Mom Status

Today I met with another Mom who is planning to return to medical school and I can't help but be excited for her and energized after hearing her journey. Seeing other moms working towards fulfilling their goals outside of parenthood in their own time and on their own terms is nothing short of inspiring. I've come to understand that our contribution to the medical field is something is so essential. We bring a level of maturity and a skill set that simply can not be matched. I have no doubt that I will be a better physician from the very start because I was a mother first. I've met many moms along the way who chose to hide their "mom status" either during medical school admissions, residency application or for both. It is discouraging to me that these women felt the need to hide motherhood because it represents the egocentric, close-minded mentality that still permeates much of the medical community. I'm Puerto Rican, which is considered one of the underrepresented populations in the field, but I dare say that being a Mom is not only more underrepresented but also more widely discriminated in this field. In one of my interviews I was asked, "how will you manage being a mom and a medical student?" I responded politely but later that evening I wondered whether any of the father applicants were asked that question. Early in medical school I spoke to a mom physician who conducted interviews for one of our home residency programs. She confessed that when she gave tours of the school and was obviously pregnant, big belly in tow, she was often asked by the applicants about work-family life balance; however, after giving birth or before she was showing, the applicants never felt comfortable to ask these types of questions. Just by having a belly and outwardly exposing her "mom status" applicants felt more comfortable to ask the forbidden questions. In my second year I met another mom who was applying to a very competitive field. Ultimately she felt that disclosing would hurt her application because she may not be viewed as being rigorous enough despite the fact that she had a fantastic board score and a strong application. I'm not going to pretend that things are not harder for mom medical students but the fact that our rigor, or assumed lack thereof, is measured by our attachment and love for our children is just ridiculous. Those of us who are in medical school, pulling late nights with a sick kiddos and still showing up to take our final exams, pumping milk for our little ones in empty classrooms, trying to make financial aid money stretch for child care expenses, filling in as full-time parents when our spouse has to travel for work, making sure that school uniforms are ready for next week while we study for board exams and work on research projects and doing any number of things all at once at all times are the most rigorous people that I know. We deserve to be recognized and respected for achieving level of perseverance and diligence that far exceeds most of our peers!

Post Step One Burnout Is REAL!

I am in my scholarly activity period now and I'll admit that its been a challenge to stay motivated these days. I'm currently working on a few research projects and trying to prep for my surgery rotation which starts in July. We also found out a few weeks ago that we have to move to a different house. Luckily I was able to find a place quick and so now we are in the packing stage. I think I'd be burned out regardless of all the unrest but having to move and coming off some recent health issues has only compounded these feelings. In hindsight, it's probably good that I had this less intense time to decompress after Step 1. I'd highly recommend other moms try to plan a post-step break if at all possible. I haven't taken any spring breaks or summer breaks since starting med school so this lull is long overdue! Pace yourself if you can is my suggestion. If you don't get a real break or vacation, give yourself permission to take it easy when the opportunity presents.

USMLE Step 1 Prep For Moms.

My experience with Step 1 taught me a few important things that I would like to share with my fellow medical school mommas.

1. Start prepping on day one of medical school or set aside several weeks of dedicated prep time in the summer between MS1 or MS2. This might seem like overkill but I honestly wish I had paid more attention to Step-1 and less attention to my coursework during the pre-clerkship phase. We are on a pass/fail pre-clerkship curriculum but you would never have known it if you saw how hard I studied during those years. For me it just did not feel right to be okay with simply passing. I was a 4.0 student in undergrad and wanted to keep that level of achievement regardless of whether or not it would show on my transcript. I was repeatedly told that if I do well in pre-clerkship, my board scores would reflect my hard work. This could not have been more untrue. I am not an experienced standardized test taker and I have a learning disorder that hinders my speed on highly timed tests. Additionally, I am in my mid-thirties so my processing speed is already slower than the students who are at their peak in their 20s. But irrespective of these issues, I still do not feel that my diligence in my pre-clerkship period gave me any advantage on the USMLE Step 1 exam. In order to do well on Step 1 and not have a miserable dedicated Step study period it is essential to have completed at least one question bank and 2 passes through First Aid prior to your dedicated prep period. For parents, particularly mothers, you are much better off starting early. Because I had too little prep prior to my dedicated period, I ended up studying 12-15 hours a day with ZERO days off.  My son's school performance slipped considerably because he missed his Mom. I was unhappy and didn't have time to workout or do anything for myself - I even had Pathoma videos playing while I showered.  In the end I did well (not as well as my pre-clerkship grades) but it was not at an incredible expense to my family and my own mental and physical well-being.

2. Had it to do all over again I would have done 3 FULL question banks.  I liked USMLERx Qmax as a starting question bank. UWorld was great for the dedicated period. Your score will directly correlate with the number of practice questions you do so get started early....re-read number 1.

3. Five full passes through First-Aid. One as you go through your blocks, one the summer prior to your  MS2 year, a third during your MS2 year and two passes in the dedicated prep period.

4. If you have done 1-3 as I listed you prep period will be much more efficient. You will be much faster as you work through the UWorld questions which will enable you to study 8 hours a day and even have a day off.

5. Use your day "off" to take a practice test. They usually take about 4 hours. I would avoid trying to look up answers to your practice tests for the ones you missed. It is very time consuming and you will get little return for the hours that you spend hunting for the solutions and explanations. 5-6 practice tests is plenty. You may want to add a few blocks of questions from uworld or another bank as you approach your test day just to get a feel for the endurance you will need on test day.

6. Your school may encourage you to be okay with a lower score that is "just passing". Keep in mind that state (public) medical schools may have incentives to have a few top performers who go on to competitive residency programs and raise their Step-1 mean, whilst a bulk of their students pass and go into a primary care residency. These schools receive funding according to the number of primary care slots that they fill which includes: family med, IM, Peds and OB/GYN. If you desire to go into one of those fields, no problem, but if you are interested a field that requires a more competitive score you may feel a disconnect in the support that you receive during your Step prep. As a Mother, sometimes there is an implicit bias that you should fit into the primary care group and that is the frame of mind in which the administration will counsel you for this important exam. Don't be fooled.

7.  Have help from someone you love on your test day. I had my husband take over all childcare duties, drive me to the test center and pack my lunch so that I didn't have to waste my headspace with logistics. He left me a sweet little note in my lunchbox that really cheered me up during one of my exam breaks. This is a small thing but it helps. My husband is my partner. We have been married for 10 years, lost a child, lost a parent, endured poverty, lived abroad, you name it. It was nice to have his support in this way on the day of this test, which would impact not only my life but his as well. There is enormous pressure when you have more people on the hook, more years of debt and fewer years to get to practice medicine. When I found out that my husband had to travel for work on the week of my originally scheduled exam, I insisted on changing my date to when he was back in town - 5 days later. It wasn't easy and there was a ton of pushback from my school (another story for another day), however, it was the best decision ever! Know your rights.

8. Physiology, Pathoma, Goljan. I listened to the Goljan audio lectures during my commutes too and from school throughout the pre-clerkship period which enabled me to do 2 full passes.  Some kind soul uploaded them into 5 videos on Youtube so you can go there to listen to them.  Physiology is very high yield and often not well-taught in med school. I really liked the Pyseo.com lectures and you can watch them at 1.4x or 2x to cover the material quicker. Pathoma is a staple. I'd try to make 2-3 passes prior to step one.  If you are an auditory learner you can watch, if you learn better from reading, you can watch once and then read his study guide twice.

All for now, I will continue adding to this list as I think of more things...

There is no place like home.

Sometimes I wonder if practicing medicine will ever feel as comfortable as stepping into a ballet class. I'm on a bit of a lull right now with school so I've been taking ballet classes about 3 times a week for the past few weeks. Today I made it through the entire class which is a big accomplishment considering I haven't done much of any ballet since the summer before medical school (2015). Everything is coming back though and I'm slowly getting stronger and rediscovering my center of balance and my artistry. It never ceases to amaze me how at home I feel in the studio, no matter how much time has passed since my last class. I can be taking with a room full of complete strangers or with a new teacher and there is still an unmatched level of freedom and comfort. No matter how weak I may be physically, I can trust in my technique to carry me through. With time my strength returns and I am able to lose myself in the pure joy of finding a balance between the artistry and precision. Hold a balance just a hair longer, lengthen the movement just a bit longer, sharpen the beat, add a head or port de bras...it's like salt water taffy and I can never have enough. But I suppose there was a time that I wasn't so comfortable and ballet was new and unusual. I started dancing at 14.5 years of age, very late for a girl. I will never forget doing an audition for a summer camp after I'd only been dancing for a month. I believe it was a Boston Ballet summer intensive audition in Pittsburgh. I remember being completely lost for most of the center, particularly the petit allegro. I watched a very advanced dancer in the group before me and was in absolute awe of how comfortable and capable she seemed. I probably went home and cried that night, as I do many times when I have a particularly hard experience in medical school, but I pushed through those early years in ballet and now I have this incredible gift. In med school I often feel like I'm on the left leg and everyone else is on the right. There are moments where things come together for a brief period but then in an instant I'm back to feeling uncoordinated and awkward. I work hard each day with the hope that one day I can feel that same way about medicine as I do ballet. I want to be able to feel challenged but also have trust that my technique and knowledge base will support me. I want to push boundaries further and in order to elevate the care that I can give patients. I want to strike a balance between in the art and science of practicing medicine. I want to change a phase or an intonation in just the right way so that the patient before me somehow feels more understood or cared for. These are the hopes that keep me pushing forward.

Update - Ambulatory Rotation

Well, I made it through pre-clerkship! After countless lectures, quizzes, TBLs, labs and exams, I am finally in my clerkship training period and interacting with patients. This is an exciting and refreshing change of pace. I'm starting out in ambulatory so I am at outpatient clinic sites. So far I have attended clinics in pediatrics, internal medicine, pediatric genetics, renal clinic, and diabetes clinic. I'll get experience with several other clinics too before the rotation ends. I knew that I would really enjoy clinic and interacting with patients but I didn't anticipate just how rewarding it would be to be able to participate in patient care on this level. I'm finding myself recharged after a long bout of the burnout from the pre-clerkship phase. It has only been 2 weeks but here is the rundown:

• Wearing real clothing is weird and uncomfortable but it is growing on me.  My pre-clerkship period uniform consisted of sweat pants and my snoopy pajama pants.  I rarely dressed business casual. Now I have to do it every, single day. At first I was like, "$*@&"!!!! Now I'm getting used to it but still finding ways to make it comfortable.  I bought some grannie shoes from Clarks that I can wear all day and I'm incorporating my Mr. Rogers sweaters as often as possible to keep thinks less business and more functional. 

• Pooping schedules are complicated.  I'm just going to throw this out there and be honest. When you reach a certain age your body needs a certain type of routine. Your system is more sensitive and adapting to intrusions on this routine becomes more difficult. It is something that no one worries about in the 20s and then, WHAM, suddenly you find yourself in the mid-30s and on a delicate schedule.  Most medical students are finished with residency and are well into their practice of medicine before this change. When you start late it is just one of many issues that suddenly becomes a daily dilemma.  

• When you look and sound a little older, patients have more trust in what you say and do as a care provider. This can be good and bad. Patients are automatically more comfortable when they know that they are talking to someone who has had some real life experience. On the other hand, more trust comes with more expectations so I often feel like I should know more and have more skills than a person at my level of medical training.  It's a tough balance. 

• My superiors are from a more familiar planet. I've really struggled to connect with my peers in med school.  It seems like they are from a different world at times; I'm a Gen Xer, they are Millennials. Beyond the obvious generational and maturity gaps, most of them are from an entirely different up bringing. Now that I'm in the clinics I find myself able to identify with my superiors but from this awkward position as a subordinate. They are the people who I would want to have as friends but can't. It is very awkward and makes me long for the time that I am in practice and surrounded by colleagues who are, at the very least, from my own generation. 

Okay, back to the books for me.  I'm currently trying to study for Step 1 as I go through this rotation in hopes of starting out my 6-week intensive study period having already finished the USMLE Qmax question bank. Hopefully I can pop in and share more as I go through this rotation. I'll definitely be sharing more about my Step prep too. Best, J. 

Tips For Moms Starting Medical School - Part 1

Just a few tips that have helped in the first 2 years of medical school as a single mom.

1. Before each semester I stock up on everything and anything that is consumable and nonperishable. For example: cleaning supplies, paper towels, toilet paper, nonperishable foods, toothpaste, etc. In other words, if there is a natural disaster in Dallas, my house is the place to be! This has helped me immensely and also cut down on the weekly shopping lists.

2. Before the start of the school year, I buy 5 sets of uniforms for my son. This way I don't have to worry about any laundry. I also purchase the winter sets at the beginning of the year too so that the transition from fall to winter is easy. If your kiddo doesn't need a uniform, get their outfits, shoes, etc for the entire school year.

3. Bi-monthly cleaning lady is a must! I went the entire first semester of med school without one and that was a mistake. Showers and toilets were not getting cleaned and it weighed on my mind. Shop around before the semester starts and get someone at a decent rate who you can trust. Give them a key but start them out in the summer for a couple runs just to make sure that you can be home to answer questions and give them guidance as to your preferences. Letting go of the cleaning was very difficult for me but for the best!

4. Find a nanny/caregiver. You will want several months to put out an ad (I used care.com) and interview applicants. I started several school before my son started so It was a huge help to have the nanny all squared away. I made a contract and I do the taxes myself, which is really not that hard. Don't pay one of those companies to do the taxes, it is really easy and takes me about 10-20 minutes 4x per year to submit the quarterly taxes. This is where you can save your money! I'll make another post about this in the future.

5. If you like to cook, great, you can make meals on weekends and stock them in the freezer. If you are like me and hate cooking, I built this into my nanny's job. She cooks my son a dinner during the week and does light grocery shopping. During the weekends she only works one day and she will make his lunch on that day. I give her a credit card so that she can pick up a few things for our house when she is doing her own shopping at Costco or Trader Joes. In general, she will keep up with all the food items needed for my son's school lunches and for the meals that she provides. She also picks up extra things if she sees that we are running low. Yes, she is an angel!

Okay, I have to get back to work for now but I will be adding subsequent posts with more tips.

Jude Turns 5

This Thursday is Jude's 5th birthday. For his first 3 birthdays we always made a point to do something special and have a family day. For his first birthday we did a balloon release and for his second and third we released enormous Monarch butterflies. Last year, for his 4th birthday, everything was different. I found myself the throws of my first year of medical school without a spouse, without a single person who knew of Jude and without a spare moment to reflect and celebrate his life. My precious Mama had died just two weeks earlier and I was drowning in school work and exams. This year Jude's birthday will fall on the day before an exam so once again I will spend the day with my nose buried in a book, still without my spouse. Friday, after the exam, I will have a revision surgery on my eyes so I'll likely spend the weekend in recovery and trying to keep up with my school work. I'm okay though, I've found ways to celebrate his life when the opportunity presents itself. We took a trip to Hawaii last December when I was on a brief winter break and I drew Jude's name in the sand of every beach we visited. I also took my Mama's ashes and found a particularly beautiful private beach to release her. Then, after my last final exam for in the spring, I spent a solid week mourning and reflecting on both Jude and Mama. That was a surprise because I didn't realize how much I had suppressed my emotions in order to get through my first year of medical school. After my exam I walked to the garage feeling accomplished and happy but just as soon as the car door closed I started sobbing uncontrollably. I think it was a good 5 minutes before I could even turn on the car and begin to make my way home. The entire year, even in Hawaii, I had not let myself grieve these loss. Suddenly was as if a switch had been flipped and I could finally release a year's worth of tears and raw emotions. I ended up spending the entire week off before starting my summer research project cleaning my house, crying and reflecting on Jude and Mama. It was just what I needed.

I suppose this is the way it has to go for now, but I know that it is all temporary. Today I stumbled across something I said on the Love and Light page on 9/11/11. I said, "This experience has taught me so much about love, humankind and how I plan to move forward with my life goals. There isn't a second that goes by that I don't miss my baby terribly, but I can't regret what I am learning and how I am growing as a person. Thank you for sharing this journey with me." Thousands of beautiful souls reached out to me and surrounded me in love during the darkest weeks of my life. I'm eternally grateful I know that, in making these sacrifices now, I am not only honoring my son's life but I am also putting myself in a position to pay forward their love and kindness.