I was an undergraduate visitor at a medical school. One morning walking across campus I looked up and noticed my sidewalk was coming to an intersection and I was inevitably going to come across a man in a white coat. I did what any introvert would do, I slowed down to let him get to the intersection first and I looked down to avoid eye contact. If I walked slowly enough, I figured we would avoid walking past each other and could happily continue on our separate ways. Imagine my surprise when the man stood waiting for me at the intersection, smiling. Of course, he was a neurosurgeon. Of course, he wanted to know what I planned to do with my life. I told him my story and explained that I was confused about my future plans. I shouldn’t be confused he told me. He could tell exactly what I really wanted to do and encouraged I should do it. Before leaving me the stranger looked at me, pointed to his head and said, “the brain is the most mystical organ. It is the only organ that can transgress two realms, the Earth and one day God’s realm.” Pointing to the sky, he continued “He gave us this gift, our brain, and I never cease to be amazed by the wonderful things I can do through medicine.” He smiled and then he walked away and we went our separate ways.
I have no idea where the time has gone, let alone what happened the day before yesterday or last week because everything is like a giant blur in my mind. It is now the second semester of second year!! Wow!!
After all of the nerve-wrecking things I heard about second year, my fear and anxiety levels about it were sky high before it had even begun last July! I came in with all these buzz words floating around in my mind that I had heard over and over again: “hard,” “busy,” “fast,” “tired” “scary,” “STEP 1,” which are words that can definitely define a second year experience (or any year really) to the fullest, and words I can’t deny experiencing the effects of on many days. However, despite, all the “bad” things about second year, no one ever told me about all the amazing components that can encompass second year — what an enjoyable experience it has turned out to be so far. Such as:
I value that each course this year is its own topic. Example: Neurology course, Psychiatry course, Hematology Course…where you can really delve in and learn the material full-heartedly — one system at a time.
I love that I got to go back home to Ann Arbor to visit friends and family practically every month for a few days first semester! Something I DEFINITELY didn’t think would’ve been a possible thing to do second year.
I enjoy how fascinating each subject is, and find it incredible how much there is to learn (and keep learning) about an organ system!! I am grateful that there’s time to spend with great friends, which last semester included things such as visiting Young’s Dairy Farm (a place with delicious ice cream!), watching movies, playing board games, and trying out new restaurants…
I cherish those random “days off” that we get to study, and especially when I get a full or partial three-day weekend (and there have been many!) where I can sleep in till 10am.
I appreciate that I got a three-week winter break…where I got to spend most days catching up with friends and family. The most exciting part was where I got to enjoy Magic Kingdom with my mom and fulfill my life-long dream of visiting the Harry Potter theme parks!! (best part of second year hands down :P)
That said, the “negative buzz words” that clouded my mind have now been blanketed with words such as “enjoyable” “challenging” “amazing” “fun” “exciting” and yes, even “relaxing,” which I didn’t even think would’ve been a possible way to describe second year back when I started in July!
Six weeks of M2-done! Already flying by like summer did. My summer between M1 and M2 was perhaps the busiest, yet the most educational “vacation” I’ve ever had. I spent six weeks of my summer completing my required electives-the first two weeks spent doing a pediatric GI rotation at Dayton Children’s and the last four weeks spent doing a family medicine rotation in my hometown. Each clinical experience had its unique aspects and I learned so much by being in two incredibly different, yet sometimes-similar environments. It was refreshing to learn outside of the classroom and rewarding to see many of things I learned during first year applied in the clinic. However, it has been even more powerful when my summer experiences have started to come into play during second year and I’m able to tie in what I’m learning to what I observed during shadowing.
My schedule completely flipped when I started my GI elective because I spent around 8-9 hour days at the hospital, which had a different feel to it than the routine of go to class and study all day. Surprisingly, my exhaustion levels reached maximum capacity than during the normal school year because I wasn’t accustomed to the demands of clinical practice, but I felt like I got a glimpse of what typical days would like in the future—fast, busy, long, yet exciting and worthwhile. I had the opportunity to observe most of the pediatric GI specialists and each of their unique approaches to patient care. I enjoyed the variety that the field of GI provides—from consults, to physical exams and follow-ups, to being in the OR doing colonoscopies… you really never get bored! I valued the opportunity to listen to the dialogue between the physician, parents, and children and the process in which one comes up with a diagnosis, and follow-up care thereafter. One of my favorite experiences included the time when a GI physician let me get a glimpse of third year. I had the opportunity of having an in-depth talk with a parent about her child’s symptoms, collect all the relevant information and then summarize my findings to the physician and try to come up with a diagnosis before he went in to see them. Feelings of nervousness and excitement ran through me because this was my first time interviewing a non-standardized patient, but it was nice to use my ICM interviewing skills in a real setting!
After finishing up my GI elective, two days later my AHEC family medicine rotation began. I worked at an integrative health care clinic in Ann Arbor, which immersed me into a very unique and different approach to medicine—to the extent that I hope to apply some of the techniques and strategies that I learned here into my future medical practice.
The clinic uses an integrative approach by combining both traditional and alternative medicine to provide patients with more options and guidance. An integrative approach seeks to understand multiple factors from different bodily perspectives that could cause the said symptoms; therefore spending more time with patients is critical to improving their well-being to understand everything that is going on to connect the pieces. For many new and returning patients, we spent a minimum of 30-45 minutes discussing health concerns with them. I had many patients express to me how appreciative and full of gratitude they were to have a doctor spend this much time with them.
This experience showed me how an integrative approach can benefit some patients immensely as it provides them with more personalized choices geared toward their health when other traditional therapies do not seem to work for them. Thus, having the opportunity to see first-hand how this gives patients the benefit of attaining more health care perspectives and options by integrating conventional and alternative medicine to maximize their health care taught me that there is more than one correct way to practice medicine when balanced correctly. Further, I valued the give-and-take relationship between doctor and patient that I saw during my time at the clinic. This patient-centered approach further underscored the importance of allowing patients to a be a part of their health care conversation, allowing more information to be gathered to make patients more comfortable with their health care choices.
Many lessons taught, many things seen, and much more knowledge and facts gained this short summer than I would’ve thought possible!
I want to start by apologizing for the delay. Things have been crazy! I finished up my OB/Gyn rotation, studied for and took Step 2 CK, finalized my fourth year schedule, and started working on my application to residency. All in a little over one month! There seems to be so much to do during fourth year but I am sure it will all pay off in the end.
The OB/Gyn was a great experience! I was especially interested during the gynecology portion of the rotation because I got to be first assist on many surgeries (I am interested in surgery after all). I even got to use the laparoscopic instruments for the first time. The staff and residents were all great, but I still think surgery is for me.
I am currently in Indianapolis, Indiana on an away rotation in congenital cardiac surgery. I’m highly interested in cardiothoracic surgery and since Wright State does not have a residency program for this, I will be visiting some other schools and rotating on their service. Away rotations are a great way to learn about other programs at other institutions and get known by some of the faculty there. I am learning a lot and the hours are long, but the days fly by when you are scrubbed into a case. It is so rewarding to see the work that we do for the infants that have life-threatening cardiac anomalies. After Indianapolis I will go to Houston, then Miami, and finally Cincinnati. I am very excited to visit these cities because growing up I did not do much traveling. I have plans to spend my free time exploring the cities. As an example, I visited the Indiana War Memorial today. It is a must see for anyone that passes through and it is free to the public.
The main thing keeping me busy is my application to residency. It’s on a website called ERAS and you basically fill out all your information and then it turns it into a nice CV for you to save. I’m glad it is not like those pesky job application websites that ask you to input your information and then also upload a CV that contains the information you already entered. Why can’t you just upload the CV and be done? I’m still interested in cardiothoracic surgery and plan to apply to integrated programs (which consist of 6 years dedicated to cardiothoracic surgery) and general surgery programs.
Although I was not in Dayton for the arrival of the new class this year (I believe they just started last week) I saw many pictures online and as always it seemed to be a wonderful white coat ceremony. If any of you are reading this I wish you good luck during the next four years and do not blink because you will miss it! Oh, and if you are interested in blogging let me know. We can always use more medical school insights.
That’s all for now. The Indiana State Fair is calling my name. Did you know you can deep-fry a candy bar? Still not sure if I’m adventurous enough to try that. As always, email me with any questions!
It is difficult to grasp that in just over two weeks I will be starting my second year of medical school. There are still times where I still cannot believe that I made it to medical school and managed to complete first year. As I sit on my deck, enjoying the last few weeks of what will probably be my last summer, I figured now would be as good a time as any to reflect on the past year
I remember getting my white coat fitted during my interview, not knowing if I would ever actually wear it. Then came white coat ceremony and just like that it was official. I was the proud owner of that white coat and my journey to a career in medicine began. I knew what I was getting myself into, I have an older brother who is now a physician and he forewarned me of the long nights, constant studying and slowly decreasing social life. For the most part that is how it started with anatomy. Anatomy was much like learning a new language, but this language was both written and pronounced in English. I knew how to pronounce all the words I read, however was familiar with none of them. I had my fair share of long nights listening to video recordings and then spending quality time in lab. In the end I overcame the anatomy hurdle and each class after was just another hurdle that needed to be jumped. What “worked” in one class may not have worked for another. I found myself having more free time throughout the year. I am confident that my study skills improved with each class, but I also realized the importance of keeping myself “Healthy”. Making sure to eat right, hit the gym, and enjoy myself every now and again.
Also I need to mention that none of medical school could have been done without the friends I have made while in school. I think it is interesting how complete strangers can become the best of friends in such a short period of time. My friends kept me going when things got difficult and we always supported one another. We studied hard and partied harder. While I have my close knit group of friends like everyone else, I enjoy the remainder of my classmates and hope to continue to build friendships.
Well time to wrap up this post. First year has now come to an end. I still can’t believe the amount of information that I have learned throughout this first year. Given that I have forgotten many things, it is still crazy to think how far I have come and how much I have grown. If I can offer any advice to future first year students it is that
1) Medical school is Doable---> Everyone before you has made it out alive. Take it a day at a time...it goes by super fast!
2) Keep your sanity---> Find ways to relax or else the stress will eat you!!
3) Go outside of your comfort zone--> Make new friends, meet new people
4) Put in the effort and treat it like a full-time job--> A job that pays you nothing and charges you interest instead
5) Remain Humble---> Don’t forget everything you have accomplished to get here and everything that you will accomplish in the months/years to come.
All in all I conquered first year, went on an epic spring break trip to NOLA, saw Drake in concert….TWICE and experienced Peru over the summer. Despite the schoolwork I have had one unforgettable year. Second year is here….time to stock up on highlighters.
“Relative deprivation” is a term coined by Samuel Stouffer. According to Malcolm Gladwell, “Stouffers point is that we form our impressions not globally, by placing ourselves in the broadest possible context, but locally—by comparing ourselves to people “in the same boat as ourselves.” Our sense of how deprived we are is relative.”
The city of Loma Linda is one of the more affluent cities in the Inland Empire in CA , it is notorious for the healthy habits and good health of its residents. If you walk across the 10 freeway from Loma Linda into the city of San Bernardino you enter one of the poorest cities in CA and severely affected by health disparities. Last night I sat outdoors at a friend’s parents' hill top residence watching shows on an overhead projector overlooking a beautiful night view of the cities of Loma Linda and San Bernardino. Why not engage in this pleasant experience since “we can” was the inside joke of the night. Today, I found myself at the Al Shifa clinic in the city of San Bernardino. It is a free clinic where physicians volunteer their time in an attempt to meet the health care needs of the underserved population in the area. As a medical student you obtain an incredible amount of hands on experience, because there is so much need.
As I finished my clinical experience for the day I sat in awe at the sharp contrast between the two neighboring cities. Growing up my experiences paralleled that of the people of the city of San Bernardino yet I am blessed with the opportunity of an educational experience like those at the top of the hill. How lucky am I! How lucky are we! How lucky are we as medical students to have the opportunity to engage in a medical education and some day use the knowledge we gain to bring healing to all parts of the globe: the top and bottom of the hill. Stouffers idea of relative deprivation came to mind. We have a tendency to compare ourselves to those in our present situation or those who are doing better than us. This makes it easy to dismiss the needs of those people upon whom life has not smiled too kindly. It is therefore my hope that all medical students be aware of the blessing that it is to be in our position. So that one day when we student doctors get to “the top of the hill” we will not turn a blind eye to the needs of those stuck in the valleys, but that we will try to meet the health care needs of underserved populations with a compassionate heart simply because “we can”.
As I reflect back on my first year of medical school, I can’t believe how fast it flew by. From various experiences, opportunities, knowledge gained, and individuals I’ve met, this was by far the most transforming year of my life. Every moment is still so vivid, clear in my mind, yet such a blur because all year it felt as if I was riding a high-speed train that has now suddenly come to a halt—until M2 year that is! BSOM provides its students with so many unique opportunities and I’m so glad I had the chance to experience many of these things to enrich my medical school experience during year one.
Below are some things I learned during my first year of medical school:
- Take it one day at a time. Immersion in each moment will allow focus on one thing at a time and reduce the feeling of being overwhelmed. Be present in the moment no matter what you are doing and don’t think about what is coming next/what you have to do after until it’s time to do so.
- Don’t be afraid to change study habits from one class to another or even during a class because each class is different and requires a unique approach.
- You can and will do it even when you think you can’t. Other people know you can do it when you think you can’t. Believe in yourself. You will amaze and surprise yourself each and everyday.
- Every minute is precious—use time wisely. Seize every free minute, hour, day, weekend, to visit or call family and friends, do something fun, go to the gym, watch a movie, relax, sleep, etc. Sense of time changes in medical school. The days are long but the weeks are fast. Time never stops. Use each moment to your advantage.
- Just go for it. Studying comes first, but that doesn’t mean life has to stop. Go to events, conferences, and meetings…anything that interests you because these are the things you will remember.
- Inquire! You won’t know if you don’t ask! Talk to older students to get advice and tips for each new class and medical school in general because that will give you some direction into what to expect and new ways to approach learning.
- Stay on top of the material and don’t get behind, because playing catch up is hard to do. It’s possible to get through the material. Try to learn the material well the first time and when reviewing, because in the end we’ll be using this information for life. Don’t give up when something doesn’t make sense and make sure you spend time on what confuses you—don’t ignore it.
- Build relationships for now and for later.
- Ask for help and don’t be afraid to do so, especially when facing problems, or trying to make decisions. Talk to family, friends, and advisors for advice and second opinions. Find at least one mentor you can rely on. You don’t get through medical school alone. People want you to succeed—don’t be afraid to seek advice and share your emotions and feelings when it’s sometimes easier to just ignore the problem and bottle it in.
- Just breathe and medical on.
Having finished a whole year of medical school, I am feeling a mix of emotions; fatigue is near the top of that list. This has been the longest year of school I've ever had - from the end of July straight through until early June. As I've told many family and friends, I love school and learning as much as the next guy (probably more than the next guy, truth be told) which is a big reason why I chose medicine as a career; I knew that I could handle the schoolwork and that I would make a good student. Even so, 10 months of school, especially at the pace of medical school, would tire anyone. I am extremely grateful for the 2 month summer vacation that we are offered; I am looking forward to working on several personal projects, as well as just having additional time to relax with family and friends.
Despite feeling worn out at the end of a long school year, I have been pleasantly surprised to find myself refreshed and renewed in purpose as I study medicine. I am realizing how much more bearable school is when seen through the lens of the end goal. Medicine is a career about helping others, and the world desperately needs good, loving doctors (and people in general). When my studies weigh me down, I think of the people that I will someday, hopefully, help to heal. This makes it easier to get through the long days. I am very excited to do some shadowing and volunteering this summer, which I hope will refresh me even more and remind me why I chose this profession. So for now, cheers to finishing a year of school!
About a year ago I caught a flight midway across the country with only my carry on, a checked bag, and $1,400 dollars in my bank account. With friends and family left behind in CA and no permanent place to stay in Ohio I engaged on the most epic adveture of my life, medical school. Despite all the sleepless nights and the overwhelming feeling of "I have not studied enough" I would not trade it for the world. The Boonshoft School of Medicine has been like a secret gem that I was lucky enough to discover and I know with certainty that I could not be at a better medical school. One year down, three to go. M2 here we go!
In honor of Memorial Day and for all who have served and are currently serving our great country:
Your life has never been easy. You dropped out of school to join the marines, and when they wouldn’t take you because they thought you should go back to school, you walked across the street and joined the army. You should have been playing basketball, checking out the pretty young girls, spitting tobacco when your parents weren’t watching, graduating high school and attending college, but instead you went to Vietnam.
Forty-five years later I have met you. You are going to lose your leg they say. It is probably because you have smoked for so many years, they say. Or maybe you could have done better by your health but you chose not to do so. Rest assured, they say that too.
What they do not say is how your childhood was stolen away by war, racism, and desperation brought on by economic disparity. They do not say that you had little choice in your future, or that your experiences have brought you the wisdom you can now share with your grandchildren.
We do not talk about that. You are watching last night’s game of Cavs vs. the Bulls when I walk in, and you ask me to sit beside you and listen to your story. You ask me what life will be like when you are no longer able to walk without a prosthetic device. I tell you frankly I have no idea. You laugh. “What a riot,” you say. From that day until the day you lose your leg, we share in this routine. You show me pictures of your bulldog waiting at home, we argue about the previous night’s games, you tell me I should have become a lawyer, I say you should have gone to school. You laugh again. “What a riot,” you say.
The day we take your leg I walk into the OR with my cap and mask, but you are still able to recognize me. You ask if that is me, and the staff gives a look of confusion and tells you the surgeon will be in shortly.
But you call my name and the room becomes deafeningly quiet. You ask me to hold your hand until you fall asleep, so I do.
The day we take your leg I cry for you, and not for you alone, but for your generation of adolescent soldiers who faced the horrors of war only so that their society would stay free to forget about them. I cry for your youth spent overseas and the fear in your eyes as you watched your brethren die in battle. After surgery, I wrap you up and follow you back to your room where you ask for me by name. When you see me, you smile and tell me I took the wrong leg. I warn you to be careful, there is still time to take the other. You laugh. “What a riot,” you say.
For this, I will never forget you.
Wow! I know I say this all too often but where does the time go? I am currently about to start my last rotation of third year in a few days and have no idea how that happened. The past year has honestly seemed like one giant blur. Was it yesterday I was aimlessly walking around the halls of Miami Valley Hospital looking for a patient’s room? It sure seems like it!
I just finished my surgery clerkship. For any of you that read my blog regularly you probably know I am interested in surgery. Well…I have some news for all of you. I am still interested in surgery! It was great to actually be working hands on and I really felt like I had an immediate impact on my patient’s lives. You really get immediate results with surgery (most of the time). Even though the hours were rough, it was probably the most fun I have had during my third year of medical school.
I started out at a physician-owned surgical hospital in Springfield, OH. It was a bit of a drive but it was incredibly fun. There were no residents at this location. That’s right! It was just me and the surgeon scrubbed into every case. When you are the only one scrubbed in besides the surgeon you get to do a lot more than just retract (a fancy word for holding a metal device to move tissue out of the way) and suction (blood, water, and even feces). I was what they would call “first-assist” on every surgery. None of the surgeries were very complex but I was getting to do something that I greatly enjoyed. If you are interested in surgery and come to Wright State I recommend doing a rotation there!
The second half of the rotation I was on trauma. While putting in an average of 65 hours a week sounds like a terrible time I was actually enjoying it. The hardest part for me was the down time when nothing was going on (and we were supposed to be studying). However, it is hard to study when you are in a surgery for 7 hours (yes that happened during this rotation but it still isn’t the longest surgery I have been in) and answering trauma calls every hour or so. While I definitely enjoyed the surgery aspect of this part of the rotation I do not think I am interest in trauma surgery. Cardiothoracic surgery is where it’s at and that is still my number one interest.
Only one more rotation to go until the end of third year. What??!?! I’m still working on finalizing my schedule for fourth year. Less than a year until Match Day where I find out where I live for my residency training! A little more than a year until I am a graduate of the Wright State University Boonshoft School of Medicine! Sometimes it feels like one big dream. As always feel free to contact me with any questions! Talk to you again in a few weeks!
Wow! I want to start by apologizing for being a little late on this post. Things have been flying by and I am over halfway done with my third year of medical school! I’ll give you a quick update of what has happened since my last post.
I had my pediatrics rotation for eight weeks. Four of those weeks are spent on the inpatient service at Dayton Children’s Hospital while the other four are spent at one of many various outpatient sites. I really enjoyed inpatient; I have always felt the hospital is where I belong. The rumors are true and you WILL get sick on your pediatric rotation. No matter how many times you wash your hands those bugs seem to always follow you home. It’s RSV and flu season, but I surprisingly ended up with a 24-hour case of gastroenteritis (go figure). You also have to do one week of nights while on the inpatient service. I must say I really enjoyed it. Even though the hours are longer and it can be busier than the day shift at times, I felt that it was quiet and there were not a lot of other things going on at the hospital to distract you. Maybe I can get hired somewhere where I only work nights. People have to have surgeries at night too, right?
Outpatient was also fun and I was placed at the Wright Patterson Air Force Base (WPAFB). I think this is one of the things that makes Wright State such a unique place to go to medical school. We have several different hospitals and they all provide a different experience. At WPAFB I was able to rotate through adolescent medicine, pediatric cardiology, development, and even the newborn nursery! Many of my classmates did not get this opportunity and I think it made learning even more fun.
In other news, and not related to courses, I was accepted for an oral presentation at a medical education conference in Columbus, Ohio that will take place this April. I have been working on this research since my first year of medical school and I am glad to see my hard work paying off. If you end up coming to Wright State and have no idea where to start when it comes to research let me know. I found myself in a similar circumstance early on.
Right now I have one week under my belt of the surgery rotation. I must say that I absolutely love it! I am at a location in Springfield where there are no residents. This basically means I am first assist on all the surgeries. As you can imagine I am having a blast! After four weeks there I will start a trauma rotation at Miami Valley. Hopefully I get to be just as involved there!
As always feel free to email me with any questions about medical school, Dayton, Wright State, or life in general. See you in eight weeks!
Although my goal in this blog is to provide the perspective of a first year medical student, I realize that it is already March, and that almost three-fourths of my first year is already over. How quickly time passes is a cliché idea, but I have personally never felt it to be more true than I do this year. It truly seems like the weeks and months since acceptance to medical school, convocation, and beginning the first class to now have been artificially put on double speed (much like I do with many of my professors’ lectures…but that’s a different story). I simply can’t believe how quickly this year has passed.
And yet, so much has happened that I feel like a different person, in many ways, than I was last July. Besides all the “active” learning that has taken place – the textbooks read, notes written, classes attended, skills practiced, tests taken – there has been a certain amount of passive learning as well, as there is in all stages of life. Simply being immersed in the world of medicine has opened my mind to concepts and value systems previously foreign to me. Part of my goal in writing, especially this blog, is to sort through the complex ideas presented in medical school, as much for my benefit as for those who may stumble upon my ramblings.
So far, what I love most about medicine is its place in the world; it is the crux of my education so far, and is sufficiently challenging, but is also an obviously worthwhile pursuit. It is founded upon research and evidence and is rooted squarely in the biological sciences; yet it is the point where the sciences must meet humanity. It is not enough to study constantly or live in a lab or the library; we must learn to interact with people of all backgrounds, must learn to have a gentle touch, must learn to listen attentively and speak kindly. This first year of medical school so far has stretched me because it has forced me to improve both sides of myself. I look forward to learning more over the course of this long and exciting journey.
So after finishing the psychiatry clerkship I can honestly say that things have gone by way too fast! It seems like third year just started, but here I am halfway done with it. I know I say that every time I post, but it is so true. You will not believe how fast medical school goes by, especially during your third year. I’ve been at it since July 1 and it seems like it has only been a two months since I stepped into the hospital with my white coat on for the first time.
The psychiatry clerkship was six weeks long. I spent three weeks on the inpatient unit and three weeks doing consults. I also had experience with outpatient psychiatry one afternoon a week. The inpatient unit was probably my favorite portion of the clerkship. It was a great opportunity to really sit down and talk to patients and learn their stories. I did not feel as rushed as I did with patients during family medicine and I really had as much time as I needed to get their stories. And let me tell you, some of the stories I heard are very sad, while others are quite comical. For example, I had a patient tell me I looked like John Lennon. I don’t see it.
The consult service was interesting in its own way. These were patients that other services, like a hospitalist, would consult us on for various reasons. Most of the time we were asked to determine if a patient had the capacity to make medical decisions. Other times we were helping to manage depression and anxiety. There was a lot of down time during the consult service but I learned a lot during it and the residents had plenty of time to teach the medical students.
I must say that I was not interested in psychiatry at all before starting this clerkship. However, my opinion has changed a little. In the first two years of medical school we do not get much exposure to psychiatry. We have one course that lasts a few weeks during second year and that is about it. Don’t get me wrong, I have always been interested in surgery and still am, but if I ever lose my hands I will definitely put psychiatry as one of my top choices.
We also had a meeting about fourth-year scheduling a week or two ago. Fourth-year scheduling? What?!?!?! It is hard to believe that I will soon be entering my last year of medical school and I still feel like there is so much more to learn. As far as the scheduling is concerned I am feeling a little lost, but I really have not taken the time to sit down and think about it yet. Perhaps by the next time I post I will have a finalized schedule.
Pediatrics is up next for me and I am not sure how I feel about it. I know it will be a mix of inpatient and outpatient medicine but other than that I don’t know what to expect. See you in 8 weeks!
I’m back after six weeks of the Family Medicine rotation. Although it was relatively short, I learned so much! It is great to get some one-on-one time with a physician, something I felt was lacking during my rotation in Internal Medicine. There was a lot of outside work for this rotation but it all added to the learning experience. I definitely think having internal medicine before this was helpful, and I believe that family medicine will be even more helpful in my future rotations. I could sit here and tell you all about the rotation, but there are some other topics on my mind (and they only give me so many words to use).
Since the last time I wrote a blog our school has lost a great mentor and teacher. Dr. Elder was the teacher of our Principles of Disease course during our first year. She really went out of her way to teach us topics on microbiology and many of us felt like this was the first time we started to learn something relevant to medicine. I think the thing I will always remember about her is the way she could come up with these creative songs for remembering different antibiotics or pathogens (you try rhyming with staphylococcus aureus). At the end of our second year, our class had an award ceremony where we awarded her with the Lifetime Achievement Award. It was an honor to be able to give that to her and she even provided us with one last song! Dr. Elder was also part of the IRB at Wright State and I often went to her with questions regarding this. I remember one time asking her if I needed to make an amendment to my protocol and submit it to the IRB. She basically said, “No. Don’t worry about it. I’m the IRB chair so if there are any issues it can come back to me.” I think I speak on behalf of all of Wright State, my fellow classmates especially, when I say it was an honor and a privilege to have Dr. Elder as a teacher and a mentor.
If any of you have ever read my profile you will see I am from a small town called Lawrenceburg, Indiana. Well, to be honest, not a lot of news comes out of my town. However, recently there has been a story circulating the internet and television news about a girl named Lauren Hill who has been battling a rare form of pediatric brain cancer called DIPG. She has started a “Layup for Lauren” challenge similar to the ice bucket challenge for ALS. She has played in her first (and we are not going to call it her last) NCAA college basketball game. She is on her own Wheaties box. She has been on the copy of a videogame. She has even received messages from Lebron James and other celebrities. I am not listing all of this to commend her on being famous. No, the point here goes much deeper. DIPG is a cancer that mainly affects young children. Children too young to have a voice for themselves. What Lauren has accomplished is spreading the word on a tumor for which relatively little research exists. I think her goal on starting this whole ordeal has been to increase awareness and raise money for DIPG research. I can assure you she has done that, and she makes me proud to be from Lawrenceburg, Indiana. If you would like to donate to DIPG research in Lauren’s name please go to The Cure Starts Now Foundation website.
Next up for me is my Psychiatry rotation. I am kind of excited because I have never really interacted with these types of patients before. It is another six-week rotation so I will see you again around the end of the year (where does the time go???). As always feel free to email me at email@example.com with any questions you may have about Dayton, Wright State, or medical school in general!
Hello all! I’m really excited to share a little bit of my last few months with you! Has it really been over two months already?? Sometimes I can’t even believe I’m a medical student…FINALLY. It feels like as perspective medical students, we work towards this for so long, and now I get to actually be where I want to be. Everything I do now just counts towards my professional goals, and I love it.
Okay, so who is Lauren Gunderman? Just a quick synopsis of “me”: I was born and raised in Hillsboro, Ohio, a small farm town an hour southwest of Dayton. I am the third of six kids, (Interesting fact: three girls and three boys in that order), and I would never do anything to change that. Big families rock and I adore my siblings! I went to undergrad in Cleveland, Ohio at John Carroll University and graduated with a Biology major. Some of my best experiences there: being a Resident Assistant (helps so much with clinical skills!), being near a big city for the first time in my life, and all the amazing food Cleveland has to offer. And of course many more academically related things…;)
And now I’m back in southern Ohio! I’ve never lived in Dayton before this, but it’s a great mix between big city/small town. I stopped interviewing after I was accepted to Boonshoft because it was just a perfect fit for me: a primary care focus, block scheduling (one or two classes at a time), and the people were so amazing when I came here. You’ll hear it all the time and think it’s bogus, but no joke! My classmates have really made this journey a challenging but exciting ride.
And now for a little synopsis of my last few months: well, it started out pretty slowly and the first two weeks were more about meeting classmates (and studying for Human Development when you weren’t meeting new people). We all say they wean you into medical school here by starting with HD, which is nice because when the more time-consuming classes hit, it’s great to already have a good support system and/or study group worked out. Here’s a little hint to where we are now…Lab, Lab, and more lab. You guessed it: ANATOMY! I’d say most of us were really excited to get in the lab at first, considering many of us had not worked on a real Donor before, and it’s still really neat…but the excitement dies down a little when you’re on week eight (and haven’t washed your scrubs yet…shhhh). But we’re almost there! And I could have never done it without our amazing professors (three cheers for Dr. Neider, Dr, K, Dan Miska, and our TAs!) and my insanely supportive classmates.
Yes, it’s busy. And yes, we sometimes spend Friday nights in the lab after dinner or are those crazy people who pull out their notes at the local Applebee’s. But we find time for fun, whether it’s being aggressive on an indoor soccer team or at a “bone-studying” party. I am so happy to be where I am right now. My family, although I get to see them less than I would like, is extremely supportive; and it isn’t hard to keep a positive attitude when your peers are there to help you along the way, just as you are there for them. Some great advice: any type of patient interaction you can do only serves to increase your passion and helps you see ahead to what comes after all the school work. Recently, I have been accepted into the Early Clinical Experiences Program here at Boonshoft, our medical’s first step at getting first and second years into the clinic as soon as possible. I can’t wait to finish learning all my exam skills and to work alongside a physician regularly! Of course, I’ll let you guys know how it goes. So much is happening and time is flying by fast…can’t wait to write again!
Have a great week,
My oh my how I missed Dayton, Ohio and as a non-native, I never thought I’d say that. I am exhausted, it has been a long three months and it is SO good to be back. There are so many things that I missed. Yes, I missed my truck, my bed, my bathroom with a lightbulb that I’ve been putting off changing…but I also missed that Chinese buffet place down the street with that lo mein I always get, scenic drives to Yellow Springs when I need a pick me up and fresh air and people wearing T-shirts saying “Raider Up!”
Peace, Love and welcome me back with open arms,
Ps. Happy belated birthday to me. I came home to presents in the mail, who doesn’t love presents? (It’s rude to ask a woman’s age.)
Pps. And now, time for an extended nap.
Wow! So here I am in my third year of medical school! Time has gone by so fast and I can hardly believe I am more than halfway done with school. Since third year consists of 6 rotations I will try to do a blog update after each one. First up: Internal Medicine.
The Internal Medicine rotation is 12 weeks long and sometimes you end up working on the weekends. I have to admit it was exhausting at times but it was way better than second year. Being in the hospital and actually getting the chance to interact with real patients is such an amazing feeling! No more pharyngeal arches from anatomy. No more questions about how many people in China get diagnosed with adenocarcinoma each year compared to those in the United States. Most importantly, no constant studying! Some people might say you are studying by interacting with your patients and looking up information on their conditions. But isn’t that much more fun than reading from a textbook and taking a test every other day?
You do have tests during third year known as the dreaded shelf exams. You have one at the end of each rotation. Having only taken one I am no expert on them. However, I think the best way to study for them is to repeatedly do questions over and over. That is the best way you have to learn during third year. Do a question. If you miss it, look up the answer in another source. If you got it right, congrats! If you look up every little detail about every little thing you just won’t have the time (in Internal Medicine) at least.
The Internal Medicine rotation consists of an outpatient experience (which to me seemed pretty similar to Family Medicine), an inpatient experience, a subspecialty (my interests in cardiothoracic surgery pointed me towards cardiology), and neurology. I really think part of the experience is determined by the attitude of the residents you work with and I can say that I had excellent residents during each part of this rotation.
During this time we also met with the clerkship director and discussed what field of medicine we were interested in going into. For me, I have always been interested in cardiothoracic surgery, ever since I worked in a lab over three years ago where I got to see open heart surgeries on a daily basis. It was a good time of reflection for me. Although some current cardiothoracic surgeons have told me not to go into that field because of the long hours and intense training, I still feel it is what I am meant to do. There will always be people telling you not to do something or that you aren’t good enough to do something. On the other hand, there will always be people encouraging you to do your best and pushing you to work harder. Do what makes you happy! Sure, certain positions make more money than others, but I’d much rather be doing something that makes me happy than something that allows me to buy three houses, two boats, and four cars.
That’s all for now. Stay tuned for the next edition, which will be about Family Medicine! As always feel free to email me (firstname.lastname@example.org) with any questions or comments. I love hearing from potential and current students!
I am currently three months into my third year and all I can think about is how different this year is compared to last year. Whenever I have these introspective moments, of course I want to share them with you (This way, I get to look incredibly deep and pensive.). Trouble is, I updated you very little on MS2, so let's get that established first: studystudysleepeatstudystudyspringbreakstudystudystudySTEPONE. Aaaand that about sums it up!
Ok but seriously, I tried very hard to write a post about second year once I had finished my classes but struggled with reflecting on such a big year so close to its fall-out. MS2 was the most challenging year of my life. Wow, it’s crazy to read that so definitively, but it is absolutely true: the course load and pressure of the year prevented me from really feeling very human; I spent at least 15 hours a day studying for my classes, mostly studying alone (with the exception of my faithful cat Scarlet, of course); I had a quiz nearly weekly and a test every 1-4 weeks. If that doesn’t seem overwhelming enough, on top of studying for regular classes, I had to cram in as much Step 1 studying throughout the year as I could*. Turns out sedentary, near-solitary confinement coupled with lots of stress can wear you down, and all that alone time and anxiety is something I’m still recovering from. However, all this in mind, I feel incredibly blessed that no major crises (other than school-related ones) occurred last year. I say no major crises occurred for a reason: I know many of my classmates struggled with family issues, health issues, and financial issues on top of the overwhelming work load, and I feel incredibly lucky that school was my major focus and that the real world provided few distractors otherwise. I have such immense respect for my peers knowing we all got through that challenging year together in spite of all the obstacles we encountered.
*Did reading the words “Step 1” strike you to the core with terror, anxiety, and weird excitement? No? Well then, let me explain (insert evil laughter here). At the end of MS2, all medical students take Step 1, which is an eight-hour (yup, you read that right) exam that serves as a final for the first two years of medical school. Passing the exam is required to continue your medical education, and the score you get on that exam correlates to the type and quality of residency for which each student is competitive. In summary: it's a super important final over the foundation of medicine. NOW do you feel a bit more terrified? Good, then I’ve explained it adequately.
I will remember a lot of stress, anxiety, and sleepless nights from MS2. But with bad usually comes good, and what I will also remember with pride is how much I learned every single day. To go from basically no knowledge regarding an organ system to understanding its physiology and pathologies in a matter of weeks is truly impressive. I also hope I'll never forget how much I surprised myself last year: when the going got tough, I got going. And in spite of all the times I wanted to give up, I never, ever did. That is something I'll always be proud of.
So, enough about the past. Let’s discuss the now, aka life as an upperclassmen: it's awesome. I mean, I hoped it would be considering that I finally get work with patients and physicians and see all the things I've been studying for 2 years, but LAWD is it amazing. My first rotation was in pediatrics, and now I'm in surgery. I'm loving the constant stimulation, the hands-on learning, and the interactions with other humans (no offense, Scarlet). Every single day I’m reminded how the hard work from the last two years was definitely, definitely worth it, and every single day all I want to do is keep learning. As of right now, I’m not 100% certain which part of medicine I like best-for now, I’m relaxing and enjoying the ride. I can't wait until the day that I decide what I want to be when I grow up. Let's both just keep our fingers crossed that that day comes sooner rather than later!
Hello hello, I am trying to keep my energy up with as little caffeine as possible. I have only been here for two weeks but I’ve been going going going for the entire time… it’s tiring but I’ve gotten to see SO much and DO so much. It has legitimately been an awesome experience...despite the daily 4 or 4:30 am wake up time and lack of weekends. (A friend reading this over my shoulder just said “What is a weekend? That sounds like a wonderful, mythical creature.”)
There is a third year medical student on his surgery rotation on the team with me. I struggled a bit when I first got here trying to find my sea-legs and he was already more familiar with the ORs, knew crucial information like the location of the cafeteria (CRUCIAL!) and was already familiar with the strange electronic medical record system here…definitely not my beloved EPIC or even the CPRS of the VA that I can manage to navigate my way around. He knew where all the medical supply rooms were so if a resident asked for a drain pulling kit, he could get to it 1 billion times (yes, this number is accurate) faster than I could….I say all this to say that I was the Sub-Intern and was concerned (‘concerned’ is an understatement) that he was showing me up. I was supposed to be here to impress and he was here stealing my shine. Was he doing this on purpose? (You already know I have a tendency to be dramatic but paranoia isn’t usually my style.)
I’ve since figured my way around those feelings and it involved getting up even earlier in the morning until I became more efficient…don’t worry, the sleep deprivation was worth it.
As tempting as it was to think of myself as ‘just the medical student’, (and I think this crosses the mind of every rotating student from time to time) I must say that the team members here really did their best to include me and play to my capabilities (no, I cannot yet write a script for Cipro but I can happily write all the ‘brief op notes’ and make the outpatient surgery discharge instruction packets). They recognized that there are things that the medical student can do that can make their lives easier…especially the Intern’s life. (While I am so ready to graduate and get that M.D., I am not in a hurry to get that Intern pager.)
During some of these rotations you get ‘advice’ and some mixed messages from the senior residents and the more junior ones:
“The most important thing for you to do is to get in on as many cases as possible, see as much as you can. You’re not here to do intern scut work. If someone tries to imply otherwise, let them deal with me.” Ummm, but I thought that was precisely what I was here to do: to be the Sub-Intern and a team player?
“Get as much face time as you can with the chair and program director.” Yes, yes, yes, but they are only around when operating. I don’t know about them but I wouldn’t be in a particularly chatty mood if I was in the middle of taking out someone’s prostate. Then they leave when it is time to close the patient and suturing the skin is one of my few consistent responsibilities in the OR, I can’t leave with them. I guess I can set up an appointment through their secretaries….is that too aggressive? (Answer: no, no it isn’t and stop whining.)
“Clinic? Well if you want…I’ll be in the OR.” The balance between medical management and surgery is why I LOVE this specialty, what do you mean clinic is optional? Also how else would I get meaningful face time with the attendings anyway?
“Alright. Strong work….go have some lunch”. This was a no brainer; I will welcome carbohydrates into my system with open arms.
Peace, Love and stomach rumbles,
Ps. Tomorrow is September 15th 2014, a date etched into the brain of every MS4 #ERAS
Being in this city by myself, I was tempted to go through the motions of just walking to the hospital everyday, working hard, walking home every night…then 9pm sleep time. (1. Yes, I have the same bedtime as elementary school children 2. The Scandal season premiere is in a few weeks and it will come on past my bedtime *sigh*.)
While I enjoy me, myself and I time, I told myself that traveling to these places is about a lot more than just showing that I’m hard working. Girl, experience things, meet people, meet the city. Netflix won’t get jealous. (Or will it?)
Well, there might be something to this ‘being outgoing’ thing. I’ve managed to meet a bunch of other medical students (even some from Ohio) doing surgical subspecialty rotations. I must say it’s been rather nice to have like minded people to talk with, especially since we can submit our applications in ERAS soon (September 15th, burned into my brain like my birthday)…what’s not been so nice is unsuccessfully trying to navigate public transportation. (“I give up, I’m calling the cab company.”)
Peace, Love and I really miss my truck,
I’m writing to you from Boston, on the brink of another rotation but today is Labor Day/a free day for me and I’m using it to catch my breath a little. This past month has been a whirlwind of witnessing the art of surgery, meeting some great faculty and residents, answering pimp questions (with an incorrect to correct ratio that I will let you guess) and agonizing over my personal statement. There was also a healthy (teehee) amount of sleep deprivation/caffeination, not bringing up my breakfast from nervousness during a Grand Rounds presentation and beautiful Florida weather (which I mostly enjoyed from inside the OR).
I am really grateful for the experience I just had. I learned so much about myself, what I can and cannot handle and about the profession I want to enter…I’ll get into that further in a future post but for now I’m writing because my baby sister told me to hurry up and post pictures of us at the Museum of Natural History…so bossy.
The weekend prior to my last elective, I wanted to get some continuous hours of preparatory reading in BUT it was going to be my last free weekend for a while and was my sister’s last full day with me so we went to the Butterfly and the Wolf to Woof exhibits.
Peace, Love and stay safe during your Labor Day celebrations,
Medical students occupy a very strange space, especially 4th year students. You navigate this uncomfortable space where you want to show initiative and interest and you genuinely want to learn, especially by doing…BUT you also risk coming across too aggressive or even more mortifying: annoying to the more senior team members. You risk getting/doing something very wrong even with the greatest of intentions. I understand that mistakes are bound to be made; they’re a critical part of the learning process, however when you feel like your 4th year is one long audition for residency, you tend to think of ‘mistakes’ in less understanding terms.
Maybe everyone doesn’t struggle with this, but I tend to have lengthy internal dialogues about everything: “should I ask the scrub tech for the scissors to cut now?” “What if I accidentally cut their knot?” (By the way, cutting a surgeon’s knot is one of my nightmares). “Should I ask to grab that retractor?” Mind you, these thoughts don’t paralyze me into inaction, I grab a mean retractor but as students we’re always analyzing our seniors’ response to us, asking for feedback and criticism to better ourselves…wait, I bet this is isn’t unique to just medical students, but you know what I mean.
I have these moments of hesitation because I have had mixed results: I’ve had residents say, “just grab the retractor if you want to, help is always appreciated”. Tried that, sometimes I’m met with a “thanks’, other times ‘nope, I’ll do it myself’ which invariably leads me to think “OMG, does the attending not like the way I retract!? How can I retract better?!”...I’m exaggerating…a little.
I’ve had others say “just ask” which is a much more natural approach for me (#TeamPolite) and I’ve been met with a “don’t ask, just take it…surgeons just DO” for every “sure, thanks for asking”. I’ve even had some “If I wanted you to take it, would have asked you to take it.”…always nice. I use all these words to say, it’s actually quite silly of me to take mental inventory like this. Since I’m dealing with multiple personalities, there’s probably no reliable algorithm…different strokes for different folks. (You know I enjoy a good cliché every now and then.)
As a student you are usually the least knowledgeable and experienced member of the team, BUT you still know SOME things, know how to do SOME things and you want to learn more, want to do more than just observe. Respect this and at the end of the day, no one can fault you for showing initiative, however small your gesture (as long as you’re not being obnoxious about it.) right?
Peace, Love and Overthinkers Unite,
Ps. Gearing up for my second away rotation, wish me luck friends.
Pps. I would have made the title “More savings, more doing” as I heard it in a Home Depot commercial, but it didn’t quite fit… although saving is good advice.
My time in D.C. has come to an end even though I’m not much of a city person (much more of a suburb kinda gal), I had a wonderful time on my elective … learning so much, forging new relationships, repeating that I was from ‘Wright State’ not ‘Wayne State’ every so often.
I also fortunately had the opportunity to enjoy the company of family I had not seen in a while and old friends. Weekends were devoted to being a shameless tourist even though I’ve been to DC on numerous occasions:
Peace, Love and just a 7.5 hour drive between me and the BSOM,
Ps. I heard on the radio yesterday that “selfie” has been added to the dictionary. Hmmm.
Yesterday I had the opportunity to observe a robotic surgery that took a loooong time (by the end I had to decide which was more important: finding food or finding a bathroom) because the procedure itself was just a long one and partly because the attending working the case was still a bit new to robotics. Two fellows were scrubbed in with her who were a lot more familiar as they were more recently trained in the technology and I could see them providing her with direction and instruction even though she is several years their professional senior.
Afterward the attending said to me "there's no room for ego in this profession".
Peace, love and lifelong learning,
Ps. I chose to get food first
Right now I am doing an away rotation at a Children’s Hospital in Washington, DC and all I can say is: YES!!
This is a bit (maybe a little more than ‘a bit’) surprising to me because I never thought of myself as the kind of person that ‘loves kids’. In fact, during college I told my mother that I probably was not going to have any children of my own (I’m told many women go through this phase though). Of course most people like children, mini-people are adorable (mini-anything is adorable; so many kitten and puppy memes on the internet) but they also cry, require diaper changes and have a tendency to attract trouble like Magneto to iron nails (always and forever an X-men fan), but you know what I mean. There are definitely those people out there who can easily quiet a crying baby or make a shy toddler smile…and I find myself wanting more and more to be one of those people.
Honestly, I don’t know what happened, but I do know that I felt ‘it’ first on my obstetrics rotation. I had a fleeting thought: ‘goodness this creature is so cute, what if all my patients were like this?’ and you guys know I had a blast on that rotation. Pregnant woman are not half as frightening as I expected them to be.
Then I felt ‘it’ again during my pediatrics rotation. Nothing lit up my day like a well-visit with a talkative 7 year old, nothing made me reminisce fondly about my own teenage years like chatting with a 16 year old volleyball player about her future plans during a sports physical and nothing broke my heart more than a failure to thrive infant.
Whenever I talk with individuals who work with kids, they echo the same sentiment: “the kids are innocent and haven’t even had a chance to really live yet. They didn’t do anything wrong but bad things happen to them and they deserve our care”. This didn’t always sit well with me because even that 60-pack-year smoker with end stage lung cancer deserves our care but that aspect of innocence and length of time on this earth can really make one think.
I elected to do this Pediatric away rotation just for variety in my 4th year schedule, not necessarily because I was actively thinking about the children but I am SO glad I did.
I do not think General Pediatrics is for me, I have a feeling I will end up in the OR…but maybe working with the Pediatric population IS for me…maybe? Let’s stay tuned.
Peace, Love and figuring out your calling,
Last week Friday, I took my final shelf examination for my third year of medical school. As Murphy’s Law exists, I decided not to really exhale until I had received my Pediatric Shelf Exam passing results.
I really would like to sit here and write something that can tie my third year experience into a neat literary bow but that just seems like such a tall order right now: so many experiences to recount, so little creativity.
This past Monday we welcomed the former second year students to their clinical years at the Student Clinicians Ceremony and I had the privilege of saying a few words in recognition of one of the Interns I had the real pleasure of working with during my Pediatrics rotation for the resident Humanism and Excellence in Teaching Award. I’m just going to leave my little speech here, I think that will have to do as far as bow tying goes:
“Disclaimer: I’ve been known to be a little dramatic…I’ve tried to tone it down but apologies in advance.
I am very tempted to stand here and make mediocre puns about Dr. Shannon Golden’s name being golden and how she happens to also be that in both appearance and demeanor…but I will do my best to spare you.
I got to my very last third year rotation, Pediatrics and thought: YES, the kids and I are going to have so much fun…then I thought oooh, one month of sick kids in the hospital and another month of not so sick kids in the clinic, eh maybe they’re not going to have as much fun. Also, while third year is amazing and you have the privilege of taking care of people in one of their more vulnerable states, it can get to be quite difficult knowing that as a medical student, you are at the absolute bottom of the food chain and some team members see you only as the person lengthening their work day. I was definitely feeling this weight when I got to Peds. Then I met Dr. Golden at Dayton Children’s Hospital and it did not feel quite as heavy and I didn’t feel like as much of a burden.
In my experience, you come across three main types of residents: those that ignore students completely (and from a student perspective, sometimes flying under the radar is not a terrible thing), those that acknowledge your existence by asking you random questions here and there and enquiring if your note is finished 5 seconds after rounds had ended (spoiler alert: mine never was) and those that make an effort to make the student feel like an actual member of the treatment team and this is where Dr. Golden comes in. While sometimes during the year I felt like…an extra…just the medical student, in general, I’ve had the opportunity to work with some pretty great residents but rounding off the year with Dr. Golden was a treat. It was very new and strange to me when she would ask each of us which patients we wanted to see in the morning or suggest interesting cases based on the specialties we hoped to pursue…it was even stranger when before rounding but after we went to see said patient she sought US out to talk about OUR observations, OUR assessment and OUR plan. She was open to answering any questions and brainstorming WITH me and not just leaving me to fend for myself in front of the attending with a haphazard plan during rounds but even more importantly, not just telling me what to say during my presentation so that I didn’t embarrass myself in front of the attending, but I also, didn’t gain as much education-wise since the presentation wasn’t fully my own. Furthermore, she gave daily feedback whether it was on your note or your interaction with a patient, she let you know that you and your work were not unnoticed. Dr. Toussaint and Dr. Taylor, the clerkship directors kept talking to us about active learning and its merits and I can say that Dr. Golden definitely facilitated that on the wards...so much more fun than TBLs. Why was this such a big deal for me: first of all, I learned the hard way that some residents do not want to be bothered before rounds, spending time with the medical student is time not spent elsewhere (but students understand, residents are under extreme pressure and intern year seems scary) and secondly, I felt useful, to both the team and the patient.
All I’ve talked about thus far is how Dr. Golden treated me like I was a person but also it was refreshing to see her treat EVERYONE this way…consistently, not just medical students and not just at the caffeinated beginning of the day (to be fair, the Pediatrics day started a lot later than the Surgery and Obstetrics day so she had an advantage in the morning grumpiness department). She seemed to be such a pleasant light on the team, a light with difficult patients and a golden light (sorry, I really could not help it) with parents of difficult patients. She was a great example of what it means to be a conscientious resident physician and that’s why she deserves this…she deserves to know that we appreciate her. ”
In the end, Dr. Golden was not able to make it to the event so it was a little awkward. Additionally, I have a fear of public speaking so throughout the entire time on stage I suffered palpitations and wondered why I had volunteered to participate, but it’s good to push yourself out of your comfort zone from time to time, right? I am also avoiding photos since I don’t want to see pictures of myself looking scared while wearing red lipstick, something tells me that isn’t an attractive combination.
Peace, Love and one year closer,
Ps. I am going to be out of the Dayton area for a few weeks trying to rock out at an away rotation. Added bonus: my baby sister is in the country visiting from Trinidad, and my away rotation is in the same location as my other sister…three Metzger sisters reunited…and yes, you guessed it, it does feel so good.
What is my father doing right now? Probably relaxing at home watching the World Cup. (Unfortunately the Trinidad and Tobago team/Soca Warriors won’t be there but I have very pleasant memories of them qualifying in 2006…but I digress, this is supposed to be about my father.)
I would just like to thank that man for EVERYTHING he’s done for me: for being present in my and my sisters’ lives, we’re getting older…I’m almost at retirement age, but he continues to be involved (and no, not in a stifling ‘helicopter parent’ type of way…didn’t I say I was almost at retirement age?) I’m grateful for his ungrudging financial support all these years (tuition, yay!), for making an effort to visit regularly despite the distance between Trinidad and Dayton, Ohio…and of course so much more. I hope he knows that it is all and always will be greatly appreciated and respected.
Make sure to let your fathers and father figures (man or woman) know that you appreciate and recognize their role. Yes, we all know that we shouldn’t reserve our show of gratitude for just a single day of the year, but Fathers’ Day is a pretty nice reminder.
Peace and lots of LOVE,
Ps. He’s a little disappointed that none of his daughters are particularly skilled in the kitchen, however considering he’s skilled when it comes to a kitchen and a stovetop, we don’t need to be, right? And no one can poo poo my rice boiling and broccoli steaming talents…and I hear my sister makes a mean bean salad.
Wow! That is the only way I can describe the last month or two of my second year of medical school. I’ll try to describe it to you as best I can, but it all still seems like one huge blur. It went by so fast and I apologize in advance if I forget to mention something.
Once we returned from spring break we had three classes that lasted for two weeks each. The best analogy for these classes I can think of is that if you imagine second year as a 2-mile race, these courses are the final lap. You are tired and don’t know if you can go on and finish the race. You don’t know why you are even running in the first place. However, you know that it will all be worth it once you finish. (Side note: I was a cross-country runner in high school, hence the running reference).
The three courses were endocrine, reproduction, and digestion. I would say there was not much of a difference between the courses except for the fact that endocrine had a quiz almost every day. While this may seem stressful, I really think it helped in learning the material. Other than that the only major stressful item for each course was the exam. The exam was worth around 80% of our grade for each of these classes. Talk about stressful!
Following the digestive exam we had approximately three days to study for a term final. This consisted of questions based on all the courses we had taken during the second semester of second year (cardio – digestion). Three days does not seem like much (and I assure you it is not), but sometimes you have to work with what you are given. Lots of practice questions later, I completed the exam.
Now comes the part that I am sure you are all wondering about: the dreaded Step 1 exam of second year. For those who are not familiar with it, it is a test of a medical student’s cumulative knowledge over the first two years of medical school. You didn’t think they would just let you learn all this stuff and then move on to seeing patients, did you?
I took my test on June 9 and had an entire month to study. While it was hard to find the motivation to keep going at times, other days I saw the light at the end of the tunnel. I am going to briefly tell you how I studied for Step 1, but keep in mind everyone learns differently and this in no way guarantees you will get your dream score.
My first resource for studying was Pathoma. Pathoma consists of a series of video lectures about various pathology topics. It is a must have for all of second year so I would recommend purchasing this around July so that you can use it all year (including during your Step 1 studying). If I remember correctly our school got a discount so make sure you have the code for that before you go off buying it on your own.
First Aid is probably a book everyone is familiar with and I would highly recommend using it throughout medical school. The things in it are pertinent to first and second year. However, it is important to not use First Aid as your only study source. I liked to use it to review things I had learned in lecture and found it to be a great tool for solidifying my knowledge. Another thing to remember is that there will be things in First Aid that you do not learn in lecture and there will be things you learn in lecture that will not be in First Aid. Again, don’t rely solely on this book.
Finally, everyone needs a good question bank. I found Kaplan to be useful during the school year. The weekend before a test I would do all of the questions that were pertinent to that particular subject. While studying for Step 1 I mainly used the UWorld QBank. I cannot say enough amazing things about UWorld. This is not a question bank I would recommend using during the school year, but it is a must have for when you seriously begin studying for Step 1.
Before I knew it my second year of medical school and Step 1 exam were a part of the past. I am incredibly excited to begin seeing patients and doing more active learning in the hospitals. My first rotation is in internal medicine and I am looking forward to it. It seems like yesterday I was walking into White Hall for my first lecture and though I will not be attending the building as frequently now, it will always have a special place in my left and right ventricles.
As always feel free to contact me with any questions you have about anything you may have read or may have just been contemplating. If this all seems overwhelming at first then that is a good thing! Medical school is not easy, but I assure you that you can do it. Don’t ever give up! If you find yourself in Anatomy next year and wonder how you will ever learn all of the arteries or all of the parts of the heart feel free to contact me. I, along with everyone else at the Wright State University Boonshoft School of Medicine, want to see you succeed!
The “Great Divide” at the end of 2nd year really is a divide. You spend two years in the lecture hall with all of these people, you get to know them, you dissect the brachial plexus in anatomy lab together, you get owned by the autonomic nervous system TBL/quiz together, you stress about Step 1 together, you realize you’re all friends and then 3rd year you’re separated.
Some may be on the same rotation as you are but not the same site or the same team but at least you can say “what’s up?” once a week during Didactics. However, many are on completely different clerkships, or have ‘interesting’ weekend schedules...or are in a different group altogether with spring/fall breaks that don’t coincide with yours...you find yourself sending/receiving “what’s up?” texts while knowing a hurried text conversation could never be enough to catch up.
Then there are beautiful days like today…you have the weekend off and someone throws a surprise birthday party/cookout and you think, “hey, I miss these people”.
Peace, Love and Friends smiley
During orientation the clerkship director warned us that they expected some of us to get sick. I’m in the middle of my fourth week and I’m sick…again. Despite the hand washing and mask wearing, my immune system was just not ready; I write this post while coughing and sneezing. My senior resident asked me jokingly last night if I was allergic to them; in reply, I just sniffled and excused myself to go blow my nose. It’s difficult to mouth breathe and talk simultaneously.
While trying to listen to a little girl’s lungs, she told me my eyes reminded her of Lucy. Her mother later let me know that Lucy is her puppy…I’ve never seen a puppy with sparse eyebrows, snazzy winged eyeliner and eyelashes brought to you by Maybelline and M.A.C. but then again I have never met Lucy so who knows.
Terms like “cute little chunk-monster” are not uncommon and you will find yourself using them.
That high pitched baby-talk voice that adults adopt when around children is extremely difficult to avoid, I found myself doing it way too often.
If you don’t have a pen-light handy, you’re doing something very very wrong.
I was expecting runny noses but I never knew there was so much constipation in the pediatric population. Then again, I guess I wasn’t too big of a fan of fibre rich foods when I was that age either.
The Pediatrics rotation is like the Disney World of clerkships; everyone is so cheerful, there are lots bright colors, diapers, apple juice, singing and dancing. I think I mentioned before that tap dancing may not have been appropriate during my earlier rotations but I don’t think anyone would bat an eyelid if I broke out into some Broadway worthy choreography at the Children’s hospital…in fact last week, my team’s interns said that we the students could leave for the evening, but only after doing a dance…cha cha slide.
You will encounter obviously neglected babies, your heart will break.
Sometimes you will encounter a twenty-something year old patient in the children’s hospital. While interviewing them you have to keep in mind an awkward blend of your routine adult and pediatric history questions…you have to ask them about recreational drug use, safe sex practices and alcohol consumption…but you can’t forget to ask about their birth history.
Peace, Love and “will you let me take a quick listen to your belly? I want to see if I can hear what you had for lunch…oh my! Did you eat a racecar?”
Sigh. It went by so fast. Sometimes I forget it actually happened, then I remember the cost of my last minute plane ticket and just like that, the memories become crystal clear again.
Decided to hop a plane to DC to eat brunch (my absolute favorite meal of the day), visit my younger sister and to do some shadowing (in that precise order of importance)…also wanted to pay a visit to my grandmother for her 16th birthday. (There must be a math and biology genius out there willing to explain the fact that I am older than my grandmother.)
Saturday: My sister and I met up with some of my college amigos for brunch. I got a healthy dose of some of my favorite things: laughter and carbohydrates.
Later, my sister and I attempted to make a pasta dish and some salmon stew; I’d say we were quite successful. I discovered that I have a gift for chopping vegetables and washing greasy pots…critical life skills.
Monday: first day of my looooong (not nearly enough O’s) commute to/from the hospital…that train ride was for the birds.
Tuesday: I was a guest at the hospital so they were nice enough to let me borrow some scrubs. (Everyone was so nice and welcoming to me that week, I really appreciated it since being a visitor can be overwhelming.) I asked as professionally as I could if I could take a selfie in the OR…and yes, there is definitely a professional way to ask to take a selfie.
Wednesday: Swung by (and by ‘swung’ I mean ‘spent a very long time on some Metro trains’) my grandmother’s place after shadowing to surprise her. Alright, so she knew I was coming but it makes for a better story if I say I surprised her. She gave me a beautiful necklace…I think in your not so old age, you forget how gift giving on birthdays work.
Thursday: I didn’t take any more OR selfies. My apologies
Friday: My sister and her boyfriend invited me to go see ‘Spiderman 2’ with them; the movie was alright. I’m really more of an ‘X-men’ kind of gal. I was starving before the movie so grabbed some Chinese food. They wouldn’t let me take my leftovers into the theatre…something about ‘establishment policy’. My fortune cookie said: “Take care not to become too attached to the unnecessary extras in this life”, oh the irony.
Saturday: Brunch, nom nom nom
Sunday: Digestive Diseases Week conference was in Chicago…our posters may or may not (the correct answer is MAY) have won posters of distinction. WOOT!! I didn’t have the presence of mind to take a picture of them while mounted nicely…or even take a picture with them; I only have a picture of them spread on the hotel room bed. The bed wasn’t made so I’m too ashamed to post that picture.
Finally sleep time: early to bed since orientation for Pediatrics rotation was the following day. I had very pleasant dreams about being back in Dayton, Ohio with access to my pickup truck and traffic free roads after a long week of riding the trains.
Peace, Love and not a restful week at all,
Ps. Many many thanks to my sister for being such a great host (despite taking me to dinner at that weird salad place.)
I tend to worry about everything and with applying to and waiting for responses from away rotations, thinking about my fourth year schedule and then there’s matching, which I am not going to stop wailing about any time soon, I might as well be giving out personal invites to wrinkles on behalf of my twenty-something face. How do all these med students out there stay motivated, not cranky and wrinkle free?
I am sure they are going to tell me things like their faith, friends, family…Facebook (teehee). Medical school can be terribly isolating, especially in the clinical years where you’re separated from the majority of your classmates so you have no idea what they’re up to unless they actively seek you out and vice versa. At this very moment, everyone I know could be at the best party of the century and if no one thinks to send me a text, I would never know, right? Even if you have a roommate and you guys are ‘besties fo’ lyfe’ you’re on different schedules. Unless both of you make an effort to say “hey what’s up?” once an eon, it’s very easy to just end up having the same address as that person instead and being real friends. You can imagine how much harder it is to keep in touch with people who don’t share a kitchen with you, who don’t live in the same apartment complex…or state…or country.
I like to think that every student laments at the disconnect from time to time. Sometimes you want someone to talk to, sometimes you want to talk about non-medical school things….but then, for myself, I realize I literally have nothing else to talk about…except maybe if I watch an episode of Scandal. But then I always watched it a day late because it came on past my bedtime and everyone has finished talking about Mellie and Olivia Pope’s hair by then. It’s hard out here for introverts who need to be in dreamland by 10 pm.
I find that it’s the little (some even downright tiny) things that act like pick me ups: like when a senior resident notorious for breathing fire introduces you to her patient as “my doctor in training” instead of not bothering to introduce you at all, as is her known usual, or when you get a whole four pimp questions right in a row (You’re a genius until they ask an epidemiology question…“Ummm, 5-10%?”) Or when your friend in Maryland who you haven’t spoken to in months calls out of the blue and says they thought of you randomly and you both indulge happy college memories that may or may not have actually been that happy at the time. Or when your baby sister sends you a random ridiculous ‘selfie’, when your neighbor invites you over for a much needed chat/vent session or even that sea green nail polish you rock on the weekends. (What? Trust me, it looks cool.)
Peace, Love and “she called me a future doctor” *squeals annoyingly with excitement*,
Ps. I’m only two weeks into my Pediatrics rotation and I am not one of those lucky people that gets through their inpatient month illness-free. Yay for rest and keeping hydrated.
Pps. Sick babies :(
On our way home from volunteering, a fellow medical student said something that I thought was very meaningful and worth passing on to others. To paraphrase, she said, “us volunteering on Fridays makes the Monday through Thursday completely worth it.” Of course, by “Monday through Thursday,” she refers to the marathon of lectures we engage in week after week (bless the joyous 10 minute breaks we get). There are so many excellent volunteering opportunities for medical students, and I can attest to the fact that these volunteering opportunities reinvigorate my passion for helping the men and women of our society, and particularly those who are underserved.
Monday of this past week, I volunteered at the St. Vincent de Paul homeless shelter, where I helped the children of the homeless with homework. Wow! These youngsters were some of the most inspired and intelligent children I have ever met in my life. And while I am ashamed that my multiplication skills have waned since starting medical school (and thus the kids may have been teaching me more than I, them), I couldn’t help but notice the smiles on their faces and genuine happiness they showed during our time spent together. This was a very meaningful experience for me, and I hope that I was able to positively impact these children who are making the most of a truly tragic situation.
I also had the chance to volunteer for a second time at the Reach Out clinic in downtown Dayton. This time, I was helping out in the Hypertension clinic. In the midst of Healthy Habits week here at the Boonshoft School of Medicine, we have been learning about the importance of promoting healthy lifestyles in preventing diseases like hypertension, diabetes, sleep apnea, and many others. It was very encouraging to see that many adults were motivated to make changes to their lifestyle, some who came in had made significant progress (we even clapped for a patient who had lost weight and was now decreasing medication!), and some were learning about the possibility of change — how small adjustments are actually very feasible in most peoples’ lives.
I am very thankful for the volunteering opportunities that are available to us medical students, and I am excited to continue to reach out to the children and adults of our community.
Somehow, before this gynecology/oncology rotation, I had managed to avoid cancer patients. I’ve said ICUs are my least favorite place, well cancer is my least favorite diagnosis. (I suppose saying it is your favorite would be strange….even for the most soulless of human beings.)
Today is my final day of this service and I am glad that I had the exposure but I think two weeks was enough. I met so many women in various stages of their cancer journey. Let’s just say it would be hard for me to write a light, joking blog post about them.
Diagnosis: Dr. L spoke about the possibility of her having ovarian cancer and she just sat there, brown eyes unblinking, silent, flat affect; her husband cried. I sat there with my heart breaking wondering if it was ok to offer a man a box of tissues. Would that just embarrass him? Then I felt silly because if that were me, the last thing on my mind right now would be personal embarrassment, I would have a wife I needed to support emotionally.
Intra-op: “Her colon looks amazing, no mets at all. I was hoping I wouldn’t have to resect any of it”. I continued to retract and pondered his usage of the word ‘amazing’.
Post-op: “Did he get everything out?” eyes only half open, coming out of her anesthesia induced afternoon siesta. Nurse: “he said it was one of the best jobs he had ever done”. She smiled then reached for her head…I knew it was to make sure her purple knit cap was still there. My resident told me that after 7 cycles of chemotherapy, she was very self-conscious about her hair loss and allowed only the doctors to see her bare-headed. She stayed in the hospital for one week after her surgery, I remember writing in my “post-op day #7” note that I was concerned about her mood, she was not as talkative or cheerful as she usually was; no number of brightly colored balloons and flowers in a hospital room could change the fact that it’s still a hospital room and you receive scheduled pain medications…the stuff you can’t just waltz into CVS and buy on a whim. Even the strong willed, like this dear woman, have days where it is difficult to smile.
4 week follow up after surgery: “I would rather not use the term ‘cancer free’ but things are looking pretty good, surgery went well and you look great”. Then my resident recommended she go to a cancer treatment center for pelvic radiation and chemotherapy. Her response: “I really hate my body”. “Mom, please don’t say that” but her daughter could only look at the floor as she spoke. So many sighs. All I could do was give thanks that no one in the room had tried to make eye contact with me and think about my classmate who is interested in palliative care, a brave, brave man.
Peace, Love and cancer: fascinating and frightening,
This weekend I volunteered at a health fair, I haven’t volunteered at one for a long while since my weekends have not been my own for quite some time now **coughcoughWEEKENDCALLSCHEDULEcoughcough** First I worked at one of the BMI stations; I took care to break everything down into as simple terms as I could, I went through everything slowly and patiently (if this was an OSCE, I think I would have made Dr. Binder proud…maybe not, maybe that’s wishful thinking on my part.) I asked each patient what his or her personal concerns were, discussed realistic health goals and let them know that the road to a healthy lifestyle was a long marathon so I didn’t want anyone being discouraged if they didn’t have Adriana Lima’s physique by next week…or the week after that…or month after that for that matter.
Next I worked as a nutrition counselor. I let each patient come up with changes they could make in their life over the next few weeks and I reiterated that no change in the right direction was too small. (In retrospect, maybe 25 minutes with each patient at a health fair might have been too much but no one batted an eyelid at me. I promise that I am working on my time management issues). We discussed realistic and sustainable exercise plans, slowly making increasingly healthier choices day by day (no need to go off the fried chicken…cold turkey) and everyone’s favorite topic: portion size. Interestingly, several patients tried to convince me that two slices of bread was actually one serving and not two. They said that they were aware that the back of the bag said one slice was one serving but that was a mistake and companies didn’t want to pay to repackage their bread with the correct information. Where on earth were they getting this? Also, please don’t argue with patients. (That’s probably a sure way to fail an OSCE.)
Nearing the end of my shift, a clown walked into the room, not just any clown but Ronald McDonald. Sigh. Did anything I discussed with these people that day even matter?
Peace, Love and the infamous golden arches,
Ps. That didn’t stop me from taking a picture with him. After all, he is a celebrity.
On Family Medicine, my very first rotation, I remember lamenting to anyone that didn’t roll their eyes at me, that patients don’t bother to listen to your advice so why do they bother coming to the doctor at all. What’s the point of the physician even giving advice? Ok, you’re diabetic you are told over and over to eat better, work out, monitor your blood sugar, why don’t you? Do you WANT to die?
Oh to be young, self righteous and completely hypocritical.
I talk to strangers about exercise but the last time I had something even sort of resembling a regular exercise regimen (and by ‘regular’ I mean putting my running pants on more than twice a week; whether or not any sort of running was actually involved each time is a confession for another day) was at least 4 months ago. I drone about healthy eating and portion control; I eat fairly alright myself but the occasional slice of pie does find its way into my life and one of the reasons I want Summer to come is so I can feel less silly about eating ice-cream. Nevertheless, broccoli and I are good friends. Portion control is a completely different story. I can honestly say I live life as though it is one big buffet. What is portion control?
Then there are the body image issues. I know I am extremely sensitive to comments about my weight/appearance, I think MOST people are given the image conscious society we’ve createdit’s one thing for a young girl to endure her family commenting about her weight, it’s quite another to hear things like ‘overweight’, ‘BMI’ and ‘adipose tissue’ from a stranger in a white coat. (Yes, I am aware that some patients develop close relationships with their primary doctors so they’re no longer ‘strangers’ but don’t pretend you don’t get my point.)
My thinking has matured some since Family Medicine (a little less young and a little less self righteous) but now I have a new problem: I am told over and over not to “kill the patient with kindness” If I need to punch them in the back to check for costovertebral angle tenderness then so be it. (Kidding, kidding KIDDING, I promise I do not punch patientsor anyone for that matter. Violence is never the answer.) If they are obese, they need to be told so and counseled appropriately. If they smoke, they need to be told that they are actively killing themselves and offered alternatives on the journey to quitting, etc. etc. I get it, I really do. I know going to the doctor’s isn’t always the most pleasant experience for the patient (which is part of the reason why so many avoid the experience altogether. After all, who really needs to go to the doctor anyway? Physicians are just pill pushers who can’t shut up about the risk of cancer, right? Sigh. The things patients tell me.) Sometimes they need to be told things that are difficult to hear, we all do from time to time. I also know that part of the success in these ventures is the repetition; hearing something over and over contributes to a person’s motivation to change. However, it will never be ‘easy’ for me to talk to a 21 year old young woman about her weight, it will never be easy for me telling someone I recommend they stick themselves every day. I have seen patients cry at the mere mention of the word ‘Insulin’. I know if that ever happened to me, I would go through the stages of grieving and probably get stuck in the denial stage. Lifestyle changes are difficult for anyone who chooses to call herself/himself a member of the human race. (I suppose it would be difficult even for those who chose not to call themselves such.) Either way, let me never lose my patience and sensitivity.
Peace, Love and in solidarity with patients,
I had the pleasure of meeting a critical care doc yesterday. She mentioned that one of the reasons she went into critical care was because she found she had a gift for approaching end of life issues with her patients and their families. This led me to think about how the ICU is one of my least favorite places for that very reason and how physicians have one of the few professions where they can repeatedly have the privilege of being present for the last few moments of a fellow human being’s life, a privilege because the death of an individual is such an intimate thing. To me, this privilege goes hand in hand with the huge responsibility of preserving the dignity of their personhood while they are on their journey to death. One cannot help but think about how the execution of certain ‘heroic measures’ can diminish that dignity at times.
I hope I remember this during the hustle and bustle of the next code.
Peace, love and respect for the end of life,
In the fall of 2007, my foreign travels began when I first went under the bridge on West 3rd Street near Cleveland Browns Stadium. Beneath the busy highway, a man named “Jack” lived on an old, torn mattress. His camp, which smelled of brandy and cigarettes, was cluttered with empty potato chip bags, bottles, and other scraps that had been carelessly scattered by “Jack” and the rodents that he lived with. But in striking contrast to the mess, next to his bedding was a neatly organized library of at least a hundred books. “Jack” spent most of his days reading. Classic to contemporary, his book stacks did not discriminate: I remember seeing Lorna Doone sandwiched between Twilight and Harry Potter.
Besides the books, the strangest thing about “Jack” was his hospitality. I had never imagined a person in such extreme poverty being so engaging and friendly. The first thing I ever heard him say was, “How are my favorite John Carroll University students? Anyone want one of these Ensure drinks? A nurse dropped a box off for me today and I’ll never finish them all.” How could I not accept his offer? I drank one.
As we served “Jack” a dinner and gave him a blanket, I got my first exposure to his storytelling. While eating the chicken breast and mashed potatoes, he gave a riveting oral summary of The Di Vinci Code, and somehow related it to his opinions on global politics. When we were finally ready to leave “Jack” and visit other Cleveland camp sites, Brendan, the leader of our homeless outreach group, gave him a framed picture featuring “Jack” with a few of the John Carroll students. “Jack”, doting over the picture, placed it right above his mattress on the bridge beam.
For years at John Carroll, I traveled to exotic places like “Jack’s” camp as a member of the homeless outreach group, “The St. Benedict Joseph Labre Project” (often abbreviated “Labre”). On Friday nights, in two vans filled with food, blankets, clothing, and hygiene items, we visited the homeless on street corners, underneath bridges, and within abandoned structures. While befriending the homeless, I learned the details of some of their most intimate problems. “Jack” suffered from paranoid schizophrenia. At times his illness would become noticeable: “The federal government is trying to shut Labre down because you guys are coming to visit me,” he once said. After statements like these, the conversation was sometimes hard, except I knew that I had to step into his world and try to see things from his point of view.
By seeing some of the darkest and poorest parts of Cleveland, I discovered the city’s greatest beauty, the kind souls that live in its shadows. So although I have no global travel experience, it would be wrong to say that I have never visited foreign places. “Jack’s” camp was probably more exotic and colorful than the hotels, beaches, and restaurants that many American vacationers venture to when they travel across oceans. I had the privilege to explore foreign worlds, experience unique sub-cultures, and collect many strange and beautiful stories.
This summer I am traveling to Swaziland, a country in southern Africa, to do a medical school elective at a clinic run by the Luke Commission medical team. I shall assist with their efforts to provide primary care and HIV/AIDs services to the people of Swaziland, who are burdened with one of highest HIV/AIDs rates in the world. Since I have never lived anywhere other than Cleveland before coming to Dayton for medical school, a month in Africa will be a great adventure. I plan to continue this blog in the fall with a follow-up entry discussing my experience in Swaziland. After learning so much from traveling around in my own backyard, I can only imagine the new experiences that I will have and the “Jacks” that I will meet in the wilderness of Southern Africa.
So it has been quite some time since I last blogged. To be honest, I am not even sure what I blogged about last time. That is how fast time seems to be going in medical school. It seems like just yesterday I was learning biochemistry but now I only have 3 classes left in my second year!
I’m going to assume I updated sometime in December so I will fill you in on what has happened since then. Our first course of this semester was Cardiovascular. When my classmates and I first saw the size of the note pack for this course we were a little intimidated (it’s also the first time I had to use two 2.5-inch binders to hold the entire thing and it still barely fit). This is the longest of the second semester courses coming in at four weeks. You will learn a lot including how to read ECGs. I thought that was really cool because it is something I have always wanted to learn. There is a great book by Dale Dubin that teaches ECGs at a very basic level that anyone can understand. Look into it if you are interested. Don’t look into Dale Dubin’s past, however, because you might not like what you see.
Next up was Respiratory, a three-week course. Nothing much to say here. As always, a lot of information was learned in a short amount of time.
Renal is the course that we just finished. It was about three weeks long and the last week was spent reviewing with practice questions. This course is tough. I never knew the kidneys did so much but I now have a greater appreciation for them.
So here I am with 2 days of my spring break left (yes…you get a spring break in medical school) and it seems like I didn’t even have a break to begin with. It went by way too fast but I’m ready to finish up second year. Three two-week courses and the USMLE Step 1 exam stand between me and third year. I apologize in advance, but I know I will not be posting until after Step 1. Sorry to any of my fans out there.
Hopefully this gives you an idea of what second year at the Boonshoft School of Medicine is like and doesn’t scare you from applying. If you have any questions that are not answered here or if you are hesitant to apply because you don’t think you can do it please send me an email and I will be happy to answer your questions and encourage you to pursue your dreams. See you all after Step 1!
“Good afternoon, Ms. Starflight. My name is Samantha Miller, and I am a student doctor working with Dr. Singh. I know you have answered so many questions in the past few hours, but do you mind if I ask you a few more?” Haha, ‘Starflight’, what an alias? How can these people be so uninhibited?..."
For more on this story, see: This Is Not About You, a piece posted by Sarita Metzger on in-Training, an online magazine for medical students.
Can I be honest? I think most med students cannot wait until their third year…out of the lecture hall, interacting with patients. This is why we came to med school right? I was a little torn at the end of my second year. I really enjoyed my preclinical years; I loved what I was learning, I diagnosed myself with all sorts zebras. I didn’t have to get up that early in the morning. Best of all, I had autonomy: if I felt like going to lecture, I went. If I didn’t, I made sure to watch the recording later that day, no big deal. If I needed to get something done during business hours, no big deal. If I didn’t feel like using my Caribbean driving skills to drive to school in the snow, I didn’t, no big deal. I had time to do one billion and six extracurricular activities.
I felt like I would lose all autonomy my third year and just be trapped in the hospital all day. (‘Trapped’, my isn’t that a dramatic word?) Yes, seeing patients is beyond awesome, especially when they are real patients, not standardized patients mentally making a note of all the questions you forgot to ask while taking their history, but what if I had a mini emergency? I’d have to ask someone as humbly and politely as possible if I could leave and hope they didn’t think I was irresponsible….then write a bad evaluation for me…then I receive a bad grade. (The domino effect!)
First and second year I didn’t get yelled at for doing something wrong, I didn’t get pimp questions embarrassingly incorrect in front of a room full of people, I never had to wonder when I would be allowed to eat lunch, never had to feel like my weekend call schedule was oppressive…not to say that any of this actually happened to me this year or anything (saying that just made me sound defensive, didn’t it?)
In the first two years, my grades were based on how I did on quizzes and exams. I just studied my hardest and hoped for the best, whereas on rotation, part of my grade would be based on someone’s subjective impression of me. Sigh. I wish I could say I am the smartest cookie on the cookie sheet (or however the expression goes), so of course pimp questions are always a cakewalk. I am certainly not the most skilled; reasonably sure my surgery residents could not tell that I spent hours practicing suturing. (However, this one time a Plastic Surgery attending called me a ‘Young Jedi’…was not completely sure what that meant but it had to be positive right? And of course my chief resident wasn’t present to hear him call me that.) I’ve never been the best conversationalist. I mean, I only started watching CNN a few months ago so talking about world affairs was not my thing, I am not a sports enthusiast/I don’t understand the rules of football so I can’t talk about that and sometimes I feel like my sense of humor might be a little ‘off’ to people which makes for a lot of wonderfully awkward encounters…so how could I get random attendings and residents who spent varying (sometimes minimal) amounts of time with me to like me and think I was competent enough to deserve a decent evaluation? I suppose I could smile a lot and bring in baked goods…I have nice teeth, (see, this post wasn’t all self deprecation) no one would envy my baking ‘skills’ though.
Well, four and a half rotations in, I think I’m doing alright and despite my original fears and the occasional complaint (‘occasional’ is an understatement), I’m having a blast this year.
Peace, Love and it’s not as much of a jungle out there as I thought it was going to be,
Ps. And for all of you that don’t have any problems just cliquing with attendings, don’t be selfish, share your secrets.
Pps. I just registered for my Step 2 exam…anxiety mounting.
Ppps. CONGRATS TO ALL MY FOURTH YEAR HOMIES WHO FOUND OUT WHERE THEY MATCHED TODAY!!!
These past two and a half weeks of OB have taught me that I find vaginal births absolutely MAGICAL…I had never actually witnessed one before and I imagined the whole affair would just be gruesome and bloody. I suppose ‘magical’ and ‘gruesome’ don’t necessarily have to be mutually exclusive, but that’s not where I am going with this. Call me a sap (actually no, please don’t call me that), call me a traditionalist, but part of the magic for me is the aspect of love. I love it when the father of the baby, the baby’s grandmother, god-mother, great aunt Nellie etc. etc. are all in the room waiting for baby to enter the world. The love and support in the air is SO palpable and I find it absolutely amazing.
There was this Turkish lady who came to us in labor last week… all by her lonesome. She said her husband was at work, she wanted to surprise her mother so hadn’t even told her that she was heading to the hospital and her sister would be by the hospital later with some clean clothing and pizza. (She said pizza and I didn’t ask any more questions.) This woman was the one sweating, obviously in pain but trying to remain composed, refusing an epidural… like a STOIC ROCKSTAR and asking the resident if it was time for her to push yet. Then there was me, the lowly med student just feeling privileged enough to be in the room and trying not to be annoying/get in anyone’s way. SHE seemed perfectly ok with the situation so why did MY heart fall?
During the birth she reached out to me and I grabbed her hand with my gloved hand and told her to hold as tight as she needed. My gloves were dirty and the attending gave me a strange look. Yes, I know, I know. I know I broke sterility but I didn’t plan on touching anything draped in blue again, I moved out of my resident’s way and I felt like I did the right thing.
…Then I texted my father “OMG, I just saw someone give birth and it was GREAT!!” I imagined him smiling but thinking: I have such a cliché for a firstborn.
Peace, Love and just hold a hand,
My roommate has basically known since she crawled out of the womb (I am presently on my OB rotation so yes, babies crawling out of the womb is absolutely how babies are born) that Womens’ Health is for her. I haven’t been so fortunate. I am more than half way through my third year, only two more rotations left until I can call my self a fourth year, a little over a year in between me and my MD...and I still have NO idea what I want to do. Every time I think I’ve narrowed down the list or ruled something out, I have some experience or see something interesting and say to myself “hey, I think I can do this”. I used to call my parents every time I had one of these epiphanies, but I’ve had so many epiphanies now that even though we’re on the phone and I can hear them saying “oh, that’s great dear”, I know they’re thinking “so GI is the flavor of the week, huh? What will your calling be tomorrow?” In my defense, Gastroenterology has been the ‘flavor of the week’ for several weeks now, months in fact...but other strong contending flavors I have indulged include Urology and General Surgery…for a few days I was even thinking ENT...some months ago I thought “Plastics is it! I will do breast reconstructions for cancer patients!” Now that I am on my OB/Gyn rotation sometimes I catch myself thinking “pregnant ladies and pelvic exams aren’t so bad, I could do this.” My roommate would roll her eyes if I dared say that out loud.
Even though I think students should enter medical school with an open mind with respect to the various specialties, I would never ever wish being undecided in your third year of medial school on anyone…not even on Regina George or Angelica Pickles. (Please tell me you know who those young ladies are.)
The fourth years are matching soon. That is going to be me in a year; that means I am going to be applying to residency programs THIS year. Is your mind blown as much as mine yet? I remember first year wondering how was it that well adjusted human beings managed to survive the seemingly never ending histology course; I remember second year wondering how I would ever know what the Pathology lecturer was even talking about without that histology course under my belt…I even considered Pathology as a specialty, but I digress.
Most of my classmates are driving themselves in a frenzy over their fourth year schedules. All I hear is: “I want to do an Ortho away rotation here and here and there and there and everywhere…”, “Internal Medicine usually interviews at X time, so I am trying to get one of those months off to interview and I absolutely NEED a letter of rec from Dr. Y”, ”Ack! I have to take Neuro during block one but that’s when I wanted to take boards. When will I study for boards!” (It might have been me saying that last one.)
I think I want my fourth year schedule to fulfill that delicate balance of reflecting my interests in a particular specialty to residency programs while allowing me to dabble in some things that I may never have the opportunity to dabble in again…the epitome of wishful thinking. My schedule currently looks like a hodge podge, perfectly reflecting my indecision...the same goes for my CV *sigh*.
Several residents have told me that they didn’t figure out their passion until really late in the game. I’m still not sure if they’re just trying to be nice to make me feel better, they actually did survive this limbo or if they’re just saying whatever they think will make me stop moaning about it. (In all fairness, I only moan when someone asks me what I am thinking of going into; those who don’t ask are spared my moaning.)
I know part of this is me doubting myself and fearing I won’t match (*gasp* I hope I have not jinxed myself) and I know that this is not uncommon for students. I also know that some people apply to more than one specialty or they apply for transitional years to sort themselves out but I REALLY would like to avoid those options…but on the bright side, at least those are options.
Peace, Love and Indecision,
P.S. Today is my baby sister’s 19th birthday…she prefers you call it her second 18th birthday.
Let me begin by saying that I apologize for not posting in so long. The last few months have been intense. We have had several two-week courses where the final exam in that course was our entire grade. Yes, you read that correctly. I said two weeks. I have food in my refrigerator that has been around longer than some of these classes. Time sure has gone by quickly. It seems like just yesterday I was moving into my apartment the weekend before my first class at Wright State.
Without a doubt it was a difficult time and second year is much harder than first year. However, a recent conversation I overheard on one of my flights to see my wife really got me to appreciate the fact that I am pursuing my dream of becoming a physician.
The conversation between two girls about my age went a little something like this:
Girl 1: Oh what do you do in (city)?
Girl 2: I’m in nursing school.
Girl 1: Oh that’s awesome. Why did you choose to go to nursing school?
Girl 2: Well, I thought about going to medical school but I did not want to go to school for that long.
Let’s stop here. It is well known that medical school requires a lot of extra schooling. In fact, you will probably be learning throughout your entire life as a physician (unfortunately I cannot speak from experience on this yet so ask me again in 50 years). And trust me, while you are taking exams every 2 weeks, trying to have a social life, and just trying to be involved in extracurricular activities it may seem that there is no light at the end of the tunnel. However, I can assure you there is.
Looking back at myself I knew nothing about Rocky Mountain spotted fever or how Imatinib works. I entered medical school with a relatively clean slate ready to absorb whatever knowledge came my way. Here I am 1.5 years later and I am astonished at all of the things I have learned. I overheard one of our professors mentioning how many new words we have learned since beginning medical school (it is somewhere in the 1000s) and I was astonished. It seemed impossible in the beginning but now I can have everyday conversations about how Imatinib blocks a receptor tyrosine kinase. That sounded a lot more awesome in my head but you get the idea.
My advice to anyone (including this girl if I would have met her in time) is to not let time factor into your decision to come to medical school. As a medical student you will constantly be experiencing delayed gratification, but if you truly love the things you are learning (as many of my classmates and I do) it will all work out in the end. There may be times you feel like giving up (totally normal) but the key is that you and all of your classmates are in this together. If you have any questions about what medical school life is like or need some encouragement because you don’t know how you will ever be able to make it through all the things I describe in this blog please do not hesitate to email me at email@example.com. Happy holidays!
It has been only a few months since my last post, but can I just say that I feel about fifty years older than I did in July?
Second year of medical school is in full swing. By full swing, I mean this is literally the first day since the beginning of August that I have laid on my couch and watched TV all day long. This school year has been CRAZY. I remember the good old days of first year where we only had an exam every third week and I could spend the weekend following that exam relaxing. Ladies and gents, those days are gone.
At Boonshoft, our MSII classes are much shorter and faster than first year classes. To put that into perspective, by this time last year we had only covered anatomy and a small portion of biochemistry. So far this year, we have had an entire overview of the year, our neurology course, our psychiatry course, and a hematology and chemotherapy course. In other words, I’ve had a significant exam, final, or quiz about every five days since the beginning on August. YIKES. I don’t know how else to emphasize the stress, mental and physical strain, and utter insanity of the past few months other than to describe the changes in myself that I’ve seen.
For starters, I’m usually a pretty high-stress person. I was told in second grade that I was a worrywart and that pretty much stuck my whole life. Until now. During our foundational course for the year that took place in August, called PB&T (Pathobiology and Therapeutics), we had an exam covering over 500 net pages of new material EVERY. WEEK. People, that is insane. As you could imagine, I had a great (horrific) time worrying over and stressing about the material, how I could study that quickly, when I was going to shower, etc. On week three of that course, I basically hit the limit of my stressing capability. This will come to anyone who knows me as a big surprise, because usually I can muster up a good amount of fretting over just about anything. On that particular pre-test weekend, though, I quite frankly ran out of stress. Since then, I find that I am significantly more pleasant before exams, I’m pretty sure my blood pressure is lower, and I’m even sleeping better. Nice work, medical school.
Speaking of physiologic changes (don’t worry I won’t get super nerdy), I think I LOOK older. Not necessarily in the best of ways (as in I now have wrinkles underneath my eyes), but regardless, the stress of the past year and a half is definitely beginning to manifest. Before our white coat ceremony, we get pictures taken for a “baby book” that administration kindly compiles for us. This book has our picture, our interests, our undergraduate information, and the like. The running joke at our school is that by the time we graduate, we really WILL look like babies in those pictures. I already believe it.
Of course, all these crazy personality and physical changes didn’t happen without a bit of medical school fun. This year, having hardly any time to do anything outside of studying, I’ve begun to enjoy studying quite a bit more. I realize that sounds insane, but let me explain. The material we are learning this year directly applies to hospital work. I can now call my dad (who is an anesthesiologist) and talk to him about some of the drugs he uses on the job. My clinical vocabulary has significantly expanded: I can reason through nearly any medical word I encounter simply because I’ve become so familiar with all the roots. I’m learning more advanced clinical techniques like the female pelvic exam, and we are practicing focusing our patient interviewing skills around specific symptoms. I am finally starting to feel like a real medical student! Sure, it means I live at school (I literally just spent 18 hours a day at school for the past four consecutive days), but the fact that I’m finally starting to really learn medicine is amazing.
Aside from the thrill of feeling like a physician-in-training, I’ve gotten more enjoyment out of learning because of a group of people with whom I now study. Every pre-test weekend we live at White Hall as a sleep-deprived, over-caffeinated, mildly psychotic family and it’s just precious. I’ve spent more time with that group of people this year than I probably have alone (Wow, typing that makes me realize how true that is.). The connections we make, the knowledge we gain, and the late-night shenanigans that we experience together makes all the studying bearable. We are definitely all in this hellish but amazing world together, and we help each other get through it.
The next two weeks are the only two weeks of the entire school year thus far that will not include any graded activities. For me, that means taking time to sleep, cook, relax with my family and friends and cat, and shop around for some good anti-ageing cream (oh boy). I think I’ll celebrate by kicking it all off with a nap.
There was an article published on The Opinion Pages of the New York Times recently entitled “Medicine’s Search for Meaning.” Normally I’m not a huge fan of reading online articles but this one grabbed my attention because the Boonshoft School of Medicine was in it. Who else was in this article you ask? Have you ever heard of Harvard? Yes, that Harvard.
Last year as a first year medical student I took a voluntary course called Healer’s Art. I had heard from people who took it the year before that it was a course about sharing your feelings with others and talking about the difficult aspects of being a doctor. I’m not a person to talk about my feelings often, but all my friends were taking the course so I thought I would give it a shot. As it turns out, there was much more to it than that.
The article says, “Great doctors don’t just diagnose diseases, prescribe medications and treat patients; they bring the full spectrum of their human capabilities to the compassionate care of others.” A powerful statement when you think about it. As physicians we are so much more than a scientist. In healer’s art we learned about treating our patients with compassion and being able to relate to them through a concept of a wounded healer. I’m sure many of us have been to a physician where we just felt like a number or a science project. I’m sure I don’t need to ask if you returned.
On the other hand there are many doctors who sit down and talk to their patients as human beings. They ask questions that other doctors wouldn’t just because it has nothing to do with diabetes. They introduce themselves as John Smith not as Dr. Smith. They see their patient as an equal, not as a customer.
Taking this class has allowed me to see good and bad examples of the previous statement from the Times. I’ve shadowed physicians who don’t always see their patients (they let their assistants see them unless it is a new patient) and I’ve shadowed physicians who must see every patient and share stories about recent fishing trips. I’ve met doctors who volunteer their time to treat a patient outside of their normal 9am-5pm schedules. I’ve also seen physicians who watched the clock ticking at 4:55pm and headed out the door at 5pm on the dot.
Healer’s Art is a great step towards creating a more compassionate and caring physician. The class is offered to first year students here at Wright State. However, there are many schools that do not offer the course. I remember something our Associate Dean Dr. Gary Leroy said the first day of orientation at Wright State. It was something along the lines of “Our students may not average as high as other schools on the boards, but I guarantee you one thing. We outcompete other schools when it comes to real life experiences in the clinic.” I am not bashing other schools and neither was he. I think the point is that there is much more to being a physician than being able to recite Virchow’s triad.
So second year has started and I figured I should write something before I no longer have the time to do so. That is a joke…I think.
The summer between first and second year is a time when people do a variety of things. Some do research while others do shadowing. Still, others do more personal things like getting married. I did all three. Was it a busy summer? Of course. Was it worth it? Definitely.
I used to work at the Center for Integrative Research on Cardiovascular Aging in Milwaukee before going to medical school. Since my wife was in Milwaukee this summer and she was very adamant (as was I) about spending it together I decided to check out the possibility of working with them again. They welcomed me with open arms and gave me a short project to do involving amyloid and atrial fibrillation. Seeing as how I am interested in cardiothoracic surgery I felt like this would be a very worthwhile experience.
I was also fortunate enough to take part in a program called AHEC. Basically, I worked with family medicine residents and physicians in Milwaukee. I interviewed patients and performed basic physical exams. I even diagnosed a pneumonia! As a medical student you are allowed to get excited when you tell someone they have pneumonia and you are correct. Just don’t show this excitement in front of the patient. This was a great experience and it really allowed me to see what it is like to be a family practice physician. I had always wanted to go into surgery so I thought I would use this as an opportunity to explore other fields. Don’t get me wrong. I loved the program but I cannot see myself doing that every single day. I need to be using my hands more.
Many of you might be asking if it is difficult to plan a wedding while in medical school. You bet your sweet bippy it is (if you come to Wright State you will get that reference). However, it was all worth it in the end. I would like to thank my wife for putting up with my countless hours of studying while she was looking for invitations or making decorations. If you want to get married during medical school it is definitely possible with the help of a wonderful fiancé!
As you can see I had a very busy summer. Second year started two weeks ago and we have two exams next week. If you don’t hear from me in a while don’t worry. I probably haven’t died. I’m just consumed by the experience that is second year!
Guys. This post isn’t very medical school related, but I needed to document this summer and this feeling. I figured you’d forgive me for writing a post like this. Right? Thanks, you’re the best.
Summer and I have a very tumultuous relationship. By tumultuous I mean that, until very recently, it was my least favorite season. I used to hate the heat, hate how dry everything was, and hate how my summer birthday was always casually ignored because I wasn’t around my school friends. The past few years, namely since my stress level has drastically increased, I’ve started to love how ALIVE summer feels. I love the thunderstorms, how early it gets light outside, how the heat feels like a release. This summer, though, is one for the books.
This summer hasn’t been flashy by any means. I haven’t traveled abroad like I have in the past. I haven’t been saving lives on medical mission trips, or researching cures for cancer. Instead, I’ve spent more time lazing around than I think I have since eighth grade. I’ve been reading constantly, sleeping forever, and spending every second possible with my family. I’ve been sweating to death in hot yoga, in my parent’s garden, and on runs in the trail behind my house. I’ve seen movie after movie and spent hours on the couch at the apartment of my two best friends. And I’ve loved virtually every second.
For the first time in a long time, I feel sure of myself. Sure of my beliefs, my mentality, my everything. I’ve never been more myself than I am at this very instant. I am more excited about living, less stressed about the future. I feel confident, empowered, certain of my decisions and my priorities. And guys, it’s a really good feeling.
After four years in undergrad constantly worrying if I could get into medical school, worrying that I was going to be at the right place at the right time, rushing and stressing and fruitlessly planning everything, this sense of calm assuredness is the hugest blessing I’ve ever felt. I only wish I could have gotten here 23 years sooner. But I’m going to hold onto this feeling as long as I can and hope it can get me through the rough year ahead.
I thank my first year of medical school, God, new and old relationships, yoga, and especially my family for guiding me into adulthood. Today, in this moment, I feel vast, brilliant, powerful, young, wise, beautiful. I hope you join me here too.
Hey, guys. So it’s now almost a month into the last real summer break of my life, and I finally feel like I can write a reflection post that isn’t super depressing.
What, you ask? Claire, writing something depressing? Yeah guys. I literally HATED the last class of first year, so basically I was raging for the last three weeks and finally yoga’d myself out and stopped being so mad.
A lot of people hit a “dark place” during their first year. For most people, I feel like that comes during CaTOS, a very challenging course between Christmas and spring breaks. You never see the sun so you feel like a vampire, you’re staring into microscopes all day, you have to scrape frost off your car every morning making yourself even later for class, etc., etc. Me, always the weirdo, absolutely loved CaTOS (and, apparently, never seeing the sun and being late to class), so I was totally with it that whole course. Our final class of the year, though, called POD, just made me want to throw things. Every day. It was nice outside the weekend before every exam then MISERABLE the days following our test (our free days), I couldn’t study the way I like to for whatever reason, my personal life was basically a roller coaster, and I got really REALLY tired of never having time to cook a real meal. AHHHH.
OK, I just had to literally take a break because I got all raging mad again. Long story short, I’ve gotten over the stress of that last class and feel like I can breathe (and exercise and not eat freezer meals and sleep) again. That being said, I thought I’d share the major thing that helped me survive my first year: the realization that sometimes, a LOT of the time, I have to come first.
This applies to so many different things for me. Firstly, I had to learn to prioritize self-care. For me this meant getting away as frequently as possible to visit my family, to prioritize sleep over school sometimes, to clean my apartment when I was stressed (because I am a neat freak), and more. At the beginning of the year, I thought that all these things were frivolous and would no longer seem important: little things that took up time that I could eliminate to be more efficient in medical school. I was SO WRONG. Doing things for myself, even as small as taking an extra long shower, literally helped me survive. When I went too long without shaving my legs or reading something other than a textbook, I felt drained, depressed, and kind of like a (hairy, boring) robot. Taking time for myself over the past year has undoubtedly helped me feel like a human and helped me from getting too cynical or burned out. It has not, however, kept me from becoming an even bigger nerd than I was before med school. Sigh.
Secondly, and just as importantly, I’ve learned a lot this year about toxic relationships. I hate using that phrase because it makes me feel so Oprah, but I mean, it’s true. I believe relationships should be pretty much 50/50. I’m not naïve enough to think that there won’t be times when relationships are more like 100/0, but on average, if you’re not nearing 50/50 in a relationship, there’s a problem. Plenty of times this past school year I felt drained because of certain friendships, and during those times, as selfish as it sounds, I just had to completely remove myself from the situation for a while. Luckily, that was usually as simple as turning off my phone (for like a week) or avoid using any social media sites*, but I cannot even BEGIN to emphasize how much this realization saved my sanity. Guys, in medical school, you DO NOT have time to tolerate a draining relationship. You have to get a little bit selfish and a little bit critical. It’s an act of survival. That being said, there will of course be a multitude of times where YOU will be the drain on a relationship, and you will be giving 0 and the partner will be giving 100. Just ask my mom or my sister or my best friends or my cat. It happens. Just try to acknowledge that and give back whenever you can. WOW that got preachy really fast. Sorry bros. Just trust me, this realization saved me a lot of sanity, time, heartbreak, and sanity. Yes, double sanity.
*Saying social media makes me feel really old/really professional, neither of which I am. But also, I’m getting so tired of having a facebook/twitter/instagram. Like, I am addicted to all of them and obviously use them routinely, but it super creeps me out when people I don’t want knowing my bidness are all over them. Ugh 21st century problems.
Since this post is getting lengthy and emotional, I’ll wrap it up here. Just remember, it’s okay to be selfish and to prioritize YOU, and doing so will make your life over here in medical school a heck of a lot better. Also, http://www.youtube.com/watch?v=ZiLOVazwnWM.
I wonder how many other essays exist out there that start with this next sentence: medical school is hard. Typical, I know, but I will not lie to you, I will not sugar coat things, I will tell you how it really is. It is hard. But I’ll tell you what, you know that fabled light at the end of the tunnel? It’s there.
As I am finishing up my first year of med school, I am almost surprised to emerge in one piece. After countless hours of lecture, studying, and memorization of seemingly endless details about the intricate workings of the human body; after praying for “just a passing grade” when a few years ago a B wasn’t good enough; after sacrificing time with family, friends, and loved ones; after a few minor breakdowns and many tears – I can honestly say that I can’t wait for next year. More importantly, I can’t wait for third and fourth year, residency, and my future career.
Despite the struggles we all faced as MS1s, there were moments I experienced that reminded me why I am putting myself through what is possibly the greatest challenge I have experienced thus far in my life. Like tiny beacons, they happened in the most unexpected circumstances to push me through a tough year. We all have these moments, each one unique to the person experiencing it, and I want to share with you some of mine.
While practicing physical examination skills on a veteran in the inpatient ward of the hospital, fumbling with your new, large, clunky otoscope, he leans in to reassure you that you will make a great doctor – you have warm hands.
While shadowing in labor and delivery, tagging along with the MS3 on duty that night diligently answering all of your queries (thanks Ashley!), you head in to an emergency C-section to witness your first birth – and get to be one of the first people to welcome this new healthy baby boy into the world.
While conducting a volunteer patient interview, practicing how to best communicate with patients and ask all the important questions, learning to do the very basics of our chosen profession – Ms. C thanks you for being so attentive, kind, easy to talk to, and making her feel comfortable (even when you have to ask a 76 year old about her sex life).
While shadowing in hospice care, visiting people in various stages of the ends of their lives, talking to those who still can, sitting and just being with those who can’t, your social worker tells you that Mr. G asked where you were last week – you brightened his day enough to make an impression, just by listening and smiling.
While in New Orleans on the spring break trip, working with homeless HIV/AIDS patients at a transitional home, you are entrusted with a life story: he served in the army, studied psychology in college, and knows five languages – by opening your mind and your heart to the triumphs and suffering of others, you have been rewarded.
While sitting in the audience at the OB/GYN residency panel, listening to four amazing women talk about their chosen field, how they got there, and what they are most looking forward to – and realizing you wish you were in their seats, because more than anything you want to do that too.
Peers and patients alike will open up to you, should you only earn their trust and respect. The kindness of others, through shared wisdom, friendship, and kind words, will be an unheralded source of strength and support. You will be privy to so many secrets and be a part of some very special moments. You will be astounded by the perseverance of the human spirit, both in the hospital and the classroom. Take advantage of the opportunities presented to you, talk to everyone, and make each conversation count.
You will work hard and lose sleep. At times, you will be frustrated and angry. But you will seek the good, and do it. You will immerse yourself into learning and enlightenment, and be guided by your teachers, your mentors, and your peers. You will succeed, and be justly rewarded. I am only (almost!) through my first year, but I can promise you this: it is hard, and it is all worth it.
Ah! It’s that time of year again my friends! Time to decide what medical school you will call your own (or if you’re an undergrad, to which schools you will be applying). Before you start tirelessly mapping out your pros & cons lists, I will considerably ease your decision-making process by answering a few of the most common questions asked to current medical students about Wright State. So here you go, your most pressing questions answered! WARNING: You will decide Wright State Boonshoft School of Medicine is the greatest school of all time after reading my answers. Proceed with caution.
What is there to do for fun around Wright State BSoM?
Something I have always loved about moving to a new place is the opportunity to explore my surroundings. Though medical school certainly soaks up a lot of my time, I find that staying balanced is my greatest key to success. Here are some of favorite activities.
For the outdoorsy:
1) Yellow Springs: If you love hiking or simply have a taste for the unique, this is one little oasis you should definitely explore. In October, I attended the Yellow Springs biannual street fair (also held in June) where I was able to shop for eclectic handmade jewelry among street vendors, eat some delicious “Ha Ha Pizza” and listen to live music in the beer garden. I topped off the day with a beautiful fall hike through John Bryan State Park. If you enjoy biking, hop on the Little Miami Scenic Trail for a trip into Xenia Station Hub where you can link up with the Creekside Trail (see below) & make your way back to the campus area or take any number of trails that also connect at this location. To learn more about Yellow Springs, visit: http://www.exploreyellowsprings.com/
2) Creekside Trail: After nearly every exam, I take my legs down N. Fairfield Rd. to the Creekside Trail, a paved bike trail that stretches 17 miles from Xenia to Eastwood Metro Park in Dayton at the Montgomery/Green County Line. It is always a peaceful retreat from the main streets and is only about five miles (about a 10 minute drive) from Boonshoft, even less if you live in any one of the apartment complexes along Fairfield Rd.
3) Rock Walls: If you’re looking to stay sharp on your climbing skills or are just simply looking to pursue a new hobby, check out the rock walls at the Student Union. It’s harder than you think. Try the free climb wall (I did and I couldn’t move my arms for a week). In addition, Clifton Gorge near Yellow Springs has a rock climbing and rappelling area outdoors!
4) Canoeing/Kayaking: At the beginning of the year, a group of first years took to nearby Mad River for a short 2 hour canoeing excursion. I recommend this as a great bonding experience for incoming students and hope to do it again soon as the weather warms up. Also check out http://littlemiamicanoe.com for information about canoeing the Little Miami River! (Above is a picture of our group before hitting the water.)
5) Wright State Intramurals: Leaving perhaps the best for last! By far some of my favorite times away from the books have been playing intramurals with my fellow Boonshoft MS1’s against the other med school teams and undergraduate teams. BSOM usually has several teams participating during each season. Our soccer teams always dominate but we also have a strong presence with our volleyball, basketball, softball & intertube water polo teams (yes, you heard me right, intertube water polo).
For a night off from the books:
1) Oregon Historic District in Downtown Dayton:
Surround yourself with the charm of Dayton’s Oregon District. The lovely brick streets and old architecture from as early as 1820 will get your mind off the worries of simple squamous epithelium and the Kreb Cycle. In addition to cool nightlife, check out “Urban Nights,” an art gallery hop held the first Friday of every month from 5 to 10PM. Enjoy art displays and live music showcases by local artists as you peruse the streets.
2) Kings Table:
My personal favorite because of its huge selection of craft beverages. It will no doubt remind you of being in someone’s basement…like your coolest friend in high school whose parents were always so much cooler than yours? Their basement. Just go. You’ll see what I mean. To boot, on Wednesdays you can get Tater Tots and grilled cheese for just $1 a piece!
Other local bars to check out:
3) One-Eyed jacks
4) W.O. Wright’s
4) Fox & Hounds
5) The Pub at the Greene
(Definitely check out the Greene for good shopping as well!)
What one piece of advice would you give to an incoming first-year student?
When I started the school year, I was one year out of classwork but several years out of science (life of an English major, sigh). It took me a couple months not only to adjust to the pace but to realize my own abilities as a medical student. I was overwhelmed with stress and tired all the time from charts upon charts of muscle attachments in Anatomy that I thought I would never memorize no matter how long I stared at them. I soon realized that I just needed to change my perspective and approach to studies. So here is my greatest advice to any incoming student:
Sleep! Exercise! Eat well! Take a night off every now and then! Don’t sacrifice the things that keep you sane! Burn out is a buzzword for medical students these days because of their unwillingness to “schedule in” those things that are truly the keys to success. Finishing exams with enough gas in your tank to enjoy the evening after and begin focusing again for the next exam is the name of the game! Make “living” a priority and you will find that each day becomes less of a chore and you will be able to focus your study time the right way! This is why I encourage spending time outdoors (running outside in the winter kept me from getting the dreaded “Cabin Fever”) and also with your classmates. You’ll find that though the classes may get progressively more challenging and note-heavy, you WILL get better at tackling them.
In addition to this, be open to new methods of studying! You will find that each class will require different techniques for learning but that if you are open to this, your willingness to adjust will keep you from getting exhausted from worn out old methods that may or may not even be benefitting you.
Finally, do what works for you!
What has been your favorite part of first year?
Though it is hard to pick just one event, I must say that my trip to New Orleans over Spring Break takes the cake (see my last post for a detailed description of what I did there).
However, some of my favorite moments been the social gatherings held throughout the year, including the Halloween party and Holiday party hosted by our social chairs. These events are a great way to bring not only the first years together, but the second, third, and fourth years as well.
*In case you were wondering, I was the yellow power ranger for Halloween! I encourage you to attend these events as a Boonshoft student because they are always a great time!
I apologize in advance for such a short entry but a lot has happened since I last updated my blog. I could go on and on about the happenings at Wright State but I will give you a couple of examples. While sitting here reminiscing I am reminded that right now I am four weeks away from being done with my first year in medical school. Where did the time go? Sure, a lot of it was spent studying but there were so many more things that went on this year.
The Boonshoft School of Medicine Talent Show took place a few weeks ago. It was such a fun event and I recommend going next year if you are an incoming student. You can check out all the acts and more here: http://bit.ly/10Lwr1R.
The intramural softball team that I participated in wrapped up its season. Intramurals are such a fun way to relieve the daily stress of studying. If you are interested in flag football, soccer, basketball, softball, or even water polo I recommend you come to Wright State! Be warned though, my class is quite athletic so you will probably end up getting second place to us in any sport you try to participate in.
The research symposium hosted over 50 posters of students in our medical school who are doing research! Topics ranged from academic medicine to basic science research. Prizes were awarded for the top posters in each category. This was a great way to meet faculty as well since many of them served as judges for the event. There are a ton of research opportunities here at Wright State. If you are interested in research you will easily be able to find someone to work with or you can even start your own project!
These are just a few of the many stress-relieving activities that have happened since I last posted. If you have any questions please feel free to contact me or any of the other bloggers. At the Wright State University Boonshoft School of Medicine there is more to medical school than studying!
As our first year of medical school is winding to a close, I think it’s about time I update you on my life as a proud Boonshoft MS1!
Who knows where the time goes? I don’t. It may be hidden in my CaTOS course pack, or perhaps buried in the back of the student lounge refrigerator (just kidding, I always throw away all of my leftovers in a timely manner, obviously). Regardless, the light at the end of the very dim and dark igloo tunnel that was another winter in Ohio has finally come. AT. LAST. The sun is shining, I’m procrastinating from the distraction of the sun shining, and all of the undergrads are finishing up finals so the medical students can take over the parking lot and library for one last push to summer break.
Despite the brutal winter weather (honestly it wasn’t THAT bad), I made it through and was lucky enough to participate in a Boonshoft Alternative Break trip to New Orleans in March. Once there, I had the privilege of volunteering at Project Lazarus, a temporary home for persons living with HIV/AIDS. To be honest, it was my favorite experience of medical school thus far. I had the privilege of meeting a number of brilliant human beings whose daily battle with life-threatening illness has hindered neither their pride nor their positivity. Not only did they sing, dance, and even compete against some of our students in Chess and volleyball (and won!), but they opened up and told us very personal stories about their lives that I know I will cherish always. In addition to my experience at Project Lazarus, I was able to spend some much-needed quality time with my classmates while listening to blues and jazz on Frenchman street. If I could, I would do it all again.
I have also finalized plans for the summer. I have selected to travel to Peru with a couple of my classmates to work with Project Amazonas, a health care organization operating from a hospital boat on the Amazon River. We will be offering health services to remote villages that do not have access to health care. I cannot wait for this opportunity to serve and to learn about the traditions and medical practices of the Peruvian people and to assist this mission in any way possible. You can learn more about Project Amazonas by clicking here. I will also be doing some traveling throughout Ecuador as well as completing my summer trip with a 4-day hike up to Machu Picchu via the Salkantay Trail. I cannot wait.
Through the Global Health Initiative at Boonshoft, students are given numerous resources to prepare them for service abroad. The International Health Program is a specific track in which students interested in furthering their pursuit of global medical education can complete by taking two Global Health elective courses and traveling abroad during the summer between first & second year & again as a fourth year elective rotation. Last week, I was able to attend the Global Health Initiative Annual Symposium held at Miami Valley Hospital. Dr. Chuck Dietzen, founder and CEO of Timmy Global Health, spoke at the event about the role of the physician as a compassionate healer, one who “remains ordinary yet maintains an extraordinary mission.” He said that with the privilege of serving others comes the responsibility of striving to provide health care for all, even those who cannot afford it, and that we must believe it can be done. To learn more about Timmy Global Health and its mission, check out: http://timmyglobalhealth.org
Other activities I have enjoyed in 2013:
- Attending the Annual Boonshoft Talent Show!!!
- Participating in and losing the Digs for Dreams Volleyball Tournament put on by the Pediatrics Club and sponsored by Boonshoft Physician Leadership Development Program Executive Council to benefit A Special Wish Foundation
- Morning smoothies/coffee/breakfast quiches provided by our wonderful student class representatives
- Chatting with future first year medical students as they made their way through White Hall during Second Look Weekend
- Participating in the Phi Rho Sigma Canned Food Drive to benefit the local food bank!
- Competing in the Healthy Habits Pedometer challenge during Nutrition Week and helping put on the Annual AMSA AIDS Walk/Run Benefit 2013 to benefit the AIDS Resource Center of Ohio (l
- Being a part of the new Pre-Med Mentorship Program organized by our service chairs, Sarah & Courtney!
- Taking part in a co-ed Intramural softball and volleyball league! Made it to the championship in softball (then lost…maybe next year will prove more successful?)
I have had an incredible first year. I am so lucky to have such wonderful peers, faculty, and staff surrounding me here at Boonshoft. They inspire me every day. Now, off to the final stretch! Almost summer!
While most of you are probably already on or about to begin your summer vacation, we here at Boonshoft are still reminiscing over our spring break. About a month ago, over half of my class (about sixty students) went on a spring break road trip to New Orleans, Louisiana.
The timing of our spring break and vacation was impeccable: we had just finished a two and a half month class called Cells, Tissues, and Organ Systems (CaTOS for short). This class was…brutal. Our second exam covered over 1100 pages of material and the final (yes, cumulative, FML) was over almost 2000 pages. Needless to say, we all basically looked like pale, unhappy zombies walking out of that final: some fun in the sun (and on Bourbon Street) was exactly what we needed.
The NOLA trip is one that is organized entirely by our school. It’s a service trip that runs Monday-Friday of our spring break. Our class is split into groups of three and put into three different service projects on a first-come, first-served basis. I was lucky* enough to get into the smallest service group, at a site just outside the French Quarter called Project Lazarus. Project Laz is a halfway-home for people who are HIV+. Basically, if you are living in New Orleans with HIV and find yourself with nowhere safe to live, you can be accepted into this house (I believe there is a sort of referral/application process). While the residents live in the house, they participate in programming like book clubs, therapy groups, addiction counseling if they need it, and earn an income that is put into a savings account. While no residents are ever forced to leave the house, most spend a few months there, then move out on their own. It’s a really cool project, and the residents and workers there are super incredible and kind.
*When I say lucky, I mean incredibly well-planned. There were only twelve slots to be in this group and sixty med students trying to get into it. I refreshed my email every thirty seconds for, like, ten minutes and had “Project Lazarus” saved into my copy-paste. Sorry for being such a nerd but this project was too cool to act calm and collected.
While working at Project Lazarus, our group helped create a composting system for the house, tore down an old shed, cleaned one of their facilities and socialized with the residents. Obvi, socializing with the residents was the best part (but it was definitely nice to be outside in warm weather no matter what we were doing). The residents loved talking to us about our career aspirations, telling us about their past, and discussing their favorite festivals and Bourbon Street memories. They also gave us tons of food, restaurant, band, and drink recommendations and begged us to tell them if anything embarrassing had happened the night prior. They were so great.
The service work was definitely a highlight of the trip, but it was also nice that we had every evening to spend doing whatever we wanted. My group ate so much good food-like, SO MUCH FOOD-and spent a lot of our evenings at jazz clubs on Frenchman Street. (I loved the oysters and the gumbo, but my favorite meals were at a West African/Nigerian restaurant. If you have never eaten West African food, go get some. STAT. You’re welcome in advance.) I also got to go on a haunted tour which was awesome and definitely terrifying.
It was wonderful that our school planned such a cool, fun, but relaxing service trip for us after the most intense medical school class so far. Spending so much time with so many of my classmates was incredible: I loved getting to hang out with people I usually only see in class. And of course, being in one of the most fun cities in America doing work for an amazing project made it all even better.
Spring Break/My 25th Birthday Celebration was superb! Two friends from NY and another from ATL flew into Dayton. My boyfriend drove in from Indy and one of my linesisters (she told me she had an AMA conference and so would be busy…fooled me so well smh lol) who attends OSU COM all surprised me and stayed in my house. Literally, my house was full to the max capacity but it ended up being non-stop fun. The first activity was dinner at De’Lish, then afterward we went out to the club (had an absolute ball!). On Saturday they surprised me with Paintballing! It was exhilarating and nerve wrecking at the same time! By the end of the day I was in so much pain and traumatized, so much so, that I couldn’t complete the last game….my nerves were shot… just couldn’t do it any longer. Neither could the rest of the girls…we readily waved our white flags. Then my friends told me they were surprising me with homemade dinner so they needed my boyfriend to keep me out of my house for about 6 hrs….that wasn’t a typo btw… we had to be gone for 6 hrs…I wasn’t allowed back until about 8:30-9:00pm. I had no idea what Jared and I were to do for so long…but this is what we ended up doing 1. Did laundry from the paintball expedition 2. Had Chipotle 3. Saw ‘Oz: The Great & Powerful’ ( I loved it, Jared hated it lol)…finally it was 9 and we headed back to my house. I ran into my neighbor on the way in and he says, “Hey Topaz, sure have a lot of folks in there”…I’m like huh??? Anyway walk in and SURPRISE!!!!!!!!!! Classmates, linesister, friends…my house decorated with streamers, balloons, signs, homemade food, champagne…all of a sudden I’m toasting…I even had a moment and broke out a tear…I was absolutely overwhelmed with how much work my bff’s put into making my birthday special! That weekend was one for the books!
Spring break ends. Endocrinology class begins. Study. Study. Study.
Then about a 2 weeks later I head to the Student National Medical Association’s (SNMA) Annual Medical Education Conference (AMEC) in Louisville, KY, hosted by the University of Louisville SOM. I didn’t know what to expect out of Louisville or this conference as a candidate. First thing Thursday morning, I made my first presentation and addressed questions from the BOD, then later that evening my boyfriend (my helper for the weekend hehe) and I went to each Regional meeting room to present and answer questions. It was truly a test of endurance as we went to all 10 regional meeting rooms located on 2 floors of the Galt House Hotel. Whew! I was exhausted. Here come Friday morning presenting to the House of Delegates, which consists of representatives from each medical school. It was at this time the entire election changed for me as I now had an opponent. Someone was nominated and ran from the floor. The day before I had a few areas I wanted to improve on so I asked God to help me to be able to speak to the HOD with eloquent skill and with purposeful execution. I also prayed to remain calm and to enjoy the moment. Success! I felt I nailed that HOD session and was satisfied with my improved performance. I was also assured that the membership and the HOD of the SNMA would make the right decision and vote for a President-Elect that they believed was best for the job. With that in mind I looked forward to attending sessions and enjoying the rest of AMEC2013. The next evening, on Saturday night at the very end of the Board of Directors Banquet the election decisions were announced….::::drum roll please::::…… and I won! I am officially the 2013-2014 President-Elect of the SNMA and will serve as the 2014-2015 National President. All my hard work paid off and I made sure to enjoy my victorious evening as bright and early the next morning I was attending my first BOD meeting as a bonafide board member.
I would be remiss if I didn’t make you all aware of the tremendous support I received from my school when I informed them of my intent of running for President-Elect. The Dean of Student Affairs gave me his support and instructed me how to move forward with clerkships if I were to be elected. The Office of Advancement at WSU even made 300 flyers detailing my platform for me. Knowing I had the support of my medical school was really a major factor in determining if I would run… so A BIG THANK YOU TO WRIGHT STATE UNIVERSITY BOONSHOFT SCHOOL OF MEDICINE!
Returned back to Dayton…took the Endocrine final and 2 missed quizzes. PASS! For the record the 2 days of studying on my own without my study buddies was NOT FUN. But with the help of the man upstairs I successfully completed the Endocrine course.
Also when I returned to Dayton I feverishly completed my poster for the WSU Research Symposium, with the help of my research advisor and M3 colleague that brought me on to the project. This was my first opportunity presenting research and I was very excited to begin gaining experience presenting scholarly work. I really do look forward to presenting at next year’s symposium and continuing my research.
This was a long post…I know. That just goes to show how crazily amazing and busy the rest of March was. I’m nothing but smiles and so pumped to complete the last 2 courses of my M2 year and then…dum dum dummmm….Step 1 of the Boards!
Until next time, Enjoy!
This year I had the most love-filled Valentine’s Day of my life. Please keep reading: I will not be boring you with tales of dozens of long-stemmed red roses, a romantic dinner, or other inappropriate things. I actually spent February 14 in the Labor and Delivery Ward of Miami Valley Hospital. No, I did not bear any children of my own, but I did get to watch four other people deliver babies.
The OB/GYN Club here at Boonshoft set up a wonderful shadowing opportunity that allowed one medical student at a time to spend about five hours in L&D at Miami Valley. Although I haven’t the slightest idea what I’d like to specialize in when I’m a grown up MD, I couldn’t miss the opportunity to witness the miracle of childbirth. In the days leading up to my shadowing, my two main hopes were that 1. it would be a busy night so I could actually see a delivery and 2. that the medical students and residents wouldn’t think I was a huge loser for voluntarily spending my Valentine’s Day in the hospital. I shouldn’t have worried though*: the minute I arrived (it only took me one secretary, one janitor, and two nurses to find the resident’s lounge), I was ushered into a C-section. Literally seconds after I arrived, the attending pulled a baby out of a uterus. Like, I walked in and BOOM! there was the baby. It was insane.
*Please note that I did not mention whether or not the residents/medical students thought I was a loser for spending VDay shadowing. They probably did even though they didn’t show it because, I mean, come on, even I felt kind of lame.
I wasn’t sure how I would react to seeing a delivery; I didn’t know if I would think it was cool or gross, if I would get emotional or be unimpressed. Even after only being in that OR for five seconds, it was impossible to not be moved by what I had witnessed. When the attending delivered the baby, my jaw dropped. Once the baby started crying, my eyes filled with tears. I just stood there in shock, in awe that I was one of the first people in the world to see this little human. It was absolutely incredible.
The rest of the evening did not disappoint. I was able to see two vaginal live deliveries, another C-section, and watch blood clots get scooped out of a uterus via ultrasound (the last one was mildly gross but super cool). The team I was with was incredible. The intern answered all my questions and let me watch everything I could possibly watch. The attending on service made sure I could see every aspect of one of the vaginal deliveries I witnessed. The MSIII working with the team, incidentally also named Claire, taught me so much and was very patient with my childish excitement. It was honestly the best shadowing experience I have ever had.
One thing I cannot help but mention about Boonshoft is that virtually every physician I have met or shadowed thus far is incredibly excited to teach. Their love for their jobs is made apparent in their enthusiasm for working with students. I have learned so much from so many physicians here already, largely because they earnestly love educating. It’s so rewarding to learn from individuals who view you as anything but a nuisance (because, in actuality, medical students can definitely be just that, especially when they are freaking out in a busy L&D ward about how cool moms are).
I’m so glad I got to spend my Valentine’s Day doing something incredible. Medical school can change your priorities when it comes to what you find meaningful. I wouldn’t change my night spent in L&D for a thousand romantic dinners. Probably.
Perhaps one of the most memorable experiences thus far in my first year of medical school, other than trying to find the pterygopalatine fossa on a human skull, has been listening to some of the stories of my colleagues and friends. Here at the Boonshoft School of Medicine, most students enroll in an optional course called Healer’s Art. Every Wednesday night for several weeks, we students and faculty put aside our busy lives to share and listen to more intimate stories about our past, present and future.
It impresses me that not only are the medical students willing to devote time to the course, but the busy faculty and community physicians, many of whom are Wright State alumni, sacrifice their own precious time to participate as well. This indicated to me, and I hope indicates to anyone who is reading, that our faculty and community physicians contain what I believe to be honorable qualities of a physician, and perhaps most importantly, are teaching, reinforcing, and ultimately passing these qualities on to us, the next generation of physicians.
So what are these qualities? Two of the most important attributes that stuck with me after taking the Healer’s Art course were compassion and the power of listening. I believe compassion to be treating each patient not as a disease, or even as an isolated individual, but as a human being who has a family and friends, and that the holistic treatment of a patient is as important, if not more important than the treatment of that patient’s disease. It didn’t really surprise me that my peers showed a great deal of compassion when listening to my own stories, and I certainly hope I did the same for them. And the power of listening; physicians have such tremendous responsibility in society that often we believe there must be something we can do or say to help treat someone’s pain or ease their suffering. Ironically, sometimes a willingness to step back and just listen to your patients for a moment may be all that is necessary at times. During our group discussions in Healer’s Art, everyone was so respectful and willing to listen, without interjecting even if it may have been tempting. Certainly I believe that physicians should do anything in their power to help their patients, but sometimes those actions need only be passive, as a genuine willingness to listen.
So there you have it. There are so many excellent opportunities to grow as a medical student, and I believe many of these opportunities stem, ultimately, from the core values of this institution.
So a lot has happened since I last wrote a blog over a month ago. I’ve gone to tons of club meetings (who doesn’t enjoy free food?), completed CaTOS, and even learned first-hand why it is important to warm a stethoscope before placing it on a patient’s chest or abdomen. As I sit here on spring break (yes, you get a spring break in medical school) watching college basketball, I find it is a good time to reflect and share my thoughts with you. Apologies in advance if there are any grammatical errors but I have not used my brain since my CaTOS final 5 days ago.
One piece of advice I would give to anyone entering medical school is to make time for yourself to continue to do the things you love to do. If you are someone who doesn’t normally study non-stop all day do not change that just because you are in medical school. Don’t get me wrong. You will probably have to study much more in medical school than you did during undergrad but that does not mean you cannot have a life. If you see your classmates studying all day at school it might be a little intimidating. I know it was for me. What you need to remember, though, is that everyone learns differently. For me, that means studying but never missing an episode of the Walking Dead or Dexter on Sunday evenings.
You may also think that you are alone and the only one who has fears about the upcoming exam over 1,400 pages of notes. I assure you that EVERYONE feels that way. If you are accepted to Wright State you will have the opportunity to take a class called Healer’s Art. The class meets in small groups once a week for six weeks. You will talk to your classmates about some very deep stuff. I used to think everyone else was so confident with their studies before I took this class. However, I learned I was not alone and made some friends in the process.
The final piece of advice I have for you is to go to as many club meetings as you can. You do not have to be president of seven organizations, have three research projects going on, and work a part-time job while in medical school. That is not the point I am trying to make. What I am saying is that you should go to these meetings to open up your eyes to new fields you may not have had an interest in before (or to change your mind about the ones you WERE interested in). There are organizations for every specialty and attending is also a great way to meet faculty. If that is not enough incentive for you, these meetings usually occur around dinnertime and have free food such as Chipotle and pizza.
I know my blog can be comical at times (at least I hope) but these points of advice should be taken seriously. You are going to feel like you are going insane sometimes. However, all of these things should help you maintain your sanity when you just want to give up looking at the difference between simple columnar ciliated versus simple columnar non-ciliated epithelium at two in the morning.
So many great things are happening! Let’s see where to begin…well before I get to the exciting month of March…there was the end of February that brought a smile to my face.
The Boonshoft School of Medicine chapter of the Student National Medical Association (SNMA) hosted a cultural competency event on treating the LGBT patient. Our wonderful VP Jasmin put on the event, which was a follow up to the previous cultural competency talk on treating the Muslim patient. I grew up in a city full of diversity…and when I say diversity I don’t just mean the knee-jerk thought of just race but also religion, sexual preference, ability/or disability, cultures, cuisine, accents…basically name something that makes you unique and NYC provided a great opportunity to interact with that population. The world is diverse and certainly the future patients we’ll interact with will represent almost all of these types of people. So it kind of surprises me that medical education has not instituted this education into our learning experience. Speaking to my colleagues at other schools it doesn’t seem like they’re learning about how to treat diverse patients either. I know in our Introduction to Clinical Medicine (ICM) course we have lectures on “Approach to the Patient w/ Headache” or how to treat the Geriatric patient but what about the Muslim patient or the LGBT patient that has different needs or ways in which best to treat their medical needs. It is my hope that in the next decade standard medical education does evolve to include training on these type of patients that are equally as important as all our other patients. So kudos to the Boonshoft SNMA chapter stepping up and providing a forum that addresses diversity in our patient population!
And now onto the awesome month of March! Only 6 days in and its been a world wind of emotions. March 1 begins my Candidacy for the President-Elect of the SNMA. The elections take place annually at the Annual Medical Education Conference (AMEC) and the House of Delegates, composed of representatives from each medical school in the country, will vote for this position as well as other national officers. This year AMEC will be hosted by University of Louisville School of Medicine in Louisville, KY from March 27-31. Nerves and excitement, I am sure, will take over as the date approaches but my classmates and friends have been a great support so far. I’d love if you all checked out my candidate composite to see what some of my ideas and goals for the future of SNMA are at this link:
This has somewhat been a yearlong process for me after attending AMEC in Atlanta, GA last year and being inspired by the mission and leaders of this organization. I hope to report some good news later on this month!
At the start of this year, Boonshoft SOM welcomed its first female Dean of the medical school, Dr. Marjorie Bowman. Earlier this month the there was an official welcome of our new dean held in the atrium of the SOM. Many students, like myself, served as tour volunteers to show off our building to our guests that evening. I was really happy I went because sometimes you only get to see a picture or see an email from certain key people who make decisions that affect your medical education, so seeing them in person and getting to interact was important to me. In fact, I have a bit of a funny story of why it is so important we see these people more often so as NOT to do what I did. During the mingling part of the evening, I made sure to insert myself into a cluster of folks and strike up conversations. One gentleman and I hit it off and I asked him his name and he says David Hopkins…the President of Wright State University. I’m sure at that moment my eyes widened a tad… I was embarrassed but he was so gracious and made sure to not allow me to leave feeling that way…so I was thankful. Nonetheless, the welcome for Dr. Bowman was a success and everyone was happy she is now apart of our community. In her address, she stressed the importance of increasing scholarship for students so I was bought over easily lol. Dr. Bowman was also was very personable which made it very easy to talk to her, which I appreciated. I look forward to her enthusiastic approach to continuing strengthening Boonshoft SOM.
Ok, I know this post is a little bit lengthier than others but that’s just how cool March is. So the last exciting thing is that my birthday is tomorrow! Whoop whoop! :::Tootsie rolls across your screen::: Although I have a quiz on my birthday and a final to study for over the weekend I’m still pumped because right after the final begins our Spring Break. Even better, my best friends from home will be coming into town to help me celebrate. I only get to see them once or maybe twice a year if I’m lucky so I’m super happy they will be able to make it. I don’t know exactly what we’re doing because they’re planning some surprise events…so maybe next post I’ll be able to share exactly what I did for my birthday. For now just know I spent it with my bffs…yep those same people that make me go on roller coasters --__--…but they’re still alright lol.
Until next time, Enjoy!
When you think about the Middle East and Persian Gulf, war, political conflict, violence, and the brave work of the men and women of the U.S. military enter the imagination. However, there are also thousands of years of rich cultural heritage and areas of wealth, stability, extraordinary generosity, and innovation that get drowned out by the noise. During the summer of 2012, three of my classmates and I traveled to Oman—southeast of Saudi Arabia—through a formalized exchange at Boonshoft. We did observational rotations at Sultan Qaboos University Hospital near Muscat, and had our perspectives on the region opened and enlightened in ways we could never have imagined. For three weeks, I was learning from physicians in hematology and general surgery; and every afternoon and on weekends (which are Thursday and Friday there), we were exposed to the region and culture through student ambassadors from Sultan Qaboos University with truly hyperbolic generosity. I did this as part of a requirement for the international health track that the school has set up for us; I would venture that one third or more of my class traveled last summer--from Nepal and Vietnam, to Jamaica and Native American reservations.
While in the Middle East, I had the opportunity to visit Dubai, the glass city growing in the desert like the land of Oz; and Jordan, where the Dead Sea, Sea of Galilee, Red Sea, Roman ruins, Petra, and Wadi Rum were a collision of ancient and modern, and evidence of some of the regional turmoil was seeping just barely into its borders (especially north toward Syria). One of the Ph.D. students at Wright State University is from Irbid, Jordan and I visited his family there—in fact, his brother has come to Dayton for an elective that started this week at Kettering and I am looking forward to seeing him and hearing his impressions of the U.S.!
The other piece that had summer 2012 on my mind was a Middle Eastern meal that I had over the weekend. Last Sunday in Dayton was the Day of Caring, a fundraiser to help combat homelessness and hunger that happens annually at schools, churches, and community organizations. Ralla, one of my classmates, helped to set up sites at both Boonshoft School of Medicine and the Miami Valley School; the former serving a pancake breakfast, the latter serving food from the Middle East. It was a great moment to look back at that phenomenal opportunity to travel, and to remember through the tactile, sensory experience of eating; that trip seems so far away from studying for our renal course, it is like reflecting on a dream.
When I was in elementary school and got worried about something, my mom would try to give me perspective. She told me to think of how much it will matter in five years, or ten years, and essentially that such minor day to day concerns were often smoothed over with time. Though sometimes I make sport out of poking holes in adages like that, I still take that message to heart. One of the manifestations of that was writing letters…with the recipient being me. I used to write notes to open on my birthdays, especially when contemplating major life changes. Maybe it sounds a little cheesy, because it is, but I love reading those messages. Again, it’s about perspective.
So for this post, I would like to write a message to myself to read on graduation day in 2015.
Dear Jeffrey Graduating from Boonshoft School of Medicine,
You made it?! What an adventure! All of those long hours and hard work and the days and nights of turning time into knowledge and practice have paved the way for this day. But this day isn’t a switch from ‘off’ to ‘on’ in doctor-land, it’s an accumulation of maturity and skill that will carry on to wherever you are headed next. When I imagine what that will be like, my lens is now. Today, pre-clinical; I am a dreamer looking into the crystal ball trying to divine what ‘could’ into what ‘will’ be, and knowing that the error bars on my estimations are so great that the statistical significance of the prediction is abysmal…like trying to predict the weather for the day of graduation. Of course there are always clues…for instance, I have a feeling that the temperature is likely warmish, but will it rain?...I’m always up for a hearty guess. So I’m going to go with, not raining.
Here I am, celebrating the end of the respiratory class and having a relaxed intro to renal, and there you are, receiving a diploma and celebrating with friends and family. I saw on the National Resident Matching Program’s twitter feed that today is the day that the rank order list is due for the fourth year students. I can only imagine going through that process in the most abstract way, and have such a tremendous amount to learn before I could possibly feel ready for that step toward residency! But there you are, Jeffrey-about-to-get-your-degree, all ready to head out into some field or another. What did you end up choosing? How much more training will you have? Will you be moving far away?
I wish you could send a letter back to allay all of my fears and to feed my excitement. Does STEP 1 go okay? What order should I do my clerkships? Did you do an international away rotation fourth year? The answers to those questions and ones like them will be what grow me into who I have become…I wish I could have a peek, just for the energy of anticipation!
Monday after the exam, someone came to look at the old car and decided to buy it and fix it for his daughter. She is a high school senior, and is considering going to Case Western, so maybe the car will find its way back up to Cleveland this fall. Later in the afternoon, took a hike from Clifton Gorge toward John Bryan State park to enjoy the momentary 50-degree weather in the midst of the winter chill. Sat on a panel to answer questions for high school students about what it is like to be in medical school. Listened in on an AAMC student representative call for community and diversity in the evening, as I had cereal for dinner. After class today Brent arranged a session from the Ohio State Medical Association talking about their legislative and advocacy efforts, followed by a group meeting with Dr. Cauley for a review of the trip to Oman last summer with Kelsey, TJ, and Mai. Today is mom’s birthday, so I called and sang. These are the little details of my life this week. I imagine the week leading up to graduation has been filled with so much excitement and love and last moments with people before parting. Good luck to you, and tell them good luck from me too!
Jeffrey the MS2, February 20, 2013
So there… simple details, pieces of substance and fear, excitement and promise. Like I said, a little cheesy, but I hope I remember to check back years from now and reflect.
So you are interested in coming to Wright State for medical school? Either that or you are one of my family members reading this blog for proof that I am actually doing something productive. Whichever the case may be, let me start by saying that I have never blogged before so I am not really sure where to go from here. I might ramble on about things unrelated to school. Some things you might find funny, others you may not. Regardless, I will try my best to give you a mental image of what life has been like for my classmates and I since starting medical school (with the hopes of not scaring you away). If you have any questions about anything (medical school, life, why we drive on parkways and park on driveways) feel free to email me at firstname.lastname@example.org.
Medical school started with Human Development. A two week course devoted to…human development. The exam for this class will be the only time you have to write an essay. Nothing too serious so don’t freak out if you are not an English major. I assure you most of my classmates are not (although some are). Go to class and you will be fine. Next comes anatomy.
During Human Structure you can expect to spend late nights in the cadaver lab with your classmates trying to find the inferior mesenteric artery or learning the brachial plexus. There will come a point (usually after about 3 hours in the lab) when everything that is said becomes “humerus.” See what I did there? That is when it’s time to go home for the night.
Your next class is MBM or the Molecular Basis of Medicine. You are going to have several professors for this class but the notes are a great supplement for the lectures. If you want to shadow, take guitar lessons, learn to cook, or build a rocket ship, do it during MBM. You will have more free time during MBM than in any other course as a first year.
When the New Year comes you will start CaTOS, which is referred to as Cells, Tissues, and Organ Systems NOT Cells and Tissues, Organ Systems. I guess CTaOS didn’t have the same ring to it. You will put in a lot of time during this course but I feel like it is the most rewarding course we have taken so far. You are going to be amazed at how much you will learn in this class. I mean how cool is it to be able to look at a tissue section under a microscope and recite approximately 20 facts about said tissue?
When I decided to come to Wright State one of the main reasons was because of the atmosphere. All the other schools I had interviewed at seemed so competitive. Wright State was the complete opposite. Your classmates and the faculty definitely care about your success. If you aren’t getting something then anyone will help you out. If you just want someone to cry with after a week of non-stop studying I’m sure someone would oblige you as well.
That’s all I have for now. Once again feel free to email me and I will try to come up with a witty (but serious) response to your question.
I absolutely hate roller coasters. I just don’t see the point of scaring myself half to death for the sake of fun. But whenever my friends decide to go to an amusement park I’m right there front and center waiting in the long lines. They’re my friends and I love them…sooo I ride the stinkin’ rollercoasters.
To be clear the part I dislike the most is that awful feeling of the next big drop. The cart goes up the track slowly and ever so tortuously. For a split second it stops at the pinnacle over looking the entire amusement park and you (at least I do) think “What was I thinking…whyyyyyy did I sign up for this?!!?” And then I drop. And then I reach the top and again think “What was I thinking…whyyyyyy did I sign up for this?!!!!!!!!” Turn a winding corner with water or some theatrics splashing up in my face. Repeat those steps several times then its over. The absolute worst! But somehow every summer or so I’m in the long lines hurridly eating a funnel cake, getting powder all over my face, and laughing about something silly with my best friends because I love them. (The things you do for love smh).
Today us MS2’s took our Respiratory Exam. Another class successfully completed and I’m on the cruise part of the roller coaster ride. I forgot to mention the cruise part of the roller coaster ride is my favorite part…if I had to choose one. It’s so short that most people don’t even realize it most of the time. It’s in between the ascent and the big drop. Yup…that little cruise period is my part! For most people I think it goes by too quick to ever notice, but for me it slows down and I thoroughly enjoy it.
During 2nd year our class schedule is a lot more frequent than first year. The classes average 2-3 weeks. And then on to the next. The pace is fast and the course packs are thick. The week or so building up to that Monday is exam is like the ride up the rollercoaster. Nothing short of terrifying, but somehow my classmates and I make it over that drop and are on cruise mode (for a short while).
I chuckled to myself on the drive home after the exam because in three short weeks I’ll be back in the line for “that ride” with my colleagues. This time for our Renal exam. So it seems I must love it. Indeed, I am with the rest of the Boondocs (Class of 2015) as we are affectionately known and I am where I worked so hard to be at Boonshoft School of Medicine. Oh the beauty of life…I don’t like roller coasters but I inadvertently signed up for the monster of them all LOL. At the end of the day, I love learning about medicine and that’s what keeps me coming back…oh and also the fact I already took out and spent loans for this year ;)
Until next time, Enjoy!
As everything goes blazing by, class after class, it’s easy to lose sight of what is actually happening. Maybe that sounds obvious, but writing about it seems like a great time to pause and look over what’s all going on.
Next Monday, our respiratory course will be over. So let me remember this short time, and these people that I am here with, right now, because it’s so transient and we’ll all be tossed to the wind in a few years — careers and the “real world” beyond the protective walls of White Hall and Dayton and Boonshoft.
I know one day I will think back to things like this: I arrived at school for what I assumed would be an 8 a.m. start-time this past week. We were having a question session about respiratory tract neoplasia, but I misread the schedule and found an empty lecture hall until a 10:30 start-time. I know my classmate Brian arrives at school early — he always has the closest parking spot and his small car is hard to miss — so I sent a text and eventually found my way to the ICM room he was in (the ICM rooms are basically study rooms, but they’re used for our Friday Introduction to Clinical Medicine course, so that’s why we call them that). Brian was looking over material for later, so we sat for a while studying. At some point Nikki came and joined us. There was idle chatter and occasional distraction, but that’s the best sometimes, especially for me since I almost always just study at home.
Brian and Nikki are two of the four other people that were in my Team-Based Learning (TBL) group during the MS1 year. In TBL, we had a flag next to our team number so we have always called it “Team France.” The five of us really got along well and we continue to get things for each other’s birthdays and bug each other when a group might be useful to cross-check something instead of going straight to the professor or the online class message board. The year has been busy, and I haven’t felt as reliant on the group for anything compared to last year, but it’s really comforting to have that backup.
Last weekend my dad was in town from Maryland; it’s always refreshing to have a visitor — though I’m always conflicted by feeling like I’ll fall behind if I don’t put in my time on the books, at the risk of not being a good host. I’m sure I’ll write about him again later, he and my mom are both among my heroes. Uncommonly good food, hiking in John Bryan State Park, and a short visit in Columbus with my brother were perfect to enjoy some decent weather and break the winter doldrums.
Hopefully this respiratory exam goes well. I have so much physiology to look back over! I’m sure I’ll have a chance to deconstruct it all next time.
So has anyone ever read The Hobbit? I remember reading the chapter title, “Out of the Frying-pan, Into the Fire” — the first time I had heard that phrase, which so aptly describes how I feel each new stage of my medical education. Apparently the idiom pre-dates The Hobbit by hundreds of years, but sometimes I feel like Bilbo Baggins: so small, with all this vast world of information on the horizon, and all I can do is soak it in with a mix of trepidation and excitement. So yes, medical school at Boonshoft School of Medicine is, without a doubt, an epic adventure — only instead of traipsing along with a roustabout company of dwarves, I have the luck and privilege to be accompanied on my journey by some of the most phenomenal classmates and faculty I could have imagined.
Lately, I’ve been sizing up the sort of incredible stamina required to make it through the last term of my first two years and ultimately the run-up to taking STEP 1. June 6, 2013 in Beavercreek, Ohio is the day of reckoning. And by “day of reckoning” I mean… it’s just a test, and it’s just another day (that…happens to include seven hours of exam with an hour break); but to make it out to be anything less than one of the most significant culminating experiences of my life-so-far would be to sell it short. It matters enormously. But at the risk of that description sounding hyperbolic, June 6th has been kept in check from becoming too big of a bogeyman by looking at it as just another way-point on the road to reaching for that MD and a fulfilling career.
I came to medical school from undergraduate studies in biomedical engineering, and graduate studies in bioethics and social work. I’m so thankful for that diversity of experiences, and I never cease to be amazed by the variability in pathways of my classmates, significantly enriching how we learn from each other. Roughly 60% of my class of 2015 had at least a one year gap between their undergraduate studies and starting medical school, based on a survey we took during the fall of our first year. I am currently buried deep in Robbins pathology and Costanzo physiology, but thankfully we get frequent glimpses of putting it all together in clinical practice. For example, this week our respiratory system course had us doing applied physiology for ventilators at the Cox Heart Center in Kettering in the simulation lab. It seems impossibly far away and uncomfortably close: the last week of June will be the beginning of the MS3 year and clerkships, when the rubber meets the road and the clinical learning goes into high gear. Despite extracurricular volunteering and introductory clinical experiences, I have expectations for the true chorus of, “this is why it’s worth it!” to come out once the clerkships get rolling.
I love to express myself and create…but for some reason I’ve never blogged before. I’m an avid tweeter. So I’ve already told myself to imagine this is a just an extension of my iPhone with one twist (there’s always a twist!) of not being constrained to 140 characters (freeeeedommmmm)… so let’s begin this journey together…
It’s the second semester of second year (see what I did there?) and I’m ecstatic, thrilled, anxious, scared, and determined all at once. Just today I was telling my classmate that we’re rounding the corner of the track and I can almost see the finish line. I like to look at med school as 2 parts. The first part is the first 2 years where we do our “book learning” and the latter the “clinical learning.” And boy oh boy can I see the finish line to the “book learning.” But before I make it there is DUM DUM DUMMMMMMMMMMM…the dreaded BOARDS aka Step 1! (insert evil sinister laugh). So let’s go back to my track analogy and I imagine Step 1 like this…(bubble appears over my head and everything in the room gets hazy)…I’m in my Boonshoft School of Medicine green and gold track suit (looking sharp as a tack) running full speed…I can taste the sweet victory about being done with part 1 of med school and all of a sudden this hideous man jumps out of the stands and gets in my way. I’m like “Hey man what are you doing?! I’m trying to finish this race.” The more I try to dodge him the more he darts in front of me and blocks me from my goal. Talk about frustration. That was then (for the most part).
To be honest I was terrified about this year in August when we began, but how I’ve been wrong about everything so far. The moment when all of this changed is when I decided not to think about Step 1. I know that sounds impossible but I decided to just not even allow myself to get worked up about this exam. At least not right now. Some people work well under pressure, but that’s not me. At all. I’m more of a cool vibrations, let’s take one day at a time type of girl. And today is about Respiratory Pathology. And that’s it. If I just focus on that today and tomorrow on whatever tomorrow presents then I’ll maintain my sanity (rule #1: At all times maintain your cool). If there’s nothing I’ve learned best in my past 24 years of life is that I do my best work when I stay calm and collected. So until I’m proven otherwise that’s exactly what I’m going to do.
Don’t get me wrong…some days as much as I try to stay calm…my mind wanders to the same scenario on the track…me rounding the corner and this obstacle in my way, but now luckily I guess I’ll have this first post to refer to and laugh about how I just shared my the bizarre inner workings of my mind with all of you good people (aka strangers) lol.
Until next time, Enjoy!
Allow me to introduce myself. My name is Lauren Welch and I am a first-year medical student at BSOM. Six months ago, I set foot in White Hall for the first time as a bona fide medical student. I was overwhelmed with the excitement of starting my professional journey and meeting over 100 people who would experience it with me. Prior to beginning medical school, I graduated from The Ohio State University with a degree in English Literature and spent a year traveling, working, and reflecting upon the utterly confusing and awkward period of life that is our 20s. I am currently 23 and therefore have not made much progress in overcoming this treacherous decade; however, I have since learned to accept and even enjoy its unpredictable disposition.
I remember the first time I put on my short white coat at our White Coat Ceremony. For one, I was ecstatic at how well I managed myself in heels, a dress, and a stage. I was also very proud of my family members for their cooperation in the whole procedure of sitting down and listening to all of the speakers. They were not asked to leave, nor did they say anything that offended anyone else (to my knowledge). Kidding aside, the moment I slipped on my coat was one of the most proud moments of my life. I had envisioned myself on this stage for so many years and was now fully able to pursue my dream of becoming a physician. The quest was here. I looked out across all of the unfamiliar faces around me and thought to myself, Heres to four years and beyond. Every man dies, but not every man really lives." Ok, so I probably wasn’t quoting Braveheart at that exact moment. You catch my drift.
But, even amidst all the cheering and hugging and shaking of sweaty palms near the podium, I could not help but feel overwhelmed by the new medical world in which I was entering. All of the horror stories I had heard from doctors and medical students of the challenges that awaited me in medical school began to take over. In my mind was a picture of myself isolated from all I had ever known of the free world, a girl suffocating silently beneath stacks upon stacks of medical literature only to gasp out occasional medical jargon and sink back silently into the corner of the library. I worried I would be forced to part with many of the hobbies and relationships I hold dear to me.
My experience has undoubtedly proven otherwise. I have kept in close relations with family and friends. I made a resolution to write hand-written letters and have found that by doing so, I have not only managed to keep in touch, but have even rekindled old friendships that have unfortunately slipped by the wayside over the past several years. I have continued to run and also to procrastinate (I probably should be learning about the nervous system right now); yet, I would be lying if I said that medical school hasn’t been a challenge. There are periods of time when I wonder if I am smart enough or have the courage to take on such a large responsibility in our society. I worry still that I may have to sacrifice not simply time, but part of who I am, in order to become an honorable physician. I worry that I may not be able to retain the dense material for the next exam, let alone when I take boards and start medical rotations for the first time. Still, I have been blessed by classmates who stand beside me and remind me every day that I deserve to be here. They laugh when I spill coffee on myself or leave my keys in the freezer (again). They ask me questions to which they already know the answer just to make me feel smart (just kidding, but really). They are a source of strength for me every day and a reminder that medical school is not a time of my life that I must get through in order to become something else. It is a period of growth and self-discovery, a chance to enlighten myself and to be a part of a movement to shape the world in a positive way, not sometime down-the-road, but now. And hey, I have even managed to keep my white coat stain-free. I look forward to what the next half of this school year will bring, and to sharing it all with you.
Hey readers! I’m Claire Dolan, a (lowly) first-year medical student at Boonshoft School of Medicine at WSU. I’m just going to go ahead and preface this post (and all my future posts) by saying that you and I are both going to enjoy my blog better if we agree to think I’m funny.
Now that that’s settled, we can begin.
This month marks my sixth month of medical school. Six months at Boonshoft means I’ve dissected a cadaver, learned how to take vitals, memorized the Citric Acid Cycle (for the billionth time)(How do I still not know that thing?!), and heard families talk about how genetic disorders have changed their lives. Six months at Boonshoft also means I’ve developed a sincere love for the instant coffee machine in White Hall, found a group of friends who are a lot like me, cartwheeled through the atrium on late Saturday study nights, and become an expert at finding free food at meetings.
About a year and six months ago, I was a very stressed undergraduate at The Ohio State University, positively freaking out about where I was going to be in a year. As a classic pre-med (read: Type-A, OCD person), I was terrified not knowing where, or even IF, I would be going to medical school. Eventually, I interviewed at three different schools, one of which was Boonshoft. During my six hours here, I pretty much fell in love. I was honestly shocked-I had never really heard of BSOM and applied just knowing it was one of those Ohio schools you apply to. I never expected to actually like a medical school, I just wanted to get into one! At Boonshoft, I got the feeling that the administration was sincerely proud of my accomplishments and that they really wanted me to succeed. (I got this vibe after my interviewer blatantly told me, “You’re an awesome applicant. Congratulations on all your hard work!” Who says that during a med school interview?! Someone from Boonshoft, that’s who.) Once I was accepted here, I rejected interview offers from two other schools because I knew here is where I’d be happiest.
Now, six months into my medical education, I can honestly, sincerely, in a non-propaganda way say that I’m thrilled with my decision. Moving from Columbus (aka the greatest city in Ohio) to a suburb of Dayton (…) was a bit of an adjustment, but I’ve come to love it here. Not worrying about getting towed or fighting hours of traffic is incredible. The education I am getting at school is amazing. Our professors are incredible and genuinely love interacting with us, our physicians beg us to shadow them, our administrators hand-deliver our course packets well before every new class beings, and we students are seriously (SERIOUSLY) not competitive with each other (Try to name another medical school where a student would email his outline of 1,000 pages of material to the entire class voluntarily. I dare you.). Sorry for being a walking billboard, BUT I LOVE IT HERE.
Sure guys, medical school is hard. In these past six months, I’ve been expected to memorize more than 300 pages of solid, dense text in a week. I’ve been so busy that I haven’t had time to shower, let alone shave my legs (Apologies to my clinical skills partner during that lower extremity exam class.). I’ve gone DAYS without seeing the sun. I’ve had those moments the night before the test where I start laughing and end up crying (TMI? Probably.). And apparently it’s all going to get much, much harder. But I love my school, and it’s a lot easier to deal with sleep deprivation and caffeine jitters when you can call your classmates your friends and when the admissions committee gives you their leftover food.
As I reflect on my first semester of medical school at the Boonshoft School of Medicine, I often find myself thinking a lot about where I was, where I am now, and where I have the potential to be in the near future.
A lot of things about me have not changed since I first set foot in White Hall; for example, my personality of being respectful, a bit too nice — to the point where it can get awkward — slightly shy, and extremely resourceful. And I think the static nature of our personalities is a genuine thing that makes us unique and ultimately keeps our medical school class freshly diverse and open for discourse.
And at the same time, I am not the same man that I was six months ago, both in body and mind. While there are physical and mental stresses associated with the demanding nature of medical school, I have discovered my own unique ways of balancing these stresses by integrating activities into my life — some that I expected to integrate and some that I would have never guessed I would try. Whether it be running to music, watching movies, going out for coffee, doing yoga, or spending a night with friends, getting through medical school requires balance, and I don’t think there is any way around that.
It’s funny. When I took our first course in medical school, Human Structure or anatomy, I enjoyed learning the material, but I still viewed most of what I was doing as “work.” Yet, when my non-medical friends and family asked me about what I had learned, I found myself instead thinking about how blessed I am to even have this unique and challenging opportunity of exploring the human body in such intricate detail. Of course, there will be times where we students are swimming in medical details; yet, regardless of how lost we may think we are, we can always step back and think about the exciting opportunities that we have had, are having, and will have in the future.
Therefore, this is the way I hope to view my medical education in the future. I hope to continue to step back and think about how exciting most of this material really is, and to exert my passion for learning and understanding, which is something that has been a part of me since I was born. I am very excited to see what the next semester and the following years of my life will be like here at the Boonshoft School of Medicine.
I held the photo in my hands and squinted. Like an X-ray, it was black and white.
But instead of analyzing lung fields or the cardiac silhouette, I found myself looking at a photo of a young man at a rodeo, riding a bucking horse and appearing to thoroughly enjoy the attention from a capacity crowd.
Depicting a scene that was part sport, part theater, the photo itself seemed to be at least a half-century old.
"You're probably wondering why I handed you this picture," said Dr. M., the physician at the Veterans Affairs (VA) Medical Center who meets with medical students such as myself every morning.
"Tell me what you see."
Feeling uncomfortable, I looked at the photo closely, searching desperately for clues, signs of illness that the man (or the horse) might have. Perhaps, I began to wonder, I was missing something obvious.
So, logically, I counted the man's arms and legs. Start with the basics.
Both legs were present, as were his arms and hands-one used to grasp the horse's reins, and the other raised in the air, either to maintain his balance or to tip his cowboy hat to acknowledge the adoring crowd.
Really, I thought, he seemed to be having a grand old time...
On more traditional mornings, Dr. M. shows my classmates and me radiology images of patients, challenging us to find something abnormal-a small fracture on an X-ray, perhaps, or a hidden tumor on a CT scan.
It's all part of what is informally known in medical education as "pimping"—a version of the Socratic method of teaching—designed to put residents and medical students on the spot, always in front of our peers and sometimes even in front of our own patients.
Its purpose is less to make the medical students feel inadequate and more to make us learn and remember something useful.
More importantly, it's to demand that we always strive to know everything about our patients, from their liver enzyme levels to their current living situation, from their vital signs to their personal histories.
At the VA Medical Center, the personal histories come from patients who include former soldiers, Air Force pilots, Naval officers and the like. Some fought decades ago in World War II, while others more recently, in Vietnam or Afghanistan.
My first patient at the VA, a former soldier, was suffering from Hepatitis C. After seeing him every morning for several days, he was ready to be discharged from the hospital.
"My family is coming to see me later today," he said during our morning chat. "I would like it if you could stop by and tell them about my condition."
Indeed, that afternoon I met the patient's family, including his parents, and was grateful to get a glimpse into the patient's life beyond the hospital walls, an impression of what his life might have been like years ago, growing up in Dayton and hoping to nobly serve the country.
He had a kind and caring family, and though he was sick now, it was clear that the past was filled with better days...
I continued to gaze at the ragged photo in my hand, unable to find anything wrong with the mysterious man on the horse.
"He looks healthy, doesn't he?" asked Dr. M. at last.
I nodded. And mercifully, the answer was revealed.
"This is a gentleman who was here in the hospital recently and was very ill," said Dr. M. "I wanted to show this to you as a reminder that these patients at the VA weren't always old and sick."
I looked up, as did the other medical students—realizing that, although we had been duped to some degree, we had become so trained to look for disease that we had missed recognizing something far more important: good health.
Indeed, by the time we see patients, they usually are sick. Many times, they're elderly as well. But knowing everything about them means seeing more than a snapshot-knowing where they have come from, what their lives were like before meeting us in the hospital.
Hopefully, if we do that, we can take better care of them-and perhaps more importantly, help them feel young again, too.
As evidenced by the unwelcome layer of frost on the windshield, winter is approaching. And as I drive to the hospital, passing churches that stand like European castles on the still-empty streets, this morning is certainly colder, darker than yesterday.
Unfortunately, the sun won't rise for at least another hour, maybe two. Instead, I notice the constellation of Orion looming above the hospital, the moon presumably somewhere nearby, obscured for now by clouds.
It's Monday, which means last night's episode of AMC's Mad Men is on my mind. Of particular note were the haunting closing credits, which rolled solemnly to an instrumental rendition of the Beatles' song "Do You Want to Know a Secret?" The question implies two qualities at once: the great responsibility of knowing a secret and the profound sense of trust conveyed by sharing one.
I soon arrive on the mental health inpatient unit, where I am spending my six-week psychiatry rotation. Here I often find myself in the privileged position of being entrusted with other people's secrets-deeply personal information that patients choose to share with my colleagues and me.
This trust, of course, lies at the heart of our daily interactions. Within minutes of meeting a patient, we ask questions about substance use, sexual history, and bodily functions-not typical small talk.
But the power of trust allows patients to answer those questions, despite the fact that we are often complete strangers.
Particularly in psychiatry, patients share horrific secrets-about childhood sexual abuse, or multiple attempts to commit suicide-secrets about their past that, in many cases, not even their closest family members know.
And they certainly don't preface these stories by asking, "Do you want to know a secret?"
Nor should they.
After all, a crucial aspect of treating mental illness, at least from my observations, is providing a safe environment that encourages patients to confide in their physicians. In doing so, the treatment team can better understand the precipitating factors that led to the patient's arrival at the hospital, as well as predisposing factors from the patient's past, and perpetuating factors of the patient's current life.
Mental illness carries with it a stigma-even today, when diseases such as depression, schizophrenia, and bipolar disorder have been shown to be biologically, neuro-chemically, and even genetically influenced.
But the science behind mental illness means little when a physician stands in a room to interact with a patient. At that time, the emphasis is on the art of being empathetic-understanding a patient's emotional pain as a genuine experience that is qualitatively different from physical pain.
This Monday morning, as I stand in my patient's dimly lit room, just minutes before the sun finally rises outside, she tells me about the suicide attempt that landed her in the hospital, the stressors in her life, her children, and her own childhood, which included being severely bullied in school.
"Is your daughter the same age now as you were when you were bullied?" I ask.
"No," responds my patient. "But she's the same age I was when I was molested."
She says this so bluntly that it catches me off guard.
I look up, and she has a familiar, distant stare that I have seen often during the last six weeks, most notably in patients with depression. But she has told me this secret for a reason, and it hangs in the air, like so many secrets spoken by patients who have sat in this room before her.
"I appreciate you telling me that," I say, and I mean it. "I can tell these memories are really difficult for you."
Similar interactions fill the remainder of the morning, and each time, I feel that being empathetic, even in a small way, is the least I can do.
Other times, it's the most I can do.
At the end of the day, I walk back to my car not with a heavy burden of knowing other people's dark secrets, but with a feeling of appreciation for their willingness to share them.
I drive home along streets much busier than they were so many hours ago. The frost will return tonight and will bring another cold morning tomorrow.
But do you want to know a secret?
With a little warmth, I know the frost always thaws. And I look forward to doing it all again.
For the last two weeks, I have chosen to visit this hospital room, this patient, first.
I enter, and the calming sense of early morning quiet is quickly broken by the ongoing sounds of a breathing machine—a device that allows my 25-year-old patient with Down syndrome, “John,” to sleep through the night.
Beside him, as always, lies his mother, who has slept on a makeshift bed by her son’s side for 14 consecutive nights.
As always, I begin my morning routine in this room, and I do so with a combined sense of hope and dread—hoping that John will be well enough to go home, but dreading that I wilI have to tell him, again, that he’s “not quite ready yet.”
Standing in almost complete darkness, I look at John and squint at the oxygen settings of his breathing machine.
Two weeks ago, he was admitted to the hospital with right-sided heart failure, a condition that had developed secondary to heart complications related to Down syndrome. He is also diagnosed with obstructive sleep apnea—a condition that, in John’s case, increases pressures in the vessels that transmit blood from his heart to his lungs.
Now, he requires supplemental oxygen to breathe, 24 hours a day.
But he looks better, healthier, than when I first met him. He struggles much less in his effort to take deep breaths, or to sit up in his bed. His legs are no longer swollen with fluid backing up from his heart.
He seems calm.
I take a deep breath myself, and apologetically, I wake them.
“I’m sorry,” I say—always my first words to them in the morning. “I’d like to see how John is doing today.”
“It’s okay,” says his mother. “I think he’s doing better.”
John wakes up as well, and as he has done so for so many mornings, he smiles underneath his breathing mask and extends his hand.
“Good morning,” he says, earnestly clasping his other hand over our handshake. “Can I go home yet?”
“I hope so,” I reply cautiously, knowing that for days on end, our collective hope has merely translated into another night’s sleep in this room for John and his mother.
Still, they have remained—above all else—patient, understanding the notion that extra days in the hospital now may save them the grief of an unwanted return trip in the future.
For most of us, breathing is a subconscious process, driven by a coordinated effort between the brainstem, the lungs, and the chemical composition of our blood. It is a process we undoubtedly take for granted.
Our goal for John, of course, is for him to breathe without struggling to do so. If we reach that goal, we can help John reach his own goals—one of which he mentions to me every morning.
“I’d really like to go home so I can see my dog,” he says, his voice often cracking and his eyes welling up as he describes his dog to me, each day as if for the first time.
“I know,” I reply. “Let’s see if we can make that happen.”
After morning rounds—during which I discuss John’s progress with the rest of his medical team —I return to John’s room. He is sitting up in bed, his exhausted mother still by his side.
I realize that, for two weeks, I have spent more time with John and his mother than with my own family and closest friends.
And for the first time, my sense of dread upon walking into the room gives way to anticipation.
I tell them the good news—that, although John will require oxygen at home, he is stable enough to leave. Tonight, they can at last sleep in their own beds.
John, perhaps appropriately, says nothing in return. He simply smiles and sighs—out of relief, I’m sure, and with the thought of seeing his dog again.
It is, without question, the deepest breath I have seen him take in two weeks.
The next morning, purely out of habit, I visit John’s hospital room first, almost walking in and expecting to see him lying in the dark, with his mother next to him.
Now, the room is unoccupied. The window shades are up, and there is no sound of a breathing machine.
I simply stand in the doorway—still unsure why I have chosen to visit this room first every day, but aware that perhaps part of the reason is for this moment, when I know that John is breathing okay.
And I don’t have to wake him up to ask.
As graduation approaches you can see the apprehension in many of the third-year resident’s eyes. After three years of caring for patients in the hospital and clinic, having placed tubes into the throat, and catheters into every conceivable vein in the body, there comes a more daunting task. It isn’t the looming board examination in Internal medicine or the application process to obtain a license, although those are both frightening endeavors. Instead, the graduates, months clicking down until they finish their residency, face their most difficult challenge yet: finding a job.
“A lot of fellows nowadays have a B.A., M.D., or Ph.D. Unfortunately, they don’t have a J.O.B."
— “Fats” Domino
I page through the back of one of the many medical journals littering my desk, perusing the classifieds section. I see “hospitalist needed in Poughkeepsie, New York; nocturnist wanted in Little Rock, Arkansas; general internist position available in Rock Springs, Wyoming.” The internal medicine and hospitalist sections of the classifieds are the most extensive sections in the entire journal. Unfortunately, few of them look interesting to me, so I put down the journal and jump online. I find similar want ads about positions and job openings throughout the search engines. There are rural positions and academic hospital openings, permanent position offerings and locum tenens (a temp position), and generalist or more specialized hospitalist jobs. Feeling like I am drowning in this flood of choice and opportunity, I turn to my most trusted resource, my fellow colleagues and ask them a complex, yet pointed, question, “So whadda ya up to next year?”
We’re not really trained to assess the business aspect of applying for a job in internal medicine, and although there is some consolation in the amount of options, you still feel overwhelmed by the extensive research that comes with looking into business contracts. A few clauses here, addendums there, and you feel more lost. So you hit up the closest consultant to you, an attending you trust. I start to pursue this research by finding some of the younger internists I know and asking them what to do about this and that while looking for a job. The responses are, shall we say, mixed. I remember sitting down with a more senior attending physician who would carefully lay out what questions I would want to ask about vacation, call schedule, ancillary support, health benefits, and incentive packages. Another younger attending gave me very clear advice, “Get a lawyer to look at it.”
The experience underscores the maze of the ‘hidden curriculum’ that exists in the training to become a physician. There are no lectures, textbooks, or journal articles that cover this aspect of the practicing physician, and yet we still must learn it. As I page through another medical newspaper for further classifieds, a fellow senior resident sits down next to me in the lounge. “Looking for a job?” he asks.
“Just looking for now,” I reply. The statement strikes me as the same as someone whose clunker is about to give out paging through the car ads.
“I just finished my third interview,” he says.
I sit up and listen intently, “So what was it like, did they talk about salary, incentives, vacation and stuff?”
“Well, let’s put it this way…I liked it better when I was a resident.”
In Greek, stéthos means “chest” and skopé means “examine.” And from the Mediterranean to the far side of the Atlantic, from its invention in 1816 to modern times, the stethoscope has become perhaps the most recognizable symbol of the medical profession in the world.
Simply walk into a hospital, and you'll see physicians and medical students with their stethoscopes tucked into a pocket of their white coats-amidst sheets of papers, penlights and reflex hammers.
Often, we wear them around our necks like gaudy pieces of jewelry. In our defense, it's a comfortable location, and besides, that's what the doctors on television do.
When we use it, the stethoscope transmits sounds from inside the body. It's a simple but impressive instrument that somewhat magically allows us to hear a malfunctioning heart valve or detect the presence of a defect in the heart wall.
It lets us take a journey through the skin and chest wall, into the patient's lungs, and it can warn us about the possibility of narrow blood vessels, among other things.
But the stethoscope isn't what we use to actually listen to the other human being in the room. We rely most of all on our ears, which we use-by training, yes, but by human nature most of all-every moment we are with a patient.
One could, in fact, argue with ease that our ears are the most important diagnostic tool we have at our disposal-more useful and more meaningful than X-rays, blood tests and blood pressure cuffs.
After all, with our ears, we listen to our patients' stories, long before we put on the stethoscope to listen to their hearts.
Recalling William Osler's frequently quoted observation-"The good physician treats the disease; the great physician treats the patient who has the disease"-the difference between "good" and "great" may simply depend on our willingness and ability to use those two appendages on the sides of our heads.
With them, we learn not only the history of the patient's present illness, but we provide the patient with an outlet to share any deep concerns, worries, and feelings. Just like the rest of us, patients need an opportunity to share their stories-medical or otherwise-and that's why, in my experience, the patient does most of the talking.
Soon after beginning my third-year clinical rotations this August, I met a patient who came to the office with a sore throat. But the visit focused very little on the sore throat and very much on the mounting stress in her life-from losing her job to caring full-time for a family member recently diagnosed with Stage 4 cancer.
There are many more solutions for a short-term sore throat than for long-term stress. There's no question about that. But at least she was able to tell me her story, and all I needed to use for those 20 minutes were the great "medical devices" that all humans have, and that are used by physicians all around the world for listening to patients.
Ultimately, as I walked out of the room, the patient — her throat probably still sore but her mind, I hope, more at ease-offered one last sentence for me.
“Thank you so much, for listening.”
My stethoscope, of course, had never left its comfortable location, securely draped around my neck.
The stacks of charts on the desk begin to resemble an art deco building, twisting in so many levels upon levels. The nurse passes by and plunks another chart down on the stack that is accumulating in front of me.
Now my view over the edge of the desk is obscured, effectively locking me into this prison of paperwork — each chart carrying a story, each level unique unto itself. A fax of skilled nursing orders on the ground floor gives rise to a couple of medication refills on the second, followed by a request for handicap placard on the third.
Filling the hours between the patient bedside and intense study is the sea of paperwork across which I must navigate. It often seems like a daunting and fearful task, but today I am reveling in the paperwork, hiding behind this wall of parchment to avoid doing what I have to. My citadel of manuscripts is not enough to hide me forever, and before long, the nurse again passes by and slides a chart directly into my view.
“Your next patient,” she said.
The handle of the door seems cold as I grasp it, and I glance down at the collection of studies and tests in manila folders and beige files, cloistered together by a thick rubber-band. As I open the door slowly I stop for a slight moment before continuing, angry at myself that I had forgotten to knock on the door. This simple pleasantry and etiquette, drilled so hard into my brain as a medical student, has long been forgotten in the heat of the moment.
As I enter the room, the slight frame of a woman greets me, her eyes bright, her cheeks sunken and sallow. I sit down at the desk with the computer jutting out at me from the wall, demanding my attention. I shake her and her daughter’s hands, and sit down on the swivel chair, pulling the computer in between us, like a gate closing between two old friends.
Electronic medical records are the wave of the future. They are supposed to make documentation, billing and patient data, readily accessible and easily portable. They can streamline the history and physical to a point-and-click parade. They can increase productivity and decrease cost, all in a package that opens with the click of a mouse.
At least that’s what I have learned from various articles in the newspaper, medical journals, and from the technological faithful. It reminds of those news reels and cliffhanger serials of the 1950s.
I remember watching re-runs of Commando Cody on TV as a child, thinking how wonderful the future would be with flying suits, rocket ships and flying cars. Today I suppose I harbor a little resentment that I still don’t have that flying car. Now, as EMRs are thrust upon us, I wonder about how I’ll feel a decade from now about these “flying machines.”
Maybe they will bring a world of streamlined health care, and easily accessible medical records from across the globe, but today all I can see is a computer screen where my patient’s face should be.
I ask her how she’s feeling. She says she feels fine. I ask her about pain. No pain. I ask her about chest pain, shortness of breath, fever, chills, abdominal pain, bleeding. No, no, no, no, no and no, she said. I don’t feel very useful at the moment. Her daughter relates that no more chemotherapy is planned, and they are considering hospice.
Slowly, the once-vibrant lady that I saw three years back is now withering away from the mass in her pancreas that has invaded beyond the borders of a normal organ.
At the sound of her daughter saying hospice, my heart sinks. Not so much because I don’t feel this is a good decision. she would be comfortable in their care, but because I feel the unfairness of this situation more so than usual.
So many patients we see are quite ill from poor choices in life, angry at the world, themselves and us. And here this kindly lady, surrounded by a family who sings her praises as she walks through the hallways, is simply one of the sickest patients I have had the privilege of caring for. There is a saying I hear muttered throughout the hallways of the hospital, “Bad things always happen to nice people.”
I excuse myself to speak with the attending physician. There is nothing to discuss, but I present the patient to the attending physician from the beginning. I try to be thorough, feeling that treating her like a complex medical case is in some way being respectful. There is nothing complex about this, really. There simply is nothing more to offer at this point, except for supportive care, a synonym for everything else that doesn’t solve the problem.
I go back to the room and talk with the patient for a while and reminisce about our time together. I have seen her extensively over the past few years and have enjoyed our meetings. She smiles, shakes my hand, and walks out of the office with her daughter, who is calling to make arrangements for hospice at home. I hope to see her again, but I know deep down I probably won’t. I move back to the computer screen and type my note for the day, a simple note:
“Patient, 75-year-old with pancreatic cancer. Met today to discuss plans with patient and daughter. Plan for hospice at this time. No further invasive interventions. Follow-up as needed.”
It was an unseasonably warm Tuesday afternoon in early December. Outside, the temperature had climbed to over 50 degrees. Inside, meanwhile, 100 second-year medical students filled an auditorium to listen to a physician's lecture-a routine occurrence, typically not worth mentioning.
Except, we discovered, this particular physician doesn't practice medicine anymore. He's now a patient instead.
CTG. A mere three letters. This column alone contains more than 1,000 times as many. Our genetic code-the personalized Rosetta Stone within each of us-contains letters too. Over three billion of them. And in one seemingly inconspicuous spot, on one tiny chromosome, a repetition of gene bases represented by the letters CTG results in a disease called myotonic dystrophy. While the disease is not necessarily terminal, it is incurable and degenerative.
In this case, the disease's mid-life onset and progression-with muscle wasting, an inability to relax muscles, vision problems, and even difficulty eating-led our guest, Dr. M, to halt his medical career long before he ever would have planned.
All because of three letters.
Certainly, at one point or another, all physicians experience the medical profession from the perspective of a patient. But most of us won't have to face a cruel genetic disease that can take away our ability to practice medicine. That's what had happened to our guest, though, and every student in the room-myself included-listened intently. Perhaps we were particularly captivated on that warm December day because not long ago, the patient in front of us had sat exactly where we did.
Dr. M told us he had learned the exact number of CTG repetitions in his DNA that had caused his ailment, and he described his pure relief when he found out that his son had not inherited the disease. After all, he had a 50 percent chance of doing so, and anything can happen when you flip a coin.
We can only wonder if Dr. M dwells much on the past, thinking of the years he spent training and the relatively brief time he was able to care for patients. F. Scott Fitzgerald's famous final line of The Great Gatsby-"So we beat on, boats against the current, borne back ceaselessly into the past"-describes that feeling, when we look to the past because our hope for the future has been compromised.
Still, the quote seems to insist that we move on, that we keep rowing, and whether our boat is with or against the current might be irrelevant, especially for a patient. And that may be the most memorable lesson from that afternoon-even though the physician's medical career had ended, he had gained a perspective that allowed him to continue being a doctor in the truest sense of the word.
"Doctor," after all, means "teacher" in Latin.
I can assure you, Dr. M had our full attention that afternoon. And he taught. At times, his story was inspirational. But he also described his devastation and bitter disappointment with brutal honesty.
By a rough estimate, my classmates and I may care for a combined 20 million patients over the next 50 years. That's 20 million mini-lessons within the ongoing education that defines this profession. Sometimes we will teach those lessons, and perhaps more often, we will learn-from other physicians and, most powerfully, from patients as well.
This time, we were able to learn from both at once. It was just one of many upcoming lessons, but I suspect it may prove to be one of the more memorable. Because of Dr. M's connection to us, of course, and his ability to show us two perspectives at once, his willingness to sit in front of 100 pairs of curious eyes, and his memorable sense of humor, which showed us his belief in always fighting against the current.
So, it turned out we weren't only lucky because it was a rare warm day in December.
Thanks to our guest, we were fortunate, most of all, to be inside.
The crisp white coat I'm wearing belies the coffee stains that have spattered my button-up shirt beneath it. The past 30 hours while I have been on call have left the white oxford littered with brown discolorations — a splash of Sumatra here, a few drops of Arabica there. I pull my glasses off as I set the coffee cup down gently on the counter, careful not to splatter my only clean white coat. One of the young interns comes up to query me before the attending is upon us.
"Mrs. B's white count is up," he says with a hint of regret. His face carries a feeling of shame, as if every patient must make a speedy and complete recovery before he releases them back into the wild.
"Why do you think that is?" I ask, prodding. I have already seen Mrs. B's white count, examined her, and figured out why her labs are slightly abnormal. But I know that if I tell him, he won't learn. Teach a man to fish ... you know the proverb.
"I'm not sure. It could be infectious, a urinary tract infection." He sits down and hangs his head in his hands. He has been up all night too. Looking at his fatigue, so obvious upon his face in rings and circles, I stop my Socratic questioning and tell him.
"Steroids. We started steroids, remember?"
"That's right! I forgot."
"It's fine," I say. "The good news is she can probably go home."
"You know, I just can't think after a night on call," he explains. He heads off to finish up before rounds.
I look at my watch to gauge how much time we'll have to round on patients, if we'll have enough, and whether I should take a few minutes to discuss a topic for the interns and medical students. As I'm running the list through my mind and sipping my coffee, our medical student arrives. Her eyes are bright and well-rested, and she is showered, smelling of lilac perfume and Dove soap. At this time in the morning after a night on call, you would sell your soul for a shower and a pillow.
"You look a little tired, Dr. Faber," she says.
"Jason," I correct her. "And yes, I am a little tired. But you get used to it."
"How many hours do you have to stay up?"
"Depends," I say. "Sometimes it's all night, sometimes you get two to three hours of sleep or more. But the experience is important, and it teaches you your limitations."
"Well I hope I can get several hours of sleep when I'm on call," she says.
"Conceivably, you might never have to worry about that." I proceed to tell her about the changes coming.
Throughout medical training, long in-hospital calls have been commonplace. Although many programs now have shift work - with interns and residents to handle the night shift - many still have interns stay overnight while on call every fourth day. The hope is that this experience, under the watchful eye of a resident, will give the newly minted physician a taste of long hours, which are common in the real world. I remember my time in the hospital as an intern, staying 30 hours and watching patients and their progressing or worsening state. Managing sick patients over the first 24 hours can be an exceptional, valuable learning experience.
Starting next July, the Accreditation Council for Graduate Medical Education, the accrediting body for residency programs, has stipulated that interns be on call for no longer than 16 hours at a time. This could result in physicians never having to spend more than 16 hours in the hospital during their entire training. I fondly remember those long days on call, while young physicians years from now will shake their heads and say, "Nobody ever stays longer than 16 hours."
"So," the medical student asks, "do you think that means I won't get enough training?"
"I don't know if this change is good or bad," I tell her. "But I think my days of sleepless nights have made me more resilient, and ready for what the future has to bring."
“Mr. Aster” hopped up onto the exam table, the familiar sterile paper crinkling underneath him like crispy autumn leaves. From that modest amount of activity, he was completely out of breath. A few minutes later, following a monologue of Shakespearean proportions, our patient wasn't the one left breathless.
The scene: Dayton's free clinic, Reach Out of Montgomery County, located downtown in the shadows of Miami Valley Hospital.
The cast: Mr. Aster on one side of the room, Dr. S (his physician du jour) on the other, and me, intentionally blending into the background-a wide-eyed, wide-eared and ultimately wide-mouthed medical student who just watched, learned and took mental notes-to-self.
Dr. S, whom I was shadowing that evening, noticed Mr. Aster's shortness of breath as well.
"You couldn't move from the chair to the exam table without gasping for air," she said bluntly, in a tone made of equal parts concern and displeasure.
Mr. Aster looked down at his feet, which were swollen at the ankles, as if he had not heard her. He was embarrassed.
But she continued, this time more sternly: "In all likelihood, you'll be dead in 15 years."
Now Mr. Aster looked up, his lips parting to shape a defensive response. I looked up as well. That was harsh, I thought.
But it was nothing compared to the lecture that followed, one that would have made Napoleon proud, with our no-nonsense physician performing what I later recognized to be one of the most compassionate acts possible, given her position. Mr. Aster, as you may have diagnosed by now, had every risk factor for heart disease imaginable — stunningly high blood pressure, obesity, a heavy smoking history, diabetes, and the list goes on.
He was 35 years old, but his heart had aged well beyond.
In all likelihood, at a free clinic, a physician will see any particular patient once, and never again. For all Dr. S knew, she had only 20 minutes to genuinely change Mr. Aster's future.
Certainly, Dr. S prescribed medications. She suggested some followup referrals. But Mr. Aster's situation called for something more. This was a simple moment about getting through to the patient, to treat the disease not only by fixing its symptoms, but also by addressing its causes.
Without a doubt, one of the elegant aspects of the medical profession is that moments like this happen in doctor's offices all over the world every day, multiple times a day. A physician might treat high blood pressure, or warn a patient about heart disease risk factors, hundreds or thousands of times in his or her career. But that's not the way we as medical students, as physicians, think. After all, it might be the patient's first time with chest pain.
With that mindset, we build the foundation to do special things. An otologist recently told me that a tear comes to his eye every time he sees a child hear for the first time. Another physician, an ophthalmologist, told me that there is no better feeling for him than restoring someone's sense of sight. Medicine, we realize, is simply the sum of these moments, with a physician's lifetime devoted to creating them for others.
As Dr. S made her impassioned plea to Mr. Aster on that night at the Reach Out clinic, I stood in the corner, stunned at how forthright and candid she was. And she had to be. I remember watching our patient look up, first to me and then to her, and finally, something seemed to click inside. You could see it as he exhaled, nodding to himself.
"You're right," he would later say, just before walking out the door. "No one's ever said any of that to me before."
That was the last I saw of Mr. Aster. Of course, we can't know what happened to him. But we do know that Dr. S gave it her best shot, completely involved in that moment with him as if there were nowhere else she'd rather be. As for me, I realized that sometimes, the best thing we can do for a patient is simply give them the opportunity to take control.
I continued shadowing Dr. S that evening, seeing patient after patient, and that's the way it goes. I was a first-year medical student at the time, beginning to learn what it truly means to be a doctor. You may be left breathless, but you have to catch your breath and do it all again, never complaining, because it's not about you; it's about the patient. You knock on the door, meet the next one, and no matter what, you look them in the eye and say, "Hello. I'm your doctor."
"And I'm going to take care of you today."
For me and my classmates, the first two years of medical school are, as they say, in the books.
And if you've ever wondered how exactly it's possible, during a mere 30-minute nap, to dream about a scenario that seems to last much longer than a half hour — well, that's essentially how the last two years felt.
Certainly, this recently completed first half of medical school was a time defined mostly by questions— long ones, short ones, right ones, wrong ones, multiple-choice ones and open-ended ones.
Hard ones, easy ones, pointed ones, questionable ones and even overturned ones.
There were the questions that were asked of us ("What's the treatment for Crohn's disease?", those that we asked ourselves ("Which field of medicine is starting to interest me?") and, of course, those that we asked of each other ("I'm serious — does anybody know the treatment for Crohn's disease?").
There were also the probing questions we learned to ask patients who have chest pain, who feel dizzy, or who are fatigued. With these questions, we narrowed down diagnosis possibilities.
Indeed, we began to learn to ask the right questions of patients, presumably so that as our clinical rotations begin, we'll be ready at the right time. Most, if not all, of those questions are really just variations of the basic inquiries we posed once as toddlers-what, where, when, and how?
And we often ask those questions in an attempt to answer one far more profound: Why?
Occasionally, the answer to a question comes in the form of another question. Why become an oncologist if it means treating terminally ill cancer patients? Well, why not?
Without question (no pun intended), we were also faced with unanswerable questions. And questions with multiple answers. These often involved ethical scenarios, real or imagined, and the complex problems were actually the questions within the questions.
Many more of those are still to come, I'm sure.
Finally, sometimes our best answers have been mere educated guesses, the only possible response to questions that don't immediately turn on the answer light bulb.
The never-ending questions are no doubt part of the framework of the medical and scientific culture. Without them, we might not have discovered penicillin (or at least not as early as its accidental detection in 1928) or developed a surgical treatment for babies suffering from the Tetralogy of Fallot heart condition.
The questions — and in particular, the drive to answer them — keep medicine moving forward.
Still, as if we didn't have enough experience with questions, we all spent weeks doing practice ones-as a class, we attempted well over 300,000 of them, all in preparation for the 322 featured on the United States Medical Licensing Examination (USMLE) Step 1 Exam — a little test that usually goes simply by its nickname: The Boards. Think "The Shot" by Michael Jordan or "The Drive" by John Elway-this test is just as legendary.
The exam included the final set of questions we answered in our first biennium, before waking from that 30-minute nap that somehow included our first two years of medical school.
Now, as of press time, as a newly minted third-year class, we are less than 30 days from beginning our clinical rotations. Of course, the time for questions will probably never end.
Nor should it.
But we're out of the classroom and will soon be into the hospitals. And I get the feeling that we're going to start getting some answers.
"It doesn't change. It always just hangs there in the sky."
I ignore the patient's comment for a moment as I look down at my notes, making sure I haven't forgotten any important questions. Beyond the wide windows before us, trees sway back and forth, and I wonder how many lives they have witnessed come to an end as they continue to reach toward the sky.
“You could not step twice into the same river; for other waters are ever flowing on to you.
— “Heraclitus, (c. 535 – 475 B.C.E.)
"Do you have any history of diabetes, high blood pressure, COPD, cancer, heart failure—"
It is only after he interrupts me that I realize my fingers are counting the possible flaws brought upon him by time, lifestyle, or genetics, like so many bullet points on a checklist.
"No," he says. "Been healthy all my life."
He looks back outside toward the sky, his eyes fixed upon a point far from his predicament. A single star, clearly visible, twinkles back at him. He has told many of us at the hospital that he feels strangely at ease with his fate, knowing that these burning fires-running on helium and hydrogen, light years away, untouchable, unchangeable-will continue without him.
"That's the three sisters," he points out. "They're part of-"
"Orion's belt," I say.
"So you know a little astronomy?"
"I grew up in the country," I answer without looking up. "I would take my telescope out into the fields and try to find my way from one side of the horizon to the other, each constellation leading to the next."
"How often do you go now?" he asks.
"Oh, wow," I say, flipping through the chart, checking a box here, writing an order there. "I haven't been out in over a decade. Just lost interest, I guess."
He turns grim now, looking outside again.
"You should get back into it. Things change down here. Wars end, nations fall, but the stars, they're always there."
"Yes, they're very lovely," I say, finally looking up. "Now, how long have you been on chemotherapy?"
The weeks pass, and his fever starts subtly, a small spike here or there. We react aggressively, but despite our efforts, his condition slowly deteriorates. I come to visit after I've ended my rotation one night. He is in isolation for his low blood cell count. I don the mask, gown, and gloves, thinking how ironic that the closer to death he comes, the more impersonal we have to become. Upon his bedside table are books of Hubble telescope pictures, astronomy reference manuals, and a laptop whose screen shows the Pleiades, a young, open star cluster in the Taurus constellation, which is visible to the naked eye on a clear night. He is gaunt and sallow, his eyes still staring out into the night sky.
"Been out enjoying the spring view?" he asks.
"No, mostly working. I haven't had a chance," I answer.
"Well, not much to see in the city. Too much light. I wish I could get out into a dark sky, take in the view."
"Hopefully you'll be able to soon," I answer, but I know it is unlikely.
As I say goodbye, he scribbles down the titles of a couple of books on astronomy and astrophysics that he says I'll enjoy. His pen runs out of ink during the last title. He swears, and I reach into my coat pocket for another. I walk out of the room with the completed list and muse about the pen. As much writing as I do, I've always wondered which pen will be my last. When I buy a pack of pens, I wonder if I'll run out of time before one of them runs out of ink. With that in mind, I never get angry over a dying pen; I'm thankful that I've outlasted another one.
Three days later, he passes away at home. Sometime after that, perhaps two or three months later, one of the nurses mentions him and his infatuation with the stars.
"He was always saying how they never change," she says. "I guess that's a good thing to hang onto."
I look up from my chart.
"Unfortunately, they do." I tell her. "The Pleiades star cluster he kept referring to is supposed to disperse in another 250 million years. What we see in the sky today is not necessarily what our descendants will see long from now."
She looks down to the floor. "That's really sad. It seems like there's nothing constant to hold onto in the universe, then."
"Well, sure there is," I say. "The constant is change. How boring would life be if nothing changed, and how meaningful is each moment because it does."
Snow dances across the road as the old maroon Plymouth hurtles down the barren stretch of highway. The thin, pale man inside breathes deeply but rapidly as he grinds at the window crank on the door. With one hand on the wheel, he uses his other painful, arthritic hand to roll down the window for one last enjoyment before reaching his destination. The crank sticks but finally gives way, and cold winter air permeates the Plymouth. The driver smirks, looking down at the crank, admiring the old relic, which needs a little elbow grease but still works just fine. In the back of his mind, he wishes someone would think the same of him. From his coat pocket, he produces a pack of cigarettes, fondles one into his mouth and clicks his lighter into flame. A few puffs, and he blows smoke from his mouth, past his yellow-stained, patchy beard. He hasn't eaten for two days but has run through three packs of cigarettes in the same time. His bloodshot, age-worn eyes look up at the off ramp sign, and he exits the highway for the last time, along with his silent companion.
He finds a handicapped spot at the far end of the first row. After placing his oxygen tube around his face, he slings the small tank upon his shoulder, kicks open the door and with all his strength pulls himself to his feet. Immediately, he feels his sixty-seven years upon his back, weighing down on him. His blue lips huff and puff in the February air as he staggers into the emergency room. Still panting, he rests his hands on the check-in desk and he declares his purpose: "I'm… short… of breath."
Hours pass in the noisy arena as he lies on a stretcher. A small line in the back of his hand slowly feeds saline into him. Salt water, he thinks. Ten years on the sea, working my back into spasms, finally running as far as I could from that sour liquid, and here I am getting it pumped into my veins. He smirks again, and looks up to see a young man walking through the curtains. The doctor is short, his face covered with stubble, and his white coat is littered with coffee and ink stains. The youth in his eyes doesn't offset the dark circles under them, each ring representing another lesson learned, another hard night. The man answers his questions about weight loss, shortness of breath, medical history. Then the physical begins.
"You're going to do what?" asks the thin man.
"Sir, it's very important that I do this rectal exam. We have to make sure that you don't have any bleeding anywhere," the young doctor states.
"I'm not letting any boy-doctor… You know I came here because of my breathing. What does my rear end have to do with my lungs?"
"I'm just trying to exclude-" the boy-doctor starts.
"You can exclude this exam, because I ain't doin' it!"
His arms are folded in front of him, his intentions clear. I consider explaining what a rectal exam has to do with the lungs, but give up when it becomes clear my attempts at reason are more entertaining than enlightening. I complete the exam as best I can. On his lung exam I hear crackles throughout his entire chest. In his mouth I find thrush. He is thin, emaciated, and dying. I carefully broach the subject of HIV testing, but he is adamant against it, though his chest X-ray suggests a type of pneumonia seen almost exclusively in HIV patients. Over the next few days, I discuss with him my suspicion, my concerns. His condition deteriorates, and eventually we diagnose the silent companion that has accompanied him so long. He makes his wishes clear: no intubation, no mechanical ventilation. He wants to be comfortable. Throughout this process, I admire his ownership over his own existence, something so often cast aside in the immediacy of illness. His Plymouth sits in the parking lot for a short time, motionless, cold and dying. It has given one last ride for its owner, one last hurrah for the relic.
Three weeks later, I wake up to the sound of my beeper and answer a page about a new admission. I make my way to the restroom in the resident lounge and splash water on my face. As I look into the mirror, I see the rings under my eyes and notice that a new one has emerged.
The cold air penetrates, knife-like, into the spaces my gloves can’t cover. I pull my coat together at the bottom of my neck as the wind whips across my face. I look up and see that only a few more feet remain to the door of the restaurant.
The sight of that door fills me with the same feelings, perhaps, that a small island would give a weary sailor, tired from months of floating across the sea. I pull the door open with my free hand, noting the bells clanging, reminding me I am knee-deep in the season of cheer and goodwill toward man.
The hostess looks up and asks, “Reservation?”
“No. Meeting someone. Will just sit at the bar,” I say as I pass by.
Few people are here this evening. I see a few couples, eyes locked together while bags of presents sit at their feet. An older gentleman sits at the end of the bar, his eyes turned towards the televisions.
It is unbearably evident he has nowhere else to be.
I find several seats standing lonely in the middle of the bar. Taking off my coat, scarf and gloves, I seat myself on a stool and order a beer. Months of call and long hours at the clinic and hospital have begun to take their toll.
It has been some time since I’ve sat down with my friend for a chat. It has also been a long time since I’ve had time to reflect on anything that has happened over the past several years.
Taking a drink, I look up from the glass and notice my friend coming in from the chill air of this bleak winter night.
After an hour of catching up, watching a game on the TV sitting high above the bar, and poking fun at each other, he asks me what’s bothering me.
“Just tired, I guess.”
“Marathon runners are tired,” he says. “You look depressed.”
“Maybe just a little. You have these expectations of how it’s supposed to be, treating patients,” I confess. “Things just aren’t what I thought they would be.”
“Things never are.”
“What I thought was this homogenous population of experts is more like a hodgepodge of educated tailors, each one with a different talent, each one with a different amount of ability and knowledge.”
“Well,” my friend says, “a doctorate does not a smart person make. Intelligent, maybe, but not necessarily smart.”
“And the politics,” I continue. “It always feels like a losing battle.”
“Well, your humanity still appears intact. You know, everyone faces cold and horrible situations with no honorable outcome. The compassionate person meets these, while the selfish person runs from them. You knew that when you started wearing that albatross around your neck years ago.”
“When you’re young,” I tell him, “you feel like it’s a phase, that at some point the storm will let up and you’ll be in calmer waters. Sometimes it feels like the storm will never end.”
“Life isn’t simple,” he says. “It’s not supposed to be. If you go through your whole life following one set of rules, you’re living as if you were following a large truck through snow on a forgotten country road. Eventually you need to either pass or pull over.”
“Or crash.” I smile at him. “I think I’m hopeful. I just don’t think I’m happy, I guess.”
“Well, I gotta get home.” My friend stands and puts on his coat, scarf, and gloves. “I’ll get this, okay?” He pays quickly.
As my friend makes his way to the end of the bar and the door of the restaurant, before going into the deep cold of the December night, he turns back toward me.
“I would rather be hopeful than happy, and I would rather be content than hopeful.”
He smiles and walks out the door. After he leaves I stare into the glass in front of me for a long while before I smile back at my reflection. I finish my drink, put my coat, scarf, and gloves on.
The bartender walks by and comments, “That’s a pretty good quote.”
“You know. About hope, and happiness and whatnot.”
“I know. It’s one of my friend’s favorites,” I say, gesturing to the door.
The bartender, looking puzzled, asks, “What friend?”
I stop for a moment. Staring at the bar in front of me, I notice only one glass. From a look of confusion, I break a slight smile and pay the bill.
“Happy New Year,” says the bartender as I make my way toward the door.
“I hope so,” I say, and I break out through the door and into the cold night, smiling.
One of the most important things that they try to teach you in medical school, besides how to recognize and treat different diseases, is how to connect with your patient. The importance of this topic to quality health care is starting to be stressed more and more in medical schools across the country. I was recently told by one of my lecturers that most medical students are great communicators-until they get to medical school.
My first course was anatomy, and it was an absolute nightmare, not because it was difficult to learn how to study to the degree necessary (although it was), but because I was confronted with what seemed to be a whole new language. While cleaning out my apartment recently, I came across one of my first lab exams from anatomy. It reminded me that during those first few months, I could barely pronounce, let alone spell, the vast majority of my answers on that exam. Over the past two and a half years, however, something happened. This new language became my first language. No one ever tells you this is going to happen. It just sneaks up on you, and one day you look across the table at your mother or sister after venting about the details of metabolic disorders, and she is giving you a blank stare.
Now, two rotations into my clinical years, the doctor-patient relationship and the ability to communicate effectively with patients have become the struggle of my everyday life. How do I get my patients to understand what I am telling them and what it means for their current and future health? Working with so many physicians, I have seen a wide range of communication skills. I have been extremely impressed by some doctors' abilities in this realm, and at other moments, I have walked out of exam rooms with the distinct feeling that the patient didn't have any idea what the doctor had just said.
What I have learned is that in order to be a good doctor, one must, above all else, be a good teacher. I have met some brilliant people in my lifetime, but it takes more than just being smart to be a good teacher. Some of the best teachers I have ever had were the people who were able to take tough information and boil it down into small, easily digestible ideas.
The key to good medicine, then, is figuring out what it is that your patient understands, and what needs further explanation. This is rarely an easy task, and it requires medical students in their clinical years basically to develop a multiple-personality disorder. Among the hierarchy of physicians who evaluate our performance each day, we must be technical, precise, and formal, but in the exam room, we must transform ourselves into whatever we need to be for that particular patient.
My current rotation in pediatrics has given me a great venue in which to practice this skill. Three-year-olds probably cannot point to where their liver is, nor do they have any idea what the word "regurgitation" means. Words like "tummy" and "ouch," long gone from my vocabulary, have resurfaced. Along the same lines, not every adult understands what it means to say someone is "septic" or that they are "not tracking properly." I have to remember that up until two years ago, before tens of thousands of hours of studying, I wasn't really sure either.
I am lucky in that my school encourages its students to work on communication. Each patient is a new opportunity to learn and to teach, and I have no doubt that I am becoming a better physician as a result. What good are the skills and knowledge I have worked so hard to amass if I can't use them effectively? So, each day I work to find the right words, gestures and expressions, and with each patient I try to learn to be a good teacher and a better doctor.
We're taught in medical school and residency that our responsibility to our patients often supersedes all others in times of crisis, but "crisis" is a vague term. In reality, crisis tends to be defined by those moving through an experience. A young asthmatic needing intubation will very likely recover, although family members may well believe they're facing a terminal situation. An elderly grandfather hospitalized multiple times in several months for the same worsening heart failure may have few good options for treatment, despite his family shrugging off another of grandpa's "episodes." We are creatures of habit, and habit breeds apathy.
It's fifteen hours since I've slept or eaten. The on-call period is long and arduous but a great teacher. The two pagers on my hip start beeping at the same time. I call one number, and a nurse says that a 67-year-old woman admitted for diabetic ulcer is complaining of heartburn. At the second number, I'm told a 40-year-old has a sudden onset of shortness of breath following orthopedic surgery. I go to see him first.
The patient, his left leg bandaged at the knee, is breathing deeply. My heart sinks, and I fear he has a pulmonary embolus. His vitals are more concerning: tachycardia, tachypnea. When I speak to the patient, he tells me he has severe anxiety, and "No one's giving me my anxiety pill." I order a chest CAT scan with contrast. Thirty minutes later, the patient is back in his room complaining about how small the CAT scan machine was, and he is very claustrophobic. I'm sitting at the computer screen checking the scan. The final read: no pulmonary embolism, normal lung. I give the patient some Ativan, his shortness of breath subsides, and he sleeps comfortably for the rest of the night.
I then move on to the 67-year-old with heartburn. The patient looks my grandmother, and countertransference occurs-I can't help but feel an immediate emotional connection.
"My heartburn is acting up really bad," she says.
"What does it feel like?" I ask.
"An elephant sitting on my chest-"
Thirty minutes later, I'm calling the cardiologist about what I suspect to be a myocardial infarction. The patient goes to heart catheterization, does well, and eventually goes home. Despite this good outcome, I don't feel well. I can't sleep. Tonight, I chose the wrong patient to see first. What if other calls had suddenly occurred? What if she hadn't described her symptom so perfectly? What if the outcome had been poor? We can live our whole lives wondering "What if?" but put simply and succinctly, medicine is not perfect. Like everyone else in life, physicians try, but we do not always succeed. Even the most seasoned attending in any specialty makes mistakes sometimes, and if we don't remember that, we won't be able to function.
Calls about heartburn happen often, and habit breeds apathy.
I sign out and give my summary of the night to the senior resident. After noon conference, I walk down to my car and climb in. I'm so very tired, but I couldn't sleep even if I were lying on a California king. The drive home is long and full of more stoplights than I feel entitled to. Coming home fatigued and sleep deprived has become a routine, a habit. In our apartment, my wife Sarah turns to me and smiles, our son in her arms.
"Daddy's home," she says.
I pick up my son and hold him close. He looks at me, his face blank, and then, as if by magic, he smiles. He doesn't need any words. That smile says more than words ever could. I kiss my wife and excuse myself to get some rest, as I always do after a night on call.
"I thought we could get a Christmas tree on your day off," she says.
"OK," I say, moving to the bedroom. I think, I hope I never get used to this habit.
"And we still need to get a Christmas present for…"
She walks into our bedroom, but I'm already passed out on the bed. She closes the door, and so I sleep deeply.
It's 4:30 in the morning, and already I've been up for half an hour, taken a shower and had my breakfast. Most people are still fast asleep, but as I have begun to learn these past few weeks, sleep is a luxury that those of us in medicine are rarely afforded.
Never having been one to roll out of bed before noon if I could avoid it, I've been surprised by my ability to awaken before sunrise and be functional. But then, I've also been waiting two years for this chance, to actually use what I have worked so hard to learn. Time seems to be moving very quickly all of a sudden. Boards are over, and I am in the middle of the first of my third-year clerkships. My days are full of new challenges, but in a lot of ways, they represent a refreshing change from the tedium of the past.
As it happens, I have chosen to begin my journey with the beginning of life. I will admit that I had more than a few misgivings about starting my obstetrics and gynecology rotation. I've always been a bit on the squeamish side, and the birthing process is known for being rather messy.
Luckily for me, the first birth I assisted in was as amazing an experience as one could hope to have in my situation. About two weeks ago, under the guidance of a midwife whose calm, efficient and confident demeanor I can only hope to achieve someday, I helped deliver a beautiful baby boy to a truly wonderful couple.
As first-time parents, this couple was thoroughly engaged in every step of the process and graciously allowed me to be a part of their life-changing experience. As expected, there were a few moments of panic, when I wondered if I was ready for all of this, if I would just be in the way, if I would be able to overcome my weak stomach.
The thing is, I didn't really get a chance to indulge in those moments of self-doubt. Unlike a multiple-choice test, with ample time to ruminate and second-guess, I now had a woman looking at me for reassurance, depending on me to take care of her and the baby she was about to bring into the world. A powerful feeling exists in the delivery room, when a wanted child is preparing to make its entrance. The love and excitement on the father's face as he looks at his wife, the words of wisdom from a mother about to become a grandmother, but more than anything, the sheer awesomeness of the woman in labor, her fierce determination.
I have to tell you that for me, there has been no greater experience than making that connection with my first mom-to-be, coaching her and encouraging her to find those last reserves of energy. I know that I will never forget this couple, the baby I helped to be born or the midwife who was such a wonderful teacher and who let me take such an active role.
The past few weeks have made it clear to me how much I still have to learn, but I look forward to the challenge and a year filled with many new experiences.
The scrubs I’m wearing are hanging damp and heavy. My limp hand is starting to go numb from the squeeze my wife is placing upon it.
The obstetrician, her forehead drenched in sweat, yells for more light and to for my wife to push harder. The monitor starts to show the baby’s heart rate falling more frequently into gullies and canyons, dropping off.
My wife’s blood pressure suddenly surges, her eyes roll back into her head, and she starts seizing. My mind races with the possibilities.
“Oh God,” I think, “it’s eclampsia.”
Her neck stiffens, and I fear aneurysmal rupture. The obstetrician calls for the nurses to start rolling her into the operating room. As we move down the hall, my hand is now squeezing hers, which hangs limp, lifeless.
Tears stream down my face, and a nurse stops me as they take my wife into the OR.
“We’ll do everything we can,” she said. “Please stay here.”
My mind reels. My hopes surge for the best outcome, but the physician in my mind whispers to me, “They’re gone.”
I sit up, and my head falls into my hands as I reorient after the nightmare. My eyes move to the baby monitor on the bedside table. The red lights jump with each of my son’s cries. He’s been teething for three days now, each ivory challenge presenting itself at night. At least, that’s what I hope it is, and not something sinister.
My wife moans, “Can you get him tonight?”
I get up from the bed, my back aching. “This is what happens when you turn 30,” I mutter.
I climb toward the nursery. Standing there in the crib, my son has tears streaming down his face. He sees me towering over him and outstretches his arms. I pick him up, and he buries his face into my neck, breathes deep and stops crying. I rub his back gently as we rock.
Earlier, my wife had asked me about giving him some ibuprofen. I refused, fearful of an allergic reaction, something I have had the unpleasant experience of seeing firsthand. Now, sitting there with him at 3 a.m., I think I might have been too hasty.
Over a year ago, I remember a visit to the obstetrician at 30-something weeks. I sat there while he asked my wife all the regular questions about swelling, nausea and weight gain. Afterward, he turned to me and spoke the only four words he said to me that day: “Don’t treat your wife.”
I appreciated his advice but never thought much of it.
Our pregnancy and delivery went as smoothly as any other. When we got home from the hospital, however, the worry began and never left. Every cough or sneeze became a rare, incurable condition in my mind.
At six months, my son developed mucus and blood in the stool. I feared the worst. After a visit to the pediatrician, we cut out dairy from his and (much to her chagrin) my wife’s diet, and his symptoms resolved. Just a milk allergy. Since starting a family, I have seen how this knowledge of all that can go wrong, all the terrifying diagnoses sneak into your mind with each symptom. These “zebras” are driven into our minds to make us into vigilant diagnosticians, but this enlightenment becomes a curse. The fear of horrible diseases befalling those you love is always in the back of your mind.
My son is sleeping now. I stand, move quietly to his crib, and lay him down amongst the soft liner with images of farm animals. The sound of rain outside lulls him asleep. I rub his back for a few moments and realize how vulnerable life can be. Then I tiptoe down the stairs and crawl into bed.
But my ears stay turned towards the monitor with the perpetual vigilance of a parent, made worse by the knowledge of a physician.
“What do you want to be when you grow up?” I heard a woman ask a little girl at the park a week or two ago. This was during my lunch break, midway through a long day of studying.
“Maybe a teacher, or maybe a doctor,” she said.
I chuckled to myself when I heard that. Apparently, no matter how hard I try, I can't get away from medicine for even an hour.
For whatever reason, adults seem to like asking children of all ages that question. I used to think very little of this commonplace interaction between the generations. But hearing it that day-after a month of studying nine or 10 hours a day, after two years of classes and mountains of debt, not to mention the whole process of getting into medical school in the first place-I wondered if that little girl might give a different answer if she had even the slightest idea what it really means to pursue a medical career.
Goodness knows I didn't at her age. When I was young, I told people I wanted to ride horses for a living, and during stressful moments recently I've wondered if that might have been a better option.
I wonder how many kids say they want to be doctors, especially in the first decade or so of life? More than a few, I would imagine, and far more than say, “I want to be a lawyer,” or “I want to be a CEO.” Perhaps this is because people of all ages and walks of life interact with doctors. For most of us, the doctor was there when we entered the world and will be there when we leave it, with a few visits in between to help us feel better when we are sick, stay healthy, or just check to see how we are doing. The white coat and stethoscope are part of a uniform even toddlers recognize. I guess it's natural for the profession of medicine to make a child's short list.
At this point, I am just starting what may be my last summer vacation for a long time. I'll have a break of a little less than four weeks before I will start rotations and begin to see patients and learn how to care for them. I am both excited and terrified by this thought. There is still so much more to learn, and I can't help but wonder how much my life is going to change.
Will I be able to work the long shifts, or will I fall asleep on my feet after being at the hospital longer than most people are even awake? Will I have any time left over to take care of my own needs? To spend time with the people I love? Will I ever be able to keep that white coat clean? More importantly, what will it be like to help a child come into the world, or to support a patient fighting cancer? How will it feel the first time I do something that helps to save someone's life? And how will I cope when I have to accept that no matter how hard I try or how much I learn, sometimes it is just someone's time to go?
For me, this break has been a time to catch my breath and think about all that lies ahead. As I watch friends struggle to find or hold onto jobs, as I reflect on the fact that at 27, I am still in school and taking out student loans, and as the future role of physicians continues to get cloudier, I often wonder if I made the right choice. Someday, when I ask children what they want to be when they grow up, if I hear the response, “I want to be a doctor,” how will I react? Will I feel pride and camaraderie, and smile as I tell them how rewarding it can be to help those in need? Will I warn them off and tell them that medicine “isn't what it used to be,” and that it's no longer worth the years of study and the immense burden of carrying the suffering of others home with you every day? Or will I look at them and remember that they are still only children who have many years to experience life before they need to make any such decisions?
I guess I can only wait and see.
As the Greek myth goes, once Pandora had lifted the lid of the jar, every manner of evil escaped to torture and punish man. She quickly covered the jar back up, as the last evil escaped. Wondering what was left in the jar, she peered inside and found the only thing remaining was Hope.
As a metaphor, the myth shows that in the most trying times we are often reduced to the core virtues we inherit by being human. In medicine, we sometimes stand on a precipice, below which the cold, dark sea beats against the rocks. There comes a decision then, whether to carry Hope away from this cliff or allow to it drop into the rocky chasm below.
I'm standing outside the hospital room with the family as the patient's chest rises and falls easily. The ventilator beeps occasionally during the conversation, distracting the patient's adult children. Their gazes dart into the room as an alarm sounds, but it is only the blood pressure monitor, because the cuff is off the patient as the nurses clean and organize the bed. Their looks are composed of love for their dying father, confusion over all that is taking place, judgment upon the care we provide, and fear of facing their own mortality at some time in the not-too-distant future.
"But I, being poor, have only my dreams; I have spread my dreams under your feet; tread softly because you tread on my dreams."
I'm discussing the code status with the family. In Ohio, the law in all its ignorance and politics, has decreed the setting of three different levels of care during a cardiac arrest, although two of these levels overlap enough to render them useless. The law is yet another attempt by a rigid, arbitrary system to impose categorization, an organizational approach, as a blanket solution to a situation that is anything but homogenous. I attempt to explain the differences among a Full Code, DNRCC, and DNRCCA. They're convoluted and difficult for the family to understand, and-I have to be honest-not easy for me to grasp either. I go over what would happen in a cardiac arrest, or a respiratory arrest, and reassure them that at no time will any care be withdrawn that isn't already in play. The patient's wife, who has been looking down at the ground as I speak in such cold, technical terms, looks up at me. Her gray eyes wet, her age-worn hands folded in a prayer-like frame, she asks, "What are his chances?"
The stethoscope hangs around physicians' necks throughout the day. Over time though it often starts to feel like an albatross, worn not to remind us of the transgressions against man, God, and Earth that we have already made, but of those we have yet to commit. It warns us of the mistakes we will make, the people we will fail, the inability we have yet to face. Throughout many patient rounds, I have often seen older physicians throw out percentages, estimations, ideas of what the prognosis likely will be. What I came to realize over time is that these are really, in most cases, guesses. Yes Virginia, miracles do happen, but rarely.
So here I am, standing in front of this elderly woman, who longs for the man she has loved for greater than a half-century to get up and dance with her one last time, and the family wants me to guess what his chances are. I could say what I truly think: that he is critically ill and has very little likelihood of survival. That even under the best circumstances, in the healthiest people, cardiac arrest is 50/50. That I don't think he'll see out the night. I squeeze the stethoscope in my hand as if I could strangle the albatross I'm forced to wear. I look at the family, their eyes full of expectation.
I answer honestly: "I don't know what his chances are… but I'm hopeful." They nod and go to the bedside. The patient remains a Full Code, and, despite our interventions, overnight he passes on. Over time, the conclusion I've come to is that it is best to be honest, but not at the expense of dashing someone's hope. It is all we have, in the end, and it is not for us-or anyone else-to tread on.
As the first member of my family to pursue a career in medicine, I hear opinions from everyone about which specialty I should choose. My grandmother and my sister, who has three young children, seem to think pediatrics is the natural choice. They say I've “always been good with children.” They are right: I was the preferred babysitter on my block. I was great at coming up with games and activities to keep whole groups of children occupied for hours. When it came time for my first pediatric encounter, I should have been excited. This was an area where I could really shine. Babysitting and pediatrics, however, are in completely different hemispheres in the world of children.
The truth is, the idea of having infants and children as my patients has always made me a little apprehensive. Medicine is not an exact science, and all of my instructors have stressed the importance of a good and detailed patient history to help me make an accurate diagnosis. Herein lies the first stumbling block; how does one take a patient history from a child? Depending on their age, kids either can't tell you what is wrong, are too afraid of you to try, or simply lack the vocabulary to describe it. And half of what they do happen to say will be muffled by their mother's sweater, into which they have buried their face. The young patient can be quite a challenge when it comes to the physical exam as well. Children have a special talent for making students, who may already be nervous, look like they have no idea what they are doing. Getting them to cooperate often becomes a bit of a game... usually with you as the loser.
Last Friday, I spent the better part of my day at the Children's Medical Center of Dayton working with some residents. I can't say the experience altered my opinion of the difficulty involved in pediatrics. One little boy we examined was more interested in the TV than in sticking out his tongue and saying "ah." He squirmed, pulled away, and pretended not to hear when asked how he was feeling. Usually, I walk away from a patient encounter and feel that for my level of training, I have been thorough. Not this time. With children, there is always that unsettling feeling that perhaps there is an icky sound at the bottom of a deep breath they are unwilling to take. The whole process is enough to make you want to throw up your hands and say, “Forget it.”
To do so, however, would be to ignore one of health care's most vulnerable populations. The residents I saw seemed relaxed and at ease with their patients. As if sensing my discomfort, one doctor turned to me, shrugged a little, smiled, and said, "Well, you just do the best you can." I thought about that as we saw other patients. After examining the little boy, we checked on a little girl, less than a year old, sleeping peacefully with a swollen abdomen while waiting for a liver transplant. Looking at her, I realized that pediatrics may be a challenge, but it is an important one.
Getting down to a child's level, trying to think creatively to get the information and cooperation you need, may be difficult, but patients who are hurting need you to “just do the best you can” to help. Pediatrics is such a challenge because pediatricians are more than physicians. They are a voice and an advocate for their patients. A little girl may not be able to stand up and say, “I hurt. I need help.” But her pediatrician can.
To be honest, I'm relatively certain pediatrics, as a specialty, is not in my future, though I have been proven wrong before. But I am grateful for days like this that really illustrate how great medicine can be. Pediatrics may not be my new career goal, but I certainly developed a heightened level of respect for physicians willing to take on such a challenge. I hate to think what health care would be like without them.
Welcome back, summer! The sun-filled days, the endless nights, the warmth, the fun, the outdoor sports and, most important, the reappearance of the human race that seemed to be hiding for all of those cold winter months. Suddenly, the streets are full of people again: families on bikes, runners getting back into shape. Yet, for me and the rest of my class, reverse hibernation is about to take place.
For students in their first two years of medical school, the thought of one day causes even the coolest character to break out in a sweat. For most, that day will come in early June, and for a very brave few, at the end of May. Regardless of the date, each one of us has a clock in our heads that counts down the days, hours, minutes, seconds… until we take the test that will dictate the rest of our lives: the United States Medical Licensing Examination (USMLE) Step 1.
This is the time of year when it becomes very easy to spot a medical student. We are the ones making the mad dash to the bookstore to buy the latest BRS (Board Review Series) book, the ones muttering under our breath like crazy people, fervently trying to remember the configuration of the brachial plexis that we learned centuries ago (in real time, about a year and a half). The most obvious sign, however, is our new life companion, the well-worn yellow-and-blue FIRST AID for the USMLE book, which we now must keep within a five-foot radius at all times, lest we go into a full-blown panic attack.
Most of our professors try very hard to do damage control. They work to keep us focused on the courses we still have to complete, to calm us down by telling us how well Wright State students have fared in the past. But medical students are hard to fool, and every last one of us knows that the score we get on this test will determine whether or not we actually get to graduate and be what we have been working to become for about 20 years. No wonder we look a bit unkempt and unhinged!
For two years now, we have crammed more information into our brains than should be scientifically possible. Now that test-prep mode is in full swing, I basically walk around all day mentally quizzing myself and trying to go through the knowledge I have amassed to organize it in some meaningful way. Unfortunately, that means I have also lost the ability to remember where I parked my car, where I left my keys or glasses, whether or not I turned off the stove and just about anything else that requires the slightest bit of awareness. I will admit to being a bit of a liability these days.
Yet, with the pressure of the big day looming, there is also a sense of the light at the end of the tunnel. If we do manage to get through it all without too many scrapes and scars, we will emerge on the other side and finally get to see real patients! That's right, in the midst of all the Step 1 chaos, there is also the knowledge that we are getting ready for the next step in our career: medical clerkships. Set to begin on August 3rd, clerkships represent a whole new way of life. No longer will medical school consist of me, alone, in the library with a whole bunch of books. What awaits is new, exciting and downright terrifying.
The next time I write this column, Step 1 will be over, and, if the fates allow, I will be preparing to start my clinical training and to see if I can put all this acquired knowledge to good use. I will also be facing a whole new set of challenges. How do I give a patient bad news? Will my clumsiness translate to poor surgical skills? So many questions left to be answered. It's almost distracting enough to make me forget about June 13th… Almost.
The warm air kicks up dust from underneath the wooden giant standing before me. Metal rails guide the patrons from the beginning of the line to the small covered house at the end. I suddenly hear a loud whirling, and a rush of air blows past my face. I look up, too slow to catch a good look at the speedy demon, which is only a red flash at the edge of my vision. Clenching the metal rails tightly, heart racing, I wind through the maze and stand waiting at the end of the line. It's quiet in the covered house with no walls, where attendants wait with 'you-must-be-this-tall' hard plastic tubes in hand.
Suddenly, the ground shakes, and the red flash bursts into the house and slows to a halt. The riders get out of their harnesses, ladies with their long hair frizzy, and several young teenagers missing baseball caps or sunglasses. They look exhilarated. I move into a seat and pull the harness over me. The coaster juts out of the house, and I hear the tick-tick-ticking of the chain, pulling us up to the top of the hill. My heart races, hair stands on end, sweat begins to flow, and I look out over the rest of the park before I stare down into what seemed, when I was eight years old, like certain death. I close my eyes and put my hands up.
I open my eyes to reveal another exhilarating sight. The patient on the stretcher in the hallway is retching into an emesis basin. Another lies on his side, holding his left flank. Still another sits puffing through pursed lips turned a pretty hue of purple, laboring to push air into her lungs. I've come full circle now, having left the emergency room as a technician and returned a physician. I remember what I had forgotten; how such a small, enclosed space in the hospital can hold the majority of the drama and excitement.
I snap out of my reminiscing and grab the next chart in the bin. A 78-year-old female, post-fall onto the face. I make my way into the room while darting this way and that to avoid the barrage of nurses, family members, patients and physicians parading through the hall, minds focused, concentration on edge. The patient lies on the stretcher, a cervical collar around her neck, her hands shaking.
"Miss what happened today?"
"I'm nauseous. My head really hurts."
"Did you pass out when you fell? Did you trip over something?"
She turns towards me and vomits onto the floor and my left shoe.
"It's okay." I keep my hand on her neck, stabilizing it until her nausea abates.
"Nothing to be sorry about. I didn't like these shoes anyway."
My exam doesn't show anything too concerning. Her pupils are a little sluggish but equal, and there are no focal deficits. I order a CT scan of the head and some pain and nausea medication. I make my way to my attending and give him my presentation on the run, while he paces quickly, getting work done.
"Sounds like a good plan," he says. "We'll keep a close eye on her."
I move on to my next patient, a 45-year-old female who wants to throw herself in front a train. As I walk into the room, the patient breaks out into tears about her boyfriend, finances and how all she thinks about are exotic ways to end her life. I sit, listening, nodding, holding her hand. As I leave to close the door, she asks for a warm blanket, a Vicodin, and a ham sandwich, no cheese.
Later, I sit down at the computer and bring up the CT scan for my elderly patient with the fall. Staring back at me are two subdural hemorrhages. I quickly walk back to the radiology department. The patient is lying on her stretcher in the hallway. She is still neurologically intact, and I start pushing her back to her room, explaining what we've found. I ask the unit coordinator to page the neurosurgeon immediately. As she does, another patient grasping his chest wheels through the door of the emergency department on a stretcher. I close my eyes and feel myself winding up and down the tracks of the rollercoaster, through loop-the -loops and corkscrews, before bursting back into the small covered shed and coasting to a sudden stop. I open my eyes and realize the only difference is the excitement of the rollercoaster lasts less than two minutes, but I still have eight hours left in my ER shift.
This past weekend, my parents came to Dayton for a quick visit and to drop off some much-needed groceries, since medical school doesn't afford me the time or money to acquire my own food. To keep them occupied for a while, I gave them photos from my trips to India and San Francisco this summer.
When I took a break from tidying up, my mother showed me a handful of photos she had questions about. Mostly she commented on how crowded the hospital in India was, how tiny the babies, or just how generally "different" everything looked. Looking at the pictures, all I could think was that they were a poor substitute for actually being there. How do you connect with a human life through a photo? How do you convey to someone just how devastating a broken bone or treatable disease can be for patients confronting social stigma and inadequate supplies of medication, nurses and hospital beds?
When I was 17, I went with a group of doctors and aide workers to provide basic medical care to people who make their homes in the garbage dumps that dot the outskirts of Mexico City. This trip was difficult for me, as it was the first time I saw extreme poverty and need. Nothing in the United States comes close, not even in our poorest neighborhoods. It would have been easy to be overwhelmed by it all, and I was, but more than anything, I was also intrigued. Most of the medical care that takes place in these outreach settings is of the most rudimentary kind. There were no brain surgeries or heart transplants performed. Yet still, surrounded by dead rats and trash, I watched doctors change people's lives simply by treating their infections and easing their pain. I began to see that there is an art and a skill to medicine that can, despite some difficulty, overcome cultural or socioeconomic barriers. Although it would be years before I decided to pursue a career in medicine, on that trip I developed a new respect for doctors.
In the 10 years since that visit, I have been lucky enough to travel extensively throughout South and East Asia and have learned a great deal about some of the diseases and health issues that continue to plague our world. This summer, I returned to one of my favorite places: India. With tetanus, diphtheria, dengue fever and malaria still pressing concerns, India can provide quite an educational experience for any health care professional. Like every population, India also has its own prominent genetic diseases, such as Thalassemia. Although treatable, Thalassemia carries such a social stigma that children born with it are often allowed to die.
I will never forget the day we visited the Thalassemia clinic and met a little boy whose mother brought him from far away for treatment every month. It was his birthday, and the blood transfusion he needed would require him to spend most of the day on a bed with a needle in his arm. Seeing how unhappy he was, the other students and I used our break to run to a shop around the corner and buy him a cake. As we sang Happy Birthday and his mother helped him pass out pieces of cake for everyone, I saw him smile for the only time that day. In a life so devastated by a disease that in the U.S. is treated far more efficiently and without the stigma, a little bit of kindness can go a long way.
While infectious and genetic diseases often draw international students, less glamorous aspects of health care also desperately need attention. In the villages we visited in India, nothing affected residents' health more than a lack of clean water. Such a simple thing, and one we take for granted every time we go to the faucet. We often forget how much we have to be grateful for, and our responsibility as human beings to do what we can, where we can.
I often find it hard to explain to people why I keep going back. Besides my love of the colors, food and people of India, I also think about my first trip to Mexico, when I saw people from such diverse backgrounds connecting through medicine. I love that aspect of medicine, and I love the people I have met and the lives I have touched through my trips abroad. Like photos, my explanations may never fully convey my experiences and the effect they have had on me, but I know I will continue to reach out in this way, whenever I can, for the rest of my life.
The soft glow of the monitor displays a bright red and green light across the patient's face. The slender endotracheal tube juts forth, sideways from the mouth, winding down and then upward into the mechanical ventilator. The chest rises and falls. On the other side of the bed, tubes full of blood run down from the patient and into a machine. The rolling apparatus, moving steadily like a metronome, pushes the blood through the machine and back down into tubes that return it to the patient. For this patient, the lungs no longer pull in air from the room, and the kidneys refuse to strain out natural toxins from the blood. Long ago, these organs were working well, during decades when a president was shot, or when a war raged in Vietnam. Earlier, on a beach somewhere in Europe, the diaphragm was able to contract tightly, drawing in deep breaths of sea air. Going farther back, the kidneys were doing great when this patient first had a beer. But years of life have taken their toll on what was once a pristine chemical machine, leaving it an organic ruin. Now, all that keeps this flask churning and burbling are machines and electricity.
The ICU is a netherworld. It's quiet and almost serene late at night. The nursing staff sit, twisting side to side in their rolling chairs, watching… waiting. Every once in a while the quiet is broken by the annoying, computerized tune of an alarm going off. Apnea alarm, bradycardia, oxygen saturation dropping: ding-dong-ding. Buttons are pressed, the pulse oximeter wrapped around the finger is changed, and the ICU once again falls silent. As I sit there, watching… waiting, it dawns on me that it is perhaps only with expectations that we become disappointed.
A new patient from the emergency room is brought up to the ICU. Old lungs and a worn heart have left little to drive him forward, and years of smoking have further weakened his lungs and given him cancer. This is his tenth admission in the past year. Each time, he is tuned up and sent back out into the world, always a little sicker than when he last came in. His family, hearts full of hope, sit outside while we transfer him. We place him on the monitor and the ventilator and open the bag of saline. I go out to talk to the family about his code status. "Do everything. Anything you need to," they say. I smile, nod, and walk back into the ICU, but deep inside, I know that all we can do will never be enough.
It is five o'clock when the heart first stops. Slowly, it makes its declaration of intent, the pulse coming down, the blood pressure ebbing. Then the pulse ceases. In the movies, this is when heroes and heroines spring into action, desperately grabbing for paddles and needles, and they usually win, beating back the inevitable for one more day. In the real world, very little is in our hands to change. I cannot give the patient a new heart, new lungs, new kidneys. I can't erase 70 or 80 years of life. In some situations, you simply know that you are not there to try to save someone, but just to be his witness at the end.
Multiple times the heart stops, and multiple times we restart it, not knowing how much damage has been done. I speak with the family many times and paint the picture of what is happening 20 feet away, and they eventually decide to stop intervening. The patient passes in the next hour. The tubes are removed, and the family comes to say their goodbyes. The ICU again is quiet and I sit there watching… waiting. To paraphrase Arthur Young, there is a great difference between a good physician and a bad one, but in certain circumstances, often no difference between a good physician and none at all.
The summer after my first year of medical school went by in a blur: cardiology in San Francisco, global health in India, and a quick family visit. As usual, I tried to cram too much into too little time and found myself with just four days to reflect and distill my experiences before starting year two.
At the end of those four days, I found myself facing 100 pairs of expectant eyes — those of the new first-year students about to embark on the journey I had just completed. And they wanted something from me.
What they wanted were those precious gems, the secrets that helped me get through the first year of medical school. I'm sad to say I met their first few inquiries with a blank stare and stuttered response. Four days simply hadn't been enough time to really think things through.
As I write this, the incoming class is gearing up to begin anatomy, the first truly intensive course of their medical careers and, for most, their first time in the cadaver labs. Books and movies often present this course as a grueling and distasteful rite of passage in the medical world.
For me, anatomy seems long ago, lost in the multitude of new experiences the past year has presented. If I take a minute to look back, I can still recall the intensity of those first few weeks. The hours spent repeating all the bones, muscles, nerves, arteries, and veins. The agony of trying to remember which do what. The times I showed up after midnight hoping the lab would be less crowded and I could get some private time with the donors who had generously given their bodies so I might learn.
The sheer amount of material seemed overwhelming. My confidence began to waver, and free time became scarce. I remember doubting myself and wondering more than once if I was really cut out for this.
Then, around mid-year, I found my stride. Somewhere, in the mess of biochemistry and anatomy, I had lost touch with what brought me to medicine. The day I found an extra reserve, a little bit of strength left when I thought was totally spent, came when I did my first patient interview for Introduction to Clinical Medicine. I walked in ready to collect a patient history by firing through a list of standard questions I had memorized.
In the hour that followed, something truly wonderful happened. I became reacquainted with the idealism and empathy that had led me to medicine. I realized how much I cared about what this woman was going through, and how much I wanted to build a skill set to help me make her life, and other lives, better. I delved into a conversation with her that included few pre-planned questions but gathered all the information I needed to create a full patient history-and allowed me to get to know her as a person as well.
When I got up to leave, my patient stopped me and said, “What was your name dear? Jacqueline? Well, Jacqueline, I really enjoyed talking to you, and I think you are going to make a fine doctor someday.”
I left the hospital that day feeling recharged and ready for anything. For the first time in medical school, I felt like I was indeed learning to be a doctor. Days like that, the ones when I worked face to face with another human being in need of help-those were the secret. They were what got me through my first year.
Finally, I had an answer to give all those new students that I felt was honest, heartfelt, and worth its weight in gold: "No matter how caught up you get in medical school, don't ever forget that the reason you are here is to become a doctor.
Plato is credited with saying that before a man dies, he should plant a tree, write a book, build a house, and father a son. It is interesting that all but one of the items on his to-do-list for life have finite endings. Becoming a father is more akin to a lifelong tenure that doesn't pay as well as many think it should. I'm learning that being a new father isn't very different than being a young physician. There are many times when your patients can't tell you exactly what's wrong, just as a baby can't explain why he won't stop crying despite interventions such as a long feeding, a good burping, and an eventful diaper change. Patients sometimes become disgruntled at your lack of ability to fully give them relief or explain their symptoms, much like a baby wondering why you can't just walk around with him in your arms all night long. And, of course, you always have a little fear in the back of your mind while your patients are tucked in at night, a nagging worry that they might suddenly stop breathing or throw an embolism into their lungs from an occult clot in their leg. This is similar to pestering a pediatrician, despite sympathizing as a fellow medical professional, to evaluate the little cough your son has to the fullest extent. Being a new father is as daunting as being a new physician. The only difference is that as a physician, I'm only on call every fourth night.
It didn't take long for me to start worrying, even before we came home from the hospital…
I sit rocking in the oversized recliner in our post-partum room. My wife is asleep in the hospital bed, serene and exhausted. Twenty-four hours ago, we were pregnant. Now we've been parents for four hours and fifty-seven minutes. My little son lies asleep in the cradle in front of the bed. I hear him squirm, moan, and then fall asleep again. Despite the moon being at its zenith in the night sky, my eyes are wide, and my ears prick up at every groan, whimper, or cry. As someone who recently graduated from medical school, it's hard not to worry. All the horrible pediatric diseases I can remember flash through my mind every time he makes the slightest noise. Suddenly the prospect of being a father, a possibility I have excitedly awaited for thirty-eight weeks, is very frightening. I wish I didn't know everything that could go wrong. I wish I didn't have the mindset of trying to find things that are wrong. I wish I could just go to sleep and wake up when he's twenty-two and graduating from college. No matter how much I know about pediatrics, I am a mere novice when it comes to what lies before me.
"He's a little yellow," says the nurse during a visit later.
"I know. It's probably just physiologic. Nothing to be worried about." I'm saying this for my own sake. They take him out to the nursery, and I sit down, my knees rocking up and down. I look over at my wife, and she gives me that look.
"You need to settle down. He's fine."
On the ride home, I drive as if my insurance agent is in the front seat and a Department of Motor Vehicles representative and State Trooper are in the back.
A month later I'm rocking my son against my shoulder. His jaundice is all but gone. He squirms and cries. Slowly, with each little bounce, he calms down. He's almost twelve pounds now, and he's changing and growing every day. I'm starting to get the hang of this. I can tell when he's hungry and when he's just being fussy. I can tell when his diaper needs changing and when to grab a towel or duck as the cold air hits him. At work, something similar is happening. I can often tell when a patient is having more severe pain, or when a physical exam doesn't fit with the history, and I can see the potential complications of our interventions before they happen. So I guess being a father is a lot like being a new physician: there's a lot of on-the-job training.
“Medical school will test you. Not your intelligence, but your ability to adapt and grow.”
This is what a great friend and mentor told me just two years ago as we sat on her front porch enjoying one of the last warm days of the season. I don't think I understood what she was telling me at the time. Now I often wonder how she could have been so perceptive.
Most people will tell you medical school is hard. It is, but not in the way that I would have expected. Oh, yes, there are mountains of material to learn in blocks of time that always seem too short, and with each class I develop a new appreciation for the human brain's capacity. But we are medical students, and there is not a single one of us who doesn't know how to study.
What is it, then, that makes this life experience so challenging to navigate?
I think it can be summed up by a comment a friend of mine made when he saw me reading a book about South Asian History.
"How can you do that?" he said. "I would be scared to read something outside med school right now. I don't have room for anything else in my head!"
Unlike college, where most programs strive to create a well-rounded individual, medical school focuses entirely on the cause, diagnosis, and treatment of disease. Once, you could switch gears from studying calculus to completing an art project or writing a paper for a political science class. Now, everything that is not studying medicine you do while haunted, in the back or your mind, by the unending list of things you still don't know. Med school can't be left at the office. Relationships and hobbies go on the back burner, and major world events often don't even show up on your radar. When a friend asks, "What did you think of Palin in the debate?" you might distractedly reply, “What debate?”
The result is a day-to-day struggle to find balance. You start to think about where you can fit in a couple extra study hours. Should you really go to the gym? To that lecture on “Women in Shakespeare”? To church? Slowly, the events on your calendar become less and less diverse, until all that is left is one word at the top of each day: Study.
A few weeks into my first year, I called my mentor, full of frustration. She asked me one question: “Jackie, before you started medical school, why did you think you would be successful as a doctor?”
“Because I am good at relating to people. They trust me,” I said.
“How do you relate to people?”
“I don't know. I guess I talk to them.”
“What do you talk about? The latest drug to treat seizures, or the new home-testing kits for HIV?”
Right then, I saw what she wanted me to. I thought back to all my experiences with physicians and patients. I realized that the doctors I chose for my own health care were all ones I felt a connection to, based on a shared love of India or traveling, urban renewal, or even religious studies. All this time, I had failed to see that being a doctor is more than just being a pro at pathology. It's about creating relationships with patients. And that requires nurturing the part of a person that grows and develops outside of medical school.
All of us have had the experience of sitting in a white gown, uncomfortably exposed while a doctor talks AT us instead of to us. There is perhaps no more isolating feeling than dealing with a doctor with no empathy, with a poor bedside manner-a one-dimensional pseudo-person. But it's clear to me how doctors can become that way, how easy it can be for aspiring young physicians to get trapped into thinking the only thing that matters is their score on the next exam, and to let all the other great facets of their personalities slowly slip away. Part of the challenge of medical school is in not allowing that to happen to you.
I am lucky to have trusted friends and advisors outside the realm of medicine who help me maintain a healthy perspective, for the most part. With their help and my own commitment, I may turn out to be the kind of person and doctor I've always hoped to become.
It's a scary thing when people look directly at you when someone is dying. While the face can lie about its emotions, the neck never can. The pulsating carotid bulge, the contraction of the sternocleidomastoid, cannot be calmed in a moment of fear. Many years ago, when I worked in the emergency room as a technician, even the most seasoned attending physicians, with their poker faces practiced over a lifetime of medicine, were betrayed by this muscular tightening of the neck.
One of the greatest modern physicians, Sir William Osler himself, described the quality of resolve in the face of great and certain adversity, which he considered essential to the modern physician, as imperturbability. In his address Aequanimitas (a Latin conjunction meaning "even mind"), he relates, "Imperturbability means coolness and presence of mind under all circumstances… immobility, impassiveness, or, to use an old and expressive word, phlegm."
A few hours into the first of many call nights I will experience as a resident, the pager on my hip goes off and a voice comes over the address system: "Code blue, room…" I've had anxious dreams exactly like this for months, but this time, the situation is undeniably real. Flying up the stairs and into the room, I try to take control over a situation that actually seems fairly stable without my intervention. I don't necessarily feel overwhelmed. I follow the algorithm that has been beaten into my mind. I try to think out of the box, I examine, I watch, and I analyze. There really is nothing more I can do. The chest compressions are sustaining an excellent femoral pulse. The carotid pulse bounds with each push into the chest. The rhythm on the monitor jumps and falls. The cycle continues: shock, drug, shock, drug. It's almost like a dance, where each step is delineated. An anti-arrythmic drug here, a dose of magnesium there. Suddenly, I realize that I'm no longer treating the patient. I'm treating the family outside the doorway.
Osler wasn't a cold, aloof physician bent upon making robots out of medical students. The "firmness and courage" essential for physicians should never come, he insisted, at the cost of "hardening 'the human heart by which we live.'" Nowadays, physicians seem to fear our patients more than a failure of our own courage. We are much more worried about harming the patient than afraid that some disease will take them from us. Writing down an order for medication or treatment has a sense of finality to it. There is no going back.
"Do everything you have to," the patient's son tells me. I take his words to heart and assure him we are doing all we can. I wouldn't look so confident in my response if my senior resident weren't standing behind me. When you're being pushed to the edge of your comfort, it's nice to have someone back you up. I return to the scene, still filled with a deep-seated fear that I'm forgetting something, that I may do something wrong, in the incorrect order, or without some vital piece of information. But there's no time to stop and second-guess. I keep watching the monitor, my fingers on the femoral pulse, repeating the algorithm in my mind like a prayer.
The truth is that physicians make mistakes. We're only human. No matter how many checks and balances exist in the hospital system, errors will seep in. At the end of the day, you have to accept this, or you'll never be able to keep out the fear that can freeze you in your tracks. I suppose the mistakes we make, we can ultimately live with, as long as they are in good faith. These are the mistakes made from ignorance beyond medical knowledge, from the excessive complexity of a situation, not because we faltered in our resolve.
In his farewell address, Osler admitted, "I have made mistakes, but they have been mistakes of the head, not of the heart. I can truly say, and I take upon myself to witness, that in my sojourn among you: 'I have loved no darkness / Sophisticated no truth / Nursed no delusion / Allowed no fear.'"
At the beginning of what I hope will be a long and fulfilling career as a physician, I can only hope I will someday be able to look back and say the same.
There's a feeling of déjà vu as I walk through the sliding double doors. The sounds, smells, and sights remind me of times long past. Nurses and medical technicians move past me quickly carrying IV equipment, EKG machines, monitors, blood, and paperwork. I see the small rooms, some curtained, others not. As I look to my left an older gentleman lays on the stretcher, his Sunday best on, clutching at his heart. On the right, a thirty something female lays holding her right upper abdomen. I hear the moaning, calls for nurses, orders being yelled across the room, and the constant 'beep' of a monitor somewhere. In this sea of chaotic order, I feel strangely at home.
I had two decades on this earth the first time I laid my eyes upon the emergency room. I was still in college, studying Greek, Latin, and Philosophy when a friend told me about a job he was applying for at the local emergency room in Cincinnati. It paid well, sounded fun, and already I was thinking how cool it would be to say I worked in an ER. Of course, this was at the height of the TV show. The job was as a medical assistant, patient care assistant, whatever you'd like to call it. I would basically be a jack-of-all-trades. The first day we met the nursing supervisor, interviewed, and then left for a tour of the ER. The double doors swung open and suddenly I was immersed in the chaos. Physicians running quickly past me, nurses kneeling with needles in their arms, and clerks answering phones with rapidity while cross checking paperwork in front of them. I remember thinking that I would never get the hang of this, that this might be too much for me. Four years later I started medical school, leaving the ER which had given me my baptism of fire into medicine and my niche in both library and laboratory for two years.
Now I'm back. Not to the same ER, but nevertheless it feels the same. Oddly, despite the whirl of movement and work, I'm calm, a feeling of satisfaction moves over me as I stroll into my first patient's room for the day. Then the difference strikes me. Instead of running to get an EKG machine, getting paperwork ready, or grabbing an IV starter kit, I'm standing here, white coat on, trying to figure out what's going on with this thirty something female holding her right side. I run the differential. Cholecystitis obviously, but I'm also considering hepatitis, pneumonia, and ulcer. My thoughts run over the pointed questions to ask.
"Have you had any nausea or vomiting?" I start. "Yes a little, I vomited yesterday twice and, OUCH." The IV finds the vein quickly, I watch for the flash of blood, and quickly fluids are running. Vomiting, nausea, right upper quadrant pain, some increased severity to food intake. I'm confident in my differential. As I start to walk out the room, she mentions suddenly, "I've had some discharge and lower belly pain too." I stop… suddenly everything's changed. This is what I learned after years in the ER. Just a slight phrase, a word can change the way you see a patient, the picture, the process. It's what keeps you on your feet. Because beneath all that obvious history and physical exam, sometimes something very sinister and unsuspected is waiting to declare itself. By then you might be too late.
Before the night is over, we have a lull. These are transient, and must be appreciated for as long as they can be, because the storm is always coming. As we sit back and enjoy it, the doors open swing from waiting room. An older gentleman sits in a wheelchair, clutching his chest, sweating. As we lay him down I start moving quickly, grabbing an IV, cleaning the arm, and finding the vein. Retract needle, place lock, draw blood, secure with tegaderm, and flush. I do it without thinking, without pause as he starts to tell me about that elephant sitting on his chest. Later, the nurse pays me a compliment on my rapidity with the IV. "I've had a little practice with it before," I answer.
We all face it. We face it from the moment we realize its consequence, finality, and heaviness. Maybe it comes when our pet parakeet flies away, never to be seen again, or when an uncle dies unexpectedly from some sneak-thief arterial block. We are left to confront the greatest and oldest adversary of medicine. It focuses the mind on questions of God, reality, being, soul, and eternity. Beyond its frightening awe and inspiring intricacy, it is as simple for the adventurer into its depths as for those who witness it.
At times, the physician plays little more than a witness. For me, the close, sudden thunderclap of death's arrival brought back those college days when life is so wide and wonderful, and you believe you can't die, you question everything your senses and mind tell you, hoping that you'll have some glimpse of the truth that has evaded capture since our ancestors first asked, "Why?"
48 hours--I sit gazing longingly into my computer like a gypsy peers into a crystal ball, but I find no answers. So instead I pick up my stethoscope as if it were a divining rod and move down the hall toward Mr. M's room. For several days, he has been facing his cancer. There he lies making conversation to ease in my heart. He speaks of seeing his family, his son, his wife. There is hope in his voice and kindness in his words. He manifests all that I hope any man or women could when confronted with such a grim prognosis. He is courageous and calm; goodness incarnate, perhaps. Yet, he lies before me, dying. Oh, not immediately mind you. cancer is a slow mover at times. After all, how could the end come so soon to a man who is so elegant in his speech today?
24 hours--"It's been a pleasure Mr. M," I say, feeling good about what little I've done. His hand reaches into mine and we shake, with warm, strong grasps, containing pride for what one has done and what one has endured. As a medical student you suggest, never order, but feel, as the brand-new intern does, that you've done some good when it comes down to the end of the day. Mr. M will be transferred to another wing of the hospital for palliative care. The wheelchair comes, a tank of oxygen, and off Mr. M. goes. His hand rises and waves as he rounds the corner. I hope he has at least six months left. Six months to ride his motorcycle, to feel the wind in his hair, to feel the wonder of simply existing. I hope and pray his discharge comes quickly, before chemotherapy takes its toll. I tell myself, he is a strong man, and I do the Hollywood double take, almost to reassure some invisible audience, as Mr. M rounds the corner, that all will be well.
The next day--The doors swing open, and I come in out of the cool morning air. I'm tired. Not enough sleep last night compounded by a long ride in this morning. I put my coffee down on the table and go to see a few patients. I talk with them, make sure they are improving in some form or fashion and make my way to the work area to start my notes. As I enter, the resident turns to me and says, "Mr. M died yesterday." At first, it doesn't faze me. Then, I am saddened. "Oh no. That's horrible. He was such a good man." I hang my head for a few moments and then go back to typing my SOAP notes.
On the long drive back home, the reality of it all hits me. As I reach my exit, I pull into the gas station and start to fill up. I flick the clip into position and sit down in the driver seat, with the door ajar. I sit there, my head in my hands, and I think. Not about Mr. M, I'm sorry to say. When I think back on it all now, I feel ashamed. I should have thought of him, his family. But instead I was filled with that awful realization that I too will shuffle off the mortal coil someday. I hold my head in my hands and cry… for myself… for my patient… for my species. I realize at that moment that my circle has widened and I stand up, wiser. Suddenly the latch clicks and the tank is full. I snap the cover and start the car. I pull out and onto the road.
So many years of philosophical training, and I still have no clue how close I am to any answers. The questions that deal with what it means to be human: Who am I? Why are we here? What is reality? What does it all mean? What other questions are there? And how often have you asked them yourself? After so many years, I feel part of becoming a physician lies in the ability to understand what it is to be human.
I look out the passenger window, a field of corn blowing in the breeze, high and green. I smell burning wood, and hear a brass band playing in some small town. And so, I take solace that somewhere, as Ms. Teasdale says, there will come soft rains.
The radiance of the summer sun is quite a spectacle in mid-morning rounds. The light shines brightly into the hospital room of the upper floors, bathing the patient, medical staff, and myself in its glow. I squint my eyes out at the outside world. Try as I might, my eyes don't adjust to the glow, a consequence of walling myself in this citadel of the sick for so many hours. I move my gaze back to the patient, a kindly looking elderly gentleman, all smiles despite the odds. He is staring directly at me while I was looking out the window, and in a reflex response I smile back at him. He smiles and turns back to my attending physician who is talking softly and with compassion as the plan is put forth in simple terms. The patient nods his approval and looks back out the window, perhaps trying to see what I was looking at. We move back into the hallway…I field a couple of questions from the residents and the attending physician. Some I get, some I don't...and we move on down the hall to the next beam of light shining.
The crux and keystone of the practice, art, or science of medicine is the basics of Internal Medicine. A vast library of knowledge supplants this specialty and gives credence to Hippocrates' description, "The life so short, the craft so long to learn." So as my third year of medical school draws to a close, I finish on the specialty which allows me to use all that I've learned to this point. It is by far the biggest world of medicine I've come into contact with. The differentials are long and the possibilities endless.
So I start where I began so many years ago, with some simple reason to derive a common theme or two from this ocean of knowledge and practice. Up to this point, I've derived three qualities I find I cannot do without if I hope to be worth my weight in salt as doctor.
Of course, the most obvious is a love of knowledge. The curiosity has to be there or this long course of learning can't continue. Now the verve for this learning can wax and wane, with the circadian rhythms of the day or the trials and tribulations of any life, but eventually the deep entrenched curiosity of what is wrong and how to effect change must come flooding back. When the possibility of an uncommon ailment or the hoof beats sound more like a zebra than a horse, I detect the eyes of the physicians around me shining a little brighter with interest and intrigue. After all, part of being human is being humbled by not only that which we do not understand, but that which we do not commonly see. This leads to the second quality.
Einstein himself related "No amount of experimentation can ever prove me right; a single experiment can prove me wrong." Without humility, curiosity would never be strong enough to be considerate of every patient. So humility is indispensable, because without it you can run the risk of diagnosing the patient before seeing them. I've walked out of a patient's room and believed that I had the diagnosis nailed down, only to discover I was so far off as to be embarrassing. Those times in particular, I saw what I wanted to see instead of seeing what is simply there. So instead I've tried to walk into a room as Tabula Rosa, allowing the patient to paint the entire picture while I'll simply add the framing.
However, humility and a love of knowledge cannot exist without simple compassion. It's a quality that is simply human but not the simplest of emotions for humans to control. Without simple compassion I am already categorizing them without humility and often without sufficient curiosity. After four years in an inner city ER, compassion isn't the easiest of emotions to turn on or off. Nor should it be so pliable, but with anything takes practice and I haven't mastered it yet.
The patient in the next bright room is doing well, or at least much better than last night. When I saw him at admission the night before he was severely hypotensive without tachycardia. Fluids were started and antibiotics as well. As I laid in the on-call room, I tossed and turned over it. Finally, I got up and made my way to his room and sat there for some time. I don't know if he was aware of my presence--he didn't have to be. As time passed, he became normotensive, and I made my way back to the resident lounge. Today, the light is reflecting off the monitor in his room, and his lucidity has improved. The attending physician is doing his examination and his vitals are looking good. I look back out the window. An elderly woman is walking up the path to the hospital, a large green lawn stretches out into the distance, and I swear I can smell fresh cut grass.
St. Francis de Sales is credited with saying "Have patience with all things..." In my clerkship rotations so far, I've found this to be an important and indispensable piece of advice. A significant part of medicine is often spent waiting. Allowing for the tincture of time to set in often remedies the most painful of problems. Waiting for a culture, a lab value, or a patient to be ready for an interview requires the physician to have this virtue in spades. I've found this quality of character no more useful than in pediatrics.
As I walk into the exam room, I'm confronted with patient who cannot talk, cannot walk, and cannot communicate in such a way that I can understand. Despite these circumstances, nothing is wrong with this patient. She's only 9 months old. Here for a well-child check-up, I introduce myself to her translator. Mom sits the infant in her lap and I start the run of questions: bottle-fed, breast-fed, cereal, other foods, stool, diapers, babbling, stranger anxiety, etc. Mom has no questions or concerns. Everything with this little one is good. So I start the exam. I swivel on my rolling stool over to mom and spend a couple moments playing peek-a-boo. I slide the little one down, intending to listen to the heart and lungs when I'm faced with my first challenge: the Onesie. It's this little bodysuit for infants which buttons with three snaps at the bottom. At this point you can guess I have no children of my own and have virtually no experience with human beings of this length and weight. I fumble at the snaps, hoping Mom won't notice and think, "Who is this kid, think he is, examining my baby?!?" I breathe slowly, and with a little patience, it comes apart and I slide my stethoscope up underneath onto the chest. I start to listen, then look down. She's looking back up at me with a dazed look. I smile. She smiles. I get lost for a moment and then move my stethoscope. As I continue to listen to the lungs, I realize that while I was lost in her smile, I hadn't really been listening to her heart at all. I move the stethoscope back and listen again, this time with my eyes closed. I slide her down then, squeeze her belly, feel for femoral pulses, and attempt the Barlowe and Ortolani maneuver. As I squeeze and jostle her, I'm amazed with how strong this little one is as she extends her legs and pushes back on me, almost moving both me and the rolling stool that I'm sitting on. I feel the back, look in the mouth, and finally the ears. As I finish the exam, I hold the infant in my arms for few moments to get a feeling for movements and strength. I turn her on her belly in my hand and fly her towards mom; back and forth, away from mom's face and then towards her. She laughs and moves her arms, clapping her hands together, while mom's face goes from relaxed and smiling to wide eyes and puckered lips. It is in this moment, that I forget all the things I might be forgetting and suddenly this all feels a lot like simple fun. I set her down in mom's arms, thank them, and leave the room. I start worrying as the door closes, my face drops from its smile. I'm not worrying because of something I found in the history or physical exam. I'm worrying because I don't know what's normal, and without that important feature in my arsenal of medicine, learning the disease state becomes even more challenging.
Two hours later, I find myself standing outside the same exam room. As the physician whom I'm following asks if I can start, I can hear several voices, some loud, some soft, issuing forth from the room. As I enter the room, I see three children, one about 9 months sitting in mom's arms, another around 2 years of age running around the room, and finally a 5 year olds sitting in a chair giving me an interesting look. Mom looks at me and says, "Do you have any kids?" I shake my head no and smile. She smiles back, "Well this will certainly be a learning experience for you." Each of these children are here for the same complaint: cough. So, I start at the beginning, with the five year old. She sits still on her chair but clearly doesn't want to have anything to do with me. Next I move to the 2 year old, which at the beginning seems like an act of futility. I point to pictures on the wall, distract him with lights and my stethoscope, and have him hold a tongue depressor trying anything to obtain 15 straight seconds of stillness. Finally, I move to the 9 month old, who starts screaming the second I roll towards her and mom. I play peek-a-boo, move around the stethoscope on her siblings to show her there's nothing to fear, and bop the otoscope on my nose to be funny. The latter only causes her to scream more and turn her head toward mom. I try my best to listen to her lungs. She sounds clear through the screaming; at least she is definitely moving air well. Finally, I end with the ear exam. After I simply mention the exam, mom already assumes the position, holding the little one's head against her chest. I press my fingers against the head so I can move with her as she shifts her head one way and then the other. I never got near seeing the Tympanic membrane. I walk out of the room, feeling inefficient, and admit to my attending that I couldn't visualize the Tympanic membrane. Not because of earwax or discharge. I just couldn't get her to stay still enough. My attending smiles and walks in the room, within minutes, the 9 month old is laughing, and the exam is done within seconds.
Patience is really all it takes. Patience in learning the baseline of all things. Patience in learning what makes children distracted. Patience in seeing an ear infection in all of the other siblings and what settled them down after a good cry. Francis de Sales quote holds true, and as the rest of it goes, "Have patience with all things, but chiefly have patience with yourself."
I've often thought that the doctor's knock, that tap-tap-tap on the door immediately before entering the exam room, was always a great metaphor for the remaining graces and manners of office medicine. In a way, a knock on the door is usually equated, at least in my mind, as a request: "May I come into your home?" or "Will you be so kind as to let me in?" Interestingly it almost implies the invasion of one's abode by another for a philanthropic, benign cause. Yet in this day and age, where privacy is quickly becoming public domain, it still stands as a testament to a level of courtesy and respect that stands firm at the center of being a physician. This is not without irony however, because the knock-knock usually is immediately followed by a turn of the knob because, well at least in my mind, I can't hear anyone through these thick doors.
The reason I mention this little metaphor is that I've come to a realization over the past month in Family Medicine that the end is nearer than I think. I move with a little more confidence now and feel more relaxed when I counsel on giving up those Ultralights or trying for that extra thirty minutes on the treadmill each week. I feel more confident because the explanations and choices that I have to give are starting to flow out of me. I don't find myself reaching into the recesses of my mind trying to remember what antibiotic is first-line for Streptococcal pharyngitis, or what a reasonable asthma regimen might be. So with this confidence comes the questions about what the future entails and asking myself should I let the world shape me or should I shape the world. I remember almost half a year ago that I was shutting my eyes tightly trying to remember an ‘on the spot’ question, whereas now I knee-jerk the response and expect the next two to three questions as follow-up. The mantra has been knowledge before speed. So I thank my time here in Family Medicine for allowing me to slow down and truly ponder what are the choices I can give, what are the red flags I'm looking for, what canI do to develop more of a rapport. In a sense that is what this entire month in Family Medicine has been for me…a lesson in rapport.
Tap-tap…knob turns…door opens, and there sitting in a small chair is the patient. His face brightens up when he looks up at the attending physician I'm following. "How are you doing?" Simple words, but they will result in all the information you might need to help. I watch as the two, the patient and the physician, shake hands and sit down. They chat…asking how's this and that. If you would remove the white coat and gown from this picture you couldn't tell that this was a conversation between physician and patient. The attending physician leans over to me and says, "I've seen Mr. H for…oh what has it been now?" "Ten years," says Mr. H. I smile and realize that I know very few friends whom I've kept in contact with longer than ten years.
I think of all the yearly physical exams, the heartburn and sick kids, getting them through cancer and off cigarettes…this conglomeration of attempts to help mold a person's life in some manner to increase both quality and quantity. It dawns on me then that a physician's job is more akin to that of a blacksmith. Today, the patient simply has a physical. The visit ends and they both go their ways, happy to see each other. I don't believe rapport can get much better than that.
Not to say that all relationships are that friendly. I've noticed over the past month that these long time relationships often take on the form of other long term relationships: the younger and older brother, the father and son, the squabbling old married couple that never agree. But through it all, the good news and bad, the function is often the same: to remind the patient that they are as much a part of this congregation of homo sapiens today as they were on the day they were born. As for myself, with this new confidence and lesson in rapport, I move closer and closer to the end of third year and the beginning of my final year of medical school. At this point it seems so far away…and yet in a way not far enough.
As the sun sets behind the Dayton skyline, I come in from the chilly fall air and begin my next 12 hours on Labor and Delivery. As I follow around the interns, I try my best to follow the logic that leads one from evidence to action. Learning to span this gap is the purpose of these two clerkship years. Unfortunately it isn't so easy, because from my eyes this movement is almost instinctual to residents, making me wonder if it ever will be so for me. So I do what every good medical student does in the meantime…I wait…read…study…get some coffee…read again…check back. The life of a medical student in the clerkship years is spent mostly in limbo. You begin to feel like you're waiting at a train station that has no scheduled stops. Hoping and squinting off into the distance so that you can catch just one train. You get excited when a whistle blows, but realize that there is no train, or that the train just isn't stopping for you. This is very true of a rotation in Ob/Gyn, where I sit waiting to hear that whistle.
Then, in the late evening, they page me for a delivery. I shake off the daze I was in and move quickly to the room. Despite how it appears on this end, mom is doing quite fine on the other. So I find my place holding a leg here, grabbing things there, or simply watching and keeping my eyes and ears open. The delivery goes smoothly, with the normal progression of hair giving way to a head, to a neck, a body next, and feet at the end. Excitement, humility, joy, concern, satisfaction, and relief fill the room in a heavy, humid air. But the work goes on. Still two beings to care for, only now they are separated by several feet, instead of nothing at all.
As the night wears on, a young mother-to-be and her unborn begin to stride into uncomfortable areas. Heart rates go down, and quickly the decision is made for a C-section. My past rotation in surgery has prepared me for work in the OR well, so I now don the cap, gown, and boots with ease, and scrub my hands with a sense of confidence that no microbe will be left. However, after spending a month of 3-4 hour surgeries in the OR, I'm surprised by the relative quickness and rapidity of the procedure. Through the belly, into the uterus, delivery, and closing takes less than an hour.
Morning comes, and I pay a visit to the Neonatal Intensive Care Unit to check on a preterm infant of one of the mothers I'm looking after. The careful design and technology of this place awes me. It stands in my mind as a testament to the edge of reason and science that can truly change the natural pathways of life. The infant is stable, breathing well, and kicking both arms and legs, covered in soft hair, yet still so small and fragile.
I make my way back to the Rotunda in the Berry building and stand watching over the people coming and going two floors down. I watch as a young woman, baby in her arms pushes through the revolving doors and disappears. At the same time, another woman enters the building through the same revolving doors. This young woman is pregnant and looks term from where I'm standing. This is the cycle that I have to learn to live in while I'm here. But perhaps the most pressing question that I have been unable to answer is how much of all this should I let in. How much am I unable to stop from getting inside? I don't know the answers to these questions, and of course they really have no answer. So, like everything else, I'll learn by trial and error.
Suddenly, the pager on my hip beeps. The train is whistling, and I head off down the hall to Labor and Delivery.
There's a story I know. Don't ask me how or why I know it….and don't assume that the story is about me. It may be true or it may not. It doesn't have any moral undertone; it isn't a proverb. It just shows one of the worst days in the life of a medical student in the second year. For this story I'm going to exercise a little literary license and tell it in the first person.
The white wire mesh holding up my clothes in the walk-in closet of the apartment crashed to the ground. My eyes flew open and the subconscious took over. I quickly looked over at the alarm clock: 7:15. I panicked. Flying off the bed, I ran to the dresser and began frantically throwing on shirt, jeans, shoes, and hooded sweatshirt. I glanced at the wire mesh dangling from the wall. "That's for later," I thought, and dashed out the door grabbing the keys, cell phone, and wallet off of the table as I ran past.
I hit the back roads, which are usually much more light at this time of the morning. I stayed within 5 mph over the speed limit. I drove carefully and reviewed the information for this morning's test in my head. I ran through the neuroanatomy and then onto the pharmacological aspects. I realized I had not reviewed pediatrics as deeply as I had wanted to. I threw up my hands and said "Oh well" and continued on the country highway.
As I drive the traffic slows down to a crawl and I begin to wonder where I can find my professor's number so I can profusely apologize for my absence. The traffic begins to pick up and I pass the accident that caused it. The car is a small compact, resembling the small Yugos of the 1980s. It's completely flipped over onto its top at the edge of the road. There are no police but there is a tow truck. The only people are an older looking man, leaning against the car as if leaning against a bar, talking to the man who obviously owns the tow truck. The two of them laugh and then I see the older man throw up his arms as he looks toward the car. I immediately understand exactly how he feels.
It was as I was turning onto Fairfield Road that I felt it. It started as a twinge in my stomach and quickly began to engulf my whole body. All the adrenalin that had been running in my veins was catching up with me, and I began to feel sick. Worse yet, I got stuck in traffic again. When you are stuck in traffic, you watch the clock carefully, trying to make sure that every second is counted, and possibly trying to use your sheer willpower to slow time. Time, however, is stubborn and it kept on clicking by at the usual rate. Finally I reach the college and jump out of my car and into the building, knowing I'm just a minute late and that they don't always start on time. I slow down to a stroll as I enter the room and grab the sheet of paper and sit down. I breathe in and out and smile, knowing I barely made it on time. Unfortunately, for the rest of the test the adrenalin rush made my stomach churn, and I began to lose my concentration.
I was on autopilot during most of the test, which I don't really remember too well. The drive home is somewhat of a blur as the descent back down from my rush got worse. I walked into the apartment and went straight for the bed. As I passed the closet I looked at the white wire mesh hanger. There was little sign of how or why it had fallen. The hooks were still screwed tightly into the wall. I shrugged and promised myself I would clean it up later. As I passed the alarm clock, I picked it up and dropped it into the garbage bin and then promptly fell onto the bed face first. The last thing I remember thinking was, "Wow…someone really wanted me to take that test."
As I said, this story has little purpose than to show one of the worst days in a particular medical student's second year. It may be true or it might not be. At any rate, I passed.
The voice of the resident in the far corner begins to fade out. His white coat begins to blur along with everything else in my visual field. As this happens, I explain it to myself in medical terms; the blur is the result of my eyes converging due to the movement of my ocular muscles, which I'm losing control over due to my fatigue. At this point I'm only catching little phrases from the presentation.
"55 year old male…" "History of CAD and hypertension.." "Sodium 135, Potassium 2.0…" "Chest X-ray shows bilateral…"
Then, like two stage curtains, my eyelids begin to droop and I can feel my head falling forward. Suddenly, the fail-safe alarm in my subconscious comes on, rattling me back into consciousness. My head pitches back, my eyes fly open, and my hand comes up to my mouth to make me look like I'm deep in thought about what exactly is ailing this 55-year old man. It's the second week after my first-year finals, and I'm sitting in morning report at seven in the morning. I look around to make sure no one saw my descent into REM. Everyone's eyes are fixed on the overhead projection of the chest X-ray. My eyes dart toward the X-ray I look at it sternly, but I am thinking in the back of my head, "Are the lungs normal…I think so…is this pneumonia….I'm not sure…wait, is this Situs Inversus…no the X-ray is backwards." I strain my mind to remember my anatomy class and the radiographs I studied intensely. Then the X-ray begins to blur.
I wouldn't be tired if it wasn't for the fact that I have been staying up late reading my pathology book to get a head start on second year in med school. In the first class we get three weeks to read 600 plus pages from the pathology book and a pharmacology book. This then, culminated with the fact that I have to drive to Miami Valley Hospital in Dayton from Cincinnati every morning, results in one fatigued student. Sitting in morning report, I know this, but I keep telling myself the same thing I've been telling myself all year, "This is medicine…this is medicine."
As morning report draws to a close, I team up with a resident and we begin to see patients. After spending four years in the hectic pace of an ER, I expected family practice to be more lax and slower paced. I was wrong. The residents darted from room to room as patients remembered more complaints. The residents swiftly scan through test results and old medical records. They write prescriptions and medical notes quickly, with the penmanship paying the price for speed. As time goes on, I'm amazed with how much I remember about patients I've seen from a few days ago or even last week. The names of patients I've seen previously don't ring a bell, but give me a chief complaint or a medical history and I can tell you what that patient ate for breakfast on the day I saw them.
Despite the fatigue, I listen closely with each patient, desperately trying to recognize a constellation of symptoms that I can categorize or thinking about what would be in my differential diagnosis. Here is a five-year-old with diarrhea for the past two days. So I think, "What could it be…probably Rotavirus…or could be Vibrio Cholera…no, no this isn't a third world country…but could it be? Is it Salmonella….no no…there's no blood in the stool…wait, was there blood in the stool?
Lunch comes and goes, and although they are nice enough to provide me and other students with a free lunch, it comes with a side of a Conference on Obstetrics, and the dessert is Medical Journal Club. The afternoon is filled with the same, but this time more patients. Then, the resident and I go in with a patient who is scheduled for a fifteen-minute appointment, but unloads on the resident a multitude of complaints, some of which are personal and emotional. We leave the room forty minutes later, far behind the schedule. Despite the surprises and new complaints, somehow we're done just about when we should be.
I drive off toward Cincinnati and back home where I can relax for a few minutes before moving back to the books. I'm tired but awake. I treasure this long drive because I feel good about myself and about what little I've done to help these people, these patients. I arrive home feeling rejuvenated and hungry for more. As midnight rolls around, I realize I've been reading the same page for the past fifteen minutes. It's about edema due to lymphatic obstruction. I read over and over again but it doesn't quite stick. The pages begin to blur and the stage curtain begins to drop. My head pitches forward and I keep telling myself, "This is medicine..."
As I stood there in my white lab coat, I felt intimidated. In a way, I felt that I shouldn't be. For four years, before I was accepted at Wright State University School of Medicine I spent some sixty hours a week in an inner-city emergency center. I remember the gunshot victims rolling in on stretchers and the packed waiting room, swelling with the suffering and the impatient. I worked third shift during those four years, staying up late into the night to watch the sick and suffering of Cincinnati. It was a wake-up call for this twenty-year old Classics major at the time--a brief glimpse into the atrocities that bug and man can create. It was my trial by fire and an experience that would either solidify my desire to practice medicine or destroy it entirely. As fate had it, my desire to become a physician grew, and I found myself increasing my hours after graduation. The masochist in me began to take hold, and I became convinced that if I can survive this, then I just might make a good physician.
There were scenes and experiences that I took part in that have been engraved in my memory. I remember a homeless patient who had scabies over his entire body. I remember an HIV-positive woman who rolled into the emergency room at the height of a rush of trauma patients. She had cut her hand severely, and a large bandage and mass of clotted blood clumped together where her index finger used to be. As I stood before this woman, I felt concern and worry for her, yet at the same time I felt fear for myself. I remember the first patient who I did CPR on, but despite our intervention, died. His name was Marcus.
I have seen and experienced situations other first-year medical students have not and perhaps will not see for another year to come. However, despite all these experiences, I still stood there back in September of last year, and was humbled and fearful. Before me, lay my greatest teacher. The white sheet covering him hung there like a stage curtain waiting to open. The class was Human Anatomy, and this was the donor upon which I would learn firsthand the intricate design of the human body.
It's a strange feeling to be given an experience such as this. You feel like an astronaut on his or her first trip to the stars. So I steeled myself and drew back the covering to begin my examination of this donor and my career as a physician. At first, I had a great doubt in my mind. How would I ever learn all this? I looked from head to toe over this brave donor lying before me. Every intricacy of this design lay before me. Then I felt elated. I realized that however one sees the human body, by God's or evolution's design, doesn't take away from the fact that you stand in awe of this complex and highly adaptable design. So many anatomists and healers have come before us and mastered an intimate understanding of us as flesh and blood beings. Where they have gone we, too, must follow.
As time wore on in the class, the amount of information increased. It was overwhelming, and there were times when it felt like too much, and at one point your mind would suddenly shut-off, like the click of the nozzle when you've filled the gas tank to full. In the end, what kept me going was awe and fascination. You can't help but be drawn to the information, to learn what makes us lift our arms, allows us to smile, or even take five steps towards the door.
All this I learned from my donor, a man who lived a lifetime before I was even born. Throughout that lifetime, he had been overseas and traveled. He had suffered, rejoiced, hated, and loved. I'd like to believe that the vast spectrums of human emotions are experienced by all of us. Throughout all our experiences, our bodies are there with us, up to the end. In only nine weeks, we had soaked up a vast amount of information about the human body at the gross level. The final exam came and went. I answered the last questions on my donor and then bid him farewell. I never saw and will never see him again, but I can never forget. It almost feels like he was some supernatural being who appeared suddenly one day to teach me all about the human body and then disappeared just as mysteriously. I often think it's very ironic that the greatest contribution to raising physicians is giving over oneself. As for me, I passed the class, but more importantly, I can't forget it.
With my eyes closed, I take a deep breath. I review the flow of the material I need to remember and quickly recall the most important points. My hand goes up against the door and knocks. The voice on the other side says "Come-in," and I think how simple that phrase is for something so complicated. I grab the knob, turn, and walk in, exhaling with a smile and an exuberant, "Hello."
For the past two years I've been reading. Well, mostly. Medical school demands that you master the pages before touching the patients. Well, for the most part. The growing trend now is to start the clinical training earlier. When I say this I mean to say that it's not only important for me to know what pneumonia is, but what it could sound like when I listen to the lungs, what an S1 heart sound is like, and what I should be looking for on a neurological exam. So, for the first two years of medical school, I have studied the aspects of disease, the etiology, pathogenesis, and everything in between. But almost every Friday, we are trained in the technical skills of a clinician, because of course medical science alone, does not a physician make. So here I am this Friday afternoon, learning one of the more intricate techniques of the clinician: the female exam.
Am I nervous? Of course, I'm nervous. In the real world, many aspects of the physical exam would legally be considered battery. Listening to the lungs, the heart, and the abdomen are one thing. You can easily get over the invasion of privacy because you're pretty much examining a patient in something similar to their underwear or a swimsuit. This exam however, is a completely different ballpark. It is the first exam that really shocks me and makes me think, "This is what real doctors do."
Technically, I shouldn't be nervous. For the several years that I worked in an emergency room, I assisted and chaperoned in perhaps hundreds of female or pelvic exams. Holding the tube of preservative or getting the patient comfortable with the most sought after commodity for any patient in a hospital gown: a warm blanket. Several hundred times I've stepped in there and several hundred times I've not thought twice about it. Now I realize, standing in front of the door, I've gone from passive observer to active participant. Now whatever happens is pretty much my fault.
So we start where any relationships starts, with a "Hello." I should explain that the woman guiding me through this exam isn't a real patient. For the first two years of medical school, simulated patients, actors of clinical presentation and thespians of the body, train us. This exam, however, is as real as it gets. And to tell you the truth, aside from the fact that I've never done this before, the fact that I'm male doesn't seem to bode well for me.
So my reaction is the same as any other male medical student's reaction should be…sheer anxiety. Before I even grabbed the knob on the door, my hands were dripping with sweat and the hallway was spinning. A deep breath later and I'm in the room with the door closed thinking, "I forgot the order….what was the order of the exam?!?!"
Despite the fact I know I look nervous, my simulated patient, my guide through the world of the female exam, calms me immediately. She is relaxed and takes me through the motions of the exam easily. As my hands stop dripping sweat and my brow dries, I remember the order of the exam and move calmly through it making sure to ask as often as I remember, "How are you doing?"
I leave the room, beaming, and feeling like I just bought a time-share on Cloud 9. But the anxiety still churns my stomach. After worrying for the entire week about the last hour I sit back and relax. Still, I think, it's better than biochemistry.
The water runs down my arms and onto the floor as my back goes against the door, pushes open, and I enter. Don't touch anything, don't knock anything, just don't do anything stupid, I tell myself. The gown then comes over my arms and my hands dive into the plastic gloves.
Under the watchful eye of the surgeon, the first cut is too shallow, and so I have to make another. The abscess I'm cutting into has an induration thicker than three of my fingers. The bacterial cocktail bursts forth, and the cleaning and packing follow. I pull the gown off, strip the gloves off, and realize how bad my heels hurt, something I hadn't even noticed for the past hour. The resident sits down and starts writing orders. I assist in the dressing and finally the transport of the patient into post-op. As I leave I see the scalpel sitting on the tray with just a drop of blood on it. "The way to heal is with cold steel."
You see, that's just one of the sayings you'll hear. "A chance to cut is a chance to cure…Surgeons separate their patients from disease." All types of physicians are proud of what they do…surgeons are no different. So you start to pick up the quirks of the resident you're following; you're doing what they do because you have no idea what to do. You watch, you do, you teach…or so the teaching model goes.
Transition from the first two years to the last two years isn't as smooth as I'd like it though. Surgery is well known as the boot camp of 3rd year clerkships and so I've been hitting myself on the head wondering what possessed me to choose it as my first rotation. To tell you the truth I have no idea, no real rhyme or reason. Now, as I transition from 10 hours of steady study to 14 hours of constant surgery, I find myself lost again. So most 3rd years, in my opinion, have to get used to the idea that you are starting over again. Despite coming so far in the last two years, you open the door into the wards and realize there's an entire world of knowledge you haven't even touched yet.
As the scrub brush darts back and forth on my arm, I keep counting as best I can. I rinse and push my back on the door. Don't touch anything, don't knock anything, don't do anything stupid, as my mantra goes. So it begins, a bypass and transposition of several vessels in a nice lady's chest. It's a fascinating clinical presentation and an intricate story, with exciting twists and turns. For this procedure, however, I'll do nothing but watch, all gowned up and nowhere to go.
So I stand there watching, hands in front of me folded. I feel like an altar boy again, giving homage to whoever invented the electrocautery or the Metzenbaum scissors. As I stand there, the resident turns and asks me an anatomy question. "What's this…what's that?" It's a form of questioning called "pimping." So you try to know as much as you can before you even pick up a scrub brush. Problem is, for every right answer, the ante goes up. The questions get more and more complicated until you pretty much have no idea what they are even talking about. But it sticks…well most of the time.
At 4 a.m. I start to feel the burn in my feet from being upright all this time. My back is in spasms and I've been holding this retractor in the same position for the past 20 minutes. The young man in front of me, lying down with a tube in every natural and man-made orifice, had a scuffle which ended in two things: a police report and a hole in his back. The attending physician points out the anatomy to me as we go through. We trace the path of the bullet, through the liver and into the peritoneal cavity. Suction, look, suction, look, suction…you get the idea. As we close him, the attending allows me to staple the incision shut. Whenever a medical student does such a procedure, we get very excited and very nervous at about the same time. However, at this time of the night, I'm mostly excited about anything that has a flat surface on which to lie down.
A week later I'm rounding with the residents and seeing how the patients are doing. It's during this time that I've learned one immutable fact: the body can take more abuse than you think. It can be, as I've heard it so aptly described, "forgiving." So as I walk into the patients' room to ask them how they are doing today, I'm smiling for two reasons. First, I'm actually starting to understand some of this; I'm actually getting the hang of it. And, secondly, just like the Dr. Scholl commercial, "I'm gellin."