"To Everything a Season and a Time for Every Purpose under the Heavens" - Ecclesiastes 3:1

When I was four years old I received a brown, plastic toy doctor's kit. Inside were mysterious and wonderful instruments of the learned: a plastic stethoscope, a toy syringe, a small basin. I cannot recount the many hours I spent gleefully "diagnosing" adults who, in turn, exercised what could be described only as saintly patience.

Later, as a young pre-teen my uncle would refer to me jokingly as "doctor". "Hey doctor!" he would say loudly as I entered a room. I turned my precocious 12 year old self towards him one day and said with mock seriousness, "Not 'doctor', professor!". He thought that was funny.

When in high school I was only one of two students in my class who went to a cadaver lab, an exercise for those who hoped to one day go into medicine. I was 17 when I held my first human heart.

While in the military I served as a combat medic, traveling the world and patching up troops on multiple continents. How many times did I grab my aid bag and run towards the voices yelling, "doc!" - more than I can recall.

These are wonderful and treasured memories. I cannot help feeling, however, that they all have been leading up to this moment. Today, after decades of experience and years of study, I have finished my final medical school requirements. Today, I am finally a physician.

Honestly, it hardly seems possible. My mind has not yet grasped the enormity of what has happened. With the passing of that final exam and the last "click" of the computer keyboard, I have at long last received that for which I have for a lifetime labored: I am a doctor. I am a healer. God has favored me with this profound privilege and staggering responsibility. I know it will be by His Strength alone that I shall live up to this sacred title.

I have much to share with you concerning the details and nuances of medical school. This experience is surely not for the light hearted. Neither is it for those who are not absolutely sure they want to spend their lives in the service of God and humanity. Over the next several weeks I will be casting some illumination on particular experiences and challenges in the hope that this may prove helpful.

Until then, no more books for me. I think I will sleep in tomorrow.

A Very Special Day

Today is a remarkable day, a day for which I have been waiting since I resumed my undergrad studies in 2012. Today, at 1700 hours Central Standard Time in the United States, I officially finished my last day in medical school.

Honestly, I can hardly believe it. This journey has been so much more than I imagined and required so much more than I had to offer. It is God Who has carried my family and myself on eagle's wings (Exodus 19:4) and brought us through tribulation, trial, and triumph on levels heretofore unknown. He has guided us through extraordinary blessing and crippling want, academic success and biting poverty. And, through it all, we have come to know and love Him and appreciate each other as a family more. I will never stop celebrating the reality that I am a physician because of Yeshua (Jesus).

Please note I am not bouncing off the walls in wild exuberance. Though I am terribly thrilled at finally being done with my medical rotations and school work, there remains on final exam (a COMAT shelf exam in surgery) hanging over my head. This is unusual as most students by this time in their academic careers have finished all their academic requirements. When taking this particular exam many months ago, there was a computer glitch that required me to stop and restart, thus robbing me of precious time. I ended up failing by one point. My school has asked that I retake this exam. Until I do, I am not completely done.

I must be honest: this is a frustration. But, I know if God can carry me through undergraduate studies and four years of medical school with a large family and two special needs children, He can get me through this final, petty, exam. It will take about three weeks of study and two additional weeks for the results. God willing, I will pass and then I will be, officially, a doctor. It is at that point, Dear Reader, I will be exuberantly bouncing off the walls!

Despite all, today is a very special day and, though muted, a day of celebration. Shabbat has begun and my family and I will be resting. After shabbat, for me, it will be back to the books.

Thank you for your time. I will keep you posted.

P.S. I'm actually in this picture taken at my med school in 2016. Good times!

The COMLEX Level 2 PE - A Good TIme!

There is, in the saga of the advancing medical student, a particular board exam that tests the student's ability to perform physical exams and offer differential diagnoses. For osteopathic medical students this test is called the "COMLEX Level 2 PE" ("PE" for "Physical Exam"). For allopathic medical students this is called the USMLE Step 2 CE (Clinical Exam). As an osteopathic student I can speak only about the PE but I am guessing the allopathic experience is similar.

My PE was in Conshohocken, Pennsylvania, a distant suburb of Philadelphia. A nondescript, business building squatting near the river houses the testing center. After showing up several minutes early in a plain white coat and dressed with professional slacks and tie, I signed in and took a seat with eleven other medical students similarly attired. The room was filled with hushed voices and the air was thick with tension. A friendly if not slightly bored attendant behind a long counter checked my ID and inspected my stethoscope to make sure I have not surreptitiously snuck in some obscure medical algorithm on microfilm. I signed a non-disclosure agreement and it is because of this that I cannot share anything specific about the test itself. I can, however, share my thoughts about the overall experience.

After waiting what felt like an hour the dozen of us, like white-clad sheep led to the slaughter, were herded into another room where we were given a protracted briefing concerning the structure and length of the exam. It is a very long test, taking over seven hours. During the day we would see twelve "patients" (played deftly by trained actors and actresses) and would be responsible for evaluating them, performing any correct physical exams, and creating a set of differential diagnoses. We then would have a certain amount of time to properly record our efforts on a computer.

These seven hours went incredibly fast. Despite the stress I must admit there was certain sense of adventure for I never knew what was behind the next door. Overall, it was a fantastic experience assisted by a kind and professional staff.

How does one prepare for this? There are a number of professional texts available to cover the vast didactic knowledge needed. For osteopaths, there is also an intense two day course offered for those who want some additional strengthening of skills. The PE medical board exam costs about $1,250 so it behooves the prospective student to make whatever preparations are needed to pass the first time! I've often joked that, if this medical thing does not work out, I should get a job for the company that conducts these tests.

If you are reading this and are preparing to take the PE, might I suggest the following helpful hints:
- Get to the testing center about 15 minutes early
- Bring only what you need. The lockers are small.
- Wear a white coat that has no identifying marks, especially from your school. It's just easier.
- Get a good night's sleep the night before. This cannot be overstated.
- If possible, try to test in the morning. The "patients" tend to be less tired and in a better mood.
- COMBANK has a set of videos covering basic OMM techniques for this exam. I found these very helpful.
- Greet every patient with a smile and be professional at all times regardless of what may happen.
- ALWAYS WASH OR SANITIZE YOUR HANDS BEFORE TOUCHING THE PATIENT! I know you know this but in the heat of the moment it might be forgotten.
- Don't argue with "patients", staff, or admin personnel. They're their to help you.
- Try to enjoy the experience. NBOME has been doing this for a while and they know what they're doing.

There is little more I can share concerning the Level 2 PE. Thanks to God, I have passed this, yet another hurdle. I have one final exam (not nearly as large as the PE) and then I will be done with medical school.

Finally!

Until then, Dear Reader, please take care of yourself. For me it's back to the books.

The Broken Silence

It has been seven months and you, Dear Reader, have heard nothing from me - not a peep, not a tweet, not a sound. At long last, the silence has been broken.

I won't waste your time with eloquent elocutions concerning the rapidity of passing days or the "tempus fugit" nature of our lives. Suffice it to say that the past seven months have been filled with two medical board exams, numerous COMATs (readers familiar with this blog will know the pain associated with that term) and the joys of applying to medical residency programs. As you can imagine, it's been nothing but smiles and sunshine and pink fluffy unicorns riding rainbows for these several months....

Tomorrow I will begin to fill you in on the details of these experiences. For now, please know I have not, during this journey, forgotten you.

https://www.youtube.com/watch?v=qRC4Vk6kisY

COMLEX Level 2 CE

Ah, the bliss! Ah, the joy! Ah, the indulgent luxury of sleeping in! Today I didn’t get out of bed until 11:00 am. Why, you may ask? It was a bit of a reward to myself, a gift for the stress and intensity of yesterday. For you see, Dear Reader, yesterday I sat down and took my Level 2 medical boards exam. Like Level 1 from last year (and the year before and the year before that - see prior blog posts for THAT adventure) this was an eight hour, 400 question exam. Unlike, however, Level 1, yesterday’s exercise in the bounds of human stamina covered clinical medicine. Gone (mostly) were the petty questions covering inane details that I will never use in medical practice (citric acid cycle changes, anyone?) and, instead, yesterday had questions like this:

A 72 year old male nursing home resident comes to the emergency department complaining of abdominal pain, nausea, bloating, and flatulence. His medical history includes diabetes mellitus, hyperchloresteremia, hypertension, hypertriglycedemia, headaches, lower extremity cellulitis, obesity, insomnia, obstructive sleep apnea, schizophrenia, and prostate cancer. His surgical history is significant for an appendectomy, cholocystectomy, partial colectomy, and hang-nailectomy. The patient is taking metformin, amiloride, atorvastatin, zolpidem, sertraline, and acetaminophen. The patient has a 78 pack year history of smoking and drinks about twelve beers a night. He is retired and lives alone and is fond of eating Twinkies, watching reruns of Happy Days, wearing mismatched socks and taking long walks on the beach. Physical exam is significant for generalized lower abdominal tenderness without rebound pain or guarding. Vital signs are: BP 210/130, heart rate 43, respirations 25, and oxygen saturation at 91% on room air. What is the most likely color of the sky outside of the hospital?
A. Blue
B. Cyan
C. Azul
D. Turquoise
E. Green with a skiff of high stratosphere cirrus clouds

From this made-up example you can see the real danger in Level 2 questions: many of them are obnoxiously long and the answer choices, though not difficult, are very, very, very similar to each other. It is our job as senior level medical students to be able to pick the best answer from obscure hints in the question stem (The answer to the above question is “D” because it just is.....)

After the test everyone asks, “How do you feel about it?”  How can I answer this question? I would love to be able to walk out of the testing center, dancing with various spring-time birds alighting on my shoulders whilst whistling in the sunlight. The reality is that sitting for eight hours and clicking on hundreds of purposely complicated questions is the very definition of tedium. How do I feel? Exhausted.

Meanwhile, results will be available in a month. Do I feel I passed? I will be honest: I was pretty discouraged yesterday. This morning, in the light of a new day, I am feeling cautiously optimistic. Beyond my feelings, though, there remains one thing about which I am certain: God Himself placed my family and I on this road. It is God, not I, Who is making me a physician. In order for this plan of His to come to completion I must pass yesterday’s exam. This being the case, faith and logic tell me yes, of course I passed.

Dear Reader, thank you for your time today. I will keep you posted.

"Danger, Will Robinson, Danger!" - Class M-3 Model B-9 GUNTHECR Robot

Oy vey es mir! I promise frequent updates to you, Dear Reader, and find myself losing six months!

Why??

Because of a great danger associated with medical school about which, heretofore, I was blissfully unaware, namely this - medical school is all consuming. First and second year were tough, no doubt about it. Third year, however, has been a monster on time. Put simply, there isn't any. Between rotations, tests, busy-work from the school, and family, this blog has fallen behind. If you are thinking about going to medical school, please know that, as the years progress, you will have less and less time. This fact becomes crucial especailly if you are going to do this with a family. The danger is all too real that you will lose yourself in study and preparation for residency, so much so that the rest of the world begins to fall away. Indeed, there are some students who fail to take care of their own health or hygiene. This is a grave danger, indeed.

In the highs and lows of third year, I found that, with each successive rotation, I would spend less time with my family, less time doing "fun" activities. Danger! I am thankful to God that He brought this to my attention so that I can get my priorities straight. No amount of success in my career will ever make up for being a failure in the home.

So, I'm back! In a few days I will share with you some of the rigors of third year. It was an adventure, one for which I am grateful.

Until then, Dear Reader, God bless you. For me, for now, it's back to the books.

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"The fire seven times tried..." - The Prince of Aragon in The Merchant of Venice

Remarkably, I am in the beginning of my seventh clinical rotation. I have completed one month each of Internal Medicine (I &II), Pediatrics, OB/GYN, Adult Primary Care, and Family Medicine. This month I am doing an “elective” meaning I get to pick the discipline. I chose anesthesia for a couple of reasons: first, the idea of pain and its control fascinates me, second, this rotation usually offers students plenty of study time for exams.

Oh yes, I forgot to tell you about these exams.

Called “shelf exams” in allopathic schools and “COMATs”  (Comprehensive Osteopathic Medical Achievement Tests - there’s a mouthful for you) in osteopathic schools, these exams are designed to test your knowledge of a particular subject at the conclusion of the rotation. To be honest, these tests are not nearly as hard as the COMLEX step 1. Consisting of only 125 questions, the COMATs deal more with diagnosis and disease management and less with nuanced detail that has very little to do with actual patient care (Kreb's Cycle anyone?).

Though these exams pose little challenge, I still find myself struggling with them. My professors and proctoring physicians tell me I know the material very well and they universally agree I will make an excellent and able physician (thanks to God!). However, when I sit down in front of that computer for the actual exam, my struggles with the COMLEX step 1 flood back. My heart rate doubles and I am reminded of the pain of repeated failures. Perhaps I am naive but I am surprised that this is happening. For whatever reason I thought I would be able to breeze through these simpler tests and prep for the COMLEX step 2 exam next year.

So the challenges of medical school continue though, to be completely honest, I welcome them. I knew this journey would not be easy nor am I looking for a smooth road. After everything that has happened and all my family and I have experienced, I remain solidly confident in God’s goodness and faithfulness to get us through. I love this journey.

Until next time, dear reader, God bless you. For me it’s back to the books.

Me at the start of my 7th clinical rotation. Whoo-hoo!

The Answer

To be healthy involves much more than physical strength or absence of disease. It necessitates a strong spirit and a balanced mental/emotional state. If any one of these aspects of a person's life is wounded then the person entire suffers. I have believed this for many years and will, with God's help, apply this truth to my practice in the future.

Tomorrow begins my third week in something called "Primary Care Selective" which is a fancy way of saying, "General medicine for people of all ages". I am working and learning at a large non-profit, faith-based organization which aims to provide health for the uninsured. The aspirations of this group are vast and they have helped hundreds of thousands of patients over the many, many years during which they have operated.

Having said this, there is an enormous gap in the care provided at this otherwise noble place. They believe health of spirit can be attained through a nebulous definition of "faith". Put succinctly, they believe as long as a patient exercises "faith" in whatsoever manner that individual desires, health of spirit will ensue. I respectfully and emphatically disagree for I have learned not "...all roads lead to Rome".

The spirit (heart) of man is profoundly corrupt, poisoned by selfishness and blindness. We all have done or contemplated terrible things. Being a Jewish Christian (Messianic Jew) I know, beyond all doubt, the only solution for this self-defeating state is Jesus. Jesus, alone, is the answer to the health needs of our spirits and souls.

I have had the privilege, over many decades, of meeting people of nearly every conceivable ethnicity and religion: Christian, Jewish, Muslim, Atheist, Wiccan, hard-core satanist, Hindu, Buddhist, Zoroastorian, New Age, Roman Catholic, indigenous Tribal Polytheism, Latter Day Saints, Jehovah's Witnesses, Alien worship (yup, it's out there), Masons, and on and on. I have had the honor of sitting down with these folks and learning where they come from and what they believe. The One Universal Factor that stands out is this: there is no One like Jesus. He alone is unique among the figures of the world. Trust in Him alone brings lasting, radical transformation and healing for the self-stained spirit of humanity. I have witnessed this in my own life and in the lives of countless others regardless of their backgrounds.

As a future health-care provider it would be wrong of me to rob my patients of the opportunity to know how to be fully healthy; it would be unethical of me to not offer to them the option of obtaining true healing of their whole person. No, I will not now, nor have I ever in the past, pressure my patients into this faith, nor will I ever deny care simply because someone chooses not to believe. I would, however, be the worst physician if I neglected sharing this profound fact: Yeshua (Jesus, יֵשׁוּעַ, Iesu, Jésus, Ісус, 耶稣, Ιησούς, Иисус, 예수, عيسى) alone is needed for full health. May we never forget this.

He is true medicine.

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The Rumors of my Death....

I am alive!

Dear Reader, please accept my sincere apologies. Since I passed my COMLEX Level One medical boards exam this past March I have sorely neglected keeping you abreast of all that has happened.

The reason for my silence is due not from any desire on my part to distance myself from you. Quite on the contrary, it has been your prayers and support that have so much helped my family and myself get through the past two years of struggle and failure. Rather, my silence is a byproduct of the extraordinary busyness that has since consumed me. As of this weekend, I have completed four clinical rotations: Internal Medicine (I & II), Pediatrics, and Obstetrics/Gynecology.

What are clinical rotations you ask? Each lasting a month, clinicals (as they are called) are when, for a third year medical student, medicine moves from the classroom to the patient room. It is here that we learn to apply what we have so arduously learned during the first two years. Needless to say, the past four months have been far more exciting, enthralling, and electrifying than anything thus experienced in med school.

Because of the vast amount of time involved in actual patient care, I have neglected reaching out to you. I commit to you that this shall not happen again. You have so much encouraged my family and myself. Future blog updates may be much abbreviated, again due to pressed time, but, with God's help, updates WILL happen. I aim to be in touch no less than once a week, sometimes even more frequently.

Thank you, dear Reader, for your time. I look forward to our time together. Until then, for me, it’s back to the patients!

Me during a busy day at work in the hospital.

Final Attempt COMLEX Result Are In

I PASSED!!!

BARUCH HaSHEM (PRAISE THE LORD)!!

The Final Countdown

Exactly one week from today I am scheduled to sit down and take, for the last time, my Step 1 medical boards exam (lovingly known as the "COMLEX"). Friday, March 9th, is the day the destiny of my family is decided.

Or is it? Is it possible that all of this was ordained a long time ago, perhaps even by One Who is Himself beyond the bounds of time?

In the midst of studying for this final attempt, I have been looking closely at all God has, in His goodness, done to get my family and I to this point. I even took a few moments to write these things down. The point of my doing so was to get a more objective view on what God has done and try to see more clearly His will. I do not want to be one of those folks who is given to wishy ambiguity - I want my faith in Him to be solid and unwavering. If, then, I somehow have missed God all these many years and it is not His will that I serve Him as a physician, I want to know that.

So, I started my list - a list of miracles - God has performed since I returned to undergrad in 2011. Has He been leading us or have I been forcing His Hand, driven by my blind passion to become a doctor? I was determined to find out.

What started as a five minute exercise turned into fifteen minutes, then thirty, then an hour and more. I ended up listing 61 specific things God has done - 61 miracles over which my family and I had no control - to bring us to this point. God has moved mountains to get me into medical school and to sustain both my family and myself therein. Space does not permit me to detail how He has guided our steps, closed some doors and opened others, and come through for us (sometimes just in the nick of time) so that we would end up here, years later, trying to pass a fourth time my Step 1 COMLEX.

What if these failures were also part of His plan for us? It seems a departure from His Character to lead us to this point with such miraculous clarity only to allow, at the eleventh hour, failure. Thus, I strongly believe, with profound conviction, that this final attempt will end in success. I am going to pass this time. This passing, though, will be due less to my intelligence and diligence and more (much more) to God's timing and His goodness.

It has occurred to me that, to some, such a bold statement of faith will look hopelessly foolish. Perhaps I am a fool. History, though, teaches us that the greatest accomplishments have been achieved by men and women who, coming to the end of their ability, were "foolish" enough to place their trust in God and His ability. It is in such a place that I currently find myself.

God bless you, dear reader. Thank you for your time. I will keep you posted. For me, in this last week, it is back to the books.

For God’s people the best is yet to come.

וַיִּתֵּן הָֽאֱלֹהִים אֶת־דָּנִיֵּאל לְחֶסֶד וּֽלְרַחֲמִים לִפְנֵי שַׂר הַסָּרִיסִֽים׃

Sometimes it feels as if God has forgotten me: it's a big universe and, perhaps, He has more important things to which to attend. I know this is not true. I know that He loves His people with an everlasting love (Jeremiah 31:3) but it does not always feel this way.

Other times, it feels as if God has lavished so much goodness and attention on my family and myself that I wonder how the rest of the universe is surviving without Him.

Most days are a zone between these two extremes.

On January 3rd of this year, however, God did yet another miracle - another vast expression of His profound (and eternally undeserved) goodness to us.

He changed my test date.

As many of you will know about a month ago the school had given me a deadline for taking my medical boards. This cutoff date was to be "no later than the end of January, 2018" and was "non-negotiable." I was in despair. There was no way that I was going to be ready in the short time this deadline afforded. Indeed, I was torn between taking my boards for the final time by the end of January (and being certain of failure) and simply quitting school. The results of either decision would be the same.

After much agonizing prayer, my wife and I surrendered the situation to the Lord. He has carried us with so much grace to this point. We were convinced that He could somehow work through this latest challenge.

I sent a thoughtfully worded email to the school, explaining again my situation. I requested that they might consider changing my date to March 9th, giving me two months to prepare for this final attempt. I finished typing the email, pressed "Return", and surrendered it to God. Regardless of their decision, I reminded myself that God, not they, is in charge.

A few days later they sent their affirming email. Just as God had caused Daniel to find compassion and mercy before the prince so also He had granted favor to my family and myself (This is found in Daniel 1:9, the verse in Hebrew at the title of this blog entry). It truly is a miracle!

So, now, thanks again to God and His goodness shown me through the school, I have 7 weeks to prepare - more than enough time. I remain in awe at God's goodness and am more than ever convinced that I shall pass this final attempt and God is going to allow me the honor of serving Him and humanity as a physician.

HalleluYah!

I wanted to share with you, Dear Reader, this extraordinarily good news. I better let you go for now. For me, I joyfully go back to the books (and practice questions)!

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When it Rains.....

I begin this by stating that I love my medical school. I know on previous blogs I have said this, but it bears repeating here: Lincoln Memorial University DeBusk College of Osteopathic Medicine (LMU-DCOM) is an incredible place. I have learned so much there already and, the more I have learned, the more I have fallen in love with medicine. I have met incredible people: professors, staff, and students who have taught me much about professionalism and humanity. I remain in their debt.

As many of you know, I have been struggling to pass my COMLEX Level 1 medical boards exam. Most of my classmates passed this difficult test last summer and are now half-way through their fourth year (mazel tov to them!). I am still technically an OMS-II (Osteopathic Medical Student - 2nd year) because of my failures. Three attempts have ended in crushing disappointment - close but never quite enough. Despite the fact that I am now nearly two years behind my peers, LMU-DCOM has expressed continuing interest in seeing me pass.

Recently, their interest has taken a more zealous turn. They informed me that I need to make my final attempt at this test no later than January 31st of 2018 (the end of next month) or I will be kicked out of medical school.

I understand where they are coming from: they feel that I have had more than adequate time to take this test and that I should do so and move on. Also, each student is expected to pass medical school in no less than six years. For my situation, I may graduate no later than May, 2020. In accordance with how the COMLEX system works, as long as I pass this COMLEX before June 2018, I will be on track to graduate by 2020.

I explained to the school that my studies for this final attempt have been going slower than anticipated. Because LMU-DCOM cut off our school loans after my first boards failure last July, I have had to find a job. I love working, but work does take away from study time. Additionally, to keep my job, my employer has told me I need to pass two national certification exams. The last of these exams is in two weeks. Most of my study time has been filled with this task. It is my earnest desire to pass my COMLEX but putting food on the table and taking care of my large family is a bigger priority. I feel confident that, if given to the end of March next year, even with the above responsibilities, I would be able to pass my boards.

I shared with the school these concerns. Though they appreciate my dilemma, they told me that the January 31st deadline is non-negotiable.

So, now I have a choice to make: do I provide for my family so we do not end up starving on the street or do I try to cram an effective review of two years of medical education into five weeks? (The final test date for COMLEX Level 1 in January is the 23rd, thus cutting a week off of their deadline).

I love my school and I really want to be a physician. I have desired this and planned for this for 40 years. I have run up over $250,000 in student debt for this. Serving God and man as a doctor is, to me, one of the highest joys this life has to offer. But, and on this I will be clear, if becoming a physician means I must put my family at risk, then I will surrender this life-long dream: my family is more important.

As with all problems, there is a solution. In recent days God has reminded me of His gentle Presence and comforted my anxious heart with His Peace. I know that, in the end, God's Will will be done.

Dear reader, thank you for your time. I am not giving up hope. Please pray for us. I will keep you posted.

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"The reports of my death have been greatly exaggerated." - Mark Twain

I'm alive!

It is difficult to believe it has been three and a half months since my previous post. So much has happened in the ensuing weeks.

At the request of my school I have spent this time going through a number of tests. I was encouraged to see a neurologist to determine whether or not there was an organic cause to my repeated medical board failures. I was also asked to see a professional testing specialist to determine if I suffered from some type of cognitive or memory impairment.

It is extraordinary to me at the amount of time needed to see these specialists, go through the many tests required, and await the results. I have been poked, prodded, quizzed, and interviewed. I have given vials and vials of blood, had an EEG, and spent literally hours answering cognitive, memory, and IQ questions. All in all, it has been exhausting but has shed some light on my current dilemma.

Thankfully, my brain is structurally intact and functioning at the highest level (a fact held in some debate according to my wife). The testing specialist reported I do have the cognitive and memory ability to pass this troublesome COMLEX Level 1 exam.

What, then, is the problem? The only tests that came back even slightly abnormal were the ones done for attentiveness and memory. Dear reader, I have been diagnosed with ADHD.

This is an extraordinary and unexpected revelation to me. I asked why, if this is true, have I been able to complete undergrad and the first two years of medical school successfully. I have learned that ADHD can be an elusive and unpredictable condition. Apparently, the unique demands of the COMLEX, along with my traditional method of studying and testing anxiety, created a perfect storm which resulted in an essential "shut down" of my memory recall when I needed it most leading to those notorious multiple failures.

I have been given medication to help treat the ADHD as well as advised on new methods of study. Now that the medical and psychological tests are over, I have resumed studying, this time taking my time.

The school has been very supportive but has also told me this fourth attempt will be my final one: either I pass and move on to third year or I fail and, with that failure, ever lose all hope of becoming a physician.

I am truly grateful that, finally, it seems we have found the weakness that has so aggressively hamstrung my repeated attempts. I believe, with the new study strategies and the medication, success will be in our future.

Of one thing I am absolutely sure: as this final try ends in success, and I graduate and move into residency and, afterwards, begin to practice medicine, it will all be a result, not of my intelligence or diligence or strength, but of God's goodness and mercy. He is the One Who has brought us this far and it is He alone Who will see to our final victory and future medical ministry.

God bless you, dear reader. Thank you for your time. Now that my medical specialist tests are over, I will have more time to keep in touch. I purpose to do so. Until next time, hang in there. Don't give up hope. I will do the same.

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"Hope Means Hoping When Everything Seems Hopeless" - GK Chesterton

It has been a very difficult ten days. After my recent failure the future of my family and myself seems up in the air. There are many friends who are convinced that, at this point, I should move in a different direction and find something else to do with my life; give up the dream, if you will.

There are options:  I could surrender all of this and try to gain admittance into Physician Assistant (PA) School. During my years in the military I had the opportunity to work with many PAs and was always impressed by their breadth of skill and obvious care. Another option is to leave medicine altogether and return to serving as a Rabbi. I am very grateful for my many years in the ministry. However, I still desire to do more: to ministry health not only to a person's spirit but also to their body and soul. Lastly, I have the option of repeating the COMLEX - trying a fourth time to pass this same test.

Just yesterday I met with the Student Progress Committee (SPC) at my school. The purpose of this committee is to alert those students who have, in some manner, fallen into academic disfavor. Such students found in this sorry state are given options from the SPC pertaining to their futures at the school and what might be done to save their suddenly at-risk burgeoning medical careers. Thank God, this meeting went incredibly well. They were very supportive and voiced great encouragement. They stated that I would make an excellent physician and that I should try the COMLEX exam one last time.

It is difficult for me to put into words how encouraged I was after this meeting. Have I mentioned how much I love my medical school? I know that DeBusk College of Osteopathic Medicine (DCOM) at Lincoln Memorial University is far from perfect. Indeed, as long as people are involved in any endeavor then imperfection will indubitably follow. Despite my many failures the leadership at DCOM has come out in support of me. The very fact that they believe I can do this has somehow renewed in me the spark of hope that they may be right.

So, I am going to try again. My family and I have come this far. I am compelled to go the entire way for better or for worse. This begs the question: what am I going to do differently this time so as to not repeat my recent failures? My advisors have encouraged me to submit to neuro-cognitive testing and see a professional who specializes in written testing anxiety. This, then, is my plan: I will work to provide for my family, keep in touch with DCOM, and do whatever it takes to get to the root of this problem so that my fourth (and final) attempt will be successful.

Back into the fray we go. This time, it's going to be slow and steady. I may not graduate until 2019 or beyond. But if I really want this then I will be willing to do what it takes, as long as it takes, to make this happen. The flame still burns.

Thank you for your time, dear reader. I will keep you posted.

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The Nurse of Wisdom...

The result of the medical board exam is finally in! And (drum roll) -

I failed again - for the third time.

I can't believe it. Honestly, this is now just getting ridiculous. I have spent the past 12 months studying for this test, navigating two highly recommended boards prep courses, and forging through literally thousands of questions. Despite everything, I continue to fail, over and over and over.

As you can imagine my family and I are devastated to the core. I honestly cannot understand, at this point, what I am missing, what I am doing wrong, what is the root cause. My professors share my bewilderment. Meanwhile, it is worthwhile to note that I do not blame God. I am the one who failed, not He.

Miraculously, my school allows four chances for this exam. I am honestly torn: should I try this one last time? Or, should I give up this dream, this ambition I have nurtured for nearly 40 years, and find something else? The answers to these questions depend a great deal on the advice of the leadership at my school.

Meanwhile, my family and I are looking at possible options. The immediate need is survival, of course. Just today I accepted a job offer with a local medical company - I need to support my family because, for the past many years, we have subsisted on school loans, loans that are no longer available to us due to my failures. I am grateful for the new job while realizing that my ultimate goal remains the same: to become a physician.

Thank you, dear reader, for your continuing interest and support. This adventure is not over until, as they say, "the fat lady sings". Despite this extraordinary group of setbacks, I still want this, so very much. But, before I try again for the last time, I am going to take some time to reassess the dynamics involved. Why am I failing where so many before me have passed, especially in light of the reality that I performed reasonably well on all of my didactic classes during the first two years of medical school? With God's help, I will do everything I can to make this work.

I will keep you posted.

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COMLEX á Trois...

Wednesday, April 12th, I had the privilege of taking, for a third time, the COMLEX Step 1 medical boards exam.

Now, I know I have written a lot about this exam. This stupid test has become the bane of my budding medical career, halting my advancement and taking an extra year of my life merely to pass. At this point I can say with all sincerity that I hate the COMLEX.

That out of the way, my third experience was the best of the three. I arrived at my testing center in Bethesda, Maryland at 7:00 in the morning feeling not nearly as anxious as I thought I would, though my stomach still churned loudly while in the waiting room. An incredibly friendly elderly gentleman named Willie signed me in, scanned my ID card, took my fingerprints, and had me check my pockets and yarmulke just to make sure I was not sneaking in any information which could be used to cheat. Clearing this, I was shown to my cubicle (#10 this time), given a couple of plastic sheets and dry-erase markers, and invited to sit down. No sooner had I done so and begun the exam then the blessed sound of jackhammers filled the room - renovations to a building next door.  Ah yes, a typical COMLEX experience.

As soon as the first question came up I was overwhelmed with a familiar feeling. I felt like I was at home in my office tackling practice questions. I relaxed, remembered my exam training, and started clicking. Things flowed. I could tell people were praying for me. Could this be the time I pass? My first 100 questions were done and I was offered my a break. I never take my intermediate breaks. I did break for lunch after four hours, however. I left the center, called my wife, and wolfed down some tuna and crackers - never have caffeine or simple sugars on test day!

The 2nd four hours were longer but not nearly as difficult as during my second COMLEX attempt. I kept up the pace but found myself, towards the sixth hour, zoning on the questions. I sat back, shook my head, took several seconds to breathe and looked at something else, anything else, other than the computer monitor. I said a quick prayer and dove back into the fray.

At the end of the eighth hour, after clicking the final answer and finishing the post-exam feedback questionnaire, I stood and stretched. I was alone in the testing room save a physician taking a recertification exam. I walked out exhausted but hopeful. Maybe, just maybe, this time would prove to be the last and I could finally move on to third year.

Or maybe not.

I don't know what the future holds. After three attempts, however, I can say that I have given it my all. Results come out May 2nd.

I will keep you posted.

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A Revelation

It has been about a month since I last posted on this blog. The reason for the inordinate amount of time between posts is simply because, as most of you might know, I have been studying for the boards. Well, time is up.

My third attempt at the boards is this coming Wednesday, April 12th. Of course, the need to pass at this point is profoundly acute - how much I want to move forward into the third year of medical school and get out on the wards with patients!

My first COMLEX was in Kentucky. My second attempt was in Alabama. This third (and hopefully final) attempt will be in Maryland.

Interestingly, I am not nearly as anxious about this one as I was for the first two. It is true that I have put in long hours (again) studying - for example I've plowed through nearly 1,500 practice questions and innumerable books and notes in the past three months in anticipation of this exam. But there is a deeper reason for my unusual peace.

About a week ago I was in prayer, pouring out my anxious heart to God. I was reminding Him that I cannot move forward in this ministry of medicine to which I believe He has called me without His help. He mercifully brought me successfully through my first two years of medical school. Now, I need his help to pass this test, each attempt that need becoming more acute. It was during this time that I decided to put aside my own fears and begin to simply worship Him. I decided to pay more attention to Him than to my own failures and fears. As I began to worship, a deep truth struck my heart, one that I believe absolutely to be from Him.

I have spent so much time studying and negotiating practice questions while fears of failing out of med school bounced through my mind that I forgot these fundamental truths: Jesus is my future. Jesus is my goal. Jesus is my destiny.

Now, I know to some of you it may sound like I am spiritualizing my situation, in danger of "being so heavenly minded that I am no earthly good". But this sudden realization that Jesus is my future has had a profound affect on me. No longer am I terribly anxious about this exam. Yes, I want to pass and on Wednesday I am going to give it my very best. Yes, I want so much to be a physician serving the underserved that I can taste it and I have literally dreamed about it for years. In the end, though, regardless of my coming academic performance, Jesus, my dear Lord, my precious Saviour, is my destiny and He will, as He has so much already, take care of my family and myself. In other words, it will be okay. This knowledge is incredibly freeing.

So, I ask for prayer: prayer for a successful exam, prayers for my family and myself. But I also want you, dear reader, to know that God is immensely faithful. I want to be a doctor. But if, for whatever reason, He allows me to fail out, then that will be okay, too. Either way, it's going to be one heck of an exciting ride!

Thank you for time. I know it is precious. I will keep you posted.

"Perseverance, dear my Lord, keeps honor bright" - Act 3, Scene III, Troilus and Cressida

"Isn't it time to give up this game?"

"What are you thinking? You're almost 50 years old! Stop trying to do something you can't!"

"Why are you putting your family through this? You obviously cannot pass."

"You are a failure. You have always been a failure. You will always be a failure. Throw in the towel."

Like cold pebbles dropping into an empty jar, these thoughts ping around in my head, bouncing off of the hope that once filled me as I started medical school in 2014. Next year, my class will graduate and move onto residency - I will be in my fourth year of school, still hoping to pass.

This journey has been more difficult than I could have imagined. Yes, I knew the academics would be challenging. Never in my wildest dreams, however, could I imagine that I would be a two-time failure at my medical boards and slip between the cracks out of my class. I feel that I have become one of the vulgus rejecti, one of the rejected people in my school and my profession as I heap failures upon my head. It is at these times, when such feelings assail me, that the whispering of the thoughts elucidated above becomes a roar.

Please don't misunderstand me. My school has been very patient as they wait for me to pass. My family has been almost supernaturally kind and supportive and, most of all, God has not forsaken me: He has been there this entire time to gently remind me that He is present and powerful and loving. Despite all of this, feelings of inadequacy persist. Maybe, as I was advised by a dear friend years ago, I actually am crazy for trying this at my age. Maybe these failures are God's way of telling me to throw in the towel.

It is during times like this, when these feelings and thoughts bubble to the surface, that I purpose to remember why I started this journey. May I list these reasons for you?

1. God placed in me a desire for medicine from my youth. Despite my failures, this desire burns in me to this day.

2. Becoming a physician will help my family, providing for them a future that my own father could not provide me.

3. I love caring for people. I love dealing with their hurts, seeing them get better, consoling their bodies and souls. There is literally nothing else I want to do.

Dear reader, I'm not giving up and I refuse to give in to the doubts that impugn my conscious. I might go down, I might fail out of med school - with two board failures under my belt that is a possibility. But before God I promise you this: I will not go down without a fight. I will not let feelings of inadequacy and fear of failure rob my family or myself from this goal. I will, again, pick myself up from the ashes of my defeat and doggedly place one weary foot in front of the other until one of two things happens: I reach the summit of this great mountain or I die trying. 

I don't know what challenges you may be facing right now. Nor do I know with what failures you may be wrestling. I do know this, however: if your effort is for good you will meet with great resistance. Can I encourage you to never give up, never give in, never stop fighting to achieve what is right. Sometimes, life calls for just such an effort.

The Theatre of the Bizarre

As quickly as they come the months go, falling on each other like turning pages of an old book. Since learning of my second COMLEX failure at the end of October, I have completed a month-long medical boards prep course in sunny (and humid) Florida.

This course was very.......unusual, to say the least. One of the first things we were taught is that the medical boards exist less to "test knowledge" and more to "weed-out" medical students. The purpose behind this, we were told, was because of the profound disparity between the number of medical school graduates every year and the significantly lower number of available residency slots. It is for this reason that the boards are deliberately difficult and obscure - they are an effort to trip up the test-taker. Additionally, we were told that the boards are more challenging for those persons who have greater clinical experience. As someone who has 18 years of military medicine under his belt, I would agree with this latter statement!

All of this started me thinking: in what shape is medical education, and the industry of medicine itself, if we find ourselves having to stoop to such base measures simply to make doctors? Over and over I have heard that there is a drought of physicians. Yet, we create hurdles, a grinding gauntlet of the mind, making the education of new physicians unnecessarily difficult. This, in turn, leads to a sense of elitism and thus robs eager young students of any altruism they may have had when they began this journey.

Medical school should be difficult. The responsibilities a physician faces are great as daily life and death decisions are made. To my perception, though, as one already two years into this process, there are efforts both at the level of the schools and on a national level, to make this procedure more arduous than it need be. The modern medical boards reflect this.

Some may read this and say, "Yes, but most students pass their boards on their first attempt. You're just saying this because you're angry." God bless those who have so passed! I admit that the boards have been very rough for me - more so than I ever anticipated. It is because of this that I have had the opportunity, more so than most medical students perhaps, to focus not only on the boards but on the purpose of the boards. Testing is a necessary evil. But this "thinning of the herd" simply because our system is broken is a travesty that limits the number of available quality physicians. In the end, the ones who pay the price are the patients.

Regardless, the boards are here to stay - at least for now. I am going to give this third attempt my best effort. Perhaps, one day, there will be a better more patient-centric system in place. Until then, we try our best to work with what we have while trying to bring positive change.

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