Here we are. It's the end. So, the thoughts I'm leaving you all
with, are what I deem, my "commencement speech." I wasn't asked to
give the commencement speech (I don't even know if we have students
give one at all), but if I had been -- this is what it might be
In the immortal words of Diane Court, from one of the seminal
movies of MY generation (Say Anything):
"We're all about to enter 'The
Real World.' That's what everybody says. But most of us have been
in the real world for a long time. But I have something to tell
everybody. I glimpsed our future, and all I can say is... 'Go
Well, Diane, I don't have the same advice.
Yes, we're about to go out into the "Real World," and some of us
have been out there all along, and long before, but it's different
now for us. Some people have their whole lives and careers ahead of
them. They have families to create and fortunes to make -- names
for themselves. Others have different goals entirely -- coming to
this as a steppingstone, or a second career, or both. These are
exciting, and scary times for all of us. Because after we walk
across this stage, after the fanfare and the parties and the
dinners and whatever else, we'll simply be -- Doctors.
It's a title -- sure. But it doesn't mean anything unless we
MAKE it mean something. If I've learned anything at all over the
course of my professional and academic lives (and there have been a
few), it doesn't mean anything at all, if we don't do something
We're called to be leaders and teachers. We're called to make a
difference in the lives of our patients and communities. And if we
so choose, we're called to be revolutionaries.
When people ask me (nowadays) what I want to be when I grow up,
I often use the following quote (also from Say Anything -- in the
voice of the illustrious Lloyd Dobbler):
"You mean like career? Uh, I
don't know. I've, I've thought about this quite a bit, Sir, and I'd
have to say considering what's waiting out there for me, I don't
want to sell anything, buy anything or process anything as a
career. I don't want to sell anything bought or processed, or buy
anything sold or processed, or... process anything sold, bought or
processed, or repair anything sold, bought or processed, you know,
as a career I don't want to do that."
And I might add.... So, I'm becoming a Doctor.
For those of you contemplating a career as a physician, know
that it is one of the hardest choices you could ever make. The
school is grueling, the hours are long, and the thanks may not be
plentiful. If you can choose ANYTHING else that you believe you'd
be happy with, do it. If you want to be a lifelong student,
challenged every single day, and called to be more than you ever
thought you could possibly be, it's the perfect place for you. What
are you waiting for?
As for me, the first part (Yes, I said first part) of my
education is over. There may be more studies. There may be research
projects. There may be additional degrees. But I'm far from being
finished. I'm just getting started. And so are my classmates.
It's been a ridiculously long, hard road. We've been through a
lot together. There were times we hated each other -- and times we
couldn't hug each other hard enough. I have watched my classmates
grow as people and as practitioners -- into things they never
thought they could be. From the first day of dissection when people
didn't know if they could handle it, to the last days of clinic
when some of us knew we'd never see each other again after
graduation -- we are family.
For those just getting started, don't give up. No matter what --
whenever you're struggling or Life hands you a speed bump... DO.
NOT. GIVE. UP. Persevere! Keep studying. Keep moving. Keep trying.
Keep learning. I have faith in You... just like You've had faith in
Look out world. Here I come.
This is the beginning of the end -- second to the last entry. I
know I've said this before -- but time really does fly. I've been
writing with you over 2 years. We've been together through a lot.
This almost feels like a break-up.
It really is me this time -- I promise.
We're practically family -- you and I. Don't take my departure
too hard. (It'll be hard for me, though). I'll miss you guys --
just like I'll miss all of my family here. We've been together for
3-½ years. I honestly don't know what I'm going to do when we're
all apart -- probably cry. We've already talked about harassing
each other from afar -- texting each other at godawful hours of the
night (since I'll be 3 hours behind here), and flying back and
forth to see each other (since we'll finally have the money to do
so). I've already started recruiting them to move out to Oregon.
(The power of inception is a beautiful thing).
You all have been "listening" to me talk, for the last 2+ years,
about these people. So, I thought I'd introduce you -- to the
people that have kept me going. These people are my family.
Here is Julia. Julia has honestly been the glue that has held me
together for the last 3-½ years. If we were off from school, she
and I still emailed and texted back and forth at least once a day.
We stayed, and studied together during boards. Anyone that can deal
with me when I'm that neurotic deserves sainthood. We've laughed
together. We've cried together. We've dissected together. She's my
sister and my best friend. I'm going to miss her most of all. She's
my rock and I can't imagine having done any of this without
Joe has been my work/school brother since right after we met. He
actually reminds me of my brother (except he's cool and I actually
like him). He's given me way too many pep talks, helped me out with
all kinds of business-type stuff, and has the most hilarious
This is Leslie. Leslie came late in the game. She started here
(transferred from Lombard) after 8th Tri -- but it feels like she's
been a part of the "family" forever. From her pet lizard Roger, to
her brand new baby Emma, she's always been amazing -- plus she
cracks me up! She's probably glad I'm leaving Florida, because I
keep teasing that I'll run off with her baby. Crazy Auntie Andrea
will always be around Leslie... don't worry.
This guy probably has the biggest heart I've ever seen. Well, I
haven't ACTUALLY seen it -- but I've listened to it. This is Ricky.
Let me tell you, that he has been through hell and back, and always
has a smile on his face, some new tune for me to listen to, or a
REALLY corny joke. He joined our motley crew from an upper Tri --
but he never missed a beat. He's the only other intern that has
stayed until late into the night (or so it felt) with me, working
on paperwork. He's always been a dedicated guy.
Dave is the quiet guy sitting in the corner -- who, when he does
decide to share something -- usually blows my mind. We've both, not
so secretly at times, plotted to overthrow the powers that be (on
more than 2 occasions). I honestly can't wait to see what he does
in the future. He may be president someday. (I'll vote for you,
Last, but certainly not least, is Antoinette. Antoinette is the
epitome of sassy, and she gives great hugs. She's another strong,
quiet force sitting in the corner. But, she has a lot to say. She's
great with her patients, and I know she'll be amazing. I can't wait
to see where she goes.
There have been other people in my family here. Some are over at
the other clinic, like Alid, who was so sweet that he even helped
me move. (He's a smart guy -- look out for him in the future too!)
But, our group here -- we're the close ones. I'm going to miss them
terribly -- and all of you.
Next week -- the grande finale. Have a great one, Everybody.
Does it feel like spring at your house? We had a brief moment of
chilly over last weekend -- and then it started getting warm again.
Since there's no real spring here, we're definitely in the early
stages of summer.
Well, today's blog is going to be more of a community service
announcement -- and a testament to how (much better) we do things
here. Today, I went to the neurologist. Given my history, and the
fact that I've put this off FAR too long -- it seemed like a good
idea. I'll leave all of the names out of the picture, but I will
say that the person that I saw was an MD -- and the student that I
saw was a DO student. So, I arrived at the neurologist's office,
stack of MRIs and CTs in my hand -- to see if they'd do a follow-up
MRI on my head and neck.
In case I haven't filled you all in on this (or you don't want
to go through the archives) -- I was diagnosed with a Chiari
Malformation in 2005 and had surgery to "correct" it shortly
thereafter. The student walked me into the room, introduced
herself, and was supposed to take my history. She asked me a couple
of questions -- brief thoughts on why I was here with very little
about my history. I watched as she wrote down about 5 lines with
2-3 words on each line. In her defense, I have no idea what the
words said, but after hearing her give her summary to the doc, she
missed a lot of what I said.
So, the doctor came in, asked me a few more questions -- a few
more about how my condition presented itself, why I was there, and
what I hoped to gain from the visit. She made a number of
assumptions about me based on her perception without questions. All
of them were wrong. When I questioned her back, she had no idea how
to handle me or what to say. My favorite question that she asked me
was, "When was the last time you felt normal?" To which I replied,
"I've never felt normal -- what a strange question to ask me."
It's easy, as a physician, to make assumptions about people
because of the way they look, how they're dressed, their age, their
background, or a million other characteristics. Know that many
times you will be wrong when this happens. This was a great
reminder for me to not fall prey to this. I will admit that between
the poor history taking and the lack of bedside manner, it didn't
set the tone or instill much faith.
Then she did her "exam." Now, if you've ever had a neurological
exam, you know that it takes a while. There's sensory testing for
light touch and pain, strength testing, cranial nerves (if you're
going to be thorough), reflexes, and cerebellar testing (and a few
random other things thrown in). Going through this exam, even
quickly, takes 10-15 minutes. This doesn't include any advanced
testing -- it's just a screen. The exam performed on me involved
the patellar reflexes only (normally biceps, triceps,
brachioradialis, patellar, Achilles, and pathological reflexes as
the basics), 3 of the strength tests (I do 16), NO sensory testing,
and 1 cerebellar test (and not the best one at that). I kept
waiting for her to do the rest of the exam. It never happened. No
cranial nerves were tested. Now, given how severe my condition was
originally (my brainstem was herniated to the second vertebrae) and
all of the fallout from that, wouldn't you have done at least the
After waiting for 30+ minutes, talking to the student for maybe
3 minutes, dealing with the doc for a max of 10, and sitting
through that pathetic exam, I can't possibly imagine how she could
have learned anything about my current condition. Before I even
walked in the room she had a prescription for an MRI written out.
Maybe she'd already decided that the exam was extraneous. I have no
idea. But I'm STILL baffled. After offering me a prescription for
Valium (for the MRI -- assuming I'd be claustrophobic -- which I'm
not), she excused herself and walked out.
I shouldn't complain. I wanted the MRI -- in fact that was the
main reason that I scheduled the appointment. But I also expected
that I would be seen by a "real" doctor who would offer some level
of expertise -- beyond what I already have. I wasn't.
Through all of my educational forays, and now at the end of my
time here at National, I can tell you that there's no excuse for a
pathetic exam. We're taught better than that. We're taught to be
thorough -- to evaluate the tracts, the function. We're taught to
listen, watch, and test. We're taught to ask questions -- LOTS of
them. We're taught, and have the opportunity, to be good.
I don't know that I'll go back. I have my MRI scheduled. I plan
on taking the films with me when I leave and evaluating them
myself. I never anticipated having the skills to do that. Between
my own personal studies and my exposure here, I definitely trust my
own evaluation more than I trust hers.
Here's hoping that all the docs you meet are good ones, and that
if you're studying -- that you'll become one of the good ones
Have a great week, everybody! Work hard.
"I should be asleep." This is what I say to myself at hours like
this -- around O-dark-thirty when I'm still up working on
something. "I should be sawing logs or whatever people are supposed
to be doing at this hour... instead I'm here."
This last week has been a week for the record. I finished my
master's degree. I don't know how I did it -- but I did it. I
honestly don't know how I worked, had any part in my kids' lives,
was full-time here at National, and full-time at Western States.
But I did. And now it's over. I haven't quite come down from it all
just yet -- but the moment I realized I didn't have anything left
to do, my head kind of dropped. While most people would be
ecstatic, I was sullen. What do I do now? Now, granted -- I have
absolutely no shortage of things to do, read, study, learn, attend,
aspire to, whatever. But no one is making me -- but me.
On Friday of last week, I also sent in my paperwork for my
Oregon license. And all last week, when I wasn't studying for or
taking master's finals, I was working on the bridge course to be
able to sit for the licensing exam, which takes place the day after
graduation. In all of my "down" time, all I could think to myself
was -- what am I going to do now? Where am I going to go? What am I
going to do? I have to find a job. I have to move. I have to...
Sometimes we get so busy that all we do -- is do. And as those
old parts of my mind started to wander back in, you know, the parts
that think about stuff -- I started to get more and more scared.
This is it. Things are happening. Things are actually
Grey came back from Orlando, where he was competing in the FBLA
(Future Business Leaders of America) state competition (He won 5th
in his category -- which is kinda a big deal). He told me a story
that made me cry -- in the middle of the grocery store. He told me
about this guy -- Alex Sheen, who spoke at the FBLA ceremony with
thousands of high school kids from all over the state. Grey said
that there was barely a dry eye in the place. And I can see why.
Alex started the organization "because I said I would." Here's his
It made me think about what promises I might make at this point
in my life. I'm at such a point of transition -- finishing school,
Grey going to college, moving across the country, starting a new
In the quiet moments, at the clinic, we talk about what life
will be like when we're not around each other anymore. We've spent
nearly every day together for the last three and a half years. Even
when we still had breaks in between trimesters we would often text
or email each other, or sometimes hang out. I'd like to make a
promise to my close classmates that I won't lose touch and
completely disappear, as I'm apt to do.
Things are moving forward. Even though we might not all be in
the same place, I hope that we move forward together. After all,
we've been together so long that we're family.
Have a great week, everyone!
I *blinked*... and then it was gone. I couldn't even begin to
tell you what's happened over the last week. I took a comprehensive
final over a year and half's material, volunteered at an event, did
a bunch more master's work, and I don't even remember what
Work in the clinic was a little slow last week due to SPC
students being on spring break. We squeezed in a few patient
visits, though, and I had some interesting cases. There was one in
particular, a woman with a pretty complex history of stroke among
other things. I love the variety. You absolutely never know what
you're going to see each day.
We had a pretty good-sized crew to go down to Sarasota last
Saturday. We worked alongside Dr. Arick at the Sarasota-Bradenton
ITU Triathlon. We had several hundred 16- to 19-year-old
triathletes participating in swim-bike-run at Nathan Benderson
Joe Hicks, Julia Harter, Leslie Jacobi, Dave Aiello, and I did a
ton of soft tissue work on several injured, non-rehabbed athletes.
There were several that had continued training through some pretty
tough injuries. It seems like many of these teenagers have coaches
that push them really hard, but don't attend to their injuries once
Julia Harter participated in the Seminole City Fire Truck pull
for the Kiwanas. They raise money for vocational school
scholarships for kids. Dr. Jaya Prakash heads up a lot of events
with them. Dr. Carlo Gaudagno was also at event. Our team won first
place for "mixed adults" and garnered a trophy!
(L-R) Julia Harter, Alex Gubco, Brandon Alexander, Fan Yang,
and Dr. Guadagno
That's about it from me. I finish the master's program this
week. Everything should be done on Friday. I honestly can't quite
grasp it. Here's hoping that this week goes by quickly - but not
Have a great week, everybody!!!!
• After the DC Degree
• Botanical Medicine
• 1 Year at National
• Marketing Project
• First Week in Student Clinic
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