September 2006

New Beginnings

Dear Viewers,
It's hard to know what to say when you conclude one activity that you've enjoyed, but I'll try to put it into words (this is a blog, after all).

I've really enjoyed the opportunity to write this blog and want to thank everyone who has viewed, read, and/or commented on my blog. The first month is just a snapshot of the future experiences in medicine for my class and me. However, I remain optimistic about the challenges that face my classmates and me in each of our quests to become great physicians and scholars of academic medicine.
Sincerely,
Adam Tenforde
SMS-1

Marathon Days

...and by marathon, I mean both distance and time traveled

There are so many things to write about today, but where to start? My days seem to take on the characteristics of a marathon. Each morning, I wake up and prepare for the day with a good breakfast. Lately, that has consisted of an energy smoothie. Now you might ask, what's an energy smoothie? Six months ago, I started following the advice of a biochemistry PhD who specializes in nutrition named Clyde Wilson (http://www.smiweb.org/nutrition/dr_clyde.html). His theory is to create full energy meals that are portable and meet all nutritional requirements, including essential fats, protein, complex carbohydrates, and antioxidants. My power smoothies consist of: whole oats, mixed berries (raspberries, strawberries, and blueberries), bananas, peanut butter, flax seeds, green tea, and plain yogurt. The resulting smoothie is similar to Jamba Juice but with less sugar.
Following my morning shake, I've been cranking away with eight hours of class with a second smoothie at lunch, and three to four hours of homework, an easy 40-50 minute run, and seven hours of sleep. That's the formula for surviving class on Monday, Tuesday, Thursday and Friday.
However, I enjoy the free time that is afforded on Wednesdays. Here's a bit about my last Wednesday:
7:15 am - woke up and drove Kate to the Oakland Airport so she could go to her cousin's wedding
9:00 - 10:00 am - visited my physical therapists at SOLPT and gave them cookies to thank them for a year of teamwork to get my legs healthy for running
10:00 - 11:00 am - edited a draft of a sleep paper from my time at the Reiss Lab
11:00 am - 1:00 pm - drove from Oakland to Stanford, stretched, ran 50 minutes, stretched
1:00 - 2:00 pm - did a TB placement and bloodwork to demonstrate immunity from Hepatitis B and Chicken Pox
2:00 - 3:00 pm - drove home, showered and changed for Standardized Patient Interviews (more on that later)
3:00 - 4:00 pm - got fitted for a mask, in case I work with patients that are suspected/have TB
4:00 - 4:30 pm - prepared for group presentation on Cell biology lectures
4:30 - 5:30 pm - participated in a Standardized Patient Interview. Each first-year student gets to conduct a mock interview with a patient-actor in order to learn how to conduct an interview. After introducing myself and asking her for her name, I asked her why she was coming to see me. My patient was complaining about shortness of breath when she would walk up stairs and later revealed that she was a smoker. Despite getting that information from her and asking about her family history, I managed to forget to ask if she had any immediate family! One of my classmates later revealed that she forgot to ask her patient (complaining of similar symptoms) if he smoked. Again I repeat: Stanford Medical School has their work cut out to teach us the basics!
5:30 - 7:30 pm - went to a study group for Cell Biology and we presented the lectures to each other
7:30 - 8:00 pm - got a burrito at Whole Foods, drove to committee meeting for Running of the Bulls (www.bulls5k.com)
8:00 pm - 10:00 pm - Meeting of The Running of the Bulls. I have been involved with organizing this road race for 4 years. To quote the website: "The Running of the Bulls 5k Run & Walk and the Running of the Calves Kids' Fun Run are humanely inspired by the annual bull-running in Pamplona, Spain. Here in Palo Alto, our Bulls and Cows are Olympic athletes in costume! Our Olympic Bulls and Cows have a delayed start and run in timed intervals, so, whether you run or walk, you're bound to rub hooves with one along the way. Beat one to the finish line, and you’ll win the prize associated with that Bull! Mingle with them and graze on delicious treats from our sponsors after the race...the Running of the Bulls is simply an event like no other, showcasing some of the world's fastest athletes and bringing them together with the local community for an event that encourages athletics in children and challenges even the strongest non-professional athlete. We've made it our mission to nurture and inspire healthy, active lifestyles in people of all ages, and to enrich the fabric of our community." This year, we were one of three recipients of a Community Grant from Balance Bar that helped fund our event. In addition, we've received support from Molly Stones and other local community businesses to promote our event. The proceeds from the event will go to the Leukemia and Lymphoma Society, Partners in Education (an organization that raises money for Palo Alto Schools), and Sports Medicine Institute. I hope everyone will consider coming out to support this great event!
11:00 pm - to bed
So in summary, it was a long day filled with both school and non-school related activities. One of the hallmarks of Stanford Medical School is the opportunities they afford students to participate in additional activities with unscheduled class time. I feel lucky to be a part of such a wonderful program and know that my schedule is not unique - every student I meet has an amazing story about their interests and pursuits outside of medicine. The culmination of students with diverse interests yield an eclectic class ready to tackle the world.

Hawaiian-shirt wearing student-athlete band groupies

Hawaiian Shirts - Groupies - Student - Athlete: parties - Dave Matthews - 15 hour study-session - 20 miles

Ok, so my weekend was a mix of relaxing, enjoying music, running, and studying (of course:)) I am happy to report that I did it all in style. I always enjoyed the movie "Office Space," especially the part when the boss suggested that employees could 'wear a Hawaiian shirt to work with jeans on Friday.' The first-year class got together for a party on Friday evening with a tropical theme, and that was more than enough incentive to wear my vintage Hawaiian shirt. My roommates and Kate dressed the part too and enjoyed the opportunity to see our fellow classmates outside the familiar class setting of histo labs and lecture halls.

Saturday evening I enjoyed watching The Dave Matthews Band perform at Shoreline Ampetheatre with Kate. It was a really tough week, as I've been spending nearly every waking minute studying with classmates and did not have many opportunities to see Kate in a relaxed setting. The band was amazing (interesting fact on Dave Matthews: despite growing up in South Africa during Apartheid, he started a multi-racial band). Personally, the violinist Boyd Tinsley impressed me the most during the performance, though it's hard to explain the passion and zeal that he played during the concert that made him the most memorable to me.

After this brief respite from studying, Sunday was a challenging day. With quizzes due and half our 4-week quarter completed, there was so much to review. Fortunately, my classmates came to the rescue and made the day fly by with multiple study groups for anatomy, cell and molecular biology. I know that the term 'fly' should not apply to studying, but it seemed so perfect working with my fellow students to conquer the unknown and to teach each other the concepts.

My prediction is holding true - Stanford is fostering collaboration between students in mastering the material. If only the world could approach its problems and work with the same goal in mind...

Grey's Night

Just because we're going to become doctors doesn't mean we don't have an appetite to passively watch an overly dramatic portrayal of the profession. ABC sought our 18-35 year old niche and tada: Grey's Anatomy!

My house consists of Jess, Alana, Kate, and me. We've all become obsessed with the show Grey's Anatomy, and in passing conversation learned that our classmates have become infatuated with this television drama. It has been exciting to start a Grey's Anatomy night. The first episode of the third season begins on September 21st, and to gauge interest I started a Grey's Night sign-up sheet to see about making the first episode a medical student event. I was surprised to find that out of 86 students, 56 signed up (more surprising for me is that the other 30 didn't sign up)!

ABC is currently showing the reruns, so we made an open invitation to the class to come by and enjoy some home-cooked brownies and watch the show. It was a pretty relaxing way to spend the evening watching people act as doctors on television while we concurrently are learning how to act as doctors. So everyone, actors and students alike, is learning how to act like doctors. Who knew we had so much in common!

A few avid viewers (from left): Jess, Luiz, Philippa, me, Kate, and Alana

Lost in Transition

We've been in class one week, but I feel so...tired. Yet I've learned that my fellow students are feeling the crunch too. Here's a few misconceptions I've uncovered from my first week of classes. Fellow students, faculty and staff: I hope this will prove beneficial in learning the ways of the first-year medical student (please read with humor):

Everyone gets it but me
I've approached our first month schedule of classes with dread. My previous education and research experiences have centered around the macro world: predominantly organ systems and the brain. I don't know much about those small prokaryotic cellular critters, and until now I have dodged learning foundation material in cellular and molecular biology. Yet as I've learned, Stanford Medical School believes this knowledge is foundational to understanding human health and disease, so we're all getting a crash course in these areas.

While I agree that the content is valuable, what has really frightened me is the details that the material has covered. I'm not proficient at using a microscope, I haven't studied precursor cell types, and my basic knowledge in DNA replication and repair is basic. To be more specific, it's difficult to read EM, to understand microsatallite instability of DNA, and to learn 10-15 anatomical structures each time you study a cadaver.

After a pretty rough night, I decided to ask my classmates how they felt about the material, and I was relieved to find that everyone, even students with a microbiology background, was struggling with the material. It's not just me - we the students are being asked to learn a great volume of knowledge.

Sleep matters (little)
I have always loved caffeine. I'm a habitual coffee drinker and enjoy the morning cup of java. Yet, I find myself returning for a second dose in the afternoon, and reaching for the dark chocolate espresso beans (if you haven't tried these, they are VERY tasty) a bit too often. I evaluated my sleep patterns and found that I have been getting six to seven hours a night, well below the eight to nine hour average I maintained before starting classes.

Polling my fellow students, I was admittedly relieved to learn that I was doing well with my sleep. People on average reported getting a mean of five to six hours (range = 4 - 7, N=8), well below the recommended value of eight hours per night. Even more disconcerting is that we're only in the second week of classes! Fortunately, we've got time to adjust and become more efficient in our efforts, so that we can take care of ourselves and maximize our learning potential. I've put in my 45 miles of running this week, so I've got a good start on keeping physically fit. Now, if I can just find that one additional hour in the day to sleep...

The orientation to becoming medical students is over
True, we had a week set aside to travel to the Sierras for SWEAT, came back to hear the faculty and professors introduce us to the curriculum and inspire us about our educational opportunities, and get our bearings before classes began on Wednesday. However, we've learned about additional classes (a.k.a training) that are required for our practice of medicine. For instance, most of the class learned how to draw blood, take blood pressure measurements, and started on our CPR training last Wednesday.

I guess I can say that my experiences have left me feeling overwhelmed by the breadth of knowledge required to practice medicine. Fortunately, my classmates seem to concur, and I find it unlikely that Stanford would choose 86 students that are incapable of meeting the task. I find strength in my classmates and know that this too will pass.

Downtime

After a challenging week of orientation and classes, I've decided to take a little time to organize my thoughts and life. The Labor Day three-day weekend is the perfect opportunity.

I was prepared for medical school to be challenging. Whenever people heard that I was applying to med school, they would tell me that it was going to involve a lot of work. In addition, people questioned my ability to continue running professionally. The term student-athlete has applied to my life for as long as I can remember. After graduating from Stanford in 2003, I continued my education by fulfilling my pre-medical requirements. During this time, my passion for running did not change at all. I was given an amazing opportunity to run professionally for Reebok and be represented by an agent. However, injuries have prevented me from competing for the past two years.

Going into medical school, I decided that I would make a goal to qualify for the 2008 Olympic Trials in the 10,000 meters. I'm throwing that goal out there for everyone to see, as I've learned in sports psychology that a good goal-setting strategy is to publicly post your goals. I've looked at my running as an extension to my life as a student, and my current career projection lands me somewhere in the specialty of sports medicine.

Yet, I am not Superman, as I have humbly learned my first week of classes. Eight hours of sleep is hard to come by as our schedules are filled with classes (and last week by orientation materials), and life continues to go on while we are students. We have bills to pay, friendships and relationships to maintain, and occasionally we need to take out the garbage. Today I've plowed through the drifts of papers and emails that have cluttered my room and mind. I'm going to go for a leisurely run this afternoon, lift weights, and do some core-strength exercises. In addition, I'm going to spend some quality time with my girlfriend who has been very supportive but has seen little of me due to the week's demanding schedule. Most importantly, I'm going to take a moment to remember that I'm human and need to satiate my needs for nourishment of the body, mind, and soul.