"It is not the person who has too little, but the person who always craves more, that is poor."
-Ancient Chinese Proverb
Without peace of mind, happiness cannot exist. I have always tried to do what I felt was best for me, as well as those around me. My choosing Psychiatry as a career is no exception. I chose psychiatry because it is one of the only fields of medicine that delves into the more intangible elements of disease-the mental health disorders, which have always fascinated me.
I credit part of my early interest in mental health disorders to my grandmother who is the Director of one of the largest community mental health facilities in Chicago, Illinois, where I was born and raised. I attribute the remainder of my early interest in mental health disorders to my surroundings while growing up in Chicago. Due to my surroundings, I recognized the symptoms of depression long before I could put a name to it. I regularly found myself daydreaming about what I could do to help those around me even as a child and throughout my teenage years. You can imagine my further frustration when I discovered the stigmatism associated with mental illness in my community. Amongst African Americans, and in the United States as a whole, there seemed to be a negative view of people who have mental illnesses. Somehow their chronic illnesses were different from the other more commonly talked about chronic medical illnesses such as hypertension or diabetes mellitus. Yet despite this overbearing negative public opinion, my interest in helping those who are mentally ill only continued to grow. By the time I reached medical school I had no doubt I was going to be a Psychiatrist.
Admittedly, I wavered at times, due to the various pessimistic attitudes and comments of my peers, and at times, my mentors towards the profession. Also, during my Inpatient Psychiatry rotation in my third year of medical school, I encountered my first in depth experience in the field of Psychiatry. I went in to the rotation with dreams of Freudian Psychoanalysis sessions; I left with a reality check that shook me to my core. I quickly learned that the managed care industry, large randomized controlled pharmaceutical trials, and the need for faster modes of therapy had long ago replaced the eclectic treatment form I had dreamed of. What I saw were patients who were severely psychotic, suicidal, homicidal, or a combination of the former. Most of them stayed in the inpatient unit until they were stabilized and then discharged-usually 3 days. Although a much needed service, it was not what I had in mind for my career choice or myself.
As a result, I looked into the other fields of medicine, including Internal Medicine. Internal Medicine appealed to me because it gave me the opportunity to use most of the medical knowledge I was learning in medical school, including Psychiatry. There was a strange comfort in the well-defined diagnostic methods and treatments that I routinely encountered in my rotations, yet I found myself inquiring about patients' moods and dispositions even when it may not have been essential to the case. For example, after hearing how gastric esophageal reflux disease forced a severely obese patient to change their diet, I began to inquire about symptoms of depression in addition to the commonly asked questions in the review of systems. In time, I realized that I was "hard wired" for Psychiatry. I had no desire to "shake" my love of mental disorders-organic or otherwise, however I walked away from the other specialties appreciating the importance of maintaining one's general knowledge of medicine no matter what their specialty may be.
At the beginning of my last year of medical school I was accepted to the Asklepios International Telemedicine Consortium Fellowship in Germany. During my matriculation there I spent time working with Psychiatrists and Trauma Surgeons, and helping with the Telemedical research and testing of a new Global Positioning System based Emergency Medical Response technology for Southern Germany. The new response system allowed the paramedics to enter medical data and have it transferred real-time to the Emergency Physicians- who travel to the scene of the emergency and to the hospital. The software was also programmed to translate between English and German as an incentive for the United States Army to purchase the technology. While there, I discovered that Psychiatry was practiced in the same way overseas as it is in the United States, except equal emphasis was given to pharmaceutical and to non-pharmaceutical adjunctive therapies. Areas of therapy such as psychotherapy, art and music therapy were regularly used with all of the chronic patients. It was a welcome change to what my mind had begun to accept about the practice of Psychiatry.
I came to several realizations during my time there. I realized the importance of language proficiency in the practice of medicine both in the United States and abroad. I also became truly conscious of the importance research plays in the advancement of medicine, whether that research is clinical or technological. Most importantly, I revitalized my faith in Psychiatry and re-realized the important role it plays in the healing process. These realizations were the basis of my decision not to enter the National Residency Match Program in 2004. Instead, I decided to spend the year conducting research. I have had the opportunity to work on research in HIV/AIDS in minority women in Washington, D.C. The results of the research were presented at the July 2004 AIDS Conference in Bangkok, Thailand and published in the annals of the conference.
In early 2005 after "The Match", I spent time in Puerto de la Cruz, Tenerife, Canary Islands Spain in for Spanish language proficiency training, and to experience another facet of medicine abroad. My stay in was only for 2 months, as I had already had the opportunity to study Spanish in high school and undergraduate college. The nine weeks of linguistic-cultural immersion was adequate to push my Spanish-speaking ability to a medically functional level. I plan to continue my study of Spanish with a focus on medical Spanish to implement it during my Psychiatric career.
So how have research and traveling abroad play into my career in Psychiatry? I would ultimately like to work with the World Psychiatric Organization in some capacity in the future. Politics has always interested me; its role in the advancement of medicine has already been established worldwide. My other areas of interest include Disaster and HIV/AIDS Psychiatry. Eventually, I would like to participate in collaborative international research initiatives dealing with the acute treatment of Post Traumatic Stress Disorder, especially in war torn countries.
Then again, one does not have to travel to a foreign country; you can find a "war torn" atmosphere in almost any inner-city community in the United States. Eventually I would like to start multiple multi-service, multi-ethnic community based clinics in major cities around the United States. My aim is to have the clinics funded by federal and private grants and investments as well as by the other revenue they bring in. My goal is to provide the surrounding communities, especially those of underserved populations, with mental health care, primary care, complimentary and alternative medicine and social services. I had the opportunity to work in a clinic that was very much like what I have envisioned myself creating in the future. Yet, the clinic was founded to serve a very specific population and thus was limited in its spectrum of care.
I have undeniably cast my net of future goals very wide. However, I am already on my way to fulfilling my goals and dreams. I am currently a Post Graduate Year One resident at in the George Washington University Medical Center Psychiatry Department. While the busy work schedule of Intern year has not allowed much time for dream fulfillment, I have had the chance to start attending the Hospital Emergency Preparedness meetings. I truly view this opportunity as an honor because I am one of the few residents who attend these meetings. The prospect of jointly working on a Masters of Science degree in Public Health during my residency also represents another possible "stepping stone" along my path of goal fulfillment. Regardless of how my career development unfolds, over the years, I know I will significantly impact the vast morbidity that mental health disorders represent in the world today-in our country and abroad.
Friday, June 27, 2008
SAMPLE SOP - PSYCHIATRY 1
When I started medical school 10 years ago I had just graduated with honors from a good university, and I thought I knew something. Only later did I discover how ignorant I had been about mental illness.
Back then I had no idea how common the serious mental illnesses are, and when I thought about them at all I had a vague idea that mental illness was a sort of permanent generic weirdness that ran in families: something out of Arsenic and Old Lace. My only encounter with psychiatry had been an uninspired lecture during my college pre-med seminar from a psychiatrist who seemed more odd himself than the patients he described. I still have the homework from that class on which I wrote "psychiatry is definitely a low-interest career for me."
The first hint of interest came in my required neuroscience and human behavior courses in the first year of medical school. I found the brain, with its connections to our very selves and its complex physiology, infinitely more interesting than (say) the heart, which can after all be replaced by an artificial pump and in which nearly every cell does the same thing. Still, I had a hard time imagining myself as a psychiatrist. My student clerkship in neurology should have been a clue since I thoroughly enjoyed the rotation but found the nervous system below the neck a complete bore.
The turning point for my career was my student psychiatry rotation at John Umstead State Hospital in Butner, North Carolina, where I learned three crucial lessons. The major psychiatric illnesses are syndromes. They are common and serious but often treatable. And I love being a psychiatrist.
My first patient had never read a psychiatry textbook but showed every textbook feature of mania. Her thoughts were confused and she was essentially unable to function. After a week of lithium the difference in her behavior and ability to function was astounding. It was obvious to me that mania was a syndrome: a collection of medical symptoms shared by many patients, usually with the same underlying physiology. The idea that her manic behavior could be merely a personal idiosyncrasy seemed ludicrous. I wanted to know right then what wasn't working right in her brain when she was ill, why it wasn't working right, and why it worked so much better with lithium.
This patient and others at the state hospital also taught me that psychiatric illnesses are the most human of all illnesses. A broken leg or an infected lung affects a peripheral part of someone: it doesn't change one's perceptions, one's emotions, one's thought patterns, even one's very self-image. I previously had no idea of the stigma patients faced in the world in general and even among the general medical community. I also had no idea that with proper diagnosis and treatment many people with psychotic illnesses could return to perfectly normal lives.
Knowing about a patient's life and social setting, theoretically important for any doctor, was finally considered a genuine part of my job. I came home enthusiastic about trying to help my patients. For the first time, I found myself reading widely in the medical literature because I cared passionately about the answers rather than because I had to. And best of all, often my patients got better, and sometimes it was even because of something I did. I loved being a psychiatrist.
These three lessons from my medical student days are still a big part of why I chose psychiatry for my medical specialty training. But why do I also do science?
In part it's because I am still fascinated with how the brain works, both in health and in illness. In part it's because of my own personality features. But a big part of the answer is my conviction that the best answers for my patients will eventually come from scientific research.
It is true that our current treatments for schizophrenia, manic-depressive illness, obsessive-compulsive disorder, major depression, and panic disorder help millions of patients, and our knowledge of effective psychiatric treatments has improved more in the last 20 years than in the entire preceding history of the world. But as many readers well know, we haven't arrived yet. Most treatments leave something to be desired. For instance, antipsychotic medications have many annoying and sometimes serious side effects. Antiobsessional treatments usually reduce symptoms only partially. And none of the current treatments for these conditions is usually curative. Further knowledge of the causes and physiology behind these illnesses is bound to lead to better treatment.
I know better than to hope that all my research efforts will lead to better treatment. The progress of science tends to be more like tracing a maze than like riding down a well-marked highway. After all, the only way to know for sure which studies will be successful and which won't is to know the answer beforehand, in which case we wouldn't have to do the experiment. But even though I know there will be some blind alleys in research, I am optimistic about the long-term outcome. I take heart from remembering three of the major psychiatric illnesses of a century ago: neurosyphilis, untreated epilepsy, and mental retardation due to dietary iodine deficiency. Scientific effort in the 19th century--including work by the psychiatrists Antoine Bayle, Hans Berger, and Julius Wagner-Jauregg--succeeded in demystifying, destigmatizing, treating, curing, or even preventing millions of cases of psychiatric complications of these illnesses. There is every reason to hope that the powerful research tools of the 20th and 21st centuries will make similar advances with schizophrenia and the other major psychiatric illnesses of today.
I believe modern neuroscience research will continue to make progress despite some significant challenges. For instance, medical research nowadays depends much more than it used to on the generosity of private donors, since NIH funding hasn't generally kept up with inflation and since Federal grants now cover less of the total cost of the research effort. Furthermore, even very productive researchers face increasingly stiff competition for these NIH funds, and the medical schools which employ them are facing dire economic straits themselves. Consequently, private funding is more important than ever to help keep good research going between Federal grants. In my case, I am very grateful to NARSAD and its many donors for helping me at this early stage in my research career.
My NARSAD-funded research study was first motivated by a patient with Parkinson's disease whom I saw at the beginning of my movement disorders training. Initially she was tearful, sad, apathetic about former interests, and disinterested in food, and she was considering suicide. An hour later, when her morning dose of antiparkinsonian medication had "kicked in," she was telling jokes, showing off, and feeling "on top of the world." This woman had mood fluctuations which paralleled fluctuations in her brain dopamine levels. By comparing patients like this one to patients whose mood stays steady even though their ability to move fluctuates throughout the day, my NARSAD research will attempt to discover which areas of the brain (and which kind(s) of dopamine receptor) may be more involved with mood symptoms, and which with movement.
My other current research efforts include PET studies to determine which parts of the normal brain are more influenced by each dopamine receptor subtype, as well as PET and MRI studies of dystonia. Dystonia means characteristic twisting or pulling movements of the body (like writer's cramp or torticollis) which can occur for various reasons, including as a side effect of antipsychotic medication.
Research has its ups and downs, like any sustained effort, but I live for those days when we do a new type of study for the first time, or days when we get results that may explain how part of the brain works. Although I love these moments, what keeps me going the rest of the time is my continued contact with patients. The woman I mentioned with Parkinson's disease and medication-related mood changes is one example. Other patients--like a woman in her 80s getting treatment for the first time for lifelong Tourette syndrome, or a man with Huntington's disease and severe apathy--remind me of how much we have yet to learn about how the brain produces psychiatric symptoms.
These patients also remind me that there is an important part of medical practice outside of diagnosis, treatment or even cure. No matter how much medical science progresses, and whether or not there is a "miracle" treatment or even any treatment for a given patient, that patient will still need a doctor who is knowledgeable, compassionate, supportive and understanding. Hopefully in the future, when psychiatric illnesses are even more treatable than they are today, we as physicians will still be striving for this ideal.
Back then I had no idea how common the serious mental illnesses are, and when I thought about them at all I had a vague idea that mental illness was a sort of permanent generic weirdness that ran in families: something out of Arsenic and Old Lace. My only encounter with psychiatry had been an uninspired lecture during my college pre-med seminar from a psychiatrist who seemed more odd himself than the patients he described. I still have the homework from that class on which I wrote "psychiatry is definitely a low-interest career for me."
The first hint of interest came in my required neuroscience and human behavior courses in the first year of medical school. I found the brain, with its connections to our very selves and its complex physiology, infinitely more interesting than (say) the heart, which can after all be replaced by an artificial pump and in which nearly every cell does the same thing. Still, I had a hard time imagining myself as a psychiatrist. My student clerkship in neurology should have been a clue since I thoroughly enjoyed the rotation but found the nervous system below the neck a complete bore.
The turning point for my career was my student psychiatry rotation at John Umstead State Hospital in Butner, North Carolina, where I learned three crucial lessons. The major psychiatric illnesses are syndromes. They are common and serious but often treatable. And I love being a psychiatrist.
My first patient had never read a psychiatry textbook but showed every textbook feature of mania. Her thoughts were confused and she was essentially unable to function. After a week of lithium the difference in her behavior and ability to function was astounding. It was obvious to me that mania was a syndrome: a collection of medical symptoms shared by many patients, usually with the same underlying physiology. The idea that her manic behavior could be merely a personal idiosyncrasy seemed ludicrous. I wanted to know right then what wasn't working right in her brain when she was ill, why it wasn't working right, and why it worked so much better with lithium.
This patient and others at the state hospital also taught me that psychiatric illnesses are the most human of all illnesses. A broken leg or an infected lung affects a peripheral part of someone: it doesn't change one's perceptions, one's emotions, one's thought patterns, even one's very self-image. I previously had no idea of the stigma patients faced in the world in general and even among the general medical community. I also had no idea that with proper diagnosis and treatment many people with psychotic illnesses could return to perfectly normal lives.
Knowing about a patient's life and social setting, theoretically important for any doctor, was finally considered a genuine part of my job. I came home enthusiastic about trying to help my patients. For the first time, I found myself reading widely in the medical literature because I cared passionately about the answers rather than because I had to. And best of all, often my patients got better, and sometimes it was even because of something I did. I loved being a psychiatrist.
These three lessons from my medical student days are still a big part of why I chose psychiatry for my medical specialty training. But why do I also do science?
In part it's because I am still fascinated with how the brain works, both in health and in illness. In part it's because of my own personality features. But a big part of the answer is my conviction that the best answers for my patients will eventually come from scientific research.
It is true that our current treatments for schizophrenia, manic-depressive illness, obsessive-compulsive disorder, major depression, and panic disorder help millions of patients, and our knowledge of effective psychiatric treatments has improved more in the last 20 years than in the entire preceding history of the world. But as many readers well know, we haven't arrived yet. Most treatments leave something to be desired. For instance, antipsychotic medications have many annoying and sometimes serious side effects. Antiobsessional treatments usually reduce symptoms only partially. And none of the current treatments for these conditions is usually curative. Further knowledge of the causes and physiology behind these illnesses is bound to lead to better treatment.
I know better than to hope that all my research efforts will lead to better treatment. The progress of science tends to be more like tracing a maze than like riding down a well-marked highway. After all, the only way to know for sure which studies will be successful and which won't is to know the answer beforehand, in which case we wouldn't have to do the experiment. But even though I know there will be some blind alleys in research, I am optimistic about the long-term outcome. I take heart from remembering three of the major psychiatric illnesses of a century ago: neurosyphilis, untreated epilepsy, and mental retardation due to dietary iodine deficiency. Scientific effort in the 19th century--including work by the psychiatrists Antoine Bayle, Hans Berger, and Julius Wagner-Jauregg--succeeded in demystifying, destigmatizing, treating, curing, or even preventing millions of cases of psychiatric complications of these illnesses. There is every reason to hope that the powerful research tools of the 20th and 21st centuries will make similar advances with schizophrenia and the other major psychiatric illnesses of today.
I believe modern neuroscience research will continue to make progress despite some significant challenges. For instance, medical research nowadays depends much more than it used to on the generosity of private donors, since NIH funding hasn't generally kept up with inflation and since Federal grants now cover less of the total cost of the research effort. Furthermore, even very productive researchers face increasingly stiff competition for these NIH funds, and the medical schools which employ them are facing dire economic straits themselves. Consequently, private funding is more important than ever to help keep good research going between Federal grants. In my case, I am very grateful to NARSAD and its many donors for helping me at this early stage in my research career.
My NARSAD-funded research study was first motivated by a patient with Parkinson's disease whom I saw at the beginning of my movement disorders training. Initially she was tearful, sad, apathetic about former interests, and disinterested in food, and she was considering suicide. An hour later, when her morning dose of antiparkinsonian medication had "kicked in," she was telling jokes, showing off, and feeling "on top of the world." This woman had mood fluctuations which paralleled fluctuations in her brain dopamine levels. By comparing patients like this one to patients whose mood stays steady even though their ability to move fluctuates throughout the day, my NARSAD research will attempt to discover which areas of the brain (and which kind(s) of dopamine receptor) may be more involved with mood symptoms, and which with movement.
My other current research efforts include PET studies to determine which parts of the normal brain are more influenced by each dopamine receptor subtype, as well as PET and MRI studies of dystonia. Dystonia means characteristic twisting or pulling movements of the body (like writer's cramp or torticollis) which can occur for various reasons, including as a side effect of antipsychotic medication.
Research has its ups and downs, like any sustained effort, but I live for those days when we do a new type of study for the first time, or days when we get results that may explain how part of the brain works. Although I love these moments, what keeps me going the rest of the time is my continued contact with patients. The woman I mentioned with Parkinson's disease and medication-related mood changes is one example. Other patients--like a woman in her 80s getting treatment for the first time for lifelong Tourette syndrome, or a man with Huntington's disease and severe apathy--remind me of how much we have yet to learn about how the brain produces psychiatric symptoms.
These patients also remind me that there is an important part of medical practice outside of diagnosis, treatment or even cure. No matter how much medical science progresses, and whether or not there is a "miracle" treatment or even any treatment for a given patient, that patient will still need a doctor who is knowledgeable, compassionate, supportive and understanding. Hopefully in the future, when psychiatric illnesses are even more treatable than they are today, we as physicians will still be striving for this ideal.
Tuesday, June 24, 2008
SAMPLE SOP - ANESTHESIA
For me the magic of medicine is profoundly reinforced by how we are now able to make even major surgery virtually painless. This is where I find my greatest joy and pride in life as a practitioner of anesthesiology. I am searching for my first residency assignment and hope very much to be chosen by your program. I am a very family oriented person and my family
is now mostly on the West Coast of the U.S. So, this is the geographical location that I would prefer for my first residency assignment, preferably Washington, Oregon, or California. My family is my main support system, especially since my father recently just passed away.
I feel strongly that Chinese women have much to contribute to American medicine and that our insights are complimentary to that of physicians from the West, that we often make an excellent team. Being a team player, of course, is very Chinese. I was born in China and immigrated to Hong Kong as a child, so I was already westernized somewhat by the time that I came to the U.S. as an exchange student at the age of seventeen. This experience taught me early on to rely on myself and be a
quick thinker and learner, since I came here by myself without any relatives or knowing anyone at that time. After completing high school here, I went on to study nursing in the University and completed my BSN. Next, I worked as a nurse for five
years and then went on to medical school. I recently received my M.D. Degree.
In addition to my education, my application is strengthened considerably by my professional experience. I worked in various fields in nursing prior to going to medical school: medical, surgical, obstetric-gynecology, same-day surgery, rehab, nursing home, critical care, etc. Thus, I have already had a lot of exposure to a variety of health care settings and I am highly familiar
with the practice of many different aspects of medicine.My experience in critical care nursing is especially relevant to my decision to practice anesthesiology as a physician because I
have a lot of experience dealing with very sick patients who need to be constantly monitored and, often, in need of rapid life-saving interventions needed. I am especially accustomed to IV monitoring and numerous other procedures that the anesthesiologist needs to have mastered. I am especially comfortable working in the critical area of emergency room care. I
am someone who communicates well with non-native speakers of English and people from all walks of life. I keep a cool head in emergencies and work best under pressure. It is my hope as well to be able to use my linguistic skills in the course of my work as a resident physician in the area of anesthesiology. Since I am a native speaker of both Mandarin and Cantonese, I
might be able to make a special contribution to your program since there are so many immigrant speakers of these languages in America, especially on the West Coast.
I felt most ‘at home’ in the practice of medicine when I was doing my rotation in anesthesiology. I take great pride and find great joy in dealing with one patient at a time, physiology, pharmacology, etc. I have received excellent evaluations primarily because I give my all and I have become highly skilled at treating patients and making correct medical decisions. The greatest
contribution that I might be able to make to my society is to help people survive the Operating Room with minimal discomfort. I want to be that person who has the primary responsibility to make sure that operating room patients are safe and they do not have to suffer beyond what is absolutely necessary. This is where I find my greatest joy.
I received a full scholarship for my entire medical school education at the University of XXXX’s School of Medicine in XXXX, and graduated in June of 2007. I also did my rotations in XXXX and received high marks for my evaluations as well as on the XXXX. I look forward to bringing my outstanding credentials to your residency program and working shoulder to shoulder to make the experience of anesthesia everything that it should be in our modern world of advanced medicine. I want to thank you for consideration of my application.
is now mostly on the West Coast of the U.S. So, this is the geographical location that I would prefer for my first residency assignment, preferably Washington, Oregon, or California. My family is my main support system, especially since my father recently just passed away.
I feel strongly that Chinese women have much to contribute to American medicine and that our insights are complimentary to that of physicians from the West, that we often make an excellent team. Being a team player, of course, is very Chinese. I was born in China and immigrated to Hong Kong as a child, so I was already westernized somewhat by the time that I came to the U.S. as an exchange student at the age of seventeen. This experience taught me early on to rely on myself and be a
quick thinker and learner, since I came here by myself without any relatives or knowing anyone at that time. After completing high school here, I went on to study nursing in the University and completed my BSN. Next, I worked as a nurse for five
years and then went on to medical school. I recently received my M.D. Degree.
In addition to my education, my application is strengthened considerably by my professional experience. I worked in various fields in nursing prior to going to medical school: medical, surgical, obstetric-gynecology, same-day surgery, rehab, nursing home, critical care, etc. Thus, I have already had a lot of exposure to a variety of health care settings and I am highly familiar
with the practice of many different aspects of medicine.My experience in critical care nursing is especially relevant to my decision to practice anesthesiology as a physician because I
have a lot of experience dealing with very sick patients who need to be constantly monitored and, often, in need of rapid life-saving interventions needed. I am especially accustomed to IV monitoring and numerous other procedures that the anesthesiologist needs to have mastered. I am especially comfortable working in the critical area of emergency room care. I
am someone who communicates well with non-native speakers of English and people from all walks of life. I keep a cool head in emergencies and work best under pressure. It is my hope as well to be able to use my linguistic skills in the course of my work as a resident physician in the area of anesthesiology. Since I am a native speaker of both Mandarin and Cantonese, I
might be able to make a special contribution to your program since there are so many immigrant speakers of these languages in America, especially on the West Coast.
I felt most ‘at home’ in the practice of medicine when I was doing my rotation in anesthesiology. I take great pride and find great joy in dealing with one patient at a time, physiology, pharmacology, etc. I have received excellent evaluations primarily because I give my all and I have become highly skilled at treating patients and making correct medical decisions. The greatest
contribution that I might be able to make to my society is to help people survive the Operating Room with minimal discomfort. I want to be that person who has the primary responsibility to make sure that operating room patients are safe and they do not have to suffer beyond what is absolutely necessary. This is where I find my greatest joy.
I received a full scholarship for my entire medical school education at the University of XXXX’s School of Medicine in XXXX, and graduated in June of 2007. I also did my rotations in XXXX and received high marks for my evaluations as well as on the XXXX. I look forward to bringing my outstanding credentials to your residency program and working shoulder to shoulder to make the experience of anesthesia everything that it should be in our modern world of advanced medicine. I want to thank you for consideration of my application.
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