Tuesday, October 16, 2007

The Intern 15?

At our recent intern retreat, our program directors took the liberty of flashing a picture of each intern in a slide show. Most of the pics were taken from those submitted with our residency applications, and we just had to laugh! We all look so different. Shiny, happy, and new in our best suits. Now I'm wearing T-shirts over drawstring pants covered up by my greyish white coat.

After the slide show, two people commented to me that it looks like I've lost weight since my picture, and after weighing myself (finding a scale in a hospital can be surprisingly difficult), I found that it's true! While my friends have been moaning about the "intern 15" as equivalent to the "freshman 15" gain in pounds, I've been losing weight. I guess it depends how you deal with stress, and for me, I usually can't relax and eat until all my work is done. That means I've missed a meal here or there, and I rely a lot on snacks in my pockets, mostly granola bars.

However, I just started on a new wards team, and there's food everywhere! Munchkins! Candy bars! Pumpkin-shaped cookies with frosting! Maybe the "Intern 15" will be in my future!

Friday, October 5, 2007

Starting at the VA / Winning the game!

I'm about three weeks into my rotation at the VA, and at first, it felt like I was starting internship all over again.

Being in a different hospital means many things are different. As an intern, it's my job to get stuff done--tests, labs, consults, etc. If they don't get done, I see it as me failing at my job. Patients staying extra days in the hospital means higher risk for hospital-acquired infections and complications, so all around it's frustrating for me and somewhat dangerous for my patient when there are delays in diagnosis and therapy.

The VA computer system is regarded as one of the best if not the best in the country. However, if you don't know how to fully utilize it, it can be a complete disaster! Although I did a rotation at this hospital as a medical student, I wasn't familiar with all the steps it takes to get things done. It was taking me 30 minutes to figure out how to order regular finger sticks to test blood sugar levels on a diabetic! There's also cultural things about each hospital--which antibiotics they tend to use, availability of certain imaging, consults, and pharmacy rules. If you don't know these things, you'll definitely be less efficient.

However, I'm on another great team, and we all helped each other out as best we could. My first week was plagued with late nights cursing the separate menus on the computer system, and I would come home every night wondering why I could not get myself out of the hospital earlier. I have slowly picked up tips in my weeks there, and today, I won the game!

"Winning the game" in the medical training sense means discharging all your patients the day before a routine day (a day when you are not admitting patients to the hospital). It's a big deal because it means that you don't have to go into the hospital on your routine day--an extra day off! I didn't even realize I had won the game until my last patient left the hospital and my list said "no patients found". There were lots of high fives all around, but it felt that the stars aligned for this to happen. I don't know about other programs, but I see it as pretty unlikely that I'll repeat this feat again.

Saturday, September 15, 2007

Performing my IADLs

When I started internship, I knew that posting would be intermittent, but the longer it had been since I posted, the more pressure I felt to write something especially insightful. The days turned into weeks, and here we are at a whole month since my last post! I've read about this happening to other physicians-in-training with blogs, and I decided just to post about whatever comes into my head. Here we go!

The last month was fantastic! I was on an outpatient rotation, which entailed seminars and clinical experiences aimed at residents interested in primary care. While I should probably write about my excellent clinical and didactic experiences, the best part of the last month was having time for what physicians call "Instrumental Activities of Daily Living" or "IADLs". During a geriatrics conference, IADLs were jokingly referred to as "Things interns don't have time to do." It's funny but sadly true. IADLs include the following:
  • Using a telephone. During my last wards month, I had many voice mails from my mother, and at one point, she called my husband to make sure nothing had happened to me. Well, internship happened to me, but during the last month, my whole family came to town to visit. Plus, I was able to chat with some old friends I hadn't spoken to in a few months.

  • Grocery shopping and cooking meals. After burning myself on the oven my first month, I've not been as keen to cook. I do have a few recipes that I can throw together in a few minutes, such as fried rice or spaghetti, but after two years of marriage, my husband is now learning how to cook basically out of necessity. Plus, my stomach wasn't adjusting well to our greasy take-out diet. Over the last few weeks, I was able to indulge in one of my favorite hobbies--trying new recipes. Yesterday, I made my own pizza dough, and I put some in the freezer for the upcoming wards month along with some frozen vegetables.

  • Housekeeping. During this month, my husband and I actually bought some furniture and finished unpacking our boxes from our move over three months ago. Yay!

  • Laundry. If my husband didn't wash my clothes for me, I probably would be wearing scrubs daily because the hospital launders them. I hate wearing scrubs mostly because they don't fit and drag on the ground behind me, making me look like a kid playing doctor, but if my husband goes on strike, I'd wear them.

  • Paying bills. Credit cards would never get paid without the automatic payment feature.

IADLs contrast with another scale used by physicians describing Activities of Daily Living (ADLs). They are things that interns (hopefully) still do regardless how busy they are, including bathing, brushing teeth, feeding themselves, dressing, and using the toilet. However, I've been known to be driving home at 9 pm realizing I hadn't been to the bathroom since the morning, and there are days when I would have starved had it not been for the granola bars in my pockets.

I really do want to write about some of my other experiences during this month, including giving a talk in front of my fellow interns and residents and learning about outpatient pain management. However, I'm basking in my last two consecutive days off until January.

Wednesday, August 15, 2007

My pager: Putting things in perspective

I meant to write this post last week, but I kept putting it off. Anyway, I had that really crazy week, and as my husband pointed out, it wasn't a bad week, just a very busy one. I went to the beach on my day off, and while soaking in the sun, I was able to reflect on my week.

With a little distance, I could see that I was getting overwhelmed. What I really needed to do was take a few deep breaths and tick things off my to do list one at a time. It's easy to feel overwhelmed when my pager is going off every 30 seconds interrupting my routine. Coming from the ICU, I was used to returning pages right away, but I've learned that I don't always need to sprint to the nearest phone when my pager goes off on the wards. Sometimes I should take a few minutes and finish eating or the conversation I'm having with a consultant. About 99% of the pages I receive are not urgent at all. Most of the time it's the phone number of a nurse who wants to tell me that someone didn't eat any breakfast or would prefer ibuprofen over tylenol. With anything urgent, they text message me what I need to know immediately. After figuring that out, I've managed to avoid heartburn from gobbling up my lunch in the elevator and actually sit through a few conferences.

I'm on my last week of this wards block. Tonight will be my last overnight call for a few months because I'll be on a few specialty services (cardiology, oncology) that have different call schemes. While I like admitting all my own patients, I won't miss overnight call and how it screws up my sleeping schedule for days. I can't wait for next week because I start a whole month of primary care!

Sunday, August 5, 2007

What a week!

If I've been painting a rosy picture of internship, maybe it's because I've been lucky enough to have a few good weeks or maybe a bad day here or there mixed with mostly good days. This week was terrible. Everyday was a nightmare. When I tried to explain my bad days to my husband, he pointed out that nothing really bad (e.g. patient dying, giving someone the wrong drug) happened; I just had long, busy days. The wards are a crazy balancing act, and I'm working on my juggling skills. Our schedules aren't so bad if everything goes according to plan, but some things can really screw up your day:

1. When admitting, all your new patients can come to the floor at the same time. The way we're assigned patients is designed to avoid this. However, patients come from the ER, directly from clinic, transferred from other hospitals, and transferred from the ICU. Although I hear about the patients at neatly spaced intervals, through the mysteries of patient transport, sometimes they all come at once. So, I have to run around and make sure they're all stable and then try and do a quick assessment to put some basic orders in the computer (patients will complain if they don't get dinner, and nurses will complain if there are no orders in the system!). Once they're stable with dinner on the way, I have to figure out what's wrong with my new patients and how I'm going to fix them (or at least what to order to help narrow down the differential).

2. Patients can become unstable. Nothing can destabilize my day like a call that says, "Your patient is having shortness of breath and is desating to the 80s." Yikes! People not being able to deliver oxygen to their organs is really bad, and it requires dropping whatever you were doing (e.g. rounding with the team, writing prescriptions so another patient could catch his 2 pm ambulance to rehab, eating lunch and enjoying a teaching conference, or preparing your signout to leave for the day) and running in that direction. Having been in the MICU, I have some experience with unstable patients, but I also have more patients to take care of. Once the patient's oxygen saturation has gone back up with a face mask, blood has been sent to the lab, the STAT portable chest xray team are on their way, when is it okay for me to resume my other activities? For me, not for a while. The best I can do is park myself at a portable computer outside the patient's room and try to move my other patients along, but it's hard to think about anything else except my patient possibly needing to be moved to the ICU.

3. The absence of a member of your team. I'm fortunate to be on another great team, but when one team member is gone, things can get crazy. Sometimes they're at clinic or have the day off, and in addition to my work, I'm responsible for their patients, too. Double the patients to take care of! Whenever that's going to happen, we try to make sure everyone is "tucked" (e.g. discharge summaries and prescriptions ready for possible discharges, labs ordered, consults called, etc.) but sometimes you can't predict what will happen when you're covering someone else's patients. Also, having a covering attending or resident can throw everything up in the air as he or she can have a different interpretation of events and labs and want to completely change the plan. Of course, they'll say to me, "It's your patient, and your team has a plan. However, I'm not sure why you haven't considered this possibility." Well, when you put it like that, I'd be hard pressed not to go along with their suggestions.

4. Medical students. I absolutely love having medical students and teaching them, but in the crazy juggling act that is my day, finding time for them can be difficult. As I was a student just a few months ago, I remember very well what it was like to be a med student on the wards. I try to get my students out as early as I can although sometimes they insist on staying for some unknown reason. I'll take a few minutes here or there to teach them something (e.g. reading chest xrays or EKG's, going over the differential or workup of a particular problem), but some days the best I can do is try to be a role model of a busy but hopefully intelligent and efficient intern.

What makes these crazy days better? Help from my resident and moral support from my co-interns during the day, and when I come home, a big hug and some understanding from my husband that it'll take me a few minutes to shake off my grouchy mood.

Time to go to the beach, so I can start another week rejuvenated.

Saturday, July 21, 2007

Goodbye, MICU! Hello, wards!

Oh man, my last overnight call in the MICU was pretty rough. No sleep. All my other nights I slept at least 45 minutes to an hour, but the next morning I took the advice of my attending and just kept moving because if I stopped I would realize how tired I was. It's really my own fault for not getting any sleep. If things aren't too busy, I usually update future discharge summaries and note templates until 1 or 2 am. If all is quiet then, I aim to sleep between 2 and 5 am, but if a patient starts becoming unstable around then, sleep is hard to come by.

After a week on the wards, I surprisingly find myself missing the MICU. There's a wonderful sense of teamwork among your fellow interns and residents as well as with the nursing and support staff. They were all my new best friends because we depended on each other so much, and now if I pass by one of them in the hallway, we chat as if it's been years since we've seen one another.

However, there are things I don't miss about the MICU:
1. Overnight call every fourth night. It wasn't so bad at the beginning, but the sleep deprivation towards the end was making me a grouch.

2. Carrying the code pager and being on the code team. Although I had the code pager, codes were always announced on the overhead paging system first. I still get a catecholamine rush whenever there's an overhead announcement even though nine times out of ten it's something like "there will be a nondenominational mass held in the chapel at 11 am." Going to codes was fine because my role was well-defined (chest compressions, get an ABG, fetch anything that someone yelled out), but the constant state of readiness was exhausting.

3. Calling family members to let them know their loved one has taken a turn for the worse. I don't mind talking to families. I usually enjoy it, but breaking bad news isn't something that I want to do. It comes with the MICU territory because all the patients are so sick.

It's a bit of a shock to be on the wards again. My patients aren't intubated. They can talk to me, walk to the bathroom themselves, reposition for me to examine them, and often complain about the quality of the food. After being in MICU, these patients barely look sick to me, so I'm working on recalibrating my eyes. I can't say that the schedule is loads better than the MICU because some days I went home relatively early from the unit, but I can't emphasize how nice it is to sleep in my own bed more often.

Saturday, July 14, 2007

Being "Doctor" Jess

One of my first nights, a patient's family member came up to me and asked if I was one of the doctors, and after a confused paused, I realized that the correct answer was "Yes!"

I haven't yet introduced myself as "Dr. ____" to anyone yet. It's still too strange to me. I usually just state my full name and then say "I'm one of the doctors in the ICU." I've only signed my name with "MD" a few times and only when it seemed necessary to say explicitly that I'm a doctor, such as death paperwork. For my charting, I just stick with "PGY-1".

As hesitant as I am to shout from the rooftops that I'm a doctor. I'm realizing how much I love being one. My worst experiences in medicine have been when I just followed orders instead of questioning the plan set by my residents and attending. In the ICU, I'm on a great team that values my opinion. When I say I'm concerned about my patients, they listen, and we discuss the best course of action. It's hard to believe that I only have two calls left in the ICU, and then I'll likely be on the wards, which will present a new set of challenges.

Outside the hospital, I've been making an effort to see my husband and friends. There have been definitely sacrifices, such as missing a friend's out-of-town wedding and not seeing my husband everyday. However, this week after my usual post call nap, I went to see the new Harry Potter movie and have a delicious meal in Chinatown. Despite the constant exhaustion, I never regret going out. It makes me feel like a normal person for a little while. Even working up to 80 hours a week (and it's pretty close to that), I haven't had to sacrifice all the joys in my life. My Tivo keeps all my favorite reality TV shows, such as So You Think You Can Dance, for me, and I've been rereading my Harry Potter books in my spare time.

It's taken me three times as long to figure out what to say in this post. What am I really trying to say? I'm surviving, and it's not so bad. It's actually pretty darn good.

Tuesday, July 10, 2007

As the sleep deprivation sets in

I woke up this morning and thought, "I can't believe I'm on call again tomorrow. Wasn't I just on call the other night?" Yes, I was just on call Saturday night and again tomorrow night. That's the beauty of a q4 call (every fourth night). On my noncall days, I used to stay in the MICU an extra hour to do paperwork--update notes, discharge summaries, or the signout, but now when the resident suggests I go home, I say thanks, grab my bag, and run out the door.

I now recall during intern orientation an excellent talk about sleep deprivation. The presenter said that trying to judge how impaired you are when sleep deprived is as accurate as doing so when you're drunk. During one of my first post call days, I woke up from my nap and tried to cook some dinner for me and my husband. I thought I was fine after my nap, but I ended up burning my arm on the oven door! How bad was my reaction time? I have a very nice, painful, second-degree burn to remind myself that I'm a poor judge of how impaired I am post call. We eat out now on post-call days!

I'm going to sleep earlier and earlier every night trying to remedy the sleep debt, but the truth is I'm just plain tired most of the time. I have 3 more calls in the MICU but I honestly don't think being on the wards next is going to be any easier on my sleep schedule or social life. All I'm thinking about now is seeing the new Harry Potter movie on my post call day. Just one more 30-hour shift until the movie and a day off!

Sunday, July 1, 2007

And on the seventh day ...

I'm resting. There are so many things I could write about because this week has been full of firsts and emotions. Off the top of my head ...

I did my first procedure this week. I was finishing up my work at the end of the day when my resident text paged me, "Get over here. You're doing a lumbar puncture." I had never done one before, but I had seen a few. To make a long story short, I did it! What I felt when I saw the cerebrospinal fluid coming out from the needle in my patient's back was disbelief. I couldn't believe I had done it. My resident was like a proud father running around the ICU telling anyone that would hear that his brand new intern did her first lumbar puncture on her first try. It was pretty cute. I got a lot of pats on the back, and I'm pretty sure that's the closest I'll ever get to feeling like a rock star.

The down side of my rock star moment was that I was very late for my friend's birthday party. I was also dead tired and barely able to hold conversation with an awful tendency to talk about my lack of sleep and little else. I felt terrible because we had purposely arranged the dinner for the night before I was on call (logically known as the "precall" night). Typically your team tries to get you out early on your precall night so you can get a good night's sleep before your overnight shift. What my friend and I hadn't anticipated was my co-intern being off on my precall day, which meant that I was covering the whole service by myself, and things were pretty busy.

As I enjoy my day off, I know that my co-intern is now feeling what I went through on Thursday and Friday (his post call and off days). While the time off is well deserved, it comes at a price. Someone has to take care of my patients every minute I'm not in the hospital. At night plus my post call and off days, one of my co-interns is taking on my load so that I can enjoy my time out of the ICU. I do the same for them. We are all dependent on each other, and I'm with a great group of interns in the unit. We're still trying to find out the best ways to help each other because we're all new at this, but we are all helping each other. This dependency on my teammates is something new for me. As a medical student, sometimes you're a bit extraneous. You're there to learn, and if you can do some work to help the team, then that's great. However, the team can run well (and likely more efficiently) without you. You're sent home way before the rest of team because you have books to read and tests to study for.

After my call yesterday, I got home and slept until 5 pm. My husband and I went out for a wonderful dinner outside on a restaurant patio. I enjoyed actually being outdoors, and he and I talked for hours with each other. There was so much to catch up on! I have no definite plans for today except to relax and maybe read a little bit about ICU management of patients. I want to cook a meal in my lovely new, under-utilized kitchen, call my mother, and deposit my first paycheck. Otherwise, I'm a little surprised at how ready I feel to dive back into work tomorrow morning.

Tuesday, June 26, 2007

Surviving to day 2

Well, I'm still alive. I didn't die of fear, which was just one of my many fears. The first day, night, and call couldn't come anywhere near the nightmares I had the night prior.

When I arrived at the MICU the first morning, the intern signing out to me said, "You're on call tonight? Good luck with that! I was scared coming onto this rotation as the last one of my intern year, so I can't imagine how you feel. Since you're the one on call today, you get to read all the chest x-rays during radiology rounds this morning. Oh, here's the code pager." At that point, I wasn't sure if I wanted to cry or vomit. I was wondering if I could do both when my co-interns showed up. There was work to be done, and if we focused on that, I found myself slightly calmer.

Anyway, I won't bore with all the details, but I can say that most of what people told me beforehand was true. The nurses and residents did take care of us, and we were well supervised. They made sure we ate. We didn't receive any pages until later in the day when we were more oriented, and the pages I received overnight were fairly simple. My resident and attending assured me they knew it was my first night and were available for questions. The nurses were fantastic and guided me towards what was best for the patient.

It would have been nice if someone told me that the code pager goes off every 12 hours just to test them, but there were no real codes. I heard there was a code in our other training hospital overnight, and the patient died. I wonder how the intern over there is doing.

I managed to get 2 to 3 hours of sleep here and there. While I probably could have had more, I didn't feel comfortable sleeping until I knew there was nothing else for me to do and was completely exhausted. I signed out after rounds late this morning. We have intern conference on Tuesdays, and while I know no one would have blamed me for going home, I went to conference. Intern conference is a support group for my class, and I wanted some intern support. It was nice to see everyone and hear how the first day went for everyone. While I have very supportive friends and family, no one knows what this week is like except for my intern classmates. We'll all get through this year together.

Saturday, June 23, 2007

Ah! Baby scrubs!

I find this scary, but I'm keeping the link in case I decide I want to have kids and dress them in personalized scrubs.

Friday, June 22, 2007

Trial by fire?

I received my schedule, and I'm on call in the MICU my first night! Yikes! Since I'm familiar with the computer system and the hospital, it does make sense in a way to have me be the one covering the sickest patients in the hospital instead of one of my new co-interns who doesn't know how to put in computer orders. Perhaps it's best for the program, but I'm not sure if it's best for me and the heartburn I've been having all week.

Here's a selection of responses I've received since finding out about the MICU:

That means the program trusts you! The program coordinator swore up and down that I hadn't done anything to offend her. If the program does trust me, that's great and everything, but I'm not sure what I've done to earn that trust. Remember that I'm interested in primary care. I've never done a MICU rotation, so I'm not exactly reading critical care textbooks in my free time.

Isn't it better to start in the unit to get it out of the way? Well, that's one way of thinking about it, but I know they're thinking, "Better her than me!"

Don't worry the unit nurses are so good. They'll tell you what to do! I hope so because I won't know what to do!

Part of me is excited to start. I definitely didn't want to start on something easy because after all this anticipation I'm ready to dive in with both feet. However, now forced to dive in with both feet, the wading pool (i.e. anything but MICU) looks pretty darn good.

I have to say that my program has done a great job with orientation. A lot of the annoying regulatory paperwork was done online, and we spent a good deal of time meeting each other. We had workshops discussing how to cope with the stresses of intern year, and we practiced procedures on models and cadavers.

A few people commented on how much nicer this week was than med school orientation. People are really interested in getting to know each other, and we have a lot in common. Not only are we all new doctors and interested in internal medicine but we were all drawn to this particular program. I dished with some people over dinner about their thoughts on other programs, and I was surprised that we had the same impressions.

I did purchase a critical care textbook this weekend, but I honestly have so many errands to run this weekend before I start living in the hospital that I doubt I'll get much past the first few pages. I'm honestly scared about Monday. The 8-hour or less orientation days have been exhausting me so my first 30-hour shift will be a bit of a shock to the system. *Taking a deep breath* However, I know that I'll have a lot of support. That's what I love about my program--the emphasis on teamwork. So, wish me luck!

Wednesday, June 20, 2007

Emotions of Intern Orientation

need to get to sleep because lots more orientation early tomorrow morning, but here's a little bit of what i've been feeling.

exhausting. we had a few visits from the lawyers letting us know how to keep the hospital and ourselves from getting sued, the psychiatrists to let us know that at least 30% of us will become depressed, and a representative from every department you can think of (interpreter services, infection control, parking, security). plus, there were lots of lines to get ID badges, TB tests, fingerprinting (!), pagers, etc. this is all balanced out by many social gatherings to meet the department and each other. however, i've been waking up at 11 am for the last two months, and i'm not used to paying attention to anything or anyone for eight hours a day. is it bad that i'm tired and chugging coffee already?

exciting. i got a little misty eyed when i got my name badge with "MD" written at the end. plus, all of my co-interns seem super cool and down to earth ... so far.

scary. our department chairman said that we are basically the face of the medicine department as we are the primary inpatient caregivers. a visit from the medical student clerkship director reminded us that we are an important part of the teaching apparatus. i recall that my intern on each clerkship was a crucial determinant of whether i had a good learning experience. oh, and now i have to evaluate and grade medical students when i was one just a few weeks ago.

currently reading: the brochures comparing different health and retirement plans. aiya!

Sunday, June 17, 2007

Preparing for worst case scenarios

Sorry for the little break. I was a little turned off from writing since my last entry was linked to by some pro-life Canadians. I was angry that some of my words seemed to be taken out of context, but my husband told me he's not surprised because I made abortion sound really gross. Oh well, I'll live and learn. Exciting stuff is happening in my life, so there's lots to write about.

What's my biggest fear about the start of internship? Where to start? ;) Okay, the one that scares me the most is that someone will stop breathing or collapse in front of me and I won't know what to do. You never think you'll need to use CPR, but I was the first doctor-like person to arrive at two codes during my subinternship. Apparently the residency people know about my biggest fear, and maybe that's why they send us to Advanced Cardiac Life Support (ACLS) training right before we start. Our instructor says he loves teaching the two-day course to new interns because we actually pay attention. It was actually a wonderfully practical course with them drilling in the essential steps, medications, and dosages into our brains. We ran through all their scenarios at least two or three times. (What if the heart rhythm is slow but no symptoms? What if the rhythm is fast but there's no pulse? What if you're the only one there? What if it's a child under eight years old?)

I thought that ACLS training was going to be a pain in the butt, especially since it required me to be back in Boston almost a week before hospital orientation. However, I was especially grateful when a few of my new co-interns and I walked into a restaurant this weekend, and a woman had passed out. While we were still too shy to yell, "I'm a doctor," we asked all the right questions. The American Heart Association has come up with some mnemonics that sound idiotic but are pretty helpful if/when you panic. The restaurant people probably thought we were nosy rubberneckers, but we didn't proceed to our table until we were satisfied that she was okay.

In my free time, I feel as if I'm preparing for the end of my life. My friends who are residents are fond of saying, "Are you ready for the worst year of your life?" or "You're not going to have time for that next year!" While I'd like to think that I'll still have time to see my friends and watch So You Think You Can Dance, I am getting my affairs in order. I paid my bills and got my haircut. My husband and I went on a day-long date walking around our beautiful city and splurging on some wonderful meals, and I went out for a night with the girls.

I know my life is going to change in a big way soon. I don't know how big, and I hope to be able to control in some way how much things will be different. We'll see.

This coming week: A full five days of hospital and program orientation plus social events to meet my whole intern class!

Currently reading: Barack Obama's The Audacity of Hope and Mark Bittman's The Minimalist Cooks at Home. I think I'm in love!

Thursday, June 7, 2007

a trip down memory lane: the terminations

I've basically spent the last 10 days doing little else besides packing, moving, and unpacking. However, the effort is paying off in our new home actually starting to look like a home. I start my ACLS training next week, so I'm savoring a few more days of waking up at 11 am and spending unlimited time with my husband.

For those of you who haven't been on vacation for two months and are eager to read some more about medical training, the following is an old post about one of the most unforgettable experiences I had during medical school:

when i thought about going to medical school, i never thought i would spend a morning watching people have abortions, but now that i think about it, i really should have been outraged if i didn't.

one of our professors quit her job at a more prestigious medical school because abortions were no longer part of the clinical curriculum there. at my school, they don't make you watch, but the professor made an impassioned argument for observing at least one abortion regardless of what our beliefs are. being pro-choice myself, i initially didn't have any problems with going to the abortion clinic for a few hours, but as the date got closer, i started becoming more and more squeamish. other med students, even ones who were staunchly pro-choice, said that they became nauseated and couldn't stay for more than 30 minutes or so.

it would be hard to find the abortion clinic if you wanted to hurt the people who are there. it's in a normal-looking clinic, and the woman waits in the same waiting room as other clinics. when her name is called, she is brought to a nondescript room in the middle of a nondescript hallway. there are two rooms. someone else has already talked to her about her choices during a previous visit, and surgical abortion is what she's chosen. when she arrives, she changes into a hospital gown and talks to the nurses.

when the physicians walk in, everything is set. most of the women are put under conscious sedation, which means that they were drowsy but still aware of what was going on. they put a speculum in the vagina just like a pap smear and inject the local anesthetic around the cervix. then they slowly insert small rods into the cervix one at a time, increasing the size of the rod to make the cervix dilate. when the cervix is wide enough, they will use suction to evacuate the uterus. if the pregnancy is very early, they can use what looks like a big plastic syringe. by drawing back on the plunger, there's enough of a vacuum to almost empty the uterus. if the woman is further along, they can use a machine to suction. then, they'll take a metal loop and scrape the inside of the uterus to make sure nothing is left (you can feel the gritty texture of the uterus using this tool), and it's done.

the contents of the uterus are brought to another room and put in some water. the doctors sift through the contents with some tweezers, separating out the clots of blood to make sure that all the fetus parts were removed. i saw only first trimester terminations, so nothing i saw was bigger than my pinky. however, you could see a small skull with an eye and a very thin skeleton. they would usually measure the length of the fetus's foot to determine how far along the pregnancy really was. they identify all the major fetus parts to make sure nothing is left in the uterus to cause an infection.

i almost left after three procedures because i felt sick. it wasn't the procedures themselves that bothered me but the sifting through the uterine contents afterwards. the smell, the small, human-like object torn into pieces and then reassembled to make sure we didn't leave an arm or a head in the uterus ...

what were my impressions after seeing twelve surgical abortions in three hours? the physicians i worked with were all very kind, wonderful people, but i was a bit surprised at how business-like they acted. they introduced themselves, were sensitive to the patient's pain, and made sure to be as quick as possible. however, there was no chit chat before the procedure, no connection made between physician and patient, which is very different from most aspects of ob/gyn. i made this comment to a nurse, and she told me that doing abortions day after day, year after year takes a toll on providers. maybe that's how they're able to keep themselves together.

i was also surprised at how fast things went. it was very efficient with almost a factory-feel to it. the physicians were in the room for about 5 minutes. afterwards, the woman would go to recovery for 15 minutes or so and then leave.

in most areas of the world, women only get local anesthesia during this procedure, so only some of the pain is diminished. one woman did not want the drugs that would make her sleepy, and i could tell she was in a lot of pain. she screamed for the whole five minutes while the nurse who usually injects the drugs could only hold her hand.

i only write about this because i doubt any of you will ever see what i saw that day. it didn't change my mind about whether women should be able to have an abortion. i almost left the clinic after a few, but i thought it was important to stay. however difficult it was for me to see these women go through a difficult and traumatic event, it was more difficult for patient. i certainly better appreciated how performing abortions can take its toll on someone--patient and provider. even if you believe in what you do, it must be difficult, and i'm grateful that some people find an inner strength to provide this option to women.

It's been over a year since I spent the morning in the abortion clinic, but I have thought about that time often. For a while I considered going into family medicine or ob/gyn because abortion services can typically be part of that training. However, I wasn't sure if I could be an abortion provider no matter how strong my belief in a woman's right to abortion access. During my interviews, an internal medicine program director told me that one of her trainees learned how to perform abortions during residency, so I guess that door is still open to me.

Thursday, May 31, 2007

Have I saved a life? Maybe now I have!

I'm fairly certain that thus far in my medical training I haven't saved anyone's life. I have helped take care of people who were very ill, but I have never been the pivotal person who turned a patient around. In today's world of medical teams and complex medical problems, I'm not sure if you usually can point to one person who "saved" someone. However, I do know I have helped people become healthier and maybe eased their suffering a bit by spending time with them in the hospital.

What makes me think that maybe I have saved a life now? I donated blood yesterday! I've always wanted to donate blood, but there are many restrictions for the protection of donors, volunteers, and recipients. For me, the restriction was weight. As I'm blessed with good genes, I didn't meet the 110-pound minimum for donation. I also have recently traveled to the UK and Asia, and I know my husband was rejected as a donor a few years ago because of his travels to Asia. Plus, one of my friends who is a big burly man tried to donate at my urging once but wasn't able to collect a pint in the allotted time.

However, I honestly felt ashamed that I work in healthcare but hadn't donated. Thanks to a decrease in stress and eating a healthy amount on a cruise this winter, I have crossed over that milestone. (Yes, that's the upside of gorging myself for a whole week on the boat!) I know that hospitals always need blood but the need is especially great during the summer and holidays because their regular donors are on vacation. There happened to be a American Red Cross blood drive down the street from me yesterday, so I signed up! Here are a few things I learned:

  • The whole thing including paperwork took maybe an hour and 15 minutes. That's probably because I went during the post-work rush. They say that's the busiest time for them, so maybe next time I'll go a bit earlier.

  • The worst part was the fingerstick to check iron levels. That hurt! The actual needlestick for donation didn't sting as much during or after!

  • If I end up losing the weight, a nurse told me that our local children's hospital takes half-pint donations, so I shouldn't bulk up just to donate.

  • They were a bit worried about me getting dizzy since I'm a rather small adult. After collecting my pint in 6 minutes (minutes faster than my husband! good job circulatory system!), I took the usual precautions of laying down for a few minutes and then having some juice and cookies, and I felt fine afterwards.

  • There is a need also for platelet donations, which only stay good for 5 days, and people can donate every 2 weeks. However, it takeas about 2 hours to complete the donation. Since I my schedule is pretty free until internship starts, I called a platelet donation center this morning and made an appointment!

I feel absolutely great knowing that I donated blood to help someone's future patient, and the even better feeling is knowing that I can do it again.

Wednesday, May 30, 2007

a trip down memory lane: surgery

The moving continues. Three car trips later, my old apartment still looks very full.

I'll continue my trip down memory lane with my surgery clerkship. Surgery and I just didn't agree. First, it's inhumane to regularly wake up before 5 am. Second, there's something about the culture that I couldn't cope with. This is all better explained by the following note I wrote during my surgery rotation:

As a plea for your sympathy, I'm including excerpts from "The Perfect Surgery Student" from the intro of my surgery book so you know what I'm trying to deal with. You can't make this stuff up:

The Perfect Surgery Student

* Never whines

* Never complains

* Is never hungry, thirsty, or tired

* Loves to do scut work and can never get enough

* Never wants to leave the hospital

* Never asks questions he can look up for himself

* Is the first one to arrive at clinic and the last one to leave

* RUNS for materials, lab values, test results, etc, during rounds before any house officer

* Has a steel bladder, a cast-iron stomach, and a heart of gold

* In the OR, always asks permission to ask a question

* Is a high-speed, low-drag, hardcore HAMMERHEAD (defined in next paragraph as: individual who places his head to the ground and hammers through any and all obstacles to get a job done and then asks for more work.)

Man, I'm tired just reading this list. Somehow how I'm thinking that surgery is not for me.

Just rereading that note reaffirms why I didn't choose surgery as a field. Picking a specialty involves being interested in the work and finding a culture or lifestyle that works for you. I'm glad that some of my fellow classmates chose general surgery as a field. I certainly couldn't do it, but we need surgeons in this world. I'm sure if I asked one of my surgery-oriented classmates how he/she feels about spending clinics discussing preventative care and adjusting medications they would start groaning.

Tuesday, May 29, 2007

a trip down memory lane: ob/gyn

since i'm focused on boxing up my apartment while watching various talkshows (i get the most done between the view and oprah during the soaps), there isn't very much to post about. however, i thought i would take a trip down memory lane and pull some material from my old blog or emails i've written to people during medical school. for today, here are some reflections after my obstetrics and gynecology rotation over a year ago.

ob/gyn is over, and now that i'm done, i can say that it was a good rotation. i learned a lot. if caught on a plane with a woman in labor, i might even be able to handle an uncomplicated delivery. it's not that hard, the mom does all the work. doctors basically just catch the baby with some style. however, when there are complications, things can get pretty crazy.

what else did i learn? labor is not always a beautiful experience for everyone involved. sometimes it's not a beautiful experience for anyone involved.

there are lots of body fluids involved. i didn't know this before. i figured there would be blood and mucous, but some women poop as they are pushing the baby out. the baby's head is coming out, and there's a wad of poop underneath it. everyone in the room knows you're pooping including your husband who hopefully will not look too horrified. if you have an epidural, they don't really want you to walk and go to the bathroom. one woman had a pretty full bladder, and they thought it was impeding the progress of the baby. so, they got the medical student (me!) to straight cath her in front of five people (i put a tube into her urethra and let the urine come out into a box). not beautiful. people giggled because urinating in front of two nurses, two doctors, your husband, and a medical student is not fun.

someone might be holding your legs up wide. holding your legs up and wide open can sometimes help the baby come out. if you can't do it yourself, two people (likely some med students you just met) will be holding your legs up and out so your genitals are fully exposed to whoever walks past the curtain.

after the baby comes out, you still have to deliver the placenta. placentas are freakin' big. sometimes they look as big as the baby, and sometimes they make you push that through, too.

mom is the last person to hold the baby. there are exceptions to this rule, but first the doctor holds the baby. she hands it to the nurse who dries it off. then the pediatricians take a look. then they hand the wrapped baby to whoever else is around, usually some random friends or relatives, while mom is pushing out the placenta. everyone else is cooing; meanwhile, mom is tired and wondering if the baby is cute. she's stuck in the bed with her legs still wide open while some resident sews her vagina (hopefully not her rectum, too) back together because it probably has a big tear in it.

oh yeah, your vagina will tear. ok, it might not, but i didn't see a delivery without a tear. vaginas heal well, but when people think about the few minutes after giving birth, they never tell you that we're hoping you have a good epidural while we sew you back up.

consider a midwife. everything i learned wasn't negative. midwives are really quite wonderful, and if your delivery is expected to be uncomplicated, you might want to consider a midwife. i think they respect the birthing experience more, so things are more calm.

Saturday, May 26, 2007

Goodbye, med school notes ... or not!

In preparation for my move across town, I decided that I really needed to get rid of the stacks of medical school notes and journals that crowd my closet and overflow throughout our apartment.

Starting with my notes, I figured it would be easy as I haven't looked at most of those binders for the two years since I have been in the classroom. The information in them is easy to look up in any medical textbook (or with a quick Google or wikipedia search). The first binder was Pathology, and as I pulled out the pages, my hand hesitated to toss them into the recycling bin. Pathology was one of my favorite classes, the one I first learned about most disease mechanisms. Surely, this was the very foundation of my medical knowledge, and when I get confused about the different types of leukemias, there's nowhere else I would rather look. So, I put Pathology back on the shelf.

One by one, I went through the binders, and I was only able to throw out a few subjects. Some I never liked or found much use for beyond basic concepts, such as biochemistry and neurosciences. Others covered specific disease management, which changes every week with the publication of hundreds of medical journals. Looking through those pages, I was surprised to see how much is already outdated.

The journals were next. I had earlier made it a goal to read a journal a day for the last two months, but I realized that wasn't enough. I had at least two years worth of two weekly journals that my husband tries to keep in a few neat piles behind various living room furniture. He pointedly asked a few weeks ago if they were coming with us, and I assured him that they absolutely would not. However, I didn't just want to toss them. Not only had I paid for these subscriptions (albeit at drastically reduced student prices) but I also actually want to read them. They're good journals with great management-changing articles and illustrations, but during medical school, I just couldn't keep up for various reasons. So, I came to terms that I would never read these journals cover to cover and started tearing out articles.

All the medical knowledge I want to take with me is in a pile of 3-inch ring binders and a 3-inch pile of articles. Everything else is overflowing my apartment building's recycling bin. As I become more confident in my knowledge over the years, maybe I will feel comfortable tossing the rest, but I feel better just knowing that I still have with me those eagerly scribbled, multi-colored explanations that served as the foundation of my medical learning.

Monday, May 21, 2007

Hello, Dr. Jess!

All the hoopla is over, and I'm not tired of people calling me "doctor" at all. I'm beginning to wonder how long it will take before greeting my classmates with "Hello, doctor!" gets old. I'm guessing not very long into my intern orientation, so that gives me about three weeks to enjoy it.

Graduation was an emotional day but not when I expected it. During my time on stage I was a little too preoccupied with keeping my tam on while getting hooded and standing on the correct X while shaking hands with the dean to feel the weight of that moment. The emotion came later when my classmates and I stood to recite the Hippocratic Oath. We didn't swear to Apollo as in the original oath but instead said a more modern version, possibly written by Dr. Lasagna.

I do solemnly swear by whatever I hold most sacred, that:

I will be loyal to the profession of medicine and just and generous to its members.

I will lead by life and practice my art in uprightness and honor.

I will do no harm.

Into what ever home I enter it shall be for the good of the sick and the well to the utmost of my powers.

I will hold myself aloof from wrong, from corruption, and from the tempting of others to vice.

I will exercise my Art solely for the cure of my patients and the prevention of disease, and will give no drugs and perform no operation for a criminal purpose, and far less suggest such a thing.

Whatsoever I shall see or hear of the lives of men and women which is not fitting to be spoken, I will keep inviolably secret.

These things I do promise.

In proportion as I am faithful to this oath, may happiness and good repute be ever mine; the opposite if I shall be forsworn.

That is a pretty tall order, but I'll try my best. Congratulations, Class of 2007!

Saturday, May 19, 2007

Graduation eve!

I'm back from vacation! It's too bad I brought the rainy weather of Ireland back with me!

I picked up my graduation regalia, and the whole outfit borders on ridiculous. The sleeves are enormous; Anne of Green Gables would love the sleeves. At least all the other graduates will be wearing the same thing. We'll look like a bunch of Venetians due to our funny hats/tams.

It's dawning on me now how emotional graduation will be for me. Graduating from high school and college were proud days for me, but I've basically been thinking about being a doctor since I could walk. I can't believe it's actually happening. Since I regularly cry at movies made for preteens, I'm definitely going to cry during tomorrow's ceremony. In addition, most of my classmates are leaving town right away. It's time for them to start their new lives in new cities. While many say I'm lucky not to spend the next few weeks driving cross-country with all my belongings, there is a sense of being left behind. However, a new adventure awaits me, too, just around the bend. It's all happening so fast.

Wednesday, May 2, 2007

Fourth year medical students get away with ... a lot

I want to say that we get away with murder, but I don't want some news organization picking up this blog post and saying that medical students are killing patients. We're not! It's just an expression! We are just flying under the radar during our last few weeks of student life. Let me explain.

Fourth year of medical school after the match is largely viewed as vacation time--whether or not you are assigned to be in the hospital. Most students know where they are going for residency, and they know their grades no longer matter. Many people go backpacking across Europe for a few months or "learn Spanish" in Costa Rica or Honduras. My school has quite a few fourth year requirements, so a good number of my classmates are around the medical school campus. However, even if they are supposed to be on the wards, the vacation mentality still prevails. A year ago, students would read about their clinic patients the night before, take copious notes, and maybe even read up on a few of the patients' diseases; now, it's not unusual for the same fourth-year student to slip into clinic an hour late, hoping no one will notice but not too concerned if someone does.

Where did this mentality come from? How do we get away with this slacker behavior? My guess is that this mentality is largely passed on from our supervising residents and attendings. They remember with great fondness the trips they took at the end of the their medical school years and often overlook students' behavior. They know that the next year will possibly be the toughest of our lives, and they are more than willing to give us a few breaks before the insanity begins. I can't tell you how many times in the middle of the workday my resident has told me to run along homeand enjoy my fourth year. How many times can you say no to that?

I haven't been bending the rules too much, but I have been enjoying the free time that comes with relaxed rotations lacking call. My husband and I found an apartment in what my realtor said was one of the worst rental markets in years. Anyway, with that squared away, I've enjoyed the extra time to read. Some recent excellent books include the following:
  • Second Opinions by Dr. Jerome Groopman. While some students might shy away from reading about healthcare during their few vacation weeks, my fear of making mistakes during residency is very real. This book was also so engrossing that while reading it in a waiting room I asked my doctor to give me a few seconds to finish the page! The author does an excellent job of illustrating cases when doctors make mistakes. I finally got my hands on How Doctors Think from the library, and I'm looking forward to reading his suggestions on avoiding mistakes.

  • Dreams from My Father by Barack Obama. Next year's presidential election will be insane. How was there already a debate among the Democratic Party candidates? Anyway, I'm trying to learn as much as I can about each candidate, and Obama's first book flows just as well as his stump speeches. I'm not half Kenyan, half white growing up in Indonesia and Hawaii with a mixture of Muslim and Christian family members, but his story of struggling to find a place in the world is one everyone can relate to. I'm pretty sure Hillary's autobiography won't be as interesting, but I am eager to read her thought on the Clinton healthcare plan.

  • The Omnivore's Dilemma by Michael Pollan. Wow, I consider myself an environmentalist, but I had not spent much time thinking about where my food comes from and the environmental and nutritional consequences of industrial agriculture. Now that I know, what am I going to do about it? I have a small action plan, but that's another post.

Yes, I like reading nonfiction. My problem with fiction is that if the story is good I'll want to stay up all night to finish it. If the story doesn't make me want to stay up all night, then why would I want to read it?

Anyway, since this post was supposed to be how chill the end of medical school is, it should come as no surprise that I will be on vacation for the next two weeks and likely not posting at all. (I'm bringing How Doctors Think and Bridge for Dummies with me.) However, when I return, I'll be moving to my new apartment and have just a few short weeks before the beginning of intern orientation. I'm sure this blog will get much juicier then!

Wednesday, April 25, 2007

?sdrawkcab daer ot drah ti t'nsI ?siht daer uoy naC

There's a lot to learn during medical school. As a society, we know a lot more about the human body, mechanisms of disease, and evidence-based medicine than we did 100 years ago. there are thousands of medications being prescribed with mechanisms of action and clearance, indications, adverse reactions, and drug interactions to memorize, and they each have several names. There's a lot to learn, and medical school has not become longer in the last 100 years.

I'm still learning, and once in a while, there's a lecture that makes something really click for me--a new way of looking at a problem or organizing it in my head. The last one for me was on health literacy, and I hope I never forget it.

Can you read the subject line of this post? My professor handed out a whole paragraph of instructions for us to read but the words written backwards. His point? That process is what it is like to read with marginal literacy skills. If reading is difficult for people, so much effort goes into individual letters and words that the meaning of the whole sentence or paragraph might get lost in the process. That was a pretty dramatic example for me, but how many of patients would this apply to? Here are some stats:
  • 48% of Americans (53% of Bostonians) cannot consistently read a bus schedule or identify information from a bar graph

  • 21% cannot enter information on a Social Security application

  • Patients will low literacy are 4 times more likely to be non-compliant with Anti-HIV meds

  • Low literacy patients are more likely to be hospitalized, to have poorer glycemic control, to have late stage prostate cancer at presentation.

  • 68% of low literacy patients have never told their spouse about their reading problems

This lecture absolutely blew me away. In a busy office, we rely heavily on the written word. Primary care doctors do many things, but patient education is usually a large portion of the visit. Well, it should be, but often the office is busy. Instead, I just hand the patient a print out on their disease and the medication side effects and send them on their way. After being in the medical world for long, I forget that my patients might not know what "inflammation" or "contraception" mean. I thought I would never use medical jargon when talking to patients, but I catch myself doing it all the time.

What's the solution? Unfortunately, all the solutions require time, which is usually short. However, being aware of the problem is the first step. I set two goals for myself:
  • Be aware of medical jargon use.

  • Ask patients to repeat back instructions to me.

I made these changes to my education practices in ophthalmology clinic, and so far, I have caught some communication errors (e.g. one drop four times a day vs four drops once a day)!

Wednesday, April 11, 2007

trying to practice what i preach

as a future primary care doctor, i feel that i should try to follow the advice i dole out to patients, but these things are a lot easier to say than actually follow.

eat right. i have a particular interest in nutrition, so this one should be easy, right? WRONG!!! i love white rice, fried foods, red meat! i don't really understand the new food pyramid that's customizeable. i'm supposed to eat 2 cups of orange veggies and 3 cups of dried beans or peas a week? that doesn't sound very appealing to me. the only diet education that's worked at all for me is the new american plate concept--visualize the plate as 1/3 protein, 2/3 whole grains and veggies. my plate isn't there yet, but it's easy to visualize my goal.

exercise more. i went to the gym five times a week for my first two years of medical school, and i haven't been back since. how did that happen? i made the gym part of my schedule back then. after class, i would go to the gym with my study partner and then hit a coffee shop to study afterwards. if i wanted to be lazy, there was someone counting on me to be at the gym. since my schedule is much more erratic, the gym seems all but impossible for me. truthfully, i don't like the gym that much to begin with. so, i took a page out of the patient education materials i received during family medicine and started the 10,000 steps program. i bought a $10 pedometer and wore it around the hospital. it turned out that some days i was over 10,000 steps and some days i wasn't. what made the difference? strangely, it was all the things i've been trained to tell my patients--take the stairs, take more public transportation, or get off a bus stop early. if i did these things, i was consistently over 10,000 steps. i've been trying to add some pilates to that, but i was only able to do my 20-minute video three times a week for one week. that's right. i stuck with my new exercise program for one whole week, but i'll try again ... next week.

see my doctor annually. this one is definitely easier than it sounds. there was a two-year period during medical school when i didn't go to the doctor. why not? it felt like i didn't have enough time. plus, the wait for a regular appointment with my doctor is six weeks, and with the travel time to and from the office and the unpredictable amount of time in the waiting room, the doctor's appointment will take at least half my day. if i knew i had half a day free in six weeks, would i really want to spend it getting a pap smear? during my ob/gyn rotation, i did pap smears all day long on other women, and i finally worked up the courage to tell my attending i needed to take a morning off to get mine done. going to a doctor is a pain in the butt. why do i make time to go see my doctor? honestly, it's mostly because i don't want to be a hypocrite, but i'm never sorry that i took half a day to go.

Thursday, April 5, 2007

Hallelujah! I saw the macula!

today is a day of celebration! why? i finally saw the macula today with my ophthalmoscope!

the direct ophthalmoscope exam (when your doctor looks in your eyes with a light and gets really close to your face) has been the bane of my existence for the last four years. the idea is that you can look through the pupil to see structures in the back of the eye, but it's like using a telescope to find a specific constellation in the night sky when you're too zoomed in. you can only see a small part of the "sky" in your circle of vision, and you have to figure out how to navigate towards your destination with only a vague idea of where you are. in the eye, you should see blood vessels be able to follow them towards the optic disc (where all the vessels converge). then, you say "look into the light" and the macula, a part of the retina that is mostly for central vision, comes into focus.

i spent hundreds of dollars on an ophthalmoscope my first year, and i have been looking and looking into people's eyes with it. however, the best i have seen are blood vessels before my hand shook or the patient moved. maybe i imagined some of the optic nerve a few times, but that's it. i was starting to think i would never get it, and it would be best just to sell the darn thing and refer all my patients to optometrists or ophthalmologists.

however, today was magic. i was on fire! i saw the optic disc, was able to see the sharp borders and estimate the cup to disc ratio. then i said "look into the light," and there it was! the macula!!! i was surprised (and lucky) i didn't drop my ophthalmoscope. i did do a little victory dance in the hall, though.

i feel like i just climbed mt. everest, and i can't wait to do it again!

Tuesday, April 3, 2007

on shadowing

i'm now in clinic for my last weeks of patient interaction of my medical student life. i'm definitely glad for any teaching i get because because i know i still have so much to learn. i just turned in my limited license application, and i'm starting to get scared about the responsibility that comes with signing "MD" after my name.

sometimes being a medical student is boring. depending on your team, you end up doing a good amount of observation and following people around. (sometimes i go on autopilot. i once followed a male intern into the bathroom by accident! i saw urinal, and i ran back the other way!) actually performing a history and physical myself is more exciting and usually more educational; however, i enjoy shadowing here and there because you have the opportunity to see how different physicians interact with their patients. you can observe their question-asking style and their rapport with patients. i'll often take their techniques on a test run to see how they work for me, and over time, i will hopefully develop my own style.

the other interesting part of observing is seeing how people change their personalities when it comes to dealing with patients. i have met some rather gruff old men who scared the living daylights out of me and the residents, but when we are at the bedside, i'll be amazed at the transformation. they're teddy bears! kindly grandfathers! i've also seen kind, nurturing mentors of mine snap and be dismissive towards a patient. is there a correlation between a person's normal personality and his or her professional one? i suppose anyone starting in a field has to shape their professional demeanor, and i'm beginning to wonder what mine will be. will i continue in my chatty, people-pleasing ways? or will i become authoritative? cynical? callous? i'm hoping the changes will be positive ones that will allow me to be efficient in the office without short changing my patients. we had a seminar in my second year about how medical training makes people lose their empathy. i've been trying to guard against it. let's hope it stays that way.

Wednesday, March 28, 2007

is this as good as it gets?

sometimes i wonder if these months between the match and residency will be the best ones of my life. i'm fairly certain when people talk about how awesome fourth year is they are not referring to the ulcer-inducing process of applying, interviewing, and biting their nails waiting for the residency match. they are speaking of these months between the match and internship that are filled with few clinical responsibilities. my classmates are "learning spanish" in central america or backpacking across europe or asia.

since the match, i have spent my time experimenting with julia child recipes, playing beethoven on the piano, and reading about the history of ireland. i can now remember how wonderful eight hours of continuous sleep are, and i can make time to have meals with old friends. every minute i spend with my husband no longer has to be "quality time" but can just be us goofing off and watching family feud. these interests and habits have been buried for four years while i have been training to be a doctor. now that they have resurfaced, will i have to bury them again come june? i hope not.

currently reading: i finished best food writing 2005 and am now on how the irish saved civilization by thomas cahill. it has a great title but has been a bit of a bore so far. (i have been keeping up with the journal a day but not so much with the cardiology textbook.)

Thursday, March 22, 2007

trying not to become stupid

it might be too late! maybe all that i've learned in medical school has already leaked out of my brain! is taking care of patients like riding a bike? even if you don't do it for a while, does it comes back?

well, i hope that's true. i'm not very good at riding a bike. i never learned as a child, but i bought a huffy at toys 'r' us after college. my husband has been giving me lessons every summer for the last four years, but i still have trouble turning right. each year, i start unsure of myself and sometimes have an incident before i become comfortable on two wheels again. early in the biking season one year, i rode into someone sitting on a bench! (that's a long story.) anyway, the point is that even my rather poor biking skills come back pretty quickly ... but not instantaneously.

i hope i don't get out of practice with seeing patients. i wouldn't want to be the patient equivalent to that guy on the bench. for my daily bus rides, i carry three reading materials in my bag--Dr. Lilly's Pathophysiology of Heart Disease, the New England Journal of Medicine from April 2006 with an article about trans fats, and a pleasure reading book. i'm sad to say that i've read three books for pleasure in the last month, and the poor journal and textbook have not yet been opened. i even read the free daily newspapers left on the bus rather that crack open the textbook weighing down my bag.

there are two reasons i can come up with why i shouldn't be sad about reading books for pleasure.
  1. it's good for me. a physician i used to work for encouraged me to read non-medical books. he told me i would be a better doctor if i was more well-rounded, so he gave me a harry potter book as a going away present. i'm also not much of a sports fan, but i try to keep up with the sports headlines because it's something my patients are very interested in.

  2. somehow everything comes back to medicine. i'm currently reading Malcolm Gladwell's The Tipping Point: How Little Things Can Make a Big Difference. i thought it would be more about sales psychology. it is, but the first chapter discusses reasons behind a syphillis outbreak in baltimore in the mid-1990's. the debate about healthcare--who gets it, how they get it, and who pays for it--is ongoing; it's inescapable in today's world. sounds like a topic for a future post!

i'm a goal-oriented person. it's hard for me to accomplish anything without a to-do list. so, here it is:
  1. flip through one journal a day. i have a year's worth of NEJM's and JAMA's on my floor, and they are not moving to the next apartment with me.

  2. read two chapters a week in my heart book. i should know all of it, so hopefully it'll go quickly.

  3. continue reading one pleasure book a week. next week's picks: best food writing 2005 or mark kurlansky's salt: a world history. i recently read kurlansky's cod: the fish that changed the world, and it was a fun yet sobering read.

that sounds like a lot of reading, but i have a lot of time. that's also nothing compared to what i was reading my first two years of medical school. i have you all to keep me accountable!

Wednesday, March 21, 2007

"dear dr. jess"

i'm back! i had writer's block for the last few days partially induced by this blog's sudden popularity and my husband's warnings not to say anything that will have professional consequences for me in the future. as you can see, i've taken great pains to be anonymous (see this blog's name ... not my real name! really!) i've read quite a few doctors' blogs, so i'm hoping i will also figure out how to write about my life without violating any privacy laws.

anyway, i received my first piece of mail addressed to "Doctor" yesterday! i got a bit of a thrill; unfortunately, it was from a bank that wants me to buy real estate. i thought most of the nonmedical world was oblivious to the match, but apparently mortgage lenders know that i just received a conditional offer from my residency program already. their business strategy is a pretty good one as the idea of going from negative income to positive income makes me feel rich! however, my data-oriented husband sent me a few articles on the pitfalls of home ownership plus a very persuasive spreadsheet about how we're better off renting. who can fight all that data? *sigh* i guess there's no condo for me in the near future. that's okay. i already spent some of my yet-to-be-earned salary outlet shopping this weekend!

Saturday, March 17, 2007

and the paperwork begins!

this morning, i was thinking that maybe i should have delayed the start of this blog until internship since i only have two more weeks of patient interaction scheduled before graduation. the rest of the time is vacation and research. what could i blog about between now and mid-june?

the answer came in my mailbox today in the form of 2 lbs of paperwork (not an exaggeration) from my future residency program. they certainly didn't waste any time. the cover letter went something like the following:
Congratulations! We're so excited that you'll be joining our program. Make sure you get your butt back in the country in time to attend Advanced Cardiac Life Support training!!!

i only had enough energy to fill out the first third, which included a conditional offer of appointment form, application for a limited medical license, affirmative action statement, permission for a credit and criminal background check, and medical information release forms.

things i don't know what to do with yet:
  • lab coat and nametag request form. what is my numerical lab coat size? how do i want my name written on the side--middle initial or no middle initial? i almost never use my middle initial, but as my husband says, the initial adds certain authoritativeness. do i want to seem authoritative? as long as it says "MD" after my name, it's fine with me.

  • continuity clinic request form. where do i want to have my outpatient clinic for the next three years? there is a page description on each site included, but somehow they mostly end up sounding similar. they also give us phone numbers to contact preceptors and residents, so i guess i have some research ahead of me. however, i'm not sure what i would ask except "is this the clinic site i should avoid like the plague?"

  • vacation request form. i haven't bought plane tickets for places i hope to go to this spring yet, so it's hard to think about which weeks i want to take off between july 2007 and june 2008. christmas? pretty unlikely i'll get that request, but what are my nine other top choices for time off?

i know residency involves a lot of paperwork. i just didn't expect it to start so soon.

Friday, March 16, 2007

hello world (and Paul Levy!)

i've been thinking about starting a blog about my upcoming residency training for a while, and it occurred to me this week that match day was a good time to start. i figured i would fumble around with the format and find my voice after a while. however, i didn't expect paul levy, the ceo of beth israel deaconess medical center and one of my favorite bloggers, to be reading my posts during my first week!

then again, this is why i started this blog. i've had blogs in the past to keep in touch with my friends and share my kitchen experiments and love of celebrity gossip. when it came to medical issues, i was standing on the sidelines reading other people's blogs. however, the more time i spend training to be a doctor, the more i feel that i have something to say and something to contribute to the ongoing dialogue about healthcare in this country. i'm not sure what it is yet, but i'll figure it out along the way.

so, welcome everyone!

Thursday, March 15, 2007

my number one!

i matched at my first choice! after a month of people saying "oh, you know you'll match there" but not really knowing, i'm ecstatic. i'm glad my husband was there to lend his support right before because i probably looked green. afterwards, i cried tears of joy and relief. i've been doubting myself about whether i picked the right program, but this feels right. if i had ranked the other program first and matched there, maybe i would have felt the same way. however, all is right in the world ... for me.

overall, my class did very well. we matched people into a lot of top programs, and i'm so proud. however, there were some disappointed people. they got into great programs but not their top choices. it was written all over their faces, and it was hard to know what to do but say, "that's a great program! congrats!"

people in general were just happy and relieved to know where they were going to be for the next few years. this match process feels crazy long, and the residency match is unlike anything else in the professional world. in most professions, you apply for a job, they give you an offer. you have a chance to mull it and your other offers over before accepting. not for the future doctors of america! there's a lot of nice words said on both sides, a wink or two, and then you rank each other. it sounds a lot like this weird british dating experiment i saw on pbs. or maybe a professional sports team draft? i'm not sure either of those analogies are good ones.

anyway, since i matched at my home program, the head of the primary care track came by the match celebration to find me. i was so touched that she took time to welcome me into the program, and it reassured me that this program is exactly where i want to be.

T minus 12 hours!

okay, if one more person asks me if i'm excited about the match, i'm going to punch him/her in the face. no, i'm not excited about where i'm going to be living and breathing for the next three years!

even though i only applied to programs in the city i currently live in and my number one is my home program, there's still a crazy sense of anticipation regarding opening that envelope tomorrow. i'm known to get very emotional (i still can't watch the scene when nemo's mom gets eaten), so i've been practicing my reactions to all the possibilities that could be in the envelope. i think i would be very happy at my top 3, and i could make the best of the rest on my list. my husband will be there to capture it all on film or erase the film and just hold me while i weep. of course, i won't be alone! there will be 150 or so other people dashing for the mailboxes at the same time.

will i get any sleep tonight? i hope so!

Monday, March 12, 2007

and so it begins!

i've matched! i just don't know where yet.

from: NRMP Staff
reply-to: nrmp@aamc.org
to: me
date: Mar 12, 2007 11:50 am
subject: Did I Match?

Congratulations! You have matched.

could this email have a worse subject line? thursday is the day, but knowing that i matched makes me feel that this is actually happening. i will really be starting my training somewhere this summer. i will really be making money in a few short months! there are plenty of doubts in my head about whether i'm ready for this next step, but right now, they are overshadowed by giddy excitement and nervousness over finding out where i'll be living and breathing for the next three years.