The most repetitive lesson of medical school

1. If it doesn't make sense, or you don't know how to do it, fake it 
2. Just keep faking it and moving forward
3. If you fake it long enough, it will eventually make sense / you'll figure it out
4. As soon as it makes sense it will be time to move on to the next thing that doesn't yet make sense*
5. Repeat

It amazes me how many times this cycle has repeated itself during my medical school experience.  And yet, it still continues to repeat. 

*Sometimes, you actually have to move on before you realize it makes sense, but then you move on and that last thing just "clicks".  Slightly out of order but the process still holds true.

Using religion to negotiate arbitrary borders: helpful or dangerous?

During my first year of medical school I went to a talk organized by our Jewish Medical Student Organization on the separation of conjoined twins.  The talk focused on the 1977 Pennsylvania case of thoraco-omphalopagus twins born to an Orthodox Jewish family.  These girls were born with a combined 6 chamber heart that would be incapable of sustaining their developing bodies.  The case brought up the ethical debate of whether it is acceptable to separate the twins in order to save a single life, knowing that the other would die in the process.  To sum of the full story, a unanimous decision was made on behalf of the medical team, rabbinical court, and American legal system that separation was justified.  It is truly a fascinating case though and worth the read.

I was recently reminded of this case when a friend, a classmate, brought my attention to the this week's New York Times Magazine cover story: the two-minus-one pregnancy.  Reading the article I realized that I have an arbitrary border placed between abortion and selective reductions.  I fully support a women's decision to abort a pregnancy, and believe that it is not my place to judge such decisions.  I believe that it is never an easy decision for any woman to make, it is never arrived at lightly, and that my role is provide supportive, quality health care to help her live her life in the way she chooses.  Yet, as confident as I am that I WILL provide abortions as part of my career, I can't imagine that I will be comfortable  providing selective reductions.  Or at least not comfortable performing the procedure when there is not a medical indication behind it.  Analytically, academically, I support a women's decision to reduce just as I support her decision to undergo an elective abortion but emotionally I feel very differently.  When distilling this discomfort down in discussion last night, I realized that it stems from my religious doctrine.  My understanding of Jewish text is that it is not for human's to decide whose life is of more value.  It is one thing when comparing the life of a living mother to the potential life of a fetus, but seems to be a totally different matter when weighing equal-ish [potential] lives against each other. 

I imagine this issue, and similar ones, will be revisited many times in my future.  I have no idea what choices I will make if actually put in such a position.  Yet, I imagine that these are the times I will turn to Jewish text.  These defining moments in my career will be when I seek rabbinic advice and reflect on the precedent set in ancient text.  However, I hope to be learned in the surrounding issues, comfortable in my own decisions, and cognoscente enough of my arbitrary borders that I will be able to support my patients regardless of where we both stand.  If there comes a point that I am not comfortable performing a procedure, I pledge to help bridge the gap.  I will refer them out to someone who can provide the comprehensive care and also to realistically help them access that care; much the same as I hope/expect from providers who refuse to provide abortion care.

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.

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!

2011

Having New Year's Eve fall on shabbat seemed like a blessed start of 2011. While it was the 3rd year in a row spent with the same group of friends, it was much more relaxed and satiating. It allowed me to be surrounded by community, relaxation, prayer, and a lot of laughter. I gathered together with old friends for lovely shabbos meals, had a full night of sleep, received an alliyah in shul, played with a very cute child, and was reminded that I still very much have a home in the Northeast. I am hoping that these themes continue to carry out in the year to come. May we all be blessed with a year full of good conversations, reminders that we are loved, soothing laughter, fulfilling learning (& torah), places to call home, satisfaction with our current lot, and maybe even a few pleasant surprises.

silly traditions

Right before the first anatomy exam of our first year of medical school my classmates and I were all freaking out. Between the sheer quantity of information we were excepted to know, the uncertainty of what to expect from the exam, and the fear that doing poorly would alert the admissions office to their mistake of accepting us... we were anxious to say the least.

Two days before the exam we were sitting in the main lecture hall for a review session which we had been informed was "extremely high yield". About 15 minutes into the 2 hour review a noise began to grow louder outside the doors to the auditorium. Out of no where a large amount of the second year class came storming into the lecture hall, hurling candy, mardi gras beads and plush toys at us. Looking around, none of my classmates appeared to know what was happening as we laughed and ducked. Before leaving, the second years sang to us and explained that this "review session storming" was simply an annual tradition with no explanation. They left us with a noticeably more relaxed attitude and a huge mess to clean up in the auditorium.

I look back on the experience as one of my founder memories from last year. It was the moment I realized that everything really was going to be okay. If the upper classmen could take a break from their studying (as they also had an exam to cram for), and if our professor could allow for this to happen during his review time (and then continue to teach while wearing beads and eating candy), and my classmates could see the humor in oddity of the situation: I too could learn to relax and enjoy the experience.

Today it all came full circle. It was our day to storm the first year review session, which I did with 30 or so of my classmates. Seeing the same look of confused enjoyment on the faces of the first year class, I could sense that they too were getting it: the moment of clarity that medical school will be okay and maybe even a little bit enjoyable at times. The surprise though was realizing that not only did I help give this experience to the first years, I was able to take from it as well. As chaotic as this year gets with course work, step I preparation and extra curriculars, there is ALWAYS time for humor, to be silly, to carry on tradition, and to make someone else's day.

Though there really are never enough hours in the day. So, with that, back to studying for Friday's exam I go.