Liz's Medical School Journey

Now on to new adventures.

What a week!  I am sitting here on the only seat in my apartment, an inflatable mattress.  Just in case I need a constant visual reminder of the huge transition taking place, I can look all around me.  Bare walls.  Echoing rooms.  Emptiness.

Life as a medical student has ended.  This week I went from “plain old Liz” to “Dr. Liz, M.D.,” and  I feel oddly numb about this huge milestone.  Perhaps it hasn’t really sunk in yet.  I must not be alone because it seemed like all my classmates had a stunned, sort of glazed expression, as if to ask ourselves “is this real?”

On Sunday morning, after I heard the word “Doctor” followed my full name, I walked across the stage.  As I faced the audience, a large green velvety hood was placed over my head.  Then, I shook hands with the dean of my medical school, and got my oversized diploma.  No kidding, this diploma is probably the biggest diploma I’ve ever seen!

After I sat down, I noticed the fresh doctors around me lifting up the edge of the folder, to check whether there was really a diploma there, and really had our names on it.  I did the same.  In fact, I still feel the urge to go lift that huge brown glossy cover- to look at it again.  Maybe it was a dream?

Yes, it’s real.

If this week was a dream, it was pretty awesome.  One of the most amazing nights for me was the Senior Award’s Dinner.  Let me proceed this story (in case you are wondering) by making it clear that I am not exactly one of the most “popular” kids in my class, and I am certainly not the highest academic achiever.  All this is to  say I was not expecting any awards.

So you can imagine what a surprise it was to be awarded the LAST student award of the evening. I won the Leonard Tow Award from the national Gold Foundation for humanism in medicine, and my Family Medicine advisor was the faculty recipient.  What a beautiful honor to be re/awarded for one of the most important medical traits, something that I feel should be recognized and valued more during medical training.

The sweetest part of the award, which still makes me teary, were the handful of classmates and professors who came up to me afterwards to tell me why they thought that I obviously should get this award. Some friends told me they had secretly nominated me, which has to be one of the nicest surprises anybody has ever given me.

I guess it’s no coincidence that the most meaningful part of graduation day was reciting my favorite part of the modern hippocratic oath along with my 180 fellow graduates, faculty and physician members of the audience:

“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”

The rest of graduation was filled with enthusiastic family members, especially my father.  Dad is also an M.D. who provided life-long encouragement.  Now since I kept my maiden name, we share the same title.  But it will be a while before I hear the title and automatically think of myself before him.

I enjoyed meeting my classmates’ families too, including one surprise fan, a mother who had such kind things to say about my blog (thank you again, Julia).  I felt as if I had already met many of my classmates’ parents, perhaps because I’ve seen their photos and heard stories about them- all wonderful of course!

My brother and in-laws were along for the ride, and even helped Ben and I pack our apartment after my parents left the morning after graduation.  Overall Ben and I had a lot of fun celebrating with both our families together.  Then, we worked hard to load our life into a pod, which was picked up yesterday.

Filled to the max!

Soon we will be on our way to new adventures.  Thank you all for following me for the last four years.  Medical school blogging is officially over, and now to decide what to do with this blog during the rest of my training.

Time is passing so quickly lately, and the air is full of changes.  Ben defended his Ph.D. successfully right after I returned from my block 12 elective.  The very next week we went on a four-day home-finding expedition.  After seeing 18 places in 4 days, we decided to sign a lease for a cozy little condo in a neighborhood walking/ biking distance to restaurants, a farmer’s market and nature trails. 

Now the move seems real. Our apartment is a mess right now- boxes everywhere and huge dust animals appearing from dark places. I graduate in ONE week. Our families will be here sooner than that.  And our stuff gets shipped away in a moving pod the day after everybody leaves.  Two weeks from today, Ben and I will be locking the door of our apartment for the last time.

It’s no surprise that I’ve been feeling the full spectrum of emotions, is it?  When I started thinking about changing my career (in 2005) from teaching to medicine, I was overseas in Peace Corps. I remember calculating the years in my journal to see what year and how old I would be when graduating/ starting residency.  ”That’s not too old,” I thought.

Now it’s here.  I’m 31, and about to start the most infamous year of my medical training, intern year.  I’m scared.  I feel like there are so many things I still need to improve, for example my self confidence.  There is still so much to learn.  I’m studying for my ACLS (Advanced Cardiovascular Life Support) class today- which is officially my last commitment to my medical school, and feel like I’m failing miserably to recognize how to dose and use medications for emergency codes.  Shouldn’t I know this by now?

Yet, I’ve come so far.  I was able to read and identify ECG rhythms today, something I wouldn’t have even begun to understand four years ago.  I’m excited to begin one of the most rich learning experiences of my life.  I’m honored to be part of an excellent residency program that will guide me well.  I’m grateful to the patients who will welcome me into their lives at intimate and challenging times. 

I’m sad for my friends to be scattered afar, and the realities of infrequent long-distance communication.  I’ll create a new community for myself, which will take effort, but mostly lots of time.  My husband of almost 4-years is by my side, loving me throughout all the changes and challenges that are part of medical training.  My velveteen green and black gown is now hanging in my closet.  My transition from student to doctor is real, not some far-off dream anymore.  

I awake today with soft sun on my face.  It’s my last day living in these beautiful redwoods, the last rotation day of my integrative medicine elective, and sigh… my last day of medical school.  I feel surprisingly sad today.  There is a part of me that would like to curl back up in bed and stay a 4th year medical student forever.

This week has felt heavy.  I participated in an intense day of silent meditation where I fasted and was alone in nature.  I did not to communicate at all with anybody else- no technology, no eye contact/ human touch and no reading.

I had never fasted or been alone for a day before, and both were exceptionally hard for me.  I spent part of the day resting by a stump tearfully digesting the huge transitions I am facing- moving, good-byes, self-improvement and residency.  Nature comforted me in the form of soft moss, and a squirrel and beautiful blue bird who came close to gaze at me curiously.

After thinking, meditating, writing and napping- I went for a long walk.  I found many wonderful places to just be.  I walked down in a lovely creek bed, and at one point decided to remove my shoes and walk barefoot feeling the icy water.

If you want to be deep, go deep.

The more I’ve learned, the more I feel like I don’t know.  Life and medicine are expansive- so many possibilities. In medical school I feel like I’ve forgotten to reflect on all my possibilities. This month gave me the chance to see the huge ocean of healing that encompasses allopathic medicine. During that process I thought more about myself and the type of doctor I want to be in residency – happy, healthy, fun, bold, compassionate, competent, intuitive, integrative and whole.

Yesterday our lecturer pulled out her laptop to let us try a program called “Heart Math,” designed to help patients learn how to relax.  The device measures “pulse variability,” the balance between parasympathetic and sympathetic tones (our innate relax and stress responses).  Fetal variability is monitored closely during labor, and high variability is understood to be a sign of good health.  However, I had never seen anybody describe the usefulness of adult pulse variability.

We had the opportunity to try this program ourselves.  The first student clipped the black probe to his earlobe.  Our group watched the familiar EKG-like beat of his heart appear.  Then, a second tracing began to form mountains and valleys of the heart rate variability.  His pulse climbed between fifty to seventy beats per minute.

The goal of the program was to create a fluctuating variability, like a sine wave, equally balanced between parasympathetic and sympathetic tone.  The probe translated success into easy-to-view color,  red, blue and green.

The first student began in the undesired red zone.  As he relaxed, and breathed deeply, his variability improved. Closing his eyes helped even more.

The instructor asked us to try breathing in unison with our colleague.  Our entire group of medical students began deep breathing together, inhaling through our noses, exhaling through our mouths slowly. We watched in awe as his heart rate pattern began to change instantly.  The sine wave appeared, and his green score rose higher than it had been before.

When I tried this activity, the group was not surrounding me.  It felt much more difficult than it looked when my colleagues had tried.  I had a hard time getting into a true state of relaxation.  Even when I was sitting still in silence breathing slowly, my mind was still in a stressed state.  It felt like a lot of effort to get into the space where the green began to rise, and I never got my variability to match the state it had been with our group’s breathing.

After studying medicine for four years, there are some intuitive aspects of human physiology that seem surreal to me.  I was not taught in medical school about these delicate metaphysical connections.  It should not have felt surprising that the shared relaxation activity as a group had the most profound effects on our hearts (and bodies). Yet, I had never seen such an obvious scientific tool measuring these benefits before my eyes, and it made me feel in awe of our human connections.

It isn’t typical to find myself admiring a banana slug in medical school. During this last scheduled block of medical school, I am surrounded by California redwoods, participating in the American Medical Student Association’s (AMSA’s) annual HEART elective. HEART, an acronym for Humanistic Elective in Activism/ Alternative Medicine and Reflective Transformation (quite a mouthful), is an accredited elective offered to a small group of 4th year US medical students. This year twenty medical students from all over the USA (including Hawaii) have gathered for 4 weeks of intentional community and full-day sessions led by inspirational physicians.

I first read about this elective offering in my fall edition of AMSA’s student magazine, The New Physician. The location “Quaker retreat center” caught my eye because I am Quaker, and rarely see the word cross into my medical path. Although HEART has nothing to do with Quakers, the more I read, the more I felt the experience would be a phenomenal for me. The topics such as humanities, death and integrative medicine felt like areas of weakness in my training. Most of all, I think I sensed my need to connect with like-minded medical students, and strengthen myself before starting residency.

It was hard to leave home so soon after Match Day, especially after feeling like I’ve spent so much time away from home this year. I was not exactly sure what the elective would entail, although I recognized that the California redwoods were an excellent place to be immersed in integrative medicine. Now after nearly two weeks, I feel like I am in the midst of one of the best experiences of my medical training.

The lecture topics so far have included:

• nonviolent communication
• humanities/ art therapy as tools for healing
• Tai-qi and qi-gong
• shamanic breathing
• stress physiology.
• integrative medicine for pregnancy, labor and delivery
• osteopathic manipulation of bones and soft tissue
• training about web resources for integrative medicine
• homeopathy
• end of life decision-making
• meditation and mindfulness

In addition, we went on a nature walk to experience the effects of connecting with the outdoors. The physician who led us magically was able to find all sorts of critters, including newts, a live scorpion and the beautiful banana slug I mentioned above.

I love the company here, and am finding so much usefulness in the teaching sessions. Most of all, it’s giving me a chance to reflect and relate with other students about how we’ve changed (in many ways for the worse) in medical school, and how we would like residency to be a fresh experience with new goals. We seem to be reconnecting with the passions that drove us to be doctors. I plan to explain with a few more stories in the upcoming weeks.

I imagine all of you sitting at the edge of your desk chairs, full of nervous butterflies, gazing at your screens and wondering, “What happened on Match Day?!”  This  description doesn’t fit you though, it fits my state of being last week.

TOTAL anticipation.  The week felt longer than usual, my excitement building to Friday’s noon climax where my future was revealed inside a thin, white envelope. It’s hard to believe a year ago, this day meant nothing to me, and for most of the world, Friday, March 16th was just another normal day.  How could anyone feel anything besides immense anticipation about Match Day?

My school had sectioned the room by alphabet groups, and after a brief announcement and champagne toast, we got right down to the envelope business.  There was no organized line, just masses of anxious medical students crowded around poor student affairs office staff.  When my turn came, I was handed my envelope, and I walked to the side of the room to open it with my husband.

After opening it, we quickly scanned “Congratulations, you have matched!”  And there it was… below my applicant number, below school/ program codes, at the very bottom of the page… my first choice Family Medicine residency program!  Wow, my husband and I shared a moment of disbelief and joy.

Then came the unexpected long denouement.  Hundreds of medical students, families, faculty and staff hugging, photographing and congratulating.  At the periphery you could find a few people quietly crying, not unhappy, but mainly surprised that they had gotten a choice they didn’t anticipate.  Everybody was texting and calling loved ones to share the news.   And that evening my medical school held a formal dance where the celebration continued.

In fact, the celebration felt like it continued into the weekend while classmates, friends and family called and posted messages on Facebook.  Slowly I’m digesting the information about my internship, and all that I will do between now and my internship start date, June 18th.  No more anticipation of the unknown, just a mind full of buzzing ideas and joy.

The whole process of Match Day is rather unforgettable. For years to come, I’m sure I’ll find myself looking back on this emotional day, relating to all the 4th year medical students participating in this unusual envelope-opening ritual.   Now that Match Day is over, all that stands between me and my MD degree is one more elective block and graduation festivities.  UNBELIEVABLE.  This means, my friends, I almost have wings. DOCTOR Liz!

Ever since India, I feel like I finally understand why everybody calls 4th year a “vacation.” Until now, I felt like I was working fairly hard. Sure, not as hard as say, 3rd year surgery rotation, but I’ve had a busy schedule– Step 2 Board exams, applying to residencies and travelling around the country (and halfway around the world)!

Staying busy has made the time evaporate, and it feels like Match week has arrived out of nowhere.  Seriously, how is it almost March 16th?!  For anybody who needs a refresher about this Match business, here is my entry from December.

Yesterday (Monday at noon) I got the email from the  National Residency Match Program entitled “Did I match?”  Inside the email stated “Congratulations! You have matched.” But where?! I won’t know for 5 more days. On Friday, I’ll be handed a white envelope at noon with my Match inside (alternatively I could sit at home and wait for the 1pm e-mail, but no way am I going to wait an extra hour for my results).

Actually I was doing really well handling the stress of making my rank list and letting fate determine my future. Until recently. Now logistical thoughts have crowded in, creating an ever growing mental “to do” list.  I will be moving and starting a new job in two(?!) months. The anticipation is getting to me.  Match NOW.  Please.

A friend described the long periods of suspense during this process as “filled with obnoxious ambiguity,” akin to perhaps “a pregnancy tests that blinks ‘are you pregnant?!?’ while you wait for the line to turn blue. Or a blood test that blinks ‘AIDS?!??!?!’” My aunt told me she feels like she’s going to the Oscars. “At least wear an evening gown for the ceremony!” she advised.

I’m not sure what I’m wearing yet, but I know my husband and I will arrive at school by noon.  We’ve been contemplating my residency for about a year, and we’re not sure what my envelope will reveal.  We know the answer cannot disappoint us too much because we’re excited about almost every option.  It’s going to be a special moment filled with butterflies, that is if I make it to Friday without my nerves exploding inside me!