Blepharospasm

Less than 12 hours from now, I will be taking yet another set of examinations. As usually, I am not concerned about the first, which focuses on diseases covered during small group discussions, but I am concerned about the second. The second exam tomorrow is another customized NBME exam. Though, I did well on the first customized NBME, I'm worried that the faculty "went easy" on us since it was the first one.

My gut is telling me that the faculty is going to go to the opposite extreme this time -- that they've selected the toughest questions from the available pool. My gut's telling me that I don't know the material well enough to execute another knock out performance. Then again, my lactose intolerant gut may just be cursing me for that scoop of chocolate chip cookie dough ice cream I just ate.

Why did I do that? Why??

But, I know I'm really stressed about this exam because my eyelids keep twitching. That's right, my left upper lid and, sometimes, my right lower lid have lost their mind. It's the most annoying thing I've ever experienced. Every now and then, I have to stop reading because the twitching is so out of control!

I decided to look further into this eye twitching, so I looked up "eyelid twitch" on the trusty MedlinePlus Medical Encyclopedia and discovered a great new medical term: blepharospasm. Blepharospasm is the repeated, rhythmic contraction of the eyelid muscles. It's most commonly caused by fatigue, stress and caffeine. Check, check, and check.

Apparently, it can get to the point where the eyelids actually close and then re-open, i.e., you blink. Let's hope it doesn't get to that point. I don't want the professors, or fellow classmates, thinking that I'm winking at them. Though, now I have a good excuse for when I'm in one of Dr. F's lectures. "No, I'm not winking at you. I have blepharospasm."

Recognition

Everyone enjoys having their hard work acknowledged. It boosts morale. That's why I think an honor and awards ceremony, like the one held by my school this week, is so important.

As medical students, we live crazy, often unhealthy, lives. It's a life full of sacrifices and one that you have to go through to truly understand and appreciate. With all the time spent in lecture and lab and small group discussions, not to mention the countless hours spent studying, it's easy to lose sight of where you're going. After listening to two distinguished speakers who have been where I am now, however, I feel reinvigorated. I can once again see where my hard work could lead if I just keep at it.

Although the ceremony ran long, as these types of events tend to do, I was pleasantly surprised by how inspirational it was. My class all but swept the awards. Watching the top 5 or so students in the 2nd, 3rd, and 4th years go up for their awards made me want to work harder so that I too could receive one of the big awards (cash prizes are nice, y'all) before I graduate. I guess it was the spark I needed to get my competitive side burning again.

Being surrounded by these amazing physicians and future physicians me realize how much I can and already have accomplished. After all, we made it to medical school and are still here. (And, I was presented with an award (sans cash, but nice plaque) in recognition of my work over the summer. ) As one of the presenters said, "You all get so blinded by the workload and exams and sleepless nights that you can't see how high you're already flying."

Pain

Anyone else out there suffer from chronic pain? Or experience pain on a fairly regular basis?

For well over three months now, I have been been living with pain in my hip and lower back. At first, it was just a mild pain. I was aware of it, but it didn't really bother me much. Kinda like a loud neighbor watching WWE at 1am on a weeknight. He's obnoxious, but not so annoying to make you go next door to ask him to keep it down. Lately, however, the pain has become more of a moderate pain with episodes of severe pain.

Shortly after one of my most recent exams, I made an appointment at the student clinic to see if they could tell me what was wrong. Of course, I'm thinking I have chondrosarcoma or some other ridiculous differential. After taking the history and performing the physical examination, the physician believes otherwise (shocking, I know) and sends me home with prescriptions for an anti-inflammatory and a muscle relaxant.

While I did experience some pain relief after taking the drugs, I had to stop taking them after the third day. Why? Because I kept waking up in a poodle* of drool, face down in my book, page stuck to my cheek. These drugs made me so drowsy, I couldn't get any studying done. So, they had to go. I can deal with the pain.

I blame the pain on medical school. Going through first year, you think you have it rough, but then you get to second year and realize first year was like water-skiing on glass. There seems to be no time to do anything else but study this year. I tried to stick to a healthy diet and exercise plan, but that didn't last long. I wake up, go to school and sit through lectures. Lectures end, I go home or to the library and sit and study. I go to bed, sleep in the fetal position (or at least I fall asleep that way) and my body has been in the same basic position all day. I need to recommit to exercising and eating well because I can't let my health deteriorate.

Also, I think I finally understand the wheeled backpacks. I know, scary! But, I'm just one muscle spasm away from buying one. I'll make it look good, though. I know I will.

* Just noticed that I wrote "poodle" instead of "puddle." LOL

Dr. F

Fetching. There isn't another professor that captures more interest than Dr. F. When he's scheduled to lecture, we all show up to listen. . . and stare.

Everyone's had their own private love affair with Dr. F at some point during the first year and a half of medical school. For some of us, that love affair has never ended. I mean, the man commands attention by simply walking into a room. For starters, the man is Fine: tall, handsome face, great smile, and fit. No one makes a long white coat look better. (Yet.)

Once you get past Dr. F's mesmerizing beauty, you realize that there's substance to match. There is just something special about someone who can engage you in a subject and lead you through a concept in a clear, logical manner. His lectures and PowerPoint presentations match or, dare I say, exceed those of Dr. A, oftentimes clarifying concepts taught poorly by other professors. He is the king of physical diagnosis, providing us with tips on how to discriminate between, say, ehrlichiosis and RMSF. And, he holds comprehensive reviews to make sure we are retaining the information he presents.

Essentially, Dr. F is our dream instructor. Our very own McDreamy, if you will.

Dating II

Now that fall has firmly established itself and the temperatures are consistently low, my classmates are quickly pairing up like tubulin subunits. (Wow. Did I just write that? Well, can't stop now.) I think that classmates are looking for that special someone to snuggle up with during these cold fall and winter nights. You can see these alpha-beta dimers all lined up in a row in the center of the lecture hall -- a microtubule of sorts, lectures and whispers being passed from one end of the row to the other.

It seems these intra-class daters have formed their own little club, some of them even vacationing together this upcoming holiday weekend. They are having fun together, and I wish I could join in the fun.

Dating within the class is working for a healthy number of classmates. The more I think about it, the more sense it seems to make: (1) you have the same examination schedule, (2) you understand the pressures, stresses, etc., (3) you can spend a lot of time together, even if it's spent in class and/or studying.

But what if things go wrong? That question always comes up, right?

Well, I don't know. However, class attendance has dropped precipitously, with attendance being high only for Dr. A-type professors. Therefore, if things don't work out for our intra-class daters, chances are they'll only see each other on exam days and maybe the occasional lecture. Furthermore, now that one of our exams each unit is a customized NBME exam, you really can teach yourself by reading Robbins, studying board review books, and doing practice questions through prep sites such as USMLE World.

I want to be paired up too, but I think there's a mutation at one of my dimer binding sites.

Hypochondriasis

When I started medical school, I told myself that I wouldn't become one of those silly medical students who believes they have every recently learned disease. HA! Who was I kidding?

As we go through the organ systems, there are moments when I'm convinced that I have at least one or two of the diseases mentioned. OK, maybe four or five.

Gee, my hip has really been hurting. I think I have chondrosarcoma. What? My x-rays show no acute pathology? Are you sure?

Gee, I seem to have some discoloration in my skin. . . acanthosis nigricans? Could it be paraneoplastic (yes, it's always cancer)?

And now that I have my stethoscope. . .

Hmm, is that an S3 gallop? No, definitely S4. Maybe I have hypertrophic cardiomyopathy? See, not having enough time to run is a good thing after all .

Hmm, did I just hear crackles? Pneumonia-- no, interstitial lung disease-- no, pneumonia.

Fall

Just as the trees (the deciduous ones, at least) stand naked in the fall after losing their leaves, I feel that I stand bare and exposed when the temperatures drop and the nights grow longer. I don't smile as much. I don't laugh as much. I sleep way too much (that's 7-8 hours for a med student).

Though I love fall weather and fashion (who doesn't love layers?), fall also hails the beginning of what feels like a barrage of holidays. And not just any holidays, but the most hyped holidays of the year -- holidays that you're supposed to spend with your family: Thanksgiving, Christmas, Hanukkah, Kwanzaa, etc.

My mother died on Thanksgiving eight years ago. She was the only family, flesh and blood, that I knew. Every year, the holidays just seem to remind me of how lonely I feel without her. Pair that with the isolating nature of medical school life, and it's obvious why I feel so alone during this time of year. At the core, I'm still just a child that misses their mommy.

In addition to the holidays, the material that I'm currently studying is a reminder of my mother's death. I read about and study the pathophysiology of congestive heart failure and pulmonary hypertension, I hear "cor pulmonale" and "dyspnea" and "ventricular fibrillation," and I can't help but think back to how my mother had to sleep propped up by pillows (orthopnea) and how swollen (edema) she looked the last months of her life. There's just no escaping it.

Today is All Souls' Day, so at church this morning I was again reminded of my loss. However, I was also reminded that I'm not alone in my grieving. We all experience loss during our lifetime -- it's part of being human. It was a comforting reminder.

I'm sure there are others in my class who have experienced the loss of a loved one, and it's probably just as hard for them to learn and, in a way, live through the disease or process that took their loved ones life. In fact, I'm sure there are many medical students and medical professionals who have to deal with a similar situation.

We are not alone. I am not alone.

Trick?

Well, it certainly wasn't a treat.

Not two hours ago, I had two police officers, with guns drawn, at my apartment door asking me to come out with my hands up.

What's your name?

DC Med Student--I'm the tenant in this apartment.

Is there anyone else in there with you?

No.

Were you aware that your door was open?

No.

At this point, my landlord shows up from upstairs and confirms my identity. Apparently, he had heard movement and something drop upstairs when he arrived home from work. He called the police and had them come over to check things out. It doesn't look like anyone was in the house, and there certainly wasn't anyone in my apartment (on the ground floor), though it was kinda weird that my door wasn't locked and fully closed. Needless to say, I haven't been able to fully concentrate on studying since the police were here, but I can't find fault with my landlord's actions.

I live in a neighborhood that is experiencing growing pains from gentrification. And, as has happened in other neighborhoods (and there are many in DC) that have or are going through gentrification, there has been an increase in crime. For example, just last month, the new corner-store across the street which I frequent, was held up at gunpoint -- the two gunmen clearly taking advantage of the fact that this corner-store didn't have bulletproof plexiglass around the counter.

I love my apartment, but lately I've been thinking that it will probably be better to move to a safer area once my lease expires next year. This time, no windows or doors with security bars.

Hope you had a happy and safe Halloween.

Order

I need some order in my life.

While studying this past week, I felt like I was scrambling up a gravel slope, slipping two steps back with every step forward. I had an insane amount of material to go over for my three examinations. It was impossible for me to get through all of it since I had taken some time off (mental health days) to have some fun. My preparation strategy was to first get through the "big lectures," those in a series with multiple parts, and, if I had time, I quickly reviewed the small topic lectures. I also hit First Aid for the USMLE Step 1 HARD.

I didn't like feeling so behind on my studying. The stress was too much. At times, it was paralyzing. I would just look at my long "To Do" list and my stomach would turn. Life became so disorganized. My eating habits were horrible (I haven't had so much McDonald's in years) my sleep schedule was all messed up, and I took to studying in bed, which I'd rarely, if ever, done before. But, that's how bad it was. The stress and panic had lead me to believe that staying in bed would somehow save me valuable time. I slept very little, and when I would wake up, surrounded by my laptop and books and notes, I would just continue working. Insane.

Although I didn't get through all of the material, I still think I came out with a descent grade on these exams (knock-on-wood). It's not that they were easy, but I knew enough of the major diseases and concepts to work my way through the exam. I should get my grades by the end of the week. No matter what, it was worth the good times in NYC.

For this next unit, however, I think I'm going to take the advice of the education counselors and stick to a schedule. Every day, I'll either be in class or studying from 8AM to 5PM, I'll take an hour break for dinner, then continue studying until 10PM, and finally break for the rest of the night. After 10PM, I'll either exercise or prepare meals or catch up on my favorite TV shows. Or-- I almost forgot -- I'll post a new reflection.

We'll see how well I can stick to this schedule. I'm hoping it will lessen some of the stress and cramming that comes along with studying in the days leading up to exams. I'm also hoping that it will allow for guilt-free mental health days when I need them.

NYC

As you know, I was feeling a bit stir-crazy the past couple of weeks, so I decided to take a little trip to the Big Apple. It was the best thing I could have done for myself.

A friend from college met me at Penn Station around 1PM on Saturday, we dropped off my bags at her place, and then hit the city. We spent the majority of the afternoon and evening at the Top of the Rock (Rockefeller Center). The sunset and views from the observation decks are gorgeous! Unfortunately, I forgot my camera, but my friend had her camera and took over 100 beautiful pictures (two shown in this post).

At 8PM, we met up with another friend from college, who treated us to dinner and a night of bar hopping with his friends. We started off at Coffee Shop (Union Square) for dinner and drinks, made our way to Merc Bar (SoHo) for more drinks, and ended the night at Pegu Club (Village/SoHo) for some of the best cocktails I've ever had.

Without realizing it, we stayed out really late. It was past 4AM by the time we left the last bar. NYC is crazy like that. There are tons of people out and about at all hours. You can't help but lose track of time. I can see how it would be very easy to stay up all night. I love New York City!

Now that I'm back in DC, the stress level is slowing rising once again. I have an exam this week and two on Monday. Yes, I've come back to reality -- I'm a med student -- and it's not pretty.

The good news is that I don't think I'm going to be as stressed as I would be had I not made the trip to see my friends. Instead of feeling like I never get to go out and have fun, I have great memories and pictures from this weekend to look back on. I can't help but smile when I think of all the great moments. It makes it easier for me to now focus my energy on studying.

I played hard all weekend and now it's time to work hard.

SNAP!

[WARNING: Grey's Anatomy spoiler ahead]

OK, I just finished watching last night's episode of Grey's Anatomy: The Heart of the Matter. Callie (played by Sara Ramirez) was AWESOME!! She finally let Izzie have it. It was a beautiful thing. Seriously.

You feel terrible? You took advantage -- He was your best friend -- I tried to trust you. So much, I'd convinced myself that it was all in my head -- that I was crazy -- but I wasn't, was I? And then you pulled that thing in the cafeteria today -- It's not bad enough that you humiliate me by getting in bed with my husband, you have to humiliate me at work too. George may be the one who broke his vows, but you. . . We're women, Izzie; you did this to another woman. You took something from me. You stole something from me like a petty little thief. You are the one who should be humiliated. You are the one who should be ashamed. You are the one who should. . .


[Wait for it]


Don't you dare come to me for forgiveness, you traitorous bitch.

Shots

I could have used a couple shots (lemon drops, preferably) before going to the student health center for Tdap and Hep B vaccinations today. I'm such a baby when it comes to shots! I get all nervous and sweaty, and I feel like I have to get to know the nurse a little better before I let her stick me.

I'm sorry, What was your name again?

Oh! Are those pictures of your family?

Those eyeglass frames are great! Are they new?

Oh, yes, I'm sorry, I'm sure you're very busy.

OK, so my arm is going to be sore for a few days with the Tdap?

I'm right-handed, so, yes, let's put that one in my left arm.

OK. . . Yes, I'm ready.

That wasn't so ba-- The other arm, right.

It's so embarrassing, but I can't help it. I can't even look at the injections! I wonder how this is going to play out when I have to administer a shot. I've yet to be in that situation, but I don't think I have a problem giving other people shots. Just keep the needles away from me.

What can I say, I like my shots in a one ounce glass, not a syringe.

Consistency

I received the results for one of my exams from last week. The hard work payed off -- I got the H! It will be another week or so before I get the results for the customized NBME exam, but I'm pretty sure I got the H on that one as well.

Why can't I be more consistent? Why does it seem like I'm always on some sort of roller coaster?

My wish is to find that right balance that allows me to perform well in school, yet feel like I'm still participating in life. Currently, I'm either in multi-slacking (a la Seth Rogen in Knocked Up) or crazed-gunner (a la Hermione Granger in the Harry Potter series) mode. I need to find that sweet spot -- that Tiger Woods setting.

I wish I could, but I can't study non-stop week after week because after a week or two of crazed-gunner mode, I don't want to look at anything related to medical school. And then I fall behind and I'm playing major catch up. However, crazed-gunner mode seems to be the only way for me to get grades in the Honors range.

Friends have suggested a modified crazed-gunner mode, where I still study hard, but take a break every other weekend or so. On these weekends I don't study as much, but meet up with friends and get out for a while. That way I don't feel so isolated or like I'm missing out on life. I think they may be right.

So, on Saturday, I'm off to NYC to visit a friend for the weekend. That means I'm going to have to study hard all week because I'll lose some study time on the weekend. Hopefully, having "scheduled distractions" such as this will help me to feel more balanced and to perform more consistently.

Stir-Crazy

I need to get out! I am so sick of my apartment, my school, the local coffeehouse (which is not so local). I need a change of scenery. I need a change of pace.

Possible getaways before winter break:

• NYC next weekend
• London the week of Thanksgiving
• NYC next weekend

I think I'm leaning toward NYC next weekend. Heck, maybe I'll do both. I've been meaning to visit a college friend in London for 4 (5?) years now. It would be a great-crazy-fun thing to do.

Out

Twenty years ago today, the first National March on Washington for Lesbian and Gay Rights was held. That day is probably best remembered for the inaugural display of the NAMES Project AIDS Memorial Quilt. One year later, October 11, 1988, the first National Coming Out day was observed to celebrate the March one year earlier. I was just a toddler at time.

For me, coming out has been an ongoing process since my junior year of college. It wasn't difficult for me to accept, but I found it hard to tell that first person. How was one of my best friends going to react? The fear of rejection was strong, but I knew that if I was going to continue in these friendships, I needed to be completely honest and open. I needed to be my whole self. Thankfully, that whole process was very positive.

My experience as an LGBT medical student has been mixed. I was out on my medical school applications and was asked about an LGBT group I was involved with in undergrad during one of my interviews. Some LGBT students choose to hide this kind of information on their applications, but I decided I didn't want to be at a school that didn't want me.

Once I decided to attend my current medical school, I set up a meeting with a faculty member to address some of my concerns about being an LGBT medical student. Did the medical school have an LGBT group? What were LGBT students' experiences like during the clinical years? Was being openly LGBT going to negatively affect my medical education experience? The faculty member's advice was, "It shouldn't matter, but I would just keep it a secret -- like don't ask, don't tell."

I've had several uncomfortable experiences during lectures, where a professor will tell a joke at the expense of the LGBT community. Most in my class laugh, some have no visible response, and some, like me, have that "I can't believe they just said that" look. Do I say something then? Do I confront the professor after class? Do I send them an email telling them I thought their joke was inappropriate? I end up not saying anything because (1) I don't want to come off as hypersensitive and (2) I don't want to be singled out. I already feel like I don't really belong, so why add to that feeling.

I'm out to all of my friends at school, which was a must. I don't believe you can really know and trust someone if you're hiding something. You're always going to keep some distance, which is not what I want in my friendships. As for others in my class? Some have asked me and I've answered affirmatively, but it's not like I've made an announcement. There's no need for that.

Basically, I'm just trying to live an open, genuine, authentic life. I've been doing it since my junior year in college, 7 years ago, and I don't see why I should have to stop now.

Time

If there's something everyone can relate to, it's not having enough time. In medical school, I've found that there's never enough time for sleep; never enough time for exercise; never enough time for grocery shopping; never enough time for errands in general; never enough time for friends; never enough time for family; never enough time to do all the required reading; never enough time for study and review. Yet, somehow, I manage to keep up this blog. . .

Today, I barely had enough time to finish the Customized NBME Exam. We were told that the clock in the upper right hand corner of our screen would not be the official amount of time we had. They, the professors, were giving us 30 additional minutes.

Uh huh. Right.

I was so nervous about this exam, I wasn't taking any chances. I would finish the exam before the clock read 0:00:00. I was slow at first. It took me a good half hour to adjust to looking at the monitor instead of having a paper exam that I could take notes on or circle/underline "buzz words." But I picked up some time on some easy questions and finished the exam with 0:02:17 to spare.

Unfortunately, many of my classmates didn't finish before the "unofficial time" ran out. When the clock read 0:00:00, it locked them out of the exam and they could not finish. Minor technical difficulty. The professors and IT people were working over the phone with the NBME people, but they couldn't come up with a solution.

So, what happens to those who couldn't finish? It's unclear. Of course, the rumor mill is working overtime. I've heard everything from "I'm sure they'll get to finish sometime later this week" to "They'll just have to eat those points" to "They'll have to take the whole exam over again" to "Everyone is going to have to take a NEW exam."

Thanks to my mad studying, I think I did OK -- I don't want to take another exam. But bottom line: I don't have time for this . . . nonsense.

Wave

I lost control of bowel movement this morning. Squeeze your external anal sphincter tight and take a look at this article from CNN.com. That is one GIANT wave. Something I never want to see in real life.

And here I was, dreading my upcoming exams as if they were giant waves about to crash upon me. Chil' please! People are losing their homes, their businesses, their schools, their communities, their lives.

I will continue to work hard over the next two days and will gladly take the fourth set of second year medical school examinations. It's a privilege, not a natural disaster.

Dr. E

Erotic. From the moment she walked onto the stage, you knew that Dr. E was going to have some fun. She was all smiles and had a bounce in her step.

"Good morning, y'all!"

[Students half awake] Good morning.

"How many of you know about spoken-word? . . . Well, I'm a poet -- Oh, you want to hear one of my poems before we begin? OK, we're all adults here, so I can share."

Clearly, Dr. E wanted to share one of her poems with us. And, as soon as we heard the "we're all adults" line, we knew it was going to be good.

Dr. E proceeded to share with us one of her poems. I don't remember the words exactly (and I'm not about to go back to the audio), but she mentioned heat, desire, seduction, biceps, hamstrings, gastrocnemius, a king and a queen -- and I think there was something about crawling on all fours. Dr. E needs some sexual healing -- stat! (Stat. Is that word ever really used?)

The poem was hot! OK, so it really wasn't that hot -- I mean, who wants to know about their professors sexual fantasies? But, she got our attention and gave a good lecture.

And besides, nerds need love too.

NBME

The acronym has been thrown around a lot during my second year of medical school: "You have to study hard for your NBMEs," "Forget about the LCME, it's the NBME you should worry about."

So, what is the NBME?

The NBME is the National Board of Medical Examiners. Founded in 1915, it's the independent, not-for-profit organization that provides nationwide examinations so that medical licensing authorities have a standard they can use to judge candidates for, well, medical licensure. They're the nice folks that make second year hell. How? With administration of the USMLE (United States Medical Licensing Examination) Step 1 at the end of the second year of medical school. This sole exam determines whether you have the option of going into competitive specialties such as Plastic Surgery, Dermatology and Radiology, or are limited to a primary care specialty such as Family Medicine, Pediatrics, and Internal Medicine. Believe me, I'll be writing about Step 1 hell come April.

So, why am I bringing up the NBME now?

On Tuesday, I will be taking the first of six "Customized NBME Examinations." Beginning this school year, the NBME is offering 40 medical schools the opportunity to administer these web-based examinations to their students. My medical school choose to participate, making each Customized NBME Exam count for roughly 40% of my grade each unit. Since this has never been done before, I'm a bit nervous.

The process is as follows: (1) faculty sends NBME list of topics, (2) NBME sends faculty pool of questions related to topics, (3) faculty selects questions from pool, (4) NBME produces examination, (5) faculty reviews examination and makes any changes, (6) final examination produced. About a week later, students take the examination either in the computer lab or a lecture hall (a program has been installed on our laptops). Each student will get the same 100 or so questions, but in a unique, random order.

I'm looking at these new exams as a positive change. Clearly, the major benefit is that I will be very familiar with the format of Step 1 by the time June rolls around. I'll also be familiar with the style of questions asked on Step 1. Another clear benefit is that I won't have to deal with poorly worded questions written by faculty, or questions with multiple answers that are subsequently dropped. Also, I think it will be good for the faculty because they'll actually see what topics they should be focusing on in lecture. The pool of questions sent by the NBME will make it evident. If there are a lot of questions on Topic A and few on Topic B, but Dr. B spent most of his time on Topic B, then maybe he'll change that next year. (One can dream, can't they?)

Grades may dip on this first Customized NBME Exam because of the new online format and vignette-style questions with images and lab reports -- not to mention possible problems with computers and the internet connection -- but my hope is that overall we'll do well. And come June, when I break 240 on Step 1, I think I'll be grateful for these NBMEs.

Stay

One week from today, I have my second exam for the unit. Since I failed the first exam, I've been working my butt off, not just to pass this exam, but to get honors.

Around midnight last night, I decided to take a break and treat myself to some television (a.k.a abc.com episode player). I could have used some sleep, but I knew that watching the season premiers of Grey's Anatomy and Ugly Betty and the series premier of Private Practice would lift my spirits. And, for the most part, my shows didn't let me down.

[Warning: spoilers follow.] Grey's Anatomy had the weakest episode. What was up with Izzie and the deer? Stupid. Disappointing. Ugly Betty got me, though. I was like, "What? Santos didn't die at the end of last season?" But alas, at the end of the episode we find Hilda alone in her bedroom. Sadness. Private Practice was the winner. That cast is so easy on the eyes! And I just love Addison. Overall, a good TV fix.

I love the drama of the relationships on these shows. (Probably due to the lack of a relationship here.) Whenever there's a "Pick me! Choose me! Love me!" scene I always hear Bette Midler singing "Stay With Me" in my head. Throughout the seasons it could have been Izzie singing to George; Callie to George; Meredith to McDreamy; Addison to McDreamy; McSteamy to Addison; Preston to Christina; Christina to Preston; Betty to Henry; Hilda to Santos...

In case you don't know the song, I give you the Divine Miss M, Bette Midler, performing "Stay With Me." If you aren't feeling Miss M in this performance, check your pulse.

Reverence

Sometimes you just need to step back and look at your situation from a different perspective.

Last weekend I saw a fantastic film: In the Shadow of the Moon. I highly recommend that you go see it if you haven't already. It's a documentary about the Apollo space missions, launched by NASA between 1968 and 1972. The never-before-seen footage was amazing -- incredible!

Alongside the NASA footage were stories directly from the astronauts. I truly enjoyed watching and listening to them as they described what the experience was like for them. One of my favorite astronauts was the eloquent Jim Lovell. He was able to express with such clarity the epiphany he had in space -- that of connection to everything in existence. We're all just a bunch of atoms, after all. He added:

Just from the distance of the Moon you can hide the Earth behind your thumb, everything that you have ever known; your loved ones, your business, the problems of the Earth itself, all behind your thumb; it makes you consider how insignificant we really are; but then how fortunate we are to have this body and to be able to enjoy living here amongst the beauty of the Earth itself.

What Lovell said struck a cord in me because I had a similar experience during college. The more I learned about biochemistry and molecular biology, the more I grew in awe of Life.

[Leap]

During this Sunday's sermon, "The Practice of Reverence," Rev. H, defined reverence as "fundamentally, a deep respect; an attitude of awe and wonder and gratitude for something of high or ultimate value." As soon as he said this, I realized that this is partly what lead me to medicine.

The complexities of the body (how it develops, how its organ systems function, how it processes food, how it fights infection and disease, how it can turn against itself, etc.) are fascinating to me. I know I like to complain at times about the lack of sleep and social life during medical school, but when I really dive into the work and I'm "making the connections," I feel fortunate. I get to see and understand a whole other world that allows me to feel connected, on some level, to everyone around me. We're all the same; our bodies are all made up of the same stuff.

Rev. H, closed his sermon with the following quote by Henry David Thoreau: "Pursue some path, however narrow and crooked, in which you can walk with love and reverence." I believe that medicine is that path for me.

SAD

Syndromes, disorders. . .

Another late night alone.

Deciding: Books? Bed?

SOB

Studying late night --

On a Friday night, no less --

Because of “Honors.”

Security

Over the past several years, security has increasingly become a top concern at many of our nations institutions of higher learning. The administration at my medical school is "struggling to implement" measures that will create a safer environment for its faculty and students. Although we've been assured that changes have been made to make us safer, not much has been done as far as I can see, with the notable exception of the keypad locks on the study room doors. They say their biggest challenge is limiting access to the buildings, which are pretty much wide open to anyone in the community, while maintaining ease of movement between the the buildings by students and faculty. Personally, I feel they don't want to spend the money to hire more security staff.

Recent updates from the campus police have warned of an middle-aged man in dark clothing trying to steal unattended laptops and other electronics from lecture halls and study rooms. I've been studying A LOT at school this week (y'all know why), so I've been on the look out for this creep. I'm not going to lie: it's scary being here late at night with no one else around. Most of the time, the only sound is the air conditioning system and the crickets, which seem to have taken up residence here over the summer. Does the security guard (yes, I've only ever seen one at the front desk at night) ever come around to check on the lecture hall? No.

Not one hour ago, I saw a suspicious looking middle-aged man walk into the lecture hall. He didn't look familiar, but he may have been a student from another program looking for a place to study. Then again, from the look of his drawstring backpack, I doubt there were any heavy textbooks in there. He looked around the hall, took some leftover food from an early student meeting, and left.

Could this have been the creep described in the campus police alerts? Should I report the guy? Would security do anything about it?

If I see the guy again, I'll move over to the library, which is probably one of the more secure buildings on campus (you must sign in with university ID). On my way out, I'll interrupt the lone guard's TV watching by telling him that the creep may be in the building. For now, I'll just keep an eye out and hope that another classmate shows up to keep me company -- I've got to get these neoplastic and proliferative disorders of the hematopoietic and lymphoid systems down!

Interviews

The interview season has begun at my school. A dozen or so sharply dressed aspiring physicians (not so fast) medical students can be seen touring the school a couple times a week. And I know they probably don't like to hear this but: They look so young! Of course, part of that has to do with the fact that I'm about a decade older than they are. OK, maybe not quite a decade -- but it feels like it!

I remember my medical school interviews well. I'm not sure if I was lucky or what, but all of them went smoothly. No horror stories here. Most of the questions were along the lines of: Tell me about yourself?;Why do you want to pursue a career in medicine? Why this school? Tell me about your current work (non-trad here)? What are your weaknesses? Do you have any questions for me? I had prepared for all of these questions, as should you if you'll be interviewing this season.

Preparation is the name of the game. For all of you interviewing at medical schools this season, here are my top 5 tips for successful interviewing:

1. Mock Interview. Mock interviews were available at my undergrad institution. You should ask your pre-med adviser or career services office if they offered mock interviews. If you've graduated and are working, ask a supervisor or co-worker to conduct one for you. Make it as realistic as possible. The point here is that you want to practice sitting in the hot seat. This is where you want to make mistakes and learn from them, not during the real thing.
2. Travel. Try to get into town the day before your scheduled interview. Take the time to make sure you know how to get to the school. It may be worth it to stay at the recommended hotel, especially if there's shuttle service to the school. You can also spend the extra time exploring the social activities in the area.
3. Be punctual. It's actually best to arrive about 10-15 minutes early. There's usually some form or forms you have to fill out. It'll also give you time to preview the packet of material that the admissions office gives you.
4. Dress Conservatively. You want to look the part of a physician when you go in for your interviews. These aren't folks who appreciate the latest fashions. So, stick to navy, gray, or black solid or pinstripe suits with a white shirt/blouse. Simple ties, gents. You don't want anyone asking or thinking, "What are you wearing?" [Watch first 25 seconds] On one of my interview days, there was a guy in a black leather jacket just like the one worn by Joe Pesci's character in My Cousin Vinny. Being French was no excuse. The jacket made him stand out, and not in a good way. You don't want to be remembered for what you're wearing, but rather by who you are -- your talents and personality. Oh -- and make sure buttons are buttoned and/or zippers are zipped. (Yes, speaking from experience on that one.)
5. Be nice to EVERYONE. From the secretaries in the admissions office, to the students leading the tour, to students that may come talk to you, to the person conducting the interview. You want to be professional and nice to everyone. Even if during the interview you're asked a question that seems too personal or is on a taboo subject. It's best to play it off with humor or maturity than getting angry or upset. Remember, many people vote on your admission. Students (those that lead the tour) and admissions office staff may eliminate you from the pool: "No, that guy was crazy! Did you see the leather jacket he was wearing?" Faculty (those that interview you) can get you in.
   

Good luck! And remember, luck is just "preparation meeting opportunity."

eDoctor

The New York Times Health section (just added to "Favorite Medical Timesucks" in the lower sidebar to the right) always has some great articles, and usually there's at least one article that relates to something I've learned in class. Other times, there's an article that catches my attention because it deals with how physicians are practicing medicine today.

Almost two years ago I came across the article "For a Retainer, Lavish Care by 'Boutique Doctors.'" The article takes a look at the trend of "concierge" medicine, which, according to the Times, debuted in 1996. In this type of practice, patients pay an upfront cash fee of roughly $2,000 each year to have 24/7 access to their primary care physician via telephone, email, or same day appointments. The physicians carry a smaller patient load, allowing them to make thorough physicals, take extensive histories, and basically spend more time with the patient. When problems arise, the low patient load allows the physician to focus on the problem and coordinate patient care with specialists. It's an interesting concept. Kinda how medicine use to be. However, I can see how it only adds to the inequities in American health care.

Today, I came across this article via the Times' Health Around the Web section about a young doc named Jay Parkinson, M.D., in Brooklyn that wants to be your eDoctor (if you live in lower Manhattan, that is). That's right, he has no office! Most of your interaction will be over email, text, video conference or telephone. He'll only take you on as a patient after you complete an application on his website. Oh yeah, you must be 18 to 40 years of age and healthy -- "no old-people diseases." His focus is preventative medicine, which I think is a good thing. He's looking to take on about 1,000 patients and has a yearly cash fee of $500. It's a unique concept for a practice to say the least.

I don't begin my clinical years until next year, so I don't have any first-hand experience from the "physician" end. I have, however, had plenty of interaction with the health care system from the patient's perspective: waiting for hours in the waiting room, assistants taking vitals and drawing blood, and then spending 5 minutes with my primary care physician. I asked him, my PCP, on more than one occasion if he enjoyed his job (he was a relatively young doc and we had a good relationship) and he said he did.

I don't think I would enjoy practicing medicine in an environment where I only had 10-15 minutes with a patient. I just don't see how that's good for either patient or physician. As a patient, I could sense when my PCP was rushed -- he always seemed behind schedule, so I didn't always tell him everything that was going on or didn't ask questions when I wanted to. As a physician, I think the constant pressure of seeing as many patients as possible to keep a practice afloat would wear on me. I could see myself in a practice along the lines of "concierge" medicine, but I think I would feel wrong doing it. And I don't know what to think about young Dr. Parkinson. Hmmm....

[Update 9/23: NYT article on "Doctor Delivery." Like pizza or chinese food, a doctor's just a phone call away.]

Failing

It's one thing to study hard for and subsequently fail an exam. Perhaps the material was exceptionally challenging for you. Fine. You get help, change your study methods, move on to the next exam. It's quite another -- stupid really -- when you just didn't prepare well enough.

I didn't prepare well for my exam this week. It's as simple as that. As I was expecting, I did not do well. In fact, I failed by 4 points (66 -- yes, why not just put it out there) -- a "High Fail" as a classmate would say. It doesn't feel good, but there's no one to blame but myself.

Last week's procrastination was a textbook example of self-sabotage. I'm not exactly sure why I had such a hard time getting to my work, but, at the time, I knew it was a problem. One of my impulse buys on Wednesday or Thursday was a self-help book: Self-Discipline in 10 Days: How to go from thinking to doing, by Theodore Bryant, MSW. It coincidently arrived today, shortly after I received my score. I've only read Part One, but already I have a good idea of what my mental blocks are. Don't worry, hon. I'll write all the juicy details in a future post.

For now, perhaps a little tease: (1) At times I tend to have a very negative internal dialog, (2) I think I have a Fear of Success.

So, I will be working on that to avoid repeatedly shooting myself in the foot. There's one more major exam in this unit and I'm confident I can pull my grade up. I've done it in the past, and I'll do it again. However, some things are going to have to change, principally, no more staying home nor going home to "study" after class. It's the library and lecture hall for me. I'm putting myself on lockdown.

Now, some of you may be asking, What happens if you fail the unit?

At my school, you're allowed to sit for a retake examination for that unit at the beginning of the following semester or at the end of the school year. I believe you're only allowed to sit for two retake examinations, so if you fail three units (integrated blocks) within a semester, you can only make up two. If you fail the retake examinations, you have to do summer school, an extremely condensed version of the unit (up to 2 -- so if you need to make up 3 units, you're out) and then sit for a cumulative exam. If you fail that, you are asked to leave.

Once you're asked to leave, you may petition to repeat the year, but I believe it's difficult because you have to wait for a spot to open. Recently, the class sizes have increased a tad, so there are very few spots available for students who need to repeat. Once you begin again as a repeating student, however, summer school is no longer an option. If you fail the retake examinations, you're out for good. But, you see that you get to make about 5 attempts before they kick you out.

Medical schools want you to succeed, so there should be an "Academic Support" department available to you. Use it! Early and often! Even if you're doing OK, but want to be in the top 10. They can give you strategies that may help improve your academic performance. Their favorite tip (and my least favorite): make a schedule.

[P.S. I just took a look back at the Failed post. Looks like "near future" = a little more than a month. Gotta love med school.]

Dr. D

Drones. And, not only that, his drone's in double-time (yes, it's possible). Think bored micro machines man. This is why I could not attend his lectures the past couple of weeks, where he was scheduled for an unprecedented 14 hours. I believe that was a first for any professor thus far in my medical school career. I could take him for an hour here or there, but 14 hours over 4 days was just too much. I can't type or process information that quickly.

To make matters worse, was the material: skin AND musculoskeletal pathologies. Can you imagine the assault? Seborrheic keratoses, acanthosis nigricans, keratoacanthoma, actinic keratosis, dermatofibrosarcoma protuberans, dermatitis herpetiformis, osteogenesis imperfecta, mucopolysaccharidoses, osteoporosis (OK, something I recognize), osteopetrosis (didn't you just mention that? Oh, osteoPETrosis), osteoma, osteoid osteoma, osteoblastoma, osteosarcoma, osteochondroma, chondroblastoma, chondromyxoid fibroma, Ewing sarcoma, giant cell tumor, osteoarthritis, rheumatoid arthritis, juvenile rhematoid arthritis, seronegative sphondyloarthropathies. . . the list was endless.

How I managed to retain any information about a fraction of the pathologies presented is a mystery (miracle?).

In all fairness, though, Dr. D cared that we had all the information we needed not only for this latest exam, but for the boards. His PowerPoint presentations were very organized and during lecture, he gave examples of the types of questions he would ask for some of the main pathologies. The problem is that you had to slow down the audio to catch that.

Dr. D wrote a good portion of the questions on my exam this week. As I was reading the questions, I could hear him saying the key phrases, but I couldn't remember which of the hundred or so pathologies he was talking about. If only I hadn't procrastinated so much the week before the exam. . . It's just so hard to be "on" all the time. I'm not looking forward to receiving the score on this one.

Crock-Pot II

During medical school, you don't have a lot of time for a lot of things, including meal preparation. As, hopefully, you've read, I recently got over my fear of using the slow cooker. Besides it not having a light that tells me it's working, I have only positive things to say about it. It's quite the time-saving aide in the kitchen; it makes a lot of food; it's easy to clean; the food turns out yummy! (Thus far.)

Last week, I made my favorite dish in the world. Chicken cacciatore is the ultimate comfort food for me. I can remember watching my mother in the kitchen making this dish and asking me, her sous chef, to taste along the way for quality control.

My version last week was not my mother's cacciatore, but it was good nonetheless. Below is my super-simplified slow cooker recipe for chicken cacciatore.

CHICKEN CACCIATORE*

You'll need:

• One jar Italian tomato sauce, such as "Tomato Basil" or simple marinara sauce
  
• 1 medium onion, chopped
• 1-3 cloves of garlic, to taste, minced (2 was just right for me)
• 1 medium green bell pepper, chopped
• 2 packs (10 pieces total) chicken drumsticks (you can used thighs or breasts), skin removed
• One 6-8 ounce pack of fresh mushrooms (white button or baby portabella), quartered or leave whole
  
• 1 bay leaf, snapped in two
• Salt and pepper, to taste
  

Layer half the tomato sauce and all of the onion, garlic, bay leaf, bell pepper, and chicken in the slow cooker. Season with salt and pepper as you go. Toss the mushrooms on top and cover with the second half of the tomato sauce. Cover and cook until the chicken is tender and cooked through, 3 hours on "High," or 6-7 hours on "Low." When ready, serve over rice and enjoy!

(If you want to get fancy: once cooked, transfer the chicken to a plate or two. In a small bowl, whisk together 2 tablespoons each of flour, water and/or wine from that opened bottle on your counter (you know it's there) until smooth. Stir into the sauce in the cooker and turn to "High," cover, and cook until thickened, 10-15 minutes. Pour sauce and veggies over the chicken on some rice -- Yum!)

* Modified from Beth Hensperger's Not Your Mother's Slow Cooker Cookbook, 2005.

Procrastination

Ugh. . . It's kinda bright out for 6:30. . . 9:00?!?. . . How did I sleep through both alarms?. . . Maybe this is a sign I should stay home today. . . Yes, I'll stay home and catch up on reading and listen to the audio later.

I should start with a good breakfast. . . What should I have?. . . Cereal?. . . Oatmeal?. . . I could make an omelet. . . Didn't I buy blueberries the other day?. . . Oh yes, there they are. . . Cereal and blueberries it is.

I wonder what the headlines are this morning. . . Poor Britney. . . Sen. Craig, give it up already!. . . O.J., what's your problem?. . . Every woman flying Southwest should wear a tank, cami, or halter top. . . Ooo, nice tie Sanjay. . . Kathy G won an Emmy??. . . You go girl!

Hmmm. . . I wonder what her tour schedule looks like. . . She's in DC next week??. . . Kennedy Center!. . . Sold out??. . . NOOO!!. . . Show added at Constitution Hall?. . . Yes!. . . Doh!. . . Only single tickets left. . . Oh well, guess I'm going solo. . . Confirm purchase. . . EEEEE!!!. . . Kathy G next week!!!

Any new Kathy G clips on YouTube? [WARNING: clips may not be appropriate for work or children]. . . "Kathy on Ellen". . . Kathy was on the Ellen DeGeneres Show?. . . I thought she was banned from Ellen. . . "Kathy Griffin on Oprah and Weight". . . "Kathy Giffin on Ryan Seacrest". . . Hilarious!!. . . Yikes!. . . It's noon already?. . . I should start studying!

Well, first let me check on my blog stats. . . Nice!. . . Traffic is growing, slowly but surely. . . Who knew "dating a medical student" was such a hot topic?. . . Hmmm. . . Maybe I should write another dating post. . . I do know I need to edit some of these sidebar elements. . . Those aren't even my interests anymore. . . I should change that now, while I'm thinking about it. . . And they should all link to their respective AAMC Careers in Medicine specialty pages. . . Ah, that's better. . . Now let's add some more resources. . . and more med school blogs. . . There. . . Much better.

Let me see if there are any new posts on these blogs. . .

------------------------

I go on like this for hours. News. Impulse shopping. Blog reading. "Planning a study schedule." My procrastination level this past week has been ridiculous. You have no idea. And with exams coming up, this is bad news. Seriously.

Drugs

If I could learn the drugs, I would be a rock star. Instead, I'm more like Britney at the MTV Music Awards -- my chances of honors {poof!} disappearing into thin air.

Yesterday I reviewed my last written examination. I missed the vast majority of the pharmacology questions. I was able to answer general pharmacokinetic and pharmacodynamic questions, but when it came to having to choose a specific drug, I bombed.

The names all look the same to me. Ampicillin, Azithromycin, Cephalexin, Ciprofloxacin, Oxacillin, Doxycycline, Piperacillin, Ticarcillin, Capreomycin, Streptomycin, Isoniazid, Vancomycin, Rifampin, Albuterol, Metaproterenol, Propranolol, Terbutaline, Scopolamine, Doxazosin, Prazosin, et cetera. I just can't seem to remember which does what and how, and its toxic effects. There are just too many of these drugs for me to remember.

Drugs are Pharmacology is my weakness and I'm going to have to work on that for boards and, well, just about every exam I have to take this school year. Perhaps making my own flashcards instead of using Brenner's will help?

iPod

The second year of medical school is proving to be more difficult than the first for me, so I'm trying anything and everything to boost my grades. Last week, I decided to try something new. I'd been hesitant to do it in the past because it just seemed so wrong. However, the wannabe gunner in me blasted through the hesitation, and, on Tuesday, I started downloading the audio from lectures onto my iPod. Blasphemous, you say? I know! But it had to be done.

Now, I listen to part of a lecture whenever I walk to school, the grocery store, church, wherever. Whenever I'm home, cleaning or cooking, I'm listening to lectures. It's sad. Kinda breaks my heart. But the strategy is working!

On Monday, we had a quiz. I was rather worried because I had taken three days "off" last week, staying at home instead of going to class (I'll tell you why next "Dr. post"). I didn't really look at the PowerPoint presentations much and I'd done very little of the reading. However, I had been listening to the audios. Quiz result: 93. That's a huge improvement over the 67s I was getting on these irritating "pop quizzes." Every point counts, so I'm happy to have started off this new unit on the right foot.

Listen, I know the iPod is suppose to be all about fun, but, with results like that, the listening-to-lectures-on-the-iPod study technique is here to stay.

Remembrance

For much of 2001 I was away from college on a medical leave for complicated grief. I was staying out west, trying to put my life back together. On the morning of September 11, 2001, I received a call from a good friend on the East Coast. "Turn on the TV -- the news," was all he said. I gradually made my way out of bed and turned on the television. I could not believe the images I was seeing. I stood there, in front of the television. Frozen. Crying.

Whenever my friends and I tired of the wilderness during college, we would drive to one of three major cities: Montreal, Boston, or New York City. NYC was my favorite. In 2000, on one of these weekend getaways in the City, I purchased a photograph from an artist near Times Square. The black and white print has the Brooklyn Bridge in the foreground, the Twin Towers in the background. Today, that photo hangs in the hallway of my apartment as a reminder of all the gifts I have been given, especially life.

I share the sentiment expressed by Oprah in the "September 11, 2001" segment on Disk 4 of her 20th Anniversary DVD Collection. The following is an excerpt.

Every single day that is offered to us, is offered to us in grace, and you have to take it and seize the moment. . . . There's not a morning when I put on my shoes-- There's not a morning when I get dressed, when I brush my teeth -- There's not a morning I don't think about it. Every one of them did the same thing that I'm doing right now. Every one of them. And they never came home. So, I feel I owe them. I feel I owe them and everybody else who's come before me the best that my life can offer. That's what I got from September 11.

I will never forget.

Church

Today was Homecoming Sunday, the beginning of a new year at my church, and it offered the perfect opportunity to get back on my spirit-growing journey. It had been months since I last attended a service, and I was beginning to feel a bit guilty (that residual Catholic guilt just won't go away).

As always, I was greeted warmly, today by both the senior and associate ministers; the music gave me goosebumps it was so beautiful; the sermon got me thinking; I left with a greater sense of peace. It felt good to be a part of the community again -- to feel like something other than a medical student. And it was also great to be a part of such a diverse group: young, old, white, black, Asian, Hispanic, gay, straight, male, female and everything in between, in all sorts of combinations. Truly a rare gift in this city.

Today's reading and sermon made me think about a lot of things that I won't go into here. I'll spare you. But, I thought I would share the reading, a poem, with you.

"Late Fragment"

And did you get what
you wanted from this life, even so?
I did.
And what did you want?
To call myself beloved, to feel myself
beloved on the earth.

- Raymond Carver

All New

It's September, and to me that means only one thing: All New! That's right, all new seasons of my favorite television programs.

Now, as you may know, television and I went our separate ways years ago. Actually, I had to let her go since I'm a TV addict and there was no way I was going to get into medical school with TV as a distraction. Yes, it was that bad.

For a while, the No-TV Plan was working. I got through the hell that is the medical school application process; I was reading more; I was exercising more; I was participating more in life. Then I entered medical school and the workload took over my life. But then around halfway through the school year, I discovered ABC.com's Full Episode Player. And it was over.

I was instantly hooked on Grey's Anatomy and Ugly Betty. LOVE THEM! (OK, I'm getting a little too excited over here.) I caught up on all the episodes that I missed, and then every week I would wait for the new episodes, which, unfortunately post around 2 a.m. the night/morning after they air. And of course this year, we have Private Practice to look forward to. Oh, I can't wait for all the drama! September 27th. Mark your calendars!

And then my Oprah -- yes, my Oprah -- kicks off season 22 of The Oprah Winfrey Show this Monday, September 10, at NYC's Madison Square Garden, the only place suitable for the grand event. If I could just get a ticket to one of her shows. . . It's an obsession people.

Dr. C

Curses. Did Dr. C really just say what I think she just said?

Her lecture was dry and was running a bit long. We all had started shifting in our seats and many were surfing the Internet and/or chatting over AIM. How were we going to survive another hour of Dr. C?

Our schedule allows for a ten minute break every fifty minutes. Of course, professors often run over their allotted time and trim the break down to five minutes. As students, we don't mind when a great professor eats into our break time. As long as we're learning, we're happy. However, when a dull professor tries to do the same, we attack.

"Excuse me Dr. C," shouts a student from the rear of the lecture hall, "it's time for our ten minute break."

"No, I'm going to continue; I'm almost finished."

"But Dr. C, you have another hour -- Could we please take a 5 minute break?"

I don't think Dr. C heard this last request. All she heard was the grumbling throughout the lecture hall, and she wasn't pleased. This was her response, "Look, if you went to the grocery store and bought a loaf of bread and the cashier only gave you half a loaf, you would say, 'B-I-T-C-H, where's the rest of my bread?'"

We all just looked at each other and started laughing. Was she serious? From the look on her face, she was. We let her continue, and she finished the presentation 10 minutes later.

"Now you can have your damned break! All this break nonsense is a bunch of bovine defecation."

Bovine defecation? LOL! Well, at least she didn't use the S-word.

It turned out that Dr. C didn't know she had two hours and did not have another presentation for us. So, after a few tense moments and some laughs, we enjoyed a damned good one-hour break.

Endurance

I pushed myself hard, both physically and mentally, this weekend, and I've concluded that I really need to work on my endurance.

The bike ride through Rock Creek Park Monday morning was wonderful. It was meant to be a short, one hour ride, but it turned out to be more like four! I was just having too much fun with my friend, whom I hadn't seen since early June. I had a strong suspicion this might happen, so I brought some study materials with me (I had to, what with exams yesterday!) so that I could quiz myself during our half-way-point break.

What caught me by surprise, however, was how fit my friend had become since we last got together. Or was it how unfit I'd become after a year of medical school and a summer in front of the television? I couldn't keep up with my friend. My quads were burning; I was sweating buckets; I was huffing and puffing like The Little Engine that Could.

When I got home later that afternoon, I was thoroughly exhausted. There was no way I could study for my exams the next day, so after cooling down and showering, I took a nap.

An hour later, I was back at my desk (a dining table, once upon a time) ready for a final review of all the material to be covered on my exams. After about an hour, I could take no more. I kept taking breaks and trying to come back to material I was having trouble with, but I just couldn't study anymore. I went to school, hoping that I would get a second wind from the study-all-night-before-the-exam crowd. No such luck. At 9 o'clock, this little engine went back to the depot.

Besides being tired and dehydrated from the bike ride, I think part of the problem was that I kept thinking of all the fun I'd had over the long weekend. I was missing out on a lot of fun because of all the studying I have to do just to stay in the middle of the pack at school. Is medicine worth it? I've been asked, and ask myself the same question from time to time. Honestly, I don't know. I hope so! Only time will tell.

In the meantime, I need to keep working on the whole "balance" thing. I've mentioned before that medical school is like a marathon. I have to pace myself; I need to build endurance. Otherwise, I'm going to end up burned-out and miserable.

Labor

Laboring on Labor Day. As Chris Rock would say, That ain't right! I should be poolside, at a cookout, drinking iced tea and lemonade. Instead, I'm up at an ungodly hour (though, it is nice and peaceful) trying to learn cramming as many details as my tired brain can hold for exams tomorrow.

It isn't all work and no play, however. In a few hours, I'll be meeting up with a friend for a quick bike ride through Rock Creek Park. Riding through the park is one of my favorite things to do. You can spot deer, all sorts of birds, and fish (especially when they return to spawn); it's so green and lush; the sound of the creek is soothing. The ride will be a nice break.

I hope you've enjoyed the long weekend. Happy Labor Day.

Laughter

Tonight I had dinner with three friends from college. Although I have two exams on Tuesday, I took the break because it is so rare for all four of us to get together. You see, two of us are in medical school here in Washington, one just moved to the District from Philadelphia for law school, and the other was in Baltimore working on an MBA/MPH and is now working in New Jersey. As you can imagine, coordinating our schedules is quite the challenge.

We met up near the National Zoo on a little strip packed with restaurants. We walked up and down the block, carefully reviewing each restaurant's menu, before selecting a Japanese restaurant. Perfect. I love sushi, and I had my eye on the Chilean sea bass with miso and shitake mushrooms.

We caught up, enjoyed our food, shared some laughs. The waiter arrived to clear our plates, looked at our licked-clean plates and said, "Good job!" We burst out laughing. It was so unexpected and there was something about the way he said it -- he seemed so surprised. One of my friends was laughing so hard, she was having trouble swallowing the water she had been drinking before the waiter's comment. Of course, I tried to make her laugh even more. I could just see the water spraying all over the table. I know, aren't I nice. It didn't work. She somehow managed to calm down enough to swallow the water.

From that point on, we were laughing at everything. We laughed so hard I think we burned off most of the meal's calories. I'm sure everyone around us thought we were insane. For some reason, this always happens whenever we get together. (Yes, both the laughter and being perceived as insane.) I'm glad it does.

Medical school is intense and stressful -- especially during the days leading up to examinations. You have to be able to manage that stress. Social support, good food, and exercise are all key to keeping a level head. Tonight, I had a healthy dose of all three.

Virus

"Excuse me, everyone!" The lecture hall quieted down. "I have a quick announcement: There is a virus being passed around amongst the class, so please be careful."

"What??"

"That's nasty!"

"What kind of virus, and who's spreading it?"

"How is it being spread?"

"Is it safe to be in here?"

"Oh, I bet it's X. Didn't you see the outbreak he had on his lip the other day." (Gross. Seriously.)

"No, no, no. . . I'm sorry, everyone! Please quiet down. I should have been more specific: A computer virus is being passed around through our flash drives as we share files with each other."

Collective "Ooohhh. . ." and laughter.

But, seriously, some of us need to get our heads out of the gutter and into our books!

Crock-Pot

For over eight months, a brand new Crock-Pot has been sitting in its original packaging, collecting dust in my hallway closet. I was convinced that I would burn the house down if I used it. I remember thinking, "I can't believe X would give me such a dangerous thing!" as I smiled and thanked X for the gift on Christmas morning. "Yes," I agreed, "I'm going to make really good use of this when I get back to school." Of course my next thought was, "How the heck am I going to get this thing back to Washington?"

I don't know why I thought I was going to burn the house down if I used the Crock-Pot. Thousands -- millions? -- have been sold as efficient, time-saving appliances. Where the image of sparks flying and flames bursting from the outlet came from, I don't know. All I know is that the image and feelings were strong. So, I stored the hazardous gift -- out of sight, out of mind.

A couple of weeks ago, I wrote about my efforts to maintain a better diet this school year. (BTW: Healthy eating requires a certain level of planning, but so far I've been able to stick to the program despite my crazy schedule.) In the comments, The Lone Coyote suggested that I give the Crock-Pot a try. After careful consideration (yes, I tend to mull things over), I decided I was going to make my first Crock-Pot meal. I flipped through my copy of Not Your Mother's Slow Cooker Cookbook (which was part of the Crock-Pot gift) and selected a dish. What was it? Lazy Day Braised Pot Roast. I'm not a big meat eater, but I thought it best to go with a classic.

I went to the grocery store and bought the ingredients; I read the owner's manual -- thrice; I washed the Crock-Pot; I prepared the ingredients; I dumped the ingredients into the stoneware liner. Good, now I was prepared to start the cooking. I place the lid on the stoneware liner and turned the dial to "LOW". Nothing happened. Wait -- wasn't there a light to let me know that it was working? Nope, no light. See, I knew this thing dangerous! I placed my hand on the side of the cooker. Warmth. Yep, it's working. I let it do its thing for 8 hours, as directed.

Eight hours (and 8 "check-ins") later I returned to the kitchen to find a very nice looking pot roast. I made myself a plate and was pleasantly surprised by how tender the meat was. It just broke apart effortlessly with a fork. (I know, I know, that's the whole point of slow cooking!) So, now I had a tasty meal to last at least 5 meals, prep and clean up were easy, and I didn't burn the house down! The Crock-Pot may become my new best friend in the kitchen.

Lesson learned: Sometimes irrational fears are just that. Overcome them and you may be pleasantly surprised.

10 Years

Do you remember the movie "Romy and Michele's High School Reunion" starring Lisa Kudrow and Mira Sorvino? Romy and Michele have spent the ten years since high school graduation living nondescript lives when they receive invitations to their ten year high school reunion. In an attempt to impress their former classmates, they decide to attend the affair as successful business women -- the inventors of Post-its. LOL, I loved that movie!

Coincidentally, the movie came out the year I graduated from high school, and this summer, my ten year high school reunion was held. When I received the invitation, I couldn't believe that the time had come. Had it really been ten years already?

Unfortunately, I couldn't make it out West for the weekend of festivities. Thankfully, however, I did receive a link to the reunion photo album, which provided all the highlights. Let me tell you, I was stunned by some of the physical changes that some of my former classmates had made. I could hardly recognize some of them. My favorite shots, though, were those of the babies playing together at the family picnic. It was simply amazing to see where we all had ended up over the past ten years.

For me, the past ten years hold the highest of highs and the lowest of lows. Highs: getting into and graduating from "a fancy east coast college", semester abroad, first long-term relationship (2+ years), getting into medical school. Lows: the death of my mother and the subsequent complicated grief. (My mother's death was earth-shattering -- and I mean earth-shattering. It was two full years before I was able to stand on my own two feet again. I'm very grateful to my friends, professors, deans, therapists, and those I consider family for supporting and guiding me through that tumultuous period.)

I wonder what the next ten years will hold for me. Where will I end up for residency? Will I end up back on the west coast, where I want to be? What specialty will I pursue?

Two things I know for sure: I'm proud of what I've accomplished and my future is bright. No Post-it inventing story needed here.