I currently drive a 1992 325i. I got it in my 2nd year of college and I instantly fell in love with the car. Even as a sophomore I was pretty sure that I wanted to be some type of surgeon so I decided to get some personalized plates that would mirror my interests. My personalized plate basically spelled out the word SCALPEL. So since college I have been rocking that license plate but since I got into medical school I have started to become increasingly embarrassed by my plates. The plates seemed so cool in college but now that I’m actually in a medical environment it just comes off to be as showy and ostentatious, even though that was not my intention at all. Every time one of my classmates sees my tags they always chuckle…and not the kind of chuckle that says, “Hey that’s cool”, but the kind of chuckle that says, “What a D-bag, who do you think you are?”. No technically I don’t care what others think, but I can’t really describe how much discomfort I was starting to feel about my tags. I just want to be normal, and I don’t think now that I need to advertise that I want to be a surgeon, especially not on a material thing like a car. So I have decided to switch them out for normal plates…I guess its part of growing up.

Funny story though, I was driving down a road past the hospital with my scalpel plates and I pulled up at the light beside a Toyota that was being driven by a guy in scrubs. As I took off when the light turned green the guy saw my tags, and when we stopped at the next light the guys was now wearing his surgical cap!!! He started to rev his engine, I guess desiring a surgeon drag race. To be honest he was probably a scrub tech or something like this but this just encouraged me even more to just get my tags changed, lol.

So yeah, I didn’t exactly know that the General Surgery Basic Science conference actually started at 6 a.m. and not 7 a.m., so I missed that. What did happen at 7 am. though was the Morbidity and Mortality (M&M) conference where surgeons from all the fields (vascular, CT, general, peds) present patients who they either killed or made worse by their care. When I walked in I could certainly see a stark difference in atmosphere between these guys and the ortho guys. These guys just looked sad and very tired; I’m not sure if I can jump to that conclusion but it was certainly palpable.

So I heard about some interesting cases but the thing that stuck out to me the most is that they seemed to still talk about a lot of internal medicine stuff like acid-base, fluid status, etc. But they also took them in and tried to fix what couldn’t be fixed with medicine. I really liked that about what I heard; it seemed like the General Surgeons could be a pretty good internist, and a great surgeon at the same time. So yeah, I think I’m interested in General Surgery again…I just need to do some research.

So technically I’m a little behind the game in this Ortho stuff because I have no medical school research experience. People say that you can count the research you did in college for residency, but the smart ones know that for a competitive residency you need to get yourself on a project in medical school quick. So since I went on a mission trip last summer instead of doing research (which I don’t regret at all), I realized I need to make up for my lack of research. So every Tuesday, the LLU Dept. of Orthopedic Surgery has a Basic Science Lab where they either do hands on stuff like drilling screws into expensive styrofoam bones or where they present their current research projects. Today was the day that they were presenting their current research projects and throwing out ideas for future research projects.

So I decided to attend this conference. I was pretty nervous because 1) I honestly don’t think I’m smart enough to get into Ortho 2) All the ortho attendings and residents were going to be there and I didn’t know them all that well 3) Some of my classmates who have been attending these conferences since last year will finally see that I”m gunning for ortho too. So I walked in and people were kind of just chilling around talking and eating food that a Orthopedic Supply company had brought in. I greeted the residency director that I had shadowed last week and just stood a around a little trying to find my place. I saw another 2nd year medical student sitting down so I starting chatting with her for a little. After that I chatted with some 3rd year medical students but I was generally a little too nervous to walk up to a resident or attending that I didn’t know. Then I guess I got lucky…one of the older attendings that specializes in Sports Injuries decided to sit right between me and the other 2nd year. So I got to talk with him a little about iPhones, and how bad AT&T’s reception was, etc.

The research presentations started and I sat back to listen to what an Orthopedic resident had to learn during their 5 years and throughout their career. Many of the projects I listened to basically dealt with them drilling pins/screws into expensive synthetic bones, applying serious pressure by some machine that can measure the tension on the screws and the bone, and then seeing how the various angles that they screwed the pins in would affect the strength of their joint. I know that I am certainly oversimplifying what I saw, but that is the general gist I got. As I listened to the presentations I couldn’t help but feel like I was back in my college General Physics class. Orthopedic surgery deals with alot of physics like angles, tension, work load, etc. I didn’t mind physics in college, but I really hated it on the MCAT and some of that disdain started to creep up again when I was listening to the projects. So I heard all the projects, smoozed a little after that with some residents and attendings, and went home.

I was actually pretty happy that I went to this basic science meeting because it helped me to realize that Orthopedic Surgery is probably not the best fit for me. Yes the two surgeries that I saw last week were the coolest thing ever, but at this basic science conference I realized that the bones and joints actually don’t interest me very much at all. And I was trying to force myself, but I just couldn’t get excited about all the angles, and joint reconstructions, and tensions, etc. that made my classmates that are interested in ortho giddy. I had been so scared I wouldn’t be smart enough to get into ortho that I overlooked the fact that I could actually not like it very much at all. Also, I don’t feel like the field fits my personality much; my personality is such that I love to be really busy doing a variety of things at the same time. Orthopedic Surgeons really stick to their game and don’t seem to venture into the abdomen much; they really are masters of the skeleton which is good, but I like the other areas of the body too. Some say ER is good for me, but I definitely love the OR more than that, and it really seems to me that General Surgery gives me that variety, especially if I’m in a rural area or on the mission field. What I did is actually advised by a lot of medical students; if you are really interested in a certain specialty, you should make it a point to read a couple of journals and research articles in your field. If you find that subject matter dry and boring then that should send up a red flag, because as a resident you will have to be reading these journals to keep up with the rapidly changing field and this continues into your future practice also. So yeah, the ortho residents were great, and the attendings were super nice and supportive but I realized that I couldn’t get passionate about orthopedic surgery and bones and tendons, which is alright, because everyone can’t be passionate about the same specialty.

So when I got home I decided to look online at LLU General Surgery department to see when they were having their Basic Science Conference. Their conference starts at 7 a.m. tomorrow morning so I am going to sit in on that and see how it goes.

So I think that I may have the Orthopedic surgery bug. I’m not sure where it came from but I just woke up one morning sayin, “Maybe I should do ortho.” Now this really actually started to cause me a lot of distress because I tend to have a one track mind, so when I decide to pursue something I really like to see it to fruition. This change to ortho made me nervous. I had to know if ortho was for me before I decided to change my desired specialty track. So I made an appointment to see the Orthopedic Surgery Residency Director here at LLU. The guy was really nice and down to earth. He answered a lot of my questions and generally what I came back with was:

*Orthopedic surgery is a very competitive field to get into (I knew that already)
* You need to get in the 230s on Step 1 to make the cut off for most residency programs and you need to be in the 240s on Step 1 to be really competitive
*You need to have research experience, preferably in orthopedic surgery
*You need to be an absolute superstar for the 4 weeks you have for your Orthopedic Surgery elective
*You need to be in the top of your class

And even after all the information above it is still possible that you may not match simply because there are many top people in medical school classes around the world gunning for Ortho. So yeah, I was a little taken back with how much more competitive Ortho was than General Surgery but I just couldn’t shake the desire to go into the field, so I asked the program director whether I could shadow him to see the types of procedures that he actually did. He was actually performing a hand surgery today, so I woke up early and went in to see him. I actually ended up seeing both a knee replacement and a median nerve repair, both of which were extremely cool. Yes, the resident ortho doctors were quite tall like me and many of them look like they could bench press me, but not all of those residents fit the stereotype. Some were short and skinny, but one thing I must say is that all of them were super nice and all of them seemed super happy with what they were doing. So yeah, so far Ortho seems like the residency to beat on my list because these surgeries are really exciting and they seem to improve the quality of life of your patients 10 fold. The only thing I’m worried about a little is how applicable orthopedic surgery would be to rural missionary work. Certainly an orthopedist is needed on the mission field, but their field requires alot of cool power tools and I’m not sure how that would work out in a rural environment. I don’t know, we’ll see.

I got my first choice, and my wife and I have the same schedule so everything is pretty nice right now. Now I just need to pass this stupid year to get to the rotations.

So I hit a major milestone today. I finished reading First Aid for Step 1 2008 today. I will probably need to re-read it 2 more times before the actual test date, but for now I’m happy where I am. Now I plan to go through as many USMLE World question as i can, and annotate into First Aid whatever info isn’t in there. Its hard to do this when you haven’t actual read the whole book, so hopefully annotating should be easier. We’ll see how everything goes.

I’m on spring break, and I’m about to get my wisdom teeth taken out. They are putting me under which now that I think of it, I’m kind of scared of.

I almost forgot today was match day since we had tests. At LLU the students stick their face on the map where they matched. Check out the pics to see where folks went.

Why did got give us kidneys? Medical school would be 1000x easier if we had no kidneys and if I didn’t have to learn about renal pathophysiology. I know its important, but it makes my brain work after studying since 6 a.m. this morning. Our renal pathophys test is tomorrow at 1 p.m., so keep us in your prayers. Apparently this is the test that usually most of the class fails.

I truly realized the importance of good counsel this week. Because of the good counsel I received from various 3rd years, my wife and I have made several changes to how we plan on scheduling our 3rd year rotations and when to take Step 1.

My medical school has something called the National Auxillary, which is basically an organization that was formed many decades ago by the wives of the medical students and the wives of the doctors at Loma Linda. Of course, in this current age, there are just as many husbands of medical students, but the group is still going strong. Well, they have monthly get togethers for the married medical students at the houses of various professors and physicians, and at one of these meetings last week we got good counsel from a 3rd year and his wife. He told us that my wife and I should strongly consider taking the hard, grueling rotations at the same time (like medicine and surgery). They were telling us that during these rotations we may often “live” at the hospital, and if my wife is on an easy rotation like Psychiatry, and I am on a tough rotation like Surgery we really may barely see each other for up to 6 weeks at a time. Then it will repeat itself, because then soon she would be on Surgery and I would be on a easy rotation like Family Medicine. They told us that it was much better to do the easy and hard rotations at the same time so when we had an easy one like Psychiatry, we could enjoy that quasi-vacation time together rather than alone. My wife and I hadn’t really even considered this until they told us. We were simply looking at which rotation we really want to shine in, and then trying to put that rotation in a good spot so that we would be competent enough to get good evals from the residents and attendings. After that 3rd year’s good counsel, we decided to rank our rotations tracks the same way. My wife is still very interested in OB/GYN and I am still very interested in Surgery, so we still needed to place these rotations in a place where we would have enough other rotations under our belt to still do well, but not so late in the year that we would run out of steam. So the rotation order below is what we chose (click on the thumbnail to enlarge it):

Technically the tracks we ranked 3rd and 4th would be ideal but I’m a little concerned that I would be too tired by that time to give 120% for that rotations. And my wife is confident that the position of OB/GYN in the tracks ranked 1st and 2nd would be late enough for her to have enough knowledge under her belt. Honestly, doing your Medicine rotation first probably prepares you for all the other rotations so it should be a good thing. But in end, we are still just ranking our preference and we don’t know exactly whether we will get our first choice or not, but at lesat our ranks 1-4 would all benefit my wife and I. I think we will find out which track that we were assigned in a month or two. The only thing that I am concerned about with our first and second choice is that we have heard that EVERYONE who wants to do surgery does it right after Christmas break. This means that I will be competing with alot of other students, many of which may be gunners. I really don’t have the personality to return gunnerish tactics done to me, so I may get the short end of the stick. I’m still very competitive though, so I hope that I will be able to shine enough to get noticed.

On Wednesday, the 3rd years had a little meeting to give us their advice on how to handle all of our final exams and subject boards coming up and also how they prepared for Step 1. They gave us so much advice that it would be too much to write it out, but one thing that each one stressed was that they wished they had taken their test earlier. They advised that we take the test no later than 2 weeks after finals and that even 2 weeks was pushing it. Alot of them recounted how after they had taken Step 1, they realized that that extra week of study didn’t really make a difference in how they would have done on that test. With that in mind, I moved my test day up from Friday, June 19, 2009 to Monday, June 15 2009. This will almost give me 2 weeks of vacation time before 3rd year begins on June 29. So yeah, I’m really grateful for the good counsel I received this week.

So the Dean of Academic Affairs came in to talk to us yesterday about getting ready for 3rd year. As part of that speech, they told us about an online section on the school’s website where we had to rank our choices for our 3rd year rotations. To be honest it felt very good to even be sitting in a meeting about 3rd year rotations. The fact that the meeting was even taking place meant that this hell of a 2nd year would soon be over. As exciting as chosing my 3rd year rotations is, it is quite hard also to get the right order down. In theory, you don’t want to do a rotation in the field that you think you want to go into until you have gained enough basic skills from other core rotations; since I still think that I want to go into General Surgery, it would make sense for me to get my core skills down first in Internal Medicine, Pediatrics, Family Medicine, OB-GYN, etc. So below are the 8 different tracks that I have to rank in order from 1 to 8, with one being my most desired track (click the picture to see the whole thing):

So there you have it. I’ve talked to a good amount of 3rd years that I trust and I am leaning towards a couple of tracks. I’ll blog about my choices soon.

This morning my wife and I scheduled quite possibly the most important test we will ever take…STEP 1.The testing slot is allotted for 8 hours but I here that folks usually finish within 6 hours. Now that I have a date I think that I’m going put a countdown on my blog. Anyways, back to studyng.

I tell you, I’m doing a terrible job this year of blogging. Trust me that its constantly on my mind, but this year is just alot busier, and there is nothing I can do. We just finished tests today, and although we only had 4 tests (Pathophysiology, Pathology, Microbiology, and Pharmacology) it felt just as bad as when we used to have 7 tests in one week. It didn’t help that I just got a new gadget either:

I tell you, I truly have a problem. When I get a new gadget, or I get on some new self made project (like teaching myself to program, or researching an airspray to clean computers, lol) I become all encompassed by it. I can honestly think of nothing else but accomplishing that task. I guess this quality is great if focused on the right object at the right time, but it always seems to pop up at the bad times like during test week. So yeah, I would study for 20 minutes, then spend about 40 minutes on the computer, downloading stuff to make my new Pocket Pc faster…better than it was before, lol. Thankfully, the Lord blessed me to be able to pick stuff up quick, so I didn’t feel too bad when I took my tests. But only the grades will tell.

Latino Beat Down

On a more sad note, something pretty terrible happened to some Black first year medical student friends of mine. 2 weeks ago, on a Saturday night they were coming out of a restaurant after celebrating a friend’s birthday. I guess it was about midnight when they were walking to their car in the parking lot; all of a sudden a whole grip of Latino gang members jumped them. Two of them got beat until they were unconscious, and the other got his face messed up pretty bad. After the gang members did their dirty work, they left. This incident really opened my eyes up to the truth and reality of Southern California. I guess I had always heard how there was some feud between the black gangs and the Latino gangs, but I thought that was only in LA. I didn’t think it would make its way up to the quiet, quaint, well-to-do, predominantly white area of Redlands, CA. My friend’s experience initially caused me to look at any Latino male suspiciously, sizing them up, and making sure I wasn’t going to be the next victim. But I stopped myself very quickly from that line of thinking; by doing that I was being no different than those White women that would clutch their purse a little more closely when they got on the elevator with me. Because of a few bad black people out there, that woman felt like she had the right to fear me, and I didn’t want to get into the same mindset because of a few bad Latinos. I tell you…this world is so complicated and so dangerous.

Being Content

The more and more that I progress through medical school, the more I realize how hard it is to be content. You are happy with the 85% that you got on a test, right up until you learn that your study buddy got a 96%. As a medical student it is so hard to just be happy with how you have done. And you know what, it is slightly understandable; most medical students have been used to being at the top of their class since Kindergarten. Getting an A on a test was the norm…but it still brought lots of satisfaction. Then you come to medical school, and you study harder than you have ever studied in your life, and you can’t pull any higher than a C or a B on most of your tests. But your study buddy somehow seems to be able to eek out an A on their test consistently, even though you guys are studying the same thing. It happens with ranking too; right now I’m ranked somewhere in the top 20% of my class, but you know what I say in my head when I look at my ranking? I say, “I can’t believe X% of my class is smarter than me,…I have to work harder.” Isn’t that ridiculous? Rather than being content with the fact that X% of people are doing worse than me, I’m looking at those ahead of me, grabbing for their coat tails. I believe that it is imperative to overcome your overall lack of contentment when you start medical school, because there will ALWAYS be someone better or smarter than you. I’ve been working really hard at this and it has honestly made me happier. When I get my test scores back and X% of the class did better than me, I shrug my shoulders and start surfing the net or going on Facebook. If you dwell on the subject you will drive yourself crazy and you will probably end up doing more poorly in school because you are adding undue pressure on yourself to beat the man at the top.

So yeah, to be honest there really isn’t much exciting stuff to talk about right now as you will soon find out when/if you decide to come to medical school. By the time you get to 2nd year, especially this point in 2nd year you are just tired of the montomy and routine of it all. Your day mainly consists of studying your butt off, and your nights consist of Step 1 prep. I could blog about that but I’m sure my readership would drop like 20%. So yeah, that is what is going on these days.

Wells the folks at the USMLE now have $495 of my money, so Step 1 is paid for…now I just have to pass the thing. I must admit that this test tends to be on my mind a lot. You learn so much during your second year, and you have to try your best now to not let the newly learned information slip away as the year goes by, because it “Could be on Step 1”. It seems like my teachers make that previous statement a whole lot; the test really isn’t long enough to include everything that they say will be on there, so I don’t pay them much mind. I focus mainly on UsmleWorld and its 2000+ questions and First Aid. I feel that right now I am truly doing my best to prepare, and I really hope that it pays off in the end. I’m not trying to kill the thing, but a score in the 230s would make my day.

So enough with Step 1 talk. Right now in class we are learning about pulmonary pathophysiology, renal and pulmonary pathology, cardiovascular preventative medicine, and antibiotics. I’m the most excited about learning the antibiotics because its really starting to make me feell ike a doctor. Know what to give a patient if they have TB, or community acquired pneumonia, or T. gondii is pretty cool. In microbiology we have also been learning about parasites and I must say that the helminths (worms) are THE MOST DISGUSTING THINGS ON THIS EARTH. The concept of a worm larva boring into your skin as you are walking barefoot, traveling to your lung, causing you to cough, and then getting coughed up and swallowed so it can go to your small intestine and grow into a tangible worm is simply evil. My classmate who did a lot of missionary work in Peru was talking about how many of the rural people had worms, and it was so common there that people would cough some times and spit out a whole glob of worms. EEEWWWWWWWWWWW!!! I tell you, I love medicine but somethings still really gross me out. I think I would probably take draining an anal abscess over dealing with helminths.

I got a really pleasant surprise this past week that I wanted to share with you. I don’t know if you remember my experiences on my mission trip this past summer in Zambia, Africa but I helped deliver a baby and the mother named him after me. Here is a picture of him when he was first delivered:

Well, this past week, his father e-mailed me with some pictures of their son (Jaysson Mwale) and I was so cool to see how much he had grown. It is kind of wierd having a namesake that is so far away but it is kind of cool too. Here is an updated picture of him:

You know, there are just so many joys to doing missionary work, and having a child named after you is one of them. I have to admit that my fire for service and missionary work has sometimes dwindled due to the stress of medical school, but seeing these pictures rekindles it every time. I must also say that being at Loma Linda and going to our Missions Interest Group meetings has really helped to rekindle that fire too. At these meetings I get to listen to missionary doctors who have come home for a sort period of time and their stories are so amazing. From hearing their stories I’ve realized that a missionary hospital can’t really survive without support from your physician friends back home, whether that be monetary or medical supplies. I’ve also learned that you can make a much bigger impact if you assimilate your culture with theirs, because people will truly get to know Christ better in their cultural context than in mine. I honestly can’t wait to finally go over and serve, but I have to complete this medical school journey for now.

P.S.- I know some people may read the paragraph above and think that I am so selfless, but just like most medical students I constantly think about how good life would be to get into a top residency like neurosurgery or dermatology, make a ton of money, live in some exclusive million dollar neighborhood where we are the only black couple, lol, etc., etc. I certainly think about those things and to those who are smart enough and lucky enough do live those types of lives, I am at times envious. But every time I think like that I have to beat those thoughts down, because for me and to all those that Christ has called (which I believe is everyone, lol), the Bible calls us to a life of service to those who don’t have. Not just patching up poor Mexican and poor Blacks up in the ER, but getting into their lives on a more personal level where they can see the Jesus inside you. So yeah, don’t think that I’m all that selfless; I constantly have to remind myself of what Christ would prefer me to do, and head that way, or else I wold certainly head the wrong way.

It was really hard to get back into my groove after 2 weeks of Christmas vacation. It didn’t help that I bought like 5 Blu-Ray movies and started watching them this week. I bought Transformers, The Incredible Hulk, Patriot Games, and The Sum of all Fears. I was content with my slow transition back into school until the Dean of Academic Affairs (who teaches us Pathophysiology) started talking to us about Step 1. He scared me enough that I started to get on the ball by Wednesday. Its so crazy to think that I’ll be taking that crazy test in about 6 months. There is so much more to learn and study and really so little time.

I had a really interesting experience this week. In the picture you see a $100,000 mannequin. He is one of the many mannequins that LLU has in their simulation lab. In my pharmacology lab this week, they broke us into small groups of four, took my group in a room and read us our case. In my case the patient/mannequin was a 58 year old man presenting with crushing mid-sternal chest pain that woke him out of his sleep. Now this $100,000 mannequin simulates a lot of the real life presentations of a patient; if you palpated his heart you would know it was fast, you could also hear lung sounds and see all of his vital signs on the monitor. He even reponds if we shock him with a defibrillator. So yeah our ptaient had a BP of 178/110, and a heart rate of like 210 bpm. The doctor there basically told us to save the patient using what we knew already in terms of drugs and interentions. It is really amazing how hard it is to think straight when the pressure is on like that. We had learned the drugs to give to someone with supraventricular tachycardia (what the patient had after we looked at his ECG) in class, but it was so hard to actually bring that stuff up in our minds and apply it to the situation. Eventually we managed to save the patient and stabilize his vitals but the lab made me realize how crazy the actual hospital experience could be. I could just imagine being a 3rd year medical student with a patient who presented like our pharm lab case, and being a little unsure of myself as to which drug to push and which procedure to do. I could imagine a nurse or resident pushing me out of the way and cussing me out as they saved the day. I know that all it takes is experience, but its scarey to think that in just 7 months, I won’t be dealing with expensive mannequins anymore but real people, with families and expectations. Well I’m glad I’m getting some practice in now.

Besides that, nothing else interesting happened this week. All of our classes right now are dealing with the respiratory system so I’m having to remember the respiratory physiology I learned last year. This Sabbath I’ll be singing on the praise team…I really like singing, and I hope that small joys like that don’t get pushed aside as I continue my  medical training.

In all honesty, this test week truly sucked. They made us take a crazy amount of tests in 1 week, while last year they gave the 2nd years 2 weeks to take these tests. You know, I can truly see how folks can get jaded in medical school. Yes, doctors have the amazing opportunity to touch people on such deep levels. But the process of becoming one can almost sometimes zap that altruism out of you. This week I slept about 15 hours (truly), trying to make sure that I remembered the minutia that was required of me. Medical school at times can be so physically and psychologically demanding that you honestly forget why you started in the first place. To be honest, I asked myself this a couple of times this week…and you know what, I think its important to ask yourself periodically whether medicine is what you want to do. Yes I certainly have my gripes about the process that it takes to become a doctor, but each time that I asked myself why I started medical school, I remembered that many good things about the field. I remembered the little kids I got to help in the refugee camps in Zambia and the experiences I had last summer on my mission trip; I remembered these events and reminded myself that medical school truly is a means to an end.

By the time that I become a physician, I will probably only use about 20% of what I actually learned in medical school, but that isn’t the point. The point, is that if I DON’T get through medical school, I will use about 0% of what I have learned. This week more than ever I realized that medical school can truly be devoid of joy and fun, but there is always a light at the end of the tunnel. For me that light is 3rd year; I know it will have its own share of suckiness, but if you don’t have anything to look forward to you truly will go crazy.

Anyway, I’m getting ready to go home, so I’ll probably share more updates when our grades are posted.

Well I’m on the grind right now and that is all I can really say about medical school. In 2 weeks Christmas break starts but before I can enjoy any of it I have to go through a test week which also includes 2 subject board exams (Neuroscience and Psychopathology). I technically have 1 more week to get ready for it and there just aren’t enough hours. But it doesn’t make sense to complain about that anymore; right now I just have to put my head down and come up for air when it is done.

LIke my Chiropractic Medicine experience a couple of weeks ago, my school also required me to go to an Accupuncture clinic. I was not impressed at all. Their theories for why things work (i.e.- increased kidney function makes your hair grow longer) has no physiological basis, and they are fine with it. I don’t doubt that when they stick a couple of pins in you along their Meridian lines that it makes you feel better. But their are countless examples in medicine were people are “made better” from the placebo effect. Our bodies are amazing machines and from what I was shown, accupuncture only affects the internal placebo system. But you know what, everyone wants a piece of the healthcare pie, and people are paying these “doctors” to toture them, so what can I say. I don’t think I will be sending my patients to them.

I’m so glad its finally here…and unfortunately, the biggest reason for my joy is that I will be able to study more and possibly catch up. Such is the life of a 2nd year medical student.

You know, last night it really hit me that I will be taking Step 1 very very soon. I started to get a little anxious just thinking about it, and of course I had to look into the matter more to calm my anxiety. Here is what my end of the year schedule looks like:

May 25-29: In House Final Exams
June 1-5: NBME Subject Exams and Comprehensive Basic Science Exam (CBSE)
June 8-26: Study for Step 1 and take whatever little vacation is left
June 29: Start 3rd year

As you can see that period of time will be a whirlwind. What is most scary to me is that I spent almost all summer studying for the MCAT, and for Step 1, they only give us 3 weeks, or really 1.5 weeks if you want to have any type of vacation before you start 3rd year. I guess I realize the logic behind this; its been said, and I think studies have shown that the closer you take Step 1 to the end of your 2nd year (when everything is fresh) the better you do. They say that  you normally don’t increase your chances of scoring higher by studying for 3 weeks. So the biggest take home message from all of this is that by the time that finals come around, I should be READY to take Step 1. This means that I really need to be paying attention in class and reading the necessary Step 1 review books to get ready.

Personally, I’ve been getting ready by basing most of my study around First Aid for Step 1. I did this by taking the book to Kinkos so they could unbind it and 3-hole punch it; so now my First Aid book looks like this:

Doing this allows me to add important graphs and pages to the book. What I’ve been trying to do throughout the year (which hasn’t been so successful due to lack of time) is go through the questions in USMLE World Qbank in tutor mode. For every question I do I see their explanations, and if there is a concept or fact that I don’t know, and that is not in First Aid, then I add a sheet to my First Aid book and write it in. I’ve been kind of slacking on this method up until know, but I think I’m really going to pick it up, because I’m not the kind of person that remembers what he was just tested on…even if I got an A on the test, so going through this stuff often is integral for me.

I really want to use at least 1 week of the alloted 3 weeks for vacation, so I will probably take Step 1 between June 15 and June 19. Until then, I’m going to really dig in and try to do well this year.

Sunday was supposed to be the day that I finally caught up. What a stupid goal. I don’t think that I’ll be caught up until I take Step 1. Thanksgiving break starts on Wednesday, so I’ll really have to use that time to catch up.

This week so far has been a painful but helpful reminder of my title for this post. This week I had my Integrative OSCE and my Complete Physicial Exam. The Integrative OSCE is where they have a standardized patient (an actor) who you have to see. They give you a little sheet with their 1) Name 2) Chief Complaint and a clip board with a blank sheet of paper. You are expected to walk in, make the patient feel comfortable, take a good history, and do a focused physical exam all within 20 minutes. Its actually a pretty cool concept. After you are done, you can evaluate your video, and then a bunch of doctors sit with you (and some other classmates) and they go through the basic science concepts that we should have been thinking about as we went through our exam.

When I walked into my patient’s room the lights were off, and the room was pretty dim. My patient was lying on the examination table with her hands over her eyes, not really saying a word. I greeted her and asked her how she was feeling. She told me that she felt terrible. After talking with her I discovered that she had begun to have a terrible frontal headache about 3 day sago. Nothing made it better, but any type of light made it worse. At this point I wasn’t quite sure what she had, but I kept asking questions. When she said that moving her head or neck made it worse lights started to go off in my head pointing to meningitis. After the history was done I proceeded to do the focused neuro exam. I started off with listening to her heart (but not her lungs, which I should have done too). When I started testing each cranial  nerve, skipping a couple of them now that I think of it. I couldn’t really test cranial nerve 11 because it really hurt her to bend her neck side to side, however I definitely forgot to test it by asking her to raise her shoulders. I tried to do a eye exam with the ophthalmoscope, but the light hurt her eyes too much, so I backed off. I tested her reflexes and they were about +1 or +2 (she was a good actor). I tested her gait and she could barely walk without feeling like she would fall. When I finished the exam, she asked me what I thought was wrong with her. I told her I’m not quite sure, but I think she may have meningitis. I told her that a couple of tests, including a possible lumbar puncture would have to be done. I thanked her and then I walked out cause my 20 minutes were up.

As myself, about 6 classmates, and about 3 doctors began our meeting after our exams I started to see how far I was from being any kind of good doctor. First, I realized that I have a serious 1 track mind. When I was writing up my SOAP note after the exam, it was very hard for me to think of what else she could have except meningitis. Now granted, she probably did have meningitis, but the doctors made me realize that she could have had encephalitis, a neck tumor, non-communicating hydrocephalus, and a host of other things. Now I know that I’m still a 2nd year med student, and that my differential diagnosis skills are pretty low because I just don’t know about many diseases yet, but I really felt almost incapable of thinking of other diseases once I had decided on meningitis during my examination. Now my 1 track mind may be great if I get the disease right every time, but what about when I don’t? Anyways, it better to realize my problem now, and work at it.

I also had my Complete Physical Exam this week. This is where me and a partner (another med student) do a complete physical exam on each other within 45 minutes (meaning head to toe except for major orifices). My partner and I had practiced a couple of times and we felt pretty confident about the exam. On the day of the exam I decided to go first since he went first last year. So the doctor evaluating us walks in and I begin my exam. The first part is the vital signs where I am supposed to take his blood pressure. I’ve done this a bunch of times so I take the BP cuff, put it on his arm, find his brachial pulse, and then I begin pumping up the cuff. But every time I started to pump it up, the air would quickly rush out of the cuff. I thought I had forgot to close the hose on the pump, so I closed it, and tried again. Still the air rushed out. I thought that maybe I had turned the knob on the hose to the left instead of to the right, so I turned it to the right this time and started to pump it up. Still the air rushed out. By now I’m getting really flustered. This is the first part of the exam and I’m obviously doing something very wrong. Eventually the doctor gets up and tries it and we realize that the BP cuff has a hole in it. So we changed cuffs and I continued with the exam, however this incident really made me anxious and my confidence started to leave me quickly. Because of my anxiety, I started making stupid mistakes which I corrected after about 10 seconds each time, but they still looked bad. For instance, when I was supposed to be taking his pulse by palpating his radial artery, I started palpating his ulnar artery instead. Or when i was dong his breast exam (yes guys need breast exams too), I did it only in the 4 corners of the breast instead of the whole breast. So yeah, overall the exam was going pretty badly early on, so the doctor stopped me, asked me to speak with her outside the room, and told me that I would need to repeat it. I was pretty devastated at the time; I’ve never had to repeat anything academic in my life. And the worst part is that I knew my stuff more than my partner and he did fine. I felt terrible; I felt like I would never be a good clinician. After about 6 hours I cooled down, and prayed, and the Lord told me something that is obvious but that I really need to hear:

“Doctors are TRAINED not BORN”

The truth of the matter is that yes, my clinical skills are bad. I realized that I had just been going through the motions as I practiced and I hadn’t actually practiced to see if I could “really” feel the popliteal pulse or whether I could really call out the 3 visible waves on the JVP. These are things that I was very weak on, but they are things that I can practice, which is the great thing about medicine. If you aren’t good, you can always get better. I’m sure there is some type of spiritual lesson I can tie into this but I’m very tired and I need to go to bed.

I’m kind of scared. For the past week I have been feeling short of breath (dypsnea). Now it could be a case of med student hypochondriasis, but there may be something to this. I have to do a complete physical exam with my classmate on Monday, and when we were practicing for it he noticed that I had pitting edema. I’m trying to tell myself that this is all in my head since we ARE learning about heart failure right in class but I can’t shake the feeling that I may have heart failure or hypertrophic cardiomyopathy. I really hope that I’m just being a hypochondriac right now. I’ll let the doctor be the judge of that.

I’m making this post from my iPhone currently in class. I’ll be doing this more to keep my post current.

Test Week

You know, you would think that I was talking about finals week; but honestly this test week that we had was harder than my finals week last year. The sheer amount of information was amazing. Here is what it looked like:

As usual, I’ll give you my breakdown:

Neuroscience: I truly do think that we have the best neuroscience teacher in America. When he speaks, you just understand. Regardless of this though the test required us to learn alot of new stuff. We learned about most of the movement disorders (Parkinson’s, Huntington’s, etc.), many of the dystrophies (myotonic, Beckers, Duchenne’s, etc.), neuropathies, etc.

Pharmacology: I knew my drugs. We had to know about 74 drugs involved with treating heart failure, angina, myocardial infarctions, dypsnea, cardiogenic shock, etc. Every drug that they had on our list I read about in the class notes and I knew them well. Unfortunately the teacher decided to take a majority of the questions from the assigned reading in the book (Katzung). So needless to say, this test was amazingly tough. I was so exasperated when I was done but its better to know why you didn’t do well. I knew that I had made the mistake of getting too busy and not reading the book. So next time I’ll do better.

Pathophysiology: The teacher for this class takes about 3 hours to write each question and you can tell because they are very detailed. Studying for this test took alot of time but it was worth it in the end. We basically had to know all the physiology behind heart failure, atherosclerosis, cardiomyopathies, etc. To pass this test you really needed to know all the ways the Frank-Starling curve and the pressure volume loop could change depending on the type of heart condition. The image below can widen significantly when a patient has chronic mitral regurgitation, or it can get tall and skinny when a person has aortic stenosis.
You also needed to know the different EKG leads that would pick up an MI involving the different coronary arteries, and a plethora more of info invovling the physiology of the heart. I’m not sure how I did yet, but I felt pretty good about the test. Alot of people said it was terribly rough so that scares me because I thought it was pretty fair, especially compared to how bad I had felt about the Pharm test the previous day.

Psychopathology: This test was an absolute beast. We had actually started to get lectures in this class at the beginning of the school year, but during our first test cycle we didn’t have any tests on it. Instead they saved all of their questions for this test. I think I got about 3 hours of sleep studying for this thing, but it turned out pretty well. We basically learned alot of the neurochemical physiology behind many of the psychiatric diseases like schizophrenia, obcessive-complusive disorder, etc. We also learned about the personality disorders (I think I have some Cluster C traits), and many other things.

Biochemistry: This class isn’t taught very well. I did much better than I felt after I took the test but I don’t feel like I’ll be very prepared for Step 1. I guess that its honestly hard to integrate biochemistry into a systems curriculum because many of the biochemical disease don’t fit neatly into a system. On this test we learned about the glycogen storage diseases, the muccopolysaccharidoses, trinucleotide repeats, etc.

Pathology: I really love pathology. But this class required a terrible amount of studying to get ready for, especially since it was our last test of the week and I was just ready to be done with it. On this test we had to know the pathology behind many diseases like temporal arteritis, sickle cell anemia, rheumatic fever, hypertrophic cardiomyopathy, etc., etc. etc. Basically if it involved the heart or the blood or the heart vessels we had to know all the diseases involved. Many people in my class read Rapid Review Pathology by Goljan to get ready for the test along with the class notes. I much more prefer to read the main textbook because when they are writing Step 1 questions, they aren’t looking in Rapid Review, but in the main text books like Robbins or Rubins. It takes twice as long but I truly feel like I have a deeper understanding.

We haven’t received all of our grades yet but so far I’ve passed everything which is truly a miracle.

A Day with the Chiropractor

Like most medical schools, Loma Linda University requires its medical students to spend time with health care providers in alternative medicine like chiropracty and accupuncture. About 3 weeks ago it was my groups turn to go to the Southern California University of Health Sciences. Of course I had a ton of stuff to study, and of course I wasn’t all that intereseted in learning how these crooks did their business but because many of my patients would be using their care in addition to mine, it was important for us to learn about them. So when I got to the school my view of them as crooks quickly disappated. These guys at this school were on point. Everything they practiced was backed up by research and hard science. They actually reminded me more of physcial therapists than chiropracters. They were very honest about what they could and could not treat. They were open in expressing how challenging it is for them because there were so many bad apples in their practice. To be honest I would definitely go to these guys for adjustments but the problem I have is that many of my patients won’t be going to chiropracters who were trained in such an evidence based practice school. My patients will be going to the folks that say they can cure their heart failure or their diabetes by a little back adjustment. Overall it was a great experience.

Drawing Blood

Like I said when I was talking about my Pathology test…we are learning all about the pathology of the heart, blood vessels, and the blood. So as part of that they had us choose a partner, draw blood on each other, do a blood smear, and look at our cells under the microscope. Of course the drawing of blood was the scariest part. If you were lucky enough to have a former nurse as your partner then you got a nice clean stick and not much pain. Unfortunately me and my wife were partners and neither of us had stuck anyone before. So yeah, terrible pain pretty much sums up what both of us felt as I stuck her and she stuck me but in the end some blood got into the test tube and we were able to do a nice smear.

So that pretty much sums up all the interesting stuff that has happened so far. I’ll try to blog alot more regularly.

I went to sleep at 10:10 last night, and this morning I woke up at 1 a.m. I’m a little less incoherent than I was last night. Psychopath is turning out to be alot more work than I thought it would be. The problem is that its not all that scientific, yet it is. So we have to learn the proposed science behind all of these psychiatric disorders which is much harder than learning a biochemical pathway. Anyways, just giving an update. Once tests are over I will give an update of everything that has happened since I last really wrote a post. Pray for me.

I am so sick and freaking tired of school right now. This week is our test week and I honestly think its criminal how much information they want us to remember for the tests. Studying this much stuff just isn’t healthy. The only thing keeping me from giving up and going home is that I absolutely refuse to do this crap again; so I’ll stick it out, try to pass, and move on. I’ll try to get some sleep when I graduate in 2011.

I can’t believe that it has taken so long to post again on this blog. I’ll try to hit everything that has happened.

Vajay jay Time continued

So as I mentioned in my last post, this year is wrought with countless labs. I guess they don’t want us to study all day and actually master the information so we have to go to these labs. Some are pretty useful though, like the lab on pelvic exams. I was pretty uneasy about it to be honest. I mean I had always figured that I would have to do this as a medical student and doctor but its different when thought has to become action. As silly as it sounds I was asking myself whether I was being faithful to my wife since I hadn’t “seen” another woman since I got married. Lol, if I applied that feeling then no doctor has ever been faithful to their spouse. Anyways, the lab started off with a focused gynecological interview in an examination room that looks like a normal hospital room, but that has microphones and cameras hanging from the ceiling. They have me a sheet of paper, a clipboard, the patients name, and her chief complaint and told me to go in there and figure out what was wrong with her just from the interview. Her chief complaint was dryness and lots of itching in her vaginal area. Now most women (and some knowledgeable men) probably already could have figured out what was wrong with her just from the chief complaint but to be honest I’m not very knowledgeable about vaginas gone wrong so I had no idea. I walked in and interviewed her (in the 10 minutes allotted) all the while trying to write all the important stuff down while figuring out good questions to ask her. After I walked out of the room, I started to kick myself while thinking of questions I should have asked her. The nurse practitioner who runs the lab took me into a room which had the video recording of my interview and gave me pointers. She also showed me the written evaluation that the lady I interviewed wrote about me. Here’s the written comment that my first “patient” made:

Yes I was pressed enough to take a picture, lol. It really made me feel good to read this. More important to me than being the at top of my class is that my patients actually feel comfortable with me. Its something that I always saw with my mom’s patients. They would come to her and not only tell her their ailments but also about their son’s baseball game or their daughter’s recent wedding. I’ve always loved the openness her patients had with her and I hope that this is a sign that I’m on track to do the same.

So yeah, after the verbal interview then I was sent to another room to do the actually vaginal exam. They verbally walked me through everything (the instructor and the nurse that I was doing the exam on) and then I had to do it. So I learned how to do a breast exam, how to examine the outer genitalia, how to feel for the Bartholin’s glands, how to insert the speculum, how to examine the cervix and take a swab from there, etc. It went pretty well. I must admit that I can’t really see myself doing that for the rest of my life as an OB/GYN but I feel a little less nervous about it now.

First Test Week Over

Normally I post in the days preceding our test week and I post during the test week and after also. I just finished my first test week of my 2nd year today and I am truly exhausted. On Tuesday we had Pharmacology, Wednesday we had Biochemistry, Thursday we had Microbiology, and today we ended with Pathology. You may say that it was a pretty lax week since we only had 4 tests compared to the 9 we would have during some test weeks in my 1st year, but I can truly say that these 4 covered way more info.

–Pharmacology: I can honestly say that I like this class. Its the one class that makes me “feel” like a doctor because now the many drug names I hear make a little more sense. Unfortunately there are these big pharmaceutical companies out there and all of them are making drugs so learning them is very tedious. And of course we need to know the mechanism for each drug, including when it is given, its major side effects, its contraindications, etc. This pharm test covered 72 drugs and unfortunately, they taught us like 60 of the drugs during the week right before our test week so we really had to cram them in and learn them. How did I study for the test? Well I took the advice of the professor and I made my own note cards. Many of my friends used the Lippencott cards but I believe that the best cards you can study from are the ones that you make. You learn as you make the cards. I used some flash card software for my iPhone which allowed me to study my flash cards where ever I went, so it really helped. I ended  up doing pretty well on the test with this method.

– Biochemistry: Sometimes I get really frustrated with this class because what I need to know for their tests isn’t really what I need to know for Step 1 boards which is ever in the back of my mind. This test didn’t go so well but such is life. It was only 25 points, so if you miss more than 5 you are already in the C range. I think that I’m going to have to dual study in the class. I’m going to read First Aid and Lippencott’s biochem for Step 1 prep and their notes for class; hopefully their is some intersection.

– Microbiology: Last year’s 2nd year class really complained about this class so the administration at LLU has made big changes. I’m not sure what it looked like last year but their class notes are great to me. This year however to increase the class averages on the subject board that everyone takes at the end of the year they paid a large amount of money to the people who write questions for the boards to get access to their question bank. So for now on, all of our tests are on computers, and we are only taking questions written by the NBME! Its kind of crazy because right now, this is the only class in our medical school that is done like this, and we are the guinea pigs. I didn’t do too well on this test, but that is probably due to the fact that I got sick of studying the night before and decided to watch the 2 episodes of Heroes that I missed. I wouldn’t recommend that to anyone. Its kind of rough since we are the first class they are trying this with, but I honestly think its good in the end since we will be very comfortable with these boards type questions.

– Pathology: I really like this subjects because it explains the background behind the many diseases that afflict us. Our teacher is amazing and really helps us get this stuff down. I did very well on this test and since 80% of Step 1 is pathology I hope this is a good sign.

As you can see, the main thing on a 2nd year medical student’s mind is Step 1. Its this ginormous test that generally determines what specialties will be available to you when you graduate. There is just so much to learn and so little time. I hope to post more frequently now that I know what these tests are like.

2nd year has started and I feel like I’ve been hit by a truck. This is our second week and it is twice the work we had last year and they give us less time to study. They require so much lab time outside of class that its hard to actually study. Part of that lab time for me today is performing my first pelvic exam on a lady who comes in (without pay I think) to help us learn. I’ll post more later on today.