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.