Alex Lei Qin, Hofstra Northwell School of Medicine

First day of medical school. Nervous students huddled around a white bag in a cold room under pale fluorescent light. We made small talk across this white bag, trying to dance around the fact that this bag did indeed contain the body of someone who used to be alive. My memories momentarily flickered to the first episode of Grey’s Anatomy, when all of the surgical interns nervously stand around in the OR awaiting further instructions. Granted, in my case, my patient was already deceased.

Our preceptor approached us with a comfortable smile on his face. He went over the basics of what we were to do in Structure Lab today. The first part seemed simple enough: examine the patient from head to toe and make basic observations. Was the patient tall or short? Body frame size? Any abnormal markings? What are the signs on his body that tell you someone cared about him? Slowly, but surely, we unzipped the body bag. We all braced ourselves for the shock of seeing him, but it was somewhat anti-climactic; a white sheet remained, laid over his body. However, the gentle outline of his body underneath the sheet was unmistakeable. We slowly began to lift the sheet, starting from his toes.
​
Where had these feet taken him in life? Hands. Did he hold any grandchildren in these hands? Chest. Had anyone cried into this chest? Neck. What words of wisdom did he leave behind for his family? We stopped momentarily at the neck, nervous about lifting the sheet past his face. One girl in the group chimed in and said that it would be disrespectful to ignore his face regardless of how nervous we were. She was right. Face. Who was this man? We spent forty-five minutes looking at him. Just taking it all in. I found myself unwilling to believe that this was a person laying before me. He looked like a person, but didn’t feel like one. His skin; cold and clammy underneath my gloved fingertips. His expression; neutral, eyes closed, mouth slightly ajar. His chest; speckled with patches of chest hair.

We reported our findings to our preceptor. He asked us how we were feeling. Nervous? Conflicted? Unsure? Uneasy? “When going through Structure Lab, make sure you always remember that he wanted to be here just as much as you did. As such, you must treat him with respect. He is your first patient. We receive so many physical examinations throughout our life, but this, with you all here, is his last one.”

I wish I could say that this moment was a breakthrough for me. I wish I left that lab feeling empowered and ready to dive head first into the field of medicine. But I didn’t and I think that’s okay. Finding my confidence and individual voice in medicine is something that I expect I’ll be doing during the entirety of my undergraduate medical education. Perhaps even my residency. Maybe even forever. However, what I did walk away with was a deep, sobering respect for the man whose body had lay before me.

If there is a heaven, I hope he’s up there, laughing at how nervous we are about his body and cheering us on as we administer his last physical exam.

Alex L. Qin
(alexlqin.wordpress.com)

The first time I saw her, her skin was thin and wrinkled. Her hair was gray and brittle. Her eyes stared at the empty wall. She was dying. It was so, so sad. Goodbyes are so sad.

I remember wishing to be somewhere else. To pursue Obstetrics instead of Geriatrics. Where little people opened their eyes to the world for the first time. Where every day was filled with miracles of life.

I was so naive back then. Every life there was an empty book, waiting to be filled. Every life here is a masterpiece.

Again, I enter her room and see her. For the first time. Her skin is thin and wrinkled, like an aged book filled with priceless stories. Her hair is gray and brilliant, a rightfully earned crown. Her eyes look past the walls of this empty room, so full of wisdom and light.
​
She has lived and is comfortable with death. To say goodbye. And when the time comes, I will be ready to witness this miracle of life.

Fiona Scott, UC Davis SOM

Welcome Class of 2020!
You are about to embark on a most wonderful adventure. You have worked so hard to get to this moment and I hope in the midst of the craziness of orientation you find a moment to appreciate all you have accomplished, all you have sacrificed. I would also like to wish you a hearty congratulations. You have just acquired 109 or so new brothers and sisters—oh the birthdays you’ll have to keep track of! I know you’re all very busy assembling your new IKEA furniture so I’ll keep it short, here is a list of everything I know about success in medical school:

1. For better or for worse (mostly better) you are now family. Treat each other as such. Show love and patience when it is difficult to do so. Respond to texts and emails even though you’re tired, post helpful resources, bake cookies, don’t park your bike like an asshole (and wear a helmet—your brain just became exponentially more valuable).

2. Medical school is a beast. You’ll need a good team by your side to get through it. Think of who your people are (you know the ones you would call to help move a dead body). Not to be uncouth, but soon you will find you actually really need help moving a dead body in anatomy lab. You’ll also need people to talk to, to cook for you occasionally, drink with you, exercise with you, remind you to shower and vent/cry/whine to. Make sure your people know how very much they mean to you and that your victories in med school will be theirs too.
​
3. Take every piece of advice you are given with a grain of salt. Mostly people have your best interests at heart, and just want to tell you about stuff that worked for them. What was right for someone else may not be right for you. Ask lots of different people how they studied, what resources they liked, how they felt about classes and how they managed their time. Pick and choose what you like best and what you feel like helps you the most. Also…know that the library and several other indoor spaces are ironically and planet-destroyingly really cold right now. Come prepared with a sweatshirt, blanket, parka, snow shoes and snacks.

4. Numbers are not real. I think every math teacher I ever had is now sorely disappointed in me—but this is a helpful concept to keep in mind. Those loans you just took out—imaginary money which only exists on paper in the office of some boring stiff working at the Federal Reserve. You have too many important things to do, like loving others, to worry about how much debt you have. And no…you can’t pay back your loans by donating a kidney to the financial aid office—trust me I asked. The number that you see when you submit your very first quiz (and let’s be honest every exam from here on) will send your heart plummeting to the pits of your omentum. These numbers are also of very little consequence. You are not how many questions you missed, you are not how many you got right and you are especially not how many you got right compared to anyone else. You are you, not a number, not a statistic. What you have to offer is worth more than any value could ever contain.

5. Help will always be given in medical school to those who ask for it (I actually said this in my interview. I guess it worked because I got in—I mean who can resist a good Harry Potter quote). Seriously though, all you need to do is ask. Professors will meet with you as many times as you need for classes, life advice or tips on being successful. Second years will give you their two cents—whether you ask for it or not.

6. Sleep. Get some. Arianna Huffington of the Huffington Post extols the virtues of sleep to her employees. Showing up sleep deprived is like showing up drunk. Getting enough rest will help you learn better, perform better on quizzes and be less of a grouch to be around. When we sleep, we win. And no…checking email on your phone while laying in bed does not count as sleeping.

7. Crying. Someone told me that if you don’t have at least one melt down a block then you’re not showing up. Not totally sure that I think there’s a hard and fast rule to that one. But know that it is okay to feel whatever emotions come to you—and in turn give others permission to do the same. I’m British, so we have no emotions, soul or tear ducts. But its hard when you see bad things happen to people, you’re tired and stressed and pushed to the limit and then you watch a Hallmark commercial or a video of our Armed Forces returning home— and Lord Jesus why is it raining indoors?

8. Eating. Not only is eating important—it’s one of my favorite past times. Eating keeps you alive and gives you the energy you need to function. Ice cream is also a cure for most every ailment—except lactose intolerance. There will be free food. If you see food out in the lounge, just remember to use your best judgment. I ate salsa that had been sitting out for over a week last year—good thing my immune system is made of steel. There will be free pizza, every day, all the time. Use caution. Medical school was not kind to my waistline (can I get an amen second years). Eat vegetables. Buy them with your imaginary loan money. You can’t put a price on being healthy. Also we are going to be telling our patients to eat right—so try to walk the walk (and jog the jog) and stuff.

9. Dance it out (pants optional). Sometimes you just need a dance party. Sometimes that dance party is in the Medical Education building at 2am. Sometimes its when you’re alone in your room with a hairbrush microphone. TSwift has some sick beats and life is too short and too full of joy not to dance. So go on…get down with your bad selves.

10. Life is nothing but a series of experiences in which we learn more about ourselves. God, that was deep. What I mean to say, is find your voice here. If you love something, keep doing it. Or find new things to love. Writing is great—you don’t have to show it to anyone if you don’t want to. Join an interest group, go rock climbing, just promise me you’ll put the books down once in a while okay?

And that’s it. That’s all I know about medical school and basically life in general too. For more Harry Potter quotes, wry humor and vicious rhetoric follow my blog! I try to write every week for your procrastination pleasure– I’m not like a regular mom, I’m a cool mom. Welcome to the best 4 years of your life. Make yourself at home, drinks are in the fridge.
​
Fiona Scott (http://nerdseyeview22.blogspot.com)

Eyja Fridadottir

They said,
Not everyone can be the best.

And you thought,
I’ll show them.

Fast forward many months of struggle and self doubt, shame and regret
Late nights, highs and lows
In retrospect, a slide reel of a story so predictable and
Disappointing.

Maybe they were right.

But I wish you hadn’t said that.

And as delegate to my future,
You represent a system that
Has no faith in me.

You suggest
That life is a disappointment,
That this is a race,
And to get ready to

Always wish to win.

Not long ago you also said,
Take care of yourself or you will burn out.
You must practice self care to be human and be empathetic

Here are your checkmarks.

Which is it?
What is your meaning?

Should I run with all my might to a sun always just past the horizon, burning my skin, my eyelashes, my insides made hollow as all fuel has dissipated?

Or do I bend my knees in supplication,
Work what I think, you think, is reasonable?
Sleep too much, smile in moderation, trajectory predetermined,
I am so bored already.

We need no heroes
But in language framed in downward-slanting futures
I can’t help to want to save
and be saved.

I wish instead,
You said

You came here for a reason.

To not forget
That people will doubt you

To chase achievement without context will make you
Alone.

But remember,
You came here for a reason.
​
And that I decide
What I need.

Why Care about Palliative Care?“Our ultimate goal, after all, is not a good death but a good life to the very end.” – Dr. Atul Gawande, Being MortalI wish I had words as eloquent as Dr. Gawande when my aunt was receiving chemotherapy. The emotional and physical toll chemotherapy wrecked was heart wrenching to watch, let alone experience. I wish I had a perspective so wise when my aunt passed away and my heart fell through my stomach. Many people consoled, “at least the suffering is over.” But was it a good life to the very end, if she suffered so much at the end? Had I ever thought to ask her how she wanted to die?

This was a difficult question to ask amongst my family, and exists as a difficult question for many people to ask today. However, this is an essential question to ask as a healthcare provider. Treatment throughout a patient’s life does not end simply because life is ending, as it inevitably will. Treatment does not always translate to maximum extension of life. Treatment means meeting the patient’s goals. If Mr. A wants to live to see his granddaughter’s wedding, a provider should prioritize this. If Karen would feel more comfortable at home than surrounded by machines and strangers in scrubs, providers should help her achieve this.

Palliative care is not as glamorous as life-saving surgery, does not provide the adrenaline rush of emergency room care and is nowhere as endearing as rounds in the newborn nursery. Providers do not get directly compensated for taking ample time to have conversations of end of life care with their patients. The end of one’s life can arguably be defined as some of the most important days of life; this is the sunset of life, the final reflections on life and the last moments of interaction with the physical world. How then, can our healthcare system simply give a cursory nod to people in this moment? Palliative and hospice care are gaining momentum as families realize their potential to respect the wishes of their loved ones. Nonetheless, this is a frontier that has yet to be developed into a standard of care within both healthcare and families.

​The relevance of palliative care is articulately described by Dr. Gawande in his latest book, Being Mortal. My classmates and I had the opportunity to listen to Dr. Gawande speak on his own experiences and touching personal anecdotes on end-of-life care at a Minnesota Network of Hospice and Palliative Care conference. His thoughtful and frank words remind me of the care and artistry involved in the practice of medicine, aspects I hope to never forget.

​Gracen Conway, The University of Oklahoma College of Medicine,

When I was a young girl, weekends were always for writing. I would get up early and sit with my dad as he had his coffee and I would type away, dreaming up characters and plot lines. I can’t get that weekend mindset out of my head years later: I still wake up on these lazy mornings ready to contemplate the world. This weekend, more than other weekends, I really need to reflect, to delve into the writing I’ve neglected and pour out my thoughts onto the keys.

This weekend marks the end of the seven weeks of human anatomy, and any immersion that intense requires a lot of debriefing. For seven weeks I have woken up in the middle of the night arguing with myself over the location of structures, I have spent early mornings writing anatomical terms to prepare myself for a long day of learning, and I have stayed up as long as my eyes could remain open to review the hundreds of structures and terms I had learned that day. I am exhausted, but I am also excited, because for the first time in my academic career, I truly feel like I am on my way to becoming the physician I am meant to be.

I will admit that from the accounts I had heard before, I expected the anatomy course to be the worst seven weeks of my life. Really think about it for a minute: spending a minimum of two hours a day in a smelly lab looking at dead bodies. This sounds like many people’s definition of a nightmare! Yet I did this, willingly, joyfully even, for seven weeks.

Did I really just say joyfully? I’ll be the first to tell you that this course was undeniably difficult. Before this course I thought that in order to do well, you have to eat, sleep, and breathe anatomy. In many ways this is true: I spent many meals eating over my books (ew), had interrupted sleep due to anatomical terms stuck in my head (flexor digiti minimi!!!), and thought about the course as often as I took a breath. However, I have learned during this course, that there is still time to do more than just anatomy, even if it doesn’t seem like it at the time. And I learned it the hard way: by spending every moment doing anatomy, missing important aspects of real life, and not getting the results I wanted. When I finally let myself put down the books at night when I was tired and wanted to sit on my couch and relax, I started doing better in school, not worse. When I spent more time in my kitchen cooking than speeding through the drive-thru, I started doing better in school. When I got more sleep and relaxed more, I started doing better at school. Somewhere around week three or four, something clicked. I began to realize that I needed to work harder for shorter periods of time and I could get the same results (or even better!) on my assessments. I began to realize that the “hardest class” could really just be a ramp-up course to prepare me for long days, sleepless nights, and infinite amounts of material to learn in a day.

What I can learn in a day now is infinitely more than I could learn in a day seven weeks ago. I have exceeded my own expectations of what I can do, and I think this course has opened up a whole new way of learning for me. Tomorrow, I will have to figure out how to study for a new course. I am excited for the new challenge, but I will go forward with the grace and respect for medicine that I have learned through human anatomy.

Before medical school, I expected the anatomy lab to be a gruesome and miserable place. For some of my classmates, I think it still is. But to me, the anatomy lab is the site of my awakening. I have awoken to the person I need to be, to the level of skill and dedication this field requires, and to the narrow line between life and death that we tread each day.
Our school has many unique processes for this course that aren’t like other schools. One of the neat differences is that we use willed bodies donated to science for our labs, and prior to beginning the lab, we meet with the families of those who have donated their bodies to our education. This sounds like the worst idea in the world at first. But at the same time, I welcomed this bizarre tradition, and I really enjoyed learning my donor’s history and what sacrifice my donor made for me. With knowledge of the person who lived within the body under the shroud, I began to contemplate my perceptions of mortality at the same time as I searched for structures.

At first, it was hard for me to think about the body in front of me as once being a live person, but before I knew it, this mindset became second nature. I referred to my donor by name, and did the same for the donors my friends worked with. I wanted to learn the back-stories; I wanted to know the history behind the person who chose to give me immense knowledge about the human body. I found that in learning about the body in death, I learned a great deal about life. As I sit here trying to think of the right words to say, I find myself speechless. I think this is what religious conversion might feel like: a powerful feeling so intense that words are too fleeting to describe the transformation. What I do know is that I am different because of the anatomy lab. I know more about medicine, I know more of what I am capable of, and I know, however strange it may seem, another body more intimately than my own. And there are a lot of weird feelings that come with that responsibility. I know that as a physician I will hear and see things that few people will. People are going to share with me the most intimate details of their lives, their deepest fears and their strangest and scariest symptoms.

I never expected to be so changed by this process. And they don’t tell you before anatomy that you’re going to like it. Maybe those who go before us want us all to experience it for ourselves. But I think I need to share my story, less for you and maybe more for myself, so that I can finally put to words these feelings that have blossomed over the last two months. Being a part of medicine is a gift, and I learned that because of a person who gave their body for me.
​
On Friday as I went into the lab for the last time to gather my materials, I stood at my table and soaked in the holy moment: just me and my donor and the place where I truly felt alive in my profession for the first time. There I prayed, for my team, for my instructors, for my donor, and for my journey. But mostly I prayed thanksgiving for the gift I was given, to be able to participate in medicine, and for the many people who paved the way for me. If you read my last piece, you know that I have really begun to understand how important others are to my experience and my success in medical school. Through this course, I have learned that without others, I would know nothing. Without my donor, I would have only a superficial knowledge of the body, but with my donor’s gift, I was able to learn about life and death in a way that will prepare me for years of helping others lightly tread the line between this life and the next.

Cyrelle Fermin, UVA School of Medicine

Take a mental snap shot of the posture you’re in right now. Are you hunched over your computer screen or smart phone, reading this article? Do you find that you’re in this position quite often, either due to studying or reading up in preparation for rounds? Maybe this is your go-to position of comfort. I find myself naturally inclined to slouch over in this manner. When I realize it, I make a conscious effort to come out of it. I get up, I stretch, and I ditch the slouch. Turns out, coming out of this hunch can do so much good for you.
Dr. Amy Cuddy, a social psychologist and Associate Professor of Business Administration at Harvard School of Business, studied the benefits of the power stance. By assuming a power stance for just two minutes, you can:

• moderate your stress hormone levels
• give yourself a boost of testosterone

Others will also distinguish you much more positively, especially when put in positions where you are being evaluated (did someone say interview season?). But for those times when you won’t be in such a high stress environment, power stancing will still do your mind and body wonders.

Here’s a quick tutorial to get you power stancin’:
1. Find a place where you can be alone for about 2 minutes. It could be a bathroom stall, a study room by yourself, or your room. (More power to you if you feel like showing off your power stance in a more public space!)
2. Stand with your legs about shoulder width apart.
3. Assume the power stance: extend your hands and arms over your head in a V position. Keep it this way for as long as you want, 2 minutes being a pretty good length of time. Give your body this 2-minute treat when you’re feeling down and hunched. Your body will thank you and you’ll be feeling like a boss!
For a link to Dr. Cuddy’s published article on the Power Stance: http://pss.sagepub.com/content/21/10/1363.short
For a link to Dr. Cuddy’s TedTalk, explaining the theory and science behind the Power Stance (Over 30 million views!): https://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are?language=en#t-926754
(With contributions from Dr. Susanna Williams, UVA Mindfulness Center Quick!)

Raye Reeder, The University of Oklahoma College of Medicine

For me, it always starts behind my eyes. It’s the end of the day, and there’s a weight behind my eyes, pulling the rest of my face down, creating a painful point in the center of my forehead. I force myself to push through the last few pages of my notes, and then I go home. It starts earlier the next day. Eventually, I wake up with it there, the weight accompanied by a soreness in my neck, and my emotions going from balanced to that of a spark in a powder keg. When my mom asks how I’m feeling, I tell her "I’m fine, just tired,” but I don’t think there’s a word that truly describes the expanse of this exhaustion and the crippling knowledge that it will only continue through tomorrow.

When we start medical school, we are told it will be hard, that our days will be consumed with studying figures, memorizing drugs, and the occasional body part. I was prepared for this. I just don’t think I realized how tired I would feel at times, how stretched thin, how outside of myself I would become. We chose to become doctors to help people, to better our communities, and to save lives. I don’t remember signing a form that allowed medical school to give me new wrinkles, a caffeine addiction, and a stronger prescription for my glasses! But here we are, and here I am, absolutely exhausted. I would be lying if I said I had never had a moment in that exhaustion, when the weight behind my eyes spread down to my feet and dampened my drive for this dream, that I wondered if this was truly worth it. I could help people without spending my days studying. I could do something else to better my community and still have time to go out with my friends for drinks, maybe even have a hobby! And I would probably be able to do it without complaining to my friends about my workload, disgusting them with my knowledge of the lower bowel, or impressing upon them the full expanse of my exhaustion. It could be great; it could be easy. But I wouldn’t be in love with it like I am with medicine.

I know that the stories we like to share about how much we love medicine tend to involve a sweet patient, a hug from a child, or an academic epiphany, but I think I have found my love story here, in the moments when I am so tired that the dishes pile high in my sink and there is never quite enough coffee to bring the pep back in my step. Love is not always a perfect moment; sometimes it is the instances when we feel so far removed from our dreams that we nearly forget why we started pursuing them in the first place, because, in those instances, we make the choice to keep going anyway. I may not always be the happy, bubbly, high-energy doctor for my patients, but they will always have the doctor that will never stop working hard, even when her shine has worn away for a moment. In my fatigue, I have found the true depth of my love for this profession, and an indomitable strength and drive to keep pursuing and protecting this love in spite of the difficulty.
​

​
This is a love story I am so proud to be a part of, and it’s a story that I will continue to live for the rest of my career. If you’re feeling tired too, I promise you’re not alone. Maybe we can meet up for coffee and talk about it, but we should probably both take a nap first. I’m sure we both need it.

Mike Natter, Jefferson Medical College

They say you can tell the inexperience of a med student by the weight of their white coat. Pockets are stuffed with reference books, note cards, snacks, stethoscopes and a myriad of other tools. There is one tool in particular I have been wearing since starting med school – a mask. Throughout my first year, I was waiting for someone to tell me that my acceptance was a clerical mix up. “You don’t actually belong here,” they’d say. But there I stayed, making my way through. By the end of my 2nd year, that mask I wore began to lose its purpose and I was prepared to put it away for good. Now, more than ever, starting out on clinical rotations, with my inexperience, heavy white coat and all, I feel I am an imposter all over again. I suspect, as it did in the past, this feeling will fade but in the meantime while I fumble through surgery, I may need a bigger mask (and perhaps a nap).
​
Follow Mike on Instagram here: https://instagram.com/mike.natter

Mindfulness in the Medical Student
• What is mindfulness?
• A real-world application
• Why should you be more mindful?

Mindfulness. If you had a psychology class in undergrad, you may be familiar with the term. According to GreaterGood, “Mindfulness means maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment.”

When I first heard the definition of mindfulness in my “Stress and its Management” undergrad course, I asked myself…
• “Why does this need to be defined? “
• “Isn’t this something practice by pretty much everyone?”

As it turned out, mindfulness was something I could really use in my life. I was a pre-medical student at the time who knew how difficult it was to get into medical school. I had made the internal resolution that I had to
1. get a 4.0
2. be involved in tons of extracurriculars
3. be a well-rounded person at the same time

I wasn’t alone: I had many friends who were also pre-med, with the same resolutions that I had made for myself.

This mindset and environment was the perfect storm for a very stressed out, high-strung 20-year old. At times, I felt like I just had to keep up, with no time to really reflect on myself. I was on-the-go constantly, going straight from class to my volunteering position at the hospital. I was constantly on my phone, getting updates from student orgs and catching up on emails.

Now, back to that lecture in my psychology class. We proceeded to do our first deep-breathing exercise, with instructions to sit relaxed in our seats, feet flat on the floor, hands resting on our thighs. Above all, we were instructed to focus only on our breath, taking care to bring ourselves back to the present exercise if our minds wandered.

I’ll be honest: I thought it was ridiculous. Here we were at 9 am on a Monday, turning the lights down in our lecture hall, closing our eyes. It sounded like nap time to me. Our professor knew this was on our minds, cautioning us to stay awake during the exercise.

She proceeded to guide us through a deep-breathing exercise. I won’t go into too much detail, but I opened my eyes after that 3 minute exercise feeling so refreshed. It was also a time that forced me to just slow down, reflect on myself, and be present. It was liberating to say the least.

While I could be more consistent in incorporating mindfulness into my life, I will say that it has already impacted my life to a measurable degree. I am empowered to be more aware of when I am stressed, pinpoint what is overwhelming me, and find ways to minimize my stressors. Not only will mindfulness benefit me, but it will also help me provide optimal care and attention to my future patients.

As medical school on, the challenge to incorporate mindfulness may seem a little more daunting. My schedule’s busier, my days are longer, and the work is harder. But I’m up for the challenge. I hope you are too! Consider incorporating mindfulness into your daily life.

Before you leave this post, I challenge you to take 12 minutes and practice mindfulness and see its impact! Here's a great video that can walk you through a mindfulness exercise. I'd suggest closing your eyes and following the video with your ears. (Leave a comment and share your thoughts after!)
​