Interview Season

My first interview went well. Actually, better than well - I love the program. It is so well organized, with such diversity in patient population and among residents. The program director really values education, and that is evident in their board passing rate and fellowship placements. The hospital staff was incredibly friendly, and I could see myself as a resident training there. Big deal, I know. This program will be listed high in my rank list - likely number 2. I was thrilled to receive a "thank you for interview with us" from the program director - I hope that means that they liked me as much as I liked them!

My number 1 ranked program scheduled my interview for this week. I already am very familiar with the program, and I know I love it there. My mind is made up, which is half the battle - it is a "match" process, after all, so I have to love it just as much as they love me! So there's only one thing left, and that's to impress them during the interview...but I am so intimidated by the way the interview is run at this program. It will be me in the middle of a room, surrounded by interns, residents, chief residents, attendings, and the program director. I'll be asked a bunch of questions, which normally I'm not too concerned about. The only thing I try to be is myself, but that's hard sometimes when you're intimated and nervous. So I'm going to do my best to let the real me shine through despite my nerves.

This is a really exciting time for medical students, travelling around the country and deciding where they want to spend their residency training. It is a lot of fun, meeting so many new people and learning about so many different programs, and reflecting in the past years of hard work that has led us to this point.

After this week of interviews (I have 3 this week), I'll be able to truly relax and enjoy the rest of my time as a medical student. I am so lucky to be achieving my dreams - I can't wait to see where the future will take me! Fingers crossed it will involve programs of either Rank #1 or Rank #2!!!!

Sports Medicine

It's that time again - the beginning of another clerkship. This 4-week rotation is in the field of Sports Medicine.

In undergrad, I studied exercise science because I was interested in the interplay of exercise physiology on body processes. I also wanted to learn more about fitness and nutrition, as well as the physics behind movement and sport. I would say that I received a pretty good education, and I'm so glad that I majored in something other than "biology/pre-med" or "biology and chemistry". Believe me, I took more than my fair share of biology and chemistry classes (including the required gen bio 1 and 2, gen chem 1 and 2, ochem 1 and 2, as well as ones that I took "for fun" like biochem 1 and 2, molecular genetics, and cancer biology among others - enough to get a minor degree in both). But the great thing about doing a degree outside of biology is that I have knowledge in something that most of my peers don't, yet I possess an adequate knowledge of the basic sciences required of a physician. The best of both worlds. And I got to perform cool exercise testing and biomechanics exams - which was awesome. My classmates were all approachable and could hold a good conversation, which you don't always get to do in the chemistry lab. And I got to dissect a cadaver as an undergrad - something which virtually none of my classmates had exposure to prior to first year of med school.

So that brings us to why I decided a month of sports medicine might be fun. And I hope that I'm not disappointed. I'll be working with a variety of physicians and members of the health care team over the next several weeks, and I am so excited to participate in athletic activities as part of the team's doctors. I'm actually going to be assisting with minor league hockey and high school sports - which is going to be a lot of fun. I think I'm going to learn a lot of practical stuff this month, and hopefully get to do a few things as well (fingers crossed that I get to give a few cortisone injections before my time on sports medicine ends!).

All this while I'm training for my first half marathon in January (oh and also squeezing in those interviews). It's gonna be a crazy few weeks! :)

Outpatient Oncology

Clearly, recently my priorities have not included keeping up to date with my experiences on the blog. There are just so many other things I'm doing instead of this! haha

Oncology is still amazing. I still love it. I'm a little frustrated that I don't actually feel like I get to make a difference...some attendings allow me to interview a patient on my own, which is when I get the opportunity to learn about their story and get to connect with patients on a real, human level. That's what I love most. But other attendings just have me follow them around all day, then ask me random questions that I could not possibly ever answer while in front of patients ("could you explain to the patient what Dr such-and-such discovered regarding the seed-and-soil hypothesis in his paper written in the New England Journal of Medicine in October of 1975?" - ok the questions aren't that bad, but you get the idea. Might as well have been asked in a different language, I would in no universe know the answer off the top of my head to such obscure medical history or trivia). But all in all, I can't complain because no matter how the interaction occurs with the patients, I still love their stories, their presentations, their treatments, their prognosis, and most importantly, how they are handling life in general as a cancer survivor / someone battling against cancer.

It's that time of year when fourth year medical students are busy flying all around the country for interviews. I have several lined up, and I'm excited (and a bit nervous) to learn about different programs where I might end up working for the next 3 to 5 to 6 years.

I'm also keeping busy with enjoying life as much as I possibly can. I'm spending a lot of time with my fiance, my pup, my family, and my friends. I have a "fourth year bucket list" which I am happily completing. I'm also working towards competing in my first half marathon, tentatively scheduled for January 6th in the north of England. Also busy with wedding plans and other crazy things. Life is so busy when you are doing more than just "work".

I am so incredibly lucky to be where I am, doing what I love, with my soul-mate by my side. Life is incredible.

There's a saying which has been stuck in my head lately, which I think clearly summarizes how I feel at this point in medical school. Looking back to the beginning, to the early days, when I thought I would never see the end of medical school come, to now, having all of my exams finished and merely awaiting graduation day to get my MD. "At first, dreams seem impossible, then improbable, and eventually inevitable." 

Please send positive thoughts my way for my interview this week - I'll be interviewing with a program which I will likely rank in my top 2 choices. And I'll do better to keep you all updated. :)

An example on how NOT to break bad news

While on my surgery clerkship during third year, my colleague decided to break some bad news to a patient. The day before, we had performed a hemi-colectomy plus extensive lymph node dissection, which was found to be stage III colon cancer, which was a recurrence (she was "in remission" for several years prior to this surgery). She was a fairly young woman as far as colon cancer goes, in her 50-60s, and she had a very admirable performance status. Being that we had become aware of her poor diagnosis during a frozen section during her surgery, my colleague, "Breanna", decided that she would inform the patient of her diagnosis.

It was about 5:30 in the morning when Breanna decided to enter Ms. Hemi-Colectomy's room. After waking Ms. H-C, Breanna proceeded to ask her many questions regarding her recovery from surgery and her previous experience with cancer. Breanna then decided to divulge the diagnosis to Ms. H-C, while mentioning the fact that it is "not curable" and that "hospice might be able to help you stay comfortable". As you can imagine, tired and lonely Ms H-C did not take to this diagnosis and prognosis well - she began sobbing uncontrollably at her "hopeless" situation. That's when Breanna decided to leave Ms H-C to herself. Breanna came over to me and started complaining about "how hysterical my patient was in there; all I did was tell her the diagnosis. I explained to her that we can get hospice involved - I don't know why she's so upset".

About a half hour later, after Breanna had left the floor, I was rounding on a few other patients when I heard a nurse complaining about something... "My poor patient! A damn medical student woke her up to break the news to her that she has terminal cancer at 6 o'clock this morning, and now she can't stop crying! So I've been in there for the past 45 minutes, trying to talk with her...What the h*** was that stupid student thinking!? It's 6 in the morning and she's all alone!!!"

I was in complete shock - this story is so distressing to me that sometimes I think I must have only imagined it. But this true - this poor woman learned her diagnosis from a brand-new, third year medical student who could barely string a sentence together in normal conversation (she was as close to Asperger's as I've seen outside of my psych rotation), who had no idea what the patient's true prognosis was, and did not even explore the possibility of further treatment. Also, this student also knew full-well that we were NEVER to discuss the diagnosis before the attending had time to break the news to the patient first. I honestly don't know what came over her and made her decide to break the news to this poor, unfortunate woman.

This is one of the most difficult conversations a physician can have with his/her patient, one which requires a lot of experience, tact, and respect in order to be done properly. It's a conversation that patient will never, ever forget - so it's unbelievably important to do it right.

But the worst part of this story is the fact that Stage III Colon Cancer can be amendable to treatment. This diagnosis was not implicitly terminal; we do have treatment options available which may offer a significant prolongation of good-quality life with the possibility of a cure.

As a student, I've seen a few things happen that I don't quite agree with, but this was definitely the worst. I can't even imagine how furious the surgeon was when he discovered what had happened - luckily we moved on to the next service before he found out. I don't want to know what he would have done to Breanna...

Pathology: Days 4-17

Now that I'm nearly finished with my pathology clerkship, I suppose its time to give you all an update of what it's like "in the basement" of the hospital!

I spend most mornings in conferences with other specialties, showcasing the biopsies and cellular morphology of various surgical and cytological specimens and integrating that information in to the patients' care plans. From there, I have had different experiences, ranging from visiting each section of the lab (immunology, blood bank, microbiology, molecular genetics, chemistry, etc) to attending frozen sections to assisting in the gross lab (where we cut up the surgical specimens before examining under the microscope) to examining slides under the microscope for hours on end. The afternoons consist of either conferences, teaching sessions, or more time with the microscope. I'm surprised by how much I'm picking up, considering that there isn't too much teaching going on for the students (the residents get a very good education, but it is usually too intricate or detailed to be of much use for non-pathology physicians). 

I can't complain about the hours. They've been really nice. I only wish that I could learn more and utilize my time in work a little bit better. During third year, I would always have a book with me and I would study during any down time; since there aren't any shelf exams this year (and I don't have a good textbook on pathology), I'm not finding my time to be managed very well. But no complaints, I have had so much time to read for fun and socialize with my peers instead of always having my head in a book.

This week, I performed my first frozen section on a lung specimen - it was a lot of fun to do. You have to cut the specimen that you want to investigate, measure it (of course), then place it in a block to be "flash frozen" before slicing it into 4-8 micron thin slices and placing it on a slide - carefully - before finally staining it and examining it under the microscope. What we diagnose under the microscope directly influences how the surgery is continued, so the job is really important. For instance, if a patient is undergoing a lung resection for presumed squamous cell carcinoma but is found to have small cell, surgery is not going to be beneficial for this patient and the surgeon will end the surgery (but might have completed a lobectomy had it been squamous cell). So the job is vital - and the diagnosis is so crucial. It's also kind of fun because the surgery basically stops until a diagnosis is declared - brings a bit of excitement and a rush to the otherwise slow-paced world of pathology.

A frozen section:

I have a lot of respect for pathologists. The diagnoses they make directly impact patient care, and there is really no room for error (even though medicine can definitely be ambiguous). 

Happiness is a Fourth Year Med Student

This post is for anyone stuck in the preclinical years of medical school, thinking that those days will never end, studying 12+ hours every day, dreaming of one day being able to actually talk to a patient (nevermind actually help them!). It's a long road, but here are a list of things you have to look forward to during the first few months of your fourth and final year in medical school:

• Determining and officially declaring your chosen specialty.
• The moment you submit your application to residency programs after compiling the application and documents over several weeks/months.
• Accepting your first interview offer.
• Finishing the last exam of your medical school career.
• Getting the results from your last exam of med school.
• Reading through some really thoughtful and personalized evaluations from attendings you've worked with.
• Seeing third years studying for the shelf exams, relishing in the fact that you've already taken them!
• Having the weekends off (I haven't worked a weekend since I was on neuro back in April!)
• Compiling a "Fourth Year Bucket List" (it's already a full page long)
• Consisting of things such as: Enjoy a weekend in Chicago, Spend Christmas in England, but also some more mundane things like: Go To the Art Museum, Run A Half Marathon, Visit (a nearby city), Check Out the Casino, etc.

AND a few extras that have made me so happy in the past few weeks:

• I became an auntie for the fourth time (reminding me of how much I love newborns, life is truly amazing!)

• My little sister is engaged to a really great guy, making up a really perfect couple...!
• Planning my wedding while my sister plans hers is really great! I love sharing this experience with her!
• My eldest brother and his wife are pregnant with their third child! Due Date is a few weeks before my wedding! I love that our family keeps growing!
• My fiance returned from a 17-day trip to England to visit family - so happy to have him back in my life!
• I have time to do SO MUCH STUFF because I'm only working around 40 hours/week with WEEKENDS OFF!

Step 2 CK Results

I am beyond ecstatic!!!!! I am so happy that, after 7 weeks, I finally know my result - I exceeded my expectations and got a score higher than I had even hoped for on my Step 2 CK Exam!!!!

On Wednesday morning, I logged on to the NBME, started shaking like crazy, with my heart pounding out of my chest and hyperventilating. I downloaded my score report, opened it up, held my breath, and glanced at the word "pass". I decided I could breathe a little..! Then, after taking a big deep breath, I scrolled down the page, and I saw a number I totally didn't expect. I rubbed my eyes and re-checked it, to make sure I saw it correctly. I suddenly realized that I really did do that well, put on a huge goofy smile and started to tear up. Seriously, tears of pure joy started filling my eyes, and I just wanted to giggle & giggle. I cannot adequately describe how good it feels to have something you have worked so hard on come back with results that exceeded your highest expectations. I think I'm still in a bit of shock...!

I have had a lot of really great moments during my medical school career: white coat ceremony, humanism in medicine elections, connecting with patients, giving well-put together presentations, making friends, watching my knowledge base grow, getting pimped and knowing all the answers, and getting compliments from the attendings that I really look up to - but none of that even compares to finding out my results. THIS is the happiest moment of my medical school career!!!!!!!!!!

And you know what's even better? I bet there will be several things in the coming months which will surpass this - like matching into my residency program and graduation. Fourth year is pretty great...!

Pathology:Day 1, 2, 3

At the medical school I attend, we are limited to the number of weeks we can spend in each discipline of medicine during our fourth year electives. That magic number is 12 weeks...so, since I have spent 2 weeks in oncology, 4 weeks on internal, and I will spend another 4 weeks in oncology, I've been limited on what I can do. This is such a shame, because internal medicine covers a huge variety of subspecialties which I wanted to become more familiar with prior to residency - like MICU service, cardiology, nephrology, pulm, rheumatology, and oncology. But instead, I will get to see more areas of medicine before my life becomes solely internal medicine - which is nice, in a way, to give more of a well-rounded education. It's not so nice to have to find something that will spark your interest enough to make the time and effort worthwhile.

This brings me to how I ended up on a pathology rotation. Bearing in mind my ultimate desire lies in medical oncology, I decided to do an elective on a rotation which will be helpful in my future career. Pathology is definitely a specialty which I will use! So, what the heck, I signed up and here I am.

First day was spent completing an autopsy. I almost forgot how much I hated dead bodies, being that my time with my cadaver, "Hans", was three years ago. It's just so...morbid. Not my thing. And then to cut and search for a cause of death - not exactly my idea of fun. The smell, the flies and gnats flying about, the bone saw, the knives - it is just so not for me. I did get to cut through the bronchioles and breadloaf-slice a lung, so that was actually kind of cool. As for a cause of death? Still pending...

Second day began by investigating brain specimen (dissecting brains at 8am, what a way to start the day). The rest of the morning was spent in the Immunology Lab. It was really cool to see how the tests are run and what different things look like under the microscope (so that's what speckled ANA looks like!). It's also nice to see such knowledgeable staff and lab technicians who are seriously passionate about their job. It takes a team to care for a patient, that's for sure. Then I looked at a bunch of slides of uterus and cervix and ovary as well as a few skin biopsies and GI biopsies. Its very rewarding to see the diagnosis on a cellular level and to correlate it with the patient's clinical history. In the future, I think I will be more inclined to visit with the pathologists regarding particular cases when I have questions or think its an interesting case.

Today, I attended a few lectures, watched the phlebotomists draw blood from a bunch of patients (I volunteered to take a few, but was pretty quickly denied - disappointing, because I enjoy doing it and I'd like to continue to improve my technique and experience). Then I peered under the microscope for a few hours, looking at some skin biopsies and GI histology among others.

I'm enjoying this experience, but I do hope that the number of autopsies are kept to a minimum! yuck.

AI in IM: Days 10-20

I finished with my AI in Internal Medicine today. I am now completely confident in my decision to pursue a residency in internal medicine. I have had the best time I have ever had on the wards in these past four weeks. There was a lot of teaching, there was a great amount of teamwork, it was a low stress environment, I had really great residents and attendings, I saw a variety of diseases, and best of all I was actually making a real difference in patient care.

My residency application is finally submitted. It's almost an unbelievable amount of work, time, and effort that is put into this thing. From compiling the documents, signing papers, asking for and receiving letters of recommendation, putting together a confident yet humble and honest personal statement, and then determining which programs to send the application to...it is a lot of work. And, not surprisingly, actually a lot of money. Each application you send costs money, plus to release your score reports and pay for the national match program...it adds up fast. There goes another $500+ on education-related fees. And I haven't even purchased a flight or paid for a hotel yet. Geesh!

Mike took his GAMSAT today (GAMSAT = UK's version of the USA's MCAT - medical college admissions test). Fingers crossed for a good score - although we probably won't find out for several weeks (typically sometime in November). I'm praying that I'll actually have my Step2CK score before that time (yes, it has been more than 6 weeks since I took the exam...). Oh and also the GAMSAT is only given once per year, and only distributed in the UK - so Mike hopped on a flight to England on Monday and won't be back for a few weeks. Despite the fact that he's away, I am still ridiculously busy with the rest of my medical school responsibilities. I am still loving what I do - I am so incredibly lucky to be able to live my dream. I am reminded of this every day that I spend with my patients; this is truly a humbling and rewarding profession. 

AI in IM: Days 6,7,8,9

Just a quick one to keep things current...

• This service is definitely keeping me busy.
• I'm having a hard time finding the time to complete my residency application, which is due on September 15. I feel like I don't know what I'm doing and I'm scared I'll mess up one of the documents or something. It's hard to finish something that you know to be so extremely important...
• I am pretty nervous about officially selecting my specialty...particularly due to the fact that I really don't enjoy what general internists or hospitalists do. Is this the right choice for me? Am I making a mistake? Will I be stuck in IM or will I be able to snag a fellowship after residency? Will I survive 3 years of generalist training and still enjoy my life? This choice is so important, I can't afford to change my mind after September 15th.
• I'm still waiting for my results from my Step2CK. Honestly, I took this exam early in the year so that I would have a better idea of how competitive my application is - I can't determine this if I don't get my score back before applications are sent out on the 15th. I'm more than slightly annoyed...
• Mike's big exam is in two weeks, so he's actually stressing out (I have never seen him stress out before). I have a new found love for him because he's been able to put up with my three years of sporadic freak outs. It's not easy!!!
• I still need to set up a few clerkships in the UK for January/February. I seriously need to get this done...after my residency application is completed.

I'm going to go ahead and stop typing before I freak out about the millions of things I have to do and instead I'm going to go ahead and start to complete a few things!

aaaaaaaaaaaaaaaaaaaaahhh I thought fourth year was meant to be fun!?

Internal Medicine - Acting Internship: Days 1,2,3,4,5

On Monday, I began my Acting Internship in General Internal Medicine. It's going pretty much as I expected - a lot of hours, a lot of reading, a lot of learning, a lot of patient problems. So far, my most interesting cases include:

A 62y/o male with a history of IVDA and Alcoholism presents to the ED with RUQ abdominal pain and distension for the past several weeks. On physical examination, he was found to have scleral icterus, tenderness to palpation in the right upper quadrant, abdominal distension, and bilateral 2+ pitting edema in the lower extremities. After some laboratory work up, it was discovered that the patient was slightly anemic, with thrombocytopenia, elevated LFTs, and prolonged PT/INR. A CT of the abdomen with contrast was completed, which revealed a mass in the liver. Evaluation of the mass is currently pending, as are some important labs related to these findings (namely alpha-fetoprotein). So, what are we anticipating this mass to be? There are a few possibilities: benign etiologies may include hemangioma, cysts, hepatic adenoma, focal nodular hyperplasia, and abscess; malignant etiologies may include metastases (typically they appear in several focal areas with nodular margins) and hepatocellular carcinoma. Given the history of alcohol abuse, I am leaning towards the dx of HCC, but we will need a biopsy to confirm such findings before one can say for sure.

A 42y/o male with recurrent clostridium difficile presents to the ED with complaints of bouts of diarrhea occurring every 15-20minutes. C.diff is a bacteria which may reside in a spore form in the intestines; if normal, healthy gut flora are wiped out after the use of antibiotics. Other risk factors which can predispose you to overgrowth of C.Diff include: recent use of antibiotics (especially clindamycin, fluoroquinolones, penicillins, and cephalosporins), hospitalization, age over 65, severe illness, immunosuppression (steroid use, chemotherapeutics), inflammatory bowel disease (like Crohn's or Ulcerative Colitis), use of proton-pump inhibitors, gastric surgery, gastric bypass, recent major surgery. So, how do we treat C.Diff? This seems like a straight-forward answer any medical student can answer when the attending pimps them. We learn Metronidazole, if it persists give another round of Metronidazole, if it still persists give PO Vancomycin. But sometimes C.Diff persists even after this extensive treatment (especially as antibiotic-resistance increases). What do we do then? Well, we can give other antibiotics, such as Fidamoxicin or Rifaximin (there are many other options available to try if it persists after those treatments). So if we've exhausted our medical therapy without finding that the infection subsides, we have the option of fecal transplant. In order for this therapy to be effective, it is best to obtain stool from a relative or spouse, screen the stool for certain bacteria/viruses/parasites (like shigella, salmonella, campylobacter, etc), then emulsify the stool into a more liquid form, and to deliver it into the patient's GI tract via enema or via an NG tube into the duodenum. Kind of disgusting, but I would imagine a person would be desperate for a definitive treatment after months of constant, profuse, watery diarrhea.

Busy week! And I'm enjoying my time on the wards!

Inpatient Hem/Onc

I honestly don't know where the time went, but my two weeks on inpatient hematology & oncology are up. It has been a really great experience; I just wish it would have been a four week rotation rather than two!

One subject which kept coming up while on inpatient is sickle cell crisis. About half of our inpatients are people with sickle cell disease who need to be in the hospital for pain management during an acute sickle cell crisis. It is horrible to see people in such overt pain. We do our best to manage the pain with all of our best pain medications, we push IV fluids in an attempt to minimize the sickling, we give oxygen, we give transfusions...but it is still difficult to see people in such agony. It's really such a horrible disease; I am more affirmed in my opinion of the importance of genetic screening for diseases, such as sickle cell trait, prior to a couple choosing to procreate. A lifelong battle against pain just seems so difficult, when it can possibly be prevented by proper screening of potential carriers and providing useful education.

I did see a couple of really interesting cases, which I am thrilled to have been a part of the management team in these instances. I'm working on a couple of case reports at the minute, and who knows? maybe I'll be able to publish one.

For now, it's back to putting together my residency application before I begin my next clerkship tomorrow - I'll be on internal medicine for four weeks! :)

Home

Since it has been nearly two months since I have been home, I decided to finish editing a few photos I took when I was last at home.


My sister received a cute little cockapoo for her birthday in May, and he is just about the most adorable little pup ever! Our dog, Marley, loves to play with little Wrigley, and they are so much fun to watch.

My niece, Katelyn:

On the farm:

Hematology & Oncology

I have really enjoyed the last four days I've spent in the hospital. 

My patients are really interesting. We've actually been quite busy, and we've had some fairly uncommon complications in the past few days. I'm learning so much, every day. 

I love working on this service. I would love to do this for the rest of my life!

Today, I overheard one of my female patients refer to me as "Dr. Barbie"; I'm going to go ahead and take that as a compliment (please just disregard the "Dumb Blonde" jokes that have just popped up in your head). 

I'm working really hard, and I am treating the patient's as if they were my own responsibility. So I'm constantly checking up on them, refreshing their current laboratory work waiting for "pending results" to switch to "available results". I get to actually talk with the patients without feeling pulled in a million different directions. I love it. 

Medical Monday: Link-Up!

Today, I will be linking up with a few of my favorite bloggers over at Your Doctor's Wife and From A Doctor's Wife.

As a fourth year medical student, it may be easy to forget what exactly drew you to medicine in the first place. As I fill in my paperwork/CV/Personal Statements/Requests for Letters of Rec/etc etc etc for my residency applications, I am finding myself trying to make some sense of how I have evolved into who I am today from the girl I was when I entered Medical School three long years ago.

I was drawn to medicine in a fashion likely similar to most people: I have an innate, deep desire to help people. Generic, I know, but I have come across a few medical professionals who I sincerely question this seemingly ordinary characteristic's validity. I discovered this need to help others while a nursing aide at an extended care facility. Helping others with such seemingly mundane tasks - such as eating dinner, combing hair, brushing teeth - fulfilled a part of me that I didn't realize was previously empty. Hearing the stories from times past, joking around to put a smile on another's face, learning invaluable life lessons from those with long-term perspective - I absolutely loved it. So I decided to enter into medical school, knowing that there could be nothing else in the world that would make me as happy as serving others as a physician.

During the second week of my first year as a medical student (a few days after my very first exam), my mom called to tell me that my cousin had been diagnosed with Stage IV Colon Cancer. This disease has a long history in my family, having claimed the young lives of my grandmother and aunt. As a medical student, having a small grasp of what that diagnosis truly means, I feared the grave reality of the unfortunate diagnosis. As I continued life as a medical student, my cousin's diagnosis never strayed far from my mind, and I had an inclination that I would someday pursue work in the world of oncology. Cancer has impacted my personal life, and I have always found it frighteningly fascinating. In fact, my 8th grade science-fair project involving the effects of beta carotene on the growth of cancer had foreshadowed the inevitable development of my career. I have taken courses such as molecular genetics and cancer biology in an attempt to better understand the intricate disaster of life gone awry, of the morphology of the deranged cellular replication cycle which causes uncontrollable and insatiable growth of particular cell lineages which we lump into the broadly encompassing term of "cancer".

As chance would have it, my second rotation of third year was surgical oncology. This was when I discovered that the inclination of my desire to work in the world of oncology became an obviously clear choice of work for me. I knew that I was drawn to the mechanisms of cancer, of the complexities of such derangement in normal human function, but it wasn't until this clerkship that I discovered that I also really and truly love the patients. I'm not sure if it's because of my personal connections with cancer, my sincere interest in cancer, or if it is because the patients are strikingly different to those cared for in other services, all I know is that I enjoy the opportunity to participate in their care, to somehow assist them in their battle against cancer.

The final portion of my progression during medical school will finish in June of 2013. Undoubtedly, I will continue to grow through this year of training, and solidify the decision to pursue a career in medical oncology.

Final Thoughts: Third Year of Medical School

Third Year of medical school is now well and truly finished. For those who might be interested in what one's schedule may look like during the most rigorous year of medical school, I've compiled a few statistics from my third year:

• 50 of 52 weeks were spent working in various clerkships, including the mandatory Surgery, Pediatrics, OB/GYN, Internal Medicine, Neurology, Psychiatry, and Family Medicine as well as my chosen elective of Radiation Oncology.
• Throughout the year, I averaged working 48.4hours per week (this is a bit lower than I expected!). The most time-consuming clerkship was surgery (about 70hours/week); the least time-consuming clerkship was psychiatry (33hours/week).
• I enjoyed one week free from clinical duties during Christmas/New Year season, as well as a week off during my elective rotation (which I didn't actually take, as I worked several days that week because - what can I say? - I love it).
• Throughout the year, I had 69 out of 351 days off (1.37 days off per week, including holidays and weekends).

What I LOVED about Third Year:

• You gain invaluable knowledge through experiences with patients. It's one thing to understand a concept and apply it to a written examination, but it is quite another thing to apply that knowledge to real-life, clinical situations. 
• The amount of understanding which comes during third year is nothing short of amazing. You learn so much so quickly.
• You get to see patients. Every day. 
• Often, you are one of the first people in the team of doctors to interview the patient for your service. That allows you the freedom to learn the best approaches, appropriate questions, and useful clinical examination skills while still maintaining the patient's well being as a first priority. It also allows you to think through the clinical scenario and suggest subsequent tests to order and medications to prescribe. 
• Your responsibility is to learn as much as you possibly can. You can make mistakes, suggest ridiculous plans that are quickly rejected, and give a differential that is totally off-the-wall - and all of that is okay. You're here to learn, learn, learn.
• You aren't stuck behind a stack of books for the entire year - you actually get to interact with real people! That in itself makes third year pretty great! ;)

What I DIDN'T love about Third Year:

• The whole life:work balance is a difficult thing to master. I reckon it might take a lifetime before one could properly achieve the perfect balance. At times, it is hard to realize all that you're missing out on in your life outside of work - but most of the time, the work is so fulfilling and rewarding that the work is worth the sacrifices. On a very important side note, it is absolutely imperative that those you love understand how demanding life can be for a physician. The life:work balance will always be a significant struggle for the family of a physician. (I am so incredibly lucky to have such an unbelievably supportive, loving, and understanding fiance and family, and I wouldn't be here without all that they continually do for me).
• There are definitely moments when will be overwhelmed by the amount of things you don't yet know, or haven't quite mastered. That's the beauty of medicine - it is always evolving, and you have to do your best to keep up. 
• Studying for a shelf exam is not something I loved doing when I had patients that I want to help care for to the best of my ability. Fourth year is full of taking care of patients without the worry of an impending examination!

Before my first day of medical school, a recently-graduated doctor passed on her perspective of the four years spent in medical school, and it has really stuck with me as I have progressed through the course work. "I can't say that it's going to be easy, or that you're always going to love what you're doing, but I can tell you this: each year is better than the last."

And with that: BRING ON FOURTH YEAR!!!!!!!!!! :)

Step 2 CK - Check!

Well, everyone: it's over!!!!!!!!!

What a long day!

Nine hours of difficult examination is surely a form of torture in some places of the world; it was borderline unbearable! My ADHD self had one difficult time sitting and staring and concentrating and interpreting and determining and narrowing down and selecting an answer for each question! 356 questions? Or something like that? I don't even know. It all just has already been kind of wiped from my memory...

I feel like I should sit and really contemplate what it means to have just finished this exam. I know it's a huge deal, and it's the last difficult thing that stood between me and my MD. It's hard to even fathom how much a person can grow, how much someone can learn, how anyone can change in so many (hopefully) positive ways in such a short amount of time. I still can't believe how far I have come on my journey to living the life of my dreams.


Life is good.

And I am blessed enough to have an amazing man by my side, through it all.

Oh, and PS: Not a single question on Lynch Syndrome (is that too much to ask?!haha); however, there were a few that kinda/sorta linked to Lynch in a round-about way, which was ok. I made a point to thank my cousin/aunt/grandmother/great aunt a few times throughout the exam for their unbeknownst but significant contributions they have had on my education.

Right. Now I'm off to do a few things I've been neglecting for the past 5 weeks! That's right, I'm not going out celebrating tonight - I will instead be cleaning/cooking/laundry all night (with a glass of wine in hand, of course!). Tomorrow is all about taking it easy.


Enjoy your weekend, friends! Thank you for all of your unending love & unwavering support. :)

48 Hours from Freedom

Okay, things are getting serious.

In less than 48 hours, I will have completed my final written exam of my medical school career. Crazy, right? It feels like just yesterday I was sitting in the lecture hall, nervous and excited and scared out of my skin taking my very first exam of my medical school career. Here I am today, two days from the final major exam of my medical school education. I still cannot believe how far I have come on this journey to becoming something better than I ever dreamed imaginable - I will become a doctor.

Seriously. How cool is it that I will be directly involved in saving lives? This is the best job in the entire world. I cannot WAIT to continue on this amazing journey, pursuing my wildest dreams and truly changing the world.

I'm kind of freaking out; after taking hundreds of practice exams, I looked into what my predicted Step2 score is - and it's out of the ballpark. Seriously, I could never in a million years actually perform that well. According to the predictors, the score could be 297 (+/-11). I refuse to believe that I could actually do so well. But maybe this is a sign that I should have a bit more confidence - I will do just fine. I'm not expecting a 297, that's for sure!

Anyway, it's not like I'm trying to get into Derm or Ortho or something at Johns Hopkins! Geesh! ;) I just aim to do my best; its the best I can hope for - and I won't complain, no matter the outcome, because I will have truly done.my.very.best on this exam.

After 5 weeks of 10-12 hours/day of studying, everything starts to look a little fuzzy!