Congratulations to Lauren Simmons, Girard Cua and all the members of the class of 2015 on receiving their white coats as they prepare to transition into the clinical rotation phase of their medical education.
Before coming to medical school, I shadowed many physicians in various fields to get a better sense of what it is like to be a doctor. However, as an undergraduate student at a technology school with no accompanying medical school, finding a mentor in the field of medicine was quite challenging. In my senior year I was paired with a pediatrician at MIT Medical healthcare system who I shadowed and met with frequently to help me with my medical school application process. With her guidance, help from teachers and career office staff, I successfully made it into medical school. But I always wondered if I had a medical student mentor would I have been more prepared for the first two years of medical school compared to clerkship portion, on which I am about to embark.
When the UF chapter of the Student National Medical Association (SNMA) executive board sat down to plan goals for this year, a mentorship program was a top priority. My classmate, George Ansoanuur, and I developed an application for the mentors (UF medical students) and mentees (current UF undergrads), and upon release, we received significant feedback. During this process we have worked closely with our undergrad sister organization Minority Association of Pre-health Students (MAPS). To-date we have over 35 mentor/mentee matches, and in the past year several mentees have been able to join their mentor in lecture, meet for lunch, attend health fairs, etc. In addition we had a few large mentor/mentee socials to allow everyone to get to know each other better.
The goal of the mentorship program is to aid undergraduates in their pursuit of a career in medicine or dentistry, and give them the confidence they need to see themselves as future professionals. I have truly enjoyed sharing my medical school experience with my mentee, Katherine Almengo, this year and I look forward to being an integral part of her life in the next few years on her journey to medical school. We have attended several lectures together, and she even cooked dinner for me where we discussed my path to medicine among many other things! She is truly an inspiration and someone I know will make an awesome doctor one day. We are similar in many ways — from our passion to helping others in the community, to traveling and volunteering abroad.
Also this year I was more active in UF’s community clinics around Gainesville, and I helped on several health fairs with local churches and other student organizations as the community service chair of UF-SNMA. This year turned out to be a great one for the UF-SNMA chapter as we won a national award for “Most successful at Community Health Fair Outreach.” Next year’s UF-SNMA executive board has been selected, and they plan to continue the mentor program in addition to adding other community-outreach initiatives, so that UF medical students have many avenues in which they can give back.
Spring break is one of the most cherished times of year because of the numerous travel opportunities and the much-needed hiatus from school. However, just as last summer was the final one of its kind, this spring break was my last as I inch closer to life as a working adult. I was fortunate enough to be chosen as a member of the 2013 DR SALUD mission trip team, composed of 17 medical students, five pharmacy students and eight medical/pharmacy faculty members. We traveled to San Francisco de Macoris of the Dominican Republic to provide medical care to people in the area.
The first day in clinic was one of the toughest for me because I had not spoken Spanish in a very long time, so I had to rely heavily on a translator to help elicit the patient histories. But even this was a great learning experience because the translators were medical students from the DR, so in addition to translating, they taught me helpful phrases. Each day I worked on a different service. Day one I was on internal medicine for half of the day and gynecology for the second half. It was a long day, but I learned a lot especially in the GYN portion because of my previous experience with the pelvic exam.
For the rest of the week, I alternated between pediatrics and surgery; two very demanding areas. In pediatrics many of the families that came to the clinic were large with up to seven children, the average being three. So I had to work very efficiently, and I was able to do more interviews and physicals on my own by the end of day two. On my first day of surgery, I had a blast assisting with skin tag removals, joint injections and stitching up an arm lesion after removal of a lipoma. Finally I got to use the skills I learned at suture clinic! My last two days of pediatrics and surgery were similar to my first experiences except I felt even more comfortable talking with patients and trying to come to a diagnosis. By the end of the last day of clinic we had seen more than 1,500 patients as a group and distributed the majority of medication and vitamins we brought with us. I felt so blessed at the end of the trip that I had the opportunity to serve so many people in DR and learn more about the DR culture.
On our last day in San Francisco de Macoris, we were served a wonderful Dominican meal, and a local dance group put on a performance for us as well. Hanging out with the Dominican medical students, learning how to salsa and other forms of dance, was another fun part of each night after clinic.
We spent our last day and a half in the Dominican Republic at a resort, allowing us to relax before heading back to school where the beach is nonexistent and studying is a way of life.
Overall, I had an amazing spring break and enjoyed working with an awesome team of physicians. I learned so much more in one week then I could have ever possibly imagined. I am very excited for the transition to the ward in third year so I can continue learning the skills I need to be a great physician.
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I have found that as I progress through more and more of second year, I end up leaving more and more of myself behind. In a way, I have been feeling more spent than ever. I have said before that the exams are constant and the lectures are unceasing, and on any given day there is always something that requires the bulk of my attention. It has come to the point where I have not had enough time to pause and write. In looking for a pause, I found one in Spring Break. Ten days in March where I could do as I pleased and simply relax. Perhaps I would read some books or ride my bicycle around town, and on the whole, not have to think too much about medicine.
Instead, I went to Ecuador.
On March 2, at 4 a.m., my fellow University of Florida Health Science classmates and I boarded a plane in Miami, headed to Quito. This was part of a health outreach trip, of which UF was host to many. Our particular trip, called Project HEAL, was bound for many places in Ecuador, and our goal was to provide primary care to several rural villages and towns. I remember sitting on that plane in Miami thinking that this was going to be a good trip overall and a good chance to both learn something about myself as well as to make myself useful. In retrospect, that particular thought may have proved to be the understatement of my life.
I always wanted to participate in a health outreach trip, ever since I heard about them during first year. The idea of going to another country with no other motive than to help its people was exciting to me. There is something in me that wants to give and give, and receive nothing in return. Perhaps it is because I have already received many good things in my life. In truth, I was also influenced by the ideals of the Florida Medical Opportunity Scholarship. I have written before about the immense gratitude that I have for being able to study at the UF College of Medicine and being a recipient of a scholarship that prides itself on bestowing opportunities to underprivileged students. I have never let that sentiment stray far from my thoughts, and in keeping with the spirit of my scholarship, wanted to live up to it by helping others and making myself useful in any way that I could. And so, I applied to Project HEAL and they accepted me.
I remember being on the plane that morning; feeling the plane take off and leaving America behind. And the next thing I knew, we were landing, and I saw mountains.
March 3, 2013
Day 1: Breathing deeply at 15,000 feet
After we landed in the Quito airport, we quickly collected our bags and met up with the rest of the health care team. Our entire team consisted of two pediatricians, a cardiologist, two emergency medicine physicians, a gynecologist, three pharmacy students, two pharmacists, one nursing student, two fourth-year medical students, one third-year medical student, 12 second-year students, two first-year students, and a nutritionist. We were quite a well-rounded team, with people from both America and Ecuador working together.
We drove two buses from the airport, which took us from Quito to a city called Latacunga. We would stay there for a couple of days as we visited clinic sites close by. The first night in the hotel was both exhilarating and tiring. We were tired from travelling, but looking very much forward to our first clinic day. So I assume that my colleagues slept just as much as I did that night, which is to say not much at all.
For the first clinic day, we would find ourselves removed from the 10,000-feet-above-sea-level altitude that we had so little time to get used to, to the 15,000-foot elevation of Guangaje. This clinic site was in a small village in the mountains, which took us quite some time to get to by bus. But I did not mind in the slightest, as the view was incredible. I now believe that there are very few sights that can inform you as to how immense and beautiful this world is than the sight of the mountains in Ecuador. Though I have seen very little of the world, it is difficult for me to imagine anything more well-formed and breathtaking.
When we arrived at the clinic, our real work began. I worked alongside one of my classmates under one of the pediatricians. The patients who came to the clinic spoke both their native Kichwa as well as Spanish. However, I initially had difficulty communicating with the patients without the aid of a translator, as my Spanish was poor and the patients would often blend Kichwa and Spanish together. But as the day progressed, I found myself better able to communicate and adapt to my patients. I was surprised as to how much my Spanish improved, even though I really only knew how to conjugate verbs in the present tense.
I also learned many things about pediatric exam; especially regarding infants and toddlers. I learned about the importance of keeping growth and development charts for children, as well as important approaches to the physical exam itself. For instance, it is always preferable to listen to the heart and lungs of an infant first, as that is when they are the most complacent; if you start out trying to do more invasive things, like looking in their mouth and ears, they will start to squirm and scream and you will never be able to hear heart and lung sounds.
One thing that I did not expect was how the altitude would affect me. I did not notice anything back in Quito, but at the clinic I found myself suddenly dizzy and out of breath at certain moments in the day. One particularly terrifying moment came when I was looking in an infant’s ears and suddenly became very dizzy. I had to close my eyes because it became very difficult to see, and I did not know what to do, as the otoscope cone was already in the ear canal and I was unsure if I could safely remove it without possibly hurting the child. Fortunately, I was using my pinky finger to brace the otoscope against the child’s head, so I was able to hold it steady until the dizziness passed. I was able to finish the rest of the exam without any problems, and looking back, I was happy that I kept my composure and did not alarm the patient or his mother.
When it came time for the clinic to close, I realized that I had learned and done a lot. It was only the first day, and I could not wait for tomorrow. On the bus ride home, I thought about what it might be like to be a pediatrician.
Wanna get away? Go to a conference!
Medical school can seem quite monotonous at times: sit in class, study, eat, study, go home, repeat. After a few months, almost every student needs a break. Recently, I had the opportunity to go to Amelia Island for the Florida Academy of Family Physicians winter conference. I learned a lot during the workshops and interactive sessions with current family medicine residents and attending physicians. Every time I am in a room or patient care setting with a primary care physician, I feel very comfortable. Another highlight of the conference was staying at the Ritz-Carlton for two nights for only $10! (Thank you UF Department of Family Medicine). In addition to the workshops, we enjoyed a bonfire on the beach, night-life activities and more. Leaving school and spending time with some fellow MS2s and a few MS3s was just the break I needed before my last round of exams in 2012.
At the end of January, I went on another excursion to Columbia, S.C. for the Region 4 American Medical Association conference with several other MS2s and MS1s. Since winter was in full swing, the weather was a bit chilly, but I didn’t let that spoil my first trip to South Carolina. We went to a restaurant called the Flying Saucer and then headed downtown to the famous “Five-Points,” where five streets intersect—pretty cool. The keynote speaker, David Satcher, M.D., Ph.D., the former U.S. Surgeon General, provided a phenomenal presentation as he outlined the public health advancements he oversaw as the 16th surgeon general. He further motivated me to pursue my dreams of getting an MPH (master’s of public health) and combating some of the major health disparities present today. There were also tons of cool workshops, of which my two favorites were Health Policy Jeopardy and the Ultrasound tutorial. I also participated in a community health fair event put on by the University of South Carolina School of Medicine students and faculty to increase diabetes and hypertension awareness. Lastly, on our final night together, we all celebrated like only medical students can – at Jillian’s in downtown Columbia. But now I must return to my regularly scheduled programming.
Every medical student comes to school with the understanding that one day they will have to perform a pelvic and prostate physical exam. As I entered the room to learn and perform my pelvic exam, I was very nervous because the exam was more invasive than anything we had done in the past. However, I had a phenomenal instructor and after she explained everything to us, I felt comfortable enough to volunteer to go second in the group. Overall, I did a great job. My only hiccup was using the word pee instead of urinate when describing the kegel exercise, which elicited a few laughs from my colleagues.
Because of my success with the pelvic exam I went into the male exam with positive vibes. My male instructor was also great at outlining and detailing how each part of the exam was supposed to be done. However, there is something about sticking your finger into the anal canal that is a bit unsettling. A few moments later I felt the prostate, retracted my hand, removed my gloves and washed my hands especially well. Even though both my partner and I received positive feedback about our performance, I am not so sure urology is the specialty for me.
Earlier in December, I traveled to the University of Miami for the Student National Medical Association Region 4 conference with a few classmates and several undergrad students from UF. The lectures and discussion sessions covered a wide variety of topics. The three I enjoyed most were Love in Medicine, Business in Medicine and STEP 1 preparation. There was also plenty of time to network with medical students from other school all over the southeast and some evening social events that were a blast. November was a busy month, but my Thanksgiving trip home was great and when I returned to school I felt rejuvenated for the final stretch of exams before winter break.
I was around 11 years old when I first heard of parasites. I learned about tapeworms in sixth grade, and they were nothing like the fat, comical ones the inhabited the sidewalks of the ground after a rainy day. I would see those earthworms wriggling about on the cement, as if trying to get my attention, and I would pause on my walk home from school and toe them back to the grass where they belonged. But these tapeworms, I learned, lived inside of us, eating the same food that we ate. If they got big enough, they made us sick. They were nothing like their harmless cousins. It was a very unsettling realization for me that something alive could be living inside of me, let alone without my permission; so much so that I never stopped to help another earthworm again. I just couldn’t look at them the same way.
Around that time, I made the mistake of coming to the conclusion that tapeworms were the only things that parasitized humans. Learning about them was horrible enough to my younger self, so I suppose I just got the idea into my head that nothing worse than them could possibly exist. Now that we are in the middle of the parasitology unit in our Medical Microbiology and Infectious Diseases class, it seems that 12 years of denial are finally catching up with me.
Perhaps there is nothing as strange as coming to the realization that you are food. Bacteria and fungi certainly live in and on you, and maybe a parasite or two as well. What are they doing? Who is keeping an eye on them? And what exactly is keeping them alive, food-wise? I have since learned the answers to those questions, and for the longest time they have kept me up at night. But in the end, I’ve come to terms with the fact that I’m being colonized by bacteria as I write this, and taking fungi into my lungs with every breath. It only makes sense now to think of them as tenants in the very complex house that is my body.
I’ve tried explaining this insight to my non-medical school friends, but they, like my old self, demonstrate a reluctance to listen. “Did you know,” I asked one of my friends during dinner, “that 1.3 billion people in this world are currently infected by a type of intestinal worm?”
My friend looked at me and frowned. “But I’m eating right now,” she said. “… or I was.”
I looked at the chicken tenders that she had stopped consuming. “You may have a point,” I said, “Ascaris lumbricoides can occur in the Southeastern United States. But I think the people who handled your food practiced appropriate sanitation measures.” I then went on to mention a few opportunistic fungi I had learned about that day.
My friend eventually rested her chin on her hand and said sadly, “Hearing all of this just makes me want to run away.”
I thought about that for a moment. “Well, you can’t run away from fungi. Or parasites,” I said. “They’re everywhere.”
“I don’t want to run away from the fungi or the parasites or the bacteria,” she said. “I want to run away from the knowledge of them.”
I was struck by how much that sounded like my younger self. Perhaps she, like I, was in a way coming to terms with her own mortality.
In one of my favorite short stories, called, “The Monster Mash,” the author David Sedaris describes very cleverly the truth behind what happens to someone when they begin to acknowledge the boundaries of their mortal selves. For him, it came from working at a medical examiner’s office and learning about death. In the story, he writes that “Citizens were disemboweled, one right after the other, and on the surface I’m sure I seemed fine with it. Then at night I’d return to my hotel, double-lock the door, and stand under the shower until all the soap and shampoo were used up” (Sedaris 110). I could relate; after learning about all of the secondary bacterial infections you can get after a viral infection weakens your immune system, I spent the majority of my time avoiding people, afraid of getting even the slightest cold. I wanted my immune system as intact as possible because what else would keep all of the deadly microorganisms in check? As each day passed, I learned about infections that I never wanted to have; especially ones that were particular to health care providers. As Sedaris puts it, “This was the consequence of seeing too much and understanding the horrible truth: No one is safe. The world is not manageable” (Sedaris 115).
Of course, eventually I learned to lighten up and accept that the world that I live in is a complex and uncertain place. That’s kind of what makes life exciting. There is no point in worrying about what could and could not happen in the future. You just have to take life for what it is and take it as it comes, bugs and all.
Sedaris, David. “The Monster Mash.” When You Are Engulfed in Flames. New York: New York, 2008. 109–116. Print.
The past month of medical school has flown by at lightning speed. In this span our workload increased from three classes to five, I viewed an autopsy, volunteered at the St. Francis House (homeless shelter and soup kitchen) and made several visits to the VA and local clinics. Viewing an autopsy was truly a unique and humbling experience. I have a newfound respect for the art of autopsy; the ability to preserve bodies for funerals while still collecting enough evidence to determine the cause of death. The job of a medical examiner is quite complex and one must not only have a strong stomach but a strong mind and heart to deal with death on a constant basis.
In the latter part of October, myself and other medical students volunteered at the St. Francis House to serve breakfast and lunch to some of the homeless people in Gainesville. We started the morning by making dozens of peanut butter and jelly sandwiches, meat tortillas and other dishes. After a couple of hours of prep work we began to serve food in an assembly-line like fashion to anyone who came by that was in need of a good meal. Everyone who came by was so appreciative of the food we served, nothing was wasted and no one complained; in fact most people got a serving of everything that was offered. Lastly, the Student National Medical Association held a food and supply drive, allowing us to bring several bags of clothes, canned food, toiletries and other items that were donated for those who visit the St. Francis house.
The new classes we started were microbiology and systemic pathology. I didn’t take microbiology in undergrad so I wasn’t sure what to expect. One thing’s for sure—my inability to spell is being exposed on a daily basis as I try to spell the names of all these bugs. I did enjoy learning about sinusitis because I had a battle with it in high school that thankfully I won. Systemic pathology on the other hand has been just what I expected—learning the how and why behind diseases of the different organ systems. I think this course is one of the main reasons I came to medical school, so I am really enjoying it.
One of the other highlights of October was our class Halloween party; we did one last year that was a bunch of fun so I expected good things this year as well. I am not too creative, so I didn’t have a costume but most of my classmates managed to put together some cool outfits. Overall, everyone had a great time and it was a much-needed break from school after a marathon of tests the day before the event.
Its hard to believe it’s almost time for Thanksgiving vacation. I can’t wait to go home and eat some delicious food.
The first month of second year has flown by faster than I could have ever imagined, the amount of material we learned in one month last year is now covered in two weeks or less. Despite the hectic schedule, I have enjoyed the change because we spend more time in the hospital, and class material seems more applicable to diagnosing patient illnesses.
Visits to the Malcom Randall VA Medical Center have been valuable and rewarding. I’ve seen patients with aortic stenosis, COPD with emphysema, sepsis and more. The best part is working with the veterans because they are very talkative and have interesting physical findings, so by the end of each visit I’ve learned a lot of new information.
Learning the mechanisms behind inflammation in pathology was pretty insightful, considering the number of times I jammed my finger or sprained an ankle playing basketball or football over the years. Even though we have much more material to conquer in a shorter period of time, I still manage to SWIM (stay whole in medicine) by exercising, volunteering and of course, attending Florida Gator football games. The past two games have been scorching hot, so I am eager for the change in weather, as we get deeper into fall. Can’t wait to see what October has in store!
Our second year of medical school started last month, and so far it has been a big change from the first. Perhaps it is because I am more used to medical school, but everything seems more manageable the second time around. Already we’ve had two Pathology exams, and our class has taken them in stride. The passing time has shaped us well and given us tools that are now second nature to us. On second thought, our professors may have had something to do with that as well. Nevertheless, the daily ritual of learning, integrating and experiencing the art of medicine has become a habit for us second years; one that we gladly and gratefully participate in. All of this makes me wonder how the new first years are doing.
In the beginning of August, the class of 2016 took our place as the incoming first years. My classmates and I see something of ourselves in them, in how they struggle and challenge themselves to learn all of the things we learned last year. They are very much like my classmates in how diverse and talented they are, but the interesting thing is that they are the first class to be learning under the guidance of a new curriculum. It makes me curious as to how they will compare to us when they become second years. Placing two classes side by side, who have learned and grown in different environments; how will they be different, and how will they be the same? It may be like watching tigers living on Earth, and tigers living on the moon.
I had never thought about it before, but the first and second year classes seem to occupy similar, yet distinct niches in the medical school world. The both of us are students still beginning our careers, knowing only a small fraction of what there is to know about medicine, and yet what a difference a year can make! From the anatomy and histology of last year, I now find myself better prepared in studying inflammatory diseases and their causes. My years’ worth of experiences with standardized patients gives me a strong foundation when I find myself now interacting with real ones.
As I write this, I can plainly see now how everything is starting to come together. I used to imagine that time was discrete. I used to think that one year “ended” and another “began,” and I often tried to think back and pinpoint a certain day where I could say, “That was the day I realized I could do well in medical school,” or, “This was the day I became comfortable with talking to patients.” My classmates and I have often asked ourselves if that time will ever come in the future where we will simply know that we are skilled and competent doctors; as if to say that one day we will not know, yet the next day we shall. But I know now that the path to becoming a doctor is an ever-increasing and ever-intertwining process. It won’t happen in a day, but neither will it take forever. Perhaps it may be marked, not by the sudden and swift change, but by the small moments of time when knowledge from the past meets the experiences in the present.
“Planet Earth – The Future: Saving Species.” Planet Earth: The Complete Series. Prod. Fergus Beeley. BBC Video, 2007. DVD.