Grapes and Wine

June 12, 2008

You start with seeds and their finite potential. You are going to make something great with this field and these seeds. You plant them, water them, love and dote on them. They are nurtured and they sweeten in the sun. And then, when they cannot grow this way any more, you pluck the best.

You take these grapes, throw them into a barrel, and ignore them. You don’t give them sun, activity, or anything familiar. It’s quite a shock to the grapes. You do this for years. And years.

Out pops wine.

Pretty inefficient, but I don’t know how I would fix it. I don’t know that trying to speed it up won’t make for something unpalatable. I guess I just have to deal with the ignoring and waiting until those grapes magically turn themselves into something more.

Pretty much what the third year of medical school has felt like. I haven’t written about it.

Before, my shtick was looking around and sort of cataloging all the interesting things that were happening around me. Not a lot of introspection going on. Nothing to write about inside the barrel that is my hospital. Or there is, but that’s not the story.

The story is the fermenting. My classmates and I are taking on new flavors and textures. A few might be prematurely alcoholic. Others have lost their sweetness. Most rougher for the wear and rarely anyone smoother.

And it is incredible.

I put up a hell of a fight. A nine month spectacle of twisting, thrashing and spitting. On March 5th, 2008, I broke. Emotionally. Mentally. Broke. It was awful. I haven’t written about it because I’m unsure on these new, wobbly legs.

But for the first time I know what language is supposed to do. I know how people reward their physicians. I understand patience. I have experienced the risks and rewards of vulnerability. What is and is not important has been impossibly rearranged in my head. When I look at the decisions I am making now, I don’t recognize them as coming from my past. All of it seems to come from very different stuff.

But then you never could have told me, after I rolled one around in my mouth, that grapes could give way to wine.


Pancakes Every Day Video

December 26, 2007

A little over a year ago, I was behind in my work and trying to catch up. Procrastinating, I wrote a short blurb about how going to medical school is like having to eat a stack of pancakes every morning. Some people thought it was funny. About 10 months later, a good friend of mine at Saint Louis University Medical School called me up to ask if he could use the concept for a 72-hour film competition. Of course, I said yes.

So he and his friends expanded it, added new portions, and really transformed it into something better than it was before. They pulled off the 7-minute feat in 72 hours, submitted it, and then on the night of the festival came home with FIRST PLACE!

Finally, it’s up on YouTube.   Merry Christmas, everyone!

Med School Metaphor: Pancakes Every Morning (orginal story)

Pancakes Every Day (prize-winning short film)

Transferring from the Caribbean: Preparing for the Interview

July 7, 2007

iserson.jpgThere are a lot of things you should do for your interview, and Iserson’s Getting into a Residency covers all of them. I bought this book a month before I anticipated any interviews and read it cover to cover in the first two days. I was left dumbstruck by this book. When speaking about special situations like being an FMG, his advice is that the most important thing you can do is transfer to a US medical school. That knocked me in the head. There is a chapter called “The Questions – The Answers” that lists over 300 questions that people have been asked in residency interviews, what these questions are trying to discover about the interviewee, and strategies for handling them. I sat down and typed out every single question, printed them out, and then spent the next week forming my best answers. He will teach you how to stand, how to sit, and how to pack your suitcase so that things do not wrinkle. What to wear, what never to say, and what to do before during and after the interview are all topics that are covered very well in this book. If you walk into this interview without a resource like this, you are making a mistake.Why am I recommending a book about getting into a Residency? As a transfer student, you are already in medical school and are expected to know a little more about the field, its problems, and your place in it. There is an assumption made that if you have the grades and the recommendations to transfer, then you must be a very serious and driven medical student. Serious, driven medical students know what they want and have researched how to get it. In this way, you are much like a residency applicant who knows what type of physician he wants to be, where he wants to live, and which program will help you achieve this.

After reading this book, doing the research that it outlines for each institution to which I was applying, and answering all of the questions, I was in a place where I could enter the interview confident that I had not forgotten anything and that I had prepared as well as I Possibly could have. The confidence that comes when you can stop worrying about these things is invaluable, and I highly recommend the book for this purpose.

carnegie1.jpgThe second book I recommend it Dale Carnegie’s How to Win Friends and Influence People. This book changed my life. The way I read people’s response to what I say, the way I understand what they are saying, and how I handle every situation has been informed and altered by this book. I can say with confidence that a great deal of the good that has happened to me in the last year has happened because of the way I handled situations after reading this book. During my interview day, I saw so many of the other students making mistakes (some of them crippling) that are outlined by Carnegie. There was also one applicant that I noticed because she was so expertly handling the same questions and situations that were killing the other applicants. After the day was over, I told her that out of the entire field, she had her best foot forward the entire time and that if anyone was going to get in based on their interview today, it would be her. She emailed me a week later with the good news that she had been offered a spot. Do yourself the favor of reading this book. There are almost 500 reviews at (avg 5 stars). Here is a review of the book and how it changed someone else’s life.

Transferring from the Caribbean: Getting the Timing Right

June 29, 2007

Depending on your academic calendar, the timing of your application and your options may change. As an SGU student, I will speak about our problems specifically.

Students that begin in August have a good chance to apply for a second year spot at the end of their first year. Most schools begin accepting applications in February march, interview in June, and accept at the end of June/July for an August start date. Having completed only a year of medical school, you likely have had little time to explore research and develop strong relationships with the faculty that may write your recommendations. The school does not have much to use when considering you. They have your first year grades (mostly useful in comparing you to your classmates) and your MCAT scores. Know that you will be competing against people with a 4.0 and a 30+ MCAT. If you can get a hold of someone that has successfully transferred into the second year, ask them who wrote their recommendations. There is a good chance that this person has a reputation for endorsing strong students.

If you are planning on applying for a third year spot at the end of your second year, you will find this to be much harder. Most schools will want to see your USMLE Step 1 score when considering your application. Any January students from the term ahead of you will have already taken their Step 1 and have scores in hand. It will be very hard to compete against someone that already has a 99 even if you end up with a similar score. You can still apply for a third year spot at the end of your third year (which means repeating a year of clinical work). If you decide to do this, know that it will not be enough that you are “so far ahead” of the other applicants in terms of experience, the school will want to see that you have Honors in your clerkships.

Students that begin in January have more options. As a January student, I had the option of applying for a second year spot halfway through my second year. In this way, you have the opportunity to demonstrate A-level work on the second year material that you would have to repeat, you have a little more time to develop relationships with the faculty in hopes of having a strong letter of recommendation written, and you have enough time to become involved in research or other projects that might set your application apart.

You are also well positioned to apply for a third year spot at the end of your second year. Finishing in December, you will have five months off until you begin your clinical rotations. You can use this time to prepare as much as you need to for the USMLE Step 1, you have time to receive your scores and submit them by April (two months before the application deadlines), and you have plenty of time to make sure that your essays, recommendations, and transcripts are heading in the right directions. You also have an opportunity to pursue research or some other project to strengthen your application. The drawback is that you will have to begin your clinical rotations before the interviews begin. This means moving to a new area, finding a place to live, and taking time off to interview. I went through this and recommend starting your rotations instead of deferring them (if you defer, you may have some difficult questions to answer in the interview), subletting an apartment for two months instead of committing to a lease that you may have to break (and leaving any roommates in a difficult situation), and giving ample notice to your site director that you may need to take some time off for interviewing.

Transferring from the Caribbean: Which Schools Accept FMGs?

June 29, 2007

It changes. Coming from the Caribbean, you are part of an institution that is outside of the Liaison Committee on Medical Education (LCME). Almost all the medical schools in the US and Canada are LCME-accredited and this is the requirement to move between them as a transfer. Few schools elect to consider non-LCME students. To find out which schools accept non-LCME students, I went to the AAMC’s website for transfer policies by school. I asked to search by policy then narrowed my search by selecting ALL schools in ALL regions and selecting all the boxes accept for the first four (LCME-accredited applicant, Osteopathic applicant, Dental applicant, Oral and Facial surgeon applicant). This generated a list of 54 institutions accepting transfers into the second year and 73 accepting applicants into the third year. There is some overlap.

I then sat down and called every single institution to ask about their transfer policy for non-LCME students. This is important to do if you are serious about transferring and this level of effort will separate you from your peers. You will find out before applying if a school that has always accepted transfers has recently changed its policy, has no availability this year due to an oversubscribed first year class, or has recently begun to accept transfers. There have been cases where the school said “no” over the phone, the student applied anyway and was then offered an interview. The determined student will always have an advantage over the complacent student. Decide which one you are going to be and then plan accordingly. The programs that I contacted told me that the information on this site concerning number of available spots is inaccurate, so do not let a “0 spaces available” stop you from inquiring. Plus, it builds character.

There are several schools that often have spaces available nd are well known to those that frequent the discussion boards. These school are:

1. Drexel University

2. George Washington

3. New York Medical College

4. Northeastern Ohio University College of Medicine (NEOUCOM)

5. SUNY Upstate

6. Tulane University

7. University of Medicine and Dentistry, New Jersey (UMDNJ)

In addition to this list, I was able to confirm that eight other schools would accept non-LCME applicants. I do not feel like I have given too much away with this list as it is available everywhere, but if you are willing to search for the remaining schools than you deserve to be separated from others for your effort. Do not forget to call the medical schools in the state where you have residence. Several state schools do not accept non-LCME applicants but do accept applicants that are residents of the state regardless of school affiliation.

As the information begins to pile, it is a good idea to remain organized. Open a spreadsheet with a space for the school, its application deadline, fee, email contact, phone number, application cost, number of required recommendations from undergraduate and medical faculty, required transcripts, etc. Happy hunting.

Transferring from the Caribbean: Why?

June 29, 2007

I wrote a guide about attending a Caribbean medical school, singing the praises of St. George University. I kept a blog for two years at the Rumors Were True shedding light on some of the uniqueness of the island experience. SGU was a place that invited me to test my mettle and gave me the space to realize my potential in medicine. I love the school, the Caribbean, and still count it as the first great decision that I made in a new life of great decisions.

Then I transferred to Drexel University College of Medicine. Why?

When I applied to SGU, I knew that I wanted to be a physician in the United States, that medicine was the only thing that I felt could fulfill me as a profession, and that no matter what obstacles I faced I was going to make this happen. I was not sure what I wanted to do in medicine and it was important to me that as many doors remain open as possible. Going to the Caribbean (you will be told) can close many doors, and you will hear people tell you that you cannot do such-and-such if you come from the Caribbean.

SGU has an earned reputation for producing strong students and their residency placement list each year boasts this, showing students in fields such as Anesthesiology, Diagnostic Rad, ER, Ophthalmology, Orthopaedics, and Urology. The list of residency placements between 1997 and 2002 impressed me particularly when I decided on SGU. That said, my understanding of the residency application process has matured to reveal things previously missed.

The first is that Foreign Medical Graduates (FMGs) are able to accept residency placements outside of the match. This can be to the advantage of FMG applicants that might be able to secure a spot now that they would not get if they waited for the match (plenty of stories of this happening). The list available through SGU does not draw a distinction between how their students’ placements were secured, so looking at the list alone does not tell you how you can expect to fare when it is your turn to open the letter on Match Day. The second thing I have come to appreciate is that while there is a bell curve for desirable fields, there are bell curves within those fields for desirable residency programs. For example, while Orthopaedic surgery is a desirable field and incredibly competitive on the whole, there are Orthopaedic residency programs that are incredibly desirable and those that are less so. If your goal is to become an Orthopaedic surgeon coming from the Caribbean, this is certainly possible. If you want to do Orthopaedics at the Mayo Clinic, this truly approaches the impossible. It is also important to keep perspective on how many students are able to place into these fields. If only three students from your school made it into the specialty that you want and your class size is somewhere near 600, you need to honestly asses where you stand in your class and if it is likely that you will be one of the three in the coming years.

The process of “auditioning” for certain programs is also at issue. SGU has many hospitals for its students in the New York and New Jersey area and you are more or less free to complete your rotations and electives at any of them. When it comes time to apply for residencies, it is sometimes a good idea to complete an “away” elective at the desired hospital. In this way, the program gets to see your stuff and give you a much better look when it comes time to invite people into their program. This process of completing “away” rotations is open for US medical students but is much more difficult for FMGs, and this is because of reciprocity. Reciprocity is the agreement that schools like Mayo will accept and train a Harvard student during an elective “away” rotation with the understanding that Mayo students can be accepted and trained at Harvard should they so choose (an example from NYMC). These agreements are often non-existent between Caribbean schools and their US counterparts. If you plan on staying in the New York/New Jersey area and completing your residency training at one of the hospitals already associated with SGU, then this is not an issue. For those looking to enter competitive programs spread across the US, this is an issue that puts you at a disadvantage.

Finally, insomuch as residency program directors and medical school administrators represent an Old Boy’s Club (I have no idea if this is true or its possible extent) where a well-placed phone call can mean your application at the top or bottom of the stack, I wanted that resource available to me. I wanted to make sure that the clinicians that were teaching me were also faculty with my university and that their professional connections could be opened up to me should I impress them. Moving from the islands to the US left me with the feeling that my mentor, advisers and teachers were largely unavailable to me and that any influence they could have offered stopped in the tropics.

It is good to be aware of these concerns, but they are not unique to anyone. As an FMG, when it comes time for you to answer the “why transfer?” question at your interview, you are not setting yourself apart by regurgitating this. This may be fine since the interviewer is looking for someone that knows why he is doing something as opposed to being just another guy that heard he should apply for transfer since he has good grades, but it does not help the interviewer remember your answer.


June 27, 2007

Anymore, it’s hard to write.

It’s been hard to write for months. A lot of that was masked by my time in Asia, but really I didn’t want to write while I was there either. It’s strange to be surprised by yourself over something like this. I have always felt that writing was something that I had to do, but this isn’t the case.

I don’t have to write.

I’ve been thinking about everything that changed. So much of my writing before was driven. No one to have met me these last two years could help but concede that I was driven. Driven by fear of failure, by a desire to prove all the invisible people that thought I was less for being from the Caribbean that they were wrong, driven by competition with my classmates, driven to surprise everyone.

I’ve always taken a great deal of pleasure and satisfaction from RWT. The success of this space (as such a thing can be measured by the hit counter or your thoughtful comments) was always a source of pride. It’s nice to have an audience, especially when you’re convinced that you’re being ignored or dismissed. I’m not claiming that any of this was reasonable, but it was all felt just the same. But this space took a sharp turn in my mind in June and that change was really alarming. It’s part of why I’m stopping, but not the whole of it.

I saw RWT as a liability. I had never been as careful as I should have been with my anonymity, and several people have figured me out (especially those from my new Drexel class). I made it pretty easy, and this was foolish. RWT used to be a place where I pretended to be a writer. I tried to be funny, or shallow, or helpful, but recently I’ve needed this to be a space to vent and be laid bare. As I met with the hospitals in New York, I became incredibly disoriented and upset and I needed a place to scream at the top of my keys.

And then I thought of the people reading this. I thought about the admissions committees of different schools coming to this place and finding a student with light and dark sides, and I imagined them seeing this and rushing to judgment. We all, I think, would prefer to imagine each other as shiny happy shells and to show the rest is to risk the rest. As the days fell from the calendar without word from any of the schools to which I applied, I become more and more convinced that this was happening. True or imagined, the risk was real and I had previously ignored it.

I was stupid to do this.

And yes, I had the stupid argument with myself about “censorship” vs “honesty.” As regulars know, I deleted everything on this blog that was negative. Old posts, new posts, anything that could be seen as criticizing the medical establishment. I decided that transferring was more important to me than all the rest. After all of it, I was still being driven.

So my goal of transferring and keeping best faces forward (I’m a Janus, after all) meant that RWT was becoming less a journal and more a resume. Keeping something that sterile (at least for me) means writing very little worth reading. All of this worry was immediately followed with fantastic news. My worst fears were not realized; I was accepted into Drexel.

What happens to someone that gets what they want? For me, things fall apart. I don’t feel like celebrating (and didn’t when I was accepted). I was happy for the news and shared it with everyone that had been working on an ulcer with me (parents, mostly) but these things are never the way they play on television. The celebration is in the act, not the aftermath. Executing the interview successfully was a celebration. Submitting my application materials and coordinating my recommendations was a celebration. Studying for the USMLE and sitting for the exam was the celebration; the score was just the memento.

RWT has been my celebration of these last two years in the Caribbean and what I went through to get into a US medical school. I’ve gotten my wish and as a result I’m being redefined. My previous hurdles were my previous identity, and anymore I don’t feel like myself. Now I’m just a US medical student about to enter third year and there’s this huge part of me that wants to quit everything and just focus on being a great student. No more research, no more writing, no more side projects and whatnot. I want to lose myself and have a simpler life.

It won’t hold. I’ll find new challenges, find new roles and projects. Soon enough, I’ll have this new identity driven by new hurdles and I’ll want to write again. But if I start again, there’s no sense in repeating old mistakes. Choosing to continue RWT would be the first such mistake. The stakes are only going to get bigger and they drag the risk along with them.

I’ve also become complacent. Originally, I wanted to write and I’ve fallen incredibly short of this. I’ve done a good job of setting the levels academically and straining to clear them, and in this way I’ve accomplished more than I really thought I could have. But in writing, I’m so often running on autopilot. I can think of only one time where I ever challenged myself, and that was with The Old Man. I still think it’s the best thing I’ve ever written, and it kills me that it sits alone in my “creative writing” file. If I plan on chasing the dream of writing something worth reading some day, I’ve got to become unstuck from easy ruts.

Loss of anonymity, loss of drive, a sense that it’s time to start over and to break some bad habits. These are my reasons for ending this chapter in my life.

Finishing the Guide to Transferring and telling you a little bit about Asia are going to be my encores.  It should be good, so stick around.

Thanks for celebrating this with me, topher.