MINDFUL OF MEDICINE

I think that those of us who've dreamed of being a physician do so for one overarching reason: to help people. The desire to genuinely improve the lives of others often serves as motivation to get through all of the challenges that come along with working towards a career in medicine. I often hear about third year medical students allegedly becoming "jaded" as they go through their clerkships, losing parts of their humanism and ability to empathize as long hours, difficult interactions and the nuances of working become the norm. This is something I heard about almost as soon as I started med school. And, from the sound of it, it seemed inevitable. It also seemed to be met with a dichotomy of opinions: some people saw this potential disillusionment as a badge of accomplishment to be praised along the road to becoming a bonafied physician; while others (myself included) saw it as something worrisome, unreal and (hopefully) avoidable.

 



 



 


 

Thanks for reading!

 

 



 


 


 

From left to right: my sister, my mom, my youngest sister, and me.

I'm officially four months into third year which is totally crazy to me. This is the year we all look forward to as med students, but I often find myself looking back on my first two years with nostalgia. That's not to say MS3 isn't exciting, just that I wish I had enjoyed those first two years a little more. So here are 5 things I wish I knew as an MS1!

1. Don't buy all those books! Starting first year the biggest questions on my mind were "how do I study, and what resources do I need?" I was so accustomed to undergrad where the resources were concrete: lecture slides, notes, and sometimes a course textbook. I rushed to buy textbooks during my first block that I never ended up opening. Don't feel the need to buy every book or resource that's thrown at you. Take the first couple of blocks to understand how you learn best because the amount of knowledge you need to amass and commit to memory is unbelievable so being honest with yourself is a necessary skill. Honestly, I didn't figure out how I learned best until the middle of my second year. It's all about being honest, being flexible and listening to your needs! If I could go back I would take a more minimalist approach in terms of resources and ask for advice from upperclassmen more often.

2. Relax, you have more time than you think. One of the biggest differences between my undergrad experience and the first year of med school was how much time I had. Whereas I was struggling with juggling multiple majors, volunteering, work and my personal life during undergrad, my med school schedule was a lot more simple because the scheduling was done for me. I actually had way more time the first two years of med school than I ever expected. If I could go back I would tell myself to take advantage of that time. Besides studying I would spend more time on myself and less time worrying about not having enough time!

3. Shadowing is important. I think I greatly underestimated the value of shadowing. I was wrong to think I would be "in the way" and wish I would have taken more advantage of the free time I had my first two years to shadow. If I could go back I would tell myself to shadow in every single specialty I find even a little intriguing. I think it would have helped me shape my vision of a career sooner and with more confidence. Plus, shadowing in medical school is so much better than shadowing as an undergrad. Physicians are incredibly receptive to med students shadowing and some will even let you actively participate.

4. Spend more time with ones you love / doing what you love. It was easy to get caught up in the "I need to study 16 hours a day to be a successful med student" mentality when I was surrounded by my competitive classmates. My second semester of MS1 I decided to podcast from home and only attend required lectures and it did wonders for my sanity, lol. I think it's super important as a med student to keep parts of your life separate from medicine, and I have a feeling this will remain true during my career! If I could go back I would tell myself to slow down and take more time for J & Melo, my family, my interests and my inner peace overall.

5. Enjoy it. It is such a privilege to be able to study medicine. I often think of all of the factors that have lead to my ability to pursue my dream and it helps me to put things into perspective. I always try to keep a positive outlook on life and the last two years have been no exception. This is a point I would recommend to anyone, even if you're not going into medicine. If you're doing what you love, why not just enjoy the process and do good along the way?

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Hi everyone!

I've been pretty busy these days since I'm currently on my last few weeks of internal medicine. It honestly feels like I've been on this rotation forever and that's because it's a whopping 12 weeks long! I've learned a lot during medicine and as my knowledge base has grown, so have the contents of my white coat pockets. Now that might sound comical (it is) but it can also be really heavy on the shoulders. So to optimize my pocket contents I've narrowed it down to a few essential things!

 


 


 


 


 



 




          

Happy Friday!

One of my all-time favorite dishes is my mom's green chicken enchiladas, and they've quickly become one of J's favorites too! I don't know what it is about tortillas, chicken, and salsa verde blanketed with cheese but when they come together it's magical. Top the fresh-out-of-the-oven enchiladas with fresh onion and sour cream and you have yourself a bonafide flavor explosion. I also love enchiladas for breakfast with an over-medium egg. I just love enchiladas, can you tell?

Since I find myself craving my mom's enchiladas more often than I'm proud of, I started experimenting with my own salsa verde recipe. My mom doesn't write down any of her recipes so she just gave me some basic instructions and told me to play around with the ingredients. Sounds easy right? Well it wasn't. I'll be honest, the first two..or three times the salsa didn't turn out very good (something J wasn't afraid of pointing out, lol!), but I think I've finally figured it out.

What you'll need:

12 tomatillos (medium-sized) - remember to peel them and wash them well if this is your first time working with them

1 jalapeño or serrano (add more if you want it spicier!)

1 hatch chile

1/2 white onion

2 cloves of garlic

1 bushel of cilantro - chopped

1/4 tablespoon sea salt

A saucepan, an oven & a blender

Directions:

1. Turn the oven to broil and place the hatch chile on a baking sheet. Make sure to turn it every two minutes. Don't let it burn! When it has toasted, pull it out and let it cool.

2. While the hatch chile cools, add tomatillos and jalapeño/serrano peppers to a saucepan and cover with water. Turn the heat on high and wait until the tomatillos turn from their original green to a lighter color. As soon as this happens remove the pan from the heat and drain the water - if you cook the tomatillos too long the skin will burst and you'll end up with a sour salsa.

3. Peel the hatch chile once it has cooled.

4. Add the cooked tomatillos & jalapeño to a blender along with the onion, garlic, cilantro, and salt.

5. Blend the ingredients until the mixture is an even consistency.

6. Serve and enjoy!

All in all, preparing and making the salsa verde takes less than 15 minutes. I use it on enchiladas, for dipping tortilla chips, on eggs, and even as a sauce for chicken breast.

Hi everyone. I'm currently on outpatient medicine (i.e. clinics) and while it's a lot slower than inpatient, I'm enjoying the laid-back hours and much-needed time to study. I've been thinking of doing something fun on the blog for a while now, and I'm happy to announce a book giveaway!

Back in June I got an opportunity to read and review "So You Got into Medical School...Now What? A Guide to Preparing for the Next Four Years," by Dr. Daniel Paull. Being so busy with Step 1 and and the start of clerkships it took me a few weeks to get through, but I found it to be an entertaining and insightful read. As I've gone through these last couple years of med school it's become clear that oftentimes students, including myself, are unaware of what big milestones are coming up and how they all fit into the big picture.

In his book Dr. Paull does a wonderful job of providing this much needed information while including funny, relatable stories of med students in relevant situations. Half the battle of medical school is figuring out what you should be doing next, and this book is a great resource for navigating medical school milestones. Though detailed and insightful, the first and second year-relevant topics were no longer applicable to me. I was lucky to have read the book before starting clerkships since the third and fourth year topics were a great resource for how to tackle the clinical years and applying for residency!

I only wish I had been able to read the book before starting first year - it would have cleared so many things up for me. Med school is a challenging time, but it goes beyond academics. I've often felt like I was just fumbling along trying to keep up with logistical details like planning for board exams, clerkships, letters of recommendations, and most importantly - residency. As a first year some of these things seemed so far away and I assumed they would just fall into place by themselves. That's just not the way things go, and I had to learn the hard way.

I believe that the best tool a new medical student can have is an idea of what to expect. As such, I would like to share what this book has to offer with a few of my followers. Dr. Paull has been gracious enough to provide me with three copies.

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Contest Details

- How to Enter:

1) Subscribe to my blog on the left sidebar with an email address to receive future blog posts via email.

2) Follow me on instagram and repost the giveaway picture posted on my instagram page using the hashtag #mindfulofmed. For an extra entry you may mention a friend in the comments section of the original giveaway picture on my page!

- I will choose (1) winner from new blog subscribers and (2) from instagram.

- The contest is open to US residents only - sorry international friends!

- The contest will run for two weeks. You can enter anytime between August 7th, 2015 - August 20th, 2015.

- I will choose the three winners on August 20th and will contact them shortly afterwards.

Good luck!

Disclosure: I received a complimentary copy of the book from the author.

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For more about the book and the author visit Dr. Paull's website.

Hi guys! A few weeks ago I shared some of my thoughts on the first week of my internal medicine rotation. A lot has happened since then, including finishing my first month.

The first month has been all inpatient medicine, that means it has all been in the hospital. I spent the last two weeks on the inpatient Hematology/Oncology & BMT (blood and marrow transplant) services. I was getting pretty tired during my first two weeks of general inpatient medicine since the schedule was a grueling 6am-6pm (might have been harder since I was fasting) with only one day off each week, but the Heme/Onc and BMT services both featured an amazing 7:30am-5pm schedule with weekends off - gasp! I started with a week of Heme/Onc and then switched with the other med student on the service and finished off with BMT.

HemeOnc. Transitioning from patients with a seemingly endless list of problems on general inpatient medicine to patients whose main problem is their cancer was interesting, and it also made presenting to my attending surprisingly more challenging (in medicine, interns, med students, residents and fellows are all expected to present their patients to their attending during morning rounds). Whereas I was presenting a bunch of problems on general medicine, my Heme/Onc patients have a very specific problem for which they've been admitted to the hospital - this is usually for induction chemotherapy (the first part of their chemotherapy), management for side effects, or other problems that general medicine teams feel more comfortable referring to the Heme/Onc service. In order to understand my patients, let alone present them, I had a lot of learning to do in a short amount of time. This is because Heme/Onc is a vastly research-based field where new treatment regimens can come into practice at any time. Therefore it's crucial to read up on the latest chemotherapy treatments for each patient, as well as other treatments like radiation that may be helpful in their overall management and comfort. Even though the hours were more relaxed, Heme/Onc was really intellectually challenging. More importantly, the patients themselves were also extremely special people. All of the patients on the service were so wonderful to work with - it says a lot about a person when they've been handed a difficult diagnosis yet they stay kind, cooperative and easy-going. This service was also a sad one, however. My most memorable patient of the week is one I probably won't ever forget. The patient was for pain secondary to metastatic esophageal cancer. It felt like a routine admission for pain control; one that would surely be discharged in a day or two. He was so kind even while he was in so much pain. I also got to know his wife, a hopeful woman who loved her husband very much. He quickly deteriorated and what seemed like a small problem on admission spiraled out of control just days later. It was heartbreaking, and I can't even begin to understand what it would feel like to be in the shoes of any family that has experienced something like that.

My week on Heme/Onc was great. Morning rounds were usually done by 11am and the rest of the day was dedicated to orders and management of whatever came up during the day, which generally wasn't much. It was a pretty quiet service. Some days, however, the Fellow and I would venture down to the pathology department where we would discuss certain patients or odd diagnoses with the Heme Path team - that was pretty fun. Overall, I learned that although Heme/Onc is very intellectually stimulating and a scientifically pioneering specialty, it is also very emotionally demanding.

BMT. Getting comfortable with the jargon (there are SO many acronyms in oncology!) and work flow of the Heme/Onc service made my transition to BMT a little easier. The BMT service is dedicated to treatment of "fluid" cancers like leukemia, lymphoma, myeloma, etc. In many ways it is more specialized than Heme/Onc. BMT also involves some pretty cool procedures like BMT harvest, biopsy and transplant. As a med student on clerkships you're pretty much useless after rounds (when you present to your attending) so the rest of the day is usually what you make of it. Since the BMT service had significantly less patients to take care of I got to know them all pretty well. While my Fellow and the PA on our team fielded orders and other nuances, I had the option of either studying or going to see patients. Most days I chose to study (third year is basically working on top of the same study load I had during MS1 & MS2), but other days I would visit patients and just sit to talk with them. They seemed to enjoy the company, and I really enjoyed getting to know them as a person instead of just a patient. Oftentimes it's easy to see a patient as a set of problems, orders and scheduled procedures since that's what keeps you busy, but I feel lucky to be a med student with significantly less responsibilities than the interns/residents/fellows because I can use my time to get to know the patients. It always amazes me how interesting patients are once you're able to chat with them. Unfortunately I know that I won't always have the time to spend with patients like that so I'm taking advantage of it now!

All in all, Heme/Onc and BMT were extremely interesting and I learned a ton. While this wasn't my first exposure to BMT (I volunteered in the pediatric BMT unit in high school), it was my first exposure to Heme/Onc, and my first time seeing adult patients in either field and I enjoyed it more than I thought I would! Also, both the Fellow and the PA on my BMT team complimented by presentation style and said they both wish they could present more like me - which obviously made me feel so cool lol.

Tomorrow I start my month of outpatient clinics. I'll be working in our cancer center, as well as the infectious disease, pulmonary, and endocrinology clinics. It should be more laid-back than inpatient medicine, and I'm excited to be able to study more often for our Internal Medicine Shelf Exam coming up in September which is famously difficult.

Have a great week everyone!

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Two weeks ago I got a second chance, alhamdulillah (thank God). But in order to understand why that’s so important to me, I’d like to share some of my story.

Back in November of 2009 I was 18 and barely settling into my role as a college student. I was performing well in my courses and genuinely enjoying that new stage of my career. Except something wasn’t right. For a few nights I had stayed up coughing until one day I coughed up a handful of blood. My good friend and roommate was very concerned and told me that if I didn’t go to the doctor the next day she was going to call my mom. And so, I scheduled an appointment for later that month.

November 27th was a day I’ll never forget. After reviewing my xrays that showed a large, circular shape, my primary care physician nonchalantly told me it was likely not benign and I should prepare myself for a diagnosis of a tumor. When I asked what to do next, she said I should “probably find a pulmonologist”. I don’t remember anything else from the visit, my memory of it literally stops there. I was confused, scared, skeptical, sad. I had never been sick before and, being someone who likes to plan ahead, not knowing how to proceed was terrifying. I drove home with my mom in silence. I thought about all of the things I wanted to do and might not get to. I thought about my dream of being a doctor and the irony of getting hit with a possible cancer diagnosis. I thought about God. I thought about my family. I prayed.

The next day I was back in my dorm room, frantically calling every pulmonologist in town. They were all booked for the next several months and I felt hopeless, and frustrated. I decided to call one more office. When the receptionist picked up I told her my story and before I even realized, I was crying. Hard. I couldn’t help it. To my relief she said they had an appointment in February and I was so relieved. But it also meant that I had to spend the next two months in a state of absolute uncertainty, not knowing what was wrong with me all while feeling ill, fatigued and coughing up blood every time I tried to lay down or exerted myself.

Those two months were life changing, though. I finally learned what it means when God’s plans truly deviate from our own. Whether you are religious or not, we all must face the fact that there is a force greater than our own; and in order to get through struggles we must submit to it, accept our weakness, and grow. I remember sitting on a bench during final exams that December reading my favorite book of all time (The Shadow of the Wind, by Carlos Ruiz Zafon - check it out). It was sunset and it was quite chilly out. Campus was almost empty and the air was quiet. And so, I sat there. I’ve never felt more peaceful in my entire life. I had accepted that I had no control over what happened next. I was happy, really genuinely happy. I also began to understand the beautifully ephemeral nature of this journey we call life. As a gift to myself I decided I would finally do something I had planned to do for years: I embraced Islam and became a practicing Muslim on Valentine’s Day 2010, just a few days before I saw my pulmonologist. I figured whether I had 1 or 100 years left on this Earth I would worship in the way that best suited me, I would strive to become a better person, and generally work to maintain my inner peace.

At my appointment we reviewed my CT scans and almost immediately my pulmonologist said, “Oh, that’s cocci.” (Coccidioidomycosis, also known as “cocci” or Valley Fever, is a disease caused by the dimorphic fungus coccidioides). At the time I was relieved to hear anything but the word “cancer” come out of his mouth. Little did I know this new diagnosis would send me on a longer journey than I could have ever anticipated. After some confirmatory labs, I started antifungal therapy.

I spent the next two years coughing up blood almost daily while my body deteriorated into someone I didn’t know. I had always been active, playing competitive volleyball year round, running, and swimming. I had prided myself in how strong my body was. And to see myself transition from fitness to someone who couldn’t take 10 quick steps, or lay down without coughing up a bunch of blood was heartbreaking. Nevertheless, I pushed through my first two years of university and did really well. On the surface you wouldn’t know how sick I was. How worried my family was. If you met me you’d think I was an over-achieving, stressed out premed who went to school, worked, volunteered, did research and generally enjoyed life. And all of those things were true, but there was something insidious and inescapable beneath the surface. Most days, I didn’t let my sickness become an inconvenience. That was a good thing, but often it was bad. I didn’t take care of myself the way I should have. I didn’t rest enough. And I paid for it all. Meeting my husband, J,  a year into my diagnosis was a blessing in so many ways. In terms of my health, he really pushed me to rest, eat well and take it easy. Even though we were long-distance he would call to make sure I was going to bed on time, or make sure I was going to Urgent Care when I had a bad flare up. J was the first person I ever listened to in terms of taking care of myself. And even that was hard for me! Afterall I’ve never been one to admit weakness or let anything get in the way of my plans. But getting sick will make you question everything you know about yourself.

J was also the reason I decided to find a new pulmonologist. Dr. P was a genuinely kind person. He was also thoroughly confused as to why my condition hadn’t resolved with two years of antifungals (most cocci cases are self-limiting even without treatment, but I am part of a lucky 5% of cases that get a bit more complicated!). He sympathized with me and was a stark contrast to my primary care physician who had delivered an (incorrect) diagnosis of cancer in a cold, uncaring way. Dr. P was a hero to me, I remember him taking my hand and saying “I’m sorry you’ve been through so much, I’m going to make sure you get better.” He called his friend (an infectious disease specialist) and personally asked him to see me the next day. This was a positive change in my medical management. Together my two new doctors consulted cardiothoracic surgery to have the cavity in my lung removed.

On December 23, 2011 I had a large portion of my right lower lobe removed. The recovery was really tough but I felt infinitely better almost immediately. I remember my dad telling me, while I was still in the hospital, “Wow, you’ve already got your color back” - being hypoxic for two years will do wonders for achieving an off-green complexion!  Four weeks after surgery I was in the gym jogging for the first time in two years. That was also the same time I started studying for my MCAT. Even though I was still on medication and my scars were still healing from surgery, I could see my body returning to some semblance of what it once was before I got sick.

My disease has been a backdrop for the most important events in my life. In the two years that followed my surgery, I continued pushing through school, traveled, studied abroad, got married, and started medical school. Having being diagnosed with cocci when I was 18, I’ve grown into an adult with it by my side. It’s been a constant part of me and shaped my worldview. It has influenced the decisions I’ve made, inspired me, broken me, and challenged me. And, most importantly, it will always be a part of me.

And so, as of two weeks ago, I feel as if I have been given a second chance. I am no longer on my antifungals. Getting off my meds has been something I’ve wanted to do since my surgery, but my labs didn’t suggest that would be safe to do. My labs have been stable for a year and my doctor consulted with other Valley Fever specialists to come to the conclusion that it is worth trying to discontinue them given that I’ve been asymptomatic since my surgery. In reality, any symptoms I had experienced were all side-effects from high doses of my meds. From now on I’ll be getting labs drawn every 6 weeks to make sure it’s still safe.

I cannot explain how important and exciting it is for me to be coming off my meds. Taking my meds twice a day was a constant reminder that something was wrong. And when you do that for nearly six years, it becomes a part of your being. Physically, I’m looking forward to a few things: my hair growing back into it’s thick glory, my skin no longer being super dry, my nails getting strong, my hormone cycle getting back to normal, and giving my liver a much-deserved break. Mentally, I feel very blessed to have survived my worst days and look forward to making the most of my new healthy ones. Most importantly, I’m grateful to have a second chance to maintain my health and take care of my body. I am excited to start a new “healthy” chapter with my husband because he’s only ever known me when I’ve been sick or on medication. He pushes me to be healthy and make good choices, and I owe it to him and myself to live up to that.

Whether we are faced with difficulty or blessed with happiness, I’ve learned that everything is a temporary state and will end at some point. So it is important to recognize the lessons we are supposed to learn and use them as an opportunity to grow. Every chapter is a second chance at something, and I’ve learned to make the most of whichever one I’m in.

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My life has been a series of checklists, each completed in a deliberate and timely manner. Ever since I can remember, my goal was to become a physician. It was a calling and an autonomous way to help those who need care and healing. I also knew that it required hard work, dedication, and planning. In middle school I knew I had to find a high-performing high school to attend. In high school I knew I had to do well to get scholarships to afford university. Starting university was one of the biggest chapters of my life, as I'm sure it is for many. I picked my majors, I performed to the best of my abilities, and I was really proud of my performance overall. My years in university are also where I discovered who I was, and envisioned the person I ultimately want to become. I've never allowed myself to take things slow - I've been on a path where things need to get done so that a bigger, better thing can happen. Thankfully, this approached has worked for me so far. I've completed the checklists needed to get me into medical school, so now as second year comes to a close I think to myself, "now what?"

You don't get to medical school, or other professional / graduate programs without being at least a little competitive. Whether it's an outward competitiveness or competing silently with your self, that competitive nature lies somewhere and its influence is undeniable. It pushes you to do better than before, and be better than you think you're capable of. But to get you to push yourself and grow there must be a drive beyond self-fulfillment, and that drive is uncertainty. The future is always uncertain to some degree, and this is what pushes us, at least me, to work harder to at least attempt to secure the future I want. Up until this point in my academic career, worth has been determined by test scores and grades. It's something I'm comfortable with. In two months, however, I take the most important test of my life - USMLE Step 1. An exam of this caliber is something that I'm not familiar with. The implications of my score go beyond a few numbers on a page - it can determine what specialties of medicine I can comfortably apply to. Though there are students who manage to match into competitive specialties with low Step 1 scores, they are the exception and definitely not the rule. Residency applications are all about numbers, this is something our attendings, student development staff, and mentors remind us of often. It is unfortunate that the individual applicant isn't evaluated holistically, but it's a numbers game and there's only one way to play.

The start of medical school is a clean slate where every student has the potential of pursuing whatever specialty they wish. Some of my classmates came into med school knowing exactly what specialty they wanted to pursue, and for many of them their initial interests still hold true. I, however, have a few interests but I'm not certain about any of them. And it is this uncertainty that pushes me into unfamiliar territory, and isn't comfortable. Nevertheless I know I have to do my absolute best on the boards to give myself the best chance. My biggest worry right now is falling in love with a specialty that my score isn't "worthy" of. And therein lies a whole other realm of what it means to feel "good enough," but that's a whole other topic perhaps for another day.

I know that the best approach to the boards is to do my best and not make any excuses. There's no use in worrying now since my efforts should be focused on these last two months of studying. In the end, there's never regret in knowing that you did your best.

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