52 Posts Left...

It is hard to believe this is the fourth time I've reread my first post. Today is the four-year anniversary (hence the "linen and silk" shoes pictured left - Wikipedia says a four-year anniversary gift should be something made of linen and silk) of my first acceptance to medical school. Each year I go back and relive my December 26th experience in Chapel Hill, NC - my first taste of the years to come. I still get chills when I read it, remembering the anticipation, joy, and relief like it was yesterday. Inspired by my sister's blog as a PeaceCorps Volunteer in Ukraine, I decided I would start my own literary journey, which soon turned into weekly posts that I promised myself to continue until the end of medical school. And today it seems surreal to announce that I only have 52 posts left.

Obviously (if you do the math) 52 posts doesn't take me all the way to the end of school. That's because, over the course of the spring semester, I will transition this blog to something bigger and better (waaaaay more details on this to follow in the coming months!). For now I will just say I am looking forward to continuing this personal journey for one more year, and I am excited to continue writing about my final experiences as a student.

In the coming year I hope to diversify the posts a bit more. I am going to ask my family members (yes, that means you! - Mom, Dad, Shelley) to each write a blogpost. My mother has dutifully edited this journal for the past four years, and I want her to detail her own take on the experience (and then I can edit her writing for a change!). Shelley was my inspiration, and Pops needs to comment on how pumped he is that I will actually have a real job before the age of 30 (knock on wood). I would like one or more of my preceptors to write a post, and maybe I will throw in few other guest bloggers in the process. It is going to be a good year.

As another December ends, I also must look back on my three New Year's Resolutions for 2012: first, learn to cook something. That one was mission accomplished. I also was able to reach my second goal, taking a year to study Public Policy. The third one I am going to have to fudge; I really wanted to "go somewhere crazy" in 2012 (I really wanted to go to SE Asia). I did make it to Costa Rica, and on January 1st I will head to Belize, but I wouldn't call either place "crazy" (the more Americans you find somewhere, the less crazy it actually is). Add them together and you get a pretty daggum good vacay though.

Resolutions for next year? I think I will pass. I have some personal ones, but I can say I would like to continue to learn how to cook. However, I'd really like to have a real job! That resolution, though, will have to wait until 52 posts from now...

Happy New Year!

Lots and Lots o' White Men

Earlier this fall, I had the opportunity to attend the 97th Annual Clinical Congress of the American College of Surgeons. It's the meeting of the bigwigs. Surgeons from across the country travel to Chicago to attend top-notch skill sessions, expert panels, and lectures on leading research. Speakers feature the premiere innovators and investigators in their specialties. As a medical student, I attended interview training sessions and resident panels. I also made sure I took the opportunity to take a step back and soak in the entire experience. I wrote down some of my first impressions...

Impression #1 - There are a lot of white men here.

I've spoken quite a bit about the importance of mentorship on this blog, specifically about how mentors have shaped my career trajectory. I can honestly say that I'm not sure I would've chosen General Surgery without the skilled and caring surgeons I worked with in Asheville and Linville, NC. I certainly wouldn't have considered rural surgery without briefly living the craft, getting to know surgeons who have worked in a rural area for 10+ years and then moved back into academia. I cannot stress how important it has been that people like me are already doing what I want to do. With this knowledge, I believe I can accomplish as much as they have, and even push the boundaries.

Aspiring leaders want to know that their dreams are reachable. First, they must have access to the necessary resources (e.g. students of low socioeconomic status must have the educational and financial means to even get to medical school). Second, they want to see someone who has come from their position... and succeeded. Politics aside, it is no longer a question whether an African-American can be the President of the United States. We now have a black Commander and Chief. It is no longer a distant dream of possibility; the path has been forged. Resources and mentorship: our youth need both to succeed.

So why is this an issue in medicine? I've focused quite a bit on rural disparities. One quarter of the US population lives in a rural area, yet only one out of every ten physicians work there. This population is in dire need of primary care physicians and general surgeons. Studies have shown that women are more likely than men to go into primary care and minority medical students are more likely to care for underserved and indigent populations. Yet only 6.3% of the American physician workforce is black. Women are only a third of the physician workforce.

Of course, in 1970, only one-tenth of all physicians were women, so great strides have been made. But the progress is slow, and often the leadership lacks diversity. I guess this is to be expected, since the more experienced clinicians trained at a time when the medical profession was almost exclusively white men. And their mentors were probably white men, and their mentors were white men. To change this we need to work on access to resources, and make sure there is an increasingly diverse group of mentors. In both regards, medicine can (and will) improve. Just an observation.

Of course, I am another white man. So I guess I'm not helping the statistics :).

Helplessness

(Update: for a wonderfully written article on this, click here to read the Huffington Post article.)

Today marked another unbelievable tragedy in American history. Twenty-seven are dead in Newtown, CT. Twenty of them were elementary school students. The school ran kindergarten through fourth grade. The principal was murdered. The school psychologist murdered. Dozens of children executed. I've heard that word, "executed," used quite a bit day, and it is only appropriate. Almost zero injuries, only death.

I've written quite a bit about the helplessness that medical students begin to feel in their third year. We enter as first-years expecting to ameliorate suffering in our patients. This profession is a golden opportunity to improve the health and lives of our fellow human beings. The doctor is an all-powerful being. Rarely do we think that we are going to fail, we are going to make mistakes, and we are going to fall short. We imagine our power to be much greater than it actually is. However, third year is a real wake-up call. As we spend more time in clinical medicine, many struggle with the limits of our knowledge and capabilities. Not just the knowledge that we lack as third-years, but the capabilities that we will always lack. I cannot ensure that my patients take their medications or quit smoking. I cannot guarantee they will have food on the table, and a roof over their heads. I cannot always safeguard a child from the trauma of physical abuse, or the tragedy of a mass execution. The guns used in the massacre today were legally registered to the perpetrator's mother. A pediatrician can talk about gun safety in the household, but cannot ensure it.

I don't know much about gun laws, but I do know we don't take mental health seriously enough in this country. We have no problem understanding disease processes that we can see: the flu causes fever, diarrhea, and vomiting. These are easy, physical symptoms that we can identify, and we understand the need for medical intervention. We even develop annual vaccines so we can avoid this illness. Diseases of the brain, however, these are more difficult to comprehend and more difficult to prevent. Interventions for these illnesses often do not receive the same amount of funding or support. The public doesn't equate diseases of the mind and diseases of the body. But they are one and the same. The mind is the body, and the body is the mind. The aggregate of the mental health of our populace is our country's health.

I wish I knew how to ensure that a tragedy like this will never happen again. Yet again I feel helpless, but I also feel a responsibility to try. Like medical training, it is our duty to learn as much as we can and do our best for others, even if we fail. I've enjoyed many subspecialties during my training, but few more than Pediatric Surgery. Watching TV today certainly made me wonder whether I could have handled being the surgeon on-call when those two children rolled into the Emergency Room. I want to think I could have, and that I would have been at my absolute best. If that is the road I take, perhaps that is my part. Or my part will be advocacy. Or something else. All I know is that the statement "this is an inevitability of our culture" is not acceptable. We can be better.

I moved my flight up a couple days, so I will be flying home to DC tomorrow. I will hug my parents a little harder when I return home.

WHEN MY PARENTS WANT TO KNOW WHAT I'M DOING AT SCHOOL

Recently, I have been obsessed with tumblrs. Ever since I found out that my Mom knew about "pinterest" before me, I've been making sure I'm up on my e-culture. Tumblrs are not new, but I certainly have enjoyed this one over the past week or so. It speaks to me. It's mostly nerdy lab stuff (I've spent my fair share in the lab, so I love it), but once in a while it hits on grad school in general. I wasted an hour on it procrastinating before the Thanksgiving break, continually hitting the "random" button for fresh jokes. I like this Napoleon Dynamite one specifically, because during the Labor Day weekend football game at UNC this year, my Dad had to ask one of my friends (who is getting a "real" dual degree, aka an MD/MBA), what I was doing up in Boston...

WHATEVER I FEEL LIKE, DAD! GOSH!

Sometimes, though, it is tough to know exactly what I'm doing here. I have had a couple friends, who are now fourth year med students, travel through the Boston area on the interview trail. It is awesome to hear their excitement (and sometimes weariness) about the process, and the anticipation as Match Day approaches. Most people have November and December off to interview, speed-dating all over the country at prospective programs. In many ways, I'm jealous.

I know I'm not ready to "settle down" yet (aka buy a house, pop out a few kids), but I'm definitely ready to "settle in." I would love to call one place "home." For the next year and a half, I will live five months in Boston, two in Asheville, one in a rural part of NC, two or three back here in Cambridge, then a few months jumping around DC/Boston/Chapel Hill, finally settling down Chapel Hill for a 3-4 months before moving in June 2014 permanently (wherever that might be!). The move/drive from Asheville to Boston was exhausting enough; just thinking about this itinerary makes me what to sell all my possessions so I don't have to store or move them.

Laptop, carry-on, and a free checked bag. Thanks, Delta.

Every once in a while I have to ask myself, "Am I really about to take 'end-of-the-semester' exams again (and again)? Am I really taking an undergrad level Intro to Economics class? Are people really pulling all-nighters for reasons other than call or a real job?

I keep telling myself there's a light at the end of the tunnel. A couple days in Chapel Hill to see Ronnie and meet with the Surgery department, then Christmas, then a week on an island off the coast of Belize (gloriously by myself), and then I face 2013 with a whole lot of medicine in my future. I will be reenergized and amped to start studying before my Family Medicine rotation in June, and so ready to be back in the OR and on the interview trail myself!

Time flies. Just not during exams. Come on Xmas break!