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.”

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.

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.

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."

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.

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.

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.

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...)

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.

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?

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.

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.

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 Spain, taking some classes, doing touristy-related things, and working on a farm/garden for a week. This was the right choice for me—I needed a break, needed some time to unwind, forget about academics, decompress from thesis, the interview process, etc., etc.

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!).

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.

Q and A

In the previous post, an anonymous reader posted the following question:

There are a lot of people applying for this program for the wrong reasons, like top residency, free medical school and etc... What do you have to say to those that lack the passion to do translational research?



I agree that many people do apply for MSTPs for the wrong reasons; it's also true that people apply to medical school alone, law school, podiatry school, dental school, graduate school, and so on for the wrong reasons. In the case of MSTP students doing so, I have a feeling the decision comes back to haunt them. The problem is this: 1) either you enter such a program, realize the research isn't for you, and then opt out after two years or 2) you go forward with graduate training knowing all along that research isn't for you. Both cases are undesirable. In the first case (two free years of medical school), a big reason for why you were admitted to medical school was that you were an MSTP student, hoping to do research and receive clinical training. If that goes away, what remains? Clearly, if a student had not dropped out before then end of second year of medical school, then research rotations had to have been done; and if this were the case, what does such a student tell residency directors asking what they did for the time between years one and two? "Uh, I was in the MSTP and decided it wasn't for me..." -- that has to be about the opposite of the supposed "MSTP boost" that MD/PhD students are known to benefit from on their residency applications. So while it could be a little bit harmful, the major consequence of dropping out of the dual degree program is the lack of benefit from research training and the distinction it provides you in contrast with the rest of your medical school colleagues.

In the second example (going forward with research with no intention to do it one day), the draw-back is personal and the suffering can be immense. Graduate school - as I am beginning to realize - can be approached from many different angles, and effort varies across a wide, wide spectrum. Poor effort generally means a long PhD, and I would venture to guess it is more common in students who really didn't want to do a PhD in the first place (but liked the idea of having two degrees after their names)
. I can say that I've done the math, and for individuals who choose to suffer through the PhD just for the sake of it, MSTP is not more beneficial financially even in the short-term after medical training is complete. A short time in a middle-of-the-road paying sub-specialty (presumably) outside of academia (since these people sort of swear off research after residency) will make up most of the difference that staying in the MSTP would have offered.

Alas, I'm not exactly answering the question. In the two above cases, I argue that it just doesn't much make sense to be in an MSTP for the more superficial and/or personal suffering reasons. But what to say to someone who lacks a passion for translational research?

I think that is a difficult question. The cynical response to the question would be that a person lacking a passion for translation research is a realist. In many fields, the true promise of translational research is far from reality, and so the absence of "passion" could be a recognition of a lack of feasibility in many areas. On the other hand, a more idealistic response would be this: the future (and don't ask me when, I'm like John McCain on this one, I don't do timetables) of medicine will be translational (read: stem cells, genomic/proteomic medicine...) and to not have some kind of passion is like fatally dooming a career before it starts...or something like that.

More than likely, what I would say to a person lacking a "passion" (and we'll say for research, translational or otherwise) is this: this program is not for you, and figuring it out sooner rather than later will be of great benefit to your career.

This is, of course, not to say that one must have a vision of the future well mapped out prior to entering medical school. In fact, as long as there is some passion for research, the rest can figure itself out. In my case, I find the future to be wide open. I knew I wanted research training, and I felt that there was no way I could have decided between straight medical school and a straight PhD program. Somehow, I will connect the passion for the two together, even though I haven't figured out a plan at this point. So maybe I'll go to an internal medicine + sub-specialty fellowship into postdoc and then look for positions in academics. Or maybe I'll go the surgery route and find ways to be more of a collaborator with persons solely dedicated to research. Or maybe I'll go to residency and then consult for biotechnology companies. Or whatever. The point in this case is that I couldn't imagine my life at this point without medicine or without research. Both are a part of who I am.

I should also add that in today's funding environment of the NIH - shitty - it doesn't hurt to have a researcher's best insurance policy, an MD; when people in my lab/department first mentioned it, I thought they were joking - always poking fun at the med students. But then I realized they weren't kidding. People are getting royally screwed right now because the NIH budget was slashed so that we could (warning: irrational half sentence rant to follow) go fight some stupid war in the middle east. People who have been funded for more than a quarter century on the same R01's not getting the easy renewals they once did, and there has been quite a shake-up in academia. Not to say that there aren't options for straight PhDs, but making it isn't easy and might take post-doc'ing and slave laboring in graduate school that rivals the length and effort involved in obtaining a dual degree. Oh yeah, and medicine is kind of screwed as well. Although some say it's doomed, I would say it's just entering a long and awkward phase of puberty. It's growing male breasts right now, has acne and spotty facial hair, and it gets irrationally upset and needs large amounts of sleep and its experimenting with masturbation (it's kind of screwing itself right now). Being a professional in medicine, research, or both will be better in the future; when that is, and how it manifests, who can say? But I'm glad to be in both.

New beginnings...

As a first year PhD student, I'm close to being smack-dab in the middle of our program. So it's with some sense of surprise that I got the following recently:

"...On behalf of UCLA, I'm extending an official offer of admission to the Graduate Division. You have been singled out from a pool of exceptionally qualified and talented applicants in a rigorous and highly competitive process. Your selection recognizes your academic accomplishments and potential for advanced scholarship. Let me add my personal congratulations to those of your family and friends..."

It turns out that when we go from the first two years of medical school into graduate school, we have to "apply" to our graduate programs. It's sort of fun to get letters like these when you did nothing but fill out some online forms stating your date of birth, city of origin, country of citizenship, etc...I suppose I could rant about how these form letters cheapen the meaning of such an acceptance to a person who was actually waiting for it, but whatever, there's no need.

I will continue some of my boards thoughts and offer some perspectives about the transition to graduate training when I finish the back-log of laundry I have at the moment.

Good luck to all incoming first years and folks applying at the moment!

E-mail list!

As I have mentioned a fair amount, we're attempting to keep this blog going. In the spirit of this, we'd like to keep any readers updated as to when new posts go out, and of any other goings on. As such, we have set up a new e-mail address, where you may subscribe to our email list - just send an email to mstpla@gmail.com with the subject line reading "subscribe," and we'll keep you up to date. And of course any inquiries, comments, concerns, etc may be sent to this address as well.

Post-Mortem Board Report

Every time I thought I was going to come home from the library and create a blog post on studying for the boards, I found something else to do, such as:

1. Eat canned black beans for the 5th straight evening.
2. Drink my ration of 2 glasses of red wine.
3. Watch a round-up of the best NBA playoffs in years and constantly remind myself I was not watching this because the studying was for a good cause.
4. Try to furiously send text messages to all the non-med-school people I knew and beg them to go out with me on the evenings I ended early and was taking some R&R (I wasn't too successful at this).

In any event, no posts would arrive after the first. Perhaps that is most illustrative of The Experience of studying for the USMLE step 1. I like to think of it as being transported into another dimension for, give or take, six weeks time. Everything else in your life has to take a breather. Well, at least that was my approach; which brings me to my next point. However much you (or I, or anyone else for that matter) hear things from other folks who take the exam, the most important point you can reach is that of personal enlightenment - the point where you have some idea of how your experience will play out, you have a plan for yourself, and you know how to stick to it. With that, I offer the following impressions not as a guide for others (you will probably not need to study immunology as much as I did (I still am hopeless with those Ts/Bs/Natural Killers/Langerhan, etc) nor will you likely be compelled to carry "Grays Anatomy for Students," with you to the library), but as some insight into the growth and discovery that I think makes the studying for step 1 (get ready for this) a worthwhile experience that builds character.

[I should first offer the following disclaimer: I am painfully and painstakingly superstitious about my examination performance - just ask any of my friends - so one should not read into this post as a reflection of success or bitter failure on my part; the exam was reasonable, fair, but I still could have bombed it. So until about July 15th, don't ask me how I did or assume one way or the other. Thank you. You may now diagnose me with one of the personality disorder cluster types (A, B, C, with sub-categories)].

And so, I begin with Charles' first three Ramblings on the USMLE step 1, as (un)commissioned by http://mstpla.blogspot.com:

1. Physical ailments are an inevitability, but not necessarily irreversible. Studying for 15-16 hours a day (which, according to the folks that "primed" us for boards studying at UCLA, is about 7-8 hours too many a day) takes a physical toll. For me, the most significant were lower back pain (a.k.a LBP or Mechanical Back Pain), a bizarre, bilateral fungal infection on my elbows (which Kevin helped me diagnose based on the fact that a short course with topical corticosteroids made the tinea markedly worse), double vision (a.k.a. diplopia) at, consistently, hour 13 each day, near-crippling dominant hand pain secondary to furious annotation of "First Aid 2008," two upper respiratory tract infections (I had not had a single sore throat or cough for two years prior), and of course self-limited gastroenteritis secondary to dining at the hospital cafeteria. Oh I forgot - my derrière was absurdly sore on several occasions; it didn't matter that the chairs in the library rooms we of outstanding comfort (and their height could be easily adjusted). Somehow the human body has trouble sitting for so long. Or I am particularly sensitive or allow undue chafing to get the better of me. Don't worry, friends, there were no short or long-term complications of the pain.

2. On more than one occasion, my friends and colleagues accused me of being two "hard-core," in that I would, at the two-weeks-before-the-exam peak of my studying arrive at the graduate reading room at 6:30 a.m. and study (with food to accompany at appropriate times) until around 10-10:30 p.m. I vehemently disagreed most of the time. If I was happy, not excessively fatigued (during the last couple of weeks, you can probably get away with 6-6.5 hours of sleep and be fine), and able to focus, what was the problem? And furthermore, one becomes inevitably stressed out during the last part of the studying experience (you feel you have to know everything and you know a fraction of it), and so I could imagine a much worse approach would be to slack-off (but feel rested and rejuvinated), and then come to the library with an insurmountable deficit of time and effort. I suppose if one is prone to becoming ignorant and blissful, the latter approach is appropriate. I am not one of those who has either ignorance or bliss during exam preparations. I thought of it like this: How am I going to feel right after the exam? If I put in less than "100%" of the effort I could, such a moment would be neither satisfying or enjoyable (and probably frustrating, filled with "could haves" and "should haves.")

One caveat to all of that: about three days before the exam when I repaired to my folks place in Pasadena for the final stretch (at some point, the toxic environment of medical students studying for step 1 in the same vicinity is too much), I hit a wall. I was unfathomably fatigued, for whatever reason, and it showed: I had just contracted my second upper respiratory tract infection of the six weeks, I had done a set of practice questions where I score ~20-30% below my average at the time, and I was hopelessly behind on my daily schedule for getting through endless amounts of last minute pharmacology and pathology images. I must thank my mother for observing me as I began to eat another fine home-cooked meal, who said, "You know, you really need to get some rest. You're going to be a disaster on exam day. Just go to bed in the next 30 minutes (which would have been 10 pm), and start back at it tomorrow." Going to bed and catching up on some sleep was the best thing I could have done. The next day, I was rejuvinated, was able to return to the 6-6.5 hour sleep schedule, and my mind was sharp (enough) on exam day.

3. I suppose #2 inevitably leads me to my next point. Flexibility is a must-have in the boards studying. Think of it as a healthy exercise in self-regulation (important concept in psychology and psychiatry) - dealing with not getting through that which you have planned for the day, a less-than-ideal score on a practice test, and so forth - that is not just necessary but also vital to keeping sanity in the process. There's enough riding on this whole experience, and stressing out over whether you got through 35 versus 37 pages of renal on a certain day doesn't need to be one of the areas in which that happens. Schedules can be modified. I know that for me, I had to trim down my expectations for final reviewing when all was said and done. It's just not feasible to memorize every word on every page of first aid. Better to take the triage approach to the material at the last minute. On the morning of the exam, I knew that the neurocutaneous disorders (like tuberous sclerosis and neurofibromatosis) were weak in my memory. And so I reviewed them for ten minutes. It turned out that doing that was beneficial - I got a question on tuberous sclerosis on the actual exam. Had I thought reviewing all of First Aid was feasible, I might not have helped myself at all...

More thoughts to come. Fellow Step 1 takers, what are your thoughts? Please comment and let's continue the discussion.

Board Report, Part 1

Day 5: Sunday, April 27th, 2008

Today I studied from 7:00 a.m. until 7:00 p.m. For 15 minutes of that time, I was on the phone with the LA dept of water and power; another five I spent on the phone with my mother outside of the library; another 10 minutes was spent talking to some folks who dropped by the study room. The remaining 11 hours and 30 minutes I spent sitting in a room in the library studying the gastrointestinal tract. Anatomy, embryology, physiology, biochemistry, and a start on pathology. About three times I checked my email. Tomorrow I will finish my first pass on GI; then Tuesday it will be on to Endocrine. After that Reproductive. Then Anatomy/Musculoskeletal/Connective tissue disorders. After that? I'll have to check the calender (I don't have it handy right now).

I take Step One of the United States Medical Licensing Exam on June 5th. From now until then, my days are centered on which organ system, which medically-relevant area of basic science, and which sets of questions I will choose to spend my days tackling. Five days in, I have already reviewed a crapload of material. I think of the process as a protracted trip down memory lane, in which all the random diseases, challenging pathways, and pathology slides from the first two years - then a bunch of new stuff - need thorough review, and they also fit into the context of a 350 question multiple choice exam.

In a weird way, this doesn't feel that different from any other exam preparation period. I mean, yes, it's "The Boards," and it is the first time I have put my life on hold (whatever that means, but just bear with me) for a month and a half, but I have this strange feeling that I've been here before. Not exactly when I was studying for the MCAT, not exactly when studying for Organic Chemistry exams, not exactly when I was studying for the AP Chemistry exam (certainly not); but somehow, in the back of my mind, I was preparing all along for this. When I entered medical school, I knew I had signed up for this. In the future, there will be more steps of the boards (albeit ones with much less preparation required), qualifying exams for graduate school, orals, thesis defense, then onto the wards with numerous (difficult) standardized exams for each of the rotations; then more boards; specialty boards. It's a maze. But I knew it was coming...

And I don't know why I'm ready; I don't resent the studying. Maybe it's not so grueling and not so bad as everyone says it is.

Maybe.

Check back with me in a week.

To fellow 2008 applicants and others:

You have been accepted into one or more sexy MD/PhD programs. You have been wined and dined. You have spoken with faculty, heard the pitches of the programs, current and prospective students. You let the taste of the revisit sit on your tongue. You imagine yourself at University X. You will be happy, right? You will destroy Step 1, publish a ridiculous amount of high-impact papers, yield faculty offers before you graduate, become the best clinician imaginable, match into your top residency choice, become a baller PI, an ideal physician-scientist-hybrid at highly-ranked University Y, so on and so forth, yeah? And throw in family life while you’re at it.

You may have a formulated idea of your career and personal trajectory—I don’t. I could go on and list my worries, concerns, uncertainties related to the MD/PhD experience—I won’t. What I want to address, though, is the role of this blog. Echoing Charles’s post, this blog – along with others – is a good first step to motivate, engage, provide open-access to individual experiences related to the MD/PhD training. Soon, I hope to contribute my limited insight to this blog; however, at the moment, I am merely an undergraduate who has a lot to learn, real soon.

Blog Clean-up and Repair

I recently became inspired to make some significant changes to the blog. After meeting several of the first-years-to-be for 2008-2009 for the MSTP at UCLA, several of my discussions revealed that few of us thinks about what it means to be an MD/PhD student (or MD/PhD physician scientist). And although this blog won't bring professional expertise, it will seek to document our experiences and perhaps deliver insight as a result. Because I think it's been said more than once that the ideas we have about why we're in this program are nebulous (and, more often, wholly unknown). I suppose on one hand, that's endemic to the whole pursuit of medicine and careers in medicine.

We spend so much time preparing for medical school - MCAT, college grades, hospital volunteer work, post-bac programs, research involvement, president of the debate team, newspaper writers, tuba in the orchestra - and we tout this resume as representing the "real life experience" necessary to a) be an exceptional physician and b) be better than the next person with the tricked out resume, and c) have some idea of a medical specialty or career focus (e.g. academic ophthalmologist vs. Kaiser Permanente Neurosurgeon vs. next Atul Gawande). And then if we want to be considered for an MD/PhD program, programs want to see an impressive research record. So we essentially straddle everything, often times with the idea that we will be able to do everything. I had this idea - I kid you not - that each day I would spend mornings in a laboratory directing research that successfully incorporated questions from my clinical practice, and then in the afternoon see patients. Throw in a busy travel schedule giving talks all over the country as a pre-eminent, true physician scientist in my field of interest. And I would be paid handsomely for my efforts. And I would have a family life, stay in shape, go on trips, and maybe even run for school board or city council. You know, make a difference in the community.

Then I think the last two years were spent learning basic medicine as much as they were having this grandiose vision of the future - this myth that I could straddle everything, have my cake and eat it too - dispelled by a series of discussions, observations, inquiries, and visits to the University of California highest-paid employee salaries for 2005, as provided by the San Fransisco Chronicle. (In an upcoming post, I'll explain how I started getting interested in surgery. This is not just because Dr. Ronald Busittil - and MD/PhD grad from Tulane university, chair of surgery at UCLA and pioneer of liver transplantation - was basically tied for award of highest paid employee in the UC system in 2005; Basketball Coach Ben Howland is no doubt the far-and-away highest paid employee now. If you're expecting a cynical, "Well that's just silly a COACH would be paid that much!" response then you're not giving me credit enough for understanding economics. Busittil is paid over a million a year because he brings in a boatload of revenue to the hospital. There are other amazingly talented physician scientists who don't get paid that much - and it has to do largely with revenue. Ben Howland - or more precisely his team - brings in a huge amount of revenue for the university. Sometimes I wish I could do footnotes for this post). I don't have any great answers yet about what I want to do or what I should be doing. But I am humbled by the difficulty in focusing on right now (starting my PhD in a couple months, studying for the boards, figuring out how - and with whom - I will be maintaining a bit of clinical work during the research years of this program), especially when the future seems even more daunting. But I still maintain this (UCLA, MSTP, Los Angeles, California, Science, Medicine) is where I want to be and what I want to do. Now what exactly that is eludes me. My preschool teacher - with whom I maintain contact about once a year - says we prepared for this in the sandbox growing up: you know, learning to embrace the tension of not knowing where the perfect spade is, where the caterpillar just went, and whether Sharon will do as you ask regarding the sand-castle you so desperately need to make before snack-time. It's all the same kind of tension when you approach it at a psychological/neurobiological level. So I tell myself: I've been preparing for this since the age of five.

So, what should we expect as we move forward with this blog? First, I've done some clean-up of many of the previous posts. I removed posts I felt were a little too mean-spirited (this includes many I drafted), ones that took some shots at specific folks (this includes many I drafted), and ones that really weren't relevant to the spirit of this blog (this includes many I drafted). Next, Anthony - an incoming member of the class of 2016 - will be joining the team and posting - probably closer to his arrival at UCLA in August.

Until then, join in the discussion on the question of MSTP, identity, and everything that falls through the intellectual cracks.

Coming back...

Greetings, all,

This blog might be resurrecting itself soon enough. I have decided, on the eve (um oops except for usmle step 1) of PhD years, I will begin posting on the MSTP life. Stay tuned. I swear it will return; and there's the possibility of new blood. After all, 2008 is all about change.

--CSH