Ugh!

That moment when you have a brilliant and inspired research idea, only to search google scholar/pubmed/etc to find that it has already been done,  and done exactly the way you wanted to do it.  Ugh! is both validated that it was a good enough idea to be published and yet disappointed that someone beat me to the punch. 

2013, mixed feelings

I have totally mixed feelings about this New Year.  2012 was an emotional roller-coaster.  The death of my grandmother, a rather jarring car accident, 2 trips to the Emergency room (as a patient), all the emotions of 3rd year clerkship, a hard break-up, then meeting someone new (and extraordinary), deciding to take a research year, moving to a new state, 2 cross country road trips, a trip to India... it has been a BIG and overwhelming year.

2013 was supposed to be the year I graduated medical school.  A huge part of me wishes it still would be the year I graduate medical school.  Instead, it is now becoming the year I figure out 4th year electives, begin residency applications, and try to *hopefully* get a publication out of all this research.  Ideally it will also be a year full of seeing my family, nurturing my relationship, taking better care of my health, and finding time to have fun.  Maybe I'll also make some art and learn some Spanish. 

Existential Crisis

My research year has started like this: 4 weeks of work (in which my grandmother died & my car was totaled), followed by 2 weeks abroad for a conference, followed by a week road trip with my girlfriend. 

This week was my first week back, and the first week where it became clear that I'm here to stay, at least for the year anyway.  This week was also slow.  Painfully slow.  S-L-O-W.  I felt like I wasted hour after hour, day after day, doing absolutely nothing productive.  Research projects are in various stages of stagnation for various reasons- mostly sitting on other peoples' desks waiting for their necessary contribution.  I know, I know, this is the way research rolls.

Too much free time spent surfing the inter-webs meant that I began questioning my decisions.  Why did I decide to take a year off?  What if waste this whole year and get nothing accomplished?  What if I walk away with no abstracts and no manuscripts, nothing tangible to show for my year?  How many hours can I really spend on facebook, words with friends, and the sudoku app before I kill myself from going stir crazy?  I'm just slowing down my life- an extra year before I potential don't match in OB (even having taken a research year), another year in a long distance relationship (if it survives distance) with a megaphone of a biological clock, another year before I can settle down in one city and actually began making a real community... another damn year!

I'm still hoping this was the right choice.  The opportunity to live in a kick ass city.  A year to have some free time with priorities on improving my health and learning Spanish before residency.  Maybe I'll finally get around to fine-tuning my basal rates after 16 years on an Insulin pump!  A chance to reconnect with my Jewish identity.  A chance to engage in some pretty novel, and interesting, research with some of the best in the field. 

For now though, I'm hoping a restful shabbos will silence my existential questioning.

Let the research begin!

I had a weird dream last night about applying for a research year and realizing that I was running out of time and would graduate before I had the opportunity to do it.  There was a lot of anxiety in realizing that I had missed my opportunity to do funded research before getting my MD and moving on to residency. 

Then I woke up to remember that I'm actually here, now, starting my research year!  Sub-I was successfully completed (though evaluation of exactly how successful is still pending), cross country road trip accomplished, room unpacked, first shabbos in the new home experienced.  Side note:  shabbos here felt like the promised land: beautiful weather, a nap outside on the back porch, lots of lovely people, having excellent conversations, delicious local food, everything labeled gluten free.  Tomorrow I start work!  Now I just need to figure out how exactly I'm getting there in the morning.  I also need to figure out how not to make myself look like an idiot in front of some of the smartest/best/most accomplished academic OB/GYNs in the country.  So excited to see what this year brings!

Busy week

-Last weekend I was away at a national conference.  While it was amazing and inspiring, being stuck at the airport for 12 hours on the way back due to weather drained the little energy I had left.
-This Friday I'm presenting some of my past research at another conference (that conveniently happens to be just a short drive away).  I'm a bit terrified about this as I've never done this type of platform presentation before! Hopefully they only ask questions I know the answer to.
- The neuro shelf is a week from Friday.  I'm feeling totally unprepared and overwhelmed with studying.
- It's match week!  While this isn't my year to match, it's so exciting to watch all my 4th year friends.  I can't wait to hear where everyone is going!  It's crazy to imagine that this may be me next year.
- In theory, research fellowship responses are to be released this week.  Crossing my fingers that I'm accepted for the one I want.  Either way, I should hopefully know soon if I'm taking next year off or continuing on to 4th year.
-My mom's birthday.  I can not forget to call her!

Passing of the tourch

Since coming back from winter break, we second years have been working hard to hand off our extra curricular responsibilities to the first year medical students. The theory is that by starting so early we are allowing for a bit of transition before we fully disappear into step 1/clinical rotation land. The reality is that most of us just want to play a game of "ding dong ditch" with some of these things. Yes, they are causes that I'm passionate about, and leadership roles that I really appreciated having this year; but my current priorities have shifted to 1) staying sane, 2) doing well on step 1, 3) staying sane. Staying sane, which involves eating health, sleep, exercise, and a bit of socializing, doesn't leave much time for running 2 student groups, doing research, and involvement with major amounts of grassroots organizing.

The problem is finding first years who are idealistic and naive enough to take on these responsibilities. Just as we are trying to hand them off, their work load has increased... scaring them out of taking on too much. Last year, I hated hearing my class referred to as "slackers" for not wanting to take on leadership roles. So I am trying my hardest not to be frustrated with the current first year class for their lack of eagerness to take over all of these wonderful opportunities. I do get it. But PLEASE, take my positions! I want to be done with them already! I want to disappear to step 1 land foot-loose and fancy-free!

Research

Research is a necessary evil of medical school. Yes, it is possible to go through the educational system without doing research. It is even possible to do well and match in a good residency without a publication. But as someone interested in academic medicine, research is basically a required optional activity. The process fascinates me. The ability to spend time questioning, exploring, and explaining speaks to my inner child. However, the process also creates an emotional roller coaster which drives me nuts. There are constantly ups and downs, with very little balance between the highs and lows.

Currently I feel overwhelmed by the lows of the process. My abstracts from this summer need to be submitted this week, yet are stuck in the in-box of my PI waiting for revisions. I can't imagine how he's going to edit them in time, and being 3000 miles away limits my ability to nag him about it. If he does get them back to me, will they still need work before submission? How does one even submit abstract proposals to a conference in the first place? (I am sure I will learn as I go, I'm just not sure that timing will allow me to learn with these abstracts). What will happen if they aren't ready? Will this be the end of everything I worked on this summer?

The second project I've been involved with is currently stuck in the IRB labyrinth. We submitted our application for exemption on Thursday, right before the Friday deadline. This was our last chance to submit and get a reply before our intended (and non-negotiable) project start date. Late Friday afternoon we were informed there is a snafu in our application, and it may be insurmountable. I may have thrown a temper tantrum yesterday morning when I found out about this. I may have acted immature and unprofessional by sending out a rather pungent e-mail to my adviser and co-researchers, an e-mail I now can't take back. I intellectually know why the IRB is necessary but am so frustrated that silly bureaucracy (relating to intellectual property rather than ethical concerns) may impede on interesting and important research, biased opinion of course. Not to mention that this is research I WANT to spend my time doing instead of just doing it for the sake of my future... but maybe that is the problem. Being so attached to the topic might be increasing the emotional weight of every set-back. I guess you can never win...

All good things must come to an end

Today was my last day of work, wrapping up a summer spent researching in a city that I love. I was fortunate enough to spend the last 8 weeks surrounded by big brains in long white coats who happen to also have very big hearts. Half my time was spent in front of a computer screen: analyzing data, researching prior literature, writing, and rewriting. The other half of my time? That was a mixture of shadowing in clinic, getting into theoretical and hysterical conversations with my coworkers, and collecting mentors as if they were baseball cards.

After all, medicine still is an old boys network, with an emphasis on the network part. Being here, in the city that I love, surrounded by forward thinking and well established medical providers gave me an opportunity to begin forming my network. While my PI may be the only one that I keep in touch with, sitting across a table with so many fabulous physicians has given me the opportunity to begin envisioning MY future as a physician. Scary and exciting at the same time.

While only I time will tell if I get a publication of this summer, I am already aware that I gained so much from this experience. As I prepare to go back down south I am making sure to pack these moments of inspiration as I am sure going to need them getting through the forthcoming uphill journey. One such pearl of wisdom is the following quote "It is your job as a physician to take care of your patients and then pursue the things that interest you. It doesn't matter how many papers you write or how many awards you win." As school starts up again, and times get stressful, I need to remember why I am doing this: my future patients and my interests.

seems to be the summer of sex talk*

Through a conversation about Dr. Richardson & Dr. Schuster's book Everything you NEVER wanted your kids to know about SEX (but were afraid they'd ask), my coworker and I got into a very long discussion about sex, power, and knowledge. Somewhere in the conversation we derived that knowledge may in fact be what holds us captive. Without knowledge, we're able to enjoy inherent and simple pleasures: food, shelter, sex. When knowledge increases so do more complex emotions: stress, anxiety, worry, doubt, fear, etc.

In fact, we decided that as a species, an orgasm is the most intrinsic and intense emotion we can experience. It carries with it huge amounts of power for humans to realize what we are each individually capable of. Through knowledge, and through the learned experience of sex being shameful and secretive, that power is negated and control centralized to an outside authority. Here is where discussion turned to Adam & Eve, original sin, and religion as a whole. From there it continued to spiral into sociology, philosophy, and literature.

The conundrum: without knowledge, would we even enjoy sex (and all the other intrinsic simple pleasures) in the same way?

The point of all of this is simple that I am loving my summer. I miss this kind of liberal arts discourse that used to occupy my life pre-med school. Oh, and that EVERYONE needs to read the above mentioned book. Especially all of you parents and future-parents. I promise that it will screw with your thoughts some and make you question everything you thought you knew/believed.

*One of my research papers I have been working on this summer is about adolescents and sex. I blame it, and the necessary lit review, for fueling a lot of the conversations I have been having this summer.

"Can I Physically Do This?"

I am spending my summer doing research on adolescents with lifelong, and function limiting, chronic illness. Spending hours pouring over qualitative data on how teens identify with their illness has reminded me of my relationship with diabetes as I transitioned through adolescents. It also reminded me of the summers I worked at diabetes camp, and my tween and teenage campers who I desperately wanted to grab by the shoulders, look in the eye, and promise that it would get better in a way that they could hear.

Today, in hopes of nurturing my professional development, my PI (principle investigator) spoke wise words about my academic future: "You are in a tunnel. There is an end. But at this point you need to be careful that the light you see isn't another train coming at you." These same words so adequately describe the double edged sword of being a teenager and having a chronic illness.

Even now, a few years removed from the turmoil of teenage insecurity, I still struggle with acceptance of future: as a physician, as an adult giving back to society, as a sister, daughter, wife (maybe?), mother (hopefully), AND as a type 1 diabetic. Below is a "fear essay" on the subject that I had to write for our humanism in medicine class this past fall:

Can I Physically Do This?
My biggest fear about becoming a physician is actually less about the process of becoming one and more about my future career in medicine. I am afraid of not being able to physically handle the life-style associated with the practice of medicine. I am also afraid that the stress associated with a life in medicine will have a negative influence on my health. I am afraid of there being truth in all of the nay saying I have heard over the past 19 (plus) years of living with type 1 diabetes.
At six years old I was diagnosed with diabetes after an abnormal result was found on a routine blood glucose test during my annual physical. My blood sugar was 157 and I was completely asymptomatic. Three days later my pediatrician performed a very unscientific glucose tolerance test (checked my blood sugar, sent me out to eat a sugary breakfast, had me come back to check my blood sugar again). This led to me being ushered off to the pediatric endocrinology unit at the local teaching hospital. The events of that day are my first tangible and complete memory.
Growing up with a chronic illness, especially one that is surrounded by a huge amount of misinformation, has been hugely influential in the development of my personality. I believe that my experience as a “diseased” person in society is what led me to major in Medical Anthropology, a background that will be hugely beneficial to my career in medicine. With no one in my family in the medical field, I strongly believe it is also what inspired me to seek a career practicing medicine. This desire was strengthened when I was diagnosed with Celiac disease after many years of seemingly unrelated symptoms. Diabetes has given me a (sometimes overzealous) drive to achieve everything I possibly can and not take a single day for granted.
However, there have been tremendous physical and emotional obstacles to surmount. One of the greatest challenges for me has been overcoming the emotional burden of the “scare tactics” used on me as a child. I grew up in the age of “if you eat that your arm will be amputated”, “if you don’t check your sugars more often, you’ll loose your eye sight”, and “high blood sugars will kill you”. I was taught to weigh my food, to micromanage my sugars, to be meticulous about taking insulin, and to use food exchanges as a way of cheating death. My parents, doing the best they knew how, had the attitude of “everyone has their problems and so at least you know what yours is” which left little room for me to ever be upset or frustrated at the disease that shared my childhood.
I made the decision to pursue a career in medicine a little later then most of my peers, as I had to first determine that diabetes was not going to get in my way. While I rationally know that it wont, and know that it never has before, I am still fearful that it will. There are many events that have happened recently to reaffirm my fear of a future as a diabetic in medicine. Such as my endocrinologist advising me to keep my disease hidden in the application process and in medical school rotations, as according to him, “old world surgeon types will judge you and think you are incapable”. Or having to fight to be able to take my insulin pump and blood glucose meter into the testing room with me during the MCATs. Or that countless numbers of people have given me unsolicited advice about how as a diabetic I should avoid high stress lifestyles in order to avoid complications.
I find myself wondering how I will manage to keep my blood sugars stable during the unpredictable pace of 3rd and 4th year rotations. How will I carry my pump, multiple pagers, and a smart phone on scrub bottoms without them falling down? (I have mastered the pump and 1 pager or radio already, but not multiple.) I worry that I wont be able to fit exercising, sleep, and cooking healthy meals into the packed life style ahead of me. I am concerned that high levels of stress combined with little sleep will lead to uncontrolled blood sugars. And I worry about what will happen if I have a sudden low blood sugar, or accidentally pull out my pump site, while working a code or during surgery? Will diabetes hold me back from a specialty I really want to pursue?
I also find myself worried about diabetic complications, and irreversible past damage I may have already done to my body. If I loose a limb as a result of this disease, will that be the end of my career? And if so, why am I putting all of this time into trying to be a doctor in the first place? Should I be taking advantage of the time I have with all my appendages somewhere else? Or what happens if I go blind?
I also worry about how my experiences with a chronic disease will influence my ability to doctor, and how I view my patients. I already know that I have an unfair frustration towards type II diabetes and diabetics due to the assumptions made about me from the mention of “diabetes”. I need to quickly get over this bias, as I will probably have many type II diabetic patients regardless of my specialty choice. Will I be unsympathetic or judging of non-compliant patients? I really hope not.
I know that I am not the first diabetic to pursue a career in medicine and I am sure I will not be the last. I also know that I have had the blessing to grow up surrounded by new technology and that things like constant glucose monitoring systems will significantly ease the burden of managing diabetes in a fast paced life style. I also realize that it is okay for me to have these fears but I need to ensure that the fear does not become debilitating. Hopefully my diabetes will aid me in my career as the best physician I can possibly be instead of holding me back.

Don’t drink the Kool-Aid

This summer, what is likely my last real summer, I am working as a research fellow in an elite hospital nestled in a North Eastern City that used to be my home. In fact, it is one of the world’s best hospitals, something we are often reminded of. While talking to a first year fellow last week, I was strongly warned not to “drink the kool-aid”. She, a newly minted physician activist, spoke of coercion and loss of ideals. She warned of the magical allure that these old white men have, drawing the vulnerable young idyllic doctors in with promises of prestige. She has a compelling point, but at the same time she seems to be making it work.

Plus, I am learning this summer how tasty the kool-aid is. I have come to terms with the idea that I am smart and capable. But, while smart enough, I have never been THE best or THE brightest, instead always having to settle for my second or third choice. Such was the case with my college selection, with my post college employment, and with medical school. While I loved my college experience, and I am content with my medical school, this was never the path I envisioned myself on. Being at the best hospital this summer in a relatively elite fellowship is giving me a glimpse at the power and freedom that comes from it all. Because they are the best, they are able to talk about taboo topics: sexuality, psychosocial complications in delivering health care, medical standards; and, shockingly, can even conduct research in these uncharted lands. This is not something we can readily do in my southern medical school, where instead we are instructed to not tremble the waters. What I am learning is that the kool-aid gives you a pass to the unknown, but with it comes a signed contract: no matter what, the institution, one of the world’s best institutions, needs to be kept on its pedestal.

The other problem with the kool-aid is it leaves you thirty, and unable to settle for anything less than kool-aid of equal caliber or better. But the better kool-aid is going to cost you more of your ideals and personal autonomy for the sake of protecting the institution. The point of all this kool-aid talk? I am in limbo between loving the reality I am experiencing this summer and being terrified about my future. I want more of this opportunity- more ability to do research at a hospital with countless resources and copious respect. I want to apply for a fogurty or a doris duke fellowship so that I can accumulate prestige to compensate for my decently (but not overly) adequate Southern medical school’s reputation. I also want to be smart enough so that I can work and live in this, or a similar, North Eastern City that used to be my home. The terrified? That comes from feeling insecure by the elite that surrounds me. From worrying that I will never be smart enough for this to be my life, and that again I will have to settle for second or third best instead. That before this summer even ends, they will discover that I shouldn’t even be here now. Even worse, I fear what will happen if second and third best aren’t even options when it comes time for residency matching? What if all this work is for naught, after sacrificing so much, I never become the physician activist I so hope to be? But on a third hand (which anatomically we don't have), I am also learning that sometimes going with the less prestigious option allows for a better fit and more flexibility to be a change-agent, and less hurdles to jump through... a lesson I assume will be important to remember over the coming years.