The Drama of Grad School (Rodent Reinactment)

Click below to see how to respond to the question, "How's the dissertation going?" Be sure to always have a tape recorder handy for the music, a very important thematic element.

Diagnose me, student doctor!

One really tough thing about being a medical student is that everyone thinks you know lots of stuff and can help them out with any number of medical and diagnostic conundrums. It isn't that I mind answering questions; at least I wouldn't, if I actually knew the answers. That's the problem. At my stage, you don't know much of anything practical. The first two years are basic science, physiology, and the like. There isn't all that much medicine (Surprise! You came to medical school to learn medicine, but first, here are two hideous and painful years of genetics and biochemistry!).

You do learn some medicine; but as I said, what is really lacking is "practical" part. You see, the medicine you learn is the kind of stuff that would scare the living bejeezus out of people if you told them about it. What they mostly teach you are worst case scenarios, I suppose to prevent you from missing those and causing someone to die later on when you are actually doing medicine stuff. For example, the fact that a headache is just a headache in 99% of cases isn't really emphasized very much in the first two years. Rather, you learn about meningitis, epidural hemorrhage, West Nile virus, tumors, and a slew of other horrible things that it could be. We are taught that even something as innocuous as a runny nose could be—and again, it isn't as though this is likely, even if you have recently sustained a major head injury—cerebrospinal fluid leaking out of your brain. Do you see how this type of knowledge might be a problem when trying to council people about the possible cause of their typically completely benign symptoms? “Well, Aunt Molly, your abdominal pain could be that ten day old tuna you ate, or you could have a bowel torsion leading to ischemia which requires surgical removal of your colon so that for the rest of your life you will be pooping into a bag.” I therefore try to refrain from doing this, unless my last birthday gift from the person was less than satisfactory.

Of course, as I said, the alternative to knowing the most horrible possibility is simply not knowing any possibility. This is also very common. But your loved ones seem so confident in your abilities, so certain you will know the answer, so trusting, that it is hard not to just make something up on the spot. It’s important to make up a name that is complex enough that the loved one will not remember it, and then follow that up by telling them that they should talk to their doctor about it. You know: “Hmmm. That sounds like it could be superiomedial recurrent extraclavicular uvulitis. You should probably talk to your doctor about that.”

In any case, remember that most of what medical students know is worse than knowing nothing. Don’t ask for their opinion of anything, except maybe pizza toppings. In the meantime, I’d be happy to give you my opinions on what that strange rash might be. I’d have to go with leprosy.

Hello! You look familiar… are we married?

Being in a program like this one can be a strain on all kinds of relationships. Your parents don’t really understand what you’re doing, or why you don’t know yet if you will have to work over Christmas. Things between the mudphud and his or her spouse/partner is even worse: The mudphud partner is exhausted, stressed, emotional, and has almost no spare time and no control over his or her life. The partner is lonely, bored, frustrated, and tired of hearing the mudphud constantly bitch about stuff. I know all about this from both sides, since my husband is also an MD/PhD student. I haven’t decided if being married to another crazy person like me makes things easier or harder. I’m pretty sure it’s both.

On one hand, we have all of the negatives associated with this mess times two. Both of us have very demanding schedules with long hours that we can’t control. Both of us have to study even when we get to be at home. We have both been through a major episode of clinical depression, aka “graduate school”.

On the other hand, we at least understand why the other has to do these things. I think all mudphud or medical spouses kind of understand. But the more I do this the more I believe it’s kind of like being at war with someone. It’s impossible to really, truly understand what it’s like unless you’ve been through it yourself.

There is another interesting wrinkle to this for me, which is having a front row seat to the madness to come. My husband is a year ahead of me in the program, so I get to watch the events—and the effects of those events—before they happen to me. I knew that finishing grad school, writing my dissertation, etc, would be hard. After watching my hubby go through it, I redefined my expectations of “hard”. Knowing exactly what I’m in for this coming year is good and bad. There is less mystery and I have the advantage of his survival tips and gems. On the other hand, I know things that other students at my level seem to not understand yet. For example, at our last class meeting, one of my classmates asked how many weekends we were going to have to work on surgery; another asked who they had to speak to to make sure they could leave by a certain time every day. I was almost the only one to laugh.

Anyway, the absolute hardest part of all of this is not getting to see very much of your spouse. My husband is my best friend and I love spending time with him—that is, after all, why I married the guy. It’s been hard all year, but now that I have lots of time and he has basically none, it is much worse. In a few weeks I won’t have much of a chance to think about it, but sadly he will have quite a bit of free time next year, and it will be my turn to be totally slammed. We will basically alternate this way—one of us AWOL, the other with a reasonable amount of time—for the next three or four years. Then, God willing, we’ll have more time and say-so about our schedules. At least we will have time off together, for the first time in a few years, for the holidays this year. And in a week we get a whole week off together! It’s the small victories you savor in this business.

I’ve been writing this while waiting for him to finish a question set. He’s studying hard for his last shelf exam (very difficult exams at the end of each rotation), but I have gotten to see a little of him this weekend, which has been great. He’s ready to take a break now, so off I go. I’ve learned that these past few years; be flexible, and you might just remember what your spouse looks like.

Studyin' again... naturally

When you're in medical school, you--by necessity--get used to studying a lot. I did my fair share in first and second year, but I was probably in the bottom third of the class in terms of hours logged. I'm not proud of it, and in fact, if I could, I would go back and kick up the hours I spent (not enough to push me into the top third, but a healthy middle of the middle third). In any case, what is done is done, and all I can do now is learn from my regrets.

By, for example, starting some proactive studying now, while I have lots and lots of spare time, before I start surgery and become overwhelmed with the hours. I have done a little bit, but nothing close to the one hour a day deal I had with myself before I started vacation. What the hell is my problem? It's not like I have anything pressing other than moving the laundry into the dryer before it mildews. It could be any number of things:
1. I'm scared to start studying again in earnest, because it will make me realize how much I've forgotten and made me even more nervous about starting back.
2. My brain reasons that starting too early will just be a waste of time since I will forget the stuff before I start.
3. I'm still recovering from graduate school trauma.
4. I'm a pathetic loser.

I think number four there has the edge. I mean, they all have merit, but it's number four that cuts to the heart of things. Some people think that insane individuals like me, who have chosen years and years (and years and years) of schooling like to study, or have a crazy robust work ethic, or whatever, but I am living proof that that is not always the case. However, once again, my recent fascination with LHotP has shown me the light. Yesterday's episode featured Pa working four jobs, seven days a week (including the Lord's day, as Ma repeatedly reminds him), from before dawn until after sunset, and then continuing to stack giant bags of grain despite four broken ribs, all so he wouldn't lose the farm. As I watched him sweat and wince and stagger and fall (all in a very manly fashion, of course), it occurred to me that picking up a book and doing something with my brain for one stupid hour out of the day is not such a big deal. So now, I go to read. For real. Seriously. Right after I take a little nap.

The four most important decisions of graduate school

Yes, there are lots of chump-traps you need to dodge to survive. But in essence, there are four decisions which will determine the bulk of your misery or happiness (okay, I'm not positive that one can truly be happy in graduate school, so let's say.... not-misery) in graduate school. Here they are, in order.

1. Make sure you really want to go to graduate school. This sounds silly, but I can't tell you how many students I ran in to who had not actually thought about this decision very much. Some did it because they were done with college and didn't really want to get a "real" job. Some did it because they did an undergraduate research project and kind of liked it. Some didn't know what else to do, and some like the idea of research and science but don't yet realize they hate the day-to-day. By my estimate, about half of these people drop out of graduate school, and the other half don't quit, usually for the same bad reasons they decided to come. Then they end up doing something totally different, usually after languishing for years. These days graduate schools are trying to limit entry of these people by requiring at least a year of post-undergraduate research, but sometimes that isn't enough. It's up to the individual to really understand what research is like; how political and grueling and repetitive and sometimes empty it can be, how much reading and writing and 'rithmetic is involved, etc etc. Make sure you understand these things, plus what kind of careers and pay is available to you if and when you get that degree. Make sure you are really happy with at least two of the options.

2. Choose the right department. Don't make this decision based purely on the subject matter. Know important things such as the nature of the preliminary (or qualifying) examination, class and teaching requirements, graduation requirements, reputation, pay, etc., all of which can sometimes vary widely from department to department. If you are an MD/PhD it is very important to learn how each department you're considering has treated mudphuds in the past, because believe me, this can vary wildly too. Often, if you like a particular primary investigator (PI, the person who would be your mentor/boss), and the project you are interested in is related to another field with a department which is a better fit for you, the PI will consider getting a joint appointment so you can have your cake and eat it, too.

3. Choose the right PI/lab. I've mentioned this in the past, but it is very, very, very important to find a PI whose style and personality is a good fit for you. For example, if you are a normal, balanced person, you would not want to work for a Yankees fan, since they all have strong tendencies towards evil. Don't work for a control freak if you are a control freak. Don't work for a slacker if you are a slacker. It's kind of like finding someone to marry, someone who will balance out all of your crazy parts, and whose crazy parts you can in turn balance out. Also it is better if you don't want to stab them with any handy object, blunt or sharp, after speaking with them for short periods of time. As I said, the other people in lab can be a good measure of this. Ask yourself: Do these people look despondent? Depressed? Are all the windows nailed down to prevent further suicide attempts? Are they angry? Drooling? Does their skin show signs of having seen even a few seconds of sunlight in the past year? These are important things to know. Also, ask about people who have recently left the lab. Did they do so in a tight, wrap-around coat and a white van, escorted by men with tranquilizer guns? Or did they move on in a normal span of time to a respectable position at a respectable institution (not the kind of institution the white van was going to)? Also: do you hate them?

4. Choose the right project. I learned this one the hard way. It might seem all shiny and flashy and awesome to start a new project, but this is the kiss of graduate school death in 95% of cases. Read that sentence again, because you, like dumb ol' me, will almost definitely be lured into this crap. You have to remember: It almost never works out for you. Who it works out for is the graduate student who follows you. And what are you, Mother Theresa? No, you will never graduate with that kind of altruistic attitude. What you need to find is some other poor Mother Theresa sap senior student who was tricked into starting such a project and is leaving and is ready to hand it to you with the four or five years of crappy, monotonous leg work all done. You might have to be co-author on the first paper (maybe), but believe me, it is almost always worth it. Also, the PI should be able to outline for you what sort of stuff will be included in your first paper in a decent amount of detail, and it should make sense to you and stand up to some hearty questions.

So there you are. The four main decision tree branches leading to graduate school success. Just try not to fall out of the tree, and you'll be all set.

The MD/PhD Journey: Welcome to the bottom of a new ladder!

One of the most difficult things about the MD/PhD training program is that every time you start to get good at something, you have to switch to something totally different. It’s not that there is never any overlap, but you are usually a stone’s throw away from square one, if not smack in the middle of it. Also, if you were starting to gain any kind of clout, you slide immediately back to whipping boy/girl.

The first is when you start medical school. Almost all medical students are starting something totally new, in a new language. It isn’t until you take Step 1 of the Board Examination at the end of second year medical school that you begin to feel like you know something—however meager—about medicine. It took two years of hard work, but you know something. At this point most medical students proceed on to third year, which in a lot of ways is a step down again, since it is very clinical and different from the classroom learning of years one and two. Also, although it is building on the foundation laid during the first two years, there is an enormous amount of new material to learn. This is also prime whipping boy/girl time, as you are the lowest man on the totem pole in the hospital (although some would argue that interns have it worse, and in a lot of ways this is true). However, you proceed with your classmates, so you at least have peer support. And that foundation of knowledge is still fresh and strong to learn the new stuff.

At this stage, MD/PhD students go to graduate school instead of clinic. This means that you start completely over. New classes, a totally different set of things to know, new (and often strange) people, etc. It isn’t until you are finishing up that you feel you are just beginning to learn the field you have chosen for your PhD. You have become attached to a new set of people who you have to leave again, and you have had plenty of time to forget all of that nice foundation you spent two years building up. You’re starting 3^rd year with a group of people who are largely strangers, most of whom are 4-8 years younger than you (whippersnappers!!). If you are lucky, there might be a few other MD/PhDs returning with you to 3^rd year, and if you are really lucky, you might like some of them, but it is unlikely you will have any rotations with them. You start completely over—again.

I’ve been told that there is not quite as much attrition in the medical knowledge as you fear; that it comes back faster and better than you expect. I hope that is true, but it still feels like I’m starting over for the third time in six years. But at least I get to stick with the clinical stuff for a while—probably about six years—before starting back in lab. Also, even then, I will still be doing clinical stuff, so in a way, I’m finally starting the job I’ll have the rest of my life. The one I've been working towards most of my life. Finally. There will be other ways in the coming years in which I'll be starting at the bottom of new ladders, but at least they will be ladders above the ones I’ve been climbing so far, and not on totally different walls, if you get my meaning. It’s a good feeling.

TODAY ON LITTLE HOUSE: Carolyn goes through menopause, becomes despondent, and fears Charles will no longer love her. Instead, they get remarried. Is there any issue this show doesn’t tackle?!?

"I did absolutely nothing, and it was everything I dreamed it could be."

So, I’m on vacation (hence the lack of posts). It hasn’t hit me yet that I am totally done in lab, but it feels awful nice to not be there. Yesterday I was painting a (very pathetic) picture when my phone rang. It was a friend of mine who is still trying to finish up, with a technical question about an experiment. I put down my paintbrush and answered his question, and he asked how things were.

Awesome. Things are awesome.

The time is going by frighteningly fast, but it is great. A few days ago I didn’t even change out of my pajamas until 3pm. Pathetic, you say? Definitely. But I’ve really been able to catch up on my Little House.

Let me tell you what: the shit always goes down on the prairie. One of my best friends, Andrea, and I realized this some years ago. We didn’t notice it so much when we were kids watching the show, but as an adult it can really put things in perspective. Have a rough day at work? I’ll bet it wasn’t as bad as the time that Pa got run over by the giant, one-ton milling wheel. Got stuck in traffic? Not as bad as the time that Mary, newly blind, got into a really bad stagecoach accident, was stranded for days with her also blind husband trapped under the coach, and almost died in the open plains. Missed your favorite TV show? At least you didn’t lose your baby and your best friend, mother of two young children, in a boarding school fire.

I haven’t just been sitting around watching LHotP. I’ve engaged in other highly impressive activities, such as going to the grocery store and occasionally showering. I’ve had a really good friend visiting so we’ve been hanging out and that forces me to put on real clothes, but I’m going back to the PJ’s when he leaves on Wednesday.

I worry sometimes that this lifestyle is spoiling me, and it will make it all the more painful when, in a few weeks, I have to get up at 4am, work for 15 hours, come home and eat whatever is in the fridge while studying for several hours, and then pass out, hopefully in or near the bed. On the other hand, maybe it will get me nice and rested up.

I sure will miss Little House, though. I might have to check in now and again, when I really feel sorry for myself, and see what kind of horrible plague has descended on the people of Walnut Grove, or who died in a tragic barn raising accident. It will help me remember that they, too, have to get up at 4am, but I'd take walking around an air conditioned hospital over slaving in scorched fields any day.

Graduate skill set number 2,304: Evaluating yourself

Every now and then, a grad student is lucky enough to have a mentor that will praise him or her on a regular basis. This is so rare that I have never heard of it happening. Usually, as a grad student, you are only praised once in a blue moon. And I'm not talking about mediocre or plain bad grad students, and I'm not being picky about what I call "praise", or requiring that kudos be lavished for the tiniest or most simple tasks, such as mearly showing (although sometimes this would have been very helpful). No--for the sake of this argument, let's give praise this definition:
When you are doing an exceptional job, or accomplish something impressive, you are bestowed with the following words: "Good job."
Even with this measly definition of praise, it doesn't happen very often. In fact, it wasn't until after my defense that some members of my committee very slid some really quality praise into our conversations. They did it almost sneakily, as if afraid that I would notice that they praised me. And we certainly couldn't have that.
I vividly recall when a particularly no-nonsense, kind of gruff bigwig told me one day, almost off-handedly, that I was a very good grad student, and he thought I would be a great researcher. I was so surprised that I said something like, "Wow, it's nice to hear that. We don't really get positive reinforcement like that."
He looked at me strangely and said, "You shouldn't need it."
I thought about those words for a long time. On one hand, it's true. We should be able to get to a point in our training where we know if we are doing a good job; we shouldn't need to hear it from anyone else. On the other hand--and I think this gets to the core of why grad school is so hard--we are beginners. Students. Just starting out. But they never really treat you like that. No, the way they approach training is to throw you in with both hands, and turn and walk away. A lot of the time they don't even stick around to see if you sink or swim; they might come back a few years later and see if there's a body to fish out of the pool, but that's about it. It's not as though they lavish you with praise early on and wean you off of it over time. No, in most cases, if they run into you later, they'll say, "Hey--way to get out of that pool without drowning."
So, if you are a mentor with access to grad students (they're easy to spot; just look for the most haggard, depressed people in the halls), I implore you: throw a little kindness their way. If they are doing a great job, would it kill you to let them know about it? In my experience, one morsel of praise can sustain a downtrodden student for months.
In the meantime, we will have to develop the ability to evaluate and praise ourselves. This task is almost insurmountably difficult, at least for me. If you're an insecure person (me!), it's tough to be fair with yourself. If you're an overly confident person (I know lots!), it's tough to be fair with yourself. But, with practice, and importantly, some caring, honest friends, you might be able to get to the point where you look yourself in the mirror after a particularly trying day and say to yourself:
Boy, you sure did screw the pooch on that one.

ATM, PDQ, ASAP FBI

I start my surgical rotation July 2^nd. To prepare for this, I have begun the following regimen:

1. I have my husband wake me up at random intervals throughout the night, and if I do not immediately and accurately recite the Gettysburg Address, he beats me with a sock full of nickels.
2. Sometimes, when I get out of my car, I slam my fingers in the door on purpose.
3. I’m slowly weaning myself off of coffee so that when I start it will be potent enough to keep me conscious.
4. I’m reading some of the study books for the surgical rotation.

It’s that last one that is really the problem. You see, doctors record patient information in the form of “notes”, and since doctors are usually too busy to even sign their full name (ever noticed that if your doctor’s name is, say, William Slatherington, his signature looks like Wie Saaa?), they have invented a lot of shorthand to write these notes. As a medical student I need to be able to (1) read, (2) understand, and (3) write this medical shorthand. So far this is not going very well, in the same way that the maiden voyage of the Titanic did not go very well.

How bad can it be? Well, friend, allow me to slide a little taste of confusion your way, in the form of this ACTUAL EXCERPT which I totally swear I am not making up. Seriously, I am copying this verbatim.

55 yo WM admitted for perforated PU, HD#3, POD#2 s/p Graham patch, NPO, abx=Ancef D#1/5, Flagyl D#1/5, central line D#1

D5 ½ NS @ 80cc/hr, JP output->15cc-12 hr total

PE: Gen: WD/WN male in NAD, A&O x 3.

CV: RRR, nl S1/S2, no M/R/G

Chest: CTAB, no W/R/R

Fantastic!!! Now, if you are a layperson, I know what you’re thinking. You’re thinking that since I have had two years of medical education that I can understand at least part of that mess. Allow me to correct you. My general reaction to the above string of letters and numbers is an abbreviation that I do know, one that you may be familiar with: WTF?

It’s kind of like reading personal ads from hell. I am slightly heartened that I managed to correctly guess what about three of the above letter strings stood for. Three. After two flippin’ years of medical school. Other than that it looks like one of the subway signs in New York.

I just wanted to fill you in on how things are going (Great! Just great! Haha!), and now, if you don’t mind, I’ll return to my regularly scheduled panic attack which was already in progress.

Moving out of lab; aka, What IS that?

Today is my last experiment, and tomorrow I develop it, analyze it, and leave lab for good.
Leaving a lab is sort of like leaving an apartment you've lived in for four years. Instead of food in the fridge, you have reagents and solutions in several fridges as well as up to five freezers of different temperatures. Going through these can be kind of depressing, since I wrote the date on them, and some of them date from 2003. 2003, for God's sake!!! There are also emergency supplies (such as a real necessity for research, aspirin) stashed around, a lots of random things with crazy memories attached to them.
Case in point: We have a small troll doll--the kind with the crazy hair--that has been our lab mascot for years. It dates from a time when I was on my way back from another facility about 20 miles away at 1am, having just finished an impressively boring 6 hour experiment. I realized I was starving, which made sense, because I had last eaten at lunch. So, I stopped at McD's and got a happy meal. Inside was this crazy troll doll and I thought, you know, this is the perfect mascot for our lab. Why? Because things like this make a lot of sense at 1am.
There's also the white mouse stuffed animal that one of my best friends left on my desk when I found out my mom had breast cancer. My giant microbe collection (don't laugh--they're awesome!), my Wonder Woman pez dispenser, green tea, and my Far Side cartoons... you know, the random crap that got me through the day.
Packing these things up gives me the finish I didn't get--it is graduation from grad school. Am I happy? Ecstatic. But a little sad. It's hard to leave something you've been doing for four years. I'll really miss the people. Okay, some of the people. Some of them I'm hoping to see soon, and some of them I'm hoping to see in prison, or perhaps cornered by bears.
The weird thing is that I don't really have a place for this stuff any more. Where does it go now? In a box, I suppose, with the rest of the souviners from previous stages of my life.
Except the troll. That stays, because I had to leave a few people behind that are going to need a mascot.