Tag Archives: Studying

Swim

I survived boards!

To sum it up as concisely as possible, preparing for my Step 1 exam was like diving into the ocean, and I ended up going for a longer swim than I anticipated.  Long story short, I took boards in September instead of during the summer, which is partly why I’ve been away from blogging for so long.

IMG_6579

I also wasn’t sure where to start writing again.  Which is why this post if being written in December, long past the reasonable timeframe for using my I’M-STUDYING-FOR-BOARDS-AND-CAN’T-WRITE excusplanation (my latest neologism: a cross between an excuse and an explanation.  I coined it specifically for this post). 🙂

IMG_6583

Since I’ve taken time off for research before starting my clinical rotations, I had the flexibility to extend my study period, and that’s what I ultimately did.  For some reason, saying I took additional time almost feels like a confession.  I suppose part of me feels a little guilty for having the opportunity to study longer (other med students may not have schedules that are so accommodating), and part of me wonders if I should’ve felt ready sooner.  However, a friend passed on some advice from his sister (a medical resident) that helped to ease my decision: take the time you need, and take the exam when you feel ready.  It’s okay not to rush it.

I think it’s unlikely that any student ever feels completely ready for boards, but at least it’s possible to feel that we’ve done everything we can with the time and resources each of us have.  For me, this was the right choice even if it did mean doing a lot of swimming and diving (figuratively speaking, of course, since my real-life water skills fall into the category of barely-good-enough-to-not-drown).

I finally came up for air after my full day at the Prometric testing center, only to realize that life was waiting for me above water like a clamoring flock of seagulls.  To be honest, part of me wanted to just go back into the water and turn into a mermaid.  Over the last several years, the life of studying (for college, the MCAT, med school, and finally Step 1) has become a familiar ebb and flow around me, and it’s comfortable in its own odd way.

Well, I guess it’s time to get pushed out of that comfort zone.  I’m done with my preclinical years, and there will be no more quarters to define the pace of my life, or daily lectures and midterms, or labs where curiously-shaped cells make faces at me through the microscope lens.

Now I’m gearing up for my clinical years.  I still have a few months to prepare myself, but it’s daunting for me to think about functioning as part of the medical team.  I’ve had opportunities to participate with patients throughout the first two years of medical school, but it was always briefly, as if our interaction were a haiku of three lines instead of an essay of three hundred.  I’ll still have supervision and guidance, but my responsibilities and expectations will be greater, including the expectations I place upon myself.

One thing I’ve been thinking about is how to connect with people on a personal level, because that is important to me.  Sometimes medicine can feel very mechanized, and with the pressures of being a clinical student, I can see myself losing sight of the more ephemeral aspects–the very things that make this pursuit worthwhile.  I’m worried that in trying to navigate wards and find my way around, I’ll lose some of myself.

And maybe I will for a little while, as I try to orient to the life of a clinical student with its early hours (on some rotations) or intense schedules (on others).  But I also have faith that I’ll be able to find myself again if I do.  Beneath my white coat (which still feels like a costume when I wear it), I’m an artist and a writer.  That, I think, will help me find my way home to what I care about: the story, the healing art of listening, the release of telling, the feeling of having been seen and understood.  That’s my hope, at least.

IMG_9959

I was surprised by a rain shower today as I left a meeting at the hospital.  I found some leaves with pearlescent water droplets reflecting the diffuse light, and the constellation of spheres made me think of a universe in miniature.  Maybe this is what souls look like, with droplets of memory and experience coalescing to reflect the light and shadow of who we are inside?

My imagination is getting the best of me.

But I like to think that if each droplet were a little world of its own, and if I were as small as an ant, I’d be able to see and appreciate each one.  And when we meet people, that’s really what we do, isn’t it?

Each of us has our oceans, and each of us is a universe of our own.

Pancreatic Passion

On Monday, we had our renal system exam.  After two-and-a-half weeks, we’ve finished our journey through the kidneys and their combined 2.5 million nephrons, as well as the ureters, bladder, urethra and prostate (where applicable).  It was a fast-paced and fascinating journey, although I’ve barely caught my breath and we’re already on to studying the GI system.

Today we learned about the pancreas, which I’ve found to be more interesting than any other organ I’ve studied so far.  Including the brain.  IMG_0361 - Version 2Some people may argue that the brain is much more fascinating than the pancreas, but I really like the pancreas.  (Please excuse my bias if you happen to be a passionate lover of the brain.  It really is amazing also.)  I guess I just never pondered how I have the ability to digest myself, and I think it’s amazing that I don’t.  I mean, it sounds rather like science fiction, doesn’t it?  The power of self-digestion.  It’s the closest thing I have at this point to a super-power, except it’s one that wouldn’t save the world. :/

Let’s talk a little about the pancreas and why I’m digesting my dinner and not myself right now (unless I were to get acute pancreatitis at some point.  Which I rather hope I don’t.).  The pancreas produces several different digestive enzymes to break down protein, fat, and nucleic acids.  This arsenal is essential for digesting the nutrients in the steak salad I ate this evening, but it’s also perfectly capable of breaking down my own cells.  However, these enzymes are actually stored as inactive precursors, so they aren’t able to do any damage in the pancreas.  It’s only once they’re released into the intestine that they can be activated, and by that point it’s safe to do so.

The activation cascade itself is quite beautiful.  In the intestine, there is an enzyme that activates trypsinogen (an inactive precursor) into trypsin (a protein-digesting enzyme).  Trypsin then cleaves all the other inactive enzyme precursors into their active forms, and suddenly your intestine has all the digestive enzymes it needs.

On top of all this, there are mechanisms inside the pancreas to stop this cascade from taking place just in case it’s accidentally triggered too early.  There’s another protein hanging around that inhibits any trypsin that might have been aberrantly activated.  And there are to more enzyme precursors that, if activated in the pancreas by trypsin, will actually turn around and break it down!

I’ve tried to make this easier to read by omitting most of the specific enzyme names, as words like “mesotrypsinogen” and “phospholipase A2” are a bit of a mouthful (but still much easier to say than “focal segmental glomerulosclerosis,” one of the diseases we learned about in renal block!).  If you’re interested in learning about it in much more detail, though, there’s information here!

How is it possibly 1:30 AM?  I guess I’d better go study about the pancreas a little more before going to bed…goodnight!

P.S. What do you think of the title of this post?  It sounds like a fruit juice blend… 🙂

Untitled
A sleepy pancreas

Carry On

It’s been one of those days where you come up at the end of it feeling rather exhausted. I keep getting this picture in my mind of the swirling ocean with water as deep and dark as the night sky traced with clouds of foam, and I’ve just surfaced after a long plunge beneath the waves.

Even as I write this my thoughts are wandering about my head, wondering how the pressures in my lungs would change if I took such a dive, and what impact this would have on the respiratory control centers in my body.  I’m guessing this is a side effect of studying for today’s Human Health and Disease exam on the respiratory system (and antibiotics and neoplasia).  We just finished the exam this morning, and although it was intense, I’m happy to have made it through.

I wish I had something more original or profound to say at the moment, but since I’m pretty tired I’ll instead comment on two quotes which help me to find perspective when I need it most.

The first quote I’ve known for a long time, and it holds a special place in my life. My mom taught it to me years ago and it’s been a part of me ever since:

Mistakes are opportunities to learn.

For example, I’ve been tempted to get tangled up in frustration with myself for not planning my studying better.  (I can now empathize with bacteria a bit more, as I’ve finally found common ground with them. We both underestimated the power of antibiotics.)  The antibiotics are more challenging to learn than I had thought/hoped, and looking back, I should’ve started memorizing the information about them earlier than I did. Lesson learned: make flashcards promptly.

The second quote I just came across yesterday, and it was a great encouragement to me.  These words by Winston Churchill capture the essence of the perspective I need at this stage in my life:

Success is not final, failure is not fatal: It is the courage to continue that counts.

These words remind me that this is a journey, a process. It’s a continuum of sorts, and things change.

In a way, this is the same perspective that the seasons give.  Springtime is not final, for blossoms must mature into fruit that ripens and eventually falls from the tree.  Winter is not fatal, for the tree blooms again.  What counts is that the tree sends its roots down into both the warm, rich soil and the cold, frozen earth, that it stretches its branches heavenward in both the bright sunshine and in the slanting rain.

Trees, I think, could be called courageous.

While I know there are times in life when failure literally can be fatal, I am reminded in moments like these to also step back and see the bigger picture.  And then, with the ocean before me, to find the courage to plunge in once again and swim.

This Moment

I’ve been feeling a bit worn out today.  Nothing in particular happened, although I’m guessing it may be influenced by the knowledge that I have my first block exam for Human Health and Disease at the start of next week, and I still have lots of information that I need to wrap my mind around.  Antibiotic and antifungal names, actions, and uses are presenting a particular challenge for me at the moment, although I’ve bought some nifty blank flashcards and plan to do all I can to drill these antimicrobial names n’ natures into my mind this week.

Sometimes, on days like today when I’m tired and would rather be doing something other than studying, I lose sight of the unique beauty of the day.  Just now, I was looking out my window while going through some online modules for an elective I’m taking.  The wind has been blowing all day, and the way it scatters the sunlight and shadows across the ground reminds me of autumn breezes.  I love autumn because it means that Thanksgiving and Christmas and family time are coming, and for a moment I found myself wishing it was November.  After all, the holiday season only comes once a year, and for me, the weeks leading up to it are so ripe with anticipation that you could almost juice them for cider.

But then a though struck me—spring only comes once a year also.  Today, April 22, is a single day, just like Thanksgiving or Christmas Day.  In fact, each day only comes once a year, and this particular moment only comes once a lifetime.  I’ll never have the afternoon of April 22, 2014 again.  Doesn’t that make it something to be treasured?

From this perspective, the very air is alive with possibility.  The next breath I take is as fresh, fleeting and beautiful as a shooting star tracing the arc of the midnight sky, or as a hawk catching the currents of the heavens and spiraling up into the blue.

This moment is a gift.  In truth, the fact that I can study right now is a gift.

So I shall get back to studying.

And if you’re feeling a bit tired too, I hope you find refreshment in this moment, this very moment of life.

The Test that Matters

I love new beginnings: the first robin that greets the dawn, the fresh shoots of grass drawn up by the sun, the start of a year still crisp with January newness.  The beginning of the New Year is like the ocean foam, smoothing the footprints from the wet shore so we can dance in the surf again.

Inspired by OneWord365, I have chosen a single word to center my focus on this year.  I will follow this word throughout the coming months, paying attention to how it intersects my life—my interactions, thoughts, perceptions, feelings, responses.  I hope that throughout the year, I will grow so that this word describes me more completely, and that I will be able to look back and see it woven throughout my days like a silver thread.

 My word is perspective.

As I continue to explore who I am as a medical student and how to best grasp the sacred responsibility of interacting with others as a health care professional, the concept of perspective keeps coming to mind.  Empathy and compassion are drawn from perspective—from being able to see through another’s eyes and understand their point of view, their pain.  So is gratitude, which allows me to shift my attention from wishes and wants to what I already have.  So are many other things, things which I hope to discover this year.

One of my first encounters with perspective came on my final day of winter break.  After a few wonderful weeks with my family, my car was packed and ready for the journey back to Stanford.  The reality of leaving that day made the beauty of being with my family more vivid than ever, as if lightning had blazed across the sky and cast everything into bold relief.  As I stood on our deck, I felt what countless others have recognized before me: things become precious when time is short.

Time has indeed flown, and today finds me at the end of my second day of winter quarter.  I have been pleasantly surprised at the ease with which I’ve slipped back into my academics, since I missed my family a lot after break and was uncertain how the quarter would start for me.  For those of us who still get homesick at times, there is hope!

And now, in my second day of medical school this quarter, I have had another encounter with perspective.  We had our first lecture in Intro to Human Health and Disease this morning, which is the start of a series of courses designed to teach us how the body functions in health and illness by examining the various organ systems.  Our instructor, Dr. Robert Siegel, opened the session by bringing up several important questions we ponder as medical students.  One of the questions he posed made me smile because I have wondered it many times, particularly while studying for final exams last month:

What do we need to know for tests and boards?

After all, how can I become a physician if I don’t pass my classes?  And how can I get a residency placement if I don’t know the right material for the boards?  Although passing exams isn’t the ultimate objective of my learning, I admit that the desire to make it through an exam can overshadow thoughts about the future applications of what I am learning when I am studying for finals.

Dr. Siegel’s answer to the question awoke something in me.  “The test that matters,” he emphasized, “is the one when you walk into the patient’s room.”

The ultimate, most meaningful test is not the exam at the end of the quarter.  No matter how well I retain the material for the final, it will not benefit my future patients if it is lost in the recesses of my mind over spring break.  This shift in perspective—focusing on the material so that I can apply it in the clinical setting throughout my future, rather than learning it to pass a test in my first year of med school—breathes life into my studying.  Everything I learn has a purpose besides earning a “pass” so that I can make it to the next year, and to boards, and to the year after that.…

This is about becoming, as Dr. Siegel said, the doctor I would want to see if I were the one in need of care.

I know I’ll slip throughout the quarter and forget the true purpose of my studying, especially when finals come up in not-so-many weeks, but this is what I’m aiming for: the perspective that will enable me to recognize the real meaning of my studying, so I may one day pass the test when I step into my patient’s room.