MS-0

Pre-moving jitters

A good friend of mine from high school got married this past weekend. At the reception, I met people I haven’t talked to since high school graduation (and one guy I went to elementary school with). As recent college graduates, we all asked each other the same question.

“What are your plans for next year?”

I told everyone that I’m moving to New York in mid-August to start medical school and that I was very excited. I mean, it’s New York City. It’s on every tourist’s must-see list; it has all these songs written about it; it’s an absolutely unique place to be. No other city has more theaters, publishing houses, and academic institutions, not to mention an amazingly complex subway system that will ferry you hither and thither for just two bucks a ride. I want to be a part of all that. I want to be a New Yorker.

And at the same time, I’m terrified of the City.

I’ve never lived anywhere but a suburb and a college town. What if I can’t stand city life? What if I get mugged? I don’t know anyone in New York; what if I get lonely? What if I can’t handle being so far from home? What if I fail anatomy, or worse still, realize that doctoring isn’t for me? (*mentally adds “hobo” to list of backup plans*)

You know, once I write all those fears down, they seem kind of silly. I’ll be ok. It’s just a little bit frightening to go through all the stuff in my room — the books and papers and clothes and trinkets of 22 years — and decide what I’m taking with me and what stays behind. Except for a week’s vacation at Christmas, I won’t really be coming back here again. I think that’s what scares me the most.

Going off to college was not such a big deal; it was just two hours away and I never really moved out. But towards the end (fourth year, especially), “home” stopped being my parents’ lovely house in suburbia and became my little 11 x 13 room with the high ceiling and the two windows. The one night I spent in New York, at a second look weekend, I became incredibly homesick — for my dorm.

I do insist that I made the right choice. The school where I’ll be matriculating in less than a month (ahhh!) was the only place with which I really fell in love. My future classmates seem chill. It’ll just be … different. As Richard Curtis wrote in The Vicar of Dibley, there’s good change, and there’s bad change. (“There’s the Changing of the Guard … and then there’s prawn-flavored crisps!”)

I think the moral here is when in doubt, watch something written by Richard Curtis. Truly, the man’s a genius.

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books · MS-0

Agency

Yesterday I read Better: A Surgeon’s Notes on Performance, by Atul Gawande. It was an excellent book, especially after The Spirit Catches You and You Fall Down. Both address problems in healthcare, but whereas Spirit is anecdotal and a little touchy-feely, Better provides facts to back up its claims. Most importantly, Better focuses on how doctors and nurses can improve things. Mainly, it seems, by giving themselves agency.

Agency is a funny sort of word. I first heard it in my first semester of college, in a class about Shakespearean comedies. I think it was the lecture about Much Ado about Nothing (great play, fantastic movie starring Kenneth Branagh, Emma Thompson, and Denzel Washington). It refers to the power to effect change. So, Hero (“Leonato’s short daughter”) has no agency in the events of the play. Instead of, say, Merchant‘s Portia, who does things like cross-dress as a lawyer, Hero allows things to be done to her.

Literary digressions are fun!

But the main point is that agency, and a belief in one’s own agency, is important. It underlies the ethical principle of autonomy. There’s a lot of energy focused on the patient’s autonomy, as there should be. For example, the Lees in Spirit lost autonomy in part because of their inability to communicate with the physicians. In many ways, the book is as much about their struggle to be subjects as it is about Lia’s battle with epilepsy.

But there is also the autonomy of the physician. This seems to be gaining ground nowadays, with physician discontent with the insurance system in this country and with government/administrator involvement in how their practices are to be run. Better‘s kind of unique in that it addresses the autonomy of physicians, surgeons, and nurses to make choices about their practice of medicine. One chapter, which I personally found the most fascinating, deals with medical practitioners assisting in lethal execution, and their ethical and personal dilemmas about how far to go.

It’s a great book, even better than Complications, his first. Go read it.

books · MS-0

More on The Spirit Catches You

I finished reading The Spirit Catches You and You Fall Down a few days ago. First off, I mistakenly called the family Cambodian in my earlier post; they are Hmong. I didn’t really know a whole lot about the Hmong before reading this book, and I still don’t know a lot about them. Interspersed within the medical narrative were histories of the Hmong, who have faced persecution just about everywhere because of their refusal (stubborn or courageous, depending on your point of view) to assimilate into the mainstream culture. Anne Fadiman characterizes them as “scrappy.”

But I begin to see why people on SDN are so frustrated with the way the parents behaved. They took the epilepsy meds and pretty much made up their own medication regimen, without informing the doctors. The kid kept seizing, and the result was painful.

What I don’t understand is this: why did the parents, who were very mistrustful of Western-style evidence-based medicine, keep bringing Lia back to the doctors? In general, it seemed as though they loved the kid to distraction, but they were so ambivalent about her treatment: medicating her whenever they felt like it, skipping days, overdosing her. For a long time, this was not communicated to the doctors, either willfully or because of faulty (or non-existent) interpretation.

Some bleeding hearts might say it’s politically incorrect to suggest that the parents purposely withheld information. But no. Politically (and factually) incorrect would be saying something like “All Hmong are dirty liars,” which is just ludicrous. Don’t confuse personal accountability with group stereotypes. In fact, the only criticism I have of this book is that Fadiman treats the Hmong like porcelain figurines. The doctors are very realistic — some efficient and some effusive — but the Hmong are long-suffering victims to the last man; no criticisms allowed. Although she devotes a lot of time to what the doctors could have done to facilitate communication, she seems almost afraid to point out that compromise is a two-way street and that the parents’ confused stubbornness is just as much to blame as the physician’s insistence on a biomedical treatment.

In the end, I found myself sympathizing with the parents but empathizing with the doctors. Lack of compromise can have terrible results.

MS-0 · premed

The Scrivener’s Guide to Applications

(or, how to retain some semblance of sanity and financial solvency)


Let’s get one thing clear: the medical school admissions process is designed to encourage neuroses. If you subject a group of intelligent, hardworking people to a process shrouded in secrecy and with terrible odds (half of those who apply will be rejected from all schools), you’re bound to incur some paranoia.


That being said, you, too, can get into medical school if you follow these easy tips. What makes me qualified to give you advice? I applied to 12 allopathic schools for Fall 2007 (including one Canadian school), got 9 interviews, and ended up with 7 acceptances. All told, applications cost me about $2000 (3000 if you include the MCAT fee, my two suits, and Second Look weekends). Plus, I just like giving away free advice. This particular post comes via a suggestion from my friend K, who is applying for Fall 2008. As I told him, if you know what you’re doing, this process is not a crapshoot.


Tip #1 is to be normal. I really can’t stress this enough. A friend of mine had a stellar academic record, but she was so obsessed with getting into med school that she ended up shooting herself in the foot and not doing as well as one would have thought. Myself, I was so nervous at my first interview that I babbled and gushed about how great medicine was and ended up waitlisted and then rejected. Maintain an interest in something outside academics/work and applications, because otherwise, sure as the sun rises in the east, you will go crazy. Watch some TV; read a book; hike a mountain—anything.


Tip #2 Let it go. Three days after I took the MCAT, I woke up in a cold sweat because I suddenly remembered that I had confused the Lyman and Paschen series in the physical sciences section. This was a bad idea. Once the proctors call “time,” once you mail off your secondary (with sizable check), once you shake your interviewer’s hand and walk out, it’s over. There isn’t a lot more you can do, short of sending a letter of intent (which is legally binding, so think carefully before you write it). Move on with your life. Hike that mountain I mentioned in Tip #1.


After those two rather philosophical tips, #3 is a bit more practical. Get a copy of the MSAR. The Medical School Admissions Requirements book is a must-have when you start the application process. I don’t recommend buying—you’ll only use it for a week or two, and since an updated one comes out every year, the resale value is almost nil—but borrow from an older friend or check it out from the library. The MSAR is basically an alphabetical listing of all the medical schools in the US and Canada, with a page-long description of each along with average GPA and MCAT. The rule of thumb is GPA*10 + MCAT; your score should be within one point of the school’s score. That means you’re a good match numerically, but doesn’t take into account your state residency, minority status (Native American, black, or Hispanic; sorry, Asians!), or other personal circumstances. Once you have a list from the MSAR, go to individual schools’ websites to narrow it down to 15 or so.


Interlude for personal gripe! AMCAS really sucks. The centralized application service is very poorly-designed. For instance, you have to painstakingly enter each college course (including high school APs and IBs) exactly as listed on your transcript. Not in a table; no, that would be too easy. Nope, each course has an individual HTML form, and once you hit “add course,” it’s almost impossible to go back and fix mistakes. And then you send them an official transcript so that they can verify all the information you told them, a process that can take several weeks (see below). AMCAS may be streamlined for the schools, but for applicants, it’s an exercise in following directions.


Tip #4: Apply early. SDN would have you believe that several thousand premeds hit “submit” on AMCAS at midnight on June 1, the day the whole thing opens. Like most things on SDN, that’s an exaggeration, but do try to get your AMCAS in by the end of June. Verification gets more and more backlogged as the summer goes on, and since most schools have rolling admissions, it’s best to be at the front of the pack. Turn your secondaries around fast, too; two or three weeks is the norm. If you’re still in college, try to get them all in before classes start. Nothing sucks more than having to write a convincing essay (show, don’t tell!) about how empathic and diverse you are after taking a three-hour biochem exam.


Tip #5: Don’t splurge on a suit. Before buying from Ann Taylor or Jos. A. Bank, go to outlet stores and mid-range department stores. Look for lightweight wool in conservative colors (dark blue, brown, dark gray—avoid black if you can). Try things on. Women, get a three-piece wardrober (jacket, pants, and skirt). Keep an eye out for sales. No one really knows or cares that you are wearing last season’s lapels. You shouldn’t have to spend more than $75 on a good-quality suit. And get really comfortable shoes. At one school, the girl next to me was wearing those pointy-toed witch shoes. She slipped them off while she was waiting for her interviewer, and her feet had actually molded to squeeze into that unnatural shape. No fashion is worth that price.


Tip #6: Interviews are fun! I know this seems counter-intuitive, since they are so subjective and all, but the vast majority of my interviews were low-key and conversational. At one, we talked for about fifteen minutes about Harry Potter. But be prepared to explain any weakness in your file: a low semester GPA, a red flag in a letter of recommendation. Interviews are also cool because you get to check out the school and the area in person. My opinion of several schools changed a lot after the interview.


Tip #7: Don’t take rejection personally, and don’t get cocky over an acceptance. Like I said, this process, while certainly difficult, isn’t a crapshoot. That’s why rejections hurt so much—some school thought that your best wasn’t good enough. Take a deep breath and follow Tip #2. (Keeping a stash of chocolate on hand is highly recommended.) Sometimes, the school is willing to look over your file again and tell you what went wrong so you can fix it. No matter what, don’t let a rejection affect your performance at other schools. Similarly, celebrate your acceptance, but don’t get arrogant about it. All it means is that you managed to convince someone that you might make a good doctor. The real work is still ahead of you.


There you go; the Scrivener’s seven certified tips for getting into med school. Apply away!

MS-0

By way of belated introduction

(This shoulda been post #1, but you can’t win ’em all.)

I’m a soon-to-be medical student at a school in New York. My parents are both Indian immigrants who showed up in the States to do some programming in the early 1980s and ended up staying for the jobs and later, for the schools. After a fairly typical suburban childhood, I ended up at my state university, where I double-majored in biochemistry (aka premed, in more ways than one) and comparative literature (aka pure joy). I had a great time there, especially in my third and fourth years, but alas! in May they handed me a piece of fake-parchment and evicted me from my idyllic residential college room. So I’m back at home with my parents for the summer, writing, reading, and trying to get myself organized before school starts.

Bored yet? Me too.

Seriously, the best way to know me is to read my blog. I’ll be writing about all things medical — the application process (which, frankly, sucks), classes, issues in medical ethics or policy, international healthcare, and my pet project: medical fiction. I promise to keep the personal stuff to a minimum, because no one wants to read about how Mom hates me and doesn’t understand me and . You can get enough of that weepy stuff on Lifetime.

Well, that’s it, really. I hope you enjoy.

books · MS-0

Truth be told, I don’t really know that I deserve a blog. I don’t write as well as some of the medical bloggers out there, and I’m sure many of you already know what medical school is like. I don’t even start until August.

But I’ve already begun collecting paraphenalia, like a Netter’s Atlas. It’s sitting upstairs in its shrink-wrap; the thought of opening it is mildly frightening, like an acknowledgment that I’m actually going to med school.

We have a summer reading assignment (how very middle school) — The Spirit Catches You and You Fall Down, by Anne Fadiman. It’s frequently discussed on the SDN boards, where the fashionable position appears to be Cynical Pro-Establishment. One person, who shall remain nameless in the interests of anonymity (and because my memory kind of sucks), stated that as the Cambodian refugees sought out American medical care for their daughter, they should agree to do everything the Western way. I wrote my undergraduate thesis on power struggles in medicine, and so I am loathe to suggest that the balance of power in the physician-patient relationship be so fully given to either party. That seems like less of a solution to culture clashes, and more of a Tarzan-esque chest-beating competition. (”My medicine’s better than your medicine!” “Oh, yeah? Sez who?” “Sez me!”)

That’s not to say that I’m some kind of crazy hippie throwback. I happen to think that magnetic bracelets are in the same category as, say, Chinese tattoos, but I also think it’s foolish to discount centuries-old cultural practices just because they might be unusual. Case in point: Indians have used turmeric for years as a standard home remedy for everything from stomachaches to bruises. Somewhere along the line, the West wised up to this unassuming yellow powder, and a PubMed search for “turmeric” returns 499 papers in 2006 alone, examining everything from cancer to neurodegenerative disorders. Kind of impressive, eh? The moral of the story is: don’t ignore traditional remedies. Sometimes, just sometimes, the uneducated natives get it right.

Er. That was a bit heavy for a first post. I promise I’m not so serious all the time.