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SMS Unplugged

How to get a student-friendly room for under $100

How to get a student-friendly room for under $100

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Natalia in her roomTo all the incoming med students wanting ideas on how to set up their rooms with the staggering debt of higher education, here’s what I suggest:

  • $13.38 for 32 sq feet of “Thrifty White Hardboard Panel Board,” but we can call it your new best friend. Home Depot
  • $10 for screwdriver and screws. Home Depot
  • $10.79 for dry erase markers, eraser, and spray. Office Depot
  • $4.99 for a 3 pack of scented candles in glass holders. Ikea
  • $2.98 for 300 pack of matches. Home Depot
  • $8.99 for a plastic storage box that fits under most beds – reserve that for the pile of discarded clothes, papers, and notes that you don’t have time to clean up until after finals. Ikea
  • $14.99 for a basic night stand. Let’s be real, you’re going to study late into the night on your bed and fall asleep. Set yourself up with a nightstand so you don’t have to drool on the laptop you were using. Ikea
  • $6.99 for a table lamp to go on your night stand. Ikea
  • $9.99 for curtains – color so it feels like home. Ikea
  • $7.96 for curtain rod set. Ikea
  • $4.99 for the Swedish meatballs. Ikea

Total: $91.06 with room for tax

You’re welcome.

Natalia Birgisson will soon start her second year at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo courtesy of Natalia Birgisson

Health Disparities, Medical Education, Patient Care, SMS Unplugged

In medicine, showing empathy isn’t enough

In medicine, showing empathy isn't enough

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

SMS_image_072214As a medical student, it’s difficult to face a situation where everything possible is done for a patient, yet due to circumstances (seemingly) beyond our control, the risk of future harm remains uncomfortably certain. The majority of our medical school learning focuses on how to cure illness; unfortunately we’re not always taught how to deal with the real-world issues that face our patients and that threaten the medicine we practice.

This month I’ve been on my neurology rotation at Santa Clara Valley Medical Center, a county hospital with patient demographics quite different from those seen at Stanford Hospital. As I serve a more diverse and disadvantaged socio-economic population, it’s often the case that the information in the patient’s “Social History” section, which I usually quickly pass over, becomes a defining piece in deciding next steps. The 20-something-year-old with daily seizures because he’s so high on methamphetamine that he forgets to take his pills, the 40-year-old with left-sided paralysis who keeps checking in to the emergency department because she feels unsafe living alone in a trailer park, the 60-year-old who didn’t present to the hospital until days after suffering a stroke because he couldn’t physically get to the door to call for help: These patients demonstrate how social situations can make efforts to provide medical care at times seem futile.

In medical school, we’re taught the pathophysiology of disease and systematic approaches to medical management, but not how to deal with social contributors to health. (The latter is a not-so-glamorous aspect of medicine relegated to the hidden curriculum of clerkships.) During pre-clinical years we spend a lot of time discussing how to make empathy a part of our clinical skill-set, but a pitfall to practicing medicine in a way that is sensitive to a patient’s social context is the belief that showing empathy is enough. To express concern for a patient is different from really understanding a patient’s challenges. Things like the fear that drives a patient to repeatedly present to the emergency room for “inappropriate” reasons and the thought process behind not getting an MRI done since it would mean missing work may not fit traditional logic, but they represent an important piece in delivering care.

What can’t be taught in school is an inherent understanding of the difficulties that some patients face, which is why the push for future physicians to be individuals representative of the various backgrounds that patients come from is so important. (It can be surmised that students who have endured these difficulties, themselves or through family, socio-economic or health related, could better relate to patients they come in contact with.) While socio-economic demographics are easily seen on paper, though, what is harder to select for and recruit is the student who has lived the real-world environment characterized by social issues like multiplicity of chronic illness, housing insecurity, and financial hardship. And, of course, many students in this very position never make it to the point of training for a health profession as a result of the very hardships that make them more attune to the social issues that may contribute to poor health.

Medical school recruitment has changed in ways that will hopefully improve diversity of recruited students and contribute to a greater understanding of the background of all sorts of patients among health-care providers. However, more still needs to be done to support students from less-traditional and under-represented backgrounds so they reach the point of applying in the first place. Instead of being discouraged by their less-than-ideal journeys to medical school, students who have endured educational, financial, and social hurdles should be encouraged to use their learned experiences as a frame of reference to positively impact the delivery of health care.

Moises Gallegos is a medical student in between his third and fourth year. He’ll be going into emergency medicine, and he’s interested in public-health topics such as health education, health promotion and global health.

Drawing by Moises Gallegos

Medical Education, Medicine and Society, SMS Unplugged

The woman in the elevator: dealing with death in medical training

The woman in the elevator: dealing with death in medical training

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

flowersAlmost every patient I meet gives me the gift and curse of forcing me to confront a new side of my own vulnerability. I see new ways to die, new ways to suffer, new kinds of setbacks or losses. Of course, very little of this knowledge is technically new: My mother taught me that everyone dies, life isn’t fair, and so on. But since starting clinical training, what is new is the intimacy with which I live that knowledge.

On my neurology rotation, I was sent to examine a little boy in the ICU who had become unresponsive. I will never forget what I saw when I lifted his eyelids. His right pupil was rapidly changing shape from lumpy oval, to diamond, to a slit like a cat’s eye.

I alerted my attending, who somberly explained that that the boy’s brain was probably herniating – in other words, it was under so much pressure that it was being pushed into places it shouldn’t go. A few minutes later, a CT scan showed massive bleeding in his brain. The neurosurgeons were called, but determined they couldn’t save his life. As we left, a curtain was pulled in front of the room.

A few minutes later, already back to work in other parts of the hospital, my team stepped into an elevator. Before the door could close, a young woman ran in behind us. As the elevator ascended, she sunk to the ground and wailed, “Am I going to lose my baby? Please don’t let me lose my baby.” When the doors opened, she sprinted toward the ICU. With horror, I realized the woman was my patient’s mother. Her baby was already gone.

The next morning was a gorgeous Saturday. I had the weekend off so I put on my grungiest clothes and headed to my community garden plot, determined to separate myself from the week’s experiences. Weeds had crept in during a few especially difficult clinical months. I placed a shovel in the dirt, put all my weight on it – and it didn’t budge. I tried again, but the soil wouldn’t yield. I discarded the shovel and reached to pull a huge weed. The dead branches crinkled off in my hand, roots still entrenched in the hard, dry California earth. I sat down among the weeds, defeated, face in my hands.

A woman working another plot – a fellow student gardener I had never met – walked over and asked, “Are you okay?”

“I’m just not strong enough to do this. I should give up my plot.”

“I’ll help you clean it up,” she offered.

“Thanks… Sorry… I’ve just had a bad week.”

“Lots of final exams?”

“No. But I watched a little kid die yesterday.”

My new friend didn’t miss a beat. She knelt down, gave me a hug and said, “You are strong enough. Let’s get your garden cleaned up.”

I believed her, and kept gardening. I proudly told myself I had found an outlet to successfully cope and put the horrible experience behind me.

But it turns out things like watching that child die aren’t processed and compartmentalized so neatly, and can come back to haunt even the best and most personal times. A few months later, on the night before my daughter was born, my husband and I arrived at the hospital full of excitement, and stepped onto the elevator on our way to Labor and Delivery. But as the doors slid shut, I couldn’t suppress the mental image of the last time I rode that same elevator: a desperate young woman on her knees, repeating “Am I going to lose my baby?” For the thousandth time in medical school, I knew the fragility of my own blessings.

I have come to believe that coping doesn’t mean finding a way to separate “personal” life from “professional” experiences. There is no healthy coping mechanism that will let me walk away from experiences like this unaffected. Instead, I just keep telling stories like this one over and over – to myself, my friends and family, and now you – hoping that in the retellings I will find some meaning, some wisdom, some gratitude, or some peace.

Jennifer DeCoste-Lopez is a final-year Stanford medical student applying to residency in Pediatrics this year. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.

Photo courtesy of Jennifer DeCoste-Lopez

Medical Education, SMS Unplugged

Fewer than six degrees of separation: the small world of higher education

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

six degreesSeven months ago, almost on an impulse, I decided I wanted to spend summer 2014 doing research back in Boston (home to my undergrad institution), instead of at Stanford. To this end, I started looking into possible research mentors, and after browsing through the Boston Children’s Hospital website, I found one person whose research interests aligned with my own, sent this person an e-mail and went back to studying for finals. Less than an hour later, I received a response. Two days later, we spoke on the phone. By the end of the week, I was all set for a summer in Boston.

What struck me the most about this entire exchange was not the speed with which it was conducted but the happenstance that accompanied it: I found out during the phone meeting that my now-mentor had actually attended Stanford medical school as well! What, I wondered, were the odds that the single person I chose to e-mail had graduated from the same institution that I now attended?

I thought about this coincidence more in the months that followed, and the more I thought about it, the less it felt like pure luck. Indeed, the past year has shown me just how small the world of higher education can be. Nearly 50 percent of my 102-person med school class comes from four institutions: Harvard, Yale, MIT and Stanford. One of my closest friends in medical school not only went to college with both the girls I’m living with this summer but also lived with one of my current roommates during a summer in undergrad. One of the other med students with whom I’m working with this summer gave med-school advice to the girlfriend of one of my undergrad buddies and – get this – both this coworker and I, unknowingly, performed at the same dance competition last year.

Moments like these make me feel that the “six degrees of separation” theory would more appropriately be called the “two (or fewer) degrees of separation” theory in the world of higher education. And what I’m wondering is whether or not this is a good thing.

Don’t get me wrong – I love playing the Name Game when I meet someone new (“Hi, I’m Hamsika! Where are you from? Yale? Oh, wait – do you know person X, person Y, or person Z? You know all three! No way!”). But there’s something to be said for diversity, not only in terms of race and culture (the two that seem to receive the most media buzz) but in terms of educational background, as well.

I summarized my thoughts on this “small world of higher education” phenomenon to a Harvard Med friend (incidentally, I met this friend at Stanford Med’s Admit Weekend) a few nights ago, and his response was – “Well, it kind of makes sense. If you go to a school like Harvard for undergrad, you’re probably going to end up at a similarly high-ranked institution for grad school. And,” he added as almost an afterthought, “your parents are probably decently well-off, as well.”

Could it be that we’re creating a self-perpetuating cycle in which the world of higher education becomes smaller and smaller and those who miss the “train,” per se, particularly at the “station” of undergrad education, are “derailed”?

I can’t say I know the right answer, but I’d love to hear your thoughts, as the topic of education – as you might notice from the two-liner at the end of each of my entries – is of particular interest to me. Feel free to add a comment below!

Hamsika Chandrasekar just finished her first year at Stanford’s medical school. She has an interest in medical education and pediatrics. 

Photo by Beth Kanter

Medical Education, SMS Unplugged

Countdown to clinics: The 5 best things about jumping into third year

Countdown to clinics: The 5 best things about jumping into third year

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.  

cake2Here at SMS Unplugged, we’ve been counting down to July 1, when current second-year medical students make the leap from pre-clinical to clinical trainees – arguably the most formative transition in medical training. We started our countdown with the most challenging aspects of the third year transition, and continued with the most pleasant surprises. Now that the long-awaited day is finally here, we present the final installment in this series: the best parts about jumping into third year.

5. Reclaiming your mornings
The silver lining of early mornings on the wards is the moment around noon every day when you realize that you and your team have completed almost a full day’s work. Of course the day is only half over, but still: Third year will make you into an early-morning All-Star (whether you like it or not).

4. Medicine as a survey course
As difficult as it is to start an entirely new rotation every few weeks, there’s something to be said for being a ‘chameleon’: blending in wherever you go, sampling a little bit of everything and entering each rotation open-minded. Hate suturing wounds? Don’t worry, surgery rotation will be over soon. Had second thoughts and can’t wait to get back to the operating room? Good news – it’s only a matter of time until a surgery elective comes around.

3. Delivering babies
Each rotation has its own highlights, but obstetrics and gynecology takes the (birthday) cake. Even those of us who are headed toward a different specialty can always look back and say our hands helped to guide a new life into the world.

2. Everything is interesting
For all the agonizing about picking a specialty, there’s another side of the coin: When everything is interesting, it’s hard to go wrong by picking one over the others. And for those who truly can’t make up their minds, there are fields like Emergency Medicine that still see everything.

1. Finally doing what you signed up for
After two years of studying for and taking an endless array of multiple-choice tests, it’s time to start doing what you signed up for: seeing real patients with very real needs. One of our professors would start morning rounds every day by saying, “Let’s go save some lives!” He was only half joking.

To all the new third-year students out there: Congratulations and welcome to clinical rotations!

Mihir Gupta is a third-year medical student at Stanford. He grew up in Minnesota and attended Harvard College. Prior to writing for Scope, Mihir served as co-editor in chief of H&P, Stanford medical school’s student journal.

Previously: Countdown to clinics: 5 pleasant surprises of jumping into third year and Countdown to clinics: 7 challenges of jumping into third year
Photo by Kimberly Vardeman

Medical Education, SMS Unplugged

Student transitions in medicine: putting blinders on

Student transitions in medicine: putting blinders on

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

MCAT2MCAT, AMCAS, NBME, USMLE, NRMP, ERAS. These abbreviations are a bane for many students of medicine, pre-meds to fourth-years, during the summer months. Nervous excitement tingles in the fingertips of undergraduates and post-bacs as they complete their personal statements and prepare to submit MCAT scores and AMCAS applications to medical schools. Pre-clinical students straddle the fence between longing for more time and desiring to hit the fast-forward button as their Step 1 date nears. Clinical students revel in leaving behind the classroom, only to realize there’s a mountain of medicine before that they’ve yet to learn. And final-year students like myself are beginning to suit up, prepping once again to tackle the adventure that is application season.

This past month I’ve been e-mailing with several undergrads whom I’ve had the privilege to meet: bright future physicians who are taking the plunge and applying to medical school this cycle. Reading their personal stories, seeing their ambition and hearing their excitement brings me back to when I was in their shoes. I remember the insecurities of the time, feeling as if my story wasn’t good enough and that I hadn’t done enough for my résumé to reflect my professional desires. Sadly, my excitement was overpowered with fear. I couldn’t turn to my family as I was the first to even attempt such a thing, and I was too embarrassed to seek out professors.  Ultimately it was the support and guidance from peers who had been through the unknown that helped me the most to persevere. It’s because of this that I contribute to efforts providing support along the path to medical school through mentorship, especially for students from socioeconomic groups traditionally underrepresented in medicine.

As I head into residency applications, I’m finding myself reliving the same  insecurities that I’ve been telling my former mentees to ignore. What I realize is that I’m making the same mistake I try to help them avoid: I’m drawing comparisons. I see the people who I’ll be “competing” with for residency spots, and I begin to weigh the differences between my application and theirs (as if I know everything about them). Mentorship is easy when it’s between people who are on opposite sides of the transition in question, but not so much when you’re going through it simultaneously.

This is where Stanford’s shift away from the traditional grading paradigm has helped me. What refocuses me when I find myself getting caught up in comparing myself to other students is telling myself they’re not just “other students” and we’re not “competing.” With no grades, rankings or honor societies that commonly create competition and division, I was allowed from the beginning to focus on making friends, colleagues and support systems. Yes, we may be applying into the same fields at the same time, but we never contended before, and it won’t happen now.

It can be easy to get overwhelmed during the seemingly never-ending application steps of a medical career, but I think it’s important to remember what this first-world problem represents. The medical education-training pipeline may be marked with hurdles and stressors, but reaching the finish line is a blessed opportunity; we’ve been given the chance to be part of a profession that will allow us to interact with people in beautiful, challenging and often life-changing ways. We just have to “focus-up,” “put blinders on,” and “do work.” ERAS, here I come.

Moises Gallegos is a medical student in between his third and fourth year. He’ll be going into emergency medicine, and he’s interested in public-health topics such as health education, health promotion and global health. 

Drawing by Moises Gallegos

Medical Education, Pregnancy, SMS Unplugged

The hospital becomes a different place: pregnant in medical school

The hospital becomes a different place: pregnant in medical school

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

bun_oven2“What was it like to be pregnant on the wards?”

I was pregnant throughout most of my third year of med school, so I’ve been asked this question a lot. For a while I had a habit of brushing it off. “Being pregnant isn’t extra work,” I would point out. “The baby-growing happens automatically while you go about your day.” But over time, I realized that the hospital became a different place for me when I became pregnant, both because of the mental state I brought to my learning and because of how I was treated by others. Here are some of the best and the worst aspects of my own 40 weeks living in that world.

Good stuff:

  • An incredibly meaningful OB/GYN rotation. Being pregnant when I first coached a woman through labor and delivered her baby made an already surreal, beautiful experience even more personal. Furthermore, delivering other people’s babies demystified childbirth for me, making it way less scary when it was my turn.
  • Being taken more seriously by some families on Pediatrics. Fairly or not, many parents trust other parents more than they trust the clinical training of a pediatrician. Although I wasn’t a parent yet, I looked kind of like one. So I was often granted some (unearned) credibility in their eyes.
  • A powerful reminder of how health affects everything else. I was lucky to have an easy pregnancy by most standards, but there were days when minor symptoms—nausea, joint pain, headaches I couldn’t treat with medication, or just feeling a little off—made the already draining demands of med school take more of a toll. After this experience, I try to have more patience when I ask my patients to navigate complex health systems or make major life decisions all while suffering from symptoms far more severe than the ones that brought me down.

Bad stuff:

  • Feeling like my identity was reduced to “the pregnant student” in the minds of some of my superiors. A handful of attendings thought that pointing at my belly and asking “What’s going on in there?” was totally appropriate behavior for rounds. One resident would greet me by asking “still pregnant?” when it had been only two hours since he had last seen me. Another time I was pointedly quizzed in clinic about the recommended amount of weight gain during pregnancy (not OB/GYN clinic, which would have made sense).
  • Assumptions about my professional seriousness based on my appearance. I was once scrubbed into the operating room during my third trimester and the attending surgeon asked me if I was interested in Surgery. Before I could answer, the resident blurted out incredulously, “does she look like she’s interested in Surgery?” Few times in my life have I been more aware of my gender and the barriers that come with it. The flip side of that coin is that when people found out I was interested in Pediatrics, they would often respond with a knowing nod and say, “of course, that makes sense.” I wanted to explain that I am interested in Peds for reasons that I find professionally compelling, and wanting to have my own kids is a separate decision.
  • Never being able to get my work done without having to answer well-meaning pregnancy questions. While I was pregnant, many people I had to collaborate with in the hospital wouldn’t get around to talking about the patient with me until I at least shared my due date and explained that it’s not a boy even though I “carry it all in the front.” It wasn’t the end of the world enduring some overly personal small talk, but it did sometimes get frustrating.

In the great scheme of things, the way Stanford Med handled my pregnancy gets an A+ in all the most important, practical ways. My mentors and advisors were overwhelmingly supportive, I was never penalized for having to attend medical appointments, and I was granted a huge amount of control over my academic schedule and timeline. Nonetheless, the learning environment was undeniably different because of my pregnancy. I hope that by speaking openly about it, I can help future students in my position experience more of the good lessons that came with pregnancy on the wards, and less of the negative assumptions.

Jennifer DeCoste-Lopez entered medical school at Stanford in 2010. She was born and raised in Kentucky and went to college at Harvard before heading to the West Coast for medical school. She currently splits her time between clinical rotations, a medical education project in end-of-life care, and caring for her daughter, who was born in 2013. 

Photo by Chip Harlan

Chronic Disease, Patient Care, SMS Unplugged

High yield: Lessons from a 4-year-old

High yield: Lessons from a 4-year-old

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

AlanIn two days, we take our last exam as first-year medical students. Sitting in the same library that I used to as a pre-medical student, I think about what it is, exactly, that has changed this year. For me, the point of transition from pre-med to med student really happened over Thanksgiving break a few months ago.

I had come home from my first term of medical school more ready for my mom’s hugs and homemade banana bread than ever. People say that the first few terms of medical school are like trying to drink out of a fire hose, because there’s so much information we are expected to learn and retain. On an average week, for example, we have 40 hours of class, not to mention the time we need to study.

Luckily, one of the hardest classes this term had its final the day before Thanksgiving break, so we could go home with some amount of stress alleviated. Biochemistry had been the hardest, least intuitive class for me, and I was relieved it was done – and I was happy to be with my family.

* * *

“So what have you learned in medical school?” my beloved step-dad, Dan, asks excitedly. We’re having our traditional family brunch, with my grandparents, parents and sister, and all the cousins that are around. I look down at my plate, thinking. I’ve learned that the vitamin B12 bottle I can see on our kitchen counter next to the leftover pie contains a unique vitamin because it’s only helpful to two enzymes. I’ve learned how the fatty food that we’re eating kills us, and what that food looks like in dead bodies.

“Diabetes,” I answer, smiling at Dan. “I’ve learned how the two types of diabetes happen.”

“Ah, sí?” my grandmother asks in Spanish. “Debemos invitarle a Bea para que nos enseñes.”

My little 7-year-old cousin, Aida, was diagnosed with type 1 diabetes two years ago. It’s caused quite a stir in my Hispanic family that we can’t feed her quesillo, bread or even fruit without worrying. Her mom, my Aunt Bea, has been plagued with guilt that she did something wrong ever since the diagnosis.

In every family there is that one cute little kid – usually the youngest – whose misbehavior makes all the other kids look like angels. Punishment doesn’t work because they don’t mind being yelled at, discipline doesn’t work because they’re stubborn, and praise doesn’t work because they’re so cute they get attention all the time anyway. If my siblings read this, they’ll nod their heads remembering me as a child. When I hear this description, though, I think of my 4-year-old cousin, Aida’s little brother. He is the most beautiful little child, with big brown eyes, tan skin and dark rusty red hair.

Alan was born when I was already away in college, so I don’t get to see him or his adorable older sisters very much. But here I am now, with Alan and the rest of my family, who gather on the couch after brunch and wait for me to explain to them what’s going on with Aida. I talk with Aida and Bibi, the two little girls, about clean-up cells that got the wrong message in Aida’s body.

I’m asking Aida and Bibi to explain to me what they understood from what I had said when I look over at my aunt to make sure she’s okay. It’s then that I realize that Alan is quiet. It’s the only time that I’ve ever seen him sit quietly, and I see his attention is on me, as well. There’s no way he understood what I was talking about with beta cells and the immune system, but he understands that this is important, and because everyone in his family is focused on it, so is he. In the dynamics of his family, diabetes trumps all other cards.

***

In that moment, my 4-year-old cousin taught me the two most important lessons that I’ve learned so far in medical school. First, that diseases – whether common and rather boring to learn about, or rare and still not understood – affect everyone in the patient’s family. Every family has someone with something, my own included. And, second, everyone whose life is influenced by such diseases looks to doctors more often for support, affirmation and solidarity than anything else. This moment on the couch with my precocious cousin listening to me, this was medicine. And I was becoming a doctor.

Natalia Birgisson is a first-year medical student at Stanford. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.  

Photo of Alan Higuery by Beatriz Royo Higuerey

Medical Education, SMS Unplugged

Countdown to clinics: 5 pleasant surprises of jumping into third year

Countdown to clinics: 5 pleasant surprises of jumping into third year

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.  

this wayHere at SMS Unplugged, we’re counting down to July 1, when current second-year medical students will make the leap from pre-clinical to clinical trainees – arguably the most formative transition in medical training. We began with the most challenging aspects of the third-year transition, involving early mornings and the emotional demands of confronting morbidity and mortality on a daily basis.

But for every new challenge, there comes at least one welcome surprise. Above all else, third year is a time of professional and deeply personal discovery. Systematically rotating through every major medical specialty is a tour of the health-care system that we may never experience again. And it’s during third year that we decide which specialty to pursue – a choice that will have an impact on the rest of our lives.

With that in mind, we continue our countdown with the most pleasant surprises of third year.

5. Productive confusion
There are two types of students entering third year: those with a short list of specialties they’re interested in, and others who are open to exploring the wide world of medicine. But even the most focused students can end up somewhere vastly different than they’d originally planned – much to the relief of those of us who hadn’t decided on a career path. Every rotation is truly fascinating, to the point where even the best laid plans suddenly come into question. Discovering that you’re interested in (and maybe even good at) something completely new is a great feeling, even if it derails the career you mapped out at the start of medical school.

4. You know a lot more than you think
Third year is notorious for constantly pulling the rug out from under you: As soon as you start to feel competent on a rotation, it’s on to the next one, which reminds you just how little you know. But in spite of spending most days struggling to speak the language of a new field, students also have a wider knowledge base than they realize. A seasoned resident or faculty member will have command over the information specific to their field – but if a patient has an issue the expert doesn’t remember from their own medical school days, suddenly the student becomes the teacher.

3. Nurses are not doctors… or are they?
Although the role of mid-level providers has sparked significant controversy recently, one thing is clear: Nurse practitioners and physician assistants have a lot to teach us. One big lesson I learned during third year is that high-quality patient care takes a lot more than just a professional title or even a great medical or scientific knowledge base: diligence, leadership and a certain degree of savvy in navigating a complex health-care system are required. We don’t learn those qualities in medical school lectures; we’re expected to pick them up on the wards. And as any third-year can attest, nurses and physician assistants are often the best teachers in the clinical setting. It’s humbling to realize that MDs aren’t the only ones who can make decisions in patient care. But it’s also refreshing to realize that we’re not alone in that undertaking.

2. The prescience from standardized patients
Pre-clinical students work with ‘standardized’ patients – actors who simulate a variety of clinical encounters. It feels a bit odd to practice (and be graded on) seemingly obvious interaction skills like introducing oneself, listening carefully or letting the patient speak. I didn’t fully appreciate those lessons until I observed a senior physician bluster into a patient’s room without any introduction, deliver a 10-minute soliloquy on her prognosis and leave without asking if she had anything to say. As it turns out, she did: “You were talking to the wrong patient.”

1. The person waiting for you at the end of the year
You’ll meet hundreds of patients, physicians and nurses over the course of the year, but the person you’re looking for all along is the one in the mirror. The best surprise of third year is discovering not just your interests, but your talents, passions and even weaknesses. As one of my classmates said, “It’s like being in a movie, but you get to write the ending.” And no adviser, professor or countdown list can spoil it.

Stay tuned for the final installment in this series, when we’ll count down the most rewarding parts of third year. To all the second-year medical students out there: Good luck and keep your chin up!

Mihir Gupta is a third-year medical student at Stanford. He grew up in Minnesota and attended Harvard College. Prior to writing for Scope, Mihir served as co-editor in chief of H&P, Stanford medical school’s student journal.

Previously: Countdown to clinics: 7 challenges of jumping into third year
Photo by Dave Catchpole

Medical Education, SMS Unplugged

From NICU to nursing home

From NICU to nursing home

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

NICUThis quarter of medical school has by far been my favorite, because almost everything we do has an explicit clinical correlation. Each week we work in small groups of 10 or so students to go over patient cases, practice respiratory and cardiovascular (our two organ blocks this quarter) physical exam skills, and interface with real patients in the hospital. These experiences have been both exciting and humbling, and two in particular – one in the NICU and one at a local nursing home – stand out the most in my mind.

I visited the NICU for the first time two weeks ago, to shadow the physicians and residents as they conducted morning rounds. I saw the tiniest babies I’ve ever seen in my life, buried by wires and hooked up to incredibly sophisticated technology, like ECMO and a Berlin Heart. I’ve visited the NICU two more times since then, swept away by the fast-paced nature of the ICU setting, amazed by the large number of specialists working together to coordinate each baby’s care, and – more than anything else – touched by the gentle kindness of parents. There is one parent in particular to whom my heart went out, because each time I visited, I saw this father sitting next to his child’s crib, tenderly holding the baby’s hand and reading the baby stories out of books. This image is etched in my mind, and I hope it always remains so because this parent, with his simple gestures of affection, gives me insight into just how heartbreaking it is for a parent to bring new life into this world, only to have that new life marred by the possibility of death.

Equally humbling are the experiences of patients at the opposite side of the spectrum – i.e. not neonatology but geriatrics. The same week as my first NICU visit, I joined classmates on a visit to a local nursing home, as part of our POM (Practice in Medicine) clinical skills curriculum. The very first thing our facilitator asked us to do was comment on our feelings about geriatrics and on aging. I brought up the fact that aging – and in particular, care of aging individuals – is handled differently from one culture to another. For instance, in many Indian families, including mine, grandparents live with their daughters/sons and grandchildren, and there is no doubt in my mind that I want my parents, when they grow older, to come and live with me. This group discussion was followed by patient visits, and once again, I was touched the things I saw. One particularly sweet woman meandered over to me and – ever so gently – placed a hand my shoulder, telling me quietly that she would be leaving the nursing home soon because she and her husband both felt stronger. I can’t explain why this moment felt so poignant to me. Perhaps it was because this patient – who didn’t know me at all – saw my white coat and implicitly, as she placed her hand on my shoulder, placed her trust and friendship in me as well.

I know that these patient experiences are the firsts of many I’ll be a part of during my years in medical school and beyond but it’s these firsts that I want to remember because they capture my wonder for medical advancements, passion for family- (not just patient-) centered care, and gratitude for being able to be a part of the medical community. I hope to share many more such firsts with all of you, as my journey continues these next three years.

Hamsika Chandrasekar is a first-year medical student at Stanford’s medical school, with an interest in medical education and pediatrics.

Photo by bradleyolin

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