Transamerica

In my study of US history, I considered the periods between the Civil War (1860’s) and the turn of twentieth century quite boring. People lived. Died. Stuff happened. That’s it. However, one event stands out in my mind.



In 1869, Irish and Chinese immigrants completed the transcontinental railroad, sparking the end of the western frontier – a once unthinkable accomplishment. Before this railroad existed, only horses, ponies, and oxen had the capabilities to go from the Mississippi to the Pacific.

Did you want mail delivered to San Francisco from St. Louis? Take it on the pony express. Want to move to Oregon to start a farm? Get some oxen for your covered wagon and be prepared to climb mountains, ford streams, and risk starvation and disease to get to your destination.

The transcontinental railroad signified a historical shift not only in how Americans travel, but also how we view the mysteries of The West.

As we trek I-80 from Michigan to San Francisco in the comfort of our Pontiac Vibe, I think how different things are now – only 140 years later. Now, we can trek the Rockies on a paved, national highway system at 75 miles per hour with ease. You can also swim in an indoor pool, watch HBO, eat McDonalds, and see the latest movie if you wish. Times have changed – no cholera or hay fever, no buffalo (because we killed them all), and no threats of “Indian attack” – we gave the Native Americans too many other problems to deal with.

Interestingly, the route of the original transcontinental railroad closely matches that of Interstate 80.

As I type this sentence on my macbook, we spend our first moments in Wyoming together - at 70 miles an hour. How rugged.

I will keep you posted for more news.

MD/8

...so I completed my first semester of medical school and can consider myself to be .125MD or one-eighth of an MD – that means if you come to me with eight diseases, I can only treat one of them. As I emerge from my medical cave into society, people often ask me the "how did it go?" question, which always catches me off guard. (“err… ok, I guess?” “It’s over.” “I didn’t die from studying too hard.”). Frankly, the semester went by in a blur. It flew from August to December, and I barely remember what happened in between.

For winter break, I emerged from my medical cave and we are on our way in a car from Michigan to the West Coast and back to New York to start the next semester. After my emergence, people also approach me for medical advice. Sometimes I can answer the question; sometimes I can’t (maybe I can only answer one-eighth of the questions I am asked?).

It’s a new experience that I think every professional student encounters. My friends in law school are experiencing the same types of almost-rhetorical questions. Though I sometimes feel overwhelmed with the required knowledge base to answer those questions, I appreciate the trust my friends and family place in me to listen to and address their concerns. It consistently reminds me how much I need to learn and of my changing position in society. Get ready, WolverineDoc.

Now, WolverineDoc must experience the wonders of the American West via car.

Words of advice...

for Pre-medical, Pre-dental,(and pre-physician assistant) students:

1.) Science concentrations(or majors) are optional! In medical school, I notice English and humanities majors perform just as well as Biochemistry and Neuroscience majors. Why? because we all took the same science classes in undergrad. As long as you give yourself a strong science background by taking the right classes, who cares what you major in? (studies show that medical schools don't)

2.) On the subject of a strong science background, give yourself one by going beyond the minimal pre-med/dental requirements with additional science classes. A strong science background is essential to success in med/dental school! Only you can choose which advanced classes are right for you. My picks: biochemistry, some form of physiology, and (I wish I took this) Cell or Molecular biology. Yes, they are difficult, but it will help you in the long run. You're going to learn the material anyway in grad school, so why not learn it at a slower pace first during undergrad?

3.) Take psychology. Especially if you're going into medicine. Most of my med school colleagues fear our neurology/psychiatry course, and I wouldn't be surprised if other school's psych/neuro classes are just as daunting. Prepare yourself accordingly.

4.) Take it easy! Seriously. Run. Read Leisurely. Play sports. Play an instrument. Develop a hobby. Become an interesting person. You have time. Trust me.


Can't you tell I used to be both an Academic Peer Advisor and a Pre-med Advisor?

Lose that weight...

I got upset in my problem based learning (PBL) session the other day. For those who don’t know, PBL involves receiving a sample case from a fictitious patient who presents with certain symptoms and figuring out what disease the patient might have. I love this way of learning. It complements the lectures that sometimes make me want to gouge out my eyes with a dull spork, but I digress…

This week, we assessed the symptoms of a 55-year-old African-American female who presents with symptoms of diabetes mellitus (i.e., frequent urination, yeast infections, excessive thirst, etc.). While she presented to be an “overweight” (5’4, 170 lbs) female, she had a blood pressure of 124/80, which is regular. This puzzled some of my colleagues who expected the patient to automatically have high blood pressure because of her overweight Body Mass Index (BMI). This assumption (among others) triggered a thought I must share with cyberspace.

One can’t assume a patient is automatically unhealthy simply because a he or she is overweight. Being overweight doesn't ruin your health. Ingesting excessive sweets/sodium, not exercising, and smoking ruin your health. Now might there be a problem with her blood pressure? Perhaps, but I feel very uncomfortable assuming her issues result from her weight alone. In fact, a 2005 study showed that those in the overweight range (of the BMI) are at a lower risk of death than those who are considered to have a “normal weight.”

For me, this poor assumption is analogous to discussions on evolution. Many people who haven’t studied biological anthropology may incorrectly assume that men evolved from monkeys, yet they didn’t. Both men and monkeys evolved from a common ancestor (most likely from the early catarrhini family). Juxtaposing that to obesity and diabetes, many incorrectly assume that being "fat" causes diabetes. However, how would that explain the sizable number (no pun intended) of larger people who eat well, run, and are in very good shape (and don’t have diabetes). Living an unhealthy lifestyle (drinking pop/soda, eating fast food, not exercising) can lead to excessive weight gain and can lead to insulin resistance (diabetes).

I worry about this because focusing so much attention on larger people can shunt attention away from “normal” size patients. I spoke to a slim medical student about this, she confessed that many doctors overlook her eating or exercise habits because they assume that because she’s skinny, she’s in good shape. I, however, have always received tons of criticism from my doctors for my “overweight” BMI until I tell them that I lift weights, run 2 or 3 times a week, and was on the swim team in high school. (I also have a 32”/33” waist.)

As we delve into our patient’s social history, we find out that she never exercises, consumes tons of sugary soft drinks and fried foods. Bingo! We have a problem.

Now the work must continue. As I prepare a presentation on the etiology (causes) of Diabetes Mellitus Type II, I plan to erase the words “fat” or “obese” and replace it with “poor nutrition” and “lack of exercise.”

Debate...

I encounter this in class all the time. "The patient has this disease, not that." "No, I think that's wrong. She actually has this." It's a regular component of any profession, which actually improves the quality of learning and the quality of care -- nothing wrong with that. However, for many INFJs like me, any form of debate can become painfully draining and frustrating. I'm learning to get used to this torture, hopefully without too strong of an inferiority complex.

However, this makes encountering debate/conflict with others (i.e. among friends/partner) even more draining and frustrating. After a day of torture in class, one would expect a more verbally nurturing environment. Of course, life can't alter itself for me, but I can at least attempt to communicate to the ones I love how new things that weren't challenging before are excruciating now. One of those things involve debate.

To illustrate this, I chose to quote the writings of T. Wesley, a friend of mine who discussed his views of interpersonal argument and debate. He wrote it with another intention, but I feel it sums up my feelings of this subject quite well:


"In between two people, there are often arguments. It's rather natural for people to disagree with each other. Unfortunately, one of the crudest ways we, and myself included, have learned to deal with arguments is to win them. However, winning does not necessarily grant anything to a person past a temporary burst of serotonin before the next argument happens. When a person wins, another loses. Losing is something not something that people should be doing while in a relationship with another person. Often, an argument will try to reach justification with an explanation of injustice.

"'Like what?'

"When a person asks you, "Like what?" in an argument, they are often looking for the bottom line of the argument. They want the opportunity to find out what the problem is, and then explain it. However, in an argument, especially where nobody is listening to each other, "Like what?" becomes a position of power. If someone feels that they can explain their case, then they feel that they can win the argument and therefore effectively feel justified. However, in a relationship, an argument like this is a bad sign of what's going on. It's a drastic attempt to justify feelings, which are often uncontrollable and hard to deal with. Dios mio, it can be hard to deal with.

"However the fact of the matter is, when it comes down to it, a person that you care about is a person that you do not try to defeat in a relationship. In fact, in an equal relationship, arguments should come out with an equal understanding of both persons' feelings. And usually to have that, it requires at least a deep attempt to try to understand, and then you go from there. And that, is a little bit more easy to understand, with a good heart."

Wear and Tear...

As week 10 comes around and my seven-week preceptor session draws to a close, I find myself overwhelmed by the medical field – with all the drugs, diseases, signs, symptoms, tests, procedures, policies, paperwork, and patients. This craziness comes from the sea of information from my basic science classes and leaked into my “how to be a doctor” class that day, after which, I traveled to my preceptor’s office with several depressing and self-deprecating thoughts in my mind: How do doctors handle all this medicine drama? Can I handle all this? Am I a complete idiot? Should I quit medical school and join the circus?

After sharing these serious concerns with my preceptor, he suggested that I was being too hard on myself. Most students start medical school knowing very little, so an inferiority complex can easily develop. They feel as if every other student knows more material, studies more hours, drinks more coffee, etc. The stress is on, yet my preceptor assured me that I will learn everything I need to know to treat my patients. For that, I am grateful to have such a supportive preceptor.

Now it’s time for me to drink more coffee, so I can study more hours and learn more material.

Freshman 15

…describes a debilitating malady many undergraduate college first-years experience: gaining 15 pounds (or more!) in one’s first year of school. Sadly, this afflicts med-school first years as well.

I was warned. I’ve heard the stories, the complaints, the symptoms; hence, I’ve treated the freshman 15 as if it were the flu. I watch myself closely for signs of manifestation. I try protecting myself with diet and exercise, yet there’s only so much I can do. The symptoms have recently started to appear. Though I don’t weigh myself, I see slight changes in my torso. My stomach isn’t as flat as it used to be. I feel out of shape and less physically attractive. It’s freaking me out!

I realize the increased workload eats away my exercise time, so I've biked and ran less. The stress and sleep deprivation fuel my hunger for sweets, chocolate, and carbs. The lack of free time also prevents me from cooking healthier meals. I feel more compelled to save time by buying the cheapest, fastest food (usually pizza).

I also realize these are mere excuses, but it all comes with adjusting to a new lifestyle in a new environment. I’m now trying to find more efficient ways of incorporating physical activity into my life (i.e. taking the stairs, walking longer distances, etc), and ways to keep sweets, carbs, and sugar out of my life (buying the salad instead of the burger). Such commences my battle of the bulge.

In fact, yesterday, I biked 7 miles to Brooklyn to study at a coffee shop and biked 7 miles back. Now I'm off to the gym…

Reflections on studying ahead of time...

Procrastination was in my blood – yes, was. I was in the business of saving things for tomorrow. Homework? Least save those pleasures for later. Reading? I can do that on Sunday. I have time.

However, on Sunday evening, when I’m supposed to have that time, I’m too tired; a good show comes on TV; my friends want to hang out; I discover some great music. Those problems occurred throughout high school and college, yet all that has changed. I’ve thankfully defeated the procrastination monster, but how?

Perhaps working within the trenches of the 40-hour workweek before medical school enabled me to appreciate the importance of free time? Instead of spreading out work and study along the 24-hour day interspersed with breaks, naps, and leisure, my day partitioned into 8 hours of pure work followed by 8-10 hours of nothing. I freaked out. However, I eventually found the abundant free time liberating for other activities: reading, writing, socializing, cultur-izing. Upon, returning to school, I had grown so accustomed to those little pleasures that I force myself to study ahead of time to enjoy them. I have no time to procrastinate!

Perhaps planning ahead more helps? In my two months of school, I’ve visited Michigan twice, accommodated for guests, given tours of campus, attended social functions, and planned social functions. In college, this usually happened without warning, so I had the appearance of free time, which filled quickly. Now, I have a similar amount of extracurricular and social activities; however, I now have advance notice – which reflects what happens in the real world. For example, because I knew my partner was visiting three weeks in advance, I was able to allot enough study time before his arrival. I have no time to procrastinate!

There could be other reasons: Perhaps the stress radiating from the other students keeps me in line? Perhaps the fast-paced New York City lifestyle rushes me into doing work? Perhaps my homesickness keeps me in focus? Perhaps my partner’s influence keeps me in check?

Either way, this reflects my transformation from a student into a real adult. Am I ready for this?

You know it's sad when...

you visit the Kandinsky exhibit at the Guggenheim with your partner and see nothing but cellular organelles-- Look! a golgi body!


Composition 9
by Wassily Kandinsky
(1936)

Sharing is caring

I hated other pre-meds in undergrad. Why? All the competition drove me insane!

At The University of Michigan exists a pre-med sub-culture filled with one-ups, let downs, weeding out, gunnering, competition to the extreme. Many colleges with a large number of pre-med students (Berkley, Northwestern, UTexas, The Ivy Leagues) are blessed with this sadomasochistic sub-culture, some worse than Michigan’s, sadly.

Hence, I avoided the chaos with English, Sociology, and Psychology majors. Instead of discussing how to cheat the med school admissions process, we spoke of social justice, race, literature, music, etc. It kept me sane for five years.

I even chose my current medical school because our tour guides affirmed the “chillness" of the atmosphere here. People worked together, shared notes, loved each other, didn’t care much about who gets honors, etc. (I realize these musings are naive, but work with me here.)

Now, I’m noticing competition in the air. Everyone studies by themselves or in hermetically tight clicks. People talk of getting better quiz grades than others. Classmates hold back in lecture or small group because they don’t want to sound stupid. Though these are normal behaviors or any class in the first month, it can easily go in the wrong, competitive direction, which make me nervous. So, to subside it, I’ve decided to share my lecture notes.

Small move, I know, but I hope it encourages others to share information with each other and work together without the fear of being wrong or sounding stupid. I sent my plasma membrane notes a few days ago, and soon a typed, organized outline on lipids will reside in everyone’s mailbox.

I hope it works. Let’s see. Now on to the wonders of protein folding.

"Spring Fever"

I’ve never typed on a plane before...

I’m en route to New York City, after visiting my significant other back in Ann Arbor, Michigan, my former residence. I also visited a few friends, canoed, and copied a few opera CD’s.

My return evoked thoughts and settled uncertainties. In April, when I needed to decide between multiple medical school acceptances, I had the option to stay in Ann Arbor for medical school (and stay with my friends and family), yet I made a difficult decision to leave everything I knew for my current medical school for one overarching reason: New York City. To elucidate this desire, I will share what my friend showed me, a passage from Tom Sawyer Detective that describes “spring fever:”

“It's spring fever. That is what the name of it is. And when you've got it, you want--oh, you don't quite know what it is you DO want, but it just fairly makes your heart ache, you want it so! It seems to you that mainly what you want is to get away; get away from the same old tedious things you're so used to seeing and so tired of, and set something new. That is the idea; you want to go and be a wanderer; you want to go wandering far away to strange countries where everything is mysterious and wonderful and romantic.”

When I first read this, I recognized the symptoms of this “fever” immediately and realized that my move to New York alleviated such ailments. I needed this. Soon, I stopped regretting my move and started to embrace the uncertainty of change.

Speaking of change, it’s time to refocus my attention on the changing confirmations of proteins within the influenza virus before I land and face a long train ride back to Manhattan from Newark.

"vissi d'arte et di medicina"

In 12 hours, I will have survived my first week of medical school!

Most medical schools are infamous for throwing textbooks, journal articles, and exams at first years until they forget about the existence of daylight. Our school, however, deliberately gives us first years an easier first semester in order to allow us to adjust to and enjoy New York City.

Hence, this week, I've taken full advantage of the Metropolitan Opera's Summer in HD festival at the Lincoln Center. They broadcast (in HD) previously recorded productions of world-class quality operas for free at Lincoln Center! I've gone four days in a row and seen Eugene Onegin (by Tchaikovsky), Macbeth (by Verdi), Il Barbiere di Siviglia (by Rossini), and Peter Grimes (by Britton). I've never seen a full opera before this week, and now I've seen four operas in a row. After the first opera I saw on Monday, I went to youtube and watched more opera scenes. I've been smitten. I've found another art form to appreciate and enjoy!

However, the time spent watching operas equals time spent not studying. I thought about tonight when a classmate texted me on my way to see Peter Grimes, "did you do the problem set...," which happened to be due tomorrow. I hadn't, so I'm working on it at 2:30 in the morning. Yes, I sacrificed sleep, but how often does one get to see the opera in high definition for free in New York? For that matter, who gets anything for free in New York?

Biochemistry can wait for culture, especially if it doesn't require money.

Now I must return to the aforementioned problem set, while listening to Leontyne Price's performance of "Vissi d'Arte" from Tosca.

I finally found time for this.

A Michigan wolverine has moved eastward to leave jagged teethmarks in the Big Apple. Watch out New York.

That rabid animal is me, WolverineDoc, a brand new first-year medical student who has lived the Manhattan life for a total of 10 days. I moved here from Ann Arbor to embark on a rugged journey filled with self-discovery, learning, maturity, and challenge.

I created this blog to chronicle my experiences and give myself some cathartic personal space. Hopefully, it'll bestow meaningful advice to future colleagues who are in medical school or on their way to medical school.

The name WolverineDoc has many meanings, the first being an effigy to the mascot of my alma mater, The University of Michigan, Ann Arbor. I, however, also value wolverines for their brute, exponential strength. They are about the size of a medium dog -- measuring 17-25 inches in length and weighing anywhere between 22 and 55 pounds; however, they've been known to hunt large moose and successfully fight off bears to defend their food. The wolverine has been described as "the fiercest creature on earth" and "a dangerous, fearless fighter."

Health care workers of today must also be fighters, especially in the United States. Daily, we're mauled by the jaws of insurance companies, new diseases, long lines, increasing costs, public policy issues, malpractice suits, etc. Future health professionals, like myself, must prepare to inherit this and continue to fight disease within a broken health care system that shows little promise of improvement.

I also consider myself a fighter. Everyone's journey to medical school involves challenges (coursework, MCAT, applications, interviews, etc.). My path to medical school, however, has been paved with hardships that venture beyond the scope of our organic chemistry lecture hall. As I post, I will spend more time to share those personal experiences. For the future, however, that fighter spirit must continue to ensure my success.

Hence, I must channel the wolverine's spirit and sinew to survive.

I've typed enough for now. Thanks for reading!

Books I read to get into medical school (both the good and the bad)

For substance. In order of importance (top being most important)

Med School Confidential (2006) -- If I could recommend only one book for pre-meds, this would be it. Written by Robert Miller, author of Law School Confidential, and Daniel Bissell, MD, the book has something for pre-med or med students at any phase of their career. It first discusses the thought process involved with choosing a medical career and finishes by discussing how to apply for and survive for medical residencies. I already used this book to help me select and apply to med schools and I intend to use it to help me study for the USMLE and apply to residencies in the future. you get more bang for your buck, for sure. There's even a chapter for spouses of medical students. Buy this book!

Kaplan's Get Into Medical School (2006) -- Though this may appear to be a selling gimmic for Kaplan, I enjoyed this book. Unlike Med School Confidential, this book focuses on the application process. It takes you step by step though the process and gives you good advice along the way. My favorite sections included the financial aid information (which is better than Med School Confidential's in my opinion) and especially the chapters focusing on special student populations: nontraditional students, underrepresented minorities, students with disabilities, and lesbian, gay, bisexual, and transgender students. That impressed me immensely.

Complications by Atul Gwande (2002) -- Realistic stories from a surgical resident who went to Harvard Medical School. I enjoy his writing style. I first encountered him in an essay writing class one summer, and I fell in love with the book ever since. I learned a lot about the subjective and philosophical sides of medicine.

U.S. News and World Report's Ulimate Guide to Medical Schools (2004) -- I considered this book helpful, but not because of the schools' profiles. I enjoyed the articles at the beginning of the book, which described how to pick a school that is right for me and my personality. I love how the articles encourage students to stay away from the idea of rankings or prestige and lean toward more personal factors (like location, curriculum, or environment).

Medical School Essays that made a difference (2006) -- This book freaked me out about medical school (and not in a good way). Not only does this book consist of sample personal statements, it included the students' GPA and MCAT scores and the list of schools they applied to. Seeing others' scores immediately make me nervous. In the back it shows where they were admitted (or waitlisted or rejected). Though every student was admitted somewhere, I considered the results to be very depressing. I enjoyed having the opportunity to read others' personal statements; however, I was able to find good (sometimes better) personal statements online for free.