few moments and realize how vulnerable life can be. Then I tiptoe down the stairs and crawl into bed.

But my ears stay turned towards the monitor with the perpetual vigilance of a parent, made worse by the knowledge of a physician.

As the Greek myth goes, once Pandora had lifted the lid of the jar, every manner of evil escaped to torture and punish man. She quickly covered the jar back up, as the last evil escaped. Wondering what was left in the jar, she peered inside and found the only thing remaining was Hope.

As a metaphor, the myth shows that in the most trying times we are often reduced to the core virtues we inherit by being human. In medicine, we sometimes stand on a precipice, below which the cold, dark sea beats against the rocks. There comes a decision then, whether to carry Hope away from this cliff or allow to it drop into the rocky chasm below.

I'm standing outside the hospital room with the family as the patient's chest rises and falls easily. The ventilator beeps occasionally during the conversation, distracting the patient's adult children. Their gazes dart into the room as an alarm sounds, but it is only the blood pressure monitor, because the cuff is off the patient as the nurses clean and organize the bed. Their looks are composed of love for their dying father, confusion over all that is taking place, judgment upon the care we provide, and fear of facing their own mortality at some time in the not-too-distant future.

"But I, being poor, have only my dreams; I have spread my dreams under your feet; tread softly because you tread on my dreams."
—W.B. Yeats

I'm discussing the code status with the family. In Ohio, the law in all its ignorance and politics, has decreed the setting of three different levels of care during a cardiac arrest, although two of these levels overlap enough to render them useless. The law is yet another attempt by a rigid, arbitrary system to impose categorization, an organizational approach, as a blanket solution to a situation that is anything but homogenous. I attempt to explain the differences among a Full Code, DNRCC, and DNRCCA. They're convoluted and difficult for the family to understand, and-I have to be honest-not easy for me to grasp either. I go over what would happen in a cardiac arrest, or a respiratory arrest, and reassure them that at no time will any care be withdrawn that isn't already in play. The patient's wife, who has been looking down at the ground as I speak in such cold, technical terms, looks up at me. Her gray eyes wet, her age-worn hands folded in a prayer-like frame, she asks, "What are his chances?"

The stethoscope hangs around physicians' necks throughout the day. Over time though it often starts to feel like an albatross, worn not to remind us of the transgressions against man, God, and Earth that we have already made, but of those we have yet to commit. It warns us of the mistakes we will make, the people we will fail, the inability we have yet to face. Throughout many patient rounds, I have often seen older physicians throw out percentages, estimations, ideas of what the prognosis likely will be. What I came to realize over time is that these are really, in most cases, guesses. Yes Virginia, miracles do happen, but rarely.

So here I am, standing in front of this elderly woman, who longs for the man she has loved for greater than a half-century to get up and dance with her one last time, and the family wants me to guess what his chances are. I could say what I truly think: that he is critically ill and has very little likelihood of survival. That even under the best circumstances, in the healthiest people, cardiac arrest is 50/50. That I don't think he'll see out the night. I squeeze the stethoscope in my hand as if I could strangle the albatross I'm forced to wear. I look at the family, their eyes full of expectation.

I answer honestly: "I don't know what his chances are… but I'm hopeful." They nod and go to the bedside. The patient remains a Full Code, and, despite our interventions, overnight he passes on. Over time, the conclusion I've come to is that it is best to be honest, but not at the expense of dashing someone's hope. It is all we have, in the end, and it is not for us-or anyone else-to tread on.

Welcome back, summer! The sun-filled days, the endless nights, the warmth, the fun, the outdoor sports and, most important, the reappearance of the human race that seemed to be hiding for all of those cold winter months. Suddenly, the streets are full of people again: families on bikes, runners getting back into shape. Yet, for me and the rest of my class, reverse hibernation is about to take place.

For students in their first two years of medical school, the thought of one day causes even the coolest character to break out in a sweat. For most, that day will come in early June, and for a very brave few, at the end of May. Regardless of the date, each one of us has a clock in our heads that counts down the days, hours, minutes, seconds… until we take the test that will dictate the rest of our lives: the United States Medical Licensing Examination (USMLE) Step 1.

This is the time of year when it becomes very easy to spot a medical student. We are the ones making the mad dash to the bookstore to buy the latest BRS (Board Review Series) book, the ones muttering under our breath like crazy people, fervently trying to remember the configuration of the brachial plexis that we learned centuries ago (in real time, about a year and a half). The most obvious sign, however, is our new life companion, the well-worn yellow-and-blue FIRST AID for the USMLE book, which we now must keep within a five-foot radius at all times, lest we go into a full-blown panic attack.

Most of our professors try very hard to do damage control. They work to keep us focused on the courses we still have to complete, to calm us down by telling us how well Wright State students have fared in the past. But medical students are hard to fool, and every last one of us knows that the score we get on this test will determine whether or not we actually get to graduate and be what we have been working to become for about 20 years. No wonder we look a bit unkempt and unhinged!

For two years now, we have crammed more information into our brains than should be scientifically possible. Now that test-prep mode is in full swing, I basically walk around all day mentally quizzing myself and trying to go through the knowledge I have amassed to organize it in some meaningful way. Unfortunately, that means I have also lost the ability to remember where I parked my car, where I left my keys or glasses, whether or not I turned off the stove and just about anything else that requires the slightest bit of awareness. I will admit to being a bit of a liability these days.

Yet, with the pressure of the big day looming, there is also a sense of the light at the end of the tunnel. If we do manage to get through it all without too many scrapes and scars, we will emerge on the other side and finally get to see real patients! That's right, in the midst of all the Step 1 chaos, there is also the knowledge that we are getting ready for the next step in our career: medical clerkships. Set to begin on August 3rd, clerkships represent a whole new way of life. No longer will medical school consist of me, alone, in the library with a whole bunch of books. What awaits is new, exciting and downright terrifying.

The next time I write this column, Step 1 will be over, and, if the fates allow, I will be preparing to start my clinical training and to see if I can put all this acquired knowledge to good use. I will also be facing a whole new set of challenges. How do I give a patient bad news? Will my clumsiness translate to poor surgical skills? So many questions left to be answered. It's almost distracting enough to make me forget about June 13th… Almost.

This past weekend, my parents came to Dayton for a quick visit and to drop off some much-needed groceries, since medical school doesn't afford me the time or money to acquire my own food. To keep them occupied for a while, I gave them photos from my trips to India and San Francisco this summer.

When I took a break from tidying up, my mother showed me a handful of photos she had questions about. Mostly she commented on how crowded the hospital in India was, how tiny the babies, or just how generally "different" everything looked. Looking at the pictures, all I could think was that they were a poor substitute for actually being there. How do you connect with a human life through a photo? How do you convey to someone just how devastating a broken bone or treatable disease can be for patients confronting social stigma and inadequate supplies of medication, nurses and hospital beds?

When I was 17, I went with a group of doctors and aide workers to provide basic medical care to people who make their homes in the garbage dumps that dot the outskirts of Mexico City. This trip was difficult for me, as it was the first time I saw extreme poverty and need. Nothing in the United States comes close, not even in our poorest neighborhoods. It would have been easy to be overwhelmed by it all, and I was, but more than anything, I was also intrigued. Most of the medical care that takes place in these outreach settings is of the most rudimentary kind. There were no brain surgeries or heart transplants performed. Yet still, surrounded by dead rats and trash, I watched doctors change people's lives simply by treating their infections and easing their pain. I began to see that there is an art and a skill to medicine that can, despite some difficulty, overcome cultural or socioeconomic barriers. Although it would be years before I decided to pursue a career in medicine, on that trip I developed a new respect for doctors.

In the 10 years since that visit, I have been lucky enough to travel extensively throughout South and East Asia and have learned a great deal about some of the diseases and health issues that continue to plague our world. This summer, I returned to one of my favorite places: India. With tetanus, diphtheria, dengue fever and malaria still pressing concerns, India can provide quite an educational experience for any health care professional. Like every population, India also has its own prominent genetic diseases, such as Thalassemia. Although treatable, Thalassemia carries such a social stigma that children born with it are often allowed to die.

I will never forget the day we visited the Thalassemia clinic and met a little boy whose mother brought him from far away for treatment every month. It was his birthday, and the blood transfusion he needed would require him to spend most of the day on a bed with a needle in his arm. Seeing how unhappy he was, the other students and I used our break to run to a shop around the corner and buy him a cake. As we sang Happy Birthday and his mother helped him pass out pieces of cake for everyone, I saw him smile for the only time that day. In a life so devastated by a disease that in the U.S. is treated far more efficiently and without the stigma, a little bit of kindness can go a long way.

While infectious and genetic diseases often draw international students, less glamorous aspects of health care also desperately need attention. In the villages we visited in India, nothing affected residents' health more than a lack of clean water. Such a simple thing, and one we take for granted every time we go to the faucet. We often forget how much we have to be grateful for, and our responsibility as human beings to do what we can, where we can.

I often find it hard to explain to people why I keep going back. Besides my love of the colors, food and people of India, I also think about my first trip to Mexico, when I saw people from such diverse backgrounds connecting through medicine. I love that aspect of medicine, and I love the people I have met and the lives I have touched through my trips abroad. Like photos, my explanations may never fully convey my experiences and the effect they have had on me, but I know I will continue to reach out in this way, whenever I can, for the rest of my life.

The summer after my first year of medical school went by in a blur: cardiology in San Francisco, global health in India, and a quick family visit. As usual, I tried to cram too much into too little time and found myself with just four days to reflect and distill my experiences before starting year two.

At the end of those four days, I found myself facing 100 pairs of expectant eyes — those of the new first-year students about to embark on the journey I had just completed. And they wanted something from me.

What they wanted were those precious gems, the secrets that helped me get through the first year of medical school. I'm sad to say I met their first few inquiries with a blank stare and stuttered response. Four days simply hadn't been enough time to really think things through.

As I write this, the incoming class is gearing up to begin anatomy, the first truly intensive course of their medical careers and, for most, their first time in the cadaver labs. Books and movies often present this course as a grueling and distasteful rite of passage in the medical world.

For me, anatomy seems long ago, lost in the multitude of new experiences the past year has presented. If I take a minute to look back, I can still recall the intensity of those first few weeks. The hours spent repeating all the bones, muscles, nerves, arteries, and veins. The agony of trying to remember which do what. The times I showed up after midnight hoping the lab would be less crowded and I could get some private time with the donors who had generously given their bodies so I might learn.

The sheer amount of material seemed overwhelming. My confidence began to waver, and free time became scarce. I remember doubting myself and wondering more than once if I was really cut out for this.

Then, around mid-year, I found my stride. Somewhere, in the mess of biochemistry and anatomy, I had lost touch with what brought me to medicine. The day I found an extra reserve, a little bit of strength left when I thought was totally spent, came when I did my first patient interview for Introduction to Clinical Medicine. I walked in ready to collect a patient history by firing through a list of standard questions I had memorized.

In the hour that followed, something truly wonderful happened. I became reacquainted with the idealism and empathy that had led me to medicine. I realized how much I cared about what this woman was going through, and how much I wanted to build a skill set to help me make her life, and other lives, better. I delved into a conversation with her that included few pre-planned questions but gathered all the information I needed to create a full patient history-and allowed me to get to know her as a person as well.

When I got up to leave, my patient stopped me and said, “What was your name dear? Jacqueline? Well, Jacqueline, I really enjoyed talking to you, and I think you are going to make a fine doctor someday.”

I left the hospital that day feeling recharged and ready for anything. For the first time in medical school, I felt like I was indeed learning to be a doctor. Days like that, the ones when I worked face to face with another human being in need of help-those were the secret. They were what got me through my first year.

Finally, I had an answer to give all those new students that I felt was honest, heartfelt, and worth its weight in gold: "No matter how caught up you get in medical school, don't ever forget that the reason you are here is to become a doctor.

“Medical school will test you. Not your intelligence, but your ability to adapt and grow.”

This is what a great friend and mentor told me just two years ago as we sat on her front porch enjoying one of the last warm days of the season. I don't think I understood what she was telling me at the time. Now I often wonder how she could have been so perceptive.

Most people will tell you medical school is hard. It is, but not in the way that I would have expected. Oh, yes, there are mountains of material to learn in blocks of time that always seem too short, and with each class I develop a new appreciation for the human brain's capacity. But we are medical students, and there is not a single one of us who doesn't know how to study.

What is it, then, that makes this life experience so challenging to navigate?

I think it can be summed up by a comment a friend of mine made when he saw me reading a book about South Asian History.

"How can you do that?" he said. "I would be scared to read something outside med school right now. I don't have room for anything else in my head!"

Unlike college, where most programs strive to create a well-rounded individual, medical school focuses entirely on the cause, diagnosis, and treatment of disease. Once, you could switch gears from studying calculus to completing an art project or writing a paper for a political science class. Now, everything that is not studying medicine you do while haunted, in the back or your mind, by the unending list of things you still don't know. Med school can't be left at the office. Relationships and hobbies go on the back burner, and major world events often don't even show up on your radar. When a friend asks, "What did you think of Palin in the debate?" you might distractedly reply, “What debate?”

The result is a day-to-day struggle to find balance. You start to think about where you can fit in a couple extra study hours. Should you really go to the gym? To that lecture on “Women in Shakespeare”? To church? Slowly, the events on your calendar become less and less diverse, until all that is left is one word at the top of each day: Study.

A few weeks into my first year, I called my mentor, full of frustration. She asked me one question: “Jackie, before you started medical school, why did you think you would be successful as a doctor?”

“Because I am good at relating to people. They trust me,” I said.

“How do you relate to people?”

“I don't know. I guess I talk to them.”

“What do you talk about? The latest drug to treat seizures, or the new home-testing kits for HIV?”

Right then, I saw what she wanted me to. I thought back to all my experiences with physicians and patients. I realized that the doctors I chose for my own health care were all ones I felt a connection to, based on a shared love of India or traveling, urban renewal, or even religious studies. All this time, I had failed to see that being a doctor is more than just being a pro at pathology. It's about creating relationships with patients. And that requires nurturing the part of a person that grows and develops outside of medical school.

All of us have had the experience of sitting in a white gown, uncomfortably exposed while a doctor talks AT us instead of to us. There is perhaps no more isolating feeling than dealing with a doctor with no empathy, with a poor bedside manner-a one-dimensional pseudo-person. But it's clear to me how doctors can become that way, how easy it can be for aspiring young physicians to get trapped into thinking the only thing that matters is their score on the next exam, and to let all the other great facets of their personalities slowly slip away. Part of the challenge of medical school is in not allowing that to happen to you.

I am lucky to have trusted friends and advisors outside the realm of medicine who help me maintain a healthy perspective, for the most part. With their help and my own commitment, I may turn out to be the kind of person and doctor I've always hoped to become.

There's a feeling of déjà vu as I walk through the sliding double doors. The sounds, smells, and sights remind me of times long past. Nurses and medical technicians move past me quickly carrying IV equipment, EKG machines, monitors, blood, and paperwork. I see the small rooms, some curtained, others not. As I look to my left an older gentleman lays on the stretcher, his Sunday best on, clutching at his heart. On the right, a thirty something female lays holding her right upper abdomen. I hear the moaning, calls for nurses, orders being yelled across the room, and the constant 'beep' of a monitor somewhere. In this sea of chaotic order, I feel strangely at home.

I had two decades on this earth the first time I laid my eyes upon the emergency room. I was still in college, studying Greek, Latin, and Philosophy when a friend told me about a job he was applying for at the local emergency room in Cincinnati. It paid well, sounded fun, and already I was thinking how cool it would be to say I worked in an ER. Of course, this was at the height of the TV show. The job was as a medical assistant, patient care assistant, whatever you'd like to call it. I would basically be a jack-of-all-trades. The first day we met the nursing supervisor, interviewed, and then left for a tour of the ER. The double doors swung open and suddenly I was immersed in the chaos. Physicians running quickly past me, nurses kneeling with needles in their arms, and clerks answering phones with rapidity while cross checking paperwork in front of them. I remember thinking that I would never get the hang of this, that this might be too much for me. Four years later I started medical school, leaving the ER which had given me my baptism of fire into medicine and my niche in both library and laboratory for two years.

Now I'm back. Not to the same ER, but nevertheless it feels the same. Oddly, despite the whirl of movement and work, I'm calm, a feeling of satisfaction moves over me as I stroll into my first patient's room for the day. Then the difference strikes me. Instead of running to get an EKG machine, getting paperwork ready, or grabbing an IV starter kit, I'm standing here, white coat on, trying to figure out what's going on with this thirty something female holding her right side. I run the differential. Cholecystitis obviously, but I'm also considering hepatitis, pneumonia, and ulcer. My thoughts run over the pointed questions to ask.

"Have you had any nausea or vomiting?" I start. "Yes a little, I vomited yesterday twice and, OUCH." The IV finds the vein quickly, I watch for the flash of blood, and quickly fluids are running. Vomiting, nausea, right upper quadrant pain, some increased severity to food intake. I'm confident in my differential. As I start to walk out the room, she mentions suddenly, "I've had some discharge and lower belly pain too." I stop… suddenly everything's changed. This is what I learned after years in the ER. Just a slight phrase, a word can change the way you see a patient, the picture, the process. It's what keeps you on your feet. Because beneath all that obvious history and physical exam, sometimes something very sinister and unsuspected is waiting to declare itself. By then you might be too late.

Before the night is over, we have a lull. These are transient, and must be appreciated for as long as they can be, because the storm is always coming. As we sit back and enjoy it, the doors open swing from waiting room. An older gentleman sits in a wheelchair, clutching his chest, sweating. As we lay him down I start moving quickly, grabbing an IV, cleaning the arm, and finding the vein. Retract needle, place lock, draw blood, secure with tegaderm, and flush. I do it without thinking, without pause as he starts to tell me about that elephant sitting on his chest. Later, the nurse pays me a compliment on my rapidity with the IV. "I've had a little practice with it before," I answer.

The radiance of the summer sun is quite a spectacle in mid-morning rounds. The light shines brightly into the hospital room of the upper floors, bathing the patient, medical staff, and myself in its glow. I squint my eyes out at the outside world. Try as I might, my eyes don't adjust to the glow, a consequence of walling myself in this citadel of the sick for so many hours. I move my gaze back to the patient, a kindly looking elderly gentleman, all smiles despite the odds. He is staring directly at me while I was looking out the window, and in a reflex response I smile back at him. He smiles and turns back to my attending physician who is talking softly and with compassion as the plan is put forth in simple terms. The patient nods his approval and looks back out the window, perhaps trying to see what I was looking at. We move back into the hallway…I field a couple of questions from the residents and the attending physician. Some I get, some I don't...and we move on down the hall to the next beam of light shining.

The crux and keystone of the practice, art, or science of medicine is the basics of Internal Medicine. A vast library of knowledge supplants this specialty and gives credence to Hippocrates' description, "The life so short, the craft so long to learn." So as my third year of medical school draws to a close, I finish on the specialty which allows me to use all that I've learned to this point. It is by far the biggest world of medicine I've come into contact with. The differentials are long and the possibilities endless.

So I start where I began so many years ago, with some simple reason to derive a common theme or two from this ocean of knowledge and practice. Up to this point, I've derived three qualities I find I cannot do without if I hope to be worth my weight in salt as doctor.

Of course, the most obvious is a love of knowledge. The curiosity has to be there or this long course of learning can't continue. Now the verve for this learning can wax and wane, with the circadian rhythms of the day or the trials and tribulations of any life, but eventually the deep entrenched curiosity of what is wrong and how to effect change must come flooding back. When the possibility of an uncommon ailment or the hoof beats sound more like a zebra than a horse, I detect the eyes of the physicians around me shining a little brighter with interest and intrigue. After all, part of being human is being humbled by not only that which we do not understand, but that which we do not commonly see. This leads to the second quality.

Einstein himself related "No amount of experimentation can ever prove me right; a single experiment can prove me wrong." Without humility, curiosity would never be strong enough to be considerate of every patient. So humility is indispensable, because without it you can run the risk of diagnosing the patient before seeing them. I've walked out of a patient's room and believed that I had the diagnosis nailed down, only to discover I was so far off as to be embarrassing. Those times in particular, I saw what I wanted to see instead of seeing what is simply there. So instead I've tried to walk into a room as Tabula Rosa, allowing the patient to paint the entire picture while I'll simply add the framing.

However, humility and a love of knowledge cannot exist without simple compassion. It's a quality that is simply human but not the simplest of emotions for humans to control. Without simple compassion I am already categorizing them without humility and often without sufficient curiosity. After four years in an inner city ER, compassion isn't the easiest of emotions to turn on or off. Nor should it be so pliable, but with anything takes practice and I haven't mastered it yet.

The patient in the next bright room is doing well, or at least much better than last night. When I saw him at admission the night before he was severely hypotensive without tachycardia. Fluids were started and antibiotics as well. As I laid in the on-call room, I tossed and turned over it. Finally, I got up and made my way to his room and sat there for some time. I don't know if he was aware of my presence--he didn't have to be. As time passed, he became normotensive, and I made my way back to the resident lounge. Today, the light is reflecting off the monitor in his room, and his lucidity has improved. The attending physician is doing his examination and his vitals are looking good. I look back out the window. An elderly woman is walking up the path to the hospital, a large green lawn stretches out into the distance, and I swear I can smell fresh cut grass.

I've often thought that the doctor's knock, that tap-tap-tap on the door immediately before entering the exam room, was always a great metaphor for the remaining graces and manners of office medicine. In a way, a knock on the door is usually equated, at least in my mind, as a request: "May I come into your home?" or "Will you be so kind as to let me in?" Interestingly it almost implies the invasion of one's abode by another for a philanthropic, benign cause. Yet in this day and age, where privacy is quickly becoming public domain, it still stands as a testament to a level of courtesy and respect that stands firm at the center of being a physician. This is not without irony however, because the knock-knock usually is immediately followed by a turn of the knob because, well at least in my mind, I can't hear anyone through these thick doors.

The reason I mention this little metaphor is that I've come to a realization over the past month in Family Medicine that the end is nearer than I think. I move with a little more confidence now and feel more relaxed when I counsel on giving up those Ultralights or trying for that extra thirty minutes on the treadmill each week. I feel more confident because the explanations and choices that I have to give are starting to flow out of me. I don't find myself reaching into the recesses of my mind trying to remember what antibiotic is first-line for Streptococcal pharyngitis, or what a reasonable asthma regimen might be. So with this confidence comes the questions about what the future entails and asking myself should I let the world shape me or should I shape the world. I remember almost half a year ago that I was shutting my eyes tightly trying to remember an ‘on the spot’ question, whereas now I knee-jerk the response and expect the next two to three questions as follow-up. The mantra has been knowledge before speed. So I thank my time here in Family Medicine for allowing me to slow down and truly ponder what are the choices I can give, what are the red flags I'm looking for, what canI do to develop more of a rapport. In a sense that is what this entire month in Family Medicine has been for me…a lesson in rapport.

Tap-tap…knob turns…door opens, and there sitting in a small chair is the patient. His face brightens up when he looks up at the attending physician I'm following. "How are you doing?" Simple words, but they will result in all the information you might need to help. I watch as the two, the patient and the physician, shake hands and sit down. They chat…asking how's this and that. If you would remove the white coat and gown from this picture you couldn't tell that this was a conversation between physician and patient. The attending physician leans over to me and says, "I've seen Mr. H for…oh what has it been now?" "Ten years," says Mr. H. I smile and realize that I know very few friends whom I've kept in contact with longer than ten years.

I think of all the yearly physical exams, the heartburn and sick kids, getting them through cancer and off cigarettes…this conglomeration of attempts to help mold a person's life in some manner to increase both quality and quantity. It dawns on me then that a physician's job is more akin to that of a blacksmith. Today, the patient simply has a physical. The visit ends and they both go their ways, happy to see each other. I don't believe rapport can get much better than that.

Not to say that all relationships are that friendly. I've noticed over the past month that these long time relationships often take on the form of other long term relationships: the younger and older brother, the father and son, the squabbling old married couple that never agree. But through it all, the good news and bad, the function is often the same: to remind the patient that they are as much a part of this congregation of homo sapiens today as they were on the day they were born. As for myself, with this new confidence and lesson in rapport, I move closer and closer to the end of third year and the beginning of my final year of medical school. At this point it seems so far away…and yet in a way not far enough.

There's a story I know. Don't ask me how or why I know it….and don't assume that the story is about me. It may be true or it may not. It doesn't have any moral undertone; it isn't a proverb. It just shows one of the worst days in the life of a medical student in the second year. For this story I'm going to exercise a little literary license and tell it in the first person.

The white wire mesh holding up my clothes in the walk-in closet of the apartment crashed to the ground. My eyes flew open and the subconscious took over. I quickly looked over at the alarm clock: 7:15. I panicked. Flying off the bed, I ran to the dresser and began frantically throwing on shirt, jeans, shoes, and hooded sweatshirt. I glanced at the wire mesh dangling from the wall. "That's for later," I thought, and dashed out the door grabbing the keys, cell phone, and wallet off of the table as I ran past.

I hit the back roads, which are usually much more light at this time of the morning. I stayed within 5 mph over the speed limit. I drove carefully and reviewed the information for this morning's test in my head. I ran through the neuroanatomy and then onto the pharmacological aspects. I realized I had not reviewed pediatrics as deeply as I had wanted to. I threw up my hands and said "Oh well" and continued on the country highway.

As I drive the traffic slows down to a crawl and I begin to wonder where I can find my professor's number so I can profusely apologize for my absence. The traffic begins to pick up and I pass the accident that caused it. The car is a small compact, resembling the small Yugos of the 1980s. It's completely flipped over onto its top at the edge of the road. There are no police but there is a tow truck. The only people are an older looking man, leaning against the car as if leaning against a bar, talking to the man who obviously owns the tow truck. The two of them laugh and then I see the older man throw up his arms as he looks toward the car. I immediately understand exactly how he feels.

It was as I was turning onto Fairfield Road that I felt it. It started as a twinge in my stomach and quickly began to engulf my whole body. All the adrenalin that had been running in my veins was catching up with me, and I began to feel sick. Worse yet, I got stuck in traffic again. When you are stuck in traffic, you watch the clock carefully, trying to make sure that every second is counted, and possibly trying to use your sheer willpower to slow time. Time, however, is stubborn and it kept on clicking by at the usual rate. Finally I reach the college and jump out of my car and into the building, knowing I'm just a minute late and that they don't always start on time. I slow down to a stroll as I enter the room and grab the sheet of paper and sit down. I breathe in and out and smile, knowing I barely made it on time. Unfortunately, for the rest of the test the adrenalin rush made my stomach churn, and I began to lose my concentration.

I was on autopilot during most of the test, which I don't really remember too well. The drive home is somewhat of a blur as the descent back down from my rush got worse. I walked into the apartment and went straight for the bed. As I passed the closet I looked at the white wire mesh hanger. There was little sign of how or why it had fallen. The hooks were still screwed tightly into the wall. I shrugged and promised myself I would clean it up later. As I passed the alarm clock, I picked it up and dropped it into the garbage bin and then promptly fell onto the bed face first. The last thing I remember thinking was, "Wow…someone really wanted me to take that test."

As I said, this story has little purpose than to show one of the worst days in a particular medical student's second year. It may be true or it might not be. At any rate, I passed.

As I stood there in my white lab coat, I felt intimidated. In a way, I felt that I shouldn't be. For four years, before I was accepted at Wright State University School of Medicine I spent some sixty hours a week in an inner-city emergency center. I remember the gunshot victims rolling in on stretchers and the packed waiting room, swelling with the suffering and the impatient. I worked third shift during those four years, staying up late into the night to watch the sick and suffering of Cincinnati. It was a wake-up call for this twenty-year old Classics major at the time--a brief glimpse into the atrocities that bug and man can create. It was my trial by fire and an experience that would either solidify my desire to practice medicine or destroy it entirely. As fate had it, my desire to become a physician grew, and I found myself increasing my hours after graduation. The masochist in me began to take hold, and I became convinced that if I can survive this, then I just might make a good physician.

There were scenes and experiences that I took part in that have been engraved in my memory. I remember a homeless patient who had scabies over his entire body. I remember an HIV-positive woman who rolled into the emergency room at the height of a rush of trauma patients. She had cut her hand severely, and a large bandage and mass of clotted blood clumped together where her index finger used to be. As I stood before this woman, I felt concern and worry for her, yet at the same time I felt fear for myself. I remember the first patient who I did CPR on, but despite our intervention, died. His name was Marcus.

I have seen and experienced situations other first-year medical students have not and perhaps will not see for another year to come. However, despite all these experiences, I still stood there back in September of last year, and was humbled and fearful. Before me, lay my greatest teacher. The white sheet covering him hung there like a stage curtain waiting to open. The class was Human Anatomy, and this was the donor upon which I would learn firsthand the intricate design of the human body.

It's a strange feeling to be given an experience such as this. You feel like an astronaut on his or her first trip to the stars. So I steeled myself and drew back the covering to begin my examination of this donor and my career as a physician. At first, I had a great doubt in my mind. How would I ever learn all this? I looked from head to toe over this brave donor lying before me. Every intricacy of this design lay before me. Then I felt elated. I realized that however one sees the human body, by God's or evolution's design, doesn't take away from the fact that you stand in awe of this complex and highly adaptable design. So many anatomists and healers have come before us and mastered an intimate understanding of us as flesh and blood beings. Where they have gone we, too, must follow.

As time wore on in the class, the amount of information increased. It was overwhelming, and there were times when it felt like too much, and at one point your mind would suddenly shut-off, like the click of the nozzle when you've filled the gas tank to full. In the end, what kept me going was awe and fascination. You can't help but be drawn to the information, to learn what makes us lift our arms, allows us to smile, or even take five steps towards the door.

All this I learned from my donor, a man who lived a lifetime before I was even born. Throughout that lifetime, he had been overseas and traveled. He had suffered, rejoiced, hated, and loved. I'd like to believe that the vast spectrums of human emotions are experienced by all of us. Throughout all our experiences, our bodies are there with us, up to the end. In only nine weeks, we had soaked up a vast amount of information about the human body at the gross level. The final exam came and went. I answered the last questions on my donor and then bid him farewell. I never saw and will never see him again, but I can never forget. It almost feels like he was some supernatural being who appeared suddenly one day to teach me all about the human body and then disappeared just as mysteriously. I often think it's very ironic that the greatest contribution to raising physicians is giving over oneself. As for me, I passed the class, but more importantly, I can't forget it.