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!