Let The Evening Come

David-Edwards-bannerThis is the beginning of my fourth year of graduate school, that membranous transition period between the eager expectation of third year and the panicked frenzy of fifth year. Many of my older classmates have told me that fourth year was unequivocally their most challenging, the one brimming with more knee-weakening moments of despair, self-doubt and raw frustration than any other.

(I know—what an auspicious start to the year. It’s the post-bac equivalent of your older brother telling you about the horrors of first grade. “Say goodbye to naptime, kiddo—you’re never gonna see it again.”)

Given this information, I’d be lying if I said I wasn’t nervous. I’m not looking forward to those inevitable moments lying in bed, thinking about alternative careers—does the Discovery Channel hire grad students as writers?—and attempting to fall asleep by counting failed experiments like sheep.

But I’m not completely afraid, either. Right now, there’s a mélange of fear, apprehension and…weird excitement. I’m excited not because I’m masochistic, although I did enroll in graduate school so perhaps that’s not entirely untrue.

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Choosing a surgical subspecialty: My path to Otolaryngology

Shabnam-G-bannerChoosing a career in medicine was one of the easiest decisions I ever made. Although I was the first out of a family of engineers to go into medicine, it was a natural choice for me. I loved interacting with people and thinking critically about the applications of science to the human body. My passion for medicine was clear. But, choosing a medical specialty was unexpectedly difficult.

During the first two years of medical school, students around the country are taught the foundations of clinical medicine. While there is some exposure to the various specialties, the focus of these years is to act as an introduction to medicine through lectures, textbooks and exams. In contrast, the third year of medical school transitions students out of the classroom to the bedside. Students rotate through clerkships in various specialties learning how to apply their knowledge to patient care. In this year, students begin to learn how medical teams function as well as understand the roles of the different specialties and how they work together. While some students enter these third-year clerkships already confident about their specialty choice, many students maintain an open mind.

In the fall of the fourth year of medical school, students then apply to residency programs in a chosen specialty. It happens very quickly. One minute you are being told, “You have lots of time, don’t worry about choosing a specialty yet.” The next minute you realize that you are the last one to decide and you should have been publishing research papers in the field since before medical school even started. Across the board, applying to residency has become increasingly competitive and showing commitment to the chosen field through research and letters of recommendation from faculty is important.

Halfway through my third year of medical school I remember starting to feel a little discouraged. I watched as my classmates decisively pursued their chosen specialties and met with faculty mentors to plan for residency applications. Meanwhile I continued to be undecided. I had enjoyed all of my third year clerkships so far. As I rotated through, I would try to convince myself that certain fields met some of my interests. But I was never able to wholeheartedly commit to a specialty. I had mentors in fields of pediatrics, family medicine, general surgery and radiology. None of which I wanted to pursue for the rest of my career.

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OneNote to Rule Them All, OneNote to Find Them…

Chris-Dirda-bannerSometime during the months before PA school I received an email recommending that I familiarize myself with note taking software. I didn’t think much of this message at the time. I mean, I had been pretty successful with a pad of paper and a pen all throughout undergrad, so why change what isn’t broken? Fast forward to my first day at OHSU, and I arrive with said pen and said paper in hand, ready to the face the barrage of information ahead of me. By the end of the week that pad of paper and pen were already collecting dust in my locker.

To fully appreciate how critical note taking software was, it is helpful to look back at the volume of material in the first quarter alone. We were responsible for a little over 150 lecture PDFs and each of these lectures contained between 35 and 100 slides. The bulk of these lectures were closer to 50 slides each, so I will use that value as an average. With 150 PDFs at 50 slides each, this comes out to approximately 7,500 lecture slides covered in three months’ time. If I had printed out every PDF it would have been prohibitively expensive, a vast waste of resources, and it would have taken up an entire closet of space to store it all. If I had just used pen and paper without printing anything out I would have been completely lost in tying notes to any particular slide. Cue the need for note taking software.

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Tiger Blood

Adalie-bannerThis week I will be sitting down with a group of applicants who are interviewing for positions in next year’s PA cohort. As the sage old PA student, I thought I would gather together my new-found wisdom to share with these potential students:

  • The first introductions with your new classmates can be intimidating. Getting into a competitive school like OHSU means that everyone is stupidly brilliant with seriously impressive work and volunteer backgrounds. Recognize that your feelings of imposter syndrome are normal, and will fade with each exam you crush.
    • If you still need a boost of confidence repeat to yourself this Charlie Sheen quote: “I have a different constitution. I have a different brain. I have a different heart. I got tiger blood, man.”
  • Don’t Lone Wolf your studies. Find like-minded students and study with them. It was wonderful to realize that OHSU doesn’t just preach a collaborative culture, but aims to actively create one. While I had never previously been a fan of collective studying, I now seek out small groups to work with, and am more successful because of it.
    • IE: Very bright people surround you. Dig into their minds for the knowledge you are lacking.
      • By this I do not mean to use your classmates’ brains as a zombie would. There is definitely a policy against that in the Student Code of Conduct.
  • Being a PA student can make you feel like your body is just a convenient way to transport your brain to and from class, but try and exercise daily. Then you can impress people with your razor sharp mind and your killer bod. Truly a win-win situation.
    • Also, this is the only time in the day to re-watch True Detective and not feel guilty.
      • Side note: Should one ever feel guilty about watching those modern day prophets Matthew McConaughey and Woody Harrelson? No sir.

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My First OSCE: A Tale of Tears

Ally-Rich-banner“Now, this last comment is personal advice for you as you move forward in medicine.”

It was the fall of 2013, and I was in my first year of medical school. Specifically, I was receiving feedback from my standardized patient—notably an OHSU physician—in my first OSCE (objective structured clinical examination). For those of you who don’t know, an OSCE is a series of encounters with standardized patients where you must show your ability to effectively communicate while exhibiting your mastery of taking a history and performing a physical exam. At the end of the encounter, the standardized patient gives feedback on your performance.

My standardized patient wanted to know how I thought the encounter went. I told her that I thought that the most difficult part for me was the pretending. Indeed, OSCEs entail one to act the part of a doctor, and at the beginning of my first year in medical school I felt like nothing of the sort. I can remember waiting until the last second to put on my white coat for preceptorship, afraid that a patient or non-healthcare worker would assume I was a doctor.

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From Zambia to Medical School

StudentSpeak is pleased to share an excerpt of M.D. student Malerie Pratt‘s winning essay for the Student Scholarship and Worldwide Community Ambassador Award presented by Giva. Malerie is a member of the M.D. Class of 2018 and a Swindells Family Scholar.

MalerieZambiaBecause my parents raised me to be goal-oriented, it did not surprise me when my dad asked me to write my goals for the next ten years when I was only nine. My goals focused on helping people and protecting the environment. Most importantly, I wanted to build and to run orphanages in Africa.

However, ten years later when I stepped off a plane in Zambia, Africa, I planned only to volunteer at a school for handicapped children. Although I did eventually help build a home for children, my time in Zambia made me realize that I could have a wider, more powerful impact on people in need if I would become a doctor.

I drew this conclusion early in my stay when I left my sheltered and guarded compound to experience life from the perspective of the local people. I witnessed child prostitution, malnourishment, disease, poverty and corruption; however, I also saw a beautiful and complex culture. I wanted to make a difference outside of my protected walls, so I traveled hours to visit an AIDS hospice for the dying and terminally ill.

Immediately, as I walked into the hospice, I smelled rotting bodies and saw skeletal bodies lying on mats screaming in pain. Although in shock and wanting to run away, I knew I had to remain calm and confident. Therefore, I spoke with the patients in what little of the local language I knew. They laughed at me because they were surprised and happy to see a foreigner trying to speak their language. Unknowingly, I had distracted them, for a short time, from their pain. It was the most horrific place I had been, but I realized that this is where I needed to spend my time in Zambia. As people brought their loved ones to the hospice in wheelbarrows, hoping to find them a comfortable place to die, I learned never to be fazed by a person’s physical state, but to greet him or her with compassion, to bathe and feed them, and to make their last days as comfortable as possible.

Read Malerie’s full essay on givainc.com and watch her talk from TEDxBend

Town Doctor

David Steinhardt, MS4

eastern-oregonThe road to the town where I did my rural clerkship travels east from Portland until you reach a sharp turn off Highway 84 that heads south. Soon after leaving the highway, you lose cellphone service and have to brave the rest of the route on your own. The hills are vast, beautiful, and seemingly endless, covered in green and yellow-shaded grass with scattered trees and occasional ponds sparkling in the sunlight. Compared to Portland, it feels like another planet, with wide-open space in every direction and far more cows than people. The town’s welcome sign sits in front of two large historic tractors, signaling arrival to a town that prides itself on working in the fields – growing wheat and raising cattle.

On the first morning of my rural clerkship, I felt like I had traveled back in time. The hospital was a single-hallway building consisting of an Emergency Department, ten hospital beds, and a nursing home facility all under one roof. The clinic was just up the road, allowing the doctors and staff to cover the ED, inpatient service, and clinic all at the same time. Immediately, I was struck by the friendliness of the nurses and the rest of the staff – the visiting medical student (me) was a familiar tradition, transitioning every 5 weeks from one of us to another, but they didn’t seem to mind the consistently rotating wheel of new faces.

That first morning, I rounded on an elderly gentleman who had suffered a devastating stroke two days prior, but had been started on steroid medication and his mental status was beginning to improve. We talked for a while that morning, and I learned that he was on hospice care, likely destined to spend the rest of his life in this small rural hospital. We parted ways that morning, and at that point he was simply a patient, similar to the patients I had met and treated at OHSU.

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Tomorrow’s lessons


Dear ——–,

You were my patient for four days. On the first day, we treated your many diseases. On the second day, we removed all but comfort measures. When I arrive at the hospital tomorrow, you will not be there. My boyfriend worries about me tonight, as you are my first patient to die. I am surprised to tell him that I feel only gratitude for you.

Thank you for being my first patient to die. Thank you for being old and frail. Thank you for displaying clearly and eloquently, despite an illness that has robbed you of speech, your desire to move on.  Thank you for smiling at me on day one, for asking my name, introducing yourself. Thank you for clutching my hand on days two, three and four when I came to wet your lips and ask you if you were in pain. Thank you for not being in too much pain. Thank you for having a caring family who loves you but does not depend upon you, who will have each other to share memories and grief on days five, six, seven.

I am so sad that you will die tonight. I am sad for your children, who have hovered around you over the past four days, and for your spouse, whom you cared for with love and kindness. I am so sad that we don’t get to unpack your ailments together, one by one, stating them in a problem list and labeling them – acute, worsening, improving, resolved. I don’t know how to write a discharge summary for you. I can’t discharge you from my mind: your kind eyes, your thin, frail skin, your erratic, persistent breath, your fervent dignity in the face of your body’s determined deterioration. Thank you for sharing this part of your life with me. Thank you for sharing your death with me. Thank you for your teachings over the past four days and for the lessons that await me tomorrow.  Thank you.

The Trouble With Girls and Women Scientists and Why We Won’t Just Stick to Shoe Shopping

Let’s be clear—the word “woman” is a noun. It is not an adjective.

And yet the inclusion of the word “woman” as an adjective, to subtly yet profoundly undermine the notion that women are capable, is everywhere. This prefix is not accidental, it’s diminutive, an inherent nod to the notion that women are somehow out of place in the sciences. The word “woman” as an adjective is used to suggest that there’s some kind of novelty to a female working as a professional scientist;  “Look at this woman scientist—she’s even wearing a lab coat! Isn’t she trying her best? Adorable!”

Take, for example, the comments made recently by Nobel laureate Tim Hunt. At the World Conference of Science Journalists in Seoul, South Korea, Hunt described the trouble with girls: “Let me tell you about my trouble with girls … three things happen when they are in the lab … You fall in love with them, they fall in love with you and when you criticize them, they cry” (You can read more about his comments at The Guardian).

I’ll be honest you guys….I’ve cried in lab. A little saline never hurt a tissue sample, right? I just don’t understand how a NOBEL LAUREATE could think that the experiences he’s had with a few women in his laboratory could ever possibly be extrapolated and applied to ALL women?

In 2013 Fang, Bennet, and Cassadevall published a study in which they analyzed the 228 instances of scientific misconduct reported to the Office of Research Integrity and found that over two thirds of the cases involving fraud were committed by men, a number that “exceeds the overall proportion of males among life science trainees and faculty.” But who is talking about that? Where is the female Nobel Laureate condemning men at scientific conferences, decrying their role in labs; “Good point, Hunt, you really got me there. I was just about to kiss you and cry, but I thought I’d make this counterpoint first; the trouble with boys in lab is that they lie and make up data and ruin their careers and yours in the process. I’d love to hire more men, but you just can’t trust ’em. Plus they’re so tantalizing. Does anyone have brownies?”

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A Plan with Not Quite Enough Time

Lumbad-student-speak-banner“Patient is a 26 y/o otherwise healthy, devastatingly handsome male with a history of PSVT. He presents to the ED with three ex-EMS personnel all equipped in softball attire. Patient states that he’s had 4-5 episodes of heart palpitations for the past hour. He’s attempted valsalva maneuvers with some success, but cannot ‘get out of this one.’ Patient reports lightheadedness and tunnel vision. He relates paresthesias and hypothermia of all four extremities and says ‘walking feels like there’s cement in my shoes.’ He denies chest pain but confirms precordial numbness. On physical exam he’s alert, oriented, and does not display any speech deficits. He’s hypotensive at 88/46 right arm supine and O2 sat at 93%. A 12-lead ECG reveals a regular, narrow complex tachycardia at 180 bpm without visible p-waves. ECG is negative for T-wave inversion, ST elevation and Q-waves. Delta waves also absent…”

In light of my recent trip to the ED, I was reminded exactly how impressed I should be with the human heart. In my chest there it is lubbing and dubbing – autonomically, instinctively, protectively. Normally, I don’t have to tell it when or how hard to beat. But rather, it tells me two things: 1) “you’re alive” and 2) “dude, you’re out of shape” when I take the stairs from the first to fifth floor in the CLSB. When we moved into this spaceship of a building last June, I would have been completely lost in the medical jargon the ER attending and resident were throwing around me during my ED visit. Now, my classmates and I are running the final lap of the didactic 4-minute mile with just over a week to go. We’ve covered the human body from head-to-toe, from preconception to old age and back over again. We ran ACLS megacodes for when a patient’s life is at stake, and this week we focus on how to intervene and prolong life in the O.R. The amount of information that has been crammed into our brains and regurgitated to our professors, clinician mentors and patients is mind-numbing and down right impressive.

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Ever wondered what life is like as a student at OHSU? What does it take to become a researcher? Just how gross is gross anatomy? Welcome to the blog that answers these – and many other – questions. It’s students writing first-hand about their commitment to careers in science and health care. It’s honest about the challenges as well as the joys. It’s not always pretty. But it is our story. Thank you for sharing it with us. And please, let us know what you think.

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