Finally here

Last week was a momentous occasion. I clicked submit on my ERAS application. Sitting in bed with my laptop, re-reading my residency application for the 10th time, I took a deep breath and hit submit. Everything I have done in medical school to ensure I Match in the residency of my choice came down to one click. Ah. Relief.

I can’t believe I actually made it here. It was the hardest thing I’ve ever worked on–becoming a doctor. While at the same time, the most fun I’ve ever had. I feel so lucky that I found my true passion in life.

Going for it wasn’t easy, or convenient, or even rational at the time I decided to enroll in my night organic chemistry class while working full-time. But I never looked back. Of course, I would have never been as gutsy without my boyfriend (now husband) telling me I would be crazy not to do it. When I talked about medicine (and it was pretty much all I talked about to him), my eyes would shine and reveal that fiery glow–he knew I would never be satisfied if I didn’t try (and I may never stop talking about it either). Girls: if you ever find a guy like that–don’t let him go!

Nine years later, here I am. Happy to say, I am just as passionate about medicine (and my guy).

Now that my apps are in and I’m done with my EM sub-I’s, I am currently enjoying a magical time known as 4th year of medical school. In the future, when nostalgia creeps up on me and I reminisce about medical school, I will think only of my 4th year and how wonderful life was. Of how happy, well-rested and fulfilled I was. This year makes all of the memories of stress, the lack of sleep, the endless book chapters, weekly exams, PIMPing sessions, awkward patient interactions, fumbling sutures, idiot mistakes, and otherwise feeling dumb–disappear. All I will remember is the amazing amount of free time I had during my 4th year of medical school.

I intend on taking full advantage of this amazing gift.

My husband and I just celebrated our 4 year wedding anniversary. Throughout our relationship we’ve constantly set goals and dreams of the type of life we want…”when this, then that.” Medicine is notorious for insisting on delayed gratification. But it dawned on us that life is what happens when you are busy making plans. Rather than planning ahead we are making an effort to just enjoy today.

Our priority for this year is simple–one word:travel. Now that I have time on my side we are excited to catch up on some well-deserved vacations.  I also realize that residency will be an extraordinarily tough 3-4 years and the time I have this year is precious. As it happens, things couldn’t have been better timed as there are some seriously exciting things happening in our families–including the birth of two nieces!

Here is to continuing my 4th year adventures…next stop: residency interviews!

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Away Rotations Explained

All across the United States during the months of July-September, 4th year medical students leave the familiarity of their home institutions and spend time on away rotations. What are these rotations you ask? Well, you can think of them as month long interviews. If you’ve ever been to an interview and thought a few hours with your potential boss was nerve wracking–try spending 30 days there.

For those of you unfamiliar with how your doctor got his job, the path towards becoming a bonafide, board-certified physician in any specialty starts with residency training–and residency starts with something called the Match. How do you get to the Match?–you interview at multiple training sites and then you rank them. The training sites rank all the candidates they interviewed and in the end a super secret, proprietary computer formula spits out a theoretical Match made in heaven.

The away rotations come in for several reasons. One is to simply get to know a program you may want spend 3-7 years training at and the other is to get letters of recommendation so that these places want to interview you! Either way, these away rotations can kind of make or break your application.

The whole process is fascinating to me because so much of your life is decided for you. When you apply for the Match you also sign a binding contract saying that whatever the computer decides is where you’ll go. You are locked in and you don’t even know where you are going. It’s kind of like that name your own price tool on Priceline. You put in your credit card info and if it matches what you are looking for you are committed to going there– yeah…well this is just a really long hotel stay.  Again, away rotations are that much more important because you get to picture yourself at that institution. You get a test run.

I just had my first away rotation. I have to say, I got pretty darn lucky.

The nervousness of being at a new hospital with a new computer system and all new hallways to get lost in was short-lived. I don’t know if it’s the 300 days of sunshine, the beautiful beaches or the focus on work-life-balance but I have never seen such happy attendings and residents. I really did my best searching out for the grumpiest, unhappiest guy in the bunch, thinking he’d be the best person to ask what is terrible about the program–but I never found him.

I imagined that I would show up and be just another face in the crowd, blending into a sea of medical students that rotated before me. Instead I got a super warm welcome and genuine interest from everyone I came across. If you accepted their challenge this place really allowed you to step into the shoes of resident intern, pushing you to think of yourself not as a medical student but the doctor you will be in a matter of months. I absolutely thrive in that environment. Give me an inch and I’ll just run with it. Having someone put trust in my assessments, physical exams, ultrasound findings and differential makes me work that much harder. Every day I showed up and tried to push myself a little further. That attitude does not go unnoticed so as a result I had some amazing training opportunities.

I’m really glad that my first Emergency Medicine rotation was at my home institution. It was a safe place to fall a little bit and get helped up along the way. EM is a very different specialty and it takes some time to get used to the focused exams, presentation style and the way EM physicians think. My home institution prepared me extremely well in pointing out what I was doing wrong in those aspects. I had some  wonderful residents who provided actual constructive criticism. Even though it is hard to hear that you forgot something obvious, I can promise you that the next time I have a patient with a headache I will never forget to walk them and check their gait before presenting to the attending. By the time I arrived at my away rotation I had the basics firmly in hand and could start to build on my skills.

During my month away, I came across another group of amazing teachers. People with genuine excitement about working with physicians in training. You can’t fake that kind of attitude and it was contagious. As a result I can now say that I’m entering residency having done two lumbar punctures, a chest tube placement, an intubation, a thoracentesis, a paracentesis, a cervical headache block and that I&D I somehow missed earlier. That in itself is amazing training!

The best part about 4th year has been rotating in my actual specialty and feeling like I am among my own. People who share my enthusiasm for crashing patients, multi tasking, having a good sense of humor and being accepting of anyone and everyone.

I have grown tremendously in the past month as a student, which is all I could ask for. I am really looking forward to one more away rotation…and another opportunity to keep improving.

 

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The real “ER”

When I think about my childhood and what I imagined I’d be doing when I get older–Dr. Mark Green from the series “ER” comes to mind. I grew up every Thursday night watching the show with my mom. I loved everything about the gritty, fast-paced drama. When some gruesome scene of a thoracotomy came on, my mom, turning away from the screen with a look of horror and disgust, would say, “you really want to do this in life?!” And I would sit there grinning, wide-eyed…and nod my head, yes, I can’t wait.

I’m very much still the same person who turns towards the terrible things in life. Twenty years later, it is in the Emergency Department where I feel most comfortable in the vastness that is medicine. It is unpolished, unapologetic, rough around the edges, a meeting ground of people from all walks of life. It takes a certain personality to want to spend time there. I am privileged and humbled to be there to help.

The heart of emergency medicine is what we call the “undifferentiated patient”–in layman’s terms, a patient with a complaint but no diagnosis–it is up to us–the Emergency Medicine folks to try to figure out what is causing your chest pain, stomach pain or swollen calf. We hone in on your story, symptoms, vital signs and labs to begin to narrow down from the hundreds of possible diagnoses the two or three life-threatening ones. It is our job to make sure you don’t have them and treat if you do.

Every patient is a mystery diagnosis. We don’t know you. Many times we’ve never met you or have the luxury of previous notes from your regular physicians. Yet we get to figure out what is wrong with you. Our job has been described as the most exciting 60 minutes of every speciality. And it is true. We get to see almost every diagnosis in medicine.  

Unlike the TV shows, our job is not always full-throttle, chest tubes flying, ribs cracking, shocking people (we don’t even use those paddles any more). It is some combination of charting, bedside procedures, discussions with patients, discussions with consultants and juggling a million and one tasks at once. I will say, twelve hours in the ED can fly by in a blink.

As I finish up my second month rotating in the speciality, here are the most exciting, the most typical and the most unusual things I’ve come across:

  • The normal stuff-Charting: No TV show ever shows just how much time we spend documenting. It would bore most viewers to death if they had to sit through our clicking. But that is a huge part of what we do. We pick up patients when they turn “red” on our screen (that is, the patient is finally in a bed after waiting for a very long time for that bed to become available) and after our 10 minute conversation and physical exam, we spend often double that time making sure we meticulously document our encounter. In today’s age of complicated medical coding systems and reimbursement it is just part of the job.
  • The normal stuff-Placing orders, waiting for results: After we meet you, our investigation begins. Even before we set foot in your room we begin critically thinking about the potential causes of your complaint and what path we’ll need to go down. Emergency medicine is very chief complaint driven. That is, whatever symptom is bringing you here must have a cause and in our department we love ruling things in and out-specifically the scary stuff. We geek out on pre-test probabilities, most likely scenarios, typical presentations and making sure we never ever miss anything that can kill you. That is our job in a nutshell. We place orders to relieve your symptoms and investigate the cause. Often this means juggling multiple patients and checking back on our results, re-accessing, going down a different path based on what we find. TV shows never show just how calculated our job is. Emergency Medicine doesn’t exactly have the best reputation of being the “thinking” speciality, but I beg to differ that we actually ponder and digest just as much if not more than the internal medicine folks–for us things are just done at a faster pace. Things can change in an instant and we are constantly on guard, re-prioritizing, changing course and staying on top of the very dynamic place we call the ED.
  • The exciting stuff: Yes, Emergency Departments get the sickest patients. We have to move quickly when things are going terribly wrong. We get to put in airways when you are about to stop breathing; chest tubes when you collapsed your lung or have a pleural cavity filled with blood; we place central lines when your blood pressure is low and your body is in septic shock; we even put needles into the sac around your heart when there is blood constricting it from beating; we stich up foreheads after bar fights and reduce shoulders that have popped out of their socket. We pretty much get to do lots and lots of amazing, adrenaline inducing procedures. But those are the sorts of things that break up your shift, most of the time we are just seeing patients, thinking about them and charting.
  • The abnormal but normal to us stuff: We get to see some of the oddest things that can happen to a person. Some visits are heartbreaking. Some are humorous. Some are really annoying. Others catch you off guard. We see the best and worst of humanity. You absolutely never know what is about to walk through the door and that makes our job so unique.

The past two months have been the best. I love all the mundane, the exciting, the normal and the difficult parts of my future career. Each of my rotations has been very different, building on my skill set and continuing to add to it. I’m so excited about the career path I have chosen and very proud to call myself a future ED physician. I have one more EM rotation ahead of me and then the process of applying for residency!

 

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I’m Back, Let’s Recap (Step 2 board stuff)

To my amazing readers:

We really need to catch up! My last post left you somewhere near the end of third year. I was grinding out my last two rotations and feeling fairly uninspired. You see, it took all the reserve I had left to keep coming into clinic just as excited as my first day of rotations. I ended the year with ambulatory and family medicine. Two rotations that are classically considered “easy.” Working less than 40 hours a week, having weekends off and getting home by 5 pm was so foreign to me. Paradoxically, I tend to be less productive the more free time I have. A combination of a really long year and a lack of stress propelling me forward left me struggling internally to maintain my tireless enthusiasm. There was no sense of urgency. Even the medical cases were non-emergent. Well, I did have one blood glucose stick of 38 we had to call an ambulance for–and that was the most exciting thing that happened.  Needless to say, those two months dragged. I reconfirmed that my type of medicine is the worrisome kind–at least ruling it out.

I moved from one day being the last day of my rotation to the next day starting 4th year. I began the year with a Step 2 study block.

Board exams are basically the worst thing you ever have to do in medical school. Period. No matter how prepared you are, they are always terrible.  I tried to take away some lessons from my Step 1 experience–mainly that I needed to calm down, so I approached the 4 weeks I had to study much more relaxed this time. I was surprised I didn’t freak out once. Probably because I spent the last two days before the exam dancing around my living room. Doing the Dougie, even terribly, will kill all last minute nerves. Try it.

My study schedule consisted of waking up at 8 am, doing question blocks in Uworld, taking notes, reading my notes, and doing more questions, then going to bed around midnight just to wake up and do it all over again. I kept an excel spreadsheet and ended up doing about 2,900 practice questions. I also took three practice NBME exams. NBME number 4, 6 and 7. My actual score was within 2 points of NBME 4 and 6 and 18 points higher than NBME 7. (Don’t waste your time taking NBME 7 unless you are doing it just for additional practice questions.)

The exam itself was just as terrible as Step 1. 9 hours of answering questions leaves you feeling miserable and delirious. Even though I felt I totally failed, I did not sit and cry in my car this time, instead I took a celebratory selfie and moved on. I purposefully didn’t allow myself to think about the exam at all. If I felt my mind slipping back there I immediately redirected my thinking. This was because I actually thought I failed the exam. Only to find I did incredibly well. So just remember, feeling like you failed is inversely related to your score. The worse you feel, the better you did!

With that monstrosity behind me I FINALLY began what I have been waiting for: my Emergency Medicine rotations!!

Since I will be matching into EM, the beginning of my 4th year is filled with three, 1 month EM rotations: my home institution, a Kaiser hospital and a county program. Because EM deserves its very own blog post I will leave you here. All I will say is Emergency Medicine is awesome and any feeling of lassitude immediately dissipated the second I saw that neon Emergency Room sign. It is perfect for me.

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Photo I took during my away EM rotation. Southern California.

 

 

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Surgery

A few months back I had this dream. Nothing but water all around– I was walking on a rickety boardwalk, wearing my light blue surgery scrubs. I could taste the sea. The ocean spray on my face. My body was haggard. It was with my last ounce of strength that I moved my legs. I lifted my hands, they floated there for a moment, the breeze kissing my fingertips. I felt free. 

I imagined finishing 8 weeks of surgery would feel just like that–a release perfectly timed with my last bit of strength. So many mornings waking up at 5 am I cursed the path I had chosen. Cranky that I could not crawl back into my warm bed (it would sit empty for another 18 hours) instead I was off to the hospital. When you are in the thick of it–that release is all you can think of. Now that I made it–mostly what I feel is nostalgia.  It is funny how quickly you forget the tired mornings and late nights. All I remember now are the exhilarating highs.

Surgery was the most fun I’ve had in medical school.

I will not be a surgeon. I am going into Emergency Medicine and knowing that this rotation will likely be the only time that I’ll be spending in the OR, made it that much more exciting. I transformed from a clueless 3rd year med student, hands shaky, stupidly holding my needle driver like scissors…to a confident, somewhat less-clueless surgical student. By the end of two months I was able to read ventilator settings, remove chest tubes, tie knots, close a surgical wound nice enough to have the ultimate of critics–the scrub nurse–utter the words “beautiful.” I could prepare for rounds in 30 minutes flat, knowing every lab, urine output, nutritional status, vital sign and Flowtrack indicator for my patients. This training came at an incredible price. I stayed late. Studied even later. And walked around for 8 weeks sore as hell.

I will never forget the cases I came across. Terrible calamities. Now part of my training forever. A stabbing in the middle of the night. Gun shot wounds. Flesh eating bacteria. Total body burns. Fulminant sepsis. Amputations. Tumor in the heart. Every day I felt lucky to have the privilege of being in that OR.

Of all the specialties surgery will always have a special place in my heart. It was the only one that gave me pause. Ultimately, it is not right for me, but this rotation will be one I won’t soon forget.

 

 

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My Life as a Heart Surgeon

Ever wondered what it’s like to be a heart surgeon? Since my last blog post, I’ve gotten a chance to find out. I am doing my surgical rotation on the Cardiothoracic service. I haven’t settled on how I feel about it. Over the last two weeks I’ve gone from absolutely dreading it…to pure enjoyment.

My team is small. Just myself, my resident (R3) and our attending–the only cardiothoracic surgeon at our institution. Partly out of necessity since my  first morning I’ve been pushed into the role of “acting” sub-I/junior resident. At first having such high expectations thrust upon a meager 3rd year med student was terrifying. I felt as if I was failing at every step (and I was). My confidence crumbled as my inadequacies were brilliantly pointed out every morning. This was my first introduction to intensive care medicine. I knew nothing about management of drains, chest tubes, cardiac output monitors, ventilation settings, etc. I stared wide-eyed during am rounds as I had never even heard of most of the things my resident asked me to do. She pushed me at every opportunity. She knew exactly how uncomfortable she was making me. And she did it with just that purpose. Here was a person who was interested in seeing me grow. She was dedicated to my education.

So often as medical students we are given an easy pass…don’t know something, well that’s ok, you are “just” a med student. Not on this team. Every time I didn’t know something, I looked it up, wrote it down in my handy mini moleskin notebook and burned it into my brain. The embarrassment alone was enough not to let me forget it. Nothing was ever overtly said, but not knowing the answer to something is unacceptable to me (I put a lot of pressure on myself to be the best I can). I feel so lucky to have my resident on our team. She pushed me out of my comfort zone–in the process, I face-planted. Only to get up feeling like I actually can be a resident next year. Every day, I am starting to feel more comfortable about the non-theoretical medicine stuff. Like what meds we actually use to replete mag, how much do you give? When is it time to take out a blake? What CVP are you comfortable with? What are extubation criteria? How to remove a chest tube without giving your patient a pneumothorax. Nitty gritty medicine, you don’t want to waste time intern year having to look-up. After a 6-7 hour open operation our patients are fragile; their kidneys do funny things, their hearts get funny rhythms and there are a million reasons why we manage them in the ICU. With each passing day I’ve grown less terrified about how it all works.

As in most surgical specialties the days can be long. Really, really long. My record was starting the day at 4:30 am and not getting home until midnight after two long open heart surgeries. At the end of that day my feet felt like I just climbed Kilimanjaro. (Hint: I ordered compression stockings for rush delivery that night). I am in awe of our CT surgeon who is a mythical creature. He works like a machine. Never needing to use the bathroom. Barely eating and always up for adding on an additional heart case no matter how late in the afternoon the consult is. Heart surgery requires such a person. I have convinced myself that for 4 weeks I can assume the role of a machine, but not a day longer than that.

The surgeries themselves are amazing. Who doesn’t want to spend the day staring at a human heart. Stopping it. Then bringing it back to life again. Heart surgery is surprisingly formulaic and now having done 7 or so surgeries I can start to anticipate the next move. I know where to suction, how close to cut the suture, when to retract, when it’s my turn to step in and help with opening the thoracic cavity or what closure suture to use. Now that I know what I am doing, I enjoy the OR very much.

I didn’t know what to expect starting this rotation. I have been pleasantly surprised at how much it has challenged me. My resident is an amazing mentor. She’s found the exact style of learning that will take me to the next level of my training. A combination of uncomfortable pressure with the generous reward and satisfaction of knowing something I failed at before. If I can make it through this, who knows what else I’ll be able to accomplish.

Sometimes you have have to fail at something to learn.

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Back to reality

Welp, it’s time to put those yoga pants away and trade them back in for my light blue scrubs. After 6 weeks of break setting an alarm again is torture. I am definitely feeling out of practice–especially since I am diving right back into the shark tank with my Surgery rotation. I was assigned to the cardiothoracic service and I can imagine those are not sissy surgeries. My days will be filled with open heart surgery, lung resections and endless CABG procedures (coronary artery bypass grafts). I am a mixture of terrified and excited. However, if I am going to wake up at 4 am for something, surgery pretty much tops the list. Being in the OR is unlike anything I’ve ever done. It is an adrenaline rush, a stopper of time–it drains you of every ounce of energy, yet leaves you curiously wanting to come back and do it all over again. I am preparing myself for the most physically and mentally exhausting 8 weeks of my life. Good thing I just had a seriously long vacation.

I made the most of the last 6 weeks managing to jam pack it with travel, family & friends, a little work and even an elective! Here are the highlights:

  • Spent the holidays with my family in Maryland
  • Took a road trip to NYC
  • Finished the whole House of Cards series, finished the whole The Knick series, finished the whole Making a Murder Series, caught up on all the various versions of Bravo’s Real Housewives
  • Wrote two papers for publication!
  • About 75 Surgery practice questions…
  • Started a Go Fund Me campaign
  • Did some voice over work for a promotional video
  • Did some design work and drafted an Annual Report for one of my clients
  • Got my nails painted by a professional!
  • Went shopping and refreshed my wardrobe with some killer boots, a couple of amazing dresses and the perfect lace ensemble for my best-friend’s summer wedding
  • Completed my first thoracotomy and learned how to place a chest tube (on a generously donated cadaver)
  • Booked my trip to Las Vegas, where I’ll be presenting two abstracts
  • Convinced my husband to come to Las Vegas with me (this took 5 seconds)
  • Went wine tasting in Napa with my girlfriends of almost 20 years
  • Explored San Francisco like a champ
  • Made a couple EM podcasts which are part of the Residency curriculum at my Medical School
  • Did a photoshoot with my awesome friend and a guest appearance on her YouTube channel
  • Slept in, a lot
  • Started running regularly again
  • Finished decorating our living room with some amazing photography from my father in law
  • Went on lots of overdue doctor’s appointments and other things regular people do not typically wait for a vacation to complete
  • Did a couple shifts in the ED–spending time in my favorite place in the hospital
  • Ate a lot of really amazing food
  • Forgot for 6 weeks how difficult it is to be a third year med student

Fun is over friends. Time to get back to reality.

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Turning 30

As the youngest in the family it feels strange hitting the big 3-0. My entire life I always wanted to be older. I wanted to be able to do the things my sister, who is 5 1/2 years my senior was doing. It all began when I was 4, she knew how to read, so I decided I would need to know how to do that too. When I was 10, she was going on dates, so naturally, I needed to tag along on those too. And when I was in college, she was out making her own money, so I definitely needed a real job. I raced through my twenties.

Never satisfied, I crammed as much as I could into the last 10 years and looking back–that really wasn’t such a bad idea. All in all, it was a great decade. By 23, I had finished graduate school and was working as a program manager, which meant getting to travel around the world, keeping my wanderlust at bay.  By 21, I had met and started dating the man I would marry. The kind of guy who watched Titanic and wondered when he would meet the Rose to his Jack. A perfect match to my zany nature, who wasn’t phased (or too impressed) by my endless need to do more–which is exactly what I need to keep doing more. By 25, I had moved 3,000 miles to start our lives on the West Coast and by 27, I was embarking on my first year of medical school. Now at 29 and 362 days, I own my first house and I am months away from starting my final year of med school.

My twenties meant growing as a person. Luckily, my husband and I grew along side each other. Evolving into two people who deep down really just like each other. Our dreams have evolved from dreaming of a wonderful wedding day, medical school acceptance, great job offer, awesome apartment, awesome house…to now one day, a healthy baby and retirement in a Mountain cabin…or Mexico.

My life is still just as hectic as it’s always been. I am continually searching for the next challenge (enter my Surgery rotation which starts on Monday) but I do feel more stable. Perhaps because of medicine I am more logical, concrete–less emotional. I am exactly where I wanted to be by 30: to have a passion I work for every day and a partner to share it with.

As you age, your perception of what’s “old” seems to continue inching forward–a self-preservation mechanism, I guess. I’m still the youngest, which also helps. And so true to form, being 30 just really doesn’t feel that old. I still love staying up late (maybe not at a crowded, late night happy hour) but Netflix marathons are totally things I’ll lose sleep for. I still work-out (ok, so the last time I ran a marathon was 2005) but I am still the same weight I was in high school! I love hanging out with my girlfriends (yes, we recently spent exactly 6 seconds in a college bar before hailing a ride to the ritzy wine bar in the posh financial district) but at least we are still doing girl-talk over cocktails and I can still wear the hell out of my suede pumps. Sure, things may look a bit more refined. But that is just what happens with age.

The best part of entering my 3rd decade–you don’t have to waste any more time figuring out who you are and what you want–because you are already there (that’s what my 20s were for and all those random life de-tours). Knowing exactly what you want is half the battle. And that is probably what excites me the most about my 30s. The “go after it” decade.

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1st Break

I’ve been on vacation for exactly 14 days now. It’s amazing how quickly I’ve made the transformation from over-worked, dark-under-eye-circle concealing, one-track mind, med student zombie to a life of carefree leisure. I’ve been wearing make-up, blow drying my hair, going to the movies, not setting an alarm clock, seeing friends, spending precious time with my family, updating my closet and decorating our house. All things I forgot I seriously enjoyed. One could get used to this. For those of you not in medicine, the list above, taken for granted by most people reading this blog, are actually a rare luxury during medical training. Luckily, I have 4 more weeks before I start my next rotation. Sometimes working hard until an overdue, extra-long break is worth the sacrifice.

To catch my readers up on my life: Since I last wrote, I finished my pediatrics rotation. Tiny people patients are awesome. They are guaranteed to make you smile no matter what type of day you are having. I definitely enjoyed inpatient pediatrics more than clinic, but that is because I prefer acute medicine. Case in point, the time I enjoyed clinic the most was when we had to send one of our patients to the ED because they were too sick to be in our office. Identifying critical situations is kind of my thing…the thing I hope to do as a specialty.

I’ve completed 5 out of 8 rotations, with just a few more months of third year left. When I look back I can’t help but feel happy that I can put all that hard work behind me. It’s kind of like getting to mile 19 of a marathon, you’d be feeling pretty good you are there, but if someone told you there was a mistake and you need to re-run that distance–well you’d probably feel devastated to do it again.

After all that running, it feels great to hit pause. I need this time to soak in what I’ve learned and let my brain compartmentalize. To enjoy medicine. Funny enough, I still want to read, to do practice questions, even more than when I had to do them for the shelf exams. What can I say? Medicine is a deep-seated passion, even while on vacation.

Because I am not the type of person who can just leisure for too long, January is filled with exciting projects, including a research elective, supporting a dear friend’s campaign to provide girls education in the developing world, photography and spending a few days here and there in the emergency department. Not a bad way to start off the year!

I also turn 30 this month. So there is that. I’ll be celebrating with my best girlfriends of almost 20 years, doing a mini-road trip in Northern California.

Stay tuned. This month should be a good one.

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Night and Day on Labor and Delivery

Hello? It’s me

I was wondering if after all these sleepless days you’d like to chat.

To go over everything.

They say that time’s supposed to heal…but I ain’t done much healing (sleeping).

Hello? Can you read me.

I’m in California, dreaming about who I used to be. Before 3rd year.

When I was younger and free.


I just finished 2 weeks on L&D, which means I lived at the hospital and yes, Adele was on re-play in the workroom the entire time. Now I hum my life thoughts to her amazing lyrics. Today marks the half-way point in my 3rd year of med school. How have I changed? Well, with each passing rotation I feel more and more like I deserve my white coat– that I’m not just playing dress up. I remember stepping into my first patient room on my first day of internal medicine thinking what the heck am I doing? I literally know nothing. And now, with each passing week I feel more and more comfortable in my future profession. It’s amazing how on the job training will do that to you. The training is merciless but when you get to the other side you definitely feel like it was worth it. My ob/gyn rotation pushed me to my absolute physical limits. Especially the labor and delivery service. You pretty much have to acquiesce to the fact that you will not be leaving the hospital. Once you are OK with that, it’s an amazingly fun ride.

Here is what happens when you spend 15+ hours a day delivering babies:

  1. Pandora is your new best friend.
  2. Adele’s “Hello” and Justin Bieber’s “Sorry” will forever bring me back to 4 am trying to get a second wind to finish up the night shift.
  3. You learn to eat and walk at the same time and make smart eat and walking choices at the cafeteria— like getting fruit or french fries. Soup regrettably doesn’t work.
  4. You learn to sleep sitting upright at a conference table. Even 15 minutes can be life changing.
  5. You NEVER forget to put shoe covers on when entering a c-section or a delivery room. You make that mistake only ONCE in your life.
  6. Updating the list is the fastest way to get your residents to love you. You update the list, you are loved. Oh that and doing the AFI scan for them. Extra love.
  7. You begin to have daily strange dreams about your own future pregnancy and the various complications that can happen. Enter baby with imperforate anus.

I did my Ob training at a particularly busy institution, I’ve heard 300 deliveries a month being tossed around, which means we see A LOT of laboring mammas. That also means I got an amazing experience. The highlight of my medical training was a 15 hour day that included 3 c-sections, 2 vaginal deliveries and countless rule-out laborers at our Ob ER. The day shift on Ob is non-stop. If you fail to eat a gigantic breakfast before you show up at 6am you may not be eating again until 2pm. That makes for hangry residents. Not always avoidable. But just DON’T skip breakfast.

The night shift on the other hand is a strange beast. Because I wasn’t really seeing night ever, it felt like one continuous 96 hour day when I was on. It was my own personal groundhog day, leaving and coming into work on the same day. Even though I was sleeping about 5-6 hours in the daytime, I was in a perpetual zombie-like-state. Only an IV infusion of coffee kept me going and my “dead zone” nap from 2am-4am. Of course, as a med student I didn’t want to miss anything and on L&D emergency crash c-sections are not the kind of thing they think to call the med student for. I was too afraid to find a couch to sleep on and miss out, which relegated me to sleeping in a conference room chair, pretty much with one eye open looking at the labor strip.

What made this entire experience so amazing though were the residents, particularly my senior, who allowed me to be her “right-hand” shadow the entire rotation. She was so gracious at taking time out of our insane day to allow me to close every surgical case and even taught me to close fascia and perfect my surgical knots. I will never forget how much time she devoted to my learning. I promise to pay it forward one day!

This time next year I will be on the interview trail for residency. Crazy how fast this experience is passing by. It has left me exhausted and drained yet completely aware of how special what I am doing is. I still wouldn’t trade it for anything.

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An Insider’s Perspective: What really happens when you go to the Dr.

We’ve all been there. We make an appointment to go see the doctor and it seems like a quarter of the day is gone by the time we leave. The majority of the time is spent waiting in that little room, sometimes clothed, sometimes wearing just an itchy paper gown with nothing to do but flip through old magazines or listen in to the sounds of the hallway just hoping the next footsteps are someone coming to see you. What you may not know is what really happens. Here is what your Dr.’s day looks like:

You check in downstairs with your insurance card: The moment you check in our fancy computer systems tell us you are here. Your name turns green. Sometimes we are still finishing up our notes from the last patient so we have just a few minutes to review why you are here and any past visit information and what we talked about last. If you are lucky and the system works like it should, everyone came for their appointment at the exact time they were supposed to (no one missed their bus, ran late because of their babysitter or couldn’t find what street the clinic was on), they stayed for exactly 15 minutes and there was nothing additional that needed to happen–this is the first time you’ve seen a doctor in a year, but we know you only have one thing to talk about so of course we won’t need to discuss additional issues that came up or health screening tests that you missed. Who are we kidding? This is life. Patients are late. Medical issues can become complex. And we are the type of doctors who want to help. The reality is, 3 or 4 patients turn green at the same time. We do our best.

You are sitting in your little room and a stranger with a white coat knocks on the door: If you are being seen at a clinic associated with a teaching hospital there is a high chance the first person to see you is a medical student. Before you roll your eyes or look annoyed that you’ve been waiting in this room for 15 minutes and now you are forced to speak with just a medical student I ask you to consider a few things.

You came to a teaching hospital because you likely know we practice cutting edge medicine, you have access to world renowned care and we accept all patients (those with excellent insurance and those with none). Yes, a medical student is in the early stages of their training and they can’t write you a prescription today. But what you’ll get by speaking with a medical student is their undivided attention, a propensity to seek out every detail of your health concerns, meticulous attention to every possible “red flag” and the strongest desire to really listen to you. If the medical student wasn’t here you’d probably be sitting in the room alone for another 15 minutes and the next person to come in may not have the time to probe as deeply into what you’ve been feeling. Medical students know more than you think, often times there is only one year that separates them for the title of MD. So when we walk in the room and introduce ourselves as “student doctors” give us a chance. It’s actually your lucky day! After we leave you, we’ll condense what we just talked about into the key things that are truely “worrying” and help the doctor focus when they come to see you. You are getting two visits in one! When the Dr. enters the room they will already know everything about you and can spend time explaining the plan to you or ask additional pertinent questions to help us arrive at a diagnosis.

Someone has completed their exam on you and states please get dressed and we’ll be back to talk:  It’s always great when we can tell you not to worry and that what is happening is likely benign or the medication is doing its job. Those days we jump for joy! The hardest thing we ever have to tell a patient is that there is something wrong with them. That part, I imagine, will never get easier.

As a medical student on my Ob clinic rotation I recently experienced that moment of dread. Standing in the room performing our routine exam, the resident and I exchanged a knowing glance. We both knew what had happened–there was an intrauterine fetal demise. Our pregnant patient’s baby was dead. This information was hanging in the room, dark and suffocating. For seconds it wasn’t real. It wouldn’t be real until we said it. Those moments of disparity of information–when you know something that will change a person’s life forever is a heavy burden. We want to ease you into it. To help you through it. It is hard for us, please remember that. There are dark moments in medicine and our job turns simply to easing your suffering. These are the toughest things we do all day.

The next time you are waiting, annoyed, please forgive our inefficiency. Sometimes your 15 minute visit becomes more complex. Sometimes we notice red flags that need our attention and we end up catching something before it’s too late. Sometimes patients need our undivided attention and care. You are important to us. When it is your turn to need more than 15 minutes, we will be there for you too.

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Ob/Gyn Life

To my neglected blog and readers, let’s catch up!

I successfully finished my psychiatry rotation with a clear understanding that psychiatry is not for me. It was the first rotation I’ve been on, where I wasn’t excited to go to the hospital. Work actually felt like work. The hours were wonderfully short in comparison to hospital life yet the days dragged on. I can’t put my finger on exactly what it was that didn’t appeal to me–in theory, psychiatry is fascinating– but it just didn’t grab me. Feeling ambivalent about your day is the surest way to cross a specialty off your consideration list. Done and done forever.

In comparison, this past week has been invigorating. I started my obstetrics and gynecology rotation and I am loving life. Driving in when it’s still dark out, seeing the sun rise above the hospital and knowing that I’ll be scrubbing in on gyn surgery, while the rest of the world is just waking up makes me feel alive. I love when things are happening–the busier the better. I like the fact my patient progress note is due by 6:20 am because we have a full day of surgery ahead and who has time for rounding. I love how hands-on everything is. It’s true, my back is killing me from standing and I arrive home too exhausted to cook dinner. Somedays, the thought of going upstairs is too much to bear and I end up falling asleep on the couch. The physicality of it is tough. It’s also tough to imagine going through life being this tired. But despite how draining the day is, I feel so incredibly fulfilled by what I am doing. I think that in a nut-shell is the dichotomy of medicine.

This past week, I’ve had time for exactly one thing–surgery. Unfortunately, that means my singular interest consumes my life. For two weeks, my marriage can easily handle that but much longer and I can see why doctors have such high divorce rates. I have a great husband who’s picked up dinner, vacuumed the house and even woke me up with Starbucks this week. But eventually, he’ll want a wife again. But this is the point of 3rd year of medical school– you get to put yourself in the life of various specialties and try on that life. Spend a few weeks walking in their proverbial shoes and see if you can handle it. We’re all looking for that perfect pair that fits just right. So far, I’ve felt most comfortable in my Emergency Room sneakers 🙂

In any case, I digress, I have 5 more weeks of ob/gyn which will include two weeks of clinic and two weeks of nights/days on Labor and Delivery service. What makes the rotation manageable are 4/6 weekends off and a dedicated lecture/study day on Fridays. This is the first rotation where I’ll be graded not only on my medical knowledge and interaction with patients but my (limited) technical surgical skills. Perfecting various suturing and knot tying techniques is certainly a new challenge for me–but it’s also really fun!

That’s it for now. I am quite literally too tired to write more. Until next time!

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Psych Rotation, how my own well-being improved and why that speaks to the medical profession

Third year of med school can be a grind: Long, relentless hours. No time to study, let alone take care of yourself. Rotations that just keep coming with nothing but a “golden”, rotation-free weekend in between. That is, until you get to your psychiatry rotation. Some have even called it psych-cation. So is the psychiatry rotation the vacation of 3rd year?

The answer is…not quite, but close. In comparison to inpatient medicine and my neurology clerkships, psych has been a welcome change of pace. My hours are 8 am to 5 pm, with a workload that can include maybe 2 or 3 new patients a day. I am currently on psych consult service, meaning I get called when a psychiatric patient comes through the ED doors or a hospitalized patient requires a psychiatric evaluation. As you can imagine, patient loads can ebb and flow. For unknown reasons, psych patients rarely show up at 7am to the Emergency Department, but combine a full-moon, a pleasant Friday night and our service can get pretty busy.

Being able to sleep 8 hours at night and come home around 5pm with enough energy to go on a nice jog has done wonders for my mood and my marriage. Because we have lulls throughout the day I can get my studying in while I am on service and that leaves my evenings free to do something I haven’t done since 3rd year began…relax. My husband is shocked to suddenly have me hanging around the house with free time. I’ve been so busy previously, his go-to answer anytime our friends call was “Maja is at the hospital.” Now, here I am asking if he’s up for a movie or binge watching TV shows–on a Tuesday night!

On a personal level, having this extra time to re-connect, even if for just a few hours a night is super important. I find us laughing more, talking about meaningful things (you know, going beyond the logistics of who is making dinner) and waking up smiling. So without trying, my psych rotation is improving my marriage and mental and physical health.

The hours of 3rd year had began taking their toll on my health by making me too tired to work-out. It turns out walking around the hospital and eating free cookies do not make a healthy routine. And de-conditioning is pretty much the worst thing you can do for POTS. Sorry folks, nothing can replace the heart benefits of a good cardio work-out. Luckily, I am back at it, logging some miles with my running shoes.

It wasn’t until I had time to slow down that I looked back to notice the unsustainable pace I was moving at. Of course when you have the time it’s easy to say here’s all the things I need to be doing to stay healthy– it’s when you are in the thick of it, sleeping 5 hours, feeling overworked and burnt out that your focus turns simply to surviving–who has time for the other stuff? So therein lies the dilemma.

My hope is that all the healthy choices I’ve been making in the last 2 weeks will continue as I move into my Ob/gyn rotation…at least those are my intentions. This slow down in my schedule has got me thinking a lot about how exhausting the other weeks felt at times. As a medical student we are lucky in the sense that those hours are fleeting and we can move on to more humane rotations (enter Psych). But as a resident those hours– the daily grind– it becomes your life.

For decades medicine has asked of us to become super-humans. The humans who need only a few hours of sleep, who can see the worst in people, who can face death and tragedy, who look in the face of hopeless situations and “fix them”, who can continue to log work hours when others are at home with their family….all with a smile and understanding heart. Thankfully my generation is seeing the ridiculousness of the above, no one can be that superhuman indefinitely–not without a cost. I won’t go into the depressing statistics of physician depression and suicide, or the abysmally low satisfaction rates. All I know is that a culture shift is way over due.

I don’t have the answer but I do hope that we can incorporate more balance into our profession. After all, physicians who are healthy and happy are more empathetic, productive and innovative, and more likely to stay in the field (just look at this wonderful research Stanford is doing). Somehow we must find a way to sustain the enthusiasm and dedication seen in medical students throughout our careers. The future of our field depends on it.

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Kids as Patients vs Brain Surgery

I’m wrapping up my Neurology rotation with 2 weeks at a children’s hospital–aside from having (mainly) adorable patients here is a list of things that have made this service particularly awesome. If you go to my school this list of “perks” may help you decide when picking between peds neuro, neuro surgery or ICU care.

  1. The hospital is colorful. Like seriously, there is a theme to every floor. You can’t help but smile when even the architecture of the building has color in mind. It is also a brand new hospital so everything is very modern.
  2. Parking is free. FREE!
  3. Parking is close! (when you savor every minute of sleep you can get, saving yourself 5 minutes of walk time is worth its weight in gold).
  4. Breakfast is free! The food is amazing with fresh fruit, pastries, yogurt parfaits, bagels, coffee. When you are a poor med student you can be easily swayed by the little things in life like starting your day with a full-healthyish- stomach.
  5. Lunch is free! I can’t rave as much about the lunch, but I will say it is 100% better than any of the other free lunches at other hospitals. It is always catered, so if you are not a vegetarian like me, you’ll probably love it.
  6. The electronic medical record is easily one of the best choices around. Super easy to look up stuff.
  7. The residents are super nice.
  8. The attendings are super nice.
  9. The patients are hilarious. Case in point, I was trying to examine my first little patient of the day and he looks at me and says “excuse me, you are interrupting my cartoons.” Absolutely the cutest.
  10. You have NICU patients. The tiniest, sweetest, humans around.
  11. The hours are very tolerable. Typically I start my day around 7:20 am so I have time to see my old patients and read briefly about any new ones I will be picking up. You have morning report (free breakfast!) at 8 am, which includes an hour discussion about one particularly interesting case and the teaching points involved. Followed by time to see and examine your new patient before rounds start around 9:45am. Rounds typically wrap up by noon lecture (free lunch!) followed by time to write your notes, check in on your patients before you head over to the main medical center for afternoon lecture at 4pm. You are free to go home after that, which is usually either 5pm or 6pm.
  12. Being able to put parents at ease is very gratifying. It feels tremendous when you can send a child home and they are all better.
  13. This hospital sees some of the rarest childhood illnesses you’ll come across. In one week I’ve already seen two cases of Guillane-Barre (overall incidence of 1 to 2 per 100,000 per year). You are guaranteed to learn a tremendous amount. The cases are all very interesting.

Now to the alternative….instead of peds neuro you have the choice of picking either neuro surgery or neuro ICU care. I was able to get a glimpse of the high of neurosurgery while on-call one night. This was the first time I’ve ever scrubbed for a case and it will easily be a memory that stays with me for a lifetime. The excitement of being in an OR is hard to describe. Furthermore, being in the OR when emergency neurosurgery is involved is like putting that excitement on steroids. Few things in life are as surreal as looking down on a human brain. The whole time I was standing in that OR I just kept thinking to myself how lucky I am that I am in this profession and have the absolute privilege of being in this room right now. The whole world disappears when you have surgical tools in your hands and get to watch someone literally fixing the human body. Of course, as thrilling as that experience is, picking neuro surgery as your elective comes with a price. You will have exhausting hours (think 5am start times), high stress, high pressure–yet all that comes with the prize of being in the OR. So choose carefully.

My favorite part of my neurology experience has been the camaraderie with my team. Everyone has been so eager to teach and learn. I’ve enjoyed all my co-workers. Actually, maybe I just miss having co-workers. Being in school full time was certainly an adjustment. Now I get to have a little bit of that feeling back of what it’s like to be around people you work with! Although I don’t get a paycheck, and the teams change all the time, it is nice to feel like I am working again.

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Brain Attack! and other Neuro adventures

Beep, beep… beep, beep….ahh the sound of the stroke code pager. It has its own distinct ring tone and whenever that pager goes off you can’t help but get a rush of adrenaline. Time is now a precious commodity. It is the only thing standing between intervention and inaction for our stroke patient. It doesn’t matter where we are, you drop everything and run. NIH stroke scale in hand, we burst through the doors of the ED with a singular mission–determine if this patient is eligible for TPA. The clot busting thrombolytic (TPA) can be life altering if given within 3.5 hours of onset of symptoms.

I’ve spent the last two weeks on the neurology stroke service. It is fast paced and full of heart break mixed with moments of joy. When someone presents to the emergency room with stroke symptoms, often paralysis of half their body, or slurred speech and drooping face a “brain attack” or stroke code is called. The stroke team arrives within minutes and is responsible for figuring out 1) is this person having a stroke and what kind (ischemic vs hemorrhagic) 2) when their symptoms started 3) and are they eligible to receive TPA–currently the patient’s best shot at regaining function.

The saying “time is brain” has been ingrained in my head. With every minute that passes a crucial window is quickly closing. With so much riding on finding out the correct “last known well” you start to feel like a detective. The stroke team usually divides up the tasks with someone doing a complete neurological exam to find out the patient’s NIH Stroke Scale number, while other members of the team work on getting the whole story. It may sound easy but when a patient arrives in the ED without family and is too altered to answer your questions you have to start digging…this includes calling people in their cell phone, co-workers, and anyone else who might have spent time with them before their symptoms started. Team work is crucial. We all rush to gather the most information we can to make the best clinical decision for the patient.

The highlight of the rotation was seeing TPA delivered and then having the patient improve right in front of your eyes. Yes, these times are rare but so rewarding when they happen. It is also crushing when a patient is either out of the treatment window or has some of the TPA contraindications and we can’t treat. At that time all we can do is prevent another stroke from happening again…often not enough when our patient now has devastating deficits. TPA is certainly not without its dangerous risks but it is among the only things we can offer.

I’ve gained a huge appreciation for stroke prevention. The best thing we can do for our patients is optimize their preventative medications and lifestyle. The tragic consequences of uncontrolled high blood pressure or high cholesterol are a lifetime of disability. Stroke is the number one cause of disability in the US, and the number 5 cause of mortality. Seeing our patients struggle to learn how to move, talk or walk again has made me feel so thankful for all the things I am able to do that I take for granted. The last two weeks have been incredibly humbling.

When I first started neurology I really didn’t it like, mainly because the brain is so complicated and it didn’t come as easy to me as other subjects. When you have to work to understand something often our initial reaction is simply to say eh, I hate this. But I have to say, I’ve learned a tremendous amount in a short amount of time and I am starting to come around on the topic. One of the main perks of spending 12 hours a day somewhere is that you learn a lot quickly! The rotation is fairly comparable to inpatient medicine in terms of hours, usually I am there 6:30 am to 6:30 pm. However, I am no longer fazed by 12 hour days, they seem pretty normal in fact. Perhaps the best “perk” is having 3 out of 4 weekends off!

I’ve had a lot of very sad cases these last two weeks so I’ll end this post by saying be kind to your body. Watch your diet, get some exercise and find a good family doctor who is interested in helping you prevent disease. Also, never forget “time is brain”–if you even suspect someone is having a stroke get them to the ER as quickly as possible. The stroke team will be waiting.

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