An End To The Silence

The few of you following my blog (thank you, by the way) will have noticed that I did not post at all during August. Or if you did not notice that fact specifically, you probably did observe that a good while went by without so much as a whisper from me. No worries, nothing is wrong. I'm not sick, I'm not dying, and as you saw from my two recent posts, I have not changed my mind about becoming a doctor.

So why the silence? Reason #1: busyness. August was the-month-to-get-everything-done-before-school. And when you have a family, a house, a husband, and other such life elements, figuring out how to manage them on a totally different schedule takes some time, juggling, and preparation.

Reason #2: business. Yes, I have my own business, called The Artful Diner. As with most artists, I won't be able to retire off my income from it, but the extra money helps, and I enjoy it. As the name implies, my work has to do with dining. And indeed, I make decoupaged dishware and beaded / wire-wrapped utensils to sell online and at art shows. At the end of July, I heard about a local art fair that I really wanted to participate in. I signed up, paid my fee ... and then realized I needed more inventory. So I spent the next several weeks in full production mode. (My dining room -- aka my "studio" -- still looks like a hurricane swept through it, much to my husband's delight.) Here is a link to my Etsy.com storefront, and a few photos of my recent work.

My Etsy storefront link: The Artful Diner



Here are some coaster sets I have painted and decoupaged with marbled paper (this is a new thing I am doing now):

Another new item for my online store this season is pillar candle stands. These are flat pieces of glass, with paper (and often vintage ephemera) decoupaged on the underside, on which you can put a tall pillar candle. The wax drips onto the flat, glass surface, and you just scrape it off. Here are a couple photos of those:

A set of six small decoupaged bowls:

A decoupaged serving tray, complete with a stand:

So rest assured: I have not been idle with my time. Between the life busyness and my business, posting on my blog fell between the cracks. But I missed writing during that time, and especially writing about science and medicine, so you may also rest assured that I will not let that happen again.

The Genetics Of Synthesis

"Synthesize." When I worked as a textbook editor at McGraw-Hill, we used that word all the time in our literature textbooks. (Usually in the context of asking -- rather, telling -- students to synthesize a number of elements.)

And now here I am, a student myself. And yes, I am synthesizing, too. But I will get to that shortly.

First, what is synthesizing and synthesis? It is, according to Merriam-Webster's online dictionary, "the combining of often diverse conceptions into a coherent whole." In other words, taking different pieces of evidence, material, readings, experiences, and so on and making sense of them when put together. It is an incredibly complex cognitive process, far beyond mere comprehension, even above analysis.

At the university level, it is rather taken for granted that students are capable of synthesis. Homework, quizzes, and exams require it. So to do well, it is necessary. But what is really exciting is the synthesis that happens independently of all of that required work. It may not boost your grade, but it should boost your confidence that you are understanding -- and connecting with -- the material. 

At least, that's what it does for me. It also encourages me that I am on the right track with what I am doing. Because making these kinds of connections (when it's not required by a professor, that is) requires not only knowledge, but interest. And a little passion doesn't hurt, either.

For me, the lightbulb flared this morning as I was reading my biology textbook. I will be honest -- reading that monstrous (read: insanely heavy) book was not what I felt like doing at 7:30 a.m. But I wanted to be prepared for my morning lecture, so read I did. While the whole selection -- relating the evolution of mammals -- was fascinating, the true reward lay in a nugget on the very final page: a one-paragraph blurb on a gene called FOXP2, thought to play an important role in human language. (And since language is one thing that sets us apart from our ape cousins, this gene is also thought to play a role in the evolution of Homo sapiens). 

"FOXP2 ... FOXP2 ... FOXP2 ... where do I know that from?" I asked myself as I finished reading. I knit my brow, cocked my head, and pursed my lips as I searched my brain for a possible link. Because I knew I knew that gene from somewhere. And then it dawned on me: my summer research. Olga had been looking for evidence of FOXP2 expression in her lung cell samples. Because while FOXP2 is involved in language development, it is also involved in cell proliferation (growth) in the lungs, and hence could signal the presence of stem cells. 

My eyes lit up and I laughed out loud. Synthesis indeed.

As I write this, I realize that maybe it sounds strange to get all warm and fuzzy about genetics and research. But I just can't seem to help myself.

Note: Of course, I had to tell someone who would really appreciate this "discovery." (Telling my husband, Geoff, didn't quite do it -- merely the letters "D - N - A" make his eyes glaze over). So I headed to my bio professor's office hours after my last class and told him I'd had an "interesting encounter with our biology textbook." That sure got his attention. We had a nice talk. He knows me a little better, and vice versa. One of the best parts of my undergrad education was getting to know my professors well and being mentored by a handful of them. I hope for that same kind of experience this time around as well.

The Honeymoon Will Soon End ... but that's OK

I am officially a pre-med student.

Correction: I have been for just over a week now. But it hasn't really sunk in yet, because this is still the honeymoon stage. All love songs, hugs, and kisses -- no slammed doors, curse words, or broken dishes (yet).

Everybody is still in friend-making mode; there are few cliques or ways to feel excluded, if you make an effort to be social. Everything comes easily at the moment: I still remember all that we have "learned" so far, even though I've barely touched a biology, chemisty, or physics textbook in more than a decade. Every grade is an A right now -- we haven't had any assignments, exams, or quizzes on which to lose points. The sun is shining, the future is bright, and everyone still has a chance to get in to medical school.

Soon that honeymoon will end. There will be late nights up studying before exams. And then the actual exams. Weekends lost to lab reports after hours spent in the lab during the week. The anxiety of eventually applying to medical school. The dread of not getting in.

So why do it? Is the destination worth it?

Hell no.

Don't get me wrong -- I can't wait to be a doctor. I think I'll be a pretty good one, and I have a feeling I'll enjoy it. But getting there is a long road. Years, literally, of your life. Anyone who thinks they can just push through without having any appreciation for the journey there will be incredibly miserable for an incredibly long time. And, I think, become bitter and angry about it. Yeah, that bodes real well for a person's bedside manner, doesn't it?

I'm one of those crazy people who actually likes school. When I'm interested in something, learning about it is a pleasure (most of the time -- ask me at 3 a.m. and I might tell you a different story). I'm excited about where I'm going, but I'm also excited about what I'll be doing along the way. And to do this, you have to be.

That's why it's OK that the honeymoon will soon end. Because when it does, that signals the beginning of a deeper, richer relationship with the subject matter. (For this school year: biology, chemistry, and physics.)  Sure, it will be harder. And sure, I may complain about that sometimes. I may struggle. I may even use four-letter words (*gasp*). But I wouldn't trade places with anyone.

Stay tuned.

ADCOM Q&A (learning from your mistakes)

Everyone makes mistakes. Even pre-medical students. And one trend I've noticed in the medical school interview questions I've looked at (this applies to job interview questions as well) is that the interviewers quite often will bluntly ask you about those mistakes or other shortcomings. For example, there is the infamous "What is your greatest strength and weakness?" question, which I have been asked in multiple job interviews. A similar medical school question I found online literally begins with these words: "What has been your biggest failure ... ?"

Clearly, though, if an applicant goes on for 10 minutes about how badly he did in organic chemistry, that's not going to go over well. That's why the question about your "biggest failure" ends with these words: "... and how did you handle it?"

So if an applicant did poorly in organic chemistry, explaining why he didn't do well -- such as that he didn't have good study skills -- and then what he gained from the experience -- such as that he developed better study skills as a result of his failure-- would be a much better answer.

ADCOMS want to hear us pre-meds admit that we're not perfect, and then talk about what we have learned from our mistakes, shortcomings, failures, weaknesses, and other "problem areas." Because failing is part of life (as much as I hate to admit that). It's what you do after you fail that sets you apart from other people.

The reality is, everyone falls down sometime. The question is: Do you get back up?

My answer is: YES. And here's an example from my childhood.

(Let me preface this example by saying that I was homeschooled from preschool through the end of fifth grade. So when I talk about my mom giving me a test ... it's because my mom was my one and only teacher from age 4 to age 10.)

When I was about 7 or 8, my mom gave me an impromptu spelling test. You know the kind -- the ones that are supposed to gauge where you are and where you need improvement. They're called diagnostic exams, I believe. As someone with something of a failure complex, I hated these exams because I never did well on them -- you're not SUPPOSED to do well on them. At the time, this point escaped me.

Anyway. I miserably failed this spelling test. I don't remember the number of right and wrong, and it's probably better that way. I was distraught at first. I had failed! What was I supposed to do? Then my mom sat me down and explained the purpose of this "diagnostic" exam. Her explanation brought some comfort. And in the end, while I was not necessarily happy that I had failed, I understood that the test pointed out some areas where I needed to improve.

And so I made it my absolute mission to become the best speller possible. I learned all the rules. I memorized the exceptions. I practiced spelling words until I was practically murmuring them to myself under my breath in the bathtub.

Then came time to take the exam again. And I aced it. All that work paid off -- I had learned what I didn't know, what I needed to work on, and I made it a point to not make the same mistakes again.

And guess what? When I attended public school a few years later, I went on to win several school spelling bees, and even a district spelling bee.

To this day I am a fantastic speller, and in my previous jobs, earned a reputation as such. All because I failed an elementary school spelling test and made up my mind that wasn't going to happen again.

And while I still don't like failing (although who does?!), I try to remember this example when I do. Because it proves that you can learn from your mistakes. And perhaps, that without making mistakes, we wouldn't learn quite so much.

ADCOM Q&A (working under pressure)

Being a doctor is, quite often, about working well under pressure. If someone stops breathing, for example, you better figure out how to get them breathing again, and quick! There is no time for consulting the Internet, a textbook, or (very often) other doctors. You must act. Now. Or someone might die.

That's why ADCOMS often ask pre-medical students a variation on this question (which I found on the Internet on a list of practice questions): How do you work under pressure? Give an example. What, in hindsight, were you most dissatisfied with about your performance? What did you learn from your experience?

"I'm no stranger to working under pressure," I thought when I read that question. And that is the truth. For the year and a half that I worked at the Forest Park Review, a local weekly newspaper in the Chicago suburbs, "pressure" was my constant companion. (And this was my first job out of college, so I learned it early.)

It was especially intense, though, on Tuesday mornings. That was deadline day, when the paper was sent to the printer. I would wake up at 2 or 3 a.m. in order to write a half-dozen or so stories and an editorial by 7 or 7:30 a.m. And then I would go to the office. What for? For another three hours of deadline drama: writing headlines, creating captions, approving page layouts, and so on. It was grueling.

But through it all, I had to be at peak performance. Exhaustion was no excuse. I had to get the facts right, get the dates right, and get people's names right. And do it all in captivating prose. Oh, right -- make that captivating prose in less than 700 words per story.  

But I didn't need any excuses. In fact, I kicked things up a notch on deadline day. I was intense, driven, focused. When I have a goal, and time constraints for completing that goal, I find myself subdividing time into estimated allotments for each portion of the task I have to complete. This helps me stay on track so that I don't spend too much time doing any one thing. On deadline day, that might mean 30 minutes for one story, and one hour for another. (I prioritized as well as subdivided.)

The process was intense, and I was intense during the process. It was hard to turn that intensity off right away. So when I'd leave the newsroom at around 11:30 a.m. or noon, snippets of stories would float through my mind. And I would question myself: Did I do X right? Did I change Y like I told myself I needed to? Maybe I should have opened that one story with another lede ...

Then when I saw the newspaper the next day, I saw the in most cases, yes, I did do X right, I did change Y, and in actuality the lede I opened on that one story with was fantastic.

I gradually learned to trust myself, not to second-guess myself in those high-pressure situations. Because I knew what I was doing, I really did, I just needed to BELIEVE that I knew what I was doing, and go with that. Because it was often the second-guessing that led to the mistakes.

This is an essential skill for a physician to have. There is often no time for second-guessing. Making a second guess might mean your first act is one moment too late. So trusting yourself, your skills, and also your intuition, is something that a physician must do ... is something that hopefully I will one day do.

ADCOM Q&A ... (an introduction)

ADCOM (ăd´kəm) n. An abbreviation that refers to a member of a medical school admissions committee. Can also refer to the medical school admissions committtee as an aggregate. ADCOMS are, essentially, the gatekeepers to medical school. It is their decision--based on a student's application, GPA, MCAT score, and interview--whether the student will be offered a slot at that medical school. Thus pre-medical students refer to ADCOMS with, alternately, fear, derision, and respect.

 -----                                                     

The above definition (my own) is the way most people think about the ADCOMS: cold and impersonal. And in a sense, they are. They have to make dozens of decisions, based on established criteria, in a limited amount of time. To do that effectively, you have to be a bit calculating and unemotional. (That is not meant as an insult, rather as a compliment.)

On the other hand ... ADCOMS are people. In fact, I know a handful of them personally. They smile, laugh, eat, sleep, do all the things we "normal" humans do. I have even found them to be helpful, if you can believe that. No, they are not the enemy. In fact, it would behoove more pre-med students to make ADCOMS their friends. But that is a topic for another day.

Right ... ADCOMS are people. Which means that, essentially, they respond as people, at least on some level. They possess curiosity and emotions, for example, which no amount of established criteria can completely wipe away. (That's my belief at least, however naive.)

Why do I care about all of this? The reason is simple: in a couple of years, the ADCOMS will hold my fate in their hands. So I need to understand what that means. And what that means is that I need to affect them -- to stand out above my peers -- in some way that says "Look at me! Choose me! I'm different! I'm the ONE!" I need to do this both on my application and during my interview. (Um ... in a slightly more subtle, professional way, of course.) Because there will be, literally, thousands of people just as qualified, on paper, as I am. And not all of them will get in. I want to be one of the ones who gets in.

So how do I do that? Well, there's no sure way, of course. The best way I can figure (other than do well in school, do well on the MCAT, volunteer, and get clinical experience, which are givens) is to get into the right mindset. No, I haven't gone all New Age-y. What I mean is to think about what the ADCOMS will likely want to know beyond my statistics, what types of things they are likely to question me about during my interview, and have my answers ready. And no, I'm not trying to predict the future and conjure up a list of questions that I will be asked.

My plan is two-fold: to prepare for common questions (i.e., "Why do you want to be a doctor?") and for common categories (i.e., medical current events), using sample questions to jump-start -- but not contain -- my thinking. Because the sample questions I have found online (and believe me, there are hundreds) are only a small slice of what could potentially pop up. I then plan to use this blog as a sounding board for some of my potential (but certainly not final) answers.

You might be wondering why I am giving away my strategy, and why I plan to give away some of my answers. After all, couldn't the ADCOMS, then, just ask me different questions than the ones I've prepared for?

To address the first issue: My strategy is not brilliant. It is common sense. So why hide it? In fact, I'd kind of like the ADCOMS to know that I can analytically approach something and realize it has a real-life, common-sense solution (as opposed to a nebulous theoretical one). There are plenty of pre-meds I've met -- very smart people, to be sure -- who have exactly zero common sense. I understand theory; I also understand real-world application. To be a doctor, you need to be able to understand both. So read on, ADCOMS!

To address the second issue: I don't plan to write a blog post about every single question or question type that I prepare for. That would take for frickin' ever. So I am not worried about showing my whole hand. Showing part of it, though, I don't think is such a bad thing. The medical school interviews I will (hopefully) have will be short, and there will be no way for me to communicate to the ADCOMS everything I want them to know about me. If they stumble upon my blog and discover some more pertinent information that puts me in a good light, even if it means they throw in a few more difficult questions during the interview, it is worth it to me.

As I see it, the ADCOMS and the interview are not what keep you OUT of medical school (which is how a lot of people seem to look at it), they're what get you IN. So best to embrace them, early and often.

Managing The Seagulls' Sh** (and other messes)

In my last post, I explained how I think that I might have a decent start when it comes to developing a good bedside manner--i.e., working well with patients. What I didn't take into account in that post, however, is that you don't only work with the patient. You also work with the patient's family. And that can create its own set of problems, dilemmas, and conundrums, as a hospice nurse I know explained to me this week.

Take the case of Mr. Martinez, * a terminal lung cancer patient. Most hospice patients have a DNR--a "do not resuscitate" order, which directs hospital and emergency personnel to NOT use life-saving techniques such as CPR or a ventilator, but to let the patient die naturally. Mr. Martinez, a native of Argentina, does not have a DNR, although he would like to have one. Why? Because his son, who still lives in Argentina, wants the father's life prolonged until he can make it to the United States to say goodbye to his father. The father doesn't have the heart to disagree. While this seems like a natural desire in a way, it really is very selfish, the nurse explained--it would mean keeping the father alive, perhaps in pain, just so the son can meet his own emotional needs. And it's not like the son never sees the father; he visits every couple of months, and has had plenty of opportunity to say a meaningful goodbye. Because what do you really gain from seeing an empty, non-communicative shell that's kept alive by a machine?

The nurse I know said this is a common situation--family members simply can't let go, even when the end is imminent. So it has become her job to try and convince the son--via e-mail, since he is in Argentina--to encourage the father to have a DNR. Not a task I envy, that's for sure. It's one that requires great finesse, compassion, and understanding. And a thick skin, to boot. All done in a one-way conversation, without facial expressions, body language, or vocal inflection--all tools that can be extremely helpful when trying to talk about something so serious and traumatic. 

Mr. Martinez's son, an out-of-town family member, is what one of the nurse's co-workers calls a "seagull"--someone who flies in, sh**s on everyone and then flies out. They want to help, and they (usually) have the best of intentions, but they don't really know the day-to-day situation or the intricacies of their family member's care (or health condition). So they rather muck things up. Often, they step in so aggressively and vehemently because they feel guilty for not being there on a more regular basis, the nurse told me, so they feel they must "fix" what seems "broken" to make up for that absence. When really, the opinionated assistance often does more harm than good. 

But it's not just the "seagulls" who can cause a wrinkle in a patient-care situation. Nearby relatives, even daily caregivers, can create serious problems, the nurse told me. She related the story of one family where two sisters were, in her words, "at each other's throats." Just about literally, it seems. One of the sisters actually called 911 on the other sister because she felt that sister wasn't appropriately administering the patient's medication. 

The kicker? The patient's problem was agitation. I doubt if sirens, police, EMTs, and whoever else showed up helped alleviate the symptoms the sisters *claimed* they were so concerned about. 

This is another situation that, as a health care worker, would be a sticky one to resolve (if a resolution was even possible--a temporary cease fire might be your best bet).

This is not to say that family members are always a source of trouble and ire. As the nurse told me, "Family can also be the greatest resource." When that happens, it makes the health care worker's job infinitely easier and richer. So you hope and pray for this scenario.

But for those times when the family members seem to be working against you rather than with you, I imagine you must tap deep into yourself for strength, composure, patience, and endurance. And still, even though it seems undeserved, compassion. Because while the family members may be making your life hell, you have to realize that their life is hell right now, too.

Come alongside. Understand. Empathize. And then maybe you stand a chance not of changing the family, but of helping them to decide to change themselves. 

* Names and details have been changed to protect patient anonymity.