Even When I Don’t Feel Like It…

Its 7am on a Friday morning, end of the second week of my MS1 experience. I’ve spent the last two hours previewing today’s lectures in the best way possible – still in my jammies, coffee in hand, sitting in my recliner with my feet up and brain power in high gear.

Decided I needed to chronicle the milestones so far – because it matters.

  • Celebrated my High Pass grade report for last block. Yes, my brain still works – whew!
  • Successfully negotiated a two-year contract with a local physician for my Observership – can’t wait to begin!
  • Realized it really does pay to pre-study every single lecture, every single morning… sometimes I go through the slides twice if I’m feeling particularly daunted by the material, but I haven’t missed a day yet.
  • Realized I really do understand Biochem…. which is awesome.
  • Gave myself permission to not be great yet at translating that ‘love/understanding of Biochem’ into correctly guessing at answering secondary and tertiary questions taken from the q-bank.
  • Successfully reviewed “everything” every single day, including weekends.
  • Happy dance to celebrate the realization that I can successfully study even when I don’t feel like it.
  • Got better headphones. Used ’em.

Lovin’ the life I’ve chosen…… now on to the last lectures of the week. Gotta refill the coffee one more time!

 

Grades and Egos

I will admit it. As an undergrad, I was highly competitive. I joined the hoards of students eager for grades to come out following an exam, and nearly wore out the Refresh button on my keyboard once they moved to electronic grade reporting. I wasn’t so much concerned with my class standing or comparisons between me and other students, but I was competing HARD with myself.

So when I recently received an email letting me know that last block’s grades were ready to view, I was surprised at how nervous I was.

Let’s take a short detour. IUHS does things a little differently. The first semester – or first “block” – is a catch-up block. Its a fast run-through of everything you’re supposed to have stored in your brain as foundational to the study of medicine. Think of your premed classes all condensed into four months, and you’ll pretty much have it. Since IUHS caters to career-changers and non-traditional students, it might have been quite a number of years since the last hard-science course was taken. They want to make sure we’re all starting out in the same place. In my case, it had been about ten years since I’d taken some of those courses I was supposed to remember.

I knew I passed – after all, they allowed me to begin the next block of classes, and I’m now eyeball-deep in Biochemistry, with bits of intro’s to Pharmacology, Anatomy, Cell Bio, Histology, and Imaging thrown in for good measure.

Until I got that email, I wasn’t thinking much about that foundational block and what my score might be. Or so I told myself. Any time I wondered how long it would be til I knew for sure that I was doing okay, I’d quickly stifle that thought and go back to reviewing enzymes and rate-limiting steps, diseases and inheritance patterns. Scroll through Twitter and you’ll see a bunch of ‘advice’ for med students. Cautions to remember that you might have been top of the heap in undergrad, but the bell curve still applies it just gets redistributed in medical school.

And I was ridiculously pleased to see I got a high pass.

Does it mean much?

Yes. And no.

Yes, because it once again reminds me that my brain works. That old fear from way back when I first returned to college in my 40s not sure if my brain could handle the pre-med curriculum… (see My Story)… well, I guess I’ve still got some insecurities going on. And in many ways its an enormous blessing that I haven’t a clue what my ‘class standing’ is in comparison to my colleagues.

And no, it doesn’t mean much. I can let go of the ego thing now. I’ve confirmed, through more than a decade, that I not only have the capacity to tackle this, but I can do well. Now I get to practice embracing the process, realizing this is a life long journey.

Real Review

Its not about just “re-reading”, skimming the powerpoint slides endlessly, or recognizing diagrams.

Its real review. Over and over.

If you were to be a fly on the wall watching this process, you’d likely be convinced I was a little crazy. And just maybe I am. But it works for me. I’m an old lady, remember? I’m determined, courageous, and absolutely unstoppable.

After every lecture, I spend 30 minutes going over the slides again, recalling the information presented.

Then, its what I call “REAL LEARNING TIME”. This is where I draw pictures, label steps, use simple mnemonics to recall lists of things… anything I can think of to solidify the information in a way I’ll be able to recall later.

Real Review is absolutely vital for me. This is where I go into our q-bank, pull up 100-300 questions, and go through them. Importantly, I don’t simply read the question, think about it, and click the answer. Oh no – its a much more dynamic process than that for me. Here’s how it goes:

  1. Read the question
  2. If I’m absolutely sure, WRITE THE ANSWER DOWN, then double check.
  3. If I’m NOT absolutely sure, talk my way through it. I close my eyes, OUT LOUD describe the parts of the answer I know and can see in my “mind’s eye”, and why I’m guessing a particular response. Then I check. With the program I have available, this means I see a narrative correct answer, along with the explanation. Even if I was dead wrong, here I ALWAYS WRITE OUT THE CORRECT RESPONSE.
  4. I hold myself accountable to WRITE OUT MY RESPONSE every time, whether I am certain, or uncertain. I faithfully spell out enzymes, diseases, toxins, pathways, substrates, drugs, products, inheritance patterns – doing it this way solidifies the information in my head.
  5. Finally, right or wrong, I SAY IT OUT LOUD AGAIN. This step is where I’m quite sure my pup is convinced I’ve gone ’round the bend, but that’s okay.

Review

My goal in this is to have the information so clearly in my head that I can close my eyes and know. I’ve written about this before – the whole idea of never having to struggle over identification of a primary color, how to spell its name, or understanding that color’s interaction with other colors.

I’m a realist. I’m quite clear that I won’t be able to hold every single one of the 99 guzillion bit of info required in my head. I’m not a computer. But I can hold far more than I used to believe possible. And following the five steps above inevitably results in understanding and retaining this marvelous mountain of information in ever increasing piles of understandable – oh YES I got this!

 

 

Don’t Panic

I’m an MS1. That means I’m just beginning this marvelous journey in medical school and learning the basics.

Que Biochemistry.

Its been about ten years since I studied (and fell in love with) Biochem as an undergrad. I wasn’t exactly a brilliant undergrad student; although I enjoyed the course immensely I still struggled to put it all together. So I came into this medical school Biochemistry course with a heap of trepidation.

Maybe that’s why I so faithfully pre-study for every single lecture, then review constantly.

Yes, its a whole heap of detail (far more detail than you need to know as an undergrad), presented very fast.

I’m here to tell you though that it is not “hard”. Seriously. I am daily blown away by the way my Biochem professor presents what some consider a very difficult course. And interspersed about every ten minutes or so is the following:

Is your brain bleeding yet? Ha! Don’t panic. Take the time to understand this…

I’m discovering that all the intricate details of Biochemistry make SO much sense.

Here’s the secret:

Don’t memorize it. UNDERSTAND it.

For me, there’s a huge difference between rote memorization (and there’s a finite number of factoids that can be retained in my brain in this fashion) and actually understanding  a potentially complex bunch of details. As I understand it, I’m finding that my recall goes WAY up.

So, its quite simple really. I take the time to UNDERSTAND. Which results in remembering the details, how they all go together, and importantly being able to pull out that understanding and apply it to secondary or tertiary questions. You know the ones – the little vignette followed by multiple choice questions that on first read are completely outside your knowledge base, but on second read are actually something you know but didn’t realize you did…

I won’t panic. I’m too busy understanding to panic.

How Not To Be a Doctor

We sat in the examination room, my son and I, waiting for the doc. This was a new doc for us / him – after months of searching for a new primary care physician and a very long wait for the first available appointment. We both had high hopes that this doc would listen compassionately, do a little “doctoring”, and sleuth out the cause of my son’s frustrating constellation of symptoms: debilitating headaches, episodes of syncope, right side weakness and vision and hearing loss, and six months of energy loss so extreme it was getting a little frightening.

It started out great. Firm handshake and introduction, running through the symptoms, review of basic blood work and CT and MRI and EKG.

Then, well, then it got a little weird.

Look in the mouth, look in the ears, a swipe around the neck and a quick push on the belly. Heart sounds, lung sounds, reflexes…

“Well, your symptoms don’t point to any particular diagnosis. So we’ll put you on an antibiotic for ten days just in case, give you an antidepressant for your mood that might help prevent your headaches, and check back with me in a month. Great to meet you – have a great day!”

Say what?

If you’re going to be a doctor, don’t do that.

If you’re going to be a doctor, be a doctor.

Is Medical School Hard?

I’ll be the first to admit it. I’ve spent my whole life believing that medical school is “hard”. Any time I’ve considered what it would really mean to pursue my dream of medicine, I’ve gotten mental images of bleary-eyed students studying frantically for days on end with no sleep, little food, and a complete lack of any balance in their lives. When I’ve listened to some stories of other students it has only served to solidify that notion.

But hold up now – I’m getting a new perspective these days, and I’m realizing something. A pretty important and mind-blowing something.

Let’s step sideways for just a minute. Imagine you’re a little girl or boy of about five years, and a hero of yours is a cowboy uncle. He rides in rodeos, with all the excitement and drama, and you are completely taken with the idea that you so hope to grow up and become a cowboy/girl yourself. Then the stories start – about how terribly hard it is, how many serious injuries happen every year, and how few aspiring cowboys/girls ever achieve a level of expertise where they can pursue it as a career. As the years progress, your excitement over a dream is gradually replaced with what you think is probably a more “realistic”, “mature” understanding. And if you could fast forward about twenty years down the road, it is highly likely that the little five year old has completely given up on the dream of one day becoming a cowboy/girl.

We’ve all heard that axiom, you are what you think. Okay, so if you think about how hard med school will be long enough, you’ll absolutely believe it.

Sure, there needs to be some level of understanding that medical school takes education to a whole ‘nuther level. Definitely more intense than undergrad, and even in a whole different league than grad school. In order to do well, it does require a degree of maturity and focus, a willingness to consistently study day-in and day-out no matter what. There will be days when you’ll be amazed that your tired brain can assimilate one more fact and have it make sense. You’ll even have moments when you’ll get overwhelmed, “hit the wall”, and feel desperate for tangible support from those who understand this grand goal you’re pursuing.

But STOP already with this thing of constantly telling yourself its so “hard”.

Repeat that often enough, and your brain, if its anything like mine, will begin to shrivel in terror at the mere mention of the long list of enzymes, pharmacological agents, and anatomical minutiae that you need to know and recall in some semblance of order.

Instead, embrace it. Bring the excitement back. Follow a rigorous plan of intense pre-study and review. Every day. Without fail. (Yes, that means 7 days a week). Embrace the fact that your mind is an amazing organ that is eager to make new connections and assimilate new information. Let JOY trickle through every single moment of the experience.

After all, if you tell yourself something long enough, you’ll absolutely believe it. Tell yourself,  I can do this. Its not hard. Its a lot, but I CAN do this!

What “Whatever It Takes” Looks Like

Being an older student means there is tons of life stuff going on in my life all the time. I don’t have the luxury of simply focusing on medical school and putting the rest of my life on ‘hold’. But I am determined to do whatever it takes to reach the goal I’ve worked so hard for. This is what that looks like in my life.

I’m a parent

While all of my four children are adults (and my three grandchildren are amazing), I’m still and always a parent. And with my youngest son’s issues following a traumatic closed-head injury a few years back, some days it requires quite a bit of emotional energy just to deal with that life stuff.

I’m a daughter

My mother is nearly 80, and while she’s amazing and still works full time, she’s definitely slowing down. Reality says that, as the years continue, she’ll need a little more of me and my time.

I’m a business owner

Running a business while in med school is not for everyone. But one of the most frequently asked questions I get is whether I still work while in school. Fortunately I have the sort of business that is very flexible. But as I move through the process of medical school classes and observerships and test weeks, I’m convinced that any student can do this med school thing and work – so long as they’re absolutely determined to manage their time and emotional resources very very carefully.

I’m a human being

As a woman in my 50s, somehow I’ve gotten this far with a solidified perspective on how to pursue my grand dreams while still doing life.  I’ve completely gotten rid of any vestige of an attitude of entitlement – no one owes me anything, and its a great relief to live simply while doggedly pursuing what is most important to me. That said, I definitely have a gift for multi-tasking, juggling the many “hats” I wear, and still taking care of the basics like eating right and getting enough rest.

After all, when you’re willing to do “whatever it takes”, you’ll find a way through absolutely any obstacles. The secret lies in being willing to find a way to do that with a gentle compassionate heart.

At least, that’s what works for me.

 

Like Primary Colors – How I Study

When I returned to college in my 40s intent on simply discovering if my brain worked well enough to successfully tackle a Biology / PreMed degree (truly, I wasn’t sure), I had to learn how to learn. In many ways, I hadn’t the slightest clue how to study – especially the hard sciences. And without a strong foundation of basic science and math classes in high school, I often felt like I’d been dropped in the deep end of the pool with a bag of rocks tied to my feet.

I discovered that learning won’t happen just because I read a book. Understanding won’t happen just because I sit in a lecture. And application of the information nuggets stored in my head will be absolutely useless unless I have an intentional strategy.

I’ll admit, I have a bit of an edge simply because I read very fast, and I “picture read” (create pictures of the information as I read it) and retain information once its stored. However, it took me a long time before I understood the intentional strategy required to learn, retain and apply the ginormous volume of information presented at Mach 5 speed in medical school.

Here’s what I learned:

1. Pre-read

As someone who did the majority of elementary, highschool, and even college by homeschool, I always said that my preferred and most effective method of learning was to read. (That has since been modified significantly, but in my undergrad experience, this was very true).

As a medical student, I’ve modified that pre-reading thing. Its not enough to simply skim through the slides for the week’s upcoming lectures as when I would skim through the next few chapters in the 40 pound General Chemistry book. I actually pre-study. To learn. To understand. To retain. To apply. As if I’ll never have the privilege of sitting in a lecture. Over the course of each weekend, I go through the upcoming week’s lecture slides three times.

2. Pictures

I don’t draw or paint. But as a classical musician, part of how I remember music is as a visual “picture” of notes on the page. To this day I can close my eyes and “see” the music on the page for Chopin’s Etude Opus 10 number 3.

Applied to medical school courses, I’m constantly “drawing pictures” in my head as I study. The list of essential amino acids I remember as a picture of a list on a page, and as a picture of the different R groups, what they look like, how they compare to each other, how the specifics of the different parts impact their function. Physiology is the same way – digestive processes and enzymes I remember as mental pictures, complete with color and movement. Each new bit of information gets added to the ‘picture’ in my head.

3. Verbalizing

When I’ve read the information and have pictures in my head, I run up against the biggest danger, at least for me.

I think I know it.

However, recognition does not equal knowledge. It took me a long long time to really get this one. If I can’t SAY IT, I do not know it. Period. So that third time through my pre-study every weekend, I’ll simply glance at the slide for the next item, close my eyes, and explain it out loud in my own words. 

4. Attending every lecture

It seems to have become fashionable lately to find ways / reasons / excuses to skip lectures. Not me. If I can’t attend in person, I watch the replay. Every time. Here’s the thing. Not only is it a huge respect thing (the amount of knowledge in the minds of my professors is astounding to me – as is the fact that they’re passionate about passing that information on to someone like me). But hearing the information is also another powerful way to understand new knowledge and put it together with the growing body of information that I hope to retain in some useful fashion.

5. Post study

There is nothing magical that happens for me just from sitting in a lecture for an hour. If I don’t do something with that new information, it will dribble straight out of my head and I might as well have slept in or watched a comedy on Netflix. Immediately I skim through the slides right after lecture, adding to my mental picture those points that were made more clear by listening to the presentation. Then in the evening, I spend more time doing “actual studying” where I use repetition and review to retain the new information. The final hour before I fall over into bed is spent in a quick preview of the slides for the following day.

 

Look up and name the first color you see. Did you have to guess? Did you struggle to remember the name of the color? How the word was spelled? How it interacts with other colors?

Recognition is not knowledge. However, my conscious goal is to know the ‘new’ information I’m being taught – just as well as I know my primary colors.

I remind myself daily to actually study, not to think I know what I need to know just because it looks familiar.

Pre-study. Make pictures. Verbalize. Attend every lecture. Post study. Review (the subject of a whole ‘nuther post).

 

Money Madness

I’m the sort of person who just tells it as I see it – and this is one of those posts. Its about the financial dark side of being an older medical school student. And while its only my experience and conclusions, I’ve discovered many others in the same or similar category who feel the same way.

Technically, anyone who is over the age of 25 when they begin medical school is classified as “nontraditional”. I’m not sure who started it, but that magical age of 25 and over seems to have been officially / unoffically designated as the demarcation between ‘typical’ med students, and those who for whatever reason have come to the game a little late.

I submit that there needs to be a whole ‘nuther category: adults over 40 who have decided to pursue the study of medicine, don’t have deep pockets, don’t have a scholarship, continue to have life and family responsibilities, and do a herculean juggling act just to make it from month to month financially. As one who fits squarely in this last category, I’d like to share a few helpful nuggets I’ve learned over the years when it comes to managing on a super incredibly sometimes painfully tight budget.

1. Lose the poor person attitude

This one is tough. There’s a measure of shame involved when I have to make use of the local food bank in order to have enough food for me and my son. Its downright embarrassing to have to admit I truly can’t afford to go watch a movie with friends, put gas in the car, or pay my electric bill. There’s what I call community shame and some pretty far-out-there preconceived notions that whole communities seem to embrace when it comes to those without any resources at all. The community of medical school is no different, and in some ways is even worse. And if you internalize those shame messages, you run the risk of either becoming an emotional basket case, or of turning into one of those super annoying loud-mouthed poor people with an entitlement attitude.

2. Find and use every single resource available

Every community has things like food banks, soup kitchens, and organizations that help with things as basic as utilities. Especially if you’re a parent responsible not only for yourself, but also for other people, it is especially tough when you add in the financial burden of either mass loans or a big monthly payment. Those organizations exist to help – make use of them! Join a church, make friends, go to potlucks (church potlucks have some of the best food on the planet).

3. Don’t talk about being poor

This one is a little strange for me to even write especially since I’m so passionate about staying firmly planted in reality and honesty, but I’m serious. No one (truly!) cares about your finances – they’re all concerned about their own! If you’re invited on a ski trip over Christmas break, don’t bemoan the fact that the only reason you’re not going is that you’re having a hard time saving enough money just to eat. When you turn down a fun weekend mini-golf or camping trip because the $5 in your pocket has to go in the gas tank rather than on entertainment, don’t mention it.

4. DO have a place to get real about your finances

Whether its that one good friend, a family member, a trusted professor – you’ll stay in balance and hold on to your emotional health far better if you are able to “belly-ache” about your financial woes in a safe place every once in awhile. This is especially true of single parents, who also happen to be broke med students. We are particularly vulnerable to feeling isolated and its up to us to intentionally reach out to someone we can trust. Whether its to share what it was like to eat a single frozen corn dog every day for three weeks because that’s all there was, or how we did laundry in clear water this week because we couldn’t afford detergent, or how we water down the shampoo or ate a single baked potato for dinner last night (all things I’ve done by the way) – you’ll protect yourself from brewing resentment if you share the struggles with at least one person you trust to simply hear you.

I have learned to be quiet about finances most of the time, to live frugally, to make use of every possible resource, and to reach out without shame. It saves my sanity.

I’ve also discovered that when I’ve got my (meager, insufficient) finances in their proper place using the four points above, it frees up a whole heap of brain cells that I really do need for studying.

Many years ago I was working a sales job. The top sales guy literally wore the same suit every single day for a year. I remember (in my head) judging him quite harshly. Teasing him a little even. Thinking, there’s no way I would do that!

Ummm yes, yes I would.

When the goal is so important that I’m willing to do whatever it takes to get there, having just one decent outfit is all it takes. Eating simply is enough. Walking or riding the bus isn’t an embarrassment. Its all a matter of priorities, and mine are definitely in the right place.

Now how about a corndog for lunch?

 

A Crisis of Confidence

I’m smack dab in the middle of a week between blocks, and have done pretty well with daily pre-studying for the upcoming classes – mixed in with really awesome things like trimming my overgrown rose bushes and playing with our three German Shepherd dogs.

But yesterday…… let’s just say that yesterday’s experience kinda thumped me in the heart.

A little background.

IUHS uses several amazing online tools to enhance the educational experience. One of these that I particularly appreciate is DxRClinician for virtual patient encounters. But it goes way beyond a simple “patient encounter”, and walks us through every step of the process of differential diagnosis, interview and exam, ordering labs and what they mean, consults, SOAP notes, networking, followup, costs ….. and more. Its a super cool tool that can be incredibly intimidating – especially if one is at the beginning of this whole medical knowledge thing.

Three chances per block to get it right. Only the last chance is graded. And I “used up” my first chance last night.

I started out pretty well, painstakingly went through the interview steps, the physical exam steps, listened to the heart and lung sounds over and over, and used the Consult function to double check my interpretation (my notes were like: sounds pretty good to me, except that weird totally random sound on every exhalation – or am I completely reversing the in/out thing? omg I have no idea lol ). Then I made my list of possible diagnoses (wonder when I won’t feel like I’m so totally guessing?!), and went through the next steps to rule in/out my guesses / choices.

At several points in the process, I was asked what my confidence level was. And, well, I had to honestly check the “not at all confident” button. This patient had minimal symptoms, but BUT they still had those symptoms. The DxR program tracks not only how thorough I am, but also if I go overboard on tests and procedures which might cause my “patient” unnecessary expense or duress, so I felt like I was scrambling to get enough information while being quite certain I didn’t know what I was doing.

I’ll admit, I used Google a few times.

On the Review, I was almost afraid to look.

I was sure I was wrong.

I was certain I should have waited at least a week or so into the block.

Why ever did I jump into this case when I knew I didn’t know what I was doing, and when I knew there were only three tries to get it right?

Oh yes, I spent awhile beating myself up, feeling wholly inadequate and questioning my knowledge level. In fact, by the time I realized what I was doing, I was treating myself far worse than I’d allow anyone else to treat me in real life.

And, I WAS RIGHT.

Okay, my tough woman act went right out the window and I teared up a little.

A Crisis of Confidence. Gotta work on this one.

Funny how after so long, after so much evidence, I still struggle to believe I can do this. You’d never know that by talking with me – I’m the epitome of confidence, positively exude the surety of my ability and calling to do this doc thing.

Okay, deep breath. I’ll chalk this one up to being part of the human race, part of humanity, where my fears sometimes reach out and cloud my confidence level. Onward!