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!

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 Though detailed and insightful, the first and second year-relevant topics were no longer applicable to me.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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Hi everyone!

I'm currently busy doing a week of "transitions" to third year and will start my internal medicine clerkship on Monday! I'm nervous but mostly excited to not be in lectures any more and to actually get out of my comfort zone and learn some real, hands-on doctoring. I'm still mentally recovering from Step 1 and I hope I'm ready to begin studying for the medicine shelf / Step 2 next week. Although I have yet to receive my score for Step 1, I've been trying to figure out what worked for me and what didn't. And in the midst of this thought process I keep coming back to my study approach for the MCAT. So I wanted to share a few things I would have done differently.

1. Find the right resources.

Being a first-generation college student can be really challenging in all kinds of ways, and preparing for the MCAT was no different. Often times there are resources that go undiscovered simply because we don't know where to look or that there even are resources available. In retrospect, I didn't talk to enough people who had taken the MCAT before me for advice and I wish I had. Your peers are great resources, use them! But don't get stressed out when someone else's approach is a lot different from your own, just use their advice and modify it to what works best for you.

I didn't take a course prep course. At the time, I couldn't afford it and resented it. But after getting feedback about it from a few of my friends I'm glad I didn't take it because it really sounded like a waste of time and money. Granted, if you're the type of learner that needs to be guided through different subjects then it might work for you. But if you're a more self-guided learner then I wouldn't recommend it, but that's just my two cents.

In order to ensure you're getting the right resources make sure to ask around because people who have been through it will give you some great insight. Also Tumblr and Reddit have great MCAT and premed sections - but be careful, these forums can be a little neurotic so try to not stress yourself out unnecessarily. Do your research, decide what works for you, and stick with it.

2. Be organized.

Looking back at my schedule for dedicated Step 1 study I wished I had done the same for my MCAT. Even though you don't get dedicated time off to study (unless you take a summer to study or another break), I think I could have easily incorporated some structure into my undergrad schedule. I would recommend laying out a schedule of classes, work, volunteering, etc and adding dedicated study hours to it. You will be able to track your progress and it will also be satisfying to see how much you've accomplished.

2. Start early. 

I took my MCAT in April 2012 and started studying that January. I started early, but I was also very passive with my learning which had its consequences. At the time I didn't know what practice question resources were available or how helpful they would be. I wish I had done more questions and been more of an active learner overall. After studying for Step 1 I learned the value of practice questions and saw how most of the material I've retained came directly from these questions. They're also a great way to gauge how well you're progressing and if you're ready to take the exam. Starting early can give you ample time learn a lot of material, but also redirect your studies if you find something that is or isn't working.

3. Be honest.

One of the biggest mistakes I always made when studying in undergrad was not being honest with myself about knowing a concept. I think it's really easy to assume you'll just remember something and move on. When in reality you won't remember and you'll wish you had spent a little extra time on that concept. So be honest with yourself! If a concept is hard, it's tempting to skim it and never come back to it. I can't tell you how many times in undergrad I thought to myself "Wow, that's a little confusing, it can't be on the test" - and it was ALWAYS on the test! So I fixed my approach for med school and it carried me through Step 1. By forcing yourself to be honest with what you truly do not know and committing yourself to taking a little extra time to learn something you set yourself up for success. In the end the only person you're cheating is yourself, so it's definitely worth it to be honest and power through.

4. Be confident. 

Going into Step 1 I was confident. I was confident that I knew all I could know in the amount of time I had to know it in. It was a reassuring feeling. And I consciously reminded myself to be confident during the test. I don't remember feeling confident about the MCAT. At all. Whether it's a practice test at home or the real thing, confidence is a huge factor in performance, at least for me. So be confident, because you always know more than you think you do!

 

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Hello! As of 36 hours ago I am officially finished with the USMLE Step 1! I can't explain how good it feels to not have to wake up at 6 am and study for 13-14 hours every single day. Oh yeah, and I also don't have to freak out about the most important exam of my life anymore since it's over and done with. Granted, the stress dreams haven't stopped but I'm hoping that they go away with time, lol.

The last six weeks were the most mentally exhausting of my entire life. Beyond the actual difficulty of the material there are many other elements that contribute to the challenge of studying for step 1. For example, J and I would barely have 30-40 minutes every night to recap his day and just enjoy each other's company before we had to sleep. He was so wonderful throughout this whole study period, though. He cooked every night and generally kept me sane, I seriously don't know how I could've held it together without him! I honestly don't know how students with children do it, they're the real Step 1 champs. I also felt very isolated. Not only from J, but from my family and friends. I definitely learned the true value of having a good mental and spiritual foundation before diving into such an difficult time. I learned a lot about myself and even surprised myself by being able to push through when I thought I couldn't. I'm also very glad that I put some effort into eating healthy and exercising a lot during my study period. I don't think I would have been able to stay as calm and levelheaded throughout if I hadn't taken care of my body.

Though I'm still in the process of figuring out what worked and what I would have done differently I will say this: you know more than you think. Whenever I found myself doubting my abilities or losing my confidence I would remind myself that I knew more than I thought I did. Whether it's Step 1 or your typical block exam, the key to doing your personal best is to be confident, and even a bit "cocky." I can't tell you how many times I took a practice test and had a feeling that a certain answer choice was right even though I couldn't exactly remember why, and it ended up being correct. The mind is a powerful, mysterious thing. And when you have to know as much as you need to for Step 1 you really have to listen to your brain when it's telling you something even if you can't rationalize it!

I have exactly 1 week until I start third year (crazy!), so J and I are taking a trip to San Diego to relax and hangout because I feel like I haven't really seen him this whole time. I'm excited for what this year will bring, and even more excited to be in the hospital and clinics doing some real hands-on learning. Ramadan also starts next week - I can't wait! I'm hoping it will be another Ramadan of spiritual growth and helping those in need. This is a whole new chapter in my life and I'm just excited to live it to the fullest.

Life is good. God is good. Alhamdulillah (thank God).

Here's a picture of my Step 1 study material on the left and notes from MS1 and MS2 on the right (minus the approximately 30k Firecracker flashcards I used and my iPad).

 

Good morning!

I'm on my morning walk with Melo before I start another 13-hour study day. During this busy time of board studying I won't be posting much, if anything, here on the blog but I will check and update Instagram. I'll be back to posting on June 12th inshaAllah (God-willing), which is also the day  the new season of Orange is the New Black drops - so basically, it'll be a big day for me lol!

Thanks for reading! Enjoy the first half of summer 

 I was reading a profile on a neonatologist that included the quote above and it resonated with me. I’ve often been told that I’m “too nice.” I’m certainly someone who doesn’t like to offend, or impose on anyone and will do my best not to do so. But that can also hold me back in that it keeps me from being what others perceive as assertive. And the more I think about it, the more I realize I have to be proactive. My kindness and easy-going nature is not an “issue” that must be dealt with, but as a woman in medicine it is certainly something I need to acknowledge. There is often a double standard for women in general: risk being labeled bossy (or worse) by being assertive, or passive by being a normal person.

As I approach third year and the rest of my life in clinical medicine, I am committed to being more assertive while remaining kind and compassionate. Physicians are entrusted with patients’ health and lives. It requires a great deal of strength, force, and confidence to act in your patient's’ best interest no matter what. That means fighting for your patients while also listening, and empathizing with them. It’s all about striking a balance.

At my core I am a kind person. I am also a strong person. I can do extraordinary things. There are many interpretations of what being bold with your kindness can mean, but to me it means being bold with who I am and using it to elevate my goals, not hold them back.

So, whatever you are, be that. And do it boldly!

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Hi everyone! I wanted to write at least one more blog post before taking my step 1 - study hiatus from the blog.

Anyone who knows me would tell you that I’m obsessed with skincare. Seriously, I love skin. I’m not much of a makeup person but that’s because I feel that the best makeup is actually just great skincare. My love affair with all things skin-related started while working as a clinical assistant in a dermatology practice during my last year of college. I had always taken care of my skin, but working there took my commitment and knowledge of skincare to a whole new level. It taught me a lot about mainstream “beauty” products and the false hope they give consumers. I also learned a great deal about a holistic-approach to beautiful skin - that means what you put in your body is just as, if not more, important than what we put on our skin!

It’s now Spring and that means more sun exposure and hotter temperatures in the months to come. That also means that the protection and nourishment we give our skin should be amped up accordingly. Naturally, avoiding unnecessary sun exposure is key to preventing DNA damage to our skin cells and photoaging. So that should be a top priority regardless of the season! I'm always thinking of new ways to improve my skincare regimen, and I've narrowed down my summer essentials to these 4-must haves.

Protect + Prevent. The best treatment is prevention. The environment can be quite harsh on your skin. And though resilient, skin is sensitive and needs to be cared for just as you would any other organ system - its the largest organ system, afterall! Damage to your skin can lead to obvious things like sunburns and aging, but also more insidious diseases like skin cancer. Basal cell carcinoma of the skin is the most common cancer in the world. The skin can also be affected by squamous cell carcinoma, and melanoma. The common factor behind all of these conditions is UV radiation from the sun.

Sunscreen. Make sunscreen your best friend and apply it to your entire face and neck every morning - even if you think you’ll be inside all day or if it’s cloudy out. Your skin will thank you now and in 20 years when you look younger than your peers. And if your activities require longer than minimal sun exposure make sure to re-apply accordingly! I make sure to apply sunscreen to my face, neck, upper chest and hands every morning. I’ve been using EltaMD UV Daily SPF 40 for the past three years and I love it. It’s light, moisturizing, and invisible under makeup or with a fresh face. It provides a physical UV block with Zinc Oxide, as well as a chemical block with Octinoxate. Whenever possible, try to find a sunscreen with a physical block, as chemical blocks can be irritating and unstable when exposed to UV. It is best to wear a sunscreen that is at least 30 SPF or higher to block both UVA & UVB rays.

C E Ferulic is an antioxidant combination that gives you an extra level of protection from photodamage by neutralizing free radicals. It also increases the firmness of your skin and erases hyperpigmentation (dark spots) over time. The really great thing about C E Ferulic is that it absorbs into your skin and remains effective for at least 72 hours. I try to incorporate this topical into my daily regimen as often as possible, but it is an absolute necessity in the summer months. The SkinCeuticals brand is super expensive, however. So I use a dupe by Skin Care Solutions which has the same formula and gives the same results.

Moisturize. No matter what your skin type, moisturizing is essential to maintain the integrity, firmness and health of your skin. Moisturizers increase the skin’s hydration by preventing evaporation. I discovered LUSH’s moisturizers last year and I couldn’t be happier. I’ve always had issues with moisturizers that sting or fail to soothe my face, and the list of ingredients on most products is overwhelmingly complex. My favorite LUSH moisturizer is Celestial. Vanilla water, almond milk, and dove orchid extract come together to keep your skin soft, soothed and glowing. LUSH is also a cruelty-free, vegan and fights animal testing - what’s not to love?

Correct. I get a lot of questions about skin from classmates and friends and the one thing I can’t stress enough is the importance of a retinoid. If nothing else, everyone should use a sunscreen and a retinoid. Topical retinoids pass through the cell membrane and mediate their effects by switching on genes that increase collagen production, increase vascularity and blood flow in the dermis (the deeper part of skin), and enhance the shedding of skin cells with excess melanin (fighting hyperpigmentation). The addition of a retinoid to your skincare regimen will correct past damage and make your skin more resilient to new insults. Ideally, people should start an anti-aging regimen at the age of 21, but it is never too early or too late to start protecting your skin appropriately. If you’re in the US, medical insurance will cover at least a portion of the cost for retinoid prescriptions up to age 30. If you’re over 30 or simply don’t want to get a prescription there are many high-quality retinoids on the market, like SkinCeutical’s. When starting a retinoid, begin with application once a week and work your way up to nightly applications as your skin starts to tolerate it.



A daily routine using these products looks a little something like this:

Morning

1. Cleanse face with cleanser of choice, I like Cetaphil’s Normal-Oily Cleanser


2. Apply 4-5 drops of C E Ferulic to face and neck, allow to dry for 2-3 minutes


3. Apply sunscreen or moisturizer+sunscreen mix


4. Optional: non-comedogenic foundation, like this one

Night

1. Cleanse face, pat dry


2. Apply moisturizer


3. Apply a pea-sized amount of retinol to face and neck

As with anything, make sure to read labels and instructions of individual products. Good things take time so don’t fret if you don’t see changes right away. If your skin is sensitive don’t try to add too many products at once, instead introduce changes to your routine slowly.

Have a great week  

Hello and happy Monday!

As I move into the last couple weeks of second year (crazy!) and prepare for my 6-weeks of board studying I’ve been really thinking about how I’m going to maintain my fitness goals. It’s somewhat of a med student inside joke that your body turns into a jiggly, out of shape blob during board studying. That doesn’t super appealing and so I’m committing myself to staying active, and not falling into that trap.

A meta-analysis in the Annals of Internal Medicine recently reported that sedentary behavior is not, in fact, completely neutralized by exercise. That means that intense exercise doesn’t make up for all the intense sitting we do all day! It’s more about maintaining a level of activity during the day on top of our dedicated “workout” time. It’s kind of scary to think of the damage we do to our bodies by sitting all day. It’s somewhat ironic that while I study and learn to be a healer, I’m simultaneously compromising my own health by being so sedentary. Luckily, there are so many ways to get around that!

I recently rediscovered Blogilates by Cassey Ho. Blogilates is an amazing fitness resource and it’s totally free - all you have to do is sign up for their newsletter in order to unlock the exclusive workout plan for the month. There are other features that don’t even require an email  like her meal plans, ab/thigh/arm challenges, workout calendars, before & after stories, and even recipes. I admire Cassey’s story  and her ability to bring something she is so passionate about to life! I personally love pilates, but classes can be really pricey. Cassey’s signature “POP pilates” style isn’t only free, but it’s pilates that you can do anywhere, whenever. All you need is a mat and some motivation!

One of my favorite workouts is her Pick-Me-Up Quickie Workout. I’ve been using it as a healthy study break!

[embed]https://www.youtube.com/embed/PySN5tabiLQ[/embed]

My typical workout regimen is composed of 4-5 60-minute sessions on my elliptical while watching lectures or occasionally some Netflix. Although using my elliptical at 100% incline and the highest resistance is a fantastic cardio workout, it can be hard to target other very important muscle groups including my core and arms. I’ve been sticking to my elliptical workouts and have seen some great results as far as getting leaner and having more energy in general but I’m excited to incorporate Blogilates to my routine. I’m going to start the April “Aprilates” schedule today after my elliptical workout!

Since coming off my meds I have a newfound motivation for fitness and wellness in general. I’ve been making some adjustments to my diet that I hope will be easily maintained long-term, and I look forward to blogging about it. Living a healthy lifestyle is just that - a lifestyle. That means making lasting changes and truly committing yourself to doing what is best for your your body, mind and soul. We are multifaceted beings and the care we give ourselves should be, too.

Have a wonderful, productive week!  

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.

 

 

Happy Friday, everyone!

I thought I would share my recipe for another quick, filling breakfast. Except this one you can take with you during your busy mornings! Most days I have enough time to make myself breakfast since I'm podcasting my lectures and studying for boards. But some days I have to run out of the house early in the morning and I need something quick to take with me. After doing some research I found this vanilla hemp protein by Nutiva back in December and I've loved it ever since. I had never bought any other protein shakes since I'm always a little skeptical of processing and quality standards. Nevertheless, I like Nutiva's mission statement and the ingredients of the protein shake itself. Plus I think it tastes wonderful and isn't too sweet! One package usually lasts me about 7 weeks if I use it three times a week.

 In order to get an added boost of fiber and some omega-3 fatty acids I throw in a bit of ground flax seed. Ground flax seed is flavorless and so versatile - you can add it to yogurt, smoothies or even thicken up some tasty sauces! As a base for my smoothie I use a one part almond milk and one part water to prevent it from getting too thick. Overall I've found that this combination of nutrients really helps keep me full and focused during my busy mornings. It's all about what works for you!

Things you'll need:

- some kind of blending device to get the mixture to a semi-homogenous consistency (I use a blender bottle)

- 1 cup almond milk {90 calories, 1 g protein}

- 1 cup water

-. 3 tablespoons hemp protein {120 calories, 5 g fiber, 10 g protein}

- 2 tablespoons ground flax seed {70 calories, 3 g fiber, 3 g protein}

Directions:

- join and blend all ingredients

Total protein - 14 g

Total fiber - 8 g

Calories - 280

   Enjoy  

It’s Wednesday and that means the possibility of mid-week blues. Fortunately there’s a remedy - delicious, quick homemade pizza!

Being so busy but also health conscious I’m always looking for quick, healthy, and nutritious recipes. That doesn’t always mean going out and buying things specifically for one recipe since that takes extra time and money. Instead, I try working with what I already have available.

During the week I go grain-free and on weekends I’ll allow myself to have 1-2 meals that have bread or other grains. And there are times, like this past weekend, where I crave pizza. I mean, who doesn’t love pizza? Delicious pizza doesn't mean it has to be overly greasy or unhealthy, however. So instead of going out for pizza, I decided to make it myself using pita bread and a few other fresh items.

Ingredients:

4 pieces thin pita bread (about 8” in diameter)

1 cup marinara sauce

1 cup shredded mozzarella cheese

½ bell pepper, thinly sliced

1 cup sliced green olives

1 cup sliced black olives

1 cup sliced mushrooms

2 sliced jalapeños

Directions:

1. Start with a clean work surface

2. Preheat oven to 350°F

2. Add ¼ cup of marinara to each pita and spread evenly

3. Add your choice of veggies and cheese

4. Place pizzas carefully onto a large baking sheet

5. Cook for 20 minutes, or until the crust is golden-brown

6. Add garnishments - I added some chili flakes!

The finished pizza will be crisp and deliciously thin.

Happy Sunday, everyone!

This was a very busy week for me. On top of block and board studying, I attended a conference where I presented my current research. It was my first conference and it was an oral presentation so it was definitely a bit stressful. It went well, however, and I really enjoyed getting to spend some time with my friends who also got to present. As a med student you know that your peers are smart, but you forget how brilliant they are sometimes. Watching my friends present their incredible research was really exciting. It was also really fun to spend some time at the beach (because we tried to study there but obviously couldn’t get a whole lot done, lol).

In late January we had submitted our preferences for our third year clerkship schedules. Third year clerkships or “rotations” are where you get to use all of the endless information you acquired your first two years of med school and apply it to the clinical setting. It’s also a time where you solidify what your interests are and what specialty you’ll choose to pursue. On top of all of the fun exploratory stuff, you still have to perform at your best in order to be evaluated highly and be worthy of your attendings’ letters of recommendation for residency applications. That sounds like a lot, but I’m really looking forward to it. After all, I’ve been in a lecture-based setting my whole life and this is the next step towards becoming a physician.

My school offered a choice of 16 pre-arranged “tracks” that we could choose from. We were asked to rank all 16 tracks and then submit our list in order for a lottery to be run. It was rather stressful because clerkship order is important, and getting a track that you weren’t totally fond of wouldn’t great, though you could certainly make it work. The only piece of advice that we were given is to make sure what you’re interested in is not first or last. That still leaves a lot of questions. I scoured the internet for other med student blogs that might offer insight on what the “best schedule” was, but it varied. I also asked a few of my friends that are residents or current third/fourth years. I found this resource to be the most helpful.

Though I don’t know exactly specialty I’m set on, I have a few that I’m interested in: surgery, peds, ob/gyn - in that order. With that I was able to look for tracks that would keep these three somewhere in the middle and definitely not first/last. I had also been told that in order to do well on on the surgery shelf exam, a strong background in internal med is a great starting point. I know for sure that I’m not interested in internal med as a career, and since it is so fundamental for success in other rotations I decided to place internal med first.

A few of my friends and I submitted the same rank orders since we know we would work well together and also have similar interests. And lucky for us we ended up with our first choice!



As far as subsurgical specialty choices I’m leaning heavily towrads Ortho. I’ve had exposure to the fireld through an ortho elective and find it surprisingly interesting. We also have the option to choose a hospital setting or a private practice setting for a few clerkships. I’m considering doing ob/gyn in private practice because my friend (who is now an ob/gyn intern) had such a great experience doing that. Also, ob/gyn tends to be more of a malignant experience for medical students at my institution’s hospital so private practice seems like a better choice for me, especially if I’m looking to learn a lot and be an active member of the care team.

I’m so excited to start clerkships this June. I’m also looking forward to sharing my experiences regularly through this blog since insight into the clerkship experience online is pretty bleak.

Have a great week!

Once upon a time, I was an undergrad. Just kidding it wasn’t even that long ago, I graduated from college in Spring 2013. I never really liked the label “premed.” It always sounded so pretentious and automatically conjures a specific stereotype - you know the one. I started college knowing that I wanted to go to medical school, and I knew that undergrad would define the kind of applicant I would be. So, I did everything with the intention of using the opportunity to go to college to become the most well-rounded student I could be.

Being a first generation college student had its challenges but it was definitely a blessing as well. With no one to pave the way for me or tell me what I should and shouldn’t do, I was responsible for every aspect and outcome. That meant figuring a lot of things out for myself and that was okay - if anything I was even better at navigating the nuances of college because of it. Being in the Honors program also encouraged me to explore ALL of my interests in a meaningful way. You only go to college once (usually), so why not go all out?

Majors. I knew that going to college was an opportunity that many don’t have so I felt that I should get the most out of it. Knowing that I wanted to go to medical school, I signed up for my university’s BS in Physiology, which is a challenging program. I think a lot of people in that major only chose it because they, too, wanted to pursue medical school, dental school, or otherwise. And unfortunately, by the second semester of college many people had to drop it and switch career goals altogether. I chose Physiology because I knew I could perform well and I was confident in my ability to succeed.

I’ve always loved to read and enjoyed writing. Some of my favorite classes in undergrad were actually composition classes. So I decided to pick up another major that would allow me a more creative outlet and a “break” from all of the stress of my physiology major. I started my BA in Religious Studies my second semester of college. I absolutely loved that I could think in a concrete/analytical sense in one major, while exploring the abstract, intangible parts of existence in the other. Having these two very different majors allowed me to stay grounded and focused on the bigger things in life without getting bogged down by all of the neuroticism that often accompanies a premed track.

I was raised speaking Spanish and English so I’m a native speaker of both. I had always wanted to improve my literary and written Spanish. I saw no reason for that improvement not to take place in college so I picked up a BA in Spanish & Portuguese around the same time that I had picked up my religious studies major. And since I already spoke a few languages, I figured, “Why not learn another one?” So I added a minor in Arabic.

Juggling three majors, a minor and 19-25 credit semesters was by no means an easy task, but I’m certain that my ridiculous course load on top of volunteering, working, and leadership roles prepared me for medical school.

Extracurricular activities. By the time I started college I had already been volunteering in Peds/PICU at the university hospital for three years. I loved working with the children on those wards and continued to volunteer there until I started med school. By the end of my first year of college I got an email calling for applications for a Student Coordinator position with the Hispanic Scholarship Fund. I applied and started my work with them that summer. I had heard somewhere that leadership roles were essential to a med school application, so I figured why not start my own club and be president of that? And that’s exactly what I did. I established the HSF Scholar Chapter of my university and got a few of my friends to serve on the executive board with me. I was never one to get involved in other “premed” organizations, and I saw starting my own club as something I could really grow and be proud of instead of latching onto something else. Through the Scholar Chapter we outreach events to underserved high schools & middle schools; talking to parents and students about college, and what financing a college education was all about. Encouraging students and families from lower-income districts to go to college was something I was really passionate about. I was part of other med-oriented interest groups and clubs, but the scholar chapter was my main focus.

Research. Finding and getting to actually participate in research as an undergrad was such a hassle. Many research faculty don’t take undergrads very seriously for the most part. Fortunately there was a program at my university that selected a few dozen students each year for paid research positions. I started working in a neonatal nutrition research lab right after my first year of college. I learned so much and developed a huge appreciation for the research process. Though I didn’t get published, it was definitely a great experience that I was able to talk about along the med school interview trail.

Money. I financed my entire college education with scholarships. That wasn’t easy, though. I applied to every scholarship I could find and got some really great faculty/staff to write me letters of recommendation. Applying to scholarships was basically a job, but it was worth it to not graduate with debt! The last two years of college I worked as a tutor, nanny and clinical assistant in a private practice.

Tips:

Don’t pick a major you hate just because you think you have to. If your goal is to go to med school but don’t think you can truly excel in a science major, that’s okay! Choose another major where you will do well, instead of struggling. The prereqs for med school will still be science, and since you won’t have an entire major that is super hard you’ll be able to focus on your prereqs a little more. Plus, many of my classmates come from a predominantly non-science background and they do very well.

When it comes to finding research experience as a premed you really have to show your prospective PI that you’re committed, interested and a hard worker. Research experience is vital when applying to some schools so it’s important to do your best. It’s also nice if you get a letter of recommendation out of it.

Be involved. It’s better to contribute significantly to one activity than to be involved superficially in many.

Apply broadly to scholarships. You never know what you might get!

I didn’t take any time off between undergrad and med school. After graduation, I relaxed, worked a bit, and traveled before starting med school that Fall. I know for a fact that what I did in undergrad had an impact on my med school performance. My physiology background helps with my medical knowledge curriculum and systems-based learning. My religious studies and language knowledge helps with clinical situations where communication and empathy are key. And the general craziness of my undergrad work load helps with balancing the stress of the demands of med school. Oddly enough, I actually have more free time during these first two years of med school than I ever did during college!

Undergrad is a time to explore all of your interests and become a better person. It’s a critical time from 18-22 where you really grow into yourself. You learn a lot about yourself, your goals, and what you really want out of life. The biggest piece of advice I have is to construct your own journey (both in school and life), because what works for someone may not work for you. Also, try to remember how privileged you are to be worrying about school, grades, and a future in general. Having the opportunity to attend college is a luxury, let alone med school. Whenever I feel stressed, I try to remember how fortunate I am to be where I am because education isn’t something afforded to everyone in this world. So use your education to make the world a better place, because in the end it won’t matter what your major was or if you got a B; what will matter is that you bettered the lives of your patients and their families.

Happy Friday everyone! Lately I've been thinking a lot about what it will mean for me to be a mother in medicine one day and the experiences that will entail. I think the female med student/resident/attending perspective on balancing motherhood, career, and lifestyle is an extremely important one that may not be discussed as widely as it should be.  For today's blog I featured an inspirational classmate of mine, L. She was kind enough to answer some of my questions to share with you all.

1. How many children do you have and how old are they?

I have seven children, 4 girls and 3 boys.  From my first marriage, I have three kids, ages 18, 16 and 13 and with my current husband, we have four kids, ages 8, 7, 5, and 2.  My 18 year old, is autistic and will likely always live at home.  I don’t have religious reasons to have so many children.  If I did, I’m sure it would make me look more sane.  I grew up in a large family (the oldest of nine) so it feels “normal”.  My mother was the oldest of 12 children.  They are a huge family of cattle ranchers and everyone worked to help out from the time they were small.  We’ve always viewed large families as an asset.  When I was growing up, we were the “city folk” that would help for large cattle drives, branding the calves or slaughtering the chickens, but the ranch wasn’t part of my daily life like it was for my cousins.

2. Why did you choose to go into medicine?

As a young adult, I had no clue what I wanted to do.  I had a number of scholarships, but I just wanted to play once I went to college, so I took general classes and had a “B” average.  I didn’t get into drugs or alcohol, but did a lot of skiing, hiking, rollerblading (it was something people did back then) and hanging out with friends.  I was unmarried when I had my first child during the second semester of my sophomore year.  It was surreal.  This little human was completely dependent on me.  But once I was a parent, I found myself again.  I went back to being an “A” student.  I found a job at a bank as soon as I finished maternity leave and it paid almost twice as much as my previous job plus I had health insurance benefits for myself and my daughter.

I did my best as a single mom, but it wasn’t easy.  She literally didn’t sleep more than 2 hours at a time for the first 2 years of her life.  Even today, she doesn’t sleep much.  When she was 7 months old, she began having issues with a seizure disorder and was hospitalized on a number of occasions from complications.  She saw a pediatric neurologist, but none of the medications worked for her.  When I told him that her development just didn’t seem quite right, he listened to me and referred me.  I took her to learning specialists and speech therapists.  She was in early intervention programs for “speech and language delay”.  But why she was delayed in speech and language, we didn’t know.  I remember when she was 5 years old, I received a phone call after 8:00 on a Sunday evening from her pediatrician who had just returned from a conference on Autism.  She was so excited because she thought of my daughter and couldn’t wait to call me to let me know the news.  It was hard news to hear, but it was good to finally have an idea of what we were actually facing.

I married my daughter’s father when she was a year and a half old.  To finish college and chose the easiest degree I could think of (which was a B.S. in Photography.)  I continued with my job at the bank to support my first husband as he finished his degree and our eventual three children.  I took promotions and worked my way up.  After I divorced, I kept working at the bank.  I don’t think I actually stopped to figure out what I wanted to do, but did whatever made the most sense for my family.

When I was remarried and pregnant with my 5th child, I asked my husband if I could quit work and be a homemaker.  He knew me well and warned me that I liked to work and would hate being at home.  I insisted I would love it at home, so he reluctantly agreed I could quit.  It took me less than a year to realize that he was totally right:  I needed to do something.  I liked volunteering, but felt like something was missing.  I knew that I didn’t want to return to banking, I wanted to do something that had more meaning to me, was challenging and that I felt good about.  I think the experiences I had with my oldest daughter and her medical needs that helped me realize that a physician can affect lives in unique ways.  I can thank my daughter for helping me find my path to medicine.

3. How has being a mom affected your med school experience?

My first year of medical school, I was determined that I would have the same medical school experience as everyone else.  I joined every club.  I went to parties and tailgating with classmates.  I did “electives” and started “distinction tracks”.  I volunteered to work with underserved people and volunteered to help with alumni events and for the medical school graduation ceremony.  Anything that I thought sounded interesting, I wanted to try it.  But, I saw very little of my family.  Luckily, I did a rural professionals summer program that allowed me to take my family to a rural place to do a rotation.  The doctor I shadowed had kids while she was in medical school and advised me to have fun and enjoy my summer with my kids.  She invited me over for a July 4th barbecue with her family.  She encouraged me to take the kids fishing and to the local community pool.  After the 6 week rotation, I returned home, but I had a hard time getting back into the swing of medical school.  I didn’t want to be away from my family so much.  Prioritizing is difficult, something always has to give.  I decided to commit specific time to my family.  I dropped out of some of my extra clubs (like the a cappella group) and started volunteering a lot less.  Overall, I don’t know if being a mom changed my medical school experience.  Some of my classmate are dating and I know dating is time consuming.  I don’t really watch television but most people do.  We all fill our time with something and we all have to balance school, family, friends and self.  So while my time is consumed differently than others, I don’t think it’s very different from other medical students.  I think we all took on too much at times.  Reprioritizing is part of medical school.

4. Do you have any advice for current moms that are interested in pursuing medicine?

• Shadow physicians:  make sure you like the job you want to do.  If you don’t love it, don’t do it.


• Nothing is better than having great childcare.  If you feel good about where your kids are and who they are with, you can feel good about what you are doing when you are away from them.  It’s worth every penny to have better childcare (I personally recommend family or a nanny if at all possible.)  Make sure you have backup childcare as well.  And backup to your backup childcare.  In other words, you need to know that if you couldn’t be there, it would work out, somehow.


• Don’t let people tell you that “you can’t…”  No matter what it is.  There are many ways to do things, so maybe you just haven’t found the one that works for you.  There will undoubtedly be roadblocks.  Be strong enough to find the alternate path.  Don’t let rejection be an excuse.  I was rejected my first application year, waitlisted my second year, but got into multiple medical schools the third time.  I just had to try different approaches each time.


• There will never be a good time for things.  If you wait for the best time to come, it won’t.  A pre-med friend of mine had morning sickness during the MCAT and didn’t do well.  She decided not to apply with a poor MCAT score and instead to take time off to prepare for her little one and retake the MCAT again in a year.  But a year later, she was so busy with her baby and she didn’t retake it.  Now, I haven’t had the heart to ask her why she hasn’t applied yet.  Maybe she she decided against it or maybe she has applied but I just didn’t hear about it.  She’s young, she has many years to decide.  But I kind of think you “lose” the work you’ve already done as time goes by.  Recent experiences matter on the medical school application just as much as a history of experience.  So if you’ve already done a lot, don’t make it a waste.  If you really and truly know you want to be a doctor, don’t say you couldn’t because you were a mom.  It’s not fair to them or to you.  If you want them to reach their potential, you should reach yours.


• Make sure to take the family with you on your “journey” to medical school.  Help them be part of it, if you can.  It was the coolest thing ever to see my little ones jump up and down cheering when I got into medical school.  The teens, didn’t jump up and down, but I’m pretty sure they gave me a fist bump or something.  I’ve been working on this very hard for 5 years now.  The kids are still excited and tell me they hope they can become a doctor someday, too.  Well, three of them tell me that and one of them is a 16 year old teenager, so I think that’s impressive.  This journey didn’t ruin them.  Cloud their judgement, perhaps, but not ruined. And they don’t seem to think I’m the worst mom ever.  Or they are super great at hiding it.


• Reflect.  Take the time to think about yourself, your weaknesses, your choices, your plans, your children, your significant other, your strengths.  What could you have done differently?  What are you glad you did?  What do you like?  What do you not like?  What makes you happy? How do you learn? How did you get to where you are?  What stopped you from taking another path?  What are you doing?  Are there other options? Use reflections to re-evaluate and prioritize.  Plus these sorts of activities are needed for medical school essays.  Trust me, I filled out 40 secondary apps my 3rd time ‘round.

5. Do you have any advice for other moms currently in med school?

Stop doing things because you’re supposed to do them.  Think about your time as a valuable thing.  Now granted, you need to “waste” some time each day, so make sure you waste it in ways you choose instead of letting wasted time happen to you.  Overall, how you spend your time matters.  There are so many things that don’t matter and as moms we get wrapped up in the guilt of attempting to do it all perfectly.  I think the type of person that goes to medical school may be more likely to demand perfection of herself than other moms.

Does it matter if I wait 15 months for the dental check ups for my kids when it’s supposed to be 12 months?  Meh. They don’t have cavities, so it’s not the end of the world.  And yes, those dishes really will still be there waiting for you after you tuck the kids in to bed.  They can wait: they are ridiculously patient, those dirty dishes.  Are you in the PTA because it brings you joy and overwhelming happiness, or do you feel like it’s what you’re supposed to do?  I personally would prefer to spend time reading to my son’s kindergarten class than attend PTA meetings.  Have your kids help you decide. If my kids ask me to volunteer a half hour to pass out flyers for the booster club, I ask them if they would prefer I set aside that same half hour for them, doing something they like, like maybe going to the park.  It helps them to realize that life is full of things you can do, but you shouldn’t do it for the sake of doing it.

You already know this, but you could study every moment of every day and still not be done studying.  I’d rather spend 2 hours when I’m alert and ready to study than 6 hours inefficiently rereading notes.  Just do what you can as efficiently as possible, then let it go…..

Oh, and ditto on my childcare sentiments for pre-med moms in the previous question.  Worth it. I’m pretty sure if you got into med school, you got this.  But how on earth do you find the time to read a blog? Kudos to you: please share your wisdom with me.

6. Are you interested in any specific specialties right now? If so, how has being a mom influenced your decision?

I’m still undecided.  One comfort is that I will be happier in any specialty I choose than I would be in another career, so I can’t go wrong.  I considered specialties that are more conducive to family, but am leaning towards surgery which, well, isn’t.  I think overall, the fact that I have a family won’t change the specialty I choose.  There’s no reason to put in so many years of education if it isn’t the specialty I love best.  I figure that even if it’s a longer residency, it won’t really matter.  Residency is similar to what we will be doing the rest of our lives, so the length of residency isn’t a factor in my mind.  The hours should be an issue to me, but they aren’t because I know that I would rather work more hours at something I “love” than work less hours at something I only “like”.  The thing that I am finding the most difficult is possibly moving.  I moved my family over a thousand miles for medical school.  I would feel guilty moving them again for a residency program.  Moms always wonder if they should have done something different.  It’s something that plagues moms in any career.   Luckily, there’s no right answer.

Current location: Baden, Switzerland

I have a December birthday and since I have the best husband ever, he showered me with amazing gifts (as usual) and planned a winter break trip to Europe for us. We've both had crazy semesters - he finished his masters and worked full-time at his firm, while I was in school. Now that he's a full-fledged engineer and I'm in my second year of med school it's crazy to think that this exact time in our lives is something we would fantasize about when we met just a few years ago. A trip to Europe was the obvious choice: my sister-in-law and her husband live in Switzerland and they're awesome // my husband and I have had many, many layovers in Europe but neither of us has ever actually traveled here. This trip was definitely a chance to see something completely new together.

We arrived in Switzerland a couple of days before Christmas, and I was absolutely stunned at how beautiful it is. I've been to my fair share of countries, but this is definitely the prettiest place I've ever seen. I wish I could take the landscape, infrastructure, and policy home with me. I'm also impressed with the emphasis on health and well-being. Coming from the US where obesity is rampant it's so refreshing to see a population of healthy, active people. In that vein, we went on a 6-mile hike and it was breathtaking - literally. Though we only got to explore areas around Zürich, the whole landscape was gorgeous.  I can't wait to bring our future children to see their future Swiss cousins :).

About a week into our stay, we took a day trip to Konstanz, Germany. It was a really charming place. And though we didn’t get to see Lake Constance before dark because we spent the better part of the afternoon searching for an authentic German restaurant, we ended up having the best spaetzle ever so it was okay.

Paris was an incredible, unique and memorable experience all on its own. We arrived the night of the 30th and spent the 31st sight-seeing before welcoming the New Year. The celebrations in downtown Paris were a jumble of chaos, joy, and more people than I had ever seen at once.

Before leaving back to Switzerland we visited Les Catacombes de Paris, which are underground ossuaries holding the remains of an estimated six million people. If you’re not familiar with the history please look it up, as I’m sure I cannot do it justice. The catacombs are gorgeous works of art wherein the macabre essence of death is juxtaposed against the romantic art formed solely of human bone.  Along the walkways, the walls of remains are delicately built in a deliberate, stable manner: two feet of humeri, a line of skulls, topped by a pile of femurs. While there, I thought a lot about being in the cadaver lab during my first year of med school. I remember working on "Agnes", my group's cadaver, for hours on end. I remember accidentally holding her hand while moving her arm once and experiencing the weirdest feeling I've honestly ever felt. The sensation of a hand hold isn't necessarily a uniquely human experience, but the emotions triggered therein certainly are. When cutting into inches of fat and shiny fascia it's easy to forget that the body you're picking apart was once a lover, a friend, a parent, a sibling. It's probably also protective to our own psyches to ignore those aspects of a past life. But as I walked through the resting place of those more than six million remains I tried my best to acknowledge their humanity, as well as my own mortality.

Travel has a funny way of making the world seem bigger and smaller at the same time. Smaller in that you can actually point to a place on the map and say you've been there - you've made memories there! But also bigger in the sense that there are an overwhelming number of things you have yet to discover, people to meet, languages to learn, places to see. It also makes you think of how privileged you are and how grateful you should be to see the world. Most importantly, it keeps you open-minded, accepting, and seeking new adventures. I’m truly grateful to have been able to travel during this winter break and even more thankful to have spent it with my husband. It really is something special to share experiences with your best friend. I’ve included some pictures below :).

fisibach, switzerland 

passerelle léopold-sédar-Senghor

“The good physician treats the disease; the great physician treats the patient who has the disease” - Sir William Osler

I don’t want to be a doctor. I need to be a great doctor.

November 2009: I was sitting on my favorite bench on campus in the middle of fall, just a few weeks shy of my 19th birthday. I was your typical neurotic and flustered premed, but I was happy and excited to conquer undergrad. But there was one little problem: the handfuls of blood I would cough up at night. My roommate at the time (who is still one of my close friends!) threatened to call my mom if I didn’t go to the doctor immediately. So I went.

At my primary care physician visit we reviewed my X-rays. She talked a lot, but the only thing I heard was, “there’s something big there, could be anything even cancer but you’re young.” As you can imagine, there were a few obvious problems with that statement. Even without medical training I knew you couldn’t speculate like that in front of a patient. The way she threw around the “C-word” so nonchalantly and then dismissed it by mentioning my youth still makes me angry. I was offered no assistance in finding a pulmonologist and felt absolutely alone. So there I was, almost 19, thinking I could have cancer. A few months later I found I had coccidioidomycosis, commonly known as ‘Valley Fever” (something my PCP should have thought of since it’s endemic to our area *facepalm*).

Though I was thankful it wasn’t cancer, I could have never imagined the journey my diagnosis would take me on. Starting antifungal therapy was rough. My hair started to fall out, my skin dried out, my nails turned brittle, and just felt ill all the time. The blood didn’t stop though. It seemed there was no escaping that bloody cough: when I laid down to bed, whenever I tried to exercise, whenever I walked a little too fast to class. I had two pulmonologists during those first two years post-diagnosis. One so close to retirement that his approach was almost negligent. The other, too caught up with the fact that I was “young” to treat my infection aggressively. But both taught me that I never wanted to be that doctor: the doctor that doesn’t care.

In 2011 I met Dr. P. He wore a bow tie and had a jaunty walk. He also wore bright, beaded bracelets that his granddaughters had made him. After telling him my story he grabbed my hands, and told me he was going to do everything in his power to make me better. My eyes welled up. He was my first doctor to actually care. Immediately he called his friends: an infectious disease specialist and a cardiothoracic surgeon and personally scheduled appointments for me. He was the helping hand I had needed all along. That December, two days before Christmas, I finally had a chunk of my right lung resected and graduated from the care of Dr. P to my current ID specialist, Dr. N.

It’s been five years since my journey began, and though I'm still on medication it has been such a blessing to learn the struggles of being a patient so intimately. The lessons I learned while being sick in undergrad have carried over into my first years of medical school. It's these lessons that keep me focused on becoming a great doctor through the seemingly endless stream of facts in our pre-clinical years. Being a patient ultimately taught me that the obstacles presented to us in life are a testament to our strength and allow us to develop into a stronger, more focused version of ourselves. What is even more special about these obstacles is that they happen unexpectedly and we must rise to meet them. In order to do my journey justice I have a duty to become the most empathetic doctor I can be. I never want to be the doctor that didn't care, or the one that didn't listen. I want to be the doctor that did her best.

Why do you want to be a doctor?

It was never about a want for me. I always knew I was going to be a doctor - and you better believe I was ready to do whatever it took even if I was in elementary school. Did that mean running unopposed in 4th grade for class treasurer? Yes. Did that mean that I stayed up the night before elections to rehearse my speech and make posters? Yes. Was I a “cool” kid. Haha, no. But I was something: independent.

When I think about it, it’s kind of surprising that I even went to college. I attended elementary school in a lower-income area of the city where most of my classmates came from very poor households. It was clear that most teachers didn’t really push for long-term retainment by their general lack of enthusiasm. Nevertheless, I was lucky to find a few that really nurtured my learning. I didn’t have many friends and realized later that I was bullied pretty bad. I remember not sitting with anyone at lunch, then going out to recess to take a lap around the track. Either I was incredibly independent or I was in denial. I also weirdly remember crying in the bushes furthest away from the school building at lunch and then coming back to class when the bell rang as if nothing had happened. I don’t remember being sad, but the mind is an amazing thing and I’m sure I’ve just blocked it out. I haven’t really decided how to deal with those memories but I know one thing: I didn’t care what others thought. Though some people may take pleasure in watching their “enemies” fail, many of my school bullies didn’t make it through high school and some were teen mothers. It’s sad. I’m lucky that I didn’t become another statistic. I don’t know if it was by my own accord or destiny, but I like to think it was both.

In middle school and high school I switched school districts into a more affluent area. I downloaded and sent in the registration papers by myself - a crazy thing to do at 11 years old. It was here that I met friends that were more like myself. I finally found a space where intellect and academic achievement were not just the norm, they were cool. I really flourished during those years and thus began the mindset of preparing myself for college and what would eventually make me into a suitable med school candidate. Honestly, it is amazing what opportunities are made available to students based on where they come from. I learned a whole new meaning of privilege. But I also felt somewhat behind. Not academically, but rather in the kinds of opportunities afforded to different social classes. While my classmates had parents that guided the way to college and beyond I only had myself. My parents supported my decisions but it was up to me to forge my own path, seek out opportunities, and take them.

From elementary through high school I learned that independence from what others think of you is absolutely priceless. I also learned that in order to take advantage of every opportunity, I had to be proactive. Looking back I’m kind of impressed at how I was able to change my circumstances at such a young age. And even though I didn’t realize it at the time, I was asserting my independence and that's part of what medicine is about: confidence in yourself, your choices, and the ability to step back when you don't have the answers.

I remember the first National Geographic my mom bought me, I must have been around 7. I had seen it at the grocery store and flipped through it until we checked out: it pictured a fetus, curled up in the womb. I was fascinated. It was (*insert Chris Trager voice*) literally the coolest thing I had ever seen. When we got home my mom pulled it out of a shopping bag and I remember freaking out. All I wanted for Christmas or birthdays were baby dolls from that point on. Not the ones where you just get to play mommy. The ones that were anatomically correct and would actually pee so I could see how much water I could feed it and monitor how fast it would come out.

I sometimes wonder where my drive for medicine came from. And until recently I honestly had no clue. But now I know that it was from seeing my parents work so hard to give my sisters and I the best life, and they did an amazing job. Both of my parents immigrated from Mexico. My father was orphaned at age 6 by a mother who died after giving birth and a father who decided raising 5 kids on his own was too much. My mother started working, selling tamales door to door as a young child. My parents tell funny stories about their childhoods but it’s laced with a bit of sadness at how hard they had to work - physically work - to live. Their circumstances are unimaginable. I can’t relate. But I know that I cannot relate because they worked to give me a life much more privileged than theirs. And for that I am grateful.

My parents had such an essential role in making me a lifelong learner, but it was my mother that stressed how important it was to be an educated woman. I was very young when she first told me, “you have to get an education so you don’t depend on anyone and if you’re ever in a bad situation, you can leave without thinking twice.” That’s one of the most important lessons she ever taught me. I was lucky that it was engrained at a young age because it became such a fundamental part of my mentality that still shapes my reality.

My parents gave me drive and a platform from which I could comfortably succeed in school without worrying about things many other children deal with like money, food, water, shelter. And for that I am grateful. My parents taught me about hard work. And though they didn’t push me to become anything specific they made damn sure I knew that “getting an education was my only job.” Where they had to work with their bodies, I had to work at school which is an absolute privilege that many children don’t have. And I am lucky to have parents that reminded me of that.