A Letter From the Trenches

Happy Easter. I’m back!

I warned you all that I would disappear for a few months this winter and, lo and behold, I did. This winter was that of my second year of medical school, a trying time for med students. It is during the winter of second-year that studying for the USMLE Step 1 board exam begins, the test that primarily determines our eligibility for residency. It’s like the ACT or SAT for doctors. Classes end in mid-winter and give way to “dedicated” study time which continues through the spring until most students finish boards by summer.This “dedicated” time is rough, so I’ve decided to write a reflection on these past several weeks in case it’ll help another med student or their family understand what it’s like.

My exam is Thursday, 5 days from now, and I’m proud to say I feel ready. A month ago I couldn’t have said it. Although intelligent, I’m not one of those naturally gifted med students that can goof off and do well, nor am I a gunner who will do whatever it takes to be top of the class. I have to work hard, do my best, and at the end of the day, I’m still an average student. Therefore, I set a goal for myself of “beating the average,” aka getting above 230 (an arbitrary score that means average and denotes a decent score for many specialties).

In January, everyone in my class took a practice test and I got a 185, a failing score, since it takes about 194 to pass. A month ago, after 2 weeks of studying 11 hours a day, I only got a 188 on the next practice test. I don’t think anything could have been more disheartening. Was I doing it wrong? Did I have the wrong books? The wrong practice questions? Since I couldn’t afford more resources, so I decided to keep my head down and keep working hard. Two weeks later I had my first windfall, a practice 219. I wasn’t yet where I wanted to be, but at least I was passing. Just last week I took my final practice test and got a 234, right where I’d like to be, with a week left to polish my trouble subjects.

The last few weeks have been nothing but rain here, so studying has been easy. I’m an avid fly fisher, so had the weather been nice I may not have been as productive. I used UWorld, First Aid, and Clinical Microbiology Made Ridiculously Simple, a set of practice questions and two textbooks respectively. My schedule was 5 hours of general studying and 120 practice questions 6 days a week. I usually started around 9am and finished around 8pm. It was a grueling 5 weeks and I still have 4 days to go, but the method worked. For any other med students that may read this, everyone can handle a different amount of work, and all you can do is your personal best, whatever score that leads to.

After my exam I plan to spend 2 weeks in Europe and will return for my next chapter. I will be starting a post-sophomore fellowship in pathology for a year, before returning for third year next spring. A good friend of mine took time off in college to do internships at engineering firms and I’ve always envied her experience, so since this would be my final opportunity to do something similar, I took it. I will basically be acting as a first year pathology resident for a year. Therefore, I will definitely be posting some interesting stuff in the coming months, just don’t expect anything ’til May because I’ll be on vacation.

If you’re a med student or one of their loved ones and are reading this, I’d be happy to answer any questions about what little I know of Step 1, just comment.


Life Skills 1

There are many life skills that we are just not taught in school, and unfortunately many people’s parents don’t even know them to teach their kids. I plan to do a series of posts about life skills that I think are important to being independent and self reliant. So far I have a series of 4 posts planned, split into categories: cars, household, survival, and modern skills. My first set of skills focuses on cars as you won’t get very far without a working car. These are:

1. How to winterize your car/drive in the snow
2. How to jump start a car
3. How to check and fill tires
4. How to check oil level


How to winterize your car and drive in the snow

Perhaps it is simply my living in a border state between the warm, humid lower Mississippi valley and the cold, windy great plains, but Missourians have extreme trouble with snow. I’m not sure if it is the snow or if we’re just uniquely bad drivers, but I choose to blame it on the snow. That being said, a friend of mine from Chicago once told me that “Missourians drive like they have nowhere to be” – complaining about our general lack of urgency on the road. This is compounded in the rain or snow when the average speed dwindles to a crawl and accidents abound.

The irony here is that with some simple preparation you can avoid a lot of the risks associated with slick roads and drive a lot more confidently. Here’s a list of what I consider the essentials to keep in the trunk for winter (although I just leave them in permanently because I’m too lazy to move them out).

1. jumper cables (all year)
2. fire extinguisher (all year)
3. flashlight (all year)
4. snow/rain boots (winter)
5. blanket (winter)
6. kitty litter (winter)
7. spare phone battery (all year)

The jumper cables and fire extinguisher are for general emergencies, namely a dead battery and fire respectively. The flashlight is for if you need to do anything at night such as jump-start the car, get unstuck from snow, change a tire, etc. The boots are so if you get stuck in the snow, you will have warm dry feet. The blanket is if you are stuck in the winter and have to wait for help. The kitty litter is to free you car from snow. You simply pour it onto the snow in front of and behind your tire to create grip, the clay will give your tire traction, and you can work your way out of the snow. The spare phone battery is so that you can always cal for help in case you are in an accident, are hopelessly stuck, or the car has broken down beyond your skill to repair.

Driving in the snow is much like normal driving, but slicker. At some point you will slide. This usually happens to me when accelerating from a stoplight. The key is to keep the wheels straight and take it easy. If you start to fishtail (spin side to side) your natural reaction is to try and correct the spin by turning the opposite way… this will make things worse. The best thing to do is straighten the wheels and try to stop. If the brakes don’t work, change down into lower gears to slow down – this is called engine braking.


Jump Starting a Car

this is remarkably easy. All you need is a set of jumper cables, a working car, and a dead car. Turn off both cars. Take one red clamp and attach it to the red (positive) terminal on the dead battery. Then take the other red clamp and attach it to the positive terminal on the live battery. Take the black clamp and attach it to the negative terminal on the live battery and take the other black clamp and place it on a piece of unpainted metal in the dead car, not on the battery. Turn on the live car and let it run for a while (at least 5min). Then try to start your car. If it starts, don’t shut it off for at least 15min. If it doesn’t, turn them off, check the connections and wait another 5 min, running the live car.


Checking and Filling Tires

This is even easier than jumping a car. I drive a 16 year old car with a leaky front wheel (regardless of the tire) and therefore find myself doing this about 4 times a year. Most gas stations sell a tire gauge for about $10 and have free air to boot. Just drive up to the air pump and take the cap off the tire. Use the gauge to measure the pressure by pressing it onto the nozzle of the tire. This takes some finesse, but is easy once you get the hang of it. If it’s too low (<15psi), then activate the air pump and fill it, checking until it’s at adequate pressure. The tires should be marked with a “max pressure” which you shouldn’t exceed. The higher the pressure the more fuel efficiency, but the less traction. I like to slightly under-fill my tires (~33psi) for a smoother ride and better traction on the rough St. Louis roads.


Checking the Oil Level

when you open the hood, usually right at the front there is a handle that says “oil” or shows a picture of an old fashioned oil can (like in the wizard of oz movie). Pull out this handle and attached to it is a long metal ribbon. Wipe the ribbon clean with a rag and dip it back into the reservoir. Pull it back out and note the coating of oil on the ribbon. There is a full-mark on the ribbon and a number of holes. These will tell you the oil level, namely if it’s full or needs a top-up.