It's 1645hrs on a Friday afternoon in late March. If I'm writing a post, it means either a) there isn't enough lab work for me today, b) I'm avoiding my lab work, c) both, or d) happy hour is nigh. Maybe some combination of all the above.
I recently finished all the rigorous lecture-based coursework for the graduate phase of my training. All that is left is to tweak my project to get an impressive enough quantity of data, do some tutorials with individual faculty members, take some more seminars, do qualifying exams (both written and oral). So, there's a ton more to do.
But something about this time of year always makes me feel so optimistic and forward looking. That something is the match list. In three pages, I can browse the future hospital, program, and specialty of every graduating senior in the medical school class. It looks, without question, quite impressive. And this year, I'm looking at names of people I know, people with whom I attended parties, with whom I compared notes about how to study for exams and how to make it through difficult stretches with research. Granted, nothing can prepare me for the match list next year, in which my first and second year colleagues will be the beneficiaries of The Match.
The problem I have with scrupulously looking over The List is that it allows for a thought experiment that eerily reminded me of what I did when finding out about my older friends and their successes in applying to medical school. Mulling over the final product of the labor of others takes time, but worse, it's like Facebook stalking someone [1]. You sum up a person based on a nifty quotation, a photograph, a really impressive status, or any number of other inane metrics. With The Match, one does the same kind of simplification/idealization. It's toxic. It allows me to say, "Well, because I have a similar board score to Mildred, or better research credentials than Jose, or more impressive clinical skills than Felipe, I surely can get into otolaryngology at UCLA as well!"
Perhaps the internal dialogue above is most indicative with the problem many of us (especially yours truly) have when we look at the achievements of others. We can't but help project onto/into/through ourselves. To do so with The Match not only makes a decision based on years of work and on many challenging moments of reflection seem boiled down to a single line on a PDF accessed securely through the medstudent website. It shouldn't be. So I guess my concluding emotion on The Match for MSTPs graduating this year is, "Well done, guys. Looks like you matched to impressive programs." And for at least one student, I know he matched to the specialty and institution of his choice. That's something worth celebrating.
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1. Yes I've facebook stalked before. Not something I'm proud of, but at least I'm willing to admit it. I could probably write a small opus about the feelings I've had during (and with regards to) FB stalking.
Friday, March 27, 2009
Sunday, March 15, 2009
Sit on top of the mountain...
I helped host a beer hour on Friday afternoon in my department. It was the usual host of suspects: faculty, grad students, post-docs, lots of beer and pizza, and inhibitions dissolved.
I'll keep this brief, for once.
I can't help but think, as an MD/PhD student, people think of me in a vastly different way than they do about graduate students. I'm not sure why, exactly, but:
1. They think we're really crazy. No, really crazy, obsessed, ambitious, etc.
2. They say things like, "When you're done with getting both degrees, you'll need to sit on a mountain top for a year and smoke lots of pot."
I couldn't "take a year off" (what does "taking a year off" mean anyway?).
How about just a weekend?
P.S. Really working hard in grad school is similar to studying for boards. Research can easily become your life. And according to people who do science PhDs, it almost should become your life. Just saying.
I'll keep this brief, for once.
I can't help but think, as an MD/PhD student, people think of me in a vastly different way than they do about graduate students. I'm not sure why, exactly, but:
1. They think we're really crazy. No, really crazy, obsessed, ambitious, etc.
2. They say things like, "When you're done with getting both degrees, you'll need to sit on a mountain top for a year and smoke lots of pot."
I couldn't "take a year off" (what does "taking a year off" mean anyway?).
How about just a weekend?
P.S. Really working hard in grad school is similar to studying for boards. Research can easily become your life. And according to people who do science PhDs, it almost should become your life. Just saying.
Monday, February 02, 2009
Just a heads up
For anyone coming to UCLA for an interview, if you're arriving from LAX and plan on taking the Westwood FlyAway bus, be aware that the fare is now $5.00 (exact change required) and the hours are 6am - 11 pm (this used to run until 1 am). I realized this during a rather unfortunate hour of waiting at LAX last night that ended in a $40.00 cab ride home. For more information, here is the LAX flyaway bus website. Click on "Westwood." Of course, you can always send us questions at mstpla at gmail dot com.
Saturday, January 24, 2009
Learning and trying not to forget
I can't help but think I took the red pill when I decided to enter the MSTP at UCLA. I had no idea what I would find, but I knew it would be too much to grasp at first. Or ever. And yet, two years and seven months into it, I'm starting to see the beauty of this journey all over again.
One might imagine that I'm about to launch into an (albeit weak) attempt at philosophizing [1] about the experience that is MSTP at UCLA. I am not. I just want to share some of my sentiments, now that I feel firmly entrenched in the PhD phase of my training. And I want to say that, while I do not endorse any one way at how to go about this, I will invariably focus on issues as they pertain to my roadmap. But others (Jeff, Anthony, et al) have much different roadmaps in mind, and I think they are finding similar satisfaction [2].
Which is to say the following: I do an overnight of call [3] in the Fourth Floor East Medical Intensive Care Unit (MICU) in the Ronald Reagan UCLA Medical Center (RRUCLAMC). I've watched numerous central and radial arterial lines get placed, I've seen a couple patients die, I've attempted (and failed) to draw an arterial blood gas, I've watched (and sort of helped with) endotracheal intubations, I've run when the words "Code blue team, code blue team," go up over the loudspeaker in the middle of the night. I've seen the spectacle of a patient being cardioverted during and acute atrial fibrillation episode, I've sat in on family meetings for parents whose grown children are dying, I've seen the same patients, in the units for months at a time, while pressors, ventilators, oxygen, blood, blood products, plasma, dialysis, fluids, antibiotics, keeping them alive for weeks and months longer than seems even possible [4]. In short, I've obtained a crash course into one of the most exciting and indeed "critical" areas of inpatient medicine, the ICU.
I started doing this unofficial-ICU-call-longitunal rotation in November, and I have since been in the unit, usually on a Friday night into saturday midday, every other week. I generally will arrive at campus on Friday morning at 7-7:30 a.m., do work in the lab until late afternoon/early evening, and then a call night begins [5]. I began this work when my class schedule prevented me from continuing my once-a-week clinical exposure. Logistically, the MICU call was the only way to continue some clinical exposure.
There's another reason, too. If you recall [6], I had become frustrated with some of what I had learned about scientific research. Basic science, it seemed, suffered from the same failings that evidence-based medicine (EBM) does, or of empirical and non-data-driven clinical care. And I was asking myself a series of questions about what I had gotten myself into [7]: Why was I doing this? Am I forgetting everything I learned in the first two years of medical school? What am I really trying to do?
I don't have answers to those quasi-philosophical questions, but the beauty of the last several months is that I don't even need answers to them. The ICU work, as infrequent (Q2wks) and humbling as it is (I really don't know shit [8]), has filled a small void. Somehow, since this has started, my research has flowed a little more nicely -- maybe because I take advantage of the time I am in lab, or maybe because I get a twice-a-month dose of why I am doing all of this. This isn't just the "I want to help people" sentiment. Certainly, when you watch young and old patients alike fading away from devastating illnesses, you can't help but feel some sense of sadness, sympathy, or frustration. But there's also this sense that, both at a very basic level (mechanisms, molecules and targets, animal models) and from the clinical perspective (drugs, monitoring schemes, preventitive measures) there are astounding amounts of work to be done by physicians, scientists, and physician-scientists. And this is not just for the new sexy cancer drugs, not just for the new stenting procedure for cardiac or neuro patients. I'm talking about really understanding the effects of endotoxin (LPS)-mediated septic shock. I'm talking about further nailing down what causes and how to treat Adult Respiratory Distress Syndrome (ARDS). Medicine spends a lot of time - in the hospital, the ICU - well documenting and observing these phenomena via critically low blood pressures, decreased oxygen saturation, multi-organ failure, positive disseminated intravascular coagulation (DIC) laboratory values, the list goes on. Physicians spend sleepless nights managing these patients. Researchers, who see around the corner to translational medicine, want to challenge assumptions that are in the textbooks and clinical references with fresh new experiments.
Not to belabor a point, but both medicine and research have much to contribute. I think that's cool, and I still want in [9].
Several final points:
Ultimately, the great challenges of medicine are not unlike the great challenges of our economy. We are still trying to figure out what causes disease, and yet we are treating diseases nonetheless. It's sort of like going with a one trillion dollar bailout to a problem without knowing exactly what caused the crisis in the first place and thus without quite knowing what to fix. Said Warren Buffett:
The answer is nobody knows. The economists don’t know. All you know is you throw everything at it and whether it’s more effective if you’re fighting a fire to be concentrating the water flow on this part or that part. You’re going to use every weapon you have in fighting it. And people, they do not know exactly what the effects are. Economists like to talk about it, but in the end they’ve been very, very wrong and most of them in recent years on this. We don’t know the perfect answers on it.
Replace "economists" with "physicians" or "scientists" or both. Needless to say, the quotation is more than applicable to how we approach numerous diseases. Our information is incomplete, our assumptions have been (and will continue to be) proven wrong. But you must keep flowing the water. Our basic sense of humanity requires it.
And so, more than ever, the MD/PhD path is for me. The rest is a mystery.
-----------------------------------------------------------------------------------------------------------------
1. The difference between philosophizing and sharing sentiments is sort of like the difference between using data to generate an exciting new model for some physiologic process (say a pictogram of vesicle fusion) versus simply sharing some exciting data. I would argue that here, and in most writings on this blog, we're simply trying to present our data, our observations, de novo, roughly as they happen and our thoughts about them (the data, observations) crystallize a bit. I doubt there's an MD/PhD or MSTP graduate out there who could package the experience into a philosophical model.
2. It doesn't matter what position you do it in, just that you're doing it...at least that's what she said.
3. This is a misnomer in my case. Medical students don't get "called." Case-in-point: two "calls" ago, the resident and intern with whom I was taking the overnight received a page from the Emergency Department for a patient w/ Diabetic Ketoacidosis needing to be admitted to the ICU. The resident claims she tried to wake me up by knocking on my door. "But you had my pager and cell phone number." But she didn't call. A weak knock, a med student doesn't respond, and it's just as well -- I get an extra hour of sleep, and it took the resident and intern no longer than thirty minutes to work the patient up and admit her to the unit. It probably would have taken twice as long if I was "helping." Which is also to say the following: medical students generally don't contribute much, especially if they aren't part of the ongoing care of patients (i.e. are on a rotation or a sub-internship, where they actually contribute little tasks to the medical team). Coming in for a night of call as a (quite inexperienced) medical student generally doesn't result in much help to anyone, except himself. It's this strange feeling of importance (white coat, "helping" make medical decisions) while being utterly inconsequential.
4. Or humane. Or natural. Or fair.
5. Sometimes a resident's page indicates a new admission, and at 4:30 pm I'm rushing out of lab to the ED, in scrubs and a white coat and feeling unsure of my uniform and skill set.
6. Go back to some previous posts, most recently one containing the sentence, "Yawn," or the phrase, "selling out but for less money," and you'll get the idea.
7. Admittedly, the risk of becoming overtly philosophical is highest at this point of the post.
8. If you really want, recall that I wrote these same words in a post during the first week of first year of medical school.
9. That's why I joined an MSTP. In some ways, this post feels like I'm re-writing my personal statement explaining why I want to join a medical scientist training program.
One might imagine that I'm about to launch into an (albeit weak) attempt at philosophizing [1] about the experience that is MSTP at UCLA. I am not. I just want to share some of my sentiments, now that I feel firmly entrenched in the PhD phase of my training. And I want to say that, while I do not endorse any one way at how to go about this, I will invariably focus on issues as they pertain to my roadmap. But others (Jeff, Anthony, et al) have much different roadmaps in mind, and I think they are finding similar satisfaction [2].
Which is to say the following: I do an overnight of call [3] in the Fourth Floor East Medical Intensive Care Unit (MICU) in the Ronald Reagan UCLA Medical Center (RRUCLAMC). I've watched numerous central and radial arterial lines get placed, I've seen a couple patients die, I've attempted (and failed) to draw an arterial blood gas, I've watched (and sort of helped with) endotracheal intubations, I've run when the words "Code blue team, code blue team," go up over the loudspeaker in the middle of the night. I've seen the spectacle of a patient being cardioverted during and acute atrial fibrillation episode, I've sat in on family meetings for parents whose grown children are dying, I've seen the same patients, in the units for months at a time, while pressors, ventilators, oxygen, blood, blood products, plasma, dialysis, fluids, antibiotics, keeping them alive for weeks and months longer than seems even possible [4]. In short, I've obtained a crash course into one of the most exciting and indeed "critical" areas of inpatient medicine, the ICU.
I started doing this unofficial-ICU-call-longitunal rotation in November, and I have since been in the unit, usually on a Friday night into saturday midday, every other week. I generally will arrive at campus on Friday morning at 7-7:30 a.m., do work in the lab until late afternoon/early evening, and then a call night begins [5]. I began this work when my class schedule prevented me from continuing my once-a-week clinical exposure. Logistically, the MICU call was the only way to continue some clinical exposure.
There's another reason, too. If you recall [6], I had become frustrated with some of what I had learned about scientific research. Basic science, it seemed, suffered from the same failings that evidence-based medicine (EBM) does, or of empirical and non-data-driven clinical care. And I was asking myself a series of questions about what I had gotten myself into [7]: Why was I doing this? Am I forgetting everything I learned in the first two years of medical school? What am I really trying to do?
I don't have answers to those quasi-philosophical questions, but the beauty of the last several months is that I don't even need answers to them. The ICU work, as infrequent (Q2wks) and humbling as it is (I really don't know shit [8]), has filled a small void. Somehow, since this has started, my research has flowed a little more nicely -- maybe because I take advantage of the time I am in lab, or maybe because I get a twice-a-month dose of why I am doing all of this. This isn't just the "I want to help people" sentiment. Certainly, when you watch young and old patients alike fading away from devastating illnesses, you can't help but feel some sense of sadness, sympathy, or frustration. But there's also this sense that, both at a very basic level (mechanisms, molecules and targets, animal models) and from the clinical perspective (drugs, monitoring schemes, preventitive measures) there are astounding amounts of work to be done by physicians, scientists, and physician-scientists. And this is not just for the new sexy cancer drugs, not just for the new stenting procedure for cardiac or neuro patients. I'm talking about really understanding the effects of endotoxin (LPS)-mediated septic shock. I'm talking about further nailing down what causes and how to treat Adult Respiratory Distress Syndrome (ARDS). Medicine spends a lot of time - in the hospital, the ICU - well documenting and observing these phenomena via critically low blood pressures, decreased oxygen saturation, multi-organ failure, positive disseminated intravascular coagulation (DIC) laboratory values, the list goes on. Physicians spend sleepless nights managing these patients. Researchers, who see around the corner to translational medicine, want to challenge assumptions that are in the textbooks and clinical references with fresh new experiments.
Not to belabor a point, but both medicine and research have much to contribute. I think that's cool, and I still want in [9].
Several final points:
Ultimately, the great challenges of medicine are not unlike the great challenges of our economy. We are still trying to figure out what causes disease, and yet we are treating diseases nonetheless. It's sort of like going with a one trillion dollar bailout to a problem without knowing exactly what caused the crisis in the first place and thus without quite knowing what to fix. Said Warren Buffett:
The answer is nobody knows. The economists don’t know. All you know is you throw everything at it and whether it’s more effective if you’re fighting a fire to be concentrating the water flow on this part or that part. You’re going to use every weapon you have in fighting it. And people, they do not know exactly what the effects are. Economists like to talk about it, but in the end they’ve been very, very wrong and most of them in recent years on this. We don’t know the perfect answers on it.
Replace "economists" with "physicians" or "scientists" or both. Needless to say, the quotation is more than applicable to how we approach numerous diseases. Our information is incomplete, our assumptions have been (and will continue to be) proven wrong. But you must keep flowing the water. Our basic sense of humanity requires it.
And so, more than ever, the MD/PhD path is for me. The rest is a mystery.
-----------------------------------------------------------------------------------------------------------------
1. The difference between philosophizing and sharing sentiments is sort of like the difference between using data to generate an exciting new model for some physiologic process (say a pictogram of vesicle fusion) versus simply sharing some exciting data. I would argue that here, and in most writings on this blog, we're simply trying to present our data, our observations, de novo, roughly as they happen and our thoughts about them (the data, observations) crystallize a bit. I doubt there's an MD/PhD or MSTP graduate out there who could package the experience into a philosophical model.
2. It doesn't matter what position you do it in, just that you're doing it...at least that's what she said.
3. This is a misnomer in my case. Medical students don't get "called." Case-in-point: two "calls" ago, the resident and intern with whom I was taking the overnight received a page from the Emergency Department for a patient w/ Diabetic Ketoacidosis needing to be admitted to the ICU. The resident claims she tried to wake me up by knocking on my door. "But you had my pager and cell phone number." But she didn't call. A weak knock, a med student doesn't respond, and it's just as well -- I get an extra hour of sleep, and it took the resident and intern no longer than thirty minutes to work the patient up and admit her to the unit. It probably would have taken twice as long if I was "helping." Which is also to say the following: medical students generally don't contribute much, especially if they aren't part of the ongoing care of patients (i.e. are on a rotation or a sub-internship, where they actually contribute little tasks to the medical team). Coming in for a night of call as a (quite inexperienced) medical student generally doesn't result in much help to anyone, except himself. It's this strange feeling of importance (white coat, "helping" make medical decisions) while being utterly inconsequential.
4. Or humane. Or natural. Or fair.
5. Sometimes a resident's page indicates a new admission, and at 4:30 pm I'm rushing out of lab to the ED, in scrubs and a white coat and feeling unsure of my uniform and skill set.
6. Go back to some previous posts, most recently one containing the sentence, "Yawn," or the phrase, "selling out but for less money," and you'll get the idea.
7. Admittedly, the risk of becoming overtly philosophical is highest at this point of the post.
8. If you really want, recall that I wrote these same words in a post during the first week of first year of medical school.
9. That's why I joined an MSTP. In some ways, this post feels like I'm re-writing my personal statement explaining why I want to join a medical scientist training program.
Friday, January 23, 2009
Applicant/prospective OPEN THREAD
In lieu of some posts that are brewing in my head (ICU post, research progress post, other details about the "pretentious" MSTP life), this post is an open thread for applicants and other individuals interested in MSTPs, either at UCLA or in general. So feel free to post away, and we'll offer our thoughts when/if relevant.
Friday, December 26, 2008
Bring it, Block III
Block II introduced the physiology of three organs and how they work together as a system: the heart, the center of the universe; the kidneys, the organ with mysterious forms of regulation; and the lungs, keeping our blood red, not blue or purple (inside joke). The hardest part of the block, though, was parsing the material from lecture, picking and choosing the relevant details, and reassembling it into something more coherent, digestible, which wasn’t that bad. I can’t complain. I enjoyed the material, as long as I didn’t think about it for too long, because when I tried to understand an elusive, mechanistic detail not covered in class, the set of rules given to me failed. What did I expect? Two weeks studying an organ, treating it as something autonomous is risky business: there are who-knows-how-many parameters playing around in the quicksand. So the moral of the story is to have fun learning by picking your intellectual battles: I believe a smart, compassionate student can be selectively apathetic, when appropriate.
Last post I alluded to the holy-grail, the well-intended cliché of balance. I’ll be honest: I wasn’t that successful. Sure I protected an hour here and there for pleasure reading, a weekend free of studying, etc. Something was missing, though: medical school was still dictating my schedule. After talking with my classmates, who have given this issue some thought, I’m teased with the idea that maybe medical school can work around my schedule! So I’ve come up with a New Year’s Resolution: be more promiscuous. *gasp!* This means I’m going to talk to a PI (yes, I have an attractive prospect), attend some lab meetings, read some papers, maybe start a baby experiment!?!?! I also want to read more, write significantly more, volunteer a little, explore my gastronomic talents, and enjoy the culture around me (e.g., the Hammer Poetry Series each Tuesday). I’m ambitious. We’ll see. But I’d like to end the post with a little, hacked-up blurb by the poet Allen Ginsberg that left me inspired to try a little harder. I hope you too can share something from his words, which I feel can be applied to anything you think is creative:
“The parts that embarrass you the most are usually the most interesting poetically, are usually the most naked of all, the rawest, the goofiest, the strangest and most eccentric and at the same time, the most representative, most universal… The cure for that is to write things down which you will not publish and which you won’t show people. To write secretly… so you can actually be free to say anything you want… You really have to make a resolution just to write for yourself…, in the sense of not writing to impress yourself, but just writing what your self is saying.”
Last post I alluded to the holy-grail, the well-intended cliché of balance. I’ll be honest: I wasn’t that successful. Sure I protected an hour here and there for pleasure reading, a weekend free of studying, etc. Something was missing, though: medical school was still dictating my schedule. After talking with my classmates, who have given this issue some thought, I’m teased with the idea that maybe medical school can work around my schedule! So I’ve come up with a New Year’s Resolution: be more promiscuous. *gasp!* This means I’m going to talk to a PI (yes, I have an attractive prospect), attend some lab meetings, read some papers, maybe start a baby experiment!?!?! I also want to read more, write significantly more, volunteer a little, explore my gastronomic talents, and enjoy the culture around me (e.g., the Hammer Poetry Series each Tuesday). I’m ambitious. We’ll see. But I’d like to end the post with a little, hacked-up blurb by the poet Allen Ginsberg that left me inspired to try a little harder. I hope you too can share something from his words, which I feel can be applied to anything you think is creative:
“The parts that embarrass you the most are usually the most interesting poetically, are usually the most naked of all, the rawest, the goofiest, the strangest and most eccentric and at the same time, the most representative, most universal… The cure for that is to write things down which you will not publish and which you won’t show people. To write secretly… so you can actually be free to say anything you want… You really have to make a resolution just to write for yourself…, in the sense of not writing to impress yourself, but just writing what your self is saying.”
Saturday, October 18, 2008
Symposium '08 In Review
Yesterday evening, drowned in glass after glass of wine, the 2008 UCLA MSTP 25th Anniversary Symposium drew to a close.
Yawn.
I believe that conferences - no matter how much excitement they generate - are designed to suck the life out of anyone. To sit through 30+ research talks, have UCLA catering responsible for two day's worth of food intake, and then to become "inspired" to do Great Things when it's all over is impossible.
A more substantive, reflective post to come later. Or not.
Yawn.
I believe that conferences - no matter how much excitement they generate - are designed to suck the life out of anyone. To sit through 30+ research talks, have UCLA catering responsible for two day's worth of food intake, and then to become "inspired" to do Great Things when it's all over is impossible.
A more substantive, reflective post to come later. Or not.
Wednesday, October 08, 2008
Block I Redux: Several hours post-open-book completion
Group dynamics are the ultimate mind-fuck, especially when you are knee-deep in them, with some awareness but not enough to reel yourself out the whole mess. Take middle school and Magic Cards, high school and pervasive faux-ness, college and Natty Ice, and now medical school and anxiety.
The correlation coefficient between exams and anxiety in medical school is approximately 0.99..., and that’s for the pass-fail system. I’m sure pass-fail grading has significantly dampened the anxiety-experience at UCLA, but it still exists because medical students are great at worrying and making you feel like you need to worry as much as they are because no one wants to be That Person who failed Block I.
Block I was an experience, and now that it is over, now that I’m finished test-taking and predicting how comprehensive the block-heads expect my knowledge to be re. the complement system, embryology, etc., I can press the rewind button and revisit these past eight weeks that have progressed oh-so-fast.
I can summarize Block I succulently: Shit, I have learned a lot. Before medical school, I took courses severely detached from medicine like quantum mechanics and NMR spectroscopy. Had you asked me a question about histology, the progression of cancer malignancy, adaptive and innate immunity, I would have responded with blinking. Now I can attempt to provide a bare-bones, over-simplified solution. But hey, something is better than nothing.
Baby steps, I’m telling myself. One step down, two more years’ worth to go. Now that I have grounded myself, my next goal is to balance myself. Medical school throws a lot of information at you. And you are supposed to examine this body of knowledge, as thick a body it is, and be able to manipulate and know the ins-and-outs of this body. I want to please this body, but I am only human, and I can do so much. I need pleasing too. So what’s the plan? I want to find the balance between learning what others expect me to know and what I want to know.
Med-school-Anthony has a lot of learning ahead of him; outside-med-school-Anthony has a lot of maturing ahead of him. My training will influence both spheres, but life exists outside of medical school, despite what some of our classmates may think.
The correlation coefficient between exams and anxiety in medical school is approximately 0.99..., and that’s for the pass-fail system. I’m sure pass-fail grading has significantly dampened the anxiety-experience at UCLA, but it still exists because medical students are great at worrying and making you feel like you need to worry as much as they are because no one wants to be That Person who failed Block I.
Block I was an experience, and now that it is over, now that I’m finished test-taking and predicting how comprehensive the block-heads expect my knowledge to be re. the complement system, embryology, etc., I can press the rewind button and revisit these past eight weeks that have progressed oh-so-fast.
I can summarize Block I succulently: Shit, I have learned a lot. Before medical school, I took courses severely detached from medicine like quantum mechanics and NMR spectroscopy. Had you asked me a question about histology, the progression of cancer malignancy, adaptive and innate immunity, I would have responded with blinking. Now I can attempt to provide a bare-bones, over-simplified solution. But hey, something is better than nothing.
Baby steps, I’m telling myself. One step down, two more years’ worth to go. Now that I have grounded myself, my next goal is to balance myself. Medical school throws a lot of information at you. And you are supposed to examine this body of knowledge, as thick a body it is, and be able to manipulate and know the ins-and-outs of this body. I want to please this body, but I am only human, and I can do so much. I need pleasing too. So what’s the plan? I want to find the balance between learning what others expect me to know and what I want to know.
Med-school-Anthony has a lot of learning ahead of him; outside-med-school-Anthony has a lot of maturing ahead of him. My training will influence both spheres, but life exists outside of medical school, despite what some of our classmates may think.
Sunday, September 28, 2008
Depression as a Terminal Illness
Clinical depression is not just "feeling down." It's a debilitating illness, particularly when it becomes refractory to any treatment. Consider Dave Wallace's final days.
Maturation and Graduate School
I have thought extensively of last about what constitutes a person's "growth" during graduate school. If you have read any of my previous posts, you would imagine that a certain degree of cynicism is inevitable; frustration with experiments either working or not; and unique to the MD/PhD course, trying to remain faithful to the clinical aspects of our careers remains both a priority and dilemma. These are fairly concrete issues that have arisen, and their answers tend to be straightforward: work through the difficulty with experiments (adapt, invent, etc), accept cynicism but don't let it be your downfall, and try try try to get into the clinic once in a while (even if all the forces that be seem diametrically opposed to you in that quest).
I think there is something deeper that graduate research and training does, however. In my estimation, there are several areas in which the maturation we undergo in graduate school manifests.
If we consider the format of graduate training - let's say under the broad umbrella of any of the biomedical sciences - it's the first time in our lives (save for those who took any significant time off from school) that we have significant freedoms. Our schedule (save for a couple of classes) has very little structure. Our work day does not begin at 9 am or end at 5 pm. We don't have "required sessions," "small groups," "doctoring meetings," "preceptorships," "labs"; In many cases, we can take off from lab at a moment's notice if something comes up. We can work very hard or not at all. It really is up to each of us. This is quite a departure from the first two years of medical school as well as from undergraduate years. I'm not saying that during those periods there weren't different levels of engagement or attention (certainly there's a huge spectrum in college, and to a lesser degree medical school), but much of the responsibility and potential successes associated seemed built into the system. Rarely would a person finish undergraduate training early, and certainly not with medical school. And showing up for and doing well on exams (given at specified, pre-planned times) reflects on doing an appropriate amount of work in the time alloted. Graduate school, while having all the same features, seems wide open. Each day in lab - though part of a quest for finding and/or executing a thesis project - can be spent pushing the limit withe experiments; going just one more hour, finding time for one more set of experiments, staying a little later to make sure cells will be ready for the next day of work. As I have begun to find out, a willingness to "push harder" does make a difference. It takes a project from its very nascent stages to being well-developed and sufficient for a thesis. Don't get me wrong, I'm not saying this happens in one "magical" day, but if you pile on enough "push" days, progress is inevitable.
While the desire, and the willingness, to push hard - beyond fatigue, frustration, and failure - is certainly one of the pillars of graduate training, another important aspect that is unique to the training emerges. Many students who enter graduate science programs (and this is certainly the case with MD/PhD-MSTP training environments) have already developed an ability to execute experiments, analyze data, and write-up their results. Obviously, improving on this basic skill set becomes an essential component, but the next major hurdle is one I term to be Full Synthesis. In graduate school - if the training and product that results are satisfactory - then the ultimate goal is to be able to understand where research is at the present, propose a series of experiments, experimentally execute them, and then effectively interpret the results and propose new directions. Getting to this point, I think, is one of the most difficult leaps to make in all of our training; and while certainly we may not be proposing Nobel Prize-winning research in our first attempt at Full Synthesis, we can at least be faithful to the effort. I still struggle mightily with this, because the desire to piggy-back on the ideas of others or search for answers to questions we haven't really asked yet both become traps. I find myself at an interesting cross-roads in this sense. I'm working on a couple of inter-connected projects in the lab, and although I have a firm grasp of the experimental approach I am using and I know a good deal about data analysis, I have yet to really come up with "brilliant" new ideas either for how to analyze the data or craft new experiments to test ever-evolving hypotheses.
Don't get me wrong -- I'm not expecting for the goal of Full Synthesis to be achieved anytime soon. I know it is usually one that comes closer to the end (rather than the beginning) of graduate school; but I'm just saying that it builds in this frustrating tease - this notion that there's a level of intellectual engagement with our work, experimental and analytical command of our work, and an ability to see it all come together in the ultimate "Eureka!" moment. Maybe it will never feel like a "Eureka!" moment, and instead it will resemble something more of a "Duh!" Maybe. I don't think it really matters what the emotions are in the moment. What matters, I think, is that we honestly appraise our abilities now and that going forward we be willing to take on new challenges and responsibilities; we must learn (and dare) to "push" and "synthesize."
I think there is something deeper that graduate research and training does, however. In my estimation, there are several areas in which the maturation we undergo in graduate school manifests.
If we consider the format of graduate training - let's say under the broad umbrella of any of the biomedical sciences - it's the first time in our lives (save for those who took any significant time off from school) that we have significant freedoms. Our schedule (save for a couple of classes) has very little structure. Our work day does not begin at 9 am or end at 5 pm. We don't have "required sessions," "small groups," "doctoring meetings," "preceptorships," "labs"; In many cases, we can take off from lab at a moment's notice if something comes up. We can work very hard or not at all. It really is up to each of us. This is quite a departure from the first two years of medical school as well as from undergraduate years. I'm not saying that during those periods there weren't different levels of engagement or attention (certainly there's a huge spectrum in college, and to a lesser degree medical school), but much of the responsibility and potential successes associated seemed built into the system. Rarely would a person finish undergraduate training early, and certainly not with medical school. And showing up for and doing well on exams (given at specified, pre-planned times) reflects on doing an appropriate amount of work in the time alloted. Graduate school, while having all the same features, seems wide open. Each day in lab - though part of a quest for finding and/or executing a thesis project - can be spent pushing the limit withe experiments; going just one more hour, finding time for one more set of experiments, staying a little later to make sure cells will be ready for the next day of work. As I have begun to find out, a willingness to "push harder" does make a difference. It takes a project from its very nascent stages to being well-developed and sufficient for a thesis. Don't get me wrong, I'm not saying this happens in one "magical" day, but if you pile on enough "push" days, progress is inevitable.
While the desire, and the willingness, to push hard - beyond fatigue, frustration, and failure - is certainly one of the pillars of graduate training, another important aspect that is unique to the training emerges. Many students who enter graduate science programs (and this is certainly the case with MD/PhD-MSTP training environments) have already developed an ability to execute experiments, analyze data, and write-up their results. Obviously, improving on this basic skill set becomes an essential component, but the next major hurdle is one I term to be Full Synthesis. In graduate school - if the training and product that results are satisfactory - then the ultimate goal is to be able to understand where research is at the present, propose a series of experiments, experimentally execute them, and then effectively interpret the results and propose new directions. Getting to this point, I think, is one of the most difficult leaps to make in all of our training; and while certainly we may not be proposing Nobel Prize-winning research in our first attempt at Full Synthesis, we can at least be faithful to the effort. I still struggle mightily with this, because the desire to piggy-back on the ideas of others or search for answers to questions we haven't really asked yet both become traps. I find myself at an interesting cross-roads in this sense. I'm working on a couple of inter-connected projects in the lab, and although I have a firm grasp of the experimental approach I am using and I know a good deal about data analysis, I have yet to really come up with "brilliant" new ideas either for how to analyze the data or craft new experiments to test ever-evolving hypotheses.
Don't get me wrong -- I'm not expecting for the goal of Full Synthesis to be achieved anytime soon. I know it is usually one that comes closer to the end (rather than the beginning) of graduate school; but I'm just saying that it builds in this frustrating tease - this notion that there's a level of intellectual engagement with our work, experimental and analytical command of our work, and an ability to see it all come together in the ultimate "Eureka!" moment. Maybe it will never feel like a "Eureka!" moment, and instead it will resemble something more of a "Duh!" Maybe. I don't think it really matters what the emotions are in the moment. What matters, I think, is that we honestly appraise our abilities now and that going forward we be willing to take on new challenges and responsibilities; we must learn (and dare) to "push" and "synthesize."
Wednesday, September 24, 2008
Nobel Laureates and Teachers
Today, I am joining a group of students having lunch with Nobel Laureate Erwin Neher. Dr. Neher won the 1991 Nobel Prize in Physiology or Medicine for his discovery of the patch clamp technique. The lunch discussion will no doubt provide titillating clues into the genius of Neher, his work over the years, and where he sees science going in the future. As someone who has been working on patch clamp experiments for the past three months or so, and as someone who sees how useful and revolutionary the technique is (and was), I stand in agreement with the thousands of scientists out there who marvel at his work over the years. He indeed contributes to science, medicine, academia, industry - to name a few areas - in innumerable ways. There's almost no debating the "greatness" of a person like Neher.
As I described my schedule for the day to someone this morning, she remarked, "Wow, that is so cool that you get to meet someone who has obviously done so much in the world; someone who's impact has been so immense." For whatever reason -- in part because this discussion was in the context of discussing topics in the first year of the medical school (described by some as "tutoring") -- that description instantly focused my attention on the role of teachers. Teachers spend their time - if they are college professors - doubling as researchers and lecturers/discussion leaders. In the high school or related setting, they focus primarily on introducing concepts, explaining difficult connections, and assessing student performance over time. But regardless of where teachers work and what exactly are their responsibilities, I think (and this certainly isn't a revolutionary idea) they can have an impact on the world that, much like work that warrants a Nobel prize, is not limited in its scope or seriousness.
If I had to choose three elements of my life that I credit with where I am today, I would choose 1) my parents, 2) my good fortune to live in the USA, and 3) my teachers over the years.
That is to say, it's hard to overstate the importance of teachers. Regardless of what I plan to do in the future, being a teacher -- in whatever capacity -- will be a part of my vocation.
I'm as impressed with a nobel laureate as I am with a game-changing teacher. I'll revise this post after the lunch to see if this sentiment holds up.
Update (4:00 P.M.): Sentiment holds up. Neher was great, everything I expected. And the teachers in my life continue to be up there with the Nobel laureates.
As I described my schedule for the day to someone this morning, she remarked, "Wow, that is so cool that you get to meet someone who has obviously done so much in the world; someone who's impact has been so immense." For whatever reason -- in part because this discussion was in the context of discussing topics in the first year of the medical school (described by some as "tutoring") -- that description instantly focused my attention on the role of teachers. Teachers spend their time - if they are college professors - doubling as researchers and lecturers/discussion leaders. In the high school or related setting, they focus primarily on introducing concepts, explaining difficult connections, and assessing student performance over time. But regardless of where teachers work and what exactly are their responsibilities, I think (and this certainly isn't a revolutionary idea) they can have an impact on the world that, much like work that warrants a Nobel prize, is not limited in its scope or seriousness.
If I had to choose three elements of my life that I credit with where I am today, I would choose 1) my parents, 2) my good fortune to live in the USA, and 3) my teachers over the years.
That is to say, it's hard to overstate the importance of teachers. Regardless of what I plan to do in the future, being a teacher -- in whatever capacity -- will be a part of my vocation.
I'm as impressed with a nobel laureate as I am with a game-changing teacher. I'll revise this post after the lunch to see if this sentiment holds up.
Update (4:00 P.M.): Sentiment holds up. Neher was great, everything I expected. And the teachers in my life continue to be up there with the Nobel laureates.
Friday, September 19, 2008
Friday in LA
It's a beautiful Friday, late summer/early fall kind of day. It's sunny, 82 degrees, with 34% humidity at 12:25 pm.
...and this is an average kind of west L.A. day.
A more substantive post to come.
...and this is an average kind of west L.A. day.
A more substantive post to come.
Tuesday, September 16, 2008
Six Years
As Anthony's latest post ("Let's not insulate ourselves") hints, the Pomona community -- and indeed the world of literary scholars, readers, writers, and otherwise interested persons -- was beset this past weekend with unspeakable tragedy. We lost the writer of a generation and a teacher of profound meaning to his students.
I write not to reflect on Dave Wallace; I never studied with him, and I have no unique insights to share. While he inspired me, in many ways, to continue to write after entering the MSTP at UCLA, I can't speak to who DFW was as a person. And so I won't try to reminisce or eulogize. But I have some thoughts on death, dying, grief, and how they don't simply bespeak unimaginable tragedy. They - in sum total - offer us some clues into the human experience: the very act of living.
Six years ago today - two weeks into my freshman year of college - a good friend of mine (fellow musician, tennis player, serious student of science and math) was killed in an automobile accident. He was a man of immense promise, who, in his first few days of college was plucked from the earth.
I can remember the entire sequence of events immediately after his death in chilling detail. The message from my roommate. The frantic phone calls. The confusion: was he still alive? Where was he? He's gone? Oh, my god.
The reality: the tears, the shock, the horror. I remember my friend and sister picking me up from Pomona, the drive home to South Pasadena. The vigil at the High School. I remember then staying stoic for an entire week - between the shocking revelation of his death and his memorial service - and then in an instant succumbing to overwhelming emotion. I recall playing the violin for my friend, a musical ode to a fallen artist.
Another week passed. And then I returned home again - two weeks after he had died - this time to see my friend committed to eternity in the ground below.
To return to the sequence of these events still shakes me to the core. Here I was, all of 19 years old, in the midst of the newness of college, and my friend was dead. Certainly, the rest of his friends and I faced an immense collective loss; but my own mortality was suddenly in the forefront of my mind.
As the young (and the old) tend to do, I spent the days, weeks, and months pondering my own life. What would happen if, in a split second, my life were to end? What kind of mark would I have made, and (perhaps most importantly to me at the time) how would people remember me? I recall thinking about this question frequently when walking across the quad at Pomona, during long runs, and sometimes after an evening of drinking as I faded off to sleep. I (and indeed many of my friends) felt robbed - we were robbed of a good human being, a person who made us laugh, smile, and wonder what he would do next; and we were robbed of our innocence and invincibility. Just when we were beginning to gain our intellectual footing on life, and when our minds and bodies were starting to reach unison in their maturity, our new-found stability and confidence was shattered.
Death was indeed difficult for me to swallow. While of course initially it was a question of justice - just how "wrong" it all was - that was just the first stage. Eventually, I returned to reality and could easily note the world is devoid of justice for millions upon millions of persons. The next step was fragility. Could I be next? Just as with the injustice in the world, I too learned to live with the fragility of life. Next was the live life to the fullest ethos so many people talk about. Again, while this seemed an impossible creed to follow, I soon realized that living life to the fullest was just another expression for authenticity. And who the hell can claim that he really ever reaches total and perfect authenticity? (To this day, it is, like total nirvana, an admirable but unattainable goal).
I guess as that first year began to pass, I gradually turned the corner with my grief. (In fairness, I cannot imagine, and in fact know, that this was not the case for his family. For parents, the overwhelming grief that accompanies the loss of a child is thought to last at least five years before any sense of normalcy can be possibly achieved.) For me, the year ushered in a gradual weathering of my temperament. I was a little bit more introspective, and little less worried about how I looked or what I was doing, and my journeys were a little more personal. Of course, this all seemed to be somewhat at the expense of my social connections during year one at Pomona. (Somehow I was a little disconnected from everyone else, and it wasn't until my third year that a core group of friends would be established.)
In that first year, there were hints that, in spite of the indescribable feeling of loss, I was becoming liberated from some of the innocence of life. This indeed sounds like a contradiction-in-terms. But I think that by going to the dark place of death -- seeing your friend lying in state just a month after he was vibrant, alive -- while staying engaged in life, I began to relish in the act of living. Of course I still wept for my friend. I weep several times a year when I remember him - I wept today for a few moments. But I also love the life I am living and the life that I am capable of living. It's not just a sense of "you never know how long you have to live" kind of feeling that drives this. It is the idea that, in the face of grief and sadness, happiness and ecstasy, or anything in the middle, there is a vital energy we all possess. It's an energy my friend had - it was this energy that drove me to weep for him; but it is also an energy that made me look inward. It made me acknowledge the fragility of my life, reassess the impact of my actions, and my relationships with others. It helped me to love others more fully and gladly, and it in turn made me less afraid to talk about my love for others and express it genuinely.
I still don't think I understand anything better; let's just be clear on that. After all, understanding such questions as "When is it our time?", "What is it like in death?", "What is a meaningful life?" are impossible to answer. I guess realizing that, and accepting the somber reality of death in the presence of our lives, makes the act of living less burdensome. We cannot - in our human existence as it stands - truly understand the nature of questions that science, medicine, philosophy, politics, literature, history, and mathematics have never been (and never will be) able to answer.
But, I do think our minds can evolve - our perspective can become richer and the context in which we ask these questions is capable of generous expansion. As evidence of the Epiphany-in-progress that is life, I recently had a dream about my friend. In it, I swear the premise was that he had never left. I couldn't touch him, and we had non-verbal conversations (almost telepathic, I guess), but he had not left. As I tried to make some meaning out of the dream, I reasoned that this all came back to the "energy" of my friend. Both his energy and my energy come from the same divine elements of the universe. And maybe, just maybe, what happened six years ago has helped me to begin to realize that the very energy that makes us unique (and what makes us grieve for our fallen comrades) is energy indivisible from our own. It forever binds us to them, and them to us. It keeps them in our dreams, and transforms our lives. And it is ubiquitous and limitless in our world--it sets us free.
I write not to reflect on Dave Wallace; I never studied with him, and I have no unique insights to share. While he inspired me, in many ways, to continue to write after entering the MSTP at UCLA, I can't speak to who DFW was as a person. And so I won't try to reminisce or eulogize. But I have some thoughts on death, dying, grief, and how they don't simply bespeak unimaginable tragedy. They - in sum total - offer us some clues into the human experience: the very act of living.
Six years ago today - two weeks into my freshman year of college - a good friend of mine (fellow musician, tennis player, serious student of science and math) was killed in an automobile accident. He was a man of immense promise, who, in his first few days of college was plucked from the earth.
I can remember the entire sequence of events immediately after his death in chilling detail. The message from my roommate. The frantic phone calls. The confusion: was he still alive? Where was he? He's gone? Oh, my god.
The reality: the tears, the shock, the horror. I remember my friend and sister picking me up from Pomona, the drive home to South Pasadena. The vigil at the High School. I remember then staying stoic for an entire week - between the shocking revelation of his death and his memorial service - and then in an instant succumbing to overwhelming emotion. I recall playing the violin for my friend, a musical ode to a fallen artist.
Another week passed. And then I returned home again - two weeks after he had died - this time to see my friend committed to eternity in the ground below.
To return to the sequence of these events still shakes me to the core. Here I was, all of 19 years old, in the midst of the newness of college, and my friend was dead. Certainly, the rest of his friends and I faced an immense collective loss; but my own mortality was suddenly in the forefront of my mind.
As the young (and the old) tend to do, I spent the days, weeks, and months pondering my own life. What would happen if, in a split second, my life were to end? What kind of mark would I have made, and (perhaps most importantly to me at the time) how would people remember me? I recall thinking about this question frequently when walking across the quad at Pomona, during long runs, and sometimes after an evening of drinking as I faded off to sleep. I (and indeed many of my friends) felt robbed - we were robbed of a good human being, a person who made us laugh, smile, and wonder what he would do next; and we were robbed of our innocence and invincibility. Just when we were beginning to gain our intellectual footing on life, and when our minds and bodies were starting to reach unison in their maturity, our new-found stability and confidence was shattered.
Death was indeed difficult for me to swallow. While of course initially it was a question of justice - just how "wrong" it all was - that was just the first stage. Eventually, I returned to reality and could easily note the world is devoid of justice for millions upon millions of persons. The next step was fragility. Could I be next? Just as with the injustice in the world, I too learned to live with the fragility of life. Next was the live life to the fullest ethos so many people talk about. Again, while this seemed an impossible creed to follow, I soon realized that living life to the fullest was just another expression for authenticity. And who the hell can claim that he really ever reaches total and perfect authenticity? (To this day, it is, like total nirvana, an admirable but unattainable goal).
I guess as that first year began to pass, I gradually turned the corner with my grief. (In fairness, I cannot imagine, and in fact know, that this was not the case for his family. For parents, the overwhelming grief that accompanies the loss of a child is thought to last at least five years before any sense of normalcy can be possibly achieved.) For me, the year ushered in a gradual weathering of my temperament. I was a little bit more introspective, and little less worried about how I looked or what I was doing, and my journeys were a little more personal. Of course, this all seemed to be somewhat at the expense of my social connections during year one at Pomona. (Somehow I was a little disconnected from everyone else, and it wasn't until my third year that a core group of friends would be established.)
In that first year, there were hints that, in spite of the indescribable feeling of loss, I was becoming liberated from some of the innocence of life. This indeed sounds like a contradiction-in-terms. But I think that by going to the dark place of death -- seeing your friend lying in state just a month after he was vibrant, alive -- while staying engaged in life, I began to relish in the act of living. Of course I still wept for my friend. I weep several times a year when I remember him - I wept today for a few moments. But I also love the life I am living and the life that I am capable of living. It's not just a sense of "you never know how long you have to live" kind of feeling that drives this. It is the idea that, in the face of grief and sadness, happiness and ecstasy, or anything in the middle, there is a vital energy we all possess. It's an energy my friend had - it was this energy that drove me to weep for him; but it is also an energy that made me look inward. It made me acknowledge the fragility of my life, reassess the impact of my actions, and my relationships with others. It helped me to love others more fully and gladly, and it in turn made me less afraid to talk about my love for others and express it genuinely.
I still don't think I understand anything better; let's just be clear on that. After all, understanding such questions as "When is it our time?", "What is it like in death?", "What is a meaningful life?" are impossible to answer. I guess realizing that, and accepting the somber reality of death in the presence of our lives, makes the act of living less burdensome. We cannot - in our human existence as it stands - truly understand the nature of questions that science, medicine, philosophy, politics, literature, history, and mathematics have never been (and never will be) able to answer.
But, I do think our minds can evolve - our perspective can become richer and the context in which we ask these questions is capable of generous expansion. As evidence of the Epiphany-in-progress that is life, I recently had a dream about my friend. In it, I swear the premise was that he had never left. I couldn't touch him, and we had non-verbal conversations (almost telepathic, I guess), but he had not left. As I tried to make some meaning out of the dream, I reasoned that this all came back to the "energy" of my friend. Both his energy and my energy come from the same divine elements of the universe. And maybe, just maybe, what happened six years ago has helped me to begin to realize that the very energy that makes us unique (and what makes us grieve for our fallen comrades) is energy indivisible from our own. It forever binds us to them, and them to us. It keeps them in our dreams, and transforms our lives. And it is ubiquitous and limitless in our world--it sets us free.
The (unfulfilled) promise of personalized medicine
This recent piece in the NY times outlines one of the current follies in biomedical research. The idea -- sift the human genome and find common, widespread variations that explain some of the most common diseases -- sounded great; in fact, it was downright sexy. But one researcher thinks that's a bunch of rubbish, and that the current (and very expensive) approach isn't working. And some of his rationale is rooted in the logic of rigorous genetic and evolutionary theory.
Not to sound cynical or say "I told you so," but personalized genomic medicine sure sounds a lot like a science project for which many of its conclusions (we'll know what causes X cancer and Y vascular disease) would be highly anticipated at the start of the study.
At any rate, this is food for thought, and we invite the discussion to continue in the "comments" section below.
(Plus, the article is an interesting look into a scientist who has blended population genetics with, in my best estimation, anthropology...)
Not to sound cynical or say "I told you so," but personalized genomic medicine sure sounds a lot like a science project for which many of its conclusions (we'll know what causes X cancer and Y vascular disease) would be highly anticipated at the start of the study.
At any rate, this is food for thought, and we invite the discussion to continue in the "comments" section below.
(Plus, the article is an interesting look into a scientist who has blended population genetics with, in my best estimation, anthropology...)
Sunday, September 14, 2008
Fooling everyone, including ourselves
Science is mighty clever. For a discipline that prides itself in having objectivity and brutal honesty, Science has a lot of dirty little secrets.
Consider news reports that come out -- "Scientists discover X may be linked to Y!" -- and instantly a series of articles state the seemingly indisputable claims that accompany the headlines. Famous researchers go on TV programs, touting the revolutionary results they have obtained, and people marvel at the progress and excitement such work generates.
Beneath the surface, however, is something far more sinister. I will say, and object as you wish (please comment as you see fit) that many of these Amazing Discoveries were a foregone conclusion even before the experiments were done. The answer has a lot to do with the National Institutes of Health (NIH).
Consider how the NIH gives out funding -- it requires that researchers have interesting questions, capable of extensive investigation. Of course they also require that a huge opus of work has already been done on a topic. In so many cases, the finished product is close in sight, and the $1 million + of an RO1 grant rewards the background work much more than it motivates researchers to uncover new, surprising, shocking findings. Being bold - trying outlandish experiments - requires the all-too-rare funding from the Howard Hughes Medical Institute, or from small "seed grants" from the NIH. I don't propose how this gets fixed, but I see a problem in how hard it is to be bold.
I recall a conversation I had with a research mentor early in my training during my undergraduate days at Pomona. I complained that, because I wasn't clear what the point of my research was in a particular area (I was attempting to look at oxygen toxicity in obligate, anaerobic hyperthermophiles - you can understand the contradiction in terms), I probably wouldn't see meaningful results. He explained, "It's easy to obtain and publish results when you know what you're looking for. It's much harder (and braver) to ask questions that no one has ever asked before and then attempt to make sense of experimental results...such results have no real context, but that's real science." I think I understood his point -- the real richness of science is in the truly uncharted, the rarefied air, the untasted vintage. But is such risk-taking conducive to the present world, where we are so pressed for time and money? That I cannot answer. And yet I suspect the scientists who really "get it" (the nobel laureates, the inventors, the pioneers) probably think that there is no other way to do science in spite of every imaginable obstacle convincing them they need not be bold. Maybe.
Returning to the concept of "clarity v. opacity," I think I can claim clarity on one issue: I refuse to submit to a career in either science or medicine where I cannot be bold in my approach and vision. I won't just sit in a lab, with a series of predictable and interesting projects and RO1s to get funded. I refuse. I won't just sit in the hospital or clinic and see patients every day without some sense of adventure or risk-taking. I don't want to do "translational" research if all it means is that target X that we study is related to disease Y. That's not translational. It's correlative and it's pandering. It's like saying, "Well since LA is next to Mexico, everyone who lives in LA has foreign policy experience." Translational research, for which I have a passion, must transcend the traditional boundaries of science and medicine. It must have an infinite growth mindset. It can't just answer the associative question of, "is this applicable to that?"
Research, for me, has to be bold: for it to survive in my restless soul, it must ask new and unheard-of questions. It must, or I will find another way to channel my creativity. Because writing RO1s, sitting in a lab, and pondering how to squeeze more money out of the NIH is not my idea of a career. It's just a less lucrative way of selling out.
Consider news reports that come out -- "Scientists discover X may be linked to Y!" -- and instantly a series of articles state the seemingly indisputable claims that accompany the headlines. Famous researchers go on TV programs, touting the revolutionary results they have obtained, and people marvel at the progress and excitement such work generates.
Beneath the surface, however, is something far more sinister. I will say, and object as you wish (please comment as you see fit) that many of these Amazing Discoveries were a foregone conclusion even before the experiments were done. The answer has a lot to do with the National Institutes of Health (NIH).
Consider how the NIH gives out funding -- it requires that researchers have interesting questions, capable of extensive investigation. Of course they also require that a huge opus of work has already been done on a topic. In so many cases, the finished product is close in sight, and the $1 million + of an RO1 grant rewards the background work much more than it motivates researchers to uncover new, surprising, shocking findings. Being bold - trying outlandish experiments - requires the all-too-rare funding from the Howard Hughes Medical Institute, or from small "seed grants" from the NIH. I don't propose how this gets fixed, but I see a problem in how hard it is to be bold.
I recall a conversation I had with a research mentor early in my training during my undergraduate days at Pomona. I complained that, because I wasn't clear what the point of my research was in a particular area (I was attempting to look at oxygen toxicity in obligate, anaerobic hyperthermophiles - you can understand the contradiction in terms), I probably wouldn't see meaningful results. He explained, "It's easy to obtain and publish results when you know what you're looking for. It's much harder (and braver) to ask questions that no one has ever asked before and then attempt to make sense of experimental results...such results have no real context, but that's real science." I think I understood his point -- the real richness of science is in the truly uncharted, the rarefied air, the untasted vintage. But is such risk-taking conducive to the present world, where we are so pressed for time and money? That I cannot answer. And yet I suspect the scientists who really "get it" (the nobel laureates, the inventors, the pioneers) probably think that there is no other way to do science in spite of every imaginable obstacle convincing them they need not be bold. Maybe.
Returning to the concept of "clarity v. opacity," I think I can claim clarity on one issue: I refuse to submit to a career in either science or medicine where I cannot be bold in my approach and vision. I won't just sit in a lab, with a series of predictable and interesting projects and RO1s to get funded. I refuse. I won't just sit in the hospital or clinic and see patients every day without some sense of adventure or risk-taking. I don't want to do "translational" research if all it means is that target X that we study is related to disease Y. That's not translational. It's correlative and it's pandering. It's like saying, "Well since LA is next to Mexico, everyone who lives in LA has foreign policy experience." Translational research, for which I have a passion, must transcend the traditional boundaries of science and medicine. It must have an infinite growth mindset. It can't just answer the associative question of, "is this applicable to that?"
Research, for me, has to be bold: for it to survive in my restless soul, it must ask new and unheard-of questions. It must, or I will find another way to channel my creativity. Because writing RO1s, sitting in a lab, and pondering how to squeeze more money out of the NIH is not my idea of a career. It's just a less lucrative way of selling out.
Let’s not insulate ourselves
It has been a while since I last wrote on this blog. The reason is silly: I have been expecting significance, a greater meaning from my posts. So here I go:
I am five weeks deep into medical school. The five weeks have been fine. Medical school is medical school. Nothing incredible, nothing amazing, nothing horrible. It has its pros and cons, just like any other program. But I am not writing to rant or rave about my education. Not yet. I am writing to let something out. Bear with me, please, as I struggle with some thoughts.
America is supposed to be a country of ideas, a country where ideas rule, where reason wins. Sometimes the ideas are wrong, propagating a wave of –ists that we are more than ready to forget. The compassionate American will recognize the problems and face them, address them, and challenge them.
I knew a compassionate American. To me he was a teacher, a role-model, an inspiration. I admired the way he used his words to explore what it means to be human, what it means to be an American, living the fuck-ed-ness of our society. He explored lines of thought that the average American prefers to seal off, pretending they do not exist, under the cover of our flag.
This compassionate American hanged himself two days ago. Am I disappointed? Yes. What will I do? Try to be compassionate. Ideas live on, as long as we want them to, right?
I am five weeks deep into medical school. The five weeks have been fine. Medical school is medical school. Nothing incredible, nothing amazing, nothing horrible. It has its pros and cons, just like any other program. But I am not writing to rant or rave about my education. Not yet. I am writing to let something out. Bear with me, please, as I struggle with some thoughts.
America is supposed to be a country of ideas, a country where ideas rule, where reason wins. Sometimes the ideas are wrong, propagating a wave of –ists that we are more than ready to forget. The compassionate American will recognize the problems and face them, address them, and challenge them.
I knew a compassionate American. To me he was a teacher, a role-model, an inspiration. I admired the way he used his words to explore what it means to be human, what it means to be an American, living the fuck-ed-ness of our society. He explored lines of thought that the average American prefers to seal off, pretending they do not exist, under the cover of our flag.
This compassionate American hanged himself two days ago. Am I disappointed? Yes. What will I do? Try to be compassionate. Ideas live on, as long as we want them to, right?
Saturday, July 26, 2008
Clarity and Opacity
I have a habit of declaring that moments in life offer clarity and re-invigorate (and re-define) the purpose behind what I do. Take, for example, my relationships: a series of dates, phone calls, e-mails, and then finally "what are we?" discussions lead to relationship bliss - the moments culminate to define The Relationship as it is. Or in MSTP training: good exam scores, successful grant applications, exciting results in lab, engaging clinical experiences might lead one to say The Career is a purpose-driven existence as a physician scientist.
But what if all along - instead of clarifying or defining - the milestones and the progress actually mean more questions rather than answers? What if tension builds rather than resolves?
I find this happening to me quite regularly. On one hand, things have been going pretty well -- I made it through the first two years of medical school without any major problems, the boards (at least step 1) is done and I passed, research has started (I'm learning new techniques, trouble shooting, etc) and I am funded for grad school (very lucky to have gotten an NRSA)...and I've managed to do a little bit of work in the clinic. So all-in-all, this sounds like The Career scenario above. Except that I don't feel like anything is really clarified. Rather, I see my future as quite unknown. Industry, consulting, purely clinical, purely research, policy, NIH, ahhh! I really have no clue what I will end up settling on for a career.
I think part of this dilemma (and total lack of vision for the future) stems from the nature of the first two years of the MSTP. On one hand, we are consistently medical students for the first two years. On the other hand, our program directors (and our desire to enter the PhD phase of the program with some obvious direction) require that we start thinking about our research goals; i.e. with whom will we rotate, into which program will we enter, and so on...So it's hard to firmly decide. We straddle the fence.
And now in the PhD phase, while it is tempting to completely immerse myself in research, I find myself inexorably drawn to the clinic for work every other week. Although it's for just one morning or afternoon, the experience re-affirms for me the uniqueness of my training plan. To not do this, in my mind, would be heresy; let's face it, we're doing these programs because we believe in the (tantalizing) possibility of translational research. How can we firmly believe in that if we're unable to give up two mornings or two afternoons each month to brush up on our clinical skills?
Indeed I have found my clinical experiences - interspersed within the beginnings of my research training - to be engaging and vital to my perspective on being a physician-scientist. But just as I have lacked clarity to this point, so do such experiences perpetuate the inevitability of opacity as status quo for the MSTP trainee.
But what if all along - instead of clarifying or defining - the milestones and the progress actually mean more questions rather than answers? What if tension builds rather than resolves?
I find this happening to me quite regularly. On one hand, things have been going pretty well -- I made it through the first two years of medical school without any major problems, the boards (at least step 1) is done and I passed, research has started (I'm learning new techniques, trouble shooting, etc) and I am funded for grad school (very lucky to have gotten an NRSA)...and I've managed to do a little bit of work in the clinic. So all-in-all, this sounds like The Career scenario above. Except that I don't feel like anything is really clarified. Rather, I see my future as quite unknown. Industry, consulting, purely clinical, purely research, policy, NIH, ahhh! I really have no clue what I will end up settling on for a career.
I think part of this dilemma (and total lack of vision for the future) stems from the nature of the first two years of the MSTP. On one hand, we are consistently medical students for the first two years. On the other hand, our program directors (and our desire to enter the PhD phase of the program with some obvious direction) require that we start thinking about our research goals; i.e. with whom will we rotate, into which program will we enter, and so on...So it's hard to firmly decide. We straddle the fence.
And now in the PhD phase, while it is tempting to completely immerse myself in research, I find myself inexorably drawn to the clinic for work every other week. Although it's for just one morning or afternoon, the experience re-affirms for me the uniqueness of my training plan. To not do this, in my mind, would be heresy; let's face it, we're doing these programs because we believe in the (tantalizing) possibility of translational research. How can we firmly believe in that if we're unable to give up two mornings or two afternoons each month to brush up on our clinical skills?
Indeed I have found my clinical experiences - interspersed within the beginnings of my research training - to be engaging and vital to my perspective on being a physician-scientist. But just as I have lacked clarity to this point, so do such experiences perpetuate the inevitability of opacity as status quo for the MSTP trainee.
Saturday, July 19, 2008
Open-ended
Note: this post is part fiction, part non-fiction; interpret as you please.
Q—
A— I’m doing well, thanks. Yourself?
Q—
A— That’s good. Well, first year of medical school, I’m excited, yes. It starts August fourth.
Q—
A— I’m not sure. I guess in high school the interests started to form, but I’d rather not rattle of my personal statement. I do remember, though, being placed on the medicine or science track by my high school teachers and advisors.
Q—
A— I don’t want to use the word with a negative connotation. The idea behind track is complicated, and I’m currently struggling with it. In any case, I’m fortunate to have received that type of attention in high school. I was privileged, and I was-slash-still-am naïve.
Q—
A— I was particularly naïve coming out of high school because I had a lot of expectations of college. You know how it goes. It’s been clichéd in a gazillion trashy teen movies and novels. Not that I’ve been exposed to any of this.
Q—
A— An example? Well it’s simple. I though college was about the individual. I thought college was about me, about what I would gain. I thought I would be a sponge, only a sponge. People would feed me, and I would grow without a saturation point. My carrying capacity was supposedly infinitely large, a natural wonder.
Q—
A— Are you making fun of me?
Q—
A—It wasn’t completely my fault. High-school counselors, teachers, peers, literature enabled the creation of a place, College, where the Emersons, the Individuals, created things bigger than themselves.
Q—
A— Entering college I expected of expectations. I was confused, had no idea about what the next four year entailed, so I made things up. The expectations were formed by ill-informed conceptions, filtered and collected by someone who didn’t have an accurate description of reality. Because I didn’t really know what to expect, I formed new expectations, and from these expectations I expected new things, new ideas. I was day dreaming, falling into a recursive trap.
Q—
A— I know I’m being vague and abstract.
Q—
A— So what happened in college? What really happened is I-did-not-suffocate-the-universe-with-my-immensity-because-I learned-that-college-was-not-about-the-College-or-the-Individual. I went to college for a liberal arts education, and I took courses that interested me, and then, thanks to friends, advisors, professors, and mentors, I was given incredible opportunities that started me on the MD-PhD track.
Q—
A—The Emerson-ian-half of Anthony did not like tracks. Tracks specialized my education, thus preventing the formation of a black hole. The realistic-half of Anthony understood that track were a good fit and provided a lot of opportunity, a crap-load, some might say. But it is important to note that the Anthony-of-the-past created a dichotomy between the tracked and un-tracked self.
Q—
A— The answer to that question is way above me. Ask someone else.
Q—
A— The bottom line is that this self is very privileged. Throughout my life, my parents, my friends, my acquaintances have fulfilled themselves by fulfilling me, and now it’s my time to fulfill others. I’m not totally ready yet, but I’m getting there.
Q—
A— Yes. I think medical school will be a nice step forward. I know I will have people to trust and people can trust in me. The support will be there, not just for me, for everyone. I’ve already volunteered myself. Outside of what I just said, I don’t know. I don’t know what the next eight years of my life will entail. I don’t know what to expect, and I don’t want to expect, for reasons you’ve weaseled out of me.
Q—
A— So, long story short, I’m ready to start medical school. I’m excited to start medical school. Along with all this excitement, though, follows some anxiety. Anxiety that stems from the excitement of so many opportunities and resources placed in front of me. An anxiety that is a bedfellow with expectations, because in part the anxiety is an expectation, and I don’t want to believe it is true.
Q—
A— I’d rather not talk about it now. I guess it’s something I’m going to have to find out sooner or later.
Monday, July 14, 2008
The applicant creates an application, which is then digested by a committee and reconstructed back into an applicant (whew!)
I decided not to do a summer rotation. Instead I spent a month and a half traveling around
It has been five months since my last MSTP interview, and I am glad the process is over. At this time last year I was thinking about my secondaries but not filling them out, instead concentrating on summer research. I watched as the number of forms- and essays-to-be-completed added up, reaching 15. I waited and waited until I achieved an appropriate headspace, after finishing my summer work, and resumed the application process, which lasted way too long when final decisions were sent out in middle March.
Now that I’m a veterano, experienced in the ways of interview gaffes, I’ll share my opinion regarding the application process. My opinion is pessimistic. My opinion is jaded. Whatever.
The key to the application process is to think like a car salesman, a damned good one, so good that she can write and speak about herself in a way that is seamlessly authentic, an anti-car-salesman, but because the illusion of authenticity is manufacture, in essence, the best applicant is the anti-anti-car-salesman. Enough with the meta-jiberish—I’ll save it for later.
The applicant needs to separate herself from others, create hype about her potential, and promote herself as a worthy INVESTMENT to the medical-scientist community. That being said, absurd stats (MCAT, GPA, # of pubs, etc.) are nice but not necessary because LOR’s, and personal statements and experience are equally important, and not quantitative. With that said, I can think of two rough tiers of assessment in the application process. (Feel free to add more factors that I’m forgetting.)
Tier One: MCAT, grades, LOR’s, personal statement, research experience
Tier Two: number of publications, clinical hours, extracurricular
The application selection process is complex. I have no idea what goes on behind the scenes. I could speculate about formulas to achieving interviews and acceptances, but I won’t. What I will say is, be smart with your words, tie your narrative with your career goals, be the anti-anti-car-salesman. But N.B., the anti-anti-car-salesman (okay, now for an invented acronym: aacs) is not bad. The aacs is genuinely interested in a career as a medical-scientist. The aacs is passionate about research and medicine, and wants to contribute to society. The aacs is confident, has a sense of direction, a career trajectory, and can create links between basic science and translation research. Often the aacs is so good that they have even fooled themselves.
Anyway, I have digressed into potentially worthless metaphor, but if I can give one piece of advice, the ideal applicant will create an application that constructs an applicant, perceived by the individual reader and collective committee, with confidence, passion, and sense of service. The applicant should be a master of words.
I think I have given myself a headache now, so I am signing off for now. I may post soon about my thoughts regarding the start of MS1 (August 4th!).
Monday, July 07, 2008
Q and A, part 2
Another question from a visitor to this blog:
I've a few questions about the MSTP program. More specifically, how your application process went. I'm wondering what sort of laboratory/clinical experience you had before applying to your program? What were your MCAT scores? Also what did you study in your undergraduate years?
I'll start with the quicker stuff first.
In terms of MCAT scores, I'm happy to give a range of scores (it's not really necessary to give individual scores, because everyone is different and the test will be different than it was in 2005 in terms of average scores, etc). Of the people I know in the program (including me) here are some scores:
34, 37, 36, 38
(I don't include writing because I'm not sure a single person remembers his or her writing scores...and people, especially MSTP folks, really don't care much about it).
My research experience began the summer after my freshman year and continued until I graduated. (I went to Pomona College in Claremont, California - Pomona is a small liberal arts college with active researchers in Biology, Chemistry, Physics, and Mathematics; I was a Chemistry major with a Biochemistry emphasis - there was no Biochemistry major when I attended Pomona). To be honest (because on applications it is easy to claim continuity of research) I probably worked an average of a day every other week during the year and then ~10 weeks during the summers; however, I worked in spurts, so some really meaningful experiments and results were still performed and obtained, respectively, during the years. I was fortunate to be funded as a researcher starting after freshman year - I wasn't a tech or a dishwasher, so I had a project of sorts early on, and it developed into a story that comprised two publications and a senior thesis.
I think there's a major take-home about my research experience: I could discuss my research formally and informally early on because I had a project I was invested in from the start. And so, when it came time to interview for MSTPs when I was a senior, it was second nature to talk about research. For the most, this helped me during my interviews. That said, I had a rocky start with interviews (UCSF, for example; though I would say some of that had to do with getting interviews with 'difficult' individuals, to put it nicely). So I would suggest getting your story straight - figure out how to explain the experiments you did, the background/motivation behind the work you did, where it fits into an interest in medicine, and what you see yourself doing in the future. There are no correct answers in this, but earnest and well-informed ones are rewarded with thick acceptance packets in March or April.
Don't let the fact that I (or others) have done quite a bit of research discourage individuals who have spent less time in a lab -- your commitment to a project, grasp of the subject matter, performance in classes, and letter from PI can all help if the amount of time is lacking. And if you feel you're not quite there with your research experience, by all means consider taking a year off. (In any event, admissions committees will want to know what you did if it wasn't research. If you were still trying to find your passions, and research is what you landed at, taking more time is never a bad thing).
As I said above, I was a Chemistry major at Pomona; thus I took a variety of classes related to my major (calculus series, physics, Gen Chem, O-chem, P-chem, P-chem lab, Analytical Lab, Biochem, Bio-organic chem, Analytical chem, NMR spectroscopy, senior thesis, independent study) and those for biology/med school (Genetics, Cell and molecular biology - this is a misnomer, as Pomona's intro course has now been correctly re-named cell biology and cell chemistry; and DNA repair and human disease. Being that Pomona is a liberal arts college, I also studied some classics (greek literature, lower levels), art history, music (I played in the orchestra throughout my time at Pomona and studied in the music department on solo and chamber music), shakespeare. I'm not rattling this off to be impressive - most Pomona students do this and more (there is a bit of a grade inflation problem at the school) - but instead to say that people (read: MSTP admissions committees) like this kind of diversity in courses, with also a clear commitment to some major - which doesn't necessarily have to be science. Case in point, a soon-to-be second year in the UCLA MSTP was once-upon-a-time a humanities major at a small liberal arts college. She did post-bac work, research at the NIH, and now is passionate about becoming a physician-scientist.
I spent about 2 months at the Pomona Valley Hospital doing one evening a week of bed changing, patient escorting, and other mindless tasks. But I got a sniff of medicine, and I liked what I was sniffing. My most exciting moment there, incidentally, was as a patient with a subluxated (a.k.a. dislocated) knee-cap.
Ahhhh - the application process. I'm not sure where to start. I think the short answer is that when I started my application, I felt like I really believed in being a physician-scientist, and so answering questions that asked me to expound on my belief in research and medicine weren't that difficult. It didn't hurt that I was forced out of physical activity for a month after the knee injury. I will try to add some other thoughts about the application process in more detail in a later post; for now, I seek some R and R before a busy day in lab tomorrow.
I've a few questions about the MSTP program. More specifically, how your application process went. I'm wondering what sort of laboratory/clinical experience you had before applying to your program? What were your MCAT scores? Also what did you study in your undergraduate years?
I'll start with the quicker stuff first.
In terms of MCAT scores, I'm happy to give a range of scores (it's not really necessary to give individual scores, because everyone is different and the test will be different than it was in 2005 in terms of average scores, etc). Of the people I know in the program (including me) here are some scores:
34, 37, 36, 38
(I don't include writing because I'm not sure a single person remembers his or her writing scores...and people, especially MSTP folks, really don't care much about it).
My research experience began the summer after my freshman year and continued until I graduated. (I went to Pomona College in Claremont, California - Pomona is a small liberal arts college with active researchers in Biology, Chemistry, Physics, and Mathematics; I was a Chemistry major with a Biochemistry emphasis - there was no Biochemistry major when I attended Pomona). To be honest (because on applications it is easy to claim continuity of research) I probably worked an average of a day every other week during the year and then ~10 weeks during the summers; however, I worked in spurts, so some really meaningful experiments and results were still performed and obtained, respectively, during the years. I was fortunate to be funded as a researcher starting after freshman year - I wasn't a tech or a dishwasher, so I had a project of sorts early on, and it developed into a story that comprised two publications and a senior thesis.
I think there's a major take-home about my research experience: I could discuss my research formally and informally early on because I had a project I was invested in from the start. And so, when it came time to interview for MSTPs when I was a senior, it was second nature to talk about research. For the most, this helped me during my interviews. That said, I had a rocky start with interviews (UCSF, for example; though I would say some of that had to do with getting interviews with 'difficult' individuals, to put it nicely). So I would suggest getting your story straight - figure out how to explain the experiments you did, the background/motivation behind the work you did, where it fits into an interest in medicine, and what you see yourself doing in the future. There are no correct answers in this, but earnest and well-informed ones are rewarded with thick acceptance packets in March or April.
Don't let the fact that I (or others) have done quite a bit of research discourage individuals who have spent less time in a lab -- your commitment to a project, grasp of the subject matter, performance in classes, and letter from PI can all help if the amount of time is lacking. And if you feel you're not quite there with your research experience, by all means consider taking a year off. (In any event, admissions committees will want to know what you did if it wasn't research. If you were still trying to find your passions, and research is what you landed at, taking more time is never a bad thing).
As I said above, I was a Chemistry major at Pomona; thus I took a variety of classes related to my major (calculus series, physics, Gen Chem, O-chem, P-chem, P-chem lab, Analytical Lab, Biochem, Bio-organic chem, Analytical chem, NMR spectroscopy, senior thesis, independent study) and those for biology/med school (Genetics, Cell and molecular biology - this is a misnomer, as Pomona's intro course has now been correctly re-named cell biology and cell chemistry; and DNA repair and human disease. Being that Pomona is a liberal arts college, I also studied some classics (greek literature, lower levels), art history, music (I played in the orchestra throughout my time at Pomona and studied in the music department on solo and chamber music), shakespeare. I'm not rattling this off to be impressive - most Pomona students do this and more (there is a bit of a grade inflation problem at the school) - but instead to say that people (read: MSTP admissions committees) like this kind of diversity in courses, with also a clear commitment to some major - which doesn't necessarily have to be science. Case in point, a soon-to-be second year in the UCLA MSTP was once-upon-a-time a humanities major at a small liberal arts college. She did post-bac work, research at the NIH, and now is passionate about becoming a physician-scientist.
I spent about 2 months at the Pomona Valley Hospital doing one evening a week of bed changing, patient escorting, and other mindless tasks. But I got a sniff of medicine, and I liked what I was sniffing. My most exciting moment there, incidentally, was as a patient with a subluxated (a.k.a. dislocated) knee-cap.
Ahhhh - the application process. I'm not sure where to start. I think the short answer is that when I started my application, I felt like I really believed in being a physician-scientist, and so answering questions that asked me to expound on my belief in research and medicine weren't that difficult. It didn't hurt that I was forced out of physical activity for a month after the knee injury. I will try to add some other thoughts about the application process in more detail in a later post; for now, I seek some R and R before a busy day in lab tomorrow.
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