The Best Advice I Have Ever Received...

Ok, maybe not the best ever... but the best career advice I think. I have a fantasy of someday building a self-sustaining clinic in a developing country... that is completely independent of foreign aid or doctors... a project description best left to another post. But.... I know a physician who did just that! And so of course I pester him quite often about how/what/where/and how the heck can I be just like him.

Here's his advice. Write this down. It's like gold.

In order to be a physician and incorporate international projects into your career... here you go!

1. Broadening your horizons with an MPH or the like is very helpful. An MD is for medicine.... but anything you can do to increase your exposure to public health issues is extremely beneficial.

2. Learn languages, and learn them well! Communication is the #1 key to success in every field!

3. If you want to make the world a better place, medicine isn't the only way to do it. Business, politics, research, nursing, economics, environmental conservation, teaching... you can make a huge difference in many fields.

4. Pick a residency that you LIKE. Don't pick something that you assume will be useful internationally. It all will be useful. You'll be happier if you follow your passions.

5. (My personal favorite). Choose a spouse who has compatible goals and who supports your international endeavors. Having a supportive or non-supportive spouse can really make or break you.

It's About That Time

I'm signing up for STEP 1 and buying my Q-bank this week. That and we just had our 3rd/4th year rotation scheduling meeting. Just one question. How the EFF did this happen so damn fast????

And feel free to throw in your advice for scheduling rotations. FYI, my school considers 3rd and 4th year the same... so you can complete rotations in ANY order. Any order, seriously.

More Food.... what else??

Lemon cupcakes via a recipe from the Hummingbird Bakery in London

Blueberry French Toast made with Sourdough from the Fisherman's Wharf in San Francisco

Rock Cornish Hen roasted with citrus and cranberries, braised with port wine and shallot sauce

Moral of the Story? Don't wear a "bump it".

My Nephew Oliver!!

San Francisco, Bodega Bay, Petaluma, Santa Rosa

Just got back from a self-assigned vacation. My BFF got married... and I ditched 10 days of the GI block... opting for a hiatus instead. Wine tasting, pampering, champagne, bachelorette parties, etc. Here's a few shots.

Not So Much Cool as a Cuke

Last night I was a patient. And a freaked out one. So this is probs TMI, but it's my blog and I don't care. So I occasionally get a UTI. Maybe once every few years. But they are always solved within an hour by drinking a couple of big glasses of water. No biggie. But last night it didn't work. It just got worse. And worse. And eventually I started peeing blood. And then I panicked. Like panicked panicked. WTF? I knew I wasn't going to die. Well I kinda felt like it, but I knew logically I wouldn't. And the other thing. I had this horrible realization that I was alone. Like really alone. Who should I call at 2:00am? Lolo had to work in the morning... and what could she do? Dr J was sleeping... and though I called him he didn't pick up. I was seriously in too much pain to go to the ER or urgent care. And Mr. Ex Boyfriend was on vacay with his new girlfriend. Not exactly great options.

An hour later it got worse and I sacked up and called my ex. He called me in an antibiotic and some azo. I'm sure his girlfriend was thrilled that he was doing me favs while on vacation. Oh well. Then I woke up my neighbor to run to Walgreens for me. Which he nicely did. That was pretty major for me actually. I have some crazy psychosis where I am practically physically incapable of asking other people for favors. But I did. And they said yes. So thank you Eli and my neighbor. You saved my ass.

Tonight

I'm going to our block party. Its a "pink" party. Who knew that I do not own one single garment that is pink? Must be a f*&% up on an X chromosome somewhere.

My Lovebug is Here to Stay

My dog Luke, now lives with me on a permanent basis. Ex boyfriend by some miracle agreed to relinquish him... and I am looking for a new place to stay. Not right away, but within a few months where he can have more room to play.

I know it probably isn't the best decision for a med student to make... but right now I am able to take better care of him... and for once in my life I've decided to worry about the future when it comes.

3 Types Of Med Students

I wrote a guest post for Dr. D a few months back describing 3 types of med students and what the "right" reasons are for going to med school. I wanted to repost it here... bc I think it's super relevant to applying to medical school.

So before we get into what the "right reasons" are, let me clarify a couple of things. Medical school is difficult. It takes tons of time. It's stressful. It is a huge commitment. It's competitive. It is also a million other wonderful things. Everyone in medical school has essentially the same base experience.... four years of school plus residency, essentially the same course load, the same time schedule, the same amount of financial aid available for monthly living expenses, etc. Yet, you will hear every different opinion from students about their medical school experience... ranging from "it was the worst time in my life" to "this is easy cake" to "this is so much fun". In my opinion, one of the MAJOR factors that contributes to the differences in student's experiences in medical school is the vast array of reasons why they are there.

Now when I spoke before about the "right" reasons... I guess I should clarify... as who am I to say what the "right" reasons are... But let me describe a pattern I have noticed among medical student. I think there are three main groups of student attitudes about medical school. I'll describe them here.

The happiest students (those who have a balanced perspective, who do well academically, who have reasonable amounts of stress and anxiety, and those who generally "love" medical school) are those who are enjoying the journey. Meaning, they actually love medicine, love the material they are studying, love the lifestyle of continued learning and a high-paced academic environment. Of course, many have other interests and families, but to them medical school is not an obstacle in the way of those things. Med school is an awesome part of their life. Personally, I'm a second year medical student, and I love reading my huge Robbins pathology book with a cup of coffee in the early morning. I love going to lecture and participating in clinical problem solving. I feel a rush everytime I am in the hospital, I talk to my patients for too long, and my brain is always coming up with ideas for projects and research. I look forward to residency and my future career, but I am in no way miserable in school. I certainly think I fall in this category. I absolutely could NOT imagine being anything other than a physician... it took me so much work to get here that I am actually in academic bliss all the time. I know this sounds weird and a bit (ok a lot) over the top... but I know a lot of other people like this. If you ask them about medical school, they will describe it just like I have.

The second group of people are those that like medicine just fine, and it came about as a reasonable choice. They worked hard in undergrad... and are all around strong academic students. To them, medicine is more of "a good field to be in" for them instead of "the most amazing and only possible career on the planet". They are smart kids, but probably had interest in other careers as well... they could have been attorneys or engineers or business entrepreneurs or stock brokers and would have been just as happy. They are happy in medical school not because it is their #1 all time passion... but because they are very strong scholars willing to put in the work in order to be in a field like medicine. They do well academically, but are a bit blase about medicine... often eager to get home, eager to skip extra discussion about a disease or patient, and tend to be a bit disinterested and or frustrated with the rigamarole that comes with medicine. This doesn't make them less of a physician, but they do not enjoy the ride of med school as much as the above group. They are "putting up" with med school... and willing to wait to get out so they can have a family, a paycheck and a steady schedule.

The third group are the miserablites, of which there are two categories. These are the students that don't come to class because they hate medical school. They are barely hanging on by a thread academically, they are socially and academically absent, and they are caught up in the idea that that are in the wrong spot. They've figured out that medicine is a lifestyle that doesn't end after medical school... and they just come to the hard realization that the "misery" of studying, testing, stress and academic/hospital nonsense will be a theme in their lives forever. The first category of miserablites ended up in medical school because of outside pressures. Either from family or society or from within themselves, they felt pressure to do something "worthwhile", to make a choice, any choice,... and medicine seemed like it would be the answer. Their heart wasn't in it... but they either didn't have another readily identifiable passion, or they felt their other passion didn't hold enough weight. A lot of people in this category really wanted to just focus on another less traditional passion, or on family, having kids, being a parent, but got pressured into having a career first... and they are miserable because their heart isn't into med school.

The second category of miserablites came to medical school for the money or the lifestyle, and quickly figured out that those reasons are not sufficient to motivate you through the insanity of medical school. There are a million ways to be rich, that don't involve 8+ years, intense academic work, and a quarter of a million dollars in student loans. And they also figured out (news flash) that being a doctor doesn't make you rich... perhaps a bit too late. Sure you can make a life where you are comfortable financially... but 90% of doctors are not free of financial obligations. Student loans, malpractice insurance, etc. make the life less than glamorous. And frankly, though you can and will make a solid income more than the average American, the goal of being "rich" doesn't seem all that worth it two weeks before Step I when you are sleep deprived, amped up on caffeine, cramming, freaking out, and wishing you'd gotten an MBA or become a real estate agent. The miserablites are those who, as you say regard medical school as "sucking all life out of me, leaving me absolutely passionless, tired and with no ambitions". I can tell you I have NEVER even one day felt this way about medical school.

So, in essence, I think everyone applying to med school has a lot of thinking to do.

Ok No Joke

Again, cardiology is really really awesome. It is just so intuitive. I mean, not to say that I understand everything I'm learning... but the heart is the most amazing organ ever. Not to mention, taking out the heart was the only day of anatomy I even slightly enjoyed.

Kicking Papa Robbins in the Arse

Definitely read some 70 odd pages in Big Daddy Robbins path book in 4 1/2 hours. What now?

More Food (aka Med School Procrastination)!

Bow tie chicken pasta with grape tomatoes broiled in olive oil, and fresh feta and rocket arugula from the farmer's market.

Stuffed Mushrooms

Cilantro Salsa

Quail Stuffed with Port Soaked Raisins, Sage, and Walnuts, served with Brown Sugar Roasted Acorn Squash.

Sesame Crusted Seared Tuna with Floral Peppers

It's Really Too Bad

That you have to do IM before you can be a cardiologist. Cause cardio is totes awesome.

This Week Sucked. TGIO (O=over)

1. Totally missed the memo that we had a TBL on Tuesday

2. Basically love cardio but suck at it as I haven't studied for crap

3. Am considering living with my freakin' parents bc I am so broke

4. Guys suck. Is there a middle ground between those that act totally uninterested and those that won't leave me alone for 5 minutes? That would be new and different.

5. I got a flu shot

6. I have to plan a bachelorette party. Is there anything lamer on earth?

7. My dog is being naughty

8. My landlord is annoying

9. Did I mention I am broke?

10. I have a whole lot of academic catch up to play.

My Nephew Will Be Here Soon!!

When Someone You Love Bombs the MCAT

I've seen several Google searches with the above topic directed to my blog, so I thought I would address it directly. When I tanked the MCAT, the only thing worse than tanking was seeing my parents disappointment. Not that I think they really gave a rats ass about me tanking the MCAT. It was more that they were devastated that I was devastated. So here's my what to do and what not to do list.

1. DO NOT act overly disappointed. Empathize, but if you act like this is a huge fuck-up, the test taker will only feel more like a loser.

2. DO NOT push them about "what are you going to do now?" They have just been through a HUGE amount of work that was essentially wasted (well that's how they feel in the moment anyway)... and it is wayyyy too overwhelming to think about studying and taking the test again. They will get there in their own good time.

3. DO remind them that the MCAT is a nightmare for everyone. If it was easy, everyone would be a doctor.

4. DO remind them that there are many people who take the MCAT many times and still get into great US schools. If you don't know any, you do now. See the profiles on the right.

5. DO support them in their temporary "Plan B" options (like taking a semester off, getting a Masters in pharmacology, taking a research job), but encourage them to keep trying for med school. Try to dissuade them from doing anything drastic (ie. running off to the peace corps or joining the circus). The moments after bombing the MCAT are very fragile, and it is easy to convince yourself you don't want a life of medicine... even if you really do.

6. DO NOT tell others that they took/bombed/etc. the MCAT. They will figure out a way to disclose that information on their own time in their own way.

7. DO NOT undermine the importance of the MCAT score or the difficulty of the test. Tips on how to study better or stories of how you fucked up the SAT II will not go over well.

8. DO just be a friend and invite them out to do something to get their mind off the issue will help. When I bombed the MCAT my best friend brought over a bottle of wine and we got lit.

9. As a preventive measure, DO NOT tell everyone you know that so-n-so's MCAT results are due. That's just asking for trouble if it comes back bad.

10. DO send them a link my blog. At the very least, they will feel better that they didn't eff up the MCAT as many times as I did.

Syphilis... with Crabs

Last night was a great night. I'm in a women's book club (yes, me=big dork), and we all got together at this chef lady's house in historic Algiers. We had wine and food and more wine... and we also had home-made crab dip made from crabs she caught (the kind you want to catch, you know). It was totally great.

Funny thing is that unbeknownst to me, the girl who took my state syphilis epidemiologist job was there. Random coincidence. Small world.

Ok, EFF Being PC. This is lame.

Friday I went to the Standardized Patient Clinic where we were supposed to perform a cardio exam. Instead, we got a 20 minute lecture on gown ethics from an SP who was clearly not comfortable being partially (or even minimally) naked in front of people. I mean, maybe if one of us aggressively pawed at her or touched her inappropriately the lecture would have been merited. But nobody had even touched or said anything.

Look folks, I GET that there is a needed threshold of sensitivity for dealing with patient modesty. And I GET that you don't just walk up to people and put your hands down their pants without introducing yourself. But seriously, I was annoyed. I'd really like to do a cardio exam, and I get a lecture about how you should never ever ever ever expose breast or nipple tissue. How you can listen to the A&P valves from the top of the gown, and the Mitral & Tricuspid from the bottom of the gown by rolling it up carefully. And a femoral pulse requires a delicate "tucking" of the gown up the leg. Then when I went to delicately "tuck" the gown I got yelled at for touching the gown. Apparently I am supposed to ask the patient to tuck her own gown.

The entire time I wanted to yell "Give me a fothermucking break!!!!" I don't have time for this. Personally I am not all that into naked chicks, but I had a very strong desire to rip this woman's gown off, judo chop her ass back to on the exam table and have my way with my stethoscope. Seriously? A quick cardio exam turned into 20 minutes of gown-tucking nonsense?? Right. I can just see me on the wards now. "Ella, why the EFF did it take you half an hour to determine that she had normal rate and rhythm?" Oh, sorry, I had to explain to her the gown folding procedure as to not expose any nipple tissue. That should go over well.

Epigluvula

So my neighbor got strep throat and of course, me playing doctor, wanted to see. Not only did I see all that strepnastiness, but I got another surprise. His epiglottis. Popped right up like a cobra in the back of his throat. I was pretty excited, although I wasn't sure how uncommon that was to actually see an epiglottis, I'd certainly never seen one.

So last night I was out to dinner with some friends (one of which is a resident) and I asked if he'd ever seen an epiglottis while just visualizing the throat. He looked at me like I was the biggest idiot on the planet, and said "Yes, on every patient I see". Well then I started to feel like an idiot, and question my own sanity... but I just said, "Huh, I have never seen one before, I guess I'll look harder from now on".

Then he's like "look, you can see mine... it hangs down in the middle"

Then I'm like, "uh, that's your uvula"