How to study for Medical School pt. 2-- Owning it.

"I was disappointed to see only forty 40 of a class of 175 in lecture today" began one professor's email to the class last semester.  At first I bought his idea-- come to class, take notes; that's THE WAY to do it, right? Hard work, endurance, training to go without sleep, right?

 I did it that way the first block of each semester-- each time with some professor or friend's voice in my head.  Each time I tried, I had less time to study, sleep, and exercise.  I performed adequately, but not at my best, during exams.

What was wrong? I had not taken ownership of the class and of the material, of my learning style, and of all of the options available to me.

Each semester, my best blocks were those in which I attended NO classes physically, but used my time to read the course book and stream lectures online instead.  During these blocks, I was well rested, exercised daily, and cooked my own food.

Taking ownership of the material meant waking up in the morning not because of a class but because of my responsibility.  It meant actively studying in the library with a friend instead of passively sitting in the lecture hall. It meant understanding that rest and cognitive ability were paramount to success.

This was difficult.  It was difficult because the only measure of success is just that; not martyrdom, not suffering-- only mastery.

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.

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.

Medical School Fears

Time- 96 hours= med school start.
in my mind, I am overcome by the what.. if…
My fears diaphanous, dark
elude my grasp

Obfuscate and confuse,
threaten to damp my spark

Let me count and name
drag them screaming one by one

let me pull each into
truth, light, sun.

let me vigorously scrub,
tear apart, burn
each mildewy spore

open my mind to light
dry them out
build once more.

Here they are:
1. I am too stupid (or at least more dumb than my counterparts)
You slimy, insipid beast.  You grow into every dream like yeast.  First puffing me up in my imagined braineosity only to punch me down with worthless imaginings.
The truth is that I am neither savant nor fool.  I cannot be omniscient nor omnipresent, only omnivore.  The truth is that I worked hard enough and performed well enough to come through the filter to here.  This is truth for the majority of my peers.  When I feel worthless and stupid, another will feel the same.  It is only in puffing ourselves up to appear clever that we develop pernicious shame. 
After the realization of my average-ness and the average aptitude of my peers, I am free.  Honesty, truth and forthcoming will be the new beams to replace those rotten by pride and shame-- real stupidity.

2.  I am too old (or have wasted too much time)
You deranged, shallow boar.  Your desire in life is one: more.  Power, money, sex, your altar, your goal.  You tempt me to a life which ignores my very soul.
In fact, however, I have not wasted one year.  Each journey was necessary to bring me from where I began to here.  Others' journeys are different, but in the end I know only one, my own.  Reaching the MD is not life’s only or most ultimate dream.  I wanted to develop what kind of human I would be.  I wanted to journey with others, I wanted to learn about my growth.  I wanted to dwell with the poor and downtrodden, I wanted about myself to know.  So yes, I am 6 years older than my youngest peer.  But what have I gained in the interior?

3. I am not like others.
You are the weakest and most ephemeral of all.  Your lightweight punch can only knock me down after I fall.
No, I am not married with children or buying a house.  No I have not reached the plateau on which my life will peter out.  Instead, I am climbing the mountain which is mine alone.  The face is craggy and steep.  It may require the careful planning of footholds for the path is solid stone.  Others’ fleeting imaginations show only a rough shape:  I cannot judged by it.  Furthermore, I know not another’s path, way, crags  and leaps.  I have never seen it. 

4. Money, sex, and power fears
For retirement, let me save a million dollars in the richest country on earth, circia 1975, so that when I am 100, I can live on the best food and wine.  Zimbabwe.
Let me find a big, strong man, who has a calling and a vision.  I will simply follow him.  My father and mother.
Let me rise to the top, never stopping to learn, to kneel, to change, so that I call all the shots, destroying everything my way.

How can I desire that which I know is the folly of all mankind?  How can I be afraid to lose what my God, out of love, protected me from having?

In money, I will have what I need.  I will pay off my debts.  Better yet, if I am driven to public service, I would allow myself to chose the occupation after all which is best for me.

Regarding relationships, I have learned to value my call.  I believe this is singleness.  Do we all have to be frantically marrying, producing ever more hungry children?  Where is the aunt, where is the carer of orphans, where is the sister, where is the fellow journey woman?  Here am I. 

Power.  For a brief moment, during which I hated the person I watched myself become, I wanted a seat in the world's broiler room.  Never did I feel so empty, lost and untrue.  Never did I feel so strongly that life had become worthless, hollow, lonely.  Never do I desire to be the shell of a human in a suit dressed up to just exterior.  I want to be real, to connect, offer real help, to my fellow man and woman.  Instead of emptiness, humility will give me the power to reach, to connect, because I will know that I am one of them.

In this exercise, I learned a few things:
A. My fears are “all about me”-  They are all about comparing the vulnerable person I know myself to be with the “I’ve got it together” projections of others.  Neither is true.
B. My fears are “all about me”- They are not about others.  Medicine will, at it’s truest, about others.  About providing the best care for them, about doing my best work for them, about connecting with them, about being there during their lives’ most critical moments.  If I allow myself to actually think about the privilege of this connection with others that I am embarking upon, or the incredible things I will be able to do for others, it will bring me back to my original intents.  I did not want to do medicine when all I knew of it was people crazy for money or a system that shut out the poor.  I wanted to practice medicine when I saw the ability Dr. Lythe had to serve his patients, to help them, to repair fistulas, to diagnose a typhoid epidemic.  I wanted the ability my grandpa had to provide care for members of his community facing difficulties from pregnancy and childhood to old age and the end of life.  A physician is the role I wanted to play in community, a way I wanted to serve some of the most basic needs I saw around me.  It is all about the way I interact WITH OTHERS.  In this, some of the non- traditional path physicians I've known have been the most encouraging and affirming to interact with.  Let me strive to be like them.
C. My fears are “all about me”- They ignore totally the aspect of God and His spiritual leading.  I have been on a spiritual journey, one I knew I needed, one I will never leave.  If this love and sacrifice is where He leads me, I can follow.  Multiple times through the years He has orchestrated my path and made it a much more interesting, beautiful journey than I could ever have imagined.  Can I trust Him even now to continue?

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.

Freedom

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.

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.