Onto M4

Everyone says M4 is the best year of med school. I hope they are right….
I start my final year with 4 weeks to study for Step 2 CK before I go back to the clinics. 

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Minimalism and the Weight of Stuff

We have now been in the new apartment for a year. We moved because we needed more space with the baby starting to walk (and getting into literally everything), plus there was no room whatsoever outside in a yard that we could take her to play. There was also an incident with the upstairs neighbor’s water heater flooding our place and leaving behind mold–which they tried to cover up with a thin layer of white paint over half of it… and then their new water heater leaked, and we got another dose of mold. No thank you. So we were looking for a new place, a place with more square footage for the baby to roam with a yard or outside space. Bonus if it was in the country and quiet.

Then we found the new place: nearly double the square footage, huge windows, high ceilings, in the country on 4 acres and a grand total of six apartments in the building so it’s super quiet. It also affords us sunsets like this:


However, there was one thing that I didn’t like about having to move: hauling all the crap from one place to another. I didn’t realize just how much stuff we had accumulated. Frankly, I was embarrassed by how much stuff we had to move, and all the boxes and the stuff that just kept coming. By having the baby we gained a third person to our happy home and all of the stuff that comes with adding a third person to our family… but it was still way too much, and it just kept coming. Babies have a way of making anyone and everyone super generous, which can be nice, but can also add up quickly.

So here we have been, in this new spacious apartment… and it’s got two closets. Not even a coat closet. So lots of stuff got pushed into the closet space we did have.

And then came the third year of medical school with work hours and patient logs and call days with 30+ hour shifts on top of studying and assignments. I kept thinking that I needed to “go through stuff”when I finally got a day off or on post-call. Well…. guess what. When I did get time off, the last thing I wanted to do was go through stuff and sort out piles of trash, donate, sell, or return to owner. Ever so slowly, those piles did form and items started to disappear. The problem was, there was still…. stuff. Everywhere.

I kept having thoughts roll around in my mind about how to best get rid of the excess we had accumulated. Little by little those same piles started to reform. If I did find myself with some free time and if something was bugging me, I’d settle into a heated, angry, cleaning frenzy (hello cluttered sink that drove me nuts for months…).

In November I came up with an idea for a donation project. I worked through my school to set up a donation drive for the local refugee center, which was a huge hit! We wound up taking over 13 carloads of household goods to the local centers. So not only did we do some good for the local community, but I also got to donate a ton of men’s, women’s and children’s clothing that needed to find a good home.


And even then… we still had excess. And it was driving me nuts. How on earth did just three people accumulate so much stuff? We’re not hoarders by any means, but my goodness, there is just stuff everywhere. When I helped with the dropoffs for the donation drive, I can’t even begin to tell you how much of a relief it was to give away bags and bags worth of stuff that could find new life in a new home. I felt a huge weight lifted from my shoulders, and a lot of the stuff I dropped off was NOT mine/ours.

I had no idea just how much mental weight all of that stuff was putting onto me.

Months later, my husband preordered us tickets to a limited-screening documentary held here in town: Minimalism: A Documentary about the Important Things. That is the kind of people we are: we preorder tickets to documentaries. I was so happy he did this–not only because it meant a weeknight date night after a busy clinic day, but also because sometimes my husband just gets me, and it feeds my soul.

I gotta say, I love this documentary. What Joshua and Ryan say is simple and clean, and made so much sense to me. Stuff and consumerism isn’t what makes us happy. How much of the stuff that we have we bought or kept because we thought we had to, or we thought that it held the memories or was the source of our happiness? And it was then that I realized that…. it wasn’t.

Let me tell you about the stuff that I have that is weighing me down. I still have clothes in my closet from high school, back when I was a muscular, slender athlete with big dreams for what was to come. Add in the grad school weight, the married life happy weight, the baby weight… I have a closet full of clothes that I am keeping for the day when I slim down and I hope my old favorites can fit again. It’s massive. My favorite jeans, shirts, even a couple dresses. The thought of letting most of it go makes me uneasy. My closet is full of stuff that I cannot wear. But… having seen the documentary, and having thought about it for months while I finish up the third year of medical school, the time had come to clean it all out.

The closet was actually one of the last things to be tackled. First was the bookshelves. I love my books. I still have some old textbooks from college, but over the years I have been so happy to use the Amazon Trade-In program to give back some of my textbooks in exchange for funds for the next batch of books I need for school (thank goodness I am entering the last year of school and the textbooks will slow down–maybe–for a bit). Books that I didn’t want/need anymore that Amazon wouldn’t take were donated to libraries or children’s programs. Also, when I’ve been published, the publisher sends me multiple copies of the journal. Do I really need four copies of the exact same issue of the journal?? No. Away they went.


Then we tackled the movie collection. When we got married, we had so many duplicate movies. I thought we had gone through them all and found the duplicates, but I found a few more. Then there was a pile that we haven’t watched since the first viewing. Out they went. Then went (some) of the movies that are unopened (like the entire Saturday Night Live collection still pristine, wrapped in plastic).

The next thing we tackled: all the old paperwork we have kept for a rainy day or just in case. I went through it all and majorly cleaned out all that paper clutter, shredding what needed to be shredded and recycling what I could. Then out went the magazines, after one more time of reading them. Bye bye, paper clutter.

One more thing we found: at my favorite local coffee shop, there was an advertisement for a shoe collection/donation that went to making playgrounds for schools and providing clean water in resource-limited areas. After going through all of our shoes, we donated seven pairs of tennis shoes to that program.

Out went the bags of trash. Out went the bags of donations. Out went the paper and the clothes with holes and all the things that we kept that every time I looked at it I thought, I hate you. Why do I still have you?

One of the things that we do for fun in the summer is go to local home shows. I love seeing how different homes are set up as I daydream about our future home. But what I think I like most about touring this homes is just how crisp, clean and decluttered they are. I know it’s all staging and set up to be that way, but what draws me to that style is the minimalism of it all.

After the first round of attempting to be minimalists, we still had a lot of stuff. But, we have much less. I feel like a huge weight has been lifted. When we end up moving early next year after I match into a residency program, I don’t want to have that same anxiety-provoking, overwhelming nightmare occur when we move for the (hopefully) final time.

An unexpected way we’ve been able to minimize: using up what we already have.  I haven’t been to Bath & Body Works in over a year. I’ve been gifted so much that I do not need anything from there until I use up what I have.

Which means my pocketbook is happier too. I collect Starbucks mugs in their Cities collection from all of our trips. Lately, on two of our trips, I have intended to buy a mug but left without them. And I’m not remorseful about it. They’d just be collecting dust until they have their own home once we move into a house next year. For now, they’d just be clutter. And who needs that? Why organize so much when you can downsize? Less stuff = no need to organize. That makes me so much more…. free…. now that I have let go of so much stuff and the need to have so much stuff.

This weekend, we tackled the most dreaded of all tasks… the baby’s room. Holy moly, so much stuff.

We are far from done with cleaning out and adjusting to be minimalists. I still have plenty of books, as they are my first love. I still have some old jeans that I hope to once again wear. Because minimalism isn’t about never having any materialistic thing, but about knowing that things and stuff do not bring happiness. We have a long way to go, but we are trying.

 

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Introspection 

  Good morning, Virginia Beach.  This is the 4th morning of our family vacation and I woke up to a wonderful sunrise. Bonus: the hubby and the Ladybug slept in so I enjoyed this view while reading a (non-med school!) book.

While reading, my mind began to wander to my Personal Statement for residency. How on earth am I supposed to sum up my entire life to this point in time and why pediatrics has always been the next logical step for me in one single-spaced page? From what I’ve gathered from multiple conversations from my advisor, program director, and others is that Personal Statements are usually just kind of “meh” and not very personal… So I definitely don’t want to write something that leaves those impressions.

I’m not the best test taker. I’m not at the top of my class, despite working as hard as I could over the past three years, being successful in some areas and not-so-successful in others. There’s so much pressure to perform well while making it look effortless, to stand out from the crowd of other amazing and successful medical students, to land a coveted residency position when there are more applicants each year but only so many spots… I am feeling the pressure to make every section of my residency application as glowing as possible so that I am able to train at a great program. The Personal Statement, then, is an area where I need to shine so I can stand out despite being an average student in a sea of successful, hardworking, inspiring pediatricians-in-training.

The worst part of medical school is the constant competition.

I’ve tried to sit down and write this stupid thing a dozen times since January. I just can’t seem to do it. Maybe it’s the pressure, maybe the stressing out on myself has transformed into fear, and that’s why I just can’t seem to do it.

Until this morning. I had an idea on that tiny balcony, overlooking the Atlantic Ocean by myself, lost in my thoughts with a book in my hand. A friend recently made a statement about me and I thought to myself, “Actually… That’s true.” Why is it that I am still so afraid to OWN the things that make me who I am? To let my interests shine instead of trying to hide them away? This is my residency application for pediatrics–I’ve wanted to be a pediatrician for forever–so now is the time to be brave and show them who I really am. So the thought that was born to start with a statement about who I really am and let it grow organically from there, instead of wondering how to make a statement fit the expectations that doesn’t sound like me at all.


David keeps reminding me that this is a vacation, not a studycation or a workcation. I totally agree and we’re having a great time, but when the views look like this, I might as well harness the inspiration that comes from it, no?

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Tips for Third Year

The brand new third years started their first rotations this morning, which means that dispite my disbelief, I am actually a fourth year medical student. Here are my tips for a successful rotation & clinical year.

Be nice to the interns! At this time of year, they are all brand new–they may not know where anything is yet, including things like the restroom. If you’re a medical student with training on the EMR, you may need to help them out with it, if they came from other schools with different EMRs. If you know more than them, help them out. On some rotations, it’ll be the interns that write your evaluations, so don’t be a jerk to them.

Be nice to your classmates. No one likes working with a jerk who only looks out for himself.

Find ways to be helpful. Even small things will be appreciated by the team. If the patient is crying and is surrounded by physicians, no one will notice if you leave for a minute to grab a box of tissues from the nurses’ station, but they’ll remember how you helped the patient, and that’s what will go in your comments on the MSPE dean’s letter for residency.

Start studying on day 1! 4, 6, and even 8 week rotations go by quickly. Always have reading material on you. It’s hard to juggle working all day and studying only at night, so get used to using those little pockets of downtime.

Put the UWorld app on your phone. Do questions during downtime. If you’re concerned that the residents will think that you’re on Facebook/screwing around, ask questions about something in the current question (even if you already know the answer)–they’ll know that you aren’t just screwing off, and can teach you things. It makes you look interested, and then they won’t care if you pull out your phone during downtime.

Helpful apps: UpToDate, PEMSoft, MedScape, CDC Vaccine Schedule, New Innovations NI UME, various medical calculators.

Keep a snack in your white coat pocket. You may not always be able to just run back to the office/lounge/etc. to grab something out of your backpack. The three rules of surgery: Sleep when you can, eat when you can, and don’t mess with the pancreas. Very true rules, actually. Keeping that snack on you helps.

Be prepared to show up early and stay late. Don’t complain.

The residents know that “Is there anything I can help you with/do for you,” really means, “Hey, can I go home now?” After awhile, they get tired of hearing it and may keep you around longer to do nothing if you keep asking it. My advice is to go in with an idea of what you could do to be helpful or tell them what you just did to be helpful. Example: “I just finished the discharge summary for Patient X, what else can I do to help?” or “Can I go drop off scripts to X unit?” That way, you’re asking the same thing but in a much more helpful way. The answer was usually, “You did a great job, go home! See you tomorrow!” And then everyone is happy.

You have to be aggressive for your education. If you want to see/do a procedure/test, ASK. Volunteer as tribute. If the residents ask, “Have you seen….” or “Have you done…” say no, but I want to! The more you volunteer for, the more you’ll learn. For example, 10 minutes before the end of a long call day on internal, my intern turned down the opportunity to perform a paracentesis because he wanted to go home (I did, too). But then my upper level resident asked me if I wanted to do it. Ummmm, heck yes! So I got to perform one by myself, with an upper level resident as a guide/supervisor. And it was awesome. It made my 14-hour day a 16-hour day by the time we gathered everything/consented/performed/wrote notes/checked out, but it was so worth it. On OBGYN I was asked to go to the ED to use an ultrasound on a lady that had been in an accident. I’d never used the ultrasound machine by myself before, but I did it anyway. I couldn’t get the thing to calculate the heart rate for me, but I did see the fetus and showed the mom. When I told the residents I’d seen the fetus but couldn’t find the heart rate calculator, they were like, “But you TRIED! Hooray!” Everyone is happier if you make an effort.

No one cares if you get a pimp question wrong, so don’t beat yourself up over it. They just want to know where your knowledge is so they can teach you stuff.

If something happens that is just plain wrong: don’t be afraid to bring it up to the clerkship director/coordinator, or school administration.

Study resources:

UWorld is a must. Go ahead and get a Step 2 CK subscription now, even if it means you’ll need to renew it before your dedicated Step 2 study time.

Every rotation will have its own Case Files book. I really liked these. They work through cases start to finish, with questions at the end of each case. Each of these books fits in my white coat pocket, so they were great to keep on me during downtime.

Some rotations will have their own resources that are great. Internal has Step Up to Medicine, Surgery has Pestana’s Surgery Notes, for Pediatrics I used BRS Pediatrics, and for Psych I used First Aid for the Psych Rotation.

I did much better on exams this year than in the clinical years (it all makes much more sense, and in general aren’t just random factoids to remember anymore). Here’s what my strategy was, but be warned, I really think what I did was overkill.

Before the rotation started: DIT Crash Cart for that rotation to get a jump on some important topics. Starting Day 1 of the rotation: Case Files + any other resource for that rotation (see above for Internal and Surgery). Throughout: UWorld questions. Two weeks before the shelf, I’d go through the Emma Review (The University of Texas link) and take notes. Throughout: Master the Boards Step 2 CK, Step 2 Secrets, and First Aid for Step 2 CK. MTB is terrible in my opinion, and there’s no way I’d use it as my sole resource to study for Step 2, but there were a couple notes per chapter that were useful that I would transfer to my copy of First Aid. No one talks about using First Aid for Step 2, but I blame that on Step 1 PTSD. I really liked FAS2. Secrets fits into nearly every pocket and is a quick read of high-yield topics, and I really liked it too.

The day before the shelf: Emma review again, notes from UWorld questions, one or two passes through FA.

Your job as a third year medical student is to learn. You’re learning how to write notes, how to present, how to be part of the team, how to be a good intern–in addition to learning things that will be on the shelf. There will be people on your teams that are great examples of what to do as a physician, and there will inevitably be one or more that are great examples of what you don’t want to do as a physician. Make the most of it, because it goes by extremely quickly. It is so much fun–so much better than classroom work. Good luck, and have a great rotation!

 

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On the Road Again


I took my last shelf exam of third year on Friday, and I can hardly believe it.

I’m a 4th year!

There have been many struggles this year. I’ve helped deliver babies (and placentas), found fetal heart tones, used an ultrasound machine to find the baby’s heartbeat on my own, Room 9’s in the ED, so many procedures, lives saved, hands held, violent psych patients, late night/early morning surgeries…These experiences change you over time. Patients have made me laugh, made me cry, and wrote their names on my heart. I now have a much more solid idea of what type of person and physician I hope to be someday.

David and the Ladybug have sacrificed so much for me to be able to follow my passions. It was a difficult year, but so rewarding. We are now on vacation, and I am soaking up every sweet moment with my two favorite people. They are why I work so hard.

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Rotation: Pediatrics


I always knew I was destined to be a pediatrician, but when your very first patient on your pediatrics rotation is a 1 year old that demands you hold her as soon as you enter the room, then refuses to let you go when you leave… It might just be a sign!

Name/Location of Clinical Rotation

3 weeks outpatient in a local clinic; one week of mornings in Newborn Nursery; 3 weeks inpatient at our Children’s Hospital, one morning in the special needs unit at HOTI.

Typical Day Inpatient: Table rounds were at 8am before Morning Report, so I’d go in before then to see my patients (2-4, depending on the day), write my notes, then meet up with my team/study. Morning Report, then walk rounds. At noon there was usually a lecture or talk. Wednesday afternoons we had lectures and quizzes to help us prep for the shelf exam. Call was Q4 and we’d be done around 7p. My inpatient rotation was in the winter, so we saw lots of bronchiolitis and RSV.

Typical Day Outpatient: 8:30 am start, with first appointments from 8:45-9am. My classmates and I would get our laptop and otoscopes for the day and choose an attending to be with for the morning. We’d see patients and then present to the attending before going in together to see the patient again. Whenever the last patient was done in the morning, we’d grab lunch and study before grabbing a resident for the afternoon continuity clinic. It was fast-paced and I loved every minute of it. There was plenty of the bread-and-butter stuff (WCC well child checks for every age group, gastrointeritis, asthma, rashes, otitis media, etc) and cool cases of rare genetic stuff too. The latest I ever stayed was 6pm, and we had the weekends off.

What did I like most about this specialty?

It is just so darn fun. I’d go home with a face that hurt from smiling too much. 

What did I like least about this specialty?

Honestly, I was glad that I did my 4 weeks of elective time in peds subspecialties so that I got a more holistic view of all that peds has to offer. It would be nice to have more exposure to other subspecialties but in only 6 weeks, it’s hard to do. 

What I hear most from people who don’t want to go into peds is that parents are hard to deal with, which is swhy me times true, but I like counseling so it wasn’t a big deal. I had one mom ask me what was in the MMR vaccine, and after I explained it to her, she asked me if it was the one that made kids “stupid.” So that was a longer conversation about what she had heard, what her concerns were, etc. The kiddo got his vaccine, so that was a plus!😉

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I really think that it did. We were exposed to a lot in a short period of time. 

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

Absolutely! Lots of inpatient and outpatient visits, lots of acute issues, newborn nursery, and a really unique experience at HOTI. What I’m hoping for as a part of my career is community involvement, and our peds program here really excels at that. My outpatient clinic was also considered an AHEC site, meaning that it was in a rural setting.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

There are so many options. I loved outpatient clinic but I love hospitals more. I still think NICU is going to win though.

What info do I still need?

I asked everyone I could about what I could do to be a great pediatrics resident, things they wish they would have known before applying to residency, anything and everything about the application and interview process… Anyth not I could think of. I learned so much from the residents about what the job entails. This rotation made me excited about life. 

Has my perception of this specialty changed? If yes, how?

Not so much changed as reaffirmed.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

My passion was confirmed, over and over again. I had so much fun on this rotation. I had much more confidence on this rotation than the previous ones. I’m not sure if that was because I had a kid at home so I wasn’t nervous around the patients or their parents, or if it was the great faculty and residents that were so encouraging, or if I was just to my role as a second-semester third year, but it was an absolute blast and for the first time I actually felt like I knew what I was doing.

Right now, how interested am I in this specialty?

Pediatrics>Internal>Neuro>Surgery

What information do I still need to evaluate this specialty? Any other comments or reflections?

It was my goal to not get sick on this winter peds rotation. I failed big time, and got sick on three separate occasions in the span of 6 weeks: gastroenteritis, hand foot & mouth, and a cold. No bueno.
 

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Rotation: Inpatient Neurology

Name/Location of Clinical Rotation

Inpatient stroke at our local stroke center/Inpatient General Neurology

What did I like most about this specialty?

It was pretty relaxed. I got to spend a lot of time with my patients, and there was a lot of time to think and research things for my patients.

What did I like least about this specialty?

There were some really sad stories, and what I didn’t like about Neuro was that a lot of the time, the patients never got better; at best, we might halt or slow a disease process, but we didn’t really fix anything.

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I was on inpatient stroke/neuro consult and had my ED experience, which gave me a lot of unique experiences. I enjoyed that part, and I feel like I got a view of a large scope of that sort of practice.

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

I liked that I got so much time with my patients, but it isn’t the right specialty for me. It did not click at all.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

There’s inpatient, outpatient, and subspecialties in stroke and lots of things that I didn’t know about prior to this rotation! I feel like I got a good view of them, but I don’t see myself pursuing neurology. Right now my list is: IM>Neuro>Surgery, but I’m only on my third rotation!

What info do I still need?

None–I feel like I saw enough and got a good enough feel of it to know that I am interested in looking elsewhere for my specialty selection.

Has my perception of this specialty changed? If yes, how?

I learned a lot on this service. I really sucked at localizing lesions in the beginning, and with the neuro exam encompassing so many steps, I was always nervous performing a total neuro exam in front of my attending and residents. I felt like I had a good relationship with many of my patients. I still wonder about some of them, how they are doing. I do have a much higher respect for the specialty now.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

Now that I’ve gotten a chance to really see what working in neurology is like, I do not think I will be selecting it, but it has been a positive experience.

Right now, how interested am I in this specialty?

IM>Neuro>Surgery at this point.

What information do I still need to evaluate this specialty? Any other comments or reflections?

Some of these patients were so sad. I tried to give my patients plenty of time to complete the MMSE exam, but it was frustrating to them as well as me when they tried so hard on this silly set of tests and sometimes could just not do them no matter how hard they tried.

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Creating a Winning AMCAS Application: Upcoming Webinar

create_a_winning_amcas_application-1

The process of putting together your AMCAS application for medical school is daunting–so many requirements, and everything has to be just right!–and you might feel like you could use some pointers. Accepted.com is hosting an webinar next week to help you through this process!

Create a Winning AMCAS Application!

Grab your seat for an event that will make a huge impact on your AMCAS application’s success!

Join our friends over at Accepted.com for a live webinar on Wednesday, June 29th at 5pm PT hosted by one of their senior admissions consultants, Alicia McNease Nimonkar.

Learn how you can increase your chances of getting accepted. Save your seat today!

Register for Create a Winning AMCAS Application now!

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Psych so far

My last rotation of 3rd year is Child Psych, and let me tell you, it is so much different than everything else I’ve done this year, in good ways and  not so good ways.

The unit is a locked unit, with multiple doors and multiple keys. All trash bags in the unit are paper bags, not plastic. Most rooms with showers don’t have shower curtains. Since most of the kids are school-aged, there are school sessions throughout the day so that they aren’t counted as truant. There is art and music therapy. There is a schedule that is followed every day so the kids have to get up at a certain time, have showered by a certain time, etc.

We start out the day with table rounds at 8am (no pre-rounding). We then go see the kids before art/music/school/drama/the daily activity and go to any family sessions that are scheduled. I think write my notes and we’re usually done by noon or so. Lectures/Grand Rounds/Journal Club is in early afternoon, sometimes from 11-3, depending on the day. In the afternoons, three times a week, we have a clinic. We are either in the child clinic, the suboxone clinic, or the bipolar clinic. Those days can stretch out for a really long time.

During this rotation, we also have three “on call” days in EPS, Emergency Psych Services, and I’ve done all three of my calls. It is so much different than what I’m used to seeing in the day.

There are now only two weeks of third year left. Just two. I don’t feel like I know enough to be a 4th year medical student, but it is coming soon regardless.

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ERAS 2017

Welcome, (my name)!

Applying for: Residency

Holy crap. My turn has come. ERAS 2017 opened today and now it gets so real, so darn fast.

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