Category: Medicine

back into focus 

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as i shared in my last post, i’d unknowingly hit ‘pause’ on my life and my dreams these past couple years once a measly little exam seemingly took over my life but i’m back now reclaiming my time and my joy.

in that process i’ve made a few pretty big decisions about my future and just wanted to share with you all. thank you for your company on this journey. i used to constantly be in awe – and still am – of folks in the arts or humanities or really anything that didn’t have a set multistep plan for their careers. i used to find so much comfort in being a traditional applicant to medical school – straight out of college, no decisions to make about what to do with years off, etc. but the older i get the more i realize that no one’s life path goes in a linear fashion. we all face expected and unexpected challenges and have to roll with the punches. here’s how i’m choosing to roll with mine:

i’m going to be a psychiatrist when i grow up! i’m guessing that this does not come as a surprise to most of you. pretty sure most people knew this was where i was destined to be before i was able to fully embrace it myself. there were many things that fueled my uncertainty but most of them boiled down to giving too many effs about what other people think.once i set all that aside – worrying about ‘hanging up my stethoscope’ and not being considered a ‘real doctor’ (what does this even mean?? i’m in medical school, which contrary to the belief of people who continue to ask me if i’m going to be a nurse when i tell them that, i’m going to be a doctor!!), stigma against mental illness and providers in communities at large and within my family of origin, folks assuming that i’m only going into it to have a good lifestyle (anyone who knows me this is probably at the bottom of the list of reasons – and anyway what’s wrong with wanting balance in my life??) – i realized that by caring about what others thought i was simply holding my own happiness and passion hostage.

i came into medicine because of my passions for social justice and mental health and i can think of no better way to execute my dreams than by being a psychiatrist. i love getting to know my patients. i’m good at it.

of course i still have concerns – am i risking my own mental health? will my empath self be able to hold down the boundaries necessary to function in my own life without absorbing the struggles of others? will i regret missing the opportunity to be the patient’s first line and home base as their primary care doctor?

but there’s an underlying peace that i’ve found from leaning into this. into what feels right for me and what’s brought joy in some of the darkest days these past few years. into what i’ve always envisioned for my life.

i’m moving to NYC! i’ll be at columbia this upcoming year obtaining my MPH. my struggles with USMLE greatly robbed me of my passion for medicine. it often left no time or energy to explore my activism and advocacy. getting an MPH was always a part of my life plan but it’s something i’ve decided to pursue now (rather than later) in an effort to rekindle the flame and remind myself of my goals for my life, beyond passing an exam. i still have no idea where i’ll be living or how i’m going to balance moving several times this summer while taking shelf exams and OSCEs and step two. but for the first time in a long time, i’m truly excited about the future and it feels so damn good.

i only have a few more weeks of core rotations remaining in third year and i’m so happy and proud that i chose to advocate for myself to start rotations before retaking step one. i’m not exaggerating when i say that decision probably saved my life. in the past year i’ve learned so much about myself and the physician i aspire to be. i’m so excited to continue to move forward in my career and this life i’m building. grateful for your company through it all.

onward

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it’s been a minute since i’ve blogged, mostly because it didn’t feel like i had anything to say, but i’ve realized that sometimes finding healing in writing means pushing yourself to face things when it would be much easier to just run and hide. i started sharing my journey online because i felt alone in my failures and i didn’t want anyone else to ever feel that way too.

it would be easier to share after everything has worked itself out somehow – after i can pinpoint how each failure actually led to a success i may not have had otherwise. there’s, of course, courage involved in admitting to failure at any point throughout our lives but i’m choosing to take you along through the thick of it – when it’s messy and unclear how things are going to work out. because, as much as i often wish we could, we can’t fast forward through the difficult parts like they do in the movies. so let’s all try to be a little vulnerable and walk with each other through the hard parts.

one of the biggest lessons i’ve learned from all these failures, other than how to advocate for myself, is learning how to come up with a PLAN B (or C or D or E in some cases). so today i thought i’d share my plan F with you all. if you’ve been following along for some time, you probably know that i’ve struggled a lot with USMLE step one. i’m not going to go into details about how many times i’ve taken the test or what went wrong or any of that because that’s something i’m still figuring out and simply, i don’t want to. i’m trying to live without seeking validation from the others.

after finishing my core rotations in third year, i’ll be taking a year off to complete an accelerated MPH program (and also take USMLE step one and two CS & CK during that time). when i applied in november i was, of course, hoping to take this step under different circumstances but i’ve learned that we often have to just roll with the punches. so far i’ve been accepted to columbia (still pinching myself about this!!!) and am waiting to hear back from a few other schools. so excited to take this next step in my career!

my passion for public health began pretty much began with my passion for medicine because, to me, they go hand in hand. public health is the marriage of medicine and social justice and i love that. i actually applied to dual degree MD-MPH programs when applying to med school back in 2013. i’d planned on getting my MPH at some point during med school but kept putting it off because of my struggles with step one. and then i realized that i’d hit ‘pause’ on my life because of this test and that had turned it into an even bigger monster in my mind. i started putting everything off until after. but that’s not how life works. or at least not how my life works.

so i’m reclaiming my time from this dragon (i.e. step one) that took over my life there for a minute. it’s a battle i’ll have to face again. but instead of allowing it to pause my life, i’m choosing to keep living and instead hit pause – no, stop –  on all the stress and anxiety and negative self talk and depression and darkness.

i’m sure this plan doesn’t make sense to many of you. ‘how is she going to study for and pass this test while doing an accelerated master’s program when she couldn’t even do it during a year off without anything else to worry about?’ that’s a great question. one i’m choosing not to answer because i’ve decided it’s time to stop seeking approval and do what feels right for me. instead of telling y’all why this is the best way forward for me, i’m simply going to show you – by living it. and to clarify – this does not mean i’m giving up on medical school by any means. i’ll be back to finish my fourth year rotations and apply to residency in 2019 after completing the accelerated MPH program!

so ahealersheart may be heading to NYC or Cambridge or Berkeley oooooor who knows!? but first, we’re going to get through peds and obgyn and psych and OSCEs and step two CS and CK. one step (pun definitely not intended) at a time. deep breaths. one foot in front of the other. we got this.

these are my confessions

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Anyone else’s mind jump straight to the Usher track whenever they hear the word confession? No, just me? That’s cool. I’ve come to terms with my embarrassing and unwavering love for Usher during my junior high years. It’s fine.

But on the real – I thought it was time for a life update since it’s been a minute. I started sharing my journey through medicine, and life in general, on here and Instagram because I wanted people to feel less alone in their struggles. In this age of social media, it’s easy to fall into the mentality that everyone has their life together except you. But that’s obviously not the case – we just choose to present our best selves to the world. And on the surface there isn’t anything wrong with that as long as we can remember that there is so much else going on that is not being shared. But in the past couple months, since finding out I failed step one again, I’ve started to feel like I’m folding into myself and only presenting the highlights of my life. And while I don’t owe anything to strangers on the internet, I feel it’s important for me that I continue to present myself honestly.

Since December I’ve hit one of the most severe bouts of depression I’ve had in my life. I’m pretty sure I’ve struggled with both depression and anxiety for most of my life but wasn’t clinically diagnosed until starting medical school. Stress has always been a huge trigger for me and obviously failure, and step one in general, is stressful. Having been through similar, but less severe, episodes in the past I tackled my depression head on with the things that have usually helped me. I continued taking my medications, working with my therapist, etc. I put away my books and I traveled. I spent time with loved ones and my kitten. And I convinced myself that I was feeling better and dove back into studying as the new year began in January.

But I wasn’t okay. I was struggling badly. I couldn’t focus. I was irritable. I had so much trouble sleeping. I was nauseous all the time. I hand anxiety attacks weekly that were almost as bad as the ones that initially drove me to seek help. So I sought council from those I trust and one of the deans at the SOM recommended that I get tested for learning disabilities in case that there was something making it harder for me to succeed and adding to my stress. I realized that it was important for me to set my ego and internalized stigma towards disabilities aside and truly find out if there were accommodations out there that would help me with both my studying and in my exam taking. It took months before I was able to find someone who accepted my insurance and saw adult patients but I finally got an appointment about a month and a half out. Those of you becoming psychologists, thank you, you are so needed.

Around this time, 45 also started his presidency in the United States. I think it’s pretty clear from my previous posts where I stand politically. The US has always had a dark history when it comes to marginalized peoples but something about the blatant disregard/outright support of the xenophobic rhetoric during the elections made the inauguration sting so much more than I had anticipated. Every executive order and tweet and confirmation has truly felt like a personal assault. It’s taken weeks for me to be okay with the fact that my resistance, at this moment in my life, is almost always in pursuit of my career. I will continue to do my best to be aware. To understand the struggles of those who look and live differently than I. To educate and have the difficult conversations. To organize. To put my body on the line as often as possible when my sisters’ and brothers’ human rights are at risk. But for the most part – my resistance is hours and hours of studying to pass an exam so that I may advocate and care for my patients. And for now, that has to be enough.

Meanwhile, I did my best to continue studying. I searched online for tutoring programs for medical students that worked through video chat. I wasn’t ready to pick my whole life up and move to another state again, as I did when attending Wolfpacc in the summer. It was clear that I had made the most progress in my studying in the months after I had returned home and worked hard on my own. I’m certain that the most helpful aspect of being at Wolfpacc was being in a supportive environment surrounded by people who truly understood the struggle but I did also miss the tutors and the structure they provided. I also missed having someone to run my study schedule by to ensure that I was as effective as I could be in my studying. I missed doing questions with a tutor and running through my thought process with them so that I could identify holes in my knowledge. And that’s when I stumbled across Med School Tutors and was immediately intrigued. I had the opportunity to do one-on-one tutoring from home with someone who would also help me create a schedule that worked for me. It sounded perfect!

Now, I don’t think that this is something that necessarily everyone studying for USMLE needs. But having been at this for so long, I knew I needed more encouragement and reassurance this time around and I’ve found exactly that in working with a tutor through MST. Their entire team has been so incredibly supportive of my goals. The thing that I love most about MST is that they share my values. When I opened up to them about how much I had been struggling, they immediately reassured me that taking care of my health, both physical and mental, is the priority. They helped me rearrange my tutoring schedule at no additional cost to work best for my needs. Having a group of people who’ve essentially been cheering me on through the struggle of doing this for a third time has been such a blessing. If you do decide to check out MST, please cite me as your referral. This post isn’t at all sponsored by Med School Tutors but I do want to disclose that I will get a free hour of tutoring if you decide to work with them.

While struggling through all this I started falling victim to some really serious negative self talk and began to struggle with so many of the things I often warn you all about: feeling shame in the face of failure, constantly comparing myself to others, etc. and it started to take a serious toll. Part of the ugliness of depression is that it’s hard to separate when your thoughts are due to the illness versus when you’re actually right in your introspection and reflection. It’s taken me some time to be able to separate those two things and journaling daily has really helped me with that. I’ve been drowning myself in self care & self love and really doing my best to replace the negative self talk with positive affirmations.

I’ve taken the last couple weeks off from studying and really focused on getting back to feeling like myself. In my appointments with the neuropsychologist, we ruled out any learning disabilities but in talking to him about everything I’ve been through and am going through the past couple years, I realized that my depression and anxiety haven’t been managed as aggressively as they should’ve been. My primary care physician had been treating me until now and she isn’t the greatest when it comes to mental illness. (Another reason why I continually come back to a career in family medicine. We so badly need primary physicians who can provide holistic care. Shout out to all my future FM docs! I’ve got so much love for y’all). While talking to a close friend about this, she asked me why I hadn’t sought care from a psychiatrist over the past couple years that I had been dealing with my undertreated depression and anxiety. And I had no real answer. I later realized that it was because I, someone who constantly advocates against mental illness not being a true disease, had been downplaying my own mental illness for years. I hadn’t sought care from a psychiatrist, knowing that my PCP wasn’t doing a great job treating me, because I didn’t think it was that bad. I expected myself to pick myself up and just brush it off. I didn’t want to be someone who had a psychiatrist, and thus, label myself crazy. Why is it so much easier to show others compassion than ourselves? If I’d sought treatment for my mental illness as I’d encourage my patients and loved ones to do, the past couple years would have been so much easier.

So in the past few weeks I’ve talked to therapists and psychologists and psychiatrists and finally feel like I’m getting the care that I need. And while I’m still not feeling 100% like myself again, I’m finally caring for myself as I’d want my patients to care for themselves. I’ve spent a lot of time protecting my heart from those who try to dismiss my experience when I share my struggles and recognizing how strong I’ve been for so many years. I’m spending the rest of this week doing things that truly bring me joy, surrounding myself with the incredible people who have held me up in these difficult times often without even knowing it and simply finding gratitude in the little things.

I found out last week that the NBME accepted my appeal to expunge my score from my second attempt – you can read about my test day experience here. That news really helped restore my faith in ‘the system’ because I’ve recently been feeling like I’ve dedicated so much of my life to a field that doesn’t truly care about its people. I also found out that I was accepted to WISE’s Muslim Women’s Summit later this year, which will help me become a more effective activist and advocate. I’m still figuring out the details of my trip to the east coast but give me a shout if you’ll also be at the conference!

I know that I have what it takes to pass this exam and have an extraordinary career in medicine. But I’m still learning and unlearning what it takes to truly care for myself and be my best self. Thank you for your company on this journey.

study tips: practice questions

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I’m currently studying to retake USMLE step one and while I’m disappointed that I wasn’t able to pass this exam the first time around, I’m definitely grateful for the opportunity to hone my test taking skills and learn how to be a better physician with the wonderful people at Wolfpacc.

One of my biggest problems while taking multiple choice exams is being ‘seduced’ by some of the other answer choices so I’ve always felt that my exam results don’t always show how much I know about a topic. In undergrad, and now in med school, I’ve always performed better on free response questions because I have the chance to display what I know about a topic. In the past, I’ve tried to answer multiple choice questions as if they were free response (not looking at the answer choices) but I finally feel like I have a strategy I can use for the many tests I will be taking over the years.

People’s test anxiety presents in different ways. For some, the days leading up to the test they’re unable to sleep properly. During the exam they’re tachycardic and cannot focus long enough to get through a question. My problem, and maybe this isn’t even test anxiety, is never truly feeling sure of my answers and doubting myself easily. I’ve gotten into the habit of never changing my answer unless I’m 200% sure that the second option is correct. But often, even when I’m just thinking about what the answer can be, I question my instincts to the point that I don’t actually know which one feels more right to me.

Since arriving at Wolfpacc, I’ve changed my study strategy so that I’m forced to answer every MCQ question as if it is a fill in the blank and I don’t fall prey to any of the other appealing answer choices. Below I’ve shared the steps I’ve been implementing this past week for UWorld questions and aim to use for all MCQ tests I take in the future:

  1. Cover your answer choices. Don’t just say ‘I’m not going to look at them’ because you will. Use a sheet of paper or something to physically block you from seeing the answers.
  2. Read the last sentence of the vignette and summarize it. Most of the time there is a lot of excess information in the paragraph above. If you read the question before reading the paragraph, it’ll be easier to identify what information is actually relevant. So take the time to really understand and simplify the question.
  3. Talk to your patient and find hints. One of the professors here has encouraged us to think of the vignette as your patient. Some of the information they tell you will be very relevant to answering the question and the rest may be useless. You have to learn to distinguish between the two. As you do more and more practice questions, you’ll pick on some patterns.
  4. Answer the question yourself. Before you’ve uncovered the answer choices, write down what you believe the answer is. Sometimes you’ll remember some details about it but won’t remember the exact answer but you should write down whatever your answer would be if this was a free response question.
  5. Uncover the answer and pick whichever one matches what you wrote down. Even if one of the other answer choices starts to look more appealing, you still need to choose the one that matches what you wrote as your own answer. This is important for when you’re going over your question set afterwards and I’ll explain why later in this post.
  6. Move on. Don’t overthink the question or your answer. Sometimes you won’t really know why you think something is the answer but you need to trust your gut.

Because I’ve just started using this new strategy, I’m doing my questions in un-timed mode and actually writing down my thought process for each question so that I can get used to it. My paper looks like the following for each question:

  • Q: the question restated here in my own words
  • Pt: information from the vignette that is applicable to answering the question being asked – keep this short (5-6 words max)
  • A: my own answer to the question, without having looked at any of the answer choices.

Now, when you’re doing practice questions you have to remember that reviewing the entire test, including the questions you got correct, is just as important as answering the questions. This is when you correct both your technique and any holes you have in your knowledge.

For answers you get correct, make sure that the answer you wrote down matches exactly the answer choice selected. If it does, just move on – you don’t need to read the explanation or anything else from that question stem because you had the correct thought process and arrived at the right answer.

If you get an answer correct but your written answer doesn’t match the answer given in the options exactly but is generally related, you have a small hole in your knowledge and need to read the summary sentence at the end and add that to your written answer in your notes. If that still does not clarify the connection you missed, you should review more of the explanation.

If you get an answer incorrect, you repeat the same process as above but read the entirety of the explanation because this is a clear hole in your knowledge. The reason I’m recommending that you choose the answer that best matches the answer you’ve written, instead of choosing the ‘more right’ answer, is because it will be easier to correct that hole in your knowledge. If you change your answer and get it right, you’re less likely to take the reviewing process as seriously because you got it right but it’s still a hole in your knowledge. On the real exam, if you’re 200% sure that the other answer is correct and the one you came up with on your own isn’t, of course you should pick the right one. But when you’re doing practice questions, you’re still learning and you learn the most from questions that you get wrong.

Also, I usually use a different color pen to add my notes for questions I get correct (usually blue) and questions I get incorrect (usually red). If I’m ever reviewing this notebook, I usually focus on the notes I’ve written in red since those indicate the biggest holes in my knowledge.

Don’t get hung up on how many you get right or wrong. Focus on improving your technique and finding the holes in your knowledge. As you get more comfortable with the new technique, you should not have to write out as much and start doing the question sets in timed mode. And, of course, this technique may not work for everyone. It’s just something that I’ve been trying and feel more comfortable with. Happy studying!

med sisters series: Cassie Majestic, MD

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The Med Sisters Series is a series of interviews of women in various stages of their careers in medicine: pre-med, medical school, residency, fellowship and attending physicians. As women, I believe we face unique challenges within any field, medicine included. As I’ve moved along on this journey, I truly believe one of the biggest support systems we have is each other. Society works so hard to pit women against each other in every situation you can think of but, as feminists, I think it’s so important to combat that urge to try to ‘beat each other out.’ There’s room for all of us on the other side of the glass ceiling. The goal of this series is to shed light on the challenges women face in the field of medicine and how they achieve a work-life balance that works for them. This blog has always been a place for me to share the realities of this journey, both the highs and lows. I thought of this series as a way to share the perspectives of the other extraordinary women on this journey too.

Dr. Majestic is an attending emergency medicine physician practicing in a community hospital in Orange County. She recently finished her residency and you can follow along on her journey at her Instagram.

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Q: Why did you decide to pursue medicine as a career? How do you stay motivated on the difficult days?

A: Medicine somehow spoke to me when I was very young. I remember knowing I wanted to be a doctor in 4th grade. I had no friends or family members in medicine. I simply knew that I wanted to do something great with my life that involved the human body and educating others. I was serious about school since I was little, and I thought it would be fun to treat diseases.

Staying motivated on the difficult days is truly a challenge, especially because there are so many difficult days in medicine. I actually let myself take a break on those days. Talking to my mom has always been helpful when I am doubting myself, and a nice long workout with my favorite jams (Journey- Don’t Stop Believin’) has always kept me inspired to finish what I started and reach my goals as planned.

Q: What has been the most emotionally difficult aspect of your career thus far? How did you cope?


A: The Emergency Department unfortunately doesn’t provide time for me to experience much emotion. It’s so fast paced, and I rush from one patient to the next delivering good and bad news without much time for preparation or mental emotion. The toughest situation for me however, is delivering news of death to family members and loved ones. This is the one time that I have to slow myself down, and really prepare myself mentally. In addition to this, I think the most emotionally difficult part of medicine and Emergency Medicine in particular, is dealing with making mistakes and missed diagnoses, especially when this results in a bad outcome. I think the only way to cope with these situations, are to understand that we are human, we make mistakes. I also believe that maintaining open discussion with patients and their families is helpful, and allows them to see that doctors are only human. I feel better being brutally honest with each patient and their family, and addressing my mistakes if there are any that occurred.

Q: If you could go back and do undergrad and med school again, what would you do differently? 

 
A: I would honestly cut myself a little more slack. I missed a lot of family and friend functions, because I thought that if I didn’t study a certain number of hours each day, I was doing something wrong. There were many days that I beat myself up internally, for not studying 12 hours per day. It took me a long time to realize that quantity does not equal quality. I would tell my younger self that it is possible to study well without spending every hour worrying about the amount of time I was putting in.

Q: What are some of your favorite medical apps to use while at work?

A: I love Epocrates for up to date drug information. The upgraded version also has an awesome section where you can plug in a condition and it will give you treatment and further recommendations, in case help is needed with a certain clinical scenario. PediSTAT is my favorite pediatric app and I feel much safer on each shift having it in my back pocket (literally). Uptodate is great as well, and is one of my most reliable and “up to date” resources for current guidelines on any medical condition.

Q: How did you decide on Emergency Medicine as your field? What advice do you have for people who are also interested in EM?

 
A: My interest in Emergency Medicine began as an undergraduate student at Arizona State University. Most of the volunteer opportunities were in the Emergency Department, so I received most of my early exposure then. The Emergency Medicine physicians that I have met throughout life were always enthusiastic, fun, and seemed to love their job. They made it tough for me to love another field of medicine.
That being said, I still planned to go into surgery all throughout medical school, up until it was time for me to apply for residency. I made a last minute career switch to Emergency Medicine when I realized I wasn’t excited about my lifestyle as a surgeon. Once I allowed that change to happen mentally, I was SO excited and happy for my future.

For those of you interested in Emergency Medicine, I encourage you to start early. There are lots of opportunities for shadowing/volunteering in the Emergency Department. This is really important to see if you can function well in a stressful, busy, and crazy environment. Be aggressive and up front about what your interests are, when gaining experience. Persistence and follow through is key in Emergency Medicine. It is becoming a competitive field; boards scores and medical school grades are very important.

Q: You have such a passion for educating the public about health care issues! Why do you feel that this is important?

 

A: I am concerned with the way healthcare in the United States is going. Now that the Affordable Care Act is in place, all physicians are seeing extremely high volumes of patients, especially in the Emergency Department and Primary Care offices. There aren’t enough hospital or Emergency Department beds to accommodate the patient volume. Part of this problem stems from the lack of preventative medicine in the United States. I feel American medicine needs to provide more education starting from a young age, to help with prevention of diseases. Social media is a huge part of peoples’ lives. Part of the reason I started my educational Instagram account, was to attempt to reach people that otherwise wouldn’t be reached, with medical, health, and wellness education. I see many financially poor patients, and most of them have a cell phone with Internet connection and access to social media. My hopes include using social media in a positive way (since it is very easy to use in a negative way) and provide education to everyone. Maybe in the future others will start doing the same, and there will be more health and wellness programs and education in schools that will improve our lack of preventative medicine awareness.

Q: Who is a woman in medicine you look up to and why? 

 

A: My program director at University of California Irvine, is a true inspiration. She is young (under 40), married, has two children, and is in charge of a residency program at a large academic institution. She happens to also be beautiful, fit, and so smart. I know that she is confident in everything she does, despite the criticism and challenged she faces as a mom and a physician everyday.

Q: As a woman in medicine, have you faced any discrimination (either blatant or more subtle)? What advice do you have for women who go through similar challenges? 

 
A: I haven’t faced any significant discrimination, thankfully. I grew up around men primarily, as my father is military, and I enjoy working with men in the Emergency Department.

I will say that it can be intimidating at times. In the past, I believe I made some of those intimidating feelings worse by allowing myself to feel less smart and confident. Women in medicine are not unusual these days, but it can still be common for women to have emotional feelings about themselves being less adequate at a job than a man. This is very well known. So my advice to all women out there who feel they are experiencing discrimination, is to remember how far you’ve come. Your mind is powerful and confidence is a necessity in medicine! Maintain the confidence and discrimination will not set you back. Speak with confidence, make decisions with confidence, and everyone (even the men you work with) will see that and respect you!

Q: What has been your favorite part of your journey so far? Where do you see yourself after residency? 

 
A: My favorite part of my journey has been the people I have met along the way, both colleagues and patients. I have the privilege of knowing peoples’ secrets, fears, and gaining their trust to care for them. I get to work with my best friends, who I identify with, and love. During residency, I feel like I have finally found “my people”. Even across various hospitals, most Emergency Medicine physicians share a similar personality type and I have so much fun at work.
After residency (3.5 short months away!), I plan to stay in Orange County and work in a community hospital as an Emergency Medicine physician. I am delighted to say that I will also still be working at my current academic hospital sporadically. It is the best of both worlds! I’m excited to work in a smaller hospital but also maintain affiliation with the residents and medical students in the academic world as well.
Update: Dr. Majestic has completed her residency and is currently practicing at a community hospital in Orange County!

Thank you so much for stopping by our corner of the internet Cassie! We wish you the best on your journey.

Past Interviews:

on ‘failure’ and detours

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Since I was a kid, I always did my best to do the ‘right thing,’ especially when it came to my education. I was never that straight A student but I always worked hard. I felt like I had to work harder than everyone else to be average and it was difficult to feel the imposter syndrome from such a young age but I found ways to push through it, with the support of my incredible parents and some of the most amazing teachers in the world.

In high school, I signed up for classes strategically to ensure a good GPA when I applied to colleges, trying to find the perfect balance between between taking enough IB/AP classes and having the time to do my best in them, while juggling ECs. I chose to go to UC Irvine over more prestigious schools because I was thinking ahead to applying to medical school. I didn’t want to get lost in a sea of overly competitive premed students and not reach my goals. I took my classes on a schedule that allowed me to do my best, not the ‘traditional’ one that most students took because I knew I couldn’t handle that. I took an even lighter load the quarter I was studying for the MCAT. My schedule was ‘nontraditional’ but also ‘traditional’ in that I went straight from undergrad to medical school. I got married that summer in between and, two years ago, started this new life adjusting to being a wife & partner and working towards my professional goals. I paid attention to where I needed extra help and did my best to arrange my schedule so that I could be successful.

But then came medical school, and we were back to our schedules being decided for us like in elementary school and I couldn’t adjust it to make it more manageable. Instead, I had to adjust my study style and do the best I could to set myself up for success. And for the most part I did. Out of the ten blocks that make up our preclinical education, I passed eight of them on my first try and two of them on my second (and knocked them out of the park the second time, if I may add). And I am so very proud of myself for making it through two academically, mentally and emotionally difficult years. Many times I thought about quitting, more often that I’d like to admit. I thought about taking time off to center myself and make a schedule that allowed me to succeed to the best of my abilities. But I didn’t because I didn’t want to ‘fall behind’ or be forced to take a path different than my peers. I often wondered why I couldn’t handle a schedule and plan that the majority of medical students go through. Why wasn’t I strong enough? Why wasn’t I smart enough? Why is it so much harder for me?

And then I failed step one. Part of me saw it coming and another part of me was just wishing for a miracle – ‘please God, just let something work the first time.’ I know I’ve done everything I was technically supposed to do, or at least what works for most people. But it didn’t for me, as it hasn’t for most of my life. And that’s so much more than okay. Because this is my journey and each detour I take helps me become the person I’m meant to be. And I truly believe that, at the end of all this, I’ll be a better physician for it.

I’ve taken a leave of absence from medical school until January. During that time, I will be doing some traveling, reconnecting with the people I love, with God and with myself, taking a class to help me prepare for step one and knocking this test out of the park – on my second try, because sometimes that’s what it takes. 

Thank you for your company on this journey. Thank you to my village that keeps me going – I’d be lost without you. And thank You for all the blessings, especially the ones I’m so privileged to not even be aware of.

lessons from pre-clinical years

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I recently wrapped up my first two years of medical school, essentially my entire pre-clinical education. I still have to get through step one before I officially move on to rotations so I’m not letting myself completely celebrate yet but I do want to share some of the lessons I’ve learned thus far on this journey. Most medical schools in the U.S. have two years in mostly in the classroom, learning the ins and outs of the human body and all the ways it can quit on us. The third and fourth year are done in a clinical setting: hospitals, doctor’s offices, etc. As with most people who want to go into medicine, I’m here for the interaction with patients and helping them to better their lives – not to sit in classrooms and at our desks for hours on end trying to cram as much information in our brains as possible. But as with anything worth having, we’ve all gotta struggle a little. So below are some of the lessons I’ve learned in the many, many hours spent studying and trying to get through the madness.

  • Remember why you’re here. So much of why I blog is to stay grounded and remind me of how far I’ve come and how much further I still have to go. I often read my personal statement to remind myself of my journey thus far. I have the oath we took the day of our white coat ceremony taped on our bathroom mirror to remind me what a privilege this is and what a huge responsibility I have to learn as much as possible.
  • Have perspective. Remember that you’re spending endless hours of studying because you will one day be the responsible for caring for people during some of the most difficult moments in their lives. This is a huge responsibility. You, of course, need to do everything necessary to take care of yourself but remember that people are depending on us to know what we need to know to care for them.
  • Maintain balance in your life. Your entire life cannot be about medical school, especially in the first two years when you actually have a lot of free time if you plan your days well. It’s important to do things to retain your sanity and take care of your own health. Eat well, exercise, read, watch movies, etc. Do everything you want and need to make sure you’re centered and ready to learn. When you invest time in taking care of yourself, your studying will become much more efficient and you won’t have to spend the entire day going over the same lecture.
  • It’s okay that every day doesn’t feel good. There will be (seemingly too many) days when you’ll question why you’re paying thousands of dollars to spend your days studying. But there will also be days when you’ll realize how amazing the human body is. Days when you see patients and they’re so grateful that you’re spending a little extra time trying to figure out what’s going on with them. Days when you learn something in lecture and then go to clinic later that day and see someone surviving, with great quality of life, the same illness because of the work done by those who came before you. You’re entering a noble profession but path to getting there won’t always feel noble.
  • Reflect on your intentions and your happiness often. While it’s normal to have days or maybe even weeks of feeling like you’re in over your head, make sure you check in with yourself every month or so and reflect on how you’re doing. If you’re feeling depressed or anxious or just plain unhappy with where you are, please talk to someone. There is absolutely no reason for you to continue feeling this way. Medical students are at much higher risk for depression and suicidal ideation than the general population.
  • Find mentors you trust. This is something that I’m still working on but you have to realize that in every professional setting, you will not click with everyone and that’s okay. Finding a mentor to talk to about a certain issue is kind of like knowing which friend to go to depending on what you need out of the conversation. If you want someone to tell it like it is, go to the person you know will be honest with you no matter what happens. If you’re looking for someone to remind you why you’re working so hard and that you can do this, go to the person who will be be supportive and compassionate. And if you’re really lucky, you’ll find a mentor (or a few) who can do both and know when you need which. Mentoring relationships should never start with the question ‘will you be my mentor?’ I’ve never asked that question of a single person I consider a mentor. Instead, ask a question regarding their life or work or something you need advice on and based on the way they respond, you’ll know if this person is a potential mentor. This type of relationship should unfold naturally.
  • Find your village, hold them close and thank them often. I’ve said this before and I’ll keep saying it: it takes a village to raise a doctor. It takes a village of people who love you, support you, remind you of why you’re doing all this – that the sacrifices are worth it, and understand why you can’t always be around. I truly believe that God puts something special in the people who support doctors in training. This, unfortunately, also means that you’ll likely lose some people in your life because they may need more attention than you can provide at this moment in your life and that’s fine. It’s difficult but it’s honestly a part of growing up. Not everyone is meant to stay in your life forever. But those who do choose to go on this wild journey with you, hold them close and make sure they know how much you love and appreciate them.

Medical school is no joke. So many people told me beforehand that the hardest part is getting in. And it’s completely true that I worked very hard to get to where I am today, but it’s also true that the ‘hardest part’ varies from person to person. Some people thrive in the first two years because they have studying and exam taking down. I’m not that person so the past two years have felt nearly impossible and I’ve thought about quitting more often than I’d like to admit. But I truly believe that all of this is worth it, that my aspirations will be confirmed next month when I’m back in clinical settings and spending the majority of my day with patients. And it’s entirely possible that I may be wrong but I’ve already put in several years towards this goal so what’s another couple months?

I’m taking step one early next week so positive vibes and prayers are greatly appreciated!

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r & r in redlands 

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The past few months, pretty much since 2016 started, have been nonstop studying – exam after exam. And it also felt like the stakes were getting higher and higher as time went on. Now, I’m in independent study time for USMLE step one and the pressure is on. This exam is known to be the most difficult of many licensing exams and also plays a huge factor in what and where you’ll practice medicine.

I’ve always prided myself in understanding that test scores do not define me or my ability to be a good physician. When struggling with the MCAT, I knew that somehow things would still work out because this was my calling. But the step one boogie monster got to me and I started doing all the wrong things: not taking breaks, staying up too late to finish my study ‘to-do’ list, focusing on quantity instead of quality, comparing myself to others and making this test my life.

Earlier this week, I performed pretty terribly on a practice exam and after crying & wallowing and talking to one of my best friends, I realized that I was essentially setting myself up for failure. So I decided to take a couple days off and remind myself of the life I live outside of this exam. I went to a neighboring city and just explored. I dusted off my DSLR and just roamed around eating great food, shopping at local stores, hung out at a local coffee house and drank delicious coffee while reading and journaling.

Going to be back at it tomorrow, while fasting for Ramadan (which I’m nervous about but also excited that I’ll be taking this exam in such a blessed time). I’ll have even less ‘chill’ time between starting third year and taking this exam but pushing it back was just so necessary for my own well being. I’m committing myself to doing my best on this; I won’t sell myself short but I’m also not going to look at what others are doing (especially if they’re vacationing while I sit here stressin’ out).

This is my journey. It’s had a lot of twists and turns and loop-de-loops but I wouldn’t trade it for anything. I’m going to be caring for actual people one day very soon and I can’t wait. But this is just something I have to get through until then. Thank you all for accompanying me on this journey – you all push me to constantly renew my intentions and better myself.


on mental illness in med school

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As mental health awareness comes to an end, I wanted to address something very close to my heart: mental illness and reducing the stigma that often comes with it, especially in health care. I’ve suffered from depression and anxiety for, well I don’t really know how long but I was officially diagnosed with both during my first year of medical school. It was a really difficult time for many reasons and I just couldn’t deal with it on my own anymore and decided to get help. I was really hesitant to do so at first because I was worried about being perceived as weak, that I couldn’t handle medical school and the challenges that come with it. It’s so, incredibly, heartbreaking how many health care professionals we lose, both practicing and in training, to suicide each year. We’ve made progress on dealing with the lack of support for our community when it comes to mental health but we still have so much work to do. So much of why I want to go into academia is to change the way we educate and train our physicians, to do it in a way that doesn’t require us to rob them of their humanity, compassion and ability to empathize with others.

Before I get into how I’ve dealt with both of these diagnoses while in medical school, I want to address how absolutely ridiculous it is that this stigma exists at all but especially in the field of medicine where we know and understand the pathology behind mental illness. We know that there are actual problems in the balance of our hormones. We know that it’s not just laziness or something you just ‘push through’ or ‘get over.’ So the first step in dealing with depression and anxiety in medical school is accepting that there is no shame in having a mental illness.

Think about it this way: anxiety and depression are essentially like having allergies, your body is overreacting to something it perceives to be threatening when it’s not really that bad. With allergies, some people’s bodies think peanuts are the equivalent of poison when there is nothing inherently dangerous about peanuts – as long as you’re not allergic. I’m eating a peanut butter granola bar from Trader Joe’s as I type this and I’m not going into anaphylactic shock – because my body doesn’t perceive peanuts as a threat but for others, it most definitely is. It’s the same with depression and anxiety – episodes can be triggered by things that may not seem that bad to people who don’t have mental illness. Some people’s bodies do not turn on them when they have to take an exam, or have to speak publicly or for no apparent reason. But I obviously would never judge my friend with nut allergies for needing an epi pen or avoiding triggers, right? So why do we do that to ourselves and each other when it comes to mental illness? Let’s just make a commitment to not think of it any differently – when it comes to us or to our friends or our patients.

So now for tangible advice and steps you can take if you are dealing with depression or anxiety – and please keep in mind this advice is from the perspective of someone who has dealt with these issues, not as professional medical advice.

  • Find a therapist you trust and feel comfortable with. This can definitely be tough because it takes a certain level of comfort and trust to be able to discuss what you need to discuss with a therapist. I would recommend starting with counselors at your school if that’s an option since they usually understand at least some of the struggles students face. And I know that it can be exhausting to jump from therapist to therapist and repeatedly telling your story to a stranger but it’s worth it when you find someone you can really talk to. Yelp is a surprisingly great place to read reviews for various therapists. And it’s a good idea to go into each session with an idea of the topics you want to discuss and issues you want to work on. This link has really helpful advice on how to approach your first session with a therapist.
  • Don’t be afraid to try medication. Like we talked about above, there’s no shame in your Zyrtec game and there shouldn’t be with Prozac (or any other medication) either.
  • Prioritize your health and well being. We all know that we should take care of ourselves but how many of us actually prioritize doing so? Because we need to, especially if you’re dealing with mental illness. I find exercising regularly to be really helpful and I’ve recently also started doing yoga (at home with Yoga with Adriene), which has also been great. Prioritize getting enough sleep, especially in the first two years of medical school when you have much more control over your schedule. Pulling all nighters is not a good way to learn and you need sleep to be able to retain everything you spend hours studying. I also find that limiting my caffeine intake really helps keep my anxiety symptoms away so I’ve tried to stop drinking coffee on and off for the past few years. Try limiting it as much as you can! I’m not a fan of cooking so eating healthily can be difficult but I try to buy preprepared frozen meals made by companies like Evol Foods and Sweet Earth Foods because they provide healthier options. And if, even for a second, you start feeling ‘selfish’ for taking care of yourself remember:

    ‘Caring for myself is not self indulgence, it is self preservation and that is an act of political warfare.’ – Audre Lorde

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  • Get a furchild. This obviously isn’t for everyone but have Kohl in my life has made the struggles of 2016 so much easier to deal with it. There’s something about a tiny kitten purring on your lap that makes you feel like it’s all going to be okay. So if it’s something you can do, consider adopting a kitten or puppy. It’s amazing how they just know when you’re not doing well or need extra cuddles. He’s been the source of my sanity through studying for remediation and boards.
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  • Spend time in places that inspire you. This can be as simple as going to your local coffee shop to study or planning a weekend getaway with your significant other/a group of friends. Changing where you are makes coming home feel so sweet and reenergizes you to continue doing what needs to get done. And making time for fun things is so important – you need it to recharge.
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  • Work hard when you feel good. The thing with both depression and anxiety is that they can sneak up on you. You can have an objectively good day and still feel completely miserable. So in a way, it’s important to ‘prepare’ for these episodes by being extra productive when you are feeling well. That way if you have an off day, you won’t fall behind because you prepared for it. I always have a game plan for studying for each block but because I know that some days are going to be better than others, I plan goals for each week (rather than each day). So when I have a day when I’m feeling down, I’m not really falling behind as long as I spend the day caring for myself and getting recharged so I can tackle tasks the next day and still stay on schedule. Having this flexibility has been really great for me and also reduces the guilt of ‘doing nothing’ on the days when I really can’t.
  • Spend time in service of others. There’s something so incredibly fulfilling in giving your time or skills to help others. If you’re in healthcare, a big part of why you’re here is because you have that innate need to be in service of others. So stay in touch with that by volunteering with your local free clinic or mentoring youth from underserved communities. Doing these things also really helps bring your purpose back into perspective. It helps you remember why you’re spending so much of your time studying and making so many sacrifices.
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  • Don’t be afraid to reach out to your classmates or friends. I can’t tell you the number of messages and comments I read every week from others in this field who share that they too are dealing with depression, anxiety or both. Don’t feel obligated to share this part of your journey if you don’t feel comfortable doing so but please know that you’re not alone. And if you do decide to share, realize that your recovery is going to look different from others’ so try your best not to compare. In this age of social media, it’s easy for us to think that everyone’s life is so much easier and better than ours but realize that most people just show the pretty parts. We’re all going through difficult times.
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  • Be kind and patient with yourself. This is something that I still struggle with. It’s so easy to fall into the trap of comparing yourself to others who seem to be much more productive or being angry with yourself for ‘being lazy.’ But realize that type of thinking is not productive in any way. You’re only prolonging this episode of deeper depression or anxiety by doing so. Your body is clearly telling you it needs a break or a change so spend an hour or so taking care of yourself and come back to your work. Treat yourself with the same compassion you’d show your patient who is struggling with similar issues.
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So much of why I started this blog and started speaking about my journey on Instagram is because I did not want anyone else to feel alone in the struggles that come with this journey. You are not alone. You deserve the best out of life and while we make many sacrifices on this journey, you should not sacrifice your health and well being in order to care for others. It takes some courage to seek help and take the steps towards recovery but it’s well worth the effort. You deserve a life where happiness is the norm, not the exception. You deserve a life that does not feel like a burden. If you won’t do it for yourself, do it for your future patients because they deserve a healer who has spent time healing themselves.

edit: here is an additional resource by zencare on mental health while in college.

med sisters series: Brittany, MD

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The Med Sisters Series is a series of interviews of women in various stages of their careers in medicine: pre-med, medical school, residency, fellowship and attending physicians. As women, I believe we face unique challenges within any field, medicine included. As I’ve moved along on this journey, I truly believe one of the biggest support systems we have is each other. Society works so hard to pit women against each other in every situation you can think of but, as feminists, I think it’s so important to combat that urge to try to ‘beat each other out.’ There’s room for all of us on the other side of the glass ceiling. The goal of this series is to shed light on the challenges women face in the field of medicine and how they achieve a work-life balance that works for them. This blog has always been a place for me to share the realities of this journey, both the highs and lows. I thought of this series as a way to share the perspectives of the other extraordinary women on this journey too.

Brittany is a fourth year medical student (and will be an MD in days!) in Kansas City. You can follow her journey, as she starts her intern year in pediatrics, at her Instagram.

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Q: Why did you decide to pursue medicine as a career? How do you stay motivated on the difficult days? 

A: Deciding on medicine was sort of a natural choice for me. I was infatuated by science growing up and was fascinated by my first anatomy and physiology class in high school. There are no physicians in my family, but it was my parents that really gave me the confidence that I could pursue such a career. They both have had careers in healthcare and I loved the thought of being so intimately involved in other’s lives and being able to do what I love and help those who need it. What motivates me on the difficult days is that I absolutely cannot imagine doing anything else for the rest of my life. There are days I walk out of the hospital with such satisfaction, such a sense of calling, that I know this is where I was born to be.

Q: How do you balance being in a relationship, planning a wedding and medical school? 

A: It’s quite the task! I live in Kansas City and my fiancé lives in Ft. Worth, Texas so there’s a lot of plane flights and traveling when we get free time. Fourth year of medical school provides lots of flexibility with your time so I’ve gotten to come down to Texas for a few months which has been such a blessing. I am very lucky to have a man that supports me 100% in whatever I decide to do and is continually my biggest cheerleader. He understands my hectic schedule, can tell when I’m a little stressed, and knows when he needs to remind me to breathe! He’s not something I have to worry about balancing… he adds balance to my life. I think that’s how it should be. With Match Day coming up in March 2016, we currently have no idea where I’ll be located for residency. For that reason, we’ve decided to postpone wedding planning until we at least have a city to plan around! I have started looking at dresses though, which of course is the most fun part! 🙂

Update: Brittany matched to her top choice pediatrics program at Johns Hopkins All Children’s Hospital in St. Petersberg, FL!

Q: What has been the most emotionally difficult part of your journey in medicine? How have you coped? 

A: The most emotionally difficult part of the journey has been seeing first-hand the heartbreak in medicine. The look on your patient’s face when they find out they have cancer or when the 6 year old finds out his mom has passed away are images that never quite go away. As physicians, we will be constantly immersed in the most difficult parts of people’s lives. They will never forget moments like this. But, the beauty of my journey in medicine has been seeing how people respond and recover from these types of events. Sickness and death have a startling effect on people. They quickly realize what is truly important to them. The love shown by family has often brought tears to my eyes. Our society focuses so much on the negative. I wish the cameras would come into the hospital to see the incredible love, the undying faith, the unwavering will to live that I have the blessing to see each day. The difficult parts of our lives really provide us the opportunity to grasp on hard to what means the most to us. Witnessing this has been incredible and is one of the many reasons why I love medicine.

Q: What drew you to pediatrics? 

A: Come on…kids are so much better than adults 🙂 ! When I got to dress up in costume for Halloween, play with toddlers on a daily basis, and help walk new parents through both the scariest and most exciting part of their life (new parenthood), the decision became pretty easy for me. It was the only rotation I had in medical school that I would work 12 hour days, work nights, but when I went home each day, I was genuinely happy and couldn’t wait to go back! Kids bring me so much joy. They’re resilient, they’re honest, they’re always wanting to get better…. and most of the time, they do! I also had a great pediatric allergist that helped me control my asthma as a kid and that allowed me to go on to eventually becoming an All-American track athlete at Baylor! The world is yours when you’re a kid, the possibilities are endless. I’m thrilled to be apart of their ever-changing lives. The field of pediatrics isn’t for everyone. You’ll get spit up on, sneezed on, temper tantrums, and adolescent mood swings. But, there’s nothing else in this world I’d rather be doing.

Q: If you could go back and be a premed student again, what would you do differently

A: This is a tough one. I don’t think I’d do anything differently honestly. I was a premed student-athlete so my experience was a little different. I was a Health Science Studies major with a minor in Medical Humanities. I took all the core science courses required for the MCAT along with courses that showed me the ethical dilemmas of medicine. I took a mission trip to Mexico where I got to work with a physician to provide care to underserved villages and created hypertension screening clinics in my hometown of Kansas City. My best advice would be to get a well-rounded idea of what medicine is like. Volunteer at your nearby hospital. Get out in your community. If you can, get out of the country and view how healthcare is done there. This will help you form your own ideas and opinions about how you’d like to provide care. Also, have fun!!! Medical school is a full-time job and you’ll find yourself reminiscing on your fun “college days” while you’re stuck on night shift lol.

Q: Who is a woman in medicine you look up to and why? 

A: Although not a physician, I have always looked up to my mother. She is a chief radiation therapist for cancer patients and has a way with her patients that I strive for on a daily basis. She is personable, intelligent, and her spirit is so incredibly contagious. She’s a multi-tasker, a leader, and always finds a way to get the job done with a smile on her face. She has worked so hard to get where she’s at and both her and my dad have provided me with all of the love, support, and motivation a daughter could ask for.

Q: As a woman in medicine, specifically a woman of color, have you faced any discrimination (either blatant or more subtle)? What advice do you have for women who go through similar challenges?

A: Being a minority woman in medicine, you often will be either the only woman in the room or the only minority in the room. Sometimes, both. Towards the beginning of my medical education, this was a little daunting. But, as I progressed though medical school I realized I am more than capable, equally intelligent, and just as deserving to be here! Now, I don’t think twice. I am no longer focused on myself, but on the care of my patient. Many times, minority patients will pull me aside or while I’m alone in the room with them tell me how proud they are or how they want to go to medical school one day. No matter what discrimination we may face, we must realize that the picture is so much bigger than that. We must continue to climb, to motivate, and to care for others the only way we know how. There’s should be no room for negativity in our minds. There will always be those who discriminate whether it be race, gender, body size, social class, anything! Unfortunately, that’s not going away anytime soon. We can either let it bring us down or continue to fight in pursuit of our dreams. I choose the latter.

Thank you so much for stopping by our corner of the internet Brit! We wish you the best on your journey.

Past Interviews: