Seeing the Sunlight

Michael, MD/PhD Student

Over the weekend I visited the Upland Lemon Festival. Lemonade being one of my all-time favorite beverages, I couldn’t pass up the opportunity. Due to long days in the lab and things to do around the house, I haven’t spent all that much time outside lately. I pushed the concerns and worries to the back of my mind and simply enjoyed myself, exploring the various booths and sharing funnel cake with my wife. Sure, it was hot, making the lemonade that much more refreshing.

Perhaps this combination of mental state and vitamin D synthesis explains the near-euphoric feeling I had wandering around the festival in the bright sunlight. I closed my eyes, spread my arms open, and twirled around, feeling the warmth on my skin.

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Beginning of the End of the Beginning

I’ll start with the best part: Friday, I presented my thesis proposal––and passed! I’ve spent the rest of the weekend being ecstatic. Typically, the response from others follows a somewhat less enthusiastic motif. “Wow, that’s great…what does it mean? Do you start med school now?”

No, I’m not going to start med school anytime soon, but as far as the PhD goes, making it through the proposal process is significant. Getting a PhD is somewhat of an elaborate hazing ritual, in which pledges must prove to a council of five established researchers that they are worthy of joining their ranks. The thesis proposal is a particularly intense Harrowing, in which I must publicly present my intended doctoral work. I must also let the five scientists on my thesis committee that I know what I’m presenting and that I’m capable of completing the work. Passing means I’ve made it through the first level of graduate school, and am now a PhD Candidate. Now all that stands between me and the PhD is…a whole lot of research and writing.

For anyone that’s interested, my thesis (which I’m sure will come up again) explores the relationship between cholesterol regulation and Alzheimer’s disease. My presentation can even be viewed online. Of course, I’d be happy to answer any questions––what researcher doesn’t love the opportunity to talk about their work?

Since I’m MD/PhD, I have four years of med school after that, and we won’t go into the post-post-graduate years of residency. As my friend described it, I’m at the beginning of the end of the beginning: It’s the beginning of the final push toward my PhD, which is itself the beginning of my path through the combined degree program. Regardless, I’m allowing myself some satisfaction. I might even venture to say I’m around 25% complete, and that’s worth celebrating.

Wild Zones

At one point in my life I spent a lot of time mowing the lawn. We had a decently-sized area with terrain ranging from wide, flat spaces to steep hills and washed-out depressions. The ride-on mower was the closest I got to having a four-wheeler, so the chore wasn’t all bad. Even so, during the height of the summer, the grass had to be cut weekly, essentially pre-booking my Sunday mornings.

One area of the yard was especially treacherous––water runoff had formed a rocky stream bed, sycamore trees hid branches beneath bark pieces and wide leaves, and there were two wells to be avoided. This Wild Zone wasn’t highly visible compared to the rest of the yard, making it possible to leave that area for the next week’s mowing.

Each time I shifted the task to the right on my calendar, it became easier to do it again the following week. Eventually it had been postponed so many times it became part of the landscape. Nature continued to reclaim the Wild Zone, increasing the difficulty of the task and the inertia associated with completing it. And so the grass grew tall and went to seed, rippling with the breeze even as it concealed all manner of organic debris.

Containing the most egregious parts of the Wild Zone was easy enough: I mowed close to the edge and tossed stray branches further inward. Nevertheless, ulterior consequences of such a region are much harder to manage, encroaching into other areas in sinister ways. My dog began returning to house with dozens of ticks, mosquitoes diminished the enjoyment of the rest of the yard, thorns and locust saplings obstructed the wells.

This simply could not continue. I pulled on thick jeans and a hoodie despite the summer heat. I added safety goggles and tucked my earmuffs awkwardly beneath my hood. Thus armored, I adjusted the mower and plowed into the miniature wilderness. Almost immediately, I heard the telltale grind-snapping of a branch being destroyed by the blades, followed closely by stray pieces of wood and chipped rocks smacking into my face. Thorns pulled at my sweatshirt and snared my ankles, digging into skin. Disturbed insects rose to mix with the vast quantities of dust and pollen already filling the air.

This is a rather roundabout way of describing my life of late. It’s easy to carry on with the imperative parts, doing what is absolutely necessary to keep things moving forward. Dealing with the rest of it, however, requires initiative; it doesn’t have to be finished immediately, even if it should. And so life moves onward, visibly well-maintained while the more hidden, personal areas grow wild and unkempt.

Mowing the Wild Zone was every bit as difficult as I had imagined, but it had to be done. Similarly, as exhausting as it may be to continue “hanging in there,” it’s not enough. It isn’t fulfilling to merely keep pace with existence. There is a limit to how much of oneself can be sacrificed before the tangled undergrowth begins to choke even the non-negotiable tasks.

Take the extra time to truly focus on a loved one, to do something creative, to enjoy the outdoors is vital. Not mowing edges or tossing the branches farther in, but applying the same professional focus to whatever represents “the rest of life.” We ignore these things at our peril. For sure, isn’t easy to set aside the urgent to take care of something important. It’s hard to overpower the inertia and plow through the stress in pursuit of fulfillment.

That’s what it takes.

Why Two Degrees?

Looking over the long road ahead of me, one might consider asking, incredulously, why somebody would want to do an MD/PhD program at all. It’s certainly a justified question, to which the short answer is that I think receiving training in both clinical medicine and research science will be especially valuable in my future career.

The MD and PhD degrees differ in more than just the requirements – they represent two perspectives on problem-solving. The way I see it right now, medicine ultimately teaches students how to correctly apply what we have learned to new situations, and how to recognize something you have seen before when it is placed in a new context. Graduate school, however, teaches students how to find the gaps in what we know, and design questions that will yield new information.

I think the two schools of thought are complementary, and that having experience with both will improve my skills as a clinician and as a researcher. Additionally, in the field I’m currently looking at, neurology/neuroscience, I will be able to help bridge the gap between what we’re continually learning in the lab (neuroscience) and the application of that knowledge to patient care (neurology). Not only through translational research (a popular buzzword) I do myself, but also by being cognizant of and having experience with developments on both angles.

I wrote this a while back on mistypedURL, but I think it’s worth sharing again here.

When Are You Graduating?

Like every other student, I’m always being asked when I’m graduating, how many more years I have left, or what class year I’m in. As an MD/PhD student, however, the answer is more angst-producing than straightforward. Sure, the four years of medical school are a given, but the graduate school portion is highly variable. The unpredictability of research could potentially add years onto the overall time I’ll spend “in school” before leaving with my degrees.

I’m now entering my third year of graduate school, at the point where there’s little between me and my PhD aside from Data. Data, that fickle, errant wisp flitting behind such obstacles as Unreliable Technique, Incomprehensible Results, and, of course, Bewilderment. When I finally break through, I have four years of medical school waiting for me on the other side.

If there’s anything that sticking with an MD/PhD teaches you, it’s ensuring that you are actually living each day. With clearly defined endpoints, I could try and keep my head down and power through, saving other things for “when I’m finished with this.” My path doesn’t really have an endpoint; there’s always one more thing after each stage, from research to residency. Thus, I’ve had to learn to try and live my life now instead of in a mythical future state. Maintaining such a balance is a battle, but I think it’s the only way to maintain the endurance. After all, I’ve got to keep it up for 26 miles.