switching to tumblr and the evolution of sidenote

sidenote has moved here! -> http://sidenotelife.tumblr.com/

I recently decided to switch to tumblr in order to accomodate multiple posters. I wanted to allow readers to view multiple posts on the front page without having to scroll through an entire post. Like this:

Also, my friend and artistic genius, Tripp Mostertz, is currently designing a logo for sidenote. If you have any ideas - let us know. The only idea I have so far is something to do with a short white coat. 

Also again, we're on facebook now: https://www.facebook.com/sidenotelife. Please support us!

Again, here's the link to the updated sidenote: http://sidenotelife.tumblr.com/

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

ken explains the med school husband pt 1: intro

This is a new series of posts to replace what used to be "Relationships in Med School." My initial idea was that relationships are always hard, but they are especially hard at certain times. For instance, during med school. 

It's a time when everyone is broke, busy, and stressed. And there's more. It's also a time when the spouse of med student has to make many compromises. For instance, Katie had to move from her beloved home in Portland, OR to live with me in Charleston, SC. 

3k miles
So med school is a hard time to be in a relationship. That's well-established. But this new series was inspired by a recent app search I did. I searched for 'husband apps' thinking I'd get a list of apps with ways to be a supportive husband, but instead I saw a list of apps for wives to track their husbands, spy on their text messages, and other tools to catch them cheating. This is the depressing reality we live in. 

So anyways, I wanted to chronicle some posts about the ups and downs of a relationship during med school, both because it's hard and people need to know about this, but also because the internet is flooded with tons of negative shit about relationships. Celebs getting divorces, famous athletes that are sex addicts, cheap sex being glorified. This is my attempt to flood back with positive shit about relationships. So that's one of my goals for the summer. 

My first post is about moving. Katie and I got married while we were living in Portland, OR, but we knew we would have to move, and about six months after we got married, we finally got notice that we would be shipping out to Charleston, SC for the next 8 years. There was a lot of helplessness in that decision. 

Katie and I have been here for almost a year now, and overall it's been great, but for a long time after we moved I had doubts about living in Charleston. Portland and Charleston are fairly different culturally, and I wasn't sure if this was a place that Katie could thrive. Like this:

looks happy.. right?
I never considered it that seriously, but there were definitely moments when I thought about dropping out of school and trying to move back to Portland. And there were definitely times when I doubted my decision to move away from the Northwest. Was it a selfish decision to move both of us away from there, when Katie loved it so much? And it's not just that she liked Portland, her family lives in Wyoming, which isn't close to Portland, but it's a hell of a lot closer than South Carolina. So we spend a lot of time on FaceTime hanging out with her nieces and nephew. 

Which is fun, but I still feel bad for dragging her away from her loved ones. Am I a dick?

We talk a lot about our next move - mostly because I love talking about possible places to do residency. Denver, LA, Dallas, Boston, Minnesota, NC, NYC, Portland, every major academic medical center is in play. Even UT Southwestern in Dallas. (don't tell my wife) 

All that to say, it's a lot of pressure to be in the world of academia because there's a lot of moving. To some extent, I chose to leave the Northwest by applying to certain schools, but at the same time - I applied to 16 programs and only got acceptances at 2. It's not like I had a big list to choose from. I'm sure residency will be more of the same. Unless I want to match in physiatry, I'm sure it'll be touch to pick out the best opportunity. Then another move for fellowship, junior faculty-ship, tenure track faculty member, department chair, chief of pediatrics, dean of medicine, owner of the Boston Celtics. 

If there's one thing I've learned from this experience of dragging Katie all the way across the coast - I've learned to be ok with Katie being upset. There are certain things I can't change - like the bikeability of Charleston, or our location in the bible belt. I've slowly started to accept her few frustrations with Charleston, and focus on what I can control. 

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

ken asks the audience: What are you doing this summer?

Last week's question was: What are you doing this summer? I asked classmate Paras Patel for his answer, and he'll be continuing to write for sidenote through the summer about his experiences:


I don't know if I have the most interesting summer lined up or not but I am very excited for the good times ahead. This summer I am going to Argentina and India. Two opposite ends of the earth for two very different reasons. In Argentina I am living in a town called Cobalanga. Surprisingly, it is not on Google maps. I’m living with two doctors and their three little boys. I’ll be working in the hospital doing weekly rotations in areas like family medicine, surgery, pediatrics and hopefully some specialties. In the afternoon I’ll volunteer at my host family’s private practice. My goal is to learn as much as I can about their healthcare system and have an opportunity to become fluent in medical Spanish so I can get certified once I’m back in the states. 

After six weeks, I’m meeting up with two friends and we will travel to Buenos Aires, Uruguay and go skiing in the Andes. Two days after I get back to the US, I’m leaving for the motherland. This will be the first time in 10 years. I am excited to see how much has changed and partake in my cousin’s wedding festivities. 

I think this summer will be an opportunity for me to get away from everything and just reflect over these past 23 years before all hell breaks loose. I’ve come a long way and I really want to just think about where I’m going. Ken always refers to “deep conversations” and how often our conversations are superficial. I agree. It’s been a while since the last time I had a deep conversation with myself…


Next week's question: Was med school what you thought it would be like?

see you on the other side,

from ken

Want to provide the commentary? Let me know. 

Half-baked idea: now recruiting guest posters

Sidenote has exploded over the past month or two. Thanks to my amazing fans. It's been cool to see the page views go up and up. I'm assuming I'll see a downtrend if I don't publish another kevinmd post, either way, it was cool to see all those views. At the same time, for now I don't desire a Pauline Chen/Atul Gawande level following. I figure I should wait until I'm actually a doctor and I know what I'm talking about before I build up to that size. For the time, my real goal is to build community here within MUSC COM2 (crazy, right?). 

So naturally, my most recent half-baked idea is to add guest posters/co-writers to sidenote. Let's be honest, my writing is fairly entertaining, but it centers around an extremely narrow wheelhouse. Physician burnout/hidden curriculum/running diaries/interviews. It's what I love, and I plan to keep writing about it. At the same time, if there's anything that the 'so you think you know' series has revealed, it's that everyone has a story to tell. 

One of the points of sidenote is conveying the med student life. Samuel Shem's great novel on physician burnout, The House of God, keys in on an important underlying truth. The struggle in internship is not just the stress of the job, part of the struggle is how isolating it can be. You move from thinking this (the job, the patients, the red tape) is crazy, to thinking I'm crazy. And when you start thinking you're crazy, then you spiral into mental illness, depression, burnout, suicide. All the good stuff. And that's why the life of the med student - complaints, the highs, the hopes - all of it has to be shared. 

This is what 'we don't believe you. we need more people.' is all about. We need more writers telling the story of life as a med student. We need single students that are out till 5 AM partying, non-traditional students that have had other jobs, female students, black students, students from non-MUSC schools. We need more people. Granted, there are other blog/websites that fit this function, and how is sidenote different? If you go read other med school blogs - there's some good ones, but it's also a lot of fluff, and not enough people keeping it real. sidenote has no financial incentive, and it is not tied to any larger corporations. It's just med students keeping it real, and telling the med student life like it is. 

Please join the movement. So far Paras Patel (M2) from MUSC is going to write about his summer, and two of my friends from Kenyon - Jon Weil (M1) at a TBD med school, and Aaron Yo (M1) at Harvard - are going to be writing about the first year life. 

If you would like to write for sidenote, shoot me an email! ken dot e dot noguchi at gmail dot com. It's not a bad gig - the past 30d we've had 7000+ views, and I think most of the rising M2 class reads it, so the audience is definitely there. Alternatively, if you know someone who would be great for this, let me know! We need more people telling the med student life. 

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Relationships in med school pt 18 - so you think you know Tej Dhindsa

An interview with the one and only, Tej.

Ken: Tell me 3 things about you.

3 interesting things or just 3 things?

K: Could be anything.

T: Born and raised in Charleston.

An interesting thing is I didn't cut my hair until I was 20 yrs old I'm Sikh just like Balvir, that was probably my biggest life decision to this point.

Third, I have a general thirst for knowledge itself for certain things, which is I guess what I'm passionate about.

K: So tell me more about those things - you said you were born and raised here, what made you want to come back?

TIt was a big decision for me. Going to Emory was the biggest thing that's happened to me in my life. Growing up in South Carolina, and going to my high school I was very privileged, but it was very homogenous. Which is not a bad thing, I was very fortunate, but then I went to Emory and I understood that diversity was not just white, black, rich, poor it was so many other factors. My favorite people to talk to were Philosophy majors. You could ask them some weird question - like what would you do in this situation, and they've already thought about it. They've searched inside, and to me one of the most important things I learned growing up in Charleston is self-reflection. The beauty of Charleston, and driving 30 minutes to school, I had a lot of alone time to reflect and it made me try and understand my actions. 

K: And what did you learn from the hair experience?

T: What I learned from it was how differently people can treat you based on something so superficial. You can kind of understand the connotations the hair has but it's also hard to see how closed off society can be to people like that. The good thing about the turban is that you not only represent yourself but every other person that wears one. You had to be morally conscious as possible, which was good for a boisterous kid like myself growing up. My parents were like thank god you would've been off the walls. 

K: What made you decide to cut it?

TThe most important one, I wanted it not to be for social reasons, so I didn't tell anyone about it. It's funny how something like that just defines you, afterwards, people straight up didn't recognize me. No one really knew me for who I was, they just looked at my head. Can't blame them, I guess. It was also a spiritual thing, having a turban didn't make me any more religious, and to me I shouldn't have to broadcast my religion. Sikhism is a very open religion too. And my parents were very supportive. My dad cut his hair back in the 60's. From what i understand, it was one less thing that made him different as an immigrant in Iowa in the late 60's. Some things you just do to assimilate, which is understandeable. He made lots of sacrifices which I am very thankful for. 

Kthe 3rd thing you mentioned is that you have a thirst for knowledge for things you're pasisonate about - what is that? 

T: I love medicine, but my real passion is to alter healthcare in a way either through policy or business to just better the system and to better the quality of life. We always talk about controversial things like terminal health, and I've always, it sounds awful, but when you look at the numbers - what if you could quantify life? Say the age cut off was 70 or something, and you could legally pull the plug. It's hard to make the policies, but it's an interesting. idea that might be necessary soon. The problem with health is that it's the only business tied to moral human beings. It's hard. 

And this is another small idea I'm interested in - healthcare inventory managemenet. Bed pans, syringes, how do we decide where we get it from? is there a certain metric we can use to decide how efficiently we're spending our money? I'm really interested in start ups. I associate them with young kids so they're obviously appealing to me. 

KAre you thinking about politics? There's a lot of MD's in Congress.

TYeah that's true. I think about it a little bit, but something I've been thinking about more this year - my ideal job would be the president of a university as an end part of my career. A ton of them are MD's or PhD's. It'd be cool to be invovled in education, but also athletics, some politics, a little bit of everything.

K: So what are you going to do after MUSC?

TI love peds cards. I used to love peds cards surgery, but the training is so long, I don't know if it's worth it considering my end goals. 

KDo you plan to stick around in Charleston, or the southeast? 

TFor the longest time I said I would die here. I had an exemplary upbringing here, and extremely caring parents. I went to the same school for 12 yrs, it was a family. I want to come back here eventually, but first I definitely want to go somewhere that's a little more diverse - more minds. I want to be around creative minds, so I want a larger city. 

K: So if you're interested in policy, what would be one change you would want to make to med school policy?

TI had a friend's dad that really influenced me, and he taught me that I never cared about grades, I just studied to understand the information. And I've been trying to apply that since college. There are some people who get better grades than me because they know how to game the questions, but that's not truly learning. At the end of the day I want to understand the whole system. Everyone talks about who this teacher only asks quesitons like this or that, but are you learning? We're trying to learn to give people life. 

K: One of the things i've found interesting about you is that you read a lot, what've you read that's been influential?

T: Well, it's funny. I never read for recreation until I left college but I've always been intersted in biographies, and US politics. I love seeing how someone was raised, and seeing their defining moments in life. I've read Steve Jobs, Thomas Jefferson, some others. Those were great. And what I've been getting from these stories is two things: that you have to have a general sense of motivation, and the other is that you have to have self-control. Self-control is such an easy thing to say but it's so hard. It's hard to give up everything for a mission. The reason I started to read- I feel like I've been taught to think certain ways. Like religion. It's all environement. It's what their parents or friends said, but going to Emory I got to meet so many people who thought for themselves. After college I had 3 free months before med school to discover myself, and how I did that was learning how other people did it through reading biographies. 

KOk, and any last things you want to say to our class?

TUnderstand more than the superficial about each other. The most important thing you can do is understand how people think. We have superficial conversations all the time - hey how's it going, whatever - but you don't really know them. So do your best to get to know as many people as possible. 

K: preach. 

see you on the other side,

from ken

who should I interview next?

Media Fridays - Atul Gawande on Boston hospitals after the marathon bombing


I felt weird posting back-to-back Atul Gawande articles, but it's a good reminder why we put ourselves through all this. Must be something in the air. Thanks to Amit Om for the article. 

see you on the other side,

from ken

read something good? send it my way. 

ken asks the audience: how have your perceptions of medicine changed?

This past week's question was: How have your perceptions of med school/medicine changed since August? I asked classmate Mallory Roberts this question, here's her answer:
How have my perceptions of medicine and medical school changed over the past 8 months?  For starters, it’s a lot less scary.  I forget who said “We fear what we don’t know”, but I’ve found this to be very true.  I remember shadowing at Emory University Hospital last year and thinking “Wow…these third year med students seem to know a lot and they don’t seem to be struggling at all…how the hell am I ever going to pull that off?”  It seemed that there was some sort of chasm between the superhuman “I-know-everything-and-I-never-sleep” doctor (or med student) and the rest of us.  But I only thought that because I didn’t know what it was like to be a med student or a doctor.  I didn’t know that you have roughly 150 comrades to commiserate with and an army of faculty to support you.  I didn’t know that there were schools where the students were not self-obsessed and competitive.  The more I interviewed the more I got the idea that I might be wrong, but I didn’t truly believe it until becoming a med student myself.
Because we have a tendency to fear the unknown, the first time you do something is always the worst.  I remember being really stressed at our first “small group” meeting, because I didn’t understand what they were.  I was apprehensive of my first “hospital visit”, because I didn’t know how involved students were supposed to be.  Looking back now, I can see that what scared me was simply not knowing what people wanted from me.  I’m learning as I go, and trying to get rid of the stress by finding out what is expected and then working towards that.  As I get a more behind-the-scenes view of medicine, the reality of life as a doctor, and a med student, is becoming way less ominous.  Before medical school I saw academic medicine as being a grueling lifestyle in a world run by intimidating men.  I’ve been happily surprised by the realization that medicine can give you whatever type of life you choose.  There is no stereotypical doctor, and there is room for women to have significant influence and voice.  There are doctors who have families, hobbies, and friends that they dedicate time to.  There are men who are smart but humble, and women who are strong but nurturing.  There are also a whole lot of doctors, nurses, etc., who are not perfect at their jobs.  The more I see of doctors the more I realize they never get that “I-know-everything” feeling that intimidated me so much.  They are walking the same trail we are, they just happen to be far ahead of us.  Medicine is far less perfect than I imagined it would be, but thank God, because now I know that it’s human.  I’ve peeked in to the world of the unknown enough to say that, despite my worries, I can totally pull this off.


Thanks Mallory!

Next week's question: Who has the best summer lined up? I have a guess.. but if you think you know someone who has the best summer lined up, let me know. People need to know if you're doing something awesome. 

see you on the other side,

from ken

want to provide the commentary? let me know

Why pancakes?

"They'll never get caught. They're on a mission from God."

This morning a handful of my friends and I will be making free pancakes and coffee for our other med student friends. I've had several people ask us why we do this. I can't speak for the rest of the guys, but I figured I should at least speak for myself. 

Let me start with a sidenote - there's this interesting phenomenon that I've noticed. The most successful addiction treatment, AA, is run and was created by alcoholics. Similarly, black doctors make great role models for young black students. There's a reason for this phenomenon, alcoholics understand the struggle of alcoholics. I like to think they have a unique calling to help alcoholics. 

When I realized this, I struggled for a long time to find my own mission. Did I care about dying families in Haiti? Drug addicts? Well, I had never grown up in rural poverty or been addicted to drugs, so those were out. Eventually I realized, God sent me to help med students. Med students are my people. My best friends are med students. I love med school. I want to match at a competitive residency. I'm super type A. I love efficiency. I understand the med student life. I live and breathe it.  

I'm passionate about so many different sides of medicine. At different times in my life, I've wished I could be Paul Farmer/Roger Mee/Brian Druker. Realistically, I can't approach any of those guys. Instead I wanted to make my life about serving and mentoring medical students - working in academia. I want to figure out ways to empower med students so they can leave med school and change the world in millions of different ways that I could never fathom. 

Among the many facets of med student life - one thing I'm particularly passionate about is the role of the hidden curriculum in physician burnout. I believe the quality of healthcare could be improved by producing more passionate and less burned out med students. And that brings me back to the beginning, this is why I make pancakes. 

One of the promises I made to myself when I started sidenote was that I would live a life where my long-term goals were a part of my everyday life. sidenote - that's a big reason I write this blog. I want to entertain my fellow med students, and share our common story so we can all remember - we're in this together. I didn't want to start serving med students when I eventually become dean of medicine in thirty years. I want to help med students right now, by helping med students take a break, even in shit-hit-the-fan times like neuro test week. I want med students to come together and talk about life. I want them to come out of isolation and be in community. Even if it's only to come eat free pancakes and drink super strong coffee. 

Help me help you. 11:30 AM today in the lounge. Tell your friends. 

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Everyday I'm Shuffling - a day in the life of test week

We're in the midst of test week. For those of you who don't know, how med school at MUSC works is - we have about 4 weeks of class followed by a whole week of nothing but studying. That's test week. It sounds great, but in real life it's incredibly stressful and crazy. To give you an idea - I'm usually home and asleep with my wonderful wife around 9 or 10 PM. This past week I've been at the library past 11 PM, twice. And I'm not even close to the craziest study week studiers. I swear it's the most anxiety-provoking thing they could have come up with. Anyways, here's what the library looks like at 10 PM on a Monday night of test week. Hope you enjoy. PS - bonus points to anyone who knows all the empty carrels. 

still has coffee
just saw these two come back with
something called Full Throttle

happiest person here, must be the triscuits
study fort
not sure if awake

claiming islands
staying warm
doing it right
sad and alone
together and laughing
like a model


my thoughts exactly
OK quick quiz - how many people had Beats?

see you on the other side, 

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

To Rising M1 - What rising M2's wished they knew about med school

When I was going around doing medical school interviews, my favorite question to ask interviewees was: What's something you wish you had known before you started going down the MD track? I considered myself fairly knowledgeable, but I knew that it really takes experience to understand a life. And I wanted to gain from their wisdom. 

From current M1's to future M1's
So I thought I'd ask our classmates to drop some wisdom on future M1's. Please forward to anyone you know entering medical school. 

Daniel Morrison:

In my opinion, receiving very minimal advice would have allowed me to figure out my ideal approach to medical school much quicker, and could have made my first year a richer, more organic learning experience.

1. Don't study before med school. Enjoy your summer!
2. Living in walking distance of campus is helpful and gives you more motivation to go to class.
3. Review lecture notes on a daily basis instead of just cramming the weekend before a test.  Big goal is learning the material for Step 1 rather than acing every test.
4. Take advantage of the shadowing opportunities and lunch time lectures 1st year.  These experiences remind you of the reasons you want to be a doctor and keep you motivated to study (see Ken's post about burn out).

Sudeep Das

Med school is a transition, roll with the punches. its hard but great. don't neglect investing in and getting to know your awesome classmates

Jordan Shealey:

I think I would've like to have known to be patient with myself and the material. I now know it will eventually come together if you keep working hard and push through those frustrating periods (i.e. the first 2 weeks of each block).

Sean Nguyen:

My advice is to not get caught up in all the hype and scare. Do what works for you and stay confident. Enjoy things one day at a time.

Rosie Taam:

Before school starts do something wonderful, have an adventure, travel. In school, do things your way, follow what interests you, not what you feel like you should do. And don't be disappointed when your cadaver doesn't look like Rohen's; its not about the finish line, its about the process (this reality is still sinking in for me)

My advice, one practical and another not as practical.

Practical: I wish I had experimented more with different studying methods. Flash cards, re-writing notes, going to class, home schooling, religiously reading the syllabus, etc. Studying in med school is different from undergrad, and M1 grades are fairly irrelevant. The point is to peak for Step 1. 

Less practical: Don't be afraid to go out on a limb and do something different. The hidden curriculum forces homogeneity, so by taking the risk to be a little different, you'll stand out. Hopefully in a good way. 

Please share with any friends starting med school this fall. 

see you on the other side,

from ken

what do you wish you had known before med school?