Mom, you were totally spot on. My reports to you on the telephone weren’t just the mad ravings of a sleep-deprived med student. I really did love surgery. I loved being in the hospital taking care of patients, getting all their “numbers”, (re)presenting them on rounds, learning how to change their dressings (not a trivial task), and assessing their wounds, drains, staples, and sutures. I felt empowered with new skills; I was useful to my patients and team. I was even more intoxicated by the OR, its predictable rituals (draping, scrubbing, time-out, instrument counts, etc.), accoutrements, sounds, smells, colors, and people. I took every opportunity I could to steal away from the floor service to “scrub in”.

I’m surprised at how far I’ve come from my first OR exposure just 1.5 years ago as a “pre-clinical” med student—when I found everything there so alien—to now, viewing the OR as a sanctuary. But on my last day as a surgical clerk, I was reminded of the OR as the unnatural and otherworldly place it too often is.

It was our last week on the general/trauma surgery service and most of us had “checked-out” retreating to our books to study for the upcoming exam that completed our rotation. Taking a break from my studies, I ran into one of the trauma nurse practitioners (integral members of our massive team). She stopped me in the hall: “Hey, why aren’t you in the OR!?” A major car crash with three victims arrived in the ER just an hour or so before. The wife had already died; the husband hung on by a thread while my attending surgeons and chief resident were trying to save his life. They had come to visit San Francisco. Tourists and their taxi driver.

I had seen my fair share of traumas, but it had been a relatively quiet 2 months and nothing quite so devastating had come through our doors. I ran to the OR, grabbed a mask, a cap, and entered OR room #1 for the first time. OR #1 is reserved for major emergencies and remains empty waiting for them to arise. I joined a throng of nurses, technicians, anesthesiologists, surgeons, and students. It was no longer a safe and predictable place. The OR felt alien to me again. 20-30 blood-soaked sponges lined up in the corner, empty blood product bags scattered on the floor, and nurses and technicians were running about. The head trauma surgeon was in rubber boots, elbows deep in the abdomen, and anesthesiologists were monitoring his vitals closely and actively infusing life-sustaining fluids and drugs into his middle-aged body.

The draping was haphazard; meticulous control of the field was sacrificed for the sake of a few seconds of time in this life-threatening situation. Still, the various tools, towels, sheets, monitors, poles, and people that surrounded him obscured his form and face. All I could see was every effort used to keep him alive, rather than the person beneath it all. Normally, this disassociation (dehumanization, even) is what allows us to cut into and “wound” the body of another person. But this time, I struggled with that. I knew he was dying on the table and I wanted to see him as fully human, not as a part of this techno-medical mess.

My stay was brief. They were “closing him up” and hoping to stave off the bleeding and maintain his blood pressure. I left not because I was not useful, but because I was overwhelmed by what I saw. The controlled, orderly, and ritualistic OR where I had spent the past 2 months, and in which I had become so comfortable, so at home, was instantly transformed into something entirely unsettling and frightening.

Later that night on the local news I heard that the man did not make it. The next day, we discussed him in our morbidity and mortality conference and I understood why. He had fatal injuries. The chance that any OR could control the bleeding was very small. Was all that effort, the 4 hours of surgery, and the 20 liters of blood products we gave all for naught? Or was it just another ritual of the OR, of the hospital, of our medical system? We use every life sustaining effort we can because we hope that even the smallest chance will make our efforts heroic.

One of my greatest fears going into medicine and particularly surgery was that I would only see patients in the unnatural environment of the hospital—living in hospital gowns, scrubs and beds, reduced to malfunctioning body systems and lab data. I would lose sight of their humanity. I think no matter how hard we try as students or residents, this transformation of people into mechanical bodies is inevitable, if not necessary. But this last day in the OR, observing one of my first deaths despite resuscitative efforts, jarred me back to a time when I was more innocent of hospital medicine. It re-impressed me with the humanity and gravity of this work, and humbled me to it as well.

This, my first rotation in surgery, will feel different than every other one to follow. There’s no turning back now. I have chosen a path where I will constantly straddle two worlds and now hopefully I can do so while maintaining my humanity, and especially that of my patients.

I am incredibly grateful for having the opportunity to be invited into the lives of so many extraordinary people—patients as well as “the team” of surgeons, nurses, and others. Most of all, I now understand a bit of what my parents went through; how hard they worked to become who they are. I also see that they both provided us with exceptional (perhaps rare) examples of extremely dedicated and caring physicians. I’m grateful for that, too.

Will I fulfill my mom’s fantasy and travel the path to become the first ever mother-daughter ENT team? Stay tuned!

But as I listen from afar, I hear the memories stir that I have stored of my first patient encounters in the daily dramas of her medical student life. Getting to the “wards” (as we used to call the patient floors, a term left over from the open hospital wards that characterized a hospital almost a century ago) was a real milestone. And it meant that you were going to meet real, live, actual (not simulated) patients. That alone was awesome and frightening.

And to the uninitiated, no matter how close to medicine she/he may have been, no longer are the scientific facts and concepts enough to guarantee your success in this new environment. There is a large and rather complex layer of people that comes between the student and the patients. This layer is known as the “service.” A service, in a medical school/university teaching hospital, consists of many types of medical students, resident trainees at different stages of training, and the attending or staff physician. The attending (or staff) doctor is the doctor who has completed all her/his training and is now responsible for the patients on the service. He/she teaches at the medical school in a clinical capacity. He/she is the ultimate decision maker. That’s a lot of responsibility.

But in order to teach and take care of patients at the same time, a large cadre of helpers/learners is available to help the attending. Each has a different role that may change daily depending on the situation. One example is on round. On rounds (going around and seeing the patients two or three times a day to check on their progress) the student may present a patient at one time, or the chief (most senior resident) at another. Knowing when to do what can be very confusing and stressful. Another example is helping in the operating room. Knowing what and how to do something which might seem as simple as holding a retractor, can be a major life challenging experience! Let that retractor slip at a critical point in the operation, and significant harm might result. What lecture covered that in the pre-clinical years?

Thus, new skills come into play at this point in the student’s medical school journey. Social skills. Skills needed to assess a situation and respond quickly and correctly to the social cues of a totally new environment. When do I speak up? When do I volunteer to see a patient? How am I supposed to present this patient? Was I too long-winded? Did I leave out any pertinent information? Did I speak loud enough and with enough authority? When do I tell the surgeon my arm hurts and if I don’t get a rest soon, the retractor might slip?

Sometimes, when I was worried about all of these other things that go into becoming a doctor, the medical concepts I learned would fly right out of my head. I might stammer or think that I looked kinda jerky. And I guess sometimes I did. And yes, sometimes the retractor slipped, but the surgeons always saw it coming and I don’t remember any harm (even the time I fell asleep holding the retractor on a liver during the removal of a gall bladder at 4 am!) And somehow I made it.

I am sure Dana has had some of these experiences. I know that she thinks that she is unique in her mis-steps, but that just isn’t so. I hope in the next post she will tell you about her first clerkship and how she felt about stepping into a whole new world of learning how to take care of patients in the social system we call health care.

At Dana’s medical school, the University of California, San Francisco(UCSF) the students get a 2 week transitional period to ease them into clinical medicine. I am told that they learn about hospital culture, basics in chart notes, how to keep from being a pest, and how to get the nurses on your good side (so at least if they don’t help you, they are not likely to bite off your head!) These are things I think my generation of doctors just picked up as we went along, for better or for worse, for both the patient and for us.

A lottery system assigns who gets which “rotation” (another name for a clerkship) and when. You put in your request, and the computer spits out a schedule. Dana wanted to start with surgery and she lucked into a very busy hospital, one with a lot of trauma, one where medical students are likely to be needed. A lot.

She also got lucky in that her first night was a call night. She was there working for 24 hours straight. She watched a tube being put into a chest to drain an infection, and she stayed up all night except for a few hours of sleep in the wee hours of the morning before she had to get up at 4 a.m. to pre-round with the interns (real doctors in their first year of training after medical school) which happen before the usual work rounds with the residents (the more senior doctors in training) which occur before the operating room schedule starts, and most certainly before the attendings (the real doctors) come on the scene to make sure everything is being done exactly right. So as you can see, Dana is really the low woman on the team, but it’s a start!

We didn’t hear much the first few days. Only that she hadn’t been in the operating room yet. I had to wait until Sunday afternoon when she finally called and told me all about her first week.

She told us that she has great senior residents, and a great team. I knew this was very important, because if your team players (and surgery training is most certainly a team sport) are not willing to teach, you will be miserable. Inwardly I heaved a sigh of relief. Hurdle #1 overcome.

“Mom, I scrubbed on a hernia. My resident, a really nice guy from Stanford med, sat down and prepared me for all the questions I would be asked about the anatomy. When the attending asked me a question, I didn’t get the first one because I wasn’t quite sure what she was asking me. But after that I knew all the answers.” There was more than pride in my baby’s voice. A pride I couldn’t help but feel as well. Hurdle #2—she would not fall apart under pressure, even in the operating room.

“That’s good Dana,” I replied. But she really didn’t hear me, as she rushed on to the next operation.

“Then we had a perforated bowel (a hole in the large intestines) and the patient was really sick. It was the first time I had seen the intestines. They were sooooo beautiful, orange and shiny and glistening. We did a side-to-end anastamosis. It was so cool.”

Dana continued to report about the personalities. She heard others complain about the all night call which didn’t bother her. And even though it was suggested that women might not (yet) have the physical stamina, Dana was quiet. She has a lot of knowledge about that sort of thing and knows that her surgeon Mom is far better than her surgeon Dad at staying up all night and handling all sorts of physical and emotional trauma surgeons must learn to endure. Good move, Dana, I thought. Hurdle #3—she knows when to speak up and when to keep quiet.

Then, I couldn’t believe it. She said, “Mom, I could so totally see myself in surgery. I love it!”

Will Dana really become a surgeon? Maybe. And maybe not. It’s really too early to say. After all, it’s her first clerkship, and I am sure she will be drawn in many directions before her journey is complete. (But it would be really cool if we were the first mother-daughter ENT doctors!)

So after we hung up the phone, I heaved a sigh of relief as I thought, ahhhhh, she’s over hurdle #4. She is going to love being a doctor, and that’s a great feeling. I know.

But it’s not just the social sciences that help you out as a doctor. The humanities offer so much to clinical practice as well. For example, next week at UCSF Dr. Rita Charon will be visiting from Columbia to give a talk called “Stories Can Only Be Understood from their Endings.” She has an MD and PhD in English Literature, and directs the program in Narrative Medicine at the Columbia University College of Physicians and Surgeons. Her work examines the doctor-patient relationship through stories. She helps medical students understand and explore their reactions to patients through writing. These aren’t just intellectual exercises, though. They ultimately improve how we understand the people we care for and therefore help them more. She reminds us that in clinical practice—while we are working with lab tests, drugs, imaging studies, and various forms of scientific data—most of our interactions are stories we tell each other (amongst students and physicians) and texts we collect, read, and interpret (charts and notes).

So having a degree in literature, history, philosophy, or any other text based field also gives you useful tools with which to approach the complex layers of patients’ stories. And to take this even further, it’s not just the patients that have story arcs and complex social relationships that impact their health, disease processes (pathophysiology—the step by step process of how a disease begins and ends) themselves are miniature stories that students must be able to follow, piece together, and relate to the heaps of information and sources that we must consult.

So overall, I would argue that medicine is equal parts social, narrative, and scientific. So bottom line: study what you love and you’ll find ways to connect it to the art and science of healing others.

Maybe I’m being overly romantic about the liberal arts, but these thoughts just echo my own personal story. There was a moment in the middle of college, beginning my biology major and getting through the pre-med requirements when I thought about giving up on the pre-med track. I was doing fine in my classes, but I wasn’t sure why I was pursuing this path. (Because it was obvious? Because my parents did it? How could I make this path my own?) It was also quite difficult to make the connection between the less human and heavy sciences of general and organic chemistry to what it was like to be a doctor. But then I discovered anthropology. It gave me a ‘why’ and got me thinking so much about people and health and illness, much more than atoms and electrons ever could.

Enough waxing poetic, you say? Fine, let’s talk about practicality.

Even if you are concerned about how you might ‘look’ to admissions committees as a gender studies or international relations major, have no fear. I would say that my university likes to boast about how diverse its student body is, including how many non-science majors they have in a class. Studying something off the beaten path is very desirable and ‘sexy’ nowadays to admissions committees. (Of course science is awesome too! I have some classmates who’ve done mind-blowing things with electrons.)

I went on lots of med school interviews. Some of the conversations I had were regurgitations of my CV; others were more interesting and pushed beyond the limits of my written application. But over and over again, the doctors were most interested in what I had to say about all of my ‘atypical’ studies and activities.

Unfortunately, being pre-med has been distilled to a formula, and these admissions committees see the same activities over and over again—volunteer work, lab work, leadership positions, etc. But they want to know what makes YOU stand out and what gets you excited and involved. And that could be what you study OR what you choose to do when you’re not studying. Just be yourself! Being genuine and dedicated is always the way to go—following a scripted path when your heart’s just not into it will show through. Genuine enthusiasm, engagement, and passion will always win!

First the skills. Doctors learn to apply scientifically based knowledge to human beings who live, behave and act in wholly unscientific ways. Biology intersects with culture and politics and geography and much more. Cultural values and social systems may impact our health and well-being as much as or more than our biology in some cases. Think about the violence in some communities that takes the lives of innocent people. A doctor can treat the wound and maybe save a life, but only society and culture can control the behavior.

All doctors do not need the same set of skills. So there is no one “doctor type.” There are doctors who spend most of their day in their offices seeing patients, talking, looking at lab tests and doing what most people think doctors do. It made for a great TV series 30 years ago when Marcus Welby was popular. And there are some doctors who spend all their time seeing patients for a few minutes in a hospital emergency room and then move on to the next (do you any of you remember ER?)

Other doctors never (or hardly ever) talk to or directly see a patient. Those doctors still can play an extraordinarily important role in a patient’s care. Take the pathologist. A pathologist is a medical doctor who is responsible for looking at samples of tissue or body fluids that are removed from a patient in order to determine a diagnosis. They may be given very little information about the patient. Sometimes they just know the age, sex, and where the tissue sample came from. And yet their assessment, based on the different types of tests that might be done on that tissue, will determine everything that happens to the patient after that. They have an awesome responsibility in the patient’s care.

Their participation is more likely to rely on knowledge in the “science” of medicine (and physics and chemistry and imagery) than in how they interact with patients, which they rarely do. They need sometimes interact with other doctors. But their skills are more like those of a detective who has to take all the clues scientific testing of parts of the body (or in the case of an autopsy, a dead body) and try to figure out what has or is happening to that patient.

The radiologist is a doctor who interprets “films.” He or she is presented with images made from x-rays (radiation), MRIs (magnetic waves creating images), ultrasounds (sound echoes against tissue interfaces), PET (positron emission) scans and other types of imaging taken to determine the problem a patient might face. Radiologists need to have an in-depth understanding of physics (not my best subject for sure!) than might another type of doctor. Being able to imagine 3-D anatomy and computer savvy skills are also helpful.

Or take a doctor such as the pediatric surgeon. That doctor has to develop skills in caring for children, listening to families, and manual dexterity in working on small, fragile patients. Fixing very small delicate people who are fiercely protected by their families requires a completely different set of skills.

So you see, Rosalee, science, while very important, is not the only area of study that helps you to become a doctor. To become a doctor you have to be determined to become one. Learn your science, but study anything else that might interest you. Whatever you learn, you will find useful in whatever type of doctor you want to be.

BUT, they have never defined my path. Exams will never predict who I will become or how well I will do at it. And that will be true for you. No one exam can measure the value of your personal experiences, the way you see the world, or how you interact with it. They can only measure certain ways of thinking, certain types of knowledge, and given ways of organizing this complex world we live in.

The Boards don’t test for so many things: how will I interact and form relationships with patients? How will I think beyond algorithms and formulas to treat people individually and creatively? How will my non-linear way of thinking allow me to become an anthropologist and see the world in unique and more complex ways?

Daunting? Imprecise? Frustrating? Necessary evils? Yes. Impossible enough to deter us? Definitely not.

What else can keep these monstrous exams in perspective?

I’ve passed so many tests and have so many to come. But the number of tests in my life are nothing compared to the number I’ll run on patients. From the more mundane (cholesterol and sugar checks) to the more profound (prenatal and genetic screenings). Those are the results that matter. Those are the tests that change lives.

So while I’m sweating about the Boards, I remind myself that in comparison to the test results for cystic fibrosis, lupus, metastatic cancers, ALS, Huntington disease, and the thousands of other challenges patients may face, my tests pale in comparison.

So, yes, Step 1 is one of the most important exams I’ve ever taken. But it’s just another test. Just 8 hours of narrowly focused medical knowledge. And with so much uncertainty in life, in medicine, and in our own health, I welcome the reliability of these exams. So far, they’ve been one of the only constants in an uncertain (but exciting!) life.

Wish me luck on March 31st.

Well, I should qualify that: it’s the last test of my pre-clinical years. (The first two years are called pre-clinical because we don’t see much of the clinical side, because we don’t really know too much.) So, for two years we sit mostly in lectures, labs, small groups, and the library, learning the basics of human biology and illness. The cycle is predictable: three weeks of cramming, test, repeat. In our last block Life Cycle (our curriculum is organized by topic or organ system), we can finally see the light at the end of the tunnel.

But it turns out, that light is an illusion. It’s just another train heading full-speed towards us. We can’t we continue on to clinical training until we’ve passed the boards. What are the boards, you ask?

Well, “the boards”—or ‘the big quiz’ as one of my neurology professors calls it—are the first in a series of exams you take to become a doctor. Also called the USMLE, which stands for the United States Medical Licensing Exam. There are 3 Steps:

Step 1 encompasses all of general physiology (how the body works), anatomy, pharmacology (medications), microbiology (germs), biochemistry (proteins and that kind of stuff), and pathology (how disease happens and what it looks like). This is the stuff we learn during the first 1 ½ to 2 years of med school. In most schools passing step 1 is required in order to continue onto the clinical training of the second half of med school. Your step 1 score is important when you apply for the training after medical school, i.e. your residency.

Step 2 is usually taken in the 4th year of medical school. This next step tests your application of medical knowledge you have learned in diagnosing and treating patients. This is another 8 hour exam.

Step 3 is a 16 hour exam, taken over two days after the completion of the first year of residency (a.k.a. ‘internship’). Then you are finally a doctor.

More knowledge. More questions. More pressure.

So how is this supposed to be encouraging? How will this litany of obstacles keep you excited about becoming a doctor?

Well, it’s about perception. How you choose to see this path ahead. Stay tuned!

No one likes taking tests. Unless you are really well prepared and know the answers to all of the questions. And then it can be fun as an affirmation of your hard work, perseverance, and mastery of the material.

My first big, important, life-changing test occurred in the 8th grade. The DATs—tests to help you figure out what career you might be good at. Don’t remember what the “D” stood for. On this 6 part test, I scored in the 99th percentile in spatial relationships, mechanical thinking, scientific reasoning and mathematical concepts. But I only scored 80th percentile on transcription and memorization. When the test results came out, the guidance counselor met with my parents to tell them what line of work I would best be suited for.

Based on my scores, my counselor told my father I would be a very good secretary! To his credit, my father told the counselor that his honor student daughter could be other things beyond a secretary. And then he told me to ignore her the same way she ignored those tests.

Why do I tell you this? Because tests, while important in helping someone else determine your strengths and weaknesses, are only one part of what you are and what you are going to become. They are simply not a complete picture of you.

Having said that, it is important to know that test taking is a fact of life if you are going to become a doctor. The tests start early and they seem to never end. In fact, every time you take on the care of a patient, in some way, you are being tested as to how good you are as a doctor.

But let’s leave that particular philosophical debate aside for the moment. Practically speaking: What kind of tests will you encounter? How important are they in becoming a doctor? When do you take your last test?

First, it is very important you know how to take tests. The subject matter is important, and preparation is the key to success. There are the tests you take for classes. Teachers are usually pretty generous in letting you know what to study. But then there are those dreaded standardized tests that colleges require for your application to their school. Unfortunately, many times these tests are used as cut offs to separate out students who will be considered for admission and those who won’t.

The last time I looked, the pre-SATs (scholastic aptitude tests) are taken early in the junior year of high school. These tests help determine who will receive national merit scholarships. They also give the student a taste for what’s to come.

Then comes the big sister test. The SATs. They have three parts—math, English and writing sample. These scores are weighted more or less heavily towards admission depending on the college. Their results are also provided to colleges which then begin the process of sending you material encouraging you to apply to their school.

Prep courses abound. Is Kaplan better than Princeton Review? Don’t know. But they can be expensive, and I do not think there is financial aid for the near $1000 fee charged for college preparatory tests. (I sent an inquiry to each last month, but have yet to receive and answer). But they also can help boost your scores and even guarantee it or your money back.

Even without test prep courses, you can find used test prep books on-line. And then: Practice. Practice. Practice. The discipline is not only useful for these first tests, but also will help you learn how to learn to take tests for the rest of your life. Alas, a painfully necessary skill.

Hey, Dana, now that you are back from the Big Sur, what do you think of my take on tests?

So while Dana is off with younger sister Becca exploring the beauty of Big Sur, CA, during their winter break, I will tackle the first of the many great questions Rosie asked.

“How long is it to the step where you can finally say that you are a doctor?” Hard question. The answer starts with “it depends.” When is someone really a doctor?

Becoming a doctor is a process. A long process, which doesn’t really ever end until you stop caring for patients.

It can begin in high school, college or even later on. There is no one route to get there. But for the purposes of answering this one question, let’s look at the straight and narrow path to becoming a doctor.

Start with graduating high school. Take challenging courses. Get good grades. Learn to study and take tests. Find other interests. Take care of yourself and the important relationships in life. Takes about 4 years.

Go to college. The best one for you. Sometimes people don’t want to leave their family to go to a “top-rated” school or they don’t have the money, or the grades. Don’t let that stop you! Find the best fit and do your very best. Find your academic interests (may not be science, but you still have your pre-meds). Take challenging courses. Get good grades. Learn to study and to write well. Learn to take tests. Build on your outside interests. And take good care of yourself, your family and your friends. (College is usually four years, but there are some programs which combine college and medical school in 6 years.)

Go to medical school. There is no one “best” school. Medical school is almost always 4 years in length, unless you pursue a PhD in the biological sciences or, more often now, in the social sciences (like Dana who is also getting a PhD in medical anthropology).

At the end of medical school you are allowed to call yourself a doctor. The title of MD (medical doctor) or DO (doctor of osteopathy) is appended to your name. Does that make you a doctor? Well, it depends on what you want to do.

If you want to go into related fields where an MD or DO is helpful and your primary job is not one-on-one patient contact, then you have become a doctor. One of my medical school classmates works in research designing clinical trials. He never “touches” a patient but his valuable work truly touches the lives of many patients by providing information helpful to thousands of people.

But if you are like most people who travel the first 12 years, you want to take care of patients. How long? It depends on your field of medicine.

The day I graduated medical school, Dr. David Wagner, pediatric surgeon and director of emergency medicine, “hooded” our class. As I accepted the white fur cowl bestowed on one who earns the MD degree, he said to me, “You will live, eat and breathe medicine for the next 5 years. Learn everything you can about diseases and everything you can about the people who will suffer from those diseases.” Great advice that I took very much to heart.

Now you become a resident. You make the most of every patient encounter. You learn all kinds of skills, study hard and work long hours. The patients become your teachers while you are closely supervised by more experienced doctors.

Your formal training is over. It is 3 or 5 or sometimes even 9 years later. You can finally go out into the world and show people that you have learned and earned what it takes to be called a doctor, a healer. Sound daunting. It is. But it goes very fast. Be propelled by how exciting and important your life’s work is to you and for everyone who will help.

To close off this supportive round-up, we go around the circle each saying a positive word: ‘love’, ‘peace’, ‘home’, ‘turkey’, ‘mom’. I usually say ‘compassion’. When I first started, I felt awkward in this environment. Prayer circles weren’t really my thing, but having a go-to word made it easier. But that not so little word is also a very large reminder to myself of why I sing with this choir, why I’m in medicine, and what I hope not to lose through the rigors of my medical training.

Mom, in your last post, you commented on the importance of balance, and a difference that you see in my generation of future docs-to-be. The shift in the culture of medical education is reflected in institutional changes, such as the curbing of residency work rules and the shifting values in medical school admissions. Having high scores may be important, but they don’t mean everything. UCSF happens to be one of those schools that values diverse life experiences and personal qualities—all that can be read between the numbers. (One reason why I chose it!)

While UCSF’s standards are quite high, the admissions process is designed to look beyond MCAT scores and GPAs. Diversity is one of their greatest priorities. Diversity doesn’t just mean ethnicity, gender, or religion. I’m always amazed at the variety of talents, skills, passions, majors, languages, and activities that can be found amongst my classmates.

We pursue music, advocacy, activism, run marathons and run non-profits, serve actively in the air force, nanny, and even write novels (my roommate, another 2nd year med student, just signed with a literary agent). This all means that I belong to a vibrant community not just smart and fascinating people, but happy and fulfilled individuals.

We can do this because our classes are completely pass/fail, there are no rankings, lecture hours are strictly limited with a very flexible schedule, and the deans give us a lot of freedom to shape the curriculum, create electives, and use the abundant resources the university has to offer.

But I think it’s more than balance. It’s about enriching our abilities to care for and work with people.

Yes, it’s about holding on to who we are, without being swallowed up by the white coat. But really, what I see in myself and my generation is more of a paradigm shift: we believe that juggling all of our many interests will make us better physicians not just because we’re happier, but because of what those pursuits teach us about life, compassion, and about caring for others.

Medicine is still a calling. We still devote ourselves to it. But now we’ve just expanded what it means and what it takes to be accomplished and compassionate physicians. Singing has kept me sane, but what’s more is that being a part of a caring community has taught me more about healing than any lecture ever could.

Yes, my daughter the doctor-to be, if it were only our career choices that created confusion and uncertainty! How your words (and your angst) resonated with me and my own daily struggles in caring for patients. Even after a lifetime of practice (nearly 30 years), not a day goes by that I don’t feel humbled by a problem I cannot solve or a patient I cannot heal.

Learning to deal with the confusion created by the rapidly changing science of medicine which needs to be practiced on the ever changing cultural, social and economic playing field has placed enormous demands on today’s physicians. How will this new generation of healers handle this explosion of information and the ever increasing societal expectations for perfection and performance?

“Medicine is a calling; it is not just a career. It is a way of life.” How many times I have heard and repeated the mantra of medicine of my generation? But as I watch you go through medical school and see how you lovingly and thoughtfully embrace your future, without losing your love (or time) for other parts of and people in your life, I have begun to reconsider my position.

Perhaps the attitudes emerging from the upcoming generation of physicians are their protective reaction that is not only necessary but also good. This talk of balance and lifestyle. To have time with our families. To have time to restore ourselves. To have time to have and be friends. To us, who have spent decades in the trenches, this sounds so foreign. We believed that these times were denied to us so we could prepare and become and remain really fine physicians.

But the practice of medicine has become so demanding, that in order that we “first of all, do no harm,” perhaps we have to be mindful of our need to more regularly replenish our minds, our bodies and our souls. This may be essential if we are to be more than the mechanics for the human biological machine.

Medicine is unique in the sciences because it is not just a science. The intersections of culture, social, political, economic, and biologic is no more apparent than in the one-on-one critical encounter between someone in need of caring and curing and the someone who not only has the competence, but also the compassion to make that happen.

One can learn competence in a lab, on a cadaver, from a lecture or the hundreds of supervised hours of seeing virtual or real patients in the emergency room, in the hospitals, and in the clinics. But compassion is learned from nurturing the feelings that sometimes are buried deep, deep inside, which allows you to respect and receive someone else’s needs.

So if we are tired or worn, as so often we physicians can become, maybe we will be less to our patients than they really need. Less able to both care and cure.

Yes, Dana, I am sure you will continue to experience periods of confusion and uncertainty all the days of your medical life. Finding people to lean on and places to retreat to may give you, and the people for whom you care, fresh and essential energy to be that physician we all want for our own.

I know in my last post I expounded following one’s own interests, without any particular roadmap. This approach definitely has its positives. But sometimes confusion and uncertainty appear, and choices can be difficult to make. Solution? Mentors as my guideposts: While I may not be sure what might lay ahead, for the immediate future, they have helped me to know that at least I was in the right place.

Times have changed. And so have the kinds of advice and guidance that young people need. Maybe back in the 50s and 60s when you (mom) were growing up, mentorship of young women was up against much more narrow and stifling gender stereotypes. Mentors were needed to open the door, make more things possible for more girls.

For me, mentorship has served a very different function. I grew up in very different circumstances. The 80s and 90s were more liberated times. I was raised by two surgeons, and never were we allowed to believe that less was expected of girl. But even with such strong role models that didn’t mean that I didn’t need help.

Today’s world is so much more complex. The opportunities may have exploded, but learning to navigate these opportunities has never been more difficult.

Mom, you needed permission to pursue your dreams. I needed focus. My life was and still is marked by too many overwhelming possibilities. And my mentors have always been there to refocus my limitless vision.

I have so many questions that can have so many answers: What kind of doctor do I want to be? Where do I want to practice? What kind of anthropology do I want to do? Where should I do my fieldwork? How does it all fit together into a nice neat package of a career?

Even the more immediate, smaller concerns gnaw at me: Which clinical rotations should I do this summer? Am I doing enough reading, writing, research, extra-curriculars, etc? When should I start studying for the board exams? How do I compare to every other second year med student?

My advisors at Barnard, my research mentors all over the world, the many physicians and researchers who teach me at UCSF everyday, and, of course, my family have all done (and do) two crucial things: 1. they gave me a chance at my dreams and 2. they helped me stay on track amidst all the chaos and uncertainty.

My meetings with my PhD advisor: I am worried what I’ll write my dissertation on, how I’ll pick a topic, a place or a community, or how I compare to my more entrepreneurial and innovative colleagues. With a knowing smile she reminds me of my strengths, my ideas, and gently nudges me to stay on track and keep my eyes, ears, and mind open all at the same time. And bam! I’m a new person and life makes sense again.

I guess it doesn’t seem so impressive on paper, but these sorts of interactions have an intangible magic all of their own.

Maybe it’s just me. Or perhaps I’m too insecure or just too willing to admit it. But I need these guideposts at regular intervals, checking in along my way.

So if, like me, you’re prone to flurries of ideas, abundant curiosity and a little (well, ok, a lot) of angst, look for mentors who can help you harness the energy of uncertainty to take you in positive, yet uncharted directions.

Does anyone remember the scene in the movie Bye, Bye, Birdie, when the MacAfee family learns that Kim is going to be on that really big show, The Ed Sullivan Show? Does anyone remember how, transported to a scene in heaven, likely cloud nine, they sang, in four part harmony, “We’re Gonna Be On Ed Sullivan!”

Not a totally unbelievable scene for a family in the 1960’s. It was exciting to have a TV, much less to be on it. Back then the media consisted of print newspapers, magazines, radio, and the nascent, still black and white, television.

But here, almost 50 years later, in the first decade of the 21st century, I am on my own cloud nine. I am getting ready with my video camera to produce my own song to be distributed on YouTube. And what will I sing? “We’re Gonna Blog for Ira Flatow!”

Some of you reading this blog don’t know Ira Flatow (and probably not Ed Sullivan either). Ira started his radio career in Buffalo and rose to the national scene with his unique radio brand of popular science—Science Friday. Aired every Friday afternoon, Ira talks, educates and interviews to bring science into the everyday life of everyday people. That includes me and you. Whenever I am in the car on Friday afternoon, I forgo my book on tape, and turn the dial to SciFri. I love this program. Ira loves doing it—you can tell. I love Ira.

Problem is, I am told, that the demographic of his show is somewhere north of 50 years. A fact I find hard to believe. But I also learned that Ira Flatow is trying to change this in a big way.

This summer I received an email (almost as exciting as a call) from SciFri executive director, Ann Marie Cunningham. It informed me that their teenage summer intern, Rosalee Washington, had chosen me as a blogger, from all the other bloggers in the blogosphere, to be a blogger for SciFri’s website for the next generation, Talking Science. They wanted a blogger who would talk about being a woman in medicine and science. How does a girl get into medical school? What do you have to do in college to become a doctor? What are the barriers? What is life like for a woman in medicine? Can you combine medicine and a family? As you might imagine, many women could write this blog. But they chose me!

Next came a conference call. Ann Marie introduced me to Rosalee who shared with me her immediate concerns (presumably those of other young women) about how to get from high school to college to medical school. I could do this! How fortunate that I was really close to that phase, as my daughter Dana had just finished her first year as a medical student. She could be a resource.

And then, there in a flash, I thought, why not do a mother/daughter blog? Would Dana agree? Would she have time? (She was the first real blogger in our family (www.danainnz.blogspot.com), so I knew she could do it well.)

You cannot imagine my excitement when Dana agreed. So now, the two of us have begun a joint venture for the newly designed Talking Science website, aimed at the 15-35 year old demographic. We branded our blog, “Like Mother, Like Doctor.” Catchy, no?

Hope you will read it regularly, share it with your families and friends, and add your own comments and questions as we try to serve as a resource for the next generation of women physicians, new age style, on our blog, on the web. From the black and white TV screen to the color, flat panel computer screen. Science Friday, Talking Science, Ira Flatow, here we come!

The first mentor ever mentioned is found in Greek mythology. When Odysseus begins his journey, his son, Telemachus, is left in the care of Mentor, for guidance and protection. The story unfolds with the goddess Athena intervening and assuming the form of Mentor in than she could encourage Telemachus to assert himself and take charge of his role in the lives of his mother Penelope and father Odysseus.

Is it an accident that the very first mentor in literature is both a mortal man and a female god? I think not. The moral of this mythological story is that the role of protector and guide is complex and can be filled by many different types of people (and to those who they help can even take on god-like qualities!)

So, who and what is a mentor? On the most basic level, a mentor is anyone who will influence your growth and development in a positive manner so that you can determine and then achieve your life’s goals. Mentors are role models, teachers, cheerleaders, and trusted friends. Mentors are experienced and willing to open doors to opportunities. Mentors help you develop skills, both practical and personal.

And mentors help keep you out of trouble. And when the deed is done and you are already stuck in the mud, mentors help lift you up, clean you off, and get you going in the right direction again. Mentors help you believe in yourself, especially when the going gets tough, as it is bound to from time to time. Being a mentor is not an easy job.

And mentors are sometimes found in the most unlikely places, teaching you the most unlikely things. Sometimes you don’t know that person is a mentor. When I think about it, first mentor (except for my parents) was my Aunt Marilyn. She is my mother’s youngest sister by 17 years, and a mere 5 years older than I. At our present ages, the age difference doesn’t mean a lot, but way back in my early childhood, it was a huge difference. She knew all the new dance steps, the new rope jumping steps and new ball games girls would play with the pink hued Pensy Pinky ball or the sturdier Spaulding. (I preferred the latter).

As we tossed the ball against the side of our house, bounced it over and under our legs and arms, and threw it “like a girl” to and at each other, I discovered my rather decent hand-eye coordination, my love for games which morphed into my love of sports, and revealed to me the satisfaction gained from my competitive spirit. These early self-revelations were all critical to my life’s path.

My next important early childhood mentor was my fifth grade teacher, Rita Braver. She had been warned that I was “challenging” by my fourth grade nemesis, Miss Z. Miss Z. ranked me at the bottom of the class for hygiene because I bit my other-wise clean nails, could not control my unruly hair, and always had rumpled clothing from being slightly chunky and preferring to play with the boys. This not so subtle form of gender stereotyping plagued many ambitious girls of my generation who spent more time on our books than on our looks. Despite this not-so-rave review, when I reached the fifth grade, Mrs. Braver chose me, out of all the girls in our class, to help with kindergarten set up when school began. I could join my class 10 minutes late every day! Someone important believed in me! She knew I could make up the work load. She new I could be reliable. She recognized me for important characteristics and gave me an opportunity that set me apart from the rest. I never have forgotten how much she changed my life.

So you can see that mentors are all around. They can be found in unexpected places and can be unexpected people. While letting people help you in life, you can learn about yourself, develop skills, and move towards your goals. If you look around you will find these people and you will learn to develop these increasingly important (and as you go along increasingly more complex) relationships.

As my life went on, I gathered up mentors wherever I went. And when I got into high school, these critical guides became increasingly more important. Shaping my education, the foundation for giving me the choices I needed to follow my dreams, was one of the most important gifts I received from my next level of mentors.

No, I didn’t always want to be a doctor. For a while—I’d say from age 6 to 12–I wanted to be a pop singer or a Broadway star. School was never my strong suit, but singing was. I was pretty convinced that I would very soon be discovered. (I’m still holding out for my big break!)

Maybe it was the self-consciousness of pre-adolescence or the hard-nosed practicality of my family, but at some point I slowly abandoned my dreams of stardom and started thinking about a more realistic future.

Unlike my mom, I struggled quite a bit in grade school keeping organized and focusing on even the most basic assignments. But no matter how well I did in my classes (or not), I managed to stay focused on what interested me most. And that was science. Using my interests to guide me became a theme throughout rest of my academic career. At times it was super difficult to be a straggler with two very high-achieving parents. But I was lucky. My parents helped me through my struggles as a student. They always made me believe that whatever I wanted to do was possible.

My growing interest in science coincided with a whole lot of orthodonture—beginning about age 8. Unlike most kids, I loved having my braces tuned up. I loved talking to my orthodontist. Dr. Bochacki. I loved knowing all the details. I soaked it all up.

The plan: I would go to dental school and spend my life helping other unfortunate kids (like myself) have a presentable smile.

But by high school, I had a really hard time imagining looking down people’s mouths every day for the rest of my life. I also realized that I wanted to care for people as a whole, beyond their smiles. This turn to medicine seemed pretty natural, too. A life of taking care of people and families, being ”on call’, and surgery were really all that I knew from my parents. In that way, medicine felt comfortable, maybe even safe.

I also started to think more critically about the world. About societies and culture. I began to have a vague idea about people and health, and about the social complexities of illness and wellness.

So off I went to Barnard. I mainly set out to study science, but I also wanted social science in my academic life there—at that point I wasn’t sure what kind. I was hardly a stereotypical “pre-med”. I took the biology, chemistry and physics coursework for granted, but, like my mom, I really dove into a less typical path for future physicians with a double major in biology and cultural anthropology. Throughout college, I struggled with my true allegiance. Sometimes I wanted to defect to the hard sciences, continuing the plant biology laboratory work that I had started, and at other times, to abandon science altogether for a life as a cultural anthropologist.

Part of my waffling definitely had to do with wanting to explore careers other than what I grew up with. I felt a little self-conscious with how ‘safe’ med school was and how unimaginative I felt going into the ‘family biz’.

In the end (which was really only the beginning), I did what I always did, and what worked for me. I just followed my interests. Just like when I was younger, feeling overwhelmed and confused by so much around me, I just stuck with what I liked and followed what sparked my curiosity. I discovered medicine not as alternative to my other interests but as way to explore all of them on my own terms.

Mom, when I was at Barnard, my many mentors were so key to my experience there. Who were your mentors in college? How did you get to know them? How did they contribute to you becoming a doctor?

To begin our blog, “Like Mother, Like Doctor”, we, Linda and Dana, decided to interview each other about our experiences with becoming and being a woman in medicine. After all, between the two of us there’s a lot of firsthand experiences of what it means to be a woman in medicine—as seasoned practitioner, newly minted medical student, and for both, as patients.

So here we go! To begin, we offer a series of discussions, in which both of us weigh in with our perspectives and insights at times generated by your questions and comments. Others post will feature “A Day In the Life”, “Ask the Doctor”, and random, interesting observations and stories that will make you think, laugh, and maybe even cry.

DG: Hmmm. Where to start? Well, for this first blog, how about at the beginning? The question I want to ask, is “Did you always know you wanted to be a doctor?”

LB: No, I don’t think so. When I grew up in the 1950s and 1960s, your Grandma Zelda wished for me the college education she never had. “Be a teacher,” she told me again and again. “Teaching is a good profession for a woman.” For a long time I thought teaching would be my path, but when I reached high school I realized it was her dream, not mine.

And so my “non-specific” dreams loomed large over my early life. I was always very driven to achieve. Whether it was a pick-up kick ball game on Jackson Place where I grew up in Bellmore, NY, or the fifth grade spelling bee, or being editor of the Buccaneer, my high school newspaper, I always gave it all that I had. I totally immersed myself to be the best I could be. I liked a challenge.

I finished my first year of college still without a clear direction, and still without a plan. Admiration for my Aunt Roberta, a clinical nurse specialist and author, led me to discuss my plans with her as I thought I could become a nurse just like her. Her response startled me into a new mindset. “Why don’t you become a doctor like your Uncle Murray (her husband and my mother’s brother)?” I hadn’t thought about that possibility. My Uncle Murray was a family icon—first and only in his family to go to college. Medical school was beyond the family’s imagination. If my aunt and uncle believed that I could become a doctor, well then, maybe I could. And so I decided I would try to become a doctor.

I returned as a sophomore to Bryn Mawr College. Pre-med courses intermingled with my History of Religion major and Chemistry minor, kept me really busy and really challenged. Not the typical science pathway for anyone who wanted to become a doctor in the 1970s, especially a woman. But as I have learned through these many decades, there doesn’t have to be a typical pathway.

What I also learned was that having someone believe in me really helped me to believe in myself. And as I am writing this blog, I just now realized my aunt and uncle were my first mentors, but thankfully not my last. I knew I could make this difficult journey. And now, 35 years later, my mentors, my drive, the intellectual stimulation and the deeply felt need to make a difference in the lives of others has pushed me on this long and winding road.

And you? Did you always know you wanted to be a doctor?Di