I thought medical school had done it. Beginning in my first year of medical school, as I spent hours memorizing minutiae off of Powerpoint slides, I noticed that my ability to stay focused when reading texts was decreasing. I chalked it up to the tedious nature of the materials I was reading as anatomy and biochemistry texts are pretty dry stuff. In the past I was an avid reader who devoured fiction and even non-fiction books whenever I could get my hands on them. And, in tune with my liberal arts education, I enjoyed contemplating what I read and discussing it with others. I remember reading a couple of works of fiction during the summer after my first year had ended and feeling relieved when after a couple of days my ability to stay focused seemed to return.
But as the years of medical school went by, the problem seems to have grown worse. Perhaps I have gotten too used to having "important" ideas presented to me in bullet points on the Powerpoint slides or in abstracts at the top of the journal articles. Now I find that my attention span for reading has diminished across the board. Whether it is a textbook, journal article, work of fiction, or even blog post, it is hard to stay engaged for long.
It must have been medical school that did this to me, right? Memorizing and regurgitating, skimming articles to find one to bring up the next day on the wards... or even worse just pulling up an UpToDate clinical summary and presenting that. The type of learning one does in medical school is generally the antithesis of most intellectual endeavors. So it would stand to reason that after four years of this type of learning I now find it harder to stay focused and to actually slow down and to contemplate what I am reading.
Then today I stumbled across an article by Nicholas Carr in this month's Atlantic entitled "Is Google Making Us Stupid?" The second paragraph summed up my struggle of the past several years, "I’m not thinking the way I used to think. I can feel it most strongly when I’m reading. Immersing myself in a book or a lengthy article used to be easy.... That’s rarely the case anymore. Now my concentration often starts to drift after two or three pages. I get fidgety, lose the thread, begin looking for something else to do." In his case the culprit is not medical school but the Internet with its vast amount of information that can be accessed rapidly with the click of a mouse. Following the trail from hyperlink to hyperlink, from text to movies, has apparently affected other bloggers and writers who are all noticing decreasing attention spans and changes in their way of thinking.
Maybe it is not just medical school that has changed my thinking. Ironically, all of my online reading and web surfing, which was often an attempt to keep reading and writing in the little bits of free time I did have in medical school, may have contributed as well. The article goes on to discuss the plasticity of the brain, how different changes in technology have shaped the way we process information over the centuries, and how Google's and the Internet's creation of an information network that essentially serves as a sort of artificial intelligence may have the potential to transform our culture. It is definitely worth a read and is great food for thought.
But, be warned, it requires staying focused through 4 hyperlinked pages of text and not getting distracted by any of the links in the sidebars that tempt you to skim rapidly and click away. Such are the ironies of Internet media.
uo apparently I managed to catch the sore throat bug that was going around the class at our graduation events last weekend. I thought I had escaped. Then on Thursday evening I started noticing some really funky, tender submandibular and anterior cervical adenopathy on my left side. By Friday evening my throat hurt pretty badly on the left when I swallowed, but I felt fine otherwise. I hung out with some friends in the afternoon, went to another friend's dance performance and a dinner that night. But yesterday I started to feel like I had been hit by a truck--body aches, fatigue, headache, and the sore throat. I moped around most of the day.
Of course, when it rains it pours; in the midst of my feeling like crap, we started to smell natural gas pretty strongly. So it meant a visit from the power company to determine we did not have a gas leak from the pipe, but likely a malfunctioning switch on the really tacky gas fireplace that is in our new living room. Since we will likely not use it much, we had them just shut the gas off to the fireplace. Problem solved. The dude was very thorough about checking everything and told us we definitely did the right thing to call and get it looked at now before it created an even worse situation.
Today I feel a bit better but still definitely not 100%. Thankfully, I am not starting residency tomorrow like a number of my friends are, so I will have time to kick this thing. Ironically, I was just reading an article in some journal about the attitude among many physicians that we just need to keep working through illness and are wimps if we call in sick. I definitely saw that mentality at work on the wards and it can be pretty destructive. You are not your best when you are sick and can make mistakes and provide substandard care. Plus by coming in you expose your patients and colleagues to whatever you have. Not a good situation. I can only hope that eventually rational thinking will prevail on this issue in general.
I'm chilling in a hotel in downtown Sacramento before heading over to the medical school for the last time. It is hard to believe this is really about to end on Saturday.
We had the Senior Awards Banquet last night. It was in a really cool old bank building in downtown that had been converted into a banquet hall. The food was actually pretty good (not that I could eat much of it) and much better than the food at some other ceremonies I have attended. Some of my friends in the class are rock stars, so it was nice to see them collect some awards last night as expected. And it was really great to see some people who I think will be great doctors, and who have not often been recognized, take away some of the awards too.
There were some class gag awards as well. Yours truly was selected as one of a number of students "Most Likely to Win a Nobel Prize" and "Most Likely to Have a Finding Named After Them." That surprised me. Maybe I will find that tumor marker for ovarian cancer or write tons of award winning novels. Who knows. Or better yet The Lone Coyote Sign... I'll have to think about that one.
It is one student's take on how to defer your loans at this critical time for deferral. I have not read through it, so read it for yourself take it with the requisite grain of salt like anything else on the Internet. But hopefully it will be helpful to someone.
Holy crap, I am really a doctor! That was essentially the title of the Evite I sent out for my graduation party that happened yesterday. And it pretty much sums up what I am feeling today. It is really surreal. After four long years, that actually did move pretty quickly overall, it is all over. I cannot believe it. And to realize that the State of California has conferred an MD upon me, when I feel I know very little at this stage, is a bit daunting. But logically I know that this whole journey is just beginning and eventually I will have the knowledge and confidence to be a good provider.
The graduation itself was quite good. Given that there were only ~100 MD graduates and about fifteen MPH graduates, the whole thing was under two hours. Our speakers were very good and it was a nice touch to have the same faculty member who welcomed us at our induction ceremony send us off into the world as newly minted physicians. Davis has a unique tradition where each student could have two family members/friends walk across the stage with us. My parents walked with me, which was very nice, and all of my guests said they got good seating and had a good view of the action. My only minor complaint about the ceremony was how hot it was. The heavy, black velvet doctoral robes were hot, especially under the stage lighting. And being hooded was interesting--a bit tight on the airway. The hood was green, the color of medicine, with blue and gold trim for the University of California.
After the ceremony we all hung around for a reception in the lobby. It was nice to get to say goodbye to some of the faculty members who had been very supportive and for them to get to meet my family. Unfortunately, it was so crowded I did not get to see and say goodbye to some of my friends who I will likely not see for awhile. It was strange to think that after spending so much time for the last four years with my classmates that I will likely not see many of them for a long time. As with any transition, we will all be moving on to new places and experiences. But I know that I will stay in touch with the people I became close to over the last four years.
My party the next day was a fun celebration and it was fun to see some people who I have not seen very much over the last four years. It will be nice to re-kindle some of the friendships that medical school and its time commitment put a damper on. Then again, who knows it residency will be much better. We can only hope... at least going into pathology I have no traditional intern year, so that's a start.
8 days until graduation. It is crazy how suddenly it seems to have crept up on me. Since I finished all of my requirements in early May, I have almost forgotten that medical school exists except in the flurry of emails about graduation, loans, and people's books and furniture for sale that I get daily. I am SO glad I had a significant chunk of time off at the end of this year to focus on moving and everything else that needs to be done before I get started on residency.
I have been talking with friends and am realizing that I will be starting much later than most of then. My orientation seems briefer and I do not have to do ACLS. So I end up with a couple of extra weeks to get settled before having to worry about starting to work. Unfortunately, I realize that I now must begin to study for Step 3. Since my knowledge base of clinical medicine has nowhere to go but down during pathology residency, it is to my advantage to take it as soon as possible. So once I get more unpacked and our freaking DSL gets set up (we're still without Internet), I need to spend some time with my favorite friend USMLEWorld and get ready to take the final installment of the beast we know as boards in July.
Sorry for being MIA the past few days. My laptop bit the dust at a cafe on Friday night. I know it is a Windows problem and not the hard drive at least. Frankly, I got 4+ years out of it and all I wanted was for it to make it through med school. It basically did that, so I can't complain too much. I managed to get it going long enough yesterday to get most of my important stuff off of it for now, and once I replace it I can pull out the hard drive.
We also still do not have DSL. Moving really gives you a chance to evaluate your providers and our great company that we had no problems with up to this point is not distinguishing itself. They blame the phone company for not updating our # in some database. The phone company, which I know is not great on customer service, blames the DSL company. For now, the DSL company gave me a "free" dial-up account until the problem is resolved. Blogging on dial-up blows, but going to cafes and buying unwanted $4 drinks to use the Internet or driving around to look for wireless is getting old too.
In other news, I tried venison for the first time over the weekend. I am one to try out bizarre meats, and this one is not really that out there compared to others. It was just okay--kind of tough and gamey. I think I prefer bison or ostrich which lack the gamey taste and have much less fat than beef.
The graduation festivities begin this week. There are a bunch of class social events, the Senior Banquet, and loan exit counseling before the big event on Saturday. Speaking of loans, does anyone really understand their loan paperwork? There seem to be different numbers on each set I get from different sources: the school printout, the government. I guess I'll have to trust the government on this one seeing as I owe the $$$ to them. It looks like I may want to do another consolidation too. Hopefully, the session later in the week will make it all clear. Our financial aid office is quite good.
So this week I hope to order a new laptop, get DSL and cable in, get the wrinkles out of my gown for graduation without ironing, understand my loans, figure out what has to be done to register for Step 3, finish unpacking, and have some time to relax before graduation. We'll see how much I can accomplish. Once I get a new computer, or at least DSL in, hopefully I can write some of the posts I would like to do on the end of medical school.
We have DSL. Finally. And I got a new laptop. I managed to find one of the last machines without Windows Vista on it. It took driving to a different store in another city, but it was totally worth it to get XP. After hearing so many Dell horror stories, which I was lucky enough to escape with my Dell laptop for the last 4 years, I went with a Lenovo (formerly IBM) in the end. They got the highest ratings in Consumer Reports and did not seem that much more pricey than other brands like Toshiba and Sony.
Now I am waiting for out cable provider to show up. We are approaching the last hour of the "installation window"I was given for this morning. I hope they show soon because I would like to get out of the house and hit the gym at some point today.
Anyway, more blogging later. It's nice to be back in business.
Since it's that time of year when many people are cramming for Step 1 and anxiety is running very high, I wanted to share a few thoughts about this test now that I am just about on the other side of this entire medical school process. This test freaks a lot of people out, and for good reason. You spend the first two years with it looming over your head as you cram in the basic sciences. Every class forces you to ask: do I learn the material for the school exam or the boards? What is important for the boards? All of a sudden, 2nd year is over and, boom, you are dumped into the library to spend a month or so cramming for this beast of a test. And, if you do not do well, you are told that you will jeopardize your chances of getting the residency that you want. It makes for a month or so of stress and misery, which is often compounded by talking with classmates and freaking out over the test together.
In retrospect, studying for and taking Step 1 was one of my lowest points in medical school and it caused a huge amount of stress. I did some things well and some things poorly when studying. But, in the end, it really did not play a huge role in my residency applications and having a mediocre score did not stop me from getting to where I wanted to go. Yes, there are score cut-offs at some programs and in some fields ie radiology, ortho, etc. But if you talk to 4th year students, I bet they can give you examples of people in their class who matched quite well with terrible scores and people who didn't match/did not get their top choices with very high scores. So keep in mind that this test is not the be-all and end-all. Even if you do not get the score that you hope to get, remember that there are many ways to compensate for the score on your residency application, i.e. good grades on clinical rotations, strong letters of rec, and rotating away at a place you want to go and doing well there.
Just try to keep it in perspective is the best advice I can give you. Other than that, try to have some semblance of normality in your life for a couple of hours each day while studying. Take breaks to exercise, spend time with friends/family, and eat well. It will keep your mind clearer and make your studying more effective. No matter how far behind you feel in your studies, do not reschedule your test date! From what I saw from others who did, the extra time was not that helpful and just led to more stress. Get this beast over with and take a real vacation for at least a couple of weeks before you start 3rd year. And avoid stressful situations while you study. This may mean leaving school and heading elsewhere to study if you find other medical student studiers to be more anxiety-producing than motivating.
Finally, do questions. Buy an online question bank like Q-Bank or USMLEWorld and do questions, questions, and more questions. I wish I had put down the freaking First Aid and done more questions for Step 1. I think that was what was most lacking in my studying. Remember, the test is testing your ability to answer test questions and not your entire knowledge base. Doing more questions will help you with timing, re-focus your studies when you can't read anymore, and expose you to the material that is most likely to make up a good chunk of your test.
Okay, now that you have read this post, take a deep breath and get back to studying/doing questions. Remember, this is just the first of 3 hurdles on the road to getting a medical license, and this too shall pass.
In about 12 hours the movers will be here to take away all of our crap. Just about everything is boxed except for a bit of annoying clutter. I am out of boxes and have turned to suitcases at this point.
Since this is the first "real" move I have made, I thought I would share a bit about what I have learned in the past few weeks about making big moves and hiring movers. I have found it is much more complicated than the moves involving your friends, a few cars or maybe a truck if you're lucky, and some pizza, beer, and sore backs at the end of the day.
I can tell you what not to do first based on my one other experience with movers. If you liked my recent Craigslist story I posted, you'll appreciate this one. I was about 21, pretty clueless about moving, and was desperate to get out of a toxic roommate situation that I had found on, you guessed it, Craigslist. So, where do I go to look for a mover? Yup, Craigslist. I talked to some guy who said he had his own truck and could do my small move in a couple of hours for really cheap. The day of the job he called to say he was "in an accident returning a rental truck" and could not come. What was that about owning his own truck? I later found out he had done the same thing to many other people and they all posted their experiences on Craigslist whenever he put up his ad. Soon he was out of business on Craigslist at least.
The moral of the story is do your research before you book a mover. People who get screwed most by movers are those who pick an random mover online without checking them out. It turns out there are some really sketchy moving companies out there. They can run the range from incompetent (see above) to criminal (ie holding your crap hostage on a truck or in storage until you pay them lots of money to get it released). If California is on your moving itinerary, check out the CPUC Moving site. These guys regulate movers so you can check if the company you are considering has complaints filed against it, and if it is properly insured. Check and see if your state has something similar. If not, your local Better Business Bureau is another place you can inquire about the customer satisfaction with a particular company. MovingScam is another great site for checking companies out. They also have a SuperList of movers in the message board section that runs down most companies in each area by state and what feedback has been left about them on the site.
Pick a few companies and ask them to come out and do an in-person estimate. This is really important. I found some companies did not want to do this and relied on emailed inventory lists or your summary of your stuff on the phone. You want an estimate so that you have some idea of what ti will cost you, and so that on the day of the move they can't tell you "you have way more stuff than we thought, so it is going to cost you tons more money." Get several estimates and compare before you book a company. We found the prices varied drastically. And seeing how the company functions in person for the estimate can give you a gut feeling about hiring them. The company that called to re-schedule our estimate to later and later in the day and sent a creepy dude did not get our business.
In California moving companies are supposed to give you a "not to exceed" price with the estimate. No matter what happens, this will be the most you will pay. All of the companies that came out gave us this price. Be wary if such a thing is typical in your area and they refuse to do it. Read up about the insurance they offer to cover your stuff and be sure you understand what it covers before you buy.
We have done all of this and picked a company with a very good reputation that gave us a good price. We'll see how it all unfolds tomorrow. I may be without Internet access for a few days, but I'll do my best to report back with an update.
The move went flawlessly. Best move I have ever had. Now I am buried under unpacking,
And, we have no DSL because they cannot find our phone number. Hmmm. So it may be a few days. I am in serious internet withdrawal. In fact, I am typing this from the car in the dark as we have had to go cruising around to find wireless networks to jump on at night. Parking near cafes works the best so far.
Not much else to say right now and my battery is nearly dead. More later I hope.
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