Boonshoft Blogs

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,

Sarita

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,

Sarita

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.

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,

Sarita

Ps. I chose to get food first

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,

Sarita

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.

The hostess and I have teeth in common… also where exactly am I looking?

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

Sarita

I didn’t join in because was wearing a dress and also not the hugest fan of sweating, especially in public

Felt like I hadn’t seen this cutie patootie in EONS

Perfect hostess snuck some veggie burgers in the corner for me

PSA: you want this gentleman as your kids’ future pediatrician. When his practice becomes packed and he can no longer take any new patients, don’t say you didn’t hear it here first…you also want this guy manning your grill. Yum!

This guy = best neighbor/carpool buddy ever, despite his Dave Matthews Band fandom. I kid, I kid

Birthday boy’s actual birthday was over a week ago, but it’s never too late to enjoy some Doritos

Just another picture of food. Enjoy.

I will spare you pictures of the salmon stew.

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.

I call this my “let me fake like this 5am train commute isn’t the worst thing ever” smile

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,

Sarita

Ps. Many many thanks to my sister for being such a great host (despite taking me to dinner at that weird salad place.)

The (insert adjective of your choice) view from my train window…

I will one day tell my children that when I had the opportunity to stand in the OR with one of my surgeon idols, Dr. Burnett, I was wearing mismatched paper scrubs. Operating room chic.

Menu nope, I did not try the ‘brunch pizza’

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,

Sarita

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,

Sarita

“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.

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,

Sarita