reflecting on the year, and looking ahead (or, a post filled with cliches)

12/31/2015. It's New Years Eve, and in less than an hour, I'll have to say goodbye to 2015 and begin a whole new year. I think New Years Eve is my favorite day of the year, because it's the perfect time to think back and reflect on the events of the past twelve months, and think about how many things you've experienced and how much you've changed as a person in that time. Of course, being the sentimental sort, I guess it's no surprise that I love this day. It's quite honestly bittersweet, because even though it's exciting to have a new beginning and think about all the amazing things that are yet to come, it's also kind of sad to think back on all the great memories from the past year and realize that once the clock turns midnight, you'll have to say goodbye to them forever.

This past year was a rollercoaster - there's honestly no better way for me to describe it. Academically, socially, and personally, it was a year of growth. I went through so many things - some good, some bad - but overall, no matter how good or bad they were, the important thing is, I came out of them stronger and learned some lessons that I probably wouldn't have learned otherwise. What's that saying, about experience being the best teacher? That is so very true.

I've never much believed in the whole New Years resolutions business, but a few weeks ago, when we were all sitting around and talking, one of my friends asked me what my resolution was for 2016. I stopped for a minute, because I had never really given it much thought, but I soon came up with one. We went around the circle, and each person said their resolution. And when it was my turn, I looked up, smiled, and said, "My resolution is to live each day to the fullest." That might be cliche, but that is honestly my goal - to cherish all the little moments that make the year memorable, because those are what make life worth living.

the end of the semester

Finals week is finally over, and with that marks the end of my third semester at UT Dallas. It's crazy to think how time flies - it honestly doesn't feel like I've been in school for four and a half months, and that half my sophomore year is already over. I remember being really excited about this year - I expected that this year as a whole was going to be challenging, yet rewarding, and this semester in particular, I was the slightest bit nervous about how well I was going to do, with all the stuff that was going to be on my plate - not just classes, but extracurricular commitments as well. This semester, I took 19 hours (4 of those hours were research), and on top of that, I had an on-campus job, was in the PLTL mentor program, was involved in two research programs (one in a lab on campus, and one at Parkland), was secretary of PCFA (Pro-Choice Feminist Alliance), and was a part of several other organizations. I remember thinking back in August, "How am I going to balance all of this stuff?" But now that the semester is over, looking back, I think I did pretty well. I made good grades in all of my classes (even organic chemistry, the class that threatened to kill me this semester), and I was able to devote time to all of those other commitments as well. I love my job, and I'm definitely continuing that next semester, as well as continuing in research. Next semester will be equally as tough, if not more - I have 21 hours on my schedule, and in addition, I'll be a PLTL leader for general chemistry II and moving up to vice-president of PCFA. Things are ramping up, but I know I'll be able to handle it.

This semester was probably one of my favorite semesters at UTD so far - last year, I enjoyed my fall semester, but since I only took 16 hours, it was kind of a light semester for me and I wished I had done more at the end of it. Spring semester last year wasn't as great, but it taught me some really valuable and necessary lessons about time management and making sure that I wasn't ruining my own health and well-being in the process. This semester, I felt ready to take on the challenges that my schedule presented, and overall, I think I handled it pretty well. Not just that, but the classes I took this semester were some of the best and most enjoyable classes I've taken here so far - literature of science fiction, patient narratives, socio-behavioral sciences for medicine, and bio I were my personal favorites. I'm going to miss these classes and the professors who taught them immensely, but I felt that they were definitely rewarding experiences that I'm thankful to have. I can only hope that next semester proves to be a similar story - the classes I'm particularly looking forward to are biochemistry and health economics (although the latter doesn't sound immediately interesting to most people, I know it's going to be a heavily writing and discussion-based class, and that's the kind of stuff I enjoy, so I hope it does go well).

it's been a good week

It's been one of those weeks where the universe makes you aware of how lucky you are to have the things you have. It's when the universe decides to shower you with compliments and remind you about all your positive qualities and the things you're talented at and make you feel better about yourself so that when you feel like beating yourself up or dying under the crushing weight of finals, you can think back to all the lovely things that have happened to you and smile and be grateful for who you are and the life you have.

MCAT musings

A few weeks ago, I began thinking ahead for next year - specifically, I began thinking about the MCAT and how I'm going to prepare for it. In light of the recent changes being made to the MCAT requirements for our program, I've been trying to plan ahead and do my best to begin preparing early so that I can ensure that I do well on this exam, especially since now it means more than it did before.

I have decided to dedicate this summer to MCAT prep, and because of that, I will not be going to India or anywhere else for vacation. I registered with Princeton Review's MCAT summer prep course, which begins a week or two after finals end in the spring semester and ends the final week of July. This also means that I have to stay on campus for the summer, so I renewed my apartment lease this week when the housing application renewal period opened. The MCAT class is from 7-10 pm on weekdays (except Friday), so even though my Clinical Medicine II course is this summer as well, that will typically end around 3-5 pm, which gives me enough time to drive back to UTD from UTSW and make it to my MCAT class.

I had the option of registering for an MCAT course next semester, but I didn't do that for two reasons - one, I'm taking biochemistry next semester, which I need to know for the MCAT, so it wouldn't make sense for me to review material that I haven't even learned yet; and two, I wanted to be able to devote all my time to MCAT, which I can only do over the summer. Reviewing for the MCAT at the same time as taking classes and doing research and all the other commitments that I have would not have been a wise decision. I would much rather have nothing else going on, so that I can just sit down and focus on preparing for the exam. As of now, I expect to take the real thing in September, so I will have a total of 3.5 months to study. I hope that that's enough time.

I've already decided to start preparing  for the MCAT as early as possible, so I plan to try and find some CARS passages to practice so that I can brush up on my critical reading skills and anything else that I haven't done in a while that may be a bit rusty. 

working shifts in the Parkland ED

This semester, I started working as a research associate in Parkland's Emergency Department. This past summer, during our Clinical Medicine I course, representatives from a program called the "Emergency Medicine Research Associate's Program" (or EMRAP) at Parkland came to speak with is about this new opportunity. As research associates, we work weekly four-hour shifts in the ED, shadowing the residents and evaluating patients for their eligibility to join the current clinical studies being done at the hospital. The two studies we evaluate patients for look specifically at closed head injury and congestive heart failure.

So far, it's been my third week at Parkland. They had trouble starting off the program this semester, with getting all our paperwork in, giving us badge access, and getting us access to EPIC, the electronic medical record system that they use here at Parkland and UTSW as a whole, so that's why it's only been my third shift here so far. However, even though I've only spent a total of twelve hours in the ED, I've seen a variety of interesting cases and been able to learn some things about medicine that I probably wouldn't have learned until medical school. Shadowing is such a great experience in my opinion and I feel really fortunate to have been given this opportunity. I'm definitely continuing this program next semester, and possibly next year as well, and I hope to be able to learn even more as time goes on.

the semester is more than halfway over

It's hard to believe that my second year at UT Dallas is almost halfway over already. Midterms just ended, and that realization came to me in tandem with the relief that comes with finally (finally!) being done with exams. For our sociology class this semester, our midterm exam was a paper wherein we had to choose a character from Jurassic Park, pretend they were recently diagnosed with symptoms of tuberculosis, and write a quick character sketch, history of present illness, and create a treatment plan. This paper required us to incorporate many of the major concepts and theories that we've studied in class, and I personally had a lot of fun writing it. I chose Dr. Hammond, the creator of Jurassic Park, as my character, and wrote a total of five pages. When we got our papers back during class last week, I was pleasantly surprised to find that I made an A on it! Our professor also wrote in her note at the end of my paper that I have a talent for writing, and that made me really happy. I love when my writing skills are validated :)

volunteering is honestly the best

Last week, I volunteered with UNICEF at the Genesis Children's Theater. At the theater, we helped the staff prepare for their show "The Drowsy Chaperone," which they were to be putting on in a few weeks. I worked from noon to 5 pm, helping set up chairs for the audience seating, organize and clean the backstage storage areas, and paint the stage. This experience made me aware again of how much I really love volunteering. Giving back to the community is honestly such a rewarding experience; it feels so good to help people and have them express their gratitude for what you've done. It makes you feel like you've really done something worthwhile. The staff at the theatre were absolutely charming and great to work with, and the children who came in the afternoon for voice lessons and practice were so happy and thankful for what we'd done that day. I hope that all my volunteering experiences are as fun and memorable as this one was.

thoughts on the memoir

I'm sorry for the brief hiatus - I had to take a break from writing these journal entries because I was sick for the past week and a half, and I simply couldn't muster up the strength that was necessary to write. This and the following several entries will pretty much be me catching up on the things I missed out on during my temporary absence.

In our sociology class, we have continued to read Dr. Verghese's memoir, My Own Country, and I'm continuing to enjoy it. I love Dr. Verghese's style; his writing is so engaging and he's so good at telling stories that I find it hard to put down the book after I've finished the required chapters for each class meeting. Though his narratives about the lives of the patients he treats and his encounters with the rest of the health care staff are fascinating, what particularly strikes me most about his writing is his description of his family life.

There were two incidents that really stood out to me in relation to this: the first was the part where he talks about his young son Stephen and how he had to rush home from the hospital late one night because Stephen was inconsolable and refused to go to sleep unless his daddy was with him. The moment when Dr. Verghese walks into the room and his son runs over, throws his arms around his neck, and starts to sob angry tears actually made me start crying. It reminded me so much of my own younger brother, who at 3 years old, is significantly younger than me, and how he feels every time I leave home and go back to college for the week. That really hit home for me. I empathized so strongly with Stephen there, but also at the same time with Dr. Verghese, because at a point in life when you have certain responsibilities to uphold and commitments to meet, you are forced to choose between that and your personal life, and by maintaining your integrity, you sometimes have to sacrifice time with loved ones. This is obviously relevant for physicians, and I know that I will definitely have to deal with this in the future myself. It's a difficult thing to consider, especially because as I continue reading this memoir, I see Dr. Verghese repeatedly make references to how he makes time for his patients and in doing so, sometimes neglects his familial duties.

The other instance of this that really stood out to me was when, at the end of some chapters, Dr. Verghese talks about his relationship with Rajani, his wife, and how at one point, he says something relating to his practice that upsets her, or the time he is late to a dinner party they're having with another Indian family because he was talking with one of his patients for a long time. These incidents are touched upon pretty lightly, and Dr. Verghese doesn't spend a significant amount of time talking about them - indeed, there's a lot that goes unsaid in those pages, and I think it says a lot about the dynamic of this marriage, and how his career affects that. That is also something about this book that really piques my curiosity.

toxoplasmosis, TB, and other fascinating topics

Our last class discussion was inspired by several diseases that we examined in various ways. We received a packet about toxoplasmosis, examined the CDC tuberculosis modules, and ended with a discussion about Dr. Verghese and his experience with caring for AIDS patients in My Own Country.

The chapter we read in My Own Country for this week mentioned toxoplasmosis, so we examined this disease in greater detail by reading about it. This week's TB module focused on incentives and enablers, so as our in-class activity, we were given a list of incentives and enablers and asked to distinguish between the two, as well as examine the list more closely and decide which ones to remove and what to add to it. This part was actually a lot of fun, because we thought a few of the things listed were pretty ridiculous (e.g. crickets) and we had some better ideas that we came up with collectively.

Near the end of class, our professor posed the following question to us: is it realistic for us, as future physicians, to expect to practice like Dr. Verghese does in his memoir? Personally, I think it depends on a number of factors - your specialty, the number of patients you have on average, and the kind of environment in which you practice. The specialty of medicine you choose determines a lot of things, including lifestyle, the number of hours you work, and the nature of the relationship you will have with your patients. Physicians who work in specialties that consist of patients with a chronic condition that continuously needs management (and thus who come into the office on a regular basis) are more likely to have a stronger relationship with them than physicians who work in specialties where they see patients on more of a "one and done" basis, and may not see them again after one visit.

The number of patients a physician sees is also important to consider; doctors who have fewer patients to see in a day can spend more time with each of them, thus learning about their stories and getting to know them really well not just as patients, but as human beings. The chapter mentioned that in the clinic, Dr. Verghese had only 2 or 3 patients to see that day, so he had the luxury to spend as much time as he wanted with each of those individuals. On the other hand, in medicine today, doctors who often have 20-30 patients to see in a day can't afford to spend too much time with any one of them, as there will always be more patients waiting to be seen.

The environment in which one practices has an impact on the physician-patient relationship as well. Working in a large public hospital means having to deal with bureaucracy and typically a greater number of patients to see, so doctors who work in this environment will have less flexibility. In contrast, doctors who work in private practice or own their own clinic are more likely to know their patients more intimately and have greater freedom to decide what they want to do.

i've been to the mountaintop

On Friday, I had the opportunity to attend an Honors Night Out through the CV honors program. That evening, I attended a play at the Dallas Theatre Center called "The Mountaintop." The play is 90 minutes long and the entirety of it takes place in a hotel room in Memphis where Dr. Martin Luther King stayed the night before his assassination. "The Mountaintop" was a fantastic play, and I really enjoyed it. It does an excellent job of humanizing Dr. King, portraying him not as the martyr that our history textbooks depict him as, but rather as a human being with real fears, vices, and vulnerabilities, just like the rest of us. I was pretty surprised by the plot twist that was revealed to us halfway through, as I didn't think the play would be taken in that direction; however, I think that really just added to the overall effect, and is what made it such a memorable experience. Also, I have to say- my favorite part was probably the actress who played Carrie Mae. She was really talented, and had the audience in stitches the entire way through. The play as a whole was hilarious, provocative, and emotionally compelling and sensitive. The speech made by the actor who played Dr. King, in which he implores the audience to "carry the baton" and not let it fall, had me in tears at the very end, because that message really resonated with me. It is up to each and every single one of us to stand up and make a difference in the world, rather than give in or sit passively. Whether that happens on a large or small scale is irrelevant; what matters most is that we never stay complacent and allow our strength, talent, and ability to go to waste.

That night, the cast of "The Mountaintop" received a well-deserved standing ovation. If I could go back and watch this play again, I honestly would. It's an experience that will stick with me for many years to come.

"We've got some difficult days ahead. But it really doesn't matter with me now, because I've been to the mountaintop." - Dr. Martin Luther King, Jr.

thoughts on discussion regarding normative behavior

Yesterday in class, our overarching discussion topic was normative behavior. We defined this term and tried to apply it to our understanding of the way our college campus functions, as well as to medicine. One of the points brought up was that by interacting with the gay community, Dr. Verghese himself would be seen as an "outlier" of sorts with respect to most everyone else, who preferred not to talk about AIDS and treated it as a "taboo" topic. This brought up the idea that physicians actually face various risks in medicine - physical, in terms of acquiring an infectious disease from a patient; emotional, in terms of the weight of having to deal with such emotionally heavy issues as losing a patient; and social, in terms of caring for a group of people who society have deemed as "outcasts." The last of these three can be seen throughout history, with diseases like leprosy and AIDS (which has often been referred to as the modern-day leprosy).

The emotional risks of being a physician are particularly important to consider. Often, the stress of work becomes too much for neurosurgeons or ER doctors to handle, and it is not uncommon to hear stories of physicians facing burnout and attempting to deal with it in various ways (some often destructive, such as self-medicating or becoming addicted to alcohol). I personally have heard stories of pediatric oncologists becoming depressed and contemplating suicide because of the young children they treat with terminal illnesses who cannot be saved. Even in specialties that are not always so high-stakes, no doctor ever forgets the first patient that they lost. It is something that stays with them and weighs upon their conscience for years and years to come. Thus, in this respect, I and my peers have chosen a difficult path. However, to me, the rewards outweigh the risks, and I'm fully prepared to face challenges along the way.

From that point, our discussion deviated from the risks doctors face to whether we, as students, are effectively prepared by our training to deal with them in the future. One of my classmates raised the question of whether our current education teaches us how to effectively and constructively deal with stress. When that deviated into a discussion about the various sociological and psychological concepts that we are required to know for the new MCAT, the professor asked us whether we believed it was really important for us to have to know the details of every theory in order to be a good physician. In response, one of my classmates argued that it isn't so much knowing the specific theories themselves as expanding our worldview and developing the critical thinking skills that are necessary to becoming a well-rounded and excellent physician. I agree with that - it's not really going to be essential for us as practicing physicians to know the difference between the nativist and interactionist theories of language acquisition, for example. However, having at least a passing knowledge of such concepts helps us understand human behavior and society on a larger scale, and that's definitely important to medical practice. On that note, I feel that the way this is tested on the MCAT is not necessarily indicative of one's true understanding of these concepts. Test scores are great and all, but on their own, they're really not indicative of a student's ability to be a good physician. They have to be complemented by other aspects of the application, like the personal statement or interview, where the student has a chance to really demonstrate their level of knowledge and thoughtfulness in considering the issues that are important to medicine today, like health disparities or the effect of racial stereotyping on the care that patients receive. These are not topics that can be assessed accurately by a multiple-choice exam, but are still essential and thus must be addressed in some other way.

examining the ethics of patient care

Last week, in class, we watched a documentary on the Lynchburg colony and the Virginia eugenics movement. This sparked a discussion afterwards in which we examined the various ethical issues surrounding forced sterilization and wrestled with the questions of "right vs. wrong" with respect to the actions of the politicians, doctors, and other authority figures who either created the program or participated in its implementation. However, we soon drifted away from the example of Lynchburg specifically and began to discuss ethics of patient care in general.

Recently in the news, there was a story of a 17-year old girl in Connecticut who was taken away from her parents and forced to undergo chemotherapy against her will. Cassandra C., who was diagnosed with Stage 3/4 Hodgkin's lymphoma, underwent a procedure to remove part of her lymph node. However, she firmly opposed chemotherapy. Even though she was still technically a minor, she was a clearly intelligent, well-spoken young lady who had done the research and had made an informed decision to refuse treatment. Her parents supported her decision. However, in spite of all this, the doctors got the state involved and made Cassandra a ward of the state, taking custody of her away from her mother and forcing her to undergo the chemotherapy that she was so strongly against.

I had never heard of this case until it was brought up in class that day, but I was honestly horrified. To think that physicians had taken this girl away from her family and forced her to undergo a procedure that she had clearly said "no" to... It made me lose faith in society, to a certain extent. In this case, it seems to me like a terrible abuse of power to do that. The fact that they even did so under alleged "parental medical neglect" just made it worse. As a future physician myself, I would do my utmost to respect the wishes of my patients, because it's their body and their right to decide what they want to do with it. Even though I'd be in a position of relative medical expertise, it wouldn't give me the right to do whatever I wanted to them. The principles of autonomy and social justice are absolutely central to medicine, and physicians must learn to wrestle with ethics, because it is almost certain that they will come across ethical dilemmas at least once in their career. I know that every ethical dilemma has a number of different angles, and there are always multiple perspectives and ways to look at them; moreover, every case is different. In Cassandra's case, I would say that the state had no right to force treatment. However, the boundary between acting in a patient's best interest and respecting their autonomy is not always clear, and that's what makes ethics in patient care such a complex issue.

I greatly enjoyed the discussion we had that day in class, and I hope I continue to have the opportunity to examine medical ethics in the future. It's a topic that I find really fascinating, and have strong opinions about.

an introduction, of sorts

This is my first entry in what I hope will be a journal that I update with relative frequency throughout the course of this semester (and beyond). I've tried my hand at doing these in the past, but I was never entirely consistent with them. However, this time, I'm starting this blog for two reasons: to practice my reflective writing skills, and to have a place where I can write down my thoughts regarding a variety of different things (e.g. a topic we discussed in class, a book or news article I read recently, a volunteer or clinical experience I had that I want to remember).

The idea for this came from my sociology professor this semester, who has asked each one of us to keep a journal and write in it periodically; we are expected to turn in these entries at the end of the semester, as part of the final exam. Even though it's technically for a class, though, in that way, I still hope that I can continue writing throughout this year and in future years. I think it would be a valuable resource to look back on several years down the road, when I'm in med school or residency, and see what was going through my head when I was a college student.