Banting Diet, "Letters on Corpulence"

Just got done reading this article, "Letters on Corpulence" from William Banting in 1863.

It is regarded as one of the first "fad diets" in which he eliminates certain foods.

He eventually saw Dr. William Harvey who told him to restrict carbohydrates such as beer, bread, potatoes, milk, and sugar which Banting declared, “had been the main (and, I thought, innocent) elements of my existence.” Once he restricted these high-carbohydrate foods, he began losing weight. He lost 46 pounds over the course of a year. After publishing his letter to the public, the “Banting diet” became famous.

Since then there have my other diets as outlined in... https://azdietitians.com/blog/the-history-of-dieting-in-america-2/

Most recently it seems that intermittent fasting has been the "fad diet". I frequently have patients come in and say it worked for them, but regained the weight. This seems to be a common theme regardless of the diet. Appears that it is not so much the diet but the adherence of a plan and thought about what one is going to eat rather than the actual restrictions. Many diets shares certain commonalities such as avoidance of saturated fats, packaged goods, high sugar foods. Thus, it is typically better to stick to the staples:

1. Eat regular, balanced meals

2. Get plenty of fiber (14 grams per 1000 calories consumed)

3. Avoid highly processed, sugary, and fatty foods

4. Exercise regularly

5. Avoid overeating

Last Year

 I'm in my final year of residency!

I've been receiving multiple emails, texts, calls regarding job opportunities. There are many lucrative jobs ranging 220K- 400K (includes OB call, ED, middle of nowhere location).  I'm also able to moonlight now so that extra check feels nice as well. I can finally catch a glimpse of what lies ahead. This year is different as I have more chief resident duties. I don't enjoy the administrative duties, but it's one of those things that I have reluctantly volunteered to do. The title is nice, but there are also times where it can feel overwhelming. 

Reflections of the first year of residency

 So initially I had planned to apply for the 2019 residency match  rather than  applying for the 2018 residency based on the advice from my Ross University counselors and the fact that I will not have my step two CS score back and I haven't taken step two CK until August 23.  How many I'm sure if I'll get my results back and whether  I would be able to match into a program or not.  The main concern of a medical student but especially heightened when coming from a Caribbean school.  Demand based on advice from  a program director I ended up applying for the 2019 matching November, which ended up being a blessing because it saves me much money on application fees and travel expenses given I know I only had a shot at matching in a few schools after applying that late.

At the start of residency I had these many expectations that typically accompany a new start for me whether that be New Year's or after Easter our any day that symbolizes a fresh start.  I was in his preparation by reading part of and watching the video by Dustin from online med ed about preparing to be an intern.  The  good news was that I had already rotated to the hospital was familiar with the computer system and logistics  which gave me a head start in that sense.  What that preparation was accompanied by various insecurities.    part of the reason I wanted to push back my residency match was partially because of some of these insecurities. I figured if I pushed back to match a year I would have the time to possibly  improve clinical skills as a junior faculty, focus on learning Spanish, improve my communication and social skills which  is something that has  always been an Achilles' heel for me given my shy and quiet demeanor.  I somehow envisioned a transformation of sorts occurring over that year between medical school and residency  as if I were a caterpillar  awaiting a sudden transformation while my imagination  and thoughts provided a nice cushion from action and reality.

 God had other plans will. So beginning that July 2018 I felt unprepared and highly overwhelmed with taking the challenge of  suddenly becoming a doctor and having  greater responsibility for the lives of others.  year start out well, I have pediatrics and I loved interacting with the kids in newborns and learning the exams. I also carved out the time to do the majority of my studying for step three during that time although it was an busy inpatient service.  In that moment I learned that sometimes the busier rotations are actually better for studying because they provide consistency. I knew hours at the hospital from 7 to 7, 6 days a week at least,  so since I will be at the hospital anyway I currently use the downtime I have for study and the time I had off work I had to diligently carveout at least 30 minutes to an hour of studying as soon as I got home.  That is contrasted with the lighter outpatient notations and residency where I felt like even though I  had significantly more free time, I did not use that time as productively. I guess because it's easier to have Alisha schedule during outpatient. And not have a sense of urgency because my procrastination nature made difficult for me to continue to grind as if I had limited time.

 This leads me to another dilemma are challenged during residency which is the worklife balance. This is something everyone in the medical field is struggled with however it becomes heightened in residency compared to medical school because you are making decisions that will directly impact the patient's. The time not directed toward studying our patient care can fill like you're doing our patients a disservice. The art of balancing the changes in my life including a new life, new house and new responsibilities shortly after the onset of residency added another tier to the complications. I would come home and study while my wife would be supportive, however  The time sacrificed with my life was boiling underground until eventually it erupted. Throughout the course of the year I had to make a lot of adjustments housed in my free time, more time with wives from more time to study, maintaining relationships I have outside of work would seem to  be put on the back burner.  my whole life without to be in a constant flux and balancing act including my spiritual, familial, social, intellectual, financial life had to constantly be  rebalanced and recalculated based on whatever rotation I was in and I were busy my wife was at the time.

 Many days sleep or leisure was a prize, however I knew that my lack of knowledge in some aspect would lead to a sense of embarrassment, disappointing my preceptors, or worse injury to my patients.  however, leisure was not leisure in the traditional sense because it was accompanied by guilt. There is always a sense that you should be studying and a sense of not studying at least doing something productive. The sense of watching movies, watching  url rap battle  binges,  Netflix binges, browsing datpiff  same like an escape at the time.  However only bought  unease. Partially because of the lack of self-control, lack of productivity in  a sport where productivity is key.  I think we often say that there's not enough time to do things in residency, however at least in my case there have been ample time to pursue hobbies, other passions.  I can't say the same for residents in other programs who may have more regular schedules, however for me it is a struggle to pursue a regular   should hobby our activity because the schedule is so unpredictable.  I can have one schedule that's mostly comprised of clinic 9-4 or five days  in the next month  have an "80 hour work week"  comprised of seven724 hour shifts in a month.  A lot of the success I had a medical school because I was able to develop a routine t and this year has fucked any resemblance of a routine up.  is not necessary bad thing but just something is different.

The first-year residency really is not so much about  how much you know, but how well you're able to follow directions, be efficient, and  be expedient in asking the people who have a little bit more knowledge on the subject i.e. specialists what the next step in action is.  It is a great thing to have d so many layers of backup when dealing with patients.  However this is also accompanied with frustration when we feel like there's a delay in patient care because you have to go through so many layers to ultimately make a decision that will  affect the patient's care.  Knowledge you gained during residency, although with less time for book studying, sticks much better because you are policymaking decisions for the patients, whether those decisions will be implemented are not based on your senior and attendings preferences.

 As I enter the next  year residency, as I have a group of residents who wall now look to me for instruction.  It is very daunting  and slightly nerve-racking.

 Overall, I am extremely pleased with the program are chosen the ability to remain in my hometown, serve the people of my city.  I have no regrets for the specialty of our program that chosen.  I feel bad for some of my colleagues that d work longer hours consistently, it can find themselves in a situation that they have not expected.  There is a great reward from d having your own patient to look at you as their doctor.  I've seen colleagues d revert back to old vices to cope with the stress of residency. Over the course of training I felt like we as doctors  have developed a coat of armor that ensures our public appearance do not reflect our inward traumas.  as I point out some of the more bitter and pessimistic doctors, I  can't help but think voice situations possibly during residency led them to their course where they feel the need to belittle others.  I am working on being more transparent and open with my coworkers, family, friends, because everyone needs support at some moments. Some are better at asking than others.

 I can say first year was so much better than medical school.  The paycheck for one is great. The ability to take on patients as your own. The economy is really what stands out. Now the setting is mostly geared towards something directly patient related rather than abject concepts.

 Towards the end of this year d and heading towards the second year of residency, I hope to be more consistent in my  study times.  Try to bring  as little work home as possible, and enjoy time with my wife and  precious little girl, Emma, who is due to come in a short eight weeks.   (Talk about worklife balance).  I hope to keep a close eye on my finances, not spending my  lowly residency salary  without forethought.  I hope to  meditate daily to church regularly.  I want to establish d close relationship with my coworkers.  I want to spend at least 30 minutes before I go to clinic to  pre-chart and how the templates of my notes finished prior to my outpatient clinic days.  I want to carve out time to exercise consistently.  complement to have a strict morning routine and evening routine.  to build some sense of routine during the  various rotations that have no routine.  I hope to get more involved in research and community outreach during my time as a resident.   I hope to  except my shortcomings  without becoming complacent.  Which Always striving for growth  and improvement.  and I do want to become more social and outgoing in the long run  both to improve my options for career after finishing  residency and to build a greater sense of community among my peers.

 Please excuse errors,  I got to go back to that Wu-Tang documentary of  mics and men.  Peace God

P.S. This student loan shit sucks. I need that 2008 general motors type bailout ASAP.

ONe year almost up

Almost finished with one year of residency. They say long days short years. That has been true so far. I now have a week off after finishing the most difficult month of residency. Ob/gyn rotation which required us to do seven 24 hour shifts. Those shifts were difficult but rewarding and allowing me to do multiple deliveries and improved my skills managing expecting mothers.

Being a resident is pretty cool. It feels surreal being on the other side at the same hospital that I did my rotations at.  It's been a difficult transition actually feeling and behaving like a doctor i.e. placing order and making decisions.  There is the constant underlying fear of doing something to harm the patient, which is counterbalanced by the excitement of being able to make decisions with the comfort of knowing that there are more experienced providers who I can go to for advice.  Planning out the day and figuring out which tasks take longer than others has been difficult, especially because some things that are not ordered in the morning will not get done later if ordered in the afternoon or on weekends, such as ultrasounds or echocardiograms. 

So far I have been with a very supportive inpatient team, but there have been many challenges along the way. Residency is definitely not easy but it's nice to finally have a paycheck.

Residency

Residency is just as hard as they said it would but, however it is also so rewarding. Being able to make decisions that affect people's lives is heavy and rewarding at the same time. I believe that I still have a huge learning curve but I am learning over time.  Trying to get better daily and making mistakes along the way.

MATCH 2018: I MATCHED!

I matched to my #1 Choice, Clinica Sierra Vista (CSV)/Rio Bravo Family Medicine , in my hometown of Bakersfield, California.  Yeeee!

It is a great feeling and relief to know I have a residency spot.  Throughout medical school as a Caribbean medical student, and despite maintaining a positive attitude, there was a feeling of uncertainty that I never fully managed to conceal.  The real possibility of being an M.D. without the opportunity to get a decent job after school if I didn't get into a residency position. I just maintained the faith through the doubt and it paid off.

This is a journey imagined since seeing that Ross was signing a contract with Kern Medical and that I may have an opportunity to rotate at home and establish some relationships.  I always envisioned returning for residency.  I was dismayed when I found out the Family Medicine residency at Kern was ending during my 3rd year of medical school, and elated when finding out that Clinica Sierra Vista was stepping up and creating their own Family Medicine rotation to fill the void.  I was able to begin my first rotation of Family Medicine with CSV and from that point on I knew that this is where I wanted to be.  However, I wasn't bold enough to tell the program director that yet, but I have a co-intern who indeed did tell her. I loved the family atmosphere, care shown when dealing with the patients, and the relationships the residents built with their patients during the clinics. When I finished the rest of my core rotations, I knew that family medicine was my residency of choice and CSV would be my #1 choice.

I didn't think I would be applying for the 2018 match.  I took a two month withdrawal to study for Step 2 CK and didn't take it until August 23, which meant I probably wouldn't have the scores by the time applications opened. I spoke with my advisor, who said that I should delay the match until 2019 to be ensured that I have a complete application including USMLE STEP 1, STEP 2 CK, and STEP 2 CS results.  I had yet to take or schedule Step 2 CS.  Therefore, I decided to push back the match until 2019, and I spread out my rotations to give breaks in between.  As I entered my Family medicine Sub-I rotation in October the program director said she was surprised to not see my application, and she thought I had applied to internal medicine.  I assured her that I had not, but explained my situation.  She, along with the program coordinator, then encouraged me to apply,  so I rushed to get a token for residency application, write my personal statement, get a final letter of recommendation, schedule STEP 2 CS, study for and take STEP 2 CS, and complete my ERAS application all while doing a sub-internship.  Throughout this process, my advisor was upset, and continued to strongly advise me not to apply.  I just continued to pray that everything would work out. I managed to condense my schedule again in order to push up my graduation date. 

It wasn't until early November that I finally completed my application, which is extremely late considering many people already had interviews and the application opened in mid Septmber.  This definitely caused some anxiety for me. Ultimately, I applied to 39 programs, significantly less than the 250-350 that I was initially advised to apply for. I still believe Ross is correct in recommending such a high number of applicants; it is better to be safe than sorry when considering the repercussions  of not matching.  Because I was applying so late, I thought that I was mostly gambling on the CSV program so I would focus my efforts there and the programs surrounding my hometown.  Outside of that, I just applied to the family medicine programs that take the most Ross students over the last 3 years.  All five of my interviews ended up coming in cities in Central California. It was nice to be able to drive to my interviews and not worry about back-to-back flights. Actually, applying late saved me alot of money with interviews and also with flights.  I probably saved at least $6,000 compared to what other students spent on application fees, traveling, and hotel stays.

During the interviews, I did develop a "gut feeling" about which program I thought would be a good fit or not.  You can tell from the interactions with the faculty, residents, and overall feel of the hospital. After the CSV interview, I felt like that was home, and I knew that that was my #1 choice. Additionally, it would allow me to be at home with my fianc, who signed a 3 year contract as a nurse with a hospital in Bakersfield. But of course I would have been happy to match anywhere and she would've been supportive.

Keeping with the theme,  I am now scrambling to get the paperwork in order for the California PTAL, which is the main thing I need to complete before residency.

Ross threw an excellent match party in Los Angeles at Madera Kitchen in Hollywood.  We had an open bar and appetizers.  I got to connect with my old interviewer from Ross, along with other staff.  I was also excited to see how well my classmates had done, and saw some really impressive match sites.   I'm really proud of our group and how well we react to adversity.

This process has further taught me to lean of God and let Him direct my steps.  On to the next part of the journey!