Boonshoft Blogs

The busy-ness of fourth year continued into the second semester. For the first two months, I completed rotations in adult nephrology, pediatric radiology, ENT, and Ophthalmology. These proved useful rotations in allowing me to more fully understand the scope of these practices (ENT was the most surprising and the most fun!). The goal of these rotations was to soak in as much information and broaden my scope of knowledge, one specialty at a time, as I might not have the chance to complete specific rotations in them during residency.

In the midst of these rotations, I completed my last residency interviews, constantly pondered, and finally submitted my rank list. A three-week waiting game to Match Day (the day medical students find out their residency program/location) then ensued. The day was surreal, the emotions ran high, and it was definitely one of the most intense days of my life from the countdown (the day of or from the last four years :P) to mentally processing the results afterward. I matched into Internal Medicine-Pediatrics (Med-Peds) and can’t wait for this next phase of training!

During Match month, I began my Emergency Medicine (EM) clerkship, which I loved. The residents were great to work with and I really enjoyed the acuity and being the first person to see the patient. This rotation helped direct my thinking and thought process in ways I was not used to. I learned that in the ER the goal is to rule out life-threatening illness, stabilize the patient (to eventually go home or to be admitted), rather than try to seek a definitive diagnosis.

Once EM ended, I headed to Lebanon for two weeks to visit my extended family. The weather was wonderful, the food was excellent, and the adventures were endless. I can’t wait to go back again! Upon getting back from my trip, I immediately started my general pediatrics sub-internship. Long days followed (11.5 hours each day), but I thoroughly enjoyed this rotation. It helped better prepare me for residency and I learned how to manage my time more efficiently as more responsibility came with this experience. The last day of this rotation marked my last day of medical school, which is so hard to believe because the time has flown by so quickly.

Graduation is in 10 days. Sometimes when asking others how they are doing they reply with a drawn out, “Livin’ the dream.” When I think back to the last four years of medical school, I can’t help but think, “I am literally living my dream.” My 5-year-old dream of becoming a doctor will soon become my reality. I will continue to cherish the lessons learned, friends made, patients met, experiences and growth during my time in medical school. Despite the ups and downs, these were some of the best four years of my life and I wouldn’t have it any other way. Medical school is definitely not a journey to be taken alone. Words can’t express how appreciative and thankful I am for all of the support from my family, friends, and the Boonshoft School of Medicine for helping me reach this point.

Next stop…Residency!

My fourth year began with my one month Sub-Internship (Sub-I) in the adult Intensive Care Unit (ICU). For those unfamiliar, as sub-I’s, fourth year medical students are typically given similar responsibilities as an intern (first year resident) in acting as the primary provider and communicator for their patients. This invaluable experience helps medical students enhance critical thinking and decision-making before entering residency, because it allows students to participate in all aspects of care including: evaluating, examining, diagnosing, treating, and managing the patient (of course with supervision).

I had been in the ICU a few times on clerkships during 3rd year for a few of our patients for extra monitoring, and had come to form my own assumptions that it was an intimidating place filled with lots of machines, chaos, and irreversible sickness. The view I had painted was one of fear, exhaustion, and sadness. However, like most things in life, you never know what something is truly like until you experience it. I admit that some of the ways I had envisioned the ICU were inescapable and true. However, once I learned how the ICU operated and understood how tough situations and complex decisions were thought out and managed in a piece by piece manner, my perspectives about this part of the hospital significantly changed and this ended up being one of my favorite rotations to date.

In the ICU, I saw the delicate tug between fragility and resilience in patients. The individuals on these units are often very sick, fighting for their lives. It is remarkable to see patients who you thought were not going to make it, suddenly improve after caring for them for weeks, creating a truly joyful moment for both the medical team and the family. Unfortunately, there were also many patients who did not make it despite our best efforts. However, as a team we had the privilege of caring for and providing comfort until the end to allow them to pass in peace and with dignity.

I saw first hand the difficulties in sometimes separating emotions from clinical medicine when trying to make decisions. This highlighted the significance of communication and transparency with patients, their families, and within medical teams to allow patients to live the end of their lives in the most comfortable way possible based on their morals, beliefs, values, and what matters most to them.

I came to realize the ICU embodies qualities of a patient and family centered environment. For those patients who are unable to voice their choices of medical care, family members become integral members of the team by giving input about their loved one’s perceived wishes (or what they think the patient would have wanted), which helps guide our decisions regarding how much or how little intervention to proceed with. Open communication with the family plays an important role because that allows the family to build a more trusting relationship with the team. This then translates into better patient care because the family is more comfortable and better able to make decisions about what is best for the patient, which can sometimes mean using minimal intervention to sustain life and keep the patient comfortable near the end.

Families coming together to make decisions on behalf of their loved ones at the end of life placed me in unfamiliar and uncomfortable situations, yet allowed me to realize the importance of these intimate, tough conversations. As medical students in the first two years, our focus is learning how to diagnose, maintain health, and treat. Rarely are we taught about end-of-life topics in the pre-clinical years and the ethical and complicated dilemmas that tend to come with such situations. Exposure to these clinical situations occurs during clerkships. At first it is hard to let go of the mindset that we should use all the tools at our disposal to sustain life, rather than accept that in some scenarios additional medical interventions may be futile and cause more harm than good, especially when the intervention will not change the outcome or prognosis and further hinder quality of life.

In addition to the medical treatment, this rotation further emphasized the equal importance in compassionately supporting, comforting, and being there for the patient and their family members. Even if medically nothing else can be or should be done, listening, empathizing, caring, spending time with the patient, hearing stories from family members and investing in the patient beyond illness can create a sense of healing.

The fast-paced, dynamic, busy environment of the ICU kept me on my toes. Constant learning, partaking in family discussions with our team and other sub-specialists, observing and performing procedures, understanding how ultrasound aids in diagnosing and decision-making, and having the support of the palliative care team allowed for an intense, rewarding experience.

I completed my final rotation of third year with Obstetrics/Gynecology (Ob/Gyn), which felt, by far, the quickest clerkship of the year, perhaps due to the fast-paced nature of the field. I’ve enjoyed aspects of all my rotations this past year, and pleasantly found Ob/Gyn to be a wonderful mix of all the rotations combined. I found it rewarding to spend two months on services dedicated to women’s health. 

My experience began with two-weeks on the Gynecology-Oncology service. Having just finished surgery, I felt comfortable in the OR; however, about 95% of the surgeries were robotic, a contrast to my prior rotation. I saw first-hand how satisfying this sub-specialty can be through its impactful improvement in the health of women, yet also witnessed the difficult conversations and heartbreaking nature of this field.

I then moved on to a private practice for two weeks, a great experience from the hours, to the learning, to the patient interactions. Jumping from gynecology to obstetrics throughout the day kept things interesting and interactive, and allowed me to see the integrative aspects of both fields side by side. Sometimes in the morning we’d be delivering babies and doing hysterectomies, and then in the afternoon we’d be in the office managing acute, follow-up, and emergency visits. There was never a dull moment given the daily flexibility and action.

Following outpatient, I headed to Labor and Delivery (L&D) for one month. As a high school student, I had the opportunity to observe a few deliveries through a program at my school, which were defining moments in confirming my desire to go to medical school. As a result, I had been particularly looking forward to this rotation since first year, and found it both humbling and just as fascinating, if not more, to experience it on the other side as a medical student.

When L&D got busy, it got busy and intense. It was often a mix of emotions in one day from the happy, sad, and in-between. The opportunity to assist in births was the highlight of the rotation and partaking in those moments were truly beautiful experiences. I saw a lot of high-risk situations necessitating immediate action and saw how different teams effectively worked together to manage and coordinate care for both mother and baby during those stressful, vulnerable times. Overall, I got to dabble in various aspects of Ob/Gyn and had a great time!

Last, but not least, on to…The Final Year! :)

Four rotations down-wow! Pediatrics finished up on Friday and I had a great experience interacting with both the kiddos and parents :) This was an 8-week rotation split between inpatient and outpatient. I had inpatient first, and started off my first 4 days of it on night shift at Dayton Children’s, which was really fun (despite the difficulty to stay awake once it hit 3am…even with the hourly snack consumption :P). I absolutely loved taking admissions down in the ER and working up patients, which reminded me of how much I enjoyed that aspect in internal medicine as well. From neck abscesses, to infantile seizures, pyelonephritis, and RSV, a variety of things were to be seen during the middle of the night.

A week later, I joined the inpatient day team. Pediatric pathology is so diverse and it was challenging, yet interesting to learn about and manage illnesses through a pediatric lens after having spent the first two years and most of 3^rd year learning adult medicine. Kids tend to bounce back fairly quickly and it was nice seeing them get better after a short stay in the hospital. Pediatric rounds were so different than I’ve ever done them before because they were patient-centered rounds. This means we presented how the patient was doing, what we thought was going on, and gave a plan moving forward at the bedside. This is helpful for families and patients because it allows them to actively participate with us and ask questions during rounds to provide the best care.

Four weeks later, I began my outpatient rotation at the Wright-Patterson Air Force Base (WPAFB). As a civilian, it was a neat opportunity to rotate here and I had a great time, as there was ample opportunity to engage in different experiences. I spent the majority of my time doing general outpatient, which allowed me to become more comfortable in tailoring my interview and physical exam skills to the pediatric world. I spent a few days in the nursery, which gave me a preview into Ob/Gyn because the pediatric nursery team was typically in the delivery room. It was incredible how much variation I experienced in one day sometimes, from labor and delivery, to circumcisions, to neonatal resuscitation, to acute outpatient visits and well-child checks. I also had the opportunity to work with pediatric dermatologists, cardiologists, neurologists, and endocrinologists while on my outpatient rotation, which provided an overall well-rounded experience.

I learned a tremendous amount during this rotation (mostly new information, some trickles of old), got to see pathologies in the clinical setting I’ve only read about in textbooks, and confirmed my desire to work with children and families in some capacity. Pediatric patients are a special population…they add joy and happiness to the day with their smiles, silly actions, and cute conversation.

This rotation was topped off with a nice study-free weekend of cooking/baking, watching movies, hanging out with friends, and relaxing before the next stop….

Surgery!  

I recently finished up my first rotation—Internal Medicine (IM). Of all the rotations this year, this one is by far the longest…three whole months!

I have to admit the transition between second year/step 1 study period to the start of clinical rotations had its natural hardships. Getting used to the typical nature/pace of what real life medicine is like (rather than passively reading from a textbook), figuring out when to study (and wishing for more time to do so), (even more) lack of sleep, and learning/navigating the hospital system and understanding my role within it wasn’t easy at first. It all definitely took time and patience to get used to, making me reminisce about second year and wanting to go back, but now I can wholeheartedly say (coming from a person who enjoyed the first two years of med school)…third year is even better, especially once you get used to how things work (until you switch rotations again :P).

I began my clinical journey on the general inpatient hospital service for four weeks, moved on to inpatient neurology for two weeks, jumped to inpatient cardiology for two weeks, went back to general inpatient for two weeks, and ended with general outpatient for two weeks. I had humbling patient experiences, and residents that challenged me in ways that allowed me to become more confident in my opinions about diagnoses and plans, making me feel like a part of the team.

Although my brain was stuffed with step 1 information, I found myself frustrated by not knowing a lot of clinical knowledge (I guess that’s the point of M3 year), but I eventually learned the importance of “time” in medicine…each day you know more “clinical pearls,” random facts, and guidelines than you did yesterday…the learning continuum. Each year in medical education has its time and place for a reason, and remembering I was an M3, not a third year resident helped keep things in perspective. A wise resident once told me, “ Don’t worry—I have six years on you, that’s a long time in medicine!”

I enjoyed inpatient very much; something I never thought would happen. It was exciting to be on-call, and enjoyable to piece together and ponder clinical information to put a diagnosis together. As a clinical student, I now better appreciate the human body as “one” and integrated rather than merely separate organ systems. Internal medicine gave me a glimpse of medicine I’d never experienced before, and exposed me to clinical situations marked by moments of frustration, happiness, sadness, and everything in between.

Now…on to Family Medicine!

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!