Wednesday, December 24, 2014

How to Study For Medical School

I had been worried about my biochemistry grade because I picked up a new boyfriend last block and was more than a little distracted from learning about complete human metabolism.  The final biochemistry block on the endocrine system, therefore, was not only experientially relevant, but increasingly critical.  In addition to allowing myself unbridled dark chocolate indulgence while studying biochemistry, I decided to skip class (watch lectures on double speed via internet) and instead to meet with my peers for problem solving and material analysis.  I chose to meet with one friend, Tracy, for a slow, detailed analysis of each chapter then with another friend, Nicole for a quick discussion of key processes twice a week.  Things seemed to go well throughout the month long block.  The last day of class, Tracy wanted to meet and so did Nicole.  I nervously suggested that the three of us join forces Friday at 7pm.  By Wednesday,  I was developing a raging viral infection; I was coughing, hoarse, aching, and tired.  Friday only provided time for my symptoms to escalate.  I arrived with five surgical masks so that I wouldn't spew contaminants all over Nicole's house. 

Nicole had been at a very fun birthday party the previous night and was still "tired". I decided not to bring food because of my germ spewing and communicated this to Nicole, suggesting she eat beforehand.  I thought Tracy indicated she planned to eat beforehand… but forgot to verify. 

Through the evening and into the night; one "tired", one spewing germs, one starving, we busted and laughed and drilled through the most difficult concepts of the biochemistry endocrine module.

At the end, Tracy confessed she hadn't eaten since breakfast and I had sneezed my way through two hospital masks, and wads of tissues…. The endocrine system and the final block of exams, however, stood no chance of deterring us.  I ended up earning the highest grade of my semester on that biochemistry block... and having much more fun than ever before.

Thursday, October 2, 2014

SURPRISE! Medical school is ....... fun!

So, what is medical school like? Hmmm, Medical school is like high school marching band camp.  I was tired and sweaty most of the time and I worked my butt off to improve my skills.  Several times, I found myself on the wrong spot in the football field and Mr. Hogeboom would shout into his loudspeaker "Zoutendam! What are you doing?"
  During the first week, we had several orientation activities.  During one, local physicians took us out to eat in groups.  While waiting for my group to assemble, I became so involved talking to a group adjacent to mine that my physician couldn't find me for a few minutes.  After the first week of orientation, we had a white coat ceremony and were given our stethoscopes and hospital badges. That weekend, I did a reflection exercise at the ER.  A minimalist, I had not purchased an ironing board but needed to iron my white coat.  I tried to save time by not putting a towel down to iron over.  As I started to lift my white coat up from the carpet, it didn't budge.  A harder tug, and streams of carpet glue became visible underneath.  The next hour was spent scraping bits of carpet from my white coat.  At the ER later that evening, an alarm I had forgotten about on my phone began to go off, with Whoopie Golberg singing "Get up off of that thing, and dance till you feel better!"  At least the ER resident laughed instead of yelling into a loudspeaker!
Then we started classes.
 I go to class everyday with 175 extremely bright, professional and motivated classmates.  Each professor, tutor, academic success person, community liason, and clinical instructor works to help us learn as much and as well as possible.  Within about three weeks, we covered what I learned in two years of undergrad science courses.
I am no longer learning alone for myself.  I no longer sit at home at a table in front of a book.  I am learning for many and with many.  I am constantly challenged to increase my knowledge so I contribute to my study group or practice group's performance.  I practice my clinical exam interview questions not for the test in December but because my team mates are very passionate about it and often invite me to practice with them.  I must read ahead of lecture so that my classmate can discuss it with me directly after class. 
Furthermore, the professors have daily office hours, multiple tutors available and academic success professionals.  The system is built for hard work and for success.  I am not working against the grain of a system weeding me out but with a team that helps me to improve in every way.
  When in need of diversion, we are constantly bombarded by extra meetings, specialty interest groups, advocacy organizations and clinical opportunities.  There is even a medical school band (pretty good too!) called the Arrhythmias.
  At the end of high school band camp, I had practiced with many small groups and mastered new choreographed moves.  I had sweat through all my packed clothes and had woken up several times into a bolt upright salute "Yes, Mr. Hogeboom, sir!"  I had also mastered a new octave (trumpet) and forged real friendships with band mates.  After doing my laundry, I found myself waiting for the next year's band camp.  Although I don't think I will long to do medical school again, I can only describe it as intensely fun.  Fun in the fact that I am truly challenged and motivated and stretched and learning.  Fun in the fact that I have great team mates that challenge me to increase my professionalism and dedication.  Fun in the fact that I am exposed to so many new and exciting opportunities.  Even if some days, I am in classes and activities for 10 hours before I can begin to study, as if I am playing trumpet in the rain in a soggy field; there's nothing I'd rather be doing.

Thursday, July 3, 2014

Auntie Sarah to the..... rescue?

On June 26, my second nephew, Aiden River Zoutendam, was born!

On June 23, my brother called me in Sioux Falls, saying, Melissa (my sister in law) is getting uncomfortable, could you come and watch Finley (my 2 year old nephew)?
Sure!  I exclaimed from the garden I was weeding outside my solo apartment, then I studied for my class and slept in peace.

I arrived in Cedar Rapids on the 24th to Melissa ready to go to a doctor's appointment. We couldn't figure out how to get the car seat strapped into my car, so I handed off my keys, tore a screaming Finley from her arms, brought him into the house, and locked the door.  As soon as his feet touched the floor, he unlocked the door and ran out, almost reaching the driveway "Mommy!!" before I caught him.  Securely in my arms, we went inside where, luckily, bubbles were on hand.  Finley saw that he could only blow the bubbles when not screaming, so, eventually bubbles won.  Bubbles and the neighborhood park made us fast friends.

On June 25, we went pre- baby shopping.  In one maternity store, displays of five different reusable diaper systems were on hand.  Melissa, exhausted, was sitting in a chair in a corner, trying to keep Finley from tasting the organic sunscreen.  I began asking David, "So, you know I wanted to get you guys something for the baby, have you thought about reusable diapers?"  "We thought about it, but we didn't have the time and energy to do it" came his reply.  "Could I get you guys a few and see if you like them?" what were they to do... ?  So I happily listened to the sales pitch and figured out what a bare bones starter pack would mean and we got a few.

At 7:30am, June 26, Finley woke up and came downstairs to wake me up as well.  I was still contemplating rolling out of my feather top air mattress at 7:50 when Melissa looked at me and said "My water's breaking, I need to get to the hospital."  That got me moving, and I selfishly got dressed and brushed my teeth before loading up the car and Finley.  After David got to the hospital from work, Finley and I were on our own.  We went straight to the park, making breaks only for bananas and crackers.  The baby came in the evening and we went to see him.  When Finley entered the room, David and Melissa looked at each other and sniffed a bit.  I changed him in the bathroom and tried to clean out his reusable diaper, full of poop, with toilet paper, while he tried to run around the bathroom and smear poop.  At one point a nurse asked if we were ok, and David said, "We're doing reusable diapers."  The nurse's reply was telling "How's that going?" "We just started" silence.

Finley and I had two and a half days to get a better handle on our diapers and on life together before the Aiden, David, and Melissa returned home.  David and I went to Menards to get a sprayer for the reusable diapers so we could spray the poop off into the toilet.... and big gloves for other contingencies....then Monday, David returned to work.  Finley watched his mom hold and feed Aiden with big, wondering eyes.  He kissed the baby but also wanted to get between mom and baby, something he learned wouldn't work.  Several times, his bottom lip projected from his little face as he learned that his mom was paying attention to someone else.  Once we just had to sit together and listen to 15 minutes of toddler jams (yes, sitting down for 15 whole minutes!) because he was so sad.  To his credit, Finley cared about little Aiden quite a bit.  He soon learned that Aiden needed his pacifier and blanket and brought them to him instantly.  He also offered his own favorite sleeping sheep.  One day when Aiden was fussing, Finley stroked his arm and offered "it's ok, kay, it's ok, kay?"  Aiden took the cue and calmed down.  I was watching the painful transformation from an only child to a caring big brother.  I had undergone it when David was born.

The day before I left, Finley and I passed a neighbor's house with several new toys next to their trash on the edge of the lawn.  I stopped and looked.  Several glistening toy trucks (Finley's favorite) tempted me, and I put them in my car.  Under the piles of toys there were four child sized cabinets.   I dropped off Finley and the first load at home, then rushed back for a second, and a third.   The neighbors' door was open, their screen door was shut, behind it, they watched me brazenly dumpster dive.  Later, while washing the toys, I counted 14 trucks, one boat, one marble works set, one car ramp and two battery operated learning toys.  After David came home and I showed him the toys, we laughed about his dumpster diving days in high school.  One summer, he found two sleds and a grill.  He couldn't fit them into his old Buick Skylark, so he tied them behind it with rope.  I guess when Santa Clause comes on trash day in July, you are part of this family.

That night, we watched Frozen together and David and Melissa gave me a thank you card.  They thanked me for my time and help and dumpster diving.  No one mentioned the reusable diapers.

Sunday, June 22, 2014


I missed mass last weekend while hiking at Glacier National Park.  I was privileged to be there with a good friend that I hadn't seen in years.  She told me that, although she has established herself financially, she feels alone in her city.  Lucrative business ventures, new sports cars, costly weekend parties, and exotic vacations seemed to be the passions of her peers and that she, with a broader vision, felt alone.
   When I returned, I went to confession and talked about missing mass as the only Catholic in my hiking group.  The priest said "Christianity is not about rules but about freedom.  We express it by being free from this world's materialistic, power hungry definition of success.  We are free to pursue justice, truth, virtue and beauty."  Later that evening, I went to a party with my friends in Sioux Falls; public school music teachers (in the worst paying state in the union), a primary care physician at a free clinic, a social worker, a few musicians, and the proprietor of the state's lone recording studio.  Each month and each holiday they gather, bringing home preserved jams and salsas, hand made jewelry and cards, and hand sewn aprons as gifts.  Some are athiests, others agnostic, others religious, but, to me, they exemplify this spiritual freedom.  When I think about the great circle of friendship and support which I have found in Sioux Falls, I feel very wealthy-- I think that such relationships are more difficult to cultivate than mere financial means.
  As I begin my new adventure and as I consider which specialty in medicine I will choose and where I will practice, my goal is to remain free.  Free to follow passion and to do what I love despite the lack of power or money involved.  I hope to gain the gift of rich friendships and a meaningful community.

Saturday, June 21, 2014

In the moment

I was walking along the trail, talking with a friend about theories of romance, when a good looking, long haired man began walking toward us and stopped. "Look!"  he exclaimed and pointed.  Sure enough, in the bushes were two black bears.  They were near but not very photogenic.  Later on, a grizzly posed for a better photograph.  My visit to Glacier National Park was a reminder of the beauty possible if I pay attention to my environment-- and of the danger present if I do not.
Recently, I listened to a talk by Ellen Langer on mindfulness.  A professor of psychology at Harvard, she spoke about the rarety and importance of being present in the moment-- not dwelling on either the past or the future.  She also stated that worry is pointless because we have no mental concept of what the future holds, only that we'll bring ourselves and our characters to it.  One of her solutions is to try to continuously notice new things in our everyday environments and the people around us.  We can never fully know our environments and loved ones, instead we must constantly notice their changes and their possibilities in a changing world.  This keeps us oriented to the present and fascinated by the changes happening around us.  It allows us to be satisfied with what we have instead of thinking we only need new or change to stay interested.

During my in-between time, while camping, while helping with a new baby, while taking a class, while preparing for medical school, there is nothing within my control that I can worry about.  Medical school loans, whether I'll be able to cut it. etc., are wastes of time and energy.  This is a time for me to be present.  When I focus on the present, furthermore, I feel as though my mind is open to learn new things instead of running through the old familiar circuitry of anxiety and regret.

Saturday, June 7, 2014


In Luke 18:35-43, (NIV)

A Blind Beggar Receives His Sight

35 As Jesus approached Jericho, a blind man was sitting by the roadside begging. 36 When he heard the crowd going by, he asked what was happening. 37 They told him, “Jesus of Nazareth is passing by.”
38 He called out, “Jesus, Son of David, have mercy on me!”
39 Those who led the way rebuked him and told him to be quiet, but he shouted all the more, “Son of David, have mercy on me!”
40 Jesus stopped and ordered the man to be brought to him. When he came near, Jesus asked him, 41 “What do you want me to do for you?”
“Lord, I want to see,” he replied.
42 Jesus said to him, “Receive your sight; your faith has healed you.” 43 Immediately he received his sight and followed Jesus, praising God. When all the people saw it, they also praised God.

As I say goodbye to good friends and loving relatives, I am struck by the blessing of learning who my friends really were.  As I changed courses and started from the ground up, I thought several times about the blind man's relationship with the crowd in this passage.  Several people in my life seemed part of the noisy but meaningless crowd.  With few hopes for themselves, they cautioned me to mute my dreams.  Before them, my words and my aspirations sounded clamorous, foolish.  
  In the other camp, Jesus told the blind man that his outspoken faith had healed him.  Unrealistic dreams, to Him, were not only good but the only method of solving the problem at hand.  Several people in my life emerged that (much to my surprise) either flat out encouraged and helped me, or made the commitment to love no matter what they thought about my decisions.  It is these people that I have grown to respect enormously.  Strikingly, these are all people who have successfully reached goals and dreams themselves.
  Especially humorous was that, when the man DID receive his sight, the crowd stopped criticizing him and praised God.  The most hilarious group I have seen were those that condemned me with the crowd at first and are now extremely encouraging.  Now I know that these people are good reflections of what I seem to be from afar... not much else.

This leaves me with the question.  In my relationships with other people, which side will I be on?  Will I encourage faith and impossible dreams?  Will I join the crowd in beating people down? In other words, am I healed of blindness to hope and potential?

Wednesday, June 4, 2014

University of Wisconsin

By February, I thought it was all over.  After all, so few applicants are granted acceptance to medical school, and here I had mine.  I had interviewed with the University of Iowa in January but it did not seem, to me, a good fit.  I began looking for future room-mates in Vermillion, South Dakota.  Then an email came from the University of Wisconsin's School of Medicine and Public Health.  I remembered putting almost no time into that school's secondary application because they accepted only 2.5% of out of state applicants--I thought I wouldn't stand a chance.  I had applied, however, because friends of friends had talked about the school being really neat and because it had a unique emphasis on both medicine and public health.  I also had to apply to a few schools in the "top ten" bracket because my surrogate mom insisted, and this was #9 nationally.

When I looked on the accompanying website to find lodging in Madison for my interview weekend, there was a list of hostels, one in a Benedictine monastery (which, sadly, was full) and a hostel international (HI) house.  I booked a bunk in the 6 women dorm at HI.  My car then went to the shop for a "routine" checkup, ended up in major surgery, and I drove a rented car over to Madison.

The first cold night (-40C windchill, warmer than South Dakota's -60C) the medical students invited all interviewees to an informal talk, strictly off the record, to ask about anything we wanted to know.  I noticed that, even though we were all seated around a big table, it was easy to discern who the medical students were and who the applicants were.  Medical students were snacking on the food provided.  Introductions involved each of us saying something unique about ourselves.  At the U. of Iowa, fellow applicants talked about the speed at which they could read, or the extremely expensive sports they played.  I only felt comfortable enough to talk about vegetarian cooking.

At the U. Wisconsin, however, one curly read headed medical student said he had spent a summer in Uganda, and the applicant to my right had grown up in Iraq.  I easily stated that I had done the Peace Corps in Uganda, had grown up in Jordan, and that the three of us should get together to speak different languages, but that I was working on English.  The medical student replied "I think your English is great," to which I was a little confused.

I returned to the hostel that night to find, not five snoring women, but only one dorm mate (I guess -40C is not tourist season).  She was a retired lawyer turned art writer.  We discussed her advocacy work for mentally ill persons in the justice system late into the evening.  The next morning, she reminded me to wake up after I dozed following my alarm.

Interview check began at 7:30 and although I was staying less than five miles away, I left at 6:45.  There were so many people and bikes on the street both morning and evening that a car had a hard time of it.  If it had not been a formal suit interview at -40C, I would have joined the full masked, snow suited mob.  Imagine a city where pedestrians not only outnumber but intimidate vehicle operators? Paradise, perhaps.

When I finally rounded the bottom of the medical school stairs, I saw a big sign "Welcome UWSMPH interviewees" it stated.  "I wonder who those important sounding people are?" I thought, confused by all of the letters.  It took me a while to realize that this was the University of Wisconsin School of Medicine and Public Health, and that sign was for ME.  I glanced up the stairs to see a crowd in suits descending.  Defrocked of heavy winter coats and wearing neat name tags, they looked like an army.  "I am late, I must have misread the schedule (which put check in from 7:30 - 8:00am), I should just drive home!" was my first thought.  I then thought about all the money I spent on the car rental and that it should not be wasted.  I ascended (7:45), prepared to be simply turned away.

When I reached the office, I found that I was within the appropriate time window, and checked in.

I had worn my interview suit, which was purchased with my grandmother as fashion advisor par excellence, two years earlier in Aberdeen, South Dakota, for this very moment.  It was the suit I had worn to my previous interviews, but at the U of Wisconsin, for the first time, I was not the best dressed applicant present.  I merely fit into a very good looking crowd.

Over forty of us, of different ages, backgrounds, and nationalities listened to multiple presentations from deans and professors.  I found that, following each presentation, I had a relevant question or two, and most presenters answered 3-5 questions.  My first question, of course, was "How much of professor promotion and tenure is determined by teaching and mentoring reviews and how much is determined by research publication?"  At the University of Iowa, I was informed that research presented the sole criteria for professorial promotion, but that all the professors were "such good people" that they mentored and taught with excellence as well. hmmmmm.  At Wisconsin, I was told that without good teaching evaluations, professors have lost their positions and been unable to gain promotions.  Other questions were more specifically relevant to the presenters, such as one UW hospitalist who spoke of using her research to inform advocacy for ACA (Affordable Care Act) legislation.  I asked which channels she used to pursue legislative advocacy, and she replied she had a contact in congress.  Another interviewee asked this same presenter to explain, again, what a hospitalist was... I felt bad for him.

As time drew near for our interviews, three of us were ushered toward offices on a different floor.  As I, the last, stepped off the elevator, a man using the wheelchair tried to load but the door began to close on him.  I hung a few paces behind my group trying to hold the door open but it continued to shut.  "This is dangerous!" I exclaimed, and I pushed the "open" button and made sure the man was secure before exiting the elevator.  I found it remarkable that the other two interviewees (one of them a paramedic) had not responded, but chalked it up to my profound ability to walk behind the others in my group.  I guess I had been trained well by my last name : )

I was led to the Global Health Institute office.  Inside, colorful paintings and masks, from different parts of the world, all of which I could identify, donned the walls.  My interviewer discussed the work of the GHI-- developing a national emergency medicine system with the government of Ethiopia and building and training professors for medical schools across sub- Saharan Africa, including Uganda.  We talked about Makerere University and Mbabrara Univerisity's medical school as partners in improving Uganda's medical infrastructure.  He only asked me one question "What will you do in medicine?"  I replied that I did not know which specialty I would choose but that I would bring myself into whichever it was.  I wanted to offer immediate medical problem solving, and to use my experiences in the clinical setting to inform advocacy work relevant to my community.  I told him that women's health was a good candidate but that, given the public policy implications in the US, psychiatry may be promising.  I mentioned the National Health Service Corps, and he replied "You don't want to do that.  Wouldn't you rather be building medical schools in Uganda?"  "That was my retirement plan," I replied.  "That's the problem" he said "we need young people who make this their career."  Ok, yes, I was in a state of bliss.  Yes, it may have been too good to be true, but if not....

Lunch with my fellow interviewees found myself and an environmental science major as the only non-engineers at table.  One biomedical engineer designed prosthetic devices for a living and we began to talk about 3-D printing.  He used it every day, I only knew what I'd heard on NPR.  Another fellow had been a childhood Olympian and had attended MIT.  I didn't even know what to talk with him about.  I munched on my hummus pita (vegetarian option) with a quiet resolve. "Wow, this would have been an amazing place to go if I had made different choices and become an engineer or something" but as it was, I did not see how I could surpass these fellows' resumes.  

After this, I was interviewed in a group of three interviewees by two students.  My interviewers were much like the other medical students I had met at UW that weekend, long droopy green and brown colored sweaters.  Girls with long hair and scarves. Men with slight beards at times. Warm, relaxed, welcoming. Smart but not intimidating, not snobby.  These were the cool kids.  I kind of wanted to just stay and hang out.  I found it interesting that the students had the ability to veto candidates they didn't feel would fit the character of the school.  High bar for me, to be sure. 

The three of us interviewees were first asked to name our college majors.  It sounded like this "Engineering, social work, environmental science."  Wow, did I feel out of place!  We were asked questions such as "If there was no illness or disease, what career would you choose?"  I answered that there would still be disparities and struggles over limited resources, so that I would want to be an advocate for disenfranchised groups-- go social work!  We were then able to ask questions, and I was glad I was in the middle.  My partner on the left asked a question, then I asked two, then my partner on the right, then I two.. then left, then me two... finally the guys on the end were done and I had the questions to myself.  This may have been slightly uncool, but this was my chance!  Here were two medical students to myself with 15 minutes to really dig down to what their lives were like, how they hoped to incorporate community advocacy into their practices, why they wanted to practice medicine, how they studied, etc.  I could not let the chance pass at any cost.  At that point, I felt as though I may not be accepted, but that I could glean valuable information from these students to inform my own medical studies in South Dakota.

That night, I called my grandmother in South Dakota and told her how wonderful the interview and school had been.  I did not ask for it, but she gave me permission--- "Sarah, if you are supposed to go to the University of Wisconsin, don't worry about me and your grandpa, we'll be ok"  I needed that liberating love.  Later, when my hostel roomate came home, she showed me her swollen knee and asked if I could do anything for her.  I looked at my hands and wished they had the knowledge to do something practical, but they did not.  "Maybe you'll lean how in Wisconsin!", was her cheery reply.

I drove home, listening to Barbara Kingslover's "Animal, vegetable, miracle" and planned for how to eat a more environmentally balanced diet next frozen South Dakota winter in Vermillion.

On March 7, I recieved a call from the head of admissions at the University of Wisconsin-- I was offered a position.  I paused.  The woman asked "Hello?"  I replied "Doesn't everyone pause when they get this kind of news?"  "Do you call everyone who is accepted?" I asked." Yes." "Do you have to call the ones who aren't accepted?" "No, I don't have to call them."  "Wow, I don't know if I want to go to medical school, your job sounds like a lot of fun."  We laughed.  Later that day, an email came to me from the University of Iowa.  It directed me to log onto their admissions portal, a decision had been made.  After I entered my identifying number, a prerecorded message and computerized confetti popped up.  I had been accepted. I didn't even watch the message, I declined the offer out of hand.

I -- the little girl in the trailer park who wished I could become as successful and stable as our mail carrier.  I-- the one with the hand me down sweatshirts with names of places I have never been.  I-- who, while visiting the doctor with medicaid as my insurance, said I wanted to become a physician.  I have been accepted into three good (2 of them top) medical schools.  Can I say it? Hallelujah!

My friends and support network in Sioux Falls have lovingly released me and although I really hate to move, I think UW is the best fit for me.  On Wisconsin!