Category: Medical School

Advice on Switching Careers: How I made my decision to move from Marketing to Medicine

I’ve had a few people ask me to write about this, so here goes.  First off, my story is just that – mine and potentially not entirely applicable to others looking to change careers, but nonetheless I’m going to attempt to pull out the pearls and advice that I can.  Here’s the step by step process I took to a total career and life change, from President of a boutique Interactive Advertising Agency, to Emergency Medicine Physician, in the span of 7.5 years.

STEP 1: Recognize you need a change

Sometimes the need for change is obvious – if you find yourself counting down the clock to the end of your workday, then something is likely wrong.  What’s harder is recognizing the need for a career change when it’s less obvious – when you like the job you have, but you have more passion for something else.  That was the case with me.  I’d been fortunate enough to have great success in my last career.  I was well-paid for doing interesting work with cool people.  But, I had been volunteering with the rescue squad for 3 years and had gone back to school to get my Advanced Life Support (ALS) certification.  I felt alive and intellectually stimulated in the course. I was finally getting to learn the deeper pathophysiology behind what I’d been seeing in my patients for the last 3 years.  And, instead of volunteering the required 48 hours per month with my rescue squad, I was logging somewhere just over 100 hours per month.  I was about to cross a threshold where I was spending just as much time pursuing my passion for Emergency Medicine as I was in my professional field of Interactive Marketing.  That’s when I first had the idea of a career switch.  That was October 2007.

STEP 2: Mull it over

A career change isn’t the kind of thing you should decide on a whim.  So, do yourself and those around you a favor and take some time to digest the idea.  One of the smartest things I did was asked my friends what they thought, “Could you see me as a doctor?” “Do you think I’d miss marketing & technology?” “When do I seem most happy?”  If you have great friends & family like I do, they’ll have noticed this and be willing to share.  For the record, my parents did ask me the night of my EMT-B graduation (December 2004), “Are you sure you don’t want to go to medical school?”

That said, be prepared that this is the stage where the naysayers also come out.  I can’t tell you how many people said to me something along the lines of, “So I guess you don’t want marriage and kids then, huh?”  To which I wanted to reply, “No, I’m pretty sure I didn’t say that.”  The implication is reasonable though, and certainly something I took into consideration.  At the time I was 27 and single with no kids.  If I was accepted to medical school, would I ever have time to date?  Even if I met the right person, would I be able to balance marriage, babies and a life as a Med Student/Resident?

But at the same time, was I going to put my dreams and my life on hold waiting for a theoretical knight on a white horse that might never arrive?  I saw myself 10 years later without my knight or my dream career in medicine.  I most certainly didn’t want to come up empty handed on both counts.

What about the financial implications?  Here’s where it helped that I was single with no kids.  Supporting just myself, I’d been able to save a decent lump of money while working.  I was in a position to quit working and go back to school full-time (more on that in a bit).  And if it meant going back to eating Ramen Noodles, it was just me who would have to suffer.

STEP 3: Gather Information

Having not been a pre-med major, I had no idea what the rules were for medical school.  For example, would they even accept someone over the age of 30?  What prerequisite courses are required?  Does it matter that I majored in Computer Science, Marketing & Spanish and not Chemistry or Biology?  What’s on this MCAT thing? Every career field will have some of these rules, written and unwritten.  You need to know what you’re up against.

Do yourself a favor and do what I did.  Make some appointments to meet with the people that matter.  I had two major challenges: 1) identify and take all of the prerequisite courses and 2) understand admission requirements for medical school and assess my competitiveness.  So, I knew I needed to talk to someone at an undergraduate university and at a medical school.  Because I wanted to stay local, I set up appointments with the Dean of Sciences at Old Dominion University (ODU) and the Dean of Admissions at Eastern Virginia Medical School (EVMS).  Getting the appointments was much easier than I had anticipated.  I simply filled out contact forms on the websites for each school; they emailed me back within 48 hours.  That was November 2007.

Also, this is a great time to network.  On a side note, coming out of undergrad I was very hesitant to play the Networking game.  I naively wanted to feel like I achieved everything I had on my own, without “cheating.”  After working for a few years, I learned that success is actually a combination of three things: hard work, luck and help from those around you.  Your neighbor may have gone to college with the Hiring Manager for the job you have your eyes on.  Ask your Facebook friends if they know the people in charge at the place you want to go.  Did you know you can search Facebook for people who work at specific companies?  Simply type in “Friends who work at ________” and you might be surprised to find that someone you know works at the company or school where you need an “in.”  Here’s an example from my page of “Friends who work at Google.”

Facebook example

The last thing I did as a part of my information gathering was organize what I had learned about the situation.  A pro and con list if you will.  It looked something like this:


STEP 4: Pull the trigger

This was actually the easiest step for me.  By the time I reached the end of my Information Gathering stage, my decision was essentially made for me.  So many people have barriers to making a big career change – no money for classes, family commitments, you name it – I had none of those things.  I knew and still know so many people that would kill to be able to pursue a new life dream but can’t. Most of my CONS were just related to money.  I couldn’t NOT do it.

STEP 5: Enjoy the ride

While med school was downright miserable at sometimes, ok many times, one thing I can say about this whole journey is that it’s been an amazing experience to help me grow as a person.  I’ve learned a ton about myself, what motivates me, what I can survive.  And, I feel true to my soul having pursued what at many points felt like an impossible dream.  Oh, and the icing on the cake, I met and married my best friend.


5 Things I Learned in EMS I Wish I’d Learned in Medical School

Hello world. Mr. TeamLouka here.

I hear my wife started a blog… and in typical Steph fashion, three days later she has hundreds of viewers in 10+ countries?! Well, I can’t let her have all the fun, and its TEAMlouka afterall. So here’s my take on…

5 Things I Learned in EMS I Wish I’d Learned in Medical School

1. ABCs

Airway. Breathing. Circulation. Often boiled down to the ever-popular “air goes in and out, blood goes round and round, and any variation of either is bad.” Seems simple enough. You might even think such a simple, crucial concept would be covered on day one of medical school, just like it was in EMT class.


I distinctly remember sitting in the auditorium at EVMS back in August 2010 and thinking to myself, “OK. Let’s do this. Doctor training, go!” The lecture topic? Intro to medical molecular cellular biology, of course! Because when that critical patient rolls in, all attention should be directed towards the golgi apparatus and endoplasmic reticulum first. Funnily enough, I didn’t leave that class feeling any more clever.

Now in all fairness, ABCs were covered in medical school. The problem is that the single most important concept in the assessment of an undifferentiated patient was sandwiched somewhere between memorizing The Krebs Cycle and the chapter on brain eating amoebas.

So out of four long, expensive years, just half a day was smushed in there for a shoddy BLS/CPR course. By that point, most of my compatriots had drunk the Kool-Aid – BLS was a boring day off for some and an unwelcome eviction from the library for others.

The effect? Time after time, I have watched medical students, residents, and even some attendings rack their brains for a diagnosis, visibly straining to remember what medicine or scan should be ordered next, when called to the bedside of someone going downhill. THE PATIENT ISN’T BREATHING. But is it multiple endocrine neoplasia type 1 or 2? THE PATIENT ISN’T BREATHING. Did she say her great-great-grandmother had psoriasis? I DON’T FEEL A PULSE. Did you do a rectal exam? MAYBE WHEN I FINISH THESE CHEST COMPRESSIONS.

(OK all you sticklers for AHA guidelines out there. I know it’s CAB now. But no one says that. It’s ABC. Forever).

2.  Acuity is just a number

In every ED there is some kind of triage coding system. Usually it’s a numerical assignment, 1-6 in ours, given to patients when they arrive, which roughly translate as:

  1. “We need a doc in here!”
  2. “Doc, my chest hurts since this morning.”
  3. “Doc, my belly hurts since yesterday.”
  4. “Doc, my toe hurts for the past 18 years.”
  5. “Need a med refill, Doc.”
  6. “He’s dead, Doc.”

We’ll that’s great when it works. But one EMS call in particular taught me to maintain a healthy dose of skepticism with those low acuity patients.

It was early in the morning. My partner and I had just signed on were still fueling up on coffee and pancakes. So when the call crackled over the radio for a priority 3 injury, “patient stubbed his toe,” we understandably finished our coffee and waited for the check. We drove to a house about 10 minutes away in no rush at all. Why the hell would someone call 911 at 6am for a stubbed toe?!

The question was partially answered when we walked into the house to find a pale, diaphoretic man sitting in his kitchen… holding a slightly bruised toe.

Turns out this guy walked outside to pick up his newspaper and collapsed down by the mailbox. He spent half an hour crawling back up the driveway, and at some point along the way managed to stub his big toe, much to his dismay. He also just happened to be having a massive heart attack.

Moral of the story: Lay eyes on the patient, then finish your coffee. Just in case.

3. Where Patients Come From

Well when diabetes and high blood pressure love each other very much…

No, that’s not what I mean. I mean physically, socially, emotionally. You see, most patients arrive to me looking more or less the same – propped up on a stretcher or in a wheelchair, clutching some form of puke receptacle, and flanked by a pair of overworked, underpaid EMTs and/or an overworked, underpaid nurse. They’ve usually been cleaned up a bit to meet some unwritten, undefined minimal standard and bare few traces from whence they came. By the time they get admitted upstairs, patients are in a standardized gown, on a standardized bed, eating a standardized turkey sandwich.

This creates a poorly recognized issue for us as doctors. We fail to see the idiosyncrasies of a patient’s life outside of the hospital and tend to place them into one of three broad categories: homed, homeless, or living in some kind of facility (nursing home, rehab, assisted living, jail – take your pick). Each of these then receives the ultimate American qualifier – insured or uninsured. That assignment basically dictates more about a patient’s care and treatment than their actual medical diagnosis. And it is horribly flawed.

Only through EMS did I have a first hand, and a first nose, perspective of just how different life can be for a fellow human being. I have clambered over mountains of hoarded garbage in what looked like a upper-middle class home from the street, been in nursing homes which would put North Korean labor camps to shame, and even pulled a young woman out of the bottom of a port-a-potty where she spent the night sleeping in a tub of chlorine and human waste. There is a spectrum to everything, and the circumstances of a person’s life leading up to his or her encounter with me can tell me as much or more about their condition, and what I can do about it, than the symptoms they describe.

I distinctly remember a call to assist a man complaining of some ambiguous pain complaint. He had just been discharged from the hospital that morning. But at well over 600lbs, he was entirely unable to care for himself at home. Never before, and never since, have my nostrils known such misery. He couldn’t fill his prescriptions, get a glass of water, or even get out of the bed to use the toilet. He was, literally, a mess.

The medics bringing me patients now have my full attention. I want to know what they know. They also have my respect – I know what their noses have been through.

4.  It’s their emergency, not mine.

This one is simple. Every person arriving in the ER is there because they feel that their condition – be it crushing, unbearable chest pain or thirty minutes of life-shattering hiccups – just cannot wait another moment to be addressed. But as a newbie EMT recruit, doing my EVOC and driver training, I was taught, on multiple occasions, a memorable and poignant philosophical lesson:

“Dude. It’s their emergency, not ours. Slow. The Fuck. Down.”

-Socrates, Field Training Officer

Now that might have had something to do with the pedestrians diving into the bushes every time we responded to a call, but it sticks with me. On a busy scene, with lights flashing, sirens of approaching units blaring, family and bystanders screaming in my ear, multiple patients and limited resources, the public looks to the collective “us” that is Police, Fire and EMS to take control of situation. In the ED that role shifts to the doctors.

Approaching even a critically ill patient, with nurses, medics and techs racing around grabbing equipment and medicines, my job is to remain calm, cool and collected. Allowing my own tumblr_ls44cgafCl1qaa241level of anxiety to meet that of my patient won’t get anything done more quickly and certainly won’t hasten the cure.

Unfortunately medical school does a terrible job of teaching this. Learning about the management of truly sick patients takes place more in the classroom than at the bedside. There is infinite time to think, weigh the options, and look up the answers. The student is usually sent to see the less acute patients, or tags along to observe when things get dicey. Then, day one, intern year, with that long white coat tickling the calves of someone who has never ordered morphine or a blood transfusion or called a surgeon in the middle of the night to say I need you down here now, many struggle when it comes to taking a step back. Looking. Listening. Thinking. Acting.

So when grandpa rolls in clutching his chest, don’t be alarmed if I’m not barking out orders like you’ve seen on TV. I’ll be at the bedside, taking his pulse, followed quickly by taking my own.

5.  Scene safe, BSI

If you had asked me five years ago for my thoughts about the pervasive mantra of EMT recruits everywhere, “Scene safe, BSI,” my response would have been an incomprehensible tirade of expletive filled muttering. I’ll wear gloves. I get it. STOP MAKING ME SAY IT. Every skills station, every practical exam, every day. As if the mannequin we were pretending to bandage had actually just escaped some Liberian Ebola quarantine zone and standing in the doorway with jazz-hands to show I remembered to put on my imaginary gloves would somehow protect me. F&*%#$#!


For those of you who don’t know, BSI stands for “body substance isolation.” The idiom is a reminder to EMT students to look for potential danger first, to protect themselves and their partner before even attempting to help anyone else, and to wear gloves. One thing is certain – no one gets extra points for getting hurt on scene and doubling the number of patients, and if you get hepatitis, you lose.

While this definitely remains true in the hospital (i.e. Steph’s “nonverbal” psych patient who wasn’t talking because of the razor blade hidden in his mouth), it goes further than that. It’s a reminder to take care of ourselves, and each other, through the emotional and physical demands of our work. Believe it or not, watching people in pain and dying every day can be rather taxing on the psyche.

Medical school spends a lot of time teaching us how to help others through the process of aging, illness and, ultimately, death. We learn every aspect of disease, how various ailments ravage the body, each in their unique way. But little time is spent learning to carry the weight of our responsibility or dealing with the death of a patient.

In that respect, EMS excels. CISM (critical incident stress management) is a program which helps medics through the worst of calls. The team, staffed by members with specialized training, provides everything from one on one counseling to group debriefings. All hospitals should have such a system.

And for God’s sake put some gloves on when you go in the room. C diff is a terrible, terrible thing.

So that’s that. 5 things which make me a better doctor, all learned at the bottom of the medical totem pole. From the basics of taking care of someone else, to the more complicated task of watching out for myself, EMS has played a huge role in my training. Even as a doctor, I continue to learn on every shift, and that is what keeps me coming back for more.


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5 Things I learned in Medical School I wish I’d learned in EMT School

Granted, it’s been 10+ years since I went through EMT school, but I still remember the gist of it. I remember often thinking the course was being dumbed down – taught to the lowest common educational denominator, which at least in the State of VA can be a GED. I actually think that’s fine – someone with a GED can do a great H&P, start CPR when needed and fashion a pretty good sling out of cravats. But EMT class is often the entry point for many folks with capability and ambitions to continue well-beyond the EMT level. I’m a firm believer in setting expectations high – assume your students want to learn as much as possible, and believe that they can. Don’t assume that they can’t understand why. Looking back on medical school and a year of Emergency Medicine Residency, I’ve complied a few things I wish I had known earlier.

1. Appendicitis pain presents around the belly button for a reason

As an EMT, I never understood why appendicitis often presented as periumbillical pain. Understanding things helps me remember better than mere memorization – that’s true for many people.  The classic presentation (50-60% of patients) for appendicitis is pain that starts near the belly button and migrates to the right lower quadrant. To understand this migration, you just need to know a bit about how the abdomen is innervated. When the appendix first gets inflamed, it’s still small and isn’t pushing against other structures. The pain one feels is deep, visceral pain (think “gut”), which happens to follow a course along the midline of the abdomen, known as the splanchnic nerves. This is why patients perceive pain in the middle of their abdomen even though the appendix is located in the right lower quadrant.  As the inflammation and infection worsen, the appendix swells and begins to irritate the muscle and tissues of the abdominal wall, producing pain in the right lower quadrant.

2. Vitals really are as important as everyone says they are

Abby Hoobler, EMT-E auscultates to determine heart rate

I will concede that my EMT instructors definitely tried to tell us this. Often though, vitals are taught in the second lesson in EMT class, just after the chapter on consent and other medical-legal issues. It’s taught up front in a focused lesson, but really should be a longitudinal study. We spend much more time up front focusing on how to take those vitals, and less time as we go along learning how to interpret and act on those vitals.  Ask yourself – how long is your differential diagnosis for hypotension?  Bradycardia?

Vital Sign DDx Carry Cards

If you’re struggling for more than 5, try this: at the top of an index card, write “hypotension.”  List all the diagnoses you can.  Now make similar cards for hypertension, bradycardia, tachycardia, respiratory depression, tachypnea, hypothermia and hyperthermia.  Carry the cards with you on shift.  Ask colleagues to help expand your list.  Pay attention to which conditions appear on multiple cards.  You’ll be surprised how much you can learn.  And next time you feel like you are doing EMT-B&%$# work by taking vitals, you’ll realize you’re probably the most important person on scene.

3. If you communicate well, doctors and nurses WILL listen to your turnover

We want to hear your turnover, if nothing else because you’ve probably asked 70% of what we will, and that will save us time. Being assertive, confident and organized in your presentations is 99% of the battle. Believe it or not, we also really really wish we could have access to the patient care report you wrote. Those initial vital signs and early medication administrations can affect medical decision-making downstream, especially if your patient gets admitted.

4. Stomas, Fistulas, Ports & Other Medical Devices

The EMT curriculum fails to educate providers about common medical procedures and indwelling devices. I never learned about the pieces and parts of a foley, colostomy, mediport or dialysis fistula, yet in any given day, 40-50% of EMS calls can be to Specialized Nursing Facilities (SNFs) where patients have problems with any or all of these devices. We do an ok job with complex devices like LVADs, but there are tremendous gaps otherwise.  Here’s one to start:

Stoma – Any man-made hole through skin or tissue that connects a normally internal structure to the outside world. So, the hole in someone with a trach is a “tracheostomy;” the bag attached to the hole coming out of someone’s abdomen and intestines is a “colostomy,” just like the drain in the head of a kid with hydrocephalus is a “ventriculostomy.” If you want to know the grossest thing on the planet regarding stomas, look up “Philadelphia Sidecar” on UrbanDictionary.  Yes, it’s a thing.

5. Normal Values for Basic Labs

Along the same lines as above, many patients are sent to the ED by a doctor due to an abnormal lab value.  Arguably, if the lab is concerning enough that the doctor wants the patient seen emergently in the ED, then you should probably know the normal range for that value, and what to expect if it’s high or low.  If you responded to an urgent care center for a potassium of 8.2, would you think to call a Paramedic?  I know I wouldn’t have 5 years ago.  Turns out hyperkalemia can kill you, but you don’t get to learn that until Paramedic School.  Whenever I need something complex explained eloquently, I always turn to my friends at KahnAcademy.

Familiarize yourself with the components of a Basic metabolic Panel (BMP) and a Complete Blood Count (CBC) and you’ll be 95% of the way there.

Check out the follow-up to this post, written by my husband, Amir: “5 things I learned in EMT School that I wish I learned in Medical School.”


Oceanfront Sunrise, Virginia Beach, VA