Author Archives: Justin Fiala, MD Candidate

About Justin Fiala, MD Candidate

Justin is currently in his third year of medical school at UIC's College of Medicine, and is hoping to pursue a career in internal medicine. He has a strong interest in addressing the health needs urban communities and is part of the College of Medicine's Urban Medicine program. Aside from academics, Justin enjoys cooking, listening to public radio, and perusing the New York Times website. He is also a trained pianist and self-professed lover of all kinds of music.

Think Before You Speak: Lessons for a Motor-mouth on the Pediatric Cancer Ward

I’m a fast talker, the majority of the time unabashedly so.  In any given conversation my mouth is going a mile a minute, with tangents, emphatic inflection changes, and wild gesticulations all part of the equation.  So you can imagine my discomfort upon entering the realm of pediatric oncology earlier this week, where everything you say holds a gravity so great even Sir Isaac Newton would be impressed.

The fact of the matter is that this field deals with very ill children whose illnesses may be life-threatening, but are always life-changing.  And one of the challenges – beyond the medical behemoth of fighting the cancer itself – is communicating the specifics of the situation with the parents, such that they have an honest, realistic assessment of what is going on with their child.  In other words, this is not the time for word vomit.

One of my patients was a tow-headed toddler undergoing her second round of multi-agent chemotherapy (6 toxic medications in total) for a non-resectable, incredibly rare sarcoma.  With only a handful of cases reported in the literature, and virtually no data with regards to treatment protocols, the attending physician sought out opinions from national experts in the field, only to find that the prognosis was most likely around a 1 in 6 chance of survival.

Little did she know that the mother of the child had contacted the same experts herself and had received the same troubling news, setting the stage for a potentially messy situation.  Luckily, this attending has an incredible way with words, and a knack for articulation that ensures that the words leaving her lips are exactly what she means to say in that moment, no more, no less.  And so she reported what she knew to the mother, succinctly yet compassionately, and in the process gained her trust.  Above all else, she seemed to be relieved that she wasn’t being placated with sugar-coated prognoses; the fact that the mother knew beforehand, and received the same news from both doctors meant that she was fully integrated into the decision-making process regarding her daughter’s care.

And so, content in that level of trust, she went on to ask a more subjective question: was the attending optimistic that her daughter would be the 1 out of 6 that beats the odds?

Of course, placed in this position, anyone would want to say yes and be able to reassure the parent that things would be okay.  Yet, in cases like this, where things actually may very well not turn out well, you can’t act on that impulse.  So in that moment the doctor did something so simple, yet so profoundly important: she paused.  It was clear that she was in deep thought during those several seconds, finding exactly the right words, fully aware of the subtle importance of syntax and semantics, because when she spoke, what came out of her mouth was the absolute perfect response for the situation.

“By my nature, I am an optimist, and I truly believe that we have found the absolute best treatment that we know of, given the specifics of your daughter’s case.  I also want you to know that she is in incredibly good hands at this institution, and that we will do everything within our abilities to aid in her treatment.  But with regards to the statistics, I cannot say one way or the other how I think it will turn out; as you know, this is a rare cancer with unpredictable course, but we will continue to do our best on her behalf and yours.”

The incredible level of respect, compassion, and empathy implicit in that response is all anyone could ask for in such a trying situation.  What the attending did was provide much needed healing during a time of suffering and uncertainty, and offered a healing of the spirit when healing of the body was uncertain.  And all because she paused and thought before she spoke.

No Kidding… A Week on the Pediatric Ward

This week I began foray into the land of runny noses, worried parents, and whaling children, otherwise known as the pediatric ward.  Above all else, I’d like to take this opportunity to express my new found admiration and respect to every single person who at one point or another was, has been, or currently is, the parent of a small child.  Seriously, one week down on the general pediatrics service and I am exhausted to the point of delirium.

I guess it had never quite occurred to me that pediatrics encompasses everything from newborns to adolescents – a full 17 and some years and countless developmental stages therein. With this wide spectrum of ages comes a whole spectrum of physical exam maneuvers and differential diagnoses, because children of different ages get sick with different diseases, and may even present differently even when they do have the same ailment.  For example, say in a given day, you see a 10 month-old, a 2 year-old and a 17 year-old, all in the hospital for a cough that sounds productive (i.e. they’re coughing up mucus).  Although, taken at surface value, the chief complaint is the same, there is very little chance that they are all suffering from the same disease process.

All this makes the field incredibly challenging.  The vast breadth of information that a pediatrician has to master is impressive to say the least.  And what is more, they have to do it all, often being unable to ask the patient questions – after all, a child younger than 5 probably isn’t completely aware of what’s going on with their body when they’re sick, and most of the time won’t know how to answer questions about their illness.

A pediatrician acts as a detective, a cryptologist, and an interpreter, all in one.  They have a variety of physical exam tricks in their arsenal, specific for age and ability level, using the results as clues as to what is going on with the child, deciphering body language and other non-verbal cues at the same time.  Most importantly, they have the keen ability to relate to parents, and ease their fears and concerns, such that they’re able to provide a thorough history and strengthen the other findings as to the etiology of the disease.  All in all, it’s a monumental task, which demands remarkable skill and the patience of a saint, what with screaming, flailing, and projectile body fluids thrown into the mix.

Admittedly, sometimes on the floor it feels like a zoo.  But at the same time, it’s refreshing to see the resilience of children when faced with adversity, something I think we can all learn a lesson from.  For instance, a young child who felt crummy on Thursday, by Friday, will have forgotten the trial of the day before, and will play as if nothing had ever happened.  That innocence that allows them to truly live in the moment is beautiful, especially in a field like medicine, where often those moments are limited.  So far it has been inspiring to walk in the shoes of a pediatrician, and get a glimpse of the long-forgotten joy for life that we all had as young children.

Can’t We All Just Get Along?

A relationship without communication ends in expletives, tears, and likely a breakup.  A hospital stay without communication ends in close calls, medical errors, and in the worst of cases, death.

The patient had a complicated history, with a recent kidney transplant managed with immunosuppressants, a subsequent ear infection, and complications which led to him to get parts of his facial bones resected in order to avoid any further spread of the infection. Nevertheless, by the end of that hospitalization in July, he was doing fine and was on the road to recovery.  With some help, he was walking short distances and overall was showing signs of improvement.

That being the case, it was quite a surprise when he came back just a month later, with leg weakness so severe that he could barely lift a foot, let alone take a step.

So he was admitted to the hospital once again and was placed under the primary care of the transplant service, despite the fact that his current symptoms were likely neurological in origin.  Now, it’s important to understand the logic here, which in itself isn’t wrong:  given his complicated medical history and kidney transplant — the complexities of which are likely to complicate any course of medical treatment — it was absolutely appropriate to have the transplant team see him.  However, the unfortunate design of the medical system (records, billing and all) meant that this initial determination of primary service precluded any other specialty (for example neurology) brought in to care for him from making medical decisions; anyone other than the transplant team were consultants, and would ultimately have limited control over his clinical course.

For the neuro team, this meant that we could only make recommendations for tests and procedures to be done, all of which would have to go through the middle-man approval of the patient’s primary team before being executed, slowing diagnostics and impeding treatments that would prove to be time sensitive.  In the case of our patient in particular, the decline was quick and severe.

Though he had come into the hospital with generalized muscle weakness, he was still able to move all of his extremities, even if that meant only a little lateral movement of his legs and wiggle of his toes (remember, his legs were the worst off).  He was also able to speak, only requiring occasional help from his daughter when communicating with us, and overall, seemed to be in no acute distress.  Over the next few days, though, he began a steep decline, as his speech rapidly worsened along with his motor capabilities.

On the second day I saw him, he was barely understandable, with marked facial weakness and the beginning signs of labored breathing.  The neurology attending I was working under realized the gravity of what she was seeing and told us to make sure we put in an order for a blood analysis known as an arterial blood gas, a test of oxygen absorption which would help us determine how well the patient was breathing.

At the top of out differential diagnosis was something called Guillain Barre Syndrome, an autoimmune disease where the body produces antibodies directed against a certain type of myelin (the fatty material that insulates nerves) found particularly in the peripheral nerves of the body.  Over a variable period of time (the process can be slow or fast, as was the case of this patient) these antibodies destroy the nerves, leading to both loss of reflexes, sensation, and ultimately paralysis of pretty much any part of the body.  In its classic presentation, the paralysis ”ascends” or goes from the periphery inward, starting in the feet and legs, (sometimes the arms) and heading towards the trunk, where it ultimately paralyses the most important muscle of all: the diaphragm.  This is the main muscle reponsible for breathing, and its paralysis basically means death.

This was our main concern, and more than anything else, we wanted to make sure that our patient didn’t progress that far.  But alas, per the system, he was not actually our patient.  And so we had to go through convoluted means of communication to get anything done, with every suggestion we made seemingly under-appreciated with regards to the urgency at hand.  So our attending, fearing that the patient could (and would) go into respiratory failure any minute, offered to take responsibility for the patient and have him transferred to the neurology service and moved floor where we’d be able to expedite the treatment plan which we thought, from a neurological standpoint, would serve him best.  Unfortunately, likely due to some inane hospital politics that never fail to surprise me with their absurdity, the primary team refused the transfer, and our poor patient stayed in the same room, on the same floor, and under the same primary service, when hour by hour he needed more and more monitoring and urgent care.

And so, with a growing sense of frustration matched only by our resolve to do right by the patient, we set out to make sure that our treatment plan would be carried out as quickly and efficiently as possible, despite the communicative obstacles. We had to breathe down the necks of the primary service to get the arterial blood gas we’d requested the day before drawn, and had to jump through hoops in order to ensure that he was getting the proper work-up for his condition.

This included an invasive procedure known as a lumbar puncture, in which a sample of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) is drawn up through a needle inserted between the patient’s 4th and 5th lumbar vertebrae while lying on their side.  So we went about preparing to do the procedure, and positioned the patient accordingly.  My job was to hold him in place from the front while the residents did the procedure on his back.  While holding the patient in this position, alternating words of encouragement and comfort, I noticed something odd about the movement of his abdominal muscles that coincided with his now erratic breathing pattern.  It looked like something I vaguely remembered from my pulmonology lectures years before called paradoxical abdominal breathing, a unique phenomenon which signified exceptional impairment of the respiratory muscles, top among them, the diaphragm.  In other words, if this were the sign I thought it was, our patient was in trouble.

But never having actually seen it outside of an illustrated textbook diagram, I was less than positive that I was actually seeing one of the harbingers of respiratory failure, and not wanting to bother the residents during the stressful procedure, waited until I saw the attending shortly thereafter back on the neurology floor to report what I had seen.  By that time, she was already on the phone getting word that the patient’s respiratory rate had doubled with decreased oxygen saturation levels (the ultimate sign of respiratory failure) and that he was about to be intubated and placed on a ventilator to make sure that he would continue to breathe while we worked on getting his muscle function back.

Fortunately, he was successfully intubated minutes later, for which the primary team deserves the credit; indeed he received the care he needed when he needed it most.  Since then he has been receiving various treatments for his condition with some improvement of motor and respiratory function (although he’s still on the ventilator). All that aside, the question remains as to whether or not we could have prevented the close call and stopped him from progressing to that stage of severity had we been able to act more preemptively and aggressively. It’s debatable, but certainly not outside the realm of possibility.

Whether it was the lack of cooperation/understanding between the teams, delayed diagnostic testing, or my own personal failure to convey a significant physical exam finding in a timely manner, better communication probably could have made a real difference in the case of this patient.  And while disaster was averted this time, it warrants thought for the future.

It seems, as in the case of a relationship, a little communication early on can go a long way in preventing less-than-ideal outcomes down the road.

It’s (Reflex) Hammer Time

This week I traded in my scalpel for a reflex hammer and began a 2 week stint on the neurology service.  The verdict? Well, aside from the fact that everyone on the neurology floor seems significantly more well-rested (and by extension nicer), I’m finding that neurology deals with a level of detail and intellectual exploration that surgery never even began to broach.  At the risk of sounding trite, neurology is far more… well, cerebral.

Somewhere along the line in the first two years of med school you are taught the neurological exam by rote. You memorize the exact maneuvers and mechanics of all those weird tasks that doctors ask patients to do (finger to nose, walking heel to toe, etc), but whose purpose you never quite understood, and still at that point don’t understand.

Remarkably, when done correctly and with a keen eye for the subtlety and nuance of patient reactions, these tests are elegantly designed to pinpoint specific neurological deficits, and have the capability of localizing a lesion in the nervous system, such as a stroke, to an incredible degree of accuracy.  All this without using invasive measures!

And yet, before the actual experience of working with patients whose exam findings are abnormal, it’s hard to have any real appreciation for this.

As far as I’m concerned, the neurological portion of the physical exam is the figure skating of diagnostic medicine: looks simple, but is anything but.  Things like eliciting a proper reflex, which look so easy to the untrained eye, can easily turn into a clinical nightmare.  With multiple failed attempts and disgruntled patients tired of being hit with a hammer, the finding of an absent reflex inevitably brings up the self-doubting question: does the patient really not have the reflex for neurological reasons, or is it just a reflex that you weren’t able to see due to lack of skill.  Of course at this stage of training (or lack thereof), the latter is much more likely, and often leads to awkward moments during morning rounds when you have to admit as the lowly third-year medical student, that you’re not quite certain what the status of the reflexes were.

Nonetheless, this is all part of the process. And with a supportive team of residents and an attending who’s willing and eager to teach, the technical challenges of performing a good neurological exam become less of a threat and more of a way to prove  and improve your clinical skills.

Whereas surgery is primarily concerned with fixing the problem at hand via physical manipulation or removal of diseased tissues or abnormal structures in the body, neurology prides itself on merely identifying abnormalities, often with limited resources to fix the problem once it’s elucidated.  And if there’s one detractor from the field, it would have to be that: the fact that there are few magic bullets or total cures.  It seems that all-too-often – take the case of stroke for example – neurologists are happy with partial improvement over time, even if it’s not full recovery to baseline, or at the very least, are content with preventing a recurrence.

From a personal standpoint, neurology is appealing in that it encourages and demands extensive thought and logical thinking, and takes into account various aspects of a patient’s life that other areas of medicine often shirk, making the process both impressive and entertaining to watch.  A skilled neurologist examining a patient is tantamount to a seasoned detective gathering clues and lining up a series of possible diagnoses as culprits responsible for the problems that the patient is presenting with.

At least for the time being, I’m pretty excited to be filling the position of gumshoe under these detectives.

“Why Medicine?”

The dreaded question at a medical school interview is, “Why did you choose medicine as a career?” the catch being that under no circumstances whatsoever should you answer that you want to help people.

Heaven forbid those words left your lips — let’s just say as an unfortunate consequence of the adrenaline and anxiety of the moment — you’d likely find yourself spending the rest of the interview trying to crawl out from the ever-deepening hole you’d created with that initial response.

“Garbage collectors help people, don’t they?” one professor always used to retort when given the answer in the course of a discussion “Why not be a garbage collector?”.  What often followed was a messy string of qualifications, the likes of which was anything but coherent, and which did little to demonstrate any true sentiment as to why someone really had chosen to dedicate their life to such a grueling profession.

All this is not to say that a desire to “help people” isn’t a part of many physicians’ motivations to enter the field; undoubtedly it is the cornerstone upon which many have pursued their careers.  Rather, the inaptness of the answer, and the whole mind game of the “Why medicine?” question, seem to have more to do with assessing whether or not a candidate for medical school has thought through the gravity of the endeavor they’ve chosen to undertake.

From the rigorous pre-med curriculum, replete with cut-throat classmates and all night study sessions to the exhaustive nature of med school itself, with more cut-throat competition, late night studying, and long hours spent on the wards (all with behemoth exams like the MCAT and USMLE Steps 1,2, and 3 thrown in), a medical education is no walk in the park.  All this, with hundreds of thousands of dollars of student debt piling up all along the way and 3-5+ years of minimal pay thereafter too look forward to during residency – one resident described the process as seeing what you think is a light at the end of the tunnel, only to realize that the light is in fact an oncoming train.

Morose, no doubt, but the realities are harsh and demand at least a temporary suspension of levity when considering medicine as a career choice.  It’s not all helping and healing people; sometimes what we do ends up causing the patient s more pain and suffering, and sometimes you come up against bureaucracy and political obstacles that you feel deep down isn’t in the best interest of the patient, but are confined nonetheless to the mandates of the hospital and the profession.  And so, realizing that medicine is grayer than you ever thought before, you start to delve a little deeper, asking yourself, “What is it that makes me want to wake up early every morning, stay up late every night, sacrifice my weekends, give my time and energy to others such that I tax and strain other relationships in my life?” “What drives me into this profession where I am surrounded by people afflicted with ailments of all sorts, confined to the insular, “sterile” environment of a hospital, putting myself at risk by caring for the sick?”

It is these questions for which, “I want to help people” just doesn’t suffice.

For me, I found myself compelled to be an advocate for patients who otherwise may not have a strong voice of their own, and for those who have been traditionally under-served by the medical system.  I wanted to pass on the knowledge that I’ve been fortunate enough to accumulate in the hopes that from this knowledge would come empowerment and changes that would spur a better life for my patients, in terms of health and otherwise.  I aim to comfort them when they are anxious, reassure them that I am dedicated to fighting for them and with them against their disease.  I aim to ensure that they have every single right afforded to them and are aware of every option regarding their treatment.  I want to help them, yes, but in such a deeper sense than allotted by that four letter verb “help.”

And of course there are the detractors.  Though intellectually fascinating, it is mentally and physically exhausting, with some serious ups and downs.  And it is a long road.  Admittedly, at this point in the process, the pursuit of a medical career seems like mountains beyond mountains.  But to this point, every peak has been worth scaling, every fall along the way, character building, so for me it’s obvious.  Why medicine?  Because  I’d never be happy or fulfilled doing anything less all-encompassing.  I was meant to climb endless mountains

I Don’t Want No Scrubs

The jade green scrubs given to operating room employees (surgeons, nurses, house staff, etc) are anything if not uninspiring.  What seems comfortable in the hazy hours of the early morning (we’re talking sometime around 4:45) ends up feeling like a grimy, sweaty encasement by the end of the long, grueling day (anywhere from 12 to 16 hours later).

And while some seem to love it – “It’s like wearing pajamas to work!!!” being a common sentiment – I found myself losing a piece of my identity.

In terms of utility it makes perfect sense.  In the case of emergency, there’s no diverting to the locker room to change into operating room attire; as a result, everything becomes a little more streamlined.  But from a psychosocial point of view, it can start to feel a little like the prescribed outfit in an authoritarian society.  The way one dresses is no longer a means of self-expression when everyone is relegated to these jade colored Mao Suits.  So I asked myself: what can I do to make these scrubs my own?  And with a little imagination and the inspirational words of Project Runway’s Tim Gunn in my head – “Make it work!” I set out to find a few ways to give some individual flare to the humdrum surgical scrub.

A few rolls of the sleeves gave the illusion of a tank top.  Similar folds on each leg yielded an 80’s high-rolled look.  Trading in the ratty gym shoes I’d been wearing around the wards for a more stylish pair made all the difference in the world, but still didn’t quite do the trick.

I just couldn’t get over the fact that I enjoyed and missed dressing up in the mornings and representing myself through my wardrobe.  In the clinical portions of my first two years of med school I’d learned that even within the rather conservative field of medicine, it’s still possible to change things up with regards to what you wear; the key is nuance. As such, I strive to put a little extra thought into it every day, hiding a god amount of personality in the details.

The type of tie (skinny vs traditional), the particular matching or contrasting of colors, and the thoughtful use of accessories (a loud pair of socks with an otherwise dulled down outfit certainly makes a statement) all come together to speak to who I am underneath the short white coat.

And so, I guess I can say that jade isn’t really my color, and that, given the choice, I’d rather not wear pajamas to work.  Aside from that, I’m now more appreciative of any chance I get to wear what I want.  And whether heading to a meeting or just running out to the grocery store, I’m more likely to be dressed to the nines than sporting sweat pants.  After all, I don’t want no scrubs.

The Life Traumatic: Reflections on 2 Weeks of Trauma Rotation

A two week stint on trauma is part of the general surgery rotation that all third year medical students complete, and the trauma service at a level 1 medical center can be disillusioning to say the least.

With gunshots, stabbings, assaults, and hit-and-runs all too common, you begin to wonder how people can be so awful to one another.  Yet with those detractors comes an energy, a rush of adrenaline and anticipation as you wait for the next patient to be rushed through the doors, that makes it all worthwhile.  In one place you get an incredible cross-section of society – after all, anyone can be in the wrong place and the wrong time –  and a spectrum of cases, from tragic to comical, all thought-provoking and full of lessons to be learned.

It was a Friday afternoon, and I was a mere 15 minutes from being able to go home when, like clockwork, my pager went off in response to a code yellow (a trauma emergency) that was on its way to the hospital.  Less-than-thrilled at the fact that I’d be hanging around for a few more hours I made my way down to the trauma bay, a fully-equipped room within the emergency department where all the action of an arriving trauma case went down.

Word had it that the incoming patient was an en-route transfer, who had been re-directed after it was deemed that a head laceration he’d suffered after falling from standing was too big to be dealt with at a lesser-equipped hospital.  Per the EMT’s, he was not only intoxicated to the point of imbalance, but also to the point of belligerence, and was particularly aggressive.

And indeed, upon his grand entrance into the trauma bay – replete with punches, racial epithets, and expletives yelled in broken English – it was clear this guy was going to be a special case.  In the same organized chaos that accompanies any given incoming trauma case, the patient was surrounded by a hoard of trauma staff – nurses,  X-ray techs, attending physicians, medical students, etc – each with their specific tasks which were to be carried out in the most timely manner, such that no time at all be wasted.

The initial surveys were completed, blood draws taken for labs, IV’s put in place, X-rays shot, despite the fact that all throughout the patient had resisted, pulling on any wire or tube he could get a hold of, swinging and kicking at those of us who attempted to his frail, yet powerful frame down.  In broken English and occasional bursts of accented Spanish he repeatedly yelled that he wouldn’t let us kill him.  To no one’s surprise, he was also less-than-helpful when answering basic questions about his past medical history and the events that had precipitated current visit to the ER.

At one point after the initial hubbub had calmed down, the attending trauma surgeon, an Eastern European woman for whom English was a non-native language, asked aloud, “What are his allergies?” leading me to relay the question to the patient in Spanish.  His response was quick and pointed:  “Tu madre,” he replied.  Those who heard and understood it burst out laughing, as the attending looked on in confusion.

“What is he allergic to?” she asked again, noticeably frustrated at the ongoing difficulties.  “This guy’s mother” a nurse chimed in, pointing in my direction.  “But I don’t think the electronic medical records will recognize that specific allergy” she continued.

Somewhere between grinning from the ridiculousness of the preceding incident, being slightly offended at having my mother insulted, and gagging at the horrendous smells emanating from the patient (a mix of urine and a special form of halitosis known as trauma breath), I continued to hold the patient down and talk to him the best I could.  He was violently writhing and trying to break free, once again pulling at anything he could get his hands on (at least 3 pulse oximeters saw their demise that day), all the while letting us know his displeasure with being there.

And then, as if in a miraculous moment where the skies above parted and a booming voice said, “LET THERE BE ATIVAN!” our riled up protagonist received a bolus of sedative and finally calmed down.  His muscles relaxed, his pupils dilated, and he finally lay back in a quiescent ambivalence to what was happening around him.

In this moment, without me even prompting, he began recounting his journey from Cuba decades earlier, and telling tales of his childhood on the island before that.  And although slurring, sedated, and still very, very intoxicated, he managed to convey a distinct overtone of humanity in his stories.

Unfortunately, everyone in that room had witnessed his worst; yet another belligerent drunk causing trouble in the ER, lost to the world and himself.  But as the sole Spanish-speaker with him at that moment, I was the only one to hear his story, and see him at least partially redeemed.  But hey, that’s life… or at least, that’s trauma.

For the Bibliophobe and the Cafeine-ophile: Coffee Shop Alternatives When the Library Just Won’t Do

Do you get nauseous at the thought of frittering away hours upon hours at a small desk in a corner of the book stacks?  Does the complete silence of the library increase your anxiety more than your concentration?  Are you the type of studier that requires direct access to caffeine at all times if you are expected to retain any of the information in your books?  Well, then you’re not alone.
Having studied pretty much day in day out for all of April and May, and having spent an ungodly number of hours in coffee shops to the point where both my books and hair perpetually smelled of espresso, I’ve come to know quite a bit about coffee shop culture in the fine city of Chicago.  Knowing I was in it for the long haul, I felt compelled to branch out from the Starbucks down the street and see what the city had to offer in terms of purveyors of caffeinated beverages.  Don’t get me wrong, as is the case with any med student, Starbucks holds a special place in my heart, and  I dare not bite the hand that sustains me; but in this case, I just felt I needed a change of pace, to ramp up both my motivation and productivity.
As such, I figured I’d give a quick run-down of some of my favorite locales around the city (mostly north side) for a good cup of java and even better cram session when you just can’t study in the library.
 Intelligentsia: 3123 N Broadway (Between Barry and Briar)
                Neighborhood: Lakeview
One of my mainstays.  Although Intelligentsia is a little pricier than some of the other options, for any self-professed coffee connoisseur the product is well worth it. With fair-trade options brewed by the cup via a variety of methods (just ask the barista and they’ll take the time to explain why they brew certain blends certain ways!) and a staff that’s well-versed in latte art, Intelligentsia puts Chicago on the map in terms of café culture.  And beyond that, the shop offers a spacious feel, with good lighting and plenty of big tables where you can park yourself across from other caffeine addicts and students alike.
                Pro’s: lots of space, outstanding coffee, and a regular group of studiers
                Con’s: pricier than most and no discounted refills; too busy and chaotic on weekends
The Coffee Studio: 5628 N Clark St.
                Neighborhood: Andersonville

If you’re from Andersonville, a surrounding neighborhood or just don’t mind travelling a little for a few good hours of productivity, then The Coffee Studio is not to be missed.  Of all the coffee shops I frequented during the lead-up to my board exam, this was hands-down one of my favorites.  The coffee is excellent, the staff amiable, and the space immaculate.  This place offers ample outlets for laptops, cushioned seats and a quieter atmosphere than most anywhere else.  The verdict: studying in comfort.  The prices vary, but can be on the higher side, and the baked good selection is better than most.
                Pro’s: newly-finished, well-lit space, quieter atmosphere than most coffee shops
                Con’s: earlier closing hours, higher price-point
Ipsento: 2035 N Western Ave.
                Neighborhood: Bucktown

If you’re into the hipster scene and don’t mind the indie band of the moment as background noise, then this hole-in-the-wall café may be a good fit.  Even if it isn’t quite your scene, it’s worth checking out at least once if just for the drink that bears its namesake.  The Ipsento is a latte made with coconut milk, honey, and a touch of cayenne pepper, and can make any day of studying bearable. (Seriously, it is out of this world).  Although the locale is a little gritty and the space is dark and reminiscent of your friend’s parents’ basement, the baristas are incredibly friendly and the overall atmosphere is one that is pretty conducive to getting work done.

                Pro’s: the Ipsento, the staff, and the younger crowd
                Con’s: pretty dimly lit, not necessarily the quietest coffee shop
Asado: 1432 W Irving Park
                Neighborhood: North Lakeview
This place is one of Chicago’s hidden gems.  Up against bigger primary producers like Intelligentsia or Metropolis, Asado seems to hold its own, processing and roasting their own beans in-store for a cup of coffee that is so smooth that milk and sugar are rendered completely unnecessary.  Despite its meager square footage, this place has a good number of tables for spreading your books out and is generally well-suited for studying.  If you don’t mind the distraction of the barista roasting a batch of beans every now and then in the gargantuan metallic roaster that serves as the centerpiece of the shop, then this place just may be for you.  And if you’re interested, and want to learn something that you’ll probably never be tested on, ask the employee behind the counter how the roasting machine works and they’ll likely give you an impromptu tour (at least they did when I asked).  In contrast to the other coffee shops in the city, this one has a mom-and-pop feel that makes it a comfortable place to be, and excellent coffee and food to boot.  Definitely worth checking out.
Pro’s: coffee roasted the same day you order it, comfortable space, street cred for knowing about this place before your friends
Con’s: small and easily crowded
New Wave Coffee: 3103 W Logan Blvd.
                Neighborhood: Logan Square
 Frequented by all types (but mostly hipsters) New Wave offers a lot when it comes to a coffee shop study session.  Located just off the infamous Logan Square roundabout, this shop offers a spacious setting with numerous couches, love-seats, tables, and yes, even desks – for some reason a desk is just easier to stomach within the context of a coffee shop.  Regardless, whatever your preferred posture while cramming information into your brain, you’ll find it here.  Oh, and the coffee and pastries (which are vegan) are good too.  So if you want a more lax feel with a lot of the same perks, all in an up-and-coming area of the city, New Wave is certainly a destination to check out.
                Pro’s: located off the blue line (i.e. UIC-accessible), spacious and comfortable
                Con’s: Noise level can get a little high at times
Honorable mentions:
Kickstand Espresso Bar (824 W Belmont) in Boystown: good on the weekends as it tends to avoid the hoards of people that make any given Starbucks unbearable from Saturday to Sunday.  Very gay and very hipster; doesn’t hurt to look the part.
Atomix (1957 W Chicago) in Ukrainian Village: spacious place to study; not the best-lit, but overall not a bad choice for studying.
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