Four Weeks Deep

Just the Tip

Well it's been just about a month since the first day of orientation and I have been extremely remiss in posting updates on here. I've started writing a few posts about surviving the "pre-med years" and hopefully those will be finished up soon. I'm hoping that this page will become a useful resource for others and perhaps more importantly a source of laughter, something that is much needed when discussing the very serious enterprise that is medicine.

Believe the hype?

Medical school has been both an intense and enjoyable experience so far. In many ways it's more like high school than college. I see the same 160 or so people everyday. We take all the same classes. We take them from 8 am to 3 pm (there is no study hall). And for the most part we all socialize (read: drink) together too. Coming from a University where one could exercise their right to anonymity to such an extent that it often seemed no one even knew you were alive, this has all been quite a shock. Our teachers and administrators seem to really care about us and have been receptive to many of the issues we have raised. I'm very thankful I was able to attend Penn and I feel they have put together an amazing class this year.

I remember hearing someone say, "believe the hype, this place is as good as everyone says." In my limited experience (and at the risk of sounding like an ass) I would say that this seems to be the case at Penn. This is not to say that I like everyone I meet or that some of the lectures don't suck. I have heard some pretty dumb and offensive questions since I've been in medical school. Sometimes it's the professors who don't have a clue. One professor, when asked what a normal curve was responded with, "Well, it's a curve...you know...like in Math." Oh yea, like in Math. Now I get it! Clearly having your PhD doesn't always mean you can or should be teaching. Other people are just douches. I'm still wondering why some people enter a profession that revolves around helping others if they clearly only care about themselves. Thankfully these sorts of things are the exception rather than the rule. When I hear my classmates cracking on these same people, I get a little warm and tingly inside.

But in a broader sense, I think it's important not to believe some of the hype about medical school. People tell me my relationship will fall apart, that I will live off of hot pockets, and that I will no longer be able to drink more than 6 beers at a time. I say bullshit. We are lucky enough to have a pass-fail grading system here at Penn and that means I can take my work seriously but also take time to do things like update this web-page or play some lax (brah). So if you're in the same boat as me, four weeks deep and wondering if you'll make it through the gauntlet, work hard, stay positive, and have a beer every once in a while.

Decisions Decisions

Well, I've returned from 5 weeks spent backpacking across Japan and it's once again time to resurrect my oft-neglected page. In typical fashion, I made my final decision about which medical school I will attend at the very last minute - only a few hours before I hopped on a plane bound for Japan. So, without further ado, next year I will be a first year student at the University of Pennsylvania School of Medicine.

Hiking for a month through Japan certainly gave me plenty of time to consider my decision, but I think well before I even made my decision I knew in my gut that Penn was the place for me. There were tons of tangible factors I considered, often simultaneously, when making my decision. Match lists and tuition figures swirled through my head on a daily basis. Certainly, the safe choice for me would have been to take the generous award I received from the University of Chicago Pritzker School of Medicine and never look back. My parents certainly wondered what the hell I was thinking.

One small comfort to me was that I was not the only one in this position. Every year, thousands of medical students face the same dilemma. They are elated to discover that they have been accepted to medical school, perhaps even the school of their dreams, only to be left wondering how the hell they are ever going to pay off 240,000$ of student loans. Many of these students will elect to attend a state school or settle for a place with more financial aid to throw around. It is a difficult decision, and there are no hard and fast rules that one can follow to find the "right choice".

So, here's hoping I made the right choice. I've got only a few weeks left of summer, and some serious drinking and chilling to do before school starts. Looking forward to getting this blog rolling.

Why I Do This

This is my personal statement from my application for medical school. I'm putting this up mostly because I was just reading something that reminded me about my grandmother and the countless important lessons she taught me as I was growing up. I knew when I was writing this that some of the opinions I expressed were going to hurt me if the wrong person read this, but honestly, I didn't really give a shit. And in the end, I think being true to myself helped me find a school that wanted me for me. This is part of who I am and this is why I'm doing this. I hope this helps others think about what is really important to them, or even inspires them to write about something more than a running list of credentials in their own personal statement. But mostly this is here to remind me, and to say thanks to my grandmother. You are missed.

“Is there anything I can do for you?” the doctor had asked. Rain was slowly pooling up on the flat roof of the adjacent hospital ward, just outside the window, invisible from the corner where my grandmother’s bed sat. “Yea,” she replied, gesturing toward the window of her cramped room, “you can throw me out the window.” The doctor (as if he had just been slapped by a bedpan) stood staring at her, his mouth moving awkwardly yet seemingly unable to form an audible or adequate response. The problem, you see, is that she was completely serious.

These were the moments – the final days, hours, and memories that I shared with the woman who had raised me – that I learned how complicated medicine can be. The truth is that you already know most of the reasons why I want to go to medical school. Like every other qualified applicant, I want to help the sick, make a difference in the lives of others, and enjoy the utter privilege of being able to learn throughout the rest of my life. I want to go to medical school to learn the tools that help make a great doctor, and to gain an understanding of a subject that I am intensely interested in. But I have also, for better or worse, learned that “healing” can mean very different things to a patient and a doctor. That is, I also want to go to medical school to learn what to do when all a patient wants is to be thrown out the window.

My grandmother taught me that life isn’t an episode of “ER,” and that everyone can’t always be saved. And for a pre-med, a doctor, or a loved one, this is both a painful and important lesson to learn. It seems that almost all of my pre-med friends hope to someday become surgeons. And while being a surgeon is certainly a prestigious and incredibly challenging job, this singular aspiration certainly speaks to the “reality” that we as students of the 21^st century inhabit. We are taught to fix problems; we open, operate, and suture our wounds. Or at least we try. But what do we do when the wound doesn’t close? Most of us stand by, mouths moving, but unable to speak.

I don’t just want to learn the most effective way to fight the cancer that killed my grandmother, and I don’t just want to continue working in the lab to help find a cure that may one day save others from suffering the way that she did. I also want to learn how to continue to help, and how to cope, as a human and a doctor, when the only healing left for a patient is death. I can say that last summer I took at least the first step toward learning perhaps the most important lesson a future doctor can learn: how to deal with death.

When my grandmother was transferred from her local community hospital in the Bronx to Calvary Hospital, where I happened to be volunteering at the time, I was devastated. Her transfer to Calvary, a hospital specializing in the care of terminal cancer patients, meant that there was no hope. Or was there? It amazed me when after months of suffering, I saw her smile for the first time thanks to the wonderful nurses, doctors, and volunteers working at Calvary. I learned about a type of medicine that I hadn’t known existed: the kind that touches people’s spirits. And I re-learned an important lesson that my Dad had inadvertently taught me years before, that sometimes simple human acts of kindness and communication (in his case ranting and raving with his patients about the Yankees) are almost as important as any medicine.

My grandmother taught me that sometimes healing is as simple as sharing a great band (and half a headphone) with someone you love. My father taught me that patients can also heal doctors. And I suppose that ultimately, I had to begin teaching myself how to deal with death. And I can honestly say that after all of my experiences I still don’t know everything that it takes to be a great doctor. But I have seen many of the most important qualities in the mentors, friends, and family that I have had the privilege of learning from. I have learned that one of the most important qualities for a doctor is to never assume that you know all the answers, to never assume that everything can be “fixed” without complications. I am applying to medical school so that I can continue to search for answers to some of the hardest questions, like death, whether they lie in an anatomy textbook or in the spirit of a patient, because sometimes it isn’t as easy as reminding a patient, “there’s a roof outside your window.”

I'm Skinny: The Beginning

The Good News

Well, I'm back from Chicago and I'll be writing my review of my revisit at the University of Chicago Pritzker School of Medicine later this week when I get my camera back to add in some cool pictures I took while there. It was a great time, and I'm still recovering a bit from a solid combination of hangover and lack of sleep. But for now, I'm going to talk a bit about my new workout plan and set this up so that you can all follow my progress and make fun of me when I screw up.

The Bad News

For anyone who doesn't know me, I'm really skinny. As long as I can remember I've been insanely tall and insanely skinny, much to my personal dismay. People often make stupid anecdotal remarks like, "Oh you're so lucky that you're skinny" or "Wow, have you grown since I last saw you?" Granted, being skinny is much better than being fat. Being fat sucks for everyone. But skinniness has its own downsides, and to be honest I'm sick of getting confused with McCauley Culkin when I take my shirt off at the beach.

I'm saying this mostly to give people an idea of where I stand now, and not so that you will feel bad for me because of my "bad genetics". This is one of those things that fat people say all the time to make up for their lack of motivation and discipline. I've even had people at work complain to me (as they simultaneously scarf down a twinkie) that they have been cursed with "bad genetics". Genetics certainly play an important part in everyone's body composition, I'm not denying that. But I am calling bullshit on the oft proclaimed excuse that there is some singular fat gene manipulating the fat people of the world.

I would say that in my own case, I certainly have a genetic predisposition to staying at a less than ideal body weight. And even though I would classify myself as a "hardgainer," I will certainly take ownership for my persistent skinniness. First of all, I spent the majority of my life with the nutritional understanding of a 5 year old. Even when I started lifting early in high school for football, I had no idea that I should be eating close to 1 gram of Protein per Pound of body weight, consuming post-workout shakes, or that my diet of processed foods like potato chips were likely halting my progress and recovery. Only within the past three years or so have I started reading extensively about nutrition and fitness. This has, without a doubt, been a huge road block in my own journey towards finding my ideal body composition. I plan on writing an article about general nutrition in the future to let you all know how I'm approaching this aspect of my training, so look forward to that.

The other thing that has been really halting my progress is that even when I was lifting, I was lifting like an idiot. In college I spent years training exclusively with drop sets (retarded), rarely did squats and deadlifted even less often. I worried about hitting three angles on the bench instead of doing pull ups, and I did biceps curls instead of working compound lifts that worked multiple muscle groups with heavy weights. The only thing I wasn't doing wrong was that I wasn't doing my curls in the squat rack (lol). I was literally doing everything wrong, and I even managed to make some small progress during this time.

What I'm Doing About It

So the other day I was entering patient data for my job at the Albert Einstein College of Medicine, and one of the values I often need to calculate is body surface area (BSA). I thought it might be fun to calculate my own, so I entered my own height, weight, and age and checked the computer's qualitative assessment of my body type. It told me what I already knew - I'm underweight - in a way that I couldn't avoid. I figured right then that it was time to start doing something.

I have been reading a lot of the articles on T-Nation over the past few months and am itching to get back in the gym. In particular, I have been really interested in Chad Waterbury's workouts, which generally incorporate full body workouts utilizing mostly compound lifts with relatively heavy weights. Now that I am going to be around my Dad's more often I figure I can relatively easily make it to his gym 3 times a week. I'll be following the plans outlined in Chad's newest book Huge in a Hurry, which I've found to contain a solid combination of experiential and scientific knowledge. Definitely check the book out if you are looking to try something new in the gym. As Chad mentions, most of what he's advocating is not new, but the way in which a lot of it is done (lifting fast, for example) is relatively different. I have no doubts that it's going to help me get to where I want to be.

I'm going to be backpacking for a month in about a month, and that is going to make things interesting in terms of getting stronger while walking 10-20 miles a day. But at the very least I'm going to be doing some body weight exercises and other relatively non-conventional stuff (in addition to a ton of walking) to stay as strong as I can. Check out my other site, Nakasendo Solo, for info on my trip. I'll post my "MacGyver Backpack Training Plan" here and over there for those who are interested.

For now, here are my stats and some pictures so that I can stay on track and you all can follow my progress. I have no doubt that by the end of the summer I'll be in much better shape and feel a lot better about where I stand.

Baseline

Weight: 170 lbs.

Height: 6'4"

Pictures: (Forthcoming)

I'm Around Here Somewhere

It's been quite a while since I've last posted, promising to provide some reviews of the schools I interviewed at for entrance in 2013. I'm still going to do that - sort of. At this point, I've heard back from every school I applied to way back last summer, and have narrowed my choices considerably. For anyone who cares and doesn't know already - I'm essentially deciding between The University of Pennsylvania School of Medicine and The University of Chicago Pritzker School of Medicine. My new plan is to record my impressions of each school after the interview and revisit weekends over the coming two weeks.

Here's the breakdown of how things worked out for me this interview season. (Keep in mind that I had to apply before I knew my MCAT score so there is quite a range of schools and far too many of them, which is why I didn't even interview at some of them after I got an invitation. If you know your scores don't be dumb and apply to less schools than I did.)

Accepted

• University of Pennsylvania School of Medicine
• University of Chicago Pritzker School of Medicine
• Albert Einstein College of Medicine
• NYU School of Medicine
• BU School of Medicine
• SUNY Downstate School of Medicine

Waitlisted

• Yale University School of Medicine
• Columbia University College of Physicians and Surgeons
• Washington University in St. Louis School of Medicine
• Weill Cornel Medical College

Rejected

• Harvard University Medical School
• Stanford Medical School
• UCSF School of Medicine

Didn't Even Bother To Reject Me

• Johns Hopkins School of Medicine
• New York Medical College

I Didn't Finish The Application/Didn't Go To Interview/Forgot to Withdraw Application

• Tufts University School of Medicine
• Stony Brook School of Medicine
• Northwestern School of Medicine
• Mount Sinai Medical School
• Duke University School of Medicine

After all this, I can say with absolute certainty that applying to Medical School is a hilarious and painful thing, full of ups and downs. After getting into the University of Chicago early on in the game I withdrew my application from quite a few places. Then I was waiting pretty anxiously during February and March to just hear back from the rest of my schools, and was rewarded with a slew of disappointing waitlist decisions. I would say I was at my lowest when I got accepted to Penn, literally the last place I was waiting to hear back from, and strangely also the most highly regarded place I interviewed at - go figure!

Interview Feedback

This new (multiple installment) section is going to be a rolling catalog of all the medical schools I visit over the next few months for admission to the class of 2013. I envision it serving two primary purposes: 1) It will allow me to remember facts and perceptions of the particular school that I would otherwise forget by the time May comes around 2) It will hopefully provide others with a candid evaluation of these schools.

I'll take a moment here to mention www.studentdoctor.net, which is invaluable in learning about the school before you show up for the interview. In the Interview Feedback section of the site you will find people's reactions to the interview day, lists of questions they were asked, and information on what kind of interview format to expect. I've prepared for all of my interviews so far by looking over the feedback for the past year or so, consulting the school's website and promotional material, as well as reviewing for a few standard questions like "why medicine?". I'd recommend a similar program for just about anyone, because it really does take some practice to get these things down. But more on all of that later, I will try to put together a comprehensive interview prep post at some point. For now, I need to work on the feedback. Cheers.

What Makes A Good Doctor?

There comes a time in the life of (some) pre-med students when they must ponder the age old question: what makes a good doctor? Normally this happens as one prepares for the interviews you've (hopefully) been invited to - perhaps the most important part of the application process. And so as I prepare to travel across the country for my own interviews, from St. Louis to Chicago, Boston to Michigan, I've been asking myself the same question: what is it that really makes a good doctor?

In college, most of my pre-med classes focused on weeding out those students who "can't cut it" and cramming in as much generally irrelevant information as possible. This is, to my mind, beneficial for only a few reasons. Firstly, it teaches you how to jump through those hoops. Because let's be honest, life as a doctor (and especially medical school) is full of hoops you're going to have to get used to jumping through. You can bitch all you want about the fact that you'll never need to know the mechanisms of Grignard reagents, but it won't change the fact that you have to learn it and do well on your exams. Also, it acclimates you to assimilating large quantities of information, which will only increase by orders of magnitude if you make it to medical school. But often, I've wondered if despite the few benefits of this "trial-by-fire" approach, we're just selecting for (in the evolutionary sense) the biggest tools around to join the medical profession?

I got solid grades in most classes I took in college. But the only way I was able to do that was by first distancing myself from the entire "pre-med" scene and mindset, majoring in the humanities, and drinking heavily. I'm guessing that of all the kids in my organic chemistry class (400 or so), about 30 or 40 got A's. Of those 30, how many of them, would you say, were pounding 2$ PBRs with me on Thursday night? Or inhaling cheese steaks and watching football instead of studying on Sundays? Not many. Most of the pre-meds at my school were so socially retarded that the only thing they had to talk about was their grades. They generally only hung out with their other pre-med friends. And they invariably failed to realize that their 3.9 GPA is about as unique as the dyed blondes with tramp stamps my friends were hitting on in the bar last weekend. So I guess what I'm also asking is, are these the students that become good doctors?