Learning how to learn

Medical school has been an adjustment for me. The problem is not so much the volume of work, but rather the seemingly absent product at the end.

In my previous job, I did stuff. I put in the hours at the office and most of the time I had something to show for my time at the end of the day, week, or project. This is not the case with school and it's starting to get to me.

We're on a true pass/fail system in that my grade is registered as a Pass no matter how high above 70% I score. There are no honors, no percentage, nothing to indicate how I did in the course. All that matters is that I get above the 70% that is required to pass the class.

This system is awesome because it creates a low-stress environment and a very collaborative atmosphere within our class. People help each other out all the time and I know that if everything went to shit, I would still pass medical school.

On the other hand, I find it very hard to find the motivation to do as well on exams as I would like, because, well, who cares. It's all the same in the end. A Pass is a Pass.

But it's not. I am capable of being in the top 25% of my class.* I was up there in anatomy and I should continue to be there throughout the rest of the year. I need to learn this stuff well now so I don't have to relearn it next year when it really matters. I just cannot find the motivation to study that much, though, when all I get at the end is a percentage on a screen.

I have no problem putting in the work throughout the week to be prepared for lecture. I've turned school into an extended 9 to 5 where I go to class in the morning and prepare for the next day's lecture in the afternoons, coming home around dinner-time. I have a goal of finishing a chapter or a subject and at the end of the day, it's done.

When it comes to learning stuff for the exam, though, I completely shut down. There is no end to what I can know or the depths of my understanding. I can always do more and the goals of being done are not as clearly defined. Instead of chipping away at the work, I stop studying altogether. I think I've watched a whole season of "Survivor"** in the past three days instead of memorizing random genetic diseases.

Maybe it'd be easier if I was coming straight from undergrad or my break from school wasn't over 5 years long. Maybe I would have accepted my fate of living with my nose in a book a bit better. I really don't think that's the case and instead the problem is that my personality does not naturally fit with this way of life. I like seeing the product of my labors and I'm not good with delayed gratification, neither of which are conducive to pre-clinical studying.

Alas, my personality won't change and neither will the next year and a half of school. In fact, it's only going to get harder. So instead of accepting my lackluster grades (I was below the median in all four subjects tested last block), I'm taking a more proactive approach and learning how to do better with each exam. Mostly, I'm strengthening my motivation muscles and gaining a bit more pre-exam work ethic with each test.

Thus far, this has been successful. My downfall with the first block exam was not covering some subjects until a couple of days before the exam. That stressed me out incredibly and I just gave up on Histology. This block, I made sure to cover each lecture/subject during the week and my levels of stress were significantly lowered these last few days before the exam. The material is still really shaky, though, because I've only seen it once or twice, again adding to that dreadful feeling of being overwhelmed. To help with that, next block I plan on reviewing the material on the weekend so I don't go weeks between seeing it the first and second time.

Moral of the story is that I have to re-learn how to study so that I don't get so overwhelmed right before the test that I completely shut down. It seems pretty basic but it's been a pretty big struggle for me. Luckily, I'm getting better and I can only go up from here.

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*While we are true pass/fail, we're kinda sorta ranked. Our class is divided into quartiles based on scores and that distinction goes into our dean's letter for residency application in some sort of coded way ("Student was exceptional/satisfactory/etc.") depending on where we fall. However, this ranking is heavily skewed towards clinical grades so an exam here or there in the first or second year doesn't mean much in the grand scheme of things. This also contributes to my lack of motivation right now.

**Reality TV is my guilty pleasure. I recently discovered that I actually like "Survivor" and I have plenty of seasons to catch up on. Bad idea.

Reflections on anatomy

Our anatomy final is tomorrow and it's so surreal to think that gross anatomy is finally over. It felt like such an impossible task when we first started 11 weeks ago.

I remember stressing out about the three muscles we learned in the first week. "I have to know the arterial supply as well? How am I ever going to remember the transverse cervical artery?!" That actually happened.

Towards the end of our first block, we learned the entire leg in 4 days. That seemed ridiculous and impossible.

But now, the seasoned medical students that we are, we did the entire head and neck in under two weeks. No one batted an eye at that. It just seemed normal.

I wish I had learned some things better. The pelvis and perineum still confuse me. The details of the poop cycle are also lost on me. All in all, though, I have a pretty good grasp on how our bodies are put together and I'm okay with that.

It's not surprising that I glossed over those areas because I've never found them interesting. Similarly, it makes sense that I enjoyed learning the anatomy of certain parts of the body (muscles, lungs, and eyes) because I've been interested in that stuff for a while.

Some things surprised me, though, like really nerding out on the autonomic nervous system and cranial nerves. I don't think I'll end up in neurology, but the logic-puzzle nature of the disease processes has been really fun to work through.

I'd like to say that I'm taking it easy tonight and taking the evening off because I need to do very, very poorly on the final exam to fail the course. But like a proper over-achieving medical student, I'm not satisfied with the pass. Instead, I'll be doing more review questions until my brain tells me to stop.

More "old" posts

I know I've been absent for a while. Part of that is due to medical school taking over my life (kind of true). But mostly it's because I just haven't wanted to write.

I'm publishing a couple of super old and somewhat old posts for now, and am writing new ones as well. I should be back to somewhat regular blogging soon.

Trial by fire

At School E, we get assigned a preceptor whose office we will work at throughout the year practicing taking patient histories and conducting a physical exam.

I was hoping to get someone in a surgical subspecialty such as orthopedics, ENT, or plastics. We don't do 3rd year rotations in those fields and I'd like to get some exposure to them to see if they're something I'd enjoy doing. Having a preceptor in any of those fields would kill two birds with one stone: practicing patient care and seeing what their clinics are like.

Be careful what you wish for because I did get a preceptor in a surgical subspecialty: urology.

My first experience interviewing patients will be asking them about their private part problems. This shouldn't be awkward at all.

Medical school has changed me

"We have three days before the exam. That's plenty of time to learn it all."

Words I never thought I'd say until I saw how much I can absorb in such a short amount of time.


Also, my reasons for being excited about the weekend have changed dramatically.

Before medical school:
"Let's go camping. Or take a brew tour. Or just relax in the yard."

In medical school:
"Phew. We have two full days without any new information being thrown at us. I may actually be able to catch up this weekend. Sweet!"

Mortui vivos docent - The dead teach the living

Earlier this week we started anatomy lab. I hate it.

Part of the reason is the ridiculous inefficiency of it. We have no idea what we're doing so everything takes us so freaking long.

The other, more disturbing reason is that I can't bring myself to cut into our cadaver, Ms. Judy. Her fingernails are painted bright red. She has that wonderful short, curly hair that's popular among elderly women. Her muscles are tiny and she has mild scoliosis. Today we took a chisel and hammer to her back and knocked out her spine. How is that normal?

I understand it was her intent to donate her body in death for me to learn and help the living. But I cannot get over the feeling that I'm disrespecting her and mutilating her body. I cannot separate her being from the body that is lying in front of me. Did this frail, old woman know that this was what she was signing up for?

My dislike of dissection is not necessarily a fear of death. I've seen people die. I've worked on people who are dying. The newly dead aren't a problem for me, and the same goes for patients in surgery. The work of a surgeon is helping his patient in one way or another. Ms. Judy, on the other hand, is being taken apart piece by piece in a rather crude manner. It sucks.

My lab mates, on the other hand, have been incredible. They've done all the work the last couple of days while I've stood in the background adjusting their masks, hair, and goggles. I've benefited from their work because although I have no desire to cut our cadaver, it's pretty awesome to see the structures demonstrated on a human body.

Every time I glance at Ms. Judy's beautifully manicured fingernails, I remind myself that this was her exact intent. She wanted us to take her apart so we could better understand how she is put together. She may have not known the details of what it would take for us to learn, but her end-goal was clear.

I cannot let her incredible gift go to waste, so I suck it up and do what Ms. Judy would've wanted: learn about the human body by putting my hands inside her newly exposed spine.

Responsibility

While it still hasn't hit me that I'm actually starting medical school, it's slowly starting to dawn on me that I am, sometime in the near future, going to be a doctor. That is a scary thought.

Amongst all the mingling, retreating, and picnicking, we've had a few serious talks at orientation and our White Coat ceremony about what it means to be a doctor.

Our keynote speaker described the first patient that he treated. Our dean spoke about the impact his patients' words of thanks have had on him. And our orientation included a history of the impact our medical school and its doctors have had on the surrounding community.

Every single one of these instances sent shivers down my spine. The quality of my work will no longer just affect my professional reputation or a potential bonus. A good day on the job could have tangible effects on another person's life and future, as could a bad day. I have never felt such a great sense of responsibility before and it's thrilling.

So although it still feels like I'm on vacation meeting new people in a new city and the "first day of medical school" seems very surreal, I am keenly aware of the responsibility that I will acquire once I get an MD after my name in four very short years.

I am incredibly excited, but at the same time very terrified. I'm in for a wild ride.

Road tripping

Since I'm unwilling to part with any of my furniture, I decided to schlep it halfway across the country in a moving truck. The drive to School E took three days, although we could've easily done it in two if we had hurried up.

My dad drove with me so we decided to take it easy and turn this journey into a road trip instead of a straight-shot to City E. I am so glad we did because driving a 16' moving truck while towing a car turned out to be rather fun. I didn't want it to end.

My rides.

We hit a beautiful thunderstorm the first evening just as the sun was setting. It was preceded by this rainbow, which the picture just doesn't do justice.

The lightning storm resembled a light show. There were strikes all around us every few seconds even before we hit any rain. So we cruised along at full speed, mesmerized by the awesome forces of nature.

Then it started pouring and the cab of the truck started leaking, which made the storm a little less enjoyable but incredible nonetheless. We still had a lot of driving ahead of us that night since we'd left so late in the afternoon so the storm was a great way to wake up a little and enjoy the long slog into Texas.

Once we crossed the state line, we knew we were in Texas. The waffle machine at the hotel the next morning made sure to remind us just how great this state really is.

In Texas, even the waffles have state pride.

We were smack in the middle of nowhere at midday of Day 2 when the "Check Engine" light turned on. We had another 10 miles to the closest "town" so we slowed down to the recommended speed limit for the truck+trailer combo and hoped the truck wouldn't stall on us.

Penske has a great road-side assistance system so we called them asking for help. They tried locating us by town name to send someone out but we were so isolated that they had to trace the GPS on my phone because BFE, TX wasn't showing up on their maps.

In the end, it turned out to be nothing. The truck ran fine so they said to continue on to the next real city where they would have someone take a look at it. Since this was already going to be a short day (~7 hours driving) and we had left relatively early (10 am), we had plenty of time and very little stress about the whole situation.

For lunch we did the proper Texas thing and stopped at an incredible BBQ restaurant. Not only was the food delicious, cafeteria-style, and filled with real Texan cowboys, it also had ample parking for our truck+trailer+car monstrosity. By that I mean, we didn't have to reverse to get out of there.

The Branding Iron in Wichita Falls, TX. Go there!

After a slight detour to the Penske service station where they confirmed what the people over the phone had said regarding the "Check Engine" light (no biggie, keep driving), we made it to our hotel by 7 pm.

Then we noticed there was a rodeo going on next door at the Rodeo Capital of Texas. How can you not go? So my dad and I put on our most rodeo-like clothes (jeans and a t-shirt) and had a fantastic time!

The whole thing began with a prayer. It wasn't just any prayer, though. It was introduced as, "They have taken prayer out of our businesses and out of our schools, but by God they are not taking the prayer out of our rodeo!" A little girl sang the national anthem (of course) and then the rodeo began.

When your hotel just happens to be next door to the Rodeo Capital of Texas.

I'd never been to a rodeo before, but I had watched the PBR on TV a few times. The live version was at times better and more entertaining. For example, one horse just refused to buck. He exited the chutes and kind of stood there. He had one half-assed attempt at bucking but that was about it. Longest 8 seconds of the whole night.

They also had a few kids, ~11-13 years old, riding mini bulls (whatever the proper term may be). None of them lasted the whole time but it was crazy to see such young boys on these animals. The little kids riding sheep (mutton busting) was also hilarious mostly because it's just so weird.

Google image, but that's how it looked at our rodeo

The rest of the road trip was uneventful. We drove through some beautiful landscapes, listened to tunes, and talked. It was great to spend so much time on the road with my dad. We took a lot of road trips with my family growing up, but I haven't taken one alone with my dad in ages and it was so much fun. He and my mom are already planning a trip out here for Thanksgiving to drive around State E some more since there's so much left to see.

After the road trip was done, my dad stayed around to help me move in and explore a bit of City E. Mostly, he reassured me that the house I chose is much better than my old one even if I don't seem to think so. In fact, I hated this place so much when I walked in the door that I considered not even unpacking my boxes and immediately looking elsewhere for a place to live.

Needless to say, I'm still here and I don't see myself moving in the next 4 years. That's not because I like this house (it hasn't grown on me that much). I just really hate moving.

2014 application cycle in a nutshell

Since it's pretty much decided where I'll be going to medical school, I figured it's time for the second edition of "My application cycle in a nutshell". The first edition can be found here.

2014 application cycle, by the numbers:

• 27 - Schools to which I applied
• 26 - Schools from which I received a secondary
• 22 - Secondaries I submitted
• 7/5 - Interviews offered/interviews attended
• 4 - Waitlists
• 1 - Acceptances
• 4 - Rejections (all waitlists turned into rejections)
• 6/11 - AMCAS submitted
• 7/2 - AMCAS verified
• 7/4 - Earliest date my application was complete at a school
• 9/6 - Last date my application was complete at a school

All in all, I am satisfied with how this process ended up for me. It would've been nice to have gotten accepted to more than one school and had some sort of a choice. After-all, I still have some pride left over after two very humbling application cycles. On the other hand, I suck at making decisions for myself, so maybe it's better this way.

Honestly, though, after looking into schools in more depth, there are only one or two schools I would have considered attending over School E. I was waitlisted at one that was a complete reach for me (School A), so I got close but no cigar. The others I viewed through rose-colored glasses so I don't actually know if I would've been happier elsewhere.

Regardless, I am incredibly grateful to have an acceptance, especially to a medical school that I am so excited to attend. I couldn't have done this without the help and support of family, friends, and even strangers I met online. It is so humbling to know that so many people rallied behind me and allowed me to achieve what seemed like a pipe dream at times.

Maybe I'll write up a more detailed post about what got me accepted this time, but if I don't then the short version is the following:

1. Earlier primary application and thus earlier secondary submissions
2. Tailoring my secondary essay answers to the mission of each school
3. Putting on my happy, joyful, enthusiastic face during interviews and selling myself shamelessly

House hunting

A couple of weeks ago I went down to City E to look at apartments/houses to sign a lease for the next year. Boy, was it stressful! My current roommate and best friend (F) who's moving down there with me accompanied me on this trip.

We flew in Thursday night and spent all of Friday, Saturday, and Sunday looking at places. We ended up touring 23 apartments, duplexes, and houses, and they ranged from nice properties to slum houses. We found most of the places on craigslist, hence the huge range in quality, but we also worked with a realtor to look at some others.

Our outlook about this whole process changed hourly. We were hopeful and happy thinking of all the awesome places we planned to see, only for them to have something terribly wrong (awful neighborhood, weird landlord, cockroaches, etc.). Up until Sunday morning, we had found a few places we would be okay living in but were not thrilled about. It was very discouraging.

Sunday turned out really well, though, by that night we narrowed our list down to three places we could see ourselves living, à la House Hunters style (my second favorite show on HGTV, right behind House Hunters International).

House 1 - Beautiful house, questionable neighborhood

I fell in love with this place as soon as I walked in. Bright and big rooms, tall ceilings, very open and airy. Lots of history. It was also in the more happening part of town where a lot of other med and grad students live, in an area that is more reminiscent of the character of City E and what it's known for.

However, a couple of blocks away was a questionable part of town and the current tenant said that every once in a while you hear of people getting mugged. The unit was the right half of this house as you're looking at the picture, so the ground floor had bars in the windows. Umm...no. I'm moving from six years in a bubble. I wasn't sure if I wanted to worry about putting my nice TV in the front room because someone might see it and want to break in. The house was AWESOME, though. Not perfect by any means because it was over 100-years-old, but great in the old-house-charm sort of way.


House 2 - Good neighborhood, awful layout

I really wanted to love this place because it was huge, kind of in our budget, and located in the "safe" part of City E (that is, as close to a suburb feel as you can get there). It was a 2-bedroom 1500 sq. ft. apartment occupying the second floor of a nice house, with ginormous bedrooms and an extra study space off one of them.

BUT (and this is a big one), the kitchen was tiny. It was so small that I couldn't figure out where we would put the microwave on the counter. On the other hand, it had a fairly large formal dining room off to the side of it, so the space was there. It was the planning that was off. Also, only two of the windows in the entire house opened, the stairs to the backyard led to the front of the house so you had to walk all the way around the property, and stuff like that. It was just weird and didn't feel natural.


House 3 - Good neighborhood, meh house

This place was just around the corner from House 2, so same neighborhood and similar style. Like House 2, it was the second floor unit with 2 bedrooms, but only 1000 square feet. Unlike House 2, it had a very open layout where the living room opened into the dining room, followed by the kitchen and stairs to the backyard. There were lots of windows (that opened!) and natural light everywhere, which is what I really loved about House 1 as well.

My beef with this place was that it was a step down from our current apartment, and I really wanted to improve my housing. The bedrooms were smaller, as was the backyard. There were window units, like I mentioned, instead of central air.* The neighborhood didn't have anything happening in it with regards to nature and trees and people. The lots in front and to the side of the house were empty and the neighbor on the other side used his home as a vacation house, so it seemed rather dead. It had a very suburban feel, which I don't like too much.

Mostly, I felt very claustrophobic when I was inside and didn't know where I would put my desk because I really like studying at home. When we were actually in the house, it didn't feel too bad, but I think I remember it much smaller than it actually is.

Lastly, the landlady was around our age and really fun to talk to so we'd have an immediate friend when we moved there. She seemed on top of everything and really cared about fixing up the place, telling us she'd replace the stairs leading to the backyard before we moved in, as well as building a fence in the backyard so we'd have our own space and she hers. I would've much rather had her install central air to replace the window units she currently had or update the appliances in the kitchen, but it's not my house so I don't make those decisions.

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So what'd we go with? House? Location? Layout?

We chose neighborhood over house, and picked the more suitable of our options: House 3.

The neighborhood is actually perfect for me, even though I'm still in denial about that. Here's why:

• 3 miles from two yacht clubs (hurray sailing!)
• 1 mile from City E's equivalent of Central Park
• 3 blocks from lots of restaurants and bars, blocks I feel safe walking through

I keep thinking that I should live in the center of all the hustle and bustle of City E because it's so awesome and I should really experience it during my time there. But then I remind myself that I like visiting cities instead of living in them and I'm 10 minutes from the center of City E. That's not far at all.

Most importantly, I really won't have that much time to experience and enjoy my neighborhood because I'll have my nose stuck in a book. So feeling safe and comfortable with where I'm living is the most important thing to consider.

The main source of my disappointment is that, like I mentioned in a previous post, I was really excited to move up in the world of housing and not live in a shit-hole anymore. Unfortunately, I believe House 3 in City E is a step-down in certain ways, a step-up in others, so on average I'm moving laterally and not up. I'm comforted by the fact that the lease is only for one year so I can move next July (although I was really hoping I wouldn't have to) and our landlady lives below us, is our age, and is generally awesome to hang out with.

All in all, it won't be too bad. I just have to suck it up for one more year and maybe find a better place next summer. Or I could end up falling in love with our house and staying there all four years of medical school. You never know.

Below are some pictures of the interior of House 3. It's actually pretty nice.

Looking from the front porch through the living and dining room, to the kitchen.

The kitchen. Entrance on the left leads to the dining room.

One of the bedrooms. It looks smaller than it is.

Edited to add:
I just looked over a post I wrote before going to City E to sign a lease which lists out my requirements for a new place. House 3 has met all of the must-haves and would-like-to-haves. Geez, I really am being a brat about this new place.

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*While my current housing situation has neither central air nor window units, all the places in City E have one or the other. I would prefer to have central air because it's nicer and quieter, and thus a step up in my HVAC experience. Oh well. You can't have everything, especially when you only have five days to look for a place to live in a city you don't know at all.