Triage and Tribulations

Kayla Nguyen sits in the Texas Christian University bookstore with a hefty study guide cracked open in her lap. Her chilled Frappuccino, a remedy for the sweltering Texas heat in June, leaves a wet ring on the scratchy brown napkin. She’s forgotten her drink already, despite the wilted look on her face and the way her exhausted head droops over the book’s pages. It’s a shame, because like the 89,452 pre-medical students who studied for and took the Medical College Admissions Test (MCAT) in 2012, she could use some caffeine.

kayla
Kayla (pictured right) is a pre-med junior at Texas A&M University in College Station.

Kayla has paid about $50 for this one MCAT study guide, no small change for a young woman who’s trying to put herself through undergrad at Texas A&M University. She’s from a big Vietnamese-American family, and money has always been tight. Her savings from various minimum-wage jobs and the summer office job she’s currently on break from are quickly dwindling thanks to the material cost of her medical school aspirations. The kicker? She’s not even taking the test until January of next year.

All students hoping to apply to medical schools in the United States must score well on the MCAT, a standardized exam which tests students’ reasoning and critical thinking skills. The test is a crucial component of a prospective student’s application because every accredited school uses it.

The Association of American Medical Colleges (AAMC), which administers the MCAT, recommends studying for approximately three to six months before taking the five-hour exam. Many pre-meds spend thousands of dollars on intensive test prep courses to refresh their knowledge of the physical and biological sciences.

However, because Kayla couldn’t afford those prep courses, she began studying all on her own for the January 2015 MCAT in mid-June using study guides, university course notes, and free online practice tests. She says studying on her own been a tough journey thus far—but that’s just life for most pre-med college students. After all, she wasn’t exactly expecting the process to be easy.

Back in the bookstore coffee shop, short hair falling in her face, Kayla finally remembers her neglected caffeinated beverage and takes a sip. The ice crystals numb her teeth and she begins to reflexively quiz herself on the names of every bone in her jaw.

Later, in October (t-minus three months to exam time), Kayla will tell me she’s reconsidering medical school right after college. Her hair is longer now—her natural color black, tipped with a rebellious streak of blue—as she crouches on the carpet of her College Station apartment.

“I’ve postponed my existential crisis because I had four exams this week, but I’m having it now,” Kayla admits over a video call, a Nutella-slathered croissant filling her mouth at ten o’clock at night. She’s beginning to wonder if this fast-paced schedule—four years of science and intensive lab training, months of preparation for an essential test, and then hopefully straight to med school—is even right for her. Working in a lab for a year or two before applying to med school might help improve her resume. That work would also balance out some unfortunate grades and, perhaps most importantly, give her time to think about what she really wants out of medicine.

Kayla’s not alone in her indecision. Few pre-med students sail through their undergraduate programs with complete confidence. After all, the numbers are often daunting. According to the AAMC, 56.9% of applicants were not accepted to any med schools in 2012. The 171 accredited medical schools in the United States can only accept so many students per class each year.

Despite the pressure, however, Kayla has made it to junior year, despite the hurdles along the way. She loves biology, the most common major for med school applicants, but she also believes health care is a basic necessity for all people. Instead of pursuing medicine simply for profit, pre-med students are now weighing the high costs of eight years spent in school against what they will actually make as doctors. Kayla, like every other aspiring doctor I spoke with, has chosen the long road to medical certification because she believes she can make a difference.

Kayla has clung on through weed-out classes like organic chemistry where her friends drop like flies; she’s watched them switch tracks to nursing, pre-dentistry, or drop out of the medical sciences altogether. She describes days when she looks around her two-hundred-seat lecture hall and recognizes only a few faces from freshman year. That can be a disheartening experience in a program where even friends compete for the tiniest differences in GPA, obsessing over exam curves because every element of their extensive medical school applications will count.

Today, I had the humbling experience of cutting through the skull of my anatomy cadaver and extracting the brain. I don’t know if I’ll ever be able to describe it with words, but it was easily among the most amazing experiences I have ever had. The human body is a perfectly magnificent creation. ‪#‎MindBlowing ‪#‎PunIntended ‪#‎OnlyInMedSchool

– Facebook status of Tariq AlFarra

10176224_1594201727472532_5347009579557502365_nTariq AlFarra, a first-year student at the Texas College of Osteopathic Medicine, is a friendly bear in a well-pressed suit. Tariq comes from a family of doctors, and his resolve to help others through medicine has only strengthened with every challenge he’s managed to overcome.

Tariq wanted to have ample time to study for the MCAT, so he took the test in the spring right before the June med school application deadline. That test date was cutting it close, especially for the typical proactive students who apply to med school. “I could get my score a year in advance. I could get it a month in advance, which is what I ended up doing,” he explains, now a student in his first semester of medical school. Fortunately, Tariq only had to take the exam once before he achieved close to his goal score.

“There are no rules!” Tariq says of the pre-med undergraduate program. “Especially pre-meds think there are so many rules you have to follow, and if you don’t do this or that by this specified time—Oh my god, you know?” He raises his eyebrows and laughs, lounging comfortably in his coffee shop chair. “The best advice I have is to do what’s best for you and what has worked in the past.”

At first, when Tariq was preparing for the MCAT, he struggled with practice tests because he was trying to follow his prep course’s recommendations religiously. However, after he realized he needed to learn the information before taking practice tests, he took a few months to learn the material, course-free. That’s when he began reviewing the material and taking one practice test every Thursday, a schedule that eventually doubled to two tests a week. The results were astounding; Tariq’s scores shot up within about a month, and his end score after taking the MCAT wasn’t too far off from his last couple of practice test scores.

“I decided that I could be happy in the process or I could just sit there and stress myself out. I knew I could have a good summer or I could have a bad summer,” Tariq explains.

For pre-med students, he says, “As long as you have a plan and you have no reason to believe that it will fail—and you don’t do something stupid like start cramming the night before—do what you think is gonna work best for you.” Tariq shrugs and confesses, “I don’t care for rules, honestly, because I don’t like to follow them.”

You’d think that junior and senior pre-med students, most of them science majors who have been memorizing challenging formulae since high school, would ace any test. However, there’s a reason pre-med students like senior biology major Alesha White describe the exam as simply “a beast.”

Alesha, a soft-spoken sorority woman with an infectious smile, has an obsession with all things Hello Kitty. Sitting across from me in the same Starbucks where I met Kayla Nguyen last summer, she delicately nurses her coffee. Her dark, almond-shaped eyes widen as she describes the worst test she’s ever taken.

“You can know a lot. You can know all the information, but if you can’t apply that, you get the questions wrong,” Alesha says. “Practicing the way they want you to answer those questions is the hard part. I took about five practice tests before I took the test itself last month.” She explains how she’s already scheduled her second MCAT for January, so she will have to study intensively while also going to school, instead of having all summer to prepare.

The problem is, the MCAT’s 144-question design tests prior knowledge and ability to apply general chemistry, physics, chemistry, and biology. In other words, pre-med students have to know their previous science courses from back to front—and there are some questions that come from material covered senior year. The MCAT’s three timed sections of 40-52 questions combined with passages from each of those disciplines make for an incredible testing pace.

 “Every time I do well on a test or pass a difficult milestone in pre-med, I grow more confident in my ability to make it through.” – Caleb Ashbrook, senior chemistry major at TCU

On September 2, 2014, Alesha entered the MCAT test center in Dallas with her head held high. Cubicles containing computers with pairs of headphones draped over the sides lined the room—so at least the room resembled the highly regulated testing centers she’d been taught to expect. She hardly even noticed the other test-takers.

A sign posted on the wall declared, “Calculators, timers, and other electronic devices are PROHIBITED.” Alesha knew this; she’d been practicing mental math techniques all summer. Once she finally sat down at the computer and turned on the program, Alesha felt her brain switch into that laser-focused mode she got when taking stressful tests. The first section, Physical Sciences, had been historically the hardest for her in practice tests.

Then the proctors announced the official start to the exam, and the entire room exploded into quiet concentration. Alesha squinted her eyes and began.

A hockey puck of mass 0.16 kg is slapped so that its velocity is 50 m/sec, Alesha read silently to herself. It slides 40 meters across the ice before coming to rest. How much work is done by friction on the puck? As the clock ticked, she took a breath and pictured the equation, burned into her retinas from practice exam after practice exam. After some mental math, she had her answer. (C) -200 J, because the work-energy theorem relates the change in kinetic energy to the work done on the puck, and all work done in the puck is friction.

Click. One question down, fifty-one to go.

Time limped on and it felt like her brain was leaking out her ears, but Alesha kept her eyes firmly on the blue-tinted glow of the computer screen. By the third section, Biological Sciences, Alesha had been taking the MCAT for more than three hours. Her stamina was flagging, and that fatigue probably affected her score. (She won’t know until a month later, when she opens an AAMC-marked envelope to retrieve her three-part scores.)

A hundred and ninety-six questions later, time was called and Alesha stood up in a daze. It felt like she had been preparing for the MCAT her entire life, and she was finally getting to the home stretch—until January 2015, when she will take the test once more.

Three pre-med young men marched across the TCU campus, armored in purple and pink Susan G. Komen t-shirts over cotton-candy-pink scrubs. They had submitted their MCAT applications, and most pre-meds would be resting from the ordeal of the past four years, anxiously anticipating their admission responses.

Tariq AlFarra and his classmates, however, did not mind that their volunteering efforts would not be recognized by medical schools. Nor did they mind the playful rumors that they had been wearing the same pair of scrubs for three weeks straight. “I had several pairs and I washed them all!” he protests now.

Dr. Chumley, Tarriq AlFarra, Trent Boehm, and Thomas Parnell (a member of the Chumley Lab) sport the pink scrubs in support of Frogs for the Cure.

Last spring, Frogs for the Cure coordinator Ann Louden asked Tariq to enlist other pre-meds to get involved in raising awareness for breast cancer research. “But I thought, why not stop there? We wanted a campus-wide movement,” he recalls. Tariq set out to register as many students as possible to participate in the Frogs for the Cure music video. And the “pink scrubs guys” did, doubling the previous record with 2800 students.

“At that point, I knew for sure that I was doing it because I believed in the cause, not to put it on my application,” Tariq recalls. “And that’s an indicator to myself that I’m doing the right thing with my life.”

Less than a month after her exam (still scoreless), Alesha sips her coffee across the table from me, contemplating the experience. “I expected it to be hard,” she shrugs, her high voice cheery. “I guess the whole thing just reinforced the difficulty.”

When asked whether she still wants to pursue medicine, Alesha nods and her smile dims. She tells me about her older brother, who was born with a cleft lip and cleft palate and required surgery immediately after birth because he couldn’t eat. “I remember having to go with him to so many different surgeries, so many different doctor’s appointments, and to me that was real life, and normal. The fact that I found comfort in that as a kid amazes me now.”

The friendly, caring doctors who reassured her family provided a model for the kind of personable doctor she now wants to become. At the time, Alesha hadn’t realized how stressful the process must have been for her family. However, as Alesha grew older, she began to grasp how much medical professionals had helped put her, and her brother, at ease.

Then, Alesha says quietly, her mother contracted cancer in her lungs and it spread to her brain. She lost her mom at age twelve.

“It was hard,” she says now. “But my goal is to prevent that, so that another girl like me doesn’t have to face that. So that another child like my brother born with a cleft lip and cleft palate doesn’t have to face the same ridicule. And so, preventing that pain and that hurt is why I want to pursue medicine.”

When asked about her practical experiences with medicine thus far (an unspoken requirement of most med schools is experience shadowing a doctor, volunteering at blood drives, et cetera), Alesha’s smile returns. “I volunteer at a free health clinic called Open Arms in Arlington,” she says, beaming. Until she got to interact with real patients and take their vitals (a practice not common to most shadowing experiences), Alesha hadn’t known for certain that she could commit to becoming a doctor. But when she saw those patients’ faces, she knew she could never do anything else.

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