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 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.

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: http://www.washingtonpost.com/wp-dyn/content/article/2010/11/12/AR2010111202853.html
-About Tracy L. Cross’s research on suicide in the gifted: http://www.wm.edu/news/stories/2013/cross-book-explores-suicide-among-the-gifted123.php
-Blog post of a Tribe member’s own struggles, written after the most recent suicide at W&M: http://wmblogs.wm.edu/skyler/one-tribe/

The COT Finale: Weeks 4-5

It’s been three weeks since my last post, and oh my, a lot has certainly happened. I had been so chronically sleep deprived that I never managed to set enough time aside to write a coherent post of what had been going on. So let’s give this a try.

The fourth week of COT was a jumble of events and emotions. We all anxiously awaited graduation, which was the Friday of Week 5. I have no idea how the BOT, ROTC, or BMT trainees do it because 5 weeks for COT already felt like eternity. I have the utmost respect for everybody who successfully completes these intense training programs.

WEEK FOUR
Monday
The day was quite busy, beginning with our final PT exam and the CWT #2, followed by lectures galore (not gonna lie, it was the first time I straight up passed out in the big red pillows. I am quite grateful I was sly and not caught by any instructors. You’re supposed to stand up in the back of the room if you’re falling asleep.) In other news, I finally got my ranks sewn onto my uniform and it feels GOOD. Now I see what OTS staff members mean by having pride in your uniform. My name and rank are looking pretty beautiful.

Some happy times in Boyd Auditorium

Some happy times in Boyd Auditorium

PT test: earned a 98.4 of 100 on the test. I have never run so quickly, smashed so many push-ups, or whipped out that many sit-ups. For the first mile of my 1.5mi, I ran a 7:28 (if you know me, this is a miracle). Ran the full deal in 11:34. Did 43 push-ups in a minute and 57 sit-ups in a minute. KILLING IT. Did not think it was possible to improve on my original score, but I did. Everybody in my flight improved across the board for all three elements of the PT exam. In retrospect, it’s funny that I stressed so much about PT before COT when it turned out to be my strongest aspect.

CWT #2 (our final academic test): solid score, felt good to be done with the academic portion of COT. Done done done done done and time to celebrate!

Tuesday-Wednesday
LRC: Leadership Reaction Course (not to be confused with the Learning Resource Center at USU)

The LRC was a continuation of Project X from the previous week where staff members graded us on leadership skills in a series of (mildly dangerous) obstacles. Playing out Navy Seal-type missions with zero prior outdoor leadership experience, we dealt with heights, climbing walls, building tripods (oh hey, that’s my claim to fame), maneuvering in water, utilizing given resources, relying on the leader, planning the mission before execution, etc. LRC was a great learning experience because it was one of the first opportunities everybody could get leadership training. I might have preferred a crash course beforehand in field activities and outdoor safety though (I was never a girl scout and have never been privy to climbing things). Bravo Bombers beat the record for one of the obstacles when we happened to have only athletic guys grouped for one of the teams.

After the LRC events, we were phased up! Ironic timing too because we were granted phase 3 privileges before our mock deployment began (called Blue Thunder), meaning we could only truly exercise phase 3 status over the weekend. It was nice in theory, but man you have no idea what it meant to be given phase 3 privileges. No more tight meals and we could leave the base outside of duty hours. Sweet sweet freedom was in grasp. Freedom tastes so good.

Anyway, we were phased up before heading to our overnight mock deployment. The tents were air conditioned even though the bunks hurt my back. Awesome Air Force planes were taking off like they were right in front of us (same with on OTS campus but the view was much better here). Luckily we were so ravenous during the events that eating MREs weren’t so bad. [[In case I didn’t mention it before, MREs are almost space-type meals with way too much sodium and interesting methods of chemistry to heat food. I am bringing a few of these meals home that I didn’t finish so Andrew can have an MRE-picnic with me.]]

Our mock deployment base

Our mock deployment base

Inside the girls' tent for Alpha and Bravo

Inside the girls’ tent for Alpha and Bravo

Thursday
Beware of the trains that you hear passing in the middle of the night and the 4:30am wake-up call to rock music. Didn’t get too much sleep at Blue Thunder before beginning our long day of the Ropes Course and Litter Carry during Black Flag weather.

Ready to embark on the day

Ready to embark on the day

The ropes course consisted of a 40 ft rock wall, the tooth pick (the second worst), a repel wall, and an actual ropes course (which was the worst). I have this massive fear of heights; despite lots of crying, I got through it. I received endless support from my Bravos and the Alphas who came after us as well as OTS staff (the OTS staff members helping on the ropes course were fantastic). I was grateful to have the most adventurous Bravo female in our group come behind me to help out emotionally along the way. Completing the ropes course events in its entirety was a big accomplishment for me but I cannot say I will ever do it again voluntarily. It was pure torture. Good to know I can accept a challenge and see it through.

Featuring the wall and the toothpick

Featuring the wall and the toothpick

I assure you, that was not a real smile

I assure you, that was not a real smile. Also, the picture is misleading; I am not walking on ground.

Who knew there were so many things involved in carrying stretchers (ie litters) in the military? So many commands. I was pretty unhappy to discover that carrying a 113 lb flight mate on the litter was painful although most of the guys didn’t have a problem. Here I thought I was a strong, capable woman, but I guess I should hit the gym some more. Luckily, black flag conditions meant we didn’t have to do the litter carry course with an actual person on the litter. A highlight of the course was when OTS staff threw sand on us (“blood and guts”) as we crawled underneath wire that got progressively narrow as we proceeded. Fun times at COT.

Sleepy during litter carry break

Sleepy during litter carry break

Friday
As part of the Blue Thunder mock deployment experience, MRIC (Medical Readiness Indoctrination Course) consisted of two portions with a massive tent set up as a combat field hospital, the first part testing response to patients with minor injuries and the second part testing response to a mass casualty event due to a bombing. Trainees had a variety of positions, including hospital administration, security, manpower, ICU, OR, patients, moulage, etc.

The Bravo moulage crew

The Bravo moulage crew

I signed up for mental health originally, but only 1-2 individuals got the slot. I was assigned the role of a patient, which ended up being ridiculously fun. First scenario, I was a marine who got hit by an IED while chasing car bomb suspects. Despite my minor injury (which was never treated), I was sedated for being so belligerent (I was trying to stick with my devil dog, aka my chaplain roommate, who was severely burned. Also security took my rifle away. You don’t take a marine’s rifle away.) I was almost sent to the morgue due to confusion about my sedation records. That was exciting. Second scenario, I had shell shock, and the team had a much more appropriate response to my clinical condition than the first round. Very interesting experience from a learning standpoint of what should be done in a mass casualty scenario.

Coming back from MRIC, we had our usual Hall Call to end the week, which is basically one big pep rally. Bravos won flight of the week within our squadron and our overall class. Within Bravo, I won the award for flight member of the week, which was exciting recognition for building flight morale and challenging myself during all the field events. In other news, my Falcon squadron rocked the drill competition (with Bravos leading the way as element leaders, guidon bearer, and flight leader for the superflight and made it #1). As per usual, Bravos REPRESENT.
FORWARD HARCH.

Getting our flight of the week award

Getting our flight of the week award

OUR GUIDON

OUR GUIDON

Falcon Superflight

Falcon Superflight

Saturday
The morning was short but eventful. We wore dress blues for the commandant inspection, consisting of open ranks (basically a fancy drill/uniform/military inspection) and room inspection. Only thing the Bravos needed to learn was folding hospital corners in our beds, which was something we had not been taught before so we were pretty proud of ourselves.

As for the rest of the day, we got to feel like normal people again, wear civvies, watch a movie (got a military discount for the first time!), eat out, and go shopping. I was a little bit of a chauffeur but I missed my Charlie baby so that was alright. One day to almost feel like a real person, despite our imposed squadron curfew at 2230 (aka 10:30pm).

Sunday
A little back to the COT world – errands galore for dining centerpieces, plus a summer camp feel when we were doing art for it, plus the ultimate Frisbee tournament. One of our Bravo’s dorm rooms had electrical issues that caused a fire alarm to go off, which added extra spice to our weekend because we weren’t allowed to go to Morehouse dorms for a solid chunk of Sunday.

WEEK FIVE
Monday
Our day mostly consisted of random lectures galore. They were actually pretty useful topics for the future. However, I had still been struggling with sleep debt and thus paying full attention was not the easiest. We spent the evening at Mellow Mushroom (deliciousness) for our flight commander dinner, where we invited Capt Warren, his wife, niece, and seven children out for a meal. They were such a lovely, happy family. His wife and kids decorated rollos to look like dynamites in honor of the Bravo “Bombers”. Adorbs.

Dinner crew at Mellow Mushroom

Dinner crew at Mellow Mushroom

Tuesday
The highlight of Tuesday was the Dining In, which was a formal event (despite wearing our ABUs, not blues) at the Officer’s Club. The military traditions were a-plenty and oh so odd. If you broke any rules, you could be sent to the grog, which was a hodgepodge of mixed drinks that apparently tasted really good (with both alcoholic and nonalcoholic options). There was a certain way of doing everything. So many rules to remember, which they cover pretty extensively and include in the red packet they leave on your table. So many little quirks about the meal; for example, instead of clapping, you tap the table with the round part of your spoon. The best part was the comedy skit coordinated by our class – absolutely hilarious and pointed out all the silly idiosyncrasies of COT. The night ended with a DJ event in the basement bar area of the Officer’s Club.

At the Officer's Club

At the Officer’s Club

The beautiful centerpieces!

The beautiful centerpieces!

Wednesday
We did our last PT with a fun run around campus, learning about the history of Maxwell AFB. At the conclusion, we got our wings! It was quite ceremonial.

Family started pouring in (so we were phased up to phase 4 privileges) and made me wish I could fast forward to Friday when my dad and Andrew were coming into town. We had the USAA dinner that evening, which included a delicious buffet. It turned out to be a huge advertisement event with bankers and USAA insurance agents at the ready while speakers were giving out random prizes and presenting certain aspects of financial opportunities with USAA. Congrats to me: USAA approved me for a career starter loan (at 2.99% interest!) so I can pay off my credit cards and my higher interest student loans. Afterwards, some of us hit the town near the Riverwalk area in the Alley (basically the only place to go out in Montgomery, Alabama).

Thursday
The last full day of COT. Falcons won Honor Squadron at the awards ceremony, and unfortunately, Bravo came in 2nd place for Honor Flight (we lost by 0.2%). In my heart, Bravo will always be #1. Even though my car battery died and needed replacing, I absolutely enjoyed my last day and night with these fabulous officers.

Friday
Thanks to an active duty meeting first thing in the morning, a few of us were late to our graduation ceremony – whoops – in the COT conference room (it was actually supposed to be in our flight room but we had too many guests to fit). When I walked in, the very first faces I saw were my dad’s and Andrew’s. So much happiness in the world when your home comes to you! Our flight commander shared funny tales about each of us while giving out certificates and coins. Great success! As per usual, we rushed to get to the graduation parade after. Because my dad was one of the few distinguished visitors (as an SES in the Army), I knew exactly where he and Andrew would be sitting and watched them with my peripheral vision during the entire parade – you’d be surprised how much you can see using peripheral vision by the end of COT. After graduation was over, I exchanged hugs and photos with my Bravos as we said our goodbyes.

Graduation

As a conclusion to this post, I have to put the cherry on top of my Bravo-loving. We’re a bunch of goofballs. I wish I could list all the things I love about each and every individual in my flight if I had the time and could dish out details of their private lives. I am grateful that I contributed to this group, with zero drama and 100% support. I am grateful we didn’t crack the whip on each other and could courteously make corrections when necessary. I am grateful we kept up good spirits while getting through such a challenging training experience together. Finally, I am grateful to have 3 Bravos in USUHS with me, 1 Alpha, and a Bravo dentist close by at Andrews AFB. I love being surrounded by good people, and COT encouraged me that we are recruiting some amazing people as officers of the U.S. Air Force.

As always,
Peace, Love, and Bravo

Phase Two at COT: Week 3

Alas, I made it to Week 4. I feel like we are about to hit the promised land because graduation is in sight!

Because I have my final PT exam in the morning, as well as my final academic test, as well as open ranks where they inspect uniforms and ask military questions, as well as room inspections in the afternoon, I am going to keep this short. Highlights:

– We got phased up last Monday. This means we are allowed to talk quietly at dinners and go around the base on the weekend. The first meal we ate outside the DFAC was fantastic (sub and FRIES). Also got to go grocery shopping and feel like a real person again. Did my squadron photographic officer duties at the UPS Store and BOOM, errands accomplished outside the OTS complex. The power of printing and shopping is something we should all appreciate.

– On Wednesday, my 5k time was under 24 minutes, major improvement of about 5 minutes from my last timed 5k. We also had picture day (yay for getting my photo officer duties in) and presented our briefs. My brief on human rights in Iran was not as coherent as I wanted it to be. I was rushed with the time limit and skipped over a lot of information (I was also interrupted by an “active shooter” exercise where we had to barricade ourselves inside the flight room). Everything is a learning experience. All in all, I enjoyed listening to the briefs and learning about cultural/regional differences and the US military.

– We went through a series of obstacles last week for field leadership training. We’ll be doing a LOT more leadership training this coming week (deep breaths thinking about the ropes course. I’ll channel the progressive relaxation techniques my flight did earlier today in anticipation for our busy day tomorrow).

Drilling and marching

Drilling and marching

– Standardization: we have to keep everything standardized (the same as everything else and everybody else), including but not limited to our dorm rooms, uniforms, name tags, how we organize books, etc.

– Had a field trip to a military museum about enlisted heritage and history. Twas interesting and a nice getaway to Gunter on a rainy day.

Museum time with my flight mates

Museum time with my flight mates

– The Bravo Bombers are continuing to rock it. I believe we currently rank in the top 3 flights. We got one of the highest flight averages on our big academic test Monday (with the smallest standard deviation of all 21 flights). This past week we won flight of the week in our squadron, as well as academic flight of the week and social butterflies (we like to smile and be nice to other people, go figure).

Bravo Bombers slash the Bravo Bunch with our spoils :) #winning

Bravo Bombers slash “the Bravo Bunch” with our spoils #winning

Peace, Love, and Bravo.

Phase One at COT: Weeks 1-2

Today signals my thirteenth day at Commissioned Officer Training (COT), and I finally found time to update the blog. Technically, we just finished training day 8 of 23 on Friday, but our schedules are packed whether it’s the duty week, the weekend, or the fourth of July. We usually scramble from activity to activity from 0430 to 2300 daily, so I’ll try to hit the big points of what’s been going on here.

Two Sundays ago, I made the full drive from McLean, Virginia to Montgomery, Alabama in about 13 hours. I had the horrible realization my drive was one hour longer than anticipated when I reached the Alabama border, with a sign indicating it’s in the central time zone (womp womp). When I arrived at the Air Force Inn on Maxwell AFB, I ran into two females in the hallway discussing COT. One was a captain who just graduated dental school and was beginning COT the next day with me, and the other was an enlisted female who shared some of her experiences in BOT (basic training). In comparison, COT is much less stressful, but at the time, I did not realize what was in store for me.

Let me preface the rest of my post by saying that it was crucial to read a few blogs beforehand and to do research on the training program. COT has been one of the most difficult professional experiences for me, challenging me in ways that I had not expected while also being easier in other ways. Everyone gets stressed out. Everyone feels uncomfortable. Everyone is sleep-deprived, which is why our large auditorium is referred to as the “big red pillow”. At the same time, you’re going to have a lot of fun and learn what it really means to become a military professional. Every person has a different experience here; it’s all about the perspective you take away from this opportunity to train to become an Air Force officer.

On day 1, I drove in with the dentist I had met from the night before, who coincidentally ended up in my squadron and lives down the hall from me. Our class of about 320 officer trainees is split into 4 squadrons with 21 flights total. My Falcon squadron has 5 flights (mine being the Bravo Bombers, the best flight ever).

Day 1 consisted of LOTS OF YELLING. I learned to stop talking, to march, to follow directions, and to stare straight forward with zero facial expressions as screaming comes from every direction. I quickly realized that this would become a regular deal, but bright side: the screaming stops phasing you really early on. They instruct by yelling. When you calm down, listen, and follow through, all goes well. Things are only a big deal if you make it a big deal (unless you’re doing something egregiously horrible, but most trainees I have encountered are individuals of high moral character). Buying uniform items was a hot mess that day, but it was refreshing to have normal human conversations with the people working at the store before being thrown back to OTS staff again.

Most activities here revolve around five main things: 1) drill/marching, 2) physical training, 3) academics, 4) your duties/leadership roles, and 5) team building activities.

1) Drill.
I have no idea why this hasn’t been mentioned in previous blogs more. Marching and saluting and rendering military customs and courtesies are way more difficult than I thought they’d be. They also play a huge role in the COT experience. We passed our pennant test yesterday and Bravo flight came out as the #1 flight in our class. This is a BIG DEAL, especially because we really got our act together and practiced drilling meticulously the couple days beforehand. We were underdogs, but we rocked it. Our success earned us a most professional flight of the week award within our squadron. THIS GUIDON IS OURS. WE OWN THE GUIDON.

After receiving our pennant and professionalism award!

Bravo flight after receiving our pennant and professionalism award!

2) Physical training.
We head out for PT at 0440 most mornings. Per other blogs, I assumed the workouts wouldn’t be challenging, but they’ve actually been good thus far. Lots of running and group stretching. I can tell certain individuals are struggling more and others are breezing through it, but I am getting some good workouts in and my physical abilities are clearly improving. We took our baseline PT test on Monday, and I got all my personal bests for the 1.5 mile run, the push-up portion, and the sit-up portion. I surpassed my goal of hitting the excellent mark (scoring 90/100) and got a little over 95. #Winning.

3) Academics.
In the first week, there is so much paperwork processing and drill that you forget you’re here to learn the logistics of being a military officer. It has definitely picked up week two, after we took our big test on the officer training school manual (I got 100%, which was a huge pick-me-up when I was getting mentally exhausted from sleep deprivation. Sleep is huge, people. You’ve got to get it.) I had assumed classes would be more on Air Force history, rules, and regulations, but it’s a lot better than I anticipated. Courses thus far have focused on team building, motivation, and leadership skills. We also have classes on warfare studies, profession of arms, as well as communication. Big test coming up Monday that I should be studying for as we speak. Also, I am giving a brief on Wednesday about human rights in Iran. Stay tuned for how those go.

4) Your duties/leadership roles.
There are dozens of opportunities to get involved in leadership here. I will admit that most people who pick those higher-up roles seem stressed out of their minds, but if that’s your thing, then definitely jump on it. Leadership comes in many forms though, and everybody plays a part here. I lucked out with my flight job as the photographic officer. I would like to consider myself a morale booster. For weekend #1, I had to crank a lot of things out, but now my main responsibilities are to take photos and update the flight board (which is pretty difficult in a place where there is basically no functioning internet and you’re not allowed to print). My flight and squadron have excellent leaders. I am grateful for the opportunity to train with such a fabulous group of people (shout out to my Bravo Bombers – BOOM BOOM – as well as my flight commander).

5) Team building activities.
I think this will come more into play later, but what I really wanted to emphasize is how closely we work within our flights. My flight consists of 16 amazing people, including mostly medical students and dentists, as well as a couple psychologists, a pharmacist, and a chaplain (who’s my roommate!). We have done some field leadership training as well as countless group activities together. Our Bravo flight is a cohesive unit, and our team morale is always high. None of us are prior-military, so it has been quite the process where we are all learning how to be military officers. These people are going to be the #1 reason I might miss COT after graduation.

Ready for the next leadership mission

Ready for the next leadership mission

Other random points worth mentioning:
-Alabama feels like a toaster oven. How we wear boots, pants, and long sleeves still baffles me.
-Tight meals consist of shoving as much DFAC (our dining facility) food as you can in under 10 minutes. Sitting at modified attention and the no-talking rules aren’t painful in comparison to the stomach pains I get after meals from eating too quickly. The food is pretty good though AND very cheap.
-Being feminine is quite the challenge. Not much time for make-up or pretty hair. Luckily, OTS staff has not been passing out demerits for hair that “looks like a rat’s nest”. In defense of all the females here, we try.
-Andrew and my dad are flying down for graduation in August. Happy happy happy happy. 3 weeks and counting.

Peace, love, and Bravo.

Preparing for COT

Considering this took oh so much time and energy over the past several months, I decided to share what went into preparing for commissioned officer training (COT) at Maxwell Air Force Base in Montgomery, Alabama. Hopefully this will help any future commissioned Air Force officers. I will be heading there tomorrow and still need to finish printing paperwork and packing!

1) Pass the medical exam.
This can involve medical waivers, blood tests, x-rays, and the works if you do not pass the first time. For me, it meant I needed to lose 15 pounds during the government shutdown so that I qualified.

2) Fill out the paperwork.
There is paperwork galore. Medical paperwork. Contract paperwork. Oath paperwork. Coordinating details after receiving orders. There is a hodgepodge of information everywhere, and you just cross your fingers that you filled everything out appropriately and sent the forms to the correct people. Luckily, I have only encountered military personnel who are beyond understanding that this is a confusing process.

3) Look the part.
This probably applies for females more than males. I like a lot of color in my life. I love painting my nails and wearing happy accessories (my favorite color is sun yellow). I have experimented with dying my hair from blonde to black, as well as the ROYGBIV spectrum of hair streaks. I never do anything to my hair when it comes to styling because it dries perfectly. I struggle more with buns and ponytails than leaving it alone. So that is my disclaimer for including this section. If you are female, I strongly encourage youtube videos and pinterest to know how to do military hair (especially the sock bun). As long as guys cut their hair appropriately, they’re set. I chose not to cut my hair under shoulder-length. If your hair is thick and layered like myself, it can be a struggle. I am still not completed prepared for COT when it comes to looking the part.

4) Anticipate the sports physical.
We have different requirements based on sex and age, but there is a 1.5-mile run, 1 minute push-ups, and 1 minute sit-ups. I have worked on all three and am hopefully going to pass at 90% (passing is 75%, but 90%+ is preferred). Honestly though, I find all three to be a struggle when I am aiming for a certain number. I will likely talk about this process in detail in another post when I do my sports physical at officer training.

5) Read up.
Know what you’re getting yourself into, and know what will be expected. There are dozens of blogs, the USUHS website, the COT website, documents detailing rules and regulation, and books galore. Previous students, especially my student sponsor, have been excellent resources. I’m also currently reading the Air Force Officer’s Guide, which provides a nice overview. I learned that we will be doing a ropes course at COT, and I am actually quite afraid of heights. I am perfectly fine on planes and on roller coasters, but being high in the air without solid ground isn’t my forte (ironic that I chose Air Force, I know). I like challenging myself though, and I went to Earth Treks with an NIH coworker in Rockville and climbed three intense rock walls to conquer my fears. I cannot say I enjoyed the experience, but I believe I can work through my fear of heights if I have to. Now I will not be taken off guard when we need to do our ropes course this summer.

6) Pack everything you need.
I read every packing list available to know exactly what I’ll need to bring (will likely post a final list after my own experience for future officer trainees!). The number of snacks I’m bringing is probably unnecessary, but I am a grazer and I don’t mind sharing.

I definitely feel out of my element. I am excited for medical school but terribly anxious for officer training. I heard it’s mostly “death by powerpoint”, so we’ll see if it holds up to its reputation. I will have lots to learn: saluting, marching, saying “m’am” and “sir”. I definitely accomplished what I hoped to accomplish before this time with my NIH paper, travel, and catching up with friends and family. Now it’s on to the next big chapter. Second Lieutenant Anvari, out!