1/8 of the way through medical school: Reflections on Fall 2016

Thank you so much to everyone for your support and kind words since my last entry. I can’t even count how many texts, calls, e-mails, and Facebook messages I received from friends and family who checked in regarding the difficulties I experienced back in July and who extended prayer, advice and their best wishes as I transitioned to my M1 year. It is a tremendous blessing to have all of you in my life.

I haven’t written an entry in months. I’m excited to be back to entertain you with some of my adventures as a first year medical student so far, but first I’d like to give a

Brief update on my medical status

I finally met with a primary care physician in IL regarding my pituitary adenoma. The nurse who called to tell me this news back in July did not say that it was non-cancerous, and urged me to see a physician who could clinically evaluate the “lesion” that the neuroradiologist described in the report. Fortunately, I am fine. 

Image taken from: http://pituitary.ucla.edu/pituitary-adenomas

Abnormal hormone levels could be an indication of a growing tumor in my pituitary gland. Other signs could also assess the pressure of a growing tumor on nearby structures; these include headaches and vision loss. My doctor asked me some questions that could point to any irregularities in my hormonal activity, then ordered a blood test to take a closer look at some of my levels, including my ACTH. I’m confident that everything will be alright. Chances of the adenoma busting a groove in my pituitary and expanding at an alarming rate are very, very slim.


Winter Break

We had our last final exam for Radiology last week, and I’ve been all over the place since then. On Friday, I flew out from Chicago to DC right after the exam. Once I arrived in DC I took an overnight bus up to NY. (Earlier I tried changing my flight to go straight to NY but Southwest didn’t have any going from Chicago to NY on that Friday). 

I arrived in Manhattan at 3:30AM. I didn’t get to my friend’s place in the Bronx until a little after 5AM. I was scheduled to be back in Manhattan for a scholarship interview at 10AM.

After that weekend I left to take a bus down to MD to stay with my sister. 

So, the sequence of trips over a period of only four days was: Chicago --> DC --> Manhattan --> Bronx --> back to Manhattan --> MD

This coming weekend we’re going to NJ (and Brooklyn) to celebrate Christmas with family. Then my sister and I are coming back to MD. Then I’m going back to Chicago to celebrate New Year’s with friends there :)

Brief Reflections on the Fall M1 Curriculum at Loyola

Anatomy lab group on our last day with our wonderful instructor!

I’m honored to be a part of Loyola’s Class of 2020 with 159 other brilliant classmates, many of whom have become good friends of mine. I can’t believe we’ve reached the halfway point of our first year.

Over a period of about five months, we coursed through Molecular Cell Biology & Genetics (MCBG), Structure of the Human Body (Anatomy), Behavioral Medicine & Development (BD), and the first part of Patient Centered Medicine I (PCM I) and Topics in Clinical Medicine (TCM I; Radiology) which are both four-year courses. In the Spring we’ll start Function of the Human Body (Physiology) and Host Defense (Immunology), and continue with PCM and TCM.

Anatomy is my favorite course that we’ve taken so far. Hands down. The content from MCBG is important, and it’s essential that every physician understand the molecular and cellular basis of disease, as well as the molecular tools that are used for diagnosis, but Anatomy is more clinically relevant, and Physiology (which we’ll take in the Spring) even more so.

Before starting med school I heard that it was common for students to forget a chunk of what they learned in Anatomy. Anatomy isn’t exactly high yield on Step 1 but it’s still very important for clinical application, so I searched for any resource I could find that gave tips about methods to effectively ingrain the material into my long-term memory. I ended up purchasing “Medical School 2.0: An Unconventional Guide to Learn Faster, Ace the USMLE, and Get Into Your Top Choice Residency” by Dr. David Larson, and it’s been a gem. I learned about a few great resources, including Anki, a free electronic flashcard software. I’ve been using Anki since the beginning of the Fall term and I find it very useful.

Others may find other methods useful; some of my classmates take the time to type up their notes, draw and diagram things out, and even rely heavily on online resources and textbooks to learn the material. Everyone learns and studies differently. I live by Anki. Sometimes I’ll diagram something I need to visualize a bit better, like the brachial plexus or the arterial branches of the abdominal aorta. But for the most part I just import images into my Anki deck and study those. I can’t draw for my life, so there’s no point in wasting time trying to hone my sketching skills when I could be studying someone else’s perfect sketch of the lumbosacral plexus. When we begin Physiology in the Spring, and especially Path and Pharm next year, unfortunately there won’t be enough time to take copious notes and draw everything out, so I've made Anki my primary study tool this year.

Our Anatomy lectures were fun. The course Director (who was also one of our Professors) was especially entertaining. He had a habit of picking on students (out of good humor), giving us little gifts from his house and garden when we answered questions correctly, and cracking jokes that ranged from crass to gut-busting.

Reflections on Shadowing experiences
One of the things I absolutely love about Loyola is the plethora of opportunities to be engaged in organizations and programs that are committed to service, personal and spiritual development, and exposure to the many specialties of medicine. I admit that the free food served at the Anesthesiology and Interventional Radiology general interest meetings, for example, was a major (ok, the primary) reason why I attended, but even though I don’t intend to pursue these particular specialties, I welcomed the opportunity to learn more about the fields.

I spent some time shadowing at the main hospital, outpatient center, and the Edward Hines, Jr. VA Hospital right across from our school’s campus. I shadowed specialists in Infectious Disease, Neurology, Anesthesiology, Neuroradiology, and General Internal Medicine. 

Loyola University Medical Center
Maywood, IL

The Medical Spanish Program and the Chaplain Mentoring Program (through our Patient Centered Medicine I course) also gave me the chance to shadow a medical Spanish interpreter in the outpatient center and a chaplain at the main hospital in the NeuroICU.

(Loyola is a Catholic medical center whose religious tradition includes providing pastoral care, or chaplain services, to patients. Chaplains are trained in a particular healthcare service area to give additional spiritual and emotional support to patients and families. Before coming to Loyola I’d never heard of a chaplain before. This shadowing experience informed my understanding of the importance of emotional connection between a healthcare professional and the patient).

At Loyola, M1s have much more time to shadow and pursue extracurricular interests. This past Fall we completed two major science courses: MCBG from August through mid-September, and Anatomy from mid-September through December. PCM, TCM, and BD lasted the entire Fall term but were not as rigorous as our science classes. M2s are overwhelmed with curricular demands – Pathology and Pharmacology are taken concurrently throughout the entire year; they’ll hit you like a ton of bricks come August. The sheer amount of material that the M2s are responsible for is unfathomable to me right now because I have not yet experienced that level of rigor.


Anyway, I’ll go ahead and share a couple of stories from my clinical encounters this past Fall term. Patient names and personally identifiable information are of course omitted.

In the NeuroICU

On a Saturday morning during the week of our Thanksgiving break I decided to take a break from Netflix to shadow a Neurologist in the NeuroICU. I stayed for about three hours as he and a resident rounded on the patients.

One patient in particular suffered a massive MCA (middle cerebral artery) ischemic stroke. He'd been transferred from another hospital. The neurologist (let’s call him Dr. X) broke this news to the patient’s wife and son. It seemed they had not understood how serious the situation was because they were shocked to hear this. Dr. X started a neurological exam to check the patient’s status, but it couldn't be completed because he was quite comatose. Dr. X talked to the family a little more, regrettably sharing that their loved one would be unlikely to regain complete functioning of the right side of his body; he would also exhibit some cognitive deficits, behavioral changes, and speech impairments. The wife and son solemnly nodded their heads but did not make eye contact with Dr. X.

I was suddenly aware of my own presence in the room and I felt like an intruder. I was a useless M1 clothed with what felt at that moment like a meaningless white coat because I couldn’t even do anything for the family. I was only benefiting myself when I decided to come in that day to learn a little neuropathology at the expense of patients and their family’s suffering.

Before I knew it we were out of the room and moving on to the next patient. Dr. X ran to briefly answer a page and my eyes fell back on the stroke patient through the glass window to his room. The wife and son chatted with the nurse for a little bit, then I caught a glimpse of something that made me tear. The son leaned over the bed and pressed his cheek up against his dad’s, whispering something in his ear. The wife looked on lovingly and patiently. When the son lifted his head back up, his face was red and his eyes wet with tears. I was stunned, and a lump began to form in my own throat. I didn’t expect to get emotional. I can’t imagine the pain of seeing a loved one degenerate cognitively or physically before my very eyes. One moment your father is completely fine, the next he’s suffered a severe stroke which will leave him with many defects, unable to regain full independence and functioning. What a heart rending misfortune.

A quote from Dr. Lissa Rankin’s “Mind over Medicine” has entered my mind. She shares her motivations for pursuing a medical career: “What drew me to the practice of medicine was the desire to touch hearts, to hold hands, to offer comfort amid suffering, to enable recovery when possible, and to alleviate loneliness and despair when cure wasn’t possible.” I wanted to walk up to the wife and son, lay my hands on their shoulders, and apologize for what they were going through. I didn't though. They would have every right to slap my hands away and ask who in the world I was. I chose to silently comfort them instead.

Intubating a patient

I signed up for our school’s Anesthesiology Preceptorship Enrichment Program (APEP). To be honest, I probably won’t pursue Anesthesiology, but this program is a great way to learn about the specialty and gain more clinical exposure. On my first day shadowing in the OR, my mentor told me that I was going to intubate a patient. I was terrified. ME? Intubate a patient? I’d just started medical school four months prior! What did I know about intubating a patient?!

Luckily, I was able to calm down when my mentor and one of the residents patiently talked me through it. Even though I was told that if I inserted the tube into the esophagus (ventilating the stomach) instead of the trachea (to ventilate the lungs) it wouldn’t be the end of the world and they would simply fix my mistake. I was told that I'd have several minutes to intubate the patient before they start to crash. In other words, I could afford to make the mistake of pushing the tube down the wrong hole without running out of time and killing the patient. But I didn’t feel right about it. I wasn’t completely confident about where to place the tube. At that moment, I decided to defer the task to my mentor rather than risk pushing the tube down the esophagus.

I am comforted by knowing that we'll have plenty of opportunities down the line to hone our skills. The greatest thing I appreciate about this APEP experience so far is my mentor’s adamancy about my learning by doing.


Books

I try to read for pleasure to keep my mind stimulated and to satisfy my interests in many different arenas. Since August I’ve only been able to finish a couple of great books as part of my 2016 Goodreads Challenge:

"I Shall Not Hate: A Gaza Doctor's Journey on the Road to Peace and Human Dignity" by Izzeldin Abuelaish. Dr. Abuelaish is a Palestinian physician who was nominated for the Noble Peace Prize for his efforts to bring peace between Israel and Palestine. In this book, he shares his inspiring yet tragic story of growing up in the Gaza Strip of Palestine, becoming a doctor in Egypt, and moving back to the Gaza Strip where he crosses the border daily to work at a hospital in Israel. His three daughters and niece were brutally killed by the Israeli military in 2009. He shares that the deaths of his loved ones further galvanized him into fighting the ongoing conflict between Israel and Palestine.

"Do No Harm: Stories of Life, Death & Brain Surgery" by Dr. Henry Marsh. Dr. Marsh is a retired neurosurgeon from the U.K. who shares his journey through medical school and residency. Aside from the personal anecdotes and patient stories, Dr. Marsh delves into his cross-cultural encounters in Ukraine where he helped revolutionized neurological surgery, and shares with us valuable and profound life messages. Such a great read! 

~*~

I want to savor the next week or so of break that we have left, but I also want to be more productive. I can't even count how many Friends episodes I've watched since last week. Besides writing this entry, this break so far has not been as productive as I hoped.

Have a Merry Christmas and a Happy New Year!

July 2016: summer preparation for medical school, unexpected mishaps, and meeting a phenomenal M1 class

We've reached the end of orientation week for M1s here at Loyola. Before I jump into how much I've enjoyed moving in, learning more about Stritch, and meeting the staff, faculty, and my classmates, I'm going to start by sharing a few insane and stressful events that happened over the last month leading up to this past week. 

I was hesitant at first to disclose these misfortunes and expose things about myself that the average person would prefer to keep private. But, if, by the end of this entry, you are inspired and/or encouraged by what you read, it will be gratifying to have prayerfully revealed these personal events which made the month of July 2016 both a troubling and exhilarating time for me.

First week of July

"Incidental finding" on my brain MRI scan

During the last week of June, I participated in a four-hour MRI study through the National Center for Complementary and Integrative Health (NCCIH) on the main NIH campus. The study recruited participants to understand the mechanisms of pain. Basically, they put electrodes in different locations on my forearm, administered varying degrees of thermal stimulations (heat), and studied my body's responses to the pain (through eye tracking, heart and pulse rate measurements, and brain MRI scans). Before they began the study, they took several "baseline" scans, which they then sent to a neuroradiologist to take a closer look at. That's a great benefit of the study. Besides the ~$200 you could earn from just sitting inside an MRI machine for a few hours, you also receive a report from a neuroradiologist who reads your scans for FREE.

Several days later, I received a call from a nurse practitioner with the results of my MRI scan. I didn't even know that I would be getting a call, so that threw me off. When I called her back (I missed her first call), she wasted no time in telling me that there was an "incidental finding" on my scan. 

I asked her to explain. "What do you mean by incidental finding?" She told me, "You have a small focal abnormality in the anterior lobe of your pituitary gland. It looks like you have a tumor." I said nothing. It's very unlike me to jump to conclusions as impetuously (and pessimistically) as I did after hearing those words leave the NP's mouth, but I couldn't help but think, "Dear God, I'm going to die."

"A tumor?" I finally said.

Pituitary adenoma (circled in orange). This is

not my brain scan. Photo taken from:

http://www.mayfieldclinic.com/PE-Pit.htm

"You may have what is called a pituitary adenoma. We cannot tell you if this abnormality is cancerous or noncancerous. For that, you must schedule an appointment with your doctor for a complete neural exam. If you have other questions, you should talk to your doctor. I won't be able to send you this report tonight; I am swamped with a few other patient cases I need to wrap up this evening. I'll send the report in the morning."

I still couldn't believe what I was hearing. Soon I became angry with the NP. How dare she ruin my night by insensitively and inadequately explaining this life-changing news? You tell me I have a tumor, then say you can't answer my questions or send me more information about my MRI scan results because you're busy with other things? What patient wants to hear that? At that moment, my intensified fear of death mixed with rage toward the NP.

One of my best friends shared my frustration about the insensitive delivery of my (possibly dire) medical situation. "Isn't that against the Hippocratic Oath? Aren't you supposed to be....compassionate?" I suppose the Hippocratic Oath doesn't apply to nurses, I thought bitterly. "I would call her back," my friend continued.

"What?" I couldn't help but laugh.

"Yes. I would tell her I didn't appreciate the way in which she delivered the news. She wasn't empathetic. She needs to know that."

I completely agreed, but I didn't call her back. After I'd hung up with the NP, I sat in my bed for about an hour, considering the possibility of having a cancerous tumor in my pituitary gland. I'd read many cases and stories about patients having tumors (both benign and malignant), but I never imagined that I myself would have one of my own. My life flashed before my eyes a couple times and I began to cry. "I'm too young," I said aloud. "I haven't even experienced some things yet. I want to get married, have a family, become a doctor, grow old. God please."

When I finally gathered myself, I went ahead and did a little research on pituitary adenomas. The information eased my troubled mind, making me feel a bit silly about my previous imploring prayers: "Pituitary adenomas are relatively common. Tiny, microscopic pituitary adenomas are found in one in five adults. However, most of these tumors never grow or cause problems. Often, a patient is undergoing a magnetic resonance imaging (MRI) scan of the brain for another reason, and the doctor discovers a pituitary adenoma." However, I couldn't help but become more vexed with the NP. At what point in one's career as a healthcare professional is it ever alright to reveal debilitating news to a patient without giving her appropriate reassurance as well as ALL (if not most) of the information necessary to help her understand her condition? I was only told that I have a tumor, it may be a pituitary adenoma, it could be either cancerous or noncancerous, and that if I had more questions I had to go elsewhere. That is not okay.

My prayers, the support of my parents and friends, and the research I did on adenomas gave me a lot of peace. During this transition period of moving from Maryland to Chicago this month, I have not been able to see a primary care doctor. I will soon be seeing someone here in Chicago to get a more definite diagnosis.

Car accident

That same evening, after learning about my pituitary tumor, I was on my way to meeting with someone at a Starbucks to sell my MacBook Pro when I got into a car accident. I was making a left at a stop light when I realized a few seconds too late that a car was coming (speeding it seemed) from the opposite direction. In those three seconds or so of seeing the oncoming car, I remember trying to frantically decide between stomping on the gas to make it across the intersection in time or swerving enough out of the way (to the right) to avoid a collision before it was too late. I eventually decided to swerve to the right but because I hesitated it was too late. The other car hit the left side of my SUV.

I remember screaming and ending up on the opposite end of the road nearby a power pole. I suffered no injuries, thank God. I buried my head in my hands, not yet having processed the magnitude of what just happened. I turned to get a look at the other vehicle. The person's air-bag had exploded and I couldn't see a face. The entire left side of the car was smashed in and transmission fluid was leaking like blood out of a fresh wound. I stepped out of my car and ran to the other person's vehicle. A couple of witnesses were helping the driver - an older, heavy-set man - out of the passenger's side. He was not able to open the door by the driver's seat. I remember not being able to stop crying, apologizing profusely to the man, and trying to help the witnesses get him out of his car.

Damages to the left side of my car

It was a blessing that neither of us was hurt. Not even a scratch. Unfortunately, though, I was found at fault. Two witnesses saw that the other driver had a green light. If he had a green light, I couldn't have had the green arrow to turn left. I honestly could not remember not having a green arrow. That was the last thing I recalled seeing on the stoplight before the collision: the left green arrow. I couldn't believe the light changed to red so quickly. It had just turned green when I started making the left turn. I must have been distracted, without a doubt. Right before the accident, I was feeling anxious because I was running late to meet with someone to finally sell my computer and use the much needed money. Other thoughts must have been running through my mind as well; I was still shaken by the news about my brain MRI.

After the police wrote up a report, they issued me a citation, which will go on my record. I calmly listened to the officer as he explained the report and citation to me. I thanked him, apologized again to the other driver, then hopped into my smashed car and drove it the rest of the way to the Starbucks I was heading to before the accident.

It took me several days to recover from the accident. The night of, I couldn't sleep. I kept seeing the other car speeding towards me when I closed my eyes. I was so angry with myself. I'd just gotten Olive (my car) in April and already I got into an accident that was MY fault and that would cost me a lot of money for repairs. I didn't know how I would tell my parents (I knew my Dad was going to kill me), how I would pool the money to get the repairs done, or how I would even get to Chicago in a couple of weeks. I couldn't drive my car out west with these damages. 

Eventually, I came to peace with the accident and my responsibility for causing it. I believe that God allows everything to happen for a reason. We don't always know His plan or His purpose in many things, but I've learned to step back and trust Him completely (hey, I trusted Him in the medical school application process and He has done exceedingly and abundantly more than I could have thought of or asked [Eph 3:20]. But anyway, my experience in the 2015-2016 application cycle is another story). What good would come from stressing about what happened anyway? Worrying can't make me go back in time to avoid the accident. I told myself to suck it up, accept the consequences of the situation, and learn from them. Everyone makes mistakes. Now I drive more carefully than ever.

Second week of July:

Brake failure on the highway going home to New Jersey

My position at the NIH finished the previous week on Fri, July 8. This was the start of my two week "vacation" before orientation. Much to my relief and surprise, my Dad was not upset about the accident. (I think for a couple of reasons: 1. he's gotten into a fair number of accidents himself, and 2. I told him about my tumor before mentioning the accident so that he would go easier on me). We agreed that before leaving for Chicago, I would first go to New Jersey to get the repairs done by one of my Dad's friends who charged very little. Unfortunately, because I was on my parent's insurance plan (which was liability only), I had to pay out of pocket. I got a price quote from one repair place in Rockville, MD. It would have cost me around $3800. I didn't waste my time going to any other repair shops in the area. There was no way I could afford what they were charging.

I drove the five hours to New Jersey at the beginning of the week. My car was damaged, but it was still drivable... or so I thought. Everything was going smoothly until I reached the highway. I was still in Maryland at this point. About half an hour into the drive, I realized with horror that my brakes were no longer working. They'd been acting funny since the accident, but they were still functional. Now, on a major highway in Maryland, while going 70 mph, I decided to simply tap the brakes just to make sure they were still working. My foot pressed on the pedal. When the car did not slow, I pushed down further...and further. After pushing it as far as it could go (until the pedal hit the floor), and my car still did not slow down, I began to panic. Thankfully, traffic was sparse and the car in front of me was at least 500 feet away. I pulled over to the right shoulder, took my foot off the gas and waited for my car to slow down.

While waiting for Triple A on the side of the highway, I found myself laughing and shaking my head in disbelief at everything that occurred just over the past week. "Why is all of this happening?" I asked the roof of my car.

Triple A towed my car to the nearest auto repair shop. I had to pay a few hundred dollars to get the brakes fixed. My father was furious about the cost and demanded to speak to the shop's owner, a calm and kind, young Middle Eastern man. My father threatened to report the shop to the Bureau of Automotive Repair. "Dad, come on," I said.

"Make sure you save the contact information of the place," he said, ignoring me.

I never gave him the name of the shop.

I drove with anxiety for much of the rest of the way home. I had to pull over again because my hood was slightly loose and bounced up occasionally because of the wind. I was afraid that a hook would come entirely loose and the hood would fly up and hit my windshield. Oh man, my car was falling apart. Thankfully, I made it safely home later that night.

Time at home

I spent the week getting my car fixed.

My car post-repairs

I also spent some time with my family and a few friends before leaving the next week for Chicago, getting together some paperwork for orientation week, and finishing up a book I'd borrowed from our local library on my mother's library card. It's called Cutting for Stone by Abraham Varghese, which is now one of my favorite books. If you're really interested in medicine, world history (particularly in Northern Africa, some parts of the Middle East, and India), geography, and/or adventure narratives, you will love this book. The following week I began reading Loyola's required book for orientation: Attending Children by Dr. Margaret Mohrmann (a pediatrician who worked at Johns Hopkins and the Medical University of South Carolina). This was a great read.

Being at home this week has also made me more aware of our deepening financial struggles as well as a couple of my family members' ongoing battles with mental illness. I continue to pray for my family and intervene where I best see fit. Throughout the past few years, and even more recently however, it's been a terrible feeling knowing that, for reasons that are hard to explain, I am incapable of reversing my family's financial situation and getting a couple of them the help they desperately need.

Third week of July:

Driving to Chicago

I took off for the ~11 hour drive to Chicago from New Jersey at 8AM on Monday morning of this week. I made sure to get a good night's rest, eat a decent breakfast, and have my cooler (filled with water, snacks and meals my mom made) next to me on the passenger's seat. My car was filled to the brim with my belongings - clothes, books, bed sheets, comforters, pillows, a couple of mirrors, a bunch of appliances, etc. I brought everything with me because I did not have money to purchase a new set of everything once I'd arrived.

At first, the drive was difficult. I stopped three times (or 4?) before 12PM to use the bathroom, get more gas, and munch on something to wake me up. My sister bought me a cassette adapter to hook up to my iTunes playlist, but of course my car doesn't even have a cassette player -___- (it's a 2005 Mazda Tribute). I tried to burn a CD, but it wasn't working out (long story), so I took most of the old CDs my sister and I had in our old bedroom.

I jammed to *NSYNC, Mary Mary, the Glee Christmas album, and some others. (The Celine Dion CD wasn't working). These songs didn't last the entire ride of course, so I eventually played my phone's playlist with the volume on max. I sang at the top of my lungs, hitting some notes, missing others, creating harmonies here and there... I needed to stay awake and keep my mind active. I stopped a couple more times after that to get gas, eat, and use the bathroom again.

I finally made it to my beautiful new neighborhood at 8PM CST (9PM EST) that night.

Last week of July:

M1 Orientation

Loyola University Chicago Stritch School of Medicine

Class of 2020 (with our Dean and Chief Diversity Officer)
The most diverse class in our school's history

This past week of orientation at Loyola has been incredible. There's no other way to describe it. I'm not able to find a website about statistics regarding the most diverse medical schools in the U.S., but I believe that Loyola is among the most diverse. I have yet to meet one person in my class who does not have a unique background (culturally, socio-economically, academically, etc). I don't have the exact numbers (I don't believe they've been released on our website yet), but here's a snippet of what I remember from a presentation given on our second day of orientation: the majority of our class is made up of women (59%), most of us speak more than one language, many students have a Master's and even a PhD, a handful of us are DACA students (Loyola was the first medical school to allow students with DACA status to apply), and nearly everyone has traveled abroad and/or been deeply involved in local and international service.

I've only been here a week but I cannot imagine being anywhere else for my medical education. Loyola is an institution that truly values diversity and importantly (the most important aspects for me), social justice, reflection, and humanism in medicine. Social justice is a core facet of our mission; it is refreshing to be in a community of people who are just as passionate about justice in our world as I am and embrace this mission as much as I do.

During the first couple days of orientation, I couldn't help but feel a little intimidated by the brilliant people around me. I'm surrounded by exceptional and accomplished classmates; they have worked with top world researchers, pursued higher degrees, traveled to and served in the most historic and impoverished communities across the globe, and done much more.

My student ID badge

"Some of you may be thinking that you don't belong here," our Dean for Student Affairs told us on our second day. "If you are, get that out of your head. You were chosen by our admissions committee for a reason. I can assure you of that. They saw something invaluable in you that you might not yet see in yourself. Believe me when I say that each and every one of you belongs here."

I am blessed to be where I am today. There's no way I could have made it through the mucky mess of this past month (and the past few years) without the grace of God and the peace He's given me. For that I am truly grateful. Similarly, there's no way I'll make it through the next four years without God (and coffee).

~*~

I hope that this narrative of events has touched you in some way. I decided to share a portion of the difficulties I've encountered at this point of time in my life to motivate and encourage others, especially those facing challenges in their own lives. There will be many obstacles and emotionally draining circumstances that you may encounter in your academic, professional, and/or personal life, but do not let them debilitate you. I personally found much comfort and support in my family, friends, and the love of God, but whatever your religion, outlets or support system, take advantage of the resources at your disposal.

Until next time! Our first class, Molecular Cell Biology and Genetics (MCBG) starts on Monday (and so will my dependence on coffee. Yikes).

Gap Year at the National Institutes of Health

NIH Main Campus

I am nearing the end of my post-baccalaureate research fellowship at the National Institutes of Health in Bethesda, MD. I had such a great year working with my lab, meeting other post-bacs and NIH employees, and getting involved in programs and activities that kept me active and engaged in the larger community.

I live in an apartment in a beautiful Bethesda neighborhood with three roommates, one of whom is also a post-bac research fellow at the NIH. Bethesda is one of the most educated places in the US (this is primarily due to the presence of the National Institutes of Health of this suburban town, which attracts workers and researchers from all across the globe). "83% of residents over 25 have a bachelor’s degree — that’s 50% more than the national average of around 30% — and over half of residents also have a master’s degree."

I decided to spend my gap year before medical school as a student researcher at the NIH. I am very glad I made this decision (and was accepted! This program is highly competitive). A gap year is a great time to step back, explore your personal interests, determine if Medicine is the right career choice for you, and perhaps also strengthen your application. Research, teaching, traveling, and completing a post-bac program to boost one's science GPA are just a few examples of what people decide to do during their time off.

I am an IRTA (Intramural Research Training Award) fellow, and I work in the Section on Neural Coding and Computation in the National Institute of Mental Health.
What better way to appreciate the tremendous contributions of scientific research to health and medicine than to have an immersive experience at the largest research agency in the world? I am enjoying the work that I'm doing here; it's a privilege to be part of the ground-breaking research of my lab.

NIH Post-bac Poster Day 2016

A few weeks ago, I presented my research at Post-bac Poster Day with 621 other post-bacs.

My project involves creating a 3-D model of the orbital pre-frontal cortex (OFC) and the amygdala in the rhesus monkey brain. Our lab studies other brain areas that are implicated in motivational learning, emotional processing, and decision making, but my research focuses just on the OFC and amygdala. The goal is to understand how we can improve the methods we are currently using to induce cellular expression in these regions. Cellular expression is induced upon injection of a virus-that we develop- into the brain areas.

So, I am analyzing the shape, size, and 'coverage' of what we call "expression sites". ('Coverage' just means how much of the amygdala and OFC we are seeing expressing cells). This analysis will help us understand the necessary adjustments we need to make in certain parameters to reach more desirable results (which is to see more cellular expression throughout these brain regions). The parameters we'd like to improve include the amount (volume) of the virus and the way in which we're injecting the virus into the monkey's brain during surgery.

Anyway, I won't go into all the details, but I'll answer the question 'Why do we care about all of this?' Well, let's think about it more broadly. My project will get us a little closer to understanding how we can effectively control and modulate neuronal activity in certain brain regions. This is essential for human gene therapy applications, especially in the brain.

A few other wonderful experiences this year:

• My lab paid for the Human Neuroscience course that I took through the NIH Foundation for Advanced Education in the Sciences (FAES) Graduate School last fall semester. It was incredible, overwhelming a little, but I was excited to learn the material, including basic neuroanatomy of major structures (i.e. the four lobes, cerebellum, brain stem, and spinal cord), the 12 cranial nerves (the most reoccurring topic throughout the course; I can now recite each nerve and its function), and the neurophysiology of the sensory (somatic and autonomic), motor, association, extrapyramidal, and limbic systems.
  
  
  I took another FAES course this spring. It was free for post-bacs who are applying to med school or have already been accepted. We learned the basics of taking a patient history and performing a physical examination. We have our final case presentations tomorrow. Each week, we learned how to perform physical examinations of each system (i.e. neurologic, gastrointestinal, pulmonary, etc) from specialists within these fields who work at the NIH. My favorite was the one given by the neurologist. I'm sure you can guess why. This was a short course but the information we learned was invaluable. Here are a couple of important common themes that came up again and again throughout the class:

Much of what you need to know to make a diagnosis is in the patient's history. Listen to your patient and his or her family. They are all the true 'experts' on the patient's illness. William Osler, the Founder of Modern Medicine, once said, "Listen to your patient, he is telling you the diagnosis." The percentage of misdiagnoses and delayed diagnoses in the U.S. has risen over the years, due to many factors, partly to cursory physical examinations and patient histories. That's not a big surprise; today's physicians are burdened, overwhelmed, and overworked. It's no wonder medical errors are one of the leading causes of death in our country.


It is important to learn to triage a patient's concerns. Danielle Ofri, a general internist at Bellevue Public Hospital in NY and an author of several books, explains this well in her third book, Medicine in Translation: Journeys with My Patients. She describes a frustrating encounter with one of her patients. The patient comes in every so often with a litany of complaints, most of which Dr. Ofri deems trivial. These complaints include back pain, abdominal pain, headache, nausea, chest pain, heartburn, and it continues. It's not possible to address all of these complaints in one short appointment with the patient. More importantly, how can you determine which pain is more "real" than the others when the patient insists that all of her pain is of the same magnitude? This is a perfect case to explain this point. The differential diagnoses for a headache, for example, are innumerable. They can range from the 'minor', such as lack of sleep, stress, and poor eating habits, to the more serious, such as a brain aneurysm, tumor, dehydration, and encephalitis. Ascertaining the patient's graver symptoms will depend on the physician's ability to triage the chief complaints.

• Another wonderful experience I had this year was joining a Christian Book Club at the beginning of my research fellowship. It was founded by another post-bac a couple of years ago. We've been reading books written by Christian authors as well as a few books in the Bible. In the past, the group read Blue Like Jazz by Donald Miller, Every Good Endeavor by Timothy Keller, Love Does by Bob Goff, and In the Company of the Poor by Father Gutierrez and Paul Farmer. Currently, we are reading The Language of God written by Dr. Francis Collins, the Director of the NIH. He is a Christian scientist and one of the world's leading geneticists who argues that "a modern understanding of science can be harmonized with a belief in God." It's a fascinating read so far, and it has certainly produced provocative discussions during our morning meetings.

• To make a little extra money on the side, I picked up a job as a substitute ESL Instructor at the International Language Institute (ILI) in Gaithersburg, MD, the most diverse city in the U.S. (There is another ILI branch in DC). I fill in for a teacher when he/she cannot make it to a session. I started a couple of weeks ago and I love it. Back in college I was an ESL volunteer teacher for 4 years with the migrant Latino farmworker community in upstate NY. Working at ILI reminds me of this past experience, which I thoroughly enjoyed.

The basic level students I've been teaching on Saturdays are from a few different countries: El Salvador, Nicaragua, China, and Russia. So far we have touched upon the basics of the English language, including the verb "to be" (I am, you are, he/she is, etc), the verb "to have", nouns, adjectives, prepositions...All of those things. However, I feel as though I am learning more from the students than they are from me. It's a privilege to have the shared responsibility (with the other teachers) to arm these wonderful individuals with the language skills they need to have a voice in a foreign country.

I've gotten involved in other community activities this year ---

• As a volunteer at Mary's Center, a clinic in Washington, DC that serves the uninsured population
• Promoting the work of Partners in Health (a non-profit organization co-founded by Paul Farmer and Jim Kim [President of the World Bank] that is dedicated to serving disadvantaged populations all across the globe)
• And just hanging out and having fun with other post-bacs, my sister, and college friends who live in the area

In mid-July, I will be making the 12 hour drive to Chicago from Bethesda, a distance I've never driven before. I'm excited to wrap up the year and begin the next chapter of my life as a medical student.

Thanks for reading! :)

Dayton, Boston, and books

Dayton

Dayton, OH

A month ago I was in Dayton, OH for another interview at Wright State University Boonshoft School of Medicine.  The faculty and students were beyond kind and supportive, the facilities were freshly new, and the program had many offerings… but I realized that my heart was back in Chicago. I accepted the spot at Loyola University Chicago Stritch School of Medicine a week before my Wright State interview, and shortly thereafter I withdrew from several other schools. After much prayer, talks with family and friends, and a strong gut feeling, I made up my mind. I still went to Wright State because my flight ticket was non-refundable and it was fairly short notice to cancel the interview.

Dayton is the sixth largest city in OH of about 140,000. The people in the area are friendly, and there are a few cool shops and fun places to hang out. I stayed with a friend from college who is currently a first year at Wright State and lives in a beautiful apartment complex 5 minutes from campus. I grabbed some pizza with another college friend (who’s a second year at the school) from a thin crust place. Wright State's SNMA (Student National Medical Association) chapter hosted a dinner for ethnic minority applicants the night before our interview. I think we went to TaqueriaMixteca. The food was beyond delicious. I ordered something with rice, guacamole, and chicken.

There were many opportunities during my three days in Dayton to learn a lot about the school. One of the cool things I learned was that Wright State is ranked number four in the nation for its commitment to its social mission. The faculty and students were unbelievably friendly and warm. My interview felt more like a conversation than anything else. I had two interviews that were back to back, both with faculty members. One was a retired Professor who was still seeing patients at the hospital, and my other interviewer was the Anatomy Professor. I was not nervous, worried, or ridden with anxiety before, during, or after the interview. Getting worked up doesn't help with anything. I believe it went well, but at this point I am certain that I belong at Loyola.

Boston

This past weekend (April1-3) I returned to Boston for the Biomedical Science Careers Program (BSCP) conference and New England Science Symposium (NESS). I have to admit, while I learned a lot at the conference and symposium, I enjoyed the mini-reunions I was having left and right so much more. I met with a college friend who is a second year in the Harvard MD-PhD program, several Harvard SCTRP (Summer Clinical & Translational Research Program) alumni from last summer, a high school friend who’s completing an MBS at Tufts (and who I hadn’t seen in 5 years!), another friend who’s doing a PA program also at Tufts (who I met volunteering in Guatemala three years ago), and a few others. I didn’t get to see everyone I hoped to see, but there’s always a next time. Though I came back from Boston feeling exhausted physically (mostly because of the crazy 9 hour bus ride), I was rejuvenated and refreshed mentally and emotionally. Social interactions and relationships with others does have a wonderful impact on our mental and emotional wellbeing.

Books 

This year, as part of the Goodreads Challenge, I made a resolution to read at least 30 books. I finished 11 and am loving this challenge so far. I’m grateful to have time during my gap year and before M1 to read for pleasure. Sure, I work full-time, but I very rarely take work home. I definitely didn't have this much free time during undergrad.

I stayed with a friend in Cambridge this past weekend. She lives near Central Square, which is peppered with coffee shops, restaurants, and bookstores! I stopped by two, browsed around a bit, and eagerly added some books to my “Want to Read” list on my Goodreads app (which is now at 75; needless to say, there’s no way I’m going to get through all of these by the time I ‘settle’ down after my medical training, let alone by the end of the year. So I've made it a life goal to get through all 75...and more). I ended up buying a little book called “Writing the Family Narrative”. About a year ago I decided that sometime throughout my career I will write my memoir and a narrative of my family’s history. This is a new initiative that I'm excited to take on. I’m confident that through research, interviews with my relatives, and much reflection, I can craft an engrossing narrative that explores my family’s roots in Jamaica, my erratic childhood, and the journey I’m currently taking through this exciting thing called life.

Anyway, leisurely pursuits and projects outside of school and work such as my memoir writing are taking a temporary backseat. I’m using the time I have to catch up on must-reads and bestsellers including (and I highly recommend these):

• "The Help" - Kathryn Stockett
• "The Kite Runner" - Khaled Housseini
• "A Thousand Splendid Suns" - Khaled Housseini
• "Brain on Fire" - Susannah Cahalan 
• All of Atul Gawande's books
• Many more (I can add a full list in another post)

What are you waiting for? Sign up for the 2016 Goodreads challenge! You will find it to be an exciting and gratifying experience.

Chicago cruising

I was in the Chicago area this past week for a medical school interview, and during the weekend I met up with a few friends from Cornell. On Saturday, after a big breakfast from Yolk, we took off to explore downtown Chicago, starting with Millennium Park. One of our friends is a Chicagoan, so he led our tour :)

We stopped first by the Giant Bean (“Cloud Gate”). It was designed by Anish Kapoor between 2004 and 2006, and is a main attraction in the city due to it’s shape, design, and ability to reflect and distort the skyline. Millennium Park also has an outdoor theater (Pritzker Pavilion) where many music and performing arts events take place.

We walked through the Chicago Cultural Center (which used to be the public library) and alongside Lake Michigan on the Navy
Pier. We also snagged some food for the afternoon and evening, including Jamba Juice (which I had for the first time), deep dish pizza (a Midwest staple), and BBQ chicken wings. I think we should’ve had more iconic food dishes from this city, but, I guess when we come back we’ll try to work that into our plans better.

We played Kanos for hours into the night (which is an addicting card game) and watched many episodes of “Real Husbands of Hollywood” and “The Office”. I used to think Kevin Hart was annoying, not funny, and vulgar (I still think the latter actually), but now I have a better idea why so many people find him hilarious. “The Office” will forever be my favorite television show.