Monday, May 31, 2010

Monday With Mom: The Need for Respite

When life is chaotic and the candle is rapidly burning from both ends, it is time to find a moment or two of respite (per the dictionary – a temporary suspension of distressing or trying times)

Stress is bad – Relaxation is good.

I am in stress overload mode. I declared a much needed day of respite (well ….actually it is a ½ day– the morning was spent in meetings). The afternoon is to be spent driving from Montezuma, Iowa to Omaha, NE – but that is irrelevant. I will find my respite on the road.

The goal – I have 3.5 hours in the car and I am going to find as much laughter and relaxation as possible at 70 mph.

Available tools – a camera (to capture the moments) , 44 oz Diet Dr Pepper, the open road and a great radio station.

First challenge - my rent car had manual roll down windows. What?? How I am suppose to snap pictures while driving if I have to lean over and manually roll down the window.

And the Fun begins…

Montezuma pant-less man – I zipped past this house and at first glance, I thought someone was hanging from the porch. Slammed on the breaks, backed up and took a picture. Shortly after snapping the pic, the front door opened and a boxer wearing man said….”hey – what are you doing”. I sped away.

Trucks that I saw…. the HUGE tires, a HUGE tank and a marathon cheese truck (why would anyone think that branding cheese with “marathon” was a good idea)?

Signs I saw…Rest Area with Internet Access (very cool, Iowa) and the rivers…..Upper Skunk, Upper Raccoon, Middle Raccoon,….I guess the rule in Iowa is first vermin to be spotted gets to name the river? The river pics didn’t turn out, I was driving pretty fast and my aim was off.

Buildings that I saw….HOLY MOLY, Harley Davidson of Des Moines is in at barn with a silo. Love it.

More signs and things that made me go ….ahhhh, I wish I had more time….Bridges of Madison County, a Iowa vineyard and John Wayne’s home town. Yes, I would have absolutely visited all of the above except GPS kept warning me that I might miss my flight.

Bottom line – it was a wonderful ½ day and I am rejuvenated. Grab your moments of respite when you can. A little bit can go a long way. Even on a solo drive through Iowa, much relaxing laughter can be found.

Sunday, May 30, 2010

Playing The Game

I love surgery so much and I so badly want to match well, that I been pushing myself to do things outside my comfort zone .  Basically, I've been learning to play the game.

I've never been in any big corporate environment, in fact, I've never really been in any hierarchical system where I have to 'play the game' to get ahead.  But now I am.  And I'm getting better at it every day.   I'm not cut-throat, or anything, but I am starting to recognize the chain of events that will lead to my success and where I can intervene.  Let me explain.

     Goal: Get into an AWESOME residency for surgery
     To do that, I need to have great letters of recommendation from the top surgeons in our program
     To do that, I need to (1) spend time with them in the OR, (2) get them to talk with me, and (3) get them to see how brilliant I am.

(1) How To Get Into The OR-  I'm on surgery, so this should be easy, right?  Wrong.  There are one or two attendings that I need to spend time with and get letters from, and they are the same attendings that EVERY medical student going into surgery is vying for OR time with.  Here's how I've 'played the game'- I look ahead in the OR schedule and find out when these attendings are going to have big cases (2+ hours, more extensive surgeries= more time to talk and more interesting things to talk about).  Then I 'kindly' offer to  the other medical student that they can take the small really cool cases that the doc is doing this week.  And then the next week rolls around and, "O look at that, I guess it's only fair for me to go to the OR with that doctor, since you went last week".  O looky there- it's an awesome, huge case that I have been studying about for a whole week now.  This may seem a little cut-throat, but I figure that if any other med student wanted this as bad as I do, then they would be playing the game too.

(2) How To Get Them To Talk To Me-   Also should be easy, right? Wrong.  Most of the attendings aren't interested in talking about the surgery that they are doing while they are doing it.  They want to talk about sports and politics.  And if I can't keep up with those conversations, I fade into the background of the OR and no one notices me.  So I've learned which attendings follow which sports.  Dr. A cares a ton about the hockey playoffs.  Dr. B watches every Red Sox game.  So I know that I'm better off looking up the score from the night before than looking up the patient's hemoglobin if I have 10 minutes before the case.  Danny has been my personal savior for sports advice.  He'll give be a briefing any time of day on reasonable things to say.  My fallback is to make generic comments like,  "Well, look at what happened last year...."  because there's always something that happened last year that semi-relates to whatever they're talking about and normally someone else can fill in all the details.  I'm sure this will bite me in the butt sometime soon, but for now it has worked just fine.

(3) How To Get Them To See How Brilliant I Am- The hardest task of all.  I can't just start rambling off the details of GI track physiology in the middle of a case.  And it's harder than you would think to ask good questions that show how smart I am.  Very rarely, an attending will ask me questions that give me a chance to show off a little; but this is a rare occurrence.  The best trick that I've come up with, is to get the resident in the case on my side beforehand.  The residents on my team really do like me and want me to do well, so I've let them know which attendings I am trying to impress.  Then, when we are in the OR with that attending, they will set me up to show off a little.  They'll just casually ask me about a patient that I saw that morning, "Laura, did you see that Ms. C's creatinine was up this morning?"  And then I'll be like, "I did see that.  I'm thinking that it's secondary to her dehydration because her BUN/Cr ratio is up too, and increasing her IV fluids to 200cc/hr should resolve it.  But I can't rule out ATN, so I ordered a urine electrolye study so that I can calculate her FeNa."  And we keep that up for an hour or so, and suddenly I'm looking brilliant.  Sweet.

I think that 'playing the game' is one of the most important skills that I have learned on my Sub-I.  It's outside my comfort zone to be so calculated in my actions, but it's good to go outside my comfort zone every so often.  And I think I'm going to get some awesome letters of recommendation.

Saturday, May 29, 2010

Sometimes I Forget That I'm a Grown Up

I left my headlights on my car turned on all day on Thursday.  So my battery was dead when I went to my car at the end of the day.  I immediatly called Danny, who lives a mile away from the hopsital, and asked him to come jump my car.  After I hung up with him, I remembered that I was at a major medical center that  had securtiy guys who could jump my car.  I also remembered that I have AAA, and they could also come jump my car. 

I forget that I'm a grown up a lot.  I'm used to having to call my boyfriend when I get into a sticky situation.  I forget that I have grown-up resources- like the security guys and AAA.

The security guy got to me before Danny did, and I was on my way home within 5 minutes.  Danny made fun of my knee-jerk reaction of calling him when anything related to my car goes wrong.  Sometimes it's just hard to remember that I'm a grown up.

Similarly, I'm doing an away elective in Chicago soon.  I've been making plans for where I'm going to live, how I'm going to commute, when I'm going to fly in and out, how I'm going to get my stuff there-- and it's strange to me that I don't have to run any of my plan by anyone. Because grown-up's just DO things without someone telling them what the best way to do it is.  WEIRD.

Here's what I was like before I was grown up.  Sometimes I would get stuck in between mattresses.  But now that I'm a grown up; I don't do silly things like that.

Thursday, May 27, 2010

World's Best Cup of Coffee

I had the best day ever yesterday.  All because of the world's best cup of  coffee.

It started in the OR of my first case, with Dr. Lovely (scary attending who I am simulataneously insanely admirous and terrified of, but who I'm trying to get a letter of recommendation from).   The resident who was supposed to be there got caught up doing something else; so I was first assistant.  For some reason, he let me do A TON.  Normally, he would manage to do both my and his jobs without letting me so much as touch the skin.  But I was suturing and cutting, and he was letting me try everything at least once before he took it over to do it correctly.  What was going on....

After the case, he sat down and went over the case with me.  Then he went over 2 of his other patients with me  Then he took me to see a new consult.  Then he offered to buy me a cup of  coffee.  The world's best cup of coffee.  At this point, I was starting to believe that he was starting to actually take me seriously as a future surgeon.  He was actually investing time and energy in me. The coffee was delicious. What was going on...

I had to leave this parallel universe for a meeting with the chairman of the department of surgery.  This wasn't just A metting though; this was THE meeting. In his words, THE meeting was to "discuss how competitive of a surgery applicant you think you are; and how competitive you really are".  I was feeling great walking into the meeting, with my magically affirming-and-inspiring cup of coffee in hand.  We went talked about everything from my board scores and research to my travel experiences.  Finally, I manned up and handed him my very ambitious list of surgery residency programs that I wanted to apply to. 
     He looked at the list. 
           I looked at my cup of coffee. 
     He looked at me. 
           I started thinking about law school. 
     He said, "Looks perfect". 
I almost spilled the world's best cup of coffee all over his desk- I was so exctied.  This guy knows his shit- and he just told me that it's appropriate for me to be applying at the top schools in the country.  Seriously-  what's in this coffee?!

After that, I headed back to Dr. Lovely's OR.  Where once again, he proceeded to let me do EVERYTHING.  I don't know what was in that cup of coffee; but it was magical.

And now for something silly from XKCD (because every blog post should be a little silly):

Friday, May 21, 2010


Apologies in advance if this post is way too much/too gross of information. I just feel like sharing.  I'm usually on the recieving end of gross/overly personal information; but today I feel like being on the giving end.  So here goes.
  1. We have a woman on our service who swallowed her own IUD
  2. I learned that when you cauterize a wart cause by HPV, it aerosolizes and if you breathe it in then you can get cervical cancer in your nose.
  3. A patient said, "Hang on, I need to show you something" then reached down next to her bed, and produced a cup with her most recent bowel movement in it.  Sadly, I actually did need to see it.  I still would've like some warning.
  4. I was 'talking' with a patient for about 5 minutes before the patient's roommate chimed in to inform me that the patient was deaf.  But his roommate told me that he really enjoyed how well I explained the bowel prep. 
  5. I'm so tired that I fell asleep during my pap smear. True story.

Wednesday, May 19, 2010

Day In The Life

I realized the other day that no one knows what I do all day when I was trying to explain something about my day to Danny and he had a very glazed-over look. So here's what I did yesterday.

4:55am- alarm; clothes already laid out from the night before
5:10am- out the door; eat breakfast in the car
5:15am- see 3-4 patients, write notes and orders
6:15am- find a resident to co-sign all my notes and orders
6:30am- 'run the list';  aka sit down with the whole surgery team and briefly discuss each patient and the plan for the day
7am- conference (sometimes a lecture, sometimes a small group discussion of a topic)
8am- OR cases (it take ~45 minutes to clean the room between cases, in which times I eat, pee and check on labs/imaging that I ordered in the morning)
4pm- meet as team to 'afternoon round' aka- literally stick our heads into each patients room to make sure they are still alive. we seriously just check whether or not they are alive. I'm not exaggerating.
6pm- get a page that there is an emergency case that I should scrub in on
9pm- finish the case (still haven't had dinner)
9:30pm- get home. eat cereal in bed as I watch HGTV. Everything else seemed like too much work to make; so cereal it was.

Normally my day is done around 6pm. But I thought I'd get more sympathy if I posted an exception where I had to stay til 9pm. Just kidding. I don't want sympathy. I love every minute of what I do. Even the minutes from 6pm-9pm when I'm super hungry.

You'll notice that showering hasn't made it into the schedule yet. On normal days I shower after I run in the evening. But I haven't figured out when I'm supposed to do it on long days. I'm already pushing how little food and sleep I can function on. I'd rather be stinky than so tired that I'm stupid.

Saturday, May 15, 2010

Running v. Surgery

Seeing as these are the only two things that I do anymore; I've noticed a lot of similarities and differences in why I love each of them. 

  • Surgery is still, running is moving.  On Wednesday, I stood in the OR for probably 6-7 hours.  I was able to go on a quick 3 mile run afterward, and it just felt so good to move.  I love the stillness of the OR- it feels peaceful and controlled.  And somehow the movement of running is also so peaceful and controlled.
  • Surgery is measured in millliliters and cenitmeters; it feels good to do something afterward that's measured in miles.
  • Surgery is completely for the benefit of someone else, and running is completely for my own benefit.  I love that no one else benefits from me running. It's a completely selfish thing to do; which feels nice after doing what everyone else tells me to do, and doing it all for someone else's benefit.
  • I love the preparation time before either starts (scrubbing in, or lacing up my shoes).  There's a rhythm and routine to the preparation allows time to plan and focus on what's next.
  • Great accomplishments in either are the results of a million little decisions to keep going, keep trying, keep pushing.
  • My heart races.
That's the end of my attempt at insightfulness.  Here's a silly picture.  Danny dove head first over some bushes on Brown's campus.  When I asked why, he said, "So that you'll remember me every time you see those bushes."  Kinda romantic, kinda ridiculous. :-)

Thursday, May 13, 2010

Surgery Sub-Internship

I'm 4 days into my surgery sub-internship (for those of you who missed my medical school explanation- sub-internship means a rotation in the field that I am planning on applying to residency in; where I'm hypothetically treated like a first year intern and have more responsibilities)

I love it.  It's super.  The hours are long (5:30am until anywhere between 6pm and 8:30pm...) but I'm happy the whole time I'm there.  It's fun and exciting; it challenges me in so many ways and I love it.

I'm WAY too tired and I still have WAY too much left to read tonight, so I can't blog long. The bottom line is that I am happiest when I am busy and constantly challenged.  That's why I love surgery.  And it helps that everyone I work with is great.  With one possible excpetion, my nemesis/hero Dr. Lovely. Long story short- I work with one attending (Dr. Lovely, as he will be known here, as an attempt to fabricate reinforce a positive attitude toward him) who is an amazingly gifted surgeon and an excellent teacher- but who can pretty much reduce me to tears at will. He takes his work very seriously (as well he should), and tolerates zero error or uncertainty.   I'm pretty much a walking bag of errors and uncertainty at this point in my career; and he knows it.  And, of course, all of my advisors have told me that I need to awe Dr. Lovely and get him to write a letter of recommendation for me.  More stories about Dr. Lovely later.

Sunday, May 9, 2010

Uncle Danny

I don't think words can do justice to how much Danny's nieces and nephews ADORE him.   They literally wouldn't let go of him for the 3 days that we were visiting.  Here's the proof:

Saturday, May 8, 2010

Thursday, May 6, 2010

5K with Dad (yes, I'm 2 weeks behind in blogging)

Danny and I just got back from an awesome trip to Chicago for 5 days.  It was FANTASTIC.  I have lots of pictures to post from that; but I just realized I never put up any pictures from 2 weeks ago when Dad came up and ran a 5K with me, Danny, Ala and Morgan.  The Chicago ones will be up soon, but here are the others to tide you over! 

It was about 40 degrees, rainy and windy- so we sat in the backseat of Ala's car until they were just about to fire the starting gun.  It was cramped cozy.
Here we are after the run.  The state park that we ran in was right on the bay; which was beautiful, but I think it lowered the temp an extra 5 degrees.  Do you like my highlighter-yellow running jacket?  It's so reflective that I think it can be seen from outerspace.

I don't know if you'll be able to see these, but they are the results sheets from the race.  Dad got 3rd in his age group and I got 2nd in mine!!!  It was a total fluke that we happened to be in age groups with very few runners; but we'll still take the glory!  Danny SOLIDLY kicked both of our butts,  but his age group was very competitive.  This might be the only time I've ever gotten 2nd place in a race.  Actually, I take that back.  Sometimes Danny and I race, and I always get 2nd place in those races.