Bloodlines.
I have engaged in some lengthy debate about my choice to go abroad, to be a foreign medical student and the consequences. This is written for those who may care about what becomes of me. In short, I have done my homework and decided the risk reward is in my favor – I will be a psychiatrist and run my own private practice someday. I am being told that I should have considered re-applying, or choosing a different degree. I am here to explain what I believe, what I know.
The AAMC and the academy do not care about me. I am a dime a dozen and come in droves looking for a place in their hallowed institutions. I am their worst nightmare: a student who does not care about them, and makes it well known. Of course I am not up to par with their standards and they are for profit. This means I would spend an extra year pleasing them and giving them more money. Nowhere does the promise of a bright future enter the equation. I hear that US medical schools provide me very high assurance of having a good job and residency. Nobody can give you that, it is a myth. This is America; you will not have your hand held for long. Medical schools cannot prevent me from getting sick, my family problems or will teach me basic medical science any better than the next one. I must put in the work and accomplish my own goals. With a little bit of luck I will be competent and on my way.
I’ve been told I should have gone into a different profession – why should I do that when I have the opportunity in front of me? The rest is history. I will never step foot in the academic medical profession. I have no interest in working in a hospital or sitting around feeling great about my pedigree. I will never be accepted by the upper credentialed medical establishment and I don’t care. I care about my patients, my practice. My interest in hanging out with other esteemed individuals is of course, dependent on the individual. If I am snubbed because of my degree or where I came from, I may have to decline further invitation. I care about my future family; my allegiance is to nobody but myself and my interests. Modern medicine has succumbed to marginalize someone like myself who wants to make a decent living out of a career. This is a job on the end of the day and nothing more to me – if students feel there is significance in their academic bloodline they have full right to delay their progress. I made my careful analysis – I am a professional risk taker and I have made mine.
Earlier I stood around my father’s medical practice. It has oak walls and leather chairs and bound textbooks. The office is like a home, patients come here to feel better about life – to get the help they want. They don’t know he came from abroad but they love him. His practice speaks for itself. I told him I was embarrassed that I was going to medical school where I never imagined, but I caught my tongue and told him I was glad I was going to be a psychiatrist and someday have my own practice. Nobody was going to stop me in my own hallowed walls.
Accepted, split, fail.
In the last several weeks a few things happened that were noteworthy: I was accepted to medical school, Berkshire Hathaway split 50:1, and Steve Jobs let the whole world down with the iPad.
I guess I could write about each of these events as they are milestones for me in a few ways. To start, yes, I was accepted to a medical school and I am glad to have the burden lifted - I have a place to go this August. I am still being considered for a few schools and have upcoming interviews, which I am going to attend and hope that I be given some choices before the summer. My goal has been and will continue to be the same, get into medical school and do your best to become a physician. My path was a little convoluted but I wound up with the opportunity; I have no reason to second guess anything. I am going to be a doctor and a damn good one.
Berkshire Hathaway is interesting because Warren Buffett has always given the stock split a grin of disdain. Years ago he was making it clear that he did not like the proposition and had wanted to retain a class of shareholders that reflected his ideals. To split the stock meant to swap out a group for a lesser one. Some may call this elitism but what else is Berkshire Hathaway after its 140 thousand price tag? Now, the B share which cost 3300 is split 50 times so is a 70 dollar item, it seems to be attracting attention for two reasons. One is that Buffett is somewhat altering his publicized opinions on stock splits, the other is that it coincides with a large deal which has been both praised and derailed (no pun intended). I believe a new class of shareholder will come into being, the average investor may now afford to buy these shares even though the split is immaterial. In short, I do not really believe the company is any less for the move, but I do not endorse this except for the one truth: Warren Buffett will soon die. Yes, he knows it, I know it, we all know. I’m betting that Berkshire will remain a fine investment but they may have more opportunity to maneuver in the future using this newer share structure. I hope more interest is given to Berkshire, and it has, but I hope nobody is expecting the moon from this investment. Berkshire works on principals laid out 40 years ago and has no ability to compete with the more nimble investments of the modern era.
Apple came up with their iPad device and I was most upset by the release. For one thing I do not feel it kept pace with the rest of the company in terms of ‘invention,’ but rather rehashed the devices of yesteryear in a larger format. I did not care for the display or the nature of its operating system - it seems like it is literally a blown up iPod Touch. For all the hype and mythology surrounding Steve, I found his performance and his attitude disenchanted, I felt brainwashed. At least 8 times in the presentation I heard the phrase, ‘magical device,’ and almost felt like I was being told that I cannot understand this until I hold one. Are they right? No, I doubt I speak alone in my opinion - the iPad has been near universally panned among the technophiles. Perhaps the intent of the device is that it serves a less technical crowd which is fine. I just wanted more.
Hitting the bulls-eye and how I learned Latin
Earlier this week at the patient conference, our esteemed Chief made his inspirational point of how easy medicine is. The art, he suggested, is where the mania happens - the ideas and the craft build into something different. This is the animal. The analogy is a game of hunters, and doctors must learn to pull the arrow far back, with an eye on the target - to strike the bullseye.
Today it seems we prefer to run guns ablaze, hitting everything in sight. There is no craft or precision in that. Modern medicine is becoming a madman with a gun. Arriving at that skill is not art, but almost exactly how I learned Latin. It requires the patience of a expert to do many non-expert exercises to achieve the goal.
When I was in college not long ago I chose Latin for my language requirement. This was the language I felt was the lesser evil and so I took it. I have no use for this class, however I needed to pass it and do well. I prefer learning a story, or how something works, but Latin was nothing but memorization; I hated this.
But I did one thing I am grateful for, and it was how I learned the subject. There were some old study spaces around campus and one in particular I loved – old chalkboards with wooden fixtures – and I found them empty on weekend mornings at which point I would begin to hesitantly write down a few things I knew, and would build outward. Over the course of hours I filled the boards with conjugations, verbs, and vocabulary. I was certainly no expert and this class drove my anxiety levels through the roof, but I was doing whatever I could. This strategy was not even a strategy, it just came to me out of desperation.
This strategy never felt productive, but I achieved a certain level of repetition and exhaustion just standing there writing things over and over, reading the board from afar and up close. Saying things out loud and scribble them in my little pad I held. I whispered the words over in my mind, in voice and would later type them up.
I managed to get A’s in the class and I believe there is nothing that helped me outside of making the choice to go back to those old stuffy rooms and doing this activity every week for an entire year.
And like the art of anything, we are too fascinated with the great chef or marksman but miss the truth: there is very little art involved for those experts; it is the product of breaking down the many pieces to their core, to rebuild them into a fluid motion, for the kill.
Haunting memories of the MCAT
I am truly haunted by my current state of affairs. I’m unable to satisfy with meals. No amount of nectar or grilled chicken or junk food or coffee gives me what I want, what I need. I am itching but can’t find it. I am preparing for my third MCAT before throwing in the towel. As well as having jumped off the cliff and applied this year to medical school, I am in limbo. Rejection is piling up. Time is ticking and I am studying every day to get insignificantly better at a monumental task. I need to get a better score on this attempt. I’m up against the concrete, with ogres staring me down; all I got is a pistol. Or a fighting chance in hell. I suck at this stuff. My potential was earmarked for ground shipping, not overnight. Next month the challenge will be tough since I am really not good at this test but I know I am ready to take it for a final dance.
That said, I am haunted by the world that spins around the process of pre-medical education, and the big exams and applications. That stuff bothers me but I am not in any mood to fight those tonight. I just want to slip into bed and drift until I feel it is time to get to the library. I want to do this again and again. Finally I convinced myself this retake is for me and me alone. I cannot use this test to ‘legally’ get into medical school. However if I improve significantly I can get attention from schools and have me another look. That’s all I ask. I would be honored to get that far in the process of becoming a doctor.
I don’t want to go to an island school abroad, or deal with the issues of residency selectivity. I want to be a MD and not a DO, I’ve gone this far. I want to go to a United States MD school and that’s what I am going to do. This MCAT is hard for me, I don’t know how other people get those numbers but I realize I am not special; I am not a smart guy. I’m just introspective and am able to arrive at good conclusions if I let it simmer. I am not the guy who can read passages and make quick judgments and all that. It’s something I have to bite the bullet and just do. I’ll likely be out of commission for a month until the exam on January 30th but I hope there is no catharsis from it. I want this to be a haunting memory for me, at least until I get my score and I can just say I am one step closer to becoming a doctor.
I never even knew I had entered no-mans-land with the MCAT until this winter, staring my poor score in the face – I had to retake. Retake. Retake. Retake. Retake. Retake.
True love waits.
I don’t think I ever doubted it for a minute.
What gets me down is my own fallibility. I won’t achieve my dreams; I am not as good as my rivals. What I discovered got me thinking – it started with Muhammad Ali’s quote about himself.
There is a total disconnect in the minds of the greatest people in history. He shouts ‘I am the greatest, the greatest that ever lived!’ and suggests the world loved him. He knew he’d win fights, he even picked the round. Ali was certainly the greatest boxer that ever lived. What’s more, he knew it before he even knew it. I just love this sort of conviction.
Affirmation was the key. Ali knew he was the greatest, and wanted to be the greatest boxer in the world. He told himself this every day. Die or live a champion. The same type of logic applies to many individuals. My post title is a quote from Warren Buffett when asked about his wealth.
If you spotted one famous person in a group of athletes or investors – you will find they had the conviction. They believed in themselves far more than their rivals. How can it be that Michael Jordan was better than any other professional basketball player? Talent is derived from the will to exercise talent – he practiced harder. He believed, he didn’t just levitate, he flew.
Big risks lead to big rewards or failure. I doubt these men worried for long, they were convinced. God spoke to Ali himself; Warren Buffett was 12 years old when he knew he would be the richest man in the world. The insane bets of our time will always seem insane to everyone else. I am suggesting we find affirmations and bring them to the next level. I am after those who march on without attention to critics: Edward Lampert buying Sears; Bill Clinton who was a poor nobody from Arkensas; Steve Jobs returning to Apple. All of it is insane. Could you do it? Would you?
Instead of saying I can, say I will. If you want to be a banker, tell yourself you will be the greatest banker that ever lived. If you want to cook a meal, it will be the greatest meal of your life. This is not just fanaticism, it borders on a total failure of the blood-brain barrier. There is no way the magic elements wound up in a single person, it must have been exercised there. I believe if you give yourself the benefit of the doubt, it will happen.
For one thing, Lance Armstrong is not an outlier in cycling. He is the greatest athlete that ever lived. Although he had the natural form and genetic disposition to being a cyclist, how did he turn it into theater? Watching the video of his press conference in 1996 as he told his audience he had cancer, one can see it. He still fucking believed. He said point blank that he intends to return to professional cycling. It drove him over the edge. The adrenaline rush isn’t quite the same for his rivals, every pulse is just better.
Armstrong wanted to know why he should trust his brain surgeon. What about the other opinions? Why should his hands be the one to remove the tumor? The neurosurgeon told Lance to shut up, and that as good as Lance was on a bike, he was with brain surgery. Lance chose him.
Fear is good, but never be scared. I can be the greatest and so I will be the greatest doctor that ever lived.
The more that I do
I’ve taken to a bit of philosophy in my spare time. One has me hooked: fatalism and destiny.
These ideas are further explored in my research, by my mentor. He remarked that young folks today have lost their sense of fate. “What will be, will be,’ he says. Our massive grant is under review so he has been working very hard toward it. His daughter one evening asked what would happen if the grant were not approved. He told her that like an Olympic athlete, you train to finish the event, you don’t think about externalities. No person who has trained and planned thinks they will fall on the landing, they just do it. He has not imagined a scenario where failure occurs. This is destiny.
The Indian idea of Karma, the Kismet of the ether is that billions of possibilities occur, and each choice leads us on a determined path. A child is born with so many degrees of freedom - their upbringing and persona develop and they become specialized with time. I fear our sense of specialization has become lost to generalities. Students are pushed to be all-rounders, good at a little of everything, but great at nothing. Life is a tortuous path that converges in unknown ways; our cosmic purpose is one that is not as wide as we assume. It comforts me to cede to the cosmic theater.
It may seem ‘fate’ is a conduit to defeat, but I urge you to believe you can change your lot. Every man has a bullet with his name on it, but that shouldn’t stop you. The great endpoints are not even significant compared to the mid-point. We don’t give up or assume there isn’t hope. Like a lottery winner who only wins if he plays, we must perform our due diligence. We cannot go that far if we do not start walking, we may go further if we run. I have to assume my actions today have a profound effect on the future, or everything becomes meaningless.
I think the phrase, ‘the more that I do,’ is indicative of the overarching idea of determination. We, like all things, are serving a purpose. The goal of life is to increase your economy, your value – whether in monetary form or your value to another person. Hopefully you do both and live well, or you become despondent and fail the cosmic theater.
Of course the cosmos doesn’t give a shit about you, so you must forge your own ideals and become determined. For the more that I do, the more that I know, the more that I can.
the Sisyphus complex
The legend of Sisyphus is on wikipedia; you can read some more detail on it if you’d like.
For all eternity Sisyphus was punished to roll a boulder to the mountaintop only to watch it fall. The tale is ancient and reminds mortals of their quest to achieve meaning, or the repetitive nature of our work-lives.
Albert Camus wrote in his epic, the Myth of Sisyphus, that our interpretations of the tale are wrong. At first the story is a tragedy about a king who wished to live forever and paid the price. He is the personification of the absurdity of human life, or the search for meaning. Camus wrote in his final inspection that we could imagine Sisyphus happy, that, “the struggle itself towards the heights is enough to fill a mans heart.”
I am ready to accept that notion, that the eternal struggle is the price and the prize. The repetitive nature of research, the mindless perfection on a test or the hours we will place into our work, our profession, is the same struggle as the boulder uphill. It will fall and we will be damned to repeat it.
The do-it-at-all-costs attitude has sprung meaning to me. I’m in no race to the top, but heading that way. It is exactly what drives the greatest men in history. There are few actualized goals; the obsession itself proves to be everything. Legendary investors pour over details so insignificant, they memorize them. Bruce Lee trained so hard, that he suggested the great ‘form’ was to have no form at all - to become waterlike.
Somewhere along this road I will fail, as I have failed many times before in my quest. I have no end-game, that would be like Sisyphus getting to the top, the boulder would just fall over the other way. We can smile at the god’s and push back.
