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!

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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!

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

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

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

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

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

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

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

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

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

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

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

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

Happy Spring!

Beginning the 2015 Chapter

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

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

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

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

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

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

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

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

In Seaport Village

In Seaport Village

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

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

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

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

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

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

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