The Existential Crisis of a Second Year Medical Student

As someone who never intended to be a doctor growing up, I struggle with this crossroads at times where I am losing the side of myself I find most precious and dear. I worry about losing the girl who loves creative writing, reading fiction, watching political discussions, and contemplating the philosophical complexities of humanity and how we fit into this strange world.

My interests go far and are certainly not limited to science or medicine. I could have chosen many professions, but of them all, I most preferred becoming a doctor. Perhaps my reasons are the same as others, for the cliché reasons of wanting to help my patients. And I find the functioning of the human body amazing. Studying medicine is useful both in practice and in my own life. Mostly though – I am inspired by the pain of the human condition and how I can play a part in using my knowledge to take that pain away.

I began the second year of medical school feeling confident in my abilities as a student. I excelled academically and knew how to study for exams. Reproduction and Endocrinology Module set me off on a good start for second year and certainly helped for my first rotation in Ob/Gyn. Multisystems Module felt like the academic time to tie up loose ends, build on previous concepts, and reminded me that microbiology is more complicated than I realized. I had a great run and ended up with a distinguished performance award for pre-clerkship didactics. The first year and half of my medical school career were some of the best times of my life. I figured out a routine and thoroughly enjoyed my free time. I stayed close with friends and family and got to spend time in my favorite area (northern Virginia ie home).


Jessie and I at her wedding!

My last real break this past winter felt like more work. I spent the majority of my time packing my entire apartment into storage amidst construction due to a flooding/molding issue and catching up with friends in the area before heading out to San Diego for rotations. I spent a few days in Sacramento (Andrew’s first trip to California!) for Jessie’s wedding – first time I was a bridesmaid. I learned about how American weddings normally go and got to wear a beautiful dress and take part in their beautiful wedding. Jessie and Andrew (her husband is also named Andrew) had a lovely ceremony and amazing New Year’s wedding party.

USUHS is unique in that we go out on rotations halfway through our second year of medical school and postpone Step 1 exams until after our “clerkship” rotations (Ob/Gyn, Surgery, Pediatrics, Family Medicine, Internal Medicine, Psychiatry, and an elective). 3.5 months in San Diego for Ob/Gyn and Surgery was the longest time I have been away from Virginia.

The first few weeks of Ob/Gyn, I was insanely enthusiastic and enjoying learning. As the days continued, I began feeling the enthusiasm wane a little as my days consistently dragged longer, as I was missing home, as I felt like I was never good enough. Being a medical student at a teaching hospital is being at the bottom of the totem pole. Some doctors want to help you climb up and others will stand on you and ignore you. Ob/Gyn in San Diego consisted of 5 weeks: complicated obstetrics, labor and delivery, reproductive endocrinology and infertility, gynecology, and oncology. I loved getting a taste of everything, but it was exhausting switching teams weekly. As soon as I felt comfortable, I had to start all over. The program director was amazing and the experience was great to start out with as Ob/Gyn exposed us to the wards, surgery, and clinic.

The next 10 weeks were surgical rotations: cardiothoracic surgery (I held a heart – it was cool), ENT (great life experience), and general surgery. My existential crisis pretty much compounded itself during surgery when I began questioning whether I fit into medicine as a culture. I enjoyed my weekend trauma shifts, met inspiring people, and did awesome things in the OR. Something just didn’t click though.

During my time in San Diego, a beautiful friend of mine from college took her life. I think about her in waves of mixed emotions, and sometimes I find myself falling apart at the thought of the world losing such a lovely person. It got me questioning the purpose of life and what I want to get out of it. San Diego represented this new phase in my life where I no longer felt confident in who I was as a person anymore. I survived because of the beautiful weather, my amazing USUHS classmates, and my mom.

On days I question why I wanted to become a doctor, I try to remember what brought me to this moment. When I feel like a failure, or feel exhausted, or wish I did something else with my life, I try to think about the superficial struggles in life that tear us apart. The little things keep us going, but the little things are also enough to break us down.

I define myself by my academics, life choices, dedication, compassion, need to learn, and by my desire to change the world. I want to be a writer, but I don’t know how to write anymore. I want to be a doctor, but I am only beginning to understand what that entails. I want to stand out, yet I find myself hiding as if I am ashamed of being caught, of people thinking that I do not belong in this field because I question it. Is it bad to not love anything enough to want to do it for more than 12 hours a day every day? Is it bad to say that by throwing myself into one facet of my being, I feel like I am losing the rest of who I am? I try to take a deep breath at the end of each day – both the good and the bad – to reflect and remind myself that I am in a microcosm of medicine that is but a small piece of my career and future. I may not be the philosopher or writer I once hoped I would become, but I cannot lose the humanities side of myself and part of me that is so deeply engrained to love my patient more than I love medicine.

I might not enjoy new uncomfortable situations, but I constantly find myself doing things I never planned to. I sometimes think I crave challenges just to prove to myself that I am capable. That probably factored into my choice of commissioning into the Air Force (one of the best life decisions I have ever made). The military forces me to experience the world in ways I never would have otherwise.

Anyway, the existential life crisis continues. Throughout medical school, I assumed I would pursue psychiatry, but I am definitely considering pediatrics. I beyond LOVED my pediatrics rotation at Walter Reed, and it reinstated my faith in medicine. For the first time throughout my rotations, the faculty and patients made me feel like I belonged in medicine, which is a beautiful thing. I had never picked a baby up before nor changed diapers, and now I am pretty much pro at both (nursery week was my favorite). It is funny to think back at the cardiothoracic surgeon attending who kept calling me a pediatrician, because he said I was “too nice to be a surgeon.” Pediatricians definitely won the prize for most friendly field thus far.

So that brings me to now – I am currently in Omaha, Nebraska during this transition to being a third year medical student. Family medicine has been treating me well, and I love being with the Air Force. As opposed to the San Diego experience where I questioned if I should be in medicine at all, Omaha is giving me time to figure out how and where I fit in because the options are endless.

Pretty sure existential crises are healthy parts of introspective awareness. I have been doing way too much thinking this past year and could not figure out how to get it into words, so I appreciate anyone who took the time to read my stream of consciousness written on a late Sunday night.

The MSI Finale, Summer, and Beginning MSII

I have been living with a new motto recently: learn to enjoy the moment. That being said, I will blame said motto for the extended hiatus between blog posts. This past year has flown by, and I cannot believe I am already in the second year of medical school. It’s been an amazing journey, and I am truly grateful!

GI Module
Neuroscience module came at a great time after spring break and was extremely well-organized, fun, informative, and the easiest module for me. Granted, I was a neuroscience major at William and Mary, so it came in handy. GI module (let me clarify: Gastrointestinal Tract, Hepatobiliary System, Hematology, Oncology, Metabolism and Nutrition Module) was pretty horribly timed. As the last module of first year with no more than Saturday/Sunday to de-stress after our last final, I was burnt out and didn’t even realize it. The first couple weeks of school were killed in terms of productivity because the lottery to determine third year rotations took place throughout the school day and really distracted from learning – especially for the few lecture-goers like myself who found ourselves checking our lottery statuses instead of paying attention and taking notes.

Because the first two weeks of GI module were lottery weeks and the next weekend after that was Memorial Day weekend spent catching up with family/friends, including a lazy tubing adventure in West Virginia, I focused all of my energy studying like mad for the next couple of weeks before midterms. I thought I had appropriate catch-up time studying and actually felt prepared for my midterm exams. At this point, I have learned that feeling prepared for an exam is a major red flag. When I feel prepared – as I was for both MSK and GI midterms – I do far worse than when I have a mini-freak-out the night before an exam. Anywho, my midterm scores motivated me to kick it into high gear, so finals were fantastic. They were redemption for my bruised academic ego. I think I might be more interested in Heme/Onc/Nutrition, so that likely played a part as well. For current USUHS classmates, beware that the GI midterms were a dud across the board for our class and the class before, but I hear that the module directors are working on improvements to see how to fix that trend from the past couple years. Ultimately, it was my worst module academically, but I still passed and feel confident about the information we learned!

The Lottery: Third-Year Rotations
The lottery is quite the system. In the end, it all works out. Basically everyone was happy in the end, and we are getting a great experience at all of the locations. We started out with 100 points, and at least 1 point had to be used for each of the 9 rotations. You can prioritize based on the order you want to do your rotations or the places you want to go. I knew I wanted to get the surgical rotations over with, and being local to northern Virginia, I wanted to stay in the area as much as possible. My order of rotations was definitely not how I originally planned, and I am not going to Hawaii at all despite putting it #1 almost every time. However, I feel particularly lucky and am ecstatic at how my rotations came out.

We had two options: go homestead or go singles. Homesteads group three rotations together in one location. It’s a pretty great deal. It’s less stressful in terms of moving between rotations and less stressful in terms of time towards the lottery during GI module. I am doing my first set of three rotations in San Diego and my last set of three rotations at Walter Reed.

Local locations became vastly more popular this year than previous years because the system for housing at rotation locations changed. Now, we have housing provided for us at rotation locations rather than having an allowance for housing. I myself prefer this, but it was not a pleasant surprise for the folks with families who planned on bringing their kids to different locations. We were told that our lodging is comfortable for a spouse or significant other to stay, so I am excited for Andrew to visit while I am in San Diego!

Stay tuned in 2016 for rotation updates. My schedule is as follows:
– San Diego for Ob/Gyn, Surgical Subspecialties, and General Surgery, January – April [where my mom lives]
– Walter Reed in Bethesda for Pediatrics, May – June
– Offut Air Force Base in Omaha, Nebraska for Family Medicine, June – July [believe it or not, I’m actually excited for this one too]
– Fort Belvoir, VA for Psychiatry: Addiction, July – August [my selective rotation]
– Walter Reed for Internal Medicine (Outpatient and Inpatient) and my favorite for last, Psychiatry, August – December

I had four days off after the end of the school year to run errands galore before leaving for my summer operational experience. All Air Force students go to the Aerospace Medicine Primary 101 (AMP101) course, the first of three required courses to become a flight surgeon/medicine doctor. I road tripped up to Wright-Patterson AFB in Dayton, OH with a few other USU students and was happy to see my fellow classmates as well as familiar HPSP students’ faces. Of the 70 attendees at our July 6-17 AMP session, the majority were USUHS kids, about 20 were HPSP, and four non-2nd-lieutenants were doctors and reservists who were given the responsibility for accountability. Our AMP session was booked to max capacity. The two June sessions were majority HPSP students and the July session after ours was reserved for mostly physicians rather than students.

First week at AMP101 was death by powerpoint, but I enjoyed the presentations in the sense that I have a much better idea of real life operational Air Force now. The weekend of AMP I attended my first friend wedding at the Alumni House in Williamsburg, VA. It was a blast to my college past, and I was glad to have Andrew meet the fabulous bride and groom – two of my friends from William and Mary. It was a mess of stress to coordinate this. I had been emailing the AMP higher-ups as well as up my own chain of command for a few months to get permission because I needed to take leave and plan my flight back to Virginia – – note that on the Thursday afternoon of the first week, students had the opportunity to switch schedules around with other students to allow for personal trips. We were given three days off that were different based on your group, and I am happy I did all the work and coordination in advance because I would have originally been scheduled for a fly day on the same day as the wedding and would not have wanted to wait until last minute for scheduling.

Reunion of friends at William and Mary for the #LizGoesPro wedding

Reunion of friends at William and Mary for the #LizGoesPro wedding

That being said, I also was at the mercy of weather. For such a large AMP session, we had three groups scheduled to fly on Saturday, Sunday, and Monday. Unfortunately, Saturday had the best weather and not enough pilots scheduled, so a few students were pushed to Monday fly day when it rained in the afternoon. I was among 8 students who had to go in for a chunk of our Wednesday off to fly. If I had lounged around Ohio all weekend like most folks did, I wouldn’t have minded. However, I was beyond exhausted and sleep deprived. I do not regret going to the wedding, but it most definitely put a damper on some fun activities during the second week of AMP festivities, the highlights for me including the tour of the Air Force museum, flight simulators, and flying the SR-22 Cirrus with a pilot. We had to present a safety brief and study for the final exam, both of which were not difficult at all but involved time and energy I was horribly lacking.

Heads up for those afraid of heights, flying is an incredible experience and not-at-all scary because of how exhilarating it is. It helps that there was a seasoned pilot manning the controls in the passenger seat like driver’s ed.

About to fly the Cirrus SR-22

About to fly the Cirrus SR-22

Summertime Off
After coming back from AMP, I finally had time to catch up with friends and family in the area. It was so very necessary to see the important people in my life that I had trouble keeping in touch with over the past year. As an INFJ often mistaken for an ENFJ, I recuperate by becoming a bit of a hermit and organizing my life. I had to balance my excessive social life with scrubbing the bathroom and trashing random items I hoarded as mementos for my past or references for the future. And of course, there was lots of HGTV/Netflix.

Andrew and I attended a wedding in Long Island that should have been on MTV (it reminded me of those crazy impressive super sweet 16 parties). We also spent several days at Sebago Lake in Maine. I spent the first rainy day reading Go, Set a Watchman. The rest of the days were gorgeous and sunny, so they were filled with paddle boarding, paddle boating, canoeing, swimming, speed boating, and being lazy. It was lovely. We went to Portland for our last full day to shop, eat, and be merry. Lobsters all day, every day.

ACME: TCCC, BLS, ACLS, Antietam March
All the acronyms.
ACME – Advanced Combat Medical Experience, part of MFP 102 (Military Field Practicum)
TCCC – Tactical Combat Casualty Care
BLS – Basic Life Support
ACLS – Advanced Cardiovascular Life Support

We were split into two groups. One group started with TCCC (i.e. “TC3” or “T triple C”) and the other started with BLS/ACLS. I was happy to start with TCCC – we had longer days, but they included fun activities and were reflective of our combat medicine classes during first-year medical school. All we had to do to pass was to study TC3 guidelines and learn the primary/secondary assessment sequences for patient encounters. TC3 was especially fun because we had paintball guns, ran into the forest to save patients, and got to see ourselves on camera to realize we weren’t as much as a mess as we felt during the experience. We also learned medical skills like cricothyroidotomies and chest tubes.

Ready to save some lives!

Ready to save some lives!

In the weekend of ACME, Andrew and I attended our third wedding of the summer and saw two of our friends get married!

In the weekend of ACME, Andrew and I attended our third wedding of the summer and saw two of our friends get married!

BLS and ACLS were more fun for the emergency medicine/ICU personality types. It involved a lot more studying for folks like myself who did not have the background for it, but it was a worthwhile experience. BLS was the simple CPR and defibrillation sequences. ACLS involved leading a megacode team (and being part of a megacode team). It involved a team leader, time keeper, CPR, maintaining the airway, defibrillation, and medications. There was a practical where we could use the all-mighty ACLS card and a written exam based on classroom material (it helps to do the practice questions we were given as well as reading the book/supplementary packet).

I had been looking forward to the Antietam March. It was a 6.5 mile walk/trail/hike that is easy when you aren’t falling behind schedule and basically jogging it with all your gear on. Also, I didn’t mind the rain much because it cooled us down, but rain + jogging = blisters (and here I thought my boots were the most comfortable shoes I owned!). It was a fun way to end ACME and to allow us to compare military medicine from the days of the bloodiest battle of the Civil War to today.

The Official End of Summer
This past weekend consisted of a fun MSI/MSII mixer and an impromptu beach trip to Dewey Beach (the waves were so aggressive!), so I have definitely had some laughter and sun before hitting the books hard again. Cheers to this past year and making it to Reproduction and Endocrinology Module!

COT Packing List and Words of Advice

I have received multiple inquiries concerning: “what do I pack for COT this summer?” and here is an all-inclusive list including optional items. Please send a message or comment if you believe there is anything I should add, and I will edit the post!

Note that there is a Military Star credit card that you can receive after getting your orders. With the star card, you get 10% off your first purchase, so buying your uniforms the first round will be when you want to use it. I personally didn’t want to keep track of another credit card, but it’s a great option to keep in mind. I spent upwards of $3500 or so in my first 6 months on military gear (during COT you’ll get $400 back towards uniforms).

If you have the time and a prior service individual to help you out, I strongly encourage you to buy your uniforms and get your name tags in advance. I didn’t purchase them in advance myself (I only had a few days between returning from Brazil and leaving for Alabama) and it worked out fine. If you buy them at COT, you’re assembly-lined throughout the store and are likely to get many things at slightly the wrong size. The poor tailors are also rushed to get everything done, so you might need re-tailoring when you return. Bright side, it feels like a break on day 1 from all the yelling (but OTS staff will be circling to make sure you’re not hanging out). Keep your uniform list on you and ASK QUESTIONS if you think you’re missing something. You don’t get opportunities to go to the shop in the first couple of weeks unless you get flight commander approval.

Uniforms to get beforehand or at COT [# suggested]:

  • ABUs/field uniform [2-3]: blouse, pants + 1 belt and 1-2 covers
    • Last name, USAF, and rank tags for the blouses are ordered at the shopette counter – can be sewn on in the later weeks at the tailor when you get privileges to go. You can also get your specialty badges sewn on (MS badge for USUHS/HPSP). These badges are optional for COT. For some career tracks, like chaplains, you are technically required to get your badge for the uniform. You won’t be called out on it if you wait until after COT to sew them on.
    • I personally preferred 3 uniforms because I sweat buckets at COT, but 2 uniforms are definitely enough after COT.
  • Subdued hard ranks [2-3 sets]:
    • Get however many you need to have a pair of hard ranks for your blouses and a single hard rank for your cover. You can transfer hard ranks but I thought it was easier to have extras and leave them on.
    • You will have sewn versions later and won’t use these after COT, but they’re cheap.
  • Desert tan shirts [3-9]
    • If you are a female who never sweats, you can probably re-wear the t-shirts. I ended up buying like 12 t-shirts (excessive) by the end of COT because I would change my shirt at any opportunity when we had time to stop by the dorms. Everyone smells bad, so not a big deal if you’re trying to save money. After COT, you’ll never wear half of them if you buy as many as I did.
  • Sage socks [3-9]: again, buy as many as you think you’ll need.
  • Sage boots [1-2]: people say to break them in but I didn’t have any problems with mine
  • PT shirts [3-6]
  • PT shorts [2-6]
  • Optional: PT pants, jacket, sweatshirt (it’s really cold at night, but useful if you go during the colder months)
  • White or black socks for PT [6]
  • Blues: you only wear a few times in the last couple weeks
    • Short sleeve shirt [2] – get the princess cut if you’re female! You don’t have to tuck them in.
    • Long sleeve shirt [1]
      • Not required for our summer session
    • Wool pants [2]
      • Don’t get the polyester pants because they don’t match your service coat. The “wool” pants also have a percentage of polyester in it, so you’re looking for the wool/polyester tag.
    • Belt [1]: cut to fit your waist, buckle on R side for females, L for males
    • Rank epaulets [1-2 sets]: to slide onto blues shirt and optional pull-over
    • Bright rank [2-3 sets]: to pin onto service coat, flight cap, and optional blues light jacket
    • Females: skirt [1]
      • We weren’t required to buy the skirt and never wore them at COT, but we all wished we bought them once we returned. You’ll wear them with tan or black tights and synthetic leather black pumps or flats (no taller than 2 inches high, plain)
    • Tie tab (females)/neck tie (males) [1]
    • Garters/blousing straps [1]
    • Shoes [1 pair]
    • Long black socks [3]
    • Service coat [1] + name tags, U.S. Insignia, 2 required ribbons (DoD and national service ribbons I believe) and ribbon mount, optional specialty badge
    • Flight cap [1]
    • Optional: jacket, pull-over sweater, cardigan (seasonal)
    • Males/optional for females [1-3]: white v-neck undershirt (worth it on the hot days so you don’t sweat through your blues shirt)
  • Note that you do NOT need to get mess dress or your service coat for COT, but you’ll be required to get these uniform items for USUHS by spring. Most waited until they came back and you will not be assembly lined to get these uniforms.

Packing list:

  • Civilian clothes [2-4 outfits]: wear an appropriate outfit on day 1
    • Might want more if you go to religious services on Sunday
    • Only useful during the last couple weeks to wear on the weekends
  • Hair gel
  • Hairspray
  • For ladies with longer than shoulder-length hair: hair ties galore that match to your hair color, bobby pins that match your hair color (I love love love hair pins for the buns, work better than bobby pins for thick and unruly hair), sock/mesh buns if you don’t roll your hair into a bun or don’t braid your hair
  • Underwear
  • White shower towel [1-2]
  • White hand towel [1-2]
  • Hygiene supplies – don’t forget that deodorant!
    • Shampoo/conditioner/soap
    • Razor
    • Small detergent bottle
  • Combination or padlock
  • Green service duffle bag
    • Will hold all your things when you’re coming from the uniform store and you’ll be using this for field exercises
  • Notebooks/paper/pens/pencils/stapler/highlighters/erasers/sharpies/tape whatever things you like for classes
    • If you’re photographic officer (like myself), more supplies were useful to decorate the flight room board
  • Black eyeglass straps if you have glasses (I hear they’re called croakies), can purchase at uniform store
  • CASH ~$400: small bills preferable
    • If you’re not going straight into active duty (HPSP and reserves), you’ll need cash to pay for your meals all the way through. It’ll be 3 meals/day, very cheap but it adds up. If you’re AD, you’ll get a card midway through with money on it (deducted from your pay) to pay for food at the DFAC. There’s an ATM at the shopette, but you won’t have privileges to go there in the first few weeks.
  • Credit card/debit card to spend ~$1500 on day 1 for uniforms and supplies
  • Wallet/ID/etc.
  • Phone + charger (you will not be able to keep your phone on you in the first few weeks unless you are a leader of some sort with the privileges)
  • Laptop + charger
  • AA batteries (can buy at shopette)
  • 10+ copies of your orders
  • Immunization records
  • Note that the shopette is like a convenience store, so if you don’t pack certain items, you can get them on the first training day. The uniform store and shopette have almost everything you’ll need.

Buy at COT (for convenience/standardization with your flight):

  • White Rubbermaid storage container for food
  • Plain, white mesh laundry bag
  • Plain black camelbak 4L bladder: your “hydration system”
  • Black flashlight


  • Car
    • Convenient for when you get privileges to go off base, but your car will be sitting in Alabama heat for 3-4 weeks and you CANNOT go to your car during this time (but the parking lot is next to the Morehouse dorms). There were 5 cars in my flight, which was very convenient, but beware of your car battery dying (happened to myself and one other person in my flight). There’s a good auto shop right off base I got mine fixed.
  • Digital camera + charger
    • Helpful if you want to be the photographic officer (I was and it is a way better flight job than most)
  • USB flash drive
  • Non-perishable food (you will have a specific place you will be storing these in your dorm room)
    • All the snacks, all the granola bars – can buy these at the shopette on day 1 too
  • Baby wipes
  • Little scissors or nail clippers
    • You’ll really want to bring these to cut cables (the little thread pieces on your uniform). Demerits galore from the little cables you’ll inevitably miss. I kept my scissors in my pocket at all times and they were popular for daily use as we passed them around in our flight room.
  • Black umbrella
  • Pocket knife
  • Hotspot (ideal if you have it available on your phone)
    • The internet is awful, and you’ll need it. Be nice and let your flight makes use it when they’re frustrated. Ask for a few dollars if you’re worried about cost. I would’ve willingly paid to get quality internet access.
    • You will be a savior to your flight if you bring a printer. Ask everybody to chip in $2-3 for ink so your flight-mates can use it for the random things you’ll need to print when you’re not given access to any computers or printers.
  • Bug spray
  • Sun screen
  • Ear plugs/face mask if you’re a picky sleeper
  • Energy drinks/caffeine pills (I’m not a fan, but many swore by them)
  • Ladies: makeup/accessories for your few days of freedom
  • Black watch cap (seasonal)
  • Sage watch cap (seasonal) – you can only wear with ABUs
  • Black gloves (seasonal)

Despite this EXTENSIVE packing list, try your best to pack light and tight. Buying uniforms at COT gives you the benefit of lighter luggage but the loss of having your uniforms actually fit right. In terms of quantity, buy what you feel comfortable with. I liked having extras, but I have a friend who wished she bought far less. Just keep in mind you’ll be wearing your ABUs 6 days a week and your PT gear 5-6 days a week before you can do laundry. If you have time to kill before COT begins, you might want to skim/read the OTSMAN. It will make no sense at first, but you will be quizzed on it constantly from OTS staff and you’ll have a written quiz on the first Saturday. You will also have a tiny font book version of it issued that you will need to have on you AT ALL TIMES. Every spare moment where you’re doing nothing at COT, they’ll want you to hold it a special way as you read read read it slash pretend to read it as you daydream about all the things you’d rather be doing. Just be grateful your training is way easier than BOT and that you are already a commissioned officer.

When you first report in, the screaming starts. Better have everything at the ready when you come in (if they don’t change things up, this includes $60 cash – an advance for food – and your ID). You might be lugging your baggage in gravel on day 1. Keep your cool. It’s okay that people are yelling. They want to see you stay calm. Even if you’re doing everything perfectly, you’re going to get yelled at. Still though, don’t smile (OTS staff do not like that, and it took me a while to keep a straight face).

Wear appropriate clothing (sneakers, no short shorts). Always have a pen and cash on you. Men, cut your hair short. You cannot have your hair beyond 1 inch bulk (you can gel down longer hair) and you will not be able to get a haircut for the first few weeks. Ladies, tie your hair up in a bun (as neat as you can, you’ll get the trick a few days in). Don’t wear jewelry besides wedding rings (in real life Air Force, you can wear studs, plain bracelets, and up to 3 rings). Day 1 is meant to throw you off your game. Keep your cool, and remember that this is all testing how you respond to stress.

During the first or second night, your flight will need to meet and assign duties. Pick whatever you feel most comfortable with. I was squadron photographic officer and was very happy with it (you have to sign up for a flight duty, but there are squadron and group officers too, putting you in charge of more people). FOIC, flight-officer-in-charge, is recommended if you want to step it up as a leader (VERY stressful, but you can keep your cell phone on you; they prefer captains for FOICs over lieutenants). Standardization officers never realize how much they’re actually signing up for; it’s A LOT of work and you get demerits for your flight mates who mess up their uniform. You’re responsible for everyone’s rooms and uniforms and appearance (that they are appropriate and match each other). Administrative officer is pretty easy; they collect mail (they got rid of postal officer my year). Financial and social officers seemed like good deals too. If you’re prior service, drill officer is a good call to teach everybody how to march. In my class, the positions were as follows: FOIC, academic, social, drill, photographic, standardization, administrative, computer, finance, athletics, dining in/out, logistics, safety, and field trainings officer (I cannot remember the exact name of that last one; it’s good if you like outdoorsy activities). The general consensus is that FOIC and standardization officers have way more work to do than everybody else and take a lot of heat from staff. The rest are fine as long as you pick something you are okay with (organizing flight grades, coordination for COT graduation, taking pictures, IT, finance spreadsheets, coming up with exercise routines, making table centerpieces for dining in, logistics of picking food up etc.)

The most upsetting thing I saw in COT was when people let the stress get to them. If you keep your cool, do your best, follow directions, and take care of your fellow wingmen, you will do just fine. Remember it is only 5 weeks, and once you get to weeks 4-5, you’re in the clear! The first two weeks are the hardest, and the worst thing you can do is let it get into you mentally or emotionally.

Unlike previous years, THERE ARE ROOM SEARCHES and you will get demerits (possibly for your roommate as well) if you do not have your things organized. You might not be an organized person, but help yourself, your roommate, and your standardized officer out and try your best to stay neat and keep your rooms standardized to regulations. They say that they will take your luggage away with all the things that do not follow regs, but that never happened with my group so I hid my civilian clothes and other random items in my luggage that didn’t have a place anywhere else.

Last words of advice: sleep as much as you can before COT, make friends, and ENJOY YOURSELF during this experience! Real world Air Force is completely worth it.

Quarter Century Update: Writing, CPR, Neuroscience, and Finding a Balance

This might sound silly, but I am destined to do something great with life. Perhaps we should all feel this way to some degree. It drives my intrinsic motivation haywire and might explain my joining the military to be a physician. This might also explain why I feel a lurking presence telling me I should be doing more. I want to do something great, but I cannot tell you what that is yet. If it’s not medicine, I want it to be a book.

My greatest goal in life is to write a novel. Nothing like the ramblings in this blog, mind you, but something more legitimate. There’s a story I have been wanting to tell for quite some time. Still cannot figure out how I want it to end though. Maybe I’ll figure it out as I put the pieces together and start letting my stream of consciousness take over into something of substance.

An unfortunate thing about creative writing: I am most motivated in times of emotional despair. Words come easily when my amygdala is on fire. Probably related to why the most amazing artists have the most tragic backgrounds. I will use that as one of my explanations for the gaps in my blog posts during medical school: I am having a great time and do not feel the need for writing to be an outlet for negative energy anymore. I think I need a new approach: channeling my positive energy into writing as much as I use it as an emotional outlet.

In other news, I turned 25 on Friday. Celebrated at the Cheesecake Factory (my fave) and received warm wishes from friends and family all over. Birthdays 23 and 24 don’t feel like too long ago, yet so much has happened in the past couple years, let alone the past few months. For one, my first-author manuscript about hippocampal volume changes in childhood-onset schizophrenia has been accepted for publication in Psychological Medicine! Achieving a first-author publication has been a dream since I first looked into working at NIH. I have experienced my fair share of projects falling through last minute, as is the case with medical research. I am lucky to have a few co-authorships, but achieving that first-author was a battle and great success.

For anyone curious about post-winter break USU curriculum, CPR (cardio-pulmonary-renal) and Neuroscience modules have certainly lived up to their reputations. Most organized modules but also the most difficult. Rumor has it that school is much easier during GI module, which seems like a break in comparison. Honestly though, in CPR I began relaxing more and successfully struck a balance in this work-life business that people say you lose during medical school.

Medical school is about balancing priorities. Mine are academics, mental wellness, physical health, and family/friends (I show up to the important things)… with my priorities in that order on a normal school day. Others likely have a different order, especially if they have children, focus on extracurricular organizations, or are social butterflies. We all have our own methods of studying and we all have our own methods of decompressing. You do you.

CPR was a great opportunity to find that balance, and I have kept it up in Neuroscience. The module directors in both of these modules are beyond accessible and approachable; faculty members genuinely want their students to succeed. I watch a lot of television these days, but I feel my time spent studying is more high quality (I will let you know if I am singing a new tune after Tuesday’s midterms). CPR and Neuroscience have Dean’s Time galore (2-3 free afternoons a week), making it easier to keep up with the material. I find this is the case more so with Neuroscience because CPR had dozens of assignments due (plus I was not a huge fan of the graded small group sessions), but the nice thing in CPR was having a full week dedicated to both midterms and finals. My preferred study style is old school: by myself, with papers and notebooks. Some other classmates prefer the group style and/or computers/tablets.

Our combat medical skills classes have been pretty cool the past few rounds. Military Medicine is an overarching module we have interspersed in our curriculum. We’ve learned how to intubate and other methods of establishing an airway, how to appropriately assess a patient at a scene and safely transport them, and we’ve done basic IVs on each other. Later this week, we will be doing more advanced IV techniques (still on each other) that involve injecting local anesthetics. I’m both excited and terrified! [Note: no one is pressured to perform the procedures or to have IVs done on them, but most people do. The goal is that we know the process and are familiar with these techniques during our preclerkship years].

Life has been treating me well. Today is actually the first day in two months that I have not had a low-grade fever, and I am finally recovering from an unfortunate bout of pneumonia. Oh right, my other explanation for not updating my blog… The Saturday after our CPR midterms, I went on a 7-hour GoRuck event romping around DC with some Air Force buddies. I had a sore throat before the event, which likely predisposed me to catching something more serious. I progressed to full-blown “I have never felt so awful in my entire life” within 24 hours and lost 8 pounds in the first week. Don’t worry, I got my appetite back pretty quickly and found those pounds again. All that matters is I am finally feeling well and got my much-needed energy back, hence motivation to write🙂

Well, that’s all I have for now. Neuroscience is certainly my favorite module thus far — coming from a Neuroscience major who wants to specialize in something related to Neurology/Psychiatry. No matter your interests, opening a human skull and dissecting brains are surreal and truly amazing.

Stay tuned for an up-to-date COT packing list for those of you heading to Alabama this summer. TBA in a future blog post.

Happy Spring!

Beginning the 2015 Chapter

2014 came and went, and along with it a plethora of emotional highlights I felt along the way: unadulterated happiness and relief with my unconditional acceptance into USUHS, excitement visiting close friends around the world, mixed feelings saying goodbye to the NIH, joy traveling to Brazil for the World Cup with childhood friends, stress when I hastily submitted my research paper for publication, anxiety due to sleep deprivation at Commissioned Officer Training, and passion, resolve, plus occasional fits of overwhelming despair during my medical training.

The MSK module ended on a solid note. I beasted during finals and redeemed myself from a post-midterm funk when I felt beyond burnt out for a few weeks. Without a doubt, winter break was well-welcomed. I spent the better half of our two weeks off in San Diego with my mom – we figured out Uber and adventured the city together. First day consisted of decompressing, food, and a lovely walk in her neighborhood where we could see the ocean and appreciate the great weather. Just what I needed after my first four months in medical school.

My family never really celebrated Christmas when I grew up, so lo and behold, I was in for a treat this year. I woke up to a breakfast feast – filet mignon, eggs, yogurt, and tea. My mom is the best cook ever, and I have been missing out since she’s moved to the west coast! After the necessary time needed to digest, most of Christmas Eve consisted of pool time and me appreciating warm weather galore. As for the evening, we were graciously invited to dinner with the Mormon President’s family and some other church-goers. My mom has become a regular attendee at a Mormon church near her and entered this network of lovely individuals I enjoyed meeting during my trip. [Note: I myself am a little confused about the role of the President, but I knew that he is a trained lawyer by profession. I learned a great deal about Mormonism from my mom, who’s working on a project comparing the Book of Mormon in English to the Persian translation to see if the translations are appropriate in Farsi.] Dinner was delish – ham, cheesy hash browns, green beans, followed by pumpkin and banana cream pies (everything home-made, the President literally whipped cream just before dessert).

Our Christmas Eve festivities were unlike anything I had imagined. After we ate, we all sat together and sang Christmas hymns. I had expected this to be uncomfortable, but I was pleasantly surprised. We all sat in a circle and picked our favorite songs (thankfully there were books for lyrics) while the President or his daughter played the piano. As a first-generation Persian American, it almost felt like one of those perfect families featured in the end of a Christmas movie. It didn’t feel like real life, but I certainly enjoyed it. The Elders joined for hymns later in the night to; this is when I learned that “Elders” are missionaries, with all the ones I met recently out of high school.

After singing hymns, we all dressed up in costumes the President’s wife had made to re-enact the nativity scene. My mom volunteered herself to be the Virgin Mary, and I played two roles: an angel and a wise man. Truly one of the most fun and memorable Christmases.

Virgin Mary (mom in the middle), three wise men, and Joseph on the right.

Virgin Mary (mom in the middle), three wise men, and Joseph on the right.

On Christmas day itself (with more steak and eggs for breakfast), my mom and I went to Seaport Village and Coronado Island, enjoying seafood, the warm weather, beautiful views of water, shopping, and a festive evening at Coronado Hotel.

In Seaport Village

In Seaport Village

After Christmas, I spent a good amount of time with family friends in the area, some of whom I hadn’t seen in nearly ten years! It’s amazing how at home you can feel with certain people, picking up just where you left off no matter how many years have passed. My ‘cousin’ took me to La Mer, so I got some face time with the ocean.

My last full day in San Diego was truly beautiful and my favorite day of the trip. My mom and I gallivanted all over La Jolla, which seemed to have all the fun activities packed into one area – with the beach, the lounging sea lions, an outdoorsy picnic area, shops, and restaurants. We showered each other with some much-needed love and attention before we parted ways the following day, when I returned to the real world of Virginia.

The week before classes began consisted of working on my NIH paper and seeing friends in the area, but mostly working on my paper revision. After recently catching up with some friends/former coworkers from NIH, I realized how much easier medical school feels in comparison! It’s nice to be a professional student. I enjoyed the longest lunch ever with my fellow genetics IRTA the other week and had this epiphany that she (along with Andrew and the IRTA she replaced) was one of the few people who were intimately a part of my post-graduation transformation. I don’t know how to describe that post-graduation phase I know many of us experience… It was certainly a time of figuring out my priorities in life and what I wanted from myself, others, and my environment. Few people in the world know you on that deeper level, and seeing her felt like this unexpected reminder of the younger Afsoon before she grew up.

So here we are. Break has come and gone, and classes are in full force. Despite the cold, which generally arrests my sense of productivity as my body and mind become increasingly lethargic, I have been faring pretty well this winter (knock on wood). Somehow I anticipated the cold to be much more gripping coming back from San Diego than it turned out to be. Warm weather was paradoxically a cure to my cold-weather loathing simply because I expected the cold weather to be so much worse.

The CPR (Cardio-Pulmonary-Renal) module has been more unrelenting than others, and yet, I feel like I am managing time better. Maybe I needed that positive encouragement on the first day back to school when I was awarded a free Gray’s Anatomy textbook for getting a 100% on my anatomy exam in MSK [I hate to be the nerd that says good grades are motivating, but they are.] I felt like I was trudging through medical school for a few weeks last module, and I finally have the energy and motivation to manage a better work-life balance that I didn’t have before. Maybe it’s because I started Crossfit too – something about lifting heavy weights and my muscles hurting 24/7 has helped me focus more and take the necessary breaks away from school and thinking too hard about science and medicine. Then again, Crossfit is also pretty intimidating, so maybe med school has simply become less intimidating.

Midterms are in a week, and I need to pick up the pace for our big exams coming up. I went overboard and bought prep books galore – including BRS (board review series is amazing) physiology, BRS pharmacology (pharm is a subject area I need to work on), First Aid Organ Systems, and a book on how to read EKGs. Granted, this might have been a response to well-deserved me-time rather than study-time. Andrew and I celebrated our two-year anniversary last week! Our second celebration at L’Auberge Chez François in Great Falls, where the ambiance and food make the experience worthwhile. I’m lucky our anniversary falls on a three-day weekend so I can carve out time from studying with zero guilt or anxiety. We spent a fabulous Saturday watching Breaking Bad and enjoying our fancy meal at L’Auberge. Grateful for Andrew who’s supported me from pre-MCAT NIH days to military medical school today. He’s the best fake patient for all my practice medical interviews/physical exams.

December and January have been good months to me. I addressed a few long-standing goals of my life. I bought a tablet (feeling pretty fancy as I get with the ages). I learned how to study (it’s an ongoing process, but I think I finally figured it out…for now). I began reading regularly (for fun, nothing with too much intellectual substance). I sleep more than I used to and still make time for Netflix. I think I understand how blood flows in the body and might even identify some murmurs accurately. Most importantly, I got to spend much-needed quality time with my mom.

A Tragic Reality Check

Alas, the further I fall into the abyss of medical science, the less I have been writing. Balancing passions of life is quite the challenge, but we shall carry on.

I could talk endlessly about this module, Musculoskeletal, and about the countless hours of dissection, labs, lectures, and feeling legit in scrubs. I could talk about all the work that has gone into clinical exams and our first [terrifying] Integrated Clinical Skills assessment. I could discuss the struggles of the average medical school student. Maybe I will talk about those later, and maybe I won’t.

The reason I wanted to post on a late Saturday night [when I originally wrote this] is because I need to talk about some grave reminders we get when we experience serious reality checks: 1) we’re human, 2) we don’t live forever, and 3) there are more important things in life.

At 12:36am Friday morning (I know because I looked straight at the clock when I was abruptly shaken awake), my boyfriend told me his former roommate and close friend attempted to commit suicide. I was shocked but not surprised. I know that might not make sense to others, but it’s certainly a distinction to me. At that very moment, it was like my mind went clear. Looking back, I would have expected my response to include panic and tears. But it didn’t.  I remained quiet as Andrew described how his night progressed, how he walked from a bar to visit his friend, how his friend’s current roommate broke the news, and how he drove to a nearby hospital in a panic.

Lying in bed that night, vigilance had taken over. I felt alert as if an emergency had taken hold, as if my fight or flight response was in full gear. I knew I had to do something. Both Andrew and I knew that we had to wait until the morning, when he figured out exactly which psychiatric facility we could find our friend and when we could visit.

Navigating rush hour traffic that evening frustrated me as we headed to a hospital nearly an hour away. With a gallon of fruit punch in Andrew’s hand and a box of chocolates in mine, we were armed for some loving and ultimately enjoyed our visit, all things considered. After signing in and dropping our belongings in a locker, a kind employee escorted us inside to a room filled with grey foldable tables, rectangles lined against the wall by the window, with fold-out chairs tucked under. The only individuals in the room were exactly who we expected: the man himself and their other former roommate with his girlfriend. The following hour and a half was full of laughter, nostalgia, and light-hearted talk regarding grave circumstances.

I kept looking at the wall of art made by the patients, abstract colors, sketches, landscapes, quotes both deep and snarky accompanied by illustrations. I desperately wanted (and still want) a one-on-one talk with him. He’s one of my favorite people. I get how his mind works. I see where he’s coming from. And I desperately wish I could help. Way back, he helped me in a dire family situation when I had nobody else I could call – I knew he would help with no reservations or judgment.

I came to a realization a couple months back when William and Mary had their most recent suicide – there is a stark polarity in decision-making when it comes to the choice to live. Because, when you think about it, every day you live is your choice. To a certain extent, that is quite empowering, whether or not it seems like a decision you would ever consider.

I graduated from an amazing institution that has been criticized as the “suicide school” in Virginia, the College of William and Mary. I can’t say I know all the statistics, and I can’t vouch for one side or the other. Certain people believe this to be a horrible misperception of our university, and others think the title reflects a greater problem that needs to be addressed. The facts I know are the following: there were 3 suicides during my 4 years at W&M and one this past August. If anything is for sure, these unfortunate tragedies reflect the vulnerability of our college years and the need to support one another.

In the William and Mary community, if you didn’t know the person, you knew a friend, a classmate, a hall mate, a professor. The campus went quiet a day or so before the shock wore away. Quickly thereafter, we fell victims to the same stress and runabouts of daily activity, until we would hear horrible news again, this time a new name, a new story.

My heart goes out to those with depression. It’s a crippling disorder that makes you consider your options in ways that most people don’t. For now, I am grateful my friend is alive and has not been permanently harmed from the event, physically at least. The mere thought of losing him hurts my soul, a reality check that both curbs my frivolous complaints and inspires me to move forward in my career. Right now, I want to be a psychiatrist so badly, more than I have every wanted something in my life. I want to help people like my friend, like my lost members of the Tribe, like the countless individuals out there struggling from severe depression, as well as other individuals suffering with mental health illnesses.

If there’s anything I wish for humanity, it’s compassion. Unconditional compassion, for our friends, neighbors, and strangers. I am convinced this world would be a far different place if we listened to compassion as a paramount factor in decision-making. Maybe then it would be easier to seek mental help. Maybe then we could save precious lives.

There are some great articles out there on the subject, and just a few suggestions for anyone’s interest:
-The challenges of suicide prevention on campus after three suicides within a year:
-About Tracy L. Cross’s research on suicide in the gifted:
-Blog post of a Tribe member’s own struggles, written after the most recent suicide at W&M:

To Pandakar and Back

It’s time to break my longest hiatus from the blog. Alas, I’ve officially succumbed to the hectic life of being a medical student. I often choose the pleasures of sleep, food, and an occasional Netflix or Hulu episode over writing. I might need to reevaluate my priorities.

Fundamentals proved fruitful. Unlike the other modules, it’s a hodgepodge of information, and I personally liked the variety of subject material (most of my fellow classmates probably disagree and prefer the focused content of most modules). We were graded on more classical methods of class work (lab quizzes, weekend quizzes, NBME midterm, NBME final, practical final, faculty exam final) and some more society-centered studies (medical interviewing of patients, full physical examination, and humanities essays on medical history and emotion processing after seeing patients). I actually enjoyed myself during Fundamentals. Despite the stress and long days, I enjoyed the information and had a decent time on the weekends, not so social, but I at least managed to get relaxing time in, which I desperately need to recharge.

Within 20 hours of my last Fundamentals final, I found myself on a bus to Pandakar, our patient role-play destination where the four-year USU med students used first-year students as well as volunteers as guinea pigs for a mock deployment scenario of patient health care. We stayed in barracks, which were much nicer than I anticipated. Likewise, all the porta-potties around Pandakar were surprisingly well-maintained. It’s the simple pleasures that keep you going.

We began our first day by taking an emotion intelligence test, personality test, and by learning how to play patients (which included an understanding of various medical abnormalities, how to act them out, and how the fourth-years should be treating our conditions). The next few days in Pandakar were quite epic and exhausting with more or less moulage involved. We played patients in combat scenarios as well as in sick call scenarios to give the fourth-years a plethora of presenting conditions to treat.

I will have more on what the MSIVs do in a few years for their side of the story of Bushmaster (Bushmaster was this doctor-patient role-play experience in fake-country Pandakar/real-world Fort Indiantown Gap in Pennsylvania). They had several roles to play, including security, surgery, ATL, CSC (for mental health), medic, litter carry, and a few more I either cannot remember or never learned myself. The poor fourth-years seemed exhausted by the end and were organized by platoons into different clinical teams by helmet color. I happened to see the Red platoon all the time, and I also happened to play a couple of hilarious patients, one of which was an “odd person”. For the respect of not showing us goof off with fake injuries, we can’t share our photos from Bushmaster, but it was an awesome/exhausting/educational experience for both the patients and the physicians – an experience no other medical school gets!

After Bushmaster, we had our own military training experience as MSIs within our platoons that included M9 shooting/safety training, LRC (leadership reaction course – my COT training served me well), land navigation, preventive medicine, ultrasound, CBRNE (training for chemical, biological, radiological and nuclear defense), combatives (thanks to a West Point graduate I partnered up with, I learned way more and definitely enjoyed myself…slash we sparred in pairs at the end, which I found terrifying to watch but fun/painful to do myself), Health Service Support (strategy of establishing medical/military posts during combat), casualty evacuation, and movie nights to watch clips of videos/documentaries and listen to panels/speakers ultimately illustrating the realities of military medicine [besides my parenthetical insertions, I promise this sentence/paragraph wasn’t a run-on].

And thus, we reached the end of our time in Pandakar. I bonded with the members of Alpha company (the half of MSIs that did Bushmaster before MSI training), and it was nice to go home and have a few days off before classes started up again. Unfortunately, on my last day in Pandakar, I woke up with the world spinning around me. I basically crawled to the bathroom to vomit from dizziness. Luckily I found two kind classmates to take me to the medic who diagnosed me with vertigo due to a viral infection. Fun times. The next few days were mostly spent at home recovering and relaxing, with some occasional activities within the scope of my ability to sit and walk slowly.

This past weekend before classes started, I went to a pumpkin patch with some Air Force friends and had my first experience pumpkin-carving at my parents’ place with Andrew. Also got to catch up with a few local friends and family before classes began yesterday. After organizing my calendar and planner for this next module, MSK (musculoskeletal), I am both excited and terrified to hit the books again.

Here we go again.