Five Months and I'm Petrified

Savor the Days

I remember when I got my acceptance letter. After running around my older sister's basement in an ecstatic fit of glee, I calmed down and relished the stress-free months that laid ahead. It's hard to believe that I've already burned 4 of those months down, with only 5 left (less than that before I move to the city where my school is).

I've been so settled into my newfound state of "post-accepted senior" that I've forgotten what it is like to put in a hard day of studying. I live in an on-campus apartment with 2 other fine gentlemen (intended to be a six-person apartment; we have 3 now, had 4 last semester). One of them is a post-accepted Pre-Dental senior and the other is a non-traditional Pre-Med junior studying his butt off for the MCAT in May.

There is something liberating about having time left before the storm. My last months as a truly lay person. Go do what you want to do; travel, see friends and family, live, rave, visit Greece, heck I don't care. But live while you still can! I'm petrified about starting in a measly 5 months. I'm not sure how quickly I'll be able to adjust. In the meantime, I plan on shadowing a few Emergency Physicians, finishing up my undergraduate research involvement (finally), having as much fun as possible, and getting everything ready for the big move.

The Calling

The Calling

Pressure mounts on all medical students to decide on a specialty earlier and earlier these days (the last decade or two). Medicine as a career-choice is not to be taken lightly. You absolutely must be someone willing to sacrifice lots of time and energy for your goals. Not only that, but for many physicians, their family, friends, and social life suffer as well.

I truly believe that medicine has always been a deeply-rooted calling for me. My decision to enter it has been affirmed time and time again every day that I wake up. Sure, medical school will be tough; rotations will screw me over and residency will grind me to the bone. But I've accepted this. 80-hour work weeks in General Surgery rotation with call? I'm aware of this. "You think you know, but you have no idea." I'm aware of this and ready to accept what comes.

But beyond all this, I feel especially called to Emergency Medicine. I know that online medical blogs are no place from which to base real-life experiences or future plans. But they do offer an unedited, unscripted view into a lot of physician/resident/student's lives that you would never know about from medical school itself. Third and Fourth year medical school clinical rotations, as many say, do not give you a complete or accurate picture of life in those particular specialties. Sure, you get exposure and a good idea of what each of those specialties offers, but what about community vs. academic hospitals? What about doing that for 3 decades instead of 3 weeks? What about politics, hospitals, burn-out? The bottom line is that you should not limit your choice of a medical specialty based solely on your clinical rotations in medical school. They are very valuable, yes, but they are to be taken with a grain of salt. This is what I gather from reading many blogs and sites, at least.

I believe that your medical specialty should truly be a personal calling; a deep passion. If it is something you could not imagine doing for 30+ years and waking up every day to, do not do it! A specialty should also be one that appeals to you personally. If you find that patient-interaction is not important to you, you will want to avoid Family Medicine and Internal Medicine. With Emergency Medicine, I find myself rabidly fascinated; I read and keep up with every EM blog I can find online (just look at my links list). I read about EM on the Student Doctor Forums down to the last post and enjoy every bit of information I can read.

I look up information on specialties and read about every one, checking out lifestyle, compensation, nature of the work, residency, etc. I keep an open mind, and time and time again I find myself gravitating towards EM. I find the idea of the field exciting and wonderful for many reasons. I must organize this whirling mess in my head:

Pros

+Personality Match - The kind of guys I got to know through Panda Bear MD, M.D.O.D, Doc Shazam, and Scalpel or Sword (see my links) are a good personality match with me. They're realistic, laid-back, blunt, and seriously great doctors when they need to be. I've never quite fit in with the other pre-meds here; I'm not all 100% serious and anal all the time. These EPs seem to possess that same air of being free and alive that so many medical students lose. I've shadowed EPs (Emergency Physicians) and volunteered in the ED; the docs are really awesome people.

+Lifestyle - Shift-work. EPs are known in medicine for being people who have a true passion for life. They are able to separate their professional responsibilities from their personal life. Now, I'm not trying to shirk the Hippocratic Oath, but personal time is critical to one's happiness as well as their success as a doctor. From the doctorjob.com website:

When most people think of a physician's career, they associate it with long hours, little or no personal or family time, and tireless effort. Many newer physicians entering the workforce are not as willing to sacrifice themselves at the expense of spending time with their loved ones. And rightly so – having a more enriching family life and social life will make you happier and more successful in your professional life as well.

Currently, many physicians are focusing on specialties that have more flexible lifestyles instead of focusing purely on income level and prestige. Some fields of practice that can be considered “lifestyle friendly” are areas such as anesthesiology, dermatology, emergency medicine, ophthalmology, neurology, radiology, and pathology. These specialty areas offer you more control over your hours, and the income can be commensurate with the workload and level of responsibility.

As you can see, EM is consistently considered one of the "lifestyle" specialties, meaning that it allows a physician to have control over his/her hours and actually have a real life outside of the hospital (for general surgeons, internists, and OB/GYNs, this is a foreign concept). I have always been a firm believer in "work hard. play hard." I also like to leave work at work.

Q: You like to leave work at work? You want to have a life outside of medicine? Then why did you go into medicine!

A: My friend. This is precisely why EM has found me.

EPs are always the kind of people with lots of interests outside of medicine. I know an accomplished older EP who also runs his own audio business. He helps do live audio mixing for a very large and well-known Jazz festival near my home every summer. He loves RVs and outdoor living. He has had great success in the software/hardware business. I did not even know he was an EP until long after I heard about his other accomplishments in life. This is what I want - the ability to work hard and be a great physician while returning to my home/family and pursuing other passions!

+No Call - Apparently, call sucks. I've heard it from physicians, friends with physician-parents, and probably worst of all on every med blog I've ever been to. It seems that call is this old-school tradition in medicine where you come into work at 6AM Monday morning and do not leave until Noon on Tuesday (basically a 36-hour shift). I hear that it is not really "just" call, but indeed extended work ( at least for residents). For example, a Family Practice physician will be on call 24/7 and will be interrupted at 3AM, during dinner, during a wedding etc. to act as a consult for one of his/her patients.

Imagine going home from the hospital after a long shift and being able to relax with nothing on your mind. Your mind suddenly shifts to your patients - how are they doing? What kind of medications might they need when you round on them tomorrow morning at 5:30 AM? Yeah right. An EP stays far from this reality!

+No Rounding - Apparently, rounding sucks. Rounding is when you rotate through your roster of patients on the wards. You ask them how they're feeling, check their progress, discuss possible further treatments, and have 2-hour discussions on K+ levels and electrolytes. Again, I have had zero experience rounding, but from what I know and what I know about myself, I'm likely to agree with many that rounding is not the high-point of many specialties. Sure, some specialties do not admit patients too often, but still, why mess with it?

+Short Residency - 3 Years (in some cases, 4) is relatively short for a residency. Compare to 4 for neurology and 5+ for general surgery and its subspecialties. Do you know what a shorter residency means? You'll be out working and paying off those pesky 6-figure loans while your colleagues in cardiology keep training for another 2-3 years after you're out! Get to the point, that's what I say.

+Lots of Procedures - Now, I've developed a taste for working with my hands. I have not been able to suture up real wounds or anything, but I dissect frogs a lot. I enjoy working with tweezers, scissors, scalpels, retractors, surgical silk, etc. I like tying those little knots and poking at soft tissues. I do not want to be a surgeon, but I do enjoy working hands-on. ER offers an insane myriad of procedures from suturing lacerations to splinting broken bones and injecting dental nerve blocks. Did I mention traumas?

+When you're off, you're off - This is something certain people want, others don't. Me personally, I never liked homework much. The ability to leave work at work with a clear conscious (even if it is at 1AM when you get off) is its own beautiful thing.

+Variety - Newborn babies to the elderly, indigent and wealthy, kings and peasants, come one, come all. You get them all in the ED. Drunk or sober, pregnant, raped, stabbed, shot, stomachache. Everything. Not to mention, where else will you read an EKG, and X-ray, and pump someone's stomach on the same day?

+Compensation - It's not everything, but in the face of very high debts, medical students have been seeking higher-paying specialties. Again, while salary is not everything, EM has particularly good compensation.

Cons

-Lack of Continuity - OK. So I suppose I won't be tracking Mrs. Nesbitt's progressive loss of feeling in her extremities over the years. And I won't see Billy grow up into a big man. But it's ok! I really don't mind the idea of no continuity. Some people like the relationships and ongoing stories, but I really just want to practice medicine.

-Working Nights/Holidays/Weekends - All right, well you kind of got me there. Yeah, I love my weekends. But you know what? Loving what you do take precedence over hours. Yeah, staggered shifts from night to day and back are tough. But guess what; EPs tend to work far less hours per week than docs in other specialties (35-40 hours a week are not unheard of). Compare to 55-60 hours a week in other specialties with similar or even lower pay. When the month is said and done, you worked an average of around 40, perhaps 45 hours a week. Big deal. The point is that those hours are self-contained. That is, you worked them and when you went home to your family/recording studio/pets/friends you really went home to them. You didn't go home and spend your remaining hours on call or worrying about what you would come to work and find the next day. Every specialty has a downside; if you have overwhelming positives and love it - do it!

-Indigent/Drunk/Disrespectful Patients - Yeah. You're on the front-lines of medicine, down in the trenches. You get the drunks taking swings at you and the psychotics begging for drugs. You have the guy who got stabbed in the gut screaming the F-word at the top of his lungs while you try to anesthetize his abdomen. It's part of the job and it's reality. Just remember, not everyone is going to be like that.

-Disrespect from other doctors - "He's the whipping boy! He just stabilizes patients and then sends them to us!" Ok, sorry I didn't spend 6 years in residency studying the cardiovascular system like you did. At least I got Mr. Doe stabilized and worked up properly for you, Mr. Cardio. I hear this situation is getting better, as the specialty gains more support and recognition.

Bottom Line: I cannot and do not claim to truly know the ins and outs of this, or any other specialty. Not even close. I understand that I am only a pre-MS1 kid with an idealistic smile and and a lofty head. But you know what? It's never too early to start thinking. You have a personality and you know yourself. You can read up on specialties, talk to docs, think, discuss, ponder. You have every right to say "Hey, this is how I am...this is how these specialties are. I think that, based on what I observe, I would most likely enjoy this specialty the most." And along the way, the additional data keeps reaffirming my EM hypothesis. I am open to whatever comes my way, but I have a hunch, a gut-feeling that I'll end up in this insane place.

Pre-Med Culture

Pre-Med: The Stigma! Oh, the Stigma!

The inevitable question that comes up to any college student: "...and what are you majoring in [little boy/girl]?" I feel like smiling and saying, "I'm...I'm going to become a big doctor when I grow up!" and then getting patted on the head three times while the relative smiles at everyone else and replies, "Aww, well isn't that just adorable?"

Yeah, and I forgot to mention that I want to be a fire-fighter and an astronaut, too. Thanks, Aunt Sally.

Seriously, I cannot stand the word Pre-Med. It stands proudly with its annoying, pretentious sisters: Pre-Vet, Pre-Pharm, Pre-Dental and Pre-Law to name some. Pre-professional programs have their purpose: they are intended to provide a framework from which to schedule classes and plan for the future. They give one's undergraduate career a greater sense of direction and meaning, not to mention a cutesy label to tack onto one's soul. That's great, but does Pre-Med culture have to be so annoying!?

They Do Not Even Have to Tell You

The pale, blond girl sitting at the front-right of the room. The skinny, curly-haired guy trudging up 4 flights of stairs at 7:52 AM with his chemistry goggles hanging around his neck. The Kenyan boy who furiously scribbles notes down in 4 different colors. The brunette holed up at the back of the school's cafe, dark-rimmed glasses, hair tied tightly back in a bun, MCAT books sprawled out confusedly over the table.

We are the few, the proud, the Pre-Med! (What, were you expecting the Marines?) At larger schools, we (sneak into the lab after-hours and) sabotage each other's organic chemistry experiments. We get old exams from last year and hide it from our peers to get an edge over them on the next test. We'll cut you off in the hallway to get to class faster. We feverishly ingest every science fact and store it for both the upcoming exam and the looming MCAT. Don't even sit with us in the dining hall, your basic, non Pre-Med major cannot possibly hold up against our biochemistry!

And so it has been, at a small, Liberal Arts (Population: 1,000) college for nearly four years, living in a unique (and oh-how-colorful) sub-culture hell-bent on one goal: acceptance. They are a very driven and hard-working bunch, but also an edgy bunch.

Just For Show

Pre-Med has become a national catch-phrase. By tacking that flattering label on yourself, you are set up for great expectations. If you make it past the "weed-out" courses during college (read: organic chemistry), you will be applying for a (very sought-after) position at a medical college. The national acceptance rates have been hanging around 46% to 49% since the turn of the century. I'd say that "a little less than half" of all applicants are able to get a spot nationally. Often, the local statistics are far worse. At the medical school in my state, upwards of 2,000 applicants apply each year for a fixed ~200 spots. Thus, in this particular case, the acceptance rate is around 10% (ouch!).

Important: Most (75%) of the applicants to this school are out of state. Of the out of state applicants, the odds are around 10%. This is because schools are pressured by state legislature to accept mostly in state applicants. The 25% of total applicants that are in state have a much better chance (around 60-70% are accepted). So you have to consider that. Bottom line: A state school will typically interview tons of out of state kids and only accept a small fraction of them, while accepting a much higher proportion of in state applicants.

Culture

I chose to avoid the culture as much as possible. I had everything I needed right in front of me; the courses to take, the MCAT (and study guides), and the AMCAS site to apply. My college is small; gossip/rumors/news travels fast. Everyone knows everyone else's status. Nonetheless, my policy was always to slip underneath the other's inquiring noses and mind my own business with my admittedly computer-science major friends.

I haven't much to say or reflect on the kids here, because there is not much to say. Pre-Med kids live with their path, work hard in classes, often sneer and act snobby, and tend to think they're big stuff. Maybe it is the pressure of being successful? One thing is that most of them (me included) have absolutely no clue about what this profession really means. Even once you weed out all the freshman who came into college all starry-eyed, 75% of the remaining kids would turn tail and run if they tried an 80-hour week on an OB/GYN rotation, waking up at 4:00 AM and being on call.

Well, that concludes my exhaustive (sure...) thoughts on Pre-Med culture. It's full of pressure, expectation, constant check-ins from nosy parents and relatives, and competition with kids you'd rather chuck off of a schooner than spend a lab period with. It's bright and full of dreams, hopes, and ambitions! It's for all the academic superstars to shine and show how many hours they can spend in the ER pushing gurneys! Unspoiled and uninitiated, we form ranks and march towards certain destruction. So God help us.

To Take or Not to Take?

The $50,000 question: Prep-Courses for Medical School?



"The guy smokes!" I thought to myself as I watched my physical sciences section teacher sitting in his car, puffing away during a break. I would not have been surprised if the guy had been blowing trees; he was a sharp fellow, well-versed in his subjects, a (presumably successful) biochemistry major at a prestigious private school, and had done well enough on the MCAT to teach at this center.

Yet,

he was a total bad-ass. The guy taught us with a confident yet smug attitude, but he laid it down thick and heavy. The first time I saw him he was in a dingy white T-shirt, baseball cap covering his eyes and a goatee on his chin as he raised his muscular arm to the board to write out physics equations. But I respect him; an educated individual with a diverse lifestyle (though I certainly disapprove of smoking) is something I have not had enough of in the Mennonite culture I was brought up in.

That's great, but should I take courses or not?

You're (most likely) 19-21 years old and medicine is where it is at for you. You rocked grades at your undergraduate institution, volunteered, worked at your Aunt's clinic, and became president of the student body. Super. Excellent. Great! But medical school admissions needs to have a standardized measuring stick for you as well - one that is constant across the nation! You face the hurdle in its most ugly form: the MCAT (Medical College Admissions Test). The format has been changed from pencil-and-paper to electronic-only for 2007, but the core remains the same: Biological and Physical Sciences, General and Organic Chemistry, Verbal Reasoning, and a Writing Sample.

Run out to the nearest bookstore and get an MCAT guide if you want the scoop. I'm going to tell you what did and did not work for me.

Thinking...

My forehead hit the table and my head jerked up. Another Saturday afternoon wasted in the test center, taking (full-length, 5.5 hours + breaks mind you) practice test #4 out of 5. How far would you go to get the high-score? I admit; I am not Mr. Standardized test. Anyone can take basic science courses and spit concepts and facts back at their professor, but this thing makes your gears turn.

I took my first MCAT in April of 2006 and got a decent but not stellar score. I decided to take a prep-course over the summer to see if I could smash the test that August. That August was also the very last administration of paper-and-pencil MCAT, so I figured I'd be a part of history. Cute. Not.

You never know until you try, and things are always different in retrospect. I have no regrets about taking the course, but in the end it made no appreciable difference in my overall application process. In short, a waste of $1,000, lots of gas (45-minute commute each way), lots of evenings, and lots of Saturdays I could have spent playing video games and hanging out with friends.

Again, I could not have possibly known during the course that my performance after all that work would not jump into the realm of super pre-med. My personal experience may be discouraging to one considering prep-courses, but take it with a grain of salt, please!

Course Anatomy

The course was simple. You get a pile of books to compliment lectures (twice a week, 3 hours each). The lectures went on (6 hours a week) for about 10 weeks (most of the summer). In the second-half of the summer, you had to come in every Saturday to take full-length practice exams (this gets you in the mode for the real thing, apparently). You have extensive homework assignments and practice test booklets to work on, plus a huge "question-bank". All in all, you could easily spend 8 hours a day all summer with the material they gave you.

The best course, the perfect tutor, the most expensive study aids: they are all useless unless you yourself put your head to it.

If I can take away anything from this whole charade, it is that studying for tests like this comes from within, not from the outside. I made progress when I worked through my own books and did my own practice. By getting caught up in the rigors of the classroom setting, I found myself sliding into a false sense of security that I think a lot of kids in there got:

"I'm going to classes, so I must be improving my mad skills!"

Verdict...

Taking these multiple-choice, standardized tests is an art and a science. Anyone can bust their butt preparing for them (MCAT, USMLE, etc). For me, the trick is knowing the core material cold, then doing practice questions like there's no tomorrow. Time put in correlates positively with performance (up to a reasonable point). Put in a lot of time and still did not do well? Most likely, "a lot of time" wasn't really a lot of time. For MCAT? Some people are inherently better than others at test-taking - welcome to life.

Ultimately, the MCAT is a surmountable hurdle for anyone serious enough about medicine to pursue it. As for prep-courses, they're potentially useful, but it greatly depends on your style of learning. Prep-courses could also feed your ego if you want to be surrounded by pre-med gunners and bigots. I would recommend saving the money and spending perhaps a fifth of it to get some good study materials. You'll likely spend your time more efficiently, get more bang for your buck, and not have to deal with other stinky pre-meds.

I salute you who have yet to jump over the MCAT. Good luck and see you on the other side!

Volunteering

Why did I wear the Red Coat?

It was not until the second-to-last day of volunteering that I ran into an acquaintance from my college. He was an ER tech and, upon asking him, he politely informed me that the red coat need not be worn in the ED (Emergency Department). Nobody ever complained, and I never even got any weird looks (beyond the looks I usually get). But in the end, I could only smack my forehead as I realized that wearing that big, bulky coat made me look like a total tool. In the pristine, white halls of the then-under-construction ED, I probably looked like a crimson avenger moving meandering aimlessly to and fro.

My Purpose

"Valuable clinical experience", as it was proudly written on my AMCAS statement. Perhaps it was valuable ... for the nurses to look at me and laugh at me.
"Here comes big red again, guys!"
Yeah. Thanks. As I learned in my undergraduate days, the wards of the hospital, as well as the hospital itself, are not a place to joke around in. There is a hierarchy in place (perhaps more apparent in academically-affiliated teaching hospitals as opposed to community hospitals like the one I was in). Everyone has a specific job to do that they were very thoroughly trained for and ideally, every aspect of the hospital (and thus, health-care) should run like a machine.

I was useless. It would have sufficed to have been an actual ghost, floating around and watching the events of the ED. At least then I would a) be able to actually see doctor-patient interactions and b) not be a big, red eyesore taking valuable bed-changing time away from the techs. I am not sure if it was my particular ED, the guy that "trained" me, or my lack of initiative, but my job description was pretty bleak. The ED is the place, if nowhere else in the hospital, where teamwork and efficiency is vital to saving lives. Skills and roles were important, and I had neither of them.

I mostly hung around the nurse's station, chatting with them on slow days. I begged to take urine samples (still warm and toasty) to the lab, and I fought the techs to change patient's beds after discharge (making a one-minute job take even less). I sat outside the ED and directed people to various wings of the hospital, and once I even wheeled a teenage mother in labor up to the maternity ward. But in the end, I was a big, red eyesore.

Better Dead than Red

I was the only volunteer under the age of 65 in the entire hospital. "You're a young red coat!" they would always say with a gleeful smile as I scampered by on my way to the mail-room to fetch mail for the ED. Like a 3rd year medical student on their rotation, my coat was packed with MCAT flashcards, keys, a cellphone, and my wallet. The big difference? My coat was red, not white, and I did not have even 2 years of medical school curriculum under my belt. Why did I wear the coat? Oh, that's right. Dan, my trainer, had worn the coat as well.

There were a few other "kids" in the ED. "Patient liaison", it said on their name-tag. They were getting paid. They did more than me! They had a purpose, and they dressed up in normal dress clothes plus their name-tag. Yet, they did not tell me I looked like a gigantic, sore thumb against the cool, white background of the ED. I'm sure red is the last color to comfort a nervous patient; scrubs are green and blue for a psychological reason.

Finished

I had one day left. It was early-August. I should have just stuck my name tag onto a dress-shirt, but I put that glaring red coat back on for the last time. It was also my second day in the newly-renovated ED; I stuck out even more. Patients probably wondered what a completely unskilled kid with no purpose was doing wandering the halls. At least I was going over MCAT equations in my head (the life of the pre-med...).

6 Months have passed since that balmy August, and 6 more months will pass before I set my foot into medical school for my first day of class. I'm sure the ED staff still looks around from time to time and wonders where that red blob went.