Men Will Believe What They See

While doing my rotation, I followed my attending to the door of a patient’s room in his small town clinic. Under his long white coat he wore dark jeans, polo shirt and wingtip boots; he looked like a local, like he belonged here. As he pushed the door open, his velvety voice quietly permeated the space, "And that's the sound of sunshine coming down..." The patient’s expression opened into a broad smile. The doctor’s convivial hello illuminated the room like a burst of light. I was surprised by his cheerful energy as we had been up the night before, delivering a baby.

When his patient spoke he sat quietly and listened, giving her a chance to tell her story, gently focusing her efforts. He treated the patient, finished his chart and walked out the door within the scheduled time. 

This is how nearly every visit of every day went; it wasn’t a façade simply for the benefit of the patient. Once out the door, no matter what had happened in the room we just left, a quiet song created a balloon of tranquility that enveloped us in an atmosphere of care. As its notes drifted away and he opened a door to the next unknown, it was as if he transcended whatever malady he had just treated only to begin the same cycle again. Before the end of the day he would pause during a chance encounter with his nurse and thank her for her meticulous work. 

On the weekend I invited his children to rock climb with me. He calmly and firmly supported his young children as they faced their fear of trusting their belayer and the rope. When they cried he climbed up to support their back and hold their feet so they could learn how to rappel securely. He whistled as he walked along the climbing area, stopping to chat with the other climbers in the area, exchanging fishing-hole secrets and coming back from his conversations to cheer on his wife who was taking her turn on the climb. 

The experience fundamentally changed my idea of professionalism. I no longer associate stark dress code and rigid rules with professionalism, but think of it as fluid and ever changing to meet the demands of each circumstance and individual. It’s like monitoring a heartbeat and responding as needed, moment by moment. Professionals dress according to the culture so as to reach those around more effectively; they conduct themselves in a way that is respected both in and out of the office; and they likewise give respect to all those who touch their lives. What gives professionalism its fire and buoyancy are the qualities of humility, compassion and joy. These are the essence of professionalism that gives depth and meaning to every task and interaction.

Professionalism well lived spreads like a contagion from its practitioner. As Thoreau said, "If you would convince a man that he does wrong, do right. But do not care to convince him. Men will believe what they see. Let them see." The doctor never told me what I should do. He never sat me down to lecture on professionalism. The subtle beauty of his influence changed my heart, and in this way I will continue through my days, quietly striving to live the life I have come to admire.

In the Mirror

Until this week if you would have asked me what the hardest part of medical school was I would have said changing the parts of me that needed honing to succeed in medical school. It has ground me ruthlessly down via a relentless daily scouring until I shed the bad habits and unnecessary clutter that I've carried like suitcases for years.

I've learned I can't always be there for everyone, goodness knows I can't even be there for people I love many times. I've learned the world goes on anyway and the people I love and who love me do their best to understand.

I've learned to draw lines around myself emotionally and protect what little vital energy is flowing in my soul and not waste it on things that aren't important.

I've learned how much time I've wasted in my life and what's possible to accomplish in 30 minutes.

I've learned that I need help, desperately.

And in spite of what the American/Protestant way has woven into every fiber of my soul. I've learned that motivation and self-control should be regulated.

I've learned when motivation and self-control are given free reign they cause my heart to die and my body to become ill. That there is a point where you can have too much self-control and too much motivation. Imagine that.

I've learned, "They're the expert... Why not try it?" Isn't always the best sentence to live by. That experts don't know all of what is best for the individual.

I've learned that it is only healthy to change so much at one time.

I've learned that there are things that are my essence and I shouldn't change them or they break my soul.

I thought the list above was the sum of what I needed to learn...

Then I went for a climb, my first trad multi-pitch 480 ft climb, and my perspective changed; my heart beat again. I was ready to learn the real lesson.

Today I should be studying, and I will. But instead I've sat for awhile, looked out the window and cried. I had a long text with my mom. I ran across a Ted Talks that spoke to my heart...

http://www.ted.com/talks/brene_brown_listening_to_shame.html

And I realized the personal change hasn't been the hard part.

The hard part is trusting myself, accepting I am smart enough, wise enough and have what it takes to survive. Not just for medical school but the future that sits before me.

The hard part is being ok, that I failed a class and being ok with the shame of not being perfect. Facing the critic inside that will never be satisfied and with a smile saying, "I am satisfied".

The hard part is learning to look in the mirror and loving what looks back, even if I'm messed up.

The fight isn't medical school, the fight isn't changing habits, the fight is with myself.

Medical school isn't special. We all face the potential shame of failure or the shame of past failure. Almost all of us have to make the decision to start the fight again or give into the inner critic every single day.

It takes courage to get back on your horse and go into hand to hand combat.

And so I am trying again to be kinder to those around me, be gentle and encouraging. Less judgmental...

I'm trying to say more often, "Take heart, you're not alone. And no matter how many times you've fallen, I'm proud you have the courage to stand up, face the possible shame of failure and try again. I know what that feels like."

"It is not the critic who counts: not the man who points out how the strong man stumbles or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again, because there is no effort without error or shortcoming, but who knows the great enthusiasms, the great devotions, who spends himself for a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who, at the worst, if he fails, at least he fails while daring greatly, so that his place shall never be with those cold and timid souls who knew neither victory nor defeat."

Shutter Island

It is never boring interviewing. There is always some bit of craziness to amuse the astute observer and often craziness that doesn't require any sort of astute'ness on the part of the observer.

The school is on an island in the middle of the old Navy base. Windows are broken out of large warehouses, that allow shafts of sun to penetrate the dust stirred up by the ghosts of sailors or more likely gang members planning wars. Shutter Island is the name given to it by the shuttle driver who takes us from the hotel.

The foyer of an old inn is the headquarters the school and is under construction so the place appears closed with various hand written yellow signs pointing out that these doors are not to be used. The shuttle driver gallantly finds the correct door for his cargo of women and we all enter a storage room with tables and chairs lining the walls. Welcome.

We are settled into the conference room, fluorescent lights flicker menacingly, we've entered the asylum. The Dean of Admissions skips into the conference room in his enthusiasm and proclaims with large smile slashed into a weathered face that they interview "right" as opposed to other schools. Fifteen minutes later we are still listening to how the other schools do it wrong and they do it right. And then the hot shock of pain that comes from a rampaging UTI hits me. I just finished my antibiotics yesterday and its back already. I rock slightly and nearly cry, I forget to keep listening how they do it right while others do it wrong.

When he quiets, with a composed rush I enter into the room with the secretaries and ask if anyone has Tylenol, explaining to a room of women that I've just come down with a UTI. With pity they all reach into purses and desk drawers. The one nearest me pulls out Tylenol 800, anti-inflammatory and some sort of muscle relaxant, her prescription. "I choose you." I chug the pill with a handful of water from the sink, begging the Tylenol gods to give me quick relief.

The Dean of the SOM comes in to tell us about the school and answer questions. He has trouble getting to the point and so I sit in agony while he spends 15 minutes telling us that they are proud that they are focused on getting their students good at the patient history and exam. Hands fold contentedly on a flabby belly, "I am proud that we are focused on the medical history and exam." I start my second water bottle. "I am proud that we are focused on the medical history and exam." I stop listening.

My biggest question is always about the curriculum, is it PBL or lecture based? Is it systems based or structured like undergraduate classes? He says, "it's hard to quantify but we are changing it every year... I am proud that we are focused on the medical history and exam."

Do they use student input in these curriculum changes? "We value student input..." the students and professors are close... they are focused on getting their students good at the patient history/exam. After ten more minutes of hearing about patient history and exam, he pauses for a breath and I try to condense 10 minutes into a sentence, "The student's input is informal based on close relationships with the professors?" No, he says emphatically, it is formal too... "Excellent," I wait to hear what formal procedures they have in place, he doesn't say another thing about it but talks about the patient history and exams. I feel sincerely amazed.

We wander around campus for the tour with a first year student who at 6'7" ducks instinctively at every doorway, even while walking backward and talking. "And here is the exam room...*bob* the lab *bob* the cadavers *bob*. No I wasn't a basketball player *bob*." The hazards of being tall.

The campus is old but has character. I like it. I like old buildings that peel paint into ratty hairdos and sneeze the dust of history.

It's a group interview, three interviewers, five students. It's my first of this most dreaded form of interview. They ask me difficult questions like, "What, besides what you have in your application, brought you here today." I smile calmly, while rushing about in my head like a rat being chased around a bucket with a stick, looking for something interesting to say. I coolly mention, "My application is incredibly thorough." This makes my cohorts laugh for some reason, it wasn't a joke or sarcasm it was just the truth. Then I ask for some time attempt to pull an adult rabbit out of my tiny suit pocket. I find, to my astonishment, I don't have a rabbit in my pocket to produce with trumpets and dancing girls so I recap what my application has already said. They are testing my ability to handle stress. I'm starved, limp from a muscle relaxant and my abdomen still feels on fire; it wasn't slick.

We get lunch and it gets interesting. It starts over a sandwich, tuna or turkey. The slightly pudgy male student insists on my choosing first. I try to let him know it doesn't matter and he states, "I'm afraid you will beat me up if you want the one I choose; you could, you know." I look confused at him and the table spontaneously erupts into everyone talking at once.

"We don't have a chance."
"She's been everywhere in the world."
"She could beat me up."
"I was waiting for her watch alarm to sound, for her to nod at us, pull on a jet pack and crash out a window on some important mission."
"What hasn't she done?"
"If she didn't get into other schools its because she intimidates the interviewers, they felt ignorant and inexperienced!"
and the ultimate,
"she is really intimidating," and "she's incredibly intense." 

I look at the whole table my mouth hanging stupidly open not quite sure how to take what I'm hearing, do they feel they are complimenting me or insulting me. I haven't said anything to the people about my life but somehow the little I've said in the interview, and I REALLY toned it down to keep from being intimidating, and what the interviewers have said has spread like the E bola virus around the room.

I finally shut my mouth and took it with a smile but I realize what the trouble might have been in my other interviews. I don't mean to be intimidating and intense but obviously I can be without trying. I focus on the person talking, razor sharp, perhaps much like a cat looking at its next meal.

I'm confident in my abilities, my support group and my work ethic otherwise I wouldn't have bet my future on a 3% chance. I laugh and joke with the kids around me trying to get everyone to relax and enjoy themselves but taken with the other I now suspect I've come across as cocky. Cocky?!?!

And so I wonder if I had appeared less confident, worn a more feminine shirt, if I had trotted out my frightened side, if I appeared helpless maybe I would have more acceptances and less wait lists. Would it be different if I were male where it seems cocky confidence is encouraged? I don't know, I'll never know, but I wonder. Then again, I am always genuine in the interview and if they don't like it I shouldn't be there... so... Admittedly I've done well, considerably better than average, considerably better than I dared to even hope, ever. To my detriment I want perfection, my own perfection.

Grad/Med School Interviewing Tips

This will bore most of you to tears. I just want to put it up in case anyone is trolling the web looking for tips on interviewing for graduate or medical school. It was written originally as an email and was written specifically for a girl applying to psychology graduate school. I've reworked just slightly it for my adviser at NCSU so it is for those going to medical school. But most of it applies to any interview.

Why do I feel qualified to write this. This is a conglomeration of my own experience and a friend of mine. We have both had well above average success in getting accepted into medical school.

The truth is if you're asked to interview you have what the school is looking for in general. You need to present yourself in the best light one more time. Also never forget you may only be interviewing for a wait list position, for those applying to medical school, so don't be depressed if they give you wait list.

---------------------------------

You are about to choose a place that you will spend four years of your life. Life is relatively short and it is worth your time to make sure you get into a place that fits you and your learning style, if at all possible. There are different schools with different perks because each of you is different in what you need.

First and hopefully before you apply look at a school's curriculum. For med schools there are several curriculum styles and I only interviewed at places that I was interested in their curriculum. Each school is predominately one of these styles usually but will mix in other styles. There are:

• PBL (problem based learning or case based learning)
  • This is where you learn all of the information based around patient cases/stories. The one I interviewed with was all patient cases (except a few that were hard to integrate) and you learned by exploring a patient's story for several hours with a small group and then taking your books and reading for hours on your own about the possible problems that the patient had. The tests are then custom made around what you studied in your group. You are lectures maybe a few hours a week and in your small group session a couple hours a day. The rest of the time is for you to read and study. This one is for a self-motivated individual.
• Undergraduate Style
  • This is where you have separate classes and separate test for each class every few weeks. Section test along with midterms and finals. This is much like your undergraduate education. You will take in a single semester classes such as Genetics, Ethical Issues, Biochem, Histology, Micro and Immunology, Doctoring and be in class from 8am-5pm and you will study after that.
• Systems based
  • Where they base the curriculum around body systems, usually starting from the micro and moving to the macro. Different schools do this differently. Some will do normal the first year and then abnormal the second and some mix normal and abnormal together. Currently this is the most popular style.
• Other
  • One school I interviewed at had “Undergraduate Style” the first year and then went to “Systems” the second year. Almost all do some mixing and matching just to a far less degree than this one.

The next step is to make sure you pay attention during the interview when they describe their curriculum or ask people students/staff about a normal day or what specific semesters are like first and second year. I found the school that was old fashioned the first year and systems the second when I went to interview. It was not made clear on the site or even via the phone when I asked specifically. Once I found this out, because I have no interest in the Undergraduate Style curriculum, I dropped them from my list of possibilities.

I chose to keep interviewing beyond my first acceptance. This is because every school is different. There are tangibles that they don't mention on their websites such as the school that is setting up time during rotations for their students to ride with the local flight for life helicopters and there are the intangibles such as the personality of the school.

You will walk in and after a few hours feel whether the school is a good fit for you. You will be able to tell whether the school and faculty are a little distant and cool, whether they are warm and inviting and how this fits in with your own personality. You will never find this out from a paper or a website and it is important. I found that the school's that accepted me right out I felt fit my personality while I was there. The ones that wait listed me didn't fit my personality quite as perfectly. So when they say they are seeing if you are a good fit, they are and they expect you to be doing the same.

Thus interviews are critical not just for them to find out about you but for you to find out about them! YOU are interviewing THEM to see if you want THEM. Don't forget this or lose focus on this, it puts you in a position of power, in charge of your own destiny and will change your attitude. This will be apparent to the interviewer. If you see interviews as being all about whether they want you, you've just lost that edge, that confidence that you have determination in your own future. This may seem like an academic point but what you think and feel changes how you behave and talk. How you conduct yourself and speak are what they are judging you on.

Preparing for Interviews:

This is the only time I personally recommend visiting studentdoctor.net or other forums. Get on, skim (important!!!) the posts about each school and look at what the interview style of the school is. Also check if there are question lists for the school provided by a student. Another option is to contact the school and see if they will put you in touch with a current student - most will – the student can help you a lot when it comes to knowing how to prepare (type of interview/questions they ask).

1. If you can, do not sweat it too much. This is hard for most people. I did great until the few hours leading up to the interview then I would get jittery. Once I walked into the school I lost the jitters by talking to people interviewing the same day. Mostly I spent it finding out about them, asking about where they applied, where they were from, their goals and dreams and I encouraged them if they were nervous or down.

Keep it friendly and light hearted and stay away from trigger points such as test scores, qualifications for med school, whether they've been accepted or not and controversial topics of all kinds. Doing this forced me to focus outside of myself and on others which made me stop thinking about the interview and becoming fearful. Perhaps this won't work for you so know yourself and what will help you lose those jitters.

2. Don't forget your position of power. It's about you interviewing them as much as it is about them interviewing you. They need to impress you not just you impressing them. This is your money and your life you're making decisions on.

3. Don't worry or think about about the other applicants qualifications or your odds of getting accepted. In fact, don't even look at what those odds are until after you're done interviewing and have been accepted some where. It doesn't matter and looking won't change anything, you are qualified or you wouldn't have been asked to interview. You have things that each of the other students do not have and that makes you uniquely interesting to the school. Your ability to smile, be caring to those around you and as relaxed as possible will put you in the best position to leave a good impression of your confidence and who you are, these are the things that in person will set you apart from the average student.

4. If at all possible give yourself at least a day to arrive, find your hotel, pre-find the school/building/room number, relax and prepare your clothes. Interviewing is a big deal and stress ridden, for me it was not worth adding the stress of not finding a taxi or the rental car or showing up and having your interview suit/clothes need pressed and not having time to do it. I wanted to do the process well the first time and not have to waste more money next year flying all over interviewing again so I took several days off work and made sure I gave myself the best chance of success.

If you can find out online or from a student of the school what kind of interview process your school has it is helpful. There are two styles formal, where they try to be objective about something that is inherently subjective; informal, where it is more of a let's get to know the real you and figure out what makes you tick.

Formal:They would read formal questions and you would answer. Lots of times they would ask the same one several times. They cannot respond to what you say and these are the ones where they ask the strange hypothetical questions you may not have considered. If at all possible get question lists for these and prepare answers for the most difficult questions. From what I could figure out the medical schools, Allopathic and Osteopathic, that are doing this are located in the Northwest of the USA. There may be others but this is what I heard. I do not enjoy these kind but again that is based on my personality, you may enjoy them.

Informal:I LOVED these interviews, especially near the last. This style is where your intuition and reading people comes in handy. I realized, later, that I was most comfortable when I knew something about my interviewer. I would read the info the school gave me on them the day of the interview, if they did, and then ask the interviewers questions about themselves when the opportunity arose and it was appropriate. This put me much more at ease and relaxed the interviewer as well. Some interviewers opened it up so I could do this first, others I did it in the middle or end. Pay attention to the body language of your interviewer and how they begin the interview, it will guide you to when this is appropriate.

For example: One told me about himself a little at first, this allowed me to ask questions and get him talking about his research then we transitioned into the interview. Another at the same school didn't give me the chance and started in on questions, mid way through I was able to find out a little about her. And one I had to ask at the end when they asked me if there was anything I wanted to know. I had done my research on the school so I took that time to get to know my interviewer. Bear in mind this is not the only thing to ask here and you may have other things you want to ask. Do what's best for you. Getting to know my interviewer was what I wanted to do.

If possible avoid the question and answer session which is easy to allow the interview to get into. It is at this point that remembering you are also interviewing them is invaluable. When appropriate, I added stories of my own to expound on points I was making. Read your interviewers and trust me you will get better at this as it goes along, my first interview, although fine, was not the quality of my last.

Give yourself a break not every interview will be perfect and you will have many different emotions about them. The interview day I felt not as positive about was the first school to accept me so don't place a lot of stock in emotions but if you know something went poorly, adjust it for next time, but don't get wrapped up in the feelings.

Often the people you are interviewing with are brilliant and outstanding in their specialty. In different interviews I was given names of authors to read which would help me in my plans for the future, insight into the school, the latest information available in the professor's research and most importantly a smile on both my face and on the face of the interviewer.

Some interviews it will be easier to insert your own stories then others but have a story or two in your mind that aren't in your application and that expound a positive trait in yourself or something you've learned that you want to bring out. Then look for ways to lead into it during your interview.

My story was about a surgery I had after a Dr made a mistake and how that allowed me to learn valuable lessons not only about how a patient feels but how a patient feels when a Dr messes up and how the reaction of the Dr changes how the patient feels. If that all makes sense. This is something a school has a difficult time teaching but is really important that the student know before they leave. I may be an asset to the school because I have this insight and it will make me a better Dr (ie a better reflection of their school)

For you, it will be different. Be creative with this there are many things that brought you to this place in life and made you confident you could handle the stress of being a doctor, draw on that.

I didn't add that story to my interview process until after interviewing at several schools. I sat down and talked with a friend and he is the one that when he heard that story told me I should use it. It was a huge asset. Talk to your friends and look for things together that you can use. It seems so obvious to me now but I didn't think I had anything before that. Don't short change yourself and definitely get the help of your friends.

Give yourself a break, find ways to enjoy the process as much as possible because you are going to spend days doing it and celebrate the fact that you have the courage to do something as difficult as try to get into medical school. In fact, I suggest, whether you get into a school or not, find a constructive way to celebrate that you made it through one more interview. Best of luck!

The Real Reason I have Options

Options are good, they scratch and smooth my ego until I'm purring like a contented kitten knowing  that I'm loved at more than one school. I walked into this season of interviewing pretty sure I'd be a lucky girl to even get one school.

Now I have two excellent options, RVU in CO and VCOM in SC and I am wait listed everywhere else I've interviewed. That means it's a good possibility they will become options later. (not sure yet at UNC) To not be turned down anywhere is a shock, I am humbled that they all see something in me they like enough to keep me around. Everyone said it would turn out this way and I always hoped everyone was right and worked my rear off like I didn't have a chance in hades. Statistically I didn't.

I still have prospects of two more interviews, Ft Lauderdale, FL, and Vallejo, CA, so it is far, far from over, just in a little lull. Even then it won't be really over until May. It's a long time to sit in limbo. Limbo is a difficult place for me, since I like to wrestle life to the ground and then reduce it to a list of steps to success. But it is in limbo I learn the most about myself and my great lack of balance. It brings out the weaknesses of my character and parades them around like lumberjacks in a ballroom. Can't miss them! :)

The odds were wretched. My statistical chance at RVU was 4.8% around the same with VCOM. I knew this before I started working toward becoming a Dr and purposefully never thought about it again. Yet odds like that are inspiring. They force me to live on the sharp edge, to drag out every reserve in my soul to do battle. While I bet my whole future, I didn't gamble that much. I know that focusing on one day at a time more can be achieved by any of us then we ever imagined we could.

It wasn't me. I learned this graphically by watching a good friend work hard for a goal they deserved. A goal they likely would have achieved but were blocked in the final stages by someone who had the power to do so, it broke my heart. I still hate it when life is unfair.

It reminded me how blessed/fortunate I've been. There were many times I was blocked from going toward my goal by circumstances. Perhaps some of you remember I lost funding after my first year back at school and it was an influential Chemistry professor that believed in my potential, my dream, who got me into a program and back on track. I can think of many other amazing people (Bobbie, Shellie, etc etc) who saw some little spark of potential in my overly excited brain and either made my path easier or passed that enthusiasm on to someone else who had never met me and in that way, made it so I could move forward.

Thus I suppose this should end as a tribute to those who helped me, the hero's of my life. They include not just the people who have straightened my difficult trail with their influence but everyone who cheers with me and groans at my super nerdy posts, Charles, family (adopted family) and (amazing) friends. It is via each of you that I get the reserve of optimism that keeps me noticing the smallest wonders, a budding tree, an odd  patient, a silly caterpillar with sinusoidal legs. These things and each of you, keep me smiling and give me strength try again tomorrow.

There is some saying about it taking a village to raise a child. It is my experience that it takes one crazy village to make a doctor!

Thank you! If I had a glass of wine/sparkling peach juice (whatever your taste might be) I'd propose a toast and dedicate each success to you!

Might as well enjoy it, it's all about to get that much harder... and I can't wait...

To the Unknown

Tested this morning and I am now a certified General Class HAM. YEOW!!! YIPPEEE! *JUMPING* One goal for the summer down and a couple more to go  and those may not get accomplished. But more on that later.

Just as important, I finished the dreaded personal statement last night and I can now apply to medical school. Once I push that button the future is shot into the unknown and it's out of my hands. I don't particularly like that part of it. I'm more comfortable when there's something left for me to do, to control and to perfect. It's good for me, pushes me to be still and exercises my character. Jumping into activity isn't scary for me, jumping into stillness, into waiting, terrifies me.

So I'm looking over the edge and about to let go... wish me luck.