Current lifts

Regarding max lifts as of this post @ BW of 175 lbs:

  • Incline dumbbell press: 110×4
  • Weighted chin up: 135×3
  • Body-weight chin up count: 33
  • Body-weight dips count: 20

The thespian’s exam: USMLE Step 2 CS preparation and thoughts

USMLE Step 2 CS is a fruitless sort of charade, but nevertheless it remains as a necessary component to becoming licensed. My school mandates a practice exam through Kaplan before taking the real exam. While I initially disliked this idea, it was a good primer and once you’ve gone through the thing once, the real one seems much more manageable. Here are some pearls:

  • Use First Aid Step 2 CS: This is a well-organized book that is probably overkill but once you go through it, you have the general gist of the idea. If you don’t have a partner, go through and do the mini-cases by covering the half of the page that shows the diagnoses and orders.
  • Practice with a partner: Either through Skype or in person, interaction is the best way to ease into the weird pseudo-clinical patient scenario. Practicing with another person lets you try your intro and closing in real time, which is probably the hardest part of the exam.
  • Have a script: I used a some sort of acronym to make sure I covered my bases in order to maximize the points I hit.
  • Have a plan: Probably the best change I made with my CS approach was to already have a list of three differentials before going into the room. This way you can ask question to rule thing in and out (pertinent positives and negatives) and include those tidbits in your note.

I took the exam fairly shortly after Step 2 CK and it’s good to know what to order and the sort of classic signs and symptoms because the obvious players show up on the real exam. Overall I’m one step closer to the goal.

Family Medicine: The nucleus

During April I rotated through my mandatory family medicine ‘elective.’ About a year prior, I began my first rotation ever, and, of course, I had formed many opinions of rotations and specialties before I even had them scheduled. Rotating through M3, you hear the stories of other students and their trials and tribulations, misfortunes and misgivings. Everyone’s a pariah. Somewhere along the line, I had formed the opinion that FM was among the more banal rotations, and, naturally, this was supported by mountains of anecdotal evidence.

However, regardless of my preformed inclinations, I always try go into a rotation with an open mind and an eager spirit because there are great teachers everywhere, and prejudgment leads more often to disappointment than substance. I was taken aback by the versatility and welcome of the program I rotated through. It was ideal for a student, and the residents were excited and genuinely caring and kind. The attending physicians were surprisingly well-attuned to listening, and were receptive to our presentations. The structure of the rotation was also well-designed; two weeks of clinic, one week of inpatient nights, and one week of inpatient days.

The population served had abundant pathology and disease, and I was thrown into the thick of it during my first overnight shift when a patient coded and I performed compressions. That memory will stay with me for some time – the code itself was successful, but, I had asked myself that night, at what cost? After the fact, I learned that the patient was on her way to hospice care and her daughter had wavered that day on a Do Not Resuscitate (DNR) order. The code was grisly. Throughout the whole ordeal there was brown seemingly feculent material streaming out of the patient’s mouth. I performed compressions as the resident valiantly attempted intubation, intermittently suctioning. The large laparotomy wound on her abdomen that was leaking serosanguinous fluid was held together tenuously by staples; these began to tease apart during only the second round of compressions – by the fourth or fifth the thing had come undone. The anesthesiologist intubated, and I was rotated out of the compressions, and that pause let me absorb the scene. Somehow we attained return of spontaneous circulation (ROSC), though the patient was unresponsive.

Other memorable events included management of post-surgical hemorrhagic shock overnight, textbook rheumatoid arthritis, and of course, clinic. The abundant clinic time gave me comfort in that setting and I was able to see the wide swathe of patients that FM encompasses; from routine pediatric visits and obstetric patients to idiopathic pulmonary hypertension and sepsis, FM is the first line for many encounters. I remember suturing supervised with a resident’s and attending’s guidance in one clinic encounter – never during surgery had that ever happened.

In short, I had a great time on FM. I learned much, was actually able to get up close and involved with some of the management aspects of ward medicine, and worked with extremely kind and caring physicians in a clinical setting.

13.1 miles in, warmed up and steady

I’ve reached a symbolic midway point in the basic sciences portion of my medical education; three of five blocks in this semester are done, with this being the third of five semesters.

The work of men who died generations ago. From here, it looks like an achievement.

I have developed reservations about the whole process of school, but nevertheless, the fact remains that time has passed and I have learned. Is it an achievement? That’s a very subjective question. In old posts I spoke of what I considered two different types of achievement: personal and existential. In fact, I explicitly said that education was always a personal achievement rather than an existential one, and my opinion on the matter remains so. Over the last ten months, I have understood the machinations and theories of other men, not created my own. This is the key flaw to such an education; however, there is nothing worth doing to change it. Shortly, I will be gone from this place, and the island will be another memory of my past.

That said, the material we’re covering is the most clinically relevant stuff we’ve learned so far. Various pathogens, the complex function of the immune system, and very circuitous (but applicable) neuroscience. The current block for microbiology is a survey of virology, which is a very interesting subject despite the droning lectures we receive.

I am looking forward to starting rotations in a little more over a year, finally seeing things in full color and form. It’s a strange question to ask myself – now that I’m here, halfway, would I start over and do it all again? This question doesn’t really represent the process that will be the other half of my education. In the first half, I developed the capacity to handle large swathes of material and study habits that will assist me for the rest of my life.

Someone wise once asked me:

How do you make a test for someone smarter than yourself?

At the time, I didn’t fully appreciate the answer to the question. I was in high school, and academic achievement tests were a joke. They were timed, difficult, and represented the perfect opportunity to prove my intelligence to others without; the tests were a pure ego-flexing opportunity to have a numerical value to rank me against my peers. The point the question made, nonetheless, was that to make any test harder, you shorten the amount of time allotted to take the test.

Take this notion and supersize it from a test to an entire curriculum, and you have medical school. The material is not hard, the volume is just incredible. It is manageable, though, and begets a transformative experience. While I initially disliked the lack of creativity, the courses I am taking have become more and more detailed, which is to my liking; the purpose is to serve as a survey rather than canvas.

Second semester

Well, I completed my second semester of medical school a few days ago. The last exams, unsurprisingly, were a wild ride. The semester culminated in a 3-day mental marathon. We had two very specific exams on the final Monday of the term, and two comprehensive, board-style exams that were exhaustive in nature on the final Wednesday. During the final hour of the testing, I genuinely wondered to myself how I would be able to complete a grueling 8-hour examination with 100% mental clarity; here I was struggling to stay focused after a mere 4 and a half.

I realized that I still have 50+ examinations left under my belt before anyone even lets me register for the big one, so it’s an inevitability that I will adapt over time to the increasing stresses of medical academia, proving myself ultimately on the USMLE.

My second semester was rough, and overall I am slightly disappointed in the quality of instruction I received. The 2 exhaustive exams I mentioned were ‘Shelf’ exams written by the NBME, and while I was entirely comfortable taking one (Biochemistry), the other left me asking myself if I even knew the material being tested (Physiology).

Nevertheless, I passed, though not as spectacularly as I did in first semester. The takeaway message for me overall for this set of 15 weeks was simple: study hard, but not to death, and you will be fine. For me, it is not feasible to expect perfection every semester. My goal in studying on this island is to learn medicine and perform well on exams. I’d rather not burn out and be a husk of a human consciousness by going overboard in studying.

The name of this blog was chosen deliberately – “a toilsome peace” – because I need to remind myself that consistency and effort are the backbone of any endeavor I will ever undertake if I intend to undertake them properly. I cannot be impatient with things that matter. Originally, this line of thought – this impatience – stemmed from my frustrations with the medical admissions process and my fitness goals. Differentiating complacency and patience has been my large personal struggle, and it will be many years yet before I am entirely at one with my thoughts, goals and motivations fully. I know at certain points I certainly am at this peace I seek, and at others I am furiously displeased. I am happy that I have the wisdom to recognize that, and more often than not I find myself patient rather than complacent.

In other news, I’ve been thinking a bit more seriously about what I’d like to pursue professionally. I’ve been reading more about hematopoietic stem cell transplantation. It is a therapy that is maturing rapidly and, therapeutically, it has amazing potential. Like any therapy, there are risks and routine use, but what fascinates me is the plethora of applications HSC transplants have – I imagine gene therapy in its fullest form.

However, it is now that I exercise great patience, because, as of now, I am on this island, no labs or full-fledged oncologists anywhere. I will wait, but not complacently, and continue to educate myself so that once I have a real opportunity to research and treat, I will make the most of it.