OB GYN OMG

So I started Ob/Gyn rotation this week. This is my "Clinic Week", so I'm working at an outpatient office seeing regular gyn and pregnancy visits.  I've perfected my pap smear, so now I'm working on adding style points (like maybe a spin on the end?).    But all of my pregnancy visits have been CRAZY!  Remember how Michael Scott always pulled a gun during his improv skits on The Office because "pulling a gun is always the most exciting thing that can happen!" ?  Well, I think that pregnancy is always the most dramatic thing that can happen in someone's life.  The drama can be due to figuring out who the father is, how he's involved, and who's fault it was that the contraception failed, or the drama can be due to how long they'd been trying,  how terrified they are of another miscarriage, and how freaked out they are by even touching their belly during the exam.  Opening the door to the room of a pregnant woman is a little like opening a door on a gameshow- you have no clue what's waiting for you.

My worst pregnant patient stories from this week?  Probably the one who already had multiple kids taken out of her custody and was having another baby for the purpose of proving that she "deserved the other ones back." Or maybe the one who couldn't afford an abortion, so she overdosed on heroine instead (which I've heard is cheap?)  to try to cause an abortion herself (bad idea).    But the best appointments? Definintely the moms who tear up when I show them their baby on ultrasound.  PRICELESS!

Next week is "Night Float" aka Vampire Week- which means I'm on the labor and delivery floor from 6pm-5am. Believe or not, I'm sort of excited for it.   After that I've got 2 weeks of gyn surgery (finally I'll be back in the OR for the first time since July!), and then 2 weeks of OB labor and delievery during the day shift.  It'll be a very dramatic 6 weeks!

Disclaimer- Of course, I change everything about any patient who I write about on here; I just try to keep the gist of the ridculousness.  I would never disclose anything that could in anyway identify any patient that I see in any capacity, or would violate their confidentiality.

Best Moment Ever

I spent this morning with a pediatrician who attends births when there might be complications- that way we can quickly take care of the baby if the baby needs anything.  Best moment of my pediatric rotation, possibly of all of medical school, happened this morning in one of those births.  It was a birth where the parents had chosen not to know the sex of the baby.  We held up the baby for the mom and dad to see for the first time, and the dad cried- "It's a boy!" and then started crying tears of joy.  He just couldn't control himself, and kept apologizing for crying and blubbering; but he was so geniuly happy that he was lighting up the whole room.  It was one of the sweetest, most genuine emotional displays I have ever seen.

Our strongest emotions tend to be kept to ourselves, whether its passion, anger, or sadness.  The stronger an emotion is, I think the more likely we are to try to keep it to ourselves lest we look vulnerable.  But this dad showed more emotion to us, a room full of strangers, than I've shown anyone. Ever.  His reaction was so geniune, unbridled and unconcerned with 'what others might think';  it was both refreshing and inspiring.  Also, I loved it because I'm rarely around truly happy people.  It's just the nature of being in a hopsital or doctor's office- people aren't happy when they are sick and scared. 

Quite frankly, he made my day.

On Death

This is a serious post.  Consider yourself warned.

You can't be in medicine for very long before you start running into death.  I made it 2 weeks into my surgery rotation before I saw a patient die.  I was on overnight call, and one of the patient who we'd operated on a few day earlier was moved to the ICU because of a failing heart.  The night resident and I hung around the ICU for 3 or 4 hours, adjusting her meds and calling consultations.  We were sitting outside of room when she 'coded', and immediatly the ICU staff lept into her room and started CPR.  As I medical student, my job is to stand quietly in the corner and do absolutly anything I'm told.  I was told to find out where her family was staying (they were from out of town, and had been at a hotel), call her hotel and tell the them to come in immediately.  At this point it's about 3am, so her daughter must've known exactly what I was going to say as soon as the phone rang.  But I still had to say it.

I know how devastaing, heart-breaking and terribly sad death is.  The thing that I didn't know about death until that night, is that it is very awkward.  There is the awkard moment when the doctor decides to stop CPR, and everyone who had been frantically running around and pounding on her chest just stops.  The awkard moment when you see a mostly naked body left connected to a million machines; but none of them are beeping or flashing anymore.  The awkward conversations as everyone leaves the room; and leaves her alone, naked, and dead.  No one knows what to say to each other, they all just hover outside the room, mostly quiet, and saying awkward things like 'At least she died in peace'- although it looked to me like she died somewhere in the frantic mess of CPR, injections and doctors and nurses shouting back and forth. All of it was so awkward- as though I'd walked on in something that I wasn't supposed to see, or was easedropping on a deeply private coversation.  This was her death; and it was messy and strange; and I just stood and watched.  Death had never seemed like a personal and private event until that night; but I felt as though I had violated her privacy by watching such an intimate moment.

It seemed so awkward to watch everyone returning to working on whatever they were doing before the code- checking on other patients, filling out paper work, checking their email, have a snack. I watched one nurse sit down and finish her sandwich. I guess I didn't expect her to throw it away, just because a patient died, but it was still odd to see her go back to business-as-usual. It seems strange to be a part of a death, and then get back to work once its finished- but it's what has to happen unless you want to be part of another death. When it's someone you know who passes away, there is so much mourning and grief. But the doctors and nurses didn't know this patient- she was already unresponsive by the time she was transferred to their ICU. To them, this was the death was of a body- not a person; at least not of any person that any of us really knew. So the death wasn't a loss to them, it was an event- a discrete event that was properly managed, and then they all needed to move onto whatever event needed to be dealt with next.  (Of course, the staff was all so warm and sympathetic when the family arrived, and I feel like they provided them great comfort.  But until the family arrived- it was back to work)  Part of the awkwardness must've stemmed from attending the event called "Her Death" with a group of strangers, but feeling that this event was so distinctly separate and unrelated to the events of mourning and grief that would follow. Death and grief are so intertwined that I never imagined witnessing one without the other. Like watching a sitcom without the laugh track- the pauses that should be filled with laughter just hang there; and these moments that should've been grief-filled were so glaringly empty. There were absolutly reverent moments following her death, but definitly not sad moments.  And it was awkward not to feel sad.  Awkward to make a cup of coffee as the family contacted funeral homes. Awkward to go to my on-call room afterward and try to go sleep for an hour before starting the next day of surgeries. It felt like I was breaking the rules of 'death' by moving on; but I hadn't lost anything, I had nothing to grieve.  All I had were lessons to learn- what went wrong (if anything), what could've been done differently, how would I have run the code, how to comfort a devastated family.  

I think there are 2 distinct deaths that occur at the end of our life: there is Death- as the marker of the end of earthly life- which is emotionally devastating, full of mourning and grief for the surviviors; but then there is Death- the actual event- which is a strange, awkward and deeply intimate drama, played out in front of a room of strangers and medical students who will soon return to their sandwichs and textbooks.

I've had a few brushes with death since then- but I don't think you ever forget the first time.  Death is ultimately the enemy that every physician is battling; and it'll probably always surprise me what an ugly enemy it really is.  I'm amazed and inspired by my near-death patients who have come to peace with death and dying- because the whole process still makes me feel very awkward, uncomfortable and unsettled.

Doctor Doodles: The Stages of Studying

PS- I'm still struggling with getting my blog to post things as big as I want them.  Sorry the writing is hard to read on the comic, but I think if you click it then it should open the full size image which is much easier to read.

My Attempt at Humor and Art (watch out, world!!)

So I LOVE this website:  http://xkcd.com/  that has funny math/science comic strips.  I decided to try my hand at a similar medicine comic. Leave me a comment to tell me if you like the comic.  Maybe I'll start doing more if people like them.  Disclaimer: I have NEVER been known for my artistic ability, but here goes nothing. 

Where Did I Go Wrong?!

I've been trying to study for my medicine shelf exam, which is Friday, but something's holding me back. What do you think, is the problem:

• that my bedroom is the warmest room in my house, so I try to 'study' in bed?
• that I can't open my computer without visiting at least 3 useless sites?
• that I haven't had my GINORMOUS cup of coffee yet?

Well, now I'm sitting at my desk with the World's Warmest Sweater, I've turned off the wireless on my laptop (after posting this, OF COURSE) and I'm halfways through the World's Largest Cup of Coffee.  Time to rock this test!!

Talkin' The Talk

A blog that I read sometimes (MothersInMedicine.com) had a post a while ago from a couple physicians describing what they would have done differently in medical school if they could go back.  I think I've done some things right so far in med school (with the exception of locking my keys in my car twice in the last 6 months)- and one of my best pieces of advice to any upcoming med student would be to live with other medical students for as long as possible.  Here's one reason why:

Medical professionals have their own words for everything- which are generally no more specific or useful than the patients words.  The patient says 'bruise', we say 'ecchymosis'.  They say 'short of breath', we say 'dyspnea'. They say 'tomato', we say 'You put a tomato, WHERE?!'.

As a med student, talkin' the talk lets people around you know that you're worth being taken seriously, and it also covers your butt when you have no idea what's going on.   If I have NO CLUE why my patient's kindeys aren't working, it sounds a lot better to say, "At this point, I can't define the pathogenesis of his renal insufficieny" than "His kidneys won't work, and I don't know why".  The big words are like the castle at Disney World-  if you get someone to look at the castle, there's a decent chance they won't notice the puke by Magic Moutain.

But it's not just a new language- it's learning to be fluently bilingual depending on your audience.  There's nothing worse than a patient who misses half of what you say, ends up taking their meds wrong and also thinks you're a pompous jerk.  But it's just as bad than having an attending who thinks you can't speak Medical-ese, and stops listening to you.

My advice to anyone, in any field where they have to learn a new language, is to LIVE WITH OTHER STUDENTS!  My roommates and I speak 'doctor talk' constantly to one another (which has consequently made our boyfriends very good at Wii) and I don't know how else I would make it at the hospitals. There's no Rosetta stone for Medical-ese. Medic-lish?

Also, there are some words that patients just don't like to hear (see cartoon)!!

Medical School- Explained!

As a service to all of my future faithful readers, I’d like to take this opportunity to fill you in on some of the lingo of medical school. Otherwise, someday I'll spout off something like “I think I’ll wait til after my Sub-I to take Step 2, but I definitely want to take it before I submit my rank list”, and you won't know what the heck I'm talking about.  But after my tutorial, you'll be able to give me some really super comment like, “O totally- otherwise you won’t be licensed in time for internship.” And we will all look so brilliant! So I’ve made a this special, once-in-a-lifetime med school tutorial just for you! 

The Basics: Med school is 4 years long, it’s preceded by a 4 year undergraduate degree in any field you want, and it’s followed by a residency that lasts anywhere from 3 years (for ER, family med, etc) up to 7 years (cardiothoracic surgery).  Medical school is people who are going to become doctors. Not nurses. Nursing school is for nurses. I was asked, just yesterday, if I was going to medical school to become a nurse, or to be a doctor. Yes, even blonde haired, female ‘medical students’ will eventually be doctors; not nurses. And big, burly men in nursing school will become nurses, not doctors. Crazy!

Medical School Itself:   Medical school year 1 and 2 are called 'preclinical years', and are basically the same structure as undergraduate- lectures 5-6 hours a day and then tests every few months.  Between year 2 and year 3, students take the 'Board Exam' also called ‘the boards’, ‘the USMLE’ or 'Step 1'. In order to be a licensed doctor in the US, you have to pass all three ‘steps’ of the US Medical Licensing Exam (USMLE aka board exam). Step 1 is after two years of med school, Step 2 is taken during your 4th year of medical school, and Step 3 is taken during residency and is specific to your chosen field (ie pediatrics, surgery or ObGyn all take different ‘Step 3' exams).

Medical school year 3 and 4: often called 'clinical years', 'rotations', 'clerkships' or 'being on the wards'. Third year is full of required clerkships- medicine, surgery, pediatrics, ObGyn, etc. Every med student has to do all of them and has to pass a test at the end of each required rotation, proving they learned everything that they were supposed to. The exam at the end of each required rotation is call a 'shelf exam'- maybe because they found the tests on a shelf somewhere? A shelf labeled 'Ridiculously Impossible Tests'? The other big issue about required rotations is that most of your grade comes from the evaluations that the doctors that you work with fill out about you. And they don't take bribes. Or I'm maybe not offering enough.  I thought my offer for a free cup of coffee from the coffee machine in the lounge was a good bribe. No?

Fourth year is full of elective rotations, and has been called by some- “The $40,000 Vacation”. There are TONS of electives you can pick from. Electives are notoriously ‘easy’, in that there isn’t a test at the end of the rotation, so a lot of the pressure is off. There are a lot of gotta-do’s during 4th year, though
(1) You have to take Step 2 of the boards at some point, otherwise you won’t be a licensed a doctor when you graduate.
(2) You have to do a sub-internship in the area that you are applying- for example, if I’m applying to surgery residency programs, I have to do a 4 week rotation on a surgery team where I am treated like an intern rather than a medical student (hang in there- we are getting to the point where I explain what an intern is)
(3) You have to apply to residency programs- which involves your personal statement, letters of recommendations, resume, picking ~30 programs to apply to, and interviewing at ~15 of the programs
(4) You have to submit you ‘rank list’ in February of 4th year, which is when you rank all the residency programs that you interviewed at
(5) You have to match to a residency program. All the residency programs rank the medical students they interviewed, and the med students rank the programs, then a big computer decides all of our fates by smushing the lists together and spitting out which residency program you will be going to.

Residency:   Interns =1st year residents, meaning they just finished medical school and are just beginning residency. After your first year of residency, you are called a resident. So technically you can call an intern a resident (they are in their 1st year of residency), but no one really does. But don’t call a resident an intern. That’s a really good way to land yourself on the wrong side of a ‘medical error’. For those of you who want to be a little extra confused- there are some residency programs that want you to do a separate internship first. Example- radiology residency is 4 years long, but before you can start it, you have to do an ‘intern year’ in either medicine or surgery. So medical student interested in becoming a radiologist have to apply, during their 4th year of medical school, to both programs for their intern year, as well as programs for the 4 years after that.

And perhaps the most misunderstood part of residency- you make about $40,000/year. That’s right. I didn’t leave off a zero. $40,000. Considering I’m PAYING that much right now, it’s actually an $80,000 raise for me, so I’m not complaining. The salary slowly creeps up to a measly $55,000 at the end of 5 years; but it’s not til after residency that doctors get paid to be doctors.  After residency, you are called an "attending"- I think because you get to attend the meeting where they hand out the real paychecks.

If you made it through all that, I’m proud of you. I took about 6 breaks and watched 2 episodes of How I Met Your Mother before I finished writing it- so I applaud your attention span.  Here's a silly picture of my nephew to reward your perserverence: