Two weeks in.

Today marks two weeks of being an intern. I have never felt so busy in my whole life. Pressed for time, but filled with energy. No time for food, every moment is devoted to my patients, my teammates, my colleagues, and soaking up new information, skills.

Everyone told me I would be humbled, and they were right. Many told me I would be invigorated, and I am.

I live, breath, eat, drink, and sleep my profession. Although I will not always be this busy or fully immersed, I continue to relish in these formative moments. God, keep giving me strength.

BOOM

Intern year is no joke. The thrills and chills of being a physician, plus all of the documentation, disposition, and other administrative work to move things along. Boom!

Much to ponder...

As my MSTP training life comes to an end, in favor of a new chapter training in Ob/Gyn in Philadelphia, there remains unfinished business, unwritten reflections. Here's a list with brief abstracts. I hope to expand on each:

1. USMLE Step 1 - why is it so hard, so feared? In many ways, it's like an intense, fast-paced language immersion program, where you have to learn the language without the why or always the precise "how." It's a way to lay out the foundations needed to start learning medicine as it is practices. It requires one to learn the foundations and science of medicine without any of the art. How frustrating and challenging. Along these lines: how do we *define* the stages of training? Should the learning objectives, and the comparisons and contrasts between and among stages of training be better defined? e.g. should medical students not simply be told to, "understand the pathophysiology, treatment, and prognosis" of a disease, but also being given the caveat that, "you will not be able, nor should you be expected to, manage X disease clinically; in this phase you are to learn to recognize and understand the core principles of the disease."

2. Philadelphia abortion doctor found guilty of murder, having killed neonates after botched late-term abortions. Ugh.

3. Career decisions in medicine: how to separate the forest from the trees, and stop listening to advice from people who shouldn't be giving it.

4. Deeply understanding the role of healthcare providers -- why isn't this better emphasized in medical training?

5. Shout out to my Ph.D. mentor, newly-elected member of the National Academy of Sciences.

6. Deep gratitude for my teachers and mentors at the UCLA David Geffen School of Medicine and the MSTP.

7. Deep gratitude for my undergraduate education at Pomona College, and it's enduring lessons and skills taught.

8. Even while medical schools are emphasizing the success of humanities-majors-turned-physicians, should we be dismissing the value of a rigorous scientific education and how it can play a role in medicine? Has science become the "S" word in medical education? Part of the burden falls on scientists, who need to learn to be more art- and humanity-minded. It's on us, too.

I'm so tired

Nearing the end of the MSTP, and intellectually, I'm exhausted. Love what I've been doing, what I am going to do, but right now, I feel weary.

Time to re-charge.

UCLA pride

It's no secret that UCLA and UCSF have a degree of healthy competition when it comes to being "Best in the West" (although UCLA is BIW x 20+years). Here's an anecdote from this weekend I think to be particularly reflective of the trash talking supposedly going on between the two schools:

According to the David Geffen School of Medicine Dean, A. Eugene Washington, UCSF from time to time ridicules the warm weather loving UCLA people, making snide comments about bruin people. Some time into his tenure at UCLA, Dr. Washington was asked by a former UCSF colleague, "Well, what do the people at UCLA say about SF?" To which Dr. Washington quickly responded,

"Nothing."

#once a bruin, always a bruin.

Middle school failure = Medical school success?

Some compelling insights (albeit completely qualitative and non-quantitative in nature) into how struggling when younger predict future success: http://www.theatlantic.com/national/archive/2013/03/how-middle-school-failures-lead-to-medical-school-success/274163/ 

I recently failed at doing a relatively straightforward procedure on a patient, and the resident said to me, "don't beat yourself up," after I apologized. And at that moment, I made a pretty important self-realization: I am probably better off not succeeding at a given procedure, because I get too forms of feedback in the process: 1) I didn't succeed, but I figured out what some of the challenges of the procedure are, and 2) I got to see how the resident successfully performed the procedure thereafter. What if I had been lucky and succeeded right off the bat? Would I have the insight I (think I) have for the next time, had it just been totally easy for me? I think not. That's the beauty of the "failing" and getting feedback. And so, realizing that, I could earnestly say, "Yeah, no, if there's one thing I've learned in med school, it's that being unsuccessful at procedures and the like is all part of the job, and it's all an opportunity to LEARN!" Over-exuberance about failure aside, true that.

Gynecologic Oncologists

For the win, according to a new study out of UCI.

Also, when financial considerations come into play, private practitioners don't always do what's best for the patient (intraperitoneal chemotherapy is used less, in part, because it takes longer to administer without reimbursing any better than intravenous; although it's more complicated than that -- it's much more toxic and ridden with side effects).

If you or anyone you know is diagnosed with, or has signs/symptoms strongly suggestive of Ovarian CA, please please please go to a gynecologic oncologist, and preferably one at an academic center. Survival may depend on it.

And if it happens in seven years from now, please come see me.