A few weeks ago, my good friend Lauren, who is a third-year medical student in Ohio, called me and informed me that she was having a crisis: "I love peds!"
"Me too!" I exclaimed. "And I don't know what to do!"
Both Lauren and I had entered medical school with a strong interest in women's health and had fully expected to pursue residencies in ob/gyn. Her love of pediatrics didn't surprise me as much as my own - she's phenomenal with kids. But I had never expected us - ok, especially me - to seriously consider this alternate career path.
Why has peds grown on me so much? It's a combination of factors. As they say, kids are not just little adults, and it is exciting and refreshing to study a whole different array of diseases, syndromes, and versions of "normal" than what I have experienced over and over again in adult medicine. (Another patient with hypertension? Yawn. A congenital heart defect or a case of precocious puberty? Now that's exciting!) The kids are mostly very sweet, and even when they're not well-behaved, hey, I don't have to bring them home. (And it's not like all adults are well-behaved and pleasant, either.) As one attending pointed out while explaining while he chose this career, kids are fixable. In most cases, this is true, whereas with adults, we often just put a temporary band-aid on their chronic condition, be it heart disease, pulmonary disease, or diabetes, that will hopefully hold them over for awhile until their next flare-up. Finally, the people have been spectacular. Never have I experienced so much teaching by attending physicians during rounds. And the residents, though tired, are enthusiastic and truly love what they do. In their words, "Why would anyone want to do anything else?"
To top it all off, I absolutely adored my week on the pediatric hematology/oncology floor. The kids I saw ran the gamut from the best possible prognosis to cases that renewed my passion for the importance of palliative, end-of-life care. In five days I wrote two poems; the atmosphere was so saturated with emotion that the words just sprang into my mind. The overall feel of the floor was special; parents took coffee breaks together and kids in neighboring rooms visited one another. Rather than each patient existing as an island on a impersonal ward, this was a community.
The teaching on heme/onc was phenomenal - the best I have yet experienced during medical school. On my first day, we took nearly five hours to round on five patients, and every minute spent standing before the attending trying to answer her questions was worth it. She asked questions in a manner that was not intimidating or aggressive, but that promoted learning. When I didn't know an answer, she backed up and asked me other questions that led me to put the facts together myself. It helped, of course, that I was absolutely fascinated by every detail we discussed. Others may not, but I certainly care about the side effects of various chemotherapies and the ways in which kids often describe them. Kidney function, which normally bores me, is enthralling in the context of a patient undergoing cancer treatment. I took copious notes, stopping only when I ran out of paper and energy, and even then listening with rapt attention.
The second attending I worked with challenged me in other ways, and especially helped me to improve my progress notes. "When you are writing a note, you are telling the patient's story," he said. And pitter-patter went my heart, out of love for telling these stories, for the patients whose stories they were, and for this celebration of humanism in medicine. And, truth be told, for my newfound love of pediatric oncology.
Sunday, December 19, 2010
Tuesday, December 7, 2010
Little People
(written halfway through Pediatrics)
I was not excited about starting Peds. On my first day, my first patient – a 1-year-old at the height of his stranger-anxiety - screamed the whole time. I looked at him empathetically. You and me both, buddy. By the end of the first week I had concluded that peds was not for me because I cannot work in a field in which:
A) I have to use falsetto every day
B) I have to utter the phrase “poopy diaper”
C) In the first week, I catch a stomach virus that makes me throw up for the first time in 13 years
But get this: pediatrics is growing on me. It turns out that most of the kids don’t scream, and I’m really pretty good with them. The parents – the reason many people give for not pursuing the specialty – aren’t that bad, either. I seem to get along pretty well with them, and a few of them have even complimented me on how I handle their kids. It’s even interesting academically; there’s a whole set of different disorders that happen in kids, so there’s plenty new to learn, which is exciting. I actually enjoying reading my review books at night and then shouting, “Hey! That’s so cool – I saw that in a kid today!” (I don’t know if Tay enjoys that part.) And of course the timing of my rotation schedule was perfect, giving me a week working in the newborn nursery immediately following my bout of illness, and the adorable, itty-bitty little babies completely made me forget about being sick the week before.
What about the sad stuff, the kids who can't be fixed up or cured? Well, I don’t know yet. My first four weeks have been outpatient, so I haven’t seen any seriously ill kids yet. Starting the week of Thanksgiving, I will do four weeks on the inpatient floor, including one in oncology. I’ll let you know how it goes.
I was not excited about starting Peds. On my first day, my first patient – a 1-year-old at the height of his stranger-anxiety - screamed the whole time. I looked at him empathetically. You and me both, buddy. By the end of the first week I had concluded that peds was not for me because I cannot work in a field in which:
A) I have to use falsetto every day
B) I have to utter the phrase “poopy diaper”
C) In the first week, I catch a stomach virus that makes me throw up for the first time in 13 years
But get this: pediatrics is growing on me. It turns out that most of the kids don’t scream, and I’m really pretty good with them. The parents – the reason many people give for not pursuing the specialty – aren’t that bad, either. I seem to get along pretty well with them, and a few of them have even complimented me on how I handle their kids. It’s even interesting academically; there’s a whole set of different disorders that happen in kids, so there’s plenty new to learn, which is exciting. I actually enjoying reading my review books at night and then shouting, “Hey! That’s so cool – I saw that in a kid today!” (I don’t know if Tay enjoys that part.) And of course the timing of my rotation schedule was perfect, giving me a week working in the newborn nursery immediately following my bout of illness, and the adorable, itty-bitty little babies completely made me forget about being sick the week before.
What about the sad stuff, the kids who can't be fixed up or cured? Well, I don’t know yet. My first four weeks have been outpatient, so I haven’t seen any seriously ill kids yet. Starting the week of Thanksgiving, I will do four weeks on the inpatient floor, including one in oncology. I’ll let you know how it goes.
Sunday, December 5, 2010
The Third Time's the Charm
During October, on my third rotation of my third year, I fell back in love with medicine. I was assigned to a private family medicine practice about 30 minutes away. The doctor has one PA working for him, and between the two of them they keep the practice open seven days per week. He takes in students from several medical and PA programs, so I got to work with other students as well. Everything about this practice was exactly what I was looking for and had not yet encountered:
-He gives students quite a bit of autonomy to not only see and examine patients on our own, but to draw blood, give shots, and do EKGs.
-As a student, you bring the patients in and do a full history and physical, then tell the doctor your findings, what you think is wrong, and what you want to do about it. He then sees the patient with you and makes the final decisions, and you write up the chart note.
-Students have space to leave their stuff and to sit to write their notes, to eat lunch, and to study in the [rare] down time.
-Everyone on staff is incredibly friendly, and most of the patients are, too.
And most importantly: he is an amazing teacher and mentor! He quizzed me on a lot of topics, and taught me both clinical pearls and tactics for caring for patients. I literally wrote down phrases that he used with patients. It probably helped that we had very compatible senses of humor, because we joked around a lot. The days were jam-packed, so the time flew by… even that stretch where I [voluntarily] worked 14 days in a row. He challenged me to develop my own diagnoses and treatment plans – “Someday you’re going to be in my position, kid, and you won’t have someone else to turn to,” he told me one day when I wavered in my decision.
As terribly sad as I was when the short four-week rotation came to an end, I left feeling rejuvenated, even considering a career in family medicine, and beginning to feel some real confidence in my clinical skills.
-He gives students quite a bit of autonomy to not only see and examine patients on our own, but to draw blood, give shots, and do EKGs.
-As a student, you bring the patients in and do a full history and physical, then tell the doctor your findings, what you think is wrong, and what you want to do about it. He then sees the patient with you and makes the final decisions, and you write up the chart note.
-Students have space to leave their stuff and to sit to write their notes, to eat lunch, and to study in the [rare] down time.
-Everyone on staff is incredibly friendly, and most of the patients are, too.
And most importantly: he is an amazing teacher and mentor! He quizzed me on a lot of topics, and taught me both clinical pearls and tactics for caring for patients. I literally wrote down phrases that he used with patients. It probably helped that we had very compatible senses of humor, because we joked around a lot. The days were jam-packed, so the time flew by… even that stretch where I [voluntarily] worked 14 days in a row. He challenged me to develop my own diagnoses and treatment plans – “Someday you’re going to be in my position, kid, and you won’t have someone else to turn to,” he told me one day when I wavered in my decision.
As terribly sad as I was when the short four-week rotation came to an end, I left feeling rejuvenated, even considering a career in family medicine, and beginning to feel some real confidence in my clinical skills.
Wednesday, November 17, 2010
Breaking News
I’m going to interrupt my progressive catching-up to report a seriously incredible, I’m-really-going-to-be-a-doctor experience.
I was doing a shift in the Pediatric ER the other night, seeing a lot of lacerations and a cute little girl whose mom was afraid she had swallowed a piece of plastic, when a resident told me that 3 traumas from a car accident were en route and suggested I go over to the Critical Care ER to watch. I ran into another medical student there, and together we stood and watched in awe as a stretcher came barreling in. The patient was a young man, lying there naked and intubated as doctors and nurses swarmed around doing CPR, inserting IVs, and giving medications. He had suffered a traumatic brain injury, though, and ultimately the resuscitation attempts were unsuccessful.
As I walked away realizing that I had just witnessed my first death, we went to a nearby room where another team was working on a young girl. A resident turned to us and said, “Med students, if you’d like to do compressions, now would be a good time to gown and glove.” We scrambled to grab gloves and plastic gowns amid the chaos, then stood in line behind the guy doing chest compressions.
Chest compressions are not easy; it requires some force to push someone’s chest down far enough to force the heart to pump blood. A person can only do them effectively for so long before tiring.
When I moved into position to relieve the person before me, I stepped up onto a little stool wondering, How is this going to feel on a real body? The answer is that the dummies used in CPR classes provide an eerily good approximation of how hard you must push. I pumped from my shoulders, bending at the waist to put my whole upper body into the effort. Inches from my fingers, someone had cut between the ribs and was suturing a chest tube into place. To my right, someone worked the bag to force air through a tube into her lungs. There was blood everywhere. I realized that I was the only one not wearing scrubs, since I had worked in the clinic that day. I’m wearing Ann Taylor. At a trauma code.
When I tired, someone else took over and I stepped aside to watch. Eventually they called this one, too; she could not be saved. It was anticlimactic; as everyone stopped what they were doing, stripped off their gowns and gloves, and walked away, my mind screamed, But she’s so young! Shouldn’t we keep trying? She’s young! But of course, that had nothing to do with it. You don’t try harder based on someone’s age, or give up sooner because of it. They had done their best – we had done our best – and despite that, her heart would not beat on its own.
The accident occurred not far from where we live. It has been in the papers, and on the way home from the gym today we saw the flowers people have stuck in a fence right near the site. I don’t know if I’m completely over it or if it hasn’t actually hit me yet, but the whole thing doesn’t seem real, that that was an actual person under my hands, who was alive last week, who is now gone.
I was doing a shift in the Pediatric ER the other night, seeing a lot of lacerations and a cute little girl whose mom was afraid she had swallowed a piece of plastic, when a resident told me that 3 traumas from a car accident were en route and suggested I go over to the Critical Care ER to watch. I ran into another medical student there, and together we stood and watched in awe as a stretcher came barreling in. The patient was a young man, lying there naked and intubated as doctors and nurses swarmed around doing CPR, inserting IVs, and giving medications. He had suffered a traumatic brain injury, though, and ultimately the resuscitation attempts were unsuccessful.
As I walked away realizing that I had just witnessed my first death, we went to a nearby room where another team was working on a young girl. A resident turned to us and said, “Med students, if you’d like to do compressions, now would be a good time to gown and glove.” We scrambled to grab gloves and plastic gowns amid the chaos, then stood in line behind the guy doing chest compressions.
Chest compressions are not easy; it requires some force to push someone’s chest down far enough to force the heart to pump blood. A person can only do them effectively for so long before tiring.
When I moved into position to relieve the person before me, I stepped up onto a little stool wondering, How is this going to feel on a real body? The answer is that the dummies used in CPR classes provide an eerily good approximation of how hard you must push. I pumped from my shoulders, bending at the waist to put my whole upper body into the effort. Inches from my fingers, someone had cut between the ribs and was suturing a chest tube into place. To my right, someone worked the bag to force air through a tube into her lungs. There was blood everywhere. I realized that I was the only one not wearing scrubs, since I had worked in the clinic that day. I’m wearing Ann Taylor. At a trauma code.
When I tired, someone else took over and I stepped aside to watch. Eventually they called this one, too; she could not be saved. It was anticlimactic; as everyone stopped what they were doing, stripped off their gowns and gloves, and walked away, my mind screamed, But she’s so young! Shouldn’t we keep trying? She’s young! But of course, that had nothing to do with it. You don’t try harder based on someone’s age, or give up sooner because of it. They had done their best – we had done our best – and despite that, her heart would not beat on its own.
The accident occurred not far from where we live. It has been in the papers, and on the way home from the gym today we saw the flowers people have stuck in a fence right near the site. I don’t know if I’m completely over it or if it hasn’t actually hit me yet, but the whole thing doesn’t seem real, that that was an actual person under my hands, who was alive last week, who is now gone.
Sunday, November 14, 2010
Ambulatory
Ambulatory Medicine – adult outpatient medicine – taught me about patterns. At first it seemed that third year would be all about revisiting the facts I had learned during the first two years, but with patients to illustrate them. That would be interesting and rewarding; I certainly don’t know all the details of even the main diseases and disorders of each organ system yet, and I have definitely been looking forward to finally developing a working knowledge of the many drugs that I memorized for the boards, but whose names and side effects I still mix up (I’m looking at you, psych drugs). It turns out, though, that third year isn’t just about going over these things again in a clinical setting. It’s actually about gelling all of your knowledge (the facts you come in with and the many more that you learn along the way) about diseases and treatments into a form that is actually usable on a daily basis.
I did my four-week Ambulatory rotation with an endocrinologist. The downside was that I didn’t get to see the full range of ailments that bring people to the doctor’s office; no low back pain or upset stomachs or coughs. It did, however, give me the opportunity to really master the assessment and management of patients with diabetes and thyroid disorders. (Plus I got to see one patient with Klinefelter’s Syndrome, which is when a male has an extra X-chromosome. He was just there for follow-up, though; it would have been more exciting to be in on the initial diagnosis.)
What I learned through seeing the same diseases over and over again is that doctors function based on patterns. At first, when I would leave out some important question during my interview with the patient, I would wonder, How do doctors remember what all to ask a diabetic? And then it hit me: because they ask the same questions of every diabetic! They don’t go into a room and start from scratch, thinking, Let’s see, what are the effects of high blood glucose? It can hurt the retinas, the kidneys, and the peripheral nerves. So, I guess I should find out if this patient has had any trouble with vision. That’s a good start, right? And maybe ask about peeing and if s/he’s had any tingling in the feet. Same goes for a patient with hyperthyroidism; there are certain questions to ask, certain things to pay particular attention to on exam, and a certain way to adjust the medication as needed and a certain timeframe for follow-up.
Of course this is an oversimplification; doctors certainly need all of their medical knowledge on hand to figure out what’s going wrong whenever something doesn’t fit the pattern, or when they get an unexpected answer to one of their templated questions. But this realization was empowering in that it gave me a framework in which to start to organize my knowledge. Remember my little metaphor about the dewdrops on a spider web from my post about the boards? Well, grouping things into patterns allows me to continue connecting those drops and constructing separate little groupings of web for each area of medicine. It makes the entire endeavor of learning medicine seem just a bit more feasible. And I’ve already reaped the benefits: part of my final exam for Ambulatory was an encounter with a standardized patient. The patient had diabetes and needed an exam and counseling. And I knew exactly what to do.
I did my four-week Ambulatory rotation with an endocrinologist. The downside was that I didn’t get to see the full range of ailments that bring people to the doctor’s office; no low back pain or upset stomachs or coughs. It did, however, give me the opportunity to really master the assessment and management of patients with diabetes and thyroid disorders. (Plus I got to see one patient with Klinefelter’s Syndrome, which is when a male has an extra X-chromosome. He was just there for follow-up, though; it would have been more exciting to be in on the initial diagnosis.)
What I learned through seeing the same diseases over and over again is that doctors function based on patterns. At first, when I would leave out some important question during my interview with the patient, I would wonder, How do doctors remember what all to ask a diabetic? And then it hit me: because they ask the same questions of every diabetic! They don’t go into a room and start from scratch, thinking, Let’s see, what are the effects of high blood glucose? It can hurt the retinas, the kidneys, and the peripheral nerves. So, I guess I should find out if this patient has had any trouble with vision. That’s a good start, right? And maybe ask about peeing and if s/he’s had any tingling in the feet. Same goes for a patient with hyperthyroidism; there are certain questions to ask, certain things to pay particular attention to on exam, and a certain way to adjust the medication as needed and a certain timeframe for follow-up.
Of course this is an oversimplification; doctors certainly need all of their medical knowledge on hand to figure out what’s going wrong whenever something doesn’t fit the pattern, or when they get an unexpected answer to one of their templated questions. But this realization was empowering in that it gave me a framework in which to start to organize my knowledge. Remember my little metaphor about the dewdrops on a spider web from my post about the boards? Well, grouping things into patterns allows me to continue connecting those drops and constructing separate little groupings of web for each area of medicine. It makes the entire endeavor of learning medicine seem just a bit more feasible. And I’ve already reaped the benefits: part of my final exam for Ambulatory was an encounter with a standardized patient. The patient had diabetes and needed an exam and counseling. And I knew exactly what to do.
Sunday, November 7, 2010
Internal Med: the Nitty-Gritty
Want more details about my time on Internal Medicine? (If not, skip to my other post about this rotation: http://beckymacd.blogspot.com/2010/11/internal-struggles.html)
If you want to know more, here's a day in the life...
Each team consisted of one attending (a "real," fully-trained doctor who oversaw everything and was ultimately responsible for the team), one senior resident (a doctor in the 2nd or 3rd year of the 3-year Internal Medicine residency, who essentially ran the team, divvying up responsibilities and doing a lot of teaching), two interns (doctors in their first year of residency, who had finished medical school and gotten their MDs about 5 minutes ago), and 1-3 medical students.
A team was assigned up to 20 patients on its service at a time, and during morning rounds, we visited each of them. Outside the patient's room, the intern responsible for the patient would present the case (patient's age, pertinent medical history, current condition(s) being treated, today's vitals and physical exam findings, and treatment plan) and the whole team would go into the patient's room and talk to/examine him or her and the attending would decide whether the team’s plan was a good plan or an entirely stupid one, possibly quizzing medical students and/or teaching us something along the way. If we were lucky.
The day really started long before rounds, though, with interns and medical students pre-rounding on patients. Students started at 7am (interns at 6am), and visited each of the patients we were following, inevitably waking them up to question them about any new symptoms and poke and prod them, then going and checking the results of their morning labs and any other new tests and writing all of this down in a progress note. All of this needed to be done by 8:30 (or 8, if you were on a team that had social workers assigned to it, in which case you met with them from 8-8:30), when medical students and residents went to Morning Report. This was a teaching conference for the residents, each day based on a different interesting/tricky patient case. Then we went back to the floor for rounds, which could last anywhere from 3-6 hours, depending on the patient load, complexity of patient problems, and speed and rounding of the attending. After rounds, the interns, residents, and students go to work, carrying out the day’s plan for each patient (ordering tests or medications, following up on the results of labs or tests, doing discharge paperwork, talking to patients and their families) and going down to the emergency department to admit any new patients assigned to our team.
I stayed each day until someone sent me home. (Guess how much I loved that lack of power over my own time.) Then I went home, ate dinner, tried to study a little bit, occasionally made it to the gym, visited with/complained to Tay, and went to bed. And got up to do it all over again.
If you want to know more, here's a day in the life...
Each team consisted of one attending (a "real," fully-trained doctor who oversaw everything and was ultimately responsible for the team), one senior resident (a doctor in the 2nd or 3rd year of the 3-year Internal Medicine residency, who essentially ran the team, divvying up responsibilities and doing a lot of teaching), two interns (doctors in their first year of residency, who had finished medical school and gotten their MDs about 5 minutes ago), and 1-3 medical students.
A team was assigned up to 20 patients on its service at a time, and during morning rounds, we visited each of them. Outside the patient's room, the intern responsible for the patient would present the case (patient's age, pertinent medical history, current condition(s) being treated, today's vitals and physical exam findings, and treatment plan) and the whole team would go into the patient's room and talk to/examine him or her and the attending would decide whether the team’s plan was a good plan or an entirely stupid one, possibly quizzing medical students and/or teaching us something along the way. If we were lucky.
The day really started long before rounds, though, with interns and medical students pre-rounding on patients. Students started at 7am (interns at 6am), and visited each of the patients we were following, inevitably waking them up to question them about any new symptoms and poke and prod them, then going and checking the results of their morning labs and any other new tests and writing all of this down in a progress note. All of this needed to be done by 8:30 (or 8, if you were on a team that had social workers assigned to it, in which case you met with them from 8-8:30), when medical students and residents went to Morning Report. This was a teaching conference for the residents, each day based on a different interesting/tricky patient case. Then we went back to the floor for rounds, which could last anywhere from 3-6 hours, depending on the patient load, complexity of patient problems, and speed and rounding of the attending. After rounds, the interns, residents, and students go to work, carrying out the day’s plan for each patient (ordering tests or medications, following up on the results of labs or tests, doing discharge paperwork, talking to patients and their families) and going down to the emergency department to admit any new patients assigned to our team.
I stayed each day until someone sent me home. (Guess how much I loved that lack of power over my own time.) Then I went home, ate dinner, tried to study a little bit, occasionally made it to the gym, visited with/complained to Tay, and went to bed. And got up to do it all over again.
Internal Struggles
You know it's a good day when you wake up before your 5:30AM alarm on a Sunday and make funny little popping noises with your mouth - just because it's fun - as you head into the shower to get ready for a day at the hospital. Then again, there are the days when you stagger toward the bathroom in the dark and accidentally drop your retainers into the wastebasket, then have to kneel on the cold tile floor to dig for them because you've already taken off your glasses and refuse to turn on the light just yet. I had a lot of both types of mornings during my eight weeks on Internal Medicine.
On the first day, I wanted to quit almost immediately. The nine third-year medical students doing the Internal Med clerkship at my hospital during July and August had an orientation session for an hour and were then sent up to the floors to join our teams on rounds. I received the briefest of introductions to the team and then was swept up into rounds, feeling completely overwhelmed and unsure whether to try to participate (and if so, how) or to try to be as unobtrusive as possible. I became sure that I would be completely unable to function in this setting and that my performance would score far below expectations, and that this was absolutely not what I wanted to do for a career. There was no way I would be able get through this one day, I suddenly knew beyond a shadow of a doubt, let alone the eight weeks of Internal Medicine and the remaining two years of rotations.
Yes, fine, roll your eyes. I made it. It's just that I'm not good with change. I always hate the first day of school/work/anything because I just can't take the uncertainty. What should I do and how will I learn how do it and when should I do it? What is the schedule? (Oh please, God, let there be a schedule!) What I always want to know is, Is this how things are going to be? And if I can't know all of that right up front, can't someone at least show me where the bathroom is and tell me when I'm allowed to eat lunch??
You can measure how comfortable I am in a situation based on how many times I use the bathroom. None of us peed on that first morning, I think. Because really, how do you ask the attending or senior resident, "Excuse me, may I take a quick bathroom break while you continue with the whole healing-and-saving-lives thing? And if you don't mind my asking, where might I locate said bathroom?" You don't. You just figure it out, make a mental note whenever you pass a door with that relieving symbol on it, and stop drinking anything at breakfast, or, for that matter, throughout much of the rest of the day, at least until you get a better sense of when you might be able to run off quickly to relieve yourself.
Eight weeks is a long time to work 10- to 12-hour days 5-6 days a week with a lecture for your lunch “break.” I guess you could say it builds character. I did indeed figure out how to make myself useful, and at times I would like to think that I actually contributed to patient care. I definitely struck up some good relationships with my patients, and the feedback I received was, for the most part, quite good. I think it’s safe to say that internal medicine will not be my field of choice. It’s obviously an important field, training most outpatient adult providers, hospitalists, and those who go on to further subspecialize in cardiology, gastroenterology, hematology, etc. But there aren’t enough procedures for me, not enough laying on of hands other than for the daily palpation of a patient’s abdomen and the quick check for edema in the ankles. There also isn’t enough decisive action for my taste; many times the internists call consults from specialists and then decide which recommendations to follow. They monitor blood pressure and electrolytes and watch out for infections. But mostly, at least in the hospital, they coordinate and deliver care to damp down the latest exacerbation of a chronic illness that will not be cured upon completion of the patient’s hospital stay. Patients with COPD will still have COPD when they leave; they will just be able to breathe a bit better than during their most recent attack. Until we see them back again the next time.
Although it’s not for me, I’m glad that I started out with Internal Med because it gave me a great base on which to continue building my clinical knowledge and skills. But I’m really glad it’s over.
On the first day, I wanted to quit almost immediately. The nine third-year medical students doing the Internal Med clerkship at my hospital during July and August had an orientation session for an hour and were then sent up to the floors to join our teams on rounds. I received the briefest of introductions to the team and then was swept up into rounds, feeling completely overwhelmed and unsure whether to try to participate (and if so, how) or to try to be as unobtrusive as possible. I became sure that I would be completely unable to function in this setting and that my performance would score far below expectations, and that this was absolutely not what I wanted to do for a career. There was no way I would be able get through this one day, I suddenly knew beyond a shadow of a doubt, let alone the eight weeks of Internal Medicine and the remaining two years of rotations.
Yes, fine, roll your eyes. I made it. It's just that I'm not good with change. I always hate the first day of school/work/anything because I just can't take the uncertainty. What should I do and how will I learn how do it and when should I do it? What is the schedule? (Oh please, God, let there be a schedule!) What I always want to know is, Is this how things are going to be? And if I can't know all of that right up front, can't someone at least show me where the bathroom is and tell me when I'm allowed to eat lunch??
You can measure how comfortable I am in a situation based on how many times I use the bathroom. None of us peed on that first morning, I think. Because really, how do you ask the attending or senior resident, "Excuse me, may I take a quick bathroom break while you continue with the whole healing-and-saving-lives thing? And if you don't mind my asking, where might I locate said bathroom?" You don't. You just figure it out, make a mental note whenever you pass a door with that relieving symbol on it, and stop drinking anything at breakfast, or, for that matter, throughout much of the rest of the day, at least until you get a better sense of when you might be able to run off quickly to relieve yourself.
Eight weeks is a long time to work 10- to 12-hour days 5-6 days a week with a lecture for your lunch “break.” I guess you could say it builds character. I did indeed figure out how to make myself useful, and at times I would like to think that I actually contributed to patient care. I definitely struck up some good relationships with my patients, and the feedback I received was, for the most part, quite good. I think it’s safe to say that internal medicine will not be my field of choice. It’s obviously an important field, training most outpatient adult providers, hospitalists, and those who go on to further subspecialize in cardiology, gastroenterology, hematology, etc. But there aren’t enough procedures for me, not enough laying on of hands other than for the daily palpation of a patient’s abdomen and the quick check for edema in the ankles. There also isn’t enough decisive action for my taste; many times the internists call consults from specialists and then decide which recommendations to follow. They monitor blood pressure and electrolytes and watch out for infections. But mostly, at least in the hospital, they coordinate and deliver care to damp down the latest exacerbation of a chronic illness that will not be cured upon completion of the patient’s hospital stay. Patients with COPD will still have COPD when they leave; they will just be able to breathe a bit better than during their most recent attack. Until we see them back again the next time.
Although it’s not for me, I’m glad that I started out with Internal Med because it gave me a great base on which to continue building my clinical knowledge and skills. But I’m really glad it’s over.
Wednesday, October 27, 2010
Whoa-oh, we're halfway there...
At the end of second year, I had about a month to study for Step 1 of the United States Medical Licensing Exam. All medical students must pass it in order to continue on to clinical rotations. In 7 hours and 322 computer-based multiple-choice questions, it tests the basic science knowledge gained in the first two years of medical school: anatomy, physiology, pathology, pharmacology, biochemistry, etc. If you fail, you cannot continue on to your next rotation until you retake and pass the exam. If you pass, you do not have the option to retake it in the hopes of earning a higher score. (In some ways I feared passing with a low score more than I feared failing.) Step 1 is a serious source of stress for second-year medical school students starting around March. While still covering new coursework in our classes, we began pre-studying, or getting ready to study (e.g., making flashcards, revisiting old notes, buying far more review books than one could ever hope to read). And freaking out.
I entered the boards studying period with a carefully-crafted plan. I made a schedule on an Excel spreadsheet outlining which topic would be covered on which day, and how I would spend the hours of each day. I emailed this plan to my parents so they would know what I was doing and also know what times of day would be appropriate to call. My plan made me feel safe and equipped to tackle the beast that is Step 1.
The first day went very well. I started with immunology, a topic that I had especially enjoyed learning and was eager to revisit. I covered the appropriate section of my review book and completed the planned number of questions. I reviewed my flashcards for immunologic drugs in the evening and went to bed at my set bedtime feeling quite good.
After a day or two, I started to stall out a bit. Sometimes I misjudged how much time I should spend on a certain study task and realized later that I had left too many things to accomplish in the afternoon. Sometimes I took a long lunch break, like when one of my sorority sisters was in town. Sometimes I just didn't feel like studying and my brain rebelled, spitting out poetry instead of medical facts.
Over Memorial Day weekend, Tay and I moved up to Vermont, where we would spend the entire month of June. I had high hopes that the change in scenery and decrease in distractions would allow me to really buckle down and stick to my rigid schedule. On the first night, we unpacked everything and I set up my study station, with everything organized just so.
It was a good decision to study in Vermont. I followed my schedule reasonably well, with breaks on most days to go for runs through beautiful scenery. Tay was fantastic about taking care of all of the grocery shopping, food preparation, cleaning, and quizzing me nightly on my drug flashcards corresponding to the organ system I had studied that day. Given the isolation, putting on nice clothes and going out to lunch became ridiculously exciting. And every now and then, with much encouragement and reassurance from Tay, I put down the books and took a night off from studying to go out for a burger and a beer, do some last-minute wedding prep, or just watch a movie.
Of course, there were darker times, too. It's exquisitely difficult to quit for the day when you have not accomplished what you hoped to, and know that tomorrow will likely yield too few hours in which to accomplish its assigned tasks, let alone to catch up from today. And that each time you are seeing each topic is the last time you will see it before the exam because there is too much to even cover fully once, let alone repetitively. These were the forces that kept me slogging along past my bedtime and - a rarity in my life - unable to achieve restful sleep. I reached a new stage of being worn out: the bags under my eyes grew such that there were actually two levels of bags. Tay and I referred to this as "double-bagging." My goal became not to be fully rested - that would take weeks - but to be down to single bags leading up to the exam... and our wedding.
I wish that I had blogged about this experience earlier, so as to actually capture the mix of tension, fear, frustration, and exhilaration as they coursed through me. It's hard to fully revisit and describe the apprehension, the feeling of Oh God I'm not studying hard enough... if only I could concentrate better and for longer... why didn't I study harder over the past two years... this is ridiculous, how can they expect anyone to know all of this stuff... what if I actually can't do this? when I know my score and have progressed through months of clinical training so that the boards are a distant memory.
One of the things I do remember is this: that sometimes, even while in the depths of worry and frustration, I would stumble across a connection so great that it made me want to cry. Often the knowledge imparted during the first two years of medical school feels like thousands of facts, each existing in its own little space with no relation any other, each to be memorized individually. And then somehow, either through a practice question or an explanation in a different review book or even just seeing the information again and seeing it in a new light, I would suddenly understand that these bits were not individual entities but part of a broad mural exhibiting and explaining one disease. Sort of: Oh, that causes that... and then they lead to that. Ohh-ohhhh! It felt like all of the facts were tiny dewdrops sprayed out separately in space, but with closer inspection I began to see the fine threads of the spider's web to which they were all stuck, that actually formed numerous links between them.
I took the exam outside of Burlington on June 21. Tay and I had planned go out in the city afterwards, but I was too exhausted; he picked me up, drove me to get my pre-wedding spray-tan, and then we went back to the condo to see Mom, Dad, and Bijou, who had arrived that day. I am rarely super-confident when I leave a test, so I refused to even speculate that I had likely passed. However, I felt that I had prepared well and that during the test I was focused and really "on."
Scores were released on July 14, but I refused to check mine for a few days. Finally, on Friday of that week, I came home from the hospital and Tay insisted that I check. I cried. He cuddled me, then pointed out that I was being a two-year-old and was no longer actually producing tears, just whimpering. (True.) Finally he logged onto the website for me. He stared at my score for a moment and my heart dropped; then he turned the screen toward me. I shrieked, we embraced, I called my parents, and then we went out for dinner.
And I reached the halfway point. From there I could begin to count down to the end of med school.
Sunday, October 24, 2010
Owning It
Surprise, I'm back to blogging!
Third year has kept me busy, and I actually have quite a lot to share, stretching way back to the boards in June. Don't worry, I have several posts planned - you know, to keep things nice and organized - but I wanted to put up a quick post as sort of a lead-in to the ones to follow.
I came across this great quote in a Runner's World article the other day that completely captured a feeling I've been having about medical school. The article was by Peter Sagal, the hilarious host of NPR's Saturday news quiz show, Wait, Wait, Don't Tell Me (and, apparently, a darn good runner). He wrote about the final 6.2 miles of a marathon (which is 26.2 miles in total), and how, no matter what, they are especially difficult and painful. He quoted Paul Carrozza, founder of a Texas running shoe company, who offers this advice: "Stay in the moment. And remember. . . once it's over, you'll own it forever."
That sentiment reflects the reason that I will likely attempt a marathon someday, and also the feeling of accomplishment and worth-it-ness that I am beginning to sense lies at the culmination of these four years.
Stay tuned for details about my transition to the clinical years.
Saturday, July 3, 2010
It's Always Sunny . . .
I always swore I wouldn't plan an outdoor wedding. I knew myself too well. I was well aware that, throughout the months of planning, my visions of sunlight sifting through my veil to sparkle on the surrounding greenery would be have to jockey for position with crazed checks of the weather forecast. I didn't want to build a fantasy only to have it crushed beneath the white plastic flaps of a hastily-erected tent.
And then somehow during my engagement to Tay, the worrywart melted away, leaving a zen bride-to-be I nearly didn't recognize. We planned a ceremony that required blue skies not only for the twenty or so minutes the nuptials would last, but for enough time to transport the entire wedding party and all the guests up and down the chairlift. In May we decided to bank on June 26 - of the following year - being sunny.
Why was I so comfortable with this scenario? Risk-averse, double-no-triple-check-everything me? At that point, my calm was due to the fact that we had a back-up plan that would also be beautiful. We decided that, if the weather were inclement, we would marry in front of the huge windows in the Gate House Lodge, where the reception was slated to be held anyway.
In the month leading up to the ceremony, I was guilty of frequenting weather.com every day or two. I watched the little illustrations in the forecast toggle between a little yellow sun and a gray cloud emitting miniscule raindrops, but my observations were colored more by interest than emotion. I was honestly just curious to see down which aisle my father would escort me.
By now, however, the reasons for my composure had shifted. Sunshine or thunder, mountaintop clearing or base lodge or even a private room somewhere with just a few witnesses, I was about to marry Tay. There are no words to express how happy I felt to join my life with his.
Wedding Weekend (yes, it's a proper noun in my mind) arrived with a flourish. I took the boards and Tay and I cleaned up the mess of books and study materials that had littered the condo for the previous three weeks just in time for my parents' arrival. The last-minute details that required only a few words to describe turned out to require more than a few hours to complete; we stuffed welcome bags, affixed tiny crystals color-coded according to entree selections to seating cards, tied bejeweled ribbons to paper lanterns, and met with the videographer and wedding planner. On Thursday a shipment of 300 pieces of baklava arrived from Turkey, compliments of Tay's father. In addition to blessing us with their presence at our wedding, my parents' close friends the Hacketts, who had traveled from Arizona, gamely rolled up their sleeves and helped us form an assembly line. We packaged the baklava into favor bags tied with silver and purple ribbon and affixed little cards highlighting the charities to which Tay and I had made donations in our guests' names. (They also gave me the huge gift of revealing that, in fact, my blog has a wider readership than just my parents and Tay. Thank you so much, Mr. and Mrs. Hackett!)
The rehearsal the day before the wedding occurred up on the mountain in bright sunshine, which lasted throughout the welcome dinner. Descending the stone steps on the side of the lodge to be met with so many loved ones from so many different times and places in our lives was surreal, almost confusing. The party lasted until Castlerock Pub closed, then spilled over into Clay Brook hotel for a few more hours of revelry.
June 26, 2010, dawned with tentative sun and emphatic reassurances from all around that the weather would cooperate. A jog with some of my closest college friends, followed by hours of hair, makeup, and estrogen-fueled fun in "Salon 106" (as my hairdresser, Richie, dubbed my hotel room) helped me to remain calm. When raindrops began to spatter the pavement visible outside my window as I sat in a high chair having my makeup applied, my stomach relaxed a bit. At least now we had an answer.
In yet another uncharacteristically calm and spontaneous moment a few days prior, I had agreed to change our rain location to Timbers, a restaurant with breathtaking woodwork that we frequent whenever we are at Sugarbush. Conveniently attached to the Clay Brook hotel, it allowed the bridal party to simply walk through the halls of the hotel to reach the foot of the aisle. As we drew near the entrance to the restaurant, I glimpsed Tay before I even registered the music or the guests, and the tears lasted from approximately that moment through my first dances with Tay and with my dad at the reception.
Most of the rest of the experience was different than most people had predicted: Tay and I actually ate our dinners, we visited with every guest during at least once (but in most cases, several times) during the weekend's events, and the night didn't fly by. It was not a blur but a series of moments that were alternately breathtaking, exhilarating, and serene. And of course, no one other than our family and wedding planner could have predicted the fireworks at the end of the night. :)
My husband and I have now stolen away for a few honeymoon days. We are spending the long weekend at a bed & breakfast in Newport, Rhode Island. It includes gourmet breakfasts and daily wine & cheese as well as a resident bichon frise. With an uncharacteristic lack of interruptions and to-do lists, we are enjoying one other's undivided attention and the inviting conglomeration of shops, eateries, and architecture. We are married and we are happy. Oh, and the sun is shining.
And then somehow during my engagement to Tay, the worrywart melted away, leaving a zen bride-to-be I nearly didn't recognize. We planned a ceremony that required blue skies not only for the twenty or so minutes the nuptials would last, but for enough time to transport the entire wedding party and all the guests up and down the chairlift. In May we decided to bank on June 26 - of the following year - being sunny.
Why was I so comfortable with this scenario? Risk-averse, double-no-triple-check-everything me? At that point, my calm was due to the fact that we had a back-up plan that would also be beautiful. We decided that, if the weather were inclement, we would marry in front of the huge windows in the Gate House Lodge, where the reception was slated to be held anyway.
In the month leading up to the ceremony, I was guilty of frequenting weather.com every day or two. I watched the little illustrations in the forecast toggle between a little yellow sun and a gray cloud emitting miniscule raindrops, but my observations were colored more by interest than emotion. I was honestly just curious to see down which aisle my father would escort me.
By now, however, the reasons for my composure had shifted. Sunshine or thunder, mountaintop clearing or base lodge or even a private room somewhere with just a few witnesses, I was about to marry Tay. There are no words to express how happy I felt to join my life with his.
Wedding Weekend (yes, it's a proper noun in my mind) arrived with a flourish. I took the boards and Tay and I cleaned up the mess of books and study materials that had littered the condo for the previous three weeks just in time for my parents' arrival. The last-minute details that required only a few words to describe turned out to require more than a few hours to complete; we stuffed welcome bags, affixed tiny crystals color-coded according to entree selections to seating cards, tied bejeweled ribbons to paper lanterns, and met with the videographer and wedding planner. On Thursday a shipment of 300 pieces of baklava arrived from Turkey, compliments of Tay's father. In addition to blessing us with their presence at our wedding, my parents' close friends the Hacketts, who had traveled from Arizona, gamely rolled up their sleeves and helped us form an assembly line. We packaged the baklava into favor bags tied with silver and purple ribbon and affixed little cards highlighting the charities to which Tay and I had made donations in our guests' names. (They also gave me the huge gift of revealing that, in fact, my blog has a wider readership than just my parents and Tay. Thank you so much, Mr. and Mrs. Hackett!)
The rehearsal the day before the wedding occurred up on the mountain in bright sunshine, which lasted throughout the welcome dinner. Descending the stone steps on the side of the lodge to be met with so many loved ones from so many different times and places in our lives was surreal, almost confusing. The party lasted until Castlerock Pub closed, then spilled over into Clay Brook hotel for a few more hours of revelry.
June 26, 2010, dawned with tentative sun and emphatic reassurances from all around that the weather would cooperate. A jog with some of my closest college friends, followed by hours of hair, makeup, and estrogen-fueled fun in "Salon 106" (as my hairdresser, Richie, dubbed my hotel room) helped me to remain calm. When raindrops began to spatter the pavement visible outside my window as I sat in a high chair having my makeup applied, my stomach relaxed a bit. At least now we had an answer.
In yet another uncharacteristically calm and spontaneous moment a few days prior, I had agreed to change our rain location to Timbers, a restaurant with breathtaking woodwork that we frequent whenever we are at Sugarbush. Conveniently attached to the Clay Brook hotel, it allowed the bridal party to simply walk through the halls of the hotel to reach the foot of the aisle. As we drew near the entrance to the restaurant, I glimpsed Tay before I even registered the music or the guests, and the tears lasted from approximately that moment through my first dances with Tay and with my dad at the reception.
Most of the rest of the experience was different than most people had predicted: Tay and I actually ate our dinners, we visited with every guest during at least once (but in most cases, several times) during the weekend's events, and the night didn't fly by. It was not a blur but a series of moments that were alternately breathtaking, exhilarating, and serene. And of course, no one other than our family and wedding planner could have predicted the fireworks at the end of the night. :)
My husband and I have now stolen away for a few honeymoon days. We are spending the long weekend at a bed & breakfast in Newport, Rhode Island. It includes gourmet breakfasts and daily wine & cheese as well as a resident bichon frise. With an uncharacteristic lack of interruptions and to-do lists, we are enjoying one other's undivided attention and the inviting conglomeration of shops, eateries, and architecture. We are married and we are happy. Oh, and the sun is shining.
Friday, May 28, 2010
Amazing News!!!!
OK, second year is over and I'm studying for the Boards and the wedding is in less than a month and we had a super-fantastic engagement photo shoot last night and I did my final dress fitting this afternoon and we're moving to an exciting new apartment in July, and I really will try to catch up on all of that, but another amazing thing just happened that I need to share right now: I got accepted to attend a 3-day conference offered by the American Medical Student Association in Washington, D.C., that is all about writing in medicine!
A physician who helps to facilitate the poetry group that I joined this year (and who is an amazing surgeon, poet, and person; an idol of mine, really) forwarded some information about the conference to students interested in the humanities. The application deadline was 4 days away, but when I visited the website, I began writing my essay immediately; I couldn't believe that a conference geared so perfectly toward my interests even existed. (Check out the website to see for yourself; it's got Becky written all over it: http://www.amsa.org/AMSA/Homepage/EducationCareerDevelopment/AMSAAcademy/WI.aspx)
I am one of 24 students accepted, and I will be participating in the prose track. (The other options were poetry and journalism.) There are workshops and seminars and small-group sessions with peer feedback and critique. The only catch is that I'd have to miss a day and a half of my internal medicine rotation. I emailed the dean about 5 seconds after getting the acceptance email (and calling Mom & Dad, obviously), so I'll be waiting anxiously to receive her response.
Now if you'll excuse me, I have to go burst with happiness.
A physician who helps to facilitate the poetry group that I joined this year (and who is an amazing surgeon, poet, and person; an idol of mine, really) forwarded some information about the conference to students interested in the humanities. The application deadline was 4 days away, but when I visited the website, I began writing my essay immediately; I couldn't believe that a conference geared so perfectly toward my interests even existed. (Check out the website to see for yourself; it's got Becky written all over it: http://www.amsa.org/AMSA/Homepage/EducationCareerDevelopment/AMSAAcademy/WI.aspx)
I am one of 24 students accepted, and I will be participating in the prose track. (The other options were poetry and journalism.) There are workshops and seminars and small-group sessions with peer feedback and critique. The only catch is that I'd have to miss a day and a half of my internal medicine rotation. I emailed the dean about 5 seconds after getting the acceptance email (and calling Mom & Dad, obviously), so I'll be waiting anxiously to receive her response.
Now if you'll excuse me, I have to go burst with happiness.
Wednesday, May 12, 2010
Open Letter to the Doctor Who Did My Physical Exam at the Student Health Clinic This Morning
Dear Dr. S---,
You walked into the exam room without knocking. You didn't introduce yourself. By way of greeting, you demanded, "What do I have to sign?"
I know that just checking to make sure I'm healthy enough to enter my third year of medical school and start seeing patients is probably incredibly boring and annoying; I'm sure it's not what you aspired to do as you to studied medicine. I know you can probably guess that I am in good health just by looking at my vital signs and overall appearance. But couldn't you have listened to all four of my heart valves rather than just three? And couldn't you have listened to more than two of the five lobes of my lungs? Yes, I am healthy, but if I weren't, you could easily have missed something.
What about the rest of the exam? Did you decide it was safe to assume I have no swollen lymph nodes, no tenderness in my abdomen, no abnormal reflexes, no back problems? Or did you just not care enough to do these things or to even say "Goodbye" or "You're welcome" as you flew out the door?
Maybe you had just finished with a difficult patient or maybe you were having a bad day. Either way, I want to thank you for signing off on my health form. Thank you, also, for reminding me exactly what kind of doctor I don't want to become.
Becky
You walked into the exam room without knocking. You didn't introduce yourself. By way of greeting, you demanded, "What do I have to sign?"
I know that just checking to make sure I'm healthy enough to enter my third year of medical school and start seeing patients is probably incredibly boring and annoying; I'm sure it's not what you aspired to do as you to studied medicine. I know you can probably guess that I am in good health just by looking at my vital signs and overall appearance. But couldn't you have listened to all four of my heart valves rather than just three? And couldn't you have listened to more than two of the five lobes of my lungs? Yes, I am healthy, but if I weren't, you could easily have missed something.
What about the rest of the exam? Did you decide it was safe to assume I have no swollen lymph nodes, no tenderness in my abdomen, no abnormal reflexes, no back problems? Or did you just not care enough to do these things or to even say "Goodbye" or "You're welcome" as you flew out the door?
Maybe you had just finished with a difficult patient or maybe you were having a bad day. Either way, I want to thank you for signing off on my health form. Thank you, also, for reminding me exactly what kind of doctor I don't want to become.
Becky
Tuesday, April 27, 2010
It just got real
You know how sometimes you look forward to (or dread) something for so long that it feels like it will always be looming somewhere out there in the future, will never be right at hand, never really occur? And then one day it sort of smacks you in the forehead and announces, "Hello, I'm here! I'm happening!"?
I'm taking Step 1 of the medical licensing boards on June 21. My last class of the pre-clinical years (the last class before my intense month of studying for the boards) starts on Monday.
Tay and I are getting married on June 26. Invitations go out tomorrow.
Oh yeah, things just got real.
If you're like me, you think you'll have everything all worked out by the time that the thing you're anticipating actually rolls around; you think you'll have completely reviewed and re-mastered all of microbiology and pharmacology as sort of a pre-study before the real boards-studying commences, and that you'll have your ceremony all written and your abs all flattened long before the Big Day. Except then you look up and realize that your second year of med school wraps up in less than a month and your wedding dress has arrived at the salon and is awaiting its first fitting. And suddenly, these two huge events are right here, right about to happen. And it's a crazy, overwhelming feeling.
Just to be clear, I am thrilled out of my mind to be marrying Tay in less than two months. It's just that there are still many details I hope to attend to, putting the finishing touches on our ceremony and celebration. I'm also thrilled out of my mind to be finishing this year of school and moving on to clinical rotations. But Step 1 of the boards is the most important test that I will ever take (Literally. This puppy tests the entire body of knowledge from the first two years of medical training, and my score will be the most important factor in determining the strength of my candidacy for residency.) and the time remaining just doesn't seem like a fraction of what I need to tackle the entire mountain range of material, of which it currently feels like I know nothing.
But here we are. Less than two months left. It's time to stop thinking (lamenting overambitious study schedules that were left in the dust months ago and worrying about, well, all of this) and start doing. Do what I can each day and then go to bed with a clear mind so I can be well-rested enough to do what I can the next. Because the boards and our wedding are here. They're real and they are happening.
And I will be ready.
I'm taking Step 1 of the medical licensing boards on June 21. My last class of the pre-clinical years (the last class before my intense month of studying for the boards) starts on Monday.
Tay and I are getting married on June 26. Invitations go out tomorrow.
Oh yeah, things just got real.
If you're like me, you think you'll have everything all worked out by the time that the thing you're anticipating actually rolls around; you think you'll have completely reviewed and re-mastered all of microbiology and pharmacology as sort of a pre-study before the real boards-studying commences, and that you'll have your ceremony all written and your abs all flattened long before the Big Day. Except then you look up and realize that your second year of med school wraps up in less than a month and your wedding dress has arrived at the salon and is awaiting its first fitting. And suddenly, these two huge events are right here, right about to happen. And it's a crazy, overwhelming feeling.
Just to be clear, I am thrilled out of my mind to be marrying Tay in less than two months. It's just that there are still many details I hope to attend to, putting the finishing touches on our ceremony and celebration. I'm also thrilled out of my mind to be finishing this year of school and moving on to clinical rotations. But Step 1 of the boards is the most important test that I will ever take (Literally. This puppy tests the entire body of knowledge from the first two years of medical training, and my score will be the most important factor in determining the strength of my candidacy for residency.) and the time remaining just doesn't seem like a fraction of what I need to tackle the entire mountain range of material, of which it currently feels like I know nothing.
But here we are. Less than two months left. It's time to stop thinking (lamenting overambitious study schedules that were left in the dust months ago and worrying about, well, all of this) and start doing. Do what I can each day and then go to bed with a clear mind so I can be well-rested enough to do what I can the next. Because the boards and our wedding are here. They're real and they are happening.
And I will be ready.
Sunday, March 14, 2010
Fit for a Princess
Sometimes I see something and I decide, I have to do that. Someday, be it soon or way in the future, I'm going to do that thing!
That's exactly what I thought last year when my friend Gina told me about a race she was running, a new half-marathon in Disney World. The theme was Disney Princesses. And I knew that, someday, I needed to run that race.
Luckily for me, it actually fit into my schedule this year. Last weekend I flew down to Orlando to visit Gina and to run what turned out to be a fantastic race. Seriously, it was made for me. Why? Because the finishers' medals look like crowns with rhinestones in them. Because people all around were running in tutus and tiaras. Because on my race bib was printed not only my number, but Princess Rebecca. Because we got to run through Epcot and the Magic Kingdom, including a path right through Cinderella's castle, with trumpeters up above heralding our arrival. Because, even after minimal training and getting up at 3:45am to wait in 40-degree weather in the dark for the race to start, it reminded me how much I love to run. Oh yes, and because, when it finally did start, it was with fireworks!
Like I said, it was fantastic. I am so glad I went. And so glad I carried a camera!
That's exactly what I thought last year when my friend Gina told me about a race she was running, a new half-marathon in Disney World. The theme was Disney Princesses. And I knew that, someday, I needed to run that race.
Luckily for me, it actually fit into my schedule this year. Last weekend I flew down to Orlando to visit Gina and to run what turned out to be a fantastic race. Seriously, it was made for me. Why? Because the finishers' medals look like crowns with rhinestones in them. Because people all around were running in tutus and tiaras. Because on my race bib was printed not only my number, but Princess Rebecca. Because we got to run through Epcot and the Magic Kingdom, including a path right through Cinderella's castle, with trumpeters up above heralding our arrival. Because, even after minimal training and getting up at 3:45am to wait in 40-degree weather in the dark for the race to start, it reminded me how much I love to run. Oh yes, and because, when it finally did start, it was with fireworks!
Like I said, it was fantastic. I am so glad I went. And so glad I carried a camera!
Monday, February 15, 2010
ZUMBA!
When I was a kid, I loved to dance. I took ballet first, but the teacher was mean and that dashed my hopes of becoming a professional ballerina. (Don't feel bad; I was five and mainly in it for the tutus anyway.) Then I discovered jazz. I danced my heart out for years. I took lessons with Donna, one of those hardcore jazz/aerobics people from the '80s who rocked the spandex shorts with a neon thong leotard over them. (That part creeped me out, but I figured it meant she was pretty legit.) I'll never forget the year that she placed me at the very front of the group's formation to lead during our end-of-the-year recital. We danced to the theme from Flashdance. It just doesn't get much cooler.
I don't remember why I stopped. It was probably due to other commitments like softball and violin. I always remember my dancing days fondly, though, and I miss having an outlet to let loose to the music like that in the company of others who love it, too. (And in a more organized way than, say, at a club or a wedding.) So when my favorite spinning instructor announced that she would be teaching a Zumba class on Monday nights, it was clear that destiny was calling my name.
Zumba (http://www.zumba.com/us/) is a new workout craze based around Latin dance. It features steps from salsa, merengue, and many other dances and uses really fun, fast-paced music. I tried it tonight and it was fantastic! It was fun because the steps changed with each song, so it was a mental workout too!
It's funny how I'm trying new things during medical school, a time that is notorious for its challenges and jam-packed schedule. I think what's happening, though, is that being frustrated by - and just plain unhappy with - school has made me really ask myself, What do you wish you could do? What makes you happy? in a way that doesn't always happen when I actually do have free time. It's like I'm forced to squeeze as much happiness as I can out of the tiny little moments of freedom that I seize. And I'm getting better and better at doing just that.
I don't remember why I stopped. It was probably due to other commitments like softball and violin. I always remember my dancing days fondly, though, and I miss having an outlet to let loose to the music like that in the company of others who love it, too. (And in a more organized way than, say, at a club or a wedding.) So when my favorite spinning instructor announced that she would be teaching a Zumba class on Monday nights, it was clear that destiny was calling my name.
Zumba (http://www.zumba.com/us/) is a new workout craze based around Latin dance. It features steps from salsa, merengue, and many other dances and uses really fun, fast-paced music. I tried it tonight and it was fantastic! It was fun because the steps changed with each song, so it was a mental workout too!
It's funny how I'm trying new things during medical school, a time that is notorious for its challenges and jam-packed schedule. I think what's happening, though, is that being frustrated by - and just plain unhappy with - school has made me really ask myself, What do you wish you could do? What makes you happy? in a way that doesn't always happen when I actually do have free time. It's like I'm forced to squeeze as much happiness as I can out of the tiny little moments of freedom that I seize. And I'm getting better and better at doing just that.
Saturday, January 9, 2010
Update
The surgery went very smoothly! I can't type very well with just my left hand, so I will write more details later. I lounged around this morning (and got pancakes in bed!) and I'm about to get back to studying. No pain or discomfort, just the awkwardness of having my right arm in a sling. That's all for now!
Friday, January 8, 2010
Surgery
I'm having surgery tomorrow. Well, today, actually. I'm up late trying to keep my mind off of it and also so I can sleep late and minimize the amount of time that I am awake and not allowed to eat anything. (I can't eat past midnight, but I don't have to be at the surgery center until 1PM. I'm going to be cranky.)
It's a minor surgery: an arthroscopic synovectomy. There has been something irritating my elbow joint lining, causing some fluid accumulation that restricts my range of motion, so the surgeon will make some small holes in my elbow, insert tools and a camera, and remove the joint lining. This should take an hour or less, and I will go home afterwards. I don't even have to go to the actual hospital; it will be done in the ambulatory surgery center, which is new and shiny and clean-looking. My doctor has assured me that this most likely isn't anything bad, and other people have assured me that he is an excellent surgeon. My parents and Tay will be in the waiting room the whole time.
And yet I'm scared. I've never had surgery or been under anesthesia. I have reasoned through this so many times in my head, telling myself that this is minor, routine, and being done by very capable people. But deep down I know that there is some tiny, itty-bitty, miniscule chance that things could go badly. And that's what I end up focusing on. The part I have the most trouble with is that I have to completely relinquish control of my body and well-being. I do not enjoy handing over the reins.
So that's why I'm blogging at 1:30 on a Friday morning... to kill time, to sort through my thoughts, and to capture them as they occur, so that perhaps someday when a frightened patient turns to me, I can reassure him or her that I, too, was scared before my first surgery; that I understand exactly what he or she is feeling; and that everything will be alright.
It's a minor surgery: an arthroscopic synovectomy. There has been something irritating my elbow joint lining, causing some fluid accumulation that restricts my range of motion, so the surgeon will make some small holes in my elbow, insert tools and a camera, and remove the joint lining. This should take an hour or less, and I will go home afterwards. I don't even have to go to the actual hospital; it will be done in the ambulatory surgery center, which is new and shiny and clean-looking. My doctor has assured me that this most likely isn't anything bad, and other people have assured me that he is an excellent surgeon. My parents and Tay will be in the waiting room the whole time.
And yet I'm scared. I've never had surgery or been under anesthesia. I have reasoned through this so many times in my head, telling myself that this is minor, routine, and being done by very capable people. But deep down I know that there is some tiny, itty-bitty, miniscule chance that things could go badly. And that's what I end up focusing on. The part I have the most trouble with is that I have to completely relinquish control of my body and well-being. I do not enjoy handing over the reins.
So that's why I'm blogging at 1:30 on a Friday morning... to kill time, to sort through my thoughts, and to capture them as they occur, so that perhaps someday when a frightened patient turns to me, I can reassure him or her that I, too, was scared before my first surgery; that I understand exactly what he or she is feeling; and that everything will be alright.
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