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!

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.

Motherhood South-East Asia

I recently had my twenty four hour work shift, it went well, if you asked. The very idea of nurses calling me up in the middle of the night several times was quite annoying to a certain extent but then I knew this was the price of getting into MBBS.

I had the opportunity of being the keen observer of the hospital, starting off with various wards, which I have not been posted, yet. The very striking ward was the antenatal ward, where most pregnant women, who are close to their due dates, were getting admitted. The ward is over loaded with women and it seems that Bangladesh is a baby producing factory.

As I was being an intern and checking the vitals (that basically sums up my work), I came across a lady, she was in her early forties and she was happy to be pregnant, when enquired about her choice to conceive a baby at such an old age, she gleefully said that it was “Allah” given. Similarly, I attended a patient who will be receiving chemotherapy for cervical cancer, (she has seven children), and she gives a very similar answer.

There is no control of birth; unmet need for family planning has made things worse for those that want to keep the maternal health status high up. The maternal health condition in Bangladesh is well versed than in Nepal even though things like birth spacing and use of contraceptives when husband is away are easily missed by women.

Most women are not familiar with the term of antenatal check up. Although, WHO has made it mandatory for pregnant women to take at least minimum 3 check ups, women are still not aware of such polices, instead, they seek medical attention when their due date arrives. What is the reason for policy making when health education is in limbo?

The process of pregnancy is a very important decision that equally both partners have a say in, but most women that I have encountered were either pressurized by their family or the husband himself or the hypocritical silent society that we are a part of.  Educating pregnant women about the birth process or informing her about how her body will change as pregnancy advances are keynote targets to save the extra patient load that most government institutions clearly fail to show interest.

Healthcare policy making is just a tool for the government to show that it abides by WHO, there are still patients who never get any antennal check up done, even if they did claim to get checked, its by a quack, when asked if she has done the basic investigations, she declines and even further she cannot even recall taking any iron pills!

This is the situation in hand, we live in the 21st century where neighboring countries are becoming super-giants in arms and ammunition and yet a primary care general physician has to face “Death of the patient- severe blood loss (Post-partum hemorrhage)!”

The Other Side Of The Computer

I have been in the other side of the computer for such a long time and I still will be for the next two years. It all started when I got a laptop for my 21st birthday. Well, I am not proud of the fact that I had my parents buy it for me.

There are several turns of events that happened afterwards. The side that I visualized from my computer was and is greener than the present that I have incorporated. So, before every break, I always kept looking forward to the place and people who were in the other side of the computer.

So eventually I slowly stared to understand my computer, I kept it clean, got mad when I could not connect with the other side and eventually it became my baby. One valentine’s days, I even declared that it was my true valentines after all. So things were so exciting, new laptop, new uses and new faces, news, stories, videos and more but at the end of it all it was always about how beautiful and wonderful the other side of the computer was.

I have been an habitual internet user for the past ten years and over the years, I have come to realize that the other side is always better than the life that I have created in the same location.

Why is that? Social media has changed the way that I had interpreted life.  There was a certain point in my life when I had to share every details of my life with friends and family, to create a buzz .I actually shared only the most happy or kind of happy moments of my life and I had no space for the sad and downtrodden moments of life. Friends who shared happy moments were someone to look forward. Also, friends who were not med students were more interesting than the counter parts.

So what happens when you do that is, you accumulate all the negative energy in your life and convert it to a conversation with a friend or you either burst in the middle of an event and you lose your balance in the social circuit.

“You don’t need friends, when you have social networking with 700 plus people.” Statements like that are randomly given by people who fail to understand the vicious cycle that social media does for one. What happens in reality, you will have a friend, best friend, and she is not in any social media sites at all.

So when does it start? Was it the initial stages of my computer use or after I got into the vicious cycle of social media. It’s an abnormal addiction; the thrill to post most amazing moments in one’s life is one of its kinds. At the same time, friends and family from different parts of the world, share their appreciation or dislike towards something that you post, has made social media more lucrative.

Med students in particular are the ones that are dominating the social media the most, from their mobiles at-least. It’s either the fact that studying all day and night for the next six months makes you the rightfully user of social media or they just like being in touch with their friends that often even when the exams are near ( nope, this aint happening).

So, you create a social propaganda. Random happy status updates or idiotic ones are just the ways of how one tries to justifying themselves in the crowd of social media. “Stay in it, with professionalism or personal details, but do make an appearance every single day for the rest of your lives”, that’s the tagline for social media users.

Use it or abuse it, it’s up to you but get it into senses that the other side of the computer, may not be the most beautiful thing that you have seen till now and the present that you create with the people who are there in your life are more valuable than the people who you constantly check upon (exception are parents).

How To Beat The Heat Waves?

I asked this very question to a doctor, few years back when I was not even a medical student. I usually expect people to respond to me. Even if they just reply with “I will let you know” or “I will respond in a while”. But when you go to a well paid medical institution for a checkup and expect a doctor to advise you and all  that you get is a blind stare at the window and “drink water” is all that he has to offer then he didn’t pay attention in med school at all.

This article comes after several days of torment. The sun is brighter in our part of the world and humidity is its best friend. I have lost my natural sleep patter, felt agitated and well, suddenly, I go into weakness fits of some sorts which has shifted my regular day-to-day life pattern.

 How many of you have these phases where you drink a huge amount of water every day to avoid the heat?  And in return, you feel weak and sleep a lot. The reason behind this is, when you drink large volumes of water, without equivalent salt intake. The salt content in your body decreases and you have low blood pressure and eventually the sleep aggravates the low blood pressure by increasing your venous return to your heart when you lie down in your bed.

To avoid this sequence of sluggishness, it’s better to take items that have a small amount of sodium chloride like any form of juice and fruits. Water is always advised but limit to 2-3 L with regular daily meals which contain ideal salt is perfect as well.

Also, one must not worry about how much sweat you produce in one day. Sweating is actually helping the thermoregulatory centre to maintain your body temperature of 37±0.5 degree. Sweating is a mechanism which helps shed some extra heat. Its better you use deodorants to avoid any mal-odorous encounters.

If you find anyone with a possible serious indication of sever heat exhaustion or heat stroke. Its advised, start with removing the person from that area to a cooler area, use a cloth dipped in cold water to actively promote evaporation from the skin surface and go to the nearest hospital when things are not getting better like when he /she is not responding to what you have done.

Other thing that must be kept in mind when you deal with heat is, what kind of clothing are you wearing? Radiant colors like black and well any dark shades are clearly not encouraged in the summer and factors like what is your cloth made of? Cotton is excellent, avoid polyester.

Other factors like, what do you consume on a regular day to day basis? Most of the food that you eat generates heat due to basal metabolic rate and henceforth a light diet for lunch and dinner is advised with plenty of fruits to add to that.

Please take care of your heath in the summer, it offers warmth and more sweating which might lead to cold problems like running nose. Those that sweat a lot ( night sweats ) when you are not unconscious, might get running nose the next day because the sweat which does not gets evaporated, causes rapid fall in body temperature and making the body susceptible to unwanted viral infection. To avoid this, you need a good cooling system; otherwise you will have to constantly change your clothes.

I can write some more “out of the text” points for those that truly follow what I have to say but this much for today.