Monday, June 23, 2008


Shortly, I will be traveling to the island of Hispaniola to participate in a medical mission to the poorest country in the Western Hemisphere.

Haiti has been in the news recently as it has been hard hit by the global food crisis. There have been riots in the capital city of Port-au-Prince, as well as smaller demonstrations in other parts of the country. You can watch a well produced video on the subject here.

I've been interested in visiting Haiti for a long time now, especially after reading Tracy Kidder's Mountains Beyond Mountains in 2003. Of course, I have had many reservations about making the trip. You'd be nuts to travel to a country in economic and political turmoil, right??

But, part of me feels that I would really enjoy this type of work, to use my skills where they are most needed. I want to see if this is something I could really do in the future on a more long-term basis. I also want to see the beautiful parts of Haiti that we don't see or hear enough about.

I was worried about security, but I will be traveling with physicians who are very familiar with the country, and we'll travel with armed security at all times. We'll visit 5 clinics and 2 orphanages throughout the country during the trip.

The thing I'm most concerned about now is the heat and humidity. It's currently about 100 degrees Fahrenheit with 84% humidity in Port-au-Prince. I've been told I'll never complain about D.C. summers ever again.

Friday, June 20, 2008

Step 1

5:46 AM
It's the morning of the day I have feared for the past couple of months. Clearly, I am so anxious about taking Step 1, that my body won't allow a full night's sleep. A couple minutes pass before I manage to get my body to sleep for another 45 minutes.

6:31 AM
There's enough light coming in through my bedroom windows to keep me from sleeping much longer. Besides, I can feel the adrenaline coursing through my body. I get out of bed, go through my morning routine, sit down at my desk (a dining table in a former life) and begin to go over some last minute notes.

7:30 AM
What to pack for lunch? PB&J on a plain bagel, two apple sauce cups, some almonds, some fig newtons, a banana, some apple juice, and some water. That should do. No, wait: spoon.

8:00 AM
Sh*t!! I have to finish getting dressed, pack my First Aid (hmm. . . security blanket?), make sure I have my admission ticket and proper ID, and then run out the door and up the street to catch the bus. Where are my keys??

8:17 AM
Knocking on the bus doors that just closed in my face. Why do metro bus drivers do that? It's not like he didn't see me running up beside the bus! Of course, the 8:22 AM bus would be early today. Better early than late, I suppose.

8:53 AM
I arrive at Prometric thirty-seven minutes before my scheduled exam time. Another "Stepper" arrives at the same time (you can just tell). Hmmm. . . he's kinda cute. He opens the door and says, "After you." And he has manners! I sign in with building security and take the stairs up one flight to the testing suite. I sign in with the front desk, put my stuff in a tiny locker, and sit in the waiting area until my name is called. Somehow I lost Mr. Manners.

9:15 AM
My name is called and I'm directed to another room where my picture is taken, and a computer is assigned to me. I can see the testing room to my left through two large windows and a glass paneled door. I receive two laminated sheets and dry-erase markers, as well as a hideous pair of orange ear muffs. I know I'm going to use the sheets to work some calculations, but there is no way I'm putting those 70's-orange, germ-crusted muffs on my head.

9:20 AM
I'm escorted into the testing room and to the cubicle where I will spend the next 8 hours. With the two dozen cameras and microphones hanging from the ceilings, I almost feel like I'm on Big Brother. Almost. I sit down, place the fugly ear muffs in a corner, set the laminated sheets and dry-erase markers to my left, enter my CIN (Candidate Identification Number) in the field beneath my picture on the monitor in front of me, I take a deep breath and . . .

5:23 PM
Time has ended. I'm kicked out of the survey section. I exhale.


You know, it wasn't that bad. No really, it wasn't that bad. Of course, there are many things that I wish I would have done better in terms of preparation, but there were no surprises as far as question topics go. The questions I received on Step 1 were all on common diseases, disorders, syndromes, bacteria, viruses, etc. The biostats questions were straight forward calculations (incidence, positive predictive value, negative predictive value). There really wasn't a question that made me ask, "Where is this coming from??"

Having said all that, I know that I missed many easy questions because I did not know the details well enough. I think I spent too much time trying to learn everything, instead of concentrating on the high-yield stuff -- and knowing it well. Like, really well. I had no problem identifying the pathology, but too often, I forgot the exact mechanism. For example, I knew one patient had Factor V (five) Leiden, but I forgot that Activated Protein C in patients with this clotting disorder is unable to inactivate Factor V, which leads to the large blood clots. Yes, missing that one hurts.

My advice to all those who are about to take or will take Step 1: Use your time wisely.

First, and foremost, SKIP THE TUTORIAL. How many times have we all heard this now? And why didn't I listen? [sigh] You will add 00:14:57 to your 45 minutes of much needed break time. Do you know how hard it is to eat a PB&J bagel in 10 minutes?? Not fun.

Lastly, push yourself. Maintain the pace you nailed down while you were doing all those practice questions. I found that I spent too much time on too many questions, trying to make sure that I selected the correct answer. If you get to a question and have no clue what the answer is, mark the question, click your favorite letter and move on. If you have time, go back to it. Likewise, if you get to a question (of course, you're always reading the last line first -- this is very important and can save you from reading whole paragraphs) and you do know the answer, click it and move on. Don't reread the question or talk yourself out of the answer.

Click and move on.

Trust yourself.

Tuesday, June 17, 2008


That's right. I want a "do over." I want to start afresh. But, not really.

You see, I've been tossing and turning in bed for hours, unable to sleep, because I fear that I did not pass Step 1. Being the sleep-deprived medical student that I am, I should be sleeping soundly now that that hypertension-, palpitations-, diarrhea-inducing examination is behind me, right?

Au contraire, mon frere!

Instead of catching up on my Z's, I've been doing the whole "coulda, woulda, shoulda" thing -- with some "shouldn'ta" thrown in for good measure. I could have been more disciplined. If I had a couple more days to study, I would have been able to answer more questions -- correctly. I should have studied more. I shouldn't have been so engaged in the presidential primaries. I shouldn't have watched all those episodes of Top Chef, Hell's Kitchen, The F-Word, The Office, Grey's Anatomy, Project Runway. . .

But, alas, we can't turn back the clock. What's done is done. And, frankly, I wouldn't want to go through the misery of the past couple months ever again.