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. 

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.

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) https://twitter.com/WillCauseNausea

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.

Holy crap, I'm going to be a doctor. No, like, REALLY.

There's a professor here who always says this is the semester students realize they're actually going to be real life, white coat wearing, stethoscope listening, prescription writing doctors. Let me tell you, she is not lying.

I think it hit me when I was reminded my facebook's gentle "Look what happened a year, two years, three years ago, seven years ago!" notification in my newsfeed. If anyone is wondering, three years ago I complained about slipping my way across an icy Loyola campus (HA, not anymore!) and posted a picture of my clarinet to instagram. I know,  SUCH a nerd. But seven years ago held the real gem- there was a picture with me and my four friends from high school laying on the floor of Walmart. I... I don't even know, guys. Teenagers are so strange; we probably thought we were "edgy" and "standing out from society's preconceived ideas of what's normal" but I would like to point out I was 100% wearing American Eagle jeans and we were in Walmart so, clearly, no.

But today in 2016 I spent the day learning which drugs to prescribe for hypertensive patients, asthmatic patients, anxious patients; memorizing different lab values for different types of lymphomas and leukemias; and listening to my neuro professor scream structures of the nervous system at bewildered medical students. Don't be too impressed, I also took a nap. Somewhere in all that it hit me that I'm going to have to DO these things. Learning to read an MRI isn't a party trick like naming the emperor's of Rome* (thanks History of ancient Rome!), it's a real life applicable gonna have to do it kinda deal. It's only a little terrifying and a lot exciting.

I think it's a pretty cool thing what we're all doing - this becoming a doctor thing, I mean. It's definitely aggravating, frustrating, exhausting, overwhelming but it's pretty neat, too. Not to get all "graduation speech"-y but it's a pretty big deal when someone entrusts their health to you and this semester is the first semester I can actually see myself as that person. It's also the first time I feel smarter than Dr. Gregory House. Try something other than sarcoidosis for once, I mean, come on.

ANYWAY! all of the above is why my posts are far more infrequent than when I first began medical school - plus the fact that the island no longer has the ability to surprise me. (Fun fact, our car died on the French side 2 weeks ago and it still lives there- no one seems to care. Except the semi we blocked and then proceeded to back up traffic for a smaaalll part of the island, that's our bad. Totally on us... ) We did manage to walk to McDonald's from there (our original destination) and hail a friend to come get us. And eat a few fries. You know, why waste a trip? We held a wake for Paco that night, it was a very somber occasion and we all feel like better people for having known him.

Now, if you'll excuse me, I'm going to memorize drug names until I forget the names of everyone in my family.

*(I can't name all the Emperor's of Rome. I only studied in Rome for the wine and mozzarella, I learned nothing other than Limencello is not to be consumed like a regular beverage)

Planned Parenthood

I stand with planned parenthood because every person deserves the right to autonomous, private, and non-judgmental healthcare. I understand that people believe abortion is wrong and I have no qualms with that. You are allowed to believe every single belief you have but that does not mean you get to inflict those beliefs onto another person.

We spend countless hours learning how to care for patients without judgment, without opinion, and without pressure. That’s what healthcare is all about. Everyone has the right to make their own choices about their own body. A doctor guides, advises, and helps educate but no one gets to make decisions about your body except for you.

Consider a patient with high blood pressure who continues to eat fatty food. As a doctor you can advise the patient of the risks that will come with continuing their diet, you can encourage your patient to switch out a burger for a salad once and a while but at the end of your visit, that patient is perfectly able to drive through McDonald’s to enjoy a milkshake. And they have every right to do so. Any decision about their health is theirs and theirs alone. 

In medicine no one can force you to donate blood. No one can inflict their beliefs on your body. If my brother was dying of kidney disease and I happened to be an exact match, no one could force me to give him my kidney. (No worries Eric, you can totally have one). No one can force me to give him anything and that is because I have the autonomous right to my body and all decisions applicable to it, except for my reproductive health.

Congress proposes defunding planned parenthood because they don’t believe in some of the medical procedures the clinics offer. Frankly, it is none of congress’s business what any man or woman decides about their health. I do not advocate for or against any procedure, I believe that is not my place. I think that every person should get to choose what happens to their body for themselves after careful and accurate advisement. Forget the societal implications and the HUGE backwards step for women’s equality – every person deserves to make their own choices when it comes to their body and as a medical student and later a physician I will never stop fighting for that.

Infections, monotony, and flat tires. And a very descriptive title.

Listening to: Strangers by Langhorne Slim (I highly recommend - so cheerful)

Med school is weird. I spent my evening scaring the crap out of my roommate with my friend Marisa's birthday present. (L-O-L Marisa, I'm still not telling you what it is). My two favorite things in this world are: scaring my loved ones (once, my cousin Amelia and I used a whole toy palette of makeup to look like zombies and then woke my brother up by screaming in his face and flashing a flash light. It was really funny until we remembered he could run faster than us.) My second favorite thing is birthdays but that's not really relevant to anyone but Marisa right now. Nor is the scaring thing to anyone but Meghan. ANYWAY! What is relevant is that med school is weird. Med school is weird because in your day to day life nothing changes but when it's been a few months and suddenly you can diagnose all kinds of crazy infections you realize "WHOA so things are actually happening when I stare at my laptop". It's pretty rad. Every day is surprisingly similar, though. My day looks pretty much like this:

6:00a.m alarm goes off and since I was that idiot who bought the alarm that makes you get out of bed and play a logic game (not super effective at 6 a.m) I usually get up. Or I shove it under my mattress. Or I get up, do the whole 3 step process including a list of the reasons I got up read to me in a creepy voice (My list reads: because you want to be a doctor, because you don't want bed sores, because now you can have coffee) and then get back into bed. Screw bed sores.
7:00a.m study at school if I got up (about once a week) or still unconscious
8:00-1:00 class/more coffee
1:00 gym/slightly earlier nap
2:00 nap or study (let's be real, nap then study)
3:00-2:00 a.m sit and study

You can see the monotony and how that might lend itself to scaring your roommate half to death for entertainment.

Somehow though, I still manage to feel like I don't have enough time for everything.

So you can see how it can be surprising when your brain starts to change. From day to day it remains pretty constant but then all of a sudden you know all about urogenital infections and pneumonias and are perfectly willing to disturb your friends and family with pictures. This semester I'm taking a class called "Medical microbiology" and it is maybe the greatest thing that has ever happened to me. First of all, our professor is basically like a rainbow personified - she's bright, cheerful, happy, nice, and somehow manages to make talking about diarrhea fun. Let's be honest, most med students think that's fun anyways... or at least I do.  I think all of micro is fun, though. It's the first class where I actually get excited to study the material and the first thing I can actually see myself going in to. Most specialties elicit a "it wouldn't be the worst" response from me but based on my willingness to discuss infections, fluid, puss, swelling, vomit, diarrhea for hours I think med micro might be my new niche.

In other news, Paco got a flat tire. For those of you who don't remember; Paco is our car and he is hanging onto life by a thread. But a well inflated thread at least. Let me just tell you how fun dealing with car problems on this island is - every single person runs on island time and every single person feels the need to make sure the three car owners are as uncomfortable as possible. It started out fine- we went to buy a new tire, totally fine until the mechanic at the dealer took it upon himself to gain our life stories. Meghan made the mistake of not talking (because Marisa and I stood in front and were perfectly capable of answering his shockingly personal questions) and then I made the mistake of joking that she was mute. We all know I can't not make a joke like that. It grew even more uncomfortable because he apparently takes everything at face value but he did then lift and deal with the filthy tire for us because "girls shouldn't have to do that". I know, eye roll at the patriarchy (you're welcome Kreila) but it was convenient considering we all were wearing nice clothes. After calling our personal drive up at his own convenience mechanic to change the tire for us (I know... we could do that ourselves but... hiring someone to do it seemed easier) but he did not show up and might have been abducted (keep an eye out) so we made (asked nicely) our friends do it and paid in cupcakes.

Calling your mechanic and having him not show up is not surprising on this island. It's not rare for someone to stop working and go chat with their friends while you wait "patiently" for them to finish discussing their kids' soccer game. (True life, I just tried to spell soccer as 'socker').

Look at that! Four whole paragraphs! I didn't have a plan when I opened this post. Not that I ever have a plan. My usual writing style is to just type out whatever crosses my mind and then go back and delete the parts that don't make any sense. Unfortunately, this whole post is kind of a giant hodge podge so.... deleting would leave very little. Plus my laptop was at 11% battery when I started this post and I wanted to see if I could make it.. I'm at 4% now, nailed it.

Med Students and their vices

My roommate is currently practicing the alcoholism screening test on me. I'm pretty sure all med students are on the spectrum- everyone has their vices and they all come out in med school. Good news, I'm not an alcoholic. Now if there was an online shopping addiction test... that one I would fail. Ha, what a good cliche joke everyone can relate to!

Back to those pesky vices: as a group, medical students might be the most unhealthy people on the planet (the irony is self evident). From the stress eating to the post block beers and the people who are less low key than me and take their outlets to levels I can't relate to and won't comment on. Med students love their vices. It's understandable really, we're in this insanely high pressure environment and have to constantly succeed - it's really a wonder we aren't all on drugs. Are we? That would be an interesting study. I have a tendency to be blissfuly naive in these situations so I can't actually fully comment on med students and their relaxation methods other than the ones I partake in which are: puffy cheetos and wine. I'm a stereotypical white girl, I know.

It's really fascinating that people who know exactly what these cigarettes, drugs, terrible foods, and alcohol are doing to their bodies continue to pump them in with little regard. There are definitely students who blow off steam at the gym and finish it off with a kale smoothie but the majority aren't in that boat.

After starting this post I became very interested in what my friends thought on the subject and asked a few to share their opinions. Bryant captured the general attitude with his comment "I think med students vices resurface because of the insane stress and pressure we're under. I smoke and drink alcohol like a fish.. I actually stopped smoking when I was a junior in undergrad but I started again when I got to the island". Mostly people replied with similar and very relatable reminder that we're under a ton of pressure and the stress is constant and always building; each semester offers more challenges than the last and leaves less time to deal with it. My question is why are medical students different? Other people face stress, other people face arguably more stress than medical students but according to the Psychiatric Clinic of North America (That's right, I did research) medical students have an alcohol rate of consumption higher than that of the general population and women are particularly noted to match their male peers in alcohol consumption by the end of their medical school career- a phenomenon not seen amongst other professional school students.

A friend pointed out that medical students might have more vices than the general population because over time we become better equipped to handle stress. Right now we're trying to make our lives happen, once we're doctors we're there, it's like we've reached the light at the end of the tunnel. That's why medical students might drink more than doctors, they've still got way more to overcome". -Akansha (she said I didn't have to give her credit but I thought that was very wise and deserved it) To add to that, I think it's more socially acceptable and even encouraged for medical students to binge drink than it is for physicians. Our welcome back parties take place at clubs and bars where the enticing factor is often free or reduced drinks. It's seen as something that is going to happen and should - the line "work hard, play hard" rings very true among medical students. On top of that we're still young, we're in a limbo between undergrad and the "real world" - it feels perfectly acceptable to go out to the bar on a Monday night and have several drinks after block exams, something someone in our age group, already in their career might not do. Medical school is a really unique experience, especially when it's on an island. My roommate, Meghan pointed out that not only are we taken out of our normal environment but we've got the added pressure of medical school - it's a lot to handle and it's very additive.

However, there are a number of students who don't drink, eat a bag of ruffles, or smoke a pack of cigarettes when things get tough. Gita the yogini summed it up pretty perfectly "You really have to know yourself and your patterns well in order to control them. That only comes with a lot of introspection.. there's nothing special about med students and their vices resurfacing. It happens with lawyers too and single moms and people who are bored. It happens to anyone who doesn't know themselves". Gita has a unique perspective, she's studied yoga and is a very mature and introspective person (you can all LOL but we all know deep down, it's true.) A lot of students aren't there yet. Part of medical students propensity to rediscover their long lost habits might come from the way we've been taught to think. As an undergrad I was taught to work and think critically and that personal weakness wasn't allowed if I wanted to get into medical school. Now, those habits are still very ingrained but the pressure has risen exponentially. I can't speak for every medical student out there but teaching people to think hard about the world around them and not about themselves can lead to students slapping some boozy bandages on their stress. I'm not saying that every medical student has a drinking problem. I certainly don't consider myself or my friends to be in that group but, we've all got our vices, maybe we drink more because we're under more stress or maybe it's to cope with the countless pictures of disgusting genital infections we've got to learn in med micro. Who knows.