One semester down, three to go...

This is a tree outside our apartment. I forgot to take pictures when we had nearly a foot of snow, so you'll have to settle for the light dusting we're getting right now.

I've made it through my first semester of graduate school! There were times when I thought this day would never come, but now that it's here, it's easy to look back and see myself getting used to a different kind of work than I'd ever done before. I think (though you'll have to confirm this one with Alicia) there was a definite upturn after midterms, when I realized that I couldn't do all of my reading on time, but that I could do enough of it to learn what I needed to learn, and get as much as possible out of what I was reading. What's more encouraging is that it took me about a year and a half to figure out how to make medical school work for me. This makes me hope that I'm getting to a part of the learning curve that is a little steeper (read: for each small unit of time, I progress upward on the curve significantly, rather than creeping upward as lots of time passes).

In all fairness, my semester has been over for a good week and a half now. I finished last Tuesday with my last exam. That said, my break didn't really start because I had gifts to craft and purchase for my family (I like the Solstice, we celebrate Christmas; it works out well.) I turned our study into "Santa¿s Secret Workshop," which I later modified to "Santa¿s Secret Sweatshop" when I realized how much I had to do before I went home to see my family. Don't worry, no elves/children/animals/other people were harmed in the making of my gifts. I got everything done with about a day to spare, and then had a really hard time sitting still, relaxing, sleeping, etc because I was so hyped up.

Now that that's over, however, I've moved on to the rest and relaxation period of my break. I've had several rough days of reading in my pajamas at my parents¿ homes, and plan to continue this strenuous relaxing mixed with small amounts of work and other things I need to get done until I return to school. For the first night in quite some time, I didn't wake up around 3:00 am last night. This is definite progress, and I'm hoping to unwind to the point that I'm ready to face next semester!

Another year, another parade, another exciting life transition...

Nothing like the Thanksgiving Day Parade to bring out the glamor in all of us!

Those of you who read my blog somewhat regularly may have recognized that photo without looking at the caption. You may have noted the 2 hoods on top of the hat, and the similarly outrageous outerwear on my mom and sister, and concluded that the only logical option was the Detroit Thanksgiving Day Parade. That or my mom got a little crazy with the thermostat...

Spending my first Thanksgiving as a graduate student was interesting. It contrasted with my undergrad breaks where I secluded myself from my family and read an entire novel before I was ready to face the world; I missed everyone and felt like I wanted to talk all the time. It contrasted with my med school breaks where I felt like the only conversation points I had were about inappropriate bodily functions (a hit with my mom's husband, but not often with everyone else); I talked to my mom about her dissertation work, and my dissertation work (work I'm dreaming about, that is), and my sister's future dissertation work. I realized that someday we'll be a family of doctors, and if we play it right, we'll be able to fix just about everything! (Mom = organizational science, Claire = political science, Me = medicine and public health) It was great!

So here I am, only a few months in to my new program, and I'm finding that I fit in and I'm even happy. There are terrible moments (okay, they are longer them moments, but allow me this sweet delusion) when I am afraid that I will never be good enough, or never get enough done, or never sleep enough. There are awful times when I know that I can't do my best, or that I've forgotten something in the rush, or that I'm sure that I must be heading down the wrong path. In spite of what Alicia may tell you (thank goodness she doesn't keep a regular blog!), overall, I think things are going pretty well. I'm variably overwhelmed, but what world health issue worthy of any effort whatsoever isn't overwhelming? (I'd have to be awfully arrogant not to be overwhelmed by the AIDS pandemic... Of course it can't be fixed with a dissertation¿ even a good dissertation... But I'm trying to do my part!)

So what I'm trying to say is: I'm still alive! I'm still kicking! I'm still excited! And I might even graduate someday!

My office!

The view from my window... (Actually, the beautiful ocean in Puerto Rico...)

The view from my new office isn't actually quite that beautiful - though until they frost the inside windows of my advisor's office, I'll be able to see through her office to the bleak gray outside. The view aside, I'm really excited to have a place to call my own.

My desk at home is overflowing with binders, papers, and other random class materials. There is also a pile of last year's coursepack for the class I'm GSI-ing, and until this morning there were two stacks of exams (one graded, one waiting to be graded). I've also been using my advisor's office to hold office hours to meet with my students. All told, my academic career has been calling out for a dedicated space.

My "office" is really a corner desk, two locking file cabinets, and a coat closet shared with the other 3 corner desks in our large cubicle. I'm separated by about 3.5 feet of cube wall from the folks walking through the offices. It's about enough to keep people from being able to grab things off of my desk as they walk by, but not much else. That aside, I welcome the move. I'll post a real picture of my office once it's up and running.

Exam craziness...

Something to think about when choosing a school: How much does the administration coordinate your exam schedules?

As an undergrad, I experienced the joy that was midterms and exams. I relaxed for the first few weeks of school, and then freaked out as the middle of the semester approached. If I was lucky, one or two of my classes would have 3 exams instead of two, so the spacing would be better. If I was unlucky, I would have one horrifyingly miserable week in the middle of the term, and another at the end.

As a medical student, this never happened. Because the curriculum at UMMS is organized into sequences, we always had exams every 2-4 weeks, but never more than one at a time. In some ways, this made every week finals week, and caused a lot of stress. In retrospect, however, it was fantastic to have everything coordinated so that you only had to focus on one particular subject area at a time.

Enter the School of Public Health doctoral program. Much like undergrad, I'm taking classes in several different departments. Much like undergrad, I feel like I'm learning incredible amounts about all kinds of things. And, unfortunately, much like undergrad, I'm coming up on what may be one of the craziest three days of my life thus far: Oct 23-25. I have two large exams, a research presentation, and a presentation of a midterm paper all within those three days. "Now," you may be asking yourself, "if I knew ahead of time that this week was going to be so bad, wouldn't I have planned ahead so that I could neatly budget all of my time?" I too, had such thoughts at the beginning of the year. Tragically, all of these plans for preparation and level-headed thinking were brushed to the side as I struggled to keep up with the day to day work for all of my classes. So now, here I am, with one 10-page reflection nearly complete, a professional portfolio all but done, and several more large assignments staring me in the face.

The bottom line, dear prospective students in any discipline, is to ask yourself how you function best. Do you prefer to have someone structure your life for you? Do you prefer to (attempt) to structure things yourself? Do you like having little bursts of stress throughout the year? Or do you prefer to have two periods of absolute insanity each semester? There are no right answers here, only important things to think about. Once you¿ve considered how you want things to go, talk to other students, and gather coping strategies like your life depends on it, because it will...

A first year student... again...

Becca and I after a long day of weeding and shoveling.

On the eve of the eve of the start of classes (I start Tuesday), I'm amazed that this is actually the last time I'll be a first year student. Sure, as we go through life we are first-timers at lots of things, but there are unique trials and tribulations of being a first year student. For example, I will never again have to find a new section of the university bookstores. (I had never found the School of Public Health books before - they are alphabetized separately, which is sneaky. All of the other sections - except medicine, which I have already found - are alphabetized by subject.) Additionally, I will never again be this in the dark about what my class schedule should look like. (The only confusing classes after this will be the 3^rd and 4^th years of medical school, and those are pretty structured and planned out. After that I won't have a "class schedule," even if I do attend classes periodically.) While some of the stresses of being the new kid don't change with the transition from student to not-student, I'm pleased to have checked off another milestone in my program.

In addition to the usual pre-class jitters, I'm excited to get started. I'm frantically hoping that I did well enough on my biostats exemption exam to be in the biostats course I want. (I did fantastically well on my practice exam, and am hoping I didn't freak out and blow it on the actual thing.) Apart from that I¿m looking forward to next week. I am taking the following classes: Social Demography, Biostats, Intro to Complex Systems, the required doctoral professional socialization seminar, and a brief MSTP-required ethics course. It should be a uniquely math-filled semester and although I'm a little anxious about that, I think I'll get through it and come out uniquely math-filled...

Jumping back a bit though, Thursday and Friday were orientation, and I learned a lot more about the specific requirements of the doctoral program (overwhelming and scary, but exciting), and got to meet the rest of my PhD cohort. There are 10 of us, which is a huge number! Also, we are all girls! I guess that shouldn't be shocking as public health is very female-dominated, but coming from the 50/50 medical school, and the unspeakably low fraction MSTP it was a bit of a shock. (As an aside, the MSTP works really hard to recruit women as fellows, but it's hard to get folks to come to the midwest...) Anyway, Friday was the "Practice Plunge" - the stated goal of which was to introduce new students to the practice of public health. We visited the Detroit Department of Health Promotion and Wellness in the morning, and learned about all of their programs. It was great to hear about the field from folks in it, and think about how research fits into all of those things. In the afternoon, we went to "Hope Takes Root," a community garden in Detroit. They provide resources to individuals in the community to help them grow their own produce. Some of it is sold at the various farmers' markets in the area, and some is consumed by the gardeners themselves. We weeded for a while, spread woodchips, and also shoveled dirt to level out an area that had previously held their fruit trees. It was intense work, and after a few hours, I was completely ready to get on the air-conditioned bus and take a nap.

On a happy note, it's cooling down in Michigan, signaling the start of my favorite season - fall (or autumn, if you prefer that). Still enjoying the last day or so of the summer, however, I'm off to relax and read a book.

How many times must I be a first year?

My schedule so far. Which I made myself. And which will not change just because a professor forgot to move clinic from a particular day, or because someone talked too long during his/her lecture, or because the sequence changes and I have absolutely no control over anything. No, the schedule is mine!

I'm gearing up to start classes in the School of Public Health this fall as a first year doctoral student. Although the newness of it all is exciting, it is a little daunting to be a first year in yet another program. It seems like nothing can ever prepare you fully for the first day of class with all new classmates and all new professors in a whole new environment. Thankfully that last bit (the new environment) won't be as big of an issue, as I've been here for a good 6 years.

Looking ahead, I think there will be two big changes for this year. Firstly, the fact that I made my own schedule is a huge leap from the first two years of medical. It's so exciting to know that the schedule I made is the schedule I'll have until December, instead of having to check the course website every month or so to see just how many hours of class were scheduled for the next sequence. It's oddly liberating, and I'm glad I don't ever have to go back to the M1-M2 way of doing things (M3 and M4 year, although overwhelming and time-consuming, are not scheduled in the same way).

Secondly, I'll be a GSI ("Graduate Student Instructor", same as "Teaching Assistant" for those of you who haven't been trained in the UM-undergraduate-speak). This is really exciting, as I've wanted to teach (or at least help teach!) for quite some time. Having been an undergrad here myself, it feels particularly bizarre to be the one putting together the coursepack and talking about the setup of the student presentations. But, I think I like being on this end of things...

AMSA is super awesome!

I know I’ve been flying to DC a lot the last few months. It’s really been every few weeks, and I’m glad that the craziness of monthly meetings is drawing to a close. It really hit home yesterday when the flight attendant on my plane from DC recognized me and commented that I might fly more than he did. While that’s probably not true, it was a sobering moment in which I contemplated how much of my life has been lost to delayed flights…

Travel time aside, going to DC so much this summer has been, as Tanya, our Global Health Action Committee chair and fellow UM Medical student, would say, SUPER AWESOME! I have been able to keep my mind off of the fact that Alicia is working in Denver for the summer (or at least do a better job of trying), and have not had to hang out by myself as much as if I were just at home. My DC trips have included the April LGBT Leadership Summit, May exec meeting, the gigantic June meeting, and I’ve now just returned from the Chapter Officers Conference. We hosted all of the AMSA chapter officers from across the country and helped them to develop the skills they need to run successful and active chapters back home. In addition to the serious stuff, we may have choreographed a dance to a rewritten version of “Sexy Back” that described the work of all the action committees (many of whose acronyms conveniently end in -AC). I got to wear a rainbow flag as a cape as well as a tiara. Other amazing costumes (also found in the basement of the AMSA office) included a cow, Ben Franklin, a vinyl nurse outfit, a Statue of Liberty hat, and various and sundry wigs. Silly time aside, it was really inspiring to talk with folks who are veteran activists as well as those just getting their feet wet - I can’t wait to get our LGBT Health Action Committee programming off the ground and into the local chapters!

I’ve been thinking a lot about how to stay involved with medical school as I enter the PhD phase of my training, and I think AMSA is a great way to stay connected. It lets me work with other medical students on issues that are important both in a medical student and a public health student context. I know that it will be hard to balance AMSA work with other work once the school year starts (let’s not kid ourselves, it’s already difficult to balance getting the rest of my stuff done with fun and exciting AMSA work), but I think that I’ll be able to keep it under control better than last year. I’ve made a sincere commitment to myself that there will be no other student organization commitments this coming year so that I can be totally devoted to this incredible organization.

If you’re curious about what we’re doing, check out www.amsa.org/lgbt and look around. You will notice my smiling face on the right! And the smiling faces of my coordinators all around mine! It makes me happy just thinking about it.

The value of taking breaks

Here is a horrifyingly pixelated version of a picture of Alicia and I at St. Mary’s Glacier. For those of you who, like me, were not entirely sure which part was the glacier, try this.

While my family and friends have been telling me for years that taking breaks is a good idea and that I should do it more often, I still haven’t gotten the hang of it completely. I still occasionally freak out and feel the need to spend several hours checking my e-mail and responding to requests that seem incredibly urgent at the time. I inevitably finish said session feeling drained and like I probably could have waited, but may never catch up. This last weekend was different, however. I barely cracked my computer, after spending Friday doing work (while Alicia was at work). In addition to getting a ton of work done on Friday (because I didn’t want to have to do it later), I think I enjoyed my weekend more than I have in a long time.

So, lesson learned. At least I hope so. To those of you close to me, hold me to this. From now on, when I plan to take breaks, I will really take breaks. I will not check my e-mail; I will not work on projects offline; I will not “just finish this one thing.” And, as I did after last weekend, I will return to my life refreshed and infinitely more productive than I had thought possible.

As an aside, while I was not doing work over the weekend I had an amazing time in Denver visiting Alicia. We hiked up and around St. Mary’s glacier. Saw our first ever (and definitely not last!) Dogs in Drag parade, which was amazing. My favorite didn’t win, probably because not everyone harbors such intense resentment of chihuahuas as I do. We also saw Waitress, which I would highly recommend. Overall it was an amazing weekend.

The rest of the books

Here’s the quick list of the rest of the books I read on my trip.

Coconut, by Kopano Matlwa: This winner of the European Union Literary Award (which is apparently how it got published - it’s a first novel) was not as good as I’d hoped, but was engaging and a fast read. First it follows a black family living in a white suburb, and is told primarily by the adolescent daughter (Ofilwe). Second it tells the story of another young black woman (Fiks) who is living in the township, but working in the white suburb where the other family lives. Her story was significantly better written, and much more compelling. She seemed to have a more authentic sounding voice, though that may have been in part because of the story that was told - Fiks has a much stronger sense of who she is and where she is going than Ofilwe, even if her perspective seems a bit skewed to one who has spent any time in Jo’burg.

Spud: The Madness Continues, by John van de Ruit: This sequel to Spud was just as good as the first one. It hilariously tracks year two of Spud’s boarding school excitement. Notable high points are descriptions of Wombat, Spud’s nickname for his grandmother, and the expansion of his father and maids growing illegal beer brewing business.

A Change of Tongue, by Antjie Krog: This book was written after Country of My Skull, and works with the changes that took/take place with the fall of apartheid and the change in government. Another beautifully written piece, it is also nonetheless difficult to read because of the thought-provoking subject matter and intense-almost-to-the-point-of-being-confrontational-but-not-quite story-telling. I particularly liked the skillful weaving of memories/stories from the youth of the narrator with contemporary anecdotes and stories, similar to Country of My Skull, with the intertwining of the author’s story with the stories of the victims, perpetrators, and other members of the Truth and Reconciliation Commission.

Blue Shoes and Happiness, by Alexander McCall Smith: This was purchased in a moment of desperation (needing something happier to read), and sticks out as the only non-South African piece I read on my trip. It also stands out as not being nearly as good as the first “No. 1 Ladies’ Detective Agency” book I read. I’m not sure what happened, but I just didn’t enjoy it as much.

Mhudi, by Sol T. Plaatje: After reading lots of contemporary fiction this was a bit of a step back. Originally published in 1930, it chronicles the fierce take-over by the Matabele and the arrival of the Boers. It is also a romance between a strong, independent, and overall amazing woman (Mhudi) and her husband, who life is frequently saved by his wife’s incredible intelligence. I didn’t much care for the meticulous style of this one, but it was interesting to gain insight into another aspect of South African history.

The Whale Caller, by Zakes Mda: Although I think I liked She Plays With the Darkness better, this book was also beautifully written. The liner notes compare Mda to the magical realists of Latin America, but I disagree (perhaps in part because I don’t care for

García Márques). I think that while the magical realists infused realism into magical happenings, Mda seems to take magic and weave it into his work. Even the most mundane thing is infused with a sort of mystical element. I really enjoyed this one, even though it was sad.

Gayle: A History and Dictionary of Gay Language in South Africa, by Ken Cage: This was a bitter disappointment. I’m not sure what I was expecting, but it was far more entertaining than what I got. While I knew that fully half of the slim, hot pink, 100-page volume was a dictionary, I had hoped an engaging history and discussion in the first 50 pages. Instead it was a dry discussion of linguistics and a brief discussion of some random gay symbols (the rainbow flag, the hanky code, etc), none of which went as deeply as I would have hoped.

Miss Kwa Kwa, by Stephen Simm: I read this one on the plane on the way home, and got it because it looked light and entertaining. For a story centered on sexual predation and violence, it was amazing fun to read. The author has a gift for capturing the voices of his different characters, and the subplot of the older wife is hilarious. (Maybe I just find old ladies funny, as I really enjoyed all of the Wombat stories in the Spud books as well…) All in all, this was a good way to end my trip.

That’s all for now - if you’re interested in borrowing one, let me know!

South Africa

I really enjoyed writing last summer’s list of books and movies, and this summer is off to a fantastic start already. Here are a list of books and movies I’ve read/seen since my trip started just 10 days ago:

The persistence of memory, by Tony Eprile: I actually started this one before I left, and returned it to my advisor before I got on the plane. I’m still looking for a copy here in Jo’burg, with little luck so far.

Age of Iron, by JM Coetzee: I read this one on the plane on the way here. The story was sad in many ways (featured an elderly woman with breast cancer, highlighted difficulties of apartheid), but was also uplifting in the evolution of relationships that grew from those difficulties. It was frustrating to read at times, although it was very well written, and was one of the first (fiction) books I’d read about apartheid. It was a great introduction and I’d highly recommend it. I’m planning on picking up some others by the author before I come home.

“El laberinto del fauno”, by Guillermo Del Toro: I was thrilled to find that this was an option on my trans-atlantic flight. I’d wanted to see it for a long time (since before it came out) and had never had a chance. I was disturbed by parts of it (thank you Franco), but overall I loved it. The monsters were amazing, but not scary to the point that I regretted watching it on the plane. The storyline with the mother was particularly fascinating (wild gender dynamics), and the whole thing was really well done. It made me think but was also beautiful to watch.

“Music and Lyrics,” no idea who directed it: This was another plane ride gem. A trashy movie (it’s the one with Hugh Grant and Drew Barrymore, in case you’re drawing a blank) about a has-been songwriter and budding lyricist that I thoroughly enjoyed. It was funny, had very little to think about, and allowed me to knit a great deal.

Country of My Skull, by Antjie Krog: This was one of my first purchases when I got here. It is a beautiful book, but one that takes a long time to read. It weaves together testimony from the Truth and Reconciliation Commission with the author’s narrative of reporting on the Commission for SABC, the national radio network. As a white journalist, the author does an incredible job of chronicling her experiences of guilt, anger, empathy, and a thousand and one other emotions she experienced over the course of the Commission. She also records the life of the Commission, as it does take on a life of its own. I must quote André Brink from the back cover of the book and agree that “Trying to understand the new South Africa without the Truth and Reconciliation Commission would be futile; trying to understand the Commission without this book would be irresponsible.”

Spud, by John van de Ruit: One of the books I bought when I realized that reading about the Truth and Reconciliation Commission was making me anxious and preventing me from sleeping well, and definitely a fine choice. This is the first in a series (I will need to import the others) about a boy in boarding school here in South Africa. It takes place in 1990, just as Nelson Mandela is being released from prison and all of the social and governmental changes dismantling apartheid are beginning. It is a hilarious book dealing honestly with not only the incredible changes in the country at large, but in the life of one 14 year old boy. I think I read this in approximately 10 days, trying to convince myself to keep going with Country of My Skull when I was feeling happy enough.

She Plays with the Darkness, by Zakes Mda: This slim novel was a great complement to the South African literature I’d been reading. I’m not sure if the author is from Lesotho, but the book takes place there, and describes the many governmental changes that have taken place there during and since the ending of apartheid. The story centers on a brother and sister. The brother is sent to the lowlands to go to school while the sister remains at home (a decision of the Catholic organization that paid for the schooling - hotly contested by the sister). Their lives never really reconnect after that, and their two different viewpoints present a unique take on the history and culture. I thought this was also a beautifully written book, and hope to pick up a few more by the author before I leave.

I think that’s all for now. I’m in the middle of several others, so there will undoubtedly be more posted soon.

Jock

Lucky

Difficult decisions

Here’s Alicia with our new dogs. Just kidding! They are, instead, Jock (white and tan) and Lucky (black and white), the two lovely boys for whom we are dog-sitting this week while their parents (M3+family) are out of town. They illustrate perfectly most of the characteristics I’d like in a pet, friendly, smell nice, short hair, not too slobbery. The only thing they don’t fit (by a long shot) is the 25 lb weight limit imposed by our new apartment complex.

Difficult decisions

Alicia and I are, in fact, strongly considering getting a dog next fall - though probably not one as large as either Jock or Lucky. We have had many discussions about which type of dog would best fit with our relatively small apartment, our busy lives, and our need for a small pet (under 25 pounds) to comply with the regulations set forth by our apartment complex. We are also weighing the kind of grooming necessary for each particular breed, how much we think the dog might bark and annoy our apartment neighbors, and how happy it will be with the amount of exercise we can provide it.

Here are the current contenders, as well as my thoughts about each one (the links will take you to the Animal Planet description of each breed, a slightly more fun-pet rather than show-pet oriented website than the American Kennel Club, though both were helpful for us):

Boston terrier: These dogs are super cute, and are at the top of the list right now. Of their minor health problems, “stenotic nares” are included, which means they snort and make crazy breathing noises all the time. I think we can work around this, as they are cheerful and energetic, but seem like they would be happy with our living arrangements (walk + playing every day, but having to stay home alone a bit in the middle of the day).

Pug: Alicia and I are somewhat divided on the cuteness of the pug. I think they are adorable. She does not. Alicia is also somewhat turned off by the fact that the grooming needs include “cleaning facial wrinkles.” They are also plagued by the “stenotic nares,” so I’m currently pushing for a Pugston - a Boston terrier/pug mix.

Miniature daschund: Alicia’s mom still has the dog they got when Alicia was in high school - Sam - a super cute little miniature daschund and she would love nothing more than to get one for ourselves. I’m strongly considering this, though I might like to branch out a little bit.

Bulldog: The bulldog was my attempt to suggest a dog that was my idea of cute like a pug, but less “ridiculous looking” for Alicia. Because of the need to clean the bulldogs facial wrinkles as well, I think this one is sort of near the bottom of our list. That being said, I think they are sort of cute and tough-looking.

So that’s the short list. I’d love to have a little vote take place, as well as get your comments/suggestions. Please click here to vote.

PS. The board exam is finally over. It’s hard to believe that it was only a few days ago (Thursday), as I’ve done so much since I finished (read: I had over a month’s worth of errands to run).

De(Construction)

I’ve been at the University of Michigan for a relatively long time. Those of us who did undergrad here (and stayed for medical school) remember that the Life Sciences Institute used to be a ratty looking collection of buildings and parking lots, and then a giant hole in the ground, all before it sprang to life as a modern, highly stylized (and debatably tasteful) new building. We may remember being in the LSA building during our first few weeks on campus, but I was shocked just last year when I realized that it was, in fact, finally completed after nearly 4.5 years of construction and inside it was beautiful (contrasting starkly with my first impressions of it). We’ve witnessed countless expansions on this campus, all of which start with knocking things down and digging holes, and we’ll be here for many more (I perhaps more than most of my classmates - yay for the MSTP!). As I was driving home the other day, I was struck by the balance between knocking buildings down to build new ones and improving the ones we have. Within a few short blocks on State St. (central campus), one can see expansions underway on both the UM Museum of Art and the Kelsey Archeological Museum (both of which are at the huge hole stage, but did not involve knocking buildings down) as well as the newly initiated demolition of the Frieze building (pictured above).

This made me pause, and reflect on my almost reflex nostalgia. Was the Frieze building really all that great? You see, as an undergraduate, I had a huge number of my classes in the Frieze building. It housed many of the foreign language departments. It was also one of the most distant buildings from my dorm, and I resented it on many frigid mornings. And the heating never worked very well so it was either still icy inside, or heated to the level that I would classify as blazing inferno. And it was laid out so poorly that you could identify those people who had never had classes there before by their frustrated looks, angry mutterings, and their unusually brisk pace. The Frieze Building apparently started out life as a high school, and was acquired by the university sometime later. From there, it was added on to and adjusted, never quite fitting the bill for a university building, but never so outrageously unworkable to have merited total destruction and rebuilding. Now, needs have changed and the site is destined to become a dorm. I guess that seems reasonable enough to me.

This never-ending sequence of renovation, demolition, and construction can at times be disturbing, but perhaps models the rest of life eerily well. Each day is like an evaluation, whether it’s of a job, of a relationship, of school, of anything, honestly - deciding whether it’s beautiful and functional just as it is, just alright how it is for a few more years, whether it needs a few little touch-ups and it will do, or whether the time has come for a massive overhaul. Especially during board studying, during the desperate moments where each of us questions everything about our lives, we wonder where on that spectrum our lives fit: whether it’s worth the misery of sitting in the library for 8-12 hours every day, whether it’s worth having to work so hard to squeeze in time with family and friends, and frankly, whether we aren’t doing more demolition than construction during this study period. And yet, here I am, on another morning, ready to head out with my books/flashcards/notes. Must be working well enough.

Need direction? Try the graduate library.

Helpful signs on the floor of the stacks.

I think that the most helpful bit of advice about board studying I’ve ever seen/read/heard was Ben Bryner’s blog posting last year. He compared it to an eating contest, which horrified me to some extent last year, and continues to appall me as I force down another subject today. And yet, there is something satisfying about reviewing all of the material from the past two years. (Maybe there’s a career for me in eating…) It’s like I’ve actually learned things along the way. In spite of my fears that I had retained nothing, I seem to have gleaned more than a few things along the way. Which is not to say I really love being sequestered in the library for long hours at a time, or that I need more than one hand to count the number of friends I’ve seen in the past week. I don’t. But at least I’m getting somewhere. I’m coming up on what is arguably one of the biggest hurdles of medical education. (I say one of the biggest knowing that third year, and internship will be insanely difficult, but they are practical, and as such, fundamentally different.) That’s exciting.

So as I look to the floor outside of where I study, and it points me in one of four cardinal directions, I think about exactly where I am going, and am somewhat pleased to discover that I don’t really know. Sure I’ll be in PhD-land next year, learning public health background and methods for my dissertation, and staying in PhD-land for a few years after that, and then I’ll be a third year, and finally a fourth year, but after that, who knows? It will be a residency, but who knows where? And who really knows in what? (Right now I’m thinking OB/GYN, but so much could change in the next 6 years…) So, as I study for boards, I try to keep life in perspective, and remember that this is just one (albeit relatively large) more step forward. Chow down!

And then it came to a gentle stop… or how I allowed my life to spin wildly out of control and had to wait it out…

Remember riding on the merry-go-round at the playground when you were little. And you’d hold on so tightly as your parents or friends spun it as fast as they could run, terrified that you’d lose your grip and fly off into the hard ground. Remember how you smiled as you screamed, loving every minute of the terror. And then, remember how gentle it seemed as the merry-go-round slowed to a delicate spin, how calm you felt as your heart slowed, your eyes adjusted to the gently revolving world, no longer a blur. Finally, remember how unsteady your legs felt as you climbed back onto steady ground. Now imagine that the merry-go-round spun until you felt sick - that it wouldn’t stop even when you started crying instead of laughing.

As my advisor so delicately pointed out last week, graduate school is about learning to balance. The imbalance of it serves to remind me of the difference between what I can do, and what I should do. Pushing the limits of a 24 hour day to see just how much fits, doing too much, struggling to keep up, and finally pulling back is starting to feel like a bad new exercise routine - just wait until the damage is barely healed and then rip the delicate tissue apart once again. Yet that perspective is often hard to see until the ripping is done, the pain is real, and one is left wondering how caution was thrown to the wind and judgment flew away with it.

And so my M2 year ends. It’s almost anticlimactic, with the craziness of February leading to the only slightly less crazy March, and finally finishing all of the commitments of student organizations as well as classes. Now that I have time to wax poetic and reflect on my “preclinical years,” I recognize that inspiration is easiest to find when well rested and fed. This is, of course, easier said than done. I’ve been thinking a lot about activism recently, and, with the wise words of many advisors, teachers, family, and friends, have come to the conclusion that activism most logically follows the same course as education. As you progress you no longer want to cover anything and everything, instead, you look for depth. You look to dedicate yourself to the few projects you can complete well, understanding that you will leave other pieces undone, hoping that someone else will pursue them with the necessary passion. And, just as my freshman year of college I was puzzled as to how I would fit every single subject into an 18 credit course-load, these last two years have been an exercise in realizing that I can’t do everything, but frequently ignoring that insight.

Which brings us to now - there are no more M2 exams, all of my student organization commitments are through, and I’ve firmly resolved to commit myself to AMSA’s new LGBT Health Action Committee next year (as chair!), and just say no to all the other organizations that call to me. I know this won’t be easy, but it can’t be as hard as February.

Over-commitment

It’s amazing how quickly things can get crazy. The number of student organizations I joined at the beginning of the year seemed totally reasonable. I had regular meetings, and lots of things to do, but everything seemed fairly doable. Now, somewhat suddenly, I can’t seem to get everything done. Everyone seems to talk about balance between extracurricular activities and school, or school and relationships, or anything other than what seems to be my problem - balance between saying yes and saying no. Every medical student thinks that s/he can change the world, and I’d argue that we should take Margaret Mead’s quote to heart: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has.” That being said, I’m not sure that I can do it on my own, by tomorrow, and still pass my second year.

For those of you who keep tabs on me, here is what I’ve been up to, and what you can do to help:

1. Women’s Health and Fitness Day: The day is over now (the event was last Saturday), and it was great. We didn’t have quite as many people attend as we might have liked, but those who did were a wonderful group. Joanne Bailey, our inspiring keynote speaker, spoke about the way that society influences women’s health, the role of medical research, and what all of us can do. We got lots of positive feedback and everyone had a great time.

2. Dominican Republic Trip: This is coming up so quickly I can hardly believe it. We’ve had lots of interesting discussions about the different aspects of health we’ll be focusing on while we’re there, as well as the limitations of our work. We met last night to discuss what we can all do to make the effects of our trip more sustainable. If you’ve got suggestions, let me know - aknittel@med.umich.edu.

3. Galens Smoker: We’re getting into intensive rehearsals, and I’m going to be missing tech week for the Dominican Republic trip. I will be dancing (in 3 dances this year!) and although the plot and details about the show are top secret, I can assure you that it will be amazing. The title of this year’s show is “The Breakfast Clubbing, (Cyanosis, and Edema),” based on “The Breakfast Club.” The shows are Friday, March 2 and Saturday, March 3 (both at 7p) at the Lydia Mendelssohn Theater. If you’d like to see the show, but aren’t sure how to get tickets (because you’ll want them before the show - they frequently sell out), e-mail me - aknittel@med.umich.edu.

4. M2 CCA: Out of everything I’ve listed, this is the scariest. I know that assessing our clinical skills is important, but did it have to be this week? The answer clearly is yes, with the note that I’ve known this was coming for months now. Nonetheless, I’m terrified that I’ll omit some critical step of my neurologic examination, or forget to wash my hands (what I’ve heard is an automatic failing grade). So today and early tomorrow I’ll be finishing honing my physical exam, history taking, and presentation skills. If you’d like me to examine you - just kidding!

I think that’s all (more than enough!).

The Life Sciences Orchestra

I'll upload a picture from my last concert as soon as I have enough batteries to operate my camera again...

The Life Sciences Orchestra (LSO, from here on out) is my Sunday night study break, and part of what keeps me going during medical school. It is comprised of individuals from all facets of the life sciences community: medical students, residents, fellows, attending physicians, music therapists, public health professors and students, nurses, medical social workers, basic scientists, mathematicians, engineers, and more, as well as a few people whose connections are through someone else - partners and loved ones of individuals in the life sciences. (For those of you musical pre-meds out there, consider this as you weigh Michigan with other schools!) We get together weekly to rehearse, and we play two concerts a year. However, the LSO is a surprise to most people. It’s separate from all of the orchestras on campus for music majors and even separate from the campus orchestras for students who are non-music majors.

I’m not entirely sure why the LSO so shocking. Maybe everyone assumes that we don't/shouldn't have time for music. I'd counter that without time for music, most of us would be unable to function in our daily lives - in addition to providing a welcome exercise for some of the parts of the brain that aren't used in science it's a fantastic study break. Maybe everyone assumes that we're in the life sciences because we're not talented enough to be musicians. This is clearly false. While our primary passions are definitely in the life sciences, and there is a wide range of technical ability in the orchestra, there are some incredibly talented musicians populating operating rooms and clinics. (Additionally, I'd argue strongly that being a musician doesn't take talent, just a willingness to show up and have a good time.) Whatever the reason for the disbelief, the orchestra exists, and it's fantastic.

In addition to playing some fantastic music (this season is comprised of an incredible amount of popular classical pieces - William Tell Overture and Peer Gynt Suite, among others), and being a delightful distraction, it’s a fantastic opportunity to get to know people in various points a long their career, and arguably a convenient time for networking. I didn't realize this at first, but after a few months in the orchestra it began to sink in. A talented bassoonist I had known only through orchestra suddenly became the radiologist who lectured my M1 class. One of Michigan's most accomplished and renowned surgeons plays bass. One of the epidemiology professors I'll probably encounter next year sits in the cello section with me. The inspiring coordinator of the LGBT curriculum component is one of the LSO flautists. My stand partner is a pediatric emergency medicine fellow. I could go on and on. Through all of these wonderful folks I've gotten a glimpse of what’s to come. Through their dedication to music (and ability to make time in their schedules) they reassure me that when I make it through this mess of medical school (and soon enough public health), I’ll still be happy and well-adjusted enough to make beautiful music. That in and of itself is worth playing for.

What’s in a curriculum?

My beautiful chia kitten - a white elephant gift from my small group leader.

(This entry is particularly for all the pre-meds reading this. A note to all of my family members: I'll try to keep it interesting for you, but bear with me on this one.)

I've been thinking a lot about our curriculum, and how we, as medical students, learn. As a student who has sat in an incredible number of lectures (I haven't counted them, but it must be in the thousands by now) over the last year and a half, as well as component representative for my class (read: the liason between the faculty for each sequence and the students), I have learned a lot about what works and what doesn't. Lists of facts do not work well - and reading them aloud doesn't help. Reading the same facts over and over is better, but is still boring. Lecturing about the concepts that support the facts is yet again a step above. Discussing those facts and concepts as they relate to cases is even better, but it takes a lot of time and a large number of well-trained dedicated faculty members. Discussing those facts and concepts while looking at relevant pictures/objects (sound like a lab?) is probably the pinnacle of this hierarchy I'm describing here. (As an aside, none of this should seem novel to anyone who has sat through two consecutive lectures or discussions, one good and one bad. I just wanted to bring everyone up to speed.)

So why does our curriculum (and that of many medical schools) so often stop at the lecture stage of things, instead of going on to small group discussions and labs? I have asked myself this question many times and have come up with lots of different answers. Firstly, I suspect, is the issue of time. We pack an incredible number of structured hours into our class time, and lecture often seems to be the most concentrated way to transmit information from teacher to student. While at the end of a 6 lecture hour day we may all be reeling, we have all the notes we need to study an incredible amount of material. Secondly, I'm not sure we have enough faculty free to teach the number of hours they would need to in order to create small groups for each topic. Additionally, as pathology lab and small groups so frequently demonstrate, a good discussion is most often the result of thoughtful processing of material that we have already learned. While we learn a lot while we discuss, it's generally not about facts and mechanisms but rather different approaches to problems.

This seems to strike at the heart of the debate between "problem-based learning" and lecture. While I am by no means an expert on medical education I think my experiences put me in a unique place to comment. While admissions folks throw around all kinds of language about curricula, and most of it seems to make sense while they are saying it, one should always consider the source. I'm not saying you shouldn't believe the admissions officials, just saying that what they tell you is probably slanted toward getting you to love the particular school you're visiting. So here are my thoughts: everyone needs a balance between what are often described as two different approaches. In my experience problem-based learning on its own leads to interesting discussions, but frequently leaves gaps where the conversation didn't go or no one had anticipated needing additional information. On the other hand, lectures alone can leave the material dry and boring, as well as leaving many of the finer points without discussion (leaving medical students with the unfortunate impression that science is exact... oops!). A combination of the two allows students to get a broad understanding of the subject at hand and ask questions about the beautiful complexities.

There is clearly a flaw in my discussion, however, and it is as follows: I have been educated in the US public school system for the last eighteen and a half years. I have only rarely experienced methods other than those described above. Many of my courses in undergrad were based only on discussion - and relied on students to read before class to supply the background information. This worked variably well depending on the amount of material that was necessary to make discussion interesting and the willingness of the class to speak. Others were based solely on lecture - and relied on students to discuss outside of class to supply the variety of approaches to the problem. Yet I know there are other methods out there: many of my classmates have unique systems of streaming video, reading, and study groups, all finely honed to be as efficient as possible. I've tried different things, and found what works well enough for me, though I often wonder if there weren’t something better. So here is my challenge to you: consider that you, rather than your medical school or your educators, are responsible for learning all of the material presented during medical school. They are certainly critical conduits for information, and important sources of explanations and clarification, but the main burden lies with you. Consider what you need to take this responsibility and look for the medical school that offers the right tools to help you along.