Saturday, February 26, 2011

Solicited advice

Before Thanksgiving last year one of our anatomy professors warned us that we were going to be treated differently by our families when we went home for break. He explained that between the turkey and the pumpkin pie, our families would likely be soliciting medical advice from us. He was right. Even if I can't answer their questions, I like being that person. I savor the roles of caretaker, hand-holder, medical translator, and reference librarian of primary medical literature. Having the knowledge and skills to be a support system is why I originally became an EMT and was part of the impetus to go to medical school.

Recently though, I've been confronted with a few different ways to handle those who offhandedly solicit medical advice from physician friends in social settings. Watching these encounters occur, I totally understand the perspective of both providers.

One answers all questions with "you should talk to your doctor about that", giving no specific answers other than to simply triage the urgency of the situation. Her perspective is that she doesn't have all the facts that their doctor will, and doesn't want to be put in a position of missing something or bearing bad news. She wants to keep boundaries between her personal life and her career.

The other views the ability to offer medical advice as her contribution to relationships. She knows that her schedule limits her ability to be part of the community: to go to shul, volunteer with the chessed committee (making meals for new families, the sick, and those in mourning), pick up carpool, and host holiday meals. So she compensates by constantly "being on call" to those in her community. In a way, she views sharing her skills and knowledge as her debt to society.

I wonder what my stance on friends soliciting medical advice will be. Of course, I actually need to know some medicine before this relevant, but i still find it interesting to think about. Will my career and family life be two separate entities or will they blur into each other? Will I get knocks on my door for emergency consultations during shabbos or will I actually choose to take a complete day of rest? Knowing my personality, I imagine I'll be more like the latter physician constantly there to support friends and family. I'm kind of curios to know other physicians choose to do. I think it is time to start asking my mentors.

Thursday, February 24, 2011

NBME = mishugas

This is what I've spent the last thirty minutes composing:

February 23, 2011

To Whom It May Concern:

I am medical student at ___ scheduled to take the USMLE step 1 on April 18, 2011 in ___. I was diagnosed with type 1 (insulin dependent) diabetes in 1990. Since 1996 I have been managing my diabetes through continuously wearing an insulin pump. The pump supplies me with a continuous basal rate of insulin necessary for me to function. I can only detach from my pump briefly, as detachment comes with the risk of clotting the infusion sight as well as slipping into diabetic ketoacidosis.

Therefore, I am writing to request that I be allowed to wear my insulin pump for my USMLE exam. Below, as per your request, you will find the model and serial number of my pump, as well as a picture of me and my pump. Included in this e-mail you will also find a letter from my endocrinologist.



Stupid NBME! Why do you waste my time with such silly tasks? Do you really think that I'd use my diabetes and insulin pump as a way to cheat on a standardized exam? How would I even go about doing that?! Also, what if I had just chosen to wear my pump in my bra during the exam and skip this mishugas all together*. Let us just hope I don't have to threaten suit for access to my medical supplies this time like I had to do for the MCATs...

*With my luck, hiding my pump would mean that it would decide to alarm during the exam. Then, how would I explain to the testing center that my chest was alarming without getting in serious trouble?

Wednesday, February 23, 2011

Continuing Involvement in Social Activism and Jewish Life

Yesterday evening I took a study break to sit on a panel about "Continuing Involvement in Social Activism and Jewish Life". There were 6 of us on the panel; all Jewish young adult involved in multiple different forms of activism. Besides me there was a lawyer, a social worker, a teacher, a independent journalist, and even a pet sitter. We all had different backgrounds, different interests, different relationships with our religious identity, and different words of encouragement to share.

Like all good Jewish events, the night started with a text study. We then were each given 8 minutes to answer the following questions: 1) Introduce yourself and describe your initial service experiences and your transitions since then. 2) Describe your path of continued involvement in social activism. 3) What insights have you found about yourself as an agent of change? 4) In what ways have Jewish values and/or the Jewish community been part of your “work?” 5) Share a story about a time when you knew you were making a difference? Then we split up around the room, and met with participants who wanted to ask us individual question.

This was the second such panel I've participated in since starting medical school/moving to this southern city. Both times I have left feeling completely energized. Through the retelling of my own story, I am afforded the opportunity to see how far I have come on my journey, to see that besides set-backs I have had significant successes, and reflect on how much work I am currently doing [even as a busy medical student]. It allows perspective to see the unexpected doors that opened, and realized that things work out in their own unique way in spite of how much I antagonize and plan. One of the other panalists explained how he became an activist the day he shifted his perspective away from living life by "checking off boxes". Another stated how her activism is accentuated through humility of her own weaknesses and through learning from her clients. A third talked a lot about self-care. I am pretty sure that while I gave out insight and advice to the participants, I walked away with much more from the experience than I gave.

And to inspire you to keep fighting, here are some inspirational short videos.

Monday, February 21, 2011

Rejoining humanity

This weekend, I played hooky from Step 1 studying and ran away to New York City. I spent shabbat walking around the city bundled up in my winter coat. I let myself get lost in though, in the mobs of people also walking around, and in the colorful storefronts. Saturday night I partook in a scavenger hunt at the Met, and while the point was to have an adventure in culture, the experience was heightened when our team won! Competitive comes naturally when there are multiple medical students on a team together.

The purpose of this weekend getaway was the wedding of two lovely friends. The wedding consumed most of my Sunday and was well worth it! Everything was beautiful, [pre-medical school] friends were copious, and I lost my stress in hours of dancing. It was so good to see so many people that I adore in one place. Surrounded by all of them, I felt normal again. I remembered what it is like to be a totally rational human instead of a crazed 2nd year medical student. The cherry on top was watching the snow fall this morning on my way to the airport. I firmly believe that no east coast winter adventure is complete without snow!

In observant Judaism it is traditional for the bride to give out blessings on her wedding day. The blessing that was given to me yesterday? Besides the traditional blessing for a b'shariet (soul mate), I was also given a blessing to find a medical specialty that suits me and match in the residency of my dreams. This is what happens when the bride is doctor and truly understands my bimodal priorities.

Friday, February 18, 2011

I'm speechless...

Since I can't seem to process all that is happening [with regards to politics and women's health] as quickly as the Republican party is moving, here are some amazing voices speaking out about the issues:

-The lovely Rep. Jackie Spears speaking out on the floor of the house.
-Another medical student, tackling the issue within her own religious and world view.

I'm scared to see how much more women's health will suffer so that politican's can feel satisfied with their own [male genitals]...

Wednesday, February 16, 2011

An eye for an eye? Really?! Are we still doing this?

Yes, I understand that the bible literally tells us that an eye for an eye is justified. But since when do we take every line of the bible seriously? And aren't we supposed to be living in a country free of religious persecution? Isn't that what US laws are supposed to be about; protecting our civil rights without imposing religious doctrine on us?

Without using the biblical concept of an "eye for an eye", how can one institute laws on justifiable homicide? (Or for that matter, capital punishment, which like most leftist liberals I am against.) Or maybe it is just that the legislators in South Dakota are just complete and totally out of their minds. How else can you explain this, a bill that allows for murder of abortion providers.

Let us revisit this: an abortion provider is a doctor who goes against all odds to get her* training in the first place. She fights against her med school administration to learn how to preform a safe and legal medical procedure, ignores the comments from her peers and faculty that it isn't worth her time, and takes ownership of her own fears about what being a provider might mean. She struggles to find a job that will allow her to even perform abortions (as many large group practices and corporate hospitals would rather not get involved with all that), pays higher malpractice insurance (because that is how insurance companies work), and has to put up with much bureaucratic BS of sonograms, waiting periods, and the rest, in-order to simply do a small facet of her job as a health care provider. Depending on where she lives and practices, she might have to crawl through windows to get into work, disguise herself in wigs, wear a bullet proof vest, face protesters and hate mail, and convince her small children that no matter what some of the other kids at school are saying she's really not a "baby killer". The best part is that she does this all because she believes in the healthcare of women. She takes her medical oath seriously and believes that all patients are entitled to quality, safe, and accessible health care. She knows that no woman makes decisions about reproduction lightly. She wants to do everything she can to empower women about their own bodies. She understands that we live in an unfair and unjust society and will do everything she personally can to combat that. She wants to be able to look her grandmothers and daughters in the eye and say "I know how hard women have been fighting for their own rights, lives, bodies, and I will continue the fight until there is fully equality." She doesn't think she's a hero. She knows she is simply doing what she was trained to do: take care of people's emotional and physical health.

(*Of course, there are MANY male providers too, and he would be going through exactly the same thing.)

So now, these lovely legislators in South Dakota are saying that it is justifiable to murder this hard-working and compassionate doctor for simply doing her job. Anyone else see a problem? To make matters worse, it is not just these fine folk from South Dakota that are out of their cherry-picking minds. It seems our elected officials in DC are behaving in a similarly problematic way. I got the following e-mail today from MSFC (who borrowed it from an ARHP email) regarding the current anti-abortion/women's health legislation currently on the floor:

"*Title X Abortion Provider Prohibition Act (H.R. 217)- Rep. Mike Pence (R-Ind.) has introduced this measure which would devastate Planned Parenthood and other similar groups by denying Title X federal family-planning funds to groups that offer any form of abortion access—even when it is not government funded. By attempting to attach this bill to the FY 2011 Continuing Resolution, Title X opponents would prohibit any agencies—like Planned Parenthood and all State health programs—that perform abortions or provide any funding to an entity that performs abortions from receiving any federal funding.
*No Taxpayer Funding For Abortion Act (H.R. 3)– While current law already bars federal money from being used to directly pay for abortions, Rep. Chris Smith (R-NJ) has proposed this bill that would deny tax credits and benefits to employers who offer health insurance to their staff if that coverage includes abortion access.
*Protect Life Act (H.R. 358)- Federal law currently requires hospitals receiving Medicaid or Medicare funding to provide emergency care to all individuals, regardless of the patient's ability to pay. If the facility can't provide the necessary care, it must transfer the patient to someone who can. This bill, introduced by Rep. Joe Pitts (R-Pa.), would allow hospitals to turn away women who need to terminate a pregnancy in order to save their own lives.

Additionally, the Republicans on the hill want to completely eliminate Title X funding through their budget cut proposal. In this budget cut, they also want to slash the budget for programs like WIC and other community programs."

So what do we do? Do we simply sit back and let them poke our eyes out? Or are we going to finally stand up and say enough is enough. Let us not repeat the fights of our mothers and grandmothers. Let us not sit blindly back as they strip us of control over our own bodies. Call your legislators. Talk to your friends. Take a stand. VOTE! Do something, damn it! Otherwise, I'm moving somewhere civilized, with socialized medicine and freedom of choice.

Tuesday, February 15, 2011

Accepting mediocrity, part 2

... and then there are the days where even being mediocre would be lovely. Shit. Trying to remember how poorly I did on my first practice MCAT but then managed to score high enough on the real thing to get into med school on the first go-around. Breath. I still have 2 months and 3 days until the real thing. Plenty of time to relearn* all of the last 2 years of basic sciences, right?

*To say "relearn" implies that I actually learned it the first time around; "learn" might be a better word choice.

Monday, February 14, 2011

Accepting mediocrity

This morning I took my last department written exam of 2nd year pathology. The completion of this exam is making it very apparent how quickly my pre-clinical years are coming to an end. My first 2 years of medical school have taught me one thing in particular: how to accept mediocrity. I am far from the top of my class, and likely not even in the top 1/2 of my class. I am a total mediocre, completely average, yet well rounded medical student. What I have learned though is that p=md and that spending time to be a complete person is important in becoming a well-rounded and humane doctor. Because I am only average, and not superwoman, I can't save the world if I don't take care of myself.

Tomorrow morning I plan to take a half-length mock STEP 1. While getting a completely mediocre score on it is more than acceptable, especially seeing as I have 2 more months to study, I pray that my score is at least mediocre. My goal: simple to pass this time around. If I pass tomorrow the next 2 months will be challenging but bearable, but if I don't? I guess that I'll cross that bridge if I have to...

Sunday, February 13, 2011

My new goal:

is to either do a marathon (at least half) or triathalon by the time I graduate from med school... A bunch of my classmates ran this morning and made me realize how much I WANT TO DO IT TOO! I want to be that cool! I'm totally falling for peer pressure, as well as a desire to do something substantial while creeping through my education.

The complication is that I'm very much a swimmer and not a runner. I'm not quiet sure how to breath on land! When to start, where to start?

Thursday, February 10, 2011


Yesterday a few of my friends had the following posts on their facebook wall which got me thinking:
"I am asking if everyone could please put this as your status for one hour if you or someone you love has diabetes. I know my family will, my prayer is that in 2011 a cure will be found. Will you post it? Just for one hour. Do it for all of us in memory of too many to mention and in honor of all fighting it! I hope to see this on your status today."
Then, a pretty frustrating conversation with a classmate about the way people handle chronic conditions made me realize how little the medical profession actually KNOWS about living with chronic conditions. Especially invisible chronic conditions. But in all fairness, it is impossible to explain to someone what living with such a condition does to you. Sure, the disease/condition doesn't define you; but it is also naive to think that it isn't a huge part of someones identity (even if you are someone who pretends this to not be the case). I don't know what it means to be a naive 20-something with health-privilege just as they don't know my perspective; but they sure as hell shouldn't judge me or project their expectations for the appropriate way to handle it.

My diabetes and celiac define me as much as being Jewish and queer do. They are just as much my identity as where I am from, my family structure, or the time I wandered away with my my brother at age 4. My morning routine: I wake up, shower, brush my teeth, check my blood sugar, pack lunch, take insulin, eat breakfast. When I eat out? I don't eat un-kosher food nor do I eat gluten. Sure, I could live my life as if I didn't have diseases, but I'm pretty sure that I wouldn't be as healthy as I currently am or be able to invest all of this time and energy into becoming a doctor. That wouldn't be good for anyone involved...

I'm sorry if the way that I handle my life, along with all of my uniqueness, upsets you. I'm sorry if my being open about my chronic, yet invisible, conditions offends you. I'm sorry if you think I'd be better off not making them part of my identity. However, I personally think you'd be better off letting me live my life the best way I know how.

Monday, February 7, 2011

career counseling

In the few months leading up to Step 1 (and 3rd year clinical rotations) there are a bunch of hurdles that my medical students makes all 2nd years run through. Besides learning the computer system, getting another TB test, taking an official standardized patient exam, etc., we also have to have a career counseling session. These sessions were billed as "a half an hour opportunity to sit down with a dean". We were sent a long form to fill out and bring to the session with us.

Turns out that the half an hour session about our future was really a nine minute psych consult. A glorified opportunity to make sure that we're not about to jump off the building nor totally oblivious to our quickly approaching destiny. He asked me how I was eating and sleeping, what my study plan is, and how I am feeling about it all. He then continued by giving me advice for 3rd year. His advice? Come in prepared, be nice to everyone, show that you care, don't slack on any of the rotations including the ones you aren't interested in. Do people not know this?! It seems so logical!

In other news, I am feeling totally unmotivated by our current academic block. Turns out that living a life of endocrinology pathology translates to complete study apathy. I really need to tap into my 20+ years of endocrinology experience, and soon.

Friday, February 4, 2011

The torch has been passed

As of today, I have officially handed off all of my extra-curricular activities. I'm super excited to see the first year students step into these roles. They are so excited, energized, and idealistic! I have no doubt that they will do wonderful things in their short stint as leaders and will heavily influence the crop of medical students that come in after them (class of 2015).

Now comes my biggest commitment yet: step 1 studying! Though I am presenting at 2 different academic conferences between now and when I take step 1; I sill have a non-boards centered outlet. But first, I think I will enjoy med prom this weekend.

Tuesday, February 1, 2011

Rethinking meat

I'm seriously considering going vegetarian (again). At 13 years old I went vegetarian as a first step in wanting to be kosher. I continued to eat kosher fish, but gave up all other meats until I was 19 years old. When faced with kosher turkey at a friend's thanksgiving dinner in college, I excitedly gave up my vegetarian identity, opting instead to do my best to find "happy" kosher meat (knowing where it comes from, free-range, etc).

While in London over winter break I started to reconsider meat. After going to a few different shiurs on kashrut I started to seriously think about what being kosher means to me. I also started to grapple with the fact that it is VERY difficult to find local/ethical kosher meat, and that killing an animal in a kosher way may no longer be the quickest/most humane way to do it. Then, today, I unintentionally ended up watching Oprah's episode on going vegan. As part of the episode, Lisa Ling goes inside a slaughter house to show the process. I think that watching those few minutes of footage were enough to get me to go vegetarian again.

I'm not saying that eating meat is wrong or that we, as humans, shouldn't eat meat. Nor am I saying that you, dear reader, shouldn't eat meat. I'm just not sure that I should keep doing it. Watching the way the cows were being processed reminded me way too much of gross anatomy lab, a class that I was VERY uncomfortable with for so many reasons. I realized that given the choice, I would never choose to slaughter, skin, or butcher a mammal in order to consume it. I'm barely comfortable taking raw meat out of the package in order to simply cook it! I strongly feel that I have no right to eat something that, in its entirety, makes me this uncomfortable. Vegetables, tofu, even fish; these are all things that I will take ownership of destroying for my own nourishment.

This is not a decision I am going to make lightly (this time around). So for now all I can definitively say is that I'm in the contemplation stage of returning to vegetarianism.