Last Minute Procrastination

I have not procrastinated much lately. Well... at least not on this blog. I have started a new clerkship, one of the last required clerkships left in medical school for me. Neurology. I am finding that life in clerkships is VERY different AFTER your residency interviews are pretty much finished. From this point forward it is not how well you do, no more competition, it is simply getting up in the morning, going to the hospital, trying to learn some medicine and coming home. No crazy ass kissing. No feigned enthusiasm. No anxiety over that final exam. Just show up, absorb what you can and don't fail.

I have one last hurdle to my medical school graduation though, that is the "triple-I" project - "Independent Investigative Inquiry". This is a research project required by our school to expose students to research. It is a good idea in general but again, like many rules, applied broadly without flexibility it too becomes one of the many hoops you simply must squeeze your body through to get out. As a researcher by training (first in physics, then astronomy and finally in genetics) I think I have a good understanding of research and I know I am not interested in fundamental research any longer. That is part of why I am going into a very clinical, hands-on speciality. Still... no matter, must jump through the hoop. To add insult to injury... many students when they get their project approved have the option of doing three different tracks in this requirement. Some (the smart ones) picked the simple track. Basically it amounts to writing a brochure about something like bike helmets while on one of your rotations. Really low work-load and honestly, I am not sure what that has to do with basic scientific research. Others, like myself stupidly, went for option 3, hypothesis driven research. This is the real deal. Come up with a question, propose a study to answer it, get data, analyze it and write a publishable paper. I thought this a good idea originally... I found a project I was interested in, related to Emergency Medicine, and already well supported. We got the initial data, and abstract was published in a major journal, but we expanded the study. Now it won't be done in time for graduation. I am stuck...

In my mind, this is a requirement that was originally devised to educate a medical student. It had a reason behind its creation I would like to believe. I think that reason is to expose and educate a student in the ways of research due to the importance of research in the medical field. Now comes the rub... what about those of us with research experience already and the self-knowledge that we are NOT interested in research. We don't like writing grants or papers. What if we already know we are not going to do it in our professional lives? Well, some smart ones picked the easy way out, write a brochure on food poisoning at family picnics or something. The more wide eyed variety, such as myself, took on something a little larger than he really wanted. Despite not getting the larger study completed and a publication out of it, we did get an abstract in a major journal and the study is being completed after I leave medical school. Besides, I already have "first-author" publications in other hard science fields. That is not good enough I guess... The solution the medical school proposes... write a "pretend" paper with "pretend" data and simulate the paper writing experience!

Wait a second. What was the original goal of this? Research exposure? Education? Don't I meet those goals already, before I even came into medical school? Didn't the project I am working on get an abstract published in a major journal? Isn't the project very successful already? Why do I need to jump through this one last hoop? Wait, you mean I still have to do this when someone else met the exact same requirement by spending one night with Microsoft Word writing a brochure on the importance of hand railings in old folks homes? .... Oh yes ... I must spend my valuable time on this last "false" paper writing experience because we are not really concerned about the original intent of the requirement, we are now concerned about checking off boxes in a rule book. Can you tell this is my biggest frustration? So, instead of finishing this paper which is due in one week, I am whining in my public forum here right now. One thing medical education has taught me (although the lesson is NOT about research) is that in medicine one needs to learn to jump through hoops. There are many people unable to "leave the booth" so to speak and they hold the pens and the checklists and they won't let you move ahead until their checklist is complete. Never mind what the intent of the rule was to begin with. I wish we had medical judges that could listen to the opposing arguments and and then weigh these against the intent of the law, not just the letter, and make a just decision on how to proceed. That would just be silly though and take way too much personal effort I think. So, my lesson is learned. The meaning is meaningless. Do as your told. Don't think beyond the books and the rules because in the end that is all that really matters. Okay, sarcasm and bitterness vented. Now to spend what could have been a nice evening out with friends writing a make believe story about make believe data. I feel my horizons broadened already....

Posts Few and Far Between

Sorry for the lack of posts this month, but interview traveling has kept me quite busy. I am going to write a little about interviews and residency, but I am so tired of that so let's start with books! I just finished reading "The Road" by Cormac McCarthy and "Out Stealing Horses" by Per Petterson. I can't say enough good things about both books. Quite amazing, both with sparse prose that was as descriptive as it was lean. Despite this minimalistic style of writing, both books dealt with a magnitude of human experience on a scale far beyond most. I loved them. When I went to my local used bookstore to find another book of similar style I was pointed to "Angle of Repose" by Wallace Stegner. So far I am about 20% into the book and it is proving to be quiet Steinbeckian (is that an adjective?). Very good as well, as you would expect from a Pulitzer winning book. Still, my tastes are narrow and somewhat unique in ways so a prize is no guarantee I will stay glued to the pages. I feel pretty lucky to have had enough time to read for leisure lately and am enjoying every word of it!

I am about to pack my bags for my last interview this year! I fly out tomorrow for Albuquerque, New Mexico, to interview at the University of New Mexico and to spend an extra day hanging out with my dad. We have not been able to see each other much these last few years and it will be nice to catch up. So much has changed for both of us, me in medicine and he now just retired. Wish I had more time to spend down there but I start my next rotation, neurology, at Harborview on Monday.... back to the grind after a glorious and rather relaxed 6 weeks off, except for all the traveling. By the way, in the last two weeks I have had two flights get canceled on my after I was at the airport, one flight delayed 3 hours, and one bag lost when it was sent to another city. I think I have paid any karmic travel debts and expect this next flight to be smooth sailing...

Now that my interviews are starting to wind down some (I do still have a couple in January) I can start the job of refelcting on each, emailing a few last minute questions and then solidifying my match rank list. This is the list of programs I want like to match at, ordered from most desireable to least desirable. Since I only applied to programs that I thought I might like in one way or another I will not get stuck with anything bad, but still prefer to get the best fit for me. Figuring out what makes a good fit is the tricky part. It is much like dating or marriage I suspect, you just don't know the future and you have to make this decision based on having only partial knowledge. The rest is faith I guess....

There are so many variables that it is hard to know what to consider when making this decision. Do you rank one program higher because their ultrasound training is better even though their residents were not as friendly or do you rank a place with people you really seem to like higher than a place with a much better trauma training system? For every program there are about 5-6 variables that I consider important and then on top of that the intangible "gut" feeling that will ultimately make some big decisions on my list. Our lists are not due until February but I am sure my will be all but done soon, although January may make some adjustments. I will let you all know when I know and in the meantime I will try and find some time to write about something more interesting....

Listen (and watch) some great old LP's!

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