Cancer Sucks

This morning on rounds, my team and I visited a lovely older lady who has ovarian cancer. It has spread throughout her abdomen, and she isn't responding to chemo any more. We were trying to solve some of her main problems, which are (relatively) minor things like nausea and constipation, when she tearfully began to explain to us that all she really wanted was to go home. She had spoken to family, who all wanted her to keep up the good fight for as long as possible, but really she was just so tired of being uncomfortable. You could tell in her voice and her eyes that, deep down in her soul, she was ready to be done and move on and not suffer, but she also did not want to let her family down. Medically, there's really not much to be done for her except keep giving her chemo that's only holding the most severe symptoms at bay, all while creating new symptoms that aren't all that much better than the old ones. And down in my heart, as we patted her shoulder and told her we would call a chaplain and arrange a family meeting to decide where to go from here, I saw the face of my grandfather as he begged us, not long before he passed away, to just take him home from the hospital.

Moments like these are visceral, soulful, painful, terrifying, gut-wrenching and momentous. They are the reason I wanted to become a doctor, and they make otherwise boring rotations meaningful. I hope I am able to visit her again tomorrow on rounds, even though she is not technically my patient. And I hope that whatever choices she makes, they are the right ones for her and she is able to live out her remaining time in as little pain as possible.

Gyn/Onc

One week into Gyn/Onc and I have very mixed feelings. Well, maybe not so mixed. I mean, on the one hand, some of the surgeries are relatively interesting (at least, what I can see of them from my appointed student spot of "the end of the table" with my retractor firmly in hand). On the other hand, the surgeries are often long and tedious and repetitive--mostly just hysterectomy after hysterectomy--and I have to stand for really long periods, which is painful for me with my back issues, and did I mention that the days are reeeeeeeally long?

I think what I've learned from this week is that I like doing. Which is kind of odd, because most people who are "doers" by nature LOVE surgery--it's the ultimate hands-on fixing of people. But for me, I get impatient. For example: in a surgery I watched the other day, we removed a mass the size of a watermelon from a woman's abdomen. It was crazy (and crazy long, at almost 6 hours between getting into the room and getting out), and something a lot of students would kill to see. But for me, while the getting out of the tumor was interesting, after that all of the nit-picky detail of digging about looking for lymph nodes was just flat out boring. Maybe it's just because as a student, I'm not the one with the scalpel, but I'm not sure I would find it that much better even then. I really prefer things like the morning I spent in clinic, where I got to see several patients and actually talk to them. A lot of people I know hate clinic because they find it tedious (and it's true that you do see a lot of the same problems over and over), but I think the time flies by much faster there than surgery because I am actively involved with a person the entire time.

Maybe this is just how I confirm that general specialties are the way to go for me--but I have to admit, I'll be rather glad when gyn/onc is over at the end of next week and I can head into an outpatient setting for two whole weeks, to see what this specialty is really like in the real world.

Two Weeks

It's amazing what a difference just two short weeks can make. For the past two weeks, I have been working on the labor and delivery service, first on day shift, then on night shift. It's hard to believe it's only been that long, because I feel like I've learned so much that I've been doing this forever. I wish I could have updated more with some of the funnier and/or crazier stories, but when you work a 14-15 hour night, pretty much all that's left is to come home, sleep as long as you can, and head straight back. Luckily, I am off all weekend (!!) before starting on the Gyn/Onc (pelvic cancers) service on Monday. In lieu of an entire post of insane stories, here is a list of some of the lessons we learned as we began our first year of clinical education.

1. There is safety in numbers. It must be a relatively entertaining sight to be an upper level resident or attending wandering through a hospital in early July, watching the looks on the faces of the brand-new third years. I mean, this week we were given a ten minute "tour" of our university's hospital, and then on day 1 were basically dropped off at our location du jour and told to get things going. Lost doesn't even begin to describe. To cope, we tended to travel almost everywhere we went in a pack.

2. It is startling how fast you can adjust to getting up at 4am. I thought it would take years, but that first week I actually wasn't all that tired--I just went to bed at 9 every day. Of course, along with that comes the fact that when you get off work at 5 and go to bed at 9, there's not much time to do anything, but oh well.

3. Medicine is not for the weak-of-heart. On my very first day on the labor floor, I got to deliver a placenta, which is possibly one of the bloodiest and most disgusting things in all of medicine. Some of the surgeries I saw were less gross. But when you're in there, it's kind of just surreal because you don't think about the gross, just about trying to do the right thing at the right time and not piss off the resident. Oh, and not kill the patient. Of course.

4. The emotions can get you. On my last night on night shift on labor and delivery, the juxtaposition between the two main patients who arrived that night was so great that I almost couldn't wrap my head around. On the one hand, we got to share in the incredible joy of a new mom giving birth with her entire family present, screaming and jumping and applauding the arrival of a new life into the world. On the other, we stood by helplessly as the doctors informed another couple that their just-shy-of-viable fetus was probably not going to live, and their devastation was palpable. It was a strange gamut of emotion that rather eloquently wrapped up the experiences on the floor.

5. You learn SO much more doing things in real life. Two years of medical education behind me, and I'm pretty sure I've retained more information in the past two weeks. While I don't know that I'm necessarily interested in OB as a specialty, it is certainly way more entertaining and satisfying to work and learn in the hospital, where information has meaning because there's someone down the hall with the problem you just talked about. Honestly, I thought I would die working 12-15 hour shifts, but they go by fast when you're busy and you get to see a lot and learn a lot. In fact, just this week I saw: at least 4-5 deliveries, 3-4 C-sections, an open surgery to evacuate a blood clot in someone's abdomen, a laparoscopic surgery to diagnose abdominal pain, and countless patients coming in and out of our triage area with complaints ranging from labor to back pain to swollen feet to urinary tract infections. And from all of them, amazingly, I learned something. Who knew?

The Calm Before the Storm

So last Wednesday and Thursday we had our third year clinical orientation, wherein we were given a bunch of relatively useless and time-consuming lectures about things we learned last year (lab values, note writing, etc.), remembered how to perform CPR (and got the cards to prove it), and got a tour of the hospital where we begin our first rotation. I start on OB/GYN, and I'll be doing 2 weeks of labor and delivery (first day shift, then night shift), 2 weeks of gynecologic oncology, and 2 weeks of working in a private practice somewhere in town. I start Tuesday morning at 7, have a few hours of orientation to the service, and then get to change into scrubs and get going. Wednesday through Saturday I'll be working 5am-5pm, then next week 5pm-7:30am. I'm not quite sure what to do, but I've been told we're not expected to know much, which is slightly comforting. I am both indescribably excited and completely terrified--after all, this is what I've been waiting for.

But before all that gets started, a brief word to celebrate the idea that became the goal of a baby nation with almost no chance of survival, from a group of rebels who (had things gone differently) could have been hanged for treason.

We hold these truths to be self-evident, that all men are created equal. That they are endowed by their Creator with certain inalienable rights; that among these rights are life, liberty, and the pursuit of happiness.

ALL. All men are created equal. No matter what we think or believe or how we vote or what struggles we face today, that's really the crux of what became the United States. Not some men, or white men, or rich or straight or English-speaking men. ALL men (and women!) are equal. We don't always get it right, but it's there and it's beautiful if you really sit down and think about it.