Medicine From The Trenches

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

Some Thoughts for Those Starting Medical School this Month

As you get settled into your first-year coursework, I want to share some thoughts that come to mind:

  • Remember that you are fortunate to be on the doorstep of pursuing a magical profession. For everyone who achieves a seat in medical school, there are many who wish to be in your place. Honor them and remember them as you gather the knowledge that will make you a good physician.
  • Medicine is not easy, especially the study of the art of practice. There are many “all-or-none” tests along the way. There is a large volume of material to learn, master and apply to the practice of medicine and as such, you must make peace with that volume of material.
  • There are no “short-cuts”. This means that you have to make a concerted effort to be willing to take the long road. If you are looking for a short way around your work, medicine likely isn’t the profession for you. Get out early rather than later because medical school is expensive and quite unforgiving.
  • You are going to be working on people and not pathology. While pathology is interesting, always remember that the person with that pathology is loved by someone. Be willing to put yourself in the place of the patient or their loved one and treat them as you would wish to be treated.
  • Don’t believe what you hear but trust what you experience. Don’t go into any class or any rotation with preconceived notions of how it will be. Medicine is interesting and absorbing. Allow yourself to learn with a fresh approach and with fresh energy. While people who go before you will tell you horror stories about certain professors and certain subjects, it’s up to you to figure out and navigate them. You may be pleasantly surprised at how much you will enjoy this process.
  • Take some time to do something outside medicine at least once per week. Go to a movie, visit a museum or attend worship services. These outside activities keep your studies in perspective and keep your brain alive.
  • Keep yourself physically fit. Walk the stairs, take a 30-minute run daily and eat/sleep well. These physical activities will decrease stress and keep you healthy in the long run. Junk food, while quick, can make you overweight, sluggish and prone to picking up infections. Take time on weekends to prepare healthy (minimally processed) food and freeze it for ease during the week. You will save money, something that is always good.

Don’t forget to enjoy the process. Remember that you WANT to be here. Before you complain/gripe about something, try to figure out a couple of solutions or if the complaint/gripe is worth your time. If not, then focus on your studies and keep moving forward.


15 August, 2016 Posted by | first-year, medical school | , , | 1 Comment

Starting the New Academic Year


As many of you head back to school (or begin medical school or university), the time is great for considering some small changes that may make a large difference in your health and academic success. I wanted to list a few things since I am on an extended vacation/adventure and now have a little time to tend to my neglected blog.

Head Check

This is a great time to “let go” of anything negative from past academic endeavors. This is a new start, a new year and a new time to reinvent yourself. Why not spend a few minutes each morning with some positive thoughts (for heaven’s sake, this can be as simple as smiling at yourself or a positive affirmation). When students begin to become overwhelmed, negativity creeps in first and threatens to magnify any problems into significant issues. I have found that my first actions when I start each day are to meditate and begin the day positive with my spiritual thoughts. This places me in the proper frame of mind to meet each challenge as they come.

Consider that in this era of expensive education and limited funds/opportunities, the fact that you are a student is a great advantage. You have a body of knowledge to master and build upon. Keep your mind open and positive so that you take the greatest advantage of your present academic challenges and events. Nothing can limit a determined individual who calmly prepares themselves for anything to come and adapts to changes when they occur. Resist the urge to see your academics as a battle with your professor or fellow students. Your only competition is with yourself to do your best honestly and constantly.

Do not neglect your spiritual needs. Find some form of spiritual outlet, be it something creative or religious (even better do both). If you are in a new location, find a church that speaks to you even if you wind up exploring another religion or belief. Allow yourself the freedom and openness to learn about other religions and beliefs. These explorations can serve to strengthen your own beliefs or widen your spirituality. The fellowship and connection with others, preferably outside of medicine or school is great for your heart and soul. Yoga is a wonderful activity to explore with its calming and peaceful effect on both mind and body.

Body Check

Plan your meals for the week and plan healthy. The pizza and beer may be a wonderful treat but one can’t eat high fat foods and consume alcohol on a regular basis. Good academic performance takes a strong body to nurture sound thinking. Packing snack-sized bags of apple slices, a few almonds, cucumber slices, baby carrots and grape tomatoes are healthier, easy and cheaper than grabbing a high sugar candy bar from a vending machine. High sugar may give one a quick energy boost but in the long run, that boost doesn’t last. Ease up on the caffeine (dehydrating) and go for water rather than fruit juice. If you must have fruit juice, make it within the context of eating the fruit whole such as a whole orange or grapefruit rather than drinking bottled or canned juice.

Perform some type of aerobic exercise where you get your heart pumping for at least 30 or more minutes daily. You don’t have to run for long periods of time as you can break your aerobic work into 10-minute sessions. My favorite trick from residency was to run the steps (up and down) in between my surgical cases or run jog the length of the subway platform several times as I waited for the train. I used climb to the top of the parking garage and just enjoy the air and the birds from the heights (I used to wave at the train engineers from the garage too). You can even park your car far away from the building and hike in for some much-needed aerobic work. Let your aerobic work be relaxation and not competition or stress.

Pumping iron in the gym is also great for stress relief. I will admit that I use my iron work to give myself positive reinforcement. With each rep, I am grateful and thankful that I can perform those reps. I generally don’t have loads of time for the gym but I take advantage of every moment when I am able to get into the gym and get a good weight-lifting work out completed. I also follow-up with a dip in the pool as a means of keeping myself flexible (vitally important in surgery).

Sleep Check

You have to figure out how much sleep you need for peak performance. Trying to “train yourself” to get by on less sleep rather than more sleep is not a sound idea for optimal learning. There are plenty of fitness devices on the market that will give you an idea of how much sleep you actually are getting and the quality of that sleep. Figure out what is optimal and get proper rest.

Anxiety can often cut into sleep and can cause your quality of sleep to deteriorate. This can cause chronic tiredness and can make your study time far less efficient. Find healthy ways to reduce anxiety (not drugs or alcohol) so that you can sleep well. Even herbal supplements can erode the quality of your sleep thus you need to make sure that you are getting proper rest without chemicals unless properly prescribed by a physician for a diagnoses where an anxiolytic is indicated.

Unplug from your electronics

I have been guilty of keeping the smart phone next to the bed on most days. Now that I am on vacation, I started to turn off the phone and rely on my natural clock to awaken me. I have discovered that I don’t over sleep and I am more peaceful. My phone is in my purse which is across the room so that I am not tempted to grab it first thing when I awaken. I plan to carry this practice into my work life when I return home.

I have many wonderful connections with my friends on social media and enjoy those connections very much. I have learned to treat my social media times as part of my recreation time. Social media is a means for me to connect with colleagues and friends and not to iron out political problems. More times than I would love to admit, I have “UN-friended” someone because they are bent on berating me for my beliefs. I just don’t have time for that much stress these days.

Consider that during this time of emphasis on academics and school, you have a limited amount of energy which should be spent on your studies rather than being outraged about things that you may not be able to affect. Yes, you need to be aware and informed but gossip, shaming and bullying take too much energy and produce negativity. Support causes that you believe in but not to the point that you are consumed by your causes.

Finally, these are a few things that I am “tweaking” as I go along. As an attending physician, I take myself far less seriously than I did as a resident physician. I have come to embrace my humanity and to embrace the wonder that is the humanity in others.  There is tremendous joy in medicine and patient interaction especially when your patients begin to see that you care about solving their problems and you connect with them. At this point in my life and career, my patients, my students and the residents me teach me so much. For that I am eternally grateful.

24 July, 2015 Posted by | academics | , | 8 Comments

Why I teach…


I have been teaching (involved in academia) in some form since 1994 which means that I have “been around the block a few times”. Teaching has been my way of “paying it forward” since I was in graduate school in the 1990s. I use the term “paying it forward” because I was fortunate enough to have outstanding professors at every juncture of my education. Medical school just added patients to the list of persons that I teach which continues to make my practice interesting and fun. I use the word “fun” to describe teaching but it’s not lost on me that my teaching is a way to show how my teachers affected the way that I learned science and medicine which I attempt to pass along to my students and patients.

The first  influential professor

The first professor who had a profound influence on me was my undergraduate physics professor. A “renaissance”  man in every sense of that word, my physics professor would start the class off by playing a few minutes of a Beethoven symphony whereupon he would ask us to identify the work. I was usually the only person to do this as I had spent more than some quality time study the compositions of Beethoven, Chopin and Mozart in my harmony and ear training courses that I had taken when I studied music. My professor marveled at how I could “guess” the identity of the piece with little more than three or four bars. For me, Beethoven, Chopin and Mozart were so distinctive in their styles that my task was simple. If he wanted to “stump” me, J.S. Bach would do the job.

In addition to music, this professor was a prolific writer, photographer and collector of thousands of ideas. My favorite idea was when he spoke of walking though Einstein’s office at Princeton and breathing much of the same air as the famous physicist. My professor also had the gift of being able to explain extremely complex ideas and theorems in a language that added this knowledge to our fledgling knowledge bases. As he filled multiple chalk boards with derivations of quantum theory and mechanics, I learned how to approach a body of knowledge, immerse myself and convey my thoughts and findings within the language of those complex theorems. In short, my professor showed me how to look at the world from the standpoint of mathematics and precision. After one semester of university physics for scientists and engineers, I was transformed.

My mentor in analytical chemistry

My next influential professor was an analytical chemist from Hungary. His influence on me was teaching me to love electrochemistry from the standpoint of chemical analysis. Like my physics professor, my chemistry professor was able to teach the utilization of any and all “tools” in the craft of studying a body of work. My chemistry mentor taught me how to prepare a PowerPoint lecture of a complex subject for different audiences.  He always said that one needed to be able to explain their research, no matter how complex, to other scientists, to scientists in other disciplines, to potential investors and to the lay public. His great lessons have proven invaluable to me over the year of graduate school, medical school and practice. He has a thriving research group that is putting out some amazing experiments because of his ability to bring out the strengths of each member of his team and his ability to get everyone to work toward a common goal. His lessons were great. Like my physics professor, my chemistry mentor was a man of ideas.

My biochemistry/physiology mentor

My mentor in biochemistry was actually a physiologist and a woman. She had a fine analytical mind but was very vulnerable in many areas. My greatest lesson from her was to be able to see collaborative possibilities in a multitude of situations. She had thousands of ideas every day which was refreshing to be around. When she needed to focus on one path, she was unshakable but she always saw the larger implications of everyone’s work and contributions which never went unrecognized.  She admired my quest for knowledge and I admired her ability to cut to the “bottom-line” of any situation, scientific or political. Under her tutelage, I became exposed to the politics of academia and came to understand how to get what I needed to present my best to my students. From my studies with her and under her, I learned how to integrate basic science with clinical medicine. One cannot separate science from medicine as science drives medicine which is its practical application. I also came to realize that since she had been one of Sir Hans Krebs’ graduate students, I was by association, a student of Sir Hans Krebs. Yes, I know the citric acid cycle inside, outside and backwards. One of my favorite tasks in graduate school was to substitute nitrogen for carbon and rework the “Krebs” cycle. (Hint: follow the electrons because it’s oxidation and reduction that “fuels” life on earth).

My first clinical mentor

My first clinical mentor was another renaissance man whose broad interests and talents make him a character. He was a specialist in Internal Medicine who was fond of referring to surgeons as “Philistines” (Orthophilistines, Neurophilistines and others) in the sense that Philistines are ill-mannered and generally crude. Some of his favorite statements were, “Internists practice classical medicine while the Philistines practice common medicine”. To his delight and astonishment, I ended up choosing to enter the practice of “common” medicine and become one of the “Philistines”  for which he always teased me when I encountered him.

The greatest thing about my clinical mentor was that he always gave his patients 100% of his attention and ability. He was a voracious reader and writer who encouraged me to begin reading the New England Journal of Medicine from the day I received my acceptance letter for medical school. He said that I probably wouldn’t understand much of the journal but have a daily habit of spending at least 30 minutes reading a journal would be of great utility to sound practice and education. He suggested that I read the Case Reports from Mass General first thing in every issue and then turn my attention to the Original Articles. To this day, this is the manner in which I approach the New England Journal of Medicine ( I have added about 30 additional journals each week). Again, I see the utility of putting the basic science with the clinical science which cannot be separated.  I am a profound believer that medical students should make it a habit of reading Mayo Clinic Proceedings, Nature Medicine and The New England Journal of Medicine from day one.

My surgical mentor

My surgical mentor is a laparoscopic surgeon who was trained a Duke University. When I met him, I realized that he had the same approach as the rest of my mentors which meant that he is a man of broad interests and abilities. He is an avid distance runner for whom I suspect his running keeps his agile and always active mind on course. He is another mentor who is able to put a strong team together where everyone’s strengths are highlighted. From my surgical mentor, I learned to never give up on any patient for any reason. When that 30th hours is creeping up and one is fighting sleep and a wandering mind, my mentor taught me to find a “kernel of focus” and build upon it. He also taught me the utility of rounding alone late at night when one can see the patient with renewed perspective. His late night teachings were some of the best (yes, he was up at 4am too). He taught me to rely on my training and thinking rather than emotion though I suspect that his emotions are far deeper than he shows on the outside. Under his direction, I became fearless to a certain degree and confident in my skills as a surgeon. The most outstanding characteristic of my surgical mentor is that he loves to teach and thrives on the excellent training of those who are under his direction.

Common thread

The common characteristics of my mentors over the years is that they are people of diverse ideas and interests. Every year at the start of a new year, I strive to get back to the characteristic that I most admire in my mentors. At each year’s end, I take stock of what I have learned and appreciate in this journey of medical practice. I know that I am fortunate to have had an opportunity to have been taught by many outstanding professors who have left their profound influence. I also know that there are those who I hear “whispering” in my ear on a daily basis. No matter where you are in your training in medicine, you should stop and take a minute to thank the people who have taken the time to teach you something. It’s good to remember that not all lessons are learned in the classroom and that it’s a privilege to have a mind that allows one to learn from a good professor.

31 December, 2011 Posted by | academics, medical school, medicine, surgery | | 4 Comments