What It's Like to Be an Intern -- Or, I'm Back!!

I have missed this blog. And I simply cannot keep a diary online in my own name. So, in short, I came back! And it feels really, really nice to be back. But there's a small difference, which you might notice in the header. I'm no longer a future doctor lady, but an actual doctor. And that's a scary thought. And given that residency is the equivalent of two full-time jobs, I likely won't be able to write often, but I do want to write. It's been amazing. Very intense, very frightening and at times, incredibly sad, but amazing. It turns out that my dream program really was my dream program.

So how does intern year work? You rotate through various areas of the hospital for a month. Child neurology is two years of general pediatrics, one harrowing year of adult neurology, and then two years of being the child neurology "fellow", meaning senior resident who is called by everyone in the middle of the night for pediatric neurology consultation (ie is this child having a stroke?). Yes, children have strokes.

I am currently rotating through the emergency department. It varies from very slow to really quite insanely busy with a lot of very serious disease. In just day for example, we had one patient with newly diagnosed cancer and one baby with pyloric stenosis, a girl with ovarian torsion, four suicidal patients (boys and girls), and multiple appendicitis scares with a couple of true cases, multiple fractures, children with bad cuts needing stitching, some concussion, and one case of possible abuse. That does not include all the children with asthma attacks, bad viral illness, and croup. It was a busy night. But I have to say, putting a fingertip and nail bed back together is a pretty interesting skill to have :) I don't like as much the heartbreaking conversations with the suicidal patient and her family centered around her gender identity. What I told her is that obviously I can't decide who she is for her, but being true to her values and treating those around her with honesty and kindness will get her through the really tough times. But honestly, what do I know, especially at three in the morning? Luckily there are really great resources for her that will do her more good than I possibly can in the emergency department in the middle of the night.

One thing I really like about the new hospital system where I work is that people don't seem to be quite as sarcastic or angry, even to the medical students :) I appreciate that. I'm thinking maybe having all the children around help the culture -- most people don't want to curse in front of a four year old. The absolute cutest moment of my current rotation this far: I'm discharging a patient home with her parents and they tell her, "Ok, sweetie, say thank you!" And this three year old says "Thank you!" to me and to her nurse, since we were standing together. Then, as she reaches the door, she turns around, bats her eyelashes at me, and says, "Bye-bye, Dr. Nia!"

Melt, darn it.

Change is in the Air Again!

Okay, although I am totally overwhelmed, I need to write. So much has happened this month. Much of it has been very, very good and exciting. A lot of it is scary. And no, I'm not pregnant.

Basically, next month is the culmination of the research year. Some of you have already heard that my molecular biology project was going really slowly. However, the fellowship I'm on expects us to have a finished, completed project that we did ourselves at the end of the year. So around December/January, I panicked a little bit and tried to think of something I could do that piqued my interests, aligned with my abilities, and was feasible in a condensed time frame if I worked hard. The project I came up with looked at predictors of refractory disease in rheumatoid arthritis patients, which I was totally psyched about because it was clinical, had statistics, and dealt with both medicine and health disparities/epidemiology.

I've basically been working every day for a long time on this project, and I finally have results! I love my data. But they are alarming, showing differences in outcomes based on level of education when adjusted for medication use and other factors. I am beyond excited that it looks like we have some interesting data. I just sent the dataset to my mentor, so I'm just crossing my fingers that she doesn't run my numbers and get something totally different. That would be a minor tragedy. My big boss I think was a little skeptical at first, but she seemed pleased at my lab meeting today and had some great ideas for what to do next.

So next week I have to somehow do the following: Finish and practice my talk, actually do the 10-minute talk for a symposium, present my poster, finish my resume and personal summary form for the Dean's office to kickstart the residency application process, go to a 2-hour evening journal club (which curtails my ability to speak with my husband on the East Coast, sadness), finish additional data analysis for my presentation, work on a different poster for a different project I've been doing on the side, and pack for a 3-day conference the week after that. Oh, and remember to give my little boss a birthday present. Actually, when I write it all down it doesn't feel so bad anymore. Thank you, therapeutic blogging. I was sad to miss meeting up with my Auntie from India, who was only in town tonight, due to a confluence of work-related and traffic-related factors. But she got to hang out with my dad (she's dad's brother's wife).

In the next month, I have to finish all my research because then I'm back on the wards! Here's my 4th year clinical schedule:

2 weeks of adult pulmonary medicine
4 weeks of neonatal intensive care nursery
4 weeks of child neurology
4 weeks of pediatric genetics
4 weeks of child rheumatology
4 weeks of adult internal medicine
4 weeks for residency interviews + some vacation time (or time to mourn lack of interviews!)
4 weeks of To Be Determined + some vacation time
4 weeks pediatric infectious disease
4 weeks of end of year required curriculum

I am so excited about this. If I do apply in child neurology, I'd like to fit in some adult neurology somewhere. So little time, so much to learn. Many of my old classmates are graduating soon. I'm a little sad when I think of it, but I'm very, very glad that I took a research year. Although I've been in medical school so long (6 years next year!) that when I graduate, it will be quite a shock to my system. If I had gone straight through, which is a big if, I could have been a 2nd-year resident by now. Then again, hopefully the added maturity will be a good thing when I have an MD behind my hybrid name. I should blog about changing my name. Anyhow, I am also nervous/excited because I finally was able to arrange a meeting with the child neurology department chair, whom everyone literally raves about (Pediatric department chair: "I'd trust her with my life...in fact, I have").

In fun news, I'm also doing Bay to Breakers! So are three people from my lab, one of my old friends who is coming in from out of town, and B. I'm so pleased B agreed to be my running buddy. He usually tries to do shorter distances because he needs to be able to sprint for Ultimate, but he was really nice about the 12K. I'm told the entire first half of the race is uphill. Ick. But then, I was also told that it's so crowded that you are forced to walk at points.

For those who asked, B is doing well. He and the other employees got to take a big group photo with The Boss of the House that Shall Not Be Named. Pretty snazzy.

And, just in case you were wondering about my political views, you heard it here first:
Keep your MITTens off my kittens. No more drama. Vote Obama.

March Madness! Career and Gender Musings.

Spring is coming, slowly but surely, to the Bay Area. We have such odd seasons here, I have to say I miss the Philadelphia and DC areas with their stormy winters, lush green springs, humid summers, and crisp, vibrant autumns. But here, in California, in the Bay Area fog-basin, we have buds appearing on the flowering trees, days alternating between 45 and 65 degrees Farenheit, and the flu season finally seems to be tapering off. Influenza is nothing to sneer at, which is why they suggest that anyone is contact with the young, the sick, and elders (>65, although nowadays that doesn't seem very elderly!) receive a flu shot. I generally don't get it, because I tend not to get the flu, unless I know I'll be working with patients whose immune systems are more vulnerable (like the young and the old).

March 5th is our deadline to submit our 4th year schedule for consideration by our advisors. Here's what I'm hoping for:

Tentative Schedule for 4th Year: Each block is 4 weeks long. * = HARD, possibly with overnight call every 4th night.

Spring 2012:
Block 1: Finish Research (In year-long CTR pathway right now)
Block 2: 2 weeks' writing up paper; then 2 weeks' child abuse (if offered) or peds critical care, or other available elective.

Summer 2012:
Block 1: Child Neuro (2nd choice: peds genetics) *
Block 2: Peds Sub-internship *

Fall 2012:
Block 1: Peds Pulmonary *
Block 2: Genetics Clinic
Block 3: Away rotation or Bone Marrow Transplant or Medicine Sub-internship*
Block 4: Vacation (maybe with a narrative writing elective; this is interview time)

~Winter Break~  my last one ever!! Hopefully will go on interviews.

Winter 2013:
Block 1: EKG Interpretation or Medicine Sub-I
Block 2: Cardiology *
Block 3: ICU/NICU or NICN *

Spring 2013:
Block 1: Adolescent Med or Toxicology/Pharm (and/or some vacation)
Block 2: Mandatory end-of-school session
Graduation!


That's right! I'm going for either Child Neuro or Pediatrics +/- eventual fellowship (meaning a sub-specialty like endocrine or cardiology). Also interested in health policy/advocacy. I still have time to change my mind, but I don't think I will. I'm so excited about working with kids AND parents. I think we would be a better society if we listened to children and parents, encouraged them to contribute, and invested in them. Parts of the US really do not have a parent-friendly culture (though I hope celebrity babies will change this mindset), which causes people who happen to be parents to either feel very defensive and that they have to be aggressive advocates for children, or just plain unsupported.

However, I knew I was excited about this choice of fields when they had a Forum discussion on the radio about raising girls to be freer of gender stereotypes (are we STILL talking about pink Barbie/Disney princess dresses? Seriously?!) and I got so riled up I emailed them a comment. They had entirely failed to mention how playing sports has really changed the process of growing up female, and what Title IX (thank you, Congresswoman Patsy Mink) and the subsequent support for female athletes did for our society.

Here are some things that our parents did that rocked my world (and hopefully my brother's) and taught me to be a strong woman. Clearly, we still need to have this conversation. Sigh:

Seven Things My Parents Did Right (and So Can You):

1) Turn off the TV. Limit screen time on weekdays, and turn off the TV. This was a strong policy in our home. Weekdays were workdays, hence no TV. Have computers and TVs in public spaces in the home, not in bedrooms. Getting hooked on teen soaps exposes you not just to the twisted messages of these 20-year-old-playing-teen shows, it also exposes you to all the advertising aimed at the target audience. Tell kids to get outside: it saves their eyesight. The healthiest TV show is still less healthy than going out and living your own life! And then their friends will realize that not *everyone* watches these things, so you'll affect more than just your child! Summers were also more fun because TV was for summer.

2) Criticize Sex in Advertising. Avoid stores that use sexualization to sell stuff. Teach your kids the difference between sexualization and sexuality, and the difference between being admired and desired. Abercrombie & Fitch keeps getting into trouble for this stuff aimed at middle-schoolers. Call these stores names: gross, disgusting, and perverted. Show them the not-very-attractive board of managers and CEO.

3) Avoid Gendered Marketing. Avoid stores that have girl sections and boy sections: for example, substitute your local toy store for Toys 'R' Us, and buy things in unexpected places: a lot of hardware stores have toys. My mom hates TRU and loves the others. Bookstores are also great (although they are dying a slow and painful death). For older teens (driving age), tea and coffee culture is strong and can supplant alcohol (and caffeine is not as bad for teenagers as it was once thought). If you can tell what gender a toy is for (pink beach shovels?), don't buy it. Vote with your wallet and explain why.

4) Treat Kids Like Kids. If you have a girl, treat her like a kid; if you have a boy, treat him like a kid. Give him dolls and animals; give her a log cabin building set. Give them both art supplies. Teach the males how to cook and the girls how to repair things effectively. My brother and I had no concept of things we couldn't both do. Essentially, check your own gender bias at the door. If they have gender bias, remember it's a phase and do your best to be a countercultural rock. It's okay if they turn out different, as long as they understand whole hog what they're getting themselves into.

5) Keep Them Busy. Encourage alternative fun. Let them play sports, get creative, be involved in after school activities -- and, oh, yeah -- study! My dad enrolled me in baseball; my mom gave me a tool kit and indulged countless plays/art projects/choir performances. Let children derive their identity from their skill set, and/or being busy all the time. Not what they look like.

6) Know Their Friends. Make sure they are good friends. Know and care about their friends; invite them over. I remember my dad hosting (by himself) a crazy sleepover party for eight 10-year olds. That's dedication. Teach your kids to care for their friends; then they'll know if their friends don't care for them. If your kid needs helping choosing appropriate friends, teach them how to choose BEFORE they're 16 and sullen and think you're so lame. It will make a world of difference if they have peers they can really lean on in their high school years when things get rough.

7) Have a Career. Take it seriously. Take your kids to work (on acceptable days or weekends) so they can see how adults roll and what you're doing all day while they are at school.

I know each household is different and parents all have different values, but these worked for us. My brother is a very kind, respectful man; I am a very strong woman. We are both good at things that are not stereotypical (he's a great cook; I am good with science and machines). We are still close to each other and our parents. Yay!

What a Non-Catholic Can Learn from Observing Lent

A week ago was Ash Wednesday. I saw many people at work going about with a black ash cross on their forehead. Although I am not a Catholic by any stretch of the imagination, I have always respected Lent. I think it has a beautiful symbolism, in so far as my understanding goes. If you want to learn more generally about Lent, here's a good overview. The forty days of Lent (Sundays do not 'count' because Sundays are a celebration of salvation) mark a time of prayer, penance, and fasting (meaning a different diet, not total starvation) in preparation for the resurrection of Christ at Easter. Many people see the temporary sacrifices of Lent (chocolate, TV, internet) as another way to do penance, develop self-discipline, and remember the sacrifice of Christ -- for instance, this 25-item list put together by and for teenagers. Pretty impressive for high school students, right? One could argue it is artificial hardship, but I was thinking how valuable it could be for anyone, not just the Lent-observing Christian, to 'do without' for 44 days.

It seems this practice would bring us closer to those people who have less than we do, while reminding us that we have much more than we think. Especially during this Great Recession, I've been remembering the old saying, "Use it up, wear it out, make it do, or do without." Not that I live a deprived life -- we live in comparative luxury on our modest income (ie my research stipend and his intern stipend). But of course it's good to be careful and frugal with money, and to be thankful for what you have -- no matter how much it is.

The 44 days of Lent are also valuable to the non-Catholic as a dedicated time to learn a new habit. It takes people anywhere from 18 to 91 days (depending on the individual, the behavior being learned, and which study you read) to really establish a habit, but 44 days is a pretty solid amount of time to devote to a new practice. Check out this Slate article on one (Indian-American) woman's experiment with becoming a morning person. You could apply this to anything, from nagging your children/spouse/employees all the way to kicking a dependence on caffeine, alcohol, or cigarettes. Speaking of which, isn't it neat that our medical school's first-year syllabus requires that we attend an AA meeting if we've never been to one, so that we understand what it is we are recommending to patients?

So my Catholic neighbors and colleagues have inspired me to re-examine my own life. What do I indulge in? What could I do without? What would make me a better person?  I think as I get older (I'm now 27 years and 4 months old), I need to decide what my priorities are going to be. As a high school student, especially, I had this strange idea that I could do everything. I could act in plays, sing in a choir, choreograph dances, ride horses competitively, study hard, do research, volunteer, etc etc. And I could do it all, but I was perpetually exhausted, never saw my family or friends, and I think I averaged about 4-5 hours of sleep a night my junior and senior years. Obviously (in hindsight), that was not sustainable. However, we'll see if I've still got it (residency is coming)!

Our little older Siamese (she's 13) had a health scare this weekend: she chewed a bump off her shoulder which turned out to be benign (a self-operating cat! Dr. Cat, M.D!). But the reminder that she, like all of us, is mortal made me want more focus in my life. I am currently deciding on a specialty (almost there; really close to deciding), starting a marriage, and trying to find enough time for family and close friends. Given that I am in the medical field, I don't know how much room there will be for anything else. Maybe kids, someday? Running? Riding? Pets? I don't think I'll be choreographing another can-can anytime soon.

At this point, I want to devote more time to my career and calling -- to becoming a really good doctor. It takes way more time than I had anticipated. But not more time than it deserves. Because it's worse to be a lousy doctor than to not be one at all. I'm in a research lab at the moment, but the MD is the goal. I need to start thinking about my future patients: which skills do I need to acquire in order to be the doctor they would want? So until Easter, I am going to read one article or chapter every day that will make my sub-internships easier during fourth year and beyond. I am also going to spend ten minutes each morning in a lovely meditation taught to me by a friend who was also a minister a few years ago. It went something like this:

The Friend Map:
Picture a map of the United States or the globe in your mind. Picture everyone whom you carry in your heart -- friends, loved ones, colleagues, frienemies, or any other group -- as pinpoints on that map. Now scroll across the continent, sending a prayer/good wish for each person. This cultivates gratitude for their presence and a loving demeanor, both of which will strengthen your ability to weather storms. And who knows? They may sense that someone is thinking of them/praying for them.

Why This Blog Is Only Nominally Anonymous

I bumped into a couple of dear friends yesterday and had a surprise Valentine's Day 'date' with them. I was walking near their place, so I should have somewhat expected it, but it was still a wonderfully unexpected meeting. Over Thai iced tea (yum), I found out that one of them knew about this blog! I was so pleased (hello K if you read this)! It feels safe and warm to know that friends occasionally pop in.

As someone who keeps a blog for the primary purpose of keeping in touch with family and friends and reflecting on my personal life, it is important to specify what this blog is and what it isn't. Although I do not post my name, address, medical school, or other identifying information for the world to see (and Google), I am fully aware that someone who really wanted to know who I was could find out based on clues and the sieve-like nature of "secure" information online. The Dr. Lindeman case (read his interview about it on ScienceRoll) illustrated perfectly why blogging, especially blogging anonymously about controversial topics, can lead to trouble.

Essentially, he is a Yale-and-Columbia-trained pediatrician who blogged as "Dr. Flea" for a few years. He had a straight-talking approach to the medical world and his commentary was often somewhat controversial. A lawsuit was brought against him by the parents of a 12-year-old boy who died of diabetic ketoacidosis six weeks after an office visit where his diabetes went undiagnosed. Because his team did not think it was true malpractice, it went to trial. During the trial, Dr. Flea blogged about the case, the jury, the attorneys, and the defense strategy. The prosecuting attorney then found a comment that linked Dr. Flea to the person on trial! I wonder if the person who posted that comment had any idea how much trouble it would cause. Basically, the attorney unveiled Flea's real identity in court, and he settled the suit. This whole saga made the Boston Globe. I have no more knowledge of or connection to this case, as far as I know, than the information available online. I feel bad for everyone involved.

That said, I do believe that medical students, residents, and doctors have a unique view of society and should try to participate in conversations about topics important to them. It's just that in a shrinking world of increasing internet fluency, it's utterly naive to think that you can post opinions that will never be identified with you. This is why I rarely blog about patients, I don't publish scathing critical reviews of anything, and I assume that my boss's kids will one day print this out and hand it to her! This blog is not a forum for me to rant about medical school or to air personal vendettas against specific people (which I don't really have, anyhow). I write to create a place online where people can check in and perhaps find something to think or at least smile about. But I have no desire to be an infamously controversial blogger; blogging, like so many things in the context of medicine, may be best done in moderation.

With all this in mind, I have drafted the following pledge:

The Sane Blogger's Pledge

1) I will not write anything 'anonymously' that I would be ashamed to have attached to my name.
2) I will not disclose secrets that do not belong to me.
3) I will remember who I am in real life and not let my blog identity overwhelm it.
4) I will blog about my past and present while remembering that what I write may affect my future.
5) Uncharitable thoughts are no less uncharitable in written form.

Does this mean no hot-button issues? No, it just means that when I take a stand, I do so knowing that to most of the people who read this blog, to our circle of friends/family/colleagues, and to anyone who does enough hunting, I am not anonymous.

Which brings up another issue: should I just post my name as the author? Would you consider blogging under your real name? What do you guys think?

Yours online,
Nia

Choosing a Specialty

Lately, the most pressing questions in my professional life have been a) which medical field to go into and b) how to get myself published. Part (b) is a topic for another post, but the choice of specialty question has been plaguing me for a couple of weeks now.

So far, I've narrowed it down to a few fields I think I'd be most happy in. Here's the list, in no particular order, with the training required for each:

1. Neurology (adult): 1 year preliminary medicine + 3 years' neurology
2. Child neurology: 2 years preliminary pediatrics + 3 years' child neurology OR 3 years pediatrics + 3 yrs child neuro
3. Pediatric rehabilitation: Same as child neuro, but put "rehab" in place of "neuro"
4. Adult rehabilitation: Same as adult neuro, but put "rehab" in place of "neuro"
5. General pediatrics: 3 years of pediatrics

So I think I'd be happy in any of these fields. The problems I have with deciding are related mainly to i) competitiveness and ii) scheduling 4th year rotations so that I have a good chance of doing well and getting a recommendation in my chosen field. Basically, I have two available slots, and I was hoping for a 'warm-up' rotation so that I could really do well in my 2nd one. I want to step it up my fourth year!

In terms of competitiveness, neurology and adult rehabilitation are not that competitive, but the 1st year -- preliminary medicine -- is. This is because everyone matching into the more competitive fields of Radiology, Ophthalmology, Anesthesia, and Dermatology (the ROAD to the good life, we call it) has to first do a prelimininary medicine year. These are the students with honors across the board, Alpha Omega Alpha (medical honor society), and great board scores as well as research in their field.

Child neurology and pediatric rehabilitation are not supposed to be competitive, but they have very few spots available each year, and so it tends to be that either you get interviewed/ranked at many programs or nobody ranks you (this refers to a complicated process known as "The Match", in which programs interview selected students applying in their field, and both rank each other so that a computer algorithm can decide who goes where).

What all of this means for me is that I have to take a cold, hard look at my scores, grades, research, and qualifications so that I don't under- or oversell myself when trying to find a position for residency. My record is that I come from a very good school, but my Step I is unfortunately quite awful, my Step 2 is quite decent, my grades are solid but nothing special, my research experience is strong but not PhD level, and I won't be a member of AOA. I do have gumption and passion and lots to give in terms of intangibles, though!

The other issue, of course, is whether I'd like to work with children or adults more. This is a huge decision and is, I think, the biggest 'branch point' in the above decision-making. I have written out lists of pros and cons, I have flipped coins, I've asked friends/families/advisors. I get different answers depending on my mood, the person I'm speaking to, etc. My mother even wrote out a flow chart analysis thing (it's so nice to have an MBA Mom with a great deal of patience for my ridiculous anxiety). Right now, I'm favoring the kiddos. And their parents. I really like parents. Parents are adorable. But we'll see!

Gingerbread and Counting One's Blessings

Thanksgiving is almost here, and we have more than enough to be thankful for. B passed the California Bar Exam! He was enormously relieved, especially given that two of his twenty colleagues did not pass this time around. B will also be on the East Coast for a few months this spring for an internship, and then will be looking for work. Where he ends up will determine where I seek a residency next year.

Assuming I pass my own exam. Results haven’t arrived yet, so I feel a bit stuck in limbo right now. I keep playing the ‘what-if’ game – what if I failed? What on earth do I do then? What if I never graduate from medical school? Finally, I got so tired of this that I called my own bluff and started to compile a list of alternate careers I could do if medicine did not work out:

Clinical research director. High school teacher. Biostatistician. Medical transcriptionist. Policy analyst. Medical writer. Bench scientist/technician. Guidance counselor (ironic). Riding for the disabled instructor. Any other thoughts?

The clinical skills exam is coming up in mid-December, and I plan to start studying immediately after Thanksgiving break. We are going to his parents for Thanksgiving and mine for Christmas. Things at work are a bit hectic, as well – I feel guilty going anywhere for Thanksgiving because it puts a forced pause in an experiment where no pause should be, and my boss offered to feed my cells over the Thanksgiving weekend. Yuck. There’s nothing like knowing you are putting your boss out to take the fun out of a holiday. I am also hugely inexperienced and am dealing with quite a steep learning curve. I’m sure that I supply the more seasoned scientists with plenty of laughter over my naive mistakes. 

As you can probably tell, I am feeling all out of balance... plans I thought I had made so carefully to schedule things out this year have gone awry, and I just hope that somehow it will all work out. I am learning important things about myself, though – I do not think I want a wildly unpredictable career where I play five different roles and juggle far too many responsibilities. Although I doubt any medical career could ever be low-stress, I would like medium as opposed to very high stress on a daily basis. A little bit of time for family would be nice, as well. I think that this culture really does emphasize doing as much as you possibly can, and de-emphasizes things like family time, sleeping, and food. No wonder obesity has become a problem – poor, stressed-out working people have too little time to cook, so they simply eat processed foods or eat out all the time. And they are so busy working that they are never able to go for a walk. It's a double whammy.

Anyhow, one of the sovereign remedies for the blues is to think happy thoughts. Funny things qualify: the other day, the children who live above us were dancing around while it was raining out. Somehow, the rain amplified their footsteps until it sounded like an army was marching over our heads. Of course, they will now forever be known as the Storm Troopers.

Secondly, one of B's colleagues called Swarthmore College, our alma mater, a "potted Ivy." I thought this was both highly flattering and quite appropriate (but then, I'm biased. I loved Swarthmore).

Another form of happy thinking (appropriate for the upcoming season) is to list the stuff you are grateful for. So here goes... 

Things I am Grateful For: (Here are the ones I can think of right now, in no particular order)

Being happily and newly married.
All the wonderful people who came to our wedding/sent us love.
Living in the same town as my brother!
Having adorable parents fifteen minutes away.
Warm gingerbread with cold milk.
My thirteen-year-old cat, who is still pretty feisty.
The friends I've made in medical school, and the friends from college who stuck around.
Having a job with good colleagues.
A car, a roof over our heads, food, comfortable clothes, and some extra goodies.
Good in-laws. Seriously.

To facilitate putting the attitude of gratitude into practice, I just got one of my favorite things in the world: a new blank journal. It's been a year since I kept one. For $3.99, isn't it worth it to feel as though your life is, once again, a clean, fresh sheet of paper just waiting to be written on? The only feeling that tops it is when you've filled it.

Emerging from the Library

The Step 2 CK exam was yesterday. It was a long, grueling nine hours, and by the time it was over, I was so brain-dead that I have no idea whether I made it or not.  It felt terrible to leave the testing center thinking that I might have done badly after studying so hard. I did feel like I was catching up during my studying, but still. Not a great feeling. And there is quite a lot riding on this exam. It is sickening not to know if my career goals will come to pass. After imagining out every possible scenario and moping around for a bit, I decided that regardless of the outcome, it's going to be weeks until I find out. And regardless of the outcome, I did what I could in the time that I had. It is now in greater hands than mine. So in the meantime, I'll write a bit about what's going on now that the board exams are (for the moment) over.

The grass is greener on the other side.

Catfish the Siamese is home, after spending a little vacation at my parents' so that I could actually get some sleep (she enjoys parading across the bed and meowing for food at 5 am every morning). I went over to my parents' place to collect her right after the exam, and was able to spend a good long time with the family. B came with me, and my brother even stopped by. It was so nice to have an impromptu family gathering.  The weather has been trending towards chilly rain with a generous helping of clear, bright days.

This morning we went to the farmer's market -- there will be just one more next Sunday and then the harvest season will be over. Guess what has come into season whilst I was studying? Fuyu persimmons! We also found fresh cauliflower, tomatoes, onions, and apples. They were selling apple cider but we decided to pass this time around. It doesn't last as long in our house as the apples do! We sliced up our bell peppers onto whole wheat toast (B's home-baked bread) with mozzarella and tomato puree -- our marinara open-face sandwiches were delicious.

B making bread dough.

A golden loaf, fresh out of the oven.

The end product!

We also took a short journey to Golden Gate Park this afternoon to enjoy the November sunshine. There were so many families out walking or boating, and any number of ducks, seagulls, and flowers still in bloom.

A bright yellow blossom seems to say, "Cheer up, cheer up! Life is worth living!"

The moss, trees, bridges -- everything felt fresh and interesting. It was lovely to be outdoors instead of studying. The animals at the lake are used to people and will let you get pretty close, hoping to be fed.

Contented ducks.

The Canada geese were quite docile.

Sleek geese getting nervous before Thanksgiving.

We made friends with an elderly gentleman who was feeding the seagulls -- I was able to catch their excitement as they flew up to catch the breadcrumbs!

Free meals draw crowds.

Whee!

As we drove home, we were treated to a beautiful early sunset against the autumn clouds.

It didn't seem real to us, either.

Speaking of Thanksgiving, I saw an article in the September Education issue of the NY Times Magazine discussing the differencing between raising overachievers and raising children with "true grit" -- the strength of character to succeed in the face of adversity. It really spoke to what I've been thinking about lately and what my boss and I have discussed -- that life is not an IQ test, and that your drive, optimism, gratitude, social skills, curiosity, and sheer gumption will get you a lot farther in life than just intelligence ever could. It's called "What if the Secret to Success is Failure?" I think the title is misleading, though; it's more about whether character can be taught than whether failure is needed for success.

For someone in my particular position (that is, trying to learn a set of skills, earn a degree, and begin a profession), it was a very hopeful read. It's been a more difficult road than I anticipated, for a whole host of reasons, so it was nice to hear that continuing to strive for the goal is worth something in itself.

A red-eared slider at the lake. Slow and steady wins the race.

To NIH and Back Again

The NIH Clinical Hospital: Every patient is on a research protocol

I recently made a brief journey to the National Institutes of Health for what I believe qualifies as my first-ever business trip! That is, if you consider a 'business trip' to be one that is both mandated and paid for by your employer. It was an incredible trip. I met nearly 100 other medical students also taking a year "off" from school to do research. They represented an incredible range of schools and interests. I took a chance by going to a neurology networking lunch one afternoon, and was invited to do an elective at NIH next year by one of the physicians there! Wow. We also attended presentations about residency selection, balancing a clinical practice with a research career, finding funding, and dealing with student loans.

The keynote speakers were very famous people -- Francis Collins (NIH director, working on aging), Anthony Fauci (he and his PI essentially discovered the treatment for Wegner's granulomatosis and his lab went on to develop AZT, the first antiretroviral, discovered much of the natural history of HIV/AIDS, and convinced three presidents to fund AIDS interventions in Africa), and Marston Linehan, whose lab is responsible for discovering the basic pathways of kidney cancer AND creating new techniques to vastly extend life in patients with kidney cancer. I was in awe that such brilliant people were also such good speakers and seemed very personable. They encouraged us to take over from them in the next generation. What shoes to fill!

Building 50: My Old Lab!

We were housed at the Hyatt in Bethesda -- my roommate was a wonderful person who studies colon cancer risk decisions and wants to be a rural family medicine doctor. I was very glad to have met her. I also reunited with medical students I had met on the interview trail years ago, but had gone somewhere else. There was not too much time to socialize except for the meals --  which were delicious and plentiful. I was very grateful that NIH had organized the weekend for those of us funded through NIH student grants (of which there are many). Bethesda was beautiful in October -- crisp air, deep blue skies, fluffy clouds, and trees just beginning to change. I very much enjoyed being back there after four years away. It was over so soon.

Trees Changing Color at NIH

I flew home and found, to my surprise, that I was sitting next to two medical students from Yale, a year my junior, going to a surgical conference in the Bay Area! We spoke at great length about the Bay Area and medicine versus surgery. We called our little area of the plane 'Medical Student Row,' and were continually being visited by other students on board who were also attending the same conference.

Cat in a Bag

NIH or no NIH, however, there is no place like home. My sweet cat had been moping around, according to B, but she was perky when I arrived, and we found her contently chewing on a receipt in a brown paper bag that evening.

Cactus and Aloe in Window Silhouette

Exam Rose!

Our plants were looking wonderful, the rose B had given me to cheer me up was still in bloom -- and this reminds me that now, and for the next month or so, you will please forgive me if you hear very little from me. I must somehow gear up for all the examinating that lies ahead. There are now only 18 days between myself and Step 2 CK.

Boundaries and Bosses

I have two bosses. They are both incredibly bright, lovely women who happen to have advanced degrees and a lot of clout. Big Boss is the head of our lab. She is one of those people who looks between 10 and 15 years younger than they are. She is very driven, down-to-earth, straightforward, and to the point. She is always juggling several things at once but somehow manages to get all the important things done. She keeps her promises. She doesn't have a lot of patience with personnel drama. However, her husband works in her lab, so I have a window into her world through their interactions.

The second boss I call my Little Boss. She is a young attending physician-scientist who works in the lab, and I'm helping her with her first big research study. She has a three-year grant and has nearly completed the work mid-way through her second year. She has been that kind of worker throughout medical school and her PhD program. However, she and her husband have just adopted a two-year-old boy and she is feeling a powerful maternal urge, I think. She is now planning to leave academia this year for half-time private practice so she will have more time with her son. I do not know that this goal will materialize for her, given the climate of private practice these days. I hope it will, since she feels compelled to leave so soon to pursue it. I have my doubts.

My Little Boss

I have come to realize that in my lab, the blurring of boundaries between work and home is so great that most of the folks who work here could write each others' biographies. Each day, we all sit down to lunch for an hour from noon to twelve, the unwritten rule being: No Work Talk. Every time I have mentioned work at lunch, I have been gently hushed until I, greenhorn that I am, got the message. It is the socializing, networking, debating, and gossiping hour, but never work. It seems so civilized and old-fashioned. It is a far cry from the inpatient hospital world, where sitting down is a crime and chewing (meaning eating) a sin. In addition, Little Boss and Big Boss tell me so much about their lives. I know about their kids', pets, spouses, their home lives, etc. Perhaps the culture is that way because everyone is a parent -- Big Boss has two teens, four others have grown-up kids, and Little Boss as well as two other scientists all have kids under two.

Little Boss says that part of the reason she wants to leave is that she thinks that private practice will have more well-defined hours. For instance, in our lab, she can go home in the middle of the day if she wants to have lunch with her son. But she hates feeling that research is this amorphous entity that could take up 20 hours a day if she allowed it to. She'd rather have the stricter hours of a clinic, knowing that when she packed up for the day, she was not bringing her work home with her. I think the people she works with are far more important than the job description on paper -- if they value family time, that will affect the culture of the workplace. I personally think our lab environment is much more family friendly than the clinics I've seen -- of course, I've only really seen clinics that are affiliated with big hospitals. Perhaps community clinics are more flexible.

I am very grateful for this year. It is giving me a chance to study, think, earn a little money, work hard but sleep enough, and reflect about my future. I really, really needed it after an emotionally overwhelming and academically underwhelming third year. The other day, Little Boss introduced me as her "senior medical student," and I could not help but think that I am really too far behind in my studies to be referred to as such. Then again, that is what my precious year is for.

Today, both bosses were helping me prepare for my lab meeting on Friday afternoon. Big Boss wanted me to include more basic science, more details about the mechanisms, signaling molecules, hypotheses and how we were going to test them. Little Boss was of the opinion that this would put my audience to sleep, and that I needed to clarify the basic principles, questions, and background. The lab meeting is a practice session for the Works in Progress talk I am giving to the other year-long research fellows on Wednesday. That one is a bit more nerve-wracking because there will be another student speaking as well, before me, and one whom I know to be very hard-working. Anyhow, my task now will be to take the advice of Little Boss while somehow also pleasing Big Boss. I am so thankful for all this feedback and attention -- it's far more than I got last year. It is challenging, though, to navigate two opposing opinions -- clearly, Big Boss trumps Little Boss, but I work much, much more closely with Little Boss and want to keep her happy.

My only fear is that I will be pressured to divulge all the personal details of my life while at work. I guess I just have to guard against it. I have already been put in an awkward position a few times because my higher-ups ask me to keep secrets from one another; I don't want them to know enough about me to get under my skin. Ironically, it's safer perhaps to discuss things here, on this online blog, than at work. It's getting late now, so I think I will turn in for the evening. Good-night!

Step 2 National Licensing Exam on the Horizon

As some of you who have been reading this for a while know, I feel like I shortchanged myself for Step 1 (the first national medical licensing exam). My studying was not that effective during the short time I had, given my master's thesis work. I think I achieved maybe two weeks of good solid studying, and barely squeaked by at the last minute. I later found that most people start studying months, if not years, in advance! It was too little time given how much exam material was not covered in the curriculum of our first two years, and given how little emphasis was placed on the exam by our program. I was probably naive and should have done my own research about the importance of this 8 hour exam, but when someone you trust tells you that you are worrying over nothing, you believe them. Oops.

Scholarship Exam, 1940

Thinking back, I'm not sure why I believed them. My entire life, people have been telling me that I took my academics too seriously. I have often heard that an exam or a grade was unimportant, only to study hard and then realize that it did make a difference later on. Working for a grade only when it 'counted' seemed wrong to me somehow. Shouldn't we be working hard for the sake of doing our best? What frustrated me about this Step 1 episode is that I did work hard the first two years of school, but I felt my energies were often directed toward irrelevant material, such as alternate therapies, politics, and social concerns. Those things are important, but not at the expense of learning the basics of allopathic medicine! I did not make sure that what I was learning correlated to what I needed to learn; I trusted the school to do that and they didn't. I suppose I wish our program had been, for lack of a better word, a stricter one. I also wish I was a little more realistic about the preparation needed.

This brings to mind another myth you hear when applying to medical schools: that all medical schools are pretty much equivalent during the first two years, because it's the clinical years that matter. In my opinion, this is blatantly false. The first two years are your foundation. The quality of teaching and the strength of the syllabus sets you up not only for your board exam studying, but also for the wards. If I were giving someone else advice about choosing a medical school, I would tell them to examine the syllabus for all four years carefully, and look at who is teaching the basic preclinical courses. Are they PhDs without any clinical background? Are they MDs without any teaching background? Are they junior or senior medical student teaching assistants (who are often great)? Do the same professors teach the course year after year? Lectures? Case-based (not necessarily as effective as it is popular)? Both? How well do preclinical grades predict performance on the Step? What sort of board preparation (if any) do they offer? What is their board exam pass rate (can they give you the actual numbers)? In our case, had I looked into this further, I would have seen some serious red flags in terms of the right fit.

Please don't get me wrong -- I am very grateful for all that I have gained and learned during my time in medical school. I understand that no medical school is perfect, and that often, we only get out what we ourselves put in. There are amazing things about my program, which I won't go into here. However, I do not know if I would recommend my program to other pre-medical students. I have no resentment or bitterness about what we didn't learn, but I do feel the need to be truthful about it to others embarking on this journey. For myself, my goal is to move onward with my life and career using everything I did learn.

Anyhow, my experience with Step 1 was a very high-stress way of taking any exam, especially one that turned out to be so much more important than I realized. I do feel that certain doors are now closed to me in terms of both specialty choice and competitiveness of residency programs, which is sad because I know I could have done much better. Looking on the bright side, though -- there is another licensing exam. While a decent Step 2 score may not entirely make up for a low Step 1 score in terms of residency applications, it would theoretically help. Thank goodness there is another exam! Now the pressure is on to prove myself. From every challenging experience or mistake comes a chance to do better, right?

I still have some time before Step 2, so my plan is to go through all the material once through briefly to get a feel for the scope of the material, maybe review some Goljan pathology or internal medicine, and then do as many practice questions as possible from USMLE world. It seems as though everyone uses some variation of review book + online question bank to study for this exam. However, everyone also says that you only need two weeks to study for Step 2, that it's easier than Step 1, etc. That may be true if you felt well prepared for the first Step. Needless to say, I shall not believe it:)

Many of my classmates have taken Step 2, and many are taking it around the same time I am. I hope we all have a better time of it. I will try to continue blogging as I study. Good luck to those taking the exam, and good luck to all those applying for the spring Match! I hope people end up in places and specialties they love. My plan is to smile and keep on keepin' on.

The Year Ahead

The dust from the wedding has mostly settled. We've moved into our new place, our photographers are slowly getting back to us, and we're still writing thank-you notes to all of the wonderful people who contributed to the start of our married life. We moved into a new place, B is taking the Bar as we speak (goodluckgoodluckgoodluck), and I started my research fellowship. On Friday, we are leaving for a 10-day belated honeymoon in Hawaii! I think all the red tape at work has been taken care of.

Today I started thinking about what happens when I return from the honeymoon. What are the most important things to focus on this year? I want to give a lot of thought to my future career and my professional identity. As a doctor, one can travel many paths: clinical care, education, research, administration. It's hard to do everything, and it's impossible to do everything well. My mentor and I had a conversation about this. Her take was that at some point, you just have to accept that with all the things you do, you will do none of them at your absolute full capacity. While that is true, I don't think it follows that you should overextend yourself to the point where you feel you are doing a mediocre job of everything. So this year is about career discernment. How do I want to make an impact in the world? How can I be of most use? What path will give me the most fulfillment?

The other concern is practice. Often, something just isn't going to be fun or interesting until you have devoted enough time to becoming good at it. I'm 26 now, and one important question comes to mind: how long am I going to spend being a beginner at many things, as opposed to advancing in a few chosen areas? So this year is also for taking stock of the skills and talents I have and capitalizing on them, rather than trying everything on for size. I'm getting impatient with not knowing anything about anything. Also, if you are a beginner you end up taking a lot of help and not giving very much back.

One of the lessons I think America can learn from the UK is that of encouraging vocations in young adults. I think many 16 or 17 year olds do know what kind of work suits them. The trouble in the States is that our indecision is encouraged, even applauded. We do four years of college. Then I did four years of masters/MD, with one research year and one additional clinical year still to go. But the choices that once felt so freeing are beginning to drag me down. I want to define myself further, not open even more doors and then stand before them all saying, "Look at all the things I might do!" Which is why this year is important.

All of this said, I have compiled a checklist of things I want to focus on this year. Hopefully, I will look back at this next May and have a tangible record of whether I met my goal.

2011-2012 Checklist:

1. Work on my work ethic.
2. Submit my thesis work to a journal for publication.
3. Finish a cohesive research project at the lab this year.
4. Decide my top two specialty choices and arrange electives accordingly.
5. Find a non-academic activity to channel my creative energies.
6. Develop good study habits and practice with my licensing exams!
7. Make time for friends and home life.

Even when plans don't work out, isn't it fun to plan? I almost feel like anticipation is half the fun! Hmmm. I don't know if that applies to a honeymoon. Anyhow, until next time!

Back to the Blogstead as a Married Lady

Hello again! As I have a wait step in one of my experiments, I have a moment to come and write. I have been away for a long time, but I do have an excuse for my absence: B and I got married at the end of May. It was one of the loveliest things that has ever happened to me. With the help of friends and family, we did a lot of the crafting of the wedding ourselves. I will post more about that in future updates, but just wanted to check back in with my new blog.

Since the wedding (pictured here, with my maid of honor and our officiant in the background), B and I have moved into our new apartment. We had dropped off his belongings from Los Angeles before the wedding, but it was only two weekends after the wedding that we were able to visit my storage unit in Berkeley and recover the possessions I had stored there while living at my parents' place for a year. Now we have a little bit of furniture (although still no chairs), a big computer, and the all-important wireless network! There are still unopened boxes, piles of important papers, and a narrow pathway through the house. However, we do have a functional kitchenette, the laundry has been effortless so far (it's free and four steps from our front door), and the cat has moved back in! Since B and I are both studying at the moment, it's hard to find time to work on unpacking and setting up. Hopefully 15 minutes here and there will eventually lead us to a completed apartment.

We went to the bank and opened a joint account two weekends ago, and the teller asked us, "Does it feel different now that you're married?" It's the standard question you get after a birthday, and in that case the answer is usually no (at least in my case). When he asked us about marriage, though, we looked at each other and paused. It did feel different. They say it's just a piece of paper, but the fact that we separated the legal and the community ceremony shows what we think of that. I think that successful marriages are based on a belief that a private and public declaration of lifelong commitment does absolutely mean something. I am very grateful for it. So it felt different. I am also glad that we both decided to change our names and have a joint account.

In terms of the name change, it became a little controversial among friends and family. Living on the West Coast in such a liberal city, it has gotten to the point where true-blue feminists get angry when they hear you are changing your name, and the traditionalists are miffed if you aren't. We came from two different families in this regard. B's mom changed her name because she did not want to keep her father's, so they all share the same last name. In my family, my brother and I got the same last name but it is an old family name from both sides, and is different from both my father's and mother's last names. So our last name is, in some ways, unique to us. I didn't want to give that up. Apparently, in Denmark at the turn of the last century, name change was so important that the king had to sign off on it (at right)!

When B and I talked about getting married, the name change was an important issue. Your name does represent your identity, after all. Together, we decided that we a) wanted the same family name for all of us and any children we had, and b) we would find a relatively fair way to do it so that I would not be giving up my whole last name while he kept all his names. At first, we thought we would just have two last names, so we would both be Firstname, Middlename, Hislast Mylast. However, California law makes this very difficult, because unlike other types of name change, you cannot do it directly on the marriage license. So we decided we would both change our middle names to my last name, and change our last names to his last name. Now we are Mr. & Mrs. Mylast Hislast, and our children will be, too. Since his last name became our last name, we agreed that we would try to give any kids that came along Indian first names so that they had a lasting sign of their bicultural heritage. I think this final decision shocked both of our parents equally, which is probably indicative of a good decision...just kidding.

Anyway, being married is an incredible gift, as is seeing B every single day. Even on nights when I get home from lab at 7 pm, I still see him more than I did when he was in LA. Imagine that! You know, it boggles my mind that people were so generous as to travel to our wedding and also send us gifts. Their presence at the wedding and the wedding itself was more than enough. What amazing friends and family. Really. I am still writing thank you notes to all these wonderful people.

Since the wedding, I also started my new job! You can see a picture of my very own lab bench, above. It's actually a research fellowship, but I call it my job because it pays me and it's not directly related to the medical school curriculum. I'm working in an immunology lab and it's a great working environment. It's fun to be surrounded by smart people, and there are many clinician-scientists. I've already had the chance to present a patient at conference, which was fun. Hopefully I can begin regularly seeing patients at the weekly clinic. My other goal (other than studying for the second medical licensing exam) is to learn STATA, a statistical software program that is widely used for epidemiology research.

So, in short, we are adjusting to a calmer and more 'normal' way of life as we try to sort out the apartment, the legal Bar studying, the research, and the being married before we go on our (slightly delayed) honeymoon in August (another very generous wedding gift).

My Last Clinic as a 3rd-year Student!

Wednesday (April 20th) was my last clinic as a 3rd year student. It happened to be psychiatry. One patient was a super brilliant, highly paid, very well-educated, slightly unstable man who came in because of multiple issues that cropped up once he started working full time. It was challenging for me to interview him because he engages in many dare-devilish practices that frankly scare me and that I've never really understood, and some that I've never heard of. But it was a great exercise in finding those little handles people have that allow you to empathize with anyone -- some small preference, a place they've lived, a hobby, a pet, a belief. In this case, the fact that we were both in the healthcare field was a common reference point, so that worked nicely and broke the ice.

The second one was just a check-in from a man who had previously had such serious problems with alcohol/drug abuse that he had to enter a live-in residential program and leave his family and home behind. Somehow, miraculously, he has not only stayed straight-edge but has reconciled to some degree with his wife and she brings their daughter to visit him regularly. He has been sober for two years now. He told us tearfully (although perhaps this is fortunate) that the child is too young to remember when dad lived at home. I have nothing but the utmost respect for my psychiatry attending. As I've watched him over the year, I've realized how often he sees people at the very lowest point in their lives and then guides them back to emotional, and often physical, safety.

Because I am in a longitudinal clerkship program, I have had precepting sessions with different attending physicians in the core disciplines (Internal Med, Family, OB/GYN, Pediatrics, Neurology, Surgery, Psychiatry, Emergency) all year long and at seemingly random times of day and week. We've had a couple of inpatient experiences (2 weeks on Medicine, 1 week on OB/GYN nights, 2 weeks on surgery, 4 days of cardiology), but for the most part it has been outpatient medicine.

We also carried a core patient panel of about 60 patients each in all of these disciplines, and followed them into the hospital whenever they were admitted or on labor & delivery (via really old-school clunky pagers that would go off when any of our patients checked in for any reason at any of our affiliated hospitals). It's been amazing. Frustrating, demanding, often sleepless, awe-inspiring, touching, poignant, tearful, and just absolutely incredible. Never again will I have such complete access to all the different services of a hospital. Never again will I just be able to walk into the room, explain that I'm a longitudinal student, and then participate in whatever happens that day. In my fourth year and from now on, I will carry a label. I will become not just a student, but a student going into X specialty. And then I will be an X specialty resident, then attending, and so forth. This year, I have had the honor of being taught by some of the best and brightest minds in medicine, many of whom took the trouble because I was still an 'undifferentiated student' who had not yet decided what to do.

I have had so many 'firsts' as a medical student this year. First solo delivery of a baby with my (gloved) hands. First digital rectal exam (also gloved). First solo pelvic exam (metal speculums are less uncomfortable). First time breaking the news that someone had terminal cancer. First time a parent told me, "Thank you so much for taking care of my child." First lumbar puncture. First code. First time comforting a grieving relative. First time staying up all night for two days straight.

First time cauterizing a liver in the OR. First person to see someone who had psychotic hallucinations. First time I've seen a terminally ill child. First time I've had to explain why a woman in her twenties had to have her uterus emergently removed and will never again have children -- the day after her would-have-been wedding day. First time someone said "no" when I asked if they were safe at home. First thank-you letter from a patient. First time someone explained to me that they had to choose a Christmas tree OR presents for their children this year, and so couldn't afford their seizure medication. First time I've seen a husband and wife in back-to-back appointments -- in the oncology clinic. First home visit (to a healthy and robust man in his late 70s).

The Girl in the Orange Hat (first child I delivered, held by proud mama & papa)

It's been a memorable year in such a visceral way, to experience these human beings and their stories. I remember their faces, the feel of a spine, the smell of blood, phrases they used, the sound of their coughs. I look at a patient's belly and see my own sutures holding their wound closed. I look at an infant and remember catching him or her, soaking wet and newly born. It is a huge, enormous, incredible privilege to be there when people are feeling their worst, or hear the most terrible news they ever will hear. Likewise when the wonderful things happen: miracle recoveries, successful treatments without side effects, a false alarm. The thing about our longitudinal clerkship, though, is that I've also been there for the in-betweens: the colds that drag on through the winter when a patient is immunocompromised, the thyroid medicine that's never quite right, the lady who everyone thinks is "difficult" due to a lanuage barrier. These are the daily lives of the people of this city, and it's amazing to be so involved.

The next two weeks will be calmer: we have an end-of-year course focusing on healthcare policy and planning our careers. I have more tests to look forward to, as well. I am taking Step 2 of the national licensing boards soon. Clinical Skills (CS) will be in about 2 weeks, and then I'll probably take Clinical Knowledge (CK) some time in July. CS is pass/fail, whereas CK is most certainly not. I'll be studying hard for that one! Also in the next two weeks comes apartment hunting, wedding planning, and recovering from sleep deprivation. I'm SO looking forward to the idea of a class breakfast tomorrow morning, when I'll see how everyone is doing as compared to last term.

After a year of ups and downs and struggling to glean a tiny bit of this terrible, beautiful beast that is clinical medicine, it is such a pleasure to sit here with a cup of tea and write to you, knowing that spring has finally arrived.

A Bend in the Road Deserves a New Blog

Half Dome in Yosemite

Hello friends! Welcome to my new blog. I decided to start fresh because of an upcoming Bend in the Road. The three years of our pre-clinical, MD-master's program were very educational (to read about them, visit my old blog), but also very different from the clinical world I have been immersed in over the past year. My first clinical year of medical school has been eye-opening. It's been amazing, frustrating, demanding, and awesome. I think I have finally started to come to terms with my identity as a future physician, and I wanted to celebrate that by starting a new chapter in my blogging life.

In addition, two important and exciting things are coming up, each of which deserve a new blog perspective: I'm taking a sponsored research year to study how bones interact with the immune system (yay!), and I'm getting married next month (yay!). In the next year, I will also be trying to decide what kind of doctor I want to be: which specialty, how much clinical practice vs. research vs. education, etc.

My desire is to use this blog to share what I learn as I continue along this (slightly daunting) path. Anything is fair game, but as the title suggests, my focus will be on my daily life of medical school, matrimony, and the mayhem that is bound to ensue! As always, comments are gladly accepted and insights much appreciated.

Hugs,
Nia