Birds and Bridges

By Anonymous

“The moment you doubt whether you can fly, you cease forever to be able to do it.”
― J.M. BarriePeter Pan

I was a bird. I’d flap my wings and the world would move beneath me.
I climbed to new heights and rode the currents to lands known and uncharted.
This was the only life I knew. Flight was so simple, so fast, so elegant.
That I could soar clearly meant that I myself was elegant, strong and quick.

I came to love the company of the other birds.
Together we sang and played as if gravity were not a law but a suggestion.
I looked down and felt the yearnings of those toiling on the earth
And I yearned to have them join me; those people of stone and clay and steel.

Be less heavy, I urged them through thoughts both silent and spoken.
Unburden yourselves from these materials of great mass.
Forget your towers and your bridges, your fears and your plans
For it is these that bind you to the soil; it is these that keep you down.

Some people heeded the call of the birds
They sighed their last sigh, hammered their last nail
And took to the sky to move from place to place by will and cheer alone,
Never again to make a journey by first taking a single step.

I have started a new journey now and it began as they so often had.
The thrill was my sun and vitality. My friends were my wind and my air.
Us birds were first to every milestone. We shared our bird’s-eye-view when we could.
Beak glinting like a beacon in the sky, I soared and I spun as I’d always done.
———————————————————
I was a bird. I’d flap my wings and I THOUGHT the world would move beneath me.
There is a funny thing about flight. Flapping ones wings is not enough.
To glide requires the wind, the air, the heat of the sun. Every inch I’d ever moved I owed to them.
Without them, I was no more mobile than the stone I’d grown to detest.

I’d traded the bonds of steel and stone, for shackles more ethereal.
Destinations and origins always had seemed close to me; no mountain seemed too high.
But the path of the avian among us becomes treacherous in a storm.
Flight becomes impossible when a bird grows weary; impossible without the sun or the moving air.

The Journey has become long now and the time for distractions is small.
My wings are tired of flapping and the sun and the air have grown sparse.
I fear that I must land now and blaze a path in a brand new way.
This terrain is alien and scary to me. I am not used to the sky being so far.

I flex my toes and take my first steps; faltering like the clumsiest of toddlers.
However will I reach where I am going with so many obstacles littering my path?
There are rivers and valleys to cross and mountains to peer over
Yet I am stuck here in the land of the stone and clay and steel.

As I search for those I thought were still behind me,
‘Toiling and tinkering with their materials of great mass,’
I realize I am alone. I look around, begging for something familiar, but experience only emptiness and silence.
Surrounded by hardness, I begin to miss the clouds and sky. I sometimes look up at what I’ve lost.

That’s when I see them: those people of work and toil:

Far above me in the clouds I see the products of their efforts.
I see the towers and the lanterns serving as beacons to let others know they are there.
These toilers are now the children of the sky and I am the one bound to the earth.
The lack of sun or wind will not shake them in their towers. To them, gravity is not a law but a suggestion.

From there they can see the other people of stone whose hard won bridges have gotten them to their goals.
Their toils took them time but the path they’ve made across the valleys will not shake
A bridge is neither ethereal nor ephemeral. It is methodical and elegant and strong.
The stone and steel, whose mass once scared me, I realized offered permanence and strength.

I once thought that through passion alone one could meet any challenge under the sky
I believed that only through chasing dreams could one reach the stars.
To toil I felt was solely the purview of those who hadn’t learned
that there exist shorter distances between A and B than that straight line that so many seem to love.

And while I still feel this to be true, I see that often the straightest line is the strongest path.
My hubris has begat a new humility and an appreciation for a day of honest work.
I now see that a balloon that isn’t “tied down” drifts away far too fast to serve its purpose.
On this new unfathomable journey I must learn to embrace these ‘materials of mass and substance.’

As I, a creature so dependent on being light that even my very bones are hollow,
struggle to make the journey of a thousand steps I will need some guidance and support.
I need to build a brace to strengthen my brittle untested legs for what’s to come
I shall build it of wood and flint and not the clouds and breezes of my former dominion.

To the toilers: While once I looked down and willed you to join me in the sky, now it is I who peers up at you.
You who remain suspended high above the earth without depending on anything but your bridges,
built so carefully and held together by your own sweat and elbow grease.
You people for whom the world is linear, and for whom order and discipline come naturally

I must ask of you a favor:

Teach me to be a stonemason, to build a foundation tall and strong
Prepare me for when the wind dies down so that I shall not fall.
Teach me to be a welder; to build connections one beam, one step, at a time
Prepare me to get where I am going when I have grown too weary to spread my wings.

Do this and I promise you, when our fatigue begins to wane and the sun and air return to give us strength,
I will cast off the braces from my legs and use their flint and wood and steel to light in you a spark.
I will show you what it means to be a bird. To let go of the details and dream without restraint,
To get somewhere simply because you want to be there and fully believe that nothing can stop you.

Together then we can build bridges to the ends of the earth and towers to the limits of the sky
And then upon reaching the limits of perseverance and toil, we can use these “boundaries,”
As our origin and then as “birds” surpass these limits, soaring higher and farther than any thought possible.
Together we can become physicians who help keep our patients strong of body and light of spirit.

Stones and Air, Steel and Sun. Substance and Freedom.
Balancing Birds and Bridges Breeds Bolder Breakthroughs.

At The Heart Of NYIT-COM

By Christie Ton, OMS II

This picture was taken after the fashion segment of the Taste of The Nations event and shows various students in traditional clothing from their country. At the heart of NYIT-COM are all the faces and smiles of the students, doctors, teachers, and staff that comprise this community. And while we are all here with the same heart to do good and to help others, every heart has a different composition of emotions and reflections. A part of every heart’s composition is culture and traditions which give us our foundation. We learn to embrace it and we learn to embrace the culture and traditions of others. Embracing culture, understanding differences, and listening to each other is really at the heart of medicine and the heart of the patient-doctor relationship. As we come together and realize the diversity of customs, ethnicities, and backgrounds within our community we begin to build an excellent framework to house our hearts.

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Alumni Highlights

Alumni Highlights

Compiled by Jaclyn Chua, OMS-IV 

The following alumni highlights include an extraordinary set of mentors at varying levels of their training who graciously agreed to provide personal advice on questions that were unique to each year of medical school. Included are two highlights from an Emergency Medicine and Internal Medicine intern belonging to the most recent graduating Class of 2014, a Pediatric resident from the Class of 2013, and a Psychiatry resident from the Class of 2012. They are all personal role models of mine, and it is my hope that their advice alleviates any anxiety that often comes with the fear of the unknown.

 

JOHN P. FLAHERTY, DO

Class of 2014

Emergency Medicine Resident, PGY1

St. Vincent’s Hospital, Allegheny Health Network, Erie, PA

 

What should my priorities be as a first year?

Work hard. Learn how to study efficiently. Take care of yourself mentally.

#OMS1, What if I don’t know what I want to do?

That’s okay, but you really need to start narrowing it down by March/April of third year. In the meantime, make sure you have a CV that is up to date.

#OMS2, #Boards

Studying for boards is a long process. You should start studying after Christmas break. No matter what, plan on doing all of the USMLE World and one of the COMLEX question banks. Do not get frustrated when you get questions wrong. Those are the ones that you will learn from. Take at least a few practice tests, perhaps one a month before your scheduled test date and then another practice test a few weeks before your scheduled test date. If you are thinking about taking the USMLE, schedule it. Doing UWorld and COMLEX questions will prepare you for both tests. You should take a practice USMLE a few weeks before the test to see if your score is where you want it to be. You can always opt out of the test if you feel like you are not prepared for it. Do not get frustrated.

#OMS3, #Showcasing

If you are going to go into a field you have not rotated in, like EM or Anesthesia, you need to set up some of those rotations early in your fourth year so that you can decide if that’s truly the field you want to go into. This will be so you have a source of letters. You can also have another rotation in that field during the fall of your fourth year.

#OMS4, #ERAS

ERAS is pretty simple to use with most of it just plugging in data from your CV and personal statement. Submitting an application to a program is inexpensive. It is best to apply broadly at the beginning and so that you have more options at the end. Researching programs take a long time, but reviewing a program’s website is a start. You will also learn a lot about programs while you on the interview trail.

#EmergencyMedicine, #SLOR

You will need decent board scores. EM programs require a specific kind of letter of recommendation called the SLOR. Typically, you will need two. They must be written by an attending physician which whom you have rotated. Your last two letters should be from someone pertinent.

 

RAYMOND CHIONG, DO

Class of 2012

Psychiatry Resident, PGY3

Undergraduate: NYU

Westchester Medical Center, Valhalla, NY

 

#OMS1, What if I don’t know what I want to do?

As a first year, you should try to just acclimate yourself to the academic rigors of med school. For me, it felt like a whole different level of concentration and studying was needed in comparison to college.

#OMS2, #Boards

Try to start studying for it as early as you can. You will need to organize your time because you will also need to dedicate time to your 2nd yr course load.

#OMS3, #Showcasing

Try to rotate in hospitals or physical locations where you hope to do your residency. This also applies to your early 4th yr rotations. For most programs, it can be a huge asset to have had rotated in their hospitals. Try to keep an open mind through all your rotations. Don’t be afraid of or dismiss psychiatry off the bat. One of the skills that you learn on your psych rotation is to how to listen empathetically which is a skill that you will need in most specialties.

#OMS4, #ERAS, #Interviews

Get your letters as early as possible because you’ll inevitably have to start stalking some people to get them to write or upload the letters. Get letters from doctors in the specialty that you’re interested in and if possible, from the specific program. There’s no such thing as having too many letters so get as many as you can. Enjoy your interviews! They are less awful than writing your personal statement or waiting for match day. Rank the programs in order of your preference – don’t try to outsmart the system or worry about how the programs will rank you.

 

PRIYAL PATEL, DO

Class of 2013

Pediatric Resident, PGY2

Undergraduate: Fairleigh Dickinson University

Nationwide Children’s Hospital, Columbus, Ohio

 

Why pediatrics? Fellowships?

I knew at the age of 11 years that I had an interest in Pediatrics. However, in medical school, I enjoyed most of my rotations and had a really tough time picking what I wanted to do. However, I ultimately did decide to go into Pediatrics, and I LOVE IT. I love my job and after starting residency, it seems like I absolutely made the right decision. I am very happy at Nationwide Children’s Hospital. We see cases here from literally all around the world. It has given me the opportunity to see both the “bread and butter” of pediatrics as well as be a part of taking care of patients with very rare conditions. Doing my residency here has also given me the opportunity to test out many sub-specialties and to do clinical research.

I originally was interested in NCH for their Pediatric gastrointestinal fellowship, but soon after I did my ward month on the Hematology/Oncology service, I knew that was what I wanted to do with my life. I am currently in the process of apply for Hematology/Oncology fellowships.

#OMS1, What if I don’t know what I want to do?

The main priority during the first year is the survive and to learn how to balance social vs. school life.  First year of medical school is emotionally and physically draining at times. Don’t get caught up with trying to figure out what it is that you exactly want to do in life. All of that will make more sense after starting the clinical years of medical school. Also, by the end of first year, it is advised that the students start thinking about how they will study for the boards.

#OMS2, #Boards

The best advice I can give is to stay calm and do a lot of questions. Everyone studies differently, but what worked for me was picking a couple of review books to read and to get through two question banks.

#OMS3, #Showcasing

For third year, decide early if you want to do a regional rotation or if you want to take the route of ranking different sites in the lottery system. I chose to do a regional in upstate NY in Kingston. I was happy with the regional because it gave me the opportunity to get to know the attendings and residents very well. Also, the regional I chose did not have a lot of students, so I had the opportunity to do a lot of procedures and to be first assist on a lot of surgical/OB cases.

It honestly is a personal choice of whether to chose a regional or not. Either choice is fine. The point of third year is to get as much exposure as possible in the different specialties. Always be on time for the rotations, ask questions, ask to do procedures, show initiative, never disappear during your work-day and just have fun. Third year will ultimately solidify what specialty you want to go into. It is a great time to start asking for letters of recommendations.

If you are interested in Pediatrics, try to do your pediatric rotation at a place that will let you do both in-patient, specialty and out-patient pediatrics. The reason being is that this will give you the opportunity to figure out whether you are interested in primary care pediatrics or doing a specialty. Knowing this will help you decide what kind of residency program to apply to. For example, I knew I was interested in doing some sort of specialty, so when I was applying for residency, it was important for me to know how many residents at a particular pediatric residency went onto doing fellowships. Also, it was important for me to know if the residency program offers research opportunities (because, research is very important for Pediatric Fellowships and Fellowship programs often look for candidates who did some sort of research in residency).

#OMS4, #ERAS, #Interviews

The biggest advice I have for the application process is to get everything done on time. Do not waste time and start your ERAS application at the last minute. Make sure you know who to ask to get a letter of recommendation from. I started asking for LORs during my third year rotations. Definitely get one or two letters from a doctor in the specialty that you are applying from. Also, try to get a letter from a program director you worked with as a third or fourth year. Residency programs love to see what program directors think of certain students. I got five total letters and submitted a different combo of four to the different residency programs I applied to. I got one letter from a Family Medicine Program Director at the regional I worked at. One letter was from a Pediatric Assistant Program Director that I worked with as a 3rd Year student. One was from a psychiatrist and one was from the head of the Gastroenterology Practice that I worked with during my 3rd year elective. Also, I got a letter from the head of the Discovery Health Center director who was trained in Med-Peds. Most residency programs only allow applicants to send 3-4 LORs so I chose from these letters which ones to send.

As for ranking programs, go with your gut feeling. I made a word document for every place I went to for an interview. In this document, I included the pros and cons of each program. I ranked based on fellowship and research opportunities and also based on where I thought I would fit in best. There were programs I interviewed at that looked good on paper but not during the interview (i.e. the residents were unhappy, program directors did not seem invested, etc.). I did not rank these couple of programs at all.

 

PUNITA SHROFF, DO

Class of 2014

Internal Medicine Resident, PGY1

Undergraduate: Drexel University

Mount Sinai Beth Israel, NYC

 

Why internal medicine? Fellowships?

My first rotation as a third year was in internal medicine. I knew before starting rotations that I would either end up in IM or pediatrics. I kept an open mind throughout the year, and found myself really loving OB/GYN and even surgery. In a 5-10 week time span those rotations were great, exciting and I experienced my many firsts. I saw my first vaginal delivery, I scrubbed in on my first OR case, and I attempted my first intubation. In pediatrics, I found myself smiling almost at a constancy – kids are so darn cute. But I found that pediatrics is a lot of times reassuring worried parents, and as much as I loved playing with kids, seeing them very sick was not easy either. When it came time to decide what specialty to go into, I won’t lie, I was very uncertain. Life decisions are scary, the fear I’d make a mistake was very apparent. But when I sat down and thought about it, I realized I found myself looking back on my IM rotation. The patients I encountered, the intellectual conversations, and the down to earth residents who worked hard but still smiled every time they walked into a patient’s room.

#OMS1, What if I don’t know what I want to do?

As a first year medical student, focus on passing your exams. Medical school isn’t impossible, but it requires commitment and dedication. It’s okay not to know what you want to do with your life in your first year. Your main goal is to stay afloat and do the best you can. Also, don’t neglect yourself – eat, sleep, exercise, make time to go out every now and then, and always remember to call your loved ones.

#OMS2, #Boards

It is not impossible. Keep your head up, focus on your own journey and do not get discouraged. We’ve all been through it, we’ve all survived.

#OMS3, #Showcasing

I decided to do all my rotations at NUMC, because I didn’t want to be moving around every few weeks. In terms of making a schedule, I would talk to as many upperclassmen as you can. Find out what rotations are great for learning and experience (not all rotations are created the same). If you’re interested in a specialty at a specific hospital that our school allows us to rotate at, it’s a good opportunity to show your face and your interest. However, be mindful that if you end up not impressing them, you’re putting yourself at a greater disadvantage. So make sure to put your game face on! Good luck, and third year just means the light at the end of the tunnel is that much closer!

#OMS4, #ERAS, #Interviews

Be organized! I wrote down all the dates of when things were due and made a plan for myself. It’s overwhelming, but having a time line makes things easier. Towards the middle of your third year, begin to ask for LOR as it will take some time to obtain them from your attendings. The higher the position, the better the letter will look. Focus on quality versus quantity (3-4 is sufficient). Also, polish your CV so you can provide your letter writers with more information about you. The CV also serves as a template for ERAS. If you are obtaining letters from someone who you rotated with very early on, also provide them with a brief paragraph or two about your experiences. It can help them jog their memory, and make your LOR more personalized.

How to rank programs will be dependent on what you want in a program. Is it the location, education, prestige, camaraderie, salary etc? After every interview I went on, I made myself a pro and con list for what the programs offered. Initially, it helped me gather my thoughts on the programs. I also started making my rank list early, and tweaked it as I went on. The truth is, I never really followed the pro con list and chose to rank programs based on my gut. Really simply, I thought about what I would be happiest with if I were to open my Match envelope at that very moment.

I’m pleased to say, it all worked out in the end.

Subtleties: OMM in a Unique Perspective

By Elizabeth Stachtiaris, OMS III

“Did you see him leg yield outward after his neck rounded?” I excitedly asked my medical classmate as I sat atop my horse, out of breath after an exhausting equine workout. My audience-of-one confusedly stared up at me. “Um…what?” I quickly realized that the visual and palpable movements of both my steed and myself, that were clearly observable to me, were too minimal for a novice to perceive. I quickly responded, “Oh, never mind. Watch me jump this oxer,” opting to display a more obvious feat.

Equestrianism is a sport of elegance and efficiency, incorporating myriad subtle movements of the rider aimed to transform the team into an unstoppable force ready to face various challenges, such as large jumps or intricate dressage techniques. A beginner might be able to rudimentarily complete these tasks with superfluous actions, which frustrate the horse and render the performance atrocious for spectators. However, a skilled equestrian masks his actions, making his riding seem effortless, while maintaining complete control of the animal underneath him. These nonverbal communications relayed to the horse allow both individuals to become a unified duo able to complete enormous tasks in competition.

The skill of subtlety only comes with years of practice. There are no short cuts. A beginner in horseback riding looks to professionals with admiration and jealousy, hoping to one day attain the skills necessary to become a successful equestrian. As an experienced rider, I cherish my years of training and ability to compete at a high level. However, as a third year medical student at NYIT College of Osteopathic Medicine, I now identify as a frustrated novice in the department of Osteopathic Manipulative Medicine. On the first day of OMM, our professors reassured us that mastery of palpation only comes with time, patience, and practice. They preached that as trained physicians, we would be able to feel numerous somatic dysfunctions and treat them with both our hands and medical innovations, practicing a holistic view of healthcare. In disbelief I laid my hands on my partners back, attempting to listen to the body with my fingers. I felt nothing. I heard nothing. I struggled in this field of medicine completely out of my comfort zone, inspired to persevere only by the doctors’ encouragement. My classmates, who did not feel anything either, and I simply performed the required techniques mandated by the curriculum, hoping that one day we would develop the necessary palpatory skills necessary to exemplify esteemed osteopathic physicians.

Despite the grueling medical school curriculum, I rode my horse every morning before classes, enjoying a field that I have mastered as a respite from the frustration and confusion of osteopathic education. A rider does hundreds of subtle movements with his hands and legs per riding session, communicating nonverbally to his partner. As I performed these equine techniques for my fellow osteopathic medical student, it was clear that he did not perceive them, and merely saw me as a girl on a horse “making him go.” I then realized the similarities between equestrianism and osteopathic manipulative medicine. A rider must partner with the horse, just as the physician must team with the patient’s body. The physician’s hands must nonverbally communicate with the body, patiently listening for anything it has to say. They must learn the body’s limits and incorporate them into treatment methods aimed to ameliorate physical dysfunctions. Both the physician and patient must cooperate to achieve the common goal of health, just as the horse and rider must collaborate to jump over a five-foot oxer.

After many years of working with my horse at high levels of competition, we have formed a strong and loving bond. As a future osteopathic physician, I trust that my many hours of palpatory practice will grant me the necessary skills to form a special relationship with my patients, along with the ability to offer them an extra tool in the medical field to alleviate their pain. As a third year medical student, I know that I must be patient to acquire the subtle skills of osteopathy. However, I am aware that there are no short cuts to expertise. I must allow my separate lives as the equestrian and the medical student to integrate in order to become a well-rounded physician.

It’s Gonna Be Okay

By Chidoziri Conrad Nwokoro, OMS II

President Franklin D Roosevelt once said “the only thing we need to fear is fear itself”. Time and again in the journey through medical school, many students feel completely lost, develop fear or anxiety, and perhaps develop a feeling of insufficiency or low self-esteem. This is even more so when the exams begin to flow like the Hudson and the test scores keep going down with a somewhat inexplicable dissociation between studying efforts and scores achieved (academic input/output disjunction). Sometimes health becomes an issue as well. It may be a physical breakdown in health, or even worse, an emotional breakdown. Some students feel they can’t make it through medical school; some even start making alternative plans for “when the inevitable happens”. Some look down on themselves, etc. In those dark moments, or perhaps dark periods in time, when all hope seem to be gone, and despair seems to reign, I’ve got a message for you . . . it’s gonna be okay.

Let’s get some facts straightened up. Medical school is no picnic. It’s not going to be easy. It is one place in the world where very brilliant, hardworking students fail exams. It’s not for the faint hearted. However, one hidden fact is, as long as you passed your MCAT, you can do it. Yes you can. It takes patience, hard work, intelligence, persistence, organization and determination to pass the MCAT. Hence if you made it through MCAT, you have what it takes to make it through medical school. Remember, there are thousands of brilliant students out there, who have tried to get into medical school without success. But you made it. You are smart enough to pass through the medical school. You just have to believe in yourself. And by the way, this is not an opinion, it is a fact. Yes, it is true; you are good enough to make it through medical school.

Passing through medical school is fraught with lots of obstacles and potential pitfalls. Occasionally the medical student may have reasons to be disappointed at one time or the other. For the purposes of this write up, let me divide the disappointments into 3 or 4 categories.

1. When you pass the exam with fantastic scores but did not make the honors territory. This is usually not much to worry about. Having fantastic scores in exams is a great thing and worrying here may be a bit unnecessary. I’ll rather the student replaces the worry with determination because there is nothing to worry about in this scenario.

2. When you pass but your scores are not fantastic. Here, my advice is that the student should simply step up his or her game. It may mean greater focus, extra hours, going the extra mile or simply working a little bit smarter than usual.

3. When the student failed the exam. Well, it is normal to be worried a bit here, but more importantly the student must rise to the occasion because, there’s another exam coming, and very soon. Constant worry may become a hindrance and perhaps even tread near the borders of psychiatric disorders.

4. When the student fails a system. This is real cause for concern. The consequences may be heavy. However, there is no reason to be in despair. Problems need solutions, not despair, and one may do well to understand that many have remediated a system and still went ahead to do well in the boards. All it takes is determination and discipline, not despair.

5. When one fails two systems and has to repeat a year

6. When one drops out of medical school

In all of these cases, attitude makes the difference. The problem with problems is that the problem is not the problem but the response to the problem may be an even bigger problem than the original problem. The best way to respond to these difficult situations in a medical school is to have a firm belief in one’s capabilities. Every problem, or at least almost every problem, has a solution. My initial advice to students, especially new students in medical school is that they must know that they have what it takes to be a doctor. As long as they passed the MCAT, they can do it. Period. They have the necessary IQ. Now they must introduce discipline, persistence, patience, proper planning and time management, etc, to make it all work. When school work seems to be impossible, my dictum is. . . it’s gonna be okay.

Concerning exams, for success to come, students need to have a plan that works. Different students may have different ways of studying and there may be no single plan that fits everyone. However, the best time to prepare for an exam is to start as early as possible. It may be a good idea to read through the coursework twice or more before an exam. The student should also find time to relax and will do well to remember that good sleep enhances memory. So this mix of near extreme hard work and relaxation needs the skill of time management. Here my advice is for the student to have a plan on how to spend the day even before getting up from bed in the morning.

Eat; don’t forget good food, regular exercise, adequate rest, and good relaxation. Deficiency of these could bring physical or emotional breakdown in health. In medical school, you don’t want to get sick at all. You can’t afford to. No, you can’t.

Before I finish, let me address the last two categories of disappointment. If in the unfortunate event one fails two systems and drops out or has to lose a year, there’s still room for optimism. Yes I said so. Remember, losing one year is not the end of your chosen career. It is a challenge that must be confronted and overcoming may even give you the extra emotional ability to handle unexpected stress, which is never scarce in the medical field. If a medical student finds himself or herself repeating a year, he or she must take it as an opportunity to start afresh and use the experience gained to make things right this time. Keep moving forward because . . .it’s gonna be okay.

If in the unexpected event one is eventually kicked out of medical school, this is sad and I honestly don’t have much advice to give with regards to restarting the lost dream of being a doctor, but I know one thing, it’s not the end of your life. And my experience in life confirms that if you keep a positive attitude to life, without forgetting to think outside the box . . . . it’s gonna be okay.
Finally, let me end by advising, be strong, sit up, step up, work hard, relax when you can, smile, because. . .. it’s gonna be okay. :-)