Imagination...101

I have now acquired the basic tools of an artist: a portfolio, drawing papers, charcoals soft and hard, gum erasers, an artist's journal, and a penchant for brooding. This is all for the new art class I'm taking over at the Boston MFA, a class sponsored by the medical school here with the twin lofty goals of exposing us medical students to "thinking outside of the box" while "giving back to the community" in unexpected ways. The course concludes with temporary installations of our art pieces at a local health clinic, along with a few exhibitions at the school of fine arts. To think, I'm getting free studio art lessons and unprecedented access to the museum's resources and collections. I'm certainly not complaining...too much.

However, being told that I need this course to teach me how to be a creative thinker with the implication that, in general, medical students coming into medical school lack imagination is, quite plainly, insulting. For one, anybody who has applied to medical school will tell you the protracted portions of the application devoted to inquiries about one's life outside of the classroom, beyond the lab work and the 'clinical experience'. I remember interviews with questions about "the difference between morals and ethics" and "the meaning of life..." With questions like these, don't tell me that medical students cannot be creative if we passed through these tests of intangibles. Now that's not to say that our creativity is solely about how to best answer questions in order to get ahead. So many of my premedical friends do things for the sheer joy of it: play an instrument, act, sing, read, travel, write poetry...the list is endless. I, for one, love to paint. Are we really the strict-laced, book-worm, antisocial overachievers who really lack any imaginagination except for how best to fight tooth and nail to get the higher GPA? I don't think so. After all, the selection process was meant precisely to weed out these 'uninspiring' candidates. Doesn't the faculty know that? We did make it here by overcoming criterias that creates ridiculous things like those interview questions above while proving that we are well rounded participants of society. Give us a little credit, will ya?

Depression and Med Student

Apparently, it is a big problem. A recent article in the New England Journal of Medicine reveals some interesting, if not alarming, statistics:

" Medical students are more prone to depression than their nonmedical peers. Researchers recently surveyed first and second years medical students at the University of California, San Francisco (UCSF) and found that about one fourth were depressed..."

" Laurie Raymond, a psychiatrist and the director of the Office of Advising Resources at Harvard Medical School [HMS] in Boston, said that she med individually with 208 medical students--about one quarter of the student body--between July 2003 and July 2005. Thirty-one students (15 percent) presented with self described depression-- 20 of them with transient, "reactive" depressed mood that improved with supportive counseling or therapy and 11 who had a history of major depression..." Some rough breakdown of the data in 322 students who responded to a questionaire and were later classified as either depressed (include all ranges of depression)or not depressed. Disclaimer: these data didn't come with p values or margins of error, so take it with a huge grain of salt:

*More Female than Male were classified as being depressed (18 vs 15%)
*More Hispanic, followed by Asian, White, and then Black were classifed as being depressed.
*More first and second years student were classified as being depressed than 3rd and 4th years
* More Homosexual/bisexual were classifed as being more depressed than heterosexual in their respective groupings
* More students with a history of depression prior to medical school were classified as being depressed than students without a history of depression prior to medical school

Among the hypothethized reasons for why being a medical student increases the risk of depression, the article cites Laurie Raymond saying " students see themselves going into a very narrow tunnel...a lot of the depression we see halfway through the [first] year--it's a reaction to having constricted themsevles down to studying these subjects in a very intense way. It's pretty unidimensional." Apparently as well, " all medical students aren't sleeping," concluded psychiatrist and dean of students at Northwestern U. Feinberg School of Medicine in Chicago, "They are overwhelmed, they are working hard, and they aren't having fun socially....of course they are fatigued."

If you're interested in the article, check it out in the New England Journal of Medicine: Rosenthal, Julie M. Okie, Susan. "White Coat, Mood Indigo--Depression in Medical School." N Engl J Med 353;11. September 15, 2005.

Personally, I'm getting more sleep in Med school than I ever did in college (7-8 hrs daily now, as opposed to 5-6 hrs). I'm having fun socially (albeit with my college friends most of the time, but the med school crowd ain't so bad), and I'm going to start taking a studio/art criticism class at the Boston Museum of Fine Arts tomorrow--something I never found the time to do while at college. Med classes meanwhile, are going extremely well.

Let's hope it stays this way.

True Doctor Stories

These stories are hilarious:

A man comes into the ER and yells, "My wife's going to have her baby in
the cab!" I grabbed my stuff, rushed out to the cab, lifted the lady's
dress, and began to take off her underwear. Suddenly, I noticed that
there were several cabs, and I was in the wrong one.

--Dr. Mark MacDonald, San Antonio, TX

+++++++++++++

At the beginning of my shift, I placed a stethoscope on an elderly and
slightly deaf female patient's anterior chest wall. "Big breaths," I
instructed. "Yes, they used to be," remorsefully replied the patient.

--Dr. Richard Byrnes, Seattle, WA

++++++++++++++++++++

One day I had to be the bearer of bad news when I told a wife that her
husband had died of a massive myocardial infarct. Not more than five
minutes later, I heard her reporting to the rest of the family that he
had died of a "massive internal fart."

--Dr. Susan Steinberg, Manitoba, Canada

++++++++++++++++++++++

I was performing a complete physical, including the visual acuity test.
I placed the patient twenty feet from the chart and began, "Cover your
right eye with your hand." He read the 20/20 line perfectly. Now your
left." Again, a flawless read. Now both," I requested. There was
silence. He couldn't even read the large E on the top line. I turned and
discovered that he had done exactly what I had asked; he was standing
there with both his eyes covered. I was laughing too hard to finish the
exam.

--Dr. Matthew Theodropolous, Worcester, M A

+++++++++++++++++++++++++++

During a patient's two week follow-up appointment with his cardiologist,
he informed me, his doctor, that he was having trouble with one of his
medications. Which one?" I asked. The patch. The nurse told me to put on
a new one every six hours and now I'm running out of places to put it!"
I had him quickly undress and discovered what I hoped I wouldn't see.
Yes, the man had over fifty patches on his body! Now the instructions
include removal of the old patch before applying a new one.

--Dr. Rebecca St. Clair, Norfolk, VA

+++++++++++++++++++++

While acquainting myself with a new elderly patient, I asked, "How long
have you been bed-ridden?" After a look of complete confusion she
answered ...Why, not for about twenty years -- when my husband was
alive."

--Dr. Steven Swanson, Corvallis, OR

+++++++++++++++++++++++++++

I was caring for a woman from Kentucky and asked, So, how's your
breakfast this morning?" It's very good, except for the Kentucky Jelly.
I can't seem to get used to the taste," the patient replied. I then
asked to see the jelly and the woman produced a foil packet labeled "KY
Jelly."

--Dr. Leonard Kransdorf, Detroit, MI

++++++++++++++++++++++++++++

And Finally . . .

A new, young MD doing his residency in OB was quite embarrassed
performing female pelvic exams. To cover his embarrassment he had
unconsciously formed a habit of whistling softly. The middle aged lady
upon whom he was performing this exam suddenly burst out laughing and
further embarrassed him. He looked up from his work and sheepishly said,
"I'm sorry. Was I tickling you?" She replied, "No doctor, but the song
you were whistling was 'I wish I was an Oscar Meyer Wiener."

--won't admit his name

This I believe...

Unbridled patriotism isn't usually my style, but this article by Andrew Sullivan is too good, and too succinctly correct, to be ignored. At any rate, it is much much more astute than anything you read in the news nowadays, from the left or the right.

3 down!

And...a whole lot more tests to go through. But at least right now, no more tests.
They maybe easy, but the stress of taking so many tests consecutively is rather draining. This Saturday, I will take the Hippocratic oath (a modern version of it, anyway) and formally receive my doctor's coat.

Joy.

John Roberts...

He really has no direct influence on my medical education, but my procrastination bouts have led me to discover the wealth of materials/commentaries on this judicial nominee. In the spirit of full disclosure, I will confess that I hold a mild interest in his past due to his nominal connection with my recent past (is that obtuse enough for you?). That said, he is truly a fascinating person to watch, literally and figurtively. Amidst Senator Kennedy's bevy of bloated, loaded words, Roberts holds his own. His tongue is so sharp it's scary. Is he guilty of obfuscation? I don't think so. The questions just have to be much smarter.

I'm back...

I am in the midst of exams, (3 of them, and 2 are midterms) after only 10 days of lectures/classes. The classes cram so much material into every lecture that keeping pace seems to be everyone's issue. Luckily, my biology background is leaving me with free time (gasp!), while my humanities-major classmates are really finding no time for sleep. I quite frankly found the exams to be too easy, or at least, not worthy of me spending so much time studying for them.

Come to think of it, it is rather strange how over half of my medical class comes to medical school without much of a biological/scientific background (this makes for painfully, agonizingly slow tutorial periods where the most basic of questions have to be answered and re-answered). This is not a really a surprise. Medical schools have been on a humanities-loving streak for the past several years. One only needs to look at admissions statistics to see this trend in motion. Sure, humanities/liberal arts major brings to the table many qualities that one would like to see in a competent doctor (communication skills, for one). But lest we forget, medicine is still a science based profession that requires a certain kind of finesse and skill sets. These skills are arguably best honed in science classes that teach critical thinking. (I love my alma mater for teaching me how to solve lab problems AND how to read Kant, even though I was a science concentrator. The school believed in broad exposures to many ways of thinking. I'm not sure that this is true at all schools.) However, when medical schools divide students into the broad distinctions between humanities and science majors, and then proceed to show a slight preference for one over the other, they are making a leap of faith that the humanities students they pick can make up for the deficiencies in their collegic science education while in medical school. After all, medical school is all science all the time, so they'll eventually get it, right?

As far as I can tell, the humanities students are having the hardest time adjusting to the onslaught of scientific material being force-fed to them during these first months. From my perspective, this material is already watered down: details are missing, concepts are barely touched upon, and jargon is tossed around as if everybody in the class know the vocabulary--all in a maddening effort to keep the pace brisk as we jump from one topic to another. There is simply no way that my fellow hummanities-major classmates have the level of understanding that biology majors have gained from years of study. This is truly a shame, because medical science builds upon foundational knowledge of the basic sciences; the deeper one understands the basics, the better one is at understanding the biology of diseases and treatments. In the short run, it means that humanities majors have a pretty rough time studying for all these exams. In the long run...well I don't know.

Of course they will be competent doctors. But competence, like anything else, can be stratified too.

word on the street...

Friend: "So I hear at Cornell Medical School med students aren't allowed to really do anything with patients."

Me: " Really? why?"

Friend: " Well, the patient population where Cornell Med is located is largely white, anglo saxon..."
Me: " you mean waspy?"

Friend:" Yeah, that which translates to: can sue your ass off if anything goes wrong because they are rich and powerful."
Me: " Well here we get to do a lot with patients..."

Friend:" Yeah, the population we serve is poor, and they don't usually sue."
Me: " That sucks---for them. But then I guess we are luckier because of it..."

-BM

Too poor to play...

Medical training costs money--a lot of money. Forget tuition for just a second (approx 40 thousand USD/year), and lets focus on my expenses after one week of entering school:

Books: approx 500 USD
Medical equipment: approx 800 USD
Office supplies: approx 200 USD
(not to mention living costs such as rent (in Boston no less!), food, and other incidentals...)

Things like stethoscope, diagnostic sets, penlights, among others, all are expensive. I understand that we are buying equipment "to lasts a lifetime" but that doesn't take away from the fact that one will inevitably lose, misplace, or have equipment stolen throughout a career (the professors have stated these facts plainly during orientation). When you lose a 200 dollars stethoscope, it will invariably hurt.

Luckily, the loan officers at Sally Mae have helped put a positive spin on the whole situation, positive outlooks such as viewing your debt as a 'money portfolio,' not too dissimilar to my investment banker friends' portfolios that are *actually* filled with cash. Well doesn't that sound nice. I can tend to my debt the way my friends tend to their annual earnings and 401k's. The only real difference, of course, is that they are actually accruing money, while I am spending money that doesn't belong to me and have to be paid back.

With debts like these, it really is hard to expect anybody to go through with so many years of living in destitution deprived of sleep. There is a reason why doctors are paid so high relative to other professions in the US. Quite simply, without such salaries, I can't pay off my loans! At the risk of medical training being reserved exclusively for those who could afford to pay out-of-pocket (but really, if you are that wealthy, why go to med school? why not just donate to charity and save thousands of African children or something?), loans have to be a fact of life here. Given also that medical students are in school for 4 years after completing 4 years of undergraduate work, and must do at least 2-3 years of residency practice ( I'm looking at specialities with an average of 4-5 years of residency training), the high salaries at the end of the long tunnel seem appropriate. Put another way, by the time I am able to practice with a normal doctor's salary and begin to pay off my debt, my friends would have already secured their retirement portfolios (or is damn close to doing so).

If one were to use the economic comparison between money and time, then the high salary for doctors could be said to be the compensation for the loss personal time it took to receive the necessary training. The equation could look like this:

(loss of prime years of youth + sleep deprivation + debt) = (eventually high salary + satisfaction in helping people + job stability+ relative high social status)

From my point of view, if you just want to help people, there are plenty of other professions out there that could use the dedication (like teaching...). 'Satisfaction from work' alone does not always pay the bills, feed the cat, or send kids to school. Medicine is a business, and compensation rates have to be where they are to continue to attract enough people to go through with sacrifices early on. After all, the common saying "medicine tends to eat its young" isn't exactly a welcoming introduction to this career path.

Welcome to Orientation...

So here I am, 21, fresh out of college, fresh into medical school. My kind of path seems, however, not typical here. The average age of incoming students is around 24 at this school. My classmates bring with them not only a love for organic chemistry, but long term relationships, fiancees--even husbands and wives. Dinner conversations drift naturally for everyone into where best to raise a family and what kind of practice would leave the most time for weekends trips with the kids. Of course, there are still others like me, young and bushy-tailed, and perhaps more prevalent would be the eager mid-twenties-career-switch students with one foot in collegic nostalgia-land and one foot already wearied by their stint in the corporate world. But in this infectious environment, it's hard not to get realistic about our futures. I'm feeling 5 years older already.

The first days of medical school here are all fun and games (as much fun as can be had with powerpoint slides and lectures on exposure to Hepatitis B and HIV that is). We try to bond as a class over 3 legged races, red rover games, and waterballoon toss, and so far the attempts seem to be working. Remarkable, though, is when it came time for each of us to try out our white coats, those lily colored cotton lab jackets that drapes over us like clean asceptic gloves (we're told ironically that this is clothing doctors wear to protect ourselves from the germs of the environment around us). By simply trying them on, I think everyone saw the glimmer of possiblity that, until now, seemed so far away: the chance to become real doctors. We are told we will need those coats very soon for our patient interviewing class. I am scared shitless, but I can't wait to start. Patient interview...as in me, 21 yrs old, fresh out of college, talking to patients within weeks of starting medical school.

Med school is no longer an idea. I'm really here.