My Letter to our Provost Regarding Saving DMC

Date: March 25, 2014 Shelley Berkley CEO and Senior Provost shelley.berkley@tun.touro.edu Dear Ms. Berkley: I am a fourth-year Osteopathic medical student speaking on behalf of a majority of the class of 2014 and in the interest of the future of Touro University California. You may be aware that third and fourth year clinical rotations are critical for completion of the Doctor of Osteopathy. However, you may not be aware how difficult it is to obtain and keep these rotations for Touro students. For example, in 2012 Ross University purchased exclusive rights for their students at Kern Medical Center in Bakersfield Ca, leaving many of our classmates to scramble for a location to do their third-year clinical courses. In addition, more than half of each class has to move away for their third and fourth years, creating a financial and logistical burden for the students, especially those with families. There exists an opportunity for Touro to improve the problems with clinical rotations while simultaneously saving an important part of our local healthcare safety net. I am speaking of Doctors Hospital San Pablo. DMC provides over 70% of the hospital beds in West Contra Costa but gets scant funding from the county and is in danger of closing without additional funds. It is the closest ER for local residents and without it emergencies would have to drive up to an hour in traffic. Touro medical and pharmacy students already perform some of their clinical rotations there so this would also be another loss for the University if they close, or if another institution were to take it over. For more information, please see http://www.savedmc.org/ I believe it would be in the best interest of Touro students for the University to step up and help DMC in the short term but I think the hospital should also figure into long-term planning. It would be an ideal location for an Internal Medicine residency program, with plenty of pathology but it would also serve a community in need, which is in keeping with the mission of the University. Indeed, a fully functional residency program may negate the need for the contracted hospitalists, which may improve the bottom line. Steps like this will help keep us competitive going forward but is also a public relations advantage that will draw attention to Touro. I imagine a Touro University Hospital East Bay and I encourage you to seriously consider this possibility. Sincerely, Kelly Campbell OMS-IV

Figuring out what to study

Figuring out exactly what to study is probably the most difficult task in medical school. There are 1,000's of pages of books, another 1,000 pages of handouts and slides plus 100's of pages of summary material. Then there is the internet with Wikipedia, Youtube and tons of other useful sites. Oh, and there are lectures and labs too! There just aren't enough hours in the day to cover it all. So, I try to figure out which ones are the most useful to get an understanding of the material.
Thus far, I have found that there are a couple of books that cover all of a particular subject, like Robbin's for Pathology but some subjects require a careful reading of the powerpoints produced by the instructor.
It seems like I get this sorted out just before for the exam. Then I have a couple of days to cram it all in!

O.M.O.C.

Not that I need them but there are daily reminders of how much older I am than my fellow med students. There's the lengthy lunch-time discussions about Mario Cart that I can't participate in or the blank stare when I mention TJ Hooker. Not to mention being above the fray when couplings are discussed; I simply sit there enjoying the drama in a pleasantly detached position. It's not that I don't remember having been there but I just don't miss it. In fact, I am amazed that anyone can put up with the demands of medical school and still have any social life at all!

It is nice to give some advice from my aged perspective and I'm sure I give way too much of it but I don't think I could stop. Why? Because I genuinely care for these people. I want them to succeed and I want to be part of it, so I give advice. Or, maybe I'm just a pompous ass..... anyway I know people will take what they need from my missives and leave the rest - they didn't get into medical school by being automatons.

My lab group decided to name ourselves "Kelly's Kids". I thought we should have been "Gluteal Cephalic" but I lost. So, we now sound like a charity telethon. I'm touched by this show of affection even if it's a jab at my age. The funniest moment came in geriatrics lab when I was presenting our group discussion and a student from across the room made a comment about being close to geriatric myself. The room erupted in laughter, myself included.

The discussion was interesting. Being "close to geriatric" I listened to these men in their mid to late 20's talking about the elderly and remembering feeling the same way when I was younger. Once you're over 70, your elderly and becoming frail, you need people to talk a little slower or you become wise somehow. I don't think 70 sounds so old anymore and I've know enough people in their 60's, 70's and 80's to know a few things about the 'elderly'. First, grumpy old men were grumpy young men second, stupid people don't ever get wise with age and a retired NASA engineer will understand more of what you say than a 20-something college grad.

I'm enjoying my unique position among this amazing group of young people, or as I call myself: The O.M.O.C. Old Man On Campus.

On Procrastination

I will do anything to stave off studying pharmacology, even update this blog. Not because it's especially boring because I find it pretty darn interesting and it's of course a major tool in the physician's tool kit. It's that I'm so damn bad at memorizing and that's what Pharm is, rote memorization at its finest. There isn't a lot of understanding to be had in the subject and it is filled with tables of drugs, their class, uses, side effects etc etc etc. Physiology is where I shine but that's only a tiny part of medical school. I think it was about a month of class last semester then it was back to "what is this drug or that drug.....". Even when Pharm has critical thinking, if you don't remember the name of the damn drug, then you can't solve the puzzle presented to you in the question.

Oh well - it just has to be done, like removing a bandage or breaking up with your girlfriend. Unpleasant but happy to have it over.

one year?!

Yes, it has been a year since I last posted anything but that could be due to the feeling that I am speaking in an empty auditorium with the lights off. This is a viscous circle - no updates = no readers = no updates and so on..... So, I will try to update more often this year.

I survived my first year of medical school relatively unscathed, meaning that I never had to remediate a topic or even a test despite the fact that I could have been more efficient at studying. That's probably the most important thing I learned in the first year was how to study the massive volume of material being thrown at us. I had never really had to study before and definitely never had to memorize so much information. In physics and math you don't memorize so much data. The trick there is to do the practice problems and be able to do similar ones on the exam. In medical school you can't really practice any problems, you memorize memorize memorize. One exam I added up the total number of lecture slides we had to cover and it was over 1,000! These aren't the usual prompt the lecture minimalist type of slides either, they are text heavy things that are packed with details about diseases, drugs, procedures and microbes.

On top of the work required for school, I decided to form a Grappling club on campus. This hasn't really required too much effort, just setting up practices and helping to instruct the members. Oh, and we had to petition the student government to pay for some new mats. That was a hassle and I'll blog on that at another time. Luckily, another student helps out with instruction but I've been the one to do everything else.

The real time suck has been my volunteering to be the student government VP of Finance. Not only am I keeping the books, writing the checks and keeping an eye on expenditures, I have to write the regulations, setup the files and clean up the bookkeeping from past neglect.

I guess I don't need more to do but I will try to keep this blog updated. Mostly for myself I guess as it may be fun to look through the posts in the years to come and see the condensed version of this journey and what I had to say about it.

Update after 4 weeks

Four weeks in and I'm wishing that I had more hours in the day because I feel that I'm not studying enough, not spending enough time with my wife, not doing enough around the house, not doing enough around the yard, not spending enough time with friends. You get the picture. The studying will have to increase as I get better at time management. It seems that studying is like running for me; if I get started, I'll work hard and feel better afterwards but the hardest part is getting started! That being said, I am getting better at it.

We had our first exam and I performed pretty well. To graduate, we just have to pass but I want to actually know the information now. When I was in undergrad I have to admit that I was pretty lazy - cramming for exams and staying up all night to finish the problem set that I had a week to complete. Now, I want to know this stuff cold! What a difference it is when you're doing something that you enjoy, that you feel is important.

Oh, and I am loving the OMT (osteopathic manipulative treatment) subject. We are learning how to feel differences in our patients, how to use our hands to heal them. Touch is a powerful thing and I think more doctors need to be taught how to touch their patients, how to use their hands to diagnose and even heal them.

Ok - enough rambling into space - back to the books!

1st week in the books

My first week consisted of three days of orientation and two of actual classes. It was pretty light but nerve-racking nonetheless. As a returning student, I'm finding that it's difficult to click with my fellow students. Their conversations about dating, video games and music are difficult to participate in because I'm not up on the latest trends in these areas. A couple of my classmates were talking about Rock Band, which I have never played and I started laughing because the last video game I played was probably Galaga, on an actual console where you put quarters in it. It is amazing to be around these students, they are a talented bunch. There are musicians, artists, writers, even a mathematician. I feel so privileged to be among them!

We dove right into dissection on the first day of class. There are five students to a cadaver so I collected four others by holding up my hand saying "we need three more here..." and counting down as one joined the group. I wanted to make the first cut but didn't want to be pushy or greedy so I suggested we do rock-paper-scissors for it. The first round every one of us chose scissors! We all broke into laughter and everyone in lab looked over at us - oops! After two more rounds, I got the honor of making the first incision. I was so jazzed to be the first! I am in awe of how resilient the human body is, how tough the skin is. Finally, I am beyond grateful for the man who chose to give his body so that I could learn hands-on about the structure and organization of the body.

Books!

The first crop of medical texts showed up yesterday and I'm so excited! I purchased all of the required texts and none of the recommended ones because I wished to stay under $2,000 for this purchase. I started reading the Histology text last night.... can't wait to be immersed in the subject but hoping I don't get under water!

Can time simultaneously fly and crawl? I have so much to do before school starts that I'm sure it won't all get done but I'm anxious to begin this next phase in my life. Recent high-level thinkers on the topic of time are saying that it's really an emergent property of nature, not a fundamental one. So, I may indeed be creating my own combination of time-dilation-contraction experience! It doesn't really matter as I've stopped counting the time between now and school in conventional units and am using 'paychecks'. There are two paychecks before school starts. Then, it's back to student loans - no more sushi Saturdays or Friday night cocktails with the gang.

Oh well - that's still two paychecks away. What about the here-and-now, the only time we know to exist? What is on my calendar?

Things I need to get done: get MMR vaccination (my titer was low), buy scrubs/books/gloves, get my study space put together.

The study space is an interesting story. My wife and I bought a small, 2-bedroom house and our niece is living with us while she goes to Community College. Therefor, I don't have a quite space where I can stretch out the books and study. I looked into buying a shed that I would insulate, electrify, drywall and paint but these things ain't cheap! Small ones start at $1500 just for the shed, then I would spend another $500 to get it in office shape. The idea popped in my head to find a vintage travel trailer that I could park in the back yard (it's an 8,000+ sf lot) and use as an office. Of course, these ain't cheap either! However, if you aren't planning on using it for it's original purpose, i.e. camping, one can be had for under $1000. I found a 19' Yellowstone circa 1964 for $700, delivered. It is missing the stove and refrigerator. The table needs to be fixed and some paneling needs to be replaced. The rear window is also missing. But, it is cheap and cute! I'm in the process of installing insulation and plywood paneling ($10 per 8'x4' panel) instead of original birch ($38 per panel). I removed the toilet and sealed some holes - the bookcase will go into the bathroom, now library. My desk will sit at the back of the trailer, facing the rear window. With a coffee maker and cat-5 cable, I think it will work. If anyone is interested, I could post pictures.

Things I want to do before school starts: Fence in the remainder of our lot. There is about 400sf of our property outside of our current fence. This space would be perfect for the office - it would get it out of view of the house. Despite being 'cute' it does take up a good chunk of the current back yard. Complete repairs on the house - the refrigerator ice maker doesn't work, the air conditioner drain is leaking, the tiny deck is falling down, and I would like to put in a vegetable garden.

All this to do, and more but I can't take any conventional time off because that would shorten my paycheck time.

Headed back to school!

Well, I finally got accepted to medical school! I was asked to interview at Touro University in California when a scheduled interviewee canceled. I live 20 miles from there so it wasn't hard to make travel plans on short notice.

It was raining hard the morning of the interview and my little hybrid felt like it was going to be blown off the bridge as I crossed the delta. There were 10 candidates, including myself. Those other 9 were about 1/2 my age but scared out of their heads. As soon as I entered the room, I started talking to them - asking where they were from, how their trip was etc. This seemed to put some at ease but a couple looked horrified. I think they were trying to assess my function - was I a plant? Did the school put me there to judge their worthiness to attend the college? It was pretty funny. I was just as nervous as they were but I have years more experience at hiding my nerves in interviews, public speaking and competition.

When the time came to start the day's schedule, the Dean of Admissions came in to chat with us about the process, even coaching us on the interview we were going to be attending in the afternoon. He assured us that his presence had no bearing on the decision but, looking back I am sure it did. He asked questions of everyone, even putting some on the spot under the guise of 'coaching' us for the interview. In fact, he did this in two separate sessions during the morning. The interview was on a Tuesday and I got my acceptance letter on Saturday. I was shocked; a combination of elation and fear filled my emotions. This combination has yet to fully give way to anything else this summer. Orientation starts Aug 1, classes on Aug 5 - Here we go!!

My PreMed Journey Thus far

I've been keeping a sporadic diary about this journey in hopes that others will find it helpful in some way. The blogs and discussion boards that I follow have been helpful and inspirational for me as I struggle with night classes, nay-sayers, and uncertainty. Now I'm in the application process. I'm suffering from rejection and silence but I don't know which is worse. Here's what I have noted thus far:

2/25/07 Age = 37.5

I’ve been telling my friends and Liz’s family about my decision to do my premedical work and go for admission to med school. I’ve been accepted to the UC Berkeley Extension post-bac program. I just barely made it because of my grades from my UC undergrad Physics program. I am scared to death and constantly worried that I won’t make it. My UC science grades were not great (2.7 avg) but keep in mind that I was taking upper division Physics classes and trying to raise my son who was 5-7 years old at the time and much more of a handful than other children.

When I tell people about my plans to tackle this their reactions range from casual interest to horrified gasps. Most have been supportive but some really become incredulous.

1/14/08 Age = 38.5

I just received my grades from the Biology A lab and lecture, both A’s. I didn’t study as much as I should have but more than I ever did for other classes while in my Bachelor’s degree. I’m still having some doubts about this. This is mostly due to my desire to reduce my workload and increase my free time. This could be construed as ‘lazy’ but I think it is a common desire among all animals; the lion would rather sit in the sun all day than chase its food or defend its territory. However, I am able to imagine what it would be like to not pursue this dream to have an advanced degree. I could go after a PhD or even ‘settle’ for a Master’s degree. But will either of these satisfy me in the long run? I think they would if I were to first prove to myself that I gave it my best shot to become an MD.

10/18/09 Age = 40

It’s been a while since I opened this file and entered some thoughts. I’ve completed my prereqs and the MCAT. Now I’m going through the application process. I only applied to the California schools; UCLA, UCSF, Irvine, UCSD, Stanford and UC Davis. I submitted my AMCAS on Aug 1^st got a secondary from UC Davis immediately and was rejected by Irvine at the beginning of October. Today I got the rejection from UCSF. That one hurt because I wanted to go there most of all. But, I’m sure it’s my grades that are pushing me into the reject pile at these premier institutions. I wrote a letter to the chair of the admissions committee requesting a review of the decision but I’ve already marked UCSF in my list as ‘rejected’. I’ve decided to submit an application to some DO schools, focusing on Tuoro-CA in Vallejo because it is only 30 min from my house. I appreciate the DO mission and philosophy but I can’t help but feel that I’m settling. While my grades match DO school averages, my MCAT score is much higher. I’ve always felt that having to work to put myself through school should account for getting B’s instead of A’s. Yet, I don’t think that the top schools really give a crap about that because they have their pick of the pool of applicants and thus don’t have to make any concessions. I do think they are missing some very good candidates because of this bias – life experience can’t be taught in college and the kids that get into medical school will have to learn about life while practicing medicine.

MCAT Prompt - Dishonesty

Saying that dishonesty is necessary to keep a friendship strong means that there are instances when being honest with your friend could actually damage the bonds of friendship. This usually requires lying to protect their feelings. For example, if a friend loves to wear bright, Hawaiian print shirts that you think are gaudy and over-the-top, it may not serve the friendship to tell them your true feelings. This is an example of lying by omission or, not sharing what you believe to be the truth. If your friend asked what you thought of the shirts and you stated that you liked them, this would be a direct lie; a statement that is the opposite of what you believe to be true. Their common thread is that both require suppression of the truth, be it ones own internal beliefs or omissions and misstatements of fact.

Yet, not all lies are created equal. It is the intent behind the lie that is the important factor in how it effects our relationships. In the example above, if your friend discovered that you in fact hate her shirts, she may decide to wear them more often to annoy you. However, if she discovered that you were making fun of her shirts to others, it could damage the friendship. This brings up betrayal, where the lie betrays the friendship and distinguishes this lie from a benign one that does not.

Usually, dishonesty is not necessary to maintain strong friendships. In fact, it is usually our closest friends who we go to for the truth. Should a friend make an appeal for an honest assessment of their wardrobe, job, significant other, it is the duty of a friend to give them an honest but tempered opinion, to share what they believe to be true or what they know about the situation. This is the true art of maintaining friendships.

In the end, what we choose to lie about and even when we lie to our friends, depends on the nature of the friendship and even our own social skills. Being able to understand your friend's personality, their needs in the moment and the nature of the lie are key factors in making this choice. If your friend is sensitive or fragile in general or even at that instance and the lie is benign, you may choose to lie to protect their feelings. If the lie serves to betray the friend, it would always be better to tell the truth regardless of their emotional state. Being able to rely on someone to know the difference between emotional support and betrayal is what separates 'friend' from 'other'.

MCAT Prompt - Health Care

The writing sample portion of the MCAT gives a prompt that you have to respond to in 30 minutes. I am practicing this and will be posting the results here.

When it is said that "Health care is a right, not a privilege", the implication is that one is entitled to health care by virtue of being part of the group that is to provide said service as opposed to only having access if one has the financial means to purchase the service. In California, employees working for a company that has a group policy have the right to be covered by that policy, regardless of previous medical conditions. However, many companies are charging most of the premium to the employee, which could prevent them from actually affording the coverage.

The key here is to determine what is a "right" and what is not. As Americans, we have several rights delineated in the Constitution, like the right to petition the government, to choose our religion or even to speak out against the government, among others. If health care is a right, then it is something the government can not take away. In this sense, the government can not give citizens their rights, either. As citizens, we are "endowed by our creator" with our rights, not by our government.

Education is a good example of what a right is and is not. In the US, education is not a 'right' as determined by the Constitution. In fact, public education wasn't widely available until the 20th century, before that it was a privilege that only the rich could afford. It was never considered a 'right' of citizenship. However, with the Industrial Revolution and a movement away from an agrarian based system, it was quickly realized by leaders in the government, business and academia that a modern society required an educated citizenry. This paradigm shift away from education as a privilege to education as a necessity for a modern nation has reaped a multitude of benefits for everyone in the US, rich and poor alike.

It is this observation that should be made today about health care. If it is not a right, should it continue to be just a privilege? Can a modern nation continue to function without its citizens having access to modern medicine? Education is only one example, others include clean water, sewer systems and roadways. These are not rights but necessities to promote the general welfare.

Taxes and Bailouts

The bailout of the financial industry is a great example of why we need to have progressive taxation where the top of the income food chain pays the most. In this age of tax cuts for the wealthiest Americans, we are quickly moving to a non-progressive tax system. The middle class is being asked to shoulder the bulk of our government while the wealthy take huge risks just to be bailed out by us, the middle class. This is what is referred to as "Private Profit, Public Risk". Don't let them dazzle you with the BS of the "Free Market", there is no free market nor should there be. Markets need regulation and unbiased institutions to keep them honest so that people feel confident enough to invest in them and have a place to go if they are ripped off. And now, a program to bail them out when they fail. These are the jobs of government and the wealthy should shoulder the costs. Think about the bank teller who's job may be saved or the consumer who can now get a car loan, they both benefit from bank bailouts. Now compare their 'benefits' to that of the CEO, CIO, Controller, major stockholders etc who are bailed out - they get Millions! Should the consumer and teller pay the same percentage in taxes? Should we be sticking with the Bush tax cuts where the top 1% got the biggest cuts? Or, should we go back to the tax rates under Reagan, Bush Sr., and Clinton? The top payed 34-35% and the capital gains and inheritance taxes were higher. The Republicans like to say that taxes are always bad and hurt the economy, but tax cuts don't seem to be doing much now, except padding the pockets of the wealthiest.