The BORED Exams

Today was the first day in a long time that I was able to relax and not worry about anything related to school. I finally took my COMLEX yesterday, the first of many medical licensing exams, and I'm not looking forward to taking the USMLE on Monday. For those who are unfamiliar, the COMLEX and USMLE board exams are required for students to apply to residency. Much like the SAT is used to get into college and the MCAT into medical school, the USMLE/COMLEX are used to compete with other students for the residency spots. The USMLE is an MD board exam and the COMLEX is a DO board exam. Luckily, the DO students can take both exams whereas the MD's can only take their USMLE. This is only one of the many perks of being an osteopathic medical student! If you can call taking two 8-hour exams a perk...

One of my practice board exam questions. These symptoms seem a liiiitle too familiar...

The COMLEX is actually a 9 hour exam composed of 400 questions. There are 8 blocks of 50 questions with a 40 minute break after the 4th block. I ended up only taking about 20 minutes of my break because you don't really feel like sitting around when you're in the zone and just want to get the test over with. The test was brutal. A lot of people have asked me how I think I did but it's just so hard to tell. After 400 questions it was all I could do to wake my rear end up after sitting for so long and on Monday I have to do it all over again. Scores aren't released for six weeks, which is a long time to wait, especially if you're just hoping you've passed! Once this exam is over, I'll be all the more happier. I wish I could say that with one exam down that I'm relieved, but honestly I feel like nothing has changed. I still have a massive exam on Monday and I won't feel the relief until Monday evening when the exam is over. I have a couple of days to relax and enjoy the 4th of July before I move into my apartment in Tucson and begin my first rotation, surgery, in a new city all by myself. I sort of wish that I could have an 'easier' rotation to ease me into the rotation state of mind and learn how things go, but it'll be trial by fire. I just hope my surgeon preceptors have the time to look at me and answer some of my questions. It will be quite an experience and I fully expect my blog to become WAY more exciting once I begin my rotations.

10 day forecast.. It's supposed to be 'cooling down' this week!

Kelcie has been more than amazing these past few months. She's been busy with school and her own rotations, but there has been plenty of times where she has downtime and can do nothing with it because I have been so busy. The end of school had me studying like crazy for my final exams, my practice COMLEX a few days after and then full-time studying for the board exams. I was studying about 12 hours a day for these exams so you can imagine how lonely things must have been for her just sort of waiting around for me to get done... and when I did get done, I was pretty wiped out. We do take time for ourselves though and enjoy getting outdoors when we can. Unfortunately one of things we love to do the most is hike and when the weather is the way it is out here in Phoenix, you can forget about it. Hiking in 115 degree heat isn't fun and it's not safe either. Still, we persevered through these past months and I'm so glad to see that there might be a light at the end of the tunnel come rotations (I hope!). I know that the rotations will pose their own challenges but from what I've heard, I will at least have some time back to myself so that I can get back to being the significant other/spouse that I want to be. Medical school is hard in the respect that you have to give up a lot of things in order to be successful. It's easy for people to say "live for today, not for tomorrow!" or "don't wait to be the person you want to be!", but honestly, medical school has stolen that from me and I'm ready to take it back!

Wish me luck on my exam this Monday. The end of this exam signifies the end of a very stressful time and the beginning of a new life for Kelcie and I. Goodnight everyone!

-Student Doctor Benjamin D. Smith

The Cost To Help

Hooooooooly smokes! I know I've written in the past that 'it's been a while since I last wrote', but it's really been a while, huh? I read a blog today written by an anesthesiology resident and thought if he could do it, then I can definitely do it! So, I've hardened my resolve to try and write in this blog more often so that not only can people catch up with what I'm up to, but so I can remember these times myself.

I'm now an MSIII (third-year student), if you can call it that at this point. I've finished my second-year course work and I'm now studying up for my Step 1 board exams (USMLE and COMLEX) that are about a week away. Studying has become a way of life and I try to embrace it as an opportunity to expand my life and myself as a person. I had a friend, Jered, in undergrad who was one of the first people to really make me realize that learning and studying doesn't have to be boring. It doesn't have to be a chore. Sometimes learning can be exciting, especially if it's about something you're passionate about. I look back through some of my posts now and laugh at how I thought I was 'soo busy' when I didn't even know the half of it.  I now spend about 12 hours a day studying for my board exams and a couple hours off is a blessing. The past year of school was absolute hell, but I made it through. I guess as you get through school you get stronger, or maybe just more tolerant, of having no life and devoting your life to studying. "Come on now Ben, don't try to sound selfless, you're going to be a doctor and doctors make bank"... is that what you were thinking? Come on, you don't have to lie. Well, I guess that brings me to my next point.

One of the things we struggle with as a medical students is debt. When all is said and done, I'll be sitting on about $400,000 of debt. And that doesn't include the interest that I'll have to pay on that capital amount throughout the rest of my life. What I'm going to start talking about now is repayment. How much do doctors earn? It depends. According to Careers In Medicine (a group of AAMC), family physicians on average make around $160,000/year. General surgeons make $343,958/year. Radiologists make on average $440,000/year. The range on these figures is huge, but guess what's the same? The cost of medical school. The US is facing a dramatic loss of primary care physicians and with the incoming baby boomer generation not only needing care, but many of them retiring from medicine themselves, where are we going to end up? Is it any wonder why students are making conscious decisions to go into specialty medicine where their compensation is vastly greater than that of a primary care physician? Would you be willing to take a hit of that much to be a family physician? The problem is that medicine is a business. In order to be a smart businessman one needs to make sound financial decisions. If everyone's input is the same, then why would you willingly choose a career that has a lower output (salary), it just doesn't make sense. The argument of many is that those who go into specialty fields worked harder or are somehow smarter than those in primary care, but this is a ridiculous claim. The field you go into should be dictated by some degree by one's intelligence, but who's to say that an extremely intelligent person shouldn't choose to go into primary care because he enjoys it more than another field? I actually found an incredible article online written by Kevin Pezzi, MD that compared the amount the average doctor makes compared to a UPS delivery truck driver. Who do you think made more money? Believe it or not, the UPS driver. I put the graphs to the side here on the right. There has been a lot of talk about moving things around with healthcare to try and put this fire out, but I honestly don't see a clear solution in the future. Don't get me wrong here; I'm not complaining about how much I'll be making. I didn't chose to become a doctor so that I could 'rake in the cash'. I chose to be a doctor because I love what I do. I chose to be a doctor because I enjoy having a high tier of understanding of the human body and what makes us tick. I chose to be a doctor because I love helping people. How much will it cost me to be the physician I want to be?

In happier news, I'm proud to announce that my younger sister, Katie Smith, will be starting her first year here at Midwestern in just over a month! I'm so proud of her and I can't wait until she's gotten started so we can discuss all these exciting things we learn in school. I wish her all the best and I hope she comes to me when times are hard for a good pep talk.

Well, I must be off. The fact that I'm writing a blog and not studying for my boards probably isn't good, but hey, we all have to relax every once in a while, right? Until next time, stay happy!

-Student Doctor Benjamin D. Smith

Physician salary graph: http://shortwhitecoats.com/2012/the-ultimate-guide-to-physician-salaries
UPS driver vs physician salary graphs: http://www.er-doctor.com/doctor_income.html

Home, Sweet Home!

Well it has been a while since I've written in the blog, which goes to show you how busy I became over the past month or so. Finals came around the corner and had me studying more than I thought possible, but I made it out onto the other side and I'm now relaxing at my mum's house outside with a cup of coffee.

School has been difficult so far, but when I look back on the past quarter that I have now finished I realize that I loved every second of it. Despite how tired and frustrated I became I still learned a lot that I'm excited about. I hear people talking about medicine or doctors visits and I can actually understand what they're talking about. I can look into people's ears now and be able to tell if they have an infection. I can look into eyes and check for hemorrhaging or exudation. I can perform a physical exam, noting any scoliosis or paravertebral humping, somatic dysfunctions, and use my hands to treat headaches. Really, it's amazing how much I've learned in the past couple of months... and it's only the beginning!

Being at home has been really relaxing. I've been spending a lot of time just doing puzzles, drinking tea, and watching hockey games... things that I would never dream of having time for during school. I can sit down and do things without having a burning thought in my head about the test coming up the following monday. The only thing I am worried about is getting back into the swing of things again once I return, without feeling like there's no end to the madness.

I received my grades for this quarter. I did decent.. not exactly what I had in mind, but I'll try my best to improve upon that this quarter. I got an A in three classes, a B in another, and a C+ in another... I think that's all the grades I have for now. I did manage to get 100% on my psychology final which was nice!

I'm off to go throw a ball around with my doggies now. Can't wait for some Thanksgiving food!

Check Engine Light

School has become increasingly hard over the past couple of weeks. Last week the school increased the number of tests we have per week to 2, which is almost impossible to keep up with. My study time has gone up dramatically and my scores have done the opposite. I'm getting to a point where I feel that I'm constantly working but without reward. Nothing is more disheartening than to spend all of your time studying to find that your score was below the class average and well below your personal expectations. I now study on the weekends rather than take it as time for myself. I only really see Kelcie in between coffee refills and when we make time to go on dates on the weekend. Even though we put time aside for us, I still find myself worrying or short-tempered when I'm not working. The academic deans here warned us that 'burnout' was a possibility... becoming overwhelmed and overworked to the point that you lose interest and drop out of school mentally and sometimes, even physically. They also warned us of the potential for depression. Since those who have had the disease before are more susceptible, I worry sometimes that I might find myself crawling into a hole that I can't get out of and feeling those horrible feelings that I felt all those years ago. Still, I do enjoy the little pleasures in life and I keep my spirits high. I feel as if my peers depend on me for a laugh and I enjoy laughing myself, so I try my best to be optimistic and keep a good sense of humor. Still, class from 8-5 and studying from 5-10 every day takes it toll and I sometimes wonder how I will ever be able to survive the next two years of it if I already feel like I'm slowing down only two months into it.

I'm worried that if I take more time for myself to enjoy my life, then I will fall behind in my studies... something that I can't afford. I get sufficient sleep, about 6.5-7 hours a night but with the pressure of school, internal conflict with my father, and keeping my relationships stable, I feel like I'm constantly overworked. Kelcie has been incredible in being understanding about my work. She never complains about never seeing me, although I know she must be so lonely when I'm working. The support that she gives me and the mental break that I get from being with her is a life-saver when the stress is high.

I must be off, I have to be in the Auditorium for a Psychology exam tomorrow at 6:45, but I have to get up early to do some review. Then it's back to studying Anatomy for my exam on Monday. Still, I have to remember that I'm a medical student and that things are going to be hard. Whether I mope around and hang my head, the exams are still going to come. What will get my through these next two years aren't depressing blog posts, feeling sorry for myself, or getting wired up on being frustrated about scores. What will get me through is keeping a smile on my face, finding comfort and support in those closest to me and remembering that though it may seem impossible; things could be a lot worse.

Holding out until Thanksgiving break,

-Student Doctor Benjamin D. Smith

The Pink Suitcase

The night before the big trip you're packing everything you could possibly need for this damn vacation in your suitcase. Clothes, socks, toothbrush, toothpaste, hair dryer, shampoo, suit, shoes- you name it. It's looking like no matter how you try it, there's no way this suitcase is going to close. You sit on it; doesn't work. You squeeze it between a door; doesn't work. You ask the nearest person to squeeze it closed while you try to zip it up; it still doesn't close...

The weeks are beginning to melt together now as I'm getting further into school. We just had a massive anatomy test today. Since last Tuesday I haven't had any time to relax except once when I went grocery shopping with Kelcie, haha. It's been pretty busy. One of the things that has really helped me with the amount of studying I have to do is the atmosphere. At Sonoma State University, my friends were from different majors and had varying amounts of work. One of my best friends had class 3 days a week and no homework. They would play videogames, watch tv, laugh, have movie nights, have parties... all while I was studying. I can assure you that studying seems ten times worse when people are laughing and having a good time in the hallway. Here at Midwestern, everyone has the same workload. All of my closest friends are up to their ears in work as well. As a result, the focus to study is a lot more welcome. I'm beginning to turn into a study machine. I go for hours in front of my computer reviewing lectures and taking notes without eating, speaking, or going to the bathroom. When you know that everyone else is doing the same thing, studying is a lot easier. 

Apart from my good habit of studying, I've developed a bad habit as well. I've begun to get migraines, something I'd never had before. I assume its because of the increased stress and work load. I don't get them too often, usually once a week... twice a week if it's a bad week. I'm taking migraine medicine when they happen and it takes the edge off a little bit. I'll keep an eye on it. 

In happier news, I've been part of a hiring process for the Communications Department. I work at the Communications Department every Tuesday and Wednesday from 8am-9am (tough hours, eh?). They're currently in the process of hiring a new writer and I was asked to help in the process. The applicants for the position were asked to interview me and write up a profile on me... where I'm from, why I'm here, why I chose medicine, etc. I've done two interviews so far and they've been fun... it's sort of weird to be interviewed by a writer. Usually when I'm being interviewed it's as an applicant for a position or a school. I feel like the writers got some good information from me.. there's nothing I'm better at than talking about myself! Some of the questions they asked were about the new healthcare debates and the future of medicine... it made me realize that even though I'm just a medical student, people are beginning to take my advice/opinions seriously and professionally. At orientation we were told, "Now that you're in medical school, people will expect you to be a doctor. Even though you're only a student, people will think that you're already a doctor". Now I'm not saying that these writers thought I was a doctor, but it was weird to know that the comments I made about medicine are no longer my personal opinions but professional opinions... weird, huh?

Mum's coming on Thursday for the White Coat Ceremony. The White Coat Ceremony is a rite of passage, a coming of age for medical students. It's the acceptance of the responsibilities and professionalism of medicine. It's almost like a graduation but a little less of a deal. I'm really glad that she'll be able to make it out. With things the way they are financially, I was worried that she might have to miss it. However, everything has worked out fine and she'll be staying with Kelcie and I from Thursday until Saturday! I hope she enjoys her time here and doesn't find it to be too hot... it's still in the 100's here! 

...finally you manage to zip up your suitcase. As you wipe the sweat from your brow, you notice a pile of clothes you forgot to pack. Is it going to fit? No way. But you have to find a way... once again you struggle to fit the extra items in as they try to spill out the sides. It seems impossible that it will ever fit, but you know someway, somehow it will. You put your head down and have faith in your goal because you know that this is no ordinary suitcase... it's your pink suitcase.

The Little Spermatozoon That Could

It's been a while since I last wrote, but it's only because I've been very busy! I've finally got in to the swing of things at school, learning how to handle the stress of classes and tests while still being able to have a little free time to myself. Kelcie and I just enjoyed a nice weekend in our room... studying, you perverts! The good news is that we managed to find time to go out on a date last night. I took Kelc out to the Cheesecake Factory and then to a movie. We had a great time.

School is going well. We had a club fair where all of the clubs at school present their club and you join the ones you're most interested in. I ended up joining the Pediatrics club, Emergency Medicine, Student Osteopathic Surgery Association, Family Practitioner club and DOCARE, which is a club that does medical missions to third-world countries. It cost me a fortune, but I think they'll be great clubs to be a part of. Classes are getting a little heavier with material. It's not that things are getting harder but rather more content. I was given some of my first embryology lectures and turned out to really enjoy them, which made them quite easy to study this weekend. Nothing is more motivating than to read about poor sperm who run a race for hours just to realize that somebody has already won... at which point they wait around to die.

My Clinical class is turning out to be the most fun. It's only a couple of hours once a week, but it's the class that teaches us all of the techniques that doctors use. By the end of the year we will be able to perform a full physical exam. This past week we learned how to take blood pressure so I was more than happy to try it out on my favorite patient, Kelcie! Needless to say from the picture to the right, she was not too impressed. We had a few friends over on Friday night so I had them take some pictures of my impeccable work for all to see.

I must be off since I have a test early tomorrow and I have to wake up early to get a couple of hours of review in before it starts. So long and keep exercising!

-Student Dr. Benjamin D. Smith

The Ultimate Map and Osteopathic Manipulative Medicine

Let's pretend I told you that by this time next year, I expect you to know the map of the world. I'll start you off easily, perhaps by giving you a continent at a time to study. Let's start with Europe. While studying this part of the map, you must take note of all its important features. What are the countries within that continent? The capitals? How about oceans, major lakes or rivers? Where are the important mountain ranges? What is the English Channel and what is its relationship to France? Now that you've studied these important aspects of the world on a map, if I gave you satellite images of these same continents, could you still name those aspects?

The sacrum, with the coccyx
at the bottom end

This is what anatomy is like. Spending copious amounts of time studying drawings and books of the 'world' and then naming the parts on a human cadaver. We just finished covering the region of the back. We learned about all the muscles of the back, the nerves, blood vessels, and bones. So far I find it pretty interesting.... a huge use of time, but interesting. Labor day was this past weekend but unfortunately I didn't spend much time relaxing but studying for my exam. I still had one day to myself so that Kelcie and I could relax, but the other two were spent studying up material for my anatomy exam. Next monday is a biochemistry exam so I will start studying for that this evening... no rest for a medical student :D

Not from my school, but a taste of what OMM is like

Osteopathic physicians are unique to their traditional/allopathic counterparts in one specific aspect; osteopathic manipulative medicine, or OMM. OMM is a form of medicine that uses the idea that the body always tries to heal itself. As any type of physician we do not really mend a patient ourselves but use drugs or therapies in order to encourage the body to heal itself. OMM is what it means; manipulation. By using our hands we find certain places on the body where pressure or other forms of manipulation can do the body good. The idea is that osteopathic physicians try this method before prescribing any medication. If a patient has had shoulder surgery and is having problems with shoulder pain during recovery, rather than throwing pain-killers at them and slamming the door, DO's will perform various manual therapies around the area in order to release tension and thus reduce pain. Sometimes these methods will not work as well as medications and sometimes they will work better. The idea is only that alternate methods are taken into consideration before using medication. A study by Johnson et al found that only 6% of osteopathic physicians actually use this procedure with half or more of their patients while 33% reported using it on 5% or less of their patients. Needless to say, the use of OMM is up to the physician's discretion. I'm open to the idea of using OMM in my practice, especially if I do go into pediatrics or family care. Today during OMM lab we learned a lot of techniques to discover somatic dysfunctions (abnormalities) in the spinal and sacral regions. It was a lot of fun learning to use your hands as most of you know that I'm a very hands on learner.

One of the hardest things I've found to cope with in medical school is not the late nights studying, the pressure of exams, the high class exam-averages that I must compete with, or even the fact that sometimes I'm so busy studying that I forget why I came here in the first place. The hardest thing I've had to handle is touching people. It sounds ridiculous but it's true. I thought that of all people, I would be the least bit uncomfortable at the thought of touching others, but there's something so weird about it. I'm referring of course to my OMM course where I have to do a lot of pushing and feeling on others... and I'm not talking about holding hands or giving back rubs to friends. Each week I'm paired with a different student that I haven't had a chance to meet before and after a hasty handshake and a "should I be the doctor, or you?", I have my hands deep into the student's crotch feeling around for the bony landmarks of the hips. There's just something unsettling about the whole thing. I'm perfectly content for others to perform the procedures and exams on myself, but once its my turn to begin fumbling around their privates like an idiot, trying to find these subtle bumps while the whole time trying not to get charged for sexual harassment, I become uncomfortable! Perhaps once I get to know them more I will feel better. I'm sure that if I were paired up with one of my good friends, I would have no problem. But in the real world, in a clinical setting, will I have time to make friends with patients?

Kelcie digging through the apartment dumpster
to retrieve my precious knife that she accidentally
threw away!

On the home front, everything has been fine. Kelcie and I are doing great at home. She's just started her classes now and is spending a lot of her free time reading textbooks, studying for her classes in neuroanatomy (and I thought my anatomy was hard!). We try to keep Saturdays open so that we can spend some much needed time together, but we always make sure to have at least an hour a night to relax with each other while watching one of our favorite tv shows! Kelcie has been extremely good to me and has been baking tray after tray of cinnamon rolls, which has unfortunately caused me to gain a few pounds.. but they're too good to pass up!

Give me a needle and I'll give an injection. Hand me a scalpel and I'll slice through flesh. Give me a stethoscope and I'll listen to the constant dull thud of their heartbeat. Ask me to palpate the posterior superior iliac spine of my patient with my bare hands? It's gonna be a long ride.