Author: Amanda Xi

Day 35: Updates and link love

Amanda Xi

Today’s inane images of the day:

A successful kick-off AMWA Dinner With Dr. Nuzzarello!
A beautiful sunset in Pasadena [this was taken from the top floor of a parking deck].
Pasadena night life.

This last week following the Renal and Urinary exam has probably been my most stressful one to date because 1) our Anatomy practical examination grades were held until Thursday afternoon and I was scared about failing 2) I neglected all of my other commitments [i.e. AMWA] to study for the exam and felt overwhelmed by having to play catch-up 3) we didn’t get a break Tuesday morning after the exam – nope, we started class at 7:30AM and went until 3PM. All of these things combined made for a very painful week.

Last weekend while I was studying, I felt empty and well, depressed… so I planned a couple of things to look forward to. One of these things was a weekend trip to visit Mike [as you can see from the photos of Pasadena] – albeit short, it was wonderful and worth the money and fatigue from traveling. Currently, I’m writing this from LAX, awaiting my flight back to Detroit [did you know there was free WiFi in LAX?! I’ve totally been missing out…].

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Have you noticed my rather sporadic posting schedule? Well… that’s because all of my blogging juices have been directed toward my weekly Kaplan medical blog entries and the newest addition – The Differential. Here are some recent entries I wrote:

Also, the Oakland Post featured me and this blog in their last issue! Check it out here.
Time to pack up and pack into the plane…

Day 31: Block 4 – Renal and Urinary

Amanda Xi

Today’s inane image of the day:

This was the cover page for one of my favorite interactive sessions during the Renal and Urinary block. [Oh and this Nephrologist blogs and tweets, too!]

We started our M2 year off delving into the convoluted structures and functions of the Renal and Urinary system.

Course Overview
This block was 5 weeks and ran similarly to the the last 2 blocks [Cardiovascular, Respiratory… Neuroscience was kind of an outlier…] – we had weekly quizzes, TBLs, Anatomy labs and lectures. Our final grade was determined by our performance on the weekly quizzes, TBLs, the final NBME exam and Anatomy practical.

What I loved
WHITE SPACE. Dr. Augustyniak started off the block explaining just how he designed the course to have a significant chunk of white space. Looking back upon the last month or so, I have to say that this extra time made Renal & Urinary much more pleasant. Not only was I getting a decent amount of sleep each evening, I had more time to study and digest the material. Although there was definitely more time off as a whole, unfortunately the last week before our final exam was jam-packed – I would have much rather had those classes earlier and more time off later.

Improved lectures/interactive sessions. A couple of professors really stepped up their game – it was really great to see some of our feedback in action [I guess this isn’t so much a Renal-specific thing, but more of a school-specific thing].

Final exam. Just like the last couple of blocks, our final exam was a customized one written by the NBME. I thought that this exam didn’t do a phenomenal job of assessing my Renal and Urinary knowledge, however, it was still a pretty darn good exam [it doesn’t hurt that I passed, haha].

What I felt neutral about
Weekly quizzes. In the past, I’ve raved about the Weekly Quizzes and for the most part, I still think they are a positive thing. However, as time passes, I’m starting to see them more as a burden and less of a way to study/assess my knowledge. At this point, I think the pros and cons of having them cancel each other out.

What could be improved
Anatomy. When I realized that we would only have 2 Anatomy sessions, I figured that it made sense since the kidney and urinary tract were not phenomenally complicated structures on a gross level. However, we soon discovered that we were also responsible for the abdominal wall and the parts of the inguinal canal region. Come examination time, I was surprised by how little we were accessed on our knowledge of gross kidney Anatomy and how much emphasis was on abdominal wall muscles. Additionally, the examination didn’t run as smoothly has it has in the past, which only added more stress to an already painful situation.

I am confident that this issue will be resolved, but it was still frustrating.

Attendance policy. [This is another school-specific and not really Renal-specific item] OUWB has implemented an attendance policy – although this change does not really affect me [I attend every lecture to take care of classroom technology, anyway], the way by which we track attendance is a bit rudimentary. Surely the system will be improved as time goes on, but for now… we’re signing a physical paper every single hour. It gets to be a bit nerve-wracking and distracting to feel like I have to chase a piece of paper around every hour, but for now, it’ll have to do.

Order of material presentation. It is likely that the order was dictated more by the clinicians’ schedules than anything else, so I’m not sure there’s much that can be done on this front. However, I think order of presentation is important in organ systems, particularly learning Anatomy, Histology and Embryology relatively early on so we can build upon these basics. For Renal, we had Embryology the last week before the exam – although there wasn’t a ton of Embryo to learn, I still felt like it would have been better placed earlier on.

Final thoughts
Like in Cardio, Dr. Augustyniak was really dedicated to making this course a success. Additionally, Dr. Dumler [clinical course director] was available for the majority of the course, which added to its overall high level of cohesiveness. Overall, I’d say the course was a success, albeit a little bumpy here and there.

Day 22: A day in the life of a med student

Amanda Xi

Today’s inane image of the day:

Back at it again with Netter’s Atlas and my laptop. Oh, and why not throw in a game of Gin Rummy while we’re at it?

Mike visited for a couple of days, then left again. As always, the visit was too short-lived and now I feel like a part of me is missing. We spent most of his visit doing what I always do – school, study, eat, exercise and sleep [admittedly, I got some shopping in, too].

Generally, my day runs something like this:

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Day 13: Frustration turned around

Amanda Xi

Today’s inane image of the day:

When we help out during interview days, we are given these notecard packets with maps and other useful information. I was an “escort” [heh…], which means I accompany applicants to their interview and back.

We had a TBL yesterday that put me in a rather foul mood. It wasn’t necessarily because of the TBL itself, but more due to my personal performance on it. It’s no secret that I struggle with multiple-choice exams, but I thought I had been improving in that department – well, apparently not so much. Sometimes I’m able to convince myself that often these tests aren’t representative of my true knowledge, however, there’s no escaping multiple-choice assessments so I’ll have to make due and just keep trying [at least I’m not failing!].

I signed up to participate in the first interview day of the 2012-2013 application cycle, which was yesterday immediately following my TBL. I was a bit concerned about my ability to talk about OUWB when I was feeling rather unhappy – but my mood markedly improved after chatting with some prospective students. One of them asked why I took time out of my busy schedule to do interview days, and I told him that it was because talking with interviewees reminded me of how excited I was to start medical school and proves to be relatively good motivation to keep moving forward.

My evening was topped off with some unexpectedly fun company. And today things are looking rather up [including the weather, which is 90+ degrees – I thought it was almost cider and donuts time?! Oh, Michigan], especially since I checked off a number of tasks this morning and I always feel better when I get stuff done.

Happy weekend, everyone!

Day 8: 2.5 years in (another long distance relationship update)

Amanda Xi

Today’s inane image of the day:

From my trip to San Fran – we made a pitstop in Malibu to visit one of Mike’s friends who was camping on the beach.

Today, we are 2.5 years into our relationship. Over 1 year of it has been on almost-opposite ends of the country. Sadly, it is likely that we will be permanently reunited only after we’ve spent more time separated by 1000s of miles than together.

Things have not necessarily gotten easier with time [whoever said time heals all, lied] – in fact, I’d argue that it has gotten harder as I move forward with medical school. Although I have arrived at a relatively comfortable point of treading the enormous volume of material, I cannot help but feel apprehensive about Step 1. I do not feel like I adequately learned the basic sciences last year, nor do I feel comfortable identifying a lesion in the spinal cord when given the results of a neurological examination. Although these fears cannot be erased by having Mike around, he could at least help keep them at bay.

But I guess we all yearn for the things we cannot have. Admittedly, I should be grateful for the endless hours he spends with me over FaceTime, merely watching me stare at textbooks or listening to me talk to myself about the pathophysiology of this, or that. I should be happy that I have someone so supportive and stubborn. I should feel lucky that he can visit on such a regular basis.

I recognize that I definitely have a pretty optimal LDR situation, but I cannot help but feel pangs of jealousy when I see my happily married peers at social events or hear about regular weekend visits from significant others in places only a couple hours away. Through my eyes, everyone else has a more optimal situation – however, I know that this isn’t necessarily true. I just have to keep reminding myself that appearances are not always representative of the truth.

My frustration comes in waves – most of the time I keep myself so busy that there isn’t enough time to let the negative feelings surface – but, sometimes they escape and morph into a fight. Mike is so accustomed to them now that he just seems to ride out the storm until the sun rises again. I really try not to let my emotions get the best of me, however, by the end of the week, I am sleep-deprived and stressed, which tends to turn me into a blubbering ball of anger and tears. Usually, if sleep it off, everything is better the next day.

We still have something like four years of long distance to go – hopefully it will all work out in the end.

Day 5: Back at it again

Amanda Xi

Today’s inane image of the day:

This time around, I decided to select my own resources to learn from [and tried to save some money by purchasing an older edition].

We just wrapped up our first week back at OUWB. Everything feels essentially like a continuation of where we left off, but not quite. This time around, there are more students [shiny, new M1s!], a different classroom [yeah, thanks a lot M1s for demoting us to the smaller classroom…] and some new facilities at Beaumont [more study space is always welcome]. Half of our building on the Oakland University campus is under construction [in order to get from the study rooms to the classrooms, we have to go down a flight of stairs, over, and then back up a flight]. Oh, and we also now have an attendance policy [I’ve updated my FAQs to reflect this recent change].

A couple weeks back, I was dreading my return to school. Honestly, I don’t necessarily feel much better now that we’ve started. I still love medicine and find everything we learn to be fascinating, but these things do not absolve the frustration of a perpetual state of exhaustion and stress. Plus, this year scares the living daylights out of me because Step 1 feels way too close for comfort.

As I went through my Google Reader [thank you dedicated, subscribed readers of this blog!], I noticed that Ali Binazir’s post, “Why you should not go to medical school – a gleefully biased rant” resurfaced in the blogosphere. I decided to revisit it [I read it maybe 4-5 years ago when someone brought it up on Student Doctor Network] briefly, and couldn’t help but nod in agreement at many of his sentiments.

Lately, I’ve been feeling extraordinarily young and naive. Although I am those things, it’s hard to come to terms with the thought that there’s so much left to learn and experience. Like many, I spent much of my childhood striving for adulthood, but now that I’m in a sort of transitional period, I can’t help but feel more like a child than ever before.

Anyway, reflective writing won’t help me understand the kidney…

Words of wisdom for 1st year medical students

Amanda Xi

Today’s inane image of the day:

Don’t forget to get some fresh air this year. [Photo from my trip to San Fran]

Lately I’ve been getting numerous requests for advice about starting medical school – instead of re-inventing the wheel, I decided to post links to my personal words of wisdom and those of some of my favorite bloggers. Enjoy!

Advice from my first semester of medical school [from this blog]
Med School Insight [that’s me!] – Learning to study when starting medical school
Medical State of Mind – A Word With First Year
Medical Admissions – To the class of 2016: Observations from 2015
WayfaringMD – Advice to Medical Students, First Year Edition

As always, feel free to post specific questions as you start on your first year of medical training! Good luck – [not that you need it…!].

P.S. OUWB M1s – enjoy your first day of classes tomorrow. We’ll be right next door if you need anything. =)

All good things must come to an end

Amanda Xi

Today’s inane image of the day:

A nighttime view of a street in San Francisco. This was taken from the back of a trolley [one of the highlights of my visit to San Fran – they’re so fun to ride!].

The best part of vacation as a single [as in, unmarried], non-parent? Being able to completely remove yourself from your world – everything falls away when you leave your comfort zone and explore somewhere new. You can temporarily ignore all the things that plague you. You can tell strangers lies about your life. You can breathe, freely.

But, all good things must come to an end.

It’s not that I don’t want to go back to school, but I’d rather not feel stressed out 24/7. Nor do I enjoy feeling relentlessly overwhelmed with the material. Or feeling very lonely while studying [though, Mike has been great about keeping me company].

In so many ways, the pre-clinical years kind of suck.

Participating in the Cardiology internship was a reminder that there’s a point to all of this. There are individuals out there with heart-wrenching stories of courage, hope and determination that I want to hear. Things don’t always work out, but when they do, it means more life. More love. More memories.

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One year ago, I was preparing to start a new chapter of my life. This year, we get an extra week of summer to enjoy before starting classes on Monday, August 13. Although the nerd in me is excited to put some new creases into my textbooks and break out a new set of highlighters/pens, another part of me is dreading our return. I am fully aware that in order to be a competent physician, I need to learn the material – but some part of me wonders if there’s a better way to do medical education.

Incoming M1s, please do relish in the excitement of this first week – it’s an exquisite feeling that cannot be replicated. You will learn all about our school and be greeted by an endless number of fresh, smiling faces. You will be interested in joining all of our organizations [come say “hi” to me at the Activities Fair – I’ll be at the AMWA table, of course], receive your laptops and lots of free food. You will bond with your classmates through group and evening activities. At the end of this week, you will be presented with your white coat by your PRISM mentor and have a million photos taken.

Then, you’ll be thrown headfirst into an ocean of material. Like I said, all good things must come to an end.

Hello from the West Coast

Amanda Xi

Today’s inane image of the day:

Hello from the West Coast! 

Just wanted to drop a line and let you know that my Cardiology internship did not eat me up – I’ve just been enjoying some time in California with my love. Being [mostly] unplugged and completely smitten with Mike for the last 5-ish days has been delightful. I feel light and happy, but a bit apprehensive to start a new semester in less than 2 weeks [August 13, to be exact]. Alas, there’s no point in worrying over the future when we’re living in the present.

I’ll be back in Michigan [and back to reality] in less than 24 hours. But until then… I’ll be enjoying my last few hours with Mike.

My first code

Amanda Xi

A real code deviates from what they depict in medical dramas like Grey’s Anatomy. Television chest compressions are usually too slow and superficial – they are nowhere near forceful enough to sustain blood flow throughout the body. There is no foreboding soundtrack to hint at what’s coming – only the numbers that appear on the monitor that suddenly dip in the wrong direction.

Although I understood the magnitude of the situation as it unraveled before me, the monitor deceived me into believing that our fluid and pharmacologic interventions were enough. I watched the numbers bounce around, then steady at a reasonable value. They sat there for a short stint, before starting a slow descent.

I felt the air in the room change.

Everything moved faster, except time. The seconds dragged on as I watched more people filter into the room. More supplies were requested. More fluids and drugs were administered. Everyone’s motions were hurried and purposeful as I stood at the end of the table with my hands together.

I remember watching everything but not really hearing it all. There were orders being called and more groups assembled to assist, but I processed it like a silent movie. Everything was surreal up until I saw that chest compressions had begun. The stoic, lighthearted facial expressions that the room started with had all faded into concerned, determined ones.

I notice the time – only minutes have passed.

Shocks were administered between bouts of compressions. Indeed, they do call out “All clear” prior to defibrillation [Grey’s got that right]. Abruptly, all the hands abandon the patient for a split second as the body receives a jolt. Everyone resumes their work immediately.

I study the compressions – they are exactly as we were taught: at least 100/minute with 2 inches of depth. There are three people switching off, but they look tired. To my left, someone asks, “Have you done compressions before?” I slowly nod my head and am nudged to assist.

The individual doing CPR looks relieved as I step forward. During the administration of a shock, we quickly switch positions. My heart raced and adrenaline coursed through my vessels as I stepped up toward the patient. At that moment, it was as if someone else took over my body – I felt myself approaching the patient, but then I saw myself rhythmically pumping the chest. Everyone continued to work around me, but all I really registered was the patient and my motions.

It seemed like I had been giving compressions for at least five minutes before someone else took over; in reality, it was only a minute or two. The motion really wipes you out – I stepped back breathing like I had just run my fastest mile. My second round of compressions was tough, but I pushed on.

The code continues to run. After what seems like hours, it comes to a close.

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In medicine, we fight time and nature with tests, drugs and surgeries. Over the years, we have been successful in extending life, however, we haven’t discovered a magic formula to live forever. The reality is that sometimes we delay nature’s course, but there is no stopping the inevitable.

Every single day of life should be lived to the fullest – even if external forces put up road blocks, we need to realize that they are temporary and sometimes out of our control.

I have wasted a lot of time and generated a hefty amount of cortisol worrying about things that I cannot predict or change the course of. But this, and the events of the last week, have shown me the importance of letting go. Not to say that I’m going to forget this patient or the experience – they will undoubtedly stay with me forever – but there is a stark contrast between healthy reflection and incessant “what ifs.” I wasn’t responsible for this code, but someday I will run one and if I continue down the path that I’m on, I will never be able to move on from nit-picking at details for years on end or forgiving myself for things that I could not alter, nor foresee.

I need to change.

I don’t expect a sudden personality shift, but I’m working slowly toward peace – as corny as this sounds, I think it’ll do me [mind & body] a lot of good.

Wish me luck moving forward.