And On To The Next One...

   I can't believe I made it through a month of SICU relatively unscathed.  It was actually enjoyable.  Yep, that's right.  I said it.  Enjoyable.  I think my second go at trauma surgery was far more bearable for several reasons.  One, I was working with a lot of really nice people.  I got lucky on this one.  Two, for some reason, everyone seems to treat you differently as a fourth year medical student.  It seems like they have more respect for you.  I don't know why, I mean, I'm the same person I was a few months ago.  Third, I got to see a lot of really interesting, sick patients and scrub in on some pretty amazing surgeries.  And I got to learn more about operating in general which will apply to OBGyn later, like learning the names of instruments, etc.  Lastly, and probably most importantly, I have a much thicker skin now as a fourth year medical student.  I am so much less sensitive to critical comments and take things a lot less personal than I used to.  Originally, I almost didn't pick SICU as a rotation, because I was scared and I knew it was gonna be tough.  I'm really glad I pushed myself though, because it was nice to prove to myself that I could do it.  And the hours were rough, but I made it.

   Now I am on a two week "vacation".  Well, really this first week I am taking Step 2 CS in LA, so that's not vacation.  But other than that, we'll be visiting friends in LA and going on our annual beach camping trip in Oregon, which I'm really looking forward to.  I'm really looking forward to getting Step 2 CS over with.  And unfortunately, it still needs a lot of work, but I actually have my first draft of my personal statement.  It's actually been a lot harder to write than I was expecting.  For some reason, I'm just really having trouble articulating my thoughts, and I am having trouble structuring it, which I need to do in order to base my entire writing process on.  So needless to say, I've been pretty busy lately.  But at least I've been productive.

   I've been pretty annoyed at myself ever since I got my Step 2 CK score back.  I didn't score nearly as high as I was expecting, and I don't know why.  It's not like I didn't feel comfortable going into it.  And I scored about 20 points higher on my practice test than on the actual one, so that was pretty disappointing.  Oh well, there's nothing I can do about it now.  But I'm having trouble letting go.

   The good news is that after my next rotation (Gyn Onc), I don't have all that much to worry about besides residency applications and interviews.  By then, I'll have taken all of my boards exams, finished my personal statement, asked for letters of recommendation, and will have finished all of my most important rotations.  Man, is it really already July?!

*  *  *

BF (as I'm typing this post prior to publishing it), "Oh, are you blogging?"

Me: "Yep!"

BF: "What are you blogging about? Your personal statement?"

Me: "YES... but also about other stuff."

BF: "Like Step 2?"

Me: "YES ... what else?"

BF:  "Finishing your first Acting Internship"

Me:  "Wtf, how do you know?! Do you even read my blog?"

BF: "No, but I read your mind..."

I'm Alive!

   I'm almost done with 3 out of 4 weeks of my SICU sub-I, and I'm alive!  I have been working 24 hour shifts every three days (which actually end up being more like 30 hour shifts with rounds and stuff), and 12 hour shifts on the days in between.  This all works out to be about 85 hours per week - and I'm exhausted!   I'm really enjoying it though, much more than I ever anticipated.  I've witnessed some pretty crazy stuff, but unfortunately, I have no energy to blog about it.  Maybe later.

 

Baby Z perfectly demonstrating how I feel these days

I Must Be A Masochist

   TGS2CKIO. (Thank goodness Step 2 CK is over).  The actual test was a bit harder than I anticipated, but if I score anywhere near my practice test score, I'll be happy.  Unlike Step 1, however, the 9 hours seemed to fly by.  At least it's over! And I am so glad BF and I got it out of the way, especially while all the material from third year was "fresh" in our minds.  Fingers crossed while I wait for my score!

   Since the test, our week off has been a whirlwind.  I jet-setted off to Atlanta for a special Medical Students For Choice conference, which was inspiration and re-charging as always.  I got to meet some  really incredible med students, some of which even have blogs too!  Check them out if you're interested in reading other medical-related blogs!

• Dr Coffee's Brain Banter
• Spelled Like Latte-Man

My last minute packing list, with an extra addition

   And while I was in ATL, I got to visit my sorority friend H, who works at the aquarium and gets to ride dolphins! Amazing.  She even took me to the aquarium and I got to see the spectacular dolphin show she performs in!

ATL

   When I got back from Atlanta, BF and I went wine-tasting in Napa with our moms, which was super fun.

   And Melvie learned how to swim!

  This week break went by way too fast, and we already start up again tomorrow.  My first acting internship (aka "AI" - a fourth year elective where you work your butt off) is the Surgical ICU.  I know, I know.  It's quite ironic that I chose to subject myself to this particularly brutal AI, especially considering what a tough time I had on my surgery rotation.  But my main goal is to learn how to take care of really sick patients, and I'm even hoping to get a letter of recommendation out of it, if all goes well.  I also think I'm in a much better place to handle it, now that I've built up a much thicker skin than when I started out third year.  The schedule is gonna be the roughest I've had to far - Q3, which means you work a 24-30 hour shift, then a 12 hours shift, then repeat.  Over and over and over.  For a month.  So, I'm pretty scared, but I'm hoping it will all be worth it in the end.  

All My Crafting Is Paying Off

   I've realized surgery (and medical procedures in general) are very much like arts and crafts.  You have to have a lot of concentration, and not get bored with being meticulous with your movements.  I observed a sacrocolpopexy the other day, and I was strangely reminded of some kind of basket weaving or needle work.

   I've also realized that OB/Gyn is all of the good things I liked about surgery (the OR, doing procedures, quick-to-the-point rounds, "fixing" your patient)... but without all of the things I hated about surgery (not liking or not caring about patients' well-being, competitive patriarchal culture, etc).

   This week, I was scrubbed in on a gyn surgery, and the team let me close the skin.  I am always rusty and awkward when I start suturing, but as I move along the incision and relax more, I get smoother and faster.  When I finally finished sewing up this lady's abdomen, the attending came over to check my handy work, and she goes, "Wow! What do you wanna go into? Plastic surgery or something?!"

Me: "No, I wanna go into OB/Gyn!"

Her: "Oh good! You're hired! Your C-section patients will love you!  Just skip 4th year of med school.  You don't learn anything then anyway.  Just start residency now."

   If only they could see my smile and bright red face underneath my mask...

My Surgery Rotation Was Like Menopause

   We had our orientation for OB/Gyn today, and I'm already super excited!  I just love learning about all these things, so it makes it easier to study.  A few friends and I decided that our surgery rotation was just like menopause.  It caused us to have insomnia, irritability, and the pimping gave us sweating and hotflashes.

    Last night, I had some really weird nightmares.  BF thinks it's my delayed processing of being done with my surgery rotation.  First I dreamed that I was in a car accident, and that 30% of my body got burned.  In the dream, I had circumferential burns on my left leg, so I was all scared because I knew I needed an escharotomy STAT (nerd alert!).  Then that dream ended, and my second dream was a lot more disturbing.  I dreamed that I was in high school again, and that someone was trying to push me into a big boiling vat of chemicals to burn me alive (yeah, I don't know what's up with the burn theme...) and I was freaking out because I knew how bad chemical burns were.  Somehow, I escaped, but then the villain shot up the whole school and I had to hide.  Eventually, I survived, and my dream ended with people evacuating the school, several of them in stretchers from being shot.  It was pretty freaky.

The End Of A More Difficult Chapter

    Now that surgery is over, I'm left with many lingering thoughts, some of which I'll discuss now, and others which I'll come back to at some other point. I'm feeling a bit burned out at this point, and like I mentioned before, I've never actually reconsidered going into medicine before this last two months. Ultimately, I think it's just a sign that surgery is not for me, and when I find what's right for me, I'll be re-inspired and reminded why I'm doing what I'm doing, or at least that's what I'm desperately hoping for.
     It's interesting because when I look back on my psych rotation, it, too, was emotionally hard on me at times, but for completely different reasons. On psych, the patient's stories were sad, and it got frustrating not being able to fix all the patient's problems, but connecting with the patients was a fun challenge. And as a med student, you were a valuable part of the team, and the team welcomed you and cared about your learning and well being. On surgery, most people don't give a shit about the med students, and instead of looking at med students as future fellow colleagues who are on their journey of training, they look at us like we're little idiots who aren't worth their time. On surgery, people have huge egos and mostly care about "knowing their shit" and looking good. They really don't care to spend any time with the patients, which might be the reason I feel so burned out. Spending time with patients is one thing that re-energizes me and gives me that "warm and fuzzy" feeling, and those feelings have been far and few in between on this rotation.  One day, when one of my fellow MS3s and I were tired of being in the OR, we decided to go up to our floor and do "social rounds" on all of the patients on our service.  We went around to each patient's room, just popped in to say "Hi, how are you doing?" and then went on our merry way.  One patient was feeling particularly down, because he had been in the hospital so long, so we sat down and chatted with him for a good 20 minutes.  It was really nice to give the patients some attention, because usually they don't get much after rounds are over.
    I started writing this post a couple of weeks ago when I was still bitter about my experience on trauma surgery, so now I'm feeling a little more optimistic about medicine after having an overall great experience on GI surgery.  Unfortunately, we just have this weekend to recharge before rotation 3, so I hope I can muster up the energy.  I start L&D for OB/Gyn this week, which I am really excited about.  I can't believe my time is finally here - time to really see if this is what I want.  I hope this is the rotation that re-inspires me.  I have a good feeling about this, so here we go!

BF and I had a BBQ to celebrate being done with 1/3 of our third year!

    ***Also, I did some much-needed retail therapy today and bought some new professional dresses and blouses.  :)  Hey... I deserved it after making it through 8 weeks of surgery, right?!

Third Year Of Med School Is Such A Rollercoaster

   ... So hold on tight, but enjoy the loop-de-loops (even if they make you nauseated at times)!

   Today was my last day of GI surgery (the second half of my surgery rotation), and it was the perfect last day.  The patient I picked up this morning was super cheery and was motivated to change his life for the better, which set the tone for a light-hearted rest of the day.  We had M&M today, which was just as dramatic as ever, however, I've learned to really appreciate the theatrics of the whole affair.  When an attending from one department asked about the management of a particular cancer, one of the surg-onc attendings answered, "Yeah, we haven't done that for years.  We also started writing with ballpoint pens instead of quills..."  At first, I used to be really bothered by how the surgeons would always humiliate eachother every week at M&M, but then I realized most of them thrive on that shit, so I learned to appreciate the humor in it.
   My fellow MS3s and I were going to try to study for our shelf on Friday, but we were sitting in the cafeteria, so throughout the day, everyone from our team kept sitting down to chat with us while they ate.  It is so nice to have such a strong team dynamic that everyone actually wants to sit with eachother to eat.  We spent hours today just shooting the shit with our attendings and chief resident about figuring out what you want in life, career choices in medicine, and the behind the scenes of what life is like as a surgeon.  It was such a positive note to end the rotation on.
   Since it was our last day, all day the whole team kept telling us how good of a job we did, and how much they were going to miss us.  At first, I couldn't really figure out why they liked us so much, because I don't feel like we made that big of a contribution.  But then I thought more about it, and I think the contribution we made to the team was by having fun, enjoying the whole process, and laughing about everything throughout the entire rotation.  The NP asked us, "Do you guys take happy pills or something?!"  I think a lot of times people in surgery are so serious because of the intensity of the specialty and the critical nature of a lot of the patients, so I think our team appreciated our bubbly, high-spirited attitudes every day.  We had several of them tell us they hadn't laughed that hard in a long time.
    I'm really glad to be ending this rotation on such a good feeling.  This second half was drastically different from the first, and it had everything to do with the team.  It makes such a huge difference when the leaders of your team actually acknowledge your existence and care about your learning/well-being.

   That's all for now.  More thoughts on my surgery rotation later... probably after I take the shelf.  I gotta study!!!

Much Needed Golden Weekend

   Today concludes the 6th week (of 8 weeks total) of my surgery rotation.  I think the one word that best sums up how I feel is "tired".  I'm excited because this is my first "golden weekend" (aka having BOTH Saturday and Sunday off) that I've had in over six weeks.  I have been pulling 12-16 hour days 6 days a week, so I've sorta been living under a rock.  I can't wait to see my family and friends this weekend while I have the chance!

    Two weeks ago I switched over to GI surgery, which is a million times better than trauma surgery was.  My team is awesome: super laid-back, approachable, like to teach, etc.  They are pretty intense at times, and even may yell at you, but they aren't mean about it, and you can tell they care.  And at least they acknowledge us med students... which is more than I can say for my previous team.

   I've been also been liking this half better because we have been getting much more OR time.  It gets a little repetitive scrubbing in on lap cholies, roux-en-y gastric bypasses and hernia repairs all the time, but still cool.  I've also been able to get a better look at anesthesiology too, which is pretty cool.  I like how much physiology it involves, and how it has moments of "routine" and other moments of "sheer terror/panic".

   Anyway, I've been ready for this rotation to be over since the first week, but I only have one and a half weeks left, I'm in the final stretch, and I am ready!  I can't wait to start OB/Gyn next.  Finally, I;m gonna be doing something I'm passionate about.  I hope surgery hasn't exhausted all my energy... This post isn't meant to be a complain-y post, but more of a reminder to myself later why I'm not interested in surgery as a career.  And I've also realized after six weeks straight of 70-80 hour weeks, that lifestyle is important to me, so I should keep that in mind when considering specialties.  When I only have 2-3 hours to myself each day between the time I get home and the time I need to go to bed, to get a whopping 6 hours of sleep, I am not a refreshed and happy person.  I guess it's probably something you get used to.  Does it ever get any better?  Should I kiss any life I had outside of medicine goodbye?

Another Year Older, A Teeny Bit Wiser?

   It's my birthday tomorrow, and I was sure that being on my surgery rotation meant that I would just have to forget about having any sort of festive celebration this year.  I was completely surprised, however, when my friends/BF pulled through and made it absolutely amazing.  Two of my sorority friends from LA showed up at my door, which completely caught me off guard.  I didn't even know they were in town!  Then, later I went to dinner at a BBQ restaurant which has my favorite mac and cheese, and all my friends showed up!  What an awesome surprise :) and BF put it all together with my friends.  I'm so lucky to have such an amazing BF and friends!

  I really wasn't expecting anything to happen this year, which is fine, but this was just so fun.  Watch this video my friends took of my surprise to see how shocked I was:

So This Is What People Meant When They Said Third Year Was Rough

   Let me start out by saying I am fully aware that many of my posts lately have been negative.  I hate to be so negative, so I'm going to end this post with positive thoughts, because really, you can always find something positive in everything - even though finding that positive thing doesn't necessarily improve one's piss-poor mood.

   Anyway, I mentioned in my last post that I was hating my surgery rotation so far.  I had previously said that I didn't want to post about it until after I recieved my grade, in case anyone happened to read it and it somehow affect my grade for the clerkship.  I've decided that I'll just talk about it now, but maybe in a more vague manner.  And like I said, I don't mean to be whiney or complainey, but I'm doing this more as a way of having something to look back to later on.  I want something I can refer to, when I forget the particulars of why I was so unhappy on this rotation, so that I know what things to watch out for when I'm deciding what specialty to go into or what sites to apply for residency. 

   First off, and this is not unique to surgery by any means, who you have to work with is SO crucial to everything.  Your co-worker's attitudes and styles set the tone for everything, so when you work with people who are passive aggressive, hate patients, don't want to be bothered by anyone, and are in a bad mood (because they are tired and overworked), it rubs off on the entire team.
   One thing that especially bothers me is some of the unprofessionalism I've witnessed from the more senior residents, who should be acting as role models for the interns and med students.  The way one of the senior residents talks about the patients behind their backs is appalling.  He casts judgement on all of them, doesn't care about their well-being whatsoever, and has even gone as far as calling them profanities.  Every time he opens his mouth, I find myself thinking, "Do you even LIKE patients?!"  I'm sure everyone has their periods of being frustrated by patients, but ultimately, isn't the reason most of us go into medicine is because we want to take care of people?  Or maybe that's just me.  Anyway, this guy just seems to despise patients and has absolutely no respect for most of them, so I don't really know what his deal is.
   Another thing I have a huge issue with, is how little respect many of the team members have for eachother.  They talk bad about one another behind eachother's backs, all the while in front of everyone else, making everyone in earshot feel extremely awkward.  Most of the time they are complaining about something that the other person has no idea they are even doing wrong.  It would be so much easier if they would just say to that person, directly, what they are doing wrong, and then they can just fix it!  And then everyone will be happy!  Some of the team members can't even show respect for the attending!  There is one girl, whose facial expressions allow you to read her thoughts like a book.  I've learned to watch her face during rounds (for pure entertainment on my part), because when other people are talking, including the attendings, she makes several expressions of disgust and contempt.  Maybe she doesn't realize how expressive she is, and has no idea that she is displaying her feelings for the whole team to see?

  That said, there ARE some things I like about this rotation.  In fact, all the things I don't like about this rotation are mostly dependent on who I'm working with.  And I'm not really sure if that's unique to this particular department?  Obviously I can't generalize these personalities to ALL surgeons, so we'll see how my experience on GI surgery is.  I particularly like the short get-right-to-the-point rounds.  From what little time I've spent in the OR so far, I like it!  I really like seeing patients, whether it's waking them up at an ungodly hour to preround on them, or popping in to say hi during rounds, I really enjoy all the little interactions I have.  I especially love the crazy patients.  I find them to be an entertaining challenge.  Luckily, I think I will come across crazy patients in any field of medicine. 

   Finally, I'll leave you with one of my favorite patient encounters.  There is one patient who suffered a severe traumatic brain injury, and is now severely disabled: physically and mentally.  He has a lot of trouble speaking, and most of the time, his words come out all mumbled and slurred.  Because he isn't really able to comunicate, a lot of the times on rounds the doctors would just ignore him and talk about him like he couldn't hear them.  Every morning I would go in to preround on him, and he began to be able to talk more and more.  One day, when I went to see him, he said, "yyyygghhh zzzhhhccckkin mmmeeaaaaan."  I had to have him repeat it several times, saying, "I really want to understand what you're saying, sir, but I can't!"  Finally, I was able to make out that he was saying, "You've been checking on me."  And I said "Ooohhhh... Yes! I have been checking on you every morning!"  He replied, "I appreciate it."     

    It's the little things that make me happy.

The 5 Types of Trauma Patients

   I only have one more week of trauma surgery left, and I am counting down the days.  I haven't posted anything about my experiences yet, but that isn't because I don't have anything to say.  Rather, I have a LOT to say, but I'll feel a bit more comfortable saying it after I get my official surgery clerkship grade.  After all, this is a public blog and you never know who reads these things.
   Long story short: let's just say I am miserable on this rotation.  This is the first time EVER that I have doubted my decision to go into medicine.  I'm really hoping that GI surgery will be better.  If not, at least I have OB/Gyn next, which hopefully will be a pick-me-up!


   Anyway, something funny I noticed is that there are about 5 types of trauma patients.  99% of patients on our service fall into one of the following categories:

1) "Old man river" or frail old lady who trips over their cat/carpet/feet/etc

2) Intoxicated person riding their bike who gets hit by a car

3) Person in a car accident (often involves someone being intoxicated or running from the police)

4) Adrenaline-seeking young man who gets injured on his ATV/watersport jump/other dare-devil activity

5) Man with too much testosterone (and/or drugs/alcohol on board) who gets punched/shot/stabbed

*** We also saw about 4 people who got injured by a horse (some variation of getting kicked/stomped/thrown off) in the span of a week.  Who knew so many people ride horses around here?!

Thoughts On The Totem Pole Of Authority In Medicine

   As in most fields, there is a distinct rank of authority in medicine, and at the very bottom of the totem pole, is the med student.  You could argue that pre-meds are the very bottom of the totem pole, but they have more of an observational role, so they don't really count in that sense.

   As third year medical students in the hospital, it is quite obvious that we are the "nobodies" of the team, especially early on in the year, when we don't know much about how the hospital works, or the politics of the team, or even how to do simple tasks.  Trust me, I'm totally fine with the pecking order.  I know my place!  But something that I find a little frustrating is how the more senior members of the team don't help you out in the least, they just stare as you awkwardly flounder.  I'm not asking for anyone to hold my hand, but it'd be nice if they could just think back to what it was like to be a medical student, not knowing anything, and be a little more direct with how things are supposed to run.  Seriously though - MS3's are not mind readers!  If we were, we wouldn't have gone into medicine, we'd be sipping champagne and laughing on our yaughts we bought with all our lottery/stock-market-won riches.

   I will say that there are some interns, residents and attendings who do remember what it was like to be a medical student.  They give you little hints and nudges, and those few moments they donate of their precious time help us out tremendously.  However, I have met several residents who obviously have absolutely no recollection of what being an MS3 is like.  They just assume you know what they know at their current state of training, and look at you like an idiot when you ask them how to do things - all the while being annoyed that you exist.

   I'll admit, it's easy to fall into this trap.  I'm thinking of a time I was shadowing as an MS1.  That day, there happened to be an undergrad shadowing too.  I think I was annoyed because I knew the attention of the attending wouldn't be solely on me that day.  I mean, was this undergrad even smart enough to get into med school?  Anyway, I found myself getting irritated with the undergrad throughout the day, especially because I kinda got stuck baby-sitting her.  Later, I thought back to my experiences as an undergrad, and how nobody in the hospital cared you existed.  I remember how surprised I was when I realized what a difference it made in the way people treated you when you moved from being a pre-med to being a medical student.  In retrospect, I feel terribly guilty for being irritable towards the undergrad.  Afterall, that was me just a few years before!  I hope that when I move on to residency, I learn from my previous mistake, and from the mistake I see a lot of residents making.  I hope that I am the helpful, enthusiastic resident, who the med students go to for things that come up.  Yeah, it takes more effort to be that resident, but the med students will be so much better for it.  And isn't that what training to be a doctor is all about?  Providing more compassionate and competent future doctors?!

Day #1 of Surgery

   Today was the orientation for my surgery clerkship, and while getting introduced to the OR was exciting, I learned two very important lessons:

1.  I don't know anything

2. Get comfortable with looking like an idiot

  Tomorrow is my first real day, and I start on trauma surgery.  I have to report at 5:45am, and that's only because I don't have any patients yet.  From now on, I'll be reporting at about 5am everyday, six days a week.  Here we go!

Getting All My "Girly-girl" Urges Out Before Surgery

   Just finished my shelf exam for the psych rotation.  The good news: I'm all done (pretty sure I passed).  The bad news: I felt a lot of the questions were way out of left field, so I don't think I have any chance of honoring.  Oh well, at least I got good evaluations!  Psych was fun, and I learned a LOT about people, but I'm excited to have a break from crazy people.  

   Next up for me is surgery, which I'm excited for.  We get a week-long "summer break" before we start, so I am going camping on the beach in Oregon again (look out for a post on that later).  I am really excited because we had such a great time last year, and it will be a really nice mini-vacation.  Then, later next week BF's mom is in town from the East Coast, so I'm excited to meet her!  I wish we got a week off between all the rotations *sigh*.

   Anyway, I am interested to see what surgery is gonna be like.  I really have no idea what to expect, so I'm going in with an open mind.  Since scrubbing in will require short, un-polished nails, I took the psych rotation as my last chance to have girly nails.  And naturally, I had to take pics.