What Can Happen in a Year?

A hell of a lot. Interestingly, if a person's life activities and experiences could be correlated to variations of colors the year, as it pertains to the medical school experience, was pretty monochromatic. However, while writing that extremely long, awkward sentence, I don't think monochromatic is a great term for the year, even for medical school.

Since my last post I have successfully battled to the end of quarter 2, quarter 3, quarter 4, quarter 5, and will soon be facing quarter 6 in mortal combat in the final battle around the first week of March. It is my weathered, exhausted, and sleep-deprived opinion that the first two years of medical school is a data train-wreck and my job is to simply survive that train-wreck and attempt to save as much of the data as I can. The true test of that data gathering will be on June 24, the level one Comprehensive Osteopathic Medical Licensing Examination. It is looking like it will be a truly worthy foe indeed.

I have developed several awful study habits that I would like to share with the internet. My most regrettable habit, the pre-test all nighter (PTAN). The recipe for a PTAN is very simple, however, not everyone can/should do it. All you have to do is start studying at around 8:30 PM or 9:00 PM and continue to study until 7:57 AM. Then take test at 8:00 AM. After taking the test, review notes for an hour or so to make sure you got the easy ones right and figure out what the hell the right answers were for the hard ones. Then, if you don't have labs, standard patient encounters, meetings, or important lectures that day, you go home to sleep a few hours. Then you do it again in a few days for the next test. Sound easy? Well it is. But the "repeat" part is the part that kills the brain cells.

I am not sure what test it was that set me down the dark, dreamless path, but it must have been an awesome one. I mean, it must have shown me that my PTAN paid off right? Seriously, though, I hate the habit but I usually dominate the tests so it is pretty hard to stop. Did it pay off every time? Negative. Especially lately. Let me expound.

First year could be summed up as a "basic sciences/core knowledge" year. Anatomy, Physiology, Biochemistry, Microbiology, and Immunology, are just a few memorable examples of first year. First year was INCREDIBLY challenging and pushed me to my absolute limits in regards to information retention and testing. It was, however, predictable. Oh so wonderfully predictable. I had a well calibrated mental thermostat for success on the approaching tests. I knew when I was worthy for a 90%, 80%, 70%, and down. I just added hours to my study session to achieve greater levels of worthiness. Second year, however, is a mysterious, nasty opponent.

Second year is the year of "clinical reasoning/clinical prep." Pathology, Dermatology, Cardiology, Women's Health, Gastroenterology, General Surgery, and Pediatrics are just a sample of the confidence wrecking machine of second year. Whether by accident or design, our professors write test questions that can be so enigmatic that even with the notes in front of me, the answer would never be clear. Our tests continue to be multiple choice, 8:00 AM, and the PTAN continue, but my success thermostat is completely unreliable. Example: I didn't get less than a 78% on any test my entire first year. The very first quarter of second year, I bombed a Pathology test with a 68%. Studied hard, studied all-night, was completely clueless on the test. It had to be a fluke right? It was simply a sign of things to come. Now my Pathology tests are the most predictable tests I can take. The internal medicine tests and Pharmacology test are true masters of disguise. I can study solid for two days and walk out of the test feeling like I never learned Anatomy. I can study ONLY the night before while taking several "youtube breaks" and "facebook breaks" and walk out with a low 90%. Nothing that I do seems to change the variability and it drives me insane. There is a possible positive outcome to all of this madness.

The bright (semi-dim at this point) side to this testing and learning mess of second year is that it is telling me repeatedly that I am not as awesome as I thought I was. That I don't know everything, or even much of anything. It tells me to cling to the longer, older coat tails of my attendings and supervising residents. It tells me that although Anatomy and Biochemistry had solid answers, I am going into a career full of gray, fill-in the blank, consult a specialist, and look it up on the internet. That I can't catalog data and expect to rely on it to be a good doctor for my patients. I also know almost 100% for sure that I will not be a Cardiologist, Pediatrician, Gastroenteroloist, Pathologist, Pulmonologist, or Family Practice Physician. So, eliminating options can be a powerful and positive experience too.

Surgery is currently the specialty of my future. The top three specialties calling my name? 1. Orthopedics, 2. Plastics, 3. General/Trauma. Will my mind change over the course of the next year in rotations? Hopefully. I started this journey with the goal of being open to surprise - open to the specialty that I never thought I would like. But I know myself pretty well and the top few and the bottom few are most likely not changing rank without a significant "surprise."

I'll be in York, PA for the next two years and they have a great surgical program with several residencies that interest me so the stage is set. My next challenge lays before me in June and no amount of planning, wishing, and hoping that I do now will matter much if I don't fight my opponents in order of appearance!

With that, internet, I leave you what is to be my longest and hopefully not last blog post as a medical student.

Recovering from Recovering

Why are vacations so darn inconvenient? We run around like wild, decapitated poultry and then a vacation comes- a supposed break from the wild, decapitated poultry dance- and we continue to run around doing everything we can to make up for what the non-vacation time takes from us. Admittedly, I loved being back in Utah for the Christmas vacation but it was a pretty wild time.

As the vacation drew to a close I was excited to get back to the grind and be my own man again. No more mooching off mommy and daddy, driving their cars, sleeping at their house, and eating their food. Of course my parents were totally awesome and provided an incredible two weeks to us, free of charge, and even nursed us back to health after a battle with the flu for the first week. I would never want to sound ungrateful, but coming home sounded amazing by the end.

Little did I suspect the nightmare that was lurking in Kansas City, Missouri, waiting for our tiny plane to land. The miserable creature first took the form of an obnoxiously busy airport. Then, after about two hours of luggage recovery and bus riding, we were confronted by the more hideous and evil form of the creature- ECONOMY PARKING!!! Over the past two weeks our hopelessly impractical car was surrounded by a thirteen inch (because 13 is unlucky) wall of ice and snow, left lovingly by the airport plow people. We hurried and shoved the luggage and the women into the car and turned up the heat. I valiantly stayed outside to brave the 3 degree weather and fight the beast with our stroller. Thankfully, the stroller lasted just long enough for me to chisel enough snow and ice away for us to make it out of the parking spot after an hour or so. Sadly, the stroller lost a wheel in the battle. A ceremony is planned and a memorial ought to be constructed at a later date to recognize the selflessness of said stroller. We then had the privilege of paying the airport for the fun and games.

Confident that the beast had been effectively pummeled, we headed toward Kirksville. No sooner had we merged onto the freeway than the steering wheel began to shimmy and shake. We took the car into the city and I thought to get new tires to replace the smooth rubber circles that are being used as tires now, along with a balancing to fix the shimmy. I thought wrong! They wanted $850 for four new tires. "I might as well buy a second car," I said snootily. Balancing was only $40 so I did that and the problem was fixed! The beast was defeated and would only gather up enough energy to freeze Kirksville for a week and get me stuck in my own driveway, forcing me to miss a lab and a quiz. Needless to say, the beast and I are not talking and hopes that our relationship will improve before spring are dismally low.

My first week back to school was pretty pathetic. I had the energy and the motivation to attend a handful of lectures aside from the required labs. I was so excited to be back to school and yet I skipped out a lot and spent the time hanging out with Ash and Boppy all week. I have officially awarded myself "The Worst Medical Student of the Week." Sadly, I'm not sure a lesson will be learned because we don't have any tests until next week, giving me ample time to cover up my week of laziness as if it had never happened.

This leaves me asking myself, "what made me lose the motivation?" The material that we are learning is exciting, valid, and very important. The professors are well rested and enthusiastic. We have our own car, house, food, and everything else that we were stealing from my family for a fortnight. What the heck happened??

I have only one theory. I hate winter. Most people don't know me to be depressed or even sad for more than an hour or two, but winter gets to me. The shorter days, the absence of green, the biting cold, the treacherous snow and ice, all add up to make Eric a sad little boy. Winter makes me feel imprisoned. It is as if the cold motivates me to stay home and sleep winter away, to wait for spring to come wake me up. Like it is stalking outside, ready to steal my motivation for the day like a bully stealing my pillowcase of Halloween candy.

My seasonal depression fights dirty. I have developed a disdain for depression and any other feeling that could ruin my day. Therefore I have mastered the art of denial and ignorance to my own unhappiness. The winter comes and freezes my otherwise blazing inferno of energy and my brain can't admit that anything has changed, leaving me confused. I argue with my body that I want to go to school and I explain the importance for studying. But the body makes an apparently strong counter-argument and I stay in bed or skip a lecture. Happens to me EVERY winter!

Not to worry, though. I have a plan. For the next few months (pray that winter lasts only a few more months) I plan on changing my opinion of winter. I need to adopt a healthy, positive opinion of winter or we will always have this issue. I don't have the luxury of escaping to the islands or the misfortune of living in dusty, ugly Arizona (no offense to you cactus and dust lovers). So, I need to buck up and thank the planet for pointing a few degrees away from the sun for part of the year. I need to step outside and say, "Man, this cold air makes me feel alive!" and possibly do a sort of dancing-skipping hybrid as I shovel my way to my iced-over car. Isn't perspective everything in life?

As a final thought, Peter Jeppson, the father of a friend of mine, posted a quote on Facebook a week or so ago. "Prioritize. A wise man said that we too often become caught up in the thick of thin things." It is something that a one-track minded, procrastinating fellow such as myself ought to keep in mind this year. Also, my next post will be exponentially more medical school oriented! Apologies!

My Bad, Folks. My Bad.

So I pretty much failed at my goal to post regularly on my blog. I'm feeling positive about my intentions and I almost posted a few times in the past few weeks. I couldn't seem to force myself to sit down and make it happen! Don't get me wrong, I did a lot of sitting down, typing, internet surfing, and reflection but none of those happened simultaneously enough to be represented as a blog post. So, my bad.

I am an official survivor of Medical School: Year One, Quarter One!!! Yeah that sounds like something silly to celebrate but it felt like a tremendous accomplishment after finals were over.

Finals. Something I completely underestimated. What seems to be my constant approach to medical school is that I underestimate it. I start thinking I am the bee's knees and I dominate all of my tests and then finals week comes along and humbles me. My poorest test performances were during finals week. I used to actually enjoy finals because I like the "big picture" stuff and that seemed to be the theme of comprehensive finals.

Example: Undergrad Finals week was similar to if you read a book and took a test on what that book was about. What were the general ideas? What was important to learn in that book that will prepare you for the next book in the series? Those sort of tests were nice because I could answer them confidently, knowing that I had the big picture by then.

Example: Medical School Finals Week was as if I had read the book and they wanted to know what happened on page 16 and how that related to paragraph 7 of pg 708. It was terrifying! I felt very under-prepared for my first final. I passed just fine and got an A in the class but I was doomed to study non-stop for the rest of the week. I stopped thinking that it was going to compare to the undergrad tests that I so dearly loved. So I pulled a few almost-nighters and one all-nighter and got straight A's for my first quarter! Work was the only defense I had against the tests that so brutally mistreated all of my classmates and me. I had never heard so many people talking after the tests with so much surprise at the difficulty and detail of the tests. At least I wasn't the only one doing the underestimating!

I have been consistently studying with two guys from my ward. Rob Root and Christian Anderson, both from St. George, Utah. Rob is one of those lucky people that can use a large percent of their brain to remember everything they read, see, smell, and taste and can then synthesize and analyze all of the data then write a 40 page essay on how it all relates to everything I don't know. In short, he is my pick for the spot at the top of the class after the first two years. It is nice to study with the genius kid. Christian and I just sit back and let the professor explain the hard stuff while I come up with ways that a kindergarten teacher would explain it and then I'm good to take the test!

On why testing methods and content seem to be somewhat impractical and overly detailed, Rob has a great theory. If they were to test us on the most practical application of the material presented in class, everyone would get 100%. If they just tested us on general ideas, and essential knowledge, everyone would be getting such high scores that no comparisons between students could be made. Then the light bulb goes on. So medical school is a new filter system on our paths to becoming physicians! Many have thought, as I have, that the filters would stop after undergrad and MCATs and personal essays and interviews. But nay! The filtration continues! But medical school filtering is much more subtle in that you only have to pass to become a doctor. Some second years have taken the phrase "Seven Oh, Dee Oh" meaning a 70% means you will still become a D.O.. I am way too obsessive and competitive to be happy with 70 so I will continue to play the intense, sleep deprived game of getting 90's on the ridiculously difficult tests.

My new question is this: When does the filtering stop!? Does it stop in Rotations? Does it stop in Residency? Will it stop sometime during my career? Have I chosen a profession that dooms me to a lifetime of weeding-out?? I wonder...

After the dust settled on Friday last week, and after I slept for two days, I have been on vacation! I have never been so thankful for Pilgrims or Native Americans or turkey in my entire life! The headaches are gone and my eyes aren't bloodshot anymore! I'm excited to head back to school (disturbing, I know) but this week of hanging out with my girls and relaxing (recuperating) has been totally awesome. I'll be better about posting next quarter. I promise!!!

Tensegrity Info/I Might Be More Popular Now

Since my blog appears to be "googleable", a word that needs to be inducted by the dictionary people, I had a few comments from people that are incalculably smarter than most people. If you are wanting to learn more about tensegrity and its biological applications go to www.biotensegrity.com. Dr. Stephen M Levin is not only my favorite kind of surgeon (cause they get to use stainless steel hammers) but is, essentially, the leading scientist behind tensegrity applications to our anatomy and physiology. He also may be a new fan of my blog (I wish) since he left a comment.

So, to correct some of the things I mentioned in my previous post, the "Harvard boys" that I mentioned, should more appropriately be referred to as the research of Dr. Donald E. Ingber, M.D., Ph.D., professor of bioengineering at Harvard. You can find info on his research by clicking here. It was also incorrect for me to say the "Harvard boys" came up with the tensegrity idea too, an example of my combination of ignorance to the subject and inability to stay fully conscious during a lecture in a warm room with dim lights.

Other very awesome links are in the comments to my post, "Remotivate, Relax, Relapse."

Thanks for commenting everyone, scientists and non-scientist people alike!

Remotivate, Relax, Relapse

It has been way too long since I posted, and for that, I sincerely apologize! My lack of posting is only a sign of my increased workload in school and not a disinterest in posting. I am running on residual testing-fuel (caffeine) and thought I would give an update.

By the way, I changed the comment setting so COMMENT if you tried before and couldn't!

Since the last post, the Secret Society of Study Stuff has contributed a biochemistry test packet, an anatomy test packet, and a histology test packet. We have had overwhelmingly positive feedback on the packets and major compliments to everyone that contributed. We also learned that we have a ton to work on in order to make the "packet assembly" more effecient and less stressful. By the time we sent out the third (histology) packet, we were feeling pretty good about efficiency and stress levels were low. Consequently, stress levels were so good, at least for me, that I got my very first 100% on a test! Now that may sound like bragging, so let me explain the significance.

I have NEVER received a 100% on any significant test in medical school OR undergrad! I always figure out a way to miss one or, on average, two. I thought I was cursed. But the evil curse was lifted and I dominated the Histology test! I had a Biochem test this morning, arguably the most complex/clinically applicable/time consuming test that I have had yet. I felt great, but the 100% is 100% not possible on this one. But at least I know the curse can't be permanent!

I have been very distracted lately. Not in the "I wish I could play video games with my brother and friends" but in the "what am I going to specialize in?" and "what am I going to do now to better my chances at the best residencies for that specialty?" I borrowed a book from a classmate of mine that helps med students self-analyze and assess their own personalities in comparison to the personalities/job-descriptions of almost every specialty out there. It is an awesome book that made me excited and made me scared half to death! I have no idea what I want to do!

I am immediately drawn to surgery. Mostly, because it is very outcome oriented (fast results) and not a whole lot of long-term patient relationship stuff. I won't be caring for people from cradle to grave, which doesn't sound interesting enough, but rather I will be meeting new people all the time and I won't have to keep up with them over a long period of time. I read some specialty descriptions and most were not surprising, i.e. Orthopedic Surgery, ENT Surgical, and Plastic Surgery were all obviously attractive to me. The scariest one, the one that is keeping me up at night, is Neurosurgery.

I always joked that if I really didn't want to have a family, I would go into Neurosurgery. The frightening reality is that when I read the Neurosurgery description (about 8 pages of stuff) I felt like I was reading a letter sent just to me. Even now, I feel awkward writing that Neurosurgery might end up being my specialty. Neurosurgery is for geniuses ("It's not Rocket Science/Brain Surgery"). I am absolutely NOT a genius. I'm an average med student with a super goofy personality with an outrageous imagination that can take over from time to time. But there have been few times in my life where I felt like something (someone) was speaking to me from within my soul.

I can't get it out of my head now. There is a lot to be experienced before Neurosurgery becomes a valid option, i.e. neuroscience I, II, III, IV, but I have to make it a priority to find out if that particular specialty is right for me. It's a tough one to match into for residency so my preparation has to start NOW to give me any sort of a decent CV.

Besides that, I have finally reached a rest phase from tests! I only have an "easy" test on Monday and only two quizzes this week! I won't have another test until next Monday! Which sounds like it is not a break but a Friday without a test is going to make Thursday feel like Christmas Eve!

I have also been struggling with the osteopathic side of my medical education. I went into school with a ton of enthusiasm and faith in osteopathic theory and practices. The theory and principles are easy for me to love, the practices were proving difficult to LIKE. That all changed yesterday during a Founder's Day lecture (founder = AT Still, the founder of Osteopathy, founder of my school). Ever heard of tensegrity? Well, i hadn't either. But you want to know who has heard about tensegrity? Some of the boys at Harvard (they came up with it), top of their fields mechanical engineers, and everyone that sees the tensegrity example on the mall of Washington DC (needle tower).

To shorten the hour long lecture in a few sentences, tensegrity, applied to biology by an MD, PhD Pathophysiologist at Harvard Medical School, is the physics, biology, and chemistry behind some things that A.T. Still tried to describe around 100 years ago. Before yesterday, I was still under the impression that the only way to think about our skeleton is that it is a frame for muscles and helps us do things in response to gravity. Now, the spine and everything attached to it becomes a beautiful, intricate balance of tensile forces that essentially defies gravity rather than just simple adapting to it. One of the most important principles of osteopathy is that the human body is a unit that constantly works to maintain homeostasis or balance. Any part of that system that takes a beating, the whole unit will react, and adapt to the change. A key osteopathic practice is the treatment of somatic (body wall or musculoskeletal) dysfunction can directly prevent disease and dysfunction of the body's organs and tissues. It all seemed pretty hokey to think that realigning someone's back or working out the knots of muscles could help lower risks of cancer, diabetes and other diseases. But the Harvard crew has an extremely detailed and convincing hypothesis as to how our genes might even be activated to change things in the body simply by moving things around everywhere else in the body, i.e. realigning the spine. SO AMAZING!

To think that it would be an MD, PhD from Harvard that might be doing the scientific research that proves that D.O.'s receive training that every doctor needs to have to be most effective.

So longest post ever! Sorry. I'll be done now. Caffeine is pretty much metabolized and I'm getting tired!

Overwhelmed Yet?

It's go time! This week has been awesome and crazy. I could say that it was crazy awesome. The next two weeks will be a test of my mind, body, and spirit (Osteopathic Principle).

The SSSS (Secret Society of Study Stuff) has a new ally, Mr. Tim Tucker, who is the student resource guru and a heralded couselor to students who needed help learning how to study in med school. He and I met on Tuesday and then he attended our first SSSS meeting that evening. It was awesome to have him there. If we can stick with this and implement our ideas, we could have a model that can be applied to every medical school. It will simulaneously help people to learn more effectively and build a team mentality among the students, reinforcing the principle of collaboration that is becoming more essential in medicine.

We have a biochemistry test tomorrow morning for which the SSSS has supplied its first study packet! It is clear that we will be working out painful kinks in the process for a while. I was so stressed out as I studied for our Osteopathic Theory and Methods tests and for Biochem and tried to get a bunch of study material out to the rest of the class. It will be invaluable to get some structure implemented so I can effectively delagate the various tasks so my brain doesn't melt.

OTM is a strange part of the D.O. road. Compare everything to M.D. training and we are nice and equal. Then you add OTM and it gets a little annoying. It is scary to know that I can fail my boards or not graduate from medical school if I don't score well on the OTM stuff. The problem lies in the fact that we have yet to apply what we are learning. It is more hocus pocus than a real diagnostic tool at this early stage. I know that it will become more fun and applicable, but I'm just recording my feelings on this whole adventure as I go.

I am also increasingly grateful to have been elected. It will be an amazing experience to be involved in the student government aspects of school. I'm planning on staying involved every year if I can. I find that medical school is bringing out some surprising sides of myself. I get excited thinking about serving in a more political position as a physician. I love to be outspoken and get things moving with structure, protocol, curriculum, etc. Administrative aspects of medicine are very appealing these days. I also love the educational side of medicine, i.e. visualizing concepts, thinking of new ways to approach the same old material, figuring out better ways to present information, etc. I love brainstorming! Brainstorming is like my own personal sporting event. Consequently, I always win when I play by myself.

I have to start studying again. It is pretty relentless. I overheard some students talking about how often the think about how nice it would be to drop out. It occurred to me that the very elements that make med school so difficult are the very same that make me love it. I am constantly pushed and challenged. How many careers can give you that feeling of constant opportunity for progression? Not many. Yeah, it is overwhelming at times. Yes, certain classes feel like mosquitos rather than warm blankets of science. However, embracing the intensity can only make medical school awesome. I am still loving it, although it takes my sleepy time away.

Thanks for reading, folks! I leave you with a diagram I made to help remember eukaryotic DNA polymerases. Enjoy!

The People Have Spoken

The results are in! I will be the First Year Class Vice President! I'm super excited. It is the first time I have ever been voted into something. It is an awesome and slightly humbling experience. I am flattered that the majority of my classmates believe in me but humbled at what they expect from me. There isn't a ton of stuff I can mess up as the VP but I still feel responsible for representing our class in a respectable way. So, a new chapter starts in medical school. Now we can track a class officer in medical school (me).

Another awesome thing is that the Secret Society of Study Stuff (SSSS) is coming into form quite nicely. We have 14 contributing members, 2 peer-review consults, and a few people ready to contribute to only one subject of their choice. If you are foggy on the goal of the SSSS see my first email that I sent to my class.

KCOMers,

I have been kicking around an idea for how to make med school studying easier and more fun (original, I know). I want to try something, an experiment. With all of the different study guides, spread sheets, drawings, etc, that circulated before the last couple of tests, I had an epiphany. I know that there are those among you that share my love of making study guides, diagrams, and anything else that feels helpful. I want to join forces to make study materials for the rest of the class. You know that you are already going to make them yourselves, why not form an alliance with fellow study guide makers?

Advantages:

• We can have a small group, the Secret Society of Study Guides, to check each other's study stuff, offer suggestions, and refine the stuff before we send it out to the rest of the class
• We will offer the study materials as a packet a day or two before a test rather than several random emails the night before the test (although that may happen in addition to our packets, thus allowing for sudden bursts of creativity).
• Combining the different types of study materials. All of you study guide makers will have your own style and there will be a fan base for your particular style. Putting them all together gives all of us the ability to see things from new perspectives, ie I love to draw and I will most likely create monsters that represent the cells in Histology and Immunology so we can think of them as something goofy, hopefully making it easier to remember.
• I will most likely make a t-shirt to show our unity in the society. It will be like a gang. Like a gang of nerds with spreadsheet and hierarchy tattoos.

Disadvantages:

• You will most likely be more popular.
• You will have to study a little earlier than just the night before the test in order to make the "cut" for the packet.
• You will be helping others beat you on the tests and they will ask you what you got on the test expecting that you did really well but you actually bombed it and should have studied that one section better so that you could have not looked like a tool in front of the kid that beat you.
• You might start to think that run-on sentences are funny.

All in all, this is an experiment. I think it could be super cool and really helpful to the rest of the class. We are all in this together and we might as well help each other out, ya know?

SO... if you are interested in becoming a part of the society, please respond, offer suggestions, etc.

Have a lovely weekend.

I sent a few more emails after that but the tone of the emails has stayed the same. It has been a big hit round these parts. I'm having a ton of fun getting to know everyone. I feel like I am finally in a situation where my personality just fits and I can make a big impact for the better.

The academic side of school is picking up pace despite what I believed to be possible. Anatomy is getting heavier in my mind. We study anatomy by a regional model, meaning we study all the structures in specific regions, i.e. the thorax, the back, upper limbs, etc. It is a great way to learn but it amounts to a ton of information and a short time to learn it. I am pushing myself not to just learn it to get an "A" but to learn it to make me a better doctor. It's a very different feeling than from undergrad. Cramming just doesn't cut it, ethically.

Dissection is still the best time of the week, however, it does get overwhelming when we have four hours of stuff to dissect. I start getting antsy!

I just thought I would get those few updates out there in the blogosphere before I go to bed tonight. Keep leaving comments! It makes me feel like people actually read this stuff!