Thursday, February 28, 2013

You know how it works….right?

19 year old female presents to the ED complaining of vaginal pain over the past couple of days. It apparently started suddenly during intercourse with her partner of two months; she finally came into the ED because the pain seemed to be worsening and was increasingly painful during urination.

Her history went something like the following:
Doctor: So are you on birth control?
Patient: No
D: Do you use condoms?
P: No
D: Do you use any protection during intercourse?
P: No
D: Are you trying to get pregnant?
P: No
D: Are you prepared to bring a child into the world at this point in your life?
P: No
D: *blank look*
P: *blank look*

*Insert face palm here.*

Physical exam was normal except for some mild suprapubic tenderness. Vaginal exam revealed a minimal amount of mucusopurulent discharge with a nickel-sized mucoscal ulceration vs possible healing vaginal wall tear on the left side of the vaginal wall about 1.5 cm proximal to the vaginal opening that was concerning for an STD (especially a herpetic lesion) or possible trauma. hCG was negative, no bacterial or yeast infections apparent on laboratory studies. Herpes study was pending when I left. Either she now has a new life-long friend, or this was a freak coital accident. But then, aren’t we all? /sarcasm

Oh yeah…when the chaperoning female tech showed the patient the speculum for the vaginal exam (which, by the way, is phallic in shape but quite small), the patient appeared nervous and said, “I don’t think that’ll fit inside me….”

One can only speculate about what that implies about her poor boyfriend…

Wednesday, December 5, 2012

How to Get into Medical School: Part 1

So you’ve decided you want to be a doctor. If this is truly how you want to spend the rest of your life—or at the very least, a significant chunk of it—then I congratulate you. You’ve chosen a noble path, though there are no guarantees as to how things will ultimately turn out. If the origin of your motivation is uncertain, or there is something else you really feel like it would be cool to try out, then perhaps it would be wise to attempt the thing that interests you most first. Medicine will always be here to come back to.

For some, deciding on medical school is a decision that is reached one day—maybe it is a sudden enlightenment, like getting struck by lightning (but perhaps somewhat less painful….or not, I suppose). For others, including myself, reaching this decision is more of a journey. Perhaps a person is headed in one direction, but along the way is exposed to medicine somehow. They don’t think much of it at the time, but perhaps repeated exposures leave them with a nagging feeling that there is something fulfilling to be had here. After a period of honest exploration, our hypothetical individual realizes that medicine—and in particular, becoming a physician—is the best fit for them. Of course, it’s generally not as clear cut. Life is messy.

Regardless of how you got to this point, you’re here now. So what’s next? Following are some of my random thoughts on important aspects of the application process. Take them with a grain of salt. Or two.

On Deciding to go to Medical School

I touched on this briefly already, but let me just reemphasize an important point: Within the realm of medicine, there are many career paths, most of which do not involve spending at least twelve years or so of your life in school. If you absolutely “know” and can articulate good reasons for wanting to become a doctor, more power to you. If not, before you plunge into a point of no return, explore a little bit. Take some classes that are not necessarily medicine-related—maybe that astronomy class you always thought would be interesting, but you never had time for. You want to be a doctor, after all. Try to talk to people in other fields, or at the very least, do some research on the internet. Though you obviously need to understand the limitations of other people’s input—particularly random internet strangers—on your own life, there are many helpful websites for all kinds of different careers that can help you get an “inside look.”

If you have done all this and are set on medical school, then I would strongly recommend taking time to research exactly what you are getting into. Research the medical education process; read books about medical school, residency and beyond; understand what it costs you to become a doctor (and not just financially); understand how this process will affect you and those you love; digest exactly how much debt you will be going into and the realities of paying that off (don’t just think, “I’ll be a doctor; it’ll be fine"); explore the current healthcare system and try to get an idea of how things are changing and how that will affect you in the future. The world of medicine is changing, and if you are going into school with unrealistic expectations regarding your future, your work, your life, your finances—you will be disappointed. Think long and hard about this decision before you do something stupid.

Creating Your Application

The formation of your medical school application begins before you even realized you wanted to become a doctor. The shaping influences in your life—your experiences, your family, your friends, your enemies, your jobs, your education, etc.—all played a role in even giving you this desire in the first place. But now that you know, now that you have joined the neurotic ranks of premedical students worldwide, the formation of your application needs to stop being a passive process and become an active one. On that note, there are certain components (listed below in no particular order) that will be helpful to have in your application.

Volunteering/Clinical Experience

Most schools will look for some type of volunteering or community service activity in your      application. Theoretically, this shows a dedication to service and a willingness to make personal sacrifices. Practically, this turns into just another box to check for most premedical students. But it doesn’t have to be that way. Volunteering just once a week for a few hours at your local hospital, community aid program, shelter, etc., can be an invaluable way to learn about the practice of medicine, interact with people who might be diametric opposites of you, and broaden your worldview. This can be an awesome experience, and it doesn’t have to be medical in nature, either.

I personally volunteered at a hospital, first at the information desk and then in the emergency department. As a volunteer, you are at the bottom of the totem pole. But, you can also wander the hospital without too many questions being asked. The experience is what you make it. The extent of your patient interaction might be handing out warm blankets and food trays, but you can hand out warm blankets and food trays like a champ. In the process, you—unlike the rest of the busy hospital staff—might have the opportunity to connect with patients on a more personal level. You are the closest thing to someone like them in a busy emergency room—everyone else is wearing scrubs, trauma scissors, and generally running around like busy ants whose ant hill is on fire. So don’t just write off the opportunity—make something of it. You can also make connections with the staff, who might let you help them out with some “cool” things every once in a while if they see that you are actually making an effort. That said, don’t just make an effort to get noticed. Make an effort for the sake of making an effort, and see what happens.

Briefly, let me also note that you don’t need thousands of hours. I think I had 130 hours total, and that was enough. I ended up stopping when I had to move, and getting too busy later to get involved in my new hometown, but I had a blast, and some pretty cool experiences to boot.

For those who choose to volunteer in a non-medical capacity, first let me say this: that’s awesome, and it will set you apart a bit in the application process. Do something you enjoy; don’t just volunteer at a hospital so that you can say you could. That said, though, you will have to get some clinical experience. This can be in the form of shadowing (start with your family doctor, or cold call offices in the area to start if you need to. But get some, even if you do hospital volunteering. If you are volunteering at a hospital, ask the doctors there) or in some type of clinical job. Personally, I worked as an emergency room scribe for about two years. I had a blast, learned a ton, made good connections, and got some good letters of recommendation on top of all that. I also worked as a patient transporter (our official title was “patient escort,” but I tried to not publicize that…) at a large hospital for about a year, which provided me with a lot of patient interaction and the chance to see how the hospital works together as a dynamic unit. Other people work as EMTs, phlebotomists, laboratory technicians, ED technicians, etc. You don’t absolutely have to work in a clinical capacity—extensive shadowing can suffice. But if you are able to, I would definitely recommend it.

Research

Research is one of those things that isn’t necessarily required, but is nevertheless a worthwhile pursuit and very helpful to have. Honestly, some schools (Mayo, I’m looking at you…) won’t even really consider your application if you are researchless. Try to get involved with professors on your campus or local research groups in your area. If you can get some type of publication or presentation, that’s a plus. Whether you do clinical research or benchwork research, try to do something if you can.

I actually didn’t do research. When I had the opportunity to finally get involved, I was too busy with life, studying for the MCAT, school, work, planning a wedding, and on the verge of applying. If I hadn’t made it in this last cycle, I would be definitely getting involved now. It worked out fine for me, and I am very satisfied with how things turned out. But it would have been interesting to see, just for the sake of curiosity, how things would have turned out if I had had more research experience…

GPA

The bottom line here is simple: do well. You don’t need a 4.0, but you do need to demonstrate that you can handle the rigors of medical school. Most matriculating medical students have an average GPA of 3.5-3.7. Figure out study strategies that work for you (group study? solo study? notecards? rewriting notes? teaching your dog?) and do them. Your GPA is important, despite what some might try to tell you. This will distinguish your application, for better or for worse. You decide. As much as it is in your power, master the information presented to you—don’t cram—and show those classes who’s boss. Do particularly well in your core premedical prerequisites—biology, general chemistry, organic chemistry, physics, etc. Will a few Bs here and there destroy your application? No. Do people get in with abysmal GPAs? Yes. But you better have a darn good reason.

This is an important opportunity to show medical schools how well you can perform. Don’t waste it. 

MCAT

Remember how your GPA was an important opportunity to distinguish your application and show how good of a student you are? Well, this is the other opportunity. GPAs may be variable from institution to institution, but the MCAT is a standardized indicator of how well you will perform in medical school, and you will be judged by it.

The first thing you have to decide is when you will take it. I, and many people, elected to take mine in the spring of my junior year. This allowed me a little bit of time for a retake (albeit in exchange for a slightly later application) and allowed me to start medical school right away after undergrad. Some people take it later, perhaps later in their junior year or even in their senior year, so that they can have more time to study or take a “gap year” to do research, travel, work, play video games, etc. Whenever you take it, try to have your premedical prerequisites out of the way. Also, keep in mind that schools get picky about old MCAT scores—as a general rule, you want to apply within three years of taking the test.

Once you’ve decided when you will take it, you have to decide how you will study. If I had to guess, I would say that most people probably study on their own. There is a lot of information out there and a lot of resources you can purchase. This method allows for flexibility and works well if you are self-motivated and able to plan out a schedule and stick to it. One self-study method I have heard good things about is this plan devised by a fellow with the alias of SN2ed, posted on Student Doctor Network (a helpful site for tons of information from other—occasionally overly-neurotic—premeds).

Another option is to use a preparatory course. There are many out there—Kaplan, The Princeton Review, etc—and you can even just buy the materials and not use the course, if you want. I personally chose to use a prep course. I did this because, in the season of life when I took the MCAT, I was already busy with school, work, and getting married, and honestly just wanted someone to hand me the material I needed so that I could get straight to studying. I used a prep course called Altius, and thoroughly recommend it—with the caveat that your experience may be very different than mine. This course provided me with classroom session, a tutor, materials, practice AMCAS tests, and an entire academic year of preparation for this monster of a test. I ended up doing pretty well, and have no regrets.

Whichever option you choose, rock it like a champ. 

A Brief Note…

Allow me to pause here and note that your clinical experience/volunteer experience, GPA, and MCAT, and research experience form the cornerstones of your application. If you can excel in all areas, that’s awesome. If one area is lacking—for me, that was research—then you should try to compensate for that in the other areas.

That brings us to the end of Part 1. Next up, I’ll focus on creating your AMCAS application, gathering letters of recommendation, writing your personal statement, submitting secondaries, interviewing, traveling, and—hopefully—getting accepted.

Wednesday, October 31, 2012

Can I Get You a Wheelchair?

Note: Again, another incident I wrote up for myself last year, posted here for your reading pleasure. 

December, 2011

I was on my way out of the ED today after a shift full of "malodorous" drug users, sick people, and a very persistent crying kid who had fallen on sheet metal and lacerated his chin.  Out of the corner of my eye, I noticed a heavyset man, probably in his sixties, leaning against the wall just inside the main entrance but out of sight of the triage desk.  I wasn't sure what he was up to, but I was tired and needed to get home and study for finals.  I slowed as I passed him and looked him over out of the corner of my eye--he appeared ashen and couldn't seem to catch his breath. That's not good.  I walked over to him.

"Sir, can I help you?"

No response, except for heavy breathing.  Now he is pulling himself along the wall towards the triage desk.

"Sir?  Can I get you a wheelchair?"

"My...pacemaker..." he gasped.

 Uh-oh.

I looked around quickly for a wheelchair--there was one just outside the door.  But now he was beginning to slide towards the floor.  I put my arms around him to support him and nodded towards one of the individuals in the small crowd that had gathered.

"Can you go grab that wheelchair?" I asked. He made a beeline out the door.  Then, I looked over to the triage desk, made eye contact with one of the staff, and gestured for her to come over.  By now, the bystander was running back with a wheelchair.  The triage staff member was running over with one too.

"Looks like you've got your choice of chairs, sir," I said, continuing to hold him up.

I had the bystander bring the wheelchair just behind the soon-to-be patient, bear-hugged the large man, and lowered him into the chair.  Once he was in the chair, I brought him back to the rest of the triage staff.

Working as a scribe has been an awesome clinical experience and a great opportunity to see how a doctor functions day to day in the ED.  But I realized after this episode that I really miss patient contact. Even though my previous job working as a patient transporter at a different hospital was a simple, often routine job, I had the opportunity to interact with and care for patients.  Though scribing is and will continue to be a valuable experience, one that I am extremely grateful to have, I look forward to the day when I get to "glove up" again and provide tangible care to patients.

Don't Taze Me, Bro!

Note: I actually wrote this last year, just for fun. Figured I'd post it here for kicks and giggles.

8/27/11

I had two night shifts this week.  Back to back, with school in between.  That was fun.

The first one was actually decently interesting.  Some guy almost got tazed.  He came in complaining of back pain after getting into a fight.  Apparently his girlfriend got into a tussle with some rather butch lesbians.  He, of course, came to her rescue...and got his butt handed to him. His girlfriend said something about him being thrown six feet.  Of course, after spending a few minutes around the guy, the rest of us wanted to throw him too.

"I've been waiting twenty minutes!" This came from his room. Nobody really responded at this point.  So he escalated.  He began shouting, cursing, and generally making it known that he was being treated unfairly and wanted to go somewhere else.  A nearby security guard came over to tell him to calm down.  The patient, yelling all the while, walked quickly toward the guard.  Big mistake. The guard stiff-armed him to keep him in his room and put his hand on his tazer.

"Get back in your room or you will be tazed!" shouted the now-pissed guard.  Repeatedly.  And to no avail. He called for stat backup to room 4, all the while keeping the patient in his room. The patient, of course, would have none of it.

"He pushed me!  Did you see that?" he said to no one in general. "He pushed me!"

Buddy, you're getting off easy.  The rest of us want him to taze you.

Of course, while all this is going on, EMS wheeled in a cardiac arrest victim into a nearby trauma room. This patient had been found down after an unknown period of time with a hypodermic needle nearby. The paramedics had intubated him, given ETT Narcan, and CPR was in progress,  but he was in asystole—a non-shockable rhythm. Once in the room, the doctor I was scribing for drilled a hole into the patient's left shin to insert an intraosseous line and administered epinephrine and fluids.   Didn't work.  CPR was stopped, and after the artifacts on the cardiac monitor passed, we all could see that this wasn't going anywhere fast.  CPR was restarted, epi was administered again.  No change.  Code was called at 02:42.

This type of contrast between life and death isn't uncommon in the ED. In one room, one patient had experienced his last high. In another room, the patient was going to live to be a jerk another day.

Somebody Loves Me

After much waiting, hand-wringing, email-refreshing, praying, nervously checking my phone for missed calls, and more waiting, I am incredibly excited and humbled to report that I have finally been accepted to medical school. Three, actually—Wayne State, followed by Saint Louis, and finally, Loyola—which, as of now, is my top choice.

I didn’t hear anything particularly exciting the first week that acceptances could go out, which, although totally normal, was still nerve-wracking. To make matters worse, Temple sent me a letter in the mail saying I was waitlisted and wouldn’t hear anything back until May 15 (cue dreams of being waitlisted at every school, anxiously wondering if I’m actually horrible at interviewing, worrying if I would have to reapply, etc.).  

Finally, half-way through the second week and before I had started crafting a new personal statement for the next cycle (ok, just kidding. I was going to give it another week…), Wayne State sent me an email saying that I was accepted for the entering class of 2013. Of course, they couldn’t just come right out and say it—the subject line of the email contained the vaguely condemning phrase “Wayne State School of Medicine Decision Date.” The body of the email continued the trend of impending doom:

“Decisions have been made for this round.  Offers are being made to approximately 1/7 of our class at this time.  The attached document indicates the decision of the committee.  We appreciate your interest in our medical school."

Of course, while reading this, especially after Temple’s waitlist decision, I thought for sure I was a waitlisted again—or worse, rejected. But when I opened the attached document, the first thing I saw—much to my relief—was “Congratulations” written in large, green, Microsoft Word 97-esque font.  Even though Wayne State wasn’t necessarily my top choice, it was incredibly humbling and exiting to know that I will, in fact, be going to medical school next year.

The next day, Saint Louis sent me an acceptance email. They were much more straightforward about it, which my nerves were grateful for—the subject line read “Saint Louis University Acceptance.” Now, not only am I going to school next year, but at a place where I really felt like I fit well and would enjoy going. Also, I’d much rather take my wife to Saint Louis than Detroit…

The rest of the week was spent alternately feeling incredibly excited about knowing what we would be doing for the next four years and growing increasingly nervous about the upcoming Monday—the day the admissions committee at Loyola Stritch would be meeting to discuss our fate. Although I would be more than happy to attend Saint Louis, my day at Loyola had blown me away and I really fell in love with the school.

That Monday, despite refreshing my email as if my life depended on it and keeping my phone close by (I literally held it in my hand during class, ready to bolt for the door at the first hint of a vibration), I heard nothing from Loyola. I had been thinking that it would be fun to go out to dinner that night with my wife and grab a movie in celebration if I was accepted. However, once I didn’t hear anything by 5:00 pm their time, I had begun to resign myself that perhaps it wasn’t going to happen, at least that day. Even so, we still wanted to go out. Before heading to our favorite local 60’s-themed diner, we stopped at a strip mall—I had recently ripped a pair of jeans helping my in-laws move, and needed a new pair. While checking out at around 6:00 pm Chicago time, my phone started ringing, and there was a 708 area code on the screen. I whispered an excited “Loyola!” to my wife and made a beeline for the door—there was loud music playing in the store, and I thought it best that the good people at Loyola didn’t think I was taking their call in a club or something. Accepted! We were then able to carry on with our evening, this time with an awesome reason to celebrate!

Now I’m just waiting to hear back from UW, which will probably happen in the next few weeks. I honestly wasn’t personally blown away by the school, though it does have an awesome reputation. However, given its price and proximity to family, it will complicate things if I get accepted there. Boston won’t say anything till January. Also, I think I’m officially going to be done interviewing, unless Baylor decides to send an invite my way. That’s exciting in of itself—though it’s fun to see new places, traveling really gets old after a while. I’d rather be home with my wife.

I am extremely grateful to have been accepted this early in the cycle. I know it’s not uncommon to have to wait until spring to find out if you are accepted or not, and many people end up having to endure multiple cycles. That could have easily been me. There are thousands of highly-qualified applicants, and though there are certain things that can be done to strengthen an application, as well as some rhyme and reason to the selection process, there is also a good bit of arbitrary randomness as well. I am exceedingly thankful that I have been accepted, particularly to Loyola, one of my top choices. Now, I can just settle in for the last part of the pre-med ride—for me, the remainder of senior year.

Tuesday, October 23, 2012

Interview Experience: University of Washington

University of Washington School of Medicine 10/22/12

For this interview, my wife and I spent the weekend before in Seattle with a relative, which was awesome. We were able to spend some time touring Pike's Place Market and downtown Seattle--a nice change of pace from some of my previous trips, which tended to be along the lines of "fly in the night before, fly out right after the interview."

The Monday of the interview, my wife and I arrived at the school around 9 am. We went up to the admissions office to check in, and they gave me a yellow envelope with some info about the day, a little information on the school, and a flash drive with a bunch of additional stuff on it about the school. After a bit, a gal introduced herself to the applicants (there were seven of us) and gave an introduction to the school and the interview day. A fourth year then came and led us on a tour of the school and hospital. The facilities weren't anything to write home about. I mean, they weren't in disrepair, but they weren't particularly nice. It looked like they were in the process of updating/expanding, though. The building is supposedly the 13th longest in the world...don't know if that's actually true, but I could definitely see how you could get lost!

After the tour, there was a faculty "meet and greet," where a doctor who taught a second-year course came to talk about the school and answer any further questions we had. Then lunch was brought in, and three more students came to talk with us...and probably to get free food.

The curriculum for the first year is fairly traditional. It sounded like two days of the week were longer...maybe 8-5 pm or so. The other days go from 12-5 pm. Second year is organ-based and goes from 12-5 pm. The students sounded like they were fairly busy, though they did have time to participate in some of the numerous interest groups available. Lectures are recorded (though it sounded like the system isn't always reliable) and each class has a syllabi with the information you need to know. There is the usual doctoring course once a week throughout the two years. Second year, all the students from the satellite campuses (twenty in Spokane and twenty from Pullman/Moscow) come back to the main Seattle campus (though it sounds like students will be able to stay in Spokane for the first two years starting next year). Grades are pass/fail for the first two years. Third and fourth year rotations happen largely in Seattle at a blend of private, safety-net, academic, community, clinic, and VA settings. This is where the cool part about UW kicks in--you can spend time anywhere in the WWAMI region and the school pays for your travel and arranges your lodging. In fact, you have to spend at least 24 weeks at least 50 miles away from Seattle.

After lunch, I had about an hour and a half until my interview. You can attend a class if you want, but nothing really worked out well with my schedule, so I just went back to the admissions office. They actually had an applicants' lounge with snacks and computers to help pass the time, and of course you can talk with the other applicants. Finally, a man came out and called me in for the interview.

The interview is a panel format with three people-faculty, staff, students, etc. One of them presents you to the admissions committee. I had heard interesting things about UW's interviews, but my panel wasn't particularly mean or anything at all. They weren't buddy-buddy either, but it wasn't too bad. No ethical questions, but they did do a role play, which was actually sort of fun. I sort of bumbled through the first few seconds, but then I felt like I got into the swing of things and made up for lost ground. I didn't have any "Why UW" questions--they were mostly about my application or how I handle stress. Overall, I felt ok about the whole thing...maybe not amazing, but ok.

Overall, I honestly wasn't really blown away by the school. It seemed pretty lecture-heavy, and the facilities were so-so. Its shining point was the clinical opportunities in the 3rd and 4th years (though, it would be a bit of hassle to spend a lot of time out of Seattle--especially since I'm married and will likely have kids by that point [though I do vaguely remember reading that kids qualify you for an exception to the 24-week policy]), and it's obviously highly ranked. I didn't quite get the "feeling" I did with Loyola and Temple, though...for what it's worth. We'll see.

Wednesday, October 17, 2012

The Waiting Continues to Continue…



October 15th, the first day that US MD schools across the nation can accept applicants, has come and gone. And here I am, acceptance-less.

Ah well…

This process takes time. Or so I keep reminding myself. And only two of the schools I interviewed at—Temple and Saint Louis—actually began handing out decisions for my wave of interviewees this week, and neither school even said anything to anyone until the 16th.  I won’t even hear something from Wayne State until the 24th, and Loyola’s admissions committee doesn’t meet to go over applicants from my interview date until the 29th. Boston won’t say anything until January, for goodness’ sake. I have another interview lined up for next week. So it’s still really early, and realistically I shouldn’t be worried yet. Besides, my wonderful wife has continued to provide plenty of much-needed encouragement.

This entire process does nothing but foster neuroticism, and all this waiting provides plenty of fertile ground for dreaming up worst-case scenarios. There are hundreds of applicants in my shoes. I should be—and am—grateful for the interviews that I have had thus far. In all likelihood, I’ll be just fine.

But still….