Tag Archives: Thoughts

Into Second Year

I’m back, and I’m officially a second year medical student now!  I admit that I was a bit confused about my status over the summer…what happens when you complete your last first-year final exam, but you haven’t started your second-year classes yet?  Are you a lingering first year?  A rising second year?  A one-and-a-half year?  Some told me that I was a second year while others said I was still a first year.  So, when describing my place in the grand scheme of things, I finally settled on something along the lines of “I just finished first year, and I’m getting ready to start second year.”  A bit redundant perhaps, but it worked.

Today, however, I can say with confident nervousness that I am an MS 2 student!  Yes, I am confidently nervous (I think that may be an oxymoron?).  I’m confident because at least I’m no longer confused about my year at Stanford, and I’m nervous (a little) because I am taking a big step towards boards…and clinics…and the rest of my life.

And because I’ll be letting one of my classmates practice an arterial blood draw on me in two weeks.

We’re kicking off the quarter with practical lessons in emergency medicine, and learning to take ABGs (arterial blood gases) is one of them.  Although I could technically opt out of volunteering, I sort of feel it’s my duty to experience an arterial stick since I’ll be doing it to patients in the future.  So, I’ll be getting a needle in my radial artery.

Thankfully, our instructor said it shouldn’t be too painful if it’s done properly.

I hope we are able to pull off “properly” on the first try.  🙂

Back to today: we looked at histology slides of kidneys in our HHD urinary system lab this morning, and I am rather intrigued by the flow of blood in the kidney.  It’s very intricate, and the vessels have great descriptive names like “arcuate arteries” (they look like arcs) and “interlobule arteries” (they run between lobules, which we learned are smaller than lobes.  Apparently the “-ule” ending indicates a smaller version of something else, such as a globule being smaller than a globe).

In our Practice of Medicine session, I confirmed (as suspected) that I’d gotten a bit rusty over summer break.  Thankfully, today’s examples on how to take a focused history and physical exams helped refresh things for me, and I’ll do a more in-depth review of the techniques I’ve learned to finish tuning things up.  I’m excited to continue developing my clinical skills, as I still have much to learn.  That’s one of the great (although sometimes overwhelming) things about being in medicine–there are endless opportunities to grow.  🙂

Well, I’m going to try to get some studying in before I call it a night, so I’ll leave you here.  I’ll try to update my blog description this weekend, although it still feels a bit odd hearing my classmates and myself referred to as second years.   As for my not-quite-so-new white coat…well, it now has some wrinkles in it, and one pocket just might have some stray paper wrappers from those alcohol wipes I use to clean my stethoscope.

Looking back, MS 1 was a great experience.  Sometimes it was like a roller coaster into the unknown, and I had my struggles, but I made it through.  And if you happen to be one of the new first years and you’ve come across this blog, welcome to medicine, welcome to Stanford and enjoy the journey of your first year!!  You’ll grow–professionally and personally–in ways you never dreamed.  Dare to dream those dreams.

The 2014 Stethoscope Ceremony, taken from LKSC 4th floor.  Welcome First Years!
The 2014 Stethoscope Ceremony, taken from LKSC 4th floor. Welcome First Years!

Leadership Session & My Credo

This evening, my classmates from the summer Leadership in Health Disparities Program and I came together for one of our leadership discussions with Dr. Jane Binger and Mark Gutierrez. It was so wonderful to be with my teammates from this past summer; although I don’t get to see everyone as often now because of our schedules, I treasure our times together. LHDP was, and continues to be, an incredible blessing, and I am so thankful to all the wonderful people who have made this program possible: Mark, Dr. Fernando Mendoza, Dr. Ronald Garcia, and so many others!

We talked tonight about “modeling the way,” which is an important component of leadership as described by James Kouzes and Barry Posner in their book The Leadership Challenge. Over the summer, we had read and talked our way through another book by Kouzes and Posner, The Truth about Leadership, and we’ve now continued to discuss practical aspects of leadership as medical students and future physician-leaders.

Part of leadership involves defining our values, which allows us to recognize what we share with those around us and empowers us to live authentic lives. As part of the preparation for our session, I wrote out a personal credo to outline some of my own personal beliefs and values. This isn’t something that I spent a long time writing and polishing; rather, it is a glimpse into what I value and who I hope to be. I haven’t arrived yet by any means, and I’m still learning how to live out some of these things, but I wanted to share them as a sketch of what I hold in my heart. It’s funny that they came out sounding a bit like an epitaph, but perhaps by looking back from the future, I can live my life moving forward.

She was not afraid to live her life out loud. She did not hide who she truly was, yet she still found common ground with all those around her and listened to their points of view, remembering that all humanity shares the joys and sorrows and struggles of life.

She valued people above things. She remembered to dance in the rain, to share her umbrella, and to run through puddles with children.

She knew her limits but did not fear them, and she always gave her work her best attempt. When she fell down, she never failed to get back up and try again.

She lived for more than just the praise of those around her, and in her own quiet way, she was courageous.

I want to live an authentic life. I think often about how I fit in…although as a general rule, I think a lot. This is a question I imagine a lot of us have, and being a medical student has a way of amplifying this. I feel that we don’t talk about it all that often, though. It makes sense; if someone is wondering how they fit in, they probably won’t mention it to everyone.

Well, if you’ve had that question, you’re not alone. I’ve wondered it too. Even something as wonderful as being a medical student at Stanford (and that’s saying a lot!) isn’t enough to dispel the uncertainties that seem inherent in my life as a med student. I’m learning that it’s okay to ask the question.

It was remarkably timely that during our session this evening, we talked about how fitting in is now what we’re not about any more. We can’t just define ourselves by our roles and degrees; we need to know what we truly believe and live it out. In order to effectively lead, we must live our lives as examples.

For me, some of the key points I took from this is that it is important to find my voice and recognize that I don’t have to change who I am just to be accepted. There is balance to this, of course, and it must be done with respect, but I cannot be an effective leader if I am always trying to reshape myself into what I think people want or expect. It’s okay to be unique. That’s the heart of diversity; we all bring something valuable to the table, even when we don’t see it at the moment.

Your life story is unique, and no matter what has happened in your journey, there is something you can take from it to inspire others. Your story doesn’t have to be like anyone else’s in order to be valid; I know that when applying to medical school (and even now, as a medical student), it is so easy to be continually comparing ourselves to others.

I’m reminded of what a UC Davis medical student told me when I was still a pre-med. His advice to me was this: Don’t lose what makes you special.

So I package these words up into a gift and pass them on to you. Don’t be afraid to sing with your face to the falling rain or to dance barefoot in the puddles, even when the world is wearing boots and bustling past with its eyes on the sidewalk.

“To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment” – Ralph Waldo Emerson

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.

Defining Questions

does the young acorn

ever question whether it

will become a tree?

– The Stethoscopist

Yesterday morning, I ran some errands in preparation for the Fourth of July. I needed a beach towel to sit on while watching fireworks that night, but since I had a coupon to Kohl’s, I decided to pick up some kitchen items at the same time. Afterwards, I ran to another store to buy some granola bars, as they are an all-important nutritional group in the Food Pyramid of Busy Students.

Larissa and Acorn (2)

Having secured the necessary granola bars, I started my car and began backing out of my parking space. It can be a small adventure backing out in parking lots—it sometimes seems that I am crossing a stretch of wilderness dotted with shifting landmarks. Watching for cars and pedestrians while trying not to brush the vehicles on either side, I eased out, my head twisted over my right shoulder.

Suddenly, a car appeared in my left field of vision. It looked so close that I had to immediately press down on the brakes, jolting to a stop. And in that instant…

…the driver honked at me.

You probably thought I was going to say that we had a fender-bender. Thankfully, it wasn’t that dramatic, but the fact of the matter is that I was honked at and it didn’t feel fair. After all, I was moving slowly, so the oncoming driver should’ve had time to see me pulling out before the car reached me. He or she could’ve simply pressed their own brakes and waited just a moment, rather than honking and driving on past me. It just seemed unnecessary.

As I finished navigating the parking lot, I tried to let the incident become the proverbial water on a duck’s back. I felt a slight twinge of hurt, though, and nothing I told myself could seem to make that little prickle of emotion go away.

Then, the thoughts began.

You shouldn’t let a honking car horn get to you.

You’re too sensitive.

How can you be a medical student?

How on earth are you going to survive in the hospital if you can’t even take a honking horn?

You’re going to be an embarrassment to yourself.

I’ve heard them all before. They are the self-doubts that dog my steps at times, even though I’m officially a med student. Even though I now have a name badge and a white coat, I still face them.

I’m sharing this because I hope that it will reach someone—some aspiring pre-med or fellow medical student—who also has doubts and thinks that he or she is the only one out there who does. Perhaps you think that everyone else is perfectly confident and has it together.

I know, because I sometimes feel that way myself. But I also know that I’m not defined by my doubts. They are challenges to overcome, and although they make me feel vulnerable at times, I will be stronger for facing them.

The acorn’s roots push against the solid ground, and with time and patience, the roots break through. The earth—which at one time must have seemed an insurmountable barrier to the tender shoot—becomes an anchor for it as it matures into a majestic tree.

Perhaps you are an acorn right now, facing the earth and needing encouragement for the journey ahead.  Or perhaps you are a tree, having already overcome many challenges and able to share encouragement with others. I think we all have elements of each. Regardless of where you are in your journey, though, please know this: you’re not alone.


How Badges Are Like Buttered Toast

In my past shadowing experience, I had the privilege of observing and interacting with many residents at the UC Davis Medical Center in Sacramento, about an hour and a half from my home town in the Sierra Nevada foothills. As an eager pre-med, I was always thrilled to have the opportunity to spend part of my day with these physicians, but there was one thing that I sometimes wondered about.

It had to do with badges.

I noticed that sometimes the badges worn by these busy health care professionals would be flipped around, showing information such as emergency phone numbers instead of the wearer’s name and photograph. Now, I recognized that this wasn’t on purpose—badges can certainly flip around by accident—but as a conscientious pre-med, I often wondered why the residents weren’t more careful to promptly turn the badges back around. If I were wearing a badge…

And then, just last week, I received my first badge. It’s the size of a credit card, a white rectangle of plastic that is tangible proof of so many hopes and dreams. After waiting at the Photo ID Office in the basement of the Stanford Hospital and hoping that my picture would turn out, I received my badge. (The pressure is on when no photo retakes are allowed, the resulting picture will represent your professional identity for the next four or more years, and you didn’t realize you would be getting your picture taken that day in the first place.) My photograph (which thankfully did turn out) is a postage-stamp-sized image at the upper right corner of the badge. The Stanford School of Medicine title and logo fill the upper left, and beneath that, in bold capital letters, are the phrases “Student Affairs,” “Medical Student,” and my name.  Oh, to be called a medical student!

I proudly purchased a retractable badge holder at the med school bookstore, snapped it on, and began wearing my badge throughout all medically-related parts of my day. (Though I admit that on the first day, I even wore it while stopping by the front desk of my housing office.) And that is when I began to notice a curious thing:

Badges flip around.

It’s almost uncanny how readily this happens—a few brisk steps forward, and suddenly the badge at my hip is announcing the numbers to emergency hotlines rather than my name. I tried adjusting its position on my belt and reversed the clip to see if it was some quirk of the holder, but my badge remains as predictable as buttered toast: it always lands facedown.

Now, when I’m walking around the Stanford campus or hospital, I must regularly check whether I need to flip my badge around. Sometimes, I forget. And in all of this, I’ve come to realize just what the residents I shadowed were experiencing. In this small way, I’ve begun walking in their shoes…or at least in their badges.

My badge struggles over the past week have drawn my thoughts to the topic of empathy. I know that it is important to place myself in another’s position before I draw conclusions. By imagining how I would feel in their situation, I can respond more appropriately and be a better friend, family member, classmate, and future physician. It’s easy to jump to conclusions, however, because it takes a conscious effort to slow down and to pause long enough to place myself in another’s position. It takes time.

Time. It is the most precious resource we have to share, for love and empathy and passion are all revealed through the time that we take to give it. Time is the breath that we take before drawing conclusions and the seconds shared in a touch or a hug. It is the minutes and hours given to listening, to learning, to realizing that each moment of contact with a fellow person is an opportunity to touch a life.

I now realize that the badge-bearers I watched with eager eyes a year ago weren’t being unmindful when they wore their badges flipped around. I had imagined the day when I would wear my own badge, but I now wish that I had also imagined what it would be like for these busy residents and team members to have to monitor not just vital signs and patient comfort, but also badges.

I don’t know if I’ll ever figure out a way to keep my badge straight, so I might have to glance down at it every so often for the rest of my career. But now that I think of it, that might be a good thing.

Because every time I see those emergency hotline numbers instead of my name, I can be reminded to place myself in the next person’s shoes.