Tag Archives: Medical School

Step 1… Closer to Being a Doctor

It’s been quite a while since I’ve written anything on this blog, and I’m sorry about that. I had to make a decision back in January, and it was really tough. Do I…..

1) Study really hard all day and every day for Step 1 so that I can become a doctor.

or

2) Continue to blog, increasing my status as an internet celebrity and cementing the love that both of my readers have for my writing (and one of them is still my mom).

I obviously went with the first option. I studied long, hard, cold days for that stupid test, and I’m here on the other side of it with a majority of my sanity intact. If you are here to read a little about the test, skip on down a few paragraphs for my take on the exam and studying. Sadly, studying for days and days on end does not lend itself well for blog posts. Frankly, nothing interesting really happened. My wife did a bunch of fun stuff, and I made sure to get out and do things in the world on a weekly basis, but the vast majority of my time (even weekends and evenings) was spent in the library or at my desk.

I received my score a few weeks ago, so I am past the nervous period of waiting for those 3 digits (hopefully 3 digits, I’d hate to be the first guy to score less than 100!). I did ok, but I feel like I was capable of scoring higher, which is a little frustrating. I would straight up just tell you guys what I got….but you know, it’s the internet, Obama, NSA, etc. I’ll just say I scored a little bit below average, which is kind of my place in the world of medical school. Not really dumb, but also not smart. It’s a good enough score for most of the specialties I am interested in, but it makes some of the competitive specialties more of a reach (orthopedics, for example). Thankfully, I’m not a super gunner (see below for explanations of new words) and I’m not trying to become a plastic surgeon at the Mayo Clinic, so my score should be just fine. To compensate for my subpar score in the dating scene that is residency applications, I plan to make sure programs know that I also have a terrific personality.

So how specifically did I study for this test? First Aid, UWorld, SketchyMicro, and Doctors in Training. Before you copy those down as bullet points, you need to read the next sentence. Figure out how YOU learn as a student, and tailor your studying to that. For example, if you don’t learn well from videos, don’t buy Doctors in Training, because you’ll just be wasting your time. I’ll run through these resources in order of importance:

1) Uworld – this is a giant question bank (2200+) that closely resembles the questions on the actual test. You simply must do the entire bank of questions. Don’t procrastinate doing these, either. Start early, take notes, and review your answers. This is as close as you can get to the actual exam, so spend a lot of time here.

2) First Aid – The Step 1 Bible, everything important can be found here once you learn where to look. Definitely have this open often. Definitely add information to the margins. Definitely never just sit and read this book. It’s not meant to be read. Because everything is in outline form, you won’t learn much from reading the words. It is useful to browse through sections to remind yourself of concepts you have already learned, but not very useful as a way to learn complex concepts.

3) Sketchy Micro- this is a series of cartoons drawn by some genius (who is also now rich). Each of the cartoons give you little memory aids for bacteria, viruses, etc. This is stupidly helpful, especially because I didn’t learn anything from out Microbiology course. It’s fairly cheap, quick and easy to watch, and I guarantee that it will add points to your exam. I hear they are also coming out with Sketchy Pharm for future tests, which should also be very helpful.

4) Doctors in Training – this is the least mandatory of all study options. First off, it’s pretty expensive. Secondly, it’s fairly time consuming. Last but not least, it’s pretty expensive. There are some advantages to it though. Let’s say you have your heart set on a specialty that is not competitive, so you just want to pass the test and have a score that starts with a 2. If you buy DIT, watch the videos, and fill in the workbook, you are going to pass the test. They do a good job covering material efficiently, and they have spaced recall built in to the workbook to help drill in some of the details. It seems like their motto is “If you don’t remember it the first time, you’ll remember it the 8th time”.

My last few thoughts on Step 1 are especially pertinent to students who didn’t do well (like me….just kidding). After just a month or so of clinical exposure, I’m beginning to realize how little anyone cares about Step 1. I think it gets overhyped to second year students (at least it was to us). The material tested on Step 1 has very little clinical significance or correlation. Attendings and residents have been very emphatic that we are just now beginning to learn actual medicine. Finally, there’s a lot more that goes in to your residency app than your Step 1 score. If you want to be a plastic surgeon or dermatologist, you may want to work crazy hard and score well, but don’t freak out because you scored 5 points under the average for your specialty.

To close out this post, I need to include a little dictionary (for people like Mom) who may not be familiar with some of the “buzzwords” of clinical medicine. I will use these words frequently in future posts. This will be on the test.

Attending – this is an actual, fully licensed physician. They lead treatment teams and represent the light at the end of a long tunnel. The attitude of the attending often determines your fate as a med student. Good ones will teach well, have a good attitude, let you do cool stuff, and let you leave to go study. Bad attendings pimp you mercilessly, make you stay tediously long hours, are cynical and jaded, or just aren’t involved with anything going on.

Pimping – this is what happens when a senior team member asks questions to a junior member, usually in a pressured setting. It’s kind of like teaching, just scarier and with a lot more crying. Pimping can be aggressive, like an attending asking rapid fire questions to a medical student in front of everyone at rounds. It can also be helpful, like a resident asking you which structures you can identify during a surgery, then helping identify ones that you have missed.

Resident – these people do most of the actual work. Residents have graduated medical school but not finished the required residency. They are doctors, but don’t have the freedom (or responsibility) of an attending. Residents come in several flavors. Interns are fresh out of med school and are highly supervised. Each successive year past intern year, residents are given more responsibility until their final year, where they transform into the chief resident, who does everything. Residents work long hours, are not appreciated by anyone, and can be the best/worst part of your rotation on the service as a medical student.

Rounds – the sacred ritual of medicine. This happens once (or more) daily, and comes in a few flavors. Walking rounds are exactly what they sound like. The team walks from room to room. First they talk about a patient in the hallway, then they go and see that patient. Sometimes they just talk, then people see patients later, but you get the idea. Sometimes everyone sits down at a table and just talks about the patients. Sometimes rounds only take 30 minutes. Sometimes it takes hours and hours and hours. Students often present their patient(s) during rounds, giving an attending or resident a chance to pimp the student on that disease/treatment.

Tune in next time for ER stories, featuring the lady you got drunk, passed out while smoking, lit her mattress on fire, and had to be admitted for simultaneous burns AND being super drunk (at 10am on a Monday). Or, tales from OB-GYN, featuring the legendary lady with a BMI of 92. I’m more motivated to write when I see stuff like that on a daily basis.

Thanks for reading!

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Status Update

It’s been a while. I’ve been absent from this blog for nearly two months now. Shockingly, I still received a couple of messages from people despite my absence. One naive soul guessed that I was participating in NaNoWriMo, AKA National Novel Writing Month. I certainly wasn’t writing anything important, much less a full novel in a month that also featured medical school.

So here’s where we are at right now. I am 4 months and 2 weeks from taking Step 1 of the USMLE, which means it’s time to get my butt in gear and study. Hopefully the irony of me saying this while actively avoiding studying is not lost on anyone. We will finish up our current unit (GI) before Christmas, and then all we have is Endocrine, Reproductive, and Skin/Bone/Joint. Effectively classes end at the end of February, and we all become hermits and study for USMLE, which we take at our discretion (somewhere during April, most likely). After that ordeal is over, we will start our third year clinical rotations at the beginning of May. This means that I am nearly halfway done with medical school!

So the title of this blog is “Highs and Lows” in medical school, and I’m certainly in a rough patch right now. First of all, I have put myself in a bad place by doing poorly on the first half of the GI Module, meaning I need to drastically improve my score on the Final Exam in a few weeks. Unfortunately, it’s the Christmas season, I have lots of stuff I would rather be doing, and it’s crazy hard to study when we have had so many dark, rainy days (I’m a little bit solar powered). The study load isn’t just GI course stuff, which would be time consuming by itself. It’s also Qbank questions for Step 1, and it’s reviewing Microbiology from 3rd party sources (because our Microbiology education was severely lacking), and it’s also working on research, among other things.

Oh right, that might be another thing to mention. Even though I don’t have the faintest idea what I am doing in research (or life, for that matter), I now have my own research project. It’s a super exciting technical paper that has me swimming in PubMed articles up to my ears. I strongly dislike research, but I guess residency directors like it (I can’t see how), so I am spending portions of my already limited time on research now too. Hopefully I get a publication or something to show for it, besides the huge Excel document saved on my desktop.

The ironic part of (nearly) failing my first GI exam is that I really like it so far. I worked in a GI practice for several years before starting medical school, and those GI docs were doing just fine. The procedural aspect of GI appeals to me, the hours aren’t terrible, and it pays decently because you have to deal with everyone’s poop all day. On the flip side it can be pretty competitive to get into and has a long residency fellowship. I actually have done fairly well in GI, but leading up to the first exam I was busy achieving Platinum in League of Legends, finishing a great book, and going through a phase characterized by a deep aversion to studying. Truth is I was a little bit burned out and it came back and bit me in the butt. Oops.

So that’s the take away message from this point. Med school is very much a grind right now, but I’m grinding through it and it’s getting better. It helps that it’s a Friday afternoon and I have the weekend ahead of me to “catch up”.

Lots of good stories to share someday in the future. Hopefully I will get those posted sometime.

Thanks for Reading!

So You’re At Chipotle…

You aren’t quite sure how it happened. Maybe a coworker mentioned something earlier in the day. Maybe you saw sign while driving yesterday. Maybe you dreamed about Mexican food last night, and your subconscious mind steered you here today for lunch. However it happened, you’re here again. You just pulled in to your local Chipotle for lunch. Wherever you are, no matter the time of day, your Chipotle experience will always include these components.

1) The Line

And this is before they open.

So you walk up to the door and find a kind soul holding the door open for you. Just kidding, they are the end of the line. You take a glance inside to confirm that, yes, the line does in fact wrap around the entire restaurant and right out to the door, where you stand. You briefly consider going somewhere else to eat, but in that instance you smell the grill in the back and you know you’re staying. As you assume your position as designated door-holder, you evaluate the line in front of you. Because there seem to be 42 people making burritos behind the counter, you figure you won’t be in line too long. The line seems to be moving well, so you whip out your iPhone. A few minutes isn’t a big deal if there is a delicious steak burrito waiting for you afterwards.

2) The Other Customers

You glance up from your phone a few minutes later, annoyed that the line seems to have stopped moving. People have piled up around the block behind you, everyone looking at their phones and waiting for that sweet, sweet burrito. The problem is at the counter, the place where you choose your salsa/toppings for the burrito. You don’t know how you missed it earlier, but this lady is clearly the bane of lunch rush. She’s reading from her iPhone, attempting to keep the 8 burritos in front of her straight. There are also 6 quesadillas on the grill behind the counter, and oh wait she forgot she needs to order 3 veggies bowls. If you’re lucky, she will pay the total (probably about $580) and collect money later. If you are having a bad day or are exceptionally hungry, she will pay for each order separately with a wad of cash and debit cards that she has collected previously. The person immediately behind this woman is guaranteed to buy a margarita, even if its 11:15am on Sunday.

3) Ordering

Once that lady clears out the line shifts into overdrive. The workers seem to sense customer frustration and go into overdrive. The manager packs an extra dozen or so people on the line. Before you know it, you are finally at the glass. Almost reverently, you order the steak burrito. The kindly Chipotle minion immediately begins warming your tortilla. “White or brown rice?” he asks you. I’ll usually get the white rice, but I’m known to switch it up. I usually prefer white rice because of the nice cilantro flavor….ok I’m getting off topic. “Black or pinto beans?” he asks next. I have a secret theory that not getting beans results in getting more meat on your burrito, but I haven’t been able to confirm that. So I order no beans.

Boom. Out comes the hot steamy tortilla. Without fail, he will look back at me and say “Which rice do you want?” I will be confused because I ordered white rice exactly 8 seconds ago, and he seems to have no memory of our very special conversation. He will then ask which beans I want (which I don’t actually want, remember) and then he has the gall to ask what kind of meat I want! To his credit this was a whole 30 seconds ago at this point, but I very clearly ordered the sacred steak burrito. Even more confusing is when multiple people team up to warm tortillas, serve rice and beans, and portion meat. I will sometimes order at the tortilla guy, who will communicate my order to the next two people. If that happens, all three of them are guaranteed to ask me at least one more time what my rice/beans/meat combo was.

Good Chipotle customers know that there are some rules. First, don’t change your order. That’s just annoying. Don’t ask for more meat unless you are willing to pay to double the meat (which I totally recommend). If they are even slightly busy (which is always) do NOT order the quesarito. It takes forever, and while it is delicious, everyone will hate you. If you order a bowl, don’t get to the end of the line and ask for a tortilla on the side.

4) Toppings

Hungry yet?

This is where the magic happens. You can choose your salsa. You can choose your toppings. This is where a burrito becomes your burrito. If it’s a lunch rush there will be a committee of nearly 14 people working to serve the ingredients on to your burrito, wrap it, and also keep their ingredients stocked behind the counter. At my local Chipotle the last step is always “What vegetables would you like on this?” Careful examination of the pans in this section will reveal the following ingredient: sour cream, guacamole, shredded cheese, and lettuce. There is only one vegetable in that section, and it’s the wussiest vegetable in existence. I mean, you can add shredded romaine lettuce to just about anything and eat it without realizing it’s there. In no world can sour cream be considered a veggie, and while guacamole is undoubtedly the most delicious substance on the planet, I’m not sure I’d include it in a list of vegetables. That would just be embarrassing for the vegetables.

5) Heading Out

Despite the amount of food in your burrito, a friendly Chipotle minion has somehow managed to wrap your burrito neatly in aluminum foil in the time it took for you to reach for your wallet. Occasionally a burrito becomes so filled with delicious stuff that it breaks, which gives you the opportunity to double your tortilla. You can also have them re-wrap it, but do that at your own risk, as you don’t want to be the guy from section 2 above. The burrito wrapper extraordinaire will whip out a sharpie and graffiti your wrapped burrito before telling the cashier that it is, in fact, a steak burrito. The most shocking part is that this side of the counter has a working memory. The guy that heated my tortilla couldn’t seem to remember anything I ordered, but the cashier acknowledges the information and then uses it. Without asking me. The left side of the counter needs to get up to speed with the right side.

Finally, you can eat your burrito. A steak burrito is so delicious it’s making me want to head over and eat one right now. I totally can. It’s not that far from my house. But I’m off subject again.

While I freely admit that I can eat a lot of food when I want to, after my first bite of burrito I usually wonder if I will be able to finish it this time. Then ten minutes later I look down at my empty aluminum wrapper and think “Not this time, burrito”.

I’ve set myself up perfectly to make a Chipotle poop joke right here. It’s perfect timing, and it’s so easy, but I won’t do it. Everyone else can (even Jimmy Fallon, who does it all the time), but I’m just going to end this post and eat a burrito.

Thanks for reading!

*Full disclosure – I don’t work at Chipotle, receive compensation from Chipotle (unless you work for Chipotle, let’s talk. I’ve seen your bags and cups. I could totally write an ode to guacamole). I just eat there every now and then and like it.

sortadrwordpress@gmail.com

The Hardest Day

Second year has started off with a bang. If you are paying attention, you’ll see some crazy stuff in any medical school. Whether it’s an official lesson, or people watching, or patient encounters, or something you learn on accident while researching something else, there will surely be something to learn. Recently we had a deep lesson that I wanted to share, but first I need to set the stage.

All of the MS2 students are packed into our lecture hall. This isn’t the nice, new lecture with comfortable chairs that we used last year. This is the older lecture hall that doesn’t have enough seats for the whole class, the one with the terrible chairs, and the one with not enough room for your laptop and anything else on the desk. There are students standing in the back, and everyone looks sharp because we all are wearing our white coats and professional clothes.

On stage are six people. Standing at the podium is a Pediatric Hematologist who is running the event. She has a very serene demeanor, but seems to radiate strength from her small stature. Sitting at the table on stage are 5 others. There is a couple in their 40’s. He is lean and tan, with the muscle tone and hands of a construction worker. She sits next to him, well dressed and confident, if somewhat anxious. Another lady sits next to them. She is African American, somewhat heavyset, with a joyful face, floral blouse, and somewhat excessive afro. Next to her is an elderly little lady with thin gray hair and a stooped posture, and she is in deep conversation with the woman beside her, who is wearing scrubs and has two phones and a pager.

This is a lecture panel on handling the death of patients, specifically children. The couple on the end lost twin boys, their 5th and 6th children. The first died before being born. The second lived for 10 months, but had a debilitating matrix of health problems and lacked any ability to develop. The lady next to them had a daughter who developed bone cancer at age 11, which metastasized to her brain and took her life when she was 13. The older was a chaplain, and the last lady was a NICU nurse. Everyone was there to talk to us about handling death.

Most learning in medical school is very clinical and sterile. We learn about our bodies from distinguished looking old professors who wear white coats and use technical language to describe anatomy and physiology of organs and diseases, of which they are experts. That approach is obviously not practical when talking about handling death, so we learned from “experts” in their own way, people who had gone through this and were willing to talk to us about their experience.

I don’t like thinking about death, and I don’t think many of my fellow students do either. We are all young and vigorous, filled with the energy and optimism of youth. In my mind, death is something far off. It’s not that I’m scared of it, I just prefer not to think about it. I have been very fortunate to have made it this far in my life with living parents and grandparents.

This forum was not the first time that I had focused my heart and mind on this idea of death, and current events will tell you why. On Saturday evening the violence in Ferguson, MO erupted after a young man was shot and killed by police. Even as I write this tensions remain high, with protests and heavy police presence keeping the conflict in the national spotlight. It was only a few days ago that the world was shocked to discover that Robin Williams had ended his own life. Violence in Iraq and the Middle East have created a summer that will go down in history as a violent, restless summer.

I don’t want to talk specifically about any of those subjects listed above, at least not in this post. Instead, I want to talk about dying. The way someone reacts to death will tell me a lot about the way they view the world.

Death is a part of life, just like birth. Everyone is born, and everyone will die. What we do in between is what makes the difference. Death is also a great equalizer. I learned this lesson at a young age helping my dad clean our boat after a day on the lake. He always said that the boat ramp was the great equalizer. At the end of the day, everyone comes back to the ramp and goes home after a fun day of boating. It doesn’t matter how big your boat was, how big the truck you used to tow it, or how many fun inflatable things you could pull behind your boat. At the end of the day everyone comes back to the ramp sunburned and tired, and everybody had fun.

So when we die, as we know we will, we are all equalized again. Your influence, your money, and your responsibilities are all lost and left behind. What happens to you after you die? What or where do you think you will be after you die? Some believe that death causes you to cease to exist, but I find that hard to accept and impossible to believe.

The hardest part of the last few weeks has been actually organizing my thoughts on this matter. It’s not easy to do, when my cell phone keeps ringing, emails keep arriving, and the world flies by on my laptop screen. It’s easy to ride the wave of now, caught up in an endless progression of thinking about what happens next. Thankfully, I found the time to take my dog to a local state park and hike. So it was there that I hiked miles from any road, on trails not commonly traveled, and sat down for a water break. The sun was high in the sky, coming through the trees to turn the world green. Except for my trampling feet, the world was perfectly still. So I sat there for a long while, and I’m glad I did, because that’s how I was finally able to write this.

Lastly, I wanted to leave with the words to a poem. It was written in the 1600’s, but people then died at the same rate as they do now, and the words speak to people today just like they did 400 years ago.

Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;
For those whom thou think’st thou dost overthrow
Die not, poor Death, nor yet canst thou kill me.
From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul’s delivery.
Thou art slave to fate, chance, kings, and desperate men,
And dost with poison, war, and sickness dwell,
And poppy or charms can make us sleep as well
And better than thy stroke; why swell’st thou then?
One short sleep past, we wake eternally
And death shall be no more; Death, thou shalt die.
Thanks for reading!

Winning The Lottery

A few weeks ago, my wife and I were at a trivia night, a fundraiser for a local church. Our group lost the overall competition pretty handily, but we managed to score a 4-way tie for first in one of the other mini games. It was decided that each group would send a representative to the front of the room and draw a card from a deck, highest card wins. I was chosen from my group, walked up to the front, and promptly drew the ace of spades, winning gift cards for everyone in my team.

The best part of this is that I never win anything. When it comes to raffles, drawings, or anything that has an element of luck to it, I generally don’t win. That’s also why I hate playing Yahtzee and poker. Full disclosure: I should point out some amazing luck I’ve had lately:

– I passed my first neurology exam by 1.3% I’m happy with that 🙂

– While running last week, my phone fell out of my pocket and landed on the only six inches of grass in a park that was otherwise mud puddles or soggy gravel (it’s been raining a lot).

None of this compares to the luckiest moment of my life: when I was born. The moment I was born I effectively won the lottery. By being born in a middle class family, I became statistically more likely to achieve higher levels of education and income. By being born in America, I became a citizen of a country that values freedom and expression. By being born in the 20th century, I am able to enjoy modern luxuries like air conditioning, automobiles, indoor plumbing, and the internet. My life at this instant is more comfortable than the lives of kings and rulers from history.

No AC, way too many clothes.

Several weeks ago we had a required lecture, which I diligently attended. It wasn’t so much of a lecture as it was a “in-class exercise” where we played a game called Oppression Monopoly, invented by someone at Harvard. It’s Monopoly with four players, each with the following rules

Player 1: Plays normal monopoly

Player 2: Starts with half the normal money. Moves half the distance rolled. Starts with a railroad, but can’t buy any property valued at more than $100. Must pay double any time he lands on another players property. If he rolls more than a seven, he must go to jail.

Player 3: Starts with the cheap properties (the brown ones) and half the normal amount of money. Most of the rules above applied to him as well.

Player 4: Starts with double the normal amount of money and all of the green properties. Moves double the roll, collects double when passing go. Must pay double taxes, and has 4 get out jail free cards at the start.

To further emphasize the direction this game was going, our instructor asked to make sure any people of ethnicity or women didn’t end up as players 2 or 3. Awkward.

I was Player 2. Because I had no money and the board was a dangerous place, I played along with the game and purposefully spent the first 30 minutes mostly in jail. After 30 minutes the rules above were lifted and normal rules applied for everyone. Since it was now significantly harder to stay in jail, I promptly landed on park place and went bankrupt.

We then had a “group discussion” to talk about what we learned. Because my class is full of medical students, when she asked for any impressions from the group, she got an immediate “I felt crushed and marginalized by the combined weight of society attempting to repress me” from the back row.

The obvious point here is to demonstrate a simple fact. There is disparity in this country and in our city. I live in one of the most racially polarized cities in the country, and it’s a problem. A serious gap in income, healthcare, and quality of life exists, and I appreciate the effort they have taken to make us aware of it (although we are getting tired of hearing it).

I don’t appreciate the victimization that occurs in this process. Many are often quick to point out that men make more than women, or that whites tend to make more than blacks, and that somehow that is something to be ashamed of. Years from now I will be a practicing physician, hopefully making a comfortable salary and taking care of my family and community. Maybe my birth or family’s status gave me opportunities others wouldn’t have had, but I put in the work to make those opportunities a reality, in an attempt to create a better life for my family and those in my community that weren’t born with that opportunity available. That’s the way it should be.

There will always be income gaps. That’s the way our country is built. People who work hard and have great ideas will go make a gazillion dollars. My favorite headline is “the rich get richer”, as if this is bad. I like to add to it. “The rich get richer….and good for them.” As long as rich people can get richer, that opportunity still exists for everyone else, including me.

The ironic part of this is we get this talk every other week at medical school. Despite my schools best attempts at creating a diverse student body, many of us come from “privileged” backgrounds, and not all of us are white males. Most of us are at this junction of opportunity, privilege, and attempting to do our part to make those opportunities reality. That’s exactly what you do with opportunity.

The differences in these lectures comes down to motivation. If the theme of the book/lecture is informative and neutral, then we are engaged in the kind of productive conversation I would like to have. If there is intent to victimize, slander, or make accusation against some specific group, you’re just wasting everyone’s time. This isn’t a zero sum world.

I need to wrap this up and study now.

Thanks for reading.

sortadrwordpress@gmail.com

 

 

4 Kinds of People Who Must Love/Hate the Internet

We all live in a new age. Since the Internet has connected all of us in ways previously thought impossible, our very culture has changed in so many ways. Some companies have profited greatly from the rise new technology (Google), while others have been ruined (Blockbuster). Some people, however, have a mixed bag. These people include

1. Photographers

Despite my own complete artistic ignorance, I am aware of the fact that there is a group of highly skilled artists who take pictures. They understand concepts like lighting, focus, mood, color, and other artsy words to create pictures that are dramatic and inspiring. I think about guys like Robert Capa, who covered five wars. He was quoted as saying “If your pictures aren’t good enough, you aren’t close enough”. To put that in perspective, this is the same man who covered relatively dangerous situations like…oh, D-Day.

Doesn’t get much closer than this.

These kinds of people still exist today, I am sure of it. The problem is that they are completely overwhelmed by millions of teenagers with Instagram. Having an iPhone and access to the internet virtually guarantees pictures with sepia filters will be posted #nofilter to Facebook at some point in time.

The upside to being a photographer nowadays is also the internet. Building a portfolio, maintaining a website, and social networking give easy access to potential employers and give an aspiring photographer more exposure than was possible years ago. It’s also possible to edit all of your pictures with photo shop, but that’s an entirely different story. In college I had a roommate who was a photographer. He would shoot weddings and senior pictures, and actually rented out a studio in his hometown (which was ~2 hours away). He was very talented, and would upload his pictures directly to an iPad so his clients could see them immediately after he took them. Keep in mind he was about 20 at this point. He made thousands of dollars in cash every weekend (which he unwisely decided to keep in his desk drawer for a long time), and he now works for ESPN, shooting college sports and parts of their annual swimsuit edition. He relied absolutely on the internet and 4 different computers to keep all of his projects straight, but he was very successful.

2. Cable Companies

Cable companies want you to buy their big cable packages. That’s where they make their money, and it’s also why I get ads in the mail every week to upgrade to cable and phone. It is becoming increasingly common for people (like me) to skip out on the cable part and just pay for monthly internet. Cable costs about triple the price, and I know we won’t watch it, so we don’t pay for it. From their perspective, they just lost a significant part of their “income” from me, their customer, while still having to maintain the infrastructure necessary for me to have that service. Netflix, YouTube, and medical school suck up huge amounts of data, and the race is on to keep up with society’s insatiable need for bandwidth (upgrading to fiber optic cables, for example). This is expensive for them, but it might also save them in the future as more people ditch the traditional cable packages but remain customers for the internet access.

3. Actors

Admittedly, celebrities have always had many people paying close attention to them. In fact, there are other people paid to follow them around and report on what they are doing, which is ridiculous, but whatever. This applies mostly to people who are already rich and famous, so it isn’t the worst thing that could happen, but it must certainly be annoying. They used to run the constant risk of having unattractive pictures taken and then finding those pictures on magazine and newspaper covers everywhere.

Now things are much worse. Paparazzi still follow celebrities around, like those little fish that attach themselves to sharks, but now they can post things to the internet. Once things hit the web, they will never ever go away, just like when you eat a single piece of pizza for lunch and you can still taste it two days later. Instead of having yourself on a magazine cover at the grocery store checkout for a week or two, you now have thousands of copies of that picture or news story circulating on the internet. Forever. Awesome. Paparazzi are also assisted by people who attempt to hack cell phones, Facebook accounts, and laptops to produce scandals and generate publicity for themselves, and they do it for free.

Most celebrities are also benefiting from their ability to use the internet to generate positive publicity. They can maintain an online presence and still generate attention, even if they aren’t in any upcoming movies or TV shows. I follow a few celebrities on Twitter just because they are funny (I have absolutely no idea if they are in any recent movies).

4. Musicians

Becoming a professional musician that makes a gazillion dollars is a lot like becoming a professional athlete. At one point, most boys in this country played baseball. Only a fraction of a percent of them ever sign an MLB contract. Tons of kids learn to play the piano, guitar, or drums. Very few of them ever play for Maroon 5 and make tons of money. Becoming a successful musician isn’t always about talent. Certain Disney stars have turned into “musicians” and continue to make money and sell songs despite their (sometimes) questionable musical ability.

I would hate to be a professional musician. It’s one of those fields where, no matter how good you are, there is always someone better than you. Nowadays, thanks to the internet, those people can be anywhere on Earth. Even when popular mainstream bands create good songs, it won’t be long before some talented teenagers with good equipment make a cover that is better than the original song.

One more thing. Remember when we bought actual CDs? From music stores? From the perspective of the band, that’s actually a good thing. How many times did you really like 4 (or less) of the songs on the CD, but you ended up buying the whole CD for those 4 songs? That created a good margin for groups, who got a whole CD of sales, even if they only had a single good song. Now nobody buys CDs. Instead, we buy music on iTunes, if we buy it at all. I haven’t bought music in years, I just listen to Pandora, YouTube, and the radio and I’m fine. Even if there was a song I absolutely had to buy, I’d get it on iTunes for $1.29. That doesn’t work out nearly as well for the band, since I am no longer paying $12 for the CD.

I could add to this list, and you probably could too. Authors lose money from illegally downloaded PDF copies of their hard work, but the Fifty Shades of Grey series started out as a PDF and that lady made a gazillion dollars. Many doctors who lecture at medical school complain about patients who are convinced they have cancer (thanks, WebMD), but huge advances in electronic health records have changed the way we do medicine. I’m convinced that an internet outage at my medical school would cause some students to have serious anxiety attacks. I am on the internet for hours and hours every single day, and many of my hobbies (like writing this blog) rely on the internet. I love it, but I hate it.

Thanks for reading! Thanks to a recent guest post featured on Student Doctor Network, I have had a huge influx of new readers from more than 15 countries, which is awesome. Thanks for the emails and comments, it’s been a lot of fun.

sortadrwordpress@gmail.com

I Don’t Know Anything About Brains

The newest unit in my adventure called medical school is Neurosciences. After just three days, I have come to a couple of conclusions.

First, neuroscience is really hard. The content of the class itself is just very challenging. There are many anatomical structures to learn, pathways to memorize, and some fairly abstract concepts that need to be applied in order to really understand what’s going on. The class itself is going to be hard because we don’t take an exam until April, meaning we cover 5 weeks worth of material before taking any sort of evaluation. There is huge potential to fall behind before the test, and there will be too much material to catch back up.

Next, I have started to second guess my speaking skills. I have always thought that the neuron, the fundamental cell of the nervous system, was pronounced “nur-on”. In fact, I have never heard it pronounced any other way until Monday, when 4 separate neurologists called it a “nur-own”. Is this some sort of professional neuroscience thing to mark the pros from the outsiders? What’s going on? We need to ask the teaching staff to address this ASAP. Every time they confidently talk about nurrowns, i feel a little bit like a morrown.

Finally, I have realized that nobody really understands the brain. I don’t mean that we know nothing about it, just that we don’t understand it. Yes, we understand the areas of the brain that process certain information. We know tracts of the spinal cord and the types of sensations they relay. We even know the functions of the brainstem and midbrain. What no one really understands is how all of this happens. Even in “smaller” nuclei in the brain, there are something like a million neurons synapsing together. There is a huge body of scientific knowledge on what a neuron does and how it functions, but a complete lack of explanation as to how a billion neurons together create conscious thought. The brain is the most complex organ in the body, home to all of our higher orders of reasoning, memory, emotion, and thought. It’s amazing, but we still don’t actually understand it.

This is the first cool brain image Google brought me.

I was talking about this with my family last weekend. Have you ever seen a 30 second commercial for an antidepressant drug, followed by a full minute of side effects and warnings? It’s because we still don’t get the brain. Compare that drug to, say, an antibiotic. We know exactly how that antibiotic is metabolized, the effect it has on bacteria, side effects on the patient, and certain kinds of infections that can be more easily treated with that drug. An antidepressant is far more complicated. For an SSRI, for instance, we know what it is supposed to do, but this action causes a huge amount of side effects due to its action on the brain and neurotransmitter levels. Why would this drug cause suicidal tendencies in younger patients? Good question.

I really like studying neuroscience because I think humans have awesome brains. We have enormous brains, by the way. Why are babies born so young and relatively helpless? Because otherwise their enormous brains would be too big to squeeze through the birth canal. Our skeleton is designed to support a large skull full of brains, and our metabolism is geared to continually supply our brains with the energy it so desperately demands. The most spectacular part of our brains is the interconnections, or synapses. This is where the magic happens. This is why humans are so fundamentally different than any other animal. The interconnected nature of the brain is the reason we make music, paint pictures, write stories, love, hate, and want things. It’s the reason certain smells can evoke such vivid memories, and it’s the reason we can even undertake an effort to learn about our own amazing cognitive ability.

The best analogy for the enormous complexity of our brain is outer space. Even the word we use to describe it fails miserably to convey the entirety of what it actually is. Calling the universe space is like calling the ocean wet. Astronomers are still discovering more planets and stars in our very own galaxy, which is sort of like finding more furniture in your living room when set to the scale of the universe. Small wonder we don’t fully understand our own brains. I wonder if we even can. Even with the elaborate supercomputer sitting in my head (ok, more like an iPhone. Or a fax machine), I will never be able to actually understand how big the Earth is, and I will definitely fall far short of grasping the size of the solar system or galaxy. I don’t think it can be done, but that doesn’t mean we shouldn’t try. Who knows, it could be my generation of neurologists that discovers ways of treating and curing Alzheimer’s disease. What’s the saying about effort? Shoot for the moon, and even if you miss, you’ll land among the stars.

Time for me to wrap this up for the night. Thanks for reading! If you have read this far, you may be interested to know I will have a guest post featured on the Student Doctor Network next week. I am very appreciative of this opportunity to reach a wider audience. Also, their forums are incredibly helpful for any pre-meds who haven’t found their way over there yet. Just saying.

sortadrwordpress@gmail.com