After each academic milestone I hit, I do two things: I listen to Explosions In The Sky’s 12 minute, “With Tired Eyes, Tired Minds, Tired Souls, We Slept” and I write. The song itself is instrumental but the title is enough to capture the feeling of finishing my first semester of PA school.
So what was it like going back to school at 34? What worked? What didn’t? Did I fulfill my goal of not missing an hour of sleep? Why was the final night of finals a highlight of my entire semester? Let’s talk.
What Worked
It’s an interesting feeling for sure: to feel “done” yet know this is just the beginning. I know Winter Break is going to fly by at lightspeed and I’ll be right back at it again soon. I think back to my time in my accelerated post-bac, feeling completely overwhelmed with organic chemistry thinking to myself, “I can’t imagine anything more challenging than this.” I’m thankful for my post-bac which gave me the mettle and grit I’ve employed this semester. The first four months of PA school were certainly challenging, but so very possible.
I spent a lot of time before PA school just thinking about the meta of learning. In fact that was the subject of some of my very first blogs. What even is studying? I learned that you need sleep for neurons to grow and solidify. I stumbled upon this Wikipedia page and learned about the importance of things like Brain-derived neurotrophic factor (BDNF). I learned about the Feynman Technique, the idea of taking complex topics and putting them into simple terms. And probably most importantly, I discovered the Memory Palace technique and sort of retro-fitted that into Google Docs Tables. The one piece of advice that I didn’t follow is handwriting my notes. As much as the research suggests that handwriting is better, typing just works better for me.
During school I stumbled upon a lot of little discoveries. It can be uncomfortable to study with other people because you feel like a dope, but you learn so much by surrounding yourself with people who are better than you at things. If you’re the smartest person in the room, you’ll never grow. Feeling stupid is the first step of feeling smart. You can hit a flashcard until your eyes bleed but hearing it once from a classmate sticks instantly.
I also tried my best to turn studying into a game, something to look forward to. I use a Nintendo Switch controller and blast music while I run through Anki. I try my best to translate PowerPoint slides into a story, typing out a stream of consciousness filled with jokes, memes, and absurd mnemonics. If I don’t make it fun, I can’t do it. I think a big mistake in academics is to take it much too seriously. Speaking of Anki, I really can’t stress how much of a game changer it is. It weeds out what you already know and makes you focus on harder content. It saves so. much. time.
I learned quickly that I don’t need to learn and memorize every single slide to succeed. Also, perfection is not sustainable and should not be a goal. You have to be happy with a 90 and be ecstatic with an 80 on an extremely hard test. Don’t beat yourself up if you fail an exam; just make sure you course correct for the future. I’ll take a 90 and a full night’s sleep over a 100 and an all-nighter, every single time. Don’t get angry because a question was written ambiguously. Learning to let go is so important. If your professor says to avoid the weeds, get out of there. If they reiterate time and time again that losing sleep is detrimental, then go to sleep. If they say focus on the new content for finals, then focus on the new stuff! The person who knows what’s best for you is rarely yourself.
Let’s talk about finals week.
Finals Week: The Lows
Finals week was tough. We had 6 cumulative exams and 2 practicals. It’s so much information, that you just become numb to it all. The most important offense to the invasion of information is simply time. If you put the time in, you’ll be okay. Just make sure you don’t lose any sleep!
The first final was our bread and butter 8-credit class; a four hour, 230 question exam. I spend the majority of my time working on that class so I felt fine and appreciated that it was up first. The second exam, History & Physical, is more about the practical part of medicine. I felt okay for that one too. The remaining 6 exams, however, I felt not so good. It’s really hard to forecast and balance out your time for 8 different classes.
After the third exam Tuesday afternoon, I returned to a home-base campus conference room where a group of us were studying. Even four months in, you still can’t help but compare yourself to your peers. It stings when someone explains a concept so matter of factly when you’re still struggling; you constantly feel like you know so little. And even the things you “know” do you really understand? I woke up the next morning and just felt deflated. I had poured everything I had into the first three exams and I wasn’t sure I had anything left.
I think Wednesday was the closest thing I had to a mental breakdown all semester. I wondered if I had what it took to be an ER PA one day or would I have to settle for something I was less interested in. Would I even get that far? I grappled with the struggle of trying to fit in as an older student. I had one of those moments where you just open the door to every doubt and insecurity that exists.
An hour or so later I headed to campus, still in a funk. Wednesday was a “break” of sorts as it had two practicals, one which was an SP or “Standardized Patient” encounter with a live patient, and the other which was an anatomy practical with a handful of… not so live patients. I enjoy the former quite a bit. After staring at PowerPoint slides for an eternity, it’s nice to interact with a human being.
After the SP encounter I headed to the anatomy practical. As grateful as I am to get the opportunity to study in an anatomy lab, it’s my least favorite part of my studies. There’s something so raw and visceral about that experience; it’s a stark reminder that medicine is gruesome and that life is temporary. The practical is timed and everyone is guarding their clipboards as to say “Yea, I know which gluteal artery that is. Maybe study a little harder next time.” It’s a torture chamber of anxious energy. As I continued around the room approaching a pinned structure, I leaned forward to get a closer look. I notably shrugged and chuckled, indicating I had no idea what structure I was looking at. My fellow classmate laughed as well as to say “Yea dude, I have no idea either.” It was a nice moment of camaraderie and levity, especially as I banged my head into the lamp that was shining onto what I think was the remnants of a piriformis muscle. It’s nice to smile and laugh, especially when you’re hopelessly overwhelmed and stressed.
Finals Week: The Highs
And then all of a sudden it was Thursday evening, the night before the final final: Anatomy.
So anatomy lab is its own class. There’s an entirely different lecture-based class on anatomy which was the subject of this final. It was cumulative (like every final), an exam on literally the entire human body. Every single nerve, muscle, blood vessel, bone, lymph vessel, and associated “Clinical Pearl” was fair game. Okay, it’s not as bad as it sounds. Sixty percent of the exam was on new material (the head and neck), so focusing there and then praying you remember some of the old stuff sounded like a solid strategy (and it was).
Luckily I had started grinding anatomy Anki the week before, mindlessly clicking through the flashcards I had made in class weeks ago. Usually dinner for me was reheated meal-prep and an episode of Workaholics, but dinners leading up to finals week became trying to figure out what the heck Scaphocephaly and Phantogeusia were. It sucked; I was taking a break from studying one subject by studying another. I realized, though, that Anki alone wasn’t working for this material so I put them on pause. I decided to start writing out what I call “StoryNotes” for the class. I had worked on these notes a bit every day leading up to Thursday night.
That night I still wasn’t feeling great. I won’t lie, I was worried that I wouldn’t do well the next day. But I always tell myself that I’m just one person and I can only do so much. Is this one exam going to be what stops me from being a great PA one day? No way. Also, I hadn’t lost a single hour of sleep all semester and I wasn’t going to make the final night the first night I lost sleep. That would seriously put a damper on the blog I was planning to write.
Some of the PowerPoint decks I was working with were… a little chaotic: a hodgepodge of wall-to-wall Arial text, Netter pictures with 50 labeled structures, overlaid text boxes, bright yellow font on this slide, bright red on that one, paragraphs of text hiding in the notes section. I can’t imagine it’s easy to put together an Anatomy deck, especially for neurology. It’s a lot.
So I pored over all of the slides. I asked myself: “Okay, they have 30 questions to ask here? Let’s find them. If I was writing this exam, what would I ask?” I translated and organized every slide into what I hoped was clearly understandable language (The Feynman Technique). As Thursday evening rolled on and I was entering into the last of the six decks and the final hours of the night, I realized an increasing number of viewers in my Google Doc (I usually share my notes with the class).
At one point, nearly half the class was in there with me; I had an audience. I received a GroupMe notification and saw that some students had some really nice words (read: some of the nicest compliments I’ve ever received) about the work I was doing. And honestly, that was a complete game changer for me; it didn’t just change my whole week, it changed my entire semester.
I cranked up Judah & the Lion’s “Over My Head” and proceeded into the most frenetic yet focused study sprint of my life. That song is the most fitting for the night before a final: “While I hydrate, caffeinate, medicate, repeat… all these thoughts are an ocean that I’m drowning in, I’m in over my, I’m in over my head.” I was a mad man typing away to the sound of a mandolin and a kick drum.
I think my favorite moment was when I discovered a mnemonic that was given to us for the branches of the External Carotid Artery: “She Always Likes Friends Over Papa, Sister and Mama.” This one… deserved a makeover. This is called an acrostic mnemonic and what I’ve learned is you should make the mnemonic as close as possible to the actual words. S for “Superior Thyroid Artery” is quite a stretch. I converted it to a hybrid acronym: ST-AP FA-LING Out-Of PA, St. Max. I don’t know who St. Max is, but nailing that mnemonic got me a point on the final. Bless up, St. Max.
Another mnemonic I was quite proud of was for Huntingdon’s Disease: It was “I wanna cauDATE Olivia Wilde,” whose character in the TV show House had Huntington’s (and a defect in the Caudate Nucleus causes it). Here’s a collection of resources I created for this exam, along with a photo of me and my messy locker on Wednesday (practical day; I needed three sets of clothes).
And then all of a sudden it was 9PM. There was a great amount I didn’t feel even close to confident in. There were entire prior exams I hadn’t even looked at. But I didn’t care. It was time for bed and not enough sleep would destroy all of the hard work I just poured out. That’s huge; after a focused study session you need a full night’s sleep or it all won’t stick. I powered down and hit the lights.
I woke up briskly at 5AM, shot out of bed, grabbed a coffee and dove right into Anki. What I learned is that after I type out my notes, it multiplies Anki’s effect because I can now anchor this information into my own writing and resources. I can now spatially recall the information I’ve organized. I hit 634 cards that morning. The exam was at 9:30AM. I drew the brachial plexus on a giant post-it on my bathroom wall while I brushed my teeth with the other hand.
I have a tradition that during my commute on the morning of an exam, I blast pop-punk and sing at the top of my lungs. It’s an exhilarating way to get the adrenaline pumping. Whichever song I choose, it’s usually stuck in my head during the entire exam and it helps me focus. This time it was “Try” by The Menzingers which was a rallying anthem for me that week. I sat in the car for a bit and quickly reviewed content from old exams; a load up on short-term memory for old content works pretty well.
I walked in to the classroom and took my seat. Our professor congratulated us on making it this far. This was it. We were 110 questions away from completing the first semester of PA School. I’ll never forget the deep breath I took before the first exam. I took another deep breath and began.
I was grinding through the questions at a steady pace, realizing I had forgotten to look over the entire unit on the abdomen. Oops. And then, boom, there it was: a question on Huntingdon’s Disease and my mnemonic was staring me right in the face. I answered the question instantly and let out a huge grin. Next question.
As the classroom emptied behind me I stuck with my strategy of going back over the exam and reviewing every question; it takes a lot of patience but I think it’s worth it. I finished up, hit submit, and walked out of the room for the last time that semester.
About five people told me they got the Huntington’s question right because of my silly mnemonic.
Two Things
If there are two things you need to succeed in PA school, I’d say it’s a consistent sleep schedule and motivation.
What I’m most proud of this semester is that I didn’t lose a single hour of sleep. For an entire semester, I went to bed by 10PM and woke up at 4:55AM every single morning, including most weekends and including all five days of finals.
I’m not saying this to boast nor am I saying I’m the only one to ever pull this off. Expressing that achievement as a proud moment is important to me. I think I just want people to know that it’s possible. For the record, I’m not some insanely disciplined person who meal preps and exercises all of the time. Despite my age, my life is next to a mess. I’m a very average and flawed human being. I’m not a genius. Never in my life have I been anywhere near the top of my class, including in PA School. To me, I’m just smart enough to know that I’m not crazy smart; I’m smart enough to know that I need to look for some tools and hacks to heighten the intelligence that I do have.
I look at my colleagues in my class and think, “Wow, they must really have their life together.” I have no idea if anyone thinks the same about me. But if they do, it’s certainly not the case. And that makes me feel better because despite outward appearances, we all have stuff going on.
Let’s talk sleep.
I’m fortunate enough to have a 1-bedroom apartment so I never once studied in my bedroom. That room was for sleep and that was it. I think it really helps you disconnect from the day and clear your mind so you can fall asleep. I don’t wake up to a phone alarm, I wake up to my favorite music. I have a different playlist that plays every morning. And it’s fully charged pop-punk we’re talking here. Every morning is like waking up in a new scene of my own movie. Life’s too short to not feel like the Main Character as you start your own day. I set my lamps to slowly turn on around 4:30 AM, the music starts playing at 4:55 AM, and then my annoying phone alarm finally goes off at 5:00AM, which is plugged in outside of my bedroom so I need to leave the room to retrieve it. Charging my phone in another room also means I can’t use it in bed. I think the big piece to this whole thing is that I try to stick to this sleep schedule on the weekends. Waking up at 5AM on Sunday, a day before the week begins, works absolute wonders.
Let’s talk motivation.
Motivation is certainly hard to find and even harder to maintain. For me, I’ve found it in writing study guides. People find the content I create useful. Two students told me they sat down over a glass of wine and watched a YouTube video I created. That’s pretty awesome. So as I study, I can help and teach other people. I’ve found an unlimited source of motivation.
The underlying theme here is that I’d love to teach one day. There’s a science to… science, but there’s also a science to learning and I feel like we vastly overlook the latter.
So that’s my secret. If my way of studying means another student can get another 1-2 hours of sleep, because they don’t have to dig through a deck looking for useful information, or can pick up a couple of points on an exam because of my stupid mnemonics, then I’ll keep doing that for the next two years.
That’s it for now. I’ll see you in the Spring!