Lessons from a n00b - The end of the beginning

12 months of clinical rotations has swept by in the blink of an eye, and here I am, approximately 8 weeks away from taking the biggest exam of my life so far (my first licensing exam). It's a somewhat nostalgic time, and thus a good time for reflection. A few more lessons I've picked up along the way:

Lesson 1:
A lot of times, attendings say words that I try to avoid. For instance: the word titrate. Do most people understand what titrate means? I mean, even I have only dull memories of the word from my chemistry classes in high school. I've heard attendings and residents often tell a patient that we'll start them on a low dosage of a particular medication, then titrate the dose as we see how the patient responds. I suppose this isn't such a bad usage, since it's the physician side that does the titration. But sometimes they'll tell patients to "titrate" the dosage of over the counter medications, based on their response, and I always have to wonder if patients understand what they're telling them to do. It's interesting what words we do and don't use in various situations, and sobering to think how important words are in a field like this.

Lesson 2:
Neurology is kind of boring to me. Maybe that's because I don't understand the basics well enough, or maybe that's because it really is boring to me. Whatever the cause, I know for sure that it's not the field for me.

Lesson 3:
On a related note, I often felt, on neurology, that if we didn't know the exact reason a patient presented with particular symptoms, we'd chalk it up to a psychogenic etiology--which means that their brain, for some reason, believed that they were weak, or felt tingly and numb, or couldn't walk, or whatever, and so they experienced those symptoms--but there was no physical abnormality causing them. I had SO many patients who we concluded had psychogenic causes for their neurological symptoms, that now I'll always wonder if a person's neurological problems are psychogenic.

Lesson 4:
Contrary to what I believed at the beginning of this year, shelf exams really do get easier to perform on and study for as you take more and more. This is great news. The key, at least for me, was to repeatedly do practice questions until I got them all right...then rinse and repeat.

Lesson 5:
It's amazing how often you'll hear interesting stories from your patients, especially when you're treating outpatients. Almost every day when I was on family medicine, I'd meet a patient or two who had had interesting life experiences, had cool goals for the future, or were interesting in various other ways.

Lesson 6:
A year's worth of clinical rotations definitely teaches you a thing or two. It's amazing how much my confidence has grown, along with my knowledge base. This is a good thing.

Lesson 7:
Shingles comes in many shapes and sizes. So does mono.

Lesson 8:
I still have a lot to learn in terms of handling patients, especially those I would call "difficult." I was impressed by my family medicine attending's ability to entertain even the wackiest of patient requests without missing a beat. And she did it all while maintaining the patients' respect and trust. Hopefully this is a skill I'll gain with time and experience.

Lesson 9:
It's surprising how many people are vehemently opposed to the flu shot. It's also surprising how many people think that the flu shot "injects the flu into you" (not quite), a belief that implies they don't realize that most other vaccines also inject the disease-causing entity into you. For the record: the flu vaccine, and the majority of other vaccines, inject a dead virus, or an inert part of a bacterium, into you. The point is to teach your body to react against the disease-causing entity, without giving you the disease itself. However, since your body is supposed to launch a counter attack (which is what you're experiencing when you feel "sick:" fever kills bugs and helps the body fight infection better; runny noses are meant to flush out bugs living inside your nose, and so on), you often do end up feeling a bit sick after getting a vaccine, any vaccine. It sounds like more people get sick after getting the flu vaccine than after getting other vaccines, but that's probably because more people get the flu vaccine, more often, than any other vaccine. Basically, my point is that if I had to choose between getting sick after getting the flu shot, but never truly getting the flu, and actually getting the flu--I'd choose the shot every time. You should too. Just saying.

Lesson 10:
Time flies. I've said it before, and I'll say it again. Forgive me for the repetition. But these 12 months flashed by in an instant, and I'm sure the next 18 will do the same. At that point, I'll just be Dr. n00b.

Kangaroo Kitty Cat

I met a new patient yesterday, a 30-something year-old dad. He was coming in with an upper respiratory illness that involved a mild sore throat and a pretty nasty dry cough. While taking the social history, I asked him if he had any animals at home. The patient chuckled then, and his laugh suggested there was a story there, but all he told me was that he had one cat, though he's allergic to cats, and two dogs.
Later, when I re-entered with my preceptor, I noticed that the patient's cough sounded mildly wheezy, not unlike the cough I get when I'm around cats (I, too, am allergic). Our patient had been sick for a little over a week, and I wondered if maybe the cat wasn't responsible for his symptoms. "How new is this cat?" I asked. "Two months," he told us. "I guess getting the cat was your wife's idea?" we asked. Well, it's a handicapped cat, he told us. Its back legs are normal, but the front legs are stunted, so that the cat walks on its hind legs or scoots around on its bottom. The very idea was both comical and precious. "So your wife rescued this cat, I guess?" my preceptor ventured. Well, not quite. Our patient had seen the cat on a ranch while he was away for business. He took a picture of the funny little creature and sent it to his wife, saying "It's too bad they'll have to kill this cat." Of course, he received an immediate, vehement response: "You bring that cat home immediately!"
So now our patient lives at home with his wife, daughter, two dogs, and a malformed, adorable kitty, to which he's allergic. He showed us pictures of the thing. It looked like a feline velociraptor. "Look at how the silly thing sleeps!" he told us, showing more pictures. We told him to use an inhaler as needed, pop antihistamines regularly, and learn to live with the cat. His fate was sealed.
Funny the people you'll meet and the stories you'll hear.

Past Medical History

This morning I did an initial History and Physical on a patient who was new to my preceptor's practice. Before I went in to meet him, I learned his chief complaint (rash), and his name: Wilbur. Funny, I remarked to my preceptor. That's a pretty old-fashioned name.

When I walked into the room, I was greeted by a sandy-haired balding gentleman in a crisp white shirt, khakis, and boots. He was wearing too much cologne, which portended sleaziness, but his manner was respectful, professional. We talked about his rash for some time. It had been around for about 5 days, he was developing new spots every day, and they were slightly painful. I think it might be shingles, he said, Or Ramsay-Hunt Syndrome. Usually, patients with shingles complain of terrible pain, I told him. Have you been taking any medication for the pain? No, he said. I've dealt with a lot of really bad pain before, took extra strength Vicodin (Vikodayn, with his Texan accent) for a long time, and now I'm off all that stuff. My eyebrows raised at this hint of a significant medical history. Yeah, he said, I was taking morphine IV and everything, because of a plane crash I was in, but I'm getting off topic. Yes, I told him. We'll get to all that later.

A few questions later, we arrived at the Past Medical History, that fateful part of the initial H&P. Finally, he could tell me what had happened. It was a plane crash, he said, in the mid '90s. Right femur broken. Right arm nearly amputated. Right ulna lost proximally, right radius lost distally. Both shoulders dislocated, sticking out "right here," he told me, indicating his mid-clavicular region bilaterally. He was in the hospital for months, out of work for over a year, underwent 27 surgeries in that time and many more for the reflex sympathetic pain syndrome he developed as a result. He underwent intensive psychiatric therapy and rehabilitation to wean himself off of the megadoses of narcotics required to manage his neuropathic pain. Nearly twenty years later, he was fully functional, working and traveling without any hitches.

The most remarkable thing in all of this was that I never would have guessed at this incredibly traumatic history until he rolled back his shirtsleeves. The scars on his right hand were barely visible, and the hand was stupendously functional, considering the trauma it had undergone. The man sitting before me was shockingly unscathed, at least outwardly.

The interview over, I examined his rash, listened to his heart and lungs, and felt his distal pulses (To my surprise, the right radial pulse was intact). Then I smiled at him and said I'd be back soon with my preceptor.

In the hallway, I gave her a quick rundown of his rash and his storied medical history. A plane crash? she asked. Wow.

When we re-entered the room, after some cursory questions about the rash, she asked what I hadn't: So tell us about this crash. You've gotta tell us the whole story.

It's a long story, he started. (And long it was; we probably ended up listening to him for 30 or so minutes; at one point, his wife called the receptionist and asked why his appointment was taking so long.) Little by little, the details came out. A private plane, a complete engine failure right after take-off. 78 seconds from take-off to hitting the ground again in a terrifying crash. The other passenger 76 years old, hurt, but not as badly as our patient. Our patient lost a lot of blood. His blood pressure was 40 over nothing, a first responder said. Our patient, declared dead on the scene. Our patient viewing the entire scene from above, in an out of body experience.

And there were three people there, he went on. I remember them so vividly, but I couldn't possibly tell you if they were male or female. I just know they were there. One placed my head in their lap, another held up my feet, and a third held my left hand and fed me some cool water. Later, I saw those three people move the other crash victim's gurney into the life flight helicopter.

Once he arrived at the hospital, my patient remembers being wheeled down a cavernous hallway, with a white sheet covering him. He saw fluorescent lights and ceiling tiles flash past as his gurney progressed, until finally he passed through a set of double doors large enough for all of humanity to enter at the same time. On the other side, he saw his wife in her wedding dress, his kids in their Easter clothes, and his father in his coveralls lined up along the right wall. As he began sitting up to speak to his family, my patient felt a hand on his left shoulder, pushing him back down. A voice said, "Lie back down. There will be time to talk to them later."

Next thing my patient knows, he sits straight up in his hospital bed, lines and tubes coming out of many natural and artificial orifices. "Holy shit, God's hand was just on me," he says. From her chair to his left, his mother turned to him and said, "There you are, son. I was wondering when you'd come back."

In bits and pieces, my patient learns that he's been unconscious for days. The doctors and his family had no idea if he would regain consciousness, no idea if he would be the same man he was before. But he has and he is. Over the next year, our patient is "put back together" by a brilliant surgeon who gave him back full function of his right arm, hand, and leg. He suffers from reflex pain syndrome, taking megadoses of Vicodin and other opioids, just trying to stave off the pain. Eventually, he undergoes intensive inpatient rehab and gets off the narcotics for good. Years pass, and now he sits before us, mildly distressed by shingles.

By this time, over half an hour has passed, and my preceptor and I have exchanged many a quick glance communicating anxiety over the increasing length of this patient encounter. There are other patients out there waiting for us. But our patient says, "I'll just tell you one more thing, and then I'll finish the story, even though there's much more to it," and we say all right. He needs to tell this to us.

A couple years ago, our patient entered a local grocery store in search of a squeegee for his shower. "I know, you're wondering where I'm going with this," he assured us as our eyebrows raised skeptically. "But don't worry." After searching the store himself with no luck, our patient asked a little old man working at the store if he could help him find the squeegees. Why sure, the little old man said. But, he said, glancing at our patient's scarred right arm, what happened to that arm there? A plane crash, our patient said stoically. I bet that's a good story, the little old man said gamely. Why don't you tell me about it while we walk? And so our patient related the whole tale to this perfect stranger. By the time they reached the squeegee aisle, the tale was nearing its end. The little old man cleared some space on a low shelf, and they sat together while our patient told the part that bugs him the most. "Whenever people hear this story, they look at me (and here, he squinted his eyes in a way that said goshdarnit I'm sure of it) and say, God saved you for a reason. You have a purpose in this life. But that's the whole problem. I don't know what my purpose is. Here I am over 10 years later and I still don't know what I'm supposed to be doing. God never told me what He wanted me to do," our patient bemoaned. The little old man put his hand on the patient's shoulder, said "Yes I did, son," and walked off.

Here our patient choked up for the first time, and my preceptor and I exchanged a look altogether different from the ones before. This was a special moment, a moment neither of us was likely to forget. Moments like these remind me how lucky I am to be in the medical field. Being a physician means being let in on the most intimate details of strangers' lives. People trust you immediately, and tell you things they don't tell others, even those they love and know well. It's a position of immense power, and one that keeps me in touch with my own humanity. For this I am grateful.

The Help

I finished reading The Help recently. I watched the movie very shortly after it came out some time last year, and I found it (of course) really inspirational and moving. The courage displayed by Skeeter made me think about the lack of courage I've seemed to show for a while now. Anyway, I marked down a few of my favorite passages from the book. They're not the very best writing in the world or anything, but they were the most relatable passages to me:

"...I'll never be able to tell Mother I want to be a writer. She'll only turn it into yet another thing that separates me from the married girls....And now she's gripping the rail, waiting to see if I'll do what fat Fanny Peatrow did to save herself. My own mother is looking at me as if I completely baffle her mind with my looks, my height, my hair."
"'It's all about putting yourself in a man-meeting situation where you can--'
'Mama,' I say, just wanting to end this conversation, 'would it really be so terrible if I never met a husband?'
Mother clutches her bare arms as if made cold by the thought. 'Don't. Don't say that, Eugenia.'"
"I shudder with the same left-behind feeling I've had since I graduated from college, three months ago. I've been dropped of in a place I do not belong anymore."

"I flick on the radio, desperate for noise to fill my ears. 'It's My Party' is playing and I search for something else. I'm starting to hate the whiny teenage songs about love and nothing. In a moment of aligned wavelengths, I pick up Memphis WKPO and out comes a man's voice, drunk-sounding, singing fast and bluesy. At a dead end street, I ease into the Tote-Sum store parking lot and listen to the song. It is better than anything I've ever heard.

...you'll sink like a stone

For the times they are a-changin'.

A voice in a can tells me his name is Bob Dylan, but as the next song starts, the signal fades. I lean back in my seat, stare out at the dark windows of the store. I feel a rush of inexplicable relief. I feel like I've just heard something from the future."

Writing about the truth takes a lot of strength. It involves going out on a limb and not knowing what life will meet you on the other side of that publication. But Skeeter Phelan, fictional character though she is, was willing to take that risk. The courage of that takes my breath away, and makes me wonder what risks I'm willing to take in order to write the truth.

Shooting Stars and Flowers Coming My Way

At the beginning of September, I moved out of my apartment and home to live with my parents because there was mold growing on a bunch of my clothing in my apartment, and that mold made my lips swell and gave me hives and sent me to an emergency room.
About six weeks later, someone decided it would be fun to vandalize [albeit mildly] my car, and I spent a considerable amount of time and energy and a small (though not negligible) chunk of change buying a new mirror for my car and getting it fixed.
Then last week, I see that I've gotten at least one, and maybe two, incredibly harsh evaluations from people I worked with on my Pediatrics rotation, the rotation in which I worked harder than ever before, yet got a few evaluation scores lower than I'd ever received before.
And today, I hear that it's a very real possibility that someone got ahold of my social security number, somehow, and is actively using it to commit, you know, tax fraud.
The world is doing a GREAT job of sending shooting stars and flowers in my direction. If President Obama does not win the election tomorrow, I may be forced to give up on everything. I cannot catch a break.

The Importance of Being Nurtured

The patient I'm taking care of right now in the Neonatal ICU is 3 months old. She was born at 33 weeks' gestation (normal is 40), along with a twin brother. Her brother has been home with their parents for some time now, but this poor little baby has had to stay in the hospital for innumerable problems, including, but not limited to, a hear that is very messed up indeed.
Now, I've only been seeing this patient for a little over a week now, but in all the time I've been at the NICU, I've never once seen her family at the bedside. This poor little 3-month-old lies on her back day in and day out, largely unstimulated by human contact the way normal babies are. By 3 months old, babies are social smiling, interacting with those around her, and starting to learn who her parents are by face. A lot of the kids who spend many of their first months in the NICU meet these important milestones much later than their healthier peers, simply because they don't receive the normal social stimulation that we all take for granted. This baby was going along the path of many NICU babies before her, and gaining her milestones very, very slowly.
So you can imagine my initial confusion, then subsequent delight, when I realized that, as I examined this baby girl this morning, the strange facial expressions she was making were her way of trying to smile! It was absolutely precious, and I swear as soon as she first took that step, it's as if a switch was flipped, and the baby became much more interactive with everyone who came by her. Seeing that little baby try to smile was probably the best part of my day.

Undergraduate Failings

I'll let you in on a little secret: I'm not really cut out to be a good college student, in all her stereotypical glory. I only just realized this sobering truth in its entirety this weekend, during the Centennial celebration for my lovely alma mater.
In the days leading up to the start of the Centennial festivities, I had whipped myself up into a reminiscent frenzy, thinking back fondly on sun-dappled courtyards and classes full of critical thinking and writing and reading; adrenaline-fueled days and nights of dance practices, performances, and midterms, with little time for sleep or food, but plenty of coffee; and the general freedom to pursue learning in its various manifestations that college affords us. I imagined myself descending upon my college campus (which, I should probably add, lives right across the street from my medical school campus) in a triumphant return, mingling with friends from various circles, both academic and social, and shedding all remnants of the social awkwardness that plagued me through much of my freshman year. It would be wonderful, I thought, and was exactly what I needed after a long seven weeks fraught with frustration and heartache, with small happinesses sprinkled throughout. Take me back to where my young adult self first began, I thought, and my heart and life will flourish once more, invigorated by the tree-filled vistas of college.
Here's what actually happened: I rather enjoyed a talk by a prominent genetics researcher, due partly, I'm sure, to the fact that I was able to sit alone in a large venue for the talk. I tried to ask a question about gene therapy at the end of the talk, but the question period ended before I found my way to the mic. However, the question period did include a woman asking an inscrutable question about seahorses and platypuses (surely the plural of that should be platypi?), and another woman inanely telling the speaker that his IQ must be "as high as a hot summer day in Texas," which was mildly infuriating because, well, a hot day in Texas is slightly above 100 degrees F, and an IQ of 100 indicates average intelligence.
I went to Alumni Pub Night the following evening, again anticipating self-assuredness and effortless mingling, a cool beer in my hand throughout. I spent the evening chatting with friends who all still live in the same city where we went to college, and I drank a very sweet cider which, at first sip, I wasn't sure was alcoholic. (It was, I later discovered.) I stood about awkwardly silent at times, unable to muster up the social energy to shout over the loud music just to have small talk with people I see all the time anyway. I saw almost no one I had been friends with in college, but had since lost touch with. I did, of course, see people who had never been my friends in college. I was also mildly alarmed at the number of men there shooting close-lipped smiles at any women who happened to glance their way. One of them asked my Taiwanese friend if she was from Korea as I stood by acting nonchalantly deaf. I feigned my disinterest so well that the next time I looked around, she had slipped away from the entire scene, leaving me frighteningly within range of Mr. Smiley's advances. I retreated post-haste. The night passed by in a vaguely-bored blur, and I woke up the next morning utterly exhausted from having only 5 hours of sleep the night before.
My next, and last, attempt at partaking in the Centennial festivities also fell flat. I headed over to one of the dorm common areas as the sun was beginning to set on Saturday evening, excited to participate in a reunion with both alumni and current students involved in South Asian Society, my extracurricular of choice when I was in college. Of course, I was the second person there, and the other girl there and I sat around coloring (the activity was intended for children of alumni who were on campus for the weekend) for about a half hour before anyone else showed up. In the mean time, we ended up talking to the wife of an alumnus, a dentist, who was spectacularly rude enough (at least in my opinion) to tell me that she thought the idea of being a specialist in pediatric genetics was "depressing," and that being a doctor was "a hard life." Thank you very much, woman with whom I have no connection. I am aware that the life ahead of me isn't going to be easy as pie. I appreciate your words of wisdom. Eventually, other alumni from our club trickled in, and we enjoyed some catch-up conversation before everyone else headed off to the glitzy "Finale" event, held in one of those amazing tents, complete with open bar and tons of free food. I hadn't bought a ticket to the Finale since I had  originally planned to attend the football game earlier in the day, and I wanted to give myself plenty of time to study for my exam coming up on Friday. Sadly, I decided right before the game to skip the game and study in the afternoon instead, and by then it was too late to buy tickets to the Finale. I had originally told myself that I would study on the idyllic campus of my daydreams for a couple hours before watching the light show that was to take place on the Academic Quad later in the evening while my peers were at the Finale, but after watching my friends walk off in their nice clothing, I just felt too defeated by the whole affair to stay around, and instead I bought Taco Bell and went back "home" to watch television online with my Dog-in-Law. I later heard that the light show was was downright breathtaking, but I couldn't bring myself to drive all the way back to campus for the later showings. I just gave up the whole night, and, indeed, the whole Centennial affair, as a bust.
I've realized, as I hinted earlier, that I don't naturally function very well in prototypical "college" situations. I don't like shouting over loud music at bars. I hate talking to random guys at bars. I'm not very good at mingling. I am, at heart, an introvert, and when I'm in big social situations, it helps me tremendously to have one person, be it a significant other or close friend, to cleave to throughout the event. I have a couple people in my life who have played such a role for me in the past, but I don't feel like I've had a huge group of friends who make my heart swell with emotion because they so wholly represent college to me. Actually, I should amend that: I can call to mind a few situations and friend groups who do indeed make me feel that way, but I don't feel like I am able to recall the emotion when placed back in the same friend groups or situations. All of that just seems lost to me. Is it like that for most people? Am I the odd one out? I really just don't have a clue. All I know is, I'm fairly certain I like the idea of college far more than the reality of it.

No, I am not a nurse.

There's a set of parents whose very young infant is cared for by the NICU team I'm on. Now, I'm sure it's very difficult to have your firstborn child be born prematurely, and end up staying in the hospital for months, literally. However, I've gathered from my team that these parents have been exceedingly "difficult."
A number of incidents have occurred between my team and this particular family, including the family yelling at my residents in public, "firing" them for not doing a good job, and many other similar things. I have to say, though, that in my short interaction with this family so far, the one thing that bothers me the most is the fact that they address my residents, both of them, by their first names. It simply drives me up a wall, and I can tell it bothers my residents, both of whom are female, too.
I heard from many female medical students, before I started clinics, that I would more than likely be called "nurse" by many, many patients during my time in the hospitals. Luckily for me, I've actually rarely been addressed that way. Maybe I have some sort of aura that projects medical student-ness. Or perhaps I'm just not that much of a hottie, and let's be real--there's something distinctly "hot" about female nurses compared to many female medical students. Whatever the reason, I'm pretty glad for it. It's annoying enough when, as a brown-skinned person, you have veteran patients assuming you're Arab and apologizing to you whenever they speak ill of people from the Middle East. (For the record, I'm not at all bothered at being mistaken for a Middle Eastern person. I'm just miffed at the sheer ignorance of it all. For anyone who paid a modicum of attention, my name would probably strike him/her as distinctly Hindu.)
You know, call me an intellectual elitist if you want (cause, well, let's be real--I am one), but when I finally get my MD, I'll be damned if my patients address me as anything other than Dr. Spinenvy. By the time I'm a resident, I will have worked my tail off and gone through 21 years of schooling to earn the title of Doctor, and I'll sure as heck be working harder than ever before during residency. I think that at least some deference should be paid for that sort of hard work and commitment, and at least some of that deference takes the form of using the correct title to address doctors. Perhaps more importantly, when your patients do not address you as doctor, you have to wonder how, exactly, they perceive you. Doctors are, generally, respected, and believed to be knowledgeable experts in the field of medical care. If your patients call you "Angel" instead of "Dr. Spinenvy," then do they simply view you as an ineffectual girl? And if they do view you as such, then surely your recommendations and words don't carry the weight they rightly should, as recommendations coming from an MD.
I also have to say that I get extra riled up about all this stuff because there's still a large portion of society that automatically affords less respect to women than to men. Again, I've heard from plenty of female medical students (and residents) that they're referred to as nurse, even as they're wearing their white coats and making treatment plans for their patients, while their male counterparts are called doctor. It's frustrating that, outside of some circles, I'm met with confusion when I tell people I'm in medical school -- "So, you're going to be a nurse, or what?"
No. I'm not going to be a nurse. I'm going to be a doctor. Please call me that.

Disclaimer: I've met a great deal of awesome nurses, and I have to say that they have a type of strength and intelligence that I lack. I could never do the work of a nurse. I just want my patients to address me with my proper title once I've earned it, and I don't want to be relegated to the appellation, "Ms. Angel" simply because I'm female, while my male counterparts get to be called Doctor. That is unfair.

The n00b Files - Week 6 of Pediatrics

I'm almost done with my pediatrics rotation, and I'm delighted to report that I continue to enjoy it. I'm on my second week of inpatient pediatrics, and so far, the experience has been good. More lessons learned:

1. My dad was right all those years ago. I should have learned Spanish. It would help so much with my patients. It's not so bad when you can get a live translator to stand in the room with you and help you communicate with the patient, but using one of those translators via phone almost completely eliminates important, human interactions like eye contact. It's not easy to show a mother that you're just as concerned about her child as she is, when you're both staring down at a speakerphone and speaking into it.
2. It's a good sign when your attending says that every day, rounds will begin with a cute photo of the day.
3. If you ever hear doctors talking about something that sounds like "go lightly," you can bet they're not discussing an Audrey Hepburn movie. 
4. I eat way fewer vegetables and fruits, on a daily basis, than I should. I mostly fill up my stomach and my day with carbohydrates, which are delicious, but empty, calories. This failing was brought into sharp relief for me recently, because I had been spending a lot of time during my community pediatrics rotation encouraging overweight children to have 5 servings of fruits and vegetables daily. It's nice that my "job" helps me reflect on my lifestyle and health.
5. I really, really like working in a community clinic.
6. Conversely, I'm really not that wild about the inpatient setting. 
7. Having an attending who empowers you, as the medical student, to call consults, assist in patient education prior to discharge, and generally do much of the work of residents, is a good thing, even if it means more work. As my new, awesome attending pointed out, if we spend all of medical school carrying no more than 2 patients at once, we'll be completely out of our element when, as interns, we'll be expected to carry close to 10 at any given time. Working hard in medical school kind of sucks, but it's good practice for when your decisions really mean something, after that arbitrary moment of graduation.
8. Life flies by. I just went to an information session about scheduling my last 18 months of medical school. It was both terrifying and incredibly exciting.
9. It's a wonderful thing when you're doing something that makes you happy, especially when you're going through a rough patch in life. I'm so grateful I'm on Pediatrics right now, and that I'm loving it.

Parents, Patients, and Attendings

On one of my last days of community pediatrics, I saw a 4-year-old Tamil girl who came in for a well-child check-up with her parents. I first encountered her in the hallway, where she was getting her vision screening. The entire thing was a tense affair, because she was having some trouble reading the chart, much to the chagrin of her parents. "Try the chart with the letters," they said, "She knows her letters." Dad was helping her cover up one of her eyes at a time because she kept peeking, the way children are wont to do. Mom came up to the chart and was pointing at letters along with the medical assistant, hoping that maybe the child was just confused by someone else's pointing. Yet the child's difficulty with vision persisted. Mom told Dad not to cover the child's eye for her, to let her do it herself. Dad kept saying, "but she's peeking!" Meanwhile, no one but me seems to notice that the little girl's eyes are welling up and she is becoming increasingly agitated by her parents' all-too-evident disappointment.
By the time my attending and I walked into the patient room after all her screening was completed, the little girl had been frankly crying and was wiping tears off her face. My attending asked why she was upset, and Mom admitted that she had been scolding her for her bad vision, that hadn't Mommy and Daddy told her not to sit so close to the television? But she had done it even when they told her not to, and now her vision was spoiled, and it was all her own doing.
I was so distressed by this whole thing. It reminded me forcibly of times I've gone through difficult situations and my parents, instead of comforting me when it was obvious I needed comforting, instead pointed out the mistakes I had made that had resulted in whatever pain I was feeling. (Case in point: when I accidentally backed into a parked car one night in my junior year of high school, setting off a cascade of events including police involvement, which was completely out of proportion to the tiny scratches my car had made on the victim's car, which was already heavily dented, I came home sobbing because I felt so terrified about having my first "accident." My mom's response? "I told you not to go out to that party tonight! Why did you drive home so late? Why were you on that street anyway? Who told you to give your friend a ride home? You shouldn't have done all those things," and, the implication was, your tears can only be blamed on yourself.)
This tendency to blame instead of comfort, to point out wrongs instead of pointing out solutions, is a terrible pattern my parents have demonstrated again and again. I suspect it's common to a lot of immigrant families, especially Asian ones. I wanted so badly to interject in the interview and ask the parents, couldn't they see how deeply their disappointment hurt their daughter? Wasn't it baldly apparent how very much this girl wanted nothing more than to make her parents proud? That it hurt her, probably more than anything else in her short life, to make her parents unhappy? And if they could see that--for who couldn't, who was observing that situation?--why on earth were they continuing to heap blame upon her? Even if some of her previous actions had indeed influenced her vision (which, they probably did not), what was done was done. No amount of scolding could make her vision 20/20 again. In short--what was the point of their displeasure with their daughter?
But even though I wanted to rip into the parents for their behavior, I knew it wasn't my place as the medical student (nor, might I add, would it have been my place as the attending...at least, not if I wanted to keep a good rapport with this family). So I'm standing there wondering how my attending would handle this somewhat awkward, and, to me, deeply painful, situation. Would she point out that the parents were being unkind? Would she be able to do so without offending them? And most important, would she be able to help them accept their daughter's vision and address it accordingly with a visit to an ophthalmologist?
In wonderful-role-model fashion, my excellent attending did all three, simply by suggesting that perhaps the girl had been sitting so close to the television precisely because she had difficulty seeing, and not the other way round. She also pointed out that the patient was upset because she was watching her Mom and Dad act visibly worked up. How could they expect her to even want to wear glasses, if she does indeed need them, if they exhibited such displeasure at the possibility? Both parents literally got looks of sudden realization on their faces, and at least to some small degree, their attitudes shifted and some of the tension in the room lifted. It was pretty masterful, I must say. I don't doubt that when that little girl has her first car accident, her parents will tell her what she did wrong before they say they're glad she's okay. But maybe my attending's small, insightful comment will do something to make those parents think, just a little bit, before blaming their child for all her failings.

The n00b Files - Week 3 of Pediatrics

I'm on my third week of Pediatrics, which means I've completed 2 weeks of Pediatric ER, and am on my first week of outpatient pediatrics. I've also fully completed 8 weeks of Psychiatry, during which time I neglected to write down any n00b lessons. But never fear! More lessons await, below:

1. Turns out it's not that hard to look into a lot of infants' and children's ears as I had previously feared. More kids than you'd expect are pretty calm about the whole thing, which makes life a lot easier.
2. On a related note, you know how you're taught to pull a patient's ear back and up in order to straighten out the canal and take a good look at the eardrum? Yeah, with infants and young children, it's a LOT easier to see the eardrum when you pull straight back. Now that was a revelation.
3. The great thing about psychiatry is that you get to spend a LOT of time with patients, just talking to them. I like talking to patients, so I liked that aspect of it. 
4. After seeing a patient who suffered from debilitating generalized anxiety disorder, I'm starting to believe that having severe anxiety may well be much, much worse than having severe depression. I actually felt like crying while talking to said patient, whereas I don't think I ever got emotional while talking to depressed patients.
5. Um, apparently you're not supposed to feed your baby any plain water until he or she is at least 6 months old. Babies are not good at regulating their water balance until then, so if you give babies water, their electrolytes can go all out of wack and then they can have seizures. So, don't feed your infant water!
6. ^Then again, very shortly after I wrote this, I heard my preceptor tell a mother of a 4-month-old that she can give her baby water if they're outside for a long time....so I guess the other lesson here is that the advice that doctors give can vary from doctor to doctor.
7. Subsequently, it's amazing/borderline scary to think how much of my behavior as a full-fledged physician will be directly influenced by the training I receive. For instance, I've learned at school that it's best to hold an otoscope with the handle down when examining ears. My preceptor last summer said that holding it upside down was the "weenie" way, and I had been taught well. Then last week, another pediatrician demonstrated a really adept way of examining an infant's ears...holding the otoscope upside-down. It was just crazy to realize that, more than likely, the way I ultimately do things (including the advice I give parents on some topics, the way I do physical exams, and probably more) may well be determined simply by the last way I was taught to do said things.
8. You can learn a LOT by watching the way your superiors interact with difficult patients and other medical teams. I was super impressed by the way one of my psychiatry attendings handled small and large annoyances. That dude had an amazingly cool head.
9. Psychiatry can really be a very amusing rotation. When I was on inpatient psychiatry, my team and I had many a laugh-filled morning of rounds while discussing some of the unusual things our patients said. For instance, this exchange:

                    Did you sleep well tonight?

                    I was 14 once.

          Or this one:

                    Can you tell me a little bit about your childhood?

                    Absolutely not. 

          ...Okay, so maybe you had to be there.

Ticking Time Bomb

In roughly the last week, I've lost my apartment, a great deal of my freedom, and my boyfriend. (To be perfectly honest, I "lost" all three of the above mainly of my own accord.) To say that it hasn't been an easy week would be a great understatement. Then yesterday, a male, Mormon, future OB/GYN classmate of mine and I were talking about childcare, and he asked me if I have a significant other. I said no, and he assured me that it was "okay" that I didn't have one at the moment, that I have "time" to find someone, but then again, my ovaries are "a ticking time bomb" because, hey, those things poop out eventually, and who knows if I'll still be fertile by the time I find someone with whom I want to procreate? (Again, to be perfectly honest, this is actually a really nice guy, and I don't think he meant any malice by what he said, none at all.)

The weirdest part of the whole exchange? His comment didn't even bother me. I don't know if that reaction was due to something awesome, like the idea that I'm well-adjusted and modern enough to know that even if I couldn't have biological children, I'd still be equally happy with adopted children; or something not-as-awesome, like I am just completely numb right now. Maybe it's just that I feel as if lots of people around me have been encouraging me to find a guy to marry/settle down with in the near future, for various reasons, and this is just another ludicrous one being presented to me. If I want to have biological babies, I better delve into the finding-a-life-partner thing with gusto!

I just feel like my life is changing rapidly, and the short-term future taking shape resembles a life I never thought I'd live, and that makes me deeply uneasy in ways I find difficult to explain. I'm glad I'm currently on a rotation that I really like, so that going to work can at least bring me some satisfaction instead of more frustration.

Spinning My Wheels

I went to my first spin class ever today (today being Wednesday July 18), and something about the class, and the music played in it, and the fact that I heard someone talking angrily about "spinning my wheels" at his current job on the lightrail last night, made me feel like the universe was telling me to blog about the experience. Or maybe I just feel like writing something.

It's a rather illustrative concept, isn't it, "spinning my wheels?" Generally, people resent finding themselves exactly where they started after expending a great deal of effort. That's why so many people I know say they hate running on treadmills; that's why "I'm just spinning my wheels at this job" was the Lightrail Guy's way of saying how frustrated he was about his work environment and lack of upward mobility. And yet.

During the second song in my spin class, the instructor was telling us to imagine ourselves coasting down a hill at full speed, 30 MPH, when we were spinning at low resistance, and I frankly was frightened at the thought. I was just fine with pumping my legs hard and fast but not changing my position at all. By which I'm trying to say--I don't mind moving fast, but staying in the same place. Is that bad?

I suppose it's a good quality for a person in medical school, which, if you enter it right after college, keeps you in a state of woman-childhood (or man-childhood, as the case may be) well into your late 20's. You learn how the human body works, how to fix it when it stops working, how to make people stop bleeding when they start and start breathing when they stop, and yet for years, you're always listening to what someone else tells you to do. You're not given true power until you're nearly 30, if not older. But I'm okay with that. I'm okay with treading water while I get my mental footing.

Last night, my second-grade teacher, who found me on Facebook about a year ago, sent me a message saying that her son possibly has a rare condition that she'd never heard about before. She asked me what I knew about it, and I was able to use my limited medical school knowledge (and the resources of the Internet) to give her some information. In a week that seems full of circles, it felt pretty great to have come full-circle enough to impart knowledge to a woman who once imparted knowledge to me. So do I mind spinning my wheels for a while? Not one bit.

I Win

Sometimes I hear about the problems my peers worry about and claim as their very worst experiences ever, and I feel so incredibly condescending. Few of my peers are experiencing the types of things I am. 

The n00b Files- Week 3 of Infectious Disease Consult/Week 11 of Internal Medicine

I'm now approximately one week away from finishing MS2 and becoming a wise 3rd year. In preparation for moving onto the second half of my medical school career, I am frantically gathering yet more knowledge as I wrap up my last month of the Internal Medicine rotation. Here's the low-down:

Lesson 1:
Being on a consult service is frustrating in that you make recommendations and write notes and put in orders, but ultimately the primary team makes all the decisions, and sometimes even decisions in your field of expertise. For instance, the primary team stopped an antibiotic on one of our patients without consulting our team first. They stopped it for a good reason, but stopping it without letting us know beforehand was kind of a crazy thing to me. But I get the feeling this sort of thing is not uncommon when you're consulting on a patient.

Lesson 2:
One thing that makes me really, really happy is talking to people in their 60s or so who've already made it through all the hurdles I face now as a 20-something. Most of them have found their life partners, borne and raised children, and had their careers. In a time when I feel like very few things about my future are certain, it gives me hope to look at others who have come before me and made it through and are still smiling. This is probably why I like working with the Alumni Association at my school so much.

Lesson 3:
This is not a lesson by any means, but I took a picture with one of my patients this week, by her request. It made me feel really happy (she was a sweet, short elderly lady who reminded me of all kinds of grandmas), and it also made me realize that doctors take pictures with their patients all the time--and this was hopefully the first in a long line of photographs to come.

Lesson 4:
I may never get over the mental/emotional trauma of seeing patients in the ICU. I know it's a bit rich to say that when I'm, oh, less than 6 months into many, many years of working in and around hospitals. But seriously, how does anyone look at a patient, legs sprawled about awkwardly, mouth open with an intubation tube and orogastric tube hanging out, and catheters and lines coming out of necks, arms, and you-know-wheres, and not shudder, even if for a millisecond?

Lesson 5:
One of the toughest things about being a student is having patients with complex medical problems, whose prognosis you can't predict. Heck, who even knows if the attendings can predict some patients' prognoses? But what I'm getting at is, it sucks to walk into a room in the morning and examine an unresponsive patient while said patient's spouse sits in the corner in expectant silence, hoping you'll tell them something about the patient's progress. Unfortunately, being as inexperienced as I am, I have no useful information for families in a situation like that. It's rough to walk out without exchanging a word with others in the room, but doing that is better than trying to exchange pleasantries, or worse, telling them things about their loved one's medical problems that simply are incorrect.

Lesson 6:
There are 14 specific "systems" that Medicare and Medicaid look for on a Review of Systems; you have to hit 10 to get full credit. They are: Constitutional, Eyes, ENT, Cardio, Respiratory, GI, GU, Musculoskeletal, Neurological, Derm, Endocrine, Allergy and Immunology, Heme/Onc, and Psych. Isn't that wild?

Lesson 7:
I'm really grateful that I don't have inflammatory bowel disease. That stuff sucks.

Lesson 8:
Learning where all the free food is in any given hospital is a worthwhile endeavor. It feels good to walk around with ice cream and smile mysteriously when others ask you where you got it.

The n00b Files - Week 3 of Internal Medicine Wards

I've made it all the way through my Surgery rotation (a 3-month slog!) and I'm 4 weeks into my Medicine rotation (another 3-month slog...what was I thinking?). I'm still learning something every day, but I haven't been very good with recording my discoveries. So here's a braindump of lessons from the wards:

Lesson 1:

Your first shelf exam will crush your soul. Twice. First, you will leave the exam hall wondering if shelf exams are supposed to feel the way you feel at that moment. Then, you'll get your grade and wonder if you've been learning anything at all and/or whether you're cut out to be a physician or if you should just quit now with fond memories of pre-clinical success to look back on. Unfortunately, there's no way to go back and change your performance on your initial shelf, and as Abraham Lincoln (or someone) said, If at first you don't succeed, try, try again. Learning during clinicals is a whole different ball game from learning during pre-clinicals. All of a sudden, you have to not only work all or most of the day (and often 6 days a week), but also go home and study. It's kind of a cruel joke, really. But I figure if thousands of doctors have done it before me, I can do it too.

Lesson 2:

It's really difficult to deal with emotional patients. I like to think of myself as a compassionate person, but I find it hard to comfort a patient when he or she is crying, or talking about how rough life has been lately. It just feels very strange.

Lesson 3:

On wards, you'll probably work with pretty darn awesome scientists/clinicians without even realizing it. In the past week, I've worked with one doctor who was instrumental in discovering the connection between H. pylori and ulcers, who is now working on curing C. diffcolitis, and another who may have found a cure to Hepatitis C. No big deal. [For those of you not in medicine, those are both really big deals.]

Lesson 4:

I've said it before and I'll say it again--having a good team makes all the difference, for real. I have some pretty darn sweet interns, a friendly upper-level, and a couple of great fellow students on my team right now, and if I have to spend the day in the hospital, it's fun to talk to them while I do it.

Lesson 5:

A lot of the time, when it rains, it pours.

Lesson 6:

You're more likely to hear an Internal Medicine resident complain about a pointless admit (for instance, a patient with a history of cancer who's had a 12-hour history of nausea and vomiting and shows absolutely no signs of dehydration) than a very complicated patient. I found that pretty interesting: residents prefer not to have a really "easy" patient who doesn't really need to be hospitalized. They'd rather take care of patients who really need tertiary care, like a hospital provides.

Lesson 7:

When you're a medical student, you can't do a whole lot to help your patients. You can suggest lab tests or imaging studies to your residents, or perhaps pick up on the fact that a patient isn't receiving an important drug to prevent blood clots. But not really much else. What you can do is simple things for your patients, like getting them a toothbrush when they ask, or helping them take their hair out of a ponytail (which was placed when the patient was intubated). Patients tend to be pretty grateful for these sorts of actions, and if something so simple can brighten a hospitalized person's day, it's worth doing, especially when, as a student, you have many fewer constraints on your time compared to your residents.

Lesson 8:

That being said, there will always be patients who seem to need to complain about at least one thing every day. And sometimes you can't do anything to address their complaints, and you don't really want to stand around and listen to them. But like most people who are venting their frustrations, many patients benefit simply from having someone commiserate, if only for a little while every day.

Ups, Downs

It was a day of ups and downs.

On the one hand, my beloved yellow netbook Sunbeam is almost certainly irretrievably dead. On the upside, I should be able to salvage all my data, and my sister has a pink version of Sunbeam that she's going to let me use, so all is not lost. Still, I liked my little yellow netbook. It won't be the same.

Went to Macy's with my mom to shop the clearance and "one day sale," ostensibly to find some professional clothes for my medicine rotation, which begins in about a month. Here's what I discovered: the clothes at Macy's are almost all ugly. I'm better off buying random things off of the clearance racks at New York and Company and Express and Ann Taylor. I did, however, buy myself a little sweater dress for $4.99. Oh how I love cheap things. Sadly, the clearance shoes were neither cheap enough to buy nor comfortable or professional enough for clinics.

Spending the weekend at home for the first time in a while gives me plenty of time to watch I Love Lucy with the parents and eat too much Indian food. I realized last night that if/when I get married, I will most certainly put I Love Lucy on DVD on my bridal registry. It might sound weird, but I know that show will be a central part of my future family's traditions, so it's of paramount importance that I get a copy when I strike out on my own--or with a husband, as the case may be.

Lastly, listening to John Mayer's Battle Studies while reading Pestana's surgery review makes studying that much better.

The n00b Files - Weeks 1 and 2 of Emergency Medicine

Working in the EC of my school's county hospital was a welcome break, to a medicine-minded (as opposed to surgery-minded) girl like me, from being in the OR a lot. It was also an opportunity to learn yet more things, some of which I shall record here:

Lesson 1:

Sometimes patients flirt with you. This can lead to very conflicting emotions. On the one hand, these patients are often people with debilitating, chronic illnesses, and you can see that this is an exciting interaction for them--and they don't get very many of those. On the other hand, you kind of want to clock them super hard for hitting on you in your workplace.

Lesson 2:

Apparently, as women progress into the later stages of pregnancy, their bellies get so heavy that if they sleep on their right side, their inferior vena cava (IVC) is compressed by the uterus, and they can't breathe well at night as a result. So a lot of women who are pregnant end up preferring to sleep on their left sides or backs instead. I found this news a little upsetting, since I LOVE to sleep on my right side. Does this mean that if/when I am pregnant I'll have to switch sleeping sides? And if I do switch sleeping sides, will I find myself continuing to sleep on my left side after delivering, or will I switch back to my old habit? There's so much uncertainty in my future!!

Lesson 3:

It's amazing how quickly two days off from work can make a person feel lazy to the bone and utterly useless. It's also amazing how one 12-hour shift in a county hospital's ER can make a person feel like they've worked for days on end, even when they've just come off of 3 days of vacation.

Lesson 4:

Turns out I'm pretty interested in women's health issues. I saw a lot of interesting OB/gyn cases while working in the ER, and I found myself really wanting to follow up with those patients and find out what happened to them. Kinda cool.

Lesson 5:

Altered mental status sure can sneak up on you. I had a patient who just seemed to be in a lot of pain and probably had strep throat with complications. A couple hours later this patient started acting strange and forgetting simple things. BAM, the patient is transferred to an isolation room and I'm sitting around worrying that I have meningitis droplets all over myself and my white coat. Thankfully, the patient probably didn't have bacterial meningitis. Something weird was definitely going on though, and I totally didn't realize it at first.

Lesson 6:

A lot of people show up in ERs for completely non-emergent reasons. Some people just call ambulances when they feel lonely or are suffering from slightly-more-than-normal pain from their arthritis. While it can sometimes be gratifying to help these patients by giving them some human interaction (which I'm pretty sure is all they're really looking for), it can also be frustrating to see them taking up beds in the ER when patients with actual medically urgent ailments are still in the waiting room.

Lesson 7:

I put in an IV while I was in the ER! I know this isn't a lesson, but I was kind of proud of the accomplishment, so I decided to count it as one. Here's the lesson: with a good teacher (a really nice nurse showed me how), even a daunting task can be accomplished successfully. Of course, it didn't hurt that my patient had really nice veins, too.

Lesson 8:

If a patient complains of generalized throat pain that gets much worse when you push posteriorly on their hyoid bone, they might have epiglottitis, which is a pretty scary thing to have, indeed. Most young people can't get it, since it's caused by a bacterium that people have been immunized against for decades now, but patients 50+ are still at risk.

Lesson 9:

Learning the dosage of narcotic pain medications is worth one's while. I'm sure most people have it completely memorized by the time they finish med school, or at least intern year, but here it is:

for morphine, give 0.1 mg/kg

1 of Dilaudid is worth 8 of morphine

for Fentanyl, give 1 microgram/kg.

Keep in mind that Fentanyl is really short-acting, despite being very strong.

These lessons may have been a little boring...

The n00b Files - Week 1 of Transplant Surgery

More things I've learned, some more pleasant than others:

Lesson 1:

One of the best things about being a surgeon is that you get to make people listen to your favorite music when you operate, if you're so inclined.

Lesson 2:

One of the worst things about being on your surgery rotation is that you have to listen to your attendings' favorite music while they operate, if they're so inclined. Sometimes you like their music, and you jam out to Chumbawumba and Third Eye Blind and Hootie and the Blowfish behind your mask. Other times it's lots of Nickelback and Lifehouse and really bad Top 40 and you feel like your ears are bleeding.

On a related note, it's funny when middle-aged white surgeons have club music on their playlists.

Lesson 3:

LUNGS ARE HUGE. I'm talking, each lung is like twice the size of my face. On the real. They're all puffy and somehow remind me of two large-ish Teddy bears. I saw live lungs for the first time last night. Crazy thing.

Lesson 4:

Organ transplantation, when successful, is a wonderful thing, giving recipients a new lease on life. What one often doesn't think about is organ donation, which almost always happens when a patient dies. I came face to face with that part of the equation last night during an organ harvest. It was surprisingly disconcerting to see the patient wheeled into the OR, and then to see the patient's vital organs being removed and the patient's life blood being flushed out. All a part of the circle of life, to be sure, and organ donation is a way to make a senseless death worth something more to others. But all these things being true, it's still a difficult thing to stomach, at least at first.

Lesson 5:

I apparently have a tendency to experience dysphagia (ie, difficulty swallowing) and subsequent throwing-up on mornings after I've had very little sleep the previous night. I've had two such nights in my 5 weeks of the surgery rotation so far, and I've thrown up on both of the following mornings. This has happened to me in the past before, too. This can't be good, as I'm sure residency will put me in this very situation many, many times. Must learn to pace oneself in the morning instead of trying to nom after a long night.

Lesson 6:

If you don't watch sports, it might be smart to start doing so in order to interact with a large number of patients during semi-awkward situations. One of my teammates last month could always talk to patients about sports while changing their bandages in order to distract them from the pain. I usually stood mute, especially when the patient was a man and I was pretty sure we had nothing in common. The talking-about-sports route was much better.

Lesson 7:

When asking questions to attendings, be careful not to ask too many questions that reveal your lack of knowledge. Otherwise you might find yourself being told to research your own question and report back to the attending the next morning. Which is what happened to me today when I asked one too many questions about the steps of a kidney transplant. Drat!

Lesson 8:

Sometimes people are just kind of crabby and prone to snapping at you. That's pretty crummy.

Lesson 9:

You know how on Grey's Anatomy, whenever they're doing a transplant they anxiously wait for the organ to "pink up" while thoughtful music wells up in the background? Yeah, that happens in real life, too. I got a bit of a kick out of that.

Lesson 10:

You'd be amazed how quickly a pink bowel turns white when it's not getting blood flow anymore. Conversely, if you look away for a second after a kidney transplant has been attached to the recipient's blood supply, you'll miss the magic moment when it goes from being white to being a rich purplish-pink. Blood flow is cool.

Things that are bound to make me cry

Taking a leaf out of my new hero Mindy Kaling's book (quite literally), I've decided to list things that inevitably make me cry:

• Watching the movie Up for any 3-6 minute interval. The chubby little boy scout will talk about his absent father, or the adorable, sad old man will remember his deceased wife, or the extremely eager-to-please Dug will show just how much he just wants to be loved, and game over. Doesn't take long for the tears to spill.
• Listening to "Stop This Train" by John Mayer. It's a song about parents getting older and kids becoming adults and life's inexorable march. How can I not cry?
• Thinking about my sister's wedding too much. It makes me too happy/sad. On the real.
• Hearing 3-5 songs by Ingrid Michaelson within a short period of time. Eventually, one of the lines will tug at one of my many, pliable heartstrings, and I'll compare myself to the protagonist in the song ("I don't believe in anything but myself" and so on) and I'm crying while I'm driving. It's always very cathartic.
• Reading good writing.
• Any and every episode of Grey's Anatomy. I'm not even joking.
• Seeing my mom cry (just like Mindy Kaling, except I don't have an amusing anecdote about watching The Help with my mother to illustrate this. In fact, I have just the opposite. Within the first 10 minutes of our watching Up together, I was crying and my mom was looking at me funny wondering why I was such an emotional wreck. She's tough, which is why seeing her cry sets me off uncontrollably.)
• Homeless people. It's so very sad.
• Any time my parents or sister express emotion towards me. We're one of those freakish not-very-expressive families, so any time anything is expressed, my emotions go haywire.
• Belting out Sara Bareilles's Gravity. "Here I am, and I stand so tall, just the way I'm supposed to be" gets me every time.
• Foundations by Kate Nash, Slow Dancing in a Burning Room by John Mayer, and other similarly spot-on breakup songs. Guh.

How is it that Mindy Kaling's list of things that make her cry is so much funnier than mine? I suspect it's all in the execution...maybe....

The n00b Files - Week 4 of General Surgery

More things I'm learning:

Lesson 1:

An NG tube is used to suction/drain fluid that is building up in the stomach. I used to be under the misguided notion that NG tubes were used to feed people. Wrong.

Lesson 2:

When examining a patient with a diabetic foot, make sure to feel for their distal pulses if you don't want to feel totally silly when your upper-level comes in to check up on the patient.

Lesson 3:

It feels pretty darn cool when your team's patients run into you outside of their rooms and address you as "doc." It also feels a little scary; I'm always quick to correct them by saying, "Well, I'm almost a doctor.."

Lesson 4:

Working with a good group of teammates makes all the difference. The other medical students on my team are nice and funny and very accommodating when I need them to cover for me. I'm glad I started out my time in clinics with them. My sister told me that one of her favorite things about clinicals was getting to know many of her classmates much better than before. I'm really grateful for this, too, and I'm off to a good start!

Lesson 5:

Taking time to engage in your interests really improves your quality of life. I've started writing these n00b lessons, and I've also redoubled my efforts to publish my latest essay. Both of these pursuits give me great joy.

Lesson 6:

Finding beauty everywhere makes you pretty happy. I think bowel is beautiful. Weird? Yes. Good for my mental health? Arguably, yes.

The n00b Files- Week 2 of General Surgery

More words of wisdom from a certified n00b:

Lesson 1:

The nicest people during the day become terse and impassive when you're on overnight call with them. It's hard not to take that personally, especially when you're fresh out of pre-clinicals and normally only saw authority figures in the bright light of day (or in the dim light of the lecture hall, as the case may be). However, one should try to keep in mind the simple fact that people are cranky when they're sleep-deprived and/or hungry. Even doctor-people.

Lesson 2:

Planning ahead helps make your life a lot easier/happier when you're on clinicals. For instance, when you're going to take overnight call and know you'll have to sit through boring meetings/lectures the following morning instead of going home before rounds like you wish you could, make some coffee at home and bring it to the hospital with you. That way you don't have to spend an arm and a leg getting coffee to keep your sad little eyelids open. Also, throw an extra granola bar into your lunchbag so you can use it for breakfast the following morning.

Lesson 3:

I can now recognize the smell of dried blood. I'm not sure how I feel about that.

Lesson 4:

Chest tubes, while very important clinically (they're designed to suck out air, fluid, blood, etc out of the cavity around the lung, so that a collapsed lung can reinflate and get back to normal), are really freaking gruesome to put in. They're also pretty unpleasant to remove, but not quite as bad as the insertion process. Shudder.

Lesson 5:

I'm pretty scared of trauma cases, and tend to tense/freeze up when I'm in the shock rooms when a trauma comes in. However, I'm glad to report that I haven't felt nauseous or faint in trauma situations so far, and that's an improvement over some of my previous experiences. Hopefully writing about said improvement won't jinx me.

Lesson 6:

When asked if you're interested in a field in which you have absolutely no interest, a very diplomatic answer would be, "I think it's a great learning experience, but I don't think it's the field for me." Not that I've had the presence of mind to utilize that phrasing so far. Still, it's a good thing to keep tucked away in my brain.

Lesson 7:

Take care of any chronic and/or annoying health issues you may have ASAP. I've had this annoying cough for the last three weeks and it's really cramping my style. I'm pretty sure it's an asthma flare-up, but who knows. Anywho, I have an appointment to get it worked out tomorrow, and I'm very excited about that. Ailments begone!

Lesson 8:

Use an alcohol wipe to clean your trauma shears or stethoscope between patients, especially for the trauma shears. You never know when the dressing you're undoing covers a wound infected with MRSA, and it's best not to spread that from one patient to the next...for obvious reasons.

The n00b Files - Week 1 of General Surgery

I'm now one week into my general surgery rotation, and I've learned a great deal in a short amount of time. Some of the knowledge is clinical, some is more in the life lesson category, and some is simply important knowledge about my own self. In the effort to record what I've learned and perhaps share it with those who might benefit, I've decided to start writing The n00b Files, filled with the edification I gain on clinical rotations. Here's to a great new start.

Lesson 1:

Everyone on the surgery rotation is nicer than the general reputation of surgeons would have you believe. I expected my interns, upper-level residents, and attendings to be much more brusque or impatient with me and my many mistakes, but nearly everyone has been nothing but kind and patient. It's a really nice thing.

Lesson 2:

You're going to mess up at first. It's inevitable. But the nice thing about a month-long rotation is that it gives you ample opportunity to learn from your missteps and do better next time. I think I'm finally starting to be useful to my team, and that feels good.

Lesson 3:

When you're scrubbing into a surgery, you might be asked if you want to double glove. If asked, say yes. Wear a blue pair of gloves as your "under glove," and a white/cream pair over those. The under glove is typically a half-size larger than the over glove, which was somewhat surprising to me, but now makes sense.

Lesson 4:

Being a surgeon basically consists of two main things: actual surgeries and wound care. Nobody becomes a surgeon because they enjoy wound care. Wound care is gross. So basically, if you're not super excited by surgeries, then you probably wouldn't be happy as a surgeon. I'm glad to report that having discovered this, I have confirmed that though surgery is a rotation that's enjoyable and informative, and though I respect surgeons a great deal, I do not want to be a surgeon. It's nice to know that my initial stance was correct.

Lesson 5:

I really, really, really enjoy the clinic setting. Today, during our first day of surgery clinic, I enjoyed myself more than I have throughout the last week. Which isn't to say the entire rotation has been a drag so far. It hasn't. Clinic has just been the highlight. Compare this to my interns' advice to avoid clinic at all costs, and you have further evidence that I am not made to be a surgeon.

Lesson 6:

Shockingly enough, waking up at 4:20 AM isn't all that horrible. It helps that the first few hours after I get to the hospital keep me very busy, so I don't have a chance to get sleepy. It also helps that I go to bed around 9 PM every night now.

Lesson 7:

While free food was the best thing ever during pre-clinicals, free coffee is the best thing ever during clinicals. I probably drink too much coffee now. I should start putting in less sugary creamer so that I don't get fat off of coffee alone...

Lesson 8:

The laparoscopic camera is pretty confusing to drive, and the medical student often has the privilege of driving it during surgeries. You can get some explanation of the camera prior to surgery, but try to ask someone to give you a quick run-down on how it works when you're scrubbed in. The scrub tech is a good resource for this (at least, that was the case in my experience), and knowing how it works will not only make you more useful during the surgery, but also make you feel like your upper-level resident doesn't think you're a total n00b.

Lesson 9:

It is truly a privilege to care for patients. It doesn't always seem that way, and I've found it difficult to interact with some of my sicker patients because I simply don't know what to say or how to act when they seem to be in such pain or so badly damaged. But when I finally did start talking to some of them (while changing their wound dressings, for instance), I felt like I was making my own small contribution towards their healing process. It's a nice thing.

Lesson 10:

Life is good when you're doing what you want to do. Weekends are wonderful for seeing friends you're not rotating with. There are always challenges to overcome and more mistakes to be made, but there's little to complain about.