Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Starting a Running Plan

2018-04-01 21.17.00 I have been a runner since my days at University.  I was a varsity tennis player who needed something for conditioning in the offseason. Since our coach would not allow any racket sports like squash or racketball, I decided to do some running and weight-lifting to keep my aerobic base intact. I became a 10K specialist loving the middle distance.

In graduate school, I didn’t play much tennis other than the occasional club tournament but kept my running plan. I ran from 2-3 miles daily; my time for relaxation between my teaching duties and research experiments. I used the time to think about problems, angles and write my dissertation in my head. My running helped my research more than anything else.

I didn’t run in medical school; devoting my time to intense study. The volume of material  I mastered for each exam was overwhelming. My stress level was maximal with weight gain and essentially a sedentary lifestyle dictated by needing to produce excellent work in my courses, my exam and board study. My academics soared but my physical conditioning suffered. This was a huge mistake.

Through the stress of surgical residency, I tried to walk the stairs and meditate when I could. Since I had a good muscle base from university and graduate school, I stayed in average shape but didn’t run very much. I carried the excess weight from medical school hating the way I felt and looked. I hid in scrubs and in my professional duties moving to attending physician and professor.

Today, I am a long-distance runner; shedding the weight of medical school at last. I am thin,  powerful and serene. Achieving my goals was not an overnight process but a process necessary for my health and mental acumen. I started out brisk walking 15 minutes out and 15 minutes back every day of the week. My walk became a run and my runs stretched longer and longer.

My running forced cleaning my food intake to fresh fruit and vegetables with lean protein. My trainer added weight-training to my long distance running. Today, I run at 3:00 AM for a minimum of 1 1/2 hours most days of the week; longer distances on the weekends when I am not on call. I am strong, setting personal records and loving the Half Marathon distance as much as I loved the 10 K distance runs of my past.

My hospital has 14 floors that I climb at least twice daily loving the view from the roof in the early morning after a night on call. I enjoy running through the empty streets of my city; greeting the policemen who keep me safe in the early hours. I meditate and pray; gratitude for my excellent health and conditioning. My resting heart rate is in the mid-40s; my body very thin and very strong.

I tell my story because the summer is a good time to start the journey of getting in good physical condition. The weather is warm in most of the country which makes the process easier. Trust me, it’s hard for me to face 2F temperatures and snow of the winters in my Midwest city but I do face them for my early morning runs. Desire and planning pushed me out the door at first but habit now keeps me going.

I lost the tired feelings after a 16-20-hour day; now replaced with the energy to give my best. My physical strength allows me to finish 6-10-hour cases without a second thought. Good physical conditioning lets me park my car in the most remote parking place and dash into the hospital with stratospheric energy. Today, my energy is my most positive characteristic as I can run to an emergency faster than most of my residents with a smile on my face.

The public health part of being in sound physical condition is that in my Midwestern city, three-fourths of the population is overweight or obese. I am 5’8″ tall and wear a US Size 2 which is smaller than 99% of the US population. Even at this thin size, I take no medications other than a multi-vitamin and a calcium/Vitamin D supplement-the hazard of working indoors in rooms without windows to the outside.

I can counsel my patients about weight loss and increasing physical activity as an example of what they might accomplish at any age. I don’t admonish them but stress the importance of taking small steps; changing eating habits replacing them with things that can become a part of an active, healthy lifestyle. Too many obese people look to strategies such as gastric bypass which is a valuable tool but is beyond the reach of many who are without health insurance.

Take the summer to do one or small steps that will benefit your health and career now. While I regret not keeping up with my running in medical school, I am grateful that I did realize how making small changes led me to excellent health now. Learn good nutrition and leave the hospital cafeteria/ fast food/junk food alone. I have not had even a cold in the past 5 years because my physical conditioning keeps my immune system strong.  Be strong and be the example that your patients need.

Advertisements

23 May, 2018 Posted by | academics, life in medicine, medical school | | Leave a comment

Using Every Tool

As all of us in academics (professors, students) enter the final stages before the semester/quarter ends, we make the push to finish strong. If you have been struggling with your studies, now is the time, just like tax time, to get your work shored up for that strong finish. It also a good time to take and inventory of sorts, in your thinking about why and how you master your studies to have the best outcome in your classes.

We finished our spring breaks with the hope of resting perhaps getting away from our studies in order to come back with renewed energy. Depending on how you spend your break-some catching up, some getting away, some planning for the next steps, you may be feeling that the “break” was not a break at all. If that was the case, then take this weekend to put some strategies into place to finish this term/semester/school year as best you can.

I always advise my students at the beginning of the year, that regular planning/study is the key to mastery of your subject matter. Making schedules and sticking to them is as important to success as my daily workouts are key to my training for an upcoming marathon. I have to work out regularly in order to complete my distance race. I can’t arrive on race day and run a marathon, half-marathon or even a 10-kilometer race without doing some daily training/conditioning work.

Like anything that I have to train for, there are days when I don’t feel like putting in the time. Sometimes, I just want to take a break but I can’t take too many breaks. My training runs, like your daily study periods are a time to work on those little details to develop the strength and tools to complete my goals. If I don’t put in that time regularly (do something) I won’t be ready for my long-distance race.

Sometimes, I do take a very short break from my training but at the end of the day, my tool is that I do something more intense so that I get a small benefit of even not running on that particular break day. These are my mini-spring breaks away from training. This strategy, I apply to studies (yes, even as a professor, I am constantly learning, honing and refining). That short break is the tool to remind me to get back onto my regular schedule as soon as possible.

I have used preparation for a long distance race because when I made the change from short-distance running to long-distance running, many other items in my life became easier and better. My studies, like your studies whether you are an undergraduate, graduate or medical student require daily work and refinement; in other words, daily training. We are all preparing and using the tools of preparation for finishing strong in our endeavors.

Consistent work is always key to academic success. In today’s world of electronic delivery of materials, one still has to devote regular study time for complete mastery of subject matter. We have millions of bits of information at our fingertips, online and even on our thumb drives, that we must master for our programs of study. Organization and regular consistent study of our academic materials is more relevant today than back when I was in medical school and graduate school.

Organize your materials, plan your study schedule and take short breaks over the course of the day but be consistent in your study. As I have written in other pieces on this blog, my tools of organization have been to review the previous material, study the present material and prepare for what will come next. These are your tools for making sure that this period before finals and before the semester/year ends are in place so that you may finish strong.

Just as I want to complete my upcoming distance race as strong as possible, I want to complete the race. Use your time wisely, take short breaks away from your studies but make those breaks matter. Don’t give up at this point because you are overwhelmed. When those feelings of being overwhelmed enter your mind, take a short minute, jot down that you are feeling overwhelmed and write out only the next small thing that you will complete.

As you complete many small things, they always add up to completion of the big items. Completing those small items also keeps procrastination from derailing your studies at this time. Until you have taken that final exam, nothing is lost and you can keep preparing but if you stop, give up and allow feelings of “everyone is doing the better that I am” to enter your strategies, you won’t be see any success. Fight the feelings to make comparison to those around you; only compare you with you yesterday.

You can’t change the passage of time and you can’t change the past but you can decide in the next minute to change your thinking about how you deal with the present to affect the future. This is the most valuable tool for anything. I can’t change how I ran my last race but I can keep preparing for the one that is coming up. This is what I tell myself as I head out the door to the gym to do a bit of speed work and lift some weights. Every weight I life, every step I take is moving forward. Use those tools and adapt as you make adjustments to finish strong but don’t forget a tiny break/ reward for keeping things going.

14 April, 2018 Posted by | academics, medical school | , | Leave a comment

Why Don’t We Feel Safe?

Today, March 24, 2018, many high school students and teachers are marching/assembling in major cities to bring attention to their increased feelings of not being safe in their educational settings. I would add my support to them as everyone should feel safe in their homes, schools, places of employment and places of recreation. Safety is a right of every individual in any environment. When individuals don’t feel safe, they experience increased stress far above what is expected in their day-to-day lives.

Even in hospitals, safety has always been of importance both in how we treat patients and the patient environment. We always pay very close attention to situations that potentially put individuals at risk but of recent, safety issues for those of us who are just going about our jobs in emergency departments, hallways and classrooms have come under scrutiny. In short, physicians, professors, students, and patients have been harm’s way because of disgruntled employees and colleagues who seek revenge for perceived wrongs.

It’s persons who feel the need to inflict harm on those who have no role in their perceived situation that is most troubling for the public at large. When guns are fired, even with intended targets, others get hurt and killed. When mentally ill individuals have access to weapons (guns, cars, knives, explosives), individuals without warning, are subjected to random violence. When the electronic and television news media spends hours and hours attempting to find motives and uncover a “story” in these random acts of violence; creating stress in individuals.

Perhaps this 24-hour scrutiny is a product of the electronic information age but there is nothing that prohibits us from turning off the news and disconnecting from social and other media. From the time I first acquired a pager as a medical student, I became acutely aware of the need to just “turn the thing off” in order to reconnect with a world that doesn’t need access to my attention at all times. I never want to be the person walking along staring at my smartphone and ignoring the world around me. Yes, I look at it when I must but certainly, I strive to look around; be aware of those around me.

As those who march in the streets today want to emphasize,  all individuals have a fundamental right to pursue their lives not only in freedom but in safety. As a physician, I don’t want to take care of even one more innocent individual who has become a victim of random violence. My stress is worrying about those I love and whether or not they will come home. The stress is palpable across many in my environment which include where I work and study. There is simply no reason in a civilized society for this to happen.

My answer is to be vigilant and to be aware of those around me at all times. My answer is not to lock-down hospitals and campuses but to pay attention to people around me who may be suffering. My answer is to not look to electronic and television media to examine what I as a physician, must examine for myself. My answer is to treat all people, even those who are struggling academically and personally, with dignity and compassion.

Just recently, more than a few of the medical students that I have taught, found out that they didn’t match into a residency position. The stress of finding employment for next year is gut-wrenching for them and for me as well. The lack of post-graduate positions coupled with a system that is in dire need of an overhaul is necessary. The feelings of despair were very deep for those who didn’t find a match when those around one are celebrating. I found more than one person who is derailed by the process.

Disappointment, anger, and despair when one does not obtain the end result of work and study or any other desired outcome is often a trigger for actions that are uncharacteristic. Even more disturbing is that those who are successful may be perceived as “bragging” on social media when they are just celebrating the next step in their training. My answer to those who didn’t match is that it’s not a personal failing and my answer to those who did is well-done but have compassion for those who are struggling.  My answer is to do everything within my power to allow my students to feel safe as they study and work. As a human being, I can do no less but I can do more.

24 March, 2018 Posted by | academics, medical school | Leave a comment

Spring Break

Whenever the hype for March Madness comes around, my thoughts go toward Spring Break for undergraduates. For many in the Northeastern United States, a nor’easter has dumped enough snow (continues to dump snow/ice) that the prospect of heading to a warmer climate most attractive. Even if one heads to the ski slopes, it’s important to take this time, if available, to get away from your academics to recharge and see new scenery.

Some students will use the time to catch up or write papers that may be due towards the end of the semester but don’t use the entire break to work on academic matters. Go to a movie (check out the Oscar nominees for Best Picture) or see a musical, hear a concert or attend a play. In short, do something outside of your normal routine that expands your mind. Even exploring a new cuisine or reading a fiction novel is a great way to break out of the academic world for even 24 hours.

Rest, relaxation and breaks are as important as hard work in the pursuit of excellence. One can argue that if one “breaks” every weekend, one does not need much of a vacation but if those weekend breaks are your routine, do something different over Spring Break. It’s the different activity that allows the mind to recharge and sets new neural networks for use as you need them. Humans were never “wired” for routine and do best with change.

Knowing that one needs a break in routine is a useful characteristic to hone at the undergraduate level. Pursuit of medicine is stressful, long and can be all-consuming which isn’t good for mental health. Taking a break, even those weekend breaks is as important as disciplined, dedicated study during the week. Planning and executing plans are great but not planning, especially during a break is good too.

As a physician/surgeon, I took pride in not taking vacations as I built up my practice and research. Fast forward to today and I recognize the value of doing something different, interacting with colleagues outside of medicine/science and enjoying nature, sporting events and travel. I need my vacations now more than ever but I needed them as I started my career too. There is no pride in having a stress level that is on the verge of causing mental/physical breakdown.

In medicine, we often place our patients ahead of our families and ourselves. I can recall countless times, my father left the dinner table for an emergency or left a family gathering to take care of a patient. I have left graduations, dinners, weddings and other events because I was called into the hospital. At this point, I realize the toll that “being too available” has taken on my relationships and mental health. Today, I head out of town for my Spring Break to catch up on my reading (novels), watch those Oscar nominees and lie in the West Coast sunshine because I will return a better physician and professor for doing so.

8 March, 2018 Posted by | academics, stress reduction | Leave a comment

New Gross Anatomy

Many medical schools have gone from cadaver dissection to prosection to digital dissection in their Gross Anatomy labs. Certainly concerns of inhalation of formalin are removed with digital delivery but hands-on dissection of the human body is quite sacred and tremendously educational for a physician. I also understand that digital dissection is far cheaper than having cadavers for teaching purposes.

With digital dissection, many lose the ability to see the variations possible. When I was in Gross Anatomy Laboratory, it was wonderful when another group shared an anatomic variation or a great dissection with the rest of the class. We could see and touch it. It was the touch with the appreciation for anatomy in three dimensions that was a wonder. That three-dimensional anatomy and seeing structures within context probably crystallized my love and appreciation for the variations I see in surgery on a daily basis.

All human bodies are a wonder to observe, examine and treat. On any given day, each patient with their capacity to heal, is a marvel that can’t be made by man. My study of medicine after study of biochemistry, deepened my appreciation for all that the human body is capable of performing without exception. Dissection and observation with hours of hands-on work only served to deepen that appreciation.

We might argue that digital learning is powerful because the medical student can be in the anatomy lab at any time. Digital anatomy platforms like Anatomatage can move through the body layer by layer but just as something is lost with a text message instead of a phone call, looking but not touching the structures is a loss.

The best use of digital dissection is as an adjunct to dissection of the cadaver. During those hours in the Gross Anatomy lab so many years ago, I carried my Netter Atlas, my Grant Dissector (filled with notes) and my list of structures that I needed to find so that I could see and feel them in all of their dimension.  The experience was profound; deepened my appreciation for those physicians who had spent hours doing the same thing in the quest to learn medicine.

Today, education experts and designers look at teaching and delivery of curriculum as a profit-making entity. Many of these experts have never studied my discipline, practiced medicine/surgery or even taught in a classroom. My duties as a professor are to be leader and coach for my students. I give them the benefit of what my anatomy professors, surgery professors and mentors in medicine passed on to me. Education experts tend to discount experience, one of the essentials of medical practice, and attempt to replace with newer (read cheaper) substitutes.

Yes, digital delivery of curriculum is a great adjunct but it doesn’t replace hands-on experience especially in the Gross Anatomy Lab. Prosections are great but the process of discovery is lost when one does not find structures for oneself. Vivid memories of the dissection of the venous supply of the face remain in my memory today though I seldom perform surgery on the face.

I would hope that those who didn’t get a chance to perform cadaver dissection at least spend some time in the Pathology lab assisting/observing autopsies. The marvel of the human form will not be lost upon you taking the time to do this. Even today, unless you are near a forensic lab, you don’t see too many post-mortem exams taking place. If you have an opportunity to observe one, take advantage and watch. Every structure, normal or abnormal is miraculous.

23 September, 2017 Posted by | academics, medical school | | 5 Comments

Getting Into Routine

Since the nature of medicine (and life) is change, getting into the best routine to greet and excel in a changing environment is being in the best mental and physical condition possible. It’s very easy with study, long hours of duty and other demands, to gravitate towards anything that bring rest and relaxation/lack of stress. My challenge for those who are starting school, getting ready to start school, starting a new year of clinical duties or any changes; is to have a routine with good stress that allows for optimal performance within the context of changes and challenges.

For many in medicine, stress is the bane of our existence. We are stressed with long hours that often demand the good performance in early morning hours, as most of the population sleeps. We are stressed with keeping up with our academics and studies that mark our ever-changing profession. We are stressed with keeping a sound balance in life that will enable us to enjoy our personal lives in addition to our professional lives. This sound balance is as vital to having a great career and general well-being but finding that balance is not easy or quick.

As the summer has always been the time that I try to improve on my routines and make changes, I will invite you to consider making small changes that will help you deal with the mental and physical challenges to come as your careers change. These challenges need not derail your health and mental resilience but might enhance the enjoyment of your career at any stage.

Good Nutrition

When one is tired physically, mental acumen wanes and one becomes both mentally and physically exhausted. This mental and physical exhaustion can lead to choosing foods that are high in sugar or fat which might lead to a quick energy fix but weight gain in the long run. Trust me, carrying extra weight around doesn’t help with mental or physical exhaustion, often leading to more of both.

Eating a well-balanced diet that has more fresh fruits and vegetables with less fat and refined sugars helps keep your weight under control in addition to keeping you healthier. You can make small changes in terms of grabbing a piece of fresh fruit for a snack rather than relying on the high fat alternatives of the vending machine. Also cooking a week’s worth of healthier food that you pack rather than eating the burger and fries in the hospital/school cafe can help make small changes.

Small changes can lead to larger changes or that routine that becomes more comfortable for you. While I love an occasional burger and sharing fries/chips with my friend (the only way I indulge in these), I keep these occasions as special and not routine. Not only does eating a healthier diet help my immune system, my healthier diet helps me avoid long term chronic disease such as obesity, atherosclerosis and diabetes.

Regular exercise

Exercise tends to be one of those activities that suffers when one enters a demanding profession. It is easy post call, to come home, drop on the sofa and rest. This was my routine in medical school where I gained significant weight after being robustly active during my graduate school years. It took years of work to rid my body of the excess weight but once regular exercise became my routine, I found that I had more energy and more time rather less.

Today, I am a distance runner, using that time on the running trail to work out problems, meditate and simply enjoy myself. I have strength and energy for my work and for recreation. I also have a greater capacity for dealing with stress and the physical stress of a 10-mile run helps everything in my life. Running is quite solitary which appeals to me but anything that gets your heart rate up at least 30 minutes 5 times per week is better than nothing.

My workout time is as precious as my work time. I have mapped out running routes around my hospital, in my neighborhood and when I travel. I keep running gear in my locker (running shoes and shorts) so that I have no excuse not to move. I also try to get my workout done in the early morning before I start my day.

You don’t need to block hours of time for a bit of an aerobic challenge as you can run up a flight of stairs several times per day; park the auto further away and walk briskly to your workplace; take a brisk walk for 10 minutes as a time over lunch with a friend. Distance running isn’t for everyone but most of us can do something as simple as walking. Incorporate small changes which can become a habit that becomes part of your life.

Avoiding excuses (reasons)

As one becomes mentally stressed and physically exhausted, reasons for not adhering to healthy habits abound. For each of us, there will always be challenges that take us out of our routines. Take a moment to reflect on what reasons/excuses become commonplace and how you might meet or avoid them. For me, I looked at every hour of my day and examined where I could make small changes. Those small changes became my routines.

For example, I wanted to have more time for journal reading thus I looked for where I could set aside 30 minutes daily for my journals. I ended up finding at least an hour for my journal reading which became a welcome habit. I looked at where I could “sneak in” a workout even on my busiest day. I also left time for complete relaxation when I needed that too.

Staying in good physical condition is the best way to stay in good mental condition. As I look around me, those friends who are physically fit are the most mentally resilient too. In my life, my good physical condition has been a key to many successes in my career. As my physical capacity increased, with a combination of endurance and strength training, the greater my capacity to work and play with my pleasures coming from enjoyment of craft beer, good food and fellowship with friends and colleagues.

Final Thoughts

Take a moment and look for the following:

  • Where you might incorporate small changes that will increase your physical conditioning.
  • Where you might substitute better food choices in terms of avoiding high fat and high refined sugary foods for foods that are whole grain, fresh fruits and vegetables with leaner meats.
  • Where you might take time for small tasks that enhance your professional development.
  • Where you can find some time for pure recreation and enjoyment of life.

Make the changes today, that will help your life and enjoyment of life in the long run. It’s easier than you imagine as you don’t have to become a spartan or fitness nut. Your studies and your mental health with be much stronger which is the key to success in today’s world of medicine.

18 July, 2017 Posted by | academics, medical school, practice of medicine | | Leave a comment

Crisis Averted

I try to meet my challenges in academics, my religious studies, medical practice and physical conditioning as they come. Recently, my academic work, specifically my teaching style, came under sharp criticism (very negative) and increased scrutiny. Now, I don’t mind criticism and will listen with an ear for what might be worthwhile but none of what I faced was even worthwhile; directed as a personal attack upon me. This scrutiny forced me to question everything and forced me into a position of vulnerability that I couldn’t help. I was in a tailspin; looking for anything of validation.

Couple my largely “mental tailspin” with my loss of my friendship of one of my most valued friends. I had retreated back to a point of reliving the death of Gene and my almost catatonic reaction post. I was feeling most of the same types of issues that I faced when I thought my world had come to an end. These were feelings that I couldn’t control but now I have learned that I can feel them and use them to force me to meet challenges with renewed strength.

My spiritual challenges are there but with my renewed strength, I allow myself to serve and feel without apology. I make mistakes in performing my duties at the cathedral during Sunday mass but I learn from my mistakes and from my very generous mentors. I know that they question me but by questioning me, I am forced to question myself too.

My friend who has been quite generous in advising me in my academic work is back in my life which gives me renewed hope that I can learn more from him. I should have listened to him in the first place but my extreme fears would not allow me to benefit from his wisdom. I am blessed and grateful that he spends even two minutes with me and I appreciate all the wise counsel that he has shared with me.

I have watched him interact with his students, his infinite patience and critiques. His student population is more vulnerable and more difficult to teach but he is kind and had great insight into where each student lies in their learning. I learned patience and kindness from him. One day, I watched him answer questions as he walked with his students into the parking lot; surrounded by those who truly appreciated what he had to say. Whenever I see him, I know that I am in the presence of someone who is far greater than myself.

I headed off to interview for another academic job challenging in that I had to deliver a grand rounds presentation and interact with some of the greatest surgeons in this country. I more than passed that test; surprising myself with how wonderful it was to assist on cases that I haven’t performed in years. Sometimes a skills check with master surgeons is good for the soul too. It also helped that a couple of my former professors from residency affirmed that they were proud of how I have made my way in practice.

My physical conditioning continues to be a source of challenges and growth. My trainer balances weight training with running so that I will conquer the marathon distance and I will continue to enjoy vigorous good health. I am getting faster and stronger; finally seeing some of the definition that I sought but with a smaller muscle mass. I am enjoying my increased running mileage while meditating; keeping my head together. I observe the world as it moves past me.

My spiritual growth comes in the form of reaching inside myself for affirmation these days. I am alone with my thoughts and examine each one carefully. I am happy with my solitude, enjoying exploration of my creative side (not very creative at all) and some of the artistic resources in my city. The creative resources of our local artists, musicians and actors have brought a kind of renewal of spirit for me. I seek to interact with humanity and I am acquiring the tools to do so. In that acquisition of tools of spirit, I know that I am not alone and that I am quite happy with the spiritual state of my life.

I don’t focus on material objects much as they have always had little meaning for me. My connections with my patients, my students and my colleagues have been most important. I read the writings and poetry of my like-minded physician colleagues always surprised by the insight and the richness that they bring to my world. One in particular, posts a daily affirmation that moves my meditations quite often. I am truly blessed to know this extraordinary individual who gives so much to the world.

I know that happiness in life comes from the “good stuff” and I have the “good stuff” in abundance these days. My crisis of spirit is no longer a crisis but an acceptance that while I am not good enough for some people; not valued by most, I value and accept myself. I am made by my creator and I seek to be kind, generous and accepting of those around me; no longer a crisis.

30 July, 2016 Posted by | academics, life in medicine, practice of medicine | | 2 Comments

Make Your Life Simple

As many are starting medical school, the most important task to master is getting your life under control. You are starting a journey of study that will absorb most of your waking hours in the next couple of years. Because of this, you have to take more than a few moments of time and figure out your basic needs. Starting medical school without taking a bit of life inventory is asking for problems that may cut into your precious study time. You have to figure out what you need and separate your absolute needs from the things that you want.

All of us who sit in that first lecture; open that first syllabus or textbook want to do well. We didn’t come to medical school to do poorly in our coursework. We seek out the wisdom of those who are a year in front of us and we start with the intention of “learning it all”. This drive for mastery comes largely from our premedical coursework where we always knew that in order to get into medical school, we had to have high grades and scholarship. Once in medical school, staying there and doing well becomes our next tasks as we adjust to the volume of information that will be presented in our pre-clinical coursework.

Making your life simple means that your living arrangements have to stable and comfortable. I largely used my apartment for showering, eating and sleeping. Much of my eating was done as I poured over my lecture notes and textbooks. I quickly found that doing much of my study at school was less distracting at first but I also found that heading off to bed early, getting up around 1AM and studying at home was also good for me. There were fewer interruptions from the phone and others as I was getting up when many were heading to bed.

My bed and bedroom were quiet, dark and restful. I refused to have any study materials in my bedroom; using my bed only for sleep. I also found that breaking my study time into 50-minute chunks worked well for me as I would often pace and recite my coursework, as a review, into a tape recorder so that I could listen to my study tapes on the subway as I made my way to class each day.

Making my life simple also meant that I bought my food for the week, on the weekends; making grocery shopping a break from studying. I had a great study group that like to meet on Saturday afternoon which meant that Saturday morning was great for food shopping. I also cleaned my house on that precious Saturday morning; getting rid of clutter that made me tired and less efficient.

Making my life simple meant that I planned each of my study sessions carefully. I made a list of what I needed to accomplish and marked off tasks as I completed them . Seeing those check marks gave my brain a sense of accomplishment that helped make the volume of material seem less intimidating. Still, I never felt completely ready for an exam but I always felt that I had a chance to do well because I studied for mastery (took no shortcuts during first and second year). “You can’t review what you haven’t learned in the first place.” was a favorite quote from one of my professors.

I always attended class prepared for the upcoming lecture by putting the previous lecture in perspective. This task helped me to see the “big picture” which can be neglected if one focuses solely on memorization. I sought understanding and perspective; organizing my studies around mastery rather than memorization.

If I have one regret in terms of my medical school work, it is that my physical conditioning suffered. As a graduate student, I was a middle-distance runner. My running helped manage stress and kept my weight down. I gained weight in medical school because the fastest foods were the ones that were unhealthy (high fat, high sugar). When I finally lost my medical school weight, it was my distance running that brought calm and organization to my life. Find a way to incorporate a minimum of 30 minutes of aerobic exercise in your schedule. Trust me, your grades will improve; your sleep will be more sound and efficient; your life will be simpler but more effective.

At the first sign of trouble, see your faculty instructors for help. They are the experts on the curriculum and should be your first and best resources if you need assistance. Your classmates are great but you should do a knowledge check with your instructor long before the exam comes up. Your instructor can also help you with organization should you become overwhelmed (very easy with the volume of material to master).

Finally, don’t forget family and friends. These people keep you sane but they can take up time if you don’t plan your interactions carefully. I often stated at the outset, “I have a couple of hours, let’s have a quick cup of coffee or breakfast”. I would set a timer on my watch so that I didn’t go overtime. It may seem rude but they adjusted to my general absence and helped my stay on task.

28 July, 2016 Posted by | academics, medical school | | 2 Comments

Summer Vacation?

As many people are heading for medical school (or finishing up a year in medical school), the summer is a time for readjustment. This readjustment process can simply be looking a things that worked, or did not work, in terms of your studies. The readjustment process for those heading for medical school will be starting to simplify your life in order to anticipate and meet any challenges ahead.

Adjustments mean that one has to anticipate and evaluate all matters that involve your studies and your daily life in order to give your full attention to any tasks that must be completed. For example, for those starting medical school, most will have to adjust your study skills to master large amounts of information. The good part of this mastery is that the information will be presented in a manner for quick mastery but one has to have the mental confidence to put doubts behind and efficiently take care of your needs. In short, you won’t have time to be wasted. You have to hone in on what you need, ask for help with organization and keep moving as you adjust to the pace. Have the confidence to know that if you have been accepted into medical school, you have all of the tools to stay there.

If your year that is ending has not been as successful as you would like, make the adjustments that you need for success. Summer is a great time to have a chat with your faculty adviser in order to change anything that might need to be changed for the upcoming year. Allow the experience of your faculty adviser to guide your objectively so that you can be more successful. Rather than spending precious mental energy on comparing yourself to your classmates, compare yourself to you and upgrade you to master what needs to be mastered.

The most valuable lessons that I have learned in surgery, all center around one unchanging fact. That fact is that medicine/surgery demands that I constantly self-evaluate my practice, my learning and my approach to my work and make adjustments that will enable me to perform at my highest level. My patients don’t care about my doubts but only care about my ability to solve their clinical problems. To this end, I do my self-evaluation and self-criticism outside my clinical practice and bring my best into my clinical practice. I seek critique from my partners, my chairman and in many cases, from my friends who know me well.

I have to be willing to listen with an objective ear, something that is difficult for all of us whether we are inside or outside of medicine. We all love to believe that we are the best that we can be but part of that “believing that we are the best” requires that we have the mental ability to accept subjective criticism. Let the summer be a time that one seeks out the subjective, listens to what is valuable and rejects (be objective on your part), those items that don’t apply. Try to keep emotion out of this process as much as possible.

My other summer activity often centers around keeping (or getting) myself into the best physical condition possible. In my recent quest to master the marathon distance (26.2 miles), I have tended to neglect my strength training in favor of aerobic conditioning. While this has enabled me to lose plenty of weight, I know that I need to be both strong and aerobically sound. This summer will mean that I will spend some time with the weights again. At my age and at any age, strength training is great for discipline which is great for the demands of life (and medicine).

Physical conditioning and sports participation help to counter the extreme hours demanded by study and medical practice. Participation in team sports have always helped me appreciate the value that every member of the team brings to a successful challenge. In this manner, medicine is no different from winning a rugby match (my favorite team sport). Medicine, though the physician is at the top of the team, involves appreciation of the contribution and knowledge of every team members role in the health of your patients. Use your sports knowledge to help your professional knowledge and role as your learning moves along. Medicine is never practiced in isolation.

Summer is definitely a time to rest as well as readjust. This rest can take the form of a much deserved and needed vacation or simply involving yourself in something that is different from your medical studies. For me, travel is my rest and relaxation. My travels overseas have allowed me to look at other cultures that are far different from my own. My favorite activity is to put on my running gear and just explore my surroundings and observe people who are observing me. Every step that I take is a chance for me to connect with nature, my body and those around me. I tend to be the type of runner who greets those running around me and keeps moving. This habit has been a metaphor for my life and practice.

If you have a chance to do a bit of summer research, take the opportunity to relearn evaluation of scientific evidence, question practice guidelines and build up your knowledge database. Research moves at a slower pace than regular academic work thus taking a fresh look at your scientific questioning can be a useful undertaking. If you are new to research, summer is a great time to become familiar with the tools that will serve you well for the rest of your practice.

Medicine and surgery are professions of experience. Those with more experience teach and impart their knowledge to those will less experience. For me, a person who attended medical school at a later age, I learned that experience isn’t related to age. I learned to listen with care to those whose experience was greater than my own. Even today, I seek out experiences at every level because I appreciate the input of those who look at what I do with fresh eyes (those with less experience) and those with more experience. Medicine demands that I keep moving, just like my distance running demands that I keep moving.

Yes, summer is approaching quickly and will be gone just as quickly but summer offers an opportunity to slow down and self-evaluate. If part of that self-evaluation process involves reinvention of ones self as needed, then summer will be a great vacation.

 

 

26 May, 2016 Posted by | academics, medical school, medical school preparation, stress reduction | | Leave a comment

A Weekend of Affirmation

I am now down to 4 days to my first marathon. I had a great last long run this past Sunday with one week to go. I feel great; passing the time between elation that I have done my best in terms of training and a little fear that I can’t finish the race. I have not run a total of 26.2 miles in a training run having been advised against running the total distance by my coach. She is confident that I can complete the distance.

My friends, save the one whose friendship I miss most, have been very supportive. My heart is glad for having set this goal and worked diligently toward it. I pray and meditate on hoping that my lost friend finds his way back into my life as he is such a generous and energetic spirit that I miss unspeakably. I am totally at peace with his decision but I can’t get past that I am without his lively character and his affirmation. That affirmation went in two directions.

I spent some great time with two of my professors from residency. It was a wonderful experience of seeing two men that profoundly affected the way I practice surgery and medicine. They are generous and wise teachers whose wisdom whispers into my ears when I am in a tough clinical situation. One, who was my residency director, is the most heroic person I have ever known, a former marathoner. The other, just joyful in his generous sharing of his knowledge and teaching. It was a great experience to see these men after many years of development on my part. I am at profound peace with where I am and how I practice.

I had many opportunities to exchange ideas and information with some of the brightest and best minds from across the nation in surgery. Such rare opportunities are not to be taken lightly. I found my brain brimming with ideas and commentary on my two long runs of last week. The weather was warm with clear blue sky and plenty of lake water to run along side. I couldn’t help but smile at every biker and fisherman that I passed, sampling the good will of people that I will never meet again. Such is the stuff of affirmation.

My running is for me and myself alone. I haven’t had an opportunity to sit on the roof of my hospital lately but I am philosophical as I take on the challenge of completing my academic duties for the semester and year. Before I left town for a short trip, I had become embroiled in a useless “ego” trial that cost me a friend, my ultimate academic friend, and shook my confidence in my teaching style/ability. My experience in reconnecting with my former professors restored my resolve to be the best that I can be without engaging in any type of “ego” exercise.

Medicine and teaching have no room for agendas other than imparting the best knowledge possible to those who are students. I renewed my resolve to impart the best and explain all that I can explain to my students. Still, as I was on the verge of my ultimate “burn-out” for many reasons, I now have a calmness and peace that my experience has been a great teacher for me. Still, I have so much that I would love to share with my lost friend, I am sad that I won’t be able to do this.

My research continues and will be running “full steam” during the summer season. I look ahead with great expectation that we will accomplish much. I will get through my marathon in the coming weekend and move forward with the things that are on my agenda for “after” the marathon. I feel that my end of week affirmation, along with my taper and rest will be the best part of my training.

Yes, I worry that I won’t finish but I will give my best. Yes, I worry that I might suffer an injury in the start of race jostling but I will give my best and keep my eyes open. I have the positive wishes and prayers of my spiritual companions from my theology course along with my wonderful and wise friends. I have learned many lessons in the past week and I have been very sad but I keep my eyes focused on where I go from here. I prepare my head and my heart for what is to come. I have no doubt of the gifts that I have been given and I am infinitely grateful for all of them; even the painful experiences.

10 May, 2016 Posted by | academics, life in medicine, medical school | | 3 Comments