Studying, Taking and Building

I just finished a 20 year career of listening to people talk at me. On Friday, I anticlimactically drew 63 filled-in ovals with a #2 pencil on a green and white piece of paper. If I put them in the right places, then it means that the $15,000 I paid in tuition this quarter, worked (actually, it was the government who paid, and the government who will make darn sure I pay it back). I have 2 short years left of working in the hospital, and then people will have to call me “doctor” and I get to write “MD” after my name (which will work out to more than $100,000 per letter).

How do I feel? Well, if you know me long enough, you’ll know that I don’t feel very much of anything emotionally. But if I feel anything, it is relief. Saturday night, I drove south from Stanford with all of my earthly possessions packed into my Toyota Prius with not a care in the world; the super moon rose over the desert landscape somewhere near Bakersfield (and I caught it!). I was on no schedule (and firmly intend to keep it that way for at least a week).

I enjoy classrooms, but I really enjoy doing things. And now I am one step closer to doing stuff. It’s rather exciting. But in the back of my mind, there a voice nags me, “Why weren’t you content in the classroom? Have you no patience?”

I told someone once that I wasn’t a patient person. In the Biblical sense (translated longsuffering), I think patience is a virtue I possess to some degree. I can endure unpleasant things (like years of stasis in classrooms). But I am not ‘patient’ as it may be used in common speech: I am not content with inaction; I am not content with stasis. Perhaps it is by my arrogance that I can look at the privilege of studying as stasis. But thus it is in my mind.

I am in my element when I am building, be it an idea, a machine or an organization. Up to now, building has been relegated to the periphery by my ‘real job’ in the classroom. And this has always frustrated me. It felt like, for the past two decades, I have done nothing but take. I’ve piled up for myself more and more knowledge, swelling my head to the point of bursting (as some of you have noticed on this blog). I understand that it may be necessary; but now, if I am to be a person who gives, I must break a lifelong career and habit of taking.

But I hope I can break it. I hope that as my life progresses, I will be able to give more. I hope that I can give in the way that I love: through building.

Professional Development

I sat on a panel today for premeds for the first time. They asked questions about (see if you can guess) getting into medical school. Would it look bad if I ____? Would doing ____ help me get in?

After about an hour, I got frustrated. They had become slaves; they were living their lives for admissions committees. Every decision they made was made with a committee's opinion in mind. In considering a volunteer opportunity at a hospital, the only end for one of the students was medical school. No thought was put into the impact he could make or the virtue in humble service. The decision was entirely based on how it would look. Eventually my frustration boiled over and I said to them, "Who cares if you get into medical school? Do what is right and what is good. If you get into medical school, great."

I strive to live by my own words, to do things for the goodness of them rather than how it would make me look. But I am a fallen man. I have not consistently maintained this attitude. But I recognize it as sin. I don't think these students see their attitude towards medical school as a problem. And that is frightening.

Though their end is a theoretical good ("Helping people"), it seems that it is achieved by four years of disregard for goodness, efficacy and excellence. Though the best applicants are those who do pursue goodness (it has been my experience that Stanford, being incredibly selective, includes mostly this sort of student), many (perhaps most) who go to medical school are those who were best able to please admissions committees. And these are the men and women who become doctors. Are we surprised that doctors, when they become doctors, are not passionate about the good, are not ruthlessly efficient and cost-controlling, and are not always role models of excellent human beings? Perhaps our selection process is filtering out those who would are Good in favor of those who are good at pleasing others.

Why are so many striving for this end? I think a part of it is power. Doctors command a power and a respect in our society that is rivaled by few. Those who care about 'medical service' rarely even consider DO school (which arguably give better clinical training), because we'd only get DO behind our name and not the coveted MD. MD's have more power than DO's. And Harvard MD's have more social power than UCLA MD's. Even I am guilty of desiring this power. You might ask, "But isn't it power for a good end?" It is. At least at first. The trick is keeping one's focus on the Good; good intentions can quickly devolve. Even if the start is noble, the Good can get lost in the pursuit of power.

There is a great danger in living one's life to please men. This is a warning I need to remember myself. Though my career is a valid consideration, the Good is ever what I ought to strive for. Too often I do not think, "What is the best thing I can do here? What is Right?" and instead think, "How do I make myself look good to those who will evaluate me?" My decisions are too often made with respect to the opinions of others disregarding God. Too often I fear man rather than God. And then I euphemize my sin and call it, "Professional Development."

Pro 29:25

The fear of man bringeth a snare: but whoso putteth his trust in the LORD shall be safe.

Bone of my bones

[Rated R – Don’t read this while eating or if you have a weak stomach or if you’re a girl (in the middle-school sense of the word :)]

Today I sawed open a man’s head. First I had to scalp him, scraping the skin and muscle from his head pulling with my gloved fingers on one hand and cutting the tissue beneath with a scalpel wielded by my other. And then I had to saw open his head. I turned on the Stryker saw, a foot-long white handle and motor connected to a steel semi-circular toothed blade. I flipped the switch, and a high-pitched whir come from the motor as it drove the blade, rotating it an eighth inch back and forth in a blur.

I held the saw with both hands, held it perpendicular to the forehead, and the pressed it to the bone. The high pitch whirring lowered its pitch. Bone like sawdust shot from side to side by the now-invisible movement of the blade. The pitch lowered still and the saw labored; the blade was buried a quarter inch in the bone. The bone dust continued to flow out of the hole, and then above it rose white smoke. And I smelled it.

In four months of anatomy, I’ve smelled a lot of strange things. But this smell has haunted me all day. I have smelled burning flesh before and it turns the stomach. But burning bone turned my soul. It didn’t make my lip curl as the smell of flesh does, but it did make my soul writhe.

Inch by inch, I cut a circle around from forehead to back. Then I cut that dome in two pieces to more easily remove it from the brain it was stuck to. After prying off these two pieces of skull, I exposed the brain. Covered in blood vessels and pinky-purple, it was an incredible thing to behold. It showed evidence of my sloppiness, a few cuts where the saw slipped from the bone and cut a gash into the tender tissue below. It was to be expected in such a violent dissection.

I cut off another piece from the back of the skull to the brainstem and finally I turned off the saw. I looked at my clothes; I was covered in a white powder that used to be skull. Having finished this cut, my lab partner cut the brainstem, and handed me the three-pound piece of meat which once housed a man.

It should have been traumatic, but it wasn’t. A well adjusted person should not be able to do what I just did without having his stomach turn. I turned off my emotions as an unwanted accessory and did what I was supposed to. But the smell has lingered, outliving the image of the bone and brain-splattered table which I was able to leave behind in the anatomy lab. The smell followed me today. After class. At dinner. While reading. Even now.

I wonder if there is something in the bone beyond marrow. I wonder if there is a special holiness to a man’s bones. Have I somehow defiled something holy?

All quiet on the western front

So I'm done with finals. Ask me about Topoisomerase II, or Nucleotide Excision Repair (from Molecular Biology) and Wnt Signaling (from Cells to Tissues) and I'll talk your ear off. Whew. That is right, four weeks in and done with a first set of finals and none in sight (that is, for 8 weeks).

A bit of celebration followed what was very high-stress for most. I joined in the imbibery with a plastic cup of champagne the second year class had poured outside of our final, and then decided to celebrate the rest of the weekend dry. Needless to say, I was in the minority. So the Friday and Saturday night (in SF) could be accurately described as being "off the hook" (I would really like to know the origin of that metaphor).

Life here has been wonderful. I really love it. The people here are incredible. I've gotten to be great friends with a handful, have about 20 friends (people I hang out with regularly) and am on relatively good terms with all the others.

Stanford has remained gorgeous. I took these on a walk by "The Dish," a trail right on campus.

Spiritually speaking, I've found a great church (ALCF) and a Bible study/small group. I'm seeing things in myself that are spiritually inadequate and weak, and beginning to strengthen them. I am even seeing some of the seeds I planted begin to sprout. Praise the Lord!

Things couldn't be much better!

And another one bites the dust...

Weeks. The title is talking about weeks (and an incredible Queen song).

So it's Friday night, half past midnight, and I'm done with another week. I'm sure you're wondering how I feel. Regardless of the presence or absence of wonders, I will tell you. To sum it up, good. Spiritually, emotionally, socially, and even academically, good.

I did a lot this week. For one, [warning, for those with weak stomachs, skip this section] I held a human heart in my (gloved) hand, and was able to find the Left and Right Cardiac Arteries. I learned all about DNA transcription, repair and proofreading (which is pretty freakin' cool, if you ask me). I also learned how to give PPDs and draw blood (I suck at both, but I know how to).

As far as work is concerned, there is a lot to do. I have online quizzes on Histology and Molecular Biology due by Sunday. There are probably 100 pages of Cells to Tissues to understand and a denser 30 pages of Molecular Biology. And I've got a scientific paper to read on Telomerase. But that's all I have to do, and I'm not being sarcastic.

I don't have a million other obligations taking up time. I can no longer spend Saturdays in Mexico, so I'll probably spend it studying. I'm still of the opinion that I won't study on Sunday to rest one day of the week (God said it was a good idea, right? ...We'll see how long my integrity lasts). I played Ultimate footba-occer today (and now am sore and ache... I must be getting old) this afternoon. I'm probably going to a party tomorrow night. What else have I to do in the remaining 16 hours per day but study? I try not to study alone, so it's a discussion on the stuff. When I'm thinking in a group, it's almost fun. Especially when I get to study with people I like (which, of course, is everyone :). Sometimes I study with people I don't really know (even though I know most of the 86 by name). It's sort of like a perpetual finals week. It's quite enjoyable.

Some people are really stressing. From what the second years have said and even the professors, it shouldn't be that hard to pass. There is a lot of information, but worrying about it never helped anyone except in getting them to work; it's the work that counts, not the worry. I guess I could cut out a few more hours of fun and replace them with study. But I don't think that would be prudent. As for the stressing, I learned a while ago (namely April of 2005... while preparing for the MCAT) that this whole thing is in God's hands and will work out for my best (whether that's passing or not, Romans 8:28); I need only to do my best. So far my best + God's will has led to Stanford, so there's no reason to change course now. Stress, at least in the academic realm, wasn't necessary and, I don't believe, will be. Again, we'll see how long my integrity lasts.

Week One Done

So I am now officially through one week (and almost one weekend of medical school). The second day of class was much the same as the first: lots of information but useful information.

There came a point today for the first time (and I don't expect it to be the last) where I was trying with all my might to focus, but the information was coming so fast, I could not even follow what was being said. I've zoned out before, but that's just my being lazy. I think this is the first time my brain reached it theoretical limit. The rain came down, the reservoir filled, and then the water poured right over the dam. Let's hope its a concrete dam.

I had a spectacular day going to church, having a great lunch with friends, and then enjoying some good, quality time with God in a beautiful, secluded oak grove very near the center of campus. Here is what I had to deal with today (left). And here is who I spent the time with (right; I took the photo today at the Stanford Church). Can Sunday get any better?

Much less inspiring, but much more funny was what happened in Histology on Friday. We had our first Histology class (looking at slides of cells). We had an hour of lecture with example cells, describing what to look for. Then we got our microscopes and tried to find the cells on our slides that they described.

I thought, "Great! This looks really easy! I'm pretty good at identifying shapes! Gee Golly Gosh!" And I looked at my first slide. I had used a microscope pretty extensively in my old lab, so the controls were very familiar. I saw other struggling with their microscopes. "Amateurs," I thought. "I'll condescend to their level and help out the poor devils with the focus. So sad..." I helped out as I could with loading the slide, and focusing on the cells. Child's play. Then I sat down at my microscope, loaded the slide, then quickly and efficiently moved down to the appropriate zoom. And I didn't recognize a single cell.

My heart raced. I began scanning violently around the slide. "Where in the **** are the Neutrophils?! ****! For that matter, where the **** are the Erythrocytes. I can't even find the ****ing Erythrocytes!!" Thus was my thinking (**** represents, 'world', 'shucks' 'heck', and 'bi-concaving', respectively).

I turned to my neighbor (who seemed to actually know what the **** was going on) and asked if I could look at her slide and she could point something out to me. And from thence came my deliverance. It was a different slide. I could clearly see Erythrocytes, Neutrophils and even an Eosionophil on her slide (peripheral blood smear looks like left) . I talked to the TA and got my own slide. I waxed prideful again, able to easily identify every cell type on the peripheral blood smear. I confidently moved onto the bone marrow slide.

"****," I thought. "They all look exactly the same. Probably another mislabel." I checked again with my neighbor. "****," I thought again, "It's just like mine." I went back and tried harder to look for differences. There were no differences! They were all purple dots that looked exactly the same. And I was supposed to tell the difference between promyelocytes, early myelocytes, late neutrophilic myelocytes, and metamyelocytes, and I couldn't even tell the difference between a myocyte and an erythroblast!

I looked for help. The TAs were occupied. Some people were packing up. Finished! And I just started my second slide! "Oh no! I had expected to be the dumb one. And it begins now, on day two!" I bemoaned to myself.

One of the TAs had projected his slide onto a TV screen and began describing the differences. And he did a darned good job. I then was able to see the subtle differences and remembered them fairly well. And by the end of that hour I got pretty good at blood histology, and actually (but just a little) started to like it.

P.S. The photo is from Wiki public domain, so don't worry course administrators, I haven't posted course materials

Day One

Wow!

Last night I struggled with insomnia. It took me 90 seconds rather than the usual 30 to fall asleep. Needless to say, I was anxious about my first day of class.

I got up before my alarm, which is usually the start to a good day. I made a sandwich and packed my lunch, pretending like I'm going to have time to do that this year. A tasty roast beef sandwich with fresh tomatoes, onions and lettuce, topped with mild cheddar, olive oil, vinegar, sea salt, and freshly ground pepper. Mmmmmm. It took me 1/2 an hour that I didn't have to make my lunch. I'll be quicker tomorrow.

Off to class!

I got out the door at about 8:30 for a 9:00 class. Another beautiful bike ride across a beautiful campus with beautiful weather (forebodingly warm at a quarter to nine) put me in an even better mood. I sat down next to two amazingly cool people in the front row of my first class ever at Medical school and got ready to start. The lecturer came in and started talking about the history of molecular biology. What surprised me was 1) he was a good speaker, 2) he actually wanted us to learn 3) he was funny 4) we talked about how prions are basically exactly the same as the Borg in Star Trek, a point we expanded for about 10 minutes. So I was sold on my Molecular Bio professor.

After two incredibly interesting hours of class, we went on to a Cells to Tissues class. The lecturer here started at about 25% the speed of light and never slowed down. This class was also very interesting. We talked about cells and stem cells (normal ones in adults) and how powerful they are. I am continually blown away (and expect this will not end) by how incredibly well designed the human body is. One reason why stem cells stay so rare is to minimize copying errors; they only grow when they need to, and they stay as close to the target tissue as they can. And the balance is also incredible. If intestinal tissue grew only 5% faster than it should, after one year of growth, it would increase its size by 10 times. Cancer is a small imbalance (~1%) of too much growth (or too little death). It's amazing that we don't always have cancer everywhere.

I ran over to the Financial Aid office to ask for money on my lunch break, but got back with plenty of time to eat my delicious delicious sandwich and chat some more (it happened to be about water infrastructure... oops).

The post-lunch lecture was Anatomy. This class I was a bit concerned with as I have never taken an anatomy class. The good thing about the class is that both the professors are Brits, which makes for endless entertainment and makes them seem inconceivably smart. We learned about the chest cavity. We had about an hour lecture on it before we headed off to the Anatomy Lab... dun dun dun.

Before we got to meet our cadavers, we had to change into our scrubs. It was like high school gym all over again. 40 guys in a locker room stripping and putting on funny blue clothes brought back memories.

We entered the Anatomy Lab and found our table. There were two sections of the room with twelve tables each. On the table was a blue fake leather bag with a big black zipper on it, each with the shape of the body visible by the folds in the bag. We walked over to the table, received instructions, observed a moment of silence for the donors, and unzipped the bags.

The cadavers were covered with a damp sheet, with an additional cloth over the hands and the face. The skin didn't seem real; it was too plastic-ey and pale. I took the plunge and made the first incision for my group along the clavicle. At first, it seemed unusual, but not as eerie as it should have been. We took off the layer of skin and fascia to reveal the pectoralis major.

To get to the serratus anterior, we needed to move the arms out to the sides. We took off the cloths and moved it out. This is when it started to feel like a body, once we could see the hands. Also noticing the armpit hair and other things which I didn't expect reminded us that it was actually a human we were working on. Even then, it was only a passing thought; the really interesting part was the intercostal muscles and the corticoid process and the other parts of the anatomy, not as much as I would have expected, the emotional side of the body.

We completed the dissection and washed up. We went back to the locker room and changed back into normal clothing. It was 5pm. We had class 9-5. And we will have class 9-5. We are all really tired and it's only the first day. I expect we will learn to strive at this pace, but we have not learned that yet.

That being said, medical school doesn't seem to be that hard. There was nothing today which I had trouble learning. The only challenge is keeping this up. Can I learn that much every day for two years? Medical school is a marathon, and one we have all been training for. If I can maintain this pace, I'll pass with flying colors (not that my colors will fly any more than the next man with a Pass/Fail grading system). I do not have significant fears that I will grow weary, but this, I suppose, is a great risk.

The second, and more likely, is distraction. There are about a billion opportunities for doing great things here. I just cannot get too distracted from class. Nothing seems to be immediately threatening, but those would be the two predicted 'modes of failure' (as Civil Engineers say), so should be protected against or reinforced.

P.S. I still smell like formaldehyde.

The Exodus

I've just written about what I like about Stanford. Now comes the previously untold story of how I got here. "Here" being after Day 1 of Orientation. And not "How" like in a philosophical or historical sense, just how I drove up the 5 and stuff like that.

Moving
I drove up to Stanford a week ago Monday. For whatever reason (but probably because I hate doing paperwork and usually protest by doing it poorly), I did not get have any information on things like where I was living and where to meet for the get-to-know-the-class camping trip called SWEAT, (Some Weird and Eccentric Acronym-Thing). I thought it was Tuesday, but that was the end of my knowledge. I had learned by this point that my phone, which was a very nice PDA, did not do phone-things like receive calls ever and made them only when it felt like it. It was under these circumstances that I drove a Prius up to Stanford loaded with all of my earthly belongings. 15N->210W->5N = 7 hours.

The drive was mostly nice. I like Kettleman city, but decided to stop at Bakersfield instead because I was too hungry. After a half-hour of clogging my arteries, I continued on. It took me about 7 hours to reach Sacramento, where I would stay on Monday night with my buddy at Davis Med. We met up, and he pretended to study while we talked. I crashed at his place.

The next morning I left early and headed for Stanford. I didn't have a map of Stanford, but I did have one of California, so I followed signs into campus. Once there, I tried to find the housing office. Not knowing anything about Stanford, I was unsuccessful. I had found a single phone number online for the housing department, so I called that. After 4 attempts of failed transfers and leaving messages, I was finally connected to someone who knew where it was. I drove right there, told them my name, showed ID, and was given a key. Simple as that.

Having figured out my housing, I decided to call Josh, the guy who was leading the camping trip (and ironically enough, the guy who used to tell me to wash dishes at UCLA), and he told me where to be the next morning. I then moved all my stuff up to my room (6th floor).

The way my roommate wanted to partition the room, I've basically got a studio to myself (instead of a shared bedroom + living room), which is fine by me. I've got a great view of the campus from my window, and privacy. Not that I really understand privacy, having had at least one person sharing my room since college began (in one case, 3 others shared my room). I kinda like it, though I can see the potential for greed in having MY space (which should always expand and never be infringed upon); I've never really had the luxury, but am certainly enjoying it (hopefully with minimal greed).

Camping
The next day we left for SWEAT. I was driving for one of the car-camping groups. Just to save my precious reputation, I wanted to go with the hard-core backpackers, but for the aforementioned loathing of paperwork and procedure, didn't sign up early enough.

Our leader was a second year, and he guided us with his fancy phone GPS. We tried to meet another group of people in Stockton for lunch, one of the girls told us they drove south from where we were. It turned out that by "south" she really meant "north," but with corroboration by the GPS, we headed south. Once we were clearly outside of any recognizable city in "French Camp," I got off the freeway and turned around amidst cries of, "It's a GPS, it can't be wrong!" It turned out that it was. We ended up finding them and getting some really good Mexican food in a sketchy part of Stockton.

We arrived and the lounging began. The three days were filled with mostly eating and waiting to eat again. We did typical camp stuff (day hikes and swimming) the first day. When it came time to build a fire, nobody knew anything about fires (except me, of course, being an Eagle Scout). Not that I was particularly good at building fires, but, being the only backpacker, my paltry knowledge was sufficient to bedazzle the poor group of campers. The concept of tinder->kindling->fuel was black magic to those who looked on in awe of my powers to control the flames. So thus I established myself as the great and wise woodsman. You know what they say: "In the land of the blind, the one-eyed man is king." [As a side note, it was pointed out to me that the saying would be more accurate if it went "In the land of the blind, the one-eyed man is stoned to death," thought the traditional story was what applied to me.]

The second day we decided to go for another day hike. A group of us decided to extend the day hike into a long day hike. One girl said she wanted to do it, I said I'd go to, and before we knew it, another four people had peer-pressured each other into going. Fortunately at that point, nobody knew that it was probably 4 miles each way or else they would never have attempted it. So a group of green campers embarked on a journey that very well could have killed them. Fortunately, they all survived and with minimal griping, so little in fact that no violence was done even to the most whiney among us. Everyone was proud of themselves upon completing the journey.

The last day we did a skit. Being the car camping group, we had procrastinated our task of coming up with a skit until the last minute. We discovered that it was not the last minute, because other groups actually started after we did. In the end, we came up with a very funny skit mocking our own laziness. The other groups ranged from obscene to confused. After a little bit more socializing, we drove back home that night.

Pre-Orientation
The weekend following SWEAT, I kept busy. I did a lot of sleeping in, a bit of shopping and lots of eating. I got a bike from Target so that I could be like everyone else. Normally a statement like that is hyperbole, but I'm pretty sure every one of us will own a bike by the end of this week. So I had to fit in. So I went to Target with two friends and we bought two bikes. We successfully fit two bikes and three people inside my Prius. That's right. It's a hybrid.

On Sunday I went with seven others to attend Abundant Life Christian Fellowship nearby. It was amazing! It looked like it used to be a Black Southern Baptist Church; it had a Gospel Choir, very upbeat music, and good, loud singing. The preacher was black, so the traditional white conservation of energy on the podium was not visible. There was no lack of power in the message, and more importantly, it was Biblically based. I'm going to try out some other churches, but I doubt I'll find anything better.

Orientation
Orientation started today, and it was pretty, pretty, pretty good. We had a very inspirational speech by our Dean, an entertaining speech by our Associate Dean, and then a very interesting talk by an author/faculty member whose book I was supposed to have gotten and read. Neither had happened, the latter on account of the former, but the talk was very interesting nonetheless. We were supposed to have a 24-student discussion on ethics and balancing life with medicine which was quickly turned into a 6 student + 6 professor discussion.

In between all this were lots of breaks where I got to meet more and more of my class, who, as I previously described, are amazing.

Next Step
School starts officially on Thursday, and before then I've got a two-page of administrative things that I'm supposed to do. They're the kinds of things that nobody really wants to do, but are indicative of the developed world. Things like online registration and financial planning. I really like flying by the seat of my pants and am rather annoyed at having to use instruments.

I've got another two-day grace period of orientation, and Mom's coming on Wednesday, so I've got lots to distract me from the elephant in the room (the hardest class of my life starting full-force on Thursday). It's a pretty angry elephant, and I think addressing it further would only upset it, so until Thursday I plan to ignore it.

"Take no thought for the morrow: for the morrow shall take thought for the things of itself. Sufficient for the day is the evil thereof." - Matthew 6:34

Why Stanford Rocks

So I'm at medical school now, for those of you who don't know at Stanford. The last week has been something of a blur, the experiences smearing into each one another like colors on film. I don't exactly know how to sum it up, but I'll say this: I am certainly happy here and with my choice. And here are some of the reasons in no particular order:

Exciting thing A - Outstanding Class
My classmates are outstanding, I'm honored to have the chance to work with them. My choice to come here because of them was truly justified. The Dean spoke today about how Stanford doesn't just want to train excellent physicians, it wants to train leaders. The 86 of us all have that spark. We're all normal enough to hold a conversation. We're all brilliant in at least one area (most of us in several). We've all done something amazing, mostly post graduation. Some have PhDs and Masters, some are Fulbright scholars, some have started NGOs, some have published extensively. Everyone has done something amazing.

Exciting thing B - Christian Community
There are actually a good number of strong Christians here. I'm going to be able to go through this with people who share my convictions, and people with whom I can pray and grow spiritually. As supportive as church groups can be, having this core of people who will share life with me for the next two years at least will be very important.

Exciting thing C - Global Health Interest
Everybody wants in on Global Health. Though there is only a minority of people who actually have done work abroad, it seems that there is broad interest, even among the basic science people (lab rats), to help out globally. We have done some pretty spectacular things separately, and we really want to work together. We're at the beginning stages of a potentially large, collaborative project.

Other Exciting Things
The weather has not ceased to be spectacular.

The faculty has not lost their gravity of presence; when they speak, especially our Dean, they speak with authority. They are not pompous, but are such strong personalities that they command attention.

There have been several groups that I've been the only American-born person in the group. The national diversity is spectacular (though we are lacking in under-represented minorities).

We have an army of people working for us to make our life easy and our learning successful.

The food around Stanford is amazing. Thai, Chinese (dim sun), and Indian were all eaten in the past few days, most of these being ordered from the place by a person who spoke the relevant language.

Interview and a bonus!

Yale Interview
So I had an interview at Yale last Friday. It went well besides the fact that it got to 6 degrees. I think that is the coldest air I've ever felt. Besides that, the Yale experience was great and I had my most interesting interview yet. Usually interviewers ask you about why you want to go to medical school, questions about your application, etc. They want to see if you're the same in person as on paper.
My interviewer seemed convinced of all that before I even walked in. He was somewhat portly and sat comfortably back in his office chair. He had a South African accent and had a jovial demeanor. We talked comfortably and he laughed with great belly-laughter at quips and jokes I'd make. The first part of the conversation was rather high-level discussion on international work and the philosophy thereof. I discovered he was a classmate of Paul Farmer at Harvard, so was well familiar with his work.

He had done his research on me. In addition to reading through my application (which seemed rare for interviewers), he actually searched for the articles I wrote to the Daily Bruin and then read them. I had gathered by this point that he had atheistic leanings, and when he told me that he had read my articles, I had a pang of fear. Then he asked me how I reconciled science and faith.

I was off-guard for this question at first, but talked through it until I was speaking coherently. As I described my views, he was tracking and had even read a book that I had. I then started asking him questions. I asked if he was a particularly religious man. He said no, but had an interest nevertheless for his children's sake. He commented weakly that he personally wished he could be like I was, that is, with the two reconciled. I asked where specifically he thought there was conflict. He stopped and thought for a long time. He finally said that it was religious people who caused him not to believe. I told him that you ought not judge a faith by its parishioners any more than you judge a scientific theory by the behavior of scientists; he ought to look at the teachings of Jesus to know what Christianity truly was.

The conversation moved on to other things, but at the end of the interview, he thanked me with genuine sincerity for my opinions.

I walked out of the interview and said a prayer of thanks. God sent me all the way to New Haven, put me before an important doctor, and then had me defend the faith and share the beautiful consistency of Christianity to a man otherwise isolated from Christians. I never expected I'd be "...being brought before kings and rulers for my name's sake" while interviewing (Luke 21:12). What an opportunity! Praise God!


P.S. - G.K. Chesterton
I'm very disappointed I hadn't heard of him earlier. It would have so greatly reduced the severity with which I have in the past banged my head against the wall. He is a magician, with his prose releasing us from the chains of super-rationalism, and sprinkles us with fairy dust, allowing us to ascend into the heavens (I think I sub-consciously ripped that off one of his reviewers).

But for the moment it is possible in the same solely practical manner to give a general answer touching what in actual human history keeps men sane. Mysticism keeps men sane. As long as you have mystery you have health; when you destroy mystery you create morbidity. The ordinary man has always been sane because the ordinary man has always been a mystic. He has permitted the twilight. He has always had one foot in earth and the other in fairyland. He has always left himself free to doubt his gods; but (unlike the agnostic of to-day) free also to believe in them. He has always cared more for truth than for consistency. If he saw two truths that seemed to contradict each other, he would take the two truths and the contradiction along with them. His spiritual sight is stereoscopic, like his physical sight: he sees two different pictures at once and yet sees all the better for that.

Incredible! That was from Orthodoxy, which I'm halfway through.


P.P.S. - Love
I was over at Andy's in Orange and I saw this cartoon. It reminded me of a previous blog I wrote about women. It came from a webcomic called xkcd.com .

Medical School... Thus far

I fully intend to write about cows after the comment on my previous post, but need to make sure, for practical reasons, I write this first.

So I interviewed at Yale and UC Irvine on Friday and Monday and here are my thoughts on the two schools and some in general.

Yale
Firstly, the campus is gorgeous. The faculty seems extremely supportive of the students, with a large amount of involvement in the programs. The anatomy and the facilities looked really good (negative airflow under the cadavers, new covers, lecture halls were cool). The thing that stood out was the level of maturity they treated the students. The Yale System essentially means their students are free to study as they like. All the lectures are recorded and posted online. They don't have exams (or they have 2 exams per semester and one is optional; the other you take online independently from wherever you like). If you don't get enough points on the one exam, you talk to the professor about why and take it again. The grading is directly pass/no pass for the first two years, and the students say it make for a very collaborative environment.

The students seem brilliant. They were really impressive. Student research is incredible. They've required their students do research since forever ago. They have a wide variety of research projects in a wide variety of fields (including international health, work with TB, etc.).

They have a really international focus, with many students choosing to go abroad over the summer. They have grants that can be applied to that pay for everything. They even said that sometime international medicine and techniques from other countries are taught. 20% of the class are international students. The doctors there do lots of work abroad; the chair of the OB/GYN department goes to Jamaica annually to run a week of a birthing clinic. The guy who interviewed me knew Paul Farmer from college.

By way of service, there are student run clinics and a poor community that the students do reach out to in New Haven. Also, many of the people I talked to before the interview were very interested in service. One of them came from Africa to Yale. Another was a Christian who had done intense medical missions throughout her college career.

The food looked amazing. They had mini roach coaches with every kind of food you could imagine (tacos, asian soups, pastrami). Also, you could eat in any of the 46 dining halls on campus.

New Haven was very cold. I know I'll be inside almost all of my life, but still.

US News put Yale's research at 10th, their primary care unranked, their business school at 14, but with nonprofits, #1.

UCI
The thing that seems to make UCI unique is community. This kept coming up again and again. They spend time together, they party together, they play sports together. They really seem to get along and trust each other. Especially within PRIME, the classes are only 12 people, but they really bond on a 5-week trip to Mexico. The student body seemed very laid back. They were stressed about their test, but even still, half a dozen came out to have dinner with applicants the night before.

The PRIME-LC program really impressed me. They actually work with Paul Farmer's PIH in Chiapas. Their leader, Dr. Vega has a very exciting vision and the leadership of the organization that makes it a reality. He is a man I would like to follow.

Community service seems to be a big thing at Irvine. The students have just pushed to open their free clinic; it will be less than a year old when I start. They have a chapter of Flying Samaritans who work in Mexico, and LMSA which does counseling for high schoolers. The students have worked in the Palestine studying the impact of the conflict on the health of the refugees, in Chiapas studying promotor model, and in Chiapas deploying better stoves (for indoor air pollution). They do seem to have a very international focus.

I'm starting not to see differences in the medical schools themselves. They have pass, no pass, honors grading but say its not competitive. They claim they are more laid back than other medical schools, and have competitive IM sports, so it seems enough time to practice to win Basketball. They seem very social and have the time to be thus. They are also very politically active in supporting universal healthcare and "equality" (more Mexicans) in medical education.

The quality of applicants were rather lower than at Yale (not surprisingly). The kinds of schools that people went to, the things that they had accomplished were much less. Nevertheless, they were much more conversational than the Yale applicants. Perhaps because the faculty was better at encouraging it.

The facilities seem to be older. The only new one is a new simulation center that has three dummies to poke and prod. The faculty (besides PRIME) did not seem especially supportive. The administration is amazingly flexible like in other medical schools. The school has a mediocre external reputation (50 in research, 41 in primary care, 53 in business).

Summary
Last night, I was high on UCI. Today, after going over my notes about Yale, I think that would be my choice if I had to decide right now. I was talking with a friend and realized that the service work in Medical school is only a shadow. I should get as well equipped as I can through medical school; the purpose is training. Service is an element, but I'll be doing plenty of service the next 50 years of my life. I can stand to be better trained. The connections I'd make in PRIME-LC would be better if I knew I'd be working in Latino health care in California. I do not know that. It's certainly a possibility, but it is less than likely. Yale's connections would be more general. They have a higher percentage of students who have done community service, and those doctors will have far more power in the world than UCI's will, both at home and abroad.

UCSF was quite underwhelming to be honest. Nobody I met really cared about service. Everyone was doing research. They were happy, had no grades and had a great education like everyone else. Their students were smart, but the applicants were the most asleep that I've yet seen. I was not impressed by UCSF.

Vanderbilt deserves another look. I had nothing to compare to when I went there. Their faculty have a huge commitment to serving abroad (I'm still on the email list). Their rankings are good (top 20 in research), with a very high number of students with experience abroad. The applicants were awake and the students were happy. Maybe I'm favoring Yale simply because it is fresher in my mind; Vanderbilt seems better regarding international service, though lacking in rankings and business school.

I think Yale's strength of students/applicants, international work, and rankings make it a better choice than any other medical school I've been to. UCI is more exciting because it'd be easier, closer to home and more able to work in Mexico, but frankly would not equip me as well as the others. UCSF was asleep. I should go back over my notes on Vanderbilt, but right now feel Yale is better.

The leader board:
1. Yale
2. UCI
3. Vanderbilt
4. UCSF

Vanderbilt

I interviewed at Vanderbilt in Tennessee on Monday and I loved it. Pretty much everything about it was amazing. Here are the best things about Vanderbilt.

1. The students are happy. They are really happy. According the surveys, they are the happiest med students in the country. They have parties, they know each other and they even go line dancing together.

2. Extremely flexible program. Vanderbilt has this emphasis program that allows you to study what you want. I would probably look into Global Health or maybe healthcare administration (they have the #1 business school in this field).

3. Location. The South is amazing. Grits are amazing. Sweet potato pancakes are amazing. Sweet tea is amazing. Southerners are amazing (they talk to you and are friendly; I pulled out a map and it wasn't 3 seconds before someone asked if I needed help). Vanderbilt has about a billion trees, and they actually are changing colors! It is beautiful! Tennessee and Nashville are pretty cool too (though their roads are very poorly designed).

The interview itself went great. I just talked about FISH for an hour while the interviewer laughed and smiled. I felt very confident about it. It was a great first interview. I'll have something to cling to when I get torn apart by questions that actually are tough (beyond just "tell stories about FISH").

I've got another one at UCSF which should be much tougher. UCSF is very highly ranked among medical schools even though it doesn't have much reputation outside the medical community.