Success

I got in to med school.

I had an interview this past Friday and I found out yesterday at 9:56am that I was accepted. I still have up to seven "pending" interviews, but it's nice to have my first acceptance.

I really enjoyed the school, the people, the town, and the interview process. It was a little hard not to get emotional sitting at the interview waiting to go back, thinking about everything that brought me to that moment.

It was conscious decision that made everything happen - conscious decisions and a lot of hard work. I feel relieved and nervous and excited all at once. I am probably still in a bit of shock, trying to come to terms with the fact that Yes Virginia, I made it in to Med School... and now the real work can begin.

Above everything else, I'm unbelievably happy and thankful for all the endless support, patience, and love that helped me get here.

Why do all these moments make me cry...

I have an interview Friday.

It's my first interview. I'm understandably nervous. I did all the reasonable things - buy a suit, hem the pants (I'm 5'2"), pick out accessories, print directions...and now we're down to "freak out."

I do a lot better when I have "to do's" on my list. Things like update CV, etc.

What I need to remember is that I worked very hard for almost three years to get to this moment. I never wavered in my commitment to this goal, even though there were plenty of stumbles. The important thing is that I got back up, I dusted myself off, and I tried again until I finally got it.

I earned this interview and I deserve to be driving down there Friday morning. I have a lot to give, and I have my own perspective on why I want to practice medicine. I want to contribute to the field, to my community, and to the world at large. I want to give something back for all the opportunity that I've had.

I think I'm just trying to organize my thoughts into concise answers to anticipated questions. And I guess I'm nervous about being around the other applicants who will, no doubt, have done some amazing things with their pre-med years. I also think I'm probably forgetting about the amazing things I did with my pre-med years too...

At any rate, Friday at 12:15 EST, I'll be interviewing for med school. And that's kind of an amazing thing.

Well. Here we are. It's almost 5 in the morning, I'm drinking a blood orange San Pellegrino I got from a patient, and tonight will be my last night here on the oncology ward. The MCAT is done and in the dust. My score put me firmly into the osteopathic camp, which really, is probably where I've belonged this whole time. I graduated college. I missed summa cum laude by .02 GPA points, but I'm still graduating with honors.

I made it through my school's pre-professional committee process and was rated as a "strong" candidate. This is the third ranking in the list of six rankings they give out, with the top three usually scoring interviews and ultimately acceptances. In the end, I had five letters of recommendation from some of my professors, an adviser, and my research mentor.  I then received a letter from the committee itself, and the another one from a DO that I shadowed in June.

July 14, 2013 I applied to med school through AACOMAS. I picked out ten schools, one as close as three hours away, some as far away as the other side of the country. August 14th I received my first secondary, and this past Friday I sent in my last secondary application. I received secondaries from all ten schools I applied to, but I elected not to complete one of them. The school that I decided not to continue applying to had a residency requirement of five years post-graduation...and really... I didn't want to live there.

I made it through the pre-med years!

In the next year, I will (hopefully) be invited for interviews and then be weighing my options when it comes to offers. I have a few top choice schools, but I'd really like to wait until I've visited the campuses to make any sort of determination of what I consider my top choices. My very supportive spouse has no real inclination towards one city over another, but ultimately he needs to be happy too so his opinion is certainly a factor.

In the meantime, I've accepted a promotion to the "Advanced" version of what I'm currently doing, which will increase my responsibilities to include starting IV's, drawing blood, performing EKG's, and probably several other things I'm forgetting. Oh, and, it's in an emergency room closer to my house that doesn't involve paying for parking or driving across the city anymore.

I'm looking forward to the next several months - I'm also taking some time to watch tv, read some books (Game of Thrones for one...), sleep late, and just enjoy being alive. I'd like to take a moment to encourage anyone who's been following the journey so far to go and do that thing you've been waiting for the right moment for. Your moment, like mine was, is now. Capture it.

This journey started at one of the low points in my life. I failed. I nearly lost everything that mattered, but somehow survived and was able to create this amazing opportunity from the ashes. 

Several years before any of this even started, I read The Alchemist, by Paulo Coelho. This book is a modern allegory that follows the journey of a young shepherd on his way to finding amazing treasure. Throughout the book he loses everything but gains so much more than he lost. 

Sometimes, I feel we get stuck where we are simply because we're afraid of losing what we have. When in reality, we aren't fully satisfied with what we have but we've settled out of fear. We tell ourselves this is good enough because we are too afraid to go after what we really want. 

In my case, I needed a little help from the universe to push myself into chasing after what I really wanted. So, after losing my job, almost losing my life and my loved ones, I realized that I was being given another chance. A chance to start over and do whatever I wanted to do - I just needed to figure out it was. 

That's another thing that holds us back. We are full of endless possibility and worlds of perseverance but lack direction. The old adage of "You can do whatever you put your mind to" chafes against us because we lack a "whatever" to actually put our minds to. This was, for me, by far the harder thing to overcome. 

It was not a meticulous and logical rationalize that got me to where I am - it was almost a whim. My heart told me to go answer the question of "what if...". I literally received some sort of lightening bolt thought into my brain one morning that told me - Hey. Go to Med School. It was October 14, 2010. 

From there I began investigating if that was a real possibility, and what it would take to actually accomplish. Along the way I learned that this career path held real hope for me - the satisfaction of everything I'd ever been seeking in a career, in a life, in a dream. 

It was easy in the beginning - Beginner's Luck they call it - and the road rose up to meet me, ushering me along the way, as if you could sense the very excitement in the air. As I get closer, it gets harder. It asks more of me, and demands that I redefine how I will continue along the path. You have what it takes - but it will take all you've got. 

So now we come to this place where the journey continues, but the terrain is about to change. I am finishing my coursework, I am studying for the MCAT, I am preparing to apply. And I am so very thankful that these chances are mine to explore. This has been the most frustrating and challenging things I have ever attempted to accomplish. And once it's accomplished, it starts a whole new journey of difficult navigations that will also demand everything I have to give. 

However. I am beyond convinced that this is the road I want to take. I know without any doubt that this is the career I want to have. And its not just because I've sacrificed everything to get here or because I've been following it so long I can't conceive of another way - it's because my heart is in the journey with me. This may not be the scientific answer I'm expected to give when asked why I've chosen this direction. It may not make logical sense or fit nicely into an AMCAS response, but it is the reason I can keep going. 

Endless joy. For me this journey has consisted of both unmatched frustrations and unequaled joy. These simple tasks with which I am entrusted may be humble, but they give me a sense of satisfaction at the end of the day. I am not maximizing profits or workflows, I am maximizing human experience. I am easing the suffering of individuals, if only for a moment. And in the end, when there is nothing more that can be done, I am taking a few precious moments to prepare things for their next step - with respect for the life that has just ended, and compassion for the family that is left behind. 

There is nothing more I can ask of the universe, and no greater tasks which I will hope to accomplish. These next few steps in the journey are simply the things that I must do to continue doing what I love. They are the obstacles along my path, and with both my heart and my mind committed to the goals, they don't stand a chance of stopping my forward progression. 

It is often said that to reinvent ourselves, we must destroy ourselves first. I truly believe that for me this was the case. The journey ahead is full of unknowns and difficult roads - but there is a pathway through it if only I would follow my heart and my mind - my compasses leading me on. In the end, I don't really believe in fatalism, but I do believe that there are certain things which will bring you great joy based upon what you find satisfying and what you are capable of. For me, the marriage of these two things is the treasure. For me, my genes, my experience, my talents, my abilities, have all written a code for me - a possible future that will bring me the greatest joy possible. That... to me... is what it means when I say... 

It is written. 

I transferred out of transport and into an oncology ward as a nursing assistant in October. I really wanted to have more meaningful patient interaction experiences. And it's been nice to actually interact with people for longer than ten minutes, and to actually have a chance to watch their case progress through its stages.

Cancer is a disease of a healthy population. That seems counterintuitive, but its true. Without considering childhood cancers caused by inherited genetic instability, cancer can only invade a population that is healthy enough to live long enough to acquire it. Millions of base pairs get replicated each day, some incorrectly, and these genetic mutations sometimes go unfixed. Unfixed and persistent genetic mutations eventually lead to other genetic mutations, which eventually mutate something required to keep cell growth in check, and boom, unregulated cell growth. Cancer.

I work in a stem cell transplant unit. Some of the very sickest people come to my ward. Those who are about to receive a transplant, those who have just received one, and those dealing with the complications from one. Despite our best efforts, survival rates for cancer as a disease class have not significantly improved since the "War on Cancer" was declared in the 1960's. Sure, there are some cancers that have excellent survival rates and that, for all intents and purposes, we really can just "fix," but these are the exception rather than the norm.

I hate to be all depressing, and I'm sorry I'm not citing my work, but the main point of this post is not to discuss cancer, but to discuss clinical detachment. That magical protective barrier that clinicians build around themselves in order to be able to do a good job for their patients without becoming emotionally involved.

I arrived on the ward after one of the ward favorites had just passed away. I don't think I ever even met her, except perhaps in passing. The next person who died was someone who arrived back on the ward after a brief stay in a nursing home. I was witness to her "code" and saw the flurry of activity that accompanies calling a code. I think I passed out barrier gowns and tried to stay out of the way. Se didn't pass that day, but sometime later, surrounded by her family. I did not cry or get upset.

There have been several people who have passed while I've been here, no one who was directly under my care at the time, but people that I helped care for, people whose names I knew. I felt detached from them and their situations. I certainly felt that their situation was unfortunate, but it wasn't my situation, and cancer, after all, is kind of a bitch.

But that emotional fortress I thought I was so cleverly hidden behind has cracks. I am not a stone, and I do sometimes become emotionally involved. The patient whose situation had me crying on the drive home last night is thankfully still with us today, although the case is complicated. There's a really wonderful spouse, there's an army of grandchildren, there's a whole life that occurred before this moment, before the word cancer changed a lot of things.

It wasn't the tears of the patient. It wasn't the pressure ulcers. It wasn't the sight of the grandkids even, really. I think it was the tears of the spouse. The patient is in pain. The patient is not perfectly lucid. The patient is asking the spouse to let them go, let them die. The spouse starts to cry. The aide at the bedside, usually so reserved, usually so much better at doing what must be necessary without emotion, is crying as well.

But vitals must be taken. Blood sugars recorded. Daily intakes and outputs collected. The ward must be rounded on. I cannot dally too long, but regardless of where else I went that night, I was still in that room, holding the patient's hand, getting the spouse blankets and pillows as the spouse prepared to stay the night.

I think it's harder when you see that someone loves them. We all assume that they have loved ones, but when you see it - day in and day out - the strain of caring for, and I mean really caring for, a sick loved one...the heavy bags under their eyes, the hand holding even while the other one is asleep...that's my weakness. I can too easily imagine myself in their place, can too readily imagine what they must feel.

Death is the final part of life, the inevitable end to this biological moment. For my patients, it is the end of suffering, the end of pain, the end of chemo. But for their loved ones it continues on. Life, suffering, memories. My empathy gets the best of me when it is their pain that I witness, and not the patient's. There is no cure for that, and I cannot help abate it.

Here we go

Well, there went summer. I did not cure cancer. Heck, I'm not even sure I figured out what I intended to figure out, although I did learn a lot. If research taught me anything, it taught me that data contains both interesting positives and pertinent negatives. It also contains "huh, I have no idea what that means." moments.

But that's neither here nor there. Here we're standing at the beginning of my actual senior year. At the end of this school year, I will finally graduate with my undergraduate degree(s). I decided that enough was enough and that I was ready to move on. It's kind of terrifyingly awesome because the next steps are actually rather cool.

I'm taking the MCAT in May. I signed up for a Kaplan course (and managed to negotiate a discount with them for my entire college...woot). I'm taking Physics 1 and Organic 2 with lab this semester. I'm also working in the lab 10 hours a week, participating in student government, shadowing doctors, and trying to find time to do the things I enjoy. I rediscovered some of my hobbies over the summer and decided that they need to be part of my life, regardless of what else is going on.

I also interviewed for and became the "final candidate" for a higher position at the hospital. It has far more patient contact (and actually counts towards patient contact, go figure!) and will give me the opportunity to confront death, dying, and survival in a much more immediate sense.

I am happy. I always wondered what you could do with your life if you didn't spend all your waking hours reading crap on the internet at a job you didn't like. Turns out you can do whatever you want with your life if you get all that time back.

Little chances

So, I'm a huge television junkie, which I think we've already established. This time of year, things are running down to their season/series end, and that means lots of reflective episodes, lots of goodbyes, lots of the ole "take a chance and never look back" message.

I've been thinking about that whole message lately, and how it translates into my life and choices. There aren't any big plane rides that I have to take, any tables of roulette that I need to bet on... in essence, there aren't any lines of demarcation between making the "Big! Giant! Choice!" and the aftermath. For me, it's all a bunch of little chances that might translate into big changes.

The decision to go to med school was not met with a sudden change in my life, although it was toasted with much fanfare and congratulations. It was a big decision, admittedly, but the changes it mitigated were small ones. My class schedule filled up with science and math, my timeline to graduation lengthened, and I added a major to my ever-growing list of credentials.

However, looking at my life this morning, while walking to the lab, I was struck by how different it was from my life two years ago. Two years ago, I drove to a job I couldn't stand, to do work that was uninspiring, for people who didn't appreciate it. My days were an endless recreation of the one before, and while graduation was on the horizon, the changes it would bring would be minuscule to my day-to-day.

I had no idea what was going to happen, or if it did, it would be satisfying and worth all the work I had to go through to bring it into reality. Majoring in public service was something I did because it was easy - the classes were offered at night and on weekends, the subjects were not too challenging, and the work I would eventually be "qualified" to do wasn't that much different from the work I was already doing.

I had a happy life - don't get me wrong - but I didn't realize it at the time. I often felt that something was missing, that I had taken a wrong turn somewhere, and I felt a profound sense of loss for a life unlike the one I was living.

Fast forward to today. I'm about half-way through the pre-requisites for applying to medical school, I'm working on a summer research project funded by the National Institutes of Health, I'm a certified Emergency Medical Technician, and I'm working towards a more patient-centered position at the hospital in which I work.

These changes did not come about overnight or even relatively quickly. They were the conscious effort of many small decisions over a long period of time. I read somewhere that our "...futures are dependent upon today's behaviors and actions." I'm finding that statement to be far more relevant than "take a chance and never look back."

In addition to lengthening the timeline of change, it also lowers the stakes of each choice quite a bit. There are many choices that once made cannot be unmade and that forever change your destiny - but these choices are often the exception, not the rule. It is far more commonplace for there to be a series of choices that actually bring about the change we wish. This gives us a great deal more leeway with individual choices, and allows us to experiment and see how the individual choices impact our environments.

I think my basic point is that it's certainly fun to watch Rachel Berry get on a train and arrive in New York City, her life forever and instantly changed, but it's not very realistic. Alas, it's hard to celebrate the little changes at the moment when a choice is made, but maybe it's better to realize that a long time ago, in a land far away, I once made a choice... and that no matter how small or insignificant it seemed at the time, it set the stage for a whole host of other choices that would eventually bring me to today - and that today is a beautiful thing.