Wednesday, April 24, 2013

It is Springtime!

Two Week Comparison
I thought I would switch up from posting about my medical journey to talk about a little side-project I have been working on.  Every spring I usually get excited and want to plant a garden.  It always goes well until three or four weeks later when weeds have sprung up, or a long dry spell comes through and inevitably wipes out my feeble efforts.

To be fair, I don't generally have much time to focus on gardening so the elements will have their way, whether it be the rapacious squirrels who always eat everything I try to plant or last year's heavy drought which sucked my plants dry.  The only thing I have had real success with have been my grape vines.  Those hardy plants grow despite me, which is a good thing.

This year I was planning on avoiding the garden altogether until I read a blog about hydroponic gardening.  The author talked about how he preferred it, because he could control everything and more importantly he didn't have to deal with bugs or weeds.  As soon as I saw that I was already 95% interested in what he had to say.  I don't know whereas I could adequately summarize what I learned in that blog, so I recommend you head on over to Hydroponic Workshop and start reading from his first post.  He takes a very scientific approach to his hobby and has debunked a lot of the myths that have been circulating about growing vegetables hydroponically.

I think that hydroponics has been unfairly treated due to the many associations with illegal production of Marijuana. If you think about it, in order to maximize their profits, those engaged in such an activity are looking for the easiest and quickest way to get their product out.  If that is not an endorsement for hydroponics I don't know what is.

As for me, I bought a simple set up and planted a tomato plant two weeks ago.  I didn't know how it would go, because I don't plan to spend much time with it, however I have been very surprised by the results.  If you look at the picture above you will see a "before and after" comparison of when I started.  In only two weeks that tomato plant has outpaced the pepper plant next to it, and I have run out of grow space since it has already reached my grow light.  Luckily I can move it outside this week since we will finally have some temperatures in the 70s, with no chance of freezing.

I am having trouble deciding how I will proceed from here.  I am tempted to plant that tomato and put more plants into the hydroponic setup so that they have a quick growth boost before going into my garden where I can set up a trellis and let them fruit.  This is opposed to letting the plant sit for it's entire lifecycle in the hydroponic setup.  The negative part to this approach is that there are only four spots for planting.

I am also considering building an "ebb and flow" system, which would give me much more space to do pure hydroponic growing.  This is an attractive idea to me, and I have learned (from the blog I mentioned above) that this can be accomplished for a fairly cheap price.  Once I have taken the MCAT, I will have an abundance of free time that I plan to use to decompress initially, before going back to volunteering and hopefully doing some research.  Rounding out this years garden looks like it will be my top priority.

After three years of substandard results, I was ready to give up.  Now I am excited about gardening again.  I can't wait to see what I can do!

Monday, April 22, 2013

MCAT Update & Study Tips

I originally planned to take a follow up practice MCAT last week, but I was derailed by a Biochemistry test that was more pertinent to study for.  After finishing up with the Biochem test, I was able to return to my original plan, so I continued my regular weekly study schedule and then took my practice test on Saturday.

This time I decided to go with one of the AAMC  practice tests, since these tests are usually the most predictive of how you will do on an actual MCAT.  This time around the test did not seem nearly as difficult as the Kaplan diagnostic I just took.  When I finished I was pleased to see that I scored a 33.  To be honest I was still a little upset by this score, since I thought I would score a 35 - 37.

When I reviewed the content I found out that the majority of the questions I missed were not due to lack of knowledge.  Several of  the questions I missed were because of some really stupid calculation errors.  A few others were because I misread the question.  This is good to know, because these are things that I can resolve quickly within the amount of time I have left.  I believe that if I had not made those avoidable mistakes, I would have scored at least a 35.

My final analysis of that Kaplan diagnostic is that it is off-the-charts difficult.  There is no reason that there should be a 10 point disparity between an AAMC practice test and the Kaplan diagnostic.  The diagnostic did serve one good purpose, and that was to frighten me enough for me to reevaluate my study techniques and make a few changes. 

If you are planning on taking the MCAT, I would like to share with you some advice that has helped me prepare.  I have tried many different approaches, and after making quite a few mistakes I feel like I am on the right path to a high score.

Finish the Core Curriculum 

My recommendation is that if you plan to take the MCAT you should not even think about it until you have finished the following courses
  • General Chemistry 1 & 2
  • Organic Chemistry 1 & 2
  • Principles of Cellular and Molecular Biology 
  • Microbiology
  • Physics 1 & 2
There are also two other courses that AAMC says aren't necessary, which is a recommendation that I have recently come to disagree with.  After having taken Anatomy & Physiology and Biochemistry I suddenly find the Biology section of the MCAT, which has always been my weak point, coming into focus.  You would do yourself a huge favor if you added these to your pre-MCAT list of courses to take.

Prepare with Adequate Review

There is an essential component of preparation that everyone has to do when studying for the MCAT.  To prepare myself I chose to use the Berkely Review prep course materials.  There are several test prep companies such as Kaplan, Princeton Review, and Exam Krackers.  When I was doing my initial research, I discovered that a lot of the guys who scored high and wrote a "how to study for MCAT" used the Berkeley Review materials as their core, while supplementing their study with material from the other prep companies.

The first, and probably most important step, is to simply slowly and methodically work your way through every subject and make sure you really understand what is being presented.  I would also like to mention that these materials are a very condensed presentation of subject matter that you should have already covered in your undergraduate course load.  I made the mistake of taking the MCAT the first time without having finished 4 of the main core required courses.  This was an extremely stupid mistake, and led to my demise on the first test.

Identify Your Weaknesses

Once you have worked your way through all of the prep books, then the hard work begins.  You now switch from reviewing, assimilating and understanding information, to working on your instant recall, test taking skills, and identifying key weaknesses in your basic knowledge.  I believe that the way you approach this portion of your preparation will be the difference between a 30 and a 35+ on the MCAT.  

This has probably been the most difficult part of the process for me.  I like the studying, and I like understanding the material intimately because I feel like I have a more profound understanding of how the Universe works.  However, I become irrationally angry when I miss questions.  I don't know why, but I take it really personally when I miss something.  If you are like me, then you really have to approach each study session with humility, ready to miss every question, ready to set aside your ego to plow forward, otherwise you will find many excuses for why you just never get around to it.

Another mistake I have made during this phase of preparation was slamming through questions with the idea that "the more questions I see, the better prepared I will be."  That is only half-correct.  It is true that the more questions you do the more variety of questions you will have encountered so you will be less surprised by such a question on test day.  The true point of running through so many passages and answering thousands of questions is to reveal to you where your major weaknesses are.

The main point of doing so many questions is so you can show yourself just where you don't measure up.  This year I decided that in addition to doing thousands of questions I would also review every single one to see if I answered correctly because I knew the answer, or because "I got lucky".  I also decided to find out why I was missing certain questions.  If it were due to a lack of knowledge then I have been forcing myself to go back and re-read the sections I am weak in.  This has resulted in a remarkable increase in my knowledge and confidence.

Fill the Gaps

You cannot memorize every single tidbit of information, but hopefully by this point in your preparation you should have noticed that several tricky things seem to keep recurring, that cause you no end of trouble.  The things I have struggled with have been; quick calculations, hormones and their corresponding organs, light spectrum questions, and chemical reactions.  Here are a few things you can do to quickly plug some of those holes.
My Study Whiteboard
  1. Note Cards - I always cringe at note card use, because I have never needed it before.  I have had a change of heart, because they do serve a very specific purpose if they are used correctly.  I stupidly bought some "MCAT Prep Notecards" from some company, that I have never used.  Instead I have found that they are most effective when you find a formula or simple relationship that you totally bombed on, so you put that on a notecard so that you can review it in your down time.  This is my opinion, but notecards only work if you fill them out yourself.
  2. Mnemonics - I always thought these were childish, but now I see how awesome they are. All information is encoded in language and a mnemonic is an extremely efficient way to recall information you already know, but had trouble dredging up in the past.  The best mnemonics I have found so far deal with light, and hormones.  ROY G. BiV (Red, Orange, Green, Blue, Violet), etc.
  3. Estimation Techniques - Every single prep book offers techniques on how to round to an easier number to make math quicker and give you a reasonable estimate of the answer.  I have been trained as an Engineer so I was quite resistant to this idea.  We are taught that a lack of exactness will lead to disastrous results.  Breaking this habit was difficult but rewarding.  Questions that caused me to sweat before, don't really stress me too much, and I generally finish the Physical Sciences section with plenty of time remaining.  I also like to use a small dry-erase board/markers while I am studying so that I can quickly jot things down, or work through a math problem.  I think it is way better than using a notebook, saves time, and simulates test day (you won't have previous notes jotted down to refer to).

Practice the Test

The only thing left now is to practice taking the test.  Take as many timed practice tests as you can, so that on test day the 3 blocks of question will be just like another day of study.  If you are planning on taking the MCAT, I hope that the many mistakes I have made will help you prepare in a more rational manner so you can achieve a great score the first time. 

As for me, I will sit for this exam again on May 18.  I will let you know how it turns out so that you can see whether or not my advice is worth taking.  Until then, lets keep studying!

Tuesday, April 16, 2013

Shadowing a Surgeon - Part 1

This is almost an exact replica of the OR I shadowed In

NOTE: I am writing this to record my recollection of this event, so it will most likely be a long read.  I completely understand if you don't make it through.  I feel that it is necessary to write down this astounding experience before it begins to fade from my memory.

On Friday I showed up to the hospital bright and early to shadow a Neuro-Spinal specialist.  I honestly did not know what to expect, and I was a little bewildered by how relaxed they were.  When I arrived, I called the department office and they let me in.  A few seconds later I was standing there alone and unattended.  Knowing I only had about half an hour before I had to meet the doctor, I tracked down a nurse who got me set up with a locker for my belongings and some scrubs to change into.  Normally when I go into a new work place, I am used to being micromanaged, followed everywhere and lectured endlessly so as to ensure that if anything goes wrong, they can be assured that I can take the blame.  It was refreshing to be given an implicit level of professional trust from the outset.

Once I was all suited up I wandered around confused, but I found the OR the doctor was scheduled to work and decided I would wait for him there.  Fortunately there was a window for me to look in, and I took note of how everyone was dressed.  I am glad I did this, because it would have been embarrassing to immediately get kicked out of the OR upon walking in.  After looking around, I found a mask, rubber gloves, some shoe covers, and a cloth surgical cap that I promptly donned before walking into the room.

It didn't take them long to ask who I was and what I was doing there.  Of course I went through the litany, "I am a pre-med student, and I will be shadowing Dr. XXXX today."  Apparently that was good enough, and they quickly went back to their various tasks of prepping the OR for the upcoming surgery.  Soon the patient was wheeled in, a kindly looking elderly woman.

The nurses were very kind and attentive to her, letting her know exactly what was happening and instructing her as necessary.  For me it is always the small details that really stick out and make an impression.  I specifically remember one instance where, as the nurse was telling the patient to breath through the mask she set her hand on the patient's arm and lightly patted her in a comforting manner.  That told me that this nurse was someone who really cared about what she was doing, she was someone who wanted the best outcome for the patient, and she was still able to display compassion when it was necessary.  That is someone I could  work with every single day, if I could.  To me medicine represents a perfect outlet for my compassion, and to see someone else display this trait so openly made me realize that I am not wrong in making this drastic career change.  Maybe many people will think that this is too idealistic and naive of a viewpoint, but I will have to simply disagree.

After the patient was anesthetized the nurse proceeded to double up the patient's legs, which would immediately straighten out when she let go.  After a few attempts she quickly looked over at me and said, "Come over here and help me.  You hold her legs, while I put this Foley in."  Not knowing what a "Foley" was, I innocently walked over and held the patient's ankles, pushing her legs into a butterfly position.  The nurse quickly raised the patient's gown as I now realized what she was going to do.  I had a front row seat to see my first catheter insertion, which means I was spared nothing when it came to "presentation" of the patient's body.  My first instinct was to look away in embarrassment, but I quickly quenched this sentiment, because I wanted to know how it was done.  I calmly forced myself to look on, despite my discomfort, and saw the Nurse quickly and efficiently insert the Foley.  It was on the next step of this process, that I was in for a little surprise.  Grabbing a syringe filled with saline solution she inserted it into a side valve on the catheter and began to inject.  Unfortunately she did make the connection completely and I was greeted with a face full of spray.  I thought I would be horrified, but strangely I found the whole event amusing.  I have to admit I was extremely happy  I was wearing the mask.

With my participation complete, I resumed my vigil in the corner of the OR, trying to stay out of the way as much as possible.  The whole prep took about half an hour before the surgeon made his grand entrance (yes I deliberately made that sound overly dramatic).  He greeted his staff in a friendly manner and I was pleased to see that there was a playful banter that existed within the team.  I could see that they worked well with each other, and that they enjoyed working together as a team.

After working in corporations for the last 8 years, I am used to seeing discord, backbiting, false sincerity, and above all avoidance of any sort of responsibility.  Here I was confronted with a group of people who were about to take someone's life into their hands.  Each one had a very specific role to fulfill to ensure the success of today's surgery.  If anything went wrong, there would be no way to obfuscate the mistake with a self excusing email that would pass the blame to some other unsuspecting coworker.  They would have to face it, resolve it immediately, and deal with the consequences that would result from it.  It was heartening to realize that incompetence could not survive in this environment.

The surgeon soon greeted me and gave me an introduction to the procedure they would perform.  There was a 50 inch flat screen monitor on the wall with MRIs of the patient's spine.  He showed me where the vertebral foramen on the L3 and L4 vertebrae had closed in,  so it was compressing the spinal cord and causing loss of feeling in the lower extremities.  Since the spinal cord passes through the vertebral foramen, he was going to enlarge the foramen again, so that the spinal cord would not be constricted anymore. 

To my recollection, the surgery took about two to three hours total, not including the prep time.  Several things stand out vividly in my mind.  First, the technology that was put to use was incredible.  Within the room there were three hanging flat screen screens, that were on moveable arms so that they could be adjusted to give view to whoever needed to see.  These were in addition to the 50 inch wall screen I already mentioned.  There were two large OR lights, that were in the center of these screens that extended out on retractable looking arms.  Within those bright lights was a camera that would give a feed into those screens.  So by merely standing in the back, I was still given a front row view into exactly what the surgeon was doing.

As a preface to describing the actual procedure, I want to describe how I felt at this point.  I have never seen a surgery so I had no idea what to expect.  More importantly, I had no idea how I would react to this experience.  I have heard of people becoming nauseous, passing out, and all manner of other horrible reactions.  As the surgery began I have to admit I was extremely amped up on adrenaline.  It was all very unreasonable, because it was all self-induced based on my uncertainty about my own reaction.  It was like a self-induced recursive reaction (if that makes nay sense at all :P ).  To combat any possible adverse effects I made sure to bounce from leg to leg, and to keep my legs slightly bent.

The vast majority of the surgery seemed to be "digging" through the various tissues to actually reach the site that they wanted to fix.  The surgeon used a cauterization tool (a laser scalpel?) to burn through the layers of dermis, and underlying adipose and muscle tissue.  The smell of burnt flesh was initially uncomfortable until I forgot about it in my fascination with what was going on.

Diamond Coated Burr Bit
Once the bone of the spine had been reached a new phase of the surgery began.  The surgeon started using a diamond coated bur bit to drill start removing bone.  Up until this point my conception of surgery, was that it was very fine and meticulous, but the usage of this tool was savage and intrusive.  The rotation of drill, suction, drill, suction, became rhythmic for ten to fifteen minutes as he quickly worked his way through the lamina of the spine.  Once he approached the meninges, the membrane protecting the spinal cord, he switched tools from the mechanical device, to a manually operated tool that I am guessing was a Rongeur.  Basically it was a surgical wrench for grasping and tearing away bone.  He did this so that he would not drill through the membrane, which would have been a huge mistake, and quite the headache to fix.  Using this tool, he methodically pulled out bone, piece by piece and exposed more and more of the spinal meninges.  Once done with L3, he drilled over to L4 and repeated the process.

All of this I watched on the monitors, and he periodically spoke up to instruct me on what he was doing.  He pointed out specific parts of the anatomy, and thankfully indicated where the head and feet were.  It sounds obvious, but if he hadn't done that, I wouldn't have realized that the head and foot were interpolated on the screen (e.g. -- it was opposite on the viewing screen from how the patient was laying on the table.)  My only complaint about this procedure was that I was behind the surgery, and he had music going while operating which made hearing what he said very difficult.  I feel like I lost some key points of instruction, but seeing as I was just an extra observer the fact that I was able to intrude on their environment and still receive patient instruction is more than enough for me.  I am very grateful they allowed me to participate.

The surgery finished up with a quick and careful closing up of the spine.  At various points I noticed the nurses would take counts of the linens used for cleaning the blood, and the needles used for suturing the wound.   It was a very organized and practical step, that seems like common sense, but obviously has been ignored in the past seeing as some of those items have been left in patients before.

Having completed the surgery the surgeon helped re-situate the patient on a gurney to take her to recovery, while the anesthesiologist started to bring her out of sedation.  As she regained consciousness I noticed the surgeon had already left the room, and I had about half an hour until the next surgery.  I took advantage of the time to run to the lounge and grab a snack, because it didn't look like lunch would be coming any time soon.  From 7:30am until about 12:00 o clock I was in the operating room watching the pre-op and the surgery.  I didn't know how long the next surgery would be, but I didn't want to miss a moment.

In closing to this chapter of my shadowing experience I want to recount my final interaction with the surgeon.  As he closed up the patient he turned back and asked, "What did you think?"  Already experiencing a complete sensory overload my only answer was "That was awesome!"  I could see his cheeks raise up in a smile behind his mask and he began to teach, this time I could hear everything.

"My rule is that the surgery should be fun.  The more interesting and fun the case is, the more I want to do it.  If I get a referral I evaluate by two criteria.  Number one -- Is it fun?  Number two -- Is it imperative?  If it is yes to both, I'll take the case.  If I say no to both questions, I'll refer it to one of my partners...and if it is yes to one or the other I have to decide whether or not to take it."

Obviously the bit about passing it off to a partner was a joke, but I understood the lesson he wanted to convey.  He was promoting a love of your job, enjoying what you do, and taking pride in it.  I don't think he understood just how deeply that resonated with me.  I will always be grateful that he took the time to pass that one on to me.  I was never serious about surgery, because I thought you don't get to spend time with time with this Surgeon taught me just how wrong I really was.

Next time I will talk about the second part of my day, and reveal to you just how wrong I was regarding patient interaction.  Stay tuned!

Thursday, April 11, 2013

Details and more Details

Often times getting accepted into medical school is distilled down into taking the MCAT and sending in your application.  It sounds pretty simple, but there are many details that you have to account for along the way, so that you can ensure your success.

The current detail that I am running after is finding shadowing opportunities.  Last year's cycle I was told that my six years of medical interpreting at the local clinic wasn't a truly representative experience for the American Medical system, so their recommendation was to find more shadowing opportunities.

I have already exhausted my personal contacts and have been forced to rely on recommendations of friends.  This has probably been one of the most difficult things I have had to do.  My schedule is very inflexible due to my full time job and the fact that most physicians (that I know) work a traditional schedule.  I also find it hard to ask other people favors.  I personally would rather be in the position to grant a favor, rather than accept one.

Fortunately I have been able to rework my weekly schedule into four days of 10 hour shifts, instead of five days of 8 hour shifts.  I am now able to pursue a more aggressive plan for securing a steady shadowing gig.  The final roadblock for me now, is to find a physician who is willing to let me follow them around.

Update: Not even an hour after I posted this, I heard back from one of the physicians I have contacted.  It looks like tomorrow I get to shadow in the OR at a Neuro Clinic.  I am very excited to take part in this.

Friday, April 5, 2013

If You Climb, You Might Fall

Last week I took a practice test to see how my preparations were coming and I was not pleased.  The final score was....wait for it....a 23.  That is one point higher than the first time I took it and six points lower than last year's test.  You can imagine, that with the MCAT only 1 and a half months away that caused me to panic greatly.

There are several ways I can interpret this outcome.  I can interpret it to say that I have taken a huge step back in my accumulated knowledge and have forgotten almost everything.  However, I don't think this is the correct interpretation.  I am positive I know much more than I did last year, so I have to examine the source of the test and where my deficiencies lie.

In my current preparations I have finished reviewing all but two chapters of the Berkeley Review test prep materials.  It is a very dense and difficult review, but I think it is more than adequate to help prepare for the MCAT.  The test I took, to show my progress, was a free diagnostic test from Kaplan.  I did remarkably poor in the Physics section, and ironically it had a lot of questions from the two chapters I had not finished reviewing.  What are the chances that the majority of questions would come from 2 of the 10 chapters that physics covers?  I thought that was a little skewed, but I also have to think that on test day, if the same thing happens I would still be screwed so maybe it is a moot point.

Being a free diagnostic test I did some research on it through Google and found several accounts where someone scored remarkably poor yet did very well on the actual test.  I began to suspect that the difficultly level on this diagnostic is much higher than the actual test in order to funnel more people into the Kaplan program.

With that being said, I still came out with some positives.  I plan to take a different diagnostic next week to see if my suspicion is correct.  Out of all the problems, there wasn't anything I didn't "know" per-se, but there were several problems that I knew how to do, yet couldn't remember the formula to do what I needed to do.  That is definitely something I can remedy, and it is certainly something that is not allowable on test day.

Because I am a theoretical thinker, I have never put much stock in memorizing huge amounts of information.  Since we have such a huge resource of data recall at our very fingertips that sort of exercise is unnecessary if you know how to find and apply theory to the necessary information.  In physics I would usually memorize one or two key equations which would allow me to derive any subsequent equations on test day.  It saves study time, and if you can derive the equations I believe you truly understand the fundamental concepts more intimately than someone who merely memorized formulae and variables by rote.

The theoretical approach is no good when approaching a test like the MCAT.  Yes, the test is designed to reveal how well you can think critically, how well you can apply information instead of regurgitate it, but when it comes to the calculation portions that is not true, because you do not have enough time to derive and then apply the solution.  Part of my past failures can be attributed to my desire to calculate the exact solution to "make sure" I was 100% correct, rather than estimating, answering, and moving on in a timely fashion.  The difference in time between both approaches is probably on the order of 1 - 2 minutes per question...which can add up quickly.

With this in mind, I have decided to use the brute force method.  I am simply going to slam as many physics formulas and chemistry reactions into my head as possible so that I will have a quick recall system ready on test day.  It is not my preferred method, but I have to admit that when pressed for time it will be an invaluable tool.  If I can immediately recall every physics equation, and quickly indicate what type of reaction is taking place I think my physical sciences score is going to shoot through the roof.

Another thing that accounts for my low score is that this is my first timed passage of my review.  I have been taking everything slow and measured up until this point to make sure I truly understand the concepts I am reviewing.  Now I am transitioning into the timed portion, and it is obvious that I am simply out of practice with regards to pacing and quickly moving through passages.  I did not run out of time during the practice test, but there were four or five calculation question I knew how to calculate, but "marked" for later because I felt pressed for time.  I know that practice will alleviate the panic I felt on those questions.

Next week I am going to post my score for the follow up practice test.  If it still sits around a 23, I may have to consider postponing my MCAT date.  Until then, stay tuned.

Thursday, April 4, 2013

The Difference Between a Dream and a Fantasy

Is This a Dream or Fantasy? Image by Karezoid Michal Karcz

 As I was speaking to my wife yesterday something very profound flew out of my mouth.  At the time I did not give it much thought, but as I mulled it over later I grew to appreciate how significant it was.  I think my subconscious was using my effort to comfort my wife to teach me something instead.

"The difference between a dream and a fantasy is that a dream is realizable."

The reason that statement is so profound to me, is that before I vocalized it, I had never made a distinction between dreams and fantasies.  I have a very active imagination and one of my favorite activities is to give it free reign to express itself.  I end up thinking along many different paths, oftentimes fanciful and impractical.  I suspect that allowing this type of thought is the root of creativity, so I have never wanted to inhibit this tendency.  This means that I have always been a "dreamer".

"Dreamers" get a bad rap sometimes.  They are often accused of chasing after something impossible to achieve, something impractical, or "silly".  I think that there is a certain level of hypocrisy injected into judgements like this, because children in the USA are often told,

"When you grow up you can be ANYTHING you want."

When the child reaches a certain age, and starts to manifest their interest in certain areas the litany changes.  Soon they are told they should go to college and study something "practical", or they are told that their chances of success in a certain field are too small because of the high amount of competition.  I think that such a drastic change in message has a crippling effect on someone who dreams.  Forced to settle for something less than their dream, they begin to fantasize.

I bought into those lies when I began my undergraduate studies.  I had no idea what I wanted to do with my life, and worse I had no idea what I was interested in studying so I took the practical approach.  I thought about the professions that payed well and were in high demand and decided on Computer Science.  That is a pretty safe call, right?

Fast forward to two years after I graduated and I was absolutely miserable.  The realization that a CS degree was essentially meaningless in my chosen profession was a huge blow to me.  Technology firms stand by the litany of "Experience over all", meaning if you have enough "experience" on your resume then you must be qualified.  I have noticed that this is extremely misleading, because many people have a tendency to lie on their resume.  I cannot count the number of "hotshot" resumes I have read, only to be met with incompetence when I performed the interview, or worse yet when I was overruled and was forced to work along someone who is merely an amateur at best.  I could never understand why there is such a professional disconnect in the IT industry.  Unqualified lawyers are not allowed to practice law, nor are unqualified physicians allowed to practice medicine, yet in IT as long as you put down you have "experience" you are good to go.

My discontent with my chosen field led me to fantasize.  I wanted to hop on a bike and ride across the United States, vicariously living from day to day (Crazy Guy on a Bike).  I wanted to buy some land and go live off grid, experiencing the freedom that only nature can give you (Wilderness Survival).  I began finding solace in long training runs, with the idea of possibly running a marathon (Daily Mile).  Inevitably the theme was always the same.  I wanted to escape, and I was seeking a way out through ethereal unrealizable fantasies.  The fact that they were unreachable only intensified my discontent, and I am pretty sure it ended up drastically affecting my attitude and performance at work.

I don't know if I can put my finger on it exactly, but a combination of things worked together to galvanize me into finally pursuing a dream.  My wife and her father are physicians so I had been learning more and more about the profession through my interactions with them.  I soon realized that working as a physician would give my life the purposeful meaning that it was missing, the professionally competent peers I was seeking, and an outlet for my fantasizing mind.  On that day, and I do remember the exact day, in 2007 a dream was born.

I knew that it would take work, persistence, and time, however, I also knew that it was something I could reach if I were willing to work hard enough, and long enough.  From 2007 - 2013, I have slowly chipped away at the pre-requisites I needed one night course at a time.  Now I sit here, nearly at the end of the road and look back at what I have done in disbelief.  I could have never come so far with a fantasy, but a dream...well that is something worth living for.