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).

FB_IMG_1466999659599

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.

Week 1 in Brasil: São Paulo

Fun fact about myself: I get extreme travel anxiety. Not that it stops me from traveling. The month before, the week before, and especially the day of my flight out to my destination (especially when it’s international), I am in no way excited. Mostly I am unhappy I decided to partake in such an expensive and inconvenient adventure. Once I land, the story changes. It’s such a fabulous learning experience, and I love broadening my horizons, acclimating to an unfamiliar culture, and participating in local activities.

To be fair, Brasil isn’t all too unfamiliar. I visited 8 years ago around the same time (summer for home, winter for here). That time I went to São Paulo, Campos dos Goytacazes, and Bahia, a great mixture of places where I got to enjoy the city, the mountains, and the beach, respectively. I am lucky to have a Brazilian best friend since third grade, Renata, who also happens to have an amazing family, including both her nuclear family in Virginia and her extended family in São Paulo. Another fun fact: her grandfather was a famous politician in Campos, and we celebrated a festival in his honor when we visited before. Give me five minutes and I can easily draw her family free. Definitely cannot say the same for my own family.

Well here I am – back in Brasil again! Like 8 years ago, the World Cup games are the talk of the town. Unlike 8 years ago, I get to experience the games happen around me. Unfortunately, soccer game tickets fell through for my friends and me (we were 2 tickets short and decided to duck out as a group instead of leave anybody out), but Renata’s sister and her friend will go to the Spain v. Chile game while we’re in Rio. So jealous! But I will try to get over it…someday.

Finishing up week 1 in São Paulo. I left to Brasil later than the rest of the group so I could celebrate Andrew’s birthday last Sunday (the poor guy spent most of his birthday weekend working on a proposal project due the next day). I took a red eye Monday to Tuesday, watching movies galore instead of sleeping as per usual, and after successfully navigating out of the duty-free shops to arrivals, I was welcomed by Renata, Olindi, Morgan (childhood/high school friends), and Michael (Renata’s grandmother’s awesome driver slash former security guard). Her grandmother and one of her aunts are gracious enough to house us during the São Paulo portion of the trip. We are leaving to Rio de Janeiro on a flight tomorrow afternoon.

This past week is beginning to seem like a blur. Because my phone pictures aren’t importing properly and it’s 3:30am here, I will simply share highlights.

1) Opening game: Brasil vs. Croatia. The first Croatia goal startled us all, and Olindi came up with an escape plan in case a riot broke out: climb to the roof if possible or leave to the bar atrium near our table and then climb to the roof towards refuge. The plan proved to be unnecessary, as Brasil scored three more times and won the game. Wish I could upload the awesome video I have of the crowds cheering in the streets of São Paulo when Brasil won; I have never experienced anything like it. No matter what jersey you were sporting, no matter what country you were representing, you were just another World Cup fan excited for the games. Everybody got along fabulously, and the caparinhas kept the crowds alive. I also had a headband that day with the Iranian and United States flags to support my motherland and my homeland. Gotta represent.

From left to right, Morgan, Renata, Olindi, and I in our opening game attire

From left to right, Morgan, Renata, Olindi, and I in our opening game attire

2) Food and drinks galore. All natural fruit juices. Cheeses like catupiry and requeijão. Bread and cheese varieties like pão de queijo, quatro queijos pizza, and breaded cheese on a stick. Coxinha chicken dumplings that melt in your mouth. Pastel deliciousness of Brazilian-type hot pockets. Desserts of the condensed milk variety: brigadeiro, beijinho, and doce de leite, as well as many other flavors.

Caipirinhas: passion fruit, lime, and strawberry

Caipirinhas: passion fruit, lime, and strawberry

3) Zoo Safari, formerly named Simba Safari, featured emus that stare viciously into your soul, these hog-type animals, ostriches that bite your fingers, pigeons, flamingos, peacocks, lazy alligators, a hippo, monkeys who attack cars, adorable South American deer who slobber all over your hands for food, tigers, a lion and lioness, albino peacocks, camels, and llamas.

Everyone's favorite: the camel, who's loving up on Morgan

Everyone’s favorite: the camel, who’s loving up on Morgan

4) Sight-seeing: a gorgeous cathedral, the city-center of São Paulo, Paulista Avenue (where we witnessed metro riots over the World Cup), and more! Statues, architecture, and streets in different parts of the city all tell a story. Renata, her sister, and her cousins constantly share information about São Paulo’s history and culture with infinite pride.

Beautiful day in the park of the zoo

Beautiful day in the park of the zoo

Favelas with the best view of São Paulo

A few favelas with the best view of São Paulo

São Paulo skyline

São Paulo skyline

That’s all I have for now. It’s been a memorable week, and I definitely appreciate what São Paulo had for us. Next up, Rio de Janeiro!

Oi, Brasil! Getting your visa 101.

Fun fact: if you decide to fly to Brazil for the World Cup (don’t get too excited – I didn’t manage to purchase game tickets), you are not just paying for that plane ticket. I was in for quite the surprise when thing after thing would cost me more money, but this is the game for trip planning. Big flight, little flights (Brazil is massive), lodging, tickets for events, visa, travel items, etc. etc. etc. I tell myself not to dwell on numbers, although I sometimes think I should have been an accountant…I really love lists, numbers, and especially lists of numbers.

I digress.

I had quite the DMV-type of experience at the Consulate General of Brazil in Washington. It was a straight shoot from Farragut North metro stop off the same line as NIH. I spent the last week scurrying to prep for this morning, and it was quite anti-climactic.

Things you need:
– Visa application filled online
– recent passport picture to include with the visa application page (The embassy will provide glue sticks. This seems very important.)
– flight itinerary
– photocopy of driver’s license
– USPS Money Order (a nice man at the post office makes life happier): $160 if you’re a US citizen, +$20 if you are mailing your application materials
– pre-paid envelope (priority mail, flat-rate) addressed to yourself so that you can get your passport back, with its fancy new visa
– passport
– visit the Consulate site for details: http://cgwashington.itamaraty.gov.br/en-us/visa_general_information.xml (I found this site horribly confusing because there is no all-encompassing list clarifying what you need to do. I will blame my lack of sleep this past week for my struggles, but thankfully, I have a fabulous roommate who checked that I was good to go for the embassy.)

Doing the above took a lot of mental energy. These extra errands came at a bad week for work (presentation at Postbac Poster Day yesterday!) and a worse week for my personal life (finally moved my mom into her new apartment, and just signed a lease for my own place). But, alas, I accomplished it just in time after using wood glue late last night to attach my passport photo to my application page.

Got into the consulate just as it opened, and the security guard was the first person to see. He spoke fast English and faster Portuguese. I must have looked like a deer in headlights, until I just responded, “I am here to get a visa.” It was easy enough to grab my ticket, DMV-style, and find my seat. In the 45 minutes of waiting there, I determined that I really liked this security guard. Wonderfully fluent in both English and Portuguese. I considered myself lucky because my roommate had to wait at least 2 hours when she came a week ago. After my number was called, the process took all of 30 seconds – probably could have taken 20 seconds if the woman did not check my expired Brazil visa from 2006 and ask about my previous trip (turns out they give 10-year visas now). Drop the goods, be content, and walk away. Guess that’s what happens when you are hyper-prepared.  The security guard’s smile is my last impression of the consulate.

All in all – a mildly stressful but positive experience. T minus 13 days until I get my visa and 37 days until I leave to Brazil!

Travel Advice: Phrases/Words to Know

Advice for those who travel: if you do not know the language, learn the following phrases. I decided to group the words I learned in Czech Republic and Austria.

Hi
Czech
– – ahoj (ahoy)
– – dobrý den (doh-bree dehn, same as good day! This was easier for me considering it’s quite similar to Russian)
German
– – hallo
– – guten tag (goo-ten tahg)

Bye
Czech
– – ahoj
– – čau (ciao)
German
– – auf wiedersehen (owf vee-dur-zane…thank you, Project Runway)

Yes
Czech
– – ano (hearing no in Czech really means yes)
German
– – ja (yah)

No
Czech
– – ne (neh)
German
– – nein (nine)

Please
Czech
– – prosím (proceem, my favorite Czech word)
German
– – bitte (bee-tuh)

Thank you
Czech
– – děkuji (dyekooyih, or as I like to pronounce it: dyekwee)
German
– – danke (dan-keh)

Excuse me
Czech
– – promiňte (proh-mih-nyteh)
German
– – entschuldigung (ent-shool-dee-goong, this word is gold)

(I found “thank you” and “excuse me” most useful – it makes people more kind and considerate to you as a foreigner)

Oh, the places you’ll go!

T minus 74 days until my last day at NIH, and 4 weeks after that I will head to Commissioned Officer Training in Alabama. From there on out, I will be a busy busy medical student. Surprisingly, I am not too worried for medical school because classroom academics used to be my jam. It’ll be an interesting transition, but I am looking forward to it. Plus, I’ll be close to amazing friends, my nuclear family, and I’ll have Andrew for emotional support at home when I hit the books day in and day out.

In the meantime, I have a massive to-do list. To touch on a few of these would be awesome, but I want to take advantage of the time I have before the ball gets rolling.

  • Travels galore – – I am truly a homebody, but I appreciate going to new places and seeing how life away from home is. Every new place gives me a better understanding of the world and how I fit into it. Mostly though, I like visiting friends and having them teach me about their lives in a different location. Just returned from Czech Republic and Austria (blog post TBA), with future plans to go to Chicago, Canada, New York, Boston, Maine, and Brazil.
  • I have been gunning for an independent project and first-author publication at work since I interviewed and asked about writing opportunities for the lab’s Post-baccalaureate IRTAs (Intramural Research Training Awardees). Fun fact: when someone is selling a position to you, the delivered information isn’t 100% honest. Different IRTAs in my lab have completely different opportunities based on their mentors and the work they have inherited, mine being a fight-for-everything-you-want sort of position. After two years of blood (oh so much blood), sweat (the lab can get hot), and tears (not just my own), I can safely say that I love the science of child psychiatry.
  • Physically prepare myself – – I am one of those individuals who barely makes the weight requirements. I needed to diet and exercise like a beast to lose 15 pounds before my USUHS weigh in (thank you for the time, government shutdown), and I will likely need to lose the weight I gained back for my next medical exam. I also want to get in tip top shape for running (not my forte) as well as the push-ups and sit-ups. Pretty sure I can currently pass the sports physical, but I don’t want to be close to the cut-off. Don’t get me wrong: I love working out. I absolutely love exercising when I have the time. I just wish that we could include more body combat, weight lifting, and yoga into PT.
  • Learn Farsi. Apparently learning my native tongue would make me more money in the Air Force – talk about motivation! I am working on my Rosetta Stone and have my family for back-up. Growing up with Farsi at home made me comfortable with listening, but I want to get the alphabet down and solidly learn the speaking basics. Afterwards, I can start thinking about Russian again.
  • Read up! I should appreciate reading while I have the time for it. I have fiction novels, detox books, and my guide to being an Air Force officer. My to-read list keeps growing and growing, including a few French novels to brush up on mon français.
  • Dabble in piano like the good old days. Jazz, classics, some pop songs that I can sing to by my lonesome. Time to invest in a portable keyboard because my Sojin is staying with the parents.
  • Enjoy down time. I know the average 23-year-old wants to go out and party, but I REALLY love doing nothing. I’ll appreciate lazy Sundays while I have them 🙂