Major Life Decisions On The Road

When I originally started writing this blog post, I went into excruciating depth about my inner turmoil deciding between psychiatry and family medicine – about the uncertainty, anxiety, insomnia, and my appreciation for both fields. Deciding between the two was truly a win-win situation, and I think anyone can understand how difficult it is to think you are going down one path for ten years only to realize you prefer something else along the way. An hour-long stroll along the Riverwalk in San Antonio at 98 degrees can help with introspective thought and major life decisions…just make sure you have a water bottle and snow cone handy. The teaching point is that I always need to remain open-minded and flexible to new opportunities, because I am truly grateful for changing my career course.

Since my last post, I alternated rotations in psychiatry and family medicine. I wrote a book chapter on childhood-onset schizophrenia for my capstone project, rotated at Fort Belvoir for family medicine, rotated at San Antonio Military Medical Center for psychiatry, and realized that family medicine is the better fit for my personality and career goals. I quickly changed my rotation schedule around to allow for time at Scott Air Force Base (AFB) and Eglin AFB to check out two more locations for family medicine. It has been a fantastic 14 weeks thus far rotating in psychiatry and family medicine, and I am beyond excited for a career in family medicine in the military. Thank you to all of the wonderful people I spent the last few rotations with!

Sometimes, I find myself grieving for what I’ll miss about psychiatry – long appointment times with patients, neurophysiology of psychiatric conditions, and treating thought disorders. Bright side, I will see plenty of behavioral health in family medicine and get the full latitude of primary medical health care. I enjoy diverse chief complaints and having a broad scope of knowledge. I love learning something new with nearly every patient encounter, even when the presenting problem seems entirely straightforward. Family medicine challenges my mind, keeps me engaged, and managed to warp the culture of medicine to a positive learning environment focused on patient care.

Time keeps flying by, and the rumors are true that fourth-year medical school is a wonderful year compared to third-year. I have gotten involved in way too many activities and projects, am planning vacations/weekend adventures galore, and am looking forward to wintertime when I will take a break from traveling and enjoy my time at home. I have been in 15 states since April with a successful road trip to Florida this past weekend (Hurricane Irma decided to stay out of my way!). Cheers to making major life decisions! T minus 3 months until I know where Andrew and I will be for the next 3 years!

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Step 1 Study Period: My Approach

If you are not studying for step 1, I’d just skip this post altogether. This is for the Googlers out there who magically find their way to my blog. I don’t feel comfortable publicly posting my score, but I will tell you it was good by any specialty’s standard.

Before I started studying, USUHS had us do an NBME pretest that I beyond failed and had zero correlation to my score. Quite demoralizing to hear people say “oh you typically improve 10-30 points from your first NBME test” when that would range from “still failing” to “oh good I hit 200.” I think 228-230 is average for the exam, so I was originally shooting for above 230 (which is probably a typical goal). I don’t suggest doing a diagnostic test prior to studying because it will likely only freak you out. If you’ve been actively studying for step 1 prior to your dedicated study period, a diagnostic might be a good idea to see where you are at.

As an FYI, USUHS does Step 1 after a year of core hospital rotations. Although it makes us further from the basic science stuff (killer when it came to relearning microbiology and neuroscience in particular), it made the clinical vignettes much simpler to understand. Pharmacology, a sore subject in pre-clerkship, became pretty straightforward after working in the hospital. I personally found it to be an advantage.

For studying, I cut out ALL social engagements. They tend to stress me out when I need to focus, and I am a happy camper doing solo activities. I would typically wake up around 9am. Sometimes I worked out in the morning and had a late start to studying (as late as noonish). I went systematically through organ systems and covered an organ system a day. I would read a chapter in First Aid, do the corresponding questions in UWorld (tutor mode), and watch the Pathoma lecture while taking notes in my book. Most organ systems could be done in a day. Cardiology and Heme/Onc needed ~2-3 days and Neurology needed ~3-4 (for me). I personally bought a fresh copy of First Aid 2017. My First Aid 2014 had notes all over it that I found either too detailed for step 1 or too basic for the level of comprehension I had reached. I tagged pages that I wanted to make sure to review again. I did one full round of UWorld and completed a chunk of the questions I got incorrect (it’s easier seeing them a second time but super frustrating to get them wrong again!).

I cooked and cleaned pretty frequently. Andrew and I would have dinner when he’d come home from work, and we’d usually watch a TV show or movie before I would get some last bit of studying done before bed. I slept a TON… like 9-12 hours a night. I can function really well if I sleep a lot, though it was probably secondary to pathologic sleep deprivation I had throughout the previous year of rotations. My study period was 5 weeks long with really 4 weeks of truly focused study time. The first week I maintained some social semblance and realized it was impossible for me to be productive. I only had a few days in the first week where I did practice problems casually and perused First Aid a little.

I did the two UWorld assessments one and two weeks before my test day and thought they were really helpful (though I panicked because people kept telling me that I would likely do 10-15 points worse on my real exam based on the uworld scaling compared to NBME). I got the same score on both assessments and ended up with 13 points higher on my real step 1 score. I personally didn’t want to pay extra for the official NBME practice exams online, especially without getting answer keys, but I have heard from many that they found it useful to get comparative test scores. Keep in mind though, I tend to test well – I am pretty calm during exams. On test day itself, I took a minute break between sections just to close my eyes and breath. I forced myself to take 25 minutes for lunch. The exam day felt shorter than I anticipated because I thought it would last forever. The nice thing is most test locations let you start early.

My grand advice is:
– Make a study plan. I felt like 5 weeks was perfect timing to include my first week of figuring the system out.
– Figure out your resources (mine were UWorld, First Aid, and Pathoma). Don’t use too many.
– Don’t be too hard on yourself if you are behind schedule. It’s inevitable. Plan your schedule like you have one less week than you really do.
– Give yourself frequent breaks!
– Don’t let yourself burn out. Schedule entire days off!

Studying for Step 1 is uber stressful but it can also be really nice to make your own schedule for once, wear pajamas all day, and be your own boss. Enjoy the perks!

Humanistic Care in Medical School

I do solemnly swear, by whatever each of us holds most sacred…

Medical students conclude their white coat ceremonies by reciting the Hippocratic Oath – at least, a modern and truncated form of the oath. The Hippocratic Oath symbolizes the essence of health care: a covenant between healthcare practitioners and the patients they serve. This is a sacred relationship. Patients submit to another human being, oftentimes a stranger, to heal their physical and mental ailments. Physicians reciprocate by honoring patient autonomy, justice, beneficence, and non-maleficence. Ultimately, I am now part of a community of physicians dedicated to patient healing and medical ethics.

That I will be loyal to the Profession of Medicine and just and generous to its members…

I began the first year and a half of medical school building my knowledge base. My classmates and I were getting assimilated to the community and admired our faculty members for directing our education. I saw my first ‘patient’ on the second day of medical school. It was an assignment to meet a child with autism spectrum disorder at the patient’s home. He was a brilliant teenager who struggled with social skills and emotional intelligence. He told me he had great aspirations and planned to apply to my alma mater, William and Mary. We bonded about this common interest and discussed the challenges he faced and the therapies he found beneficial. The first patient encounter of medical school was an important one; I learned that my patients teach me just as much as I can teach them.

That I will lead my life and practice my art in uprightness and honor…

My attraction to the art of medicine is the pain of the human condition and my role in its healing. I act according to what I believe is right and what the patients believe is right, serving patients to the best of my ability. Patients deserve respect and autonomy throughout this process; the patient role is one that can be vulnerable, or one that is empowered with the support of good healthcare providers.

That into whatsoever house I will enter: it shall be for the good of the sick to the utmost of my power, my holding myself far aloof from wrong, from corruption, from the tempting of others to vice…

There are certainly days that make me question whether the pursuit of medicine is worth the time, energy, and sanity. Medicine is a grueling career path, one that challenges my physical ability to stay awake, my mental ability to stay focused, and my emotional ability to stay engaged in my personal life. Enthusiasm wanes with burn-out. I understand how physicians can lose their heart (i.e. humanity) when treating countless patients, who become diagnoses rather than human beings. In those times when humanity wanes, I must stay grounded to the reasons I pursued this career path to begin with: my relationship with the patient and my dedication to healing. I enjoy supporting my community – at the hospital, in their homes, outside healthcare settings; at the same time, I am uplifted by my colleagues and patients on a daily basis.

That I will exercise my art solely for the cure of my patients, and will give no drug, perform no operation for a criminal purpose, even if solicited; far less suggest it…

I remember my first patient who died. I had been following an 85-year-old gentleman on the medicine ward. He was transferred from the ICU after a remarkable degree of recovery from a stroke complicated by intracranial hemorrhage after administration of tPA. Refusing feeding tubes, my patient was unable to swallow and aspirated on food or water with any meal he would take. He became progressively hypernatremic. This was my first patient with overt delirium, falling in and out of lucid states. He refused water, was a difficult ‘stick’, and would pull out IVs overnight even when he had family or a 1:1 sitter. I sat in with him and his family for numerous discussions. I became the main contact for my patient and his family, with the support of my residents and attending.

The patient told his daughters that he was ready to die. I held one of his daughter’s hands as she walked away from her dad crying. His family feared hospice but finally agreed that home hospice would be ideal for him, as he preferred to die at home. The last time I saw him was Friday – the last day of my inpatient Internal Medicine rotation. He told me, “I want to go outside.” I told him, “We are getting you home. You will finally get to go outside.” I got a phone call Sunday that he died at 10am, two hours before the ambulance was scheduled to take him home. My heart fell apart. I was attending my grandfather’s funeral that day and felt overwhelmed by the fragility of life. At the same time, I felt the need to celebrate the lives of two wonderful men who left behind families and friends who loved them.

That whatsoever I shall see or hear of the lives of my patients which is not fitting to be spoken, I will keep inviolably secret…

As a medical student, I have the opportunity to sit by my patients’ beds, speak with them (sometimes for hours when there was time), and learn their life stories. Being a healthcare worker is a privilege, one that I will continue to honor by valuing what my patients tell me and serving as their advocate. By learning about my patients, I gain respect for who they are as people and how that can affect their medical decisions. Part of being a physician is allowing the patient to guide treatment therapies to attain the best possible medical outcome. This journey is one that optimizes their values with respect to religion, culture, upbringing, and circumstance.

These things do I swear. Let each of us bow the head in sign of acquiescence…

I define myself by my academic contributions, compassion for people, and by my desire to change the world for the better. I want to be a doctor, but I am only beginning to understand what that entails. I am learning about pain of the human condition and what I can do to promote its healing. I am learning what it means to do what I can to help my patients and to let go of what I cannot control. I am learning to appreciate the good moments when my patients experience recovery and to reflect when it comes to poor patient outcomes. I aspire to be a physician who heals my patients – not just with my knowledge – but with a love for mankind and compassion for others that motivate me to serve my community.

And now, if I will be true to this, my oath, may good repute ever be mine.

The Life of an MS3: Good Times and Good Riddance

USUHS fourth-years are officially done with classes/hospital rotations and have graduated this past weekend. So concludes the third year of my medical school career. Cheers to that!

My existential crisis [see last post], though ongoing, has abated in intensity. I have accepted my fate as a physician despite the occasional fantasies of retiring to a small town by the water, becoming a fiction novelist, and traveling countryside in an RV with Andrew. I signed up as the newsletter writer in Alpha Omega Alpha (AOA), so I will consider that my attempt to bridge between the worlds of medicine and humanities. It’s the little things, my friends, that keep you going.

I have lots of updates for the past year, and I will try to keep them brief. Last post, I talked about how pediatrics restored my faith in my career in medicine. That was a wonderful rotation (shout-out to Walter Reed’s pediatrics department and their fantastic program!). The entirety of the rotation, I reevaluated my life and thought, “Man, I should be a pediatrician.” Then followed Family Medicine in Offutt Air Force Base. Yes, folks. That is in Omaha, Nebraska. I have finally ventured to the real Midwest. I was lucky to go during the summertime with a lovely classmate and had the best rotation of medical school – a much-needed escape from life’s obligations at home. I learned that I love primary care and appreciate the family medicine physician mentality. For the first time on rotations, I truly felt like I fit in.

As the five weeks in Omaha continued, I saw the perks of family medicine – especially in the military. The options are endless. I can do primary care in adults AND children. My experience in pediatrics helped facilitate more positive experiences with children. Fun fact: I had never picked up a baby prior to my pediatrics rotation at Walter Reed. Now I am a diaper-changing professional. Anywho, the physicians I worked with in Omaha were fantastic. I fell in love with the field. I felt at home. Considering I always intended to be a psychiatrist, I also became very confused.

Next up, my elective! I chose addiction/substance abuse at Fort Belvoir, VA working in both inpatient rehabilitation of active duty members and in outpatient psychiatry with a methadone clinic. What a great experience where I felt involved in understanding the epidemic of addition in our nation. I worked with fantastic psychiatrists that made me feel at home in their field, despite the fact I hadn’t even rotated in my core psychiatry clerkship yet. One resident made it his mission to reaffirm my decision to pursue psychiatry considering my recent interest in family medicine. During the rotation, I definitely felt like I wanted to be a psychiatrist again (ie positive experience).

The theme of wanting to do the field I was rotating in continued (which I hear is common for those interested in family medicine). I really enjoyed my internal medicine rotation, especially the inpatient experience where I had the opportunity to work with residents and attendings who were dedicated to my betterment as a student. So much knowledge to be had. I was nerding out. Internists are definitely the Ravenclaws of medicine [Side tangent: that would make Surgery the Slytherins, Family Medicine the Gryffindors, and Pediatricians the Hufflepuffs… I need to figure out how to fit in the other specialties].

My last rotation of 2016 was psychiatry. Naturally, I was doing exactly what I wanted to be doing for my life but at a medical student level. I felt challenged and never experienced the “psych-ation” hours some students enjoy on their core clerkship. I had hoped that it would help clarify psychiatry vs. family medicine for me, but it actually made me more confused. I love psychiatry, but maybe I also love family medicine. How can I do both? I have been looking into joint residencies – there used to be an Air Force option to do family medicine/psychiatry at Andrews AFB way back. There is currently an internal medicine/psychiatry residency (5 years as opposed to the 3 years in medicine and 4 years in psychiatry) offered to Army, Navy, and Public Health Service. Unfortunately, a double-boarded position is not currently in the needs of the Air Force right now, but I am trying to sell it [wish me luck, folks]. 

So that is how I concluded my 2016 year of core clerkships (typically done during third-year for other medical schools). I am still unsure about what I want to do for my specialty, and I approached my schedule so that both psychiatry and family medicine remain on the table. 

Over winter break, I got engaged (hollaaaa) to the love of my life while on vacation in Dominican Republic. It was a beautiful trip with us and a childhood friend of mine (the one who I credit with our relationship because Andrew was originally her friend from college). We met some great people while we were there and are developing an international friend pool, which is a good deal for future travels. 

Winter break went straight into Step 1 study time. We take it later than other medical schools to make up for the fact we start in the hospital 6 months earlier. Not much to say there because not much happened. My score was pretty awesome, and I think it is because I chose to CHILL OUT for once, minus the occasional panics about how I was behind schedule and felt like I was going to fail. In case there are pre-step 1ers reading this, I’ll lay out my study plan in another post.

After Step 1, it was back to the classroom after over a year. We had 6 weeks of trainings and additional education on certain clinical topics. We got certified in BLS (basic life support), ACLS (advanced cardiac life support), and ATLS (advanced trauma life support), when only BLS is required for medical students. We had a fun military event called Gunpowder that’s a prelude to Bushmaster in September where we do military medicine scenarios like making a rope bridge to get a patient across the river, running codes, and climbing walls (or in my case, having someone help push you over a wall). My team consisted of a group of classmates I had never spoken with before, and we worked great together – made it in third place among 16 teams!

Despite the training, I felt rusty on my hospital skills and was anxious to go back. Day 1 back in the hospital was on my birthday at Madigan Army Medical Center at Fort Lewis-McChord in Washington state. Neurology was a great transition rotation because we acted as the inpatient consultation service, so I felt like I was relearning all of medicine despite our focus on neurology. I also felt like so many things were finally clicking from basic science neuroscience to clinical practice. Neurologists are definitely friendly, love what they do, and have a good lifestyle. The brain is cool, friends. I don’t understand how neurology isn’t a more competitive field!

Washington was good to me. The lodging was comfortable. My residents were awesome. My USUHS classmates were fantastic, and I met some friendly HPSPers. A couple USU folks and I traveled on weekends – to Seattle, Portland, Crystal Mountain, and Tacoma. What a beautiful state! Despite all the rain, the sun managed to shine bright on weekends.

Although I had a great time on neurology, it was nice to come home, reunite with friends and family, and NOT have homework anymore. FYI to non-USUHS folks, neurology entails 10 papers, 1 take-home quiz, and a final exam. Fun stuff.

I am currently on ophthalmology where the surgeons are happy, and I am trying to get used to a new routine. I became re-engaged in group organizations after being welcomed into Alphi Omega Alpha and the Gold Humanism Honor Societies. I am working on a curriculum project with school and have two research projects going at the same time. I am also trying to get in shape for the wedding. So it has been pretty busy since I’ve come back home. Andrew and I had an epic engagement party with local friends/family this past weekend where his family was exposed to the beautiful wonders of Persian dining. With those wonderful memories and my social quota reached, it’s time to get busy. I have a book chapter due on June 1 and my step 2 CK on June 7. Cannot say I have been studying too much for this one…so I’ll let you know what my study plan is after I figure it out myself!

Surprised you’re still reading. It’s been quite the year, so I appreciate your time as I share my experiences 🙂

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).

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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

AMP101
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

Optional:

  • 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.
  • PRINTER WITH AMPLE INK CARTRIDGES
    • 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.

ON DAY ONE:
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.