Half-Measures

( Disclaimer: Those of you with weak stomachs or who are excessively idealistic may skip this article in which I describe how one may subvert the conventional wisdom and get accepted to medical school. As you know, I believe the medical school admission process is idiotic. It encourages self-aggrandizement and has more hoops to it than a traveling poodle circus. It is also weighted heavily against the older, more stable applicant who may have a job, a family, and no time for the usual mock compassion of the typical pre-med student.

My favorite character from literature is Odysseus. He was neither the strongest, the bravest, nor even the smartest of the Achaeans but he was certainly the most cunning. Wiley Odysseus could keep his head and accomplish through cunning and a little chicanery what others with more overt prowess couldn’t. Somewhat like Odysseus, I’m not stupid but on the other hand I am not nearly as intelligent, talented, motivated, or even as passionate as the medical heros with whom I had to compete. -PB)

I wouldn’t say I had it harder than a typical pre-med student but I did have some unique problems. First, I had a full-time engineering job at a firm that expected some real work out of me. This would complicate the task of taking the pre-requisites I lacked, about 18 month’s worth at the rate of one course a quarter. But I did have contacts and a solid reputation so by virtue of being a licensed Professional Engineer I was able to start my own engineering firm and get a little more schedule flexibility.

Next, my GPA “blew hind titty” as my advisor was so kind to point out. This only confirmed what my mother warned me about: You do have permanent record and it will bite you in the ass some day. There wasn’t much I could do about it but I did have a couple of advantages. First, from the point of view of an engineer, classes in the biological sciences, at least at the level required for medical school admissions, are ridiculously easy. There are no formulas to memorize, no design problems to solve, and no math is required. It’s all just reading and a little binge-and-purge memorization. Organic chemistry was challenging but I latched onto a professor who didn’t believe in grades and rode out those classes with no worse damage then having to listen to his philosophical ramblings.

Second, I have always been good at math and had gotten good grades in just about every math course from Algebra to Differential Equations. This is important because a big component of your AMCAS application is the BPCM (Biology, Physics, Chemistry, and Math) GPA. The upshot of this was that my BPCM GPA was almost perfect, considering the easy A in organic chemistry, the easy physics A when I was just out of the Marines and studying like a real student, and the child-like simplicity of “Biology 101” and “Anatomy and Physiology (for Sociology Majors).”

Not to mention that Engineering classes, as they are neither math nor physics don’t count in the BPCM GPA, or at least that was my assumption and I guess I was right because the AMCAS bought it. The only ones I counted as either Math or Physics were the ones were I got an A (very few actually) and that I could stretch a bit. I listed Statics as physics and Finite Element Design as math but left Structural Concrete and Fluid Mechanics alone. Hey, at that time I was angling for every advantage I could get. I really enjoyed college in the early eighties and my cumulative GPA was really, really low. (2.8).

Then there was the question of volunteering. As there was no online pre-med community at that time I never felt it necessary to go to Africa to hold dying babies. I figured EMT training might be interesting and, as I had no disdainful premed friends to talk me out of it, I took a course at the famous Delta Ouachita Community College (or the “Harvard of Ouachita Parish” as it is commonly known).

I did the minimum possible volunteering as an EMT, and I mean minimum, to let me put it on my AMCAS application with a clean conscience. What’s the point, really? At that time my wife and I had a new baby in the house who refused to sleep, I was taking classes, working full-time, my father had just died, and I was gearing up for the MCAT. Medical school admissions, as I realized even then, was a game and if I needed to show some volunteering, well, I’d check the box but there was no need to get stupid about it. There are just not enough hours in the day, especially as I now know for sure that none of it really matters. The top students in your medical school class, the ones who shadowed doctors so much that they could get board certified, are all gunning for radiology just so they don’t have to touch patients ever again.

Or, to put it another way, medical school admissions is a big fat guy standing between you and the basket. You’re going to have to get by him. He’s fat but suprisingly agile. You can charge him and hope he backs down or you can try to sneak around him. Sometimes he’ll fall for a feint and you can get around clean but the odds are you will make contact and he will get some sweat on you. Getting past him is the challenge and it doesn’t matter how you do it. I’m not advocating kicking him in the nuts or anything like that but fortune favors the crafty and the bold. Later, as you eat the cheeses and hams of victory, you’re not going to look back and regret outwitting the fat guy.

The MCAT was a big hurdle but more of a psychological one. I geared up to study, as I said, but I never actually did except for a few desultory attempts to read the MCAT “Gold Standard.” I figured I would do well enough on the Physical Sciences section, would eat the Verbal Reasoning Section for lunch, and could fake my way through the Biological Sciences section which is pretty much how things went down. I got a 29. Not spectacular but good enough for Louisiana. When I got my scores, my wife read me the sample scores from the front page over the phone which added up to 24. “That’s it,” I thought. All that effort for nothing. She called me back a few minutes later, apologized, and read the actual scores.

The MCAT is a standardized test. It is all multiple choice and designed to test your knowledge in a broad but still limited number of subjects. None of the MCAT questions will come from left-field or require any creative thinking on your part. The concepts are fairly simple, the questions don’t go into great detail, and in the rare case that a question might absolutely turn your guts, you can skip it and write it off to bad luck. You have to know a lot, no question about it, but the most efficient way to study for any multiple choice, standardized (emphasis on the “standardized”) test is to do practice questions. You can take an MCAT review course, you can buy review books and read them religiously. I’m not saying this is useless. But, like the USMLE, to truly focus on testable subjects you need to pay for any or many online question banks and go to it. And make sure the question bank includes explanations for the right and wrong answers.

The authors of standardized tests have a limited repertoire. There are only so many ways, for example, to ask you a multiple choice question on the basics of circuit analysis. If you do enough practice questions you will recognize the pattern. If you just read about it you will rapidly forget the specifics. The same with sitting in Kaplan and listening to some graduate student drone on about it. It is easier to remember a pattern than facts and the facts will come if you remember the pattern. If you don’t agree with me you may do as you please or go to the devil for all I care. The object here is not learn the subjects, you should already have a grasp on them.

The object is to get by the fat guy.

I only completed applications for my two state medical schools. I figured, probably correctly, that if I couldn’t get in at either of these I probably didn’t have a chance anywhere else. I did apply to a few more schools but got bogged down in the secondaries, most of which asked for essays on truly ridiculous topics like “Qualities that Will Make You a Good Physician” or “Describe your Greatest Weakness.” Not to mention, “Why Did You Select Tulane?”

Hey, I’ll do what it takes but I do have some self-respect. The secondary application questions for LSU were along the lines of, “Have You Ever Been Convicted of a Felony?” which I believe is the only legitimate question that should be asked of anybody applying to medical school. It has a simple, easily verifiable yes or no answer and allows no room for the usual cringe-inducing tripe.

After the usual nail-biting, I was accepted to LSU Shreveport and, after a late interview invitation, was also accepted at LSU New Orleans. I liked New Orleans better but Shreveport was closer and the real estate was cheaper. Hey, I’m not fussy. Harvard, LSU, Duke, the Carribean…it’s all the same. Or at least the differences are not worth getting worked up about.

We moved to Shreveport and the rest of the story can be found on my blog.

Was it That Long Ago?

It was one of those cool, clean April mornings in North Carolina when I was discharged from the Marines. The sun shone brightly in the clear sky as the last of the mist lingering in the shadows evaporated. A gentle wind ruffled the surface of the New River and tugged at the tops of the pine trees.

I saluted the Officer of the day who had come out of his office to admire the weather.

“Good luck, Sergeant Bear,” Said the Lieutenant (who had been my platoon commander) as he shook my hand.

“Thanks, Mister Roland,” I said, “It was a real pleasure working for you.”

“You know you’re going to miss it.”

“Not a fucking chance, sir.”

And that was that. With considerably less trouble than it had taken to enlist, I was honorably discharged. It was anti-climactic, really. Almost eight years, an eternity to a young man, at an end with a respectful salute and a friendly handshake.

Have you ever been free, my friends? I’m not talking about some unobtainable existential freedom. I had money, I had a car, I had a beautiful girlfriend, and I had nothing but time until I started classes. If that’s not freedom, then nothing is. I drove out of the main gate of Camp Lejeune and have never been back.

I started at the University of Vermont that June as a Civil Engineering major. I went to class religiously, studied, and did pretty well. A little self-discipline makes all the difference. Besides, the lifestyle of a college student is an easy one. Other than going to a few classes, your day is pretty much your own. There is plenty of time to study without turning into a jittery freak, especially if you finally see the college lifestyle for the bullshit it really is.

It’s just a job. They can dress it up, put you in a picturesque campus and you can strut around getting educated but strip away the pretensions, the inexplicable loyalty to an organization that takes your money and can cheat you out of your education if you let it, and it’s a wonder the bookstore does such a brisk business in university branded paraphernalia.

Campus politics were ridiculous. The year I returned was the year of “Diversity University,” a little shanty built on the green to protest just about everything. It was a focal point for the usual left-wing crazies making a career out of protesting. It was also the year that the usual band of idiots, in an homage to their equally idiotic parents from the sixties, stormed and, for a number of weeks, occupied the administrative offices of the President of the University…and got course credit for it. The whole scruffy, useless pack of them were eventually driven out but not before they held numerous rallies with politburo style banners of Mao and Lenin.

Nothing but the spoiled children of the elite pretending to stand for something, just like their equally spoiled baby-boomer parents. Naturally I had a lot of fun with them. I was something of a conservative political activist and even started tearing down the shanty on TV before some little tofu-eater threw himself between the shack and my sledge-hammer. I attended all the diversity meetings and agitated for conservatism, politely and in my turn, of course, until they told me that I wasn’t welcome because it’s only diversity if it is left-wing and anti-American. I got in a little trouble and had a few conservative Vermont lawyers offer to run interference for me but it never came to that. The funny thing is that many college students spend their entire four, five or six year college career doing little but political activism. They take the usual Mickey Mouse courses where one bemoans “the Man” but, other than that it’s all posturing and pontificating in the fantasy world that is Academia.

Then they spend their lives wondering why nobody takes them seriously, lamenting their glory days in college with the same intensity as the former high school jock drinking his beers of despair in some fly-blown trailer park. Or they work at Starbucks, the graveyard of liberal arrogance.

Our original plan was to wait until I graduated to get married but we decided that this made no sense and my lovely and highly intelligent wife and I were married in May of 1992. Since she was going to quit her job (in television), we looked around and realized that it made no sense to spend the kind of money demanded by UVM when Louisiana Tech could supply the same education for a fraction of the cost. I transferred and finished my degree in 1994 with decent but not spectacular grades. I did a year of graduate school because we were young and didn’t need that much money to live.

Graduate school is useless in most engineering professions if your object is to work as an engineer. It doesn’t increase your starting salary, either. I had a friend who wrote his thesis on the percolation of water through a sand bed, an important topic to be sure, but very specialized and more likely to make your prospective boss scratch his head and wonder how it’s going to help him make money off of you.

So one day I got an engineering job, started working for real money, and just lost interest in academics. I came home one day and asked my wife for permission to quit graduate school. Working and studying, not to mention grading papers and the other lame things you must do to earn your stipend was wearing me out. Graduate students, like residents, are little more than slaves. Maybe graduate students are house slaves compared to residents cutting the cane but they are slaves none the less.

Besides, I was tired of being the only guy who didn’t speak Chinese in my advanced Finite Element Design class.

I worked as an engineer for a few years. No real complaints. It’s a good career and I highly recommend it.

Why medical school? I don’t remember. That is, I remember getting the idea of being a doctor in my teeth and not being able to let it go but I don’t remember from where the idea came. I had never been to a hospital except for the birth of our first child and in no way did this spark an interest in medicine, even if I did say it did in my AMCAS personal statement.

Hey, I lied. Doesn’t everyone?

The nearest I can tell, one day I was mowing the lawn under the merciless Louisiana sun and just got sick of it. I asked my wife what it would take to hire a lawn service and she said, “Maybe if you were a rich doctor we could afford it.” This was kind of silly, of course, because I was doing pretty well as an engineer and we hired a lawn service the next week. But, like I said, I got the idea in my head and a little research revealed that it was not impossible. I don’t believe the numerous medical school discussion forums existed back then so I had very few places to turn for advice. There were a few books at Barnes and Nobles, and the head of the pre-med advisory committee at Louisiana Tech, after the obligatory “crap shoot” remarks conceded that it was possible.

More importantly, there was, as I discovered, a medical school just down the road (well, fifty miles away).

After a lot of discussion, we decided to give it a try.

Next: The Plan. MCAT Secrets.

Random Musings on the New Year

The years roll by. I have vague memories of time passing with glacial slowness. Waiting for summer vacation. The eternity of high school. The time when it seemed that I had alway been in boot camp and always would be. The months I counted during the first Gulf War waiting to be reunited with my beautiful girlfriend who I later married.

And yet, it has all come and gone in what seems like an instant. Was it really nine years ago when my oldest was born? It doesn’t seem like it. The memory is too vivid. With easy reflection I recall the eternity of of sleepless nights spent walking the baby back and forth in the nursery, the fatigue from the second child who refused to sleep and spent what seemed like her first six months of life perpetually crying, and the death of my father from what I now know was brain mets from a malignant melanoma.

So I remember this time six years ago when, like many of you, I was checking the mailbox every couple of hours for the fat envelope announcing that I had been accepted to medical school. I had to wait a little longer, unfortunately, as I wasn’t accepted until early March.

You almost wish that you could get an answer-yes, no, something, anything-right after your interview. Of course this is not the way admissions work. Medical schools angle for the big fish, patiently working the lure hoping for a strike. After the pool is played-out they may throw a common worm on the hook and go after some trash fish. I guess that was me but I don’t care. One of the top students in our fist year class who was probably offered admission on her interview couldn’t handle the stress and quit halfway through first semester. I am sorry to say I felt vindicated. I may have been on the third-string roster but obviously there are other traits besides a 4.0 GPA and a 39 on the MCAT that maybe aren’t selected for as aggresively as many of you, oh my patient readers, would hope.

I don’t know why I decided to apply to medical school. There was certainly nothing in my background that would point anybody in that direction. As many of you know, I began my career as a United State Marine back in the early 1980s. I had just been kicked out of the University of Vermont for bad grades. Well, I actually had almost no grades as I seldom went to class and a couple of times didn’t even know where or when to sit for the final.

Have you ever had that dream where you are late for a big exam for which you forgot to study? That was pretty much my reality. I partied a lot too, although that’s not much of an excuse because a lot of people party and study (the college ideal). So with no prospects, no interest in academics, but also no desire to flip burgers for a year before I re-applied I thought I’d give the military a try. I directed my pasty, lackadaisical body to the local recruiting station and presented myself to the representatives of our country’s military might, slowely recovering at that time from the ravages of the both the Carter years and Viet Nam.

The Army, Navy, and Air Force were like car salesmen and tried to sell me on the options. “College!” said one. “Travel!” another. “Great lifestyle!” said the third. Sign with us and reap the tangible benefits of job-training, medical care, good pay, good chow, and easy promotion.

The Marine recruiter on the other hand, the most ferocious-looking individual I had ever seen, looked me up and down contemptuously and said, “Son, I’d like to take you but I just don’t think you have what it takes to be a Marine.”

Bait taken, hook set, nothing to do but reel me in.

Three weeks later I was sworn in at the Manchester, New Hampshire MEPS station and eventually found myself on the famous yellow foot-prints aboard Marine Corps Recruit Depot, Parris Island. After boot camp I went to the Basic Armor Crewman Course at Fort Knox, Kentucky and spent my first four years as a Tanker, eventually becoming a Tank Commander of a 62-ton M60A1 RISE Passive Main Battle Tank. A pretty good job, all things considered. Plenty of firepower, big engines. And limited walking. All the more reason my Battalion commander thought I was crazy when he re-enlisted me for another four years and a transfer (or lateral move) to the infantry.

I did my second enlistment as a machinegunner and then a mortarman in the heavy weapons platoon of an infantry rifle company, Company K (or “Kilo”) of the Third Battalion of the Eighth Marine Regiment…or “K 3/8” for the cognoscenti. I know I complain a little on this blog about the difficulties of medical school and residency. I have apparently grown an ovary or two since my Marine days. But the life of an infantryman is a hard one and I laugh whenever some idiot surgery attendings justifies his abuse of me by how tough he had it.

Mother-fucker, I have operated for weeks at a time above the arctic circle humping a 120 pound pack as well as a machine gun, a mortar tube, or some other heavy ordinance. I have slept in the snow and longed for nothing more than a pair of warm socks to make my life perfect. I have baked in the desert, thankful for the shade of a low bush and a couple of warm gulps of plastic-flavored water from my canteen. You were on call in a nice, air-conditioned hospital while I swam in the dark, through the close, humid underbrush of a nightime jungle and while you were mistreating your medical students and junior residents I was leading some of the finest men you are ever likely to meet, without belittling them or treating them like they were somehow inferior by virtue of enlisting a few years later than me.

So this explains my low tolerance for abuse. Put on your body armor. Shoulder your pack. Grab your 19 pound machinegun and thirty pounds of ammo and lets go humping, you and I, up and down the mountains. Then we’ll talk about your so-called difficult life and your right to talk down to me. You’d have your ass kicked in the Marines by the first Private First Class to whom you opened your stinking cake hole.

But I digress. I was honorably discharged as a Sergeant and decided to go to back to college for the right reason, that is, to get a well-paying job.

Next: College. A job. You want to do what? The Plan. MCAT secrets.

Random Musings on the New Year

The years roll by. I have vague memories of time passing with glacial slowness. Waiting for summer vacation. The eternity of high school. The time when it seemed that I had alway been in boot camp and always would be. The months I counted during the first Gulf War waiting to be reunited with my beautiful girlfriend who I later married.

And yet, it has all come and gone in what seems like an instant. Was it really nine years ago when my oldest was born? It doesn’t seem like it. The memory is too vivid. With easy reflection I recall the eternity of of sleepless nights spent walking the baby back and forth in the nursery, the fatigue from the second child who refused to sleep and spent what seemed like her first six months of life perpetually crying, and the death of my father from what I now know was brain mets from a malignant melanoma.

So I remember this time six years ago when, like many of you, I was checking the mailbox every couple of hours for the fat envelope announcing that I had been accepted to medical school. I had to wait a little longer, unfortunately, as I wasn’t accepted until early March.

You almost wish that you could get an answer-yes, no, something, anything-right after your interview. Of course this is not the way admissions work. Medical schools angle for the big fish, patiently working the lure hoping for a strike. After the pool is played-out they may throw a common worm on the hook and go after some trash fish. I guess that was me but I don’t care. One of the top students in our fist year class who was probably offered admission on her interview couldn’t handle the stress and quit halfway through first semester. I am sorry to say I felt vindicated. I may have been on the third-string roster but obviously there are other traits besides a 4.0 GPA and a 39 on the MCAT that maybe aren’t selected for as aggresively as many of you, oh my patient readers, would hope.

I don’t know why I decided to apply to medical school. There was certainly nothing in my background that would point anybody in that direction. As many of you know, I began my career as a United State Marine back in the early 1980s. I had just been kicked out of the University of Vermont for bad grades. Well, I actually had almost no grades as I seldom went to class and a couple of times didn’t even know where or when to sit for the final.

Have you ever had that dream where you are late for a big exam for which you forgot to study? That was pretty much my reality. I partied a lot too, although that’s not much of an excuse because a lot of people party and study (the college ideal). So with no prospects, no interest in academics, but also no desire to flip burgers for a year before I re-applied I thought I’d give the military a try. I directed my pasty, lackadaisical body to the local recruiting station and presented myself to the representatives of our country’s military might, slowely recovering at that time from the ravages of the both the Carter years and Viet Nam.

The Army, Navy, and Air Force were like car salesmen and tried to sell me on the options. “College!” said one. “Travel!” another. “Great lifestyle!” said the third. Sign with us and reap the tangible benefits of job-training, medical care, good pay, good chow, and easy promotion.

The Marine recruiter on the other hand, the most ferocious-looking individual I had ever seen, looked me up and down contemptuously and said, “Son, I’d like to take you but I just don’t think you have what it takes to be a Marine.”

Bait taken, hook set, nothing to do but reel me in.

Three weeks later I was sworn in at the Manchester, New Hampshire MEPS station and eventually found myself on the famous yellow foot-prints aboard Marine Corps Recruit Depot, Parris Island. After boot camp I went to the Basic Armor Crewman Course at Fort Knox, Kentucky and spent my first four years as a Tanker, eventually becoming a Tank Commander of a 62-ton M60A1 RISE Passive Main Battle Tank. A pretty good job, all things considered. Plenty of firepower, big engines. And limited walking. All the more reason my Battalion commander thought I was crazy when he re-enlisted me for another four years and a transfer (or lateral move) to the infantry.

I did my second enlistment as a machinegunner and then a mortarman in the heavy weapons platoon of an infantry rifle company, Company K (or “Kilo”) of the Third Battalion of the Eighth Marine Regiment…or “K 3/8” for the cognoscenti. I know I complain a little on this blog about the difficulties of medical school and residency. I have apparently grown an ovary or two since my Marine days. But the life of an infantryman is a hard one and I laugh whenever some idiot surgery attendings justifies his abuse of me by how tough he had it.

Mother-fucker, I have operated for weeks at a time above the arctic circle humping a 120 pound pack as well as a machine gun, a mortar tube, or some other heavy ordinance. I have slept in the snow and longed for nothing more than a pair of warm socks to make my life perfect. I have baked in the desert, thankful for the shade of a low bush and a couple of warm gulps of plastic-flavored water from my canteen. You were on call in a nice, air-conditioned hospital while I swam in the dark, through the close, humid underbrush of a nightime jungle and while you were mistreating your medical students and junior residents I was leading some of the finest men you are ever likely to meet, without belittling them or treating them like they were somehow inferior by virtue of enlisting a few years later than me.

So this explains my low tolerance for abuse. Put on your body armor. Shoulder your pack. Grab your 19 pound machinegun and thirty pounds of ammo and lets go humping, you and I, up and down the mountains. Then we’ll talk about your so-called difficult life and your right to talk down to me. You’d have your ass kicked in the Marines by the first Private First Class to whom you opened your stinking cake hole.

But I digress. I was honorably discharged as a Sergeant and decided to go to back to college for the right reason, that is, to get a well-paying job.

Next: College. A job. You want to do what? The Plan. MCAT secrets.