Fear

One of my professors asked us to write a short reflection on what our biggest fear was about becoming a physician. Just for grins, I decided to post it.

Fear Essay


While sorting through my mental database of fears about being a doctor, I am finding it difficult to select just one, most prominent fear. Possibly that I’m too old for this? That I wasted all of my “young” years enduring pre-med classes, the MCAT, post-bacc, and the emotional roller coaster of applying more than once to medical school? That I’m so heavily immersed in educational debt that I’ve inadvertently tied myself down while paradoxically trying to do the exact opposite? Or perhaps that regardless of how much I love medicine, I will later find out that I missed my true calling as a UFO-ologist or a flying trapeze artist? No, I’m pretty sure it’s not one of these.

Truthfully, most of these fears are just little bubbles in a blue sea of overwhelming happiness, gratitude, and excitement that I feel whenever I take a moment to verify that I’m actually in med school and I’m going to be a doctor. Being a “pre-med” and stressing about “if I’ll ever make it” has been such an integral part of my identity for so long that I have to continuously remind myself that I’m here. And cliché as it may seem, every morning I am so thankful to simply sit in class and finally learn material that I love that I can barely contain myself. I always knew that if I could just get there, I would be the happiest medical student in the world. And I am.

As a result of this blissful happiness, I really haven’t made much time to focus on the fears that I have about becoming a physician. Imminent fears about medical school are abundant (passing my classes, socializing with much younger students, adjusting to my limited income, and securing a residency)… but my fears about actually being a physician are pretty limited. I believe that I have the resourcefulness, the curiosity, the character, the people skills, the tenacity, the decisiveness, and the intellect to be an excellent physician. I think I’ll be able to handle death, telling patients dismal news, long hours, hospital politics, tough ethical decisions, yada yada.

I suppose my biggest fear revolves around the order of my priorities, and how they may change in the next 10 years. I am, and always have been, a woman that defines success differently than most women I know. Many of my girlfriends would say that success and happiness for them involves being in love, having children and a wonderful family, being financially secure, and having a beautiful home. Of course they also place emphasis on their education, career goals, and hobbies… but if forced to choose they would certainly sacrifice portions of the latter for the former. These women I speak of are not uneducated women, nor are they simply housewives… but they derive happiness from achieving their goals of falling in love and having a family.

If I could draw a picture of what I hope my life is like in 10 or 20 years, I think it would look very different. Happiness for me is being a physician, living in a small home, traveling the world, photography and journalism, enjoying the companionship of friends and family, working on humanitarian missions, learning languages, having a peaceful and harmonic life, meditating, having a garden, living in a multitude of cities, etc. Of course love is important as are children, but to me these have never been priorities. I appreciate love when it comes my way, and companionship is wonderful, but I would not be willing to sacrifice the other things that make me happy. I’m over 30 and I don’t particularly want children. I have a wonderful long-term boyfriend, and I still don’t see myself as a mother or a wife.

My fear is that my priorities are screwed up… and by the time they change (if they do at all) it will be too late or not possible. If I suddenly decide that I want children, I may be too heavily invested in my career to switch to motherhood. Or perhaps the desire doesn’t manifest for another 12 years… and by then it may not be possible at all considering my age. I know that I’ll love being a physician, but I don’t know if I will love balancing a career as a physician with being a mother. I don’t know if I’ll even be able to handle the demands of both roles.

I have many friends who are parents as well as professionals, and observing the chaos in their lives only reinforces my feelings and validates my fears. Every woman physician I know who has children falls into one of two categories 1) They have a very hard time balancing their career with motherhood without help, and they usually end up feeling huge amounts of guilt for spending so much time away from their children or 2) They didn’t even want children to begin with, but did it because it is society’s measure of success. When I examine their relationships with their children, it doesn’t seem like anything I envy or would want for myself.

Over recent years I have certainly thought about this issue quite a bit, and my conclusion is that there is nothing I can do to address the issue except to simply not worry about it and let life unfold as it will. Maybe one day my biological clock will click, and having children will be worth all the chaos. Whether I’m young, in a relationship, adopting a child, freezing embryos, a single mom, 35 or 65, I assume that if and when I’m faced with these decisions I’ll make the choice correct for me, and until then… che sera, sera.

YUCK!

I just found out about the omentum. This is the one thing in the human body I was not expecting... as I had missed the Oprah show where Dr. Oz clued in the rest of the world. Can you say GROSS??? Basically its a curtain of fat and fascia that hangs like a big apron over your stomach and intestines... protecting all of your abdominal cavity from trauma (since it's not protected by ribs). Folks, this was the first day I was disgusted to be human. Lets just say that the one Dr. Oz is holding up doesn't do it justice. Basically, imagine an afghan made out of "fat" yarn. With blobs. I just wanted to take the scalpel to myself! Best diet ever? Anatomy lab, abdominal cavity dissection. Oh, it was so so so wrong.

Annie Le

I have to say that I've been following the Annie Le story from Yale very closely. It really breaks my heart.

If you haven't seen it in the news, Annie Le was a yale PhD student in the Department of Pharmacology who was murdered in her research building. About 2 weeks ago, video surveillance captured her entering her lab around 10:00 am on a Tuesday morning, but she never left the building. Cadaver dogs found her body last Sunday between a wall space in the basement of the same building. Tragically, Sunday was also the day she was to be married to her college boyfriend. An arrest has been made in the case, as DNA evidence places Raymond Clark III, a lab tech/custodian at the crime scene. No motive has been announced... but there's been a lot of speculation. Possibly they had an affair, possibly he stalked her, possibly it was work related issues, etc. Most recent news has centered around the possibility that Raymond Clark III murdered her over animal rights issues. Who knows?

Besides the fact that this is a huge tragedy, I am also bothered by the idea of someone possibly stalking or attacking her at work. Maybe this hits a little too close to home. Because you never know. When is weird a little too weird? How do you draw the line between "this guy is a little off" and "this guy could go postal any day"? I guess I always error on the side of giving people the benefit of the doubt... but looking back I can see a few times, one in particular, that giving the benfit of the doubt could have gone very wrong.

A few years ago while working in the same med school that I now attend, I had some unpleasant encounters with a maintenance man who worked in the building. I'm not sure of his exact age, but I'm sure he's past 40, and I was 28 at the time. My relationship with him never progressed past "Hi David. How are you? I was wondering if you know when I'll get the heat turned on in my office?" or maybe in the elevator "Hi David, headed home? Well, have a nice weekend with your family." I swear, nothing more. Somehow he turned it into more. The first instance happened in November when I was sitting working at my desk with the door open. He passed by casually and said "Hey, I bought a bunch of these boxes of chocolate almonds from my nephew for his basketball team... so I'm giving them away. Want one?" I innocently and stupidly said yes, took the candy and thanked him. That was the end of the conversation, and he left.

Several days later, he stopped by with another box of candy and said that he brought it for me. I thought that was a little odd (but not really), so I just said "Oh, thanks for thinking of me... but I just ate." I didn't want to get all bent out of shape over someone bringing me candy... maybe he's just being a nice guy, right? The next day I unlocked my office and I noticed that the candy was on my desk. I guessed he snuck it in when I wasn't looking the previous day. I planned to give it back to him as soon as I saw him, but I didn't see him for a week or so... and I subsequently forgot about it.

When I finally did see him, he stopped by my office to say hi. He kind of stood in the door but didn't say a whole lot. He said he'd been sick. At this I felt my compassionate gene kick in, and I asked if he was ok... as I hadn't seen him around in a few weeks. He then started muttering about how he has problems with his eyes... and how when he opens them all he can see is ME! His word were "all I can see is you, baby". Ok, so they guy has a crush on me. Do I ream him openly, accuse him of sexual harassment, and tell him to go crawl back under the rock he came from. I didn't. I always try to give people a graceful way to get out of situations. At least the first time. So I said "Very funny, David! I thought you were serious there for a second. I was worried you were sick! Ok, well, my boyfriend is waiting for me downstairs so I have to go." My theory is that any decent man who likes you will immediately stop his advances if you drop the boyfriend or husband word... so that's what I did.

It didn't work. The week before Christmas vacation I came to my office one morning and I found candy, a stuffed animal, and a card in my office. He had been in my office, which was locked. He had a key to my office! Well, of course he does, he's the maintenance guy. I did not know what to do. I was totally creeped out. I threw the items away. Again, I didn't want to make a huge deal out of the situation... because I knew I would have to work with the guy and possibly go to med school here... so I didn't want to make waves, and I certainly didn't want to be the girl that called sexual harassment. I tracked him down and told him that he couldn't come into my office unless it was for work related reasons, because I keep pharmaceutical drug in my office and I could get in trouble if there was any unauthorized access. It sounded lame, but I would have done anything NOT to have to take this to higher authorities. He kinda blew off my request with a "oh, sure no problem" attitude... which threw me off... thinking again that I was blowing this out of proportion.

In between these specific situations there were lots of little things as well that started adding up... and made me hyper-aware of him... and everything he did. I started ignoring him completely and giving him the stink eye just to make sure I wasn't encouraging him in any way.

The last incident was bad. I lived about three miles from campus, and I head out to work around 7:40 am. I pulled out of my driveway, headed down the block, and stopped at the first stop light. I looked over my passenger window and saw him. In a school van, next to me at the stop-light. I must have given him the look of death and shook my head, because he looked away nervously. I was not playing around now. Was this a coincidence? Not possible. Or was it? Don't know. Won't know I suppose. I couldn't find him or his supervisor that day, otherwise I surely would have caused some commotion. I calmed down over subsequent days, and after that he just stopped bothering me. Completely. I never even saw him on my floor. I never really told anyone except for a couple women I worked with... and they were sufficiently freaked out as well.

Now 2 years later, I actually still see him occasionally, passing in the hall... to which I will acknowledge him with a nod but I don't smile. It was (and still is) so wierd. Even now, as I type this... I read it once and think "holy shit girl, you had a stalker and did nothing about it". Then I'll read it again and think "Eh, big deal, he liked you and he got over it."

H1N1 Schmen-one

Today in anatomy lab our course director entered the room looking solemn, and holding a box. "Just so you know, someone in this lab group has a confirmed case of H1N1". He then tosses us a box of masks, and says "So if you're concerned, here you go".

Then one of my lab partners said that he got the H1N1 vaccine. I was like "um, no you didn't. it dosen't come out for a few weeks". Adamantly, he told me that the school nurse told him that his seasonal flu shot included H1N1.

I started to question myself, because I know this guy to be pretty on top of things... so I went home to look it up. Sure enough, the H1N1 vaccine just got FDA approval this week, and it isn't expected to be on the market until mid-October. This scenario really ticked me off, though. If nurses in a damn good MED SCHOOL are telling students they are covered for H1N1, then who knows what the average Joe has been told.

The straight dope is this.... (by the way, I really like this phrase and I'll throw it in whenever I can)...

There is always a seasonal vaccine for the common annual flu that goes around. Thats your normal "flu shot". That is totally different than the H1N1 vaccine, which is developed specifically for the H1N1 strain. If you want to be protected against the common flu as well as H1N1, you'll have to get both shots. The common flu shot is available now... but you'll have to wait until October for the H1N1 vaccine.

As a sidenote... my opinion is that you should never be the first one to rush out and get a new vaccine (or medication for that matter). Clinical trials are great and dandy, and are highly regulated... but with government politics, mass media coverage, and H1N1 hype you don't know the type of pressure that vaccine developers are under to meet deadlines, etc. If you really want it, wait a few weeks to make sure they've worked out any kinks. I'm just saying.... as someone who's done a lot of clinical trials and participated in vaccine development, that's my opinion... take or leave it.

They Don't Teach THAT in Med School

Wow! So I just got back from visiting Leslie. She invited me to the rehab center for a talk on addiction by a local physician. It was great to see her again and she's looking happy and lovely. The talk was designed for family members of rehab participants... so it wasn't heavy on the nuances of the biological and physiological components of addiction... which was fine by me as I get plenty of that in med school.

Anyway, it was great. Essentially it was explaining to the layperson that addiction has a genetic component... and how the cycle of addiction begins and is propagated. Basically, here's the straight dope (hmm... maybe bad choice of words)...

So a "normal person" is defined as a person without the genes that pre-dispose them to addiction. Addiction can be anything I assume... gambling, food, etc. but for our purposes we are talking about drugs and alcohol of any kind. When a "normal" person uses a drug or alcohol, they experience the same sort of stupidity that anyone experiences while intoxicated. They'll experience a lack of accurate perception and lack the ability to make sound judgements. They also will feel a lack of inhibition, which feels really good and can be a lot of fun. They may drink occasionally or routinely... as frequency of intoxication is really not part of what defines addiction. When intoxication causes a normal person to experience adverse affects (like hangovers, acting like a fool, making bad decisions, getting a DUI, etc.), they will give up the drug or alcohol... because their perception is that the drug is not worth experiencing the adverse events.

When someone predisposed to addiction uses a drug or alcohol, they experience all the same stupidities and lack of judgement as the normal person described above... except one thing is very different. That is that alcohol doesn't just make them lose inhibition and they feel good and have a lot of fun. When this person uses drugs or alcohol they feel like Superman. or 10 feet tall and bullet-proof as the speaker said. Normal people feel good, but not this good. There has been research that shows a four fold increase in dopamine levels in those who are genetically predisposed to addiction when intoxicated as compared to "normal" people when intoxicated. So when this person drinks or uses, they do feel like Superman. And when adverse events start happening as a result of intoxication, they refuse to quit because feeling like Superman is THAT GOOD. Feeling that good leads to continuous use, which eventually leads to tolerance. Once their body is tolerant to a drug or alcohol, it starts to take more and more of that drug to experience the same feelings. Eventually, they're getting intoxicated not so they can feel like Superman anymore... but just so they can feel normal.

Now they are in a cycle in which they must protect their decision to drink, and therefore begin denying that they are making bad choices. The speaker discussed that denial is essentially the mechanism which propagates addiction... because it allows you to put your locus of control far outside yourself and you are able to blame others and circumstances for all that is going wrong. Drugs and alcohol skew one's perception so much that they can actually convince themselves that they ARE making correct decisions... and bad things keep happening to them.

Of course I've heard much of this before, presented in statistics and pretty bar graphs... but it felt quite different hearing it in plain English in a room full of recovering addicts and their families.

Um, ignore all that...

In my experiences as both a pre-med and now as a medical student... I've been inundated with advice on how things MUST be done... Here's a short list of some of the things I can remember....

1. You can't study at home

2. You shouldn't study in bed

3. You have to finish all your pre-med classes before taking the MCAT

4. You shouldn't contact the admissions office to make yourself more visible

5. You should attend EVERY class lecture

6. You have to get at least a 30 on the MCAT

7. Caribbean schools are less prestigious and you can't get a decent residency

8. You should get only science professors to write your letter of recommendation

9. You have to have A's in your pre-med classes

10. You have to have "volunteer" hours or "community service" in order to be accepted to med school

11. You have to study in groups

12. You should take an MCAT prep course

13. You should get a Master's instead of completing a post-bacc pre-med program

14. Research is useless unless you are published

15. You should write "thank you " notes to your interviewers

16. Only wear dark conservative outfits during interviews

17. Buy all the books

18. Buy none of the books

19. Study 2 hours a day

20. Study 4 hours a day

So these are just a few of the billion things I was told. But my point is not to pass this "glorious" list of advice onto you for your use. My point is that it's all bunk. The fact is that there is no "recipe" for getting into med school or for being a success once you get there. Otherwise... everyone would get into med school and everyone would be the perfect student, right? And we all clearly know that acceptance of anyone candidate and success in med school is highly unpredictable. I'm sure everyone knows someone with a 40 MCAT that was rejected by every school (I do!), and people with horrendous scores who made it solely based on connections. And there are people in med school who study every day and fail tests... and people who cram for exams and pass. So there is NO RECIPE!!! The point is that your overall package has to convey that you are mature, capable, and a good learner. Once in med school, you have to find what works for YOU.

However, I do believe there are a few things that you MUST do (or not do)... and here they are.

This is my "success" recipe...

For Pre-Med:

1. Make yourself unique, and then show who you are to the admissions committee. You don't have to have a perfect set of credentials... but you MUST show that you will be an asset to their med school and that you are capable. So if your undergrad or pre-med grades are crappy... SHOW them SOMEHOW that you can do the work. That might mean showing that you can run with the big dogs by designing and implementing your own research project and getting published in a prestigious journal.... or maybe that you've taught pre-med material (as a tutor, etc.) or maybe you've rocked the MCAT. If you don't have even one official volunteer hour to speak of, show them that your last job was working for a non-profit agency where you were highly invested in the community.

Med schools are looking for a well-rounded, interesting, valuable package with high potential for success in med school. If you can show that you can do the academic work, that you have a commitment to healthcare and humanity as a whole, that you socialize and learn well with other people, that you are interested in expanding your own horizons while contributing to the education of your classmates, and that you don't have 2 heads.... you're golden. Who cares if you didn't volunteer in the oncology ward for at least 300 hours?

For Med School:

1. Do not procrastinate. No matter how you decide to study, when, or with whatever frequency... do not be a procrastinator. You can get away with it in pre-med... but it won't work in med school. Plus, life is so much nicer without that stress.

For Pre-Med, Med School, and Life in General:

1. Be humble in all that you do. In other words, check your ego. No matter how smart you think you are, there will ALWAYS be someone smarter with a bigger ego. If you approach everything in life with humility, you will go so much further, and you won't risk losing everything because of your ego once you are there. It really is true that the more you learn, the more you realize that you don't know anything... so I would suggest that if you constantly have that feeling that you know everything, you might want to work on that before med school. Because at this stage of the game, everyone is relatively intelligent. You didn't get to med school or through your pre-med classes because you weren't bright. What separates people at this level of education is attitude, and how your interactions with other people facilitate your advancement.

2. Know that you aren't growing as a person unless you push your comfort zone and unless you fail. If you are overwhelmed with material that you are studying, that's good. You're actually learning something new. If you're nervous because you don't know if you can handle the pressure of dealing with life and death situations, perfect. You're pushing your own boundaries, acquiring new skills, and becoming a stronger person. I look back at my post around my second week of med school (where I was panicking)... and I know that was one of these times. I was so out of my comfort zone it was ridiculous. I passed it, and here I am still in med school. If I'd have refused to experience that, I would have dropped out the second week.

If you're always comfortable and you never fail, then you haven't "tapped out" (as I use to tell my students)... meaning that you haven't reached your full potential in that situation. The example I used to give was about applying to colleges out of high school. If you apply to 10 middle tier schools and are accepted to all 10, have you reached your full potential? Certainly not. You'll never know because you didn't tap out, you didn't fail at anything, and you didn't push your limits. If you apply to 10 schools (7 middle tier and 3 top tier), and are only accepted to the 7 middle tier schools, did you reach your full potential? Yes, at this stage in your life. You TRIED your best, tapped out, and are going to a middle tier school because at this point in life that is the best you could do.

My point? Get out of your comfort zone, or you'll be a stale cookie.

3. View difficult people as a challenge. A challenge to get them to like you. I decided to do this with Dr. Kovec. And it's been what, a week now... and he's already called me "smart girl" a couple of times. It's having those difficult people on your side which can really save your ass sometimes.

Ok, that's all for now...