My USMLE Experience Part-II

Congratulations if you have gone through the first part of this article!

The second part of my journey begins after I submitted my application to ERAS and applied to a required number of programs according to an International Medical Graduate standards.

The most distressing period starts!

I remember, the exact day when I hit the submit button. After days of polishing and molding my application, I finally came to finishing it. I was also stressed out about searching programs that would match my profile. I was spending an enormous amount of money for sending each application so I had to be extremely careful.

After days of fretting and dreading about the deadline September 15th, after submitting my application, I finally sat down and talked to my family as I thought I was nearly done with the process. But that’s not the case you see!

As the days passed by and I was waiting for interview call invites. I was going through a loop–what if I never get called? what if something in my application was wrong?–what if they had a million applicants and they never went through my application? –Calm down Sarina, is what I told myself for the next one week. When I received my first interview call, it cleared one of my questions- my application did not have any mistakes.

Over the days, I planned my first interview and practiced how to properly interview. There are lists of questions and I wrote down all my answers and practiced with friends who were also giving interviews. I planned my interviews in subsequent sequence and finished half of my interviews by the end of the first month.

I was again going through a loop. This time, it was something to do with my counterpart colleagues. They were getting more interview calls than me. I was again asking myself, programs must get a million applications, how will they call me for an interview? How will they filter me out from that group? what if I got filtered out before they even went through my application?

One of the most important fact that I almost didn’t consider in the United States of America was just like Nepal, you need contacts in every single field. If you have contacts with close ties with a residency program, you are automatically filtered into the interview process.

I tried finding those contacts! It was one of those most uncomfortable processes that I have had to do. First, I asked some of my seniors to help and the other close US-based Physicians to help. Then I asked my parents if they could help me find a small connection, that could help me make that call and shamelessly ask them to help me. I always felt uncomfortable in asking people to help with this regard because I never had to ask anyone for anything in my life.

I always got things based on my hard work and determination and that’s how I was raised. Calling people up and asking them to help was something that I never learned to do in my life. I would rather lift two 23 Kg suitcase and travel all around the USA and still don’t expect people around me to help.

But despite how I felt about asking people to help. I asked anyway, swallowing my inner morals. I called each and everyone that was likely to help in any way. And I am grateful to everyone who has helped me!

There is a peak point in the interview period and when you don’t get called before the peak then you have to expect your fate and develop a self-mechanism to deal with anything in your life. I reached that phase, and my brother was the greatest support system during that phase. When I was breaking down he helped me get through that phase!

When you come to this phase, you constantly contemplate how your previous interview was and how you could have done better, you excessively work on another plan besides residency. I started to drift to research opportunities, applied to fifty positions and started to master my plan B. I had kept my mind very focused on plan A or B. Either ways, I was constantly telling myself, my greatest strength, my family was there in each and every decision that I made.

After finishing my last interview. I knew this was still not over.

[To be continued…]


Residency chaser





USMLE experience-Part-I

This is my first public post about my journey as an International Medical Graduate applying for residency in the United States of America. It started in Internship when I decided that I really wanted to do this.I started reading Kaplan Textbooks with a friend. Then eventually, I wanted to fill my CV with experiences and letter of recommendations and also wanted to utilize the board certification from Nepal to work there as an independent physician.

I started studying for the exams after the massive earthquake and things changed for me after that.  Every experience that you get makes you a different person and that is what happened to me. The earthquake killed some portion of Innocence that I had and it made me stronger and even more courageous because I came out of it alive. It was after the earthquake that I decided to have some protected time for studying for the step exams.

Starting to study is easy but maintaining it is tough. The process involves locking yourself up in a room and trying to understand, assimilate and utilize the information. USMLE wants you to be a physician that can correlate symptoms with basic science and clinical knowledge. It’s an aptitude test just like GRE and GMAT but at the same time, you need to ace it to get into the race!

When you come to the point when you are done with all the tests, you would think that’s all required but it’s not. It should start the moment you even apply for the USMLE exams. Looking for observerships, externships ( when you are a medical student), clinical research is also equally important.  How do you get all those? I wrote to all the residency programs asking for it. I had to spend an innumerable amount of time writing emails to programs asking them to give me an opportunity and among the four hundred plus programs that I wrote to only one gave me the most positive response.

Your first approach should be, grab whatever you get and make the most out of it. I started with a private clinic experience and later on moved to a community-based residency program and an university-based residency program.  I was happy to observe both programs as I equally enjoyed the teaching and learning experiences. I saw myself being a resident, an intern doing and learning every single day. The whole point about going for experiences is also to increase your network and to find people who will recommend you.

Beyond all the exams and experiences comes the most crucial period of your journey. The application process, the time where you fill your information and submit it to the desired residency programs.

( To be continued…) keep-calm-and-study-for-usmle



You Look!

You look heavenly “he said”.

I gushed with estrogen.

You look old “he said”.

I gushed with epinephrine.

You look constipated “he said”.

I gushed with less thyroid hormones.

You look Pale “he said”.

I gushed with RBC’s lacking Iron.

You look worried “he said”.

I gushed with less serotonin.

You look expressionless “he said”.

I guessed I had Parkinson’s.

You look like Angelina Jolie “he said”.

I gushed with excess histamine release from an anaphylactic shock.

You look like you have a butterfly on your face “he said”.

I gushed with excess auto antibodies from SLE.

You look  hot, hot, hot, “he said”.

I guessed this was the last time I see him. He will never know what I took! ( Hint: Atropine OD)

The list is endless folks! As medical science is not limited and so is my poetry. Hope you guys liked it!

Case A

Ever since I got the opportunity to work in the ER, I have decided to save the interesting cases on my blog for future references. Here’s one case that needs further discussion.

Case A

Female around her mid thirties presented to the ER with a three day history of acute watery diarrhea with multiple episodes of non-projectile vomiting. She was admitted in a local hospital where she received IV fluids and her routine labs showed increased Creatinine level with normal urea counts. On the third day, she started to develop rashes which where mostly predominant on the feet and legs and had a distal to proximal presentation. The rash was papule like, non-tender and not itchy. Her drug history showed that she denied any medication in the previous hospital. She is non-diabetic and non-hypertensive and no use of any drugs with the exception of omeprazole. No history of alcohol abuse and smoking. She is Multigravida with normal menstrual cycles and LMP was few weeks prior to consult. On Examination she was anemic with IV Canula in Situ. Her systemic findings were unremarkable. Her current urine output and input could not be assessed as she had no proper recording prior. Her diarrhea frequencies has decreased and now she had concerns about the rash. Her labs were sent and found that she had a low platelet count, around thirty thousand in amount with normal TLC counts. She was also positive for antibodies to Dengue, APPT was prolonged with a normal INR and creatinine levels were increasing since the last lab reports. Her routine urine examination showed plenty erythrocytes with Pus cells amounting to be less than 2/HUFF. Her D-Dimer was positive with a increase to around 1.7 mg/L. Her serology was negative.

A) What is your Plan?

B) What can be done to prevent further platelet fall?

10355380_10152350235491906_6406720956607796328_nC) What is your probable Diagnosis?

Medical Officer Diaries

“Can’t you stay back in Dhaka?” An old patient asked me during my Ophthalmology rotation when I was in medical school. I politely answered, “I have so much work to do in my country.” While sitting on a chair in my two-bedded room in Dhaka, I had always dreamt about working in Nepal and making a difference for my people. Ever since my arrival in April, I have been trying to make that dream come true. It is very easy to give other people advice or write about how one can make a difference but it is indeed very challenging to implement your values and principles.

We, humans, are subject to greed, comfort and leisure and that pushes us back at a time when we have to make radical decisions in life. When one wants to jump into a road never taken before, one has to think about a whole lot of things, and usually, one comes to a conclusion that life is better when you have loved ones around you. Why leave the comfort zone?

The work is the exact directory of what we were taught in medical school but it comes with politeness and behavior. It requires you to show your dedication on a daily basis and it rewards you accordingly. The shortage of Medical officers is a new uncharted topic that most people never touch upon. It is hard to find people who decide to work after completing their medical school. It is a huge commitment plan that doctors make on the basis of various statistical data and family pressure. Earning a degree and not working is considered worthless in the eyes of the society. A medical officer learns how to follow a consultant and how to stay in a boundary. There comes a point within a month and year when a medical officer starts rejecting the peers of being the third in line to treat a patient.

How can a hospital tap a medical officers potential? Well it depends on the institute they work for. Medical college hospitals try  as much to utilize the capability of their medical officers whereas private hospitals just make them their mediators between patients and consultants. Education wise you need a specialization to survive and avoid any insecurity about what and how you can make a difference.

Competitive examinations carried out in Nepal are not sufficient for the larger majorities of graduates. With just hundred seats in IOM and five thousand applicants it is less likely you will be hitting the jackpot with insufficient studying capacity. The learning curve studied in com med class is not helpful at all as it keeps reminding you to learn at a tender age before its too late or is it? When my senior suggested that he worked as a MO for four years before he tapped a major examination is worth reconsidering. Writing has always pushed me to become a better person and yet this is might push me achieve the dream that I evolved over five years.

What To Do Next? Part -I


“The best time to plant a tree is always twenty years ago. If for some reason, you did not plant it then, the next best time to plant a tree is now”.

I had involuntarily shared my interest to become a doctor to Kitty. She was a replica of Anne Frank diary. Most people obtain habits from influences with human relationships; I made my influences limited to books and novels. I tried to be regular at it, but often had to apologize to Kitty when I exceed a week or two.

This winter break when I got the opportunity to flip through those pages again, I realized that at 16, I had decided what my next 20 years would be like. At 16, I was locked in the boundaries of Saudi Arabia. Inspirations were showered through the Indian system of knowledge and I thought I would attain the highest attainable degree in the world like most of my friends, who discussed and shared their higher level of thinking in the lunch hour.

Two years after I departed from Saudi Arabia to finish my junior school, I was lost. I was not sure what I wanted in life. My dreams were fading and I was drifting. My dreams were not nurtured and motivated to that level. Then by the grace of the Nepalese Government, we decided to move to Dhaka. “Med school is cheap in Dhaka”, is what they said. People around me motivated me after that, they helped me to map out my dreams and they enhanced it with “pride” and called it a “great respect for our family” if I decided to go to a med school.

Plans are meant to be thought, processed, assimilated, digested and beaten up until something new emerges. That’s called life. You can’t map out your life like a building block but, you should have the courage to dream big, no matter what people have to say to you. Dreaming is your right and no one should rob you of that.

Turning into a general physician was my goal and after nearly two decades of unknowingly what life direction I would go, I completed it. But even after completing one goal, I am hungry for more. Life right now seems so undirected. I need a goal and a new direction. Where would I go, what would I do?

I cannot limit myself to just a “general physician.” I want more! Most people decide to choose London or Canada for under graduation. But I choose Bangladesh with full cooperation and with hundred percent certainty that my life would be different, if I choose to stay in a third world country. I would turn out to be humble and I would stay ground to earth if I choose to feel the pain and suffering of the normal people. I still remember how I had to convince my parents that leaving me in Bangladesh would one day make them proud parents. “Let me suffer today” I said and later on, I can get all the happiness in the world. Plant your dream today, who knows ?,it, might come true. I don’t write to Kitty anymore but she played a very crucial role in my life.

Overrated junior doctors!

There was no hesitation when I decided to do MBBS, nearly five and half years back. I just left what normal kids do during my age, giving SATs, applying colleges abroad but “No” I was so fixated to one and only goal to get a better GPA and proceed to a med school. Little did I know that life would change forever after finishing that degree! Professional wise, I am still a needle in haystack, a junior, a learner but yet the society gives it a highest accord available. Society overrates junior doctors!

No, I am not an almighty! If prescribing simple over the counter medicines makes me get the same status as of a god then I decline to get that decree. I am as normal as most people, at least, I try to show that I am normal. There are days when I am painstaking waiting for the clock to strike to two thirty and leave from work.

Education wise, I may have proved myself but the professionalism attached to being a doctor has still not gotten in my veins. Being a doctor is pretty similar to business men of any kind. The only difference is that businessmen would sell merchandise of any sort and doctors sell medicine and treatment to save lives.

Things like what it means to be a doctor aren’t taught in med school. Factors like how you treat patients are not taught in med school, which makes us come to the conclusion that the personality that you had or developed over the years becomes the highlight of your career. Since med school caters less to what most med students are like, those that have the objectively unsuitable personlaity do not get filtered in the process.

Personality is cumulative of what parents teach at home and how they confidently project it to the society. There were several days, when I struggled to be people friendly. It was not a smooth teenage hood, cracking out of the self made delusion of being the superior individual was the first step. The following steps involved, engaging with everyone in an event, including those people that you always thought were mean to you and the last is the art of pleasing people instantly.

So how did a people pleasing person have doubts about being perfect for the job?  Every day is an event, every minute is a gala event now-and-then there are moments, when I completely want to forget that I can be an instant charmer. It’s stressful as it is and communication is another factor which detaches me from making a connection.

Five and half years of med school has made us to excel at collecting information and storing  them in our memory but it fails to produce quality doctors. Med schools cannot make there student’s realize what it means to be “practicing”. The power to execute a decision, actual duty hours, and endless patients to please are not as easy as they show in television sitcoms.

Med school should filter student’s worth of the job of empathy and should introduce actual internship related job earlier than the course offers (for this, my organization Health Nepal Foundation, will be focusing in the upcoming years), otherwise countries will produce doctors with the highest record of burnout physicians!