The Differential: Medscape Med Students Blogs

On Graduate School and the Practice of Science

Ben Ferguson -- Graduate school seems to be fascinating to people who are not in graduate school. More fascinating, say, than the IT industry is to people who are not in the IT industry, or the janitorial profession to people who are not janitors, or even the medical profession to people who are not medical professionals. I say this not because I enjoy exaggerating my chosen profession’s level of interestingness, but because I always seem to get the same questions about it in passing conversations and with people I’m meeting for the first time. The most common seem to be, in this order: 1. “When will you be done?” 2. “What do you … actually do?” often followed up with “Huh?” and/or blank stares; and 3. “What on Earth is wrong with you?”

Honestly, it’s tough, for me at least, to answer these questions over and over and over again without boring my counterpart (or myself) into a deep sleep, and I think one reason that many of these questions even come up is because people have a general lack of understanding of what grad school is and what grad students do with all of their time. To be sure, almost the whole of graduate school, as I have said before, is transferring liquids between their receptacles and occasionally analyzing those liquids in different ways. Much of the rest is reading about other scientists’ experiences with their own successful liquid transfers, trying not to fall asleep, and trying not to fall asleep while reading about other scientists’ experiences with liquid transfers. Despite all indications to the contrary, the reading part has some utility.

Today, in a seminar class I’m taking, I realized that the practice of science -- graduate school included -- really is a lot different from most professions in a number of ways. Perhaps the biggest fundamental difference is that, in science, one is expected to know a number of different things -- pathways, techniques, etc. -- that rarely ever come up in one’s specific focus or area of expertise. For example, in this seminar class, we students discuss assigned papers by going through the figures and explaining them as if we have some clue about what the researchers did to generate the data within. None of us have ever actually done experiments analyzing facial phenotypes in embryonic knockouts, and none of us probably ever will in the course of our career, but we’re still loosely familiar with the concepts and rationale underlying the experiment (and even more loosely familiar with how to interpret the data). None of us have ever done wound healing assays, or mass spectrometry, or protein crystallization, or in vivo metastasis modeling, but we are expected to know what they’re all about. Through reading about them and about how others design and interpret experiments, we, then, are expected to be able to add these options to our own arsenals in case such techniques present themselves as useful methods for answering unique questions that come up in our future work.

For the most part, medicine isn’t like that. IT work isn’t like that. Janitorial work isn’t like that, and most other jobs aren’t like that. In most other fields, including medicine, you are trained broadly but then focus on a specific aspect, however large or small, of that field.

In medicine, you practice surgery, or dermatology, or pathology. Yes, in the course of your training, you’ve seen psychiatry and you might have even placed a central line or two. No radiologist though, for example, would be expected to perform trauma surgery at the drop of a hat (or even after a short amount of training), nor would any orthopedic surgeon be expected to treat schizophrenia. Reading about it in papers certainly wouldn’t cut it for these things. (This is why we specialize in the first place, no?)

In science, though, most everyone knows what siRNA does. Everyone knows what a Western blot is and how to interpret its information. Everyone has at least heard of flow cytometry, C. elegans, confocal microscopy, G proteins, and knockout mice, and would be able to become relative experts in these methods and topics within a couple of days (say, for the purposes of writing a last-minute grant). (Perhaps that’s why science, at its most basic level, is easier than medicine. Literally anyone can learn it and then go do it.) In order to be a successful scientist, you absolutely must have at once this breadth of loose knowledge alongside your hardcore, focused obsessions, or else you risk not knowing at all what others are talking about. You must also be able to interpret these data and methods and experimental rationales in the context of your own work, or else you risk not taking full advantage of what’s available to you as an experimentalist. There are only so many proteins to assay using Western blotting (and only so many conditions under which to collect the proteins), and it’s important for any scientist to stay up to date with information not only in one’s own field, but -- dare I say -- in all of science.

Medicine? IT? Janitors? Important for those too, yes, but not so much.

Discrimination in Science and Medicine

Ben Ferguson -- As a disclaimer, I debated for a long time about whether to even write this post. To be sure, it’s a controversial issue. I’m presenting one side of the story as someone who’s been more affected by this environment than I’d guess anyone who originally meant well in instituting such opportunities ever intended. The opportunities are enormously useful for their beneficiaries, and in general they have revolutionized the societal makeup of those practicing science and medicine. It’s a good thing, a very good thing, but in my opinion, it shouldn’t exclusively employ exclusivity as the means to its end. I’m not looking for sympathy; I’m not looking to complain; I’m merely describing a slightly disturbing trend I’ve noticed that has emerged as a byproduct of the current system.

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Here are two sets of criteria for applying for travel grants and awards from the three most recent conferences I’ve looked into attending:

“The conference will award two (2) travel grants to graduate students/postdoctoral fellows who are underrepresented minorities/women and one (1) travel grant awarded to a junior faculty at the level of instructor or assistant professor within the first three (3) years of their initial appointment, also an underrepresented minority/woman.”

“Every year, approximately ten diversity travel awards are given out to conference attendees. We strongly encourage students to apply for this $500 award that covers registration and travel expenses. Consideration is given consistent with the NIH guidelines for minority recruitment.”

(For the record, the other conference, upon my inquiry as to whether travel grants are available to graduate students, said, “We don’t have any.” Blatant discrimination against graduate students, I tell you.)

In all seriousness, as a white male in both science and medicine, this is one of the most frustrating things I have come across, and I come across it pretty much all of the time, or at least any time I’m looking into such things. (For what it’s worth, my dad’s a doctor, so clearly that’s how I got to where I am today, right? Certainly, then, you wouldn’t want me to be participating in these programs and attending these conferences...I’m much too privileged for these sorts of thing after all. As a matter of fact, I pay cash for all associated travel costs -- that is, if my daddy doesn’t for me.)

In college, in order to gain more research experience, make some money, and boost my then-developing (and crappy) application to medical school, I looked into a lot of summer research programs in my college’s town and also all over the country. What did I find? Dozens of opportunities, great, fantastic opportunities, all for minority and women, and minority women, students. Some of them wouldn’t even accept applications from non-minorities or men. Most of them strongly suggested that white males needn’t even bother applying, some practically coming right out and saying as much. It was, in a word, frustrating.

And it’s been the same story ever since. I’m now reminded of my “struggles” with my recent interest in attending these conferences using their support, which -- I can take a hint -- doesn’t exist for people that happen to have white-skinned penises.

Google “summer research program.” I dare you. Programs that don’t at least make a passing mention to race or gender or some other measure of underrepresentedness in their small print are few and far between.

Come on, society. We’re all graduate and professional students here, and those that are not are aspiring to be in such a position. We’ve all “made it” to a certain extent, and it’s equally up to us as individuals how far we can take our successes and turn them into lifelong careers. Do we really need to continue to exclude people who are “privileged” based on the color of their skin? We’re all making the same paltry stipends; we’re all dead tired and doing -- for lack of a better word -- bitchwork; we’re all throwing ourselves into our projects, much of the time only to experience failure after failure; and -- we’re all the same, pursuing the same things.

All I want to be able to fricking do is fricking apply to get some fricking funds to attend a fricking conference, people.

Great Medical Acronyms

Ben Ferguson -- We all know the pedestrian medical acronyms and abbreviations -- bid, CXR, DNR, po, HMO, PE, AAA, CABG, appy, GSW, INR, lap chole. Pretty much anything and everything is acronymous or abbreviated in medicine these days, and if you’re not in the loop, you can go for entire conversations without knowing what the heck someone is talking about. Therefore, it’s important to stay up to date.

Here are some my favorites I’ve heard that are a bit more ... creative?

LGFD: looks good from door

LOLFDGB: little old lady, fall down go boom

CKS: cute kid syndrome

LFTWM: looking for three wise men (pregnant patient vehemently denying sexual activity)

CROACC: cannot rule out anything -> correlate clinically (often by radiologists)

UBI: unexplained beer injury

DBI: dirtbag index (roughly, tattoo count X missing teeth count = days since bathing)

LOBNH: lights on but nobody home

ECU: eternal care unit (dead)

TFTB: too fat to breathe

OBECALP: placebo backwards

OMGWTFBBQ: badly mangled patient, e.g. from MVA (among other things)

CCFCCP: cuckoo for Cocoa Puffs (a little demented)

LMC: low marble count

CTD: circling the drain (a patient expected to die at any moment)

WNL: we never looked

Got any others? Post them in a comment. I’ve come to the conclusion that this sort of creativity is absolutely limitless.

(I found two more comprehensive lists here and here, but they are a bit more on the profane/unprofessional side, as often seems to be any bored doctor’s want. Word to the wise.)

A Day in the Life

Ben Ferguson --

First-year medical student:

6am: Wake up, get ready, breakfast

8am: Arrive to campus in time for 8:30 lecture, sit in class until 10:30

10:30am: Lunch break

1pm: Lecture

2pm: Lab until 4 or 5pm

Evening: Arrive home, dinner, look over a few notes, read a chapter or two, watch some tube, pass out at midnight

Second-year medical student:

6am: Wake up, get ready, +/-breakfast

8am: Arrive to campus in time for 8:30 lecture, sit in class until 11:30

11:30am: Read over notes, +/-lunch

1pm: Lab until 4 or 5pm

Evening: Arrive home, +/-dinner, look over a few notes, read up for next day, do boards questions, freak out about boards, do more questions, chat online with classmates about how mutually freaked out we are, pass out at 2am

First-year grad student:

7:30am: Wake up, get ready, eat breakfast

9am: Arrive to campus, +/-lab, +/-go to lecture at 10:30

11:30am: Lunch break, check on samples in lab

1pm: Lecture

3:30pm: Lab until evening

Evening: Arrive home, dinner, +/-read paper for discussion tomorrow, +/-look over notes, +/-read up on potential thesis topics, pass out at 10pm or earlier

Early second-year grad student:

7:30am: Wake up, get ready, eat breakfast

9am: Arrive to campus, check email, check blogs, check news, check websites

11:30am: Finish checking email, blogs, news, sites; recheck to make sure nothing new popped up during initial round of checking

12pm: Lunch break

3pm: Think about starting experiment or two; decline

3:30pm: Finish thinking about starting experiment or two; begin round two of internet time

Evening: Arrive home, dinner, +/-care about anything, +/-read up on potential experiments for thesis, +/-consciousness, pass out at 10pm or earlier

Late second-year grad student:

5:30am: Wake up, +/-shower, +/-breakfast

6:30am: Arrive to lab, start experiments immediately, freak out about how, at this pace, you’re never going to graduate

12pm: Continue experiments, +/-check email, freak out more

3pm: Continue experiments, totally flip out

6pm: Continue experiments, call fiancee to get reamed for not calling/being home earlier, freak out and/or flip out, sweat profusely

8pm: Arrive home, dinner, +/-think about experiments, +/-catch up with the outside world, +/-appear to have a normal life, +/-freak out

9:30pm: Go back to lab, freak out more

Midnight: Pass out

Top 10 Signs You're Spending Too Much Time in the Lab

Ben Ferguson -- 10. During dinner, your fiancee reflexively asks whether you’re going back again tonight.

9. You come across seemingly random numbers, but to you they are far from random: They are the number of amino acids in your protein of interest (987), or the first page number of the landmark paper you read (again) that morning ($4.02), or the recipe for your cells’ media (449,501).

8. You feel naked without your gloves on and generous amounts of alcohol sprayed all over them. Surely you’ll contaminate something.

7. You develop a giant blister on your thumb from too much pipette use—”pipette thumb.”

6. You’re so tired/distracted/sick of loading plate after plate that you can barely insert a multichannel pipette into a set of strip tubes without hitting the top, so you decide to get some coffee. An hour later, you’re so jittery that you can barely insert a multichannel pipette into a set of strip tubes without hitting the top, so you decide that “some coffee” probably shouldn’t mean three cups in a row in the future.

5. You don’t know how you could possibly get through loading another plate without listening to the latest "Wait Wait... Don’t Tell Me!" podcast.

4. You become genuinely miffed when your lab switches from one pipette brand to another, signaling that fact that your life revolves around the differences between little pieces of molded plastic (and is more or less over).

3. Finding a good spot to hide your stash of pipettes is probably the most excitement you’ve had all week.

2. You know the catalog number for 96-well plates by heart.

1. When you have some free time, you write a blog post about how much time you’ve been spending in lab.

The Curious Similarities Between People and Cars

Ben Ferguson -- Ever since my car started having serious trouble early last year and eventually had to be sold (if you can call it that -- it netted $400), I have been particularly sentient of the comparisons that are commonly made between glorified mechanics doctors and actual mechanics, as well as between the things they deal with: the human body and cars.

Both doctors and mechanics are sometimes seen as sketchy people who don’t always tell the whole truth, don’t appear to tell the whole truth, or tell outright lies at times, whether it’s because of potential financial gains, laziness, coercion, etc. Sometimes both are downright unethical in the way they communicate and interact with their patients and customers. Both are in possession of knowledge that most lay people aren’t privy to, and this places them squarely in a position of power relative to those they serve, allowing them to manipulate many aspects of decision-making about a person’s body or car should they want to engage in such decision-making.

Quick: Think of the last time you went to get an oil change and the mechanic told you that your system needed to be flushed in order for your car to run properly, or that you needed a new air filter because your current one is “reducing your car’s performance,” or that your battery may have needed to be replaced -- would you like to take care of that today? I bit the first time I was told some of these things, and I’ve been told them many times since.

Think of the last time repairs to your car were quoted at, say, $400 and you ended up paying $600. “Whoops,” they say, “we didn’t anticipate that.” But you know they did. You know -- at least you strongly suspect -- they underquoted you so that you’d have the work done. If they hadn’t, perhaps you’d have shopped around a bit more. Things like that happen all of the time in probably every field of work, but both doctors and mechanics are in especially enabled positions to pull that kind of crap. Trust can diminish quickly, and this is especially true in light of this recent evidence.

We are all unfortunately familiar with the universal fact of life that our bodies and our cars are expensive to maintain. They break down and inevitably need service every so often. When money is tight, the question of whether to spend money on needed repairs sometimes comes up with both. If you’re a college or grad student living from loan check to loan check, do you really need to get a referral for that back pain, or can you live with it? Don’t you ponder your account balance before filling that antibiotic script? Do you even fill it period? Do you really need to see a doctor for that wart on your hand, or for the abdominal pain you’ve had for the past 6 hours, or for the headache you’ve had for the past few days? Do you really want to blow all your money going to the ER just to r/o meningitis every time you’ve got a stiff neck? Do you think twice, like I did a few days ago, about making that dermatology appointment for five minutes just to get a skin cream script if it’s going to cost you $234.93 every time?

When money is tight, these things don’t seem so dire. What’s more important is not going broke, eating, preserving your sanity, etc. even if you have to live with an imperfect body for a while. Similarly, do you really need to head over to the body shop every time you see a dent in your car? Can you live without air conditioning for the last few weeks in September? Does the rattling under your hood really annoy you, or can you live with that too? Honestly, who needs side mirrors and hubcaps and AC dials anyway? When money is tight, these problems don’t seem like problems; they seem more like everyday annoyances, and even if they do seem like problems, what are you going to do about it beyond blowing the last few dollars in your bank account?

When money is tight, I think many of us would stop and think twice about fixing ourselves and our cars at the drop of a hat. Some extreme things just don’t seem all that extreme anymore. Even with insurance, there’s not much motivation to seek health care or car servicing. Is it really worth it to you to pay $25 for a medication when $50 of it is already covered and you’ve only got a few hundred in the bank to cover you for the month? Perhaps, but usually no: You’re still out $25 whether it’s discounted or not. Do you whip out your wallet and fork over the extra $100 over your $500 deductible to fix the body damage to your car? Likely, no; you can live with a deformed car for now. Spending money like that seems at times like a luxury, not a necessity.

The value of ourselves and our cars must come to mind too. Would you put $1000 worth of repairs into a car that’s worth $10,000? How would that decision change if fixing it would cost you $5000? $500?

You’re 90 and you’ve lived a great, full life; how much time and energy and money and optimism do you want to invest in yourself when you’re not doing so hot in the first place? How would that change if this were your first hospital admission in the past 20 years? Your twentieth in the past two years? How would it change if you’ve been diagnosed with a terminal, metastatic cancer just after your 90th birthday? Diagnosed with pneumonia? Diagnosed with the flu?

And so, as the cautious and skeptical former owner of a crappy car that was in and out of shops before finally breaking down for good, and the owner of a sometimes crappy body that has weird stuff happen to it from time to time, I am now, more than ever, aware of how cautious and skeptical patients who’ve been in and out of hospitals for the past year must feel and how most of the underinsured and, more often, uninsured population around Hyde Park must feel. I used to think it strange that some people with serious medical problems simply don’t seek care, but now I realize that “serious” becomes a seriously relative term depending on your life situation.

Some Good Advice

Ben Ferguson -- I generally have trouble talking about myself, especially in social situations where there are a lot of people I’ve never met. I say a few words and then don’t really feel like talking too much. I’ve often been told that I’m hard to get to know, that I have a wall up around me that’s hard to crack. (Granted, I say this as I’m writing about myself publicly in a weblog.) Regardless, I got some good advice from my mom several months ago when a bunch of family members were in town for a reunion.

She said, after noticing that I was starting to get pretty uncomfortable with the rapid-fire questions about what medical school is like, what I want to go into, whether I’m going to be a surgeon like my dad, whether I’m going to be an anesthesiologist like my mom, what my thoughts are regarding why they never started a surgical practice together, why I’m doing a PhD, how long it’s going to take, how much longer I have in school, what this thing on their foot is, why their fingers are so cold and whether they’re going to die from it and/or have cancer and/or should have it looked at, etc., “Ben, you have one of the most fascinating jobs on the planet. People are going to ask you about it every time they see you because they largely have boring jobs that they hate. You need to learn how to deflect the conversation to them: Ask them what they do, ask them how their job is going, ask them questions about them. Otherwise you’re going to go crazy with all the questions about you you you.”

The more I thought about it, it’s true, and it’s especially true with members of my extended family, who for the most part can and will talk and smother you until you sometimes want to take a bat to their head. Or your own. It figures that once the convo is placed squarely on them, they’d roll with it and back off of me so I can get a breather once in a while.

My dad also had some good advice for me a few years ago, something a mentor of his told him while he was a medical student, and it’s particularly timely for me given that I’m starting to put together some publications in the lab. It was regarding how one goes about writing journal articles: “First, you tell ‘em what you’re gonna tell ‘em, then you tell ‘em, then you tell ‘em what you just told ‘em.”

Great! If only it were that easy.

Game, Set, and Match

Ben Ferguson -- Match Day is upon us. On Thursday, March 20, thousands of medical students and recent graduates will find out where they’ll be spending the next several years of their lives in training. Some will have their prayers answered, some their hearts broken.

I literally would not be more excited or antsy if I were going through it myself, but I am not. My original classmates, those of the graduating class of 2008, are. These are people that I’ve known for four years and who have become some of my best friends. They are people that, at least for two years, went through the grind of medical school with me, took naps with me, helped me, taught me, and understood me. They, like me, began as lambs naive to medicine and have now emerged from the wards speaking a completely different language, one that feels so far removed from our pathophysiology and clinical skills courses that ended just a few years ago.

I remember an encounter I had with a former classmate shortly after we parted ways and I started grad school. “What are you on these days?” I asked -- that’s all anyone asks who’s trying to catch up with old colleagues. “Gens, Q4. Not too bad. After this it’s smooth sailing until winter,” he said. I nodded in acknowledgement as if I knew what the hell he was talking about. He had a partial beard and was wearing mismatched scrubs; I couldn’t even begin to tell you whether he was on a rough surgical service or had a few too many medicine patients, and I didn’t ask.

I see other former classmates randomly, walking down the street in Chicago, or at a street market, or reading books as they hustle through the bowels of the hospital (here, they truly are bowels, ones that have just been emptied in preparation for colonoscopy, perhaps), or running by the lake, or darting onto AIM for a quick semblance of a social life, or during pickup poker games during which everyone drinks Capri Suns in place of perhaps more exotic beverages because they need to be up at 4am to make grand rounds the following morning. They all look the same, not the same as before but the same as each other. They are unexpectedly awake, and they are unexpectedly alive. The ones on surgery don’t look any different from the ones on family medicine or on psychiatry, save for slight changes in facial hair upkeep. They largely do the same things outside of the hospital as they always have, albeit in less quantity. They are fighting to stay alive and to become doctors, and they are doing fantastically.

Fantastically enough, even, that in less than a week, they too will experience that rush of emotion that dozens of classes before them have felt, emotion that will fill an entire auditorium palpably as if surrounded by a thick, saline-filled ether. It’s truly one of the most incredible experiences I have in a given year, but this year will be even more special. I know them. I have listened to their dreams and watched them -- the dreams and the dreamers -- take shape and morph and evolve. I cannot wait until I too have that opportunity. But, for now, I’ll settle for getting as close as I can to theirs.

The Difference Between Medical School And Graduate School

Ben Ferguson -- Everyone always argues over whether graduate school or medical school is harder, or more difficult, or more tiresome. Everyone. If you’re not currently arguing over it at this very moment, you’re totally missing out.

Some say the former is far, far tougher; it comes in like a lamb, has its lion phases here and there, and then exits more or less like a lamb again depending on the niceness of one’s thesis committee and the degree of copying-and-pasting of one’s previous journal articles. Some feel that the latter, by its sheer time and physical demands and by its ubiquitous emotional toll, is far, far tougher; then they become interns and laugh it off. Some say that each is difficult in its own right, that each is physically and intellectually demanding in ways and over time periods different from the other.

Regardless of which is actually harder (for the record, at this point in my career, they’re about equal in my book), there are most definitely some black-and-white differences between the two:

1. Each has schedules to follow and places to be. It’s just that in medical school, you’re expected to be somewhere at a certain time of the day, but in graduate school, you’re expected to be somewhere at a certain time of the decade.

2. No one cares what you look like in graduate school. No one cares when you arrive, or how much progress you make, or how inattentive you are toward others, so long as you get your work done in a reasonable amount of time. (This all goes out the window when your advisor walks in.) In medical school, your appearance matters very much, both to attendings and to patients. You must arrive on time, make strides in making patients feel better (or at least act like you’re trying), and always be cordial to them.

3. The “DOOR CLOSE” buttons in hospital elevators actually work. In other educational buildings, not so much. (Isn’t it fascinating, though, that we always try? Apparently the variable ratio reinforcement is too engrained in us to ignore.)

4. In graduate school, you worry about the lives of worms and mice and rats and immortalized microscopic fragments of tissues that were intact decades ago. In medical school, you worry about the lives of humans, which is slightly more stressful.

5. Neither medical students nor graduate students are particularly well-versed in dressing well. They may even be known for their inability to dress well, or to even dress appropriately for the conditions or given situation at all. In this department though, medical students totally dominate. Graduate students are completely hopeless for the most part, but that’s okay because no one ever sees them anyway. (I’m not in any way excluding myself from this group, either.) Note to future graduate students (and future medical students for that matter): Black pants + black shoes + white, pilly, holey socks (+/- publication(s) +/- international awards +/- bubbly personality) = immediate rejection. Write it in your lab notebook so you don’t forget it.

6. In graduate school, you often spend entire days transferring liquid from one tube to another, perhaps after waiting for the liquid to thaw, and then adding some other liquid(s) to the tube, and then adding the mix to some other receptacle. If you’re lucky, you get to invert it several times, or if you hit the jackpot, you pipette up and down. Your life is liquids, receptacles, and vectors to get the first into the second. Amazingly, the final outcome of this fails more often than not, and you must redo everything several times. In medical school, depending on the service, you often spend entire days transferring liquids from vials to patients, removing pooled liquids from patients, observing liquids (and solids...ooh!) that patients excrete, measuring pressures of liquids, and writing stuff down about all of them.

7. The most common question you’re asked as a medical student, by far, is, “What are you going to go into?” (I have no idea.) The most common question you’re asked as a graduate student, by far, is, “When are you going to be done?” (Never?) or, if you’re also a medical student, “What were you thinking?” (At times, I wonder that myself.)

There Aren't Enough Words To Go Around

Ben Ferguson -- I’ve spent the last four hours staring at the evaluation form for the last med school applicant I’ll be interviewing this season. After doing 30 of them, I find myself completely out of words. I’ve been particularly blown away by the quality of interviewees this year, but even that can be problematic: How is one supposed to describe these people and differentiate them from one another? You can only use cookie-cutter adjectives so often before inevitably having to resort to the more exotic ones, and there are only so many of those to go around, too.

It makes me wonder: How on Earth do deans do it? Deans have to write lots of letters every year, or at least get help writing them, and at most schools there aren’t just 30; there are potentially hundreds. Being at a school with no grades for three of the four years, it’s made me acutely aware of the importance of the dean’s letter -- and of the need for the dean’s letter to effectively serve as the surrogate in differentiating students from one another in the absence of grades and class ranks. Is it possible? Apparently; people do well enough in the match, and the same goes for students from other schools with such grading systems, too. But honestly, how many “exceptional,” “outstanding,” “brilliant,” “extraordinary,” “remarkable” students can residency programs read about before going insane? (And how many of those students actually are any of those things?)

It’s a good problem to have, this abundance of quality applicants. But writing these interview reports seriously gets to be a pain after a while. When you start wondering how to incorporate “skookum” into someone’s evaluation, you know you’ve lost your marbles. (A recurring theme of mine?)

All Because of a Harmless Western Blot

Ben Ferguson -- Sometimes, the simplest things can test your patience and your sanity. At times, you wonder how you ever were able to do them in the first place.

While in Los Angeles a few weeks ago visiting a collaborator’s laboratory, I was in a car accident during the morning rush hour. (I’m totally fine -- just a scrape on my forehead -- but my glasses unfortunately suffered fatal injuries and have been reincarnated as a pair of hip, exorbitantly-priced specs.) For the next week, I was kind of terrified to drive. I drove ten miles under the speed limit, stopped for a three-count at all stop signs, white-knuckled 9 and 3 o’clock, and let people go in front of me in heavy traffic. You know, things everybody does on a regular basis, including me. I felt as though I was 16 again and just learning how to drive. The world moved so fast! How could I ever have driven with such little attention paid to the road and yet been in so few accidents?

In the lab, I’ve done roughly the same experiment six times over the past four days: a Western blot -- one of the most ubiquitous, simplest experiments in research and one that virtually everybody working in basic science knows how to do. Well, I’m 0-for-6. It was a week full of ... profanities?

I’ve done plenty of Western blots in my research career. When I was a summer researcher early during medical school, I did them regularly and successfully. But I cannot do it now, and it’s driving me nuts. The problem with these sorts of things is that they can be so simple, or perhaps that we can get so accustomed to doing relatively complex things, that we do them without thinking. They often have many steps to them too, each with their own chance of failure. By the last step, the compounded chance of failure is enormous. When the experiments fail, we must take a step back and examine why they -- or we -- failed.

Did I make the gels correctly? Are my units right? Is the glassware clean enough? Which cables am I supposed to use again? Are the protein estimations accurate? How old are these antibodies? Did I not transfer long enough? What’s with that funky noise coming from the developer? Did I touch the membrane too much? Wait, do I even know how to operate this pipette properly, or have I been doing this wrong all along?! WHAT IS A PIPETTE ANYWAY?? It’s enough to drive a person mad, especially when you ask these questions over and over, make what you think are the appropriate changes, and still fail. To make matters worse, some of these things are within your control; some are clearly not, at least not immediately.

This leads to a cycle of overthinking things. Overthinking the most minute of details that may, but probably don’t, have anything to do with the outcome of the experiment. Overthinking which combination of changes you need to make in order to do it right the next time. Overthinking how terribly long all of these repeats are taking you, and overthinking how you might speed up the process (which is almost never a good thing to do in the lab in times of distress). Overthinking precisely how and why you’re overthinking these things and overthinking how you can stop overthinking about overthinking these things.

It’s a damn mess. All because of a harmless Western blot.

I’m A Happy(er) Scientist Now!

Ben Ferguson -- I was in a funk. Now, I’m out. Mostly.

Just as funks come and go, grooves come and go too. Grooves are what make this all worth it, the drug that keeps the highs high enough and the troughs infrequent enough to stay hooked on this stuff.

One of my research advisors in college related to me once the time when he finally fell in love with research. He’d not done much research during his college time, and what little research he did do didn’t appeal to him too much. (In retrospect, it was an experience not dissimilar from my own.) When the time came to decide where his life after college would take him, he could think of only two things: medical school or graduate school, neither of which really stimulated him all that much. He chose the latter -- med school seemed too hard and was too certain for someone in a very uncertain phase of his life.

Shortly after starting grad school, he did find some success with it and eventually came to love it. That first piece of good data, he said, data that both demonstrates something of importance but also leads to bigger and better questions, was the clincher for him. It was like an addiction that he couldn’t shake. He was hooked, and each new experiment led to new insights and questions that demanded answers. It’s like reading a mystery novel but pausing at the last ten pages; how could you not go on?

So, I’m getting there. While my data isn’t spectacular at the moment, it’s really interesting in that it’s somewhat unexpected. Pair that with a fairly new and unexplored area of research, and I’ve got myself a nice little project. Each new piece of the puzzle leads to more questions, and to say I’m excited to see what comes out of it would be an understatement. Stay tuned.

Location, Location, Location!

Ben Ferguson -- When I got up this morning to take the dog out, they were putting the wind chill at somewhere between 35- and 45-below. It’s another one of those beloved Chicago days that come around every so often when your lips go paralyzed within seconds, your hands aren’t as much cold as they are in stinging pain, and you worry that you’re going to pull a back muscle from shivering so much.

In other words, it’s fricking cold here.

Today is one of the days I wish I’d at least applied to some southern schools, or California schools, or schools around or on the Equator, or purchased that battery-powered heated jacket I saw in a magazine a few weeks ago. $600 for that jacket sounds downright cheap at this point.

A conversation I had with a doctor comes to mind. He was an alum of the lab I’d worked in for several months in college and had gone on to become a big-wig MD/PhD neurologist at a certain prestigious medical school in the great state of Missouri. For some reason, my research advisor, knowing I was planning to apply to medical school at the time, suggested I head down and pick his brain. It was a very thoughtful gesture. In the course of asking him what factors I should be considering when choosing schools to apply to, he said something that, given his prestigious position at one of the most highly-reputed schools in the country, surprised me a bit. He told me to ignore all other things except location.

“Location, location, location,” he said. “Medical schools all teach you the same thing: medicine. They have to. They’re required to, or they’ll either look bad or lose accreditation. The only difference is in how they teach it to you, which really is minor. The biggest difference is in where a school is and how much you like its surroundings. Pay attention to that more than anything.” While I absolutely love -- LOVE -- Chicago, mostly without regard to weather, I’d have to say he might be onto something on days like today.

Kendra wins.

My Life Goals

Ben Ferguson -- Okay, a few others made lists of their own. Given the relative proximity to the start of the new year, I may as well join in the fun:

1. Be happy. No bones about it. (My fiancee would throw in the requirement here that I’m able, at least some of the time, to have Saturday morning pancakes with my kids.) While everyone has to strike a balance somehow between work and family, I find myself happiest when I am stressed out and challenged in my work. This ought to be interesting...

2. Work as long as I physically can. My great-grandfather was a professor of music at the University of Minnesota (there’s a building bearing his name, in fact) until he was forced to retire at the age of 68 because that’s how public institutions used to work. What did he do? He crossed the river, got a job at the private school across town, and finished what he started. At 87 he published his final book, and when he died at the age of 102, he was still chugging along. My great uncle, a prominent general surgeon for decades, worked, taught, and conducted research pretty much until he was unable, bowing only to the onset of Alzheimer’s. My dad, also a surgeon, is now nearing 60 and is very much in his prime as a professor and researcher.

3. Contribute something important. I’m not too interested in pursuing a private practice, preferring instead the life of academia and its inherent pursuit of knowledge. People often refer to the “ivory tower” of academia as being this land of seclusion from reality, but I prefer to see it from the opposite angle in that academia largely generates that reality (in terms of new and ground-breaking treatments, standards of care, etc.) within which those who practice in private or community settings operate. I have met many wonderfully talented physicians in private practice over the years, but if I were to do it, I fear I’d feel too much like a robot, merely an agent of health care delivery rather than a developer of the care itself, running in place instead of moving forward, following the recommendations from research findings as opposed to helping to actually generate them. In that regard, I suppose there is a selfish aspect to this desire. Still, I’d much prefer to be personally invested in research and working toward something than, broadly-speaking, doing the same thing, day in and day out, without accomplishing much for the future. I recently finished reading a book that chronicled the life of Judah Folkman, an ingenious and well-respected physician and cancer researcher for decades who passed away just this week, and his father used to advise him to “be a credit to your people.” Well, my people are doctors, scientists, and patients, and to go through life as a physician-scientist without having contributed much to them or to future generations would seem wasteful to me.

4. Write a book. Or several.

Those are the big ones. I should probably also include things like “graduate,” “get into residency,” “don’t die during residency,” “get enough sleep during residency,” “stay healthy,” “avoid divorce,” and so forth, but I think those are held by pretty much everyone.

On Life Epiphanies

Ben Ferguson -- My brother was walking down the street the other day and saw one of his high school classmates get hit by a car. The kid was wearing headphones while riding his bike and blew a stop sign. The offending car hit him pretty hard apparently. When my brother got to him, he was bleeding heavily from his head and appeared to be having intermittent seizures. My brother, his girlfriend, and the driver stayed with him until the ambulance arrived, holding his hand and reassuring him that medical attention would arrive shortly.

As a high school kid who’s never seen anything that even resembles this, save for violence on television, how could you possibly deal with this? I’m not talking medically here; I’m talking mentally. Most people I know, let alone a naive teenage kid without a care in the world, haven’t seen anything as heavy as this. Afterward, he called my mom, an anesthesiologist, to tell her what he’d seen, and she was able to give him a few do’s and don’ts in case anything like that ever happened again: make sure not to move him lest he had suffered a spinal injury, etc.

Later that day, undoubtedly after some reflection, he admitted to my mom that he so wished he’d been able to help more, that he felt so helpless just sitting there holding the kid’s hand while he waited for the actual doers to come do something useful. Maybe, in fact, he’d like to be one of those people, those first responders who are so crucial to saving lives in the field.

And it got me thinking: Isn’t that how so many of us get into this business? I hear so often of folks going to medical school because they suffered through a grandparent’s or a parent’s illness and had so much meaningful interaction with the relative’s care team that they wanted to be on that side of things. Maybe they themselves had struggled with an illness earlier in life. Maybe they’d experienced some other life-altering (life-threatening?) epiphany that made them realize that they want to be in medicine to be able to help those who go through similar struggles. As an interviewer, I hear this literally all the time, and no one would argue that it’s a perfectly legitimate reason for at least putting medicine on the map of potential career choices, if not acting as the paramount reason for ultimately choosing this field.

I personally didn’t have one of these experiences that so influenced me. Nothing about my decision to attend medical school was epiphanic. Mine was a more gradual realization based on a number of factors. In fact, both of my parents are physicians, and they largely did everything in their power to discourage me from entering medicine. While I had experienced their lives as physicians first-hand and therefore had a good idea of what medicine was like, my decision was one I came upon myself after much introspection. At the risk of invoking a certain sense of schadenfreude, perhaps my decision would have been expedited with such a dramatic medical experience!

What experiences motivated you all to get into medicine? Any other epiphanies out there? As someone who didn’t really have one to speak of, I’d love to hear about them.

I'm a Mad Scientist!

Ben Ferguson -- Oof. What a few weeks. I’ve reached the inevitable period in pretty much every researcher’s career where absolutely nothing goes right. Experiments don’t work, data looks either bad or opposite from what you expected (which is sometimes really cool but usually bad), equipment breaks, and the list goes on.

All of these things have happened in the lab recently, and it’s really been testing my patience and my devotion to both this project and this career track. A few weeks ago, half of my pipettes went missing, meaning I couldn’t do most of my experiments for a while. (They all were later returned, thankfully, since they go for several hundred dollars a pop.) Then one of the PCR machines broke, and when we sent one of its parts in for repair, it was sent back repaired but reformatted for a different model, meaning it may as well have been broken still. Then the qPCR machine in the lab wasn’t working properly, and I spent about three weeks straight tinkering with it and optimizing experimental conditions on it without ever getting any reliable data. Then our antibodies, provided by a colleague who has used them successfully to publish a number of papers, didn’t work at all for five weeks until we finally tried a new detection method. Then...

You get the picture.

I’m trying my best to remind myself that this is just a funk, that eventually the skies will clear and I’ll get back into a groove. It really underscores the need in research to be persistent, to keep one’s head up and not get discouraged, and to employ a little creativity when seemingly nothing works. It also underscores the importance of realizing when to keep going and when to simply move on or try something else. Quitting (or at least taking a break) while you’re ahead is often a better solution than getting more and more frustrated with each failed attempt (and each hundred-dollar wad thrown down the drain). I’m sure most advisers funding researchers in their lab would feel similarly!

Here’s a slightly modified mantra I’m starting to live by: If at first you don’t succeed, try, try, try, try, try again. And get coffee and/or do a crossword or two in between. Then, if you don’t succeed, for God’s sake do it another way!

An Awakening

Ben Ferguson -- Sometimes in medical school, especially during first year, you really feel like you’re back in undergrad again, learning about seemingly mundane details that don’t appear to be applicable to the practice of medicine. I got this feeling a lot during my first year and even at points well into my second year.

The first time I really, truly felt like I was a medical student was when I interviewed Mrs. D, a teacher from Chicago. We had just finished the heme/onc section of CPP that day and I felt like I was still really solid on most of the material. Anemias, leukemias, lymphomas, signs and symptoms -- all fresh in my head. (CPP stands for Clinical Pathophysiology and Therapeutics and is the best class at my school by far, the one that makes you realize there actually was a valid reason that you learned all that biochemistry and physiology and neurology and anatomy during first year that, at the time, seemed entirely detached from the practice of medicine.)

After a brief meeting with our resident who took us around to a few patients to expose us to some clinical findings like jugular venous distention indicating congestive heart failure, displaced point of maximal impulse indicating left ventricular hypertrophy, and spider hemorrhages from cirrhosis, I was introduced to Mrs. D and began to run through my lengthy list of questions just like with every other patient: absolutely robotically and without a clue as to the reasoning behind my questions.

After finishing up her history of present illness, I started to realize that I knew what was wrong with her. She had some of the same signs and symptoms that actual, real-life doctors had just told me should be present in situations like these. Fatigue, dyspnea on exertion, cachexia, lightheadedness, dark urine, hepatomegaly, severe jaundice, scleral icterus -- it was like she had memorized a textbook for the purpose of reciting it back to me. She couldn’t have been more spot-on had she been a standardized patient trained to present with these findings. And I felt so empowered. I felt resonation with the questions I had been asking all these patients over the past year instead of just reading them off a list. I at once knew their value like I hadn’t realized before, and I was able to direct my questioning according to her specific complaints. And it was great.

At the same time, it wasn’t great. I realized she had acute myelogenous leukemia, a nasty adult leukemia that is relatively aggressive and has a relatively poor prognosis. And I realized that I learned about this disease in a classroom, free from emotion and patients and crying and fear of one’s outcome, secure in my own worry-free environment.

Meeting Mrs. D there and coming to the abrupt realization that she was in dire straits was a very difficult situation to be thrust into. On the one hand, she introduced me to the true value in knowledge about diseases and their management; on the other, she showed me that we should always remember what we are learning. We are not merely learning scientific facts. We are learning about human diseases that affect patients’ lives -- not just their bodies -- in ways that we can’t always comprehend as hard as we may try. We should never forget that.

Listen and Learn

Ben Ferguson -- I admit it: I’m addicted. In addition to puzzles and really strange anthropomorphic delusions, podcasts get me through long days in the lab. And boring commutes. And working out. And reading papers. And doing puzzles and hallucinating about pipette boxes. And pretty much any other time I’m not actually having a conversation. As socially isolating as it is to be walking around all day with headphones in one’s ears, I find podcasts to be enormously useful for learning new things, keeping up with news, and generally making time pass more quickly, all while getting other things done at the same time. The applications of podcasts to science and medicine are broad and powerful (and, fortunately, growing!).

Let me just briefly say this before we get to the meat: If you are not listening to podcasts -- or worse, if you don’t know what a podcast is -- are you alive?!? There is a massive bank of knowledge at your fingertips, covering literally every area of life, that you could be tapping into.

Here’s a quick list of the most useful medical and science podcasts that I listen to (the links below redirect to iTunes’ browser; if you do not have iTunes, you may first want to download it here:

* Podcasts by Science and Nature are fantastic discussions of cutting-edge science with authors of articles appearing in these journals. Nature, in particular, also has podcasts covering many other topics corresponding to its various ancillary journals.

* Yale’s Cancer Center Answers podcast is a call-in show produced by a few medical oncologists and features various aspects of a different oncological malignancy in each episode.

* Scientific American's podcasts include a summary of articles appearing in their magazine as well as brief snippets of science in the news.

* The OR-Live podcast is a rebroadcast of various surgical procedures with live commentary from experts in the field. It’s priceless for anyone who’s interested in surgery as a career and for anyone who wonders what the OR environment is like (albeit muted and undoubtedly more politically-correct given the cameras).

* Learn Internal Medicine from MedPod101 is produced by a medical resident and covers a variety of case presentations and aspects of certain illnesses. It typically takes you through an entire patient encounter from H&P through diagnosis and treatment, although recently there has been a more in-depth foray into various issues on the topic of asthma. It’s a fairly new podcast, but it’s very helpful and looks promising.

* A physician and colleague at Johns Hopkins produce a fantastic podcast, JH Medicine Weekly Health News, covering recent medical news that is short, intelligent, and to the point.

* The bayblab podcast is an intelligent roundtable conversation about science between a bunch of graduate students at the University of Ottawa. They talk about their own recent blog posts on cool science news and also sometimes interject with interesting hypothetical discussions about related topics. (NB: This occasionally contains language that some would consider offensive, but it’s mostly good, clean fun.)

* NPR’s Radio Lab is perhaps my favorite podcast of them all and covers a wide variety of pop-sci topics. It’s a sort of hybrid of science journalism, edgy exposition, unbelievable story-telling, and This American Life. A contributor to Radio Lab, NPR science correspondent Robert Krulwich, also produces an NPR podcast called, hmm… Krulwich on Science, which is shorter and covers only one topic.

Many other medical journals produce podcasts that review their recent articles, big medical news, and other timely information. These include The Lancet, Annals of Internal Medicine, NEJM, Cell, Cancer Research, JAMA, and JNCI, among many, many others. Others are institution-specific: UCSF, ASCO, the Whitehead Institute, Cancer Research UK, and Yale all produce podcasts that cover medical and science news coming from their respective faculties. Many other media and news outlets put out science and medical podcasts as well, such as the New York Times, the Guardian, PBS, National Geographic, Wired, and the Discovery Channel (and they are generally fantastic). Links to each of these podcasts are easily found via their homepages. Shameless plug: I, too, produce a podcast, the Pritzker Podcast, for prospective and current applicants to my medical school that assists them in getting to know the school and the application process a bit better.

What do you listen to for your fill of science and medicine? Tell everyone about it in the comments.

With a Little Help From My Friends

Ben Ferguson -- Over brunch the other day, one of my former classmates and I were lamenting the sheer amount of material one must know these days to be a physician. It’s often said that medical school is like trying to drink from a fire hose, that it is much more difficult in its volume than in its concepts. There is such an information overload with no end in sight, he said, that pretty soon we’ll surely have sub-sub-sub-specialties.

“Yeah, eventually there will be right lower lobe lung surgery and age 5-6 pediatric cardiology specialties.” Of course he was kidding, but then again, not really.

There is just too much for any one person to know in any one field. That’s where the reinforcements come into play. These days, it seems everyone outside of the most seasoned clinicians has the latest and greatest PDA with the latest and greatest pharmacology software that will instruct the physician on dosing and contraindications, and differential diagnosis software that will scour the bowels of rare pathologies to bring up otherwise unknown diseases (that is, unbeknownst to the practitioner, undoubtedly), which almost surely are eponymous as is medicine’s collective want.

Failing that, and for the more old-school among us, pockets are filled with soft cover pharmacopeiae and dosing recommendations and OB wheels and equations and formulas and pocket textbooks and pocket study guides and pocket reference sheets and pretty much everything else that was ever designed to fit in a white coat’s pocket. And it’s all necessary, at least for green students. No one could possibly know all of this information, so it’s crucial to have these little helpers around to make sure you don’t kill anybody. It seems we need to know relatively less and less about medicine with these things around to do an acceptable job toward that goal. We’ve become, to some extent, machines that do what the little books tell us to do.

And we have analogs in the lab, too. We have quick reference cards and protocols and manuals and recipes and methods and robots (I’m not kidding; my lab just purchased a pipetting robot!), but the most basic of them is the pipette box. The pipette box is a thing of beauty. For one thing, it contains pipettes, which carry out the most fundamental of lab activities: transferring liquid from one container to another, over and over, all day, every day. It becomes a reservoir when it’s empty, or a receptacle for veteran pipettes, or a holder of small tubes. But, it plays a much more important role than that: It also counts. It’s no fancy pocket machine; it’s a counting machine, an abacus. The pipette box-as-abacus is what keeps us all in line, faithfully keeps count for us while our minds wander to various locales in daydream land and our hands carry out brainless, endless liquid transfers that, some day, somehow, get transformed into scientific articles. They’re brilliant in their own simple way as historians of the lab, and you don’t even need to be able to count to be a competent scientist! This tends to bode well for people, say, like me who daydream often and count poorly. Never underestimate the pipette box!

Study Abroad Is the New Black

Ben Ferguson -- Actually, it’s the new research, or the new volunteerism, or the new 4.0. I’ve noticed a growing trend in medical school applications, at least to my school, of people studying and working abroad. When I applied, study abroad wasn’t necessarily an extraordinary activity, but it wasn’t as if everyone you knew was doing it, either. I personally went on a trip in college to volunteer at an orphanage in the Dominican Republic, and while it was one of the most fulfilling -- and helpful, to be sure -- experiences I’ve ever had, I was also proud to have that on my application to medical school. I felt as though it helped me to stand out.

These days, it seems everyone is taking trips like this. Some study at foreign universities. Some get jobs overseas after college either with the intention of applying to medical school shortly thereafter or with goals entirely outside of medicine, only after which they decide on medicine as a career. Some go on mission trips, medical or otherwise, for weeks or even months at a time. Some simply travel for want of a new outlook on life, choosing to immerse themselves in new cultures and experience the world. Some combine these activities or pursue other interests altogether while abroad. I can’t say whether it’s become more common in the premedical community than it has in the rest of the college cohort, but it certainly seems that way on the surface.

Indeed, since the start of the interview season here, I’ve personally met several of these types. Two went on volunteer trips to Quito. Another shadowed physicians in a large Delhi hospital. One person traveled to Tijuana to build homes. Another frequently commuted to London and Paris for work. Others have done research in Paris, Madrid, Panama, and Nigeria. Others have participated in study abroad programs in Moscow, Prague, Nice, Australia, and the UK.

I realize I’ve written at length previously about how increasingly impressed I am with applicants to medical school these days, but this is one area that has really caught my eye. It seems that everyone I meet is a world traveler! Whether this is a crucial prerequisite to have for one’s admission to medical school is debatable, but it’s definitely on the rise. The New York Times has an interesting feature this week about the growing numbers of students participating in study abroad programs and the increasingly creative destinations to which they flock.

I’d say premedical students are at the forefront of this movement. This is not to imply that study abroad is becoming necessary to gain admission into medical school; it most certainly isn’t, and there are a number of students I’ve interviewed over the past several years who haven’t left their home state and yet are quite cognizant of other cultures. But, it’s hard to ignore the sense that where “volunteerism” and “research” were such buzz words for things one absolutely needed to do to even have a shot at getting into medical school, study abroad may slowly be taking their place as the hip new thing to do to make oneself stand out among the sea of picture-perfect premeds. After all, once we’re doctors, many of us will never have the opportunity to travel as freely as we once did. There’s no time like the present, and why not make yourself a more interesting person while you’re at it?

The Curse of the Long White Coat

Ben Ferguson -- “What are you doing? You just contaminated everything!!” I was doing some shadowing in the ER during my first few months of medical school, and I’d been instructed by the nurse to put on sterile gloves and insert a Foley catheter into a gentleman who was barely conscious and speaking gibberish.

“I -- um, I’m sorry, I thought you just told me to put these gloves on,” I replied. I could feel the sweat inching its way out onto my forehead.

“No! These are sterile gloves! What the heck do you think you’re doing trying to put a Foley in like that?” she snapped. She clearly had a lot on her plate, making sure his monitor leads were all connected properly, his O2 was hooked up and flowing, and his ABG was striking artery.

“I apologize, but I think I need some help with this then. I’ve never done this before.”

“You haven’t?!?”

“No, I’m a first year.”

“You’re an intern and you don’t know how to put on sterile gloves.”

“No, no … medical student. I’m a first year medical student.”

She loosened up. “Ohhhh,” she said. “I apologize. I thought you were older.” Clearly everything started to make more sense in her head, though she had looked utterly incredulous moments before. She told me to hold on a second while she finished the ABG, and then she’d come show me what to do -- how to put sterile gloves on, how to remove the catheter from its kit, how to lubricate the catheter and sterilize the field. This was by far the most complicated procedure I’d ever witnessed in my young medical career.

I can’t blame her, though. What with my white coat, my fancy get-up underneath, and my unshaven face left over from the all-nighter I pulled for that morning’s physiology exam, I might as well have been an attending physician to her. At the University of Chicago, everyone wears long white coats -- attendings, residents, and medical students. Although the medical students have the school’s name and seal embroidered on them in the same spot where the residents and attendings typically have Their Names, M.D. on theirs, it is often hard to tell on first glance who is who, and the name badges do little to identify one’s place in the hospital totem. This, I’ve found, is both good and bad.

The good: Attendings, in theory, treat you as equals. You are not some runt running around the hospital in a short white coat. Patients, too, see you as competent members of their care team, and unless they are vehemently opposed to having medical students care for them, they do not mind sharing the patient love. Nobody truly knows how low on the totem you currently reside (below ground) or how little you know (very, very little) unless they actually talk to you. If you sit on some ketchup in the cafeteria or spill some morning coffee on yourself because you fell asleep in your chair, the long coat comes to your social rescue.

The bad: The above example pretty much falls squarely in this category, and some of the aforementioned goods are also bads. Attendings treat you as equals, and as such, they don’t feel as bad being jerks to you in some situations. Patients and nurses see you as competent members of their care team and, accordingly, ask you questions that you have no business answering and request that things be done that you have no business doing. People expect things merely because you wear a long white coat and resemble a doctor. Your coat drags on the floor when you hang it on the back of a chair, and you run over it with your chair wheels.

All in all, I like the long white coat. It allows you to blend in more. It allows you to avoid broadcasting the fact that you’re the hospital peasant. It’s strangely empowering. As with any power, you just have to remember to use it wisely and remember who you truly are and how limited your skill set truly is.

A Dose of Our Own Medicine

Ben Ferguson -- I often see fellow graduate and medical students while walking around campus, and while it’s not nearly as common as in the general population, I am appalled by the percentage of smokers among them. Keep in mind, I’m a medical student, and I’m a graduate student in cancer biology. It’s not as though my classmates are non-medical people who don’t have the dangers of smoking pounded into their brains for 4 straight years and don’t see the effects of smoking on one’s health first-hand. I guess what I’m trying to say is: You’d think they’d know better.

This is merely an extension of a question that’s often raised in the context of health care professionals: To what extent should they themselves remain healthy, for whatever reason? (Reasons here could include the promotion of good habits among their patients through exemplary living, health for its own sake, and, perhaps above all, the avoidance of hypocritical actions, e.g. a physician recommending to his or her patients that they adhere to a healthy lifestyle that the physician does not personally follow as a “lay person of society.”) Honestly, could you take a 300-lb. physician seriously if he or she told you to lose a few pounds? Would you follow the advice to stop smoking from a doctor who reeked of cigarette smoke?

Let’s face it. Medical students aren’t always exactly specimens of good health. We have irregular sleeping habits. We often eat too much while studying or too little while on a surgery rotation. We drive while exhausted. Screw driving -- we operate on patients and do procedures on patients and tell patients to get some rest … while exhausted. We are too competitive with each other for our own good. We drink, sometimes heavily so, after exams. We inhale pot after pot of coffee and pull all-nighters from time to time. We eat the communal donuts at nurses’ stations on slow nights. We will wind up divorcing our spouses more often than not, and we will pay too little attention to our kids. It’s all right there in the journals.

So where does it end? If it doesn’t end, where do we get off telling our patients to avoid all of these things? We -- our patients and us -- are human. We are the same, and we all care to some extent about our own individual health. We simply have different professions. Should we be expected to follow all of the advice we give others? In my mind, the answer is “not entirely.” The same could be said for police officers who break laws, or IT people who don’t have every single virus protection software suite installed on their home computers, or financial advisors who happen to have slightly less-than-perfect credit scores as remnants from some poor decisions in college.

But I would love it if we smoked a little less.

Solving Puzzles in the Lab

Ben Ferguson -- When I get really, reeeeaaaally bored in the lab, I tend to gravitate toward crossword puzzles and sudoku to pass the time. When I was finishing up a sudoku puzzle in the local paper this weekend, it occurred to me that these games closely mirror the life of a researcher, especially that of a graduate student.

In one regard, the pace of both puzzles and research is similar. Easy puzzles are quickly conquered. There’s nothing difficult about them, and the going is straightforward and methodical. Tougher puzzles can be done with short bursts of focus with other things interspersed (such as taking a bite of lunch, finishing up a Western blot, or making a gel). The toughest puzzles require more time and attention, and they almost always require periodic guesses, retractions, and rerouting. When you’re stuck and looking for answers, it often helps to try another route or do something else altogether. Upon revisiting the problem with a different mindset and further expertise, the answer is often staring you right in the face.

Life in the lab is much the same. Easy experiments are done repeatedly and can eventually be done in your sleep. They are more a matter of muscle memory and basic arithmetic than actual brain power. More advanced experiments and protocols demand more of your attention and time, and they often are multifaceted and require a number of different methods to reach a desired outcome. Often, they must be optimized and redone several times to ensure that they work properly and that observed results are not artifactual. The most difficult experiments are not isolated experiments at all, but they are more a sequence of experiments, convergences with other lab members’ work, and integration of individual projects into a larger theme, such as, say, a graduate student’s thesis project or a principal investigator’s R01 grant application. Often, they don’t work at all, and there are a number of different ways to approach the questions that they seek to answer.

The flow of progress in science and puzzles is similar as well. In each case, you start with minimal knowledge and work up to completion (or, in the case of scientific research, you work until one project is finished, and then you start a set of follow-up experiments or another project entirely). With the addition of each solution, you have gained knowledge about the current scenario that assists you in some way. This continues until, near the end, everything logically falls into place, each new solution comes more easily and is largely an expected result, and answers again stare you in the face. There is a clear apex and subsequent denouement, and it feels so good. The stars align, the water divides, the puzzle pieces fall into place -- whatever you want to call it.

I’m reminded here of something the dean of our medical school often tells us: Medical school is a marathon, not a sprint. Clearly, I must be doing an ultramarathon or something, but when I am forced to take breaks in the lab, I can rest well knowing that I’ll be rejuvenated to tackle a particular problem when I return to it. Now, 9-letter word for “extra supply”…

"So, Tom, Do You See Yourself as a Nice Attending?"

Ben Ferguson -- We’re fortunate at my school to have the opportunity as students -- yes, even as freak graduate-medical student hybrids who haven’t been in medical school-proper for a few years -- to interview applicants to our medical school. For those of you who are applying to medical school in the States now or in the near future, cover your eyes for a few seconds.

THEY’RE GETTING SMARTER, AND BETTER, AND MORE QUALIFIED EVERY YEAR.

It’s true. I can’t tell whether this is a phenomenon that’s specific to my school, but it’s definitely an actual phenomenon, and it scares me.

These people I’m interviewing are so much more qualified for medical school than I ever was. Were I to apply now for admission to my medical school, I’d be laughed right into rejection (if they even bothered to send me a rejection letter). I mean, holy crap. I’ve talked to people with publications -- first-author publications, no less. I’ve met students who were varsity letter-winners and Phi Beta Kappa at the same time. I interviewed an applicant who lives in Paris and London and flies back and forth, and occasionally to New York, for consulting meetings. One student I spoke to was a TV news anchor on a children’s show as a kid, and another was a Congressional page, you know, in his spare time. I’ve chatted with at least three students who have been given university-wide awards for their academic and research prowess and several others who have done international volunteer trips to care for indigent locals. (Okay, I did this once, but it was “only” for a week, and I “only” taught a few orphaned kids some English. These folks have, for months at a time, assisted in operations and delivered medical supplies and served as translators and … the list goes on.)

So, what have I done? Let’s see, I graduated from college (by the skin of my teeth), got into a PhD program once (narrowly), and … oh, that’s pretty much it. Unlike one student I interviewed a few weeks a