Mine

This week, I am rotating on anesthesia in the pediatric hospital. Mostly this has been relatively boring, with lots of watching and very little doing. Today, the resident asked the attending if "the medical student" could "bag" the patient--that is, to hold the mask and squeeze the little balloon full of air to simulate breaths in the time period between the patient becoming unconscious and the patient being intubated and mechanically ventilated.

The act of "bagging" is relatively simple: hold a tight seal between the mask and the patient's face, lest any air escape rather than entering the lungs. Squeeze the bag at a rate that will allow for a normal respiration. Hold the patient's chin up to direct air into the lungs. I have seen this maneuver performed countless times, and it looks about as easy as it actually is. An important step, to be sure, but not terribly exciting.

The patient today was a beautiful little girl, about 3. Soft blonde hair, blue eyes. Anxious family members numbering into the double-digits. And the same disability as my sister. When we gave her the medicine that set her off to sleep and the resident handed me the mask and bag for the first time, it was just like I had seen a hundred times--except completely different. As the patient's own respiratory drive ceased and my hands took over, this was more than the movement of air, more than my hands performing learned maneuvers to bridge the gap to the ventilator.

In those moments, as the room buzzed and the attending searched for an IV and the nurses prepared the sterile drapes, that little girl became Mine. She was my sister, my safeguard, given over to my care and keeping. And I breathed for her.

Updates and Interviews

As I sit here at a tiny table in the med school library, chugging away at my appointed 25 pages of First Aid for Step 2 (cardiology...ugh), I am just bored enough to realize that a lot of time has gone by since posting. I finished my AI on the pediatric wards with great success, dove into two weeks at the outpatient clinic where I'll be doing a continuity clinic (one afternoon a week) for the next several months, and took my Step 2 CS exam. Now I am "blissfully" off of rotations until October 24, with the joy of vacation somewhat tempered by the fact that I have to take the written portion of my Step 2 board exam on October 20. I did at least give myself the week or so after the CS exam off and played a lot of video games, though.

CS was interesting--12 "standardized patients" (actors) who present a fake illness which we have 15 minutes to question them about and do a physical exam pertinent to, followed by 10 minutes to write a detailed note on the encounter. And repeat. Mine wasn't horrible, mostly bread-and-butter medicine cases, though there were at least a couple where, upon the leaving the room, I had the unmistakable feeling of being completely at a loss. I think I did well enough to pass, so I'm letting it go. At least with CK (the written portion of the exam), I know how to prepare--standardized tests, bring it on.

I finished my residency application and turned everything in on September 1, and so far I have 7 interviews at places throughout the country (though mostly within a 4-5 hour drive of home). I plan to try to stay at my home program since D has a job and we have a house and our families are here (and hey, it might be nice to think about starting a family before I'm 35), but I have to admit I'm kind of excited to see what other cities and programs have to offer. I sent applications to some very highly-regarded programs and already have interviews to a couple, so maybe I'll fall in love, who knows? I'm excited to do some traveling, if nothing else. Hopefully my bank account won't be too much the worse for wear at the end...

The perks of being a 4th year

Two weeks into my AI on the pads wards and I find that I actually somewhat like being in the role of a resident. I don't mind being at the hospital long hours as long as I actually get to do something with most of my time, and the nice thing is, my residents are pretty good about giving me the leeway. I do my own H&P's, see my own patients, follow-up on cross-covers, check labs, make and give check-out...all things that I couldn't (or could only do in very limited fashion) last year. It's nice to feel that I actually have some legitimate responsibility, even if I can't actually sign anything yet. But even just knowing that my residents trust me to give them an exam or to write the check-out sheet without double-checking it is awesome and reaffirming.

I do have to admit though...perhaps the greatest sign that I'm being treated like a resident is that every time the pager goes off on our call days, I cringe just a little bit inside. Thankfully, yesterday we only admitted two patients on-call, and neither of them were to our hospitalist service (one an epileptic to the neuro team, the other a new diabetic to the endocrine team). So we sat around chilling out most of the day and eating cookies, which is my idea of an excellent call.

Speaking of excellent, I secured another letter of recommendation today, which brings the grand total up to 3 and makes my applications at list a little more complete. Now to take a picture that makes me look somewhat professional and hopefully not too "deer in the headlights on a passport" and we'll be set to go.

Monday Funday

I saw a fundus yesterday, for the first time.

The eye exam has always evaded me, no matter how many times I shone glaring lights into unfortunate patients' pupils--all I ever saw was a blob of red and maybe the occasional vessel, but never any obvious optic disc or macula or other landmark the way you're supposed to.

Yesterday, with the help of a hilarious 6-year old and a very patient doctor who asked me to show him how I did the exam, then corrected all my horrible mistakes and patiently had me repeat them (all while the poor kid sat with my light blaring into his eyes) until suddenly, there it was.

I haven't necessarily become enamored of neuro, but it's nice sometimes to at least know you've accomplished something.

Found

Wow...April? And now it's...July? Well we'll just all pretend that didn't happen.

I really don't have a huge excuse for the giant and obvious lack of documentation of the last three months of my life, other than to say that, as the last post probably makes obvious, surgery was an incredibly difficult two months for me--mentally, physically, emotionally, spiritually, medically...you get the idea. The place I found myself in at the end of the rotation was not a pretty one, and while I expected to bounce back quickly with a celebratory end-of-surgery Royal Wedding Watch Party, getting back to normal was not as easy as I'd thought. In fact, I found myself to be, for lack of a better word, lost. For quite some time. I spent much of my family medicine rotation attempting to find the part of myself that surgery had someone beaten out of me, but in the end it was not something that could be forced. Instead, the defeated and sad little humanist, joy-in-medicine and champion-of-underdogs that lives in my head came crawling back slowly over time and, with the help of excellent friends, a husband with the patience of Job, a lighter rotation that allowed for some restoration of sanity, and a week at the beach, and a little help from Harry Potter, I seem to have found myself again.

So. Enough of all that depressing stuff.

A quick wrap-up of the past three months: I finished surgery and survived all of that. I spent a week in the PICU doing career exploration (saw some neat stuff), six weeks on family medicine (4 weeks out in rural areas in a private practice, where I had a minor career crisis thinking I liked it and was then reminded that day-in/day-out cholesterol checks are NOT. MY. THING.), and a week at the beach restoring my soul. It all went by too quickly. Now I'm officially a fourth year (!!!!), but unfortunately it doesn't feel like it very much yet because I start on neurology, one of the only two "required" rotations of the year. So really, because I'm still rotating through with only my class, we get no senior standing about other students, no special privileges, and aren't doing anything fun or new or interesting like many of my classmates who began the year with electives or Acting Internships. Add to that the fact that we still have to take a test at the end of the month (something practically unheard of in fourth year), and it feels like an extension of junior year. Luckily it's only four weeks, one of which is already over. I'm currently on the stroke service at our hospital, and after this week I get to switch to child neurology which I'm hoping will be much more exciting (or at least a lot cuter).

I'm also in the process of beginning residency applications, which I'm sure will be the source of many more posts in the near future. I've filled out the "Resume" portion of the application already--we can basically start entering everything now but can't turn it in until September 1. The big issue at this point is working on my personal statement--why I want to be a pediatrician/would be awesome at your institution/what I want from you/please accept me I'm awesome in 1 page or less. Woot. In fact, that's what I should be working on right now, but obviously procrastinating here is a much more desirable use of my time. Ah, well...perhaps if I go actually get it done, I can come back here and explain the insane process that is the residency application or something later.

Til' then, it's good to be back.

I've been trying, for the past few weeks, to come up with a way to write about surgery. It's been difficult. The past four weeks have been a more emotional time than I expected, and in the few brief moments of downtime it's hard to reflect on or interpret all of the feelings that bounce around in your head over the course of the 90 hour work-week.

That's basically what I've been up to the past month--I worked for 3 weeks on the general surgery service at a local private hospital, taking call every fourth night. That means that in the average week, I spent one or two 27-30 hour shifts in the hospital, maybe sleeping an average of a couple of hours each time. Some nights are lucky--my last call at this particular hospital we were pretty dead and I got to crash for six hours, but in exchange for that last night on trauma call (we all have to take one night on the trauma team at the local university hospital during our rotation) I stayed for 25 hours and didn't sleep for more than 20 minutes.

I don't particularly enjoy surgery. I expected this coming in--knew that the pace of the OR, the attitudes of the field were not really a good fit for my personality. I've been lucky to work with good residents who have made it more enjoyable than it might have been, but that doesn't make standing still for 6 hours, covered in a hot gown/gloves/mask/hat combo, craning your neck to see something that you will never be allowed to touch all that much better. I also never really want to see another gallbladder in my life.

It's stressful, this feeling of being so totally not cut out for something. I want to do well, to impress my residents and attendings and learn something even if at the same time I want to run away from this rotation as fast as possible once it's over. But I come home at the end of an 11 or 12 hour day, with barely enough time to cook dinner before it's time for bed again and still there is studying that must be done in order to pass the test, still there are things to be done around the house and things that, amazingly, I want to do in my spare time even though there is no time in which to do them. The stress of having to balance all the things that you want and need to do while managing this kind of schedule (especially sleep deprived) is what has made this rotation so difficult. There is no time to rest, no time to sit on the couch at the end of the day and take a breather or think about the day or talk with loved ones for a moment to regain some shred of humanity. That is the toll that surgery is taking on me. Long hours are do-able, boring work is tolerable, even rude or absent team members can be dealt with for a few weeks at a time, but the feeling of running ragged with no chance of ever catching a breath takes a mental toll I wasn't prepared for. (And of course, it doesn't help that I apparently don't do well in hot rooms when my blood sugar drops--add fainting once and having to sit down to prevent fainting another time to the list of stressors--and embarrassment. Woot.) I will be very glad when the next few weeks have passed and I can find myself, can let the tension go and breathe again.

The next 2.5 weeks should be better. I am back at the children's hospital, doing pediatric surgery with people who, while still surgeons, are much more pediatric-minded--more open to teaching, more talkative and friendly, and of course where there are kids and smiles and fewer whiny adults who complain about their need for potato chips the morning after appendectomies. I'm back in my happy place, even if not exactly doing the job that makes me happiest.

But still--April 29th can't come fast enough.

A recap

I'm such a horrible writer.

Much happened in February--so much, in fact, that there was hardly time to process it, let alone to write about it. I worked on a wonderful inpatient team at our local children's hospital, trying very hard to impress people in my chosen field because I hope, next year at this time, to match here for my residency training. It being winter, we were incredibly busy around the hospital, with record numbers of kids admitted, at one point so many patients hanging out in the ER waiting for beds in the regular hospital wards that they had to set up a tent outside to act as a temporary ER because there wasn't enough space otherwise. But yet even with all that going on there were all long call nights where my team sat around in the doctors' lounge watching TV and waiting for many hours to be paged with the news of a new patient who needed to be admitted to our service. Hurry up and wait, hurry up and wait.

As students, we were only allowed to work with patients who were admitted to the hospitalist team--and usually about half of the patients in the hospital at any moment were that, with the other half being admitted to private physicians who came and saw their own kids at the hospital, or were admitted to other specific teams (things like neurology, or GI, or pulmonology). So some days I would have 3 patients to see in the morning, but on some days we would only have 1, or even none, depending on how quickly we were able to discharge people. It made for a very interesting month.

I saw a lot of babies with bronchiolitis and young kids with asthma, exacerbated by whatever recent virus they happened to have picked up recently. A lot of people consider that to be boring, seeing the same thing over and over again without a lot of thinking involved. I was worried, myself, that that might be the case, but the great thing about kids and children's medicine is that there's a lot of turnover--as opposed to adult medicine, where the patients might linger for days, long after you've diagnosed the problem, waiting on lab tests or simply just not getting better, kids tend to heal quickly and leave the hospital just in time to make room for another kid. And even if that other kid has the same diagnosis, they are inherently different and have some other background story and/or cute little characteristics that make it worthwhile to hang out with them and their family, even if all that's wrong with them is the massive amount of snot hanging out in their lungs.

We saw other things, too--babies with jaundice who got put under lights for a few days, a baby with laryngomalacia who was really noisy when he breathed and made his parents (and us) really worried for a while, a teenager with mono that swelled her tonsils to the point of shutting off her airway.

All in all, it was a wonderful month, and very much affirmed my choice of pediatrics for my future career. Unfortunately, now I have been thrown headfirst into the midst of surgery, the most daunting rotation of med school, and have 7 more weeks to survive before I can catch my breath again. Wish me luck.

Goo Goo Gah Gah

Things learned after a week in the newborn nursery:

1. Newborn babies smell fabulous. Seriously. Go smell a baby. You'll be glad you did.

2. Swaddling is more difficult than you'd think. I mean, wrap a baby like a burrito, how hard could it be? Harder than it looks, my friend, harder than it looks.

3. Poopy diapers are not as disgusting as I thought they'd be.

4. Babies = not so breakable. After just a couple of days, you get used to picking them up and flipping them over and whatnot without worrying that their head will snap off.

5. Work is not work when you spend your morning with one hand on your stethoscope and the other on a pacifier.

Connect

I love Peds.

I'm probably beginning to sound like a broken record, aren't I?

Today I saw well babies who needed shots, kids with viral illnesses and fevers whose parents were worried about the possible need for antibiotics, kids with dry skin and coughs and ear infections. I sat and chatted with a very shy just-turned-teenager whose mother began our talk with "He won't talk to anyone he doesn't know."

"Ok then," said I. "Let's get to know each other." I told him my name, where I was from, things I liked to do. I asked him where he went to school, what he liked to do with friends, what he wanted to be when he grew up.

"There. Now we know each other."

And suddenly we know that I like video games just like you like your xbox, and you got a kinect for Christmas, and you might be able to use that to exercise. Now we can identify goals and make changes and try to bring your blood pressure down and get you to stop eating chips after school so you can lose some weight.

I handed out some Benadryl today, and looked in ears and proclaimed them uninfected, but more than that I made connections. And hopefully those connections will result in healthier, happier kids and families.

That is why I love peds.

Love at first sight

My day today flew by so fast I looked up and couldn't believe it was 5:30.

I saw well babies, kids with viruses, a rash, an almost teenager with a weight problem who loved basketball. I chatted with moms and played with younger sisters and was apparently the interpreter phone magnet (seriously, folks, my spanish skills are not good enough for this business).

At first I was nervous, because I'm at the clinic where I did my externship two summers ago, and wondered if my attendings would find me as impressive now as they did then (when they had no expectations--what if now, as a third year, I was just another third year?). At the end of the day, however, the attending I was working with went over my note with me, quietly told me that it was good to have me back, and that my note was better than an intern's. They asked if I still wanted to do peds and were pleased to hear that I was pretty much set at this point.

There is no other way to put it--I LOVE what I did today. I loved everything about it. I walked out of work so happy I couldn't help but smile. It was one of those Aha! moments when you just know. It's right. This is right. I am in the right place, I am meant to do this, and I am good at it. I love peds, and I will make a good pediatrician, and I am so excited for these next two months.

The only problem now will be how to force myself through two months of surgery after this is over. :-)

2010

It's 2011? Really? This seems, for some reason, much more surreal than most other changes in the calendar. I'm not sure what it is, but something about "2011" seems much more futuristic and far-off and other than 2010 or 2009 before it. Or maybe it's just that after 2011 comes 2012 and in 2012 I'll actually have someone put green hood over my head and call me "doctor" and expect me to actually know something.

Either way, with the passing of time and dropping of the ball (even with all of the absolutely horrifying musical acts it entailed--I mean seriously, was anyone else watching the washed up awfulness that was the New Kids on the Block/Backstreet Boys mix last night? I mean, how old did those guys look?) comes time for reflection on what has passed, and what will come. Sometimes it's actually hard to remember what happened a full year ago and remember that it actually was just a year ago that you were doing those things, after all.

So, in 2010:

• January started with Pathology and lots of it. That's most of what I remember--studying for a shelf and being very beaten down with it, and relieved when it finally ended.
• February and March were basically just school, with its studying and whatnot.
• In March, D and I took a fabulous spring break trip to Vienna, Austria as a delayed gratification gift for our first wedding anniversary (the previous June). Even though we were both sick by the end of it, it was fabulous--D's first time, my second, to what has quickly become our favorite city in the world.
• April and May, if I remember correctly, weren't incredibly exciting other than the weather got warmer and school got less difficult. The first weekend of May I took my last final of med school and drove home with the windows down and Sweet Caroline blaring and good times never seemed so good. Of course, the next day I had to start studying for the boards.
• The month of May I spent locked up studying for boards. That is all.
• In June I spent 3 glorious weeks on vacation, including a week in Florida with family.
• July kicked off the insanity of third year, with a six weeks spent on OB/GYN rotation, which I enjoyed somewhat (labor and delivery was fun, oncology not so much). I ruled out OB as a future specialty.
• In mid-August I switched to Psychiatry with child Psych, which I really enjoyed (mainly because of the kids and the people I worked with. We had great hours and a great team, but at the end of six weeks I was bored. Definitely not being a psychiatrist.
• At the end of September I started Internal Medicine with a month on wards at the VA. I had a good team of residents and a scary attending, got along ok, and tried to convince myself I liked it. Some things I liked, others I didn't...I went back and forth for a long time. November I spent on Infectious Disease and enjoyed my HIV patients a lot. December I was on endocrine and decided that Diabetic patients were what probably tipped the scales away from Internal medicine for me.

And now for 2011:

• I get to start my year on a pediatrics rotation, which I am very much looking forward to.
• This year, I will start applying to residency positions, and hopefully begin interviewing in November and December.
• I plan on surviving surgery.
• I will (hopefully) escape for a bit to the beach.
• I will celebrate my third wedding anniversary

Can't wait.