Anything.is.

I think there is something wrong with me. I had this thought at work today, “I can’t wait to get home and study for the mcat, it’s going to be great.”

This is serious. I should be studied.I don’t really know why this is. I was never particularly ever got excited to study anything in undergrad, except for my human sexuality class I took sophomore year, (for obvious reasons). But this excitement most likely stems from the simple truth that this is literally the first test I will take that will be part of my medical education.

How is this so?

This is how I perceive it. All of the premed classes I took, while important, do not directly test my ability to succeed in medicine. This test, this beast of a test will. While not only testing my scientific knowledge, it will test my stamina, critical thinking, and writing among others. College as a whole tested all that to some extent, but this one test will showcase all these concerted efforts. There’s a reason why this test is used for med school admissions. The trick is to play to those reasons.

These are my game rules.

I treated my premed classes like I was already in med school. This is one of the best strategies I used. While I’m sure I’m not the first to come up with this idea, It’s a great one nonetheless.
Remember when you are trying to learn something start with the basics and work your way toward the more specific. I specifically remember using this technique when I was learning metabolic processes in the body, in my bio days.
Stay on top of assignments. They key to this is making schoolwork one of your top priorities. This was one of my hardest strategies to do. Many times this came at a cost of becoming distant from friends. But I rationalize it this way. The friends who are willing to put up with your mood swings, and incessant talk of school, grades, exams, how stressed you are, etc are the friends you want around once you’re in med school and still talking about school, grades, exams, how stressed you are, etc.
Know your study style and know how to effectively study. This is a tough one too. I used to always judge myself and wish I could be like my friends who coup up at the library as if they were going on a mini camping trip, with their giant nalgenes, packs of granola bars, and other sustenance to last them a nuclear fallout. But I’m not that way, and that’s fine. The key was to figure out what worked for me.
Exercise. It’s cliche, but it’s true. Healthy body, healthy mind.
And probably the easiest one to do is to do something fun, for me it’s usually grabbing a bite to eat or a beer with a friend. Whatever it is make sure it’s something YOU want to do and enjoy. There is no point in spending those couple of hours you have on a Friday night doing something for the sake of obligation.
The mcat is definitely not a game, but there is a strategy and a mindset to have toward it that will give the best score. My brother would liken it to a chess game. But I’d rather say it’s more like Tekken with the violence turned on high, because unlike chess that’s fun.

Thanks to everyone for all the feedback on my tumblr. Your comments keep me going. It’s exciting to know somewhere in the world someone is reading the words I write!

So today at work I came across this story. Names and all that identifying stuff have been changed. 

Oh yeah. I take no credit in the production of this story.

Let us begin.

I had an interesting family interaction last week in the ER. And I can’t stop thinking about it.

Susie is a 12-year-old girl who just started the 7th grade. She recently moved here from a country in Asia, and both Susie and her mother speak very little English. They were in the ER with her older cousin, who spoke some English and seemed to be helping Susie’s mom through this difficult process. (I can only imagine, after all, what it would be like if I had to take my 4-year-old to a hospital in Laos, for example.)

We had already diagnosed Susie with appendicitis based on an outside ultrasound exam. The diagnosis, it would turn out, was the easy part in this case. I knocked on her door, introduced myself through one of our hospital’s excellent interpreters, and started to discuss appendicitis and appendectomies. We would be taking out Susie’s appendix in 90 minutes, the OR charge nurse assured me. 

That’s when things got interesting.

“Dr. Man,” the interpreter interrupted after the family spoke for awhile in their native language. “I need to talk with you outside of the room.”

That’s odd, I thought. 

Outside the patient’s room, the interpreter proceeded to tell me that Susie’s mother and cousin had a special request for the interpreter: they did not want their daughter to know that she was about to have surgery. They told the interpreter that they wanted Susie to think she was just getting an intravenous medication to treat her condition. They asked the interpreter to tell me not to tell Susie the whole truth about her operation. After all, they explained, they were worried that Susie would be scared about the prospects of surgery.

The interpreter diligently relayed this information to me outside of Susie’s room. And she looked just as surprised as I was.

I have to admit, this was a new situation for me. I have been in the middle of a lot of difficult family interactions. I have been yelled at. I have had patients walk out of a room in tears. I have had families threaten to leave the hospital. I even had families start screaming at each other when I informed them of the diagnosis. 

But I have never had this particular request. At least with such an old child. It may be one thing to temporarily withhold the gory details of an operation, or the terrible diagnosis of cancer from a really young child who might become seriously frightened. But 12 years old?! That’s middle school! She’ll be driving a car in less than four years!

Okay. So after reading this I was floored. I work in research and if I have to tell kids younger than Susie, about research they willingly participate in. Then surely this family must understand that 12 year old Susie deserves to know that an invasive operation no matter how routine it is is going to be performed on her body. I mean how disconcerting is it to get drugged, wake up a few hours later, sore and with a random scar on your belly from an IV. 

But I put my own beliefs aside and continued reading.

I had to make a decision quickly. The OR would be calling for this patient soon. And the ER was already asking me to see another consult. Pros and cons flashed through my on-call brain. Should I really withhold this type of information from a pre-teen?

Actually, my answer to this ethical dilemma in the ER ended up being pretty simple. I even based my answer on a real hospital policy. I decided to tell Susie exactly what we were planning to do in the OR. It was her body that would feel the pain post-operatively, and it was her belly that would have the small scars for years to come. Most importantly, it was Susie who would be facing the real risks of the operation, however minor those risks might be. 

I based this reasoning on our hospital policy for clinical research in kids. Our Institutional Review Board (IRB) requires agreement from children ages 7 and older for any clinical research studies in which they participate. The IRB has a full assent document that researchers must present to young children that is written at the 2nd grade level so that everyone should be able to understand it. This process ensures that kids who will be on the front lines of a research study at least have some say in whether they want to participate or not. 

If we require formal assent for 7-year-olds in clinical research trials, why shouldn’t a 12-year-old know that I was about to remove one of her organs? I asked myself. In the end, it was a no-brainer.

I called Susie’s mother and aunt outside of the room to join us. I told them quite firmly that Susie had a right to know what was going to happen here. It was my job as a pediatric surgeon to explain the details of what was happening to Susie, I said in gentle but honest terms. In the end, she is my patient, and she is my priority. She can’t be misled. Imagine if she woke up and figured out that her doctor had lied to her. I didn’t give the family any choice. 

And amazingly enough, the family acquiesced. They nodded their heads in agreement and we went back inside the ER room to talk to Susie. Looking her in the eye, I described her appendix and how it looked on ultrasound. I talked about what the appendix does and why it can get infected. I told her how we were going to remove it that night using a camera and three small incisions. The operation would make her better, I assured her, and would take away her pain. She would even be able to return to school the following week.

And what did Susie say? 

“Okay, Doctor. Thanks.”

Two hours later, the appendix was in the bucket, and Susie was in the recovery room. She would go home the following day and return to school four days later. Another nice case of non-perforated appendicitis: cured. 

You know what I think? I bet Susie was onto her family the entire time. 12-year-olds are tons smarter that we think. Or at least smarter than their parents think. Susie didn’t look surprised in the least when I told her about the appendectomy. Who knows – she probably looked it up on her iPhone when we were outside her room!

A good ending to an interesting medical dilema. But I wonder what would have happened had the family still refused the doctor’s recommendation. Question to consider, I suppose.

After a long hiatus, Here I am. I am going to use this blog an an ispiration to myself and hopefully to others as I forge…my path to med school somehow. This is going to be somewhat of a journal type quality blog. I read so many other blogs, it’s about time I finally commit to my own. Especially if I plan to be a doctor-writer. But more on that later.

Today marks the OFFICIAL DAY 1 that I begin studying for my MCAT in January. I am not sure which test day I will have, but I know for certain that I will sit for the exam that month.

I signed up for a Kaplan course. I took the diagnostic for the first day. Not horrible, but not great. I know I have a lot to work on before test day. But I have had amazing support from my family and friends. Every little bit helps.

So as my first day of official studying, here’s what I’ve done so far:

• I made a schedule of how I will budget my time. I find that if I commit things to writing, not only do I remember them, but I get more accomplished and slack off less.
• Done the HW for my first in person Kaplan, which included science review exam.I did the diagnostic a few days ago.
• Peruse SDN… It’s like my crack. I am constantly on that site.

I have a full time job, (I am VERY lucky) but that limits the amout of studying I can do week days.

Here is what I am thinking my schedule will look like:

MTWTh

• Work: 8:30-5
• Break: 5-7
• Study: 7-11

Fri

• Work: 8:30-5
• Night Off

Sat & Sun

These days I’m going to keep open, as I’m not sure what errands/activities will come up. But I will try and commit to  5 hours each day.

This is going to amount to about 25 hrs/wk. I’m sure I’m not going to always accomplish that every week. It’s a schedule, that I feel is realistic.

And now back to studying. KINEMATICS GOOOOOoooooo!