Being Successful

Sort of cliche, but sports are an appropriate metaphor for success

I often think about success, and say to myself "Wouldn't it be great?"  I don't think I have the traditional definition of success where the end result is tons of money, a hot car, trophy wife, and a white picket fence with a two story house.  No I am always impressed by true success.  Success that people reach where they look back after a long journey and say to themselves "I made it!"

One thing I have noticed about success is that I hear other people speak of those who have achieved it in hushed tones of envy.  "Oh if I was only as LUCKY as them."  or "I could never do that, he's a GENIUS." or "It's just not FAIR" or "I just don't have the TALENT they have".  These people always look at a fully realized successful person and assume that they have always been that way.  They totally ignore the journey  that person had to take in order to become successful.  They completely ignore the hard work, the agonizing moments, the long tear-filled nights, the times of self-doubt, the times when they believed they couldn't go on...yet they did.

I find my favorite success stories by reading through blogs.  I love reading about the journeys people take to become better athletes, to learn a new hobby, or to reclaim their lives from obesity.  Every day "average" people decide that they are going to do something great.  They are going to go from a sedentary life to running the Ironman in Hawaii.  Maybe it is someone who is going to get on a bike and ride from Alaska all the way down to the tip of Argentina.  How about a person who decides that their life has been ruined by complacency and that they are going to lose a tremendous amount of weight one day at a time?

For me, I always have to start at the first post when I read those blogs.  I want to know about the days when it was impossible.  I want to read about the times when they felt weak, unable, and inadequate.  It is because I feel like this all too often, and I hope that one day someone is going to read my blog and realize that they can do it too.  I want to say now, that I FEEL like I will never become a doctor.  The cards are stacked against me.  I have an average MCAT, and substandard GPA, and I have been out of college for more than 8 years.

It is impossible for me, but I have something that all the lazy apathetic people don't have.  I just can't find it within myself to give up.  For some reason, after I was laid out flat by rejection after five years of preparation I got back up and said, "Lets try again."  Even after everyone online said, "No, it is impossible for you, you just don't have the right stats."  I closed my ears and decided to keep going.

When I start my residency, I want to look back at this post and remember what it was like when it was impossible.  Because I know what will happen when I get into medical school.  People will start saying those things about me.  "Oh it is because he is so SMART." or "I wish I was as LUCKY as him."  But it isn't true.

None of them who say that noticed the tears streaming down my face.  None of them were with me when I was defeated.  None of them sat with me during the long study sessions I had to do AFTER I had already worked a full day at the office.  None of them were there when I had to turn my wife down for date night so that I could do well on a test.  None of them used their vacation time to study those final two weeks for the MCAT instead of going to Peru for some fun.  The only thing they see is the end result, the fruits of my labor, what happens AFTER all the sacrifices.  So they simply dismiss it with a casual statement, because it makes them feel better for giving up on their own dreams.  That is the real truth, and that is why when I am successful I want to look back and remember how high the price was.

I also hope I can inspire someone, somehow.  I want them to read about my journey and realize that Doctors, Lawyers, Engineers, Businessmen, or whatever you choose to be has no bearing on your intellect.  It has to do with how much time you spend practicing, improving, sacrificing and moving towards your goal.  An elite athlete practices for years so that one day he can stand on the big stage and compete in front of thousands.  It is no different for the highest levels of success in any arena.

I did not improve on my MCAT score this year.  Conventional wisdom says, that after 2 tries you should quit.  That a 29 is "good enough".  You know what?  It isn't good enough for me.  After three tries, guess what?  I am going to start studying again.  Because it is all stuff I NEED to know.  Because I know I can do better, and because I want to do better....for me.

I think that the key component to success is the ability to maintain discipline.  By managing to put for a solid effort every single day over a long period of time someone inches ever closer to the success that they have in mind.  Writing a novel does not happen in a one week flurry if intense activity.  It consists of research, writing, revising, and often times throwing away large portions of script that have to be redone.  Losing weight does not happen in a week, even if commercials tell you it does.  It happens over a long period of time after someone has changed their lifestyle and committed themselves to a new discipline of diet and exercise.  My own success, hinges on daily efforts of reviewing material I have learned in the past, keeping up with current advances in medicine, and constantly striving to involve myself in the opportunities that exist to participate in volunteering or research.

Today my goals seem impossible, but I can see that every day I am inching ever closer to what I truly want.  Once I reach the starting line of Medical School I am looking forward to raising the bar even higher and making a new set of goals that will further define my new success story.

Coming Clean

I have been avoiding this post for some time, because I honestly just didn't want to come clean.  I didn't want to own up to the disappointing results of my MCAT.  I studied hard for that test, like I have never studied before in my life (and if you are familiar with this blog, this is now the third time I have taken the MCAT.)

So how did I do?  Exactly the same.  Yes, that is correct, I got the same exact score as last year.  To me it was a disaster, because the whole point was to improve, not to stay static.  The numbers tell me I haven't learned a thing, and yet I am positive I know VOLUMES more than I ever did last year.  Last year after the test I felt horrible, I was in a fog, I couldn't even remember the content of the test.  This year was different.   I remembered almost every single aspect of the test, I spent weeks beating myself up over the questions I missed, constantly going over things I was unsure of in my mind.  It was significantly more traumatizing this time around, all because I knew what I did and didn't miss.

Upon receiving my score, the feeling was horrible.  It was almost as bad as realizing I wasn't going to be able to start Medical School this year.  That every single school I had applied to did not find me worthy.  That somehow intellectually I do not measure up to anybodies standards.  I just turned 34 this year, and the thought of spending another year in exile from the path that I am convinced I should be walking, sounds like a death sentence.  I am reminded of Moses and the nation of Israel who wandered in the wilderness for 40 years  How many years will I wander before I reach my promised land?  I have already wandered these last 5 years gathering pre-requisites one class at a time.  One of those years of exile was a year of rejection.

So now we come upon this year, and a new application cycle.  I decided to apply early decision this year.  It represents a huge risk to me, because early decision means I am selecting only one University and declaring my intention to them to ONLY go to their school.  I cannot send applications to any other school until I receive a rejection letter from my early decision application.  This would happen by October 1, which means my applications would be going out late, putting me behind the curve for the rest of those schools.

Why did I take such a risk?  I did the math.  For some reason it comforts me.  There are some aspects of my life in Engineering that I will never get away from.  I only received an interview invite from one University last year, so that is the one I chose to investigate.  I discovered that if I apply early decision I have a 37% chance of getting accepted versus only a 4% chance of doing a regular application.  If I get an interview invitation my chances of getting accepted suddenly jump to 60% in early decision, versus 37% for a regular application.

So come August I will find out if I will have an interview or not.  Until then I continue to second guess myself.  Why did I work fulltime during my undergrad?  I could have had a better GPA if I didn't.  Why did I major in Engineering, instead of Theater?  I could have had a better GPA if I did.  Why didn't I sign up for a Master's program as a contingency plan?  If I get rejected, yet again, it will be another wasted year.  I find that I learn all too many things in retrospect, after it is too late.  I wish I wasn't like this.

In other news I will be uprooting my entire life to move halfway across the country.  My wife has been accepted to a Master's program for Clinical Research, and I decided it would be better to give up my career to keep our family unified than try to maintain a "long distance" marriage.  Some of this hasn't been easy, but the process of relocating, of having to solve a myriad of life problems on a tight deadline has drawn my wife and I closer together than before.  Sometimes I feel like things need to be shook up, that we need to be broken out of our routine so that we have an opportunity to rely on each other more, and build our trust in each other even more.

Some days I find it exhausting to be the one who has to carry the load, both financially and emotionally.  Often I want to quit and say I have had enough, but how can I when this empty gnawing feeling of unfulfillment will just remain and grow even greater?  I cannot allow my current misery spill over and ruin the hope I have for the future, for that is really the only thing that pushes me to move forward.  Then there are the expectations of my family.  How could I fail them, when I have already put forth so much effort?  I don't think I could bear to look my wife in the face, to see the pain in her eyes.

I am very grateful for my wife, I don't deserve her.  Even though from the outside it looks like I am the one "bringing home the bacon", the great Software Engineer making big money, while she merely studies; the truth is I see the effort she puts forth, I see the tears of frustration she cries, the resolve she has, the passion she fights with, the organizational skills she possesses, the brilliant mind she puts to use, her patience to see things through, the strong character that allows her to stand up after several crushing defeats, and secretly think to myself that I am way out of my league.  Nobody is as lucky as I am.

I feel like we have been successful because she puts forth effort every day so she can please me, and I get stuck every day doing my best to please her.  I think that as long as we both keep putting each other ahead of our own personal desires we are always going to have a wonderful marriage.  The worst times I can remember have been when I got stuck on myself, instead of following that intrinsic Universal paradigm, that law of nature more reliable than Gravity, where I should love others more than my self.  How much moreso should I love my wife then?

Coming Back to Society

Haile Gebrselassie - Probably my most favorite distance runner of all time

For the last two weeks I have been silent, but I have not been idle.  I decided to take a two week vacation from work so that I could spend my final run into the MCAT in total isolation.  Like the ancient Taoist masters who would retreat to a remote mountain cave to contemplate the Universe, I too felt compelled to divorce myself completely from society so that I might finish my preparations unimpeded.

During those two weeks I had a Biochemistry final that was soul crushing, but I did well.  I was pleased by that.  Somehow I also managed to do a practice MCAT and review it every day.  I did not do exhaustive review, but rather re-read each question and determined whether I "guessed", accidentally got it right, or if my thinking was correct.  This seemed to be an efficient method for me to find where I was deficient in my knowledge.

Much to my chagrin, I could not score over an 11 on the Verbal Reasoning sections, no matter how hard I tried.  There always seem to be several illogical choices that the test writer insists is the "most logical" answer.  Most of the time, after reading their explanation I could see why they chose the answer that they did, but in some instances I wasn't convinced.

On Saturday I took the test and I was extremely nervous.  All that effort for a mere three hours of my life.  Much to my surprise, I started to panic on the Biology section when my mind when blank for no reason.  Fortunately I was able to take a breath, regroup and get back on track.  That was a scary moment.  Even post test, I feel like I did not do as well as I could have on the Biological sciences section.  That really annoys me, since I was counting on it to help buoy my score.  On the flipside, I felt more comfortable in the Physical Sciences section than normal.

Objectively I know that I did better than the last MCAT, but how much better?  I will be devastated if it is only one or two points.  If it is three or more points, then I will consider it to have been a success.  Running into the test, I was averaging a 32 on the practice tests, and my highest was a 35 on one test.  I think that realistically I can reach 33 if I didn't make any stupid calculation errors in PS, and I managed to see through the logic traps on VR.  We shall see in thirty days.

For now I have decided to enact plan B of my journey into medical school.  The last 9 months have been very trying for me physically.  I would usually sit at work for 10 hours, after which I would go home to study for another 3 - 4 hours.  I have gained at least 30 pounds, and I do not feel like I am presentable to an interviewing committee.  To remedy this I am going to start my Triathlon training plan over again, while also doing a juice fast for the first week.  The triathlon training will serve to replenish my overall health, while establishing a strong energy reserve, while the juice fast will be to reset my metabolism.  I feel like endurance training will consume more fat than HIIT.  I just have to be able to manage the increased food cravings that are inevitable with that type of training.

Tomorrow I will input my initial body stats, and maybe a picture to help publicly shame me into following through, although I don't know how violently the general public will react to my hideous form >:]  I am excited to be able to exercise again, and to be honest...endurance training is sort of apropos to my path into Medical School.  The journey is far, but if you take a measured pace you can reach your goal!

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!

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!

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 patients....my 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!

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.