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Thursday, January 4, 2018

Hello fourth year!

Third year is over! And with it, graded rotations and exams! (well, let's just pretend licensing exams aren't real for now). The light at the end of the tunnel is glowing and I'm feeling optimistic. I also am feeling a bit guilty for abandoning my blog for so long. A lot has happened since we last spoke, internet! I got a dog, he's great. I delivered a baby or two, that was great. I stuck a bunch of children with needles, not so great. I found my anti-calling in psychiatry, extra not great. But the most great; I was published! Not so many details to come on that but it's all very exciting.

OB/GYN was... not for me. Delivering babies is FANTASTIC. It's amazing, it filled me with awe and instantly made me believe in a higher power. However, it's also only a small part of being an OB/GYN. Arguably, it's the most fun part, but small nonetheless. I spent most of my time listening to fetal heartbeats, reading fetal heart rates, answering questions from moms, giving pap smears, and waiting. There is a whole lot of waiting around in OB/GYN. Babies are tricky like that, they don't read time well so they're not great at adhering to a schedule. Thus, I'm a big fan of planned c-sections. Interestingly, the rate of c-sections is going up because babies are getting larger and women's pelvises are getting smaller. Ironically, this trend was caused by women electing for c-sections and now they end up having to have them, just as natural births have returned to popularity. Regardless, no OB/GYN for me.

Pediatrics was very different. I would say it was my most surprising rotation. I went into it thinking I would hate it and left thinking "I could totally do this. I won't... but I could". I think a large part of that was my attending physician. She was an older Spanish woman who said exactly what she thought and took no nonsense. My personal favorite trait of hers was telling parents to pay attention to their child and not their phones. She also gave me a lot of autonomy (and was very quick to tell me exactly when I had screwed something up). That independence allowed me to learn a lot about how to be a doctor. Kids are great to practice your interview skills on because they don't know what to tell you or what's important; you've got to pull it out of them. So you have to think of every question you need to ask and make sure you cover all of your bases. Otherwise, I was definitely going to get a look from the attending. She was hands down one of my favorite attendings of my entire third year. I honestly miss her and her clinic.

And that leaves.. psych. Ah, psychiatry. There is no place quite like the psych ward and no people quite as honest as psych patients. I learned quickly that psychosis isn't always obvious. I also learned that you have to really trust your gut. One fun part of psych is listening to a patient talk, realizing you're having a hard time following them, thinking "why is this so hard! am I not listening well?" and realizing they're actually psychotic so OF COURSE I can't follow. I never really learned to get out of that, I went through that sequence with almost every patient. Psychosis isn't always obvious and it can be very subtle. It was very hard for me to deal with. Psychiatry ended up being one of the hardest rotations for me. It was beyond emotionally taxing. I saw children as young as 7 with suicidal thoughts, I saw adults who had been failed by their family, I saw patients who kept coming back because there was nowhere else for them to go. I saw a lot. I think I would have to be a much stronger person to be a psychiatrist, or at least much more guarded. It's hard to see the same people coming in and out of the psych ward, from the street, to the ward again. They've got nowhere to go and our resources are finite. A lot of patients have comorbid problems - addiction, diabetes, you name it. They can't manage them on their own and there aren't enough places for them to go to get the help they need. So they end up locked up in the psych ward. It's an ugly cycle. On a lighter note... I also did a brief rotation in the psych unit of the Miami corrections department. Now that was interesting. It's remarkable how normal people can seem until they leave and nurse Vaga whispers "he murdered his mother in law and flushed her body down the toilet in pieces". Classic Vaga.

Now for the ever popular - "what's next?!" segment of our broadcast! Well boys and girls, next are electives! Starting with family medicine. I'm pretty excited. Also a tad nervous to start studying for the next round of licensing exams. We all know what a joy I am to be around when those roll in. After that, I will be applying for residency in September of this year. Right now, I am most interested in internal medicine but who knows! And before you know it, I'll be an MD. (As in, in September). So get ready for me to be really obnoxious about it on social media!

I know. You've all been wondering desperately this whole time about the dog. "Forget med school! WHEN WILL WE HEAR ABOUT THE DOG?" Well, dear internet, now! His stats: he's a 7 year old puggle at a slim 27 pounds with a sassy attitude and desperate need to cuddle. He has IBS just like his momma except he can enjoy chicken (Rude). His name is Roscoe from obvious sources and hes really my favorite. Although, last night he was attacked by a Rottweiler (TWIST!) so he's currently on the mend in the cone of shame. (He's alright, minor surgery and a couple weeks recovery until he's good as new). Not to worry, he has a lion cone on the way so he can retain his ferocity.

We both can't wait until the stitches and cone are gone. Until then, sad eyes from Roscoe.

Wednesday, July 19, 2017

Fake it until you make it and other adventures as a fake doctor

Hello boys and girls! Well. It's been a few months. One hell of a few months, to be exact. I moved to Miami! It's insane. More on that another time. I just finished my internal medicine rotation, as in, took the exam today (Don't worry, I only cried ONCE afterwards). For those of you keeping score, thats 3 months of surgery and 3 months of internal medicine under my belt. So, basically, I'm a doctor now, right? Wrong! I had a very mixed experience in IM and some of that included time in the ER where I had quite a bit of autonomy - to diagnose, treat, and sew people's faces! I loved it. I actually understood the patient poaching on Grey's Anatomy. (Read, one patient comes in with head laceration - four medical students want to sew that head - must guard that head). I'm not kidding, I went with my patient to their CT scan and sat outside and then marched right back with them. I was GOING to sew that head. (Don't worry, I did!)

Anyways, ER side note aside, it's been intense. Learning how to work with different attending physicians every week, with very different teaching styles, learning that patients' really hate being woken up at 5 a.m by the med student, learning it's best not to wake patients up by leaning over their bed and whispering "Good Morning Mr. Smith". Apparently, that's "unsettling". Just kidding! I didn't do that! It was Mrs. Smith! Hahaha, hohoho... so funny. ANYWAY! Let's get to the topic of this post - Medicine is 100% fake it until you make it.

Let me explain - if you're wearing a white coat and speak with authority, people will believe you know what you're doing. Something else no one mentions, patients don't know the proper physical exam technique or question sequence sooo when you mess up, if you just pretend you didn't, no one knows! (Man, I use A LOT of commas). This worked very well when I was trying to find my patient's kidneys a feeeww inches too low and just readjusted. Yup, totally had to check your bladder, sir. He had no idea. I know, I'm sly. In all seriousness, this really helps you develop your clinical reasoning and skills. A big part of medicine is controlling the room when you're taking an interview or doing a physical exam and a big part of controlling the room is having self-confidence and being authoritative. There's no room for nerves or self doubt when you're interacting with a patient, what patient is going to tell you their life story, including all the private little details doctors need to know, if you're sitting there playing with your hair and mumbling. You gotta fake it until that fake confidence becomes real, I'm convinced it's the key to being a successful medical student.

All of that being said, I think the most important thing I've gained from this rotation was confidence. I feel comfortable working through a differential diagnosis, asking questions and doing a physical exam to narrow down what's going on. I even think things like "Hm, I wonder what the creatinine came back as this morning... that would make this diagnosis more likely". I KNOW! Before you think I'm incredibly smooth and talented, you should know that I also still do things like:
-ask the wrong patient, who is not on dialysis, when they go to dialysis
-get hopelessly lost because why does one hospital need 19 buildings and 213823984 elevator bays?
-Try to find coupons to support my starbucks habit
-get my toes run over by gurneys
-have absolutely no idea what I'm doing and just ask a patient a WHOLE bunch of random questions hoping one willl give me an idea but often I just walk away knowing their great great uncle died in a train accident
So, don't worry, I'm still humble and awkward and embarrassing. It's been a blast, I've got pediatrics up next and, unfortunately, it's during flu season. Everyone please hold for the sniffles featuring yours truly.

Sunday, April 9, 2017

Being a Single Woman (in medicine)

Disclaimer: I can only speak of my experiences and those people have shared with me. 

"You need someone to share your life with". Is a common remark people say to me. It comes in many different wordings, from many different mouths, and with many different intentions. Is it true? Maybe. Does it overlook everything else I've accomplished in my life? Yes. Maybe that's what I'm thinking too. Maybe that life isn't for me or won't fulfill me the way medicine has. I have no idea. But it's for me to decide without other people's judgement.

I've never minced words about how demanding medical school is. It is my husband, my child, and everything else in between. It takes up my money, my sleep, and my time. It leaves me with nothing left to give. But it has given me so much. I'm proud of how hard I've worked and what I have accomplished. I'm proud of being able to claim something as my own, knowing that I'm the one who put in the blood, sweat, and tears to make it work. I regret some of the sacrifices I've had to make but I wouldn't change it for anything. 

That being said. Is that not enough? Do I have to have a bouncing baby and doting husband to be seen as an accomplished adult? I don't think so. I didn't think other people thought so. But they do. What bothers me the most is this isn't something my male peers encounter. Men are never asked if they'll pick a more relaxed residency to be home with the kids. Men aren't expected to know how they'll balance it all and if they even want to. It isn't expected of them as a condition of their success. No one comments on how older dads can still be great dads when they hear they're in medical school, not planning on kids for awhile. No one asks them if they'll give up their practice to have children. Everyone assumes they'll marry someone who is not a doctor who will take care of those things for them. 

It's almost as if society will allow women to become physicians but only under the condition that they remain in their typical gender roles. Yes, you can be a doctor but you also better be at all the kids' soccer games and support your husband. Male physicians are not expected to balance it all. It's assumed someone else will handle the home front. But women? We're expected to not only want to take on both but bad mothers, wives, citizens if we don't. 

I'm 26. I'm single and have no kids. But I feel this pressure often. I notice the lack of women physicians in a room (which is a whooole other topic). I cringe when my friends comment on how happy they'll be to stay home with the baby, how lucky they are to have babies young. I quietly smile when someone asks me why I'm still single as if succeeding in medical school is not enough unless there's a man cheering me on. I don't know where my life will take me. I don't know if I'll have children or get married and frankly, I don't care. Right now I care about medicine and I care about doing my very best. It breaks my heart that people don't care about my passion or drive, preferring to hear about who I'm dating. But that's what it's like. People don't see female physicians as doctors first. They seem them as women and mothers first and doctors second.

Tuesday, February 7, 2017

Surgery is Terrifying

The world of the operating room is clouded in mystery to the general population; leaving a lot of room for imagination, dramatisation, and fear. Surgery is scary for patients. To them they see people being wheeled into the OR on Grey's only to have three massive bleeds, four heart attacks, and a stroke. So of COURSE it's scary. In reality, that doesn't happen (often, I mean, it probably has once over the course of surgical history). Surgeons are precise, careful, and surrounded by a team of people who make sure that doesn't happen. The sheer volume of machines monitoring every little thing within your body is astounding. So why are patients so scared?

I think part of the answer lies in vulnerability. You're naked, you're sick, and you're about to be cut open by people wearing funny masks and hats. It is an incredibly vulnerable position. Particularly in our society where people often do not understand what is going on within their bodies. That failing lies both within the education system and the healthcare system. Patient education is a crucial part of the doctor-patient interaction but it often goes untouched. Patients who understand their health and who feel like they are part of the decision-making process are more likely to be compliant with their medical plan. It also takes some of the mystery out of surgery, and thus, some of the fear.

I feel like I can speak from both the healthcare side and the patient side. I have both been a patient in surgery and a student in surgery. I remember how scary it was to be wheeled away from my parents and brought back to a freezing operating room full of equipment I didn't recognise or understand. I remember laying on the hospital bed as they told me to move to the operating table thinking I could get up and run (I was 14, what can I say). I remember the anesthesiologist holding a mask over my face and counting me down to sleep. I don't remember ever seeing my surgeon in the room. That one familiar face could have helped quell my fear but I distinctly remember being surrounded by strangers and I was terrified.

After working with different surgeons I have noticed different styles and the ones I personally resonate with the most are hands on. The surgeons who come into the room while the patient is still awake and says hello, asks how they're doing, helps calm any fears-- those are the ones who have the best patient relationships. I know, every surgeon goes and talks to the patient in pre-op but pre-op isn't scary. The OR is scary. I also understand how busy surgery gets, believe me. I know there isn't always time but I think that it is important to make time because, after all, we're all there for the patient's benefit.

One of my biggest take aways from this rotation is it's more important to take the extra minute to hold a patient's hand than it is to be fast (I mean, unless they're bleeding out.. but I'm a student, I can still hold their hand, not about to pretend I'm any use in that situation). Alright. Everyone brace yourselves for a cliche moment - I've started to feel like this is really my calling. Not surgery, ha, NOT surgery. But patient care. It fulfils a part of me I didn't even know existed. I love checking up on patients and talking with them, seeing how they're doing. I actually look forward to early morning rounds. I love giving advice and being able to help. Despite the hellacious journey, medicine is definitely the right fit for me and I am so excited to see where it takes me.

Thursday, January 5, 2017

Using a wall to itch my face and other jaunts in surgery

Surgery, oh Surgery. How do I love thee? Let me count the ways. You wake me up before dawn and lay me down to sleep long after sunset. You stole me from my old lover; sleep. I forget what day light looks like; I assume more yellow? Are there more people outside? Do they wear navy scrubs, too? You humble me at every wrong answer and leave me wanting for knowledge. But today you rewarded me with a “good job” and a literal pat on the back from an attending surgeon. I could have died of shock and pride.

You guys… I’m too exhausted to keep this weird poem thing up. Surgery is great. Those are three words I never thought I would utter. For my lawyers, I have yet to SPEAK them, so, no worries. It is exactly as exhausting as you would imagine and I often find myself wondering what a caffeine overdose feels like, but I’m loving it. I think it’s a mix of my first rotation, seeing real live patients, dealing with actual disease, and surgery but whatever it is, I love it.

I began my rotation on the urology service. When I saw my assignment, I will admit, I groaned. I wasn’t thrilled, I thought it would be a whole bunch of prostate exams, penises, and urine. While those things are super true, it’s also a lot of really interesting disease processes, cool surgeries, hands on experience, helping patients, AND penises. Remember that post about how traumatizing the genital/rectal exam was back in basic sciences? Well, that’s my life now. Although, not traumatizing and surprisingly easy to disassociate from.

Disassociation seems to be an important skill in medicine. I haven’t mastered it (I mean, it’s been three days) but I can tell that I will need to. Pain, suffering, and death are all very large parts of this career and I am still very much in a place where I feel for the patients on an emotional level.  The hardest thing I have seen so far is a patient who has lost hope. That one will stick with me for a very long time.

But back to the penis jokes! …I don’t have any. Sorry to disappoint, everyone.

My sleep deprivation is showing in my writing. The schedule on paper isn’t that intense but what it doesn’t show is the “You can go home or you can stay for a few more surgeries” pseudo choice. Yes, I’m sure it would be fine to go home and skip the last surgeries of the day but who does that serve? You have to learn these things anyways and seeing them, doing them, and asking an attending questions about them is easily the best way. Plus, everyone knows you’re not getting an “excellent” grade if you peace out early. More so, all of you know that I will die if I do not get said excellent grade; literally cease to exist. So I will go home and study (< sleep) when the cases are over.

Once I have seen more patients I will discuss themes and compilations of them but I will never discuss any specific cases so I have nothing to say on that yet. Although, today I did learn how to use a scope and guys, let your kids play video games, it will help make them great surgeons. (Thanks Eric for always hogging the N64)

One of the harder things to adjust to is the sterile procedure. Once you've scrubbed in you walk around with your hands at shoulder level until the scrub nurse can gown you and glove you. Then you cannot touch anything that is not sterile. That includes your face mask, hair cover, eye protection, door, toilet, coffee, whatever. It's hard not to itch a scratch or, today I was in a case that required protective glasses for lasers (I KNOW, SO COOL) and they kept slipping down. All I wanted to do was push them up but I had to keep using the handle on a machine to nudge them up higher. It was a vision of grace. 

Whew. This ended up being a lot longer than I thought. 

Thursday, December 15, 2016

Exams! Clinicals! White coats! OH MY!

Hello, internet. I'm coming to you from y distance above the x horizontal. And for those of you who hated algebra as much as me, I'm in a plane. ... there are so few good algebra puns these days. I'm en route home from st Maarten, I know what you're thinking - you left there four months ago! I'm so confused! Don't worry, all is well, I went back for a visit and to help a friend move home. I'm already cold in anticipation of returning to the blustery Chicago winter. 

Let me catch you up a little on my progress to the MD. Since we last spoke I've completed some pretty important exams (and passed!) and have been assigned to clinical rotations. So what were those exams? Where am I going? Will there be seasons? Will there be grubhub?! Stay with me and see! 

The first exam of exam season (despite what Macy's may tell you, the ACTUAL most joyous season of the year) was "comp". Comp is a four hour long journey into "were the last two years of my life a waste?" Formally, it's a practice exam we take for our upcoming licensure exams. In order to take said licensure exams you must pass comp. Thus, comp looms like Sasquatch; many have heard stories, few survive an encounter, many years of therapy ensue. I'm mostly kidding. The actual exam was not that bad, though I was fortunate to pass on the first go. The worst part of comp is the build up; everyone asking how you're studying, how many questions have you done, are you nervous?!! And then the survivors from semesters past, recalling the difficulty, the impossibility, the seemingly inevitable failure. It all amounts to a decent level of shared panic. Perhaps its own form of mass hysteria. Never before have there been so many people with a chronic twitch in such close proximity. We all marched (read, crawled) to the testing center one July day and we all sat through a grueling exam and we almost all walked out. It was hard, there were several questions where I wondered if they were using English (jury's still out) but I tackled the beast and I passed, and then, once over, I proceeded to lay on the beach and not do one ounce of thinking until I moved home. It was a time of pure stupidity, in a word, it was magical. 

Ironically, comp is absolutely nothing like step. The medical licensing exams are broken up into three steps: 1, 2 clinical knowledge and 2 skills, and 3. I took step 1 this past October. If comp is Sasquatch, step 1 was... a den of angry cobras, lions, tigers, suburban moms who just found out there WAS gluten in their muffin, plus Sasquatch. It was rough. It's more than double the length of comp, it requires an attention span few have, it will most likely make you feel stupid. 

I spent the few months leading up to step in my childhood room trying to push any extra knowledge I could into my brain, answering about 2,300 practice questions, and stress eating. It was a rough few months. However, I have never been more elated to be on the other side of an exam. Whew. I fully recognize the exam is designed to be hard and no one wants a doctor who skated through but good golly miss Molly. If there were several questions on comp I was confused about the language on, there were an equal amount on step plus the additional things I'm half convinced were made up to psych me out. In reality, it's a very fair exam for people who will be responsible for guiding others through life and death decisions. And I am still very happy to be done with it. 

And now! Now I get to go to clinicals! My first rotation is three months of surgery in the Washington D.C area and I am incredibly excited and also super nervous. I'm not sure what to expect but according to Greys anatomy it's going to be incredibly suspenseful and my colleagues will be strikingly attractive. I head to the east coast right after Christmas where I'm fortunate to be living with my roommate from the first two years and I'm really excited to see where the next year takes me! And more excited to tell you all about it.

Friday, June 17, 2016

Where I'm going and where my hands have been

I did not forget I have a blog! Well... I did... but then I remembered and here we are. You know I can't lie to you, internet.

Things are happening! I'm in my last semester on the island and that means I'm 50% closer to being a doctor and having a fancy car. Just kidding, I have a crippling amount of debt. Hooray for capitalism! Aside from the debt and 50% a doctor thing I will be entering into a whole new stage of my medical education - clinical rotations. DUN DUN DUN. From what I have pieced together I will be doing anything from getting coffee and filling out charts to real live brain transplants. I'm very excited to see it play out.

However, before any of that happens, I take the United States Medical Licensing Exam Step 1 aka USMLE Step 1 aka D-day aka a really expensive test that tells future residency programs if I'm smart or not and how much more or less intelligent I am when compared to my peers who are also taking this excessively expensive exam. No, but really. It's a very important exam and a huge determining factor for which specialties you will be competitive for come the match post graduation. My school has built in a little safety net where they make you take a mock step 1 or "comp" as we all call it and that is in one month and three days (if you were wondering). It's a good gauge for how well you are preparing for step 1 and is not daunting at all.

When all that is said and done I will be off to: the Uk, New York, Michigan, California, Florida, Connecticut, or hopefully another accredited institution to put all this fancy brain juice I've accumulated over the past 2 years to the test. I'll get to learn how to put IV's in, talk to patients who aren't getting paid to talk to me, continue practicing rectal exams (put a pin in it, I'm coming back), and learn all those wonderful doctor skills your nurse does. After that - who knows where life will take me! And that's that! I'm excited to see what clinical's hold for me and even more excited to tweet the insanity (shameless plug - go follow, I promise I'm sometimes funny)

Whew. Now that I've caught you all up on the finishing basic sciences and moving onto clinical's process I get to fill you in on the wonder that is your last semester of basic sciences. A little known fact about medical school is that you learn how to perform genital and rectal exams on real live people who spend their lives traveling from school to school teaching medical students exactly how to feel a man's prostate. (If you're wondering, approach the doorbell, ask him to bear down, ring the door bell, the prostate will be dead ahead under your finger... wear a glove boys and girls).

We were separated into groups of 6 for the male and 3 for the female and I was the lucky son of a gun who got to go first for the male. Fortunately, he was not as horrified as me and guided me through with ease. I have been told that my technique is fine but I need to work on controlling my facial expressions; APPARENTLY patients don't like it when you look horrified when examining their bits and pieces. The male exam is fairly simple and minimally traumatizing but the prostate is where I feel I really got to shine. First of all, we each got a lube buddy whose only purpose in life is to apply lubricant to our fingers which we were then instructed to apply to the anus with "tenacity like you've done this a thousand times!" So of course I very cautiously applied the lubricant and received a "LIKE YOU MEAN IT" shout from the patient, and thus I finished with a bit more gusto and a lot more horror. He then very calmly instructed me what to do and I told myself "Alright, Katie. You wanted to be a doctor... too late to go to law school now, just do it" and performed my first ever prostate exam. It was... an experience. I know none of you want a description so here's a description - you feel the prostate for symmetry, size, consistency then do a sweep from 12-6 o'clock and 12-6 o'clock the other way. It's very clinical and if you tell yourself it's fine it feels fine. I said "this is fine" a lot. When you're done you quickly roll away (AFTER removing your finger), discard your gloves, tell your patient you'll be back to discuss, and let them clean up/asses new emotional wounds. If done correctly there should be none. All in all it was one of the more interesting experiences in my life but not one I had nightmares over. I did, however, walk around with my finger still in pointing position because I did not want it to touch my other fingers despite it being gloved and washed. So the next time you get a prostate exam think of me and remember your doctor wants to do this just about as much as you want it done.

Onto the female! The female is complicated, choreographed, and multi-faceted. Why we gotta be so complicated? It really was not very noteworthy after the male and I think I had become mostly desensitized but I was still awkward as all hell and still told to work on my poker face. I think the female was much cooler because it incorporated more of what we've learned over the past few years and you get to feel internal organs (cool!).

So. That's what learning to perform a genital-rectal exam is like. I hope I properly informed all of you and you all sign up for a new career as standardized genital patients.