The Trilogy

The Last 3 Years (abridged)

By now you guys probably think I don't really do triathlons anymore anyway.  The gig is up, it was fun while it lasted.  You're all just sitting there in your chairs, waiting for me to announce my retirement.  But in a preview of things to come, I'll start by announcing that I'm racing this weekend!  First time in over a year, holy cow.  As I finalize this post, I'm sitting in a coffee shop in Windsor, CA.  This beautiful little town and neighboring Guerneville in the Russian River Valley play host to 70.3 Vineman, one of the most historic half-distance evens on the circuit.  It's a notoriously deep field every year, and is going to be a rude awakening fo sho.  Some guys named Craig Alexander, Matt Reed, and Tim O'Donnell are here, and I hear they're all pretty fast.  I couldn't be more excited about it, but more on that later.

 

As promised - and before my greatly-hyped return to racing sends the media into a frenzy - I wanted to write a bit about the "med" part of the tri-med lifestyle.  It is, after all, most of what I do these days.  You can't say you weren't warned about this.  And this seems like an appropriate time, as I just officially ended my third year of school, took the next step in the never-ending series of board exams, and have already started the next chapter.  So here it is, my first departure from the strictly enforced triathlon agenda.  I think I'm starting off with a bang... or at least a lot of words.  Boundaries will be crossed, social norms will be struck down, emotions will run heavy, and I'll warn you: things get a little philosophical.  You may wish you had never been born.  But I'll be able to sleep at night once more, knowing that I finally made good on all those blog ideas.  My intent is to shed some light on what's been going on in my life these past few years, between all the races and exotic trips and booze and women and trashed hotel rooms that you usually have to read about here.  Let's hop right into it.

I. Med School Year One (MS1)

Year one of med school was the best year of my life.  It was a revelation.  So much fascinating stuff to learn about and experience, from the late nights dissecting in anatomy lab, to the long hours staring through microscopes at glomeruli and cancer cells, to the exhilarating first steps in patient care.  All of my new classmates had such remarkable stories, I was humbled day by day as I learned more about them.  Great new friendships were born, fun adventures were had, and through it all I finally felt reassured that I had found my calling - that I was where I belonged.

 

As a quick outline, the classic med school curriculum is essentially divided in two halves.  You spend the first couple years focusing primarily on basic science and "book learning."  Years three and four are then partitioned into a series of clinical rotations called clerkships.  Speaking more to the early years of basic science now: I once heard it further explained that year one is all about building boxes. You learn about cell structure and function, organ systems, and how the body works when everything is running smoothly.  You then revisit those concepts in year two, but in the context of human disease, studying all the things that can go wrong; filing different disease entities away into those boxes, so to speak.  Maybe a file cabinet is a better metaphor.

 

The year was not all blissful learning, though, and there were definitely some unforeseen challenges.  I quickly discovered, for instance, that there isn't a lot of positive reinforcement in grad school.  At least there wasn't in my case, ha.  Gone were the days of extra credit and professors complimenting your thought process, even if it was nowhere near correct.  Gone were the good grades and glowing reviews.  And perhaps most disappointingly, gone were the exams you could just cram for and still pull off.  Plus, I was surrounded by so many smart people.  I mean, it seemed like everyone was having an easy time of it.  I was left to infer that all my peers were literally brilliant, and never forgot anything they read (sort like an elephant).  Consequently, I had to adjust to being very middle of the pack.  No one likes being in the middle of a pack of elephants.  And I'm not proud to admit this, but my confidence definitely took a hit.

 

Easy to get trampled in there.  Not unlike the beginning of a race, actually.

 

In hindsight, one of the ways I justified my "satisfactory" grades in the classroom was by pursuing triathlon with heightened intensity.  "You're a pro triathlete," I told myself.  "You would do better on exams if you didn't spend so much time running around in short shorts, or watching old Tour de France DVDs on your trainer."  I spent my lunch breaks in the pool and my weekends out on long rides.  I got a coach to help me make the most of limited training time (to this day one of the smartest things I've done since starting school).  Exercise has always been my escape: how I clear my head, stay grounded, and maintain some sanity.  And I really needed that during year one.  Coach Bagg has helped me continue to prioritize triathlon in my life, but in a way that accommodates my academic commitments and interests.

 

By the time summer rolled around, I was going a bit crazy.  We were given 8 weeks off, "our final summer" as we were constantly reminded.  Many of my classmates lined up really cool research experiences at the university, or went abroad to volunteer.  All I wanted to do was go race.  Those 8 weeks were a great ride, and are fairly well chronicled here on the blog.  I trained a lot, traveled to quite a few races, and ended the season with my first ever full-distance event.  Mid-August came around way too quickly, and before I knew it I was back in the lecture hall.

 

II. MS2

 

Year two of med school promptly replaced year one as the best year of my life.  We were still mostly in the lecture hall, but it was time to fill in those boxes we had constructed during year one.  The learning sky-rocketed as we immersed ourselves in a world of human pathology, studying fascinating disease processes and the body's miraculous ability to survive, evolve, and renew.  We also *finally* began to learn a thing or two about intervention: medical science's ability to modulate the body's physiologic response and help get things back on track, or in some cases to simply salvage what it can and move forward.  I quickly became overwhelmed by all the things that can go wrong, but even more impressed by the wondrous design and awesome resilience of the human body.

 

I soon realized (although maybe not as soon as I should have...) that there were a number of fairly critical differences between the MS1 and MS2 years.  For instance, the preceptors we worked with didn't grant as much leeway to simply respond "Umm.. I don't know."  To my great horror, they sometimes even wanted to know if we had a plan... "So what do YOU want to do?"  The best was when they asked you that in the exam room, right in front of the patient.  Of course it was a completely safe environment to branch out, ask questions and voice opinions (i.e. the doctors would always go with their own plans anyway, to the great relief of the patient I'm sure).  But it was a constant reminder of "Holy $H^T, some day I actually need to be the one with the plan."  In addition to rising expectations, our greater knowledge also carried with it increased autonomy, more opportunities, and a better understanding of what was actually going on, all of which was hugely exciting.

 

Two of the most saddening distinctions from MS1 year, however, were the loss of any kind of summer vacation, and the looming first step of the board exam.  To become a doctor in this country - all you readers will be relieved to learn - you have to pass an exhaustive litany of tests, all of which are no fun and exorbitantly expensive.  The first one, colloquially referred to as "Step 1" in the medical community, tests your understanding (or more accurately: your ability to recall meaningless details) of the scientific underpinnings of medicine and is usually taken at the end of the second year of school.  Our school gave us a few weeks to study for this hoss, after which most of my classmates enjoyed a one-week break before being thrown into year three.  I took the test three days earlier than most, so my summer was actually a full week and a half.  I know all of you with normal jobs are laughing right now, but it was hard for me.

 

I can whine if I want to.

With the help of my girlfriend (who is infinitely smarter and wiser than I), I had an epiphany early on in year two.  And since you're still reading, I'm assuming that means you won't mind hearing about it.  I remember exactly when and where it occurred: we were on the rough of her house on the east side, watching the sun set over the Portland skyline on a warm fall evening.  I had just raced my first full-distance event at Challenge Penticton a few weeks earlier, and I couldn't stop thinking about it, even as I faced a strenuous school year with a terrifying exam lying in wait at the end.  Worst of all, there was really no "triathlon season" in sight.  I knew I'd be lucky to race at all over the coming years, and was struggling to justify the constant energy and dedication required to continue to progress in this sport in the setting of increasing academic and professional commitments.  In the end I realized: medicine is my chosen career path, and I'm abundantly blessed to be able to pursue this passion.  Therefore, I don't owe it to myself, I owe it to my future patients to give med school everything I've got.

 

But I realized just as urgently that "giving med school everything you've got" doesn't mean you have to give up everything else in your life.  Far from it.  It means doing what you need to do to keep yourself happy, healthy, and mentally sharp, so that you can learn most effectively.  How people approach that balancing act is very individualized and personal.  Some of my classmates have taken up new hobbies.  Others travel every chance they get, and use exciting trips as little benchmarks to stay motivated.  For me, it means training as much as possible and racing whenever I can.  I mean, some of my classmates have fricking families.  They spend every spare moment they have with their spouse and kids.  I don't know how they keep up with school (I can hardly take care of my dog), but they are the ones I look to when I need inspiration.

All this might seem very simplistic, but it was the culmination of a long mental odyssey for me, with lots of conflicting thoughts and second-guessing along the way.  Finally I felt like I had come to terms with a fundamental fact of life: there is only so much time in the day.  And by extension, so much time in a year...  You only have one life to live, so do your best with it and be satisfied with the effort.  My priorities had crystalized in way that made sense, and I could continue to pursue both med school and triathlon appropriately.

So I worked my ass off that year.  I learned a ton, stayed fit, and have zero regrets.  I raced once in 2014: at Wildflower, where I had a surprisingly encouraging result, missing out on the top 10 by one spot.  I renewed my pro card and went back to school two days later.  I took the boards that June and peaced out of Portland for 10 days.  I went backpacking and made it home to Boise briefly.  Then it was time for the people of Portland, OR to prepare themselves: my classmates and I were ready to hit the wards.

 

From this...
 

...to this.

 

III. MS3

Year three of med school was hands down, indisputably, irrefutably, let there be no doubt, and with no reservations, the best year of my life.  It was also probably the hardest.  They finally let us out of the lecture hall and set us free on the hospital wards.  As a quick refresher, following the first two years of "book learning," years three and four of med school predominantly take place in the hospitals and clinics, seeing actual patients with actual problems and participating in actual care.  It's learning by seeing and doing, and no longer merely a theoretical enterprise.  And if I thought the pace was challenging before, things took on a whole new speed.  It was exhilarating and exhausting, thrilling and numbing, hope-giving and depressing, every single day.  At the start of the year - and fresh off step 1 of the boards - I thought I new a thing or two.  What I quickly realized is that I didn't know a damn thing, as I ended each day with more questions than when I woke up.

 

All MS3s make there way through a series of required rotations that expose them to the diverse world of clinical medicine, each culminating with it's own nationally-administered test of proficiency called a shelf exam.  All med schools accomplish this in their own way, but it's more or less the same (e.g. some make you do 8 weeks of peds and only 4 weeks of family, whatever).  This is a good thing, because there are some things that every doctor needs to know.  For instance, even if a student has zero interest in being a surgeon, they need to know what a surgeon does.  So you are required to do a surgery rotation.  Future doctors also need to know about childbirth in case they're on a flight and a woman decides to go into labor.  So all third years do a rotation in OB/GYN as well.  I wouldn't say it was my favorite rotation... but it was my least favorite.  OHSU divides it's third year curriculum into eight five-week rotations, two of which are in internal medicine, which is sort of the unofficial cornerstone of the undergraduate medical education.  I made my way around the track in this order:

 

1. Internal Medicine at a community hospital in Portland

2. Internal Medicine at the Portland VA

 

 

3. Family Medicine at a clinic in east Portland

 

4. Pediatrics at the OHSU children's hospital

5. OB/GYN at a community hospital down in Eugene

 6. Surgery back at the Portland VA

 

7. Rural Medicine (family med in a small place) out in Sisters, OR

 

 

 8. Psychiatry on the inpatient unit at OHSU

  

(Photo credits: all the above images were taken from this awesome blog called "The 30 Types of Doctors You Went to High School With."  It's a bit of medical humor, but it's worth it.)

While I may not have thought it at the time, I can now safely say that each rotation was awesome in its own way.  Actually... with one possible exception, I pretty much thought they were all awesome at the time.  Which basically sums up the theme of the year for me: medicine is an enormously humbling and gratifying profession.  If I lived through 525,600 minutes last year, I enjoyed almost every single one of them.  I can think of 23 total minutes spread out over those 365 days that I didn't totally love - most of which involved handling bodily fluids - so that's not bad.  I'm not going to go into this year in much more detail right now, because there is a lot of good stuff in there that I think deserves its own entry.  Lots of great stories, lots of moving experiences, lots of humiliating failures.  So stay tuned for more med-school related updates in the months ahead, all of which will be totally HIPAA-compliant (so don't worry if you were one of my patients this last year).

 

IV. The next chapter?

 

Well you made it!  You deserve a finisher's medal for arriving at the end of my longest blog entry to date, hope you enjoyed it.  But seriously, shoot me a tweet if you want a medal.  Just kidding, but not really.

 

But what of this "next chapter" I alluded to way back at the beginning of this long saga?  I do actually have some big news: I decided to take a "year out" from med school for the next 12 months, to pursue a student pathology fellowship.  It's sort of like the first year of residency for pathologists.  Actually, it's exactly like that.  I am literally doing the exact same things as the first year path residents at OHSU (although only getting paid half as much, so it's sort of a win-win for both me and the university).  Why would I do this?  A number of reasons, and counter intuitively, none of which involve me wanting to be a pathologist.  Far from it, actually.  They recommend this program to students after their MS2 or MS3 years, as a way to broaden their understanding of the pathogenesis of disease on a cellular level.  It is particularly useful for those who are considering careers in internal medicine, family medicine, or general surgery, which incidentally are sort of my three front-runners at this point.  I have a few other reasons though, like wanting to stay on the same schedule as my girlfriend (who is taking a year to get her masters in public health), starting a project at a health clinic downtown, learning French, brewing more beer, and perhaps most importantly... training and racing more!

 

Good things are ahead, starting with 70.3 Vineman this weekend.  Really excited to be returning to racing after a long hiatus.  Stay tuned, next entry will be a race report!

 

Cheers!

-Andrew