Lighter in the Wind.

I.           Am.           Doing.           IT!

 

Medical school has been like being tossed into a drying machine. I’ve been thrown around, trying to figure out which way is up or down, continuously adapting and revising my schedule and study technique. When I finally did get my legs under me, they wobbled and threatened to collapse at any given moment.

 

It has been the most challenging thing I have ever tackled. Not only because of the intensity of the course load and the heavy responsibility that is always hanging on the back of my mind, but also the emotional and psychological battle. Every day, I have to garden my thoughts – pull out the negative weeds that sprout, and nurture those seeds of passion and inspiration and confidence.

 

It took me 13 months,

 

but I am finally steady on my feet

 

and running.

  

“It’s not the load that breaks you down,

it’s the way you carry it.”

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To You.

Time rushes past me like water on my ankles.

I memorize every pathology, every genetic mutation, every twisting metabolic pathway, thinking of you. I weave through the networks of hormones and enzymes lost in wonder by the magnificence of it all, wondering which piece will be awry in you. My fumbling hands and young ears keep straining to learn the language your body will speak to me. I wrap myself in my world of diseases for you – the patient waiting for me at the end of it all. I don’t know you yet, but I do all of this for you. I will be there for you. Because every time I have needed you,

you are there for me.

 

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To Dennis.

 

“God, give me the serenity to accept the things I cannot change,

the courage to change the things I can,

and the wisdom to know the difference.”

 

You know that moment when an earth-shattering realization crashes into your body, and for a split second everything becomes still and quiet as it washes over you? Well, that was how I felt for three straight days.

I had the opportunity this week to be gathered with some of the leading minds in medicine and science, and with Li-Fraumeni patients from around the world. Here are a few moments that have changed my life forever:

  • I was laughing and wearing a silly hat in a photo booth, staring into a flash with my arm around the first Li-Fraumeni Syndrome (LFS) patient I met at the conference. She was only the second LFS patient I’ve ever known, and she stole my heart. She was 13 years old. Her bright, eager spirit poured out of her as she told me about her dream of being a professional horseback rider. I was baffled at the wise soul packed into such a tiny body. I knew from the medical literature that the odds were against her: at age 30, she had a 50% chance of already having developed one type of cancer. Many patients go on to develop 5+ different types of cancers in organs all over their bodies, and rarely survive past the age of 70 due to a mutated gene in their DNA. I sat closer to her, hoping for some sort of osmotic exchange: to soak in some of her resilience and fearlessness, while giving her all of my strength and admiration.
  • He was a large, burly man who poured over the tiny chair he sat in at the dinner table, and I will call him Dennis. When his daughter was 10, his wife died from cancer Only 3 months later, her brother also died from cancer. For 6 years, Dennis clung to the last living part of his family he had left as tumors continued to pop up in her tissues. He watched her transform over the years: her leg was cut off, a chunk of her pelvis removed, and cement was poured into the empty cavities left in her bones. He smiled as he recounted her fighting spirit, telling us how they flew to Seattle to fight her leukemia with a bone marrow transplant. Just a few days before surgery, they ordered a CT scan. I realized that his heart was as big as he was as he described crawling into her hospital bed with her when he saw the doctors’ faces arriving with the results. His giant fingers wiped his eyes and his voice broke as he said, “Her scans lit up like a damn Christmas tree.” She died 3 days later and donated her body to science. If I was Dennis, I would have run far away from from anything remotely related to the pain of LFS and never looked back. Yet here he was, sitting among a room full of people with the condition that stolen his family. He told us that he wanted to make a difference for someone else somehow. If only he knew what a difference he really made in me.
  • One night I was chatting with two incredible minds, a cricket from Wisconsin and a crinkled man from Boston, when I scanned the others seated in the dimly lit lounge. I recognized most of their faces as LFS patients and families from the conference earlier, and it plucked a nerve that stilled me like a long wavering note. Had it been any other circumstance, I wouldn’t have thought twice about the scarfs wrapping their bald scalps or the veins clearly outlined in their thin arms. In a handful of decades, chances would have left only us three sitting by the bar. That night, I remembered that we, as physicians, are simply human beings trying to help other human beings.
  • Oliver Weiss, a famous soccer coach who had also been diagnosed with LFS, paced the stage and voiced the conversation he was having with himself: “We’ve known about this condition for 40 years and what have we done? Sure, we screen the few people that we find with the gene mutation in, but we are still missing people out there. We have no cure. We have no targeted therapy. We have no way to prevent it. And I know you’re all working very hard and I’m grateful for that, truly, thank you. But I just lost my last child to this and..”. He grabbed onto the podium with both hands and stared at the floor for a long time. When he finally looked back up at us, the lights shimmered on his eyes. “It needs to go faster. We’re still dying.”
  • My mentor was telling a woman with LFS about my research developing a new liquid biopsy screening method for LFS patients. She turned to look at me and grabbed my arm, her eyes piercing mine with surprising steadfast intensity despite the empty wine glass in her hand. “Listen to me,” she said. “When you work overtime or you get frustrated or you want to quit, you remember me. I won’t quit if you don’t, do you hear me? You remember who you are helping and you remember that what you’re doing matters. It ”
  • I was staring blankly at the stage, lost in a train of thought about all the wasted time and money in research. I had been remembering a time with a friend of mine who worked in a medical research lab. I laughed and actually fought a tinge of jealousy when he had told me how he spent all day getting paid to watch Netflix. Then I reminisced on the group dinner the night before, which was unquestionably paid with department funding. Clapping snapped me out of my trance, and I began listening to someone explain how they were finally able to mimic osteosarcoma in mice. I found myself angrily wondering – how long did that take you? Because I’m sure there were 50 LFS patients who had died with remarkably authentic osteosarcoma tumors in that time. How did your work help them? Are you focused on the root of the problem, or are you filling in blank spaces far in the periphery? Is it really necessary to spend years to know the exact amino acid in a rare sequence of non-coding DNA, or the exact calculations to determine that there is a 10% false positive rate in cancer screening? Great – so those patients have a cancer scare, undergo further testing, but later find out it was a test error and they are actually cancer-free. Boy, it’s a good thing we have those numbers. I can’t help but feel guilty for undermining curiosity and the value of basic science research. But when I’m sitting around people who are stuck helplessly watching their families get obliterated, I can’t help but argue that what we must ask ourselves is: What is the true impact of our research?
  • Initially, speaking with LFS patients made me uneasy. I stared at them and wondered, how much longer will this person be here? A month? A year? Are cancerous cells bubbling out as we speak, unknowingly infesting other organs until the next yearly screening? I found myself struggling to allow myself to get close to these incredible souls – afraid of the pain that might occur when tragedy strikes. Until I realized there is nothing wrong with allowing myself to connect with their fragile state. Aren’t we all just a heartbeat away from death ourselves? Yes, they are predisposed to a higher risk of cancer – but we are not so invincible ourselves. I’ve heard that coming to terms with our own mortality is one of the biggest struggles to conquer. Maybe that is why becoming close with these patients was so difficult: It held up the mirror into my own mortality. There is uncertainty in their fragility, yes, but there is also something so incredibly beautiful.

 

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There Lies a Plan, Here.

As I bee-line towards the East Coast over valleys and states, I have realized the irony in my temporary escape:

My father, bound in dependence and adult briefs in the corner of an assisted living home, re-iterated his death wish to my sister just before my plane took off.

My mother, buried in years of depression that had been washed over by alcohol and pain pills, was headed to the hospital for presumptive liver failure.

Yet here I was, strapped in and headed to a national conference where I would be surrounded by patients whose greatest wish is to simply stay alive.

 

I am traveling from those who don’t care to stay alive, to become immersed around those who would do anything for it.

 

What a divine coincidence.

Love Changes You.

Love stops you and makes you take a long, hard look at yourself.

Love is kind and patient with you while you try to figure out your flaws and your weaknesses. They sit back with calm and encouraging words, while you fumble through the knots of your past and try to smoothen out the grooves of old habits. Love doesn’t accuse and ridicule your faults. Love simply unveils them and smiles, like a secret shared between two close friends, wanting to explore further.

Love fans your flame.

Love doesn’t shy away from your terrifyingly enormous goals – they jump on the train with you. Love sees your passion and isn’t afraid to ignite it, because love has it’s own passion as well. They see the obstacles that chasing your dreams will entail, and they grab tighter and run with you towards it. Love stares in the face of your biggest challenge, looks at you and says, “Let’s make it your biggest strength.”.

Love sees you.

Love listens to you. Not the kind of listening where the sound pours in one ear and out the other. Love closes the other eardrum, letting your words seep in and wanting to know more. Love sees your weirdness and intensifies it. They speak your secret language, smile while you collect traveling marbles from the mountain, and listen as you belt out your favorite song.

Love is better than you imagined.

If you find yourself thinking, “Is this love?”. Let me assure you, it’s not. When you meet Love, you know it without a shadow of a doubt. Love keeps you up laughing into the early hours of the morning. Love notices the effort you make and makes that effort in return, by surprising you with dinner or showing up when you need them. Being with Love is like waking up on Christmas morning every day of the week. Love infuses you like a balloon – making you feel light, like you’re going to burst with happiness. Love turns you into someone you don’t even recognize – someone who is more kind, more trusting, more confident, more caring than you ever thought you could be. Before Love, relationships made you question yourself. But being with Love makes you realize that you are actually very good at the things you questioned in yourself before – like communicating and being able to make Love happy.

Love changes you into someone you always wanted to be.

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Recap of My 1st Year in Medical School

I made it through the infamous 1st year of medical school, and here’s what I learned along the way. Most of this is stuff that I wish someone would have told me on Day 1, so that I could use the right programs and books from the beginning:

  1. Using a 50/10 timer is a life saver. You can study so much more efficiently if you set a timer for 50 minutes, and dedicate that time to focused study (no Facebook, YouTube, anything not related to your studies). Then set a 10 minute break timer. Repeat.
  2. You will feel the struggle of the bell curve. We get to medical school because we are used to living in that glorious thin sliver of the upper end of the bell curve. In medical school, unless you are the 15 students who live in the library and prioritize memorization over life itself, welcome to your new spot in the much larger area of the curve. What helped me: focus on learning the material, not reaching for a number on a test.
  3. Exercise. Just do it. I promise, it works. If you’re like me and struggle to justify the time, flashcards on the cardio machines are a game-changer.
  4. Buy First Aid on Day 1. Look over the chapter you will be learning about for the upcoming test. Don’t write notes in the book until you have a good understanding of the material. In the few days before the test, jot down the few key notes in the book.
  5. Use 2 flashcard programs: Firecracker and Anki. Firecracker has pre-made flashcards for quick review. Anki allows you to add pictures and diagrams, and uses algorithms to hide the flashcards you have mastered, and to keep showing the flashcards you struggle with. Make your own high-yield decks with diagrams and pictures you are familiar with (helpful when STEP 1 study comes around).
  6. Don’t waste time making outlines. That’s what MedBullet.com is there for. Just focus on finding ways to keep the information in your brain – not on a piece of paper. Because when you walk into STEP 1, you won’t have those papers to help you.
  7. Study efficiently so that you can balance your life with things you enjoy. Flip flashcards on your phone while you walk to school. Listen to videos while you drive. That way, you can take that 2 hour break to go rock climbing or go to dinner and completely relax.
  8. Shadow at least 3 specialties during your 1st year. You will thank yourself later for it. Not only will it help fuel the fire in your belly that will start to flicker, but it will also help steer you to choose a research project in your future specialty. These shadowing experiences were hands down some of the best memories during my first year.
  9. Start liking mornings. You will unearth so much more free time if you do.
  10. Surround yourself with people that make you feel light. If they feel heavy, if their conversations are negative, just let them go.
  11. Learn by doing questions. Per the advice of a pediatric neurosurgeon resident, studying should be 80-90% questions. This is much easier said than done – you’ll see.
  12. For cancer stuff, use Pathoma and Robbins Textbook Questions.
  13. For micro stuff, use SketchyMicro. I watch a 5 minute video once and still remember every detail of organisms, months later.
  14. For drugs, use SketchyPharm.
  15. Long-term learning in medical school boils down to one thing: how can you relate the information to something you already know? I still remember a comment I heard years ago from Tony Robbins, saying that anyone can learn quantum physics if it was taught in the context of an orange. New information has to be stored by connecting it to existing knowledge in our brain.
  16. True learning happens after-the-fact. When you go back to review something, take a couple minutes to sit back and think about the mechanism or the word and form connections – this is when you truly learn something. Not during the first-pass in class. For most people I’ve spoken to, this doesn’t happen until STEP 1 study.
  17. Medical school teaches you a superficial layer of everything. This is in stark contrast to undergrad, where you learned depth in everything. (This might be the most frustrating part of medical school for me). STEP 1 will be a dagger dangling over your head starting on your first day of medical school. Know that it’s there, acknowledge it, and embrace it. Use it for motivation, because there really is no other choice. You may be angry that your career is decided by a number on a test, but that is the truth of the game and it can be used to your advantage. So keep your eye on the prize and learn to fall in love with the mechanisms and gears of medicine.

 

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When You Hear Footsteps, Think Zebra.

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His skin reminded me of a leather belt. His eyes were piercing under his overgrown eyebrows, and he gazed up at us all in our crisp white coats for a long minute before opening his mouth to reveal a gravelly voice that said, “I want to thank you all for what you’re striving for. I hope I can help your learning somehow.”

He wore soft, faded jeans and his careful sentences trailed with a hint of country twang. I imagined him as a cowboy in his past life. He told us he had always been healthy and active. Then the patches on his arm began appearing. Next it was the shortness of breath, and the fatigue, and the colds that kept him coughing while everyone around him recovered. The doctors dismissed it with a wave of the hand, and he did as well. Years passed, each a little worse than the last, until a chance X-ray revealed his tumor. It was the size of a cantaloupe.

He recovered from his surgery, and more months passed by while his symptoms continued to widen. He shrugged his shoulders as he spoke of the pain in his knees, attributing it to ‘getting older’. This was not a man to complain.

It wasn’t until the unrelenting diarrhea prompted him to get a colonoscopy, and a keen surgeon prepping his procedure saw a unique correlation in his symptoms. After countless months of doctors visits and tests and dismissals, he was finally tested for a simple molecule in his blood that had been overlooked.

He received the call before he even got home, confirming his diagnosis.

I will never forget the way he paused, trying to explain what he understood about his condition. “My little baby red blood cells were being killed off the second they left my bone marrow.”

 

“When you hear hoof steps, think horses. These are the patients you see every day: your common cold, pneumonia, a sinus infection. But when you keep hearing hoof steps, think zebras.”