4th Year: CHECK! MD without the .

July 3, 2016 § 8 Comments

Skjalg told me that he’d heard that you get the “M” after the first two years, the “D” after the second two, and the “.” when you graduate. So, we’re officially MDs!

It’s been way too long since my last post. After Moscow I only had a week and a half before my next pharmacology midterm. It was a big deal for me because we needed over 80% on both midterms in order to qualify for the competition at the end of the semester. I put so much time into my pharma studies that this was probably the most important thing to me. I wanted to know it in and out and prove my knowledge to myself by passing the competition. The studying for the midterm paid off and suddenly there were only 2.5 weeks left in the semester. In true Semmelweis style, we were overloaded with mini-exams/competitions/papers, etc. at the end of the semester. It’s worse in the first two years – mainly due to the lab exams and the third round of midterms – but it can still be quite heavy depending on the amount of electives you have. I spent so much of this semester trying to master the new topics that I didn’t really get to review too much of last semester’s topics. As I write about it now, I feel as though I should have had enough time….but I promise that I did the best that I could with the time I had. So, I had less than three weeks to prepare for the competition. Weeks peppered with various exams, classes and other extracurriculars, like helping out with the anatomy competition and tutoring.

The competition took place on the last day of the semester. I had been through the topics twice and had a strong general knowledge of the subject. In the hours before the exam, I went through questions in BRS and Katzung and got around 75-85% of the questions right. I was at a point where I actually felt excited for the competition.

We were only ten English students, maybe four German and up to maybe 80-90 Hungarian students there that day. I sat in the front – as I usually do during exams, so as not to be distracted – and felt my throat cramp into a knot. When I opened the exam and started reading through the first questions, I felt like the blood had been drained from my body and replaced with adrenaline. Everything looked foreign. It was like I’d never studied before.

We had 60 minutes for (if I remember correctly) 60 questions. Normally, I go through and answer all the questions I can really quickly, go through a second time and answer the ones I marked for later, and finally a third time to check my answers and answer any stragglers. This exam was not like that at all. As I moved onto each new question, without having been able to answer the one before it, I completely lost all my confidence. I tried starting from the back, returning to the front again, jumping to the middle – nothing worked! I found a chunk of five or so questions that I felt I could answer correctly and gained back a little of my self-esteem. I looked at the clock. Thirty-five minutes had passed. I’d answered five questions in 35 minutes. I began to panic and started looking through the questions again. The answer choices were mixed with drug names/features from different drug groups/topics so they took a while to process. For example, it’s easier to pick out the drug with “anti-hypertensive effect” from a list of drugs acting on the cardiovascular system than a list of drugs from entirely different systems. There were also some questions that were, I thought, ridiculous. For example, “Which of the following drugs has the highest molecular weight?” followed by a list of just names of drugs. Molecular weight was not something we were expected to learn. It’s enough of a mind melter to remember the group, the physiology, the names, the mechanisms of action, pharmacokinetics, effects, side effects, drug interactions and contraindications. As a doctor, molecular weight is not something that trumps the knowledge of how the drug works, how it will help my patient, any side effects it may cause, how it may interact with other drugs, etc.

When I looked at the clock the second time, I only had twelve minutes left. Twelve minutes to answer maybe 25 or 30 questions. In those last minutes before the end of the exam, I was at a point where I was just selecting answers at random. It’s something I hate to do and something I can’t remember having done since first year. It hurt more knowing how much time and effort I’d put into it and how easily that confidence was taking away from me.

I had my exam six days later. They never posted the results of the competition, so I never found out my score. I had to ask my Hungarian friend Cintia if she knew anyone who had taken it and if they had any information. She told me that one of the guys in her dorm passed the competition. The winners had been notified by email. All were Hungarian and all were from medicine. No English, German or dentistry students made the top 10. (Edit, April 15, 2017: There was at least one English student who passed).

The days before the exam were not what I wanted them to be. I’d lost the excitement that I had before the competition. Instead, I felt defeated. I tried to motivate myself, but I was just too tired and was dreading the four weeks of exams that lay ahead. During the semester, I’d put absolutely all of my focus on pharma. Once that exam was done, I knew that I would pretty much have to start from scratch for the rest of my exams. Only my friend Amir and I took the exam that day. It was the same day at the one-time-only written exam for Bioethics, so the rest of the class was there. All 180-190 of them.

Our examiner was an older woman. She was kind but stern, a perfect mix of both. She and I did not communicate well at all. I tried my best to speak slowly and clearly, but she still misunderstood me and there were points where she would ask me questions that I had already answered. Those are the worst because it takes you forever to figure out what they want. You know you’ve said it already and don’t realize that they didn’t hear it, sometimes until it’s too late. The same thing happened to me in my pathology exam.

The topics I got were also quite…weak. All three of them were from the first semester and they were kind of “leftover” topics. The ones that don’t really have a place and are kind of thrown in at the end. They lack a system and are therefore just annoying. I’d gone through them, of course, so it wasn’t a problem recalling the information. But they weren’t the kind of topics that you could impress with. They weren’t topics that I could use to really show my knowledge – especially when an entire semester of material wasn’t even relevant! Together they represented maybe 0.5% of what we needed to know for the exam.

I was exhausted, defeated and stuck in my own head. I feel locked inside myself. Unable to show what I really knew. To convey the effort that I had put in. To prove my knowledge. On my third topic, I made a huge mistake. I said that clindamycin was a beta-lactam antibiotic rather than a protein synthesis inhibitor. This was an example of an answer where I used no logic whatsoever and was simply going off of visual memory. In my notes, there are 6 drug groups for both beta-lactams and protein synthesis inhibitors. I rushed and went with the first list in my mind, rather than giving myself time to think it through. Amir would later tell me (when I asked him to give me constructive feedback on my performance) that I need to become more comfortable with silence and let myself think. He told me that I answered immediately almost every time, rather than giving myself the opportunity to find the right answer in my mind. When I made this big mistake, the examiner flew back in her chair with an almost offended look on her face. At that moment, I thought she was going to fail me. It would have been the first time I’ve ever failed an oral exam in my entire time here at Semmelweis. “What mechanisms of actions do you know for antibiotics?” she asked me. I then proceeded to list out every group and every mechanism of action. At the end she told me that I was lucky that she was able to find the right answer in my head.

I ended up with a 3 on what was probably my worst oral exam ever. Rather than feel happy that pharma was over, I felt totally empty. I made up my mind that I was going to retake the exam. I was going to subject myself to the stress all over again. I waited almost 45 minutes for Amir to finish his exam and was beating myself up the entire time. The amount of work and effort I’d put in to pharma…all of that time and energy…and to walk away with the 3? It felt horrible. Countless hours, study group sessions and 538 pages of notes (I know because I took pics of them so I can have them in my iPad) – all felt worthless in that moment.

Here’s a taste of some of the pharma madness:

After talking it over with Amir and Skjalg and getting this perfect message (below) from my friend Andrea, I decided to accept my 3 and move on. I still love pharma and taking the exam over again may make me hate it – and I don’t want to risk that!

“Bianca WHY would you retake it?? A 3 is absolutely acceptable, and the most important point is that you know this so well! Had you gotten a 3 but were actually lucky because you should have failed, then I would understand..But putting yourself through so much stress again only for improving the grade seems unnecessary. I’m so sorry that you had a bad experience! Student X also had (the same examiner) and said she was difficult…she also got a 3. I don’t mean to tell you what to do. But please reconsider if you need to do it. It will make no difference to your future patients. I know you know this so well and I am so confident in your capabilities in pharma and on any other professional area.”

The following week I had my written public health and orthopedics exams. Studying after pharma was like trying to push through a marathon without having trained properly. Public health and I have a strange relationship. My teacher last semester was…let’s just say not motivated and after getting a 2 on the semi-final – my first two since first year! – I knew I had to make a change. I switched teachers and put in more personal effort this semester. It’s unfortunate because it is such an important class and yet most of us won’t realize its importance until we are practicing physicians. So, how did it go this time? Another 2!! Then, a 3 in orthopedics the next day. At that point, this was shaping up to be one of my worst exam periods. That Thursday, I hit an ultimate low point. I felt miserable in literally every aspect of my life and felt like the thing I was putting all of my effort into – school – was pointless. How could I work so hard and do so poorly?

After that, I had my ENT exam. Despite my weak start to the exam period, I pushed through and came out with a 5. I got the head of the department, who was a bit tough and demanding, but also easy to please. To start the exam, we drew two cards with so-called “minimal criteria” topics. These must be answered immediately – no time to think or process. After that, we drew two more cards with topics. We had over an hour to prepare these, which was more than enough!

The “minimal criteria” is a list of 32 or so items that we need to be able to repeat verbatim. They are the minimal points in the field of ENT that we should know as medical doctors. I’d come up with some memory tools for them and they proved to be extremely helpful. I even ended up sharing them with the rest of my class and got a lot of positive feedback. One of my friends told me that when she took the exam later that week, that everyone had a copy of the memory tools. Memory tricks go a long way!! Here’s an example of some of them:

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After ENT, I had two full days to prepare for my oral exam in bioethics. Since Amir and I had taken our pharma exams on the day of the written exam, we were the only English medical students who had to take the exam orally. I have to say that I absolutely loved studying for this exam. It answered a lot of questions I’ve had through medical school and it was really interesting to view medicine from a different perspective.

Once in my exam, I did something I’ve never done before: I started talking about my topics without writing anything down. I like writing everything down for two reasons: (1) It gives me time to really think about my topic, to remember the small details and make plenty of drawings/graphs, etc., to really turn it into a presentation, and (2) It gives them something to look at, read and process if for some reason they don’t understand what I am saying. The language barrier is not usually a problem, but I like to have the support just in case. I have a tendency to speak very quickly and even though I slow it down to a totally unnatural level (for myself, of course) during exams, sometimes it’s still not enough. This time, however, I felt it was an exam that should be done as a pure conversation rather than a presentation. After five or ten minutes it was over and I was out with another 5. Things were finally starting to look up again.

The following week, I started my surgical practice at the same hospital where I’d taken my surgery course this past year. I still had my surgery exam left, but my teacher said it was ok to start the practice early. We have to do a 4-week practice each summer and since we have to work, we wanted to get it done as soon as possible. The more we can work, the better!

I ended up taking my surgery exam a week into the practice. My topics were inguinal hernias and rectal carcinoma, which I’d seen plenty of times in the OR by this point, and I really got to showcase my knowledge about them. My examiner was the same doctor I’ve had as my teacher this past year. At the end of my exam, he told me some things that really warmed my heart. It felt like I was getting back to the student I want to be rather than the version I was at the beginning of the exam period. He told me that he was proud of me, that our group was a pleasure to teach and that I would make an amazing physician no matter what specialty I choose. Those words meant so, so much to me. I’ve always admired him, both as a surgeon and a teacher, and it feels good to know that I made him proud.

Even though my exam period was officially over at that point, I decided to go through with a little project I’d been working on: retaking my public health exam in order to improve my grade. During the semester, my teacher (who is the head of the English program of public health) offered me a research position with them and offered to be my thesis advisor. Thus, getting yet another 2 in Public Health did not sit quite right with me. I’ve never retaken an exam to improve my grade before, so I didn’t really know what to expect. The public health exam is written for the first attempt and oral for each subsequent attempt. The topic list was intimidating! There were 69 topics and I honestly had no idea how far to go with some of them. I ended up writing a book – pretty much – for half of the topics and then had to copy-paste from WHO, CDC, etc., for the remaining ones.

On the day I took it, I had to wait for all of the Hungarians to be examined first (their public health exams are only oral, never written. I got there at 9:00 and didn’t have my exam until around 13:00/13:30. Thankfully, I brought some protein pancakes, water and some caffeine to keep me functioning while I paced around like an insane person and powered through my notes Rain Man style.

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My teacher picked my topics out of the envelopes for me. When I saw the third one, my heart jumped. I didn’t recognize it! I realized then that I had been using the wrong topic list while studying! I told him this and he told me that I should just do the best I could. The first topic was perfect. Why? Because I had done a presentation on it this semester. It was on poliovirus and rotavirus. The second was “Occupational disorders related to air compression. Vibration and noise.”. The first part had not been on the topic list that I had studied from, but vibration and noise I knew well (thankfully!). The third and last topic was “Secondary prevention. Sensitivity and specificity. Lead time bias.”. I had the first part of the topic down, was rough on the second (despite the fact that sensitivity and specificity are brought up constantly in diagnostics *bow head in shame*), and had no clue how to start with the third. I started preparing the topics and then asked if he wanted to switch to a conversation-style so that he could save time (he had been examining people all day without a break and I didn’t want him to be irritated with me for writing for too long). It’s funny how things can click when you talk about them outloud. It’s like when you ask someone a question and your brain comes up with the answer in the same moment that you ask it. That was how this exam played out for the third topic – thankfully! After all that effort, I finally proved myself in public health. It felt so good to redeem myself.

At the end of it all, I ended up with one of the best GPAs I’ve had. It would have been the best – maybe even perfect – had I done better in pharma and maybe retaken ortho. But I’m happy with the result. It represents the hard work and the room for improvement.

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Now for a random picture section with pictures from the past two months. Lots of studying, healthy meals, walks in the sun and studying, did I mention that part?

Enough of a update for today I think :D. For those of you that have managed to stay with me, here is a little treat: Skjalg’s first Vlog! He’s decided to do one Vlog a week. I love it! It’s such a great way of summing up the week. Here you can see what our last week in Budapest was like:

7th semester: check!

January 26, 2016 § 1 Comment

We’re just a little over halfway between my last exam and the start of a new semester. In the past week I’ve slept as much as possible (in my best efforts to force away the post-exam period hangover), gone on a weekend trip to Amsterdam with an amazing group of friends and done a Making of a Murderer marathon.

The last couple days before my last exam – pulmonology – were really, really tough. I’ve been going so hard for so long that I was just absolutely, completely depleted. Having to live the same day over and over and over again for weeks is a special kind of torture. Get up, sit down, study, freak out, study, coffee, study, sleep, get up, sit down, study, etc. On the Saturday night before my exam, slow streams of tears began falling from my eyes. I wasn’t scared or stressed or panicking. It was simply because I was so, so tired. The idea of having to push myself further when I felt the way I did was an impossible task in my mind. Luckily, I’ve been through this before and know some tricks to keep pushing forward. On Sunday afternoon, Skjalg sat down with me to do an amazing thing: let me explain each and every single one of the topics to him. We sat for a total of 10-11 hours and actually managed to go through all 55 topics. I don’t think I could have done it otherwise. Sometimes, being alone while you are studying is the worst thing you can do. It lets the crazy take over and slow you down!

I slept about 5 hours before that exam which, if you’ve been following me this exam period, you know is more than twice what I normally get before exams. My friend Andrea and I took an Uber up to the exam. There was a strike against Uber that started that day, so it was a bit of a stressful start to the day. Cabs were parked in the major intersections of the center and the Uber driver couldn’t get to me. Andrea had to fight him to wait for me rather than leaving me behind. Such a dramatic situation!

I’m still not used to being examined in the actual hospital. It’s such a strange feeling to pace back and forth in your suit and heels, muttering your notes under your breath Rain Man style, while sick patients and their families wait nearby. I usually try to stay as out of the way as possible. One thing about Hungarian patients in that they are generally very sweet. I remember after my internal medicine exam last semester, a patient stopped me to ask me how my exam had went. She had such a huge smile on her face and seemed so generally invested in how it had gone (she had seen me reviewing for the 2-3 hours while I was waiting). When I told her it went well, she was so happy and squeezed my hand.

My heart dropped when I read the list with the our names and our assigned examiners. I’d been assigned to the exact examiner I had absolutely hoped not to get. She is…special, to say the least. I don’t know how, but it went really well – which I was so, so happy for! On the way out, I noted that I felt nothing. No relief, no sudden burst of emotion or happiness. In my mind it was just one more down and however many more to go.

I wasn’t able to sleep when I got home, so I watched movies instead. That night, we met up with some friends at this amazing new tapas bar called Vicky Barcelona. After some amazing food and company – and several glasses of sangria – I was finally ready for my post-exam crash. I’m usually a total zombie for a few days after my last exam. I have a tearing headache, my eyes feel swollen and I have no energy to do anything. This weather doesn’t help either!

On Thursday morning, we flew out of Budapest on the 6:00 flight to Amsterdam. The trip was absolutely fantastic! Skjalg and I stayed in a charming boutique hotel along one of the canals while the rest of the group rented a 3-story apartment in the city center. I’ve never been to Amsterdam before and I have to say that I think it is my favorite out of all the cities I’ve ever been to – even in the winter! It feels like a beautiful, giant village, like you’re walking around in one of those miniature Christmas towns (which I love).

We got back early Sunday morning and decided to close out the trip with lunch at Vicky Barcelona. After that it was home to watch a movie and relax. I had no plans on napping (didn’t want to ruin my sleep) but half way through the movie, I feel asleep and didn’t wake up for another three hours!

Yesterday, Stephanie and Amir came over and we did a 12-hour Making of a Murderer marathon. It was cold and grey out, as it has been, so it was a perfect day to stay inside. I made banana bread and corn bread and we munched on some delicious Dutch cheese we brought back from Amsterdam. Life after exams is not bad at all!

I’m still not 100% recovered, so I’m going to call it a night for the blogging. I will make a post about our trip to Amsterdam and another one about my exams (for those of you who are interested in how those were). Now, I’m off to work on some of your emails!

The courageous venture into the unknown; the persevering conquer it

June 13, 2015 § 3 Comments

Last I wrote, I was preparing to tackle the monster that is the microbiology final. How did it go? To my surprise, really well! Afterwards, I was in a bit of a state of euphoria and while in that state, decided that I could handle moving my psychology exam to that upcoming Monday (so a week earlier than originally scheduled). That meant micro on Friday, psychology on Monday and internal medicine on Tuesday. I will write more about the exams themselves in another post when I have more time and energy.

I didn’t expect to be as burned out as I was after micro. I went to the library on the Saturday following my micro exam, but my brain was as good as useless. I wasn’t really able to get any studying done until Sunday night – and that’s when I started really feeling the effects of being so burnt out. But still, I pushed through as hard as I could. On Monday night at around 20:30 I sank into a deep panic and almost made the decision to not even go to my internal exam. I’ve never done that before and honestly never would – you never, ever know what is going to happen – but that is the closest I’ve ever been. After some motivating words from my friends Jannie and Amir, I made a plan to get me through the next 12 hours. I forced myself to read through the topics once and then mark the things I needed to memorize the following morning. I ended up “sleeping” from around midnight until 3:00 am and then got up to do whatever last minute cramming I could manage. The hours after 3:00 am were probably the worst I’ve had to endure this exam period. I felt like I’d pushed my body to the absolute brink and knew I would have to pay for it later. At least the sunrise that morning was beautiful.

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The exam ended up going really well – yet another surprise! – and with that I was on my way home to collapse in bed. From Tuesday afternoon until Thursday night, I wasn’t able to get out of bed. I suffered what was probably the worst headache I’ve ever had in my life and felt like I was going to faint every time I stood up. My brain had held my body hostage for weeks and now it was time for my body to hold my brain hostage.

I’m more or less recovered now, which is great because there is still one more exam before I can fully check out! I’ve been sleeping almost 10 hours a night, plus naps during the day, and even made it to the gym for an hour of cardio this morning. My head is still quite foggy, which makes studying a little difficult. Hopefully I can push through these last few days!

As for Skjalg, he conquered patho and internal this week and has micro, genetics, surgery and psychology ahead. I still can’t believe how crazy this exam period has been! It will be so nice when it is over and we can enjoy ourselves again 😛

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Blog post title: quote by Matshona Dhliwayo

Yet again, into the fray…

June 4, 2015 § 1 Comment

Three weeks into exam period now and I’m having a hard time remembering what day it is and honestly sometimes even which month. I no longer think in proper days of the week or hours of the day. Instead, it is number of days until my exam or number of hours until one less day until my exam. Exam period is so utterly, unbelievably consuming. It’s like running a sprint for the length of a marathon.

Tomorrow afternoon I have my microbiology final. I originally had it at 8:00 am, but since I’ve been staying up quite late, I thought it would be best to push it to the afternoon. Might help to have a least a few hours of sleep. My days are monotonous and heavy. I wake up around 8, have breakfast and coffee while watching an episode of Modern Family and then I sit down to study. There are some breaks during the day, usually a 5 minute pep-talk with Skjalg or grabbing something to eat or drink. I usually hit a rough patch between 17-21, where it feels like I am running on fumes. If there is any underlying panic, this is usually when it gets fed. After, I hit a bit of a power streak that can last until somewhere between midnight and 2:00 am.

My pathophysiology final last week went surprisingly well and I promise to write more about it either tomorrow or Saturday morning. I also have probably 20 emails to respond to from some of you – I haven’t forgotten! It just takes time to read them all and write my reply and I don’t want to do it in haste.

For tomorrow’s exam, I will draw a card listing 5 topics from a total of 165 topics, divided up into 5 separate sections: (1) General Microbiology and General Bacteriology, (2) Systemic Bacteriology, (3) General and Systemic Virology, (4) General and Systemic Mycology and Parasitology and finally (5) Summary: Clinical Microbiology and Microbiological Diagnostics. If you’re curious about the topics, you can look at them here: FGM_FINALEX. By the end of tonight, I will (hopefully) have been through each topic at least once (two times for most). As always, that doesn’t feel like enough. The topics I covered last week are hardly in my memory anymore and everything feels like it is getting all jumbled together.

My positivity is starting to wane…back to the books I go. Hopefully I will have good news to report tomorrow!

I have my favorite Comptine D’un Autre été L’après-midi by Yann Tiersen on repeat to keep me company (and sane) through the night:

From Liam Nesson's movie, The Grey

From Liam Nesson’s movie, The Grey

Maybe

May 24, 2015 § 4 Comments

Sunday night and the cool night breeze flowing through the apartment carries with it the sounds of summer. It is a holiday tomorrow so the vibe in the city is that of a second chance at Saturday. Yesterday Jannie and I studied at Costa Coffee for 12 hours straight, taking a break only to meet Skjalg for a quick bite at Burrita. Today was/is an inside day for me, though it doesn’t feel like it with so much life outside.

For the past few hours, I’ve felt like I’m studying in a latin night club. There is music playing in the park and I imagine plenty of dancing to accompany it. I had planned to go and investigate a little further, but study-guilt had kept me glued to my seat.

I have two more days until my pathophysiology exam (I’m pretending only one, so that I am actually excited about the “extra day”). I’m not feeling too good about it, which is no surprise at all. I’ve had such a foggy head since pathology and have been so absolutely exhausted. Yesterday was really the first day that I was able to sit down and critically analyze and process information. I’ve been sleeping a decent amount (around 7 hours) and practicing keeping a positive mind-set, but stress still lingers in the shadows. The ferris wheel in the park changed direction today and when it did, I spent the following 30 minutes thinking I’d lost my mind. It’s been running every day for the past two or so months, from 7 in the morning until midnight or even later – and always in the same direction! It’s with me when I study and I watch its lights flicker through our curtains as I go to sleep. Seeing it spin in a different direction makes me feel like I woke up in a parallel universe. Maybe I did…

Sometimes I feel like exam period is like getting caught in a series of waves at the beach. You get pulled under and tell yourself it’s ok, you’ll surface soon, but when it goes too long you panic a little at the thought that it might not be ok, that maybe the wave will keep you under too long. Then you surface and are relieved. That was a close one, you think. Then another one comes and the same thing happens. And again, and again, depending on how many exams you have and how big they are. To keep my mood up, and I guess you could say my head above water, I’ve been listening to some of Alan Watts talks on youtube. I find his voice and words extremely calming – and so, so fitting for how I feel during all this. Sometimes his words resonate so perfectly with my thoughts, that they melt away. There is something so comforting about being reminded that you are not alone during a hard time and that your worries and fears are not unique. These are some of my favorites:

This past Wednesday, Skjalg and I met with Amir for some celebratory drinks at 360. At least we’d planned to go to 360. When we got there, we were told that they were closing because of the weather. At that point, the sky didn’t show more than some odd layered clouds with scattered dark swirls. We turned back towards Deak and ended up at Skjalg’s favorite: Boutiq’. We enjoyed some creative cocktails and then called it an early night (can’t relax too much in exam period). When we emerged, we were met with a beautiful stormy night sky. I absolutely love summer storms, so I was a little sad that we had been hidden deep inside Boutiq’ rather than front and center for the show. Luckily, I got to see some pictures. My friend Jules took these gorgeous, perfectly timed shots:

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Today, this amazing shot popped up on facebook, click here to read more about how the photo was created.

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Ok, back to studying for me. It’s already 22:00 and I still have a lot to do before bed. Wish me luck! And motivation…and a clear head! 🙂

Here’s a last little Alan Watts video, light and short but sweet and deep at the same time. It inspired the title of this post.

 

Pathology: CHECK!?

May 20, 2015 § 6 Comments

Yes, you read that right: I AM DONE WITH PATHOLOGY! I had made such peace with the idea that I was going to fail and it didn’t happen!

The exam is split up into 3 parts, two practical and one theoretical:

Part 1: Autopsy

When I entered the locker room, I was told, “We’re all getting Dr. X”. Dr. X is probably my favorite lecturer, but I had been dreading getting him at the exam because I’d heard that he really likes to drill the students. He told us in lecture once that at the final exam, we should be able to do things like group all the tumors by their color. He is extremely systematic, a feature I love in a teacher and fear in an examiner. Having a systematic method while studying is great, but being forced to be systematic on the spot, in the context of a final exam, can be difficult.

I was so resigned to having to retake the exam, that I didn’t feel nervous at all. “I’m going to go in there, give it my best and really learn from the experience,” I told myself, “then I’ll know how to prepare better the next time around.”. We were called into the autopsy room in groups of 5. Awaiting us was a similar sight: the autopsy examination table displaying the different organs. I was actually able to find photo of the room online. The picture is quite small, but at least you get an idea. Usually, there are two or three mobile metal tables with the cadavers on them in the middle.

We were each assigned an organ and I ended up getting the one I wanted the least: the urogenital complex. It includes the kidneys, the prostate and the rectum of the patient. We were allowed about 5 to 10 minutes to look over the organs and note any changes. I got a little nervous at one point but quickly calmed down and told myself to focus on the pathology and not the outcome. Dr. X called my name and asked if I was ready. Now or never!

I described the morphological changes and answered any follow-up questions he asked. The organ complex showed pyelonephritis, nephrosclerosis and cystic lesions on the kidney, benign prostatic hyperplasia (I had to explain how I knew it was hyperplasia and not carcinoma), with compensatory hypertrophy of the urinary bladder (trabeculated) and adenocarcinoma of the rectum. There were some things I fumbled on, like the term hydropyonephros, but other than that it went very smoothly and I ended up with a 4/5.

Part 2: Histology slides and Specimen

For this part, we moved on to the histology lab. The room was full with students and examiners, so I had to wait for a few minutes outside. We were only 11 English students being examined that day and maybe 30 Hungarian.

I was escorted to a computer and the technician helped me log in and open my slides. My heart dropped a little because I hadn’t reviewed the slides I ended up getting. Rather than letting that get me down, I reminded myself yet again to focus on the pathology and not the outcome. In our last histology practice, our adjunct professor told us, “We know how hard the histology is, trust me. Sometimes, we don’t even know the diagnosis when we first see it. It takes a lot of time and a lot of practice. What we want to see is that you know how to use proper histological terms to describe the changes and that you can use your pathology knowledge to properly diagnose the tissue sample”. We have covered 121 slides in these two semesters and get 2 at random at the exam. The only information we are given is which tissue the the slide came from.

I ended up with one from the colon (coincidentally adenocarcinoma, just like I’d had in the autopsy room) and one from the lymph node. When I felt I was ready, I raised my hand for one of the examiners. Once she had seated herself beside me, I began describing the tissues, first describing how the normal tissue should look, then describing the morphological changes and finally linking those changes to my diagnosis. I made sure to sort of guide her through my thought process while showing her the slide at the different magnification levels. (These are screenshots of the slides, with notes written by the fantastic Charlotte.)

For my specimen (we get 1 out of a possible 60 or so), I got this beauty: the hydatidiform mole. It’s a tumor of the cells of the placenta. When I saw it, I actually got quite excited because it meant that a new study trick of mine had worked. For the past several weeks, I have kept a google image search of whatever disease I am covering theoretically open on my screen. That way any time I look up, I have a visual association with the disease. I remember this one well because it is so creepy looking. It looks like a bunch of grapes! If you want to see another tumor with “bunch of grapes” appearance, check out the female genital tumor: sarcoma botyroides (be warned!).

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Everything went very smoothly, save for some little fumbles, and I ended up with a 4/5 for the section.

Part 3: Theory

This is the part you have to worry about. You can fail the other sections and still pass the exam, but the theory is the big one. We ended up having to wait quite a while before we were called in to our exams. I don’t think I was called until around 12:30 (and the exam started at 8:00). During that time, I tried reviewing some topics and keeping calm. I just wanted it all to be over!

I was assigned to the same examiner I’d had for the semi-final. Her topics (each of the professors have their “topics” that they are especially adept in) are hematology and oncogenes. For the semi-final, I’d struggled with my topic on oncogenes and it ended up being the reason I’d gotten a 3. That was an experience I was hoping not to repeat at this exam.

When I pulled my cards, the smile quickly dropped from my face: (A) Autosomal Dominant Diseases, (B) Oncogenes and their role in carcinogenesis, (C) Inflammation of the Trachea and Larynx. (A) and (B) were both topics that I was not looking forward to having to answer – and (B) was a serious deja vu!

For topic (A), I talked about Huntington disease and Marfan syndrome in detail and then mentioned osteogenesis imperfecta and adult-type polycystic kidney disease. She wanted me to describe the genetic alterations, pathological consequences, clinical manifestations and treatment for each and then wanted me to mention familial hypercholesterolemia and its complications.

Topic (B) was where it went downhill. This was one of those topics that I kept telling myself I needed to commit to memory, but really only superficially covered. I’ve watched videos on it, taken notes and even have a chart hanging up in my study area. Still, my brain was coming up with very little of what I should know. I tried to recall everything I could, but she was quite picky on the topic. Had I memorized this table, it would have been perfect, because this is exactly what she wanted:

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From Pathoma (board review for pathology)

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Biancafied!

 

Towards the end of this topic, she seemed pretty disappointed and said, “Ok, let’s talk about lung cancer”. My teacher is the “lung” expert among the professors, so I had no problem listing out the classification of cancers of the lung. But then she asked me about the oncogene related to adenocarcinoma of the lung. When I couldn’t answer, she got a bit upset and told me that she is sure my teacher has mentioned it before and that I should know it. This is what she was referring to:

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She shook her head, waved her hands in the air and told me that the 3rd topic would determine my grade. No pressure! Topic C was easy, but that was it’s problem…it was too easy! It’s one of those topics that feels so unimportant that you kind of jump over it. Luckily, I’d looked at it the day before. Unfortunately, it wasn’t a juicy enough topic to showcase my knowledge. Here is the topic I got plus another one just to show how much of a difference there is between them!

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My topic above, versus another respiratory topic below. Which would you prioritize? 😉

I ended up with a 3, again. I’m a 50/50 mix of excited to be done and disappointed in myself. But I’m not going to dwell on it. I worked hard, I’ve learned a lot and I have a lot to learn. These topics will be repeated over and over again during the next three years, so I will have plenty of time to get them down.

A lot of growing and self-reflection accompanied this exam and I am stronger for it. I have some improvements to make but appreciate that I have the opportunity to do so on my own time.

Skjalg’s pathophysiology exam went well, so we celebrated with some wine down by the river.

Here are some snapshots from this past week:

My study cave :D

My study cave 😀

Joshua (the teddy bear that my mom got at my baby shower - yes, he's that old!) helped me review topics. Needed someone to explain everything to ;)

Joshua (the teddy bear that my mom got at my baby shower – yes, he’s that old!) helped me review topics. Needed someone to explain everything to 😉

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Spent the last day before the exam studying outside at Starbucks

Spent the last day before the exam studying outside at Starbucks. Nice to get out every now and then!

Our celebratory wine and snacks by the river 😀

Bye, bye patho!!!

Hello, pathophysiology!

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Pathology, oh, pathology…

May 11, 2015 § 4 Comments

One week out from my first final and I can feel it in my entire body. For the past three days, I’ve done nothing but sit in my little study spot and push myself through topics. After so much work, I find myself already completely exhausted. And tonight, is the pathology competition.

I should be doing everything I am to cram for it, and trust me I will, but only with the time I have today. Last week, I had a goal of finishing 90 topics (we have 191 total), which I then had to adjust down to around 60, and I even fell short of that goal. Yesterday, I had to make a decision: give it everything I have for the competition, with what time I had left, or aim at finishing my topics. With the stakes for the competition being so high, I decided to go for the latter.

The competition will consist of 8 cases with 10-15 questions each. One teacher told their group that there will be 6 more normal cases and 2 really strange ones. Only the top three will get a prize: the first gets exempt from the entire exam and the second and third get exempt from either the theoretical or the practical portion. There is also a rumor going around that anyone that makes it into the top 10 will have a “nicer exam” based on their performance.

I really, really wanted to go for the competition, but I didn’t want to put everything I had into it and then fall short, leaving me with only 6 days to prepare for my final exam. In the beginning of the semester, the head of the department mentioned a book of cases available only in Hungarian that they soon would be translating into English. A couple of weeks ago, I heard that the cases for the competition would be taken from this book. I bought it (in Hungarian) and sat down with a plan to go through 20 a day for 20 or so days. The first two: took me 5 hours! I remember that night well because Skjalg and I got into a big discussion about my beliefs about what is possible or not. Even though I knew it was impossible to go through 290 cases in Hungarian in just under 3 weeks, I couldn’t stop myself from feeling like I’d failed.

We ended up finding someone who was willing to translate the cases, but that plan fell through. So, the cases have just been waiting there, taunting me.

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I’m feeling so scattered at the moment, so I really don’t know if this post is making any sense. The reason I started writing (rather than sitting down to start cramming) is because I felt the need to mentally prepare myself for today. I am so used to giving 100% of myself to my tasks that I have a really hard time when I can’t. The hardest of all is when I’ve made an active plan not to. My natural instinct is to feel like I’ve failed, so I need to work against that and look at the good. I made the decision to prioritize topics over the competition. Studying for it today will be a benefit to me – no matter the outcome – because I will have to apply my knowledge in a different way than I have been doing. It will allow me evaluate the practical use of my knowledge and give me an idea of where my focuses need to lie in these next days before the exam.

It’s hard to put so much work into an exam and not be assured that it is going to go well. For the past few weeks, I’ve done nothing but study patho. The idea that that still may not be enough makes my stomach turn. Still, this is a mountain and the only way I’ll climb it is my taking it one step at a time.

This is what my weekend (or life) looked like this past weekend. I really enjoyed the clouds – as you can tell!

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So strange that this much time, work and energy can still feel so inadequate…

Whenever new students ask me for tips, the first thing I say is, “Evolve, constantly.” This is actually something that I have struggled with myself quite a bit. I never really know when enough is enough and rather than thinking “they seriously can’t expect us to know all this”, I think “why can’t I get all of this in my head?”. My friend Amir said something really good that I’ve been repeating to myself, “I’m a medical student, not a parrot”. I like that way of thinking and believe it to be true, I just need to figure out how to gain confidence from it.

The reason I brought up the “evolve” idea is that my notes for this exam are a perfect example. I’ve gone from doing 1 topic a day to having to cram in maybe 10 or more. I’ve had to sacrifice doing the topics the way I would if I had all the time in the world for progress. In the end, I’ll never have all the time in the world, so might as well learn that lesson now.

In the beginning, I typed up lecture notes and topics in my iPad.

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Then I started writing them all out by hand, making sure to make plenty of charts or diagrams to make the information more fluid (at least for me):

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Then I thought I should go back to doing it on my iPad – but this time print out the notes. This ended up being too time consuming and honestly, I can’t afford to pay for that many color copies!

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Finally, I found something that worked. There are two sets of “notes” made my previous students. One is by a girl who recorded the lectures and has created topics based on those, while filling in from the book. She’s squeezed most of them onto 2-4 pages, so sometimes I have a hard time following the structure. The second is by a guy who made summaries based directly on the book, with some input from lecture. What I do now is read the topic in Robbins, while following the summary and adding in my own notes, then check the organization of the topic in BRS and then create my own little summary page of the topic. Finally, I look at the first set of notes to see if I’ve missed anything. While I’m preparing the notes for a topic, I’ve also started a habit of googling the disease and leaving up the image search on my screen, so that I look at it while I’ve coming the topic.

For this one, I was still writing out too much info

For this one, I was still writing out too much info

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My summary page…

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…and an example of the typed summary with my notes added

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Ok, getting too anxious now! Off to cram, go to lecture, go to class, cram, then finally challenge my knowledge. It’ll be great no matter what happens 😉

 

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