November life...

consisted of postponing the boards.  See previous post.  Who knew that relearning all of ob/gyn and ID (antipseudomonal drugs, anyone??) would take so long.  Or, probably more importantly, that I would be so unmotivated to study?  It's fourth year, man!

So now I am living life.  It's the least structure I've had in my schedule for some time.  There are things I need to accomplish each day - research, writing, boards studying, interview prep, etc, etc, - but it's totally 100% up to me to accomplish them.  Of course, in the past, I was also 100% responsible, but it's a little different when that responsibility consisted of going to class or showing up at the hospital.  The way my schedule works out, I am basically taking 4 months "off" to do this whole research/interviews/boards/etc thing.  Then I'm going to be a glutton for punishment and spend a month in the MICU (see knowing antipseudomonal drugs part - above).  And then, after that, I am going to spend 2 months abroad on an away clinical elective!  Our school has a formal clinical exchange program with an international medical school and each year, a few of us go there and vice versa.  I have wanted to do this program since second year, and I am so excited to go!

Now I am going to go learn those fetal heart tracings...

Why I'm looking forward to Step 2

All physicians know about the "boards" - they refer to the United States Medical Licensing Examination or USMLE. (There are specialty boards as well after that!)  To become a full-fledged doctor in the U.S., you must take 4 exams: USMLE Step 1, Step 2 CK, Step 2 CS, and Step 3.

Most students regard Step 1 as the most important. Consequently, a lot of preparation goes into preparation for Step 1.  I'll readily admit that I viewed Step 1 with quite a bit of dread.  It's over now, obviously, and I've just begun preparation for Step 2 CK.  However, this time around, I'm actually (somewhat) looking forward to the preparation.  Here's why:

1) It's going to be a great review for intern year.  I'm going into medicine and the bulk of CK is medicine.  And since I've been removed from my clinical years for a while, it's nice to go back to the material.  I'm beginning to dust out the cobwebs.

2) Outcome is directly proportional to effort.  There aren't not too many things like that anymore. 

3) USMLE World. You teach me so much.

4) How cool are mneumonics like CARDIACRIND* and WiLLiaM MaRRoW?**
*Causes of pericarditis:
Collagen vascular disease
Aortic dissection
Radiation
Drugs
Infection
Acute renal failure
Cardiac (MI)
Rhematic fever
Injury
Neoplasms
Dressler's Syndrome

**LBBB: W pattern of QRS in V1 and V2 and M pattern of QRS in V3-V6 vs. RBBB: M pattern of QRS in V1 and V2 and W pattern of QRS in V3-V6

Delightful

I am so delighted and moved by this video.

Summer thoughts

Random thoughts:

1) What is it with kindergarten/elementary school/middle school graduations, complete with cap and gown and diploma?  "Graduating" from elementary school is not an accomplishment. You cannot be Class of 2012 in the 8th grade...no, try making it through senior year of high school and then properly celebrate that accomplishment in 2016. Is this a regional thing or a generational thing? I don't remember any of the sort during my primary and secondary education.

2) I am loving the long days of summer. It's light when I wake up and when I return home, which adds so much productivity and energy to my day.

3) Orange marmalade is bitter, huh? I guess I'm used to Smucker's, which is sweeter than a treacle tart. This TJ's Seville Orange Marmalade is sweet with a distinct bitter edge. I like it.

4) Thank goodness I went the medical school and not the Ph.D route. No doubt, I love research but man, the competitiveness (irony?) and the (lack of) funding. People in my lab have been post docs for 10+ years. 10 years! These are really smart people we are talking about, underpaid, overworked and still chugging away within a very flawed promotion system.

5) I am not ready to return to the wards! I like my research year...let me stay! Can I graduate and just get assigned a residency here and skip the whole application/interview process?

6) On the other hand, I am ready for a change of pace. And a break.  Bring it on, 4th year electives!!!

Strawberry cheesecake

Strawberry cheesecake

First time making cheesecake on my own, although I bought the crusts because I don't have a springform pan. Turned out delicious and very pretty.  Modified from this site.

Recipe below:

Strawberry cheesecake

• 2 store-bought graham cracker crusts
• 1 16 oz box of fresh strawberries (frozen will do too)
• 1 tablespoon cornstarch
• 3 (8 ounce) packages cream cheese, softened
• 1 (14 ounce) can sweetened condensed milk
• 1/4 cup lemon juice
• 3 eggs
• 1 tablespoon water 

In a blender or food processor, combine strawberries and cornstarch and a little water; cover and process until smooth. Pour into a saucepan; bring to a boil.  Boil and stir for 2 minutes. 

In a mixing bowl, beat cream cheese until light and fluffy. Gradually beat in milk. Add lemon juice; mix well. Add eggs, beat on low just until combined. Pour half of the cream cheese mixture over crusts. Drop strawberry mixture by 1/2 teaspoonfuls onto cream cheese layer.  You can save some for serving or use it all up now like I did.  Carefully spoon remaining cream cheese mixture over sauce. Drop remaining strawberry sauce by 1/2 teaspoonfuls on top. With a knife, cut through top layer only to swirl strawberry sauce. 

Place a pan filled with ~1 inch of hot water in the oven.  This is to increase oven humidity to prevent cracks.  Bake at 300 degrees F for 45-50 minutes or until center is almost set. Cool on a wire rack for 10 minutes. . Refrigerate overnight. Thin chilled strawberry sauce with water if desired; serve with cheesecake. Store in the refrigerator. 

Chocolate cake!

My first attempt at making a chocolate cake was a bona fide success!  I modified this chocolate bundt cake recipe from Joy the Baker and oh my gosh, I've already eaten a quarter of the cake.

Because I lacked Dutch process cocoa, I used non-Dutch instead and used baking soda only.  I also reduced the sugar to a little under 2 cups and skipped the glaze part, instead dusting with a little powdered sugar.  The result was a moist, light, and not too sweet chocolate snack cake.  Next time, I think I'll add mini chocolate chips!

Homemade yogurt

Homemade yogurt with honey. Delicious.

Best. Project. Ever. I have always wanted to try making homemade yogurt. I am so delighted that it worked.  I followed the instructions from this site exactly.  At 6 am (yes, I am an early riser but not by choice!) I sidled down to the kitchen and carefully extracted my bowl from the oven. My fingers were crossed the whole way. And yes, success!

The only caveat was that this was not actually cheaper than store-bought yogurt.  I know all the websites rave about how DIY yogurt saves $$$, but I paid $3.69 for a half-gallon of organic milk + $0.50 for a yogurt starter. This made about 3 cups of strained yogurt, not even as thick as Greek yogurt.  At Trader Joe's here, I can buy 32 oz. or 4 cups of Greek yogurt for $4.99.  I guess it'll be cheaper if I buy bulk quantities of milk? But you know what? This was worth the expense and time. I had so much fun and the yogurt was really delicious - smooth, mild, and creamy.

Memorable bits from an inspiring talk given by an inspiring man earlier today:
- "Our job [as physicians] is not only to fight disease but also to fight injustice"
- "We could cure his marrow but we could not cure his hopelessness"
So as future physicians, the road ahead may not be clear to us, but we should not be confused. It is always right to do right for our patients.

Conversation in a taxi

Sat night going to lab, I get in a cab and have the following exchange:

Taxi driver: huh, do you have beer bottles?

Me: oh you mean the clanking noise you just heard? Ha, no those are jam jars I saved for lab

Driver: (doubtful expression) Yeah, right (and probably thinking who in their right mind saves jam jars and further, carts them to lab on Sat night)

Me: no seriously, I'm not having a party in lab tonight. They're for storing immunohistochemistry samples.

Driver: (clearly unconvinced) immuno what?

Me: never mind...

My life is so exciting! Party in lab with jam jars!!! I should have just gone along with the beer bottle story. :)

Discussing sensitive topics

I volunteer at a primary care clinic a couple evenings a month. It's a wonderful opportunity to keep my clinical skills afloat and always work with really awesome attendings who are passionate about teaching and the mission of this clinic.

At my last clinic, we met a patient who urgently wanted to be tested for STIs, distraught over the prospect that he may have given his partner an STI. Between this immediate issue and his many other life stressors, the patient was having a very hard time coping. Given his emotional state, the attending asked to take the lead with the patient.  What I witnessed was a model of how to handle this kind of encounter. First, the physician heard the patient out. Rather than launching into a counseling session on STIs, what the patient really needed that evening was to vent. Then, she cited that millions of other patients have STIs and that when her patients who have a STI speak with their sexual partners, they do x, y, z. She completely normalized the situation and made the patient feel like 1) my doctor has seen other patients with this exact problem and 2) thereby, I am not alone with this issue - in fact x MILLION Americans deal with this! Finally, this physician encouraged the patient to page her if his situation ever overwhelmed him, effectively conveying, "I am always available to you and I will help."  The entire encounter lasted perhaps 10 minutes but the patient left feeling visibly relieved. These types of patient-doctor interactions remind me of why I went into medicine.

Quiche

Made this a few weeks ago. Delicious and easy. The hardest part was grating the cheese. And I used soy milk and it didn't taste funny at all.

I like...

After my rather depressing last post, I am making a concerted effort to find small pleasures in life. This week, my favorite song is Fireflies by Owl City. So whimsical and magical.

Other small joys:
1. Noisily slurping the last drops of my smoothie just because I can!
2. Fresh, clean laundry, folded on the day of washing
3. Baking a cake for a surprise birthday celebration
4. Coffee with soy milk and Trader Joe's pumpkin butter. It's a homemade pumpkin spice latte in a pinch!
5. Venting about lab/life to a close friend...thank goodness for great friends.
6. Yoga and a great yoga instructor. I can touch my head to my knees now and stay in lowered push-up position, so I'm making progress in flexibility and strength already.

Good and Bad

First the bad, to get it out of the way: I am in a research slump. My project has taken a turn (or it has yet to take a turn and is sinking deeper and deeper into thick, thick mud), and I have yet to figure out what the heck I'm doing. Yes, and I am 6 months in...and I feel incompetent. Worse still, our study cards are due soon and I have a 1% lingering fear that my dream of becoming a medical oncologist is the wrong decision. So instead, I feel a compulsion to do one last clinical rotation before applying this year and "rule out" the 1% option. Sigh. So much introspection to do. I need to be honest with myself here. I find myself fantasizing about not only an array of medical specialties, but also other professions...like creating my own healthy food/drink line a la Honest Teas, or going the PhD/MD/JD/etc to bakery/restauranteur route. I think creating food is my stress outlet.

Now on the good, and I'm grasping at straws here compared to the weighty "bad" stuff I just detailed. It hit a record high today and it was lovely outside. I am on a smoothie kick and just enjoyed a carrot-apple-yogurt  smoothie tonight after having a peanut butter-banana-soy milk one for breakfast. I have a meeting with my medical school adviser tomorrow and am optimistic that we'll be able to sort some of life out, even if it's just logistical scheduling. I saw the dentist for the umpteenth time today to repair my tooth, and while today was not the day, I realize that I'm so lucky to have found this dentist. He is perfectionist as well as kind and incredibly patient and wants a great result as much as I do. Man, you just do not get this in health care these days any more.

Family and Career

I love this post: the underwear drawer: continuity of care.

Thank you, Michelle Au, for advocating for and sharing your experiences as a physician and mother. I've been asked countless times (and have given much thought to) how I plan to balance the demands of family life and my career. I feel reassured when others are making it work.

Taekwondo

I tried taekwondo for the first time yesterday. 24 hours later, all I can say is ouch. I am sore. Mostly my neck hurts from doing dozens of crunches and leg lifts while holding my neck in an awkward position. Nevertheless, it was a terrific workout so I will keep going.

The unique part of the class is that it was led by one of our medical school advisors, a practicing physician and dean's letter writer. He's not my advisor but I had heard many stories about him, as he is quite a character. It is weird, seeing professors outside of a professional context, clad not in crisp suit and tie but in taekwondo robe, wielding not stethoscope but wrist padding. These professors, stellar in their academic accomplishments, are people too. They tell stories to their children at night, cook meals, and yes, practice taekwondo. But perhaps their kicks are a little higher and stronger than mine are...for now. :)