Category Archives: Medical School Experience

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.


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




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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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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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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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Inpatient Medicine and other reasons why I am so sleepy

Dear readers thanks for sticking around even though I haven’t been around much. My husband is likely more upset than you are. I am 5 weeks into my 8 week inpatient medicine rotation–one of the big bad scary ones, with the long hours and exhausting schedule. You will never know what it feels like to be at the hospital 14 hours a day multiple days in a row until you actually do it. It is thrilling, but puts you through the grinder only to spit you out with bad hair, dark circles under your eyes and a crabby sleep-deprived outlook on life (I honestly don’t know how parents do it with an infant!). On top of it all, you are supposed to be studying. My MKSAP question bank is in a sad state–with the % complete abysmally low. Why do they have to show you the question progress…just to remind you that you aren’t doing enough questions each night. I can barely put together some dinner…let alone 20 questions.

But I digress, I don’t want to make it seem like I am not enjoying every second of this experience. Yes, waking up at 5:20 am I wish I could just roll over to the other side and keep sleeping. But by the time I am on the road with the sun rising and my first cup of coffee in my hand my brain starts to wake up to the reality of where I am going. There are real people who need us. The more chaotic the happier I am it seems. Emergency medicine is still definitely where I feel I belong. On one particularly sleep deprived morning I walked in to a rapid response on one of our patients. You obviously never wish ill of your patients, but I find myself drawn to those situations. Whereas some people hate the stress of managing acutely ill patients, those are the patients and type of medicine I enjoy most. Any feelings of tiredness melt away.

I’ve also really enjoyed our mystery patients, those with diagnosis pending. It is so exciting to look up new lab results and completely change your frame of view of what could be wrong with them. These patients have taught me the most as I’ve been able to become a mini expert in whatever condition we are considering them for. As a medical student perhaps the best thing you have is time. While residents are carrying a heavy patient load with responsibilities for putting in orders, med students have the time to really dissect each lab value and read up on the literature. It is my personal goal to contribute to each case I am assigned to. Some times that consists of small things I can do for my patient, like saving them a trip to the pharmacy on their discharge day or explaining their lab values or condition to them and answering any questions. Other times its helping the team learn the nuances or latest updates on a condition or just paying attention to everything that happens. It is the ultimate goal to find a physical exam finding someone skipped or a lab value that changes your perspective.

Perhaps the thing that has surprised me the most is how close you get to your fellow team. Each team consists of a couple residents, a senior resident, one or two medical students and an attending. After spending 12-14 hours a day together  6 days a week complete strangers start to feel like people who have been in your life for years. It is inevitable you will find out each other’s life stories, how they take their coffee, how much sleep they need, what makes them angry and their sense of humor. Each time the team switches you feel a little sadness to see them go. We’ve come to depend on one another.

Overall this rotation continues to challenge me every day. I think most difficult has been adjusting to the demanding schedule and finding time to study while maintaining my personal relationships. A wise friend told me you will have enough time for two things– being a good medical student and one other thing. Pick wisely. She was right.

With 3 weeks left I hope I can pick up my slack and do enough questions to get me ready for our shelf exam. This may mean my time must get skewed slightly more towards medical student, with awesome wife a close second.


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I am here to put you at ease…

I am going to cut right to the chase and let you know that if you took Step 1 and felt so bad about the potential outcome you questioned your entire existence and the last 2-6 years of your life….RELAX. It will actually be OK. I don’t think anyone could have felt worse after their exam than I did. There were tears, PTSD, depression and three weeks of sleepless nights. In the end, I actually did better than any of my NBME practice exams and scored exactly my goal score. So there you go. I think the post-exam depression is just part of the deal. Every single one of the classmates I spoke with felt exactly the same and in the end, here we are, we made it to the other side and now we are 3rd year med students!

The last week has been a blur. Back to the hectic pace of medicine. I was on for 6 days straight and have not gotten out of the hospital before 7:30 pm. The best part is–I don’t even mind it. Here’s a break down of what my new life in Inpatient Medicine looks like:

5:20 am: Wake up and race to get ready. I am one of those people who would rather sleep an extra 10 minutes than waste time in the morning. My beauty routine is a bun/pony tail and some mascara to make my eyes look less sleepy. Alright, I also need some blush because my face hasn’t seen the sun in a week.

6:10 am: Arrive at the hospital. I am on a giant medical campus so walking to my building will take another 5-6 minutes.

6:15 am: Log onto my computer and check any overnight labs that came in on my patients. I might also get lucky and see some notes from the overnight nurse (these are notoriously input later in the day).

6:30 am: Get hand-off from the overnight team and learn if anything happened to my patients over night.

6:35-7:55am: This is the only time I have in the morning to see my patients and talk to them about how they are feeling. I find out if they have any new symptoms or if their condition is getting better or worse. I also do an abbreviated physical exam. Right now I have 2-3 patients at a time, so this amount of time is perfect to do my initial checking in. I also check on various lab work and notes in the computer. After I do my information gathering I have to start thinking about a new plan for the day. This is by far the hardest part for a 3rd year medical student because we haven’t been trained in the nitty gritty of treatment plans. This is also the best part as learning what the protocol is for various conditions is why we are here.

8:00 am-9:00 am: Go to morning report. This is a time when the attendings, residents and medical students come together to go through a case. For example, someone might share an actual patient that came through our ward with his/her presenting symptoms, the labs and work-up that was done and we’ll just discuss the various differentials (things that could be wrong with them). This is kind of like a House episode. You imagine that patient in your head and as a team talk through what was wrong with them and how to fix it.

9:15 am: Morning Rounds. This is when the attending physician (the person ultimately signing off and overseeing the residents and medical students) comes in and we present our patients and assessments and plans. Because this is such a pivotal part of inpatient medicine I’ll spend a little time explaining the process.

For most medical students, this is the most anxiety provoking time of the day as this is our chance to shine in front of the attending (who is evaluating you). Even if you don’t know what you are talking about, if you can present well you can come off seemingly brilliant. In medicine, there is an art to presenting your patient. The presentation has to follow a specific format but despite its rigid guidelines it should still tell a natural story and you don’t want to sound like a robot who is spitting off facts. The best presentations keep your listener engaged, are clear, concise and to the point.

The trouble most 3rd year medical students have is knowing what is actually pertinent to your patient’s condition. You need to know EVERYTHING about your patient. Including their mother’s medical history, the surgery they had 30 years ago, the medications they took last week, their vital signs for the past week and the random phosphate lab that just came in–the skill is knowing which of those facts (which took you 45 minutes to gather) should be included in your 5 minute presentation. I found that if I focus on the true reason the patient is there– say it is heart failure– this helps to guide me in not including too many things that may be wrong with them (maybe a 10 year history of diabetes) but that is better handled outpatient and is not a priority for their current hospitalization. In any case, during Morning Rounds the attending will listen to you present your patient and will then ask you questions (known colloquially as PIMP’ING or putting you in your place) in order to see if you know anything about medicine. Most of the time you get lucky and the questions may be basic but there are often details which you learned 8 months ago and haven’t thought of since. Rounding is a grueling process that usually takes 4-5 hours, although there are stories of rounds lasting from 9 am to 6 pm!

12-1pm: Noon conference. This is when the medical students, residents and attendings meet again to listen to a noon lecture (it can be anything from Hepatitis C, Ebola to how to read an EKG). The best part is you get free food.

1pm-3pm: If you didn’t finish rounding you continue to do that. Some attendings will want to do physical exam rounds at this time, which means you go with the attending to see your patient and perform a physical exam. When you see your patient with an attending 1 of 4 scenarios is almost guaranteed to happen:

1. Your patient’s condition will have changed and everything you told your attending is no longer accurate. Result: you look like you don’t know your patient but it’s not your fault because the circumstance was out of your control.

2. The attending performs a physical exam and finds a physical exam finding that you missed. Result: You are reminded you are a third year medical student and have not yet perfected your heart auscultation skills to the point of detecting a 2/6 heart murmur.

3. Your patient suddenly remembers a new fact or completely changes their mind about their medical history because someone new with a longer white coat is now asking them. Result: You look like an idiot that doesn’t know your patient. Luckily, most people understand that being hospitalized is a high stress situation and people may remember things differently every time they are asked.

4. Your patient is excited to see you, you have a great rapport with them, which is easily noticed by your attending. Your physical exam findings and history for the patient exactly match the situation that is seen by the physician and you are able to truly help your patient get better. Result: You feel like a rock star and mentally high-five yourself. This is the rare situation we work towards!

3 pm-6 pm: This is the time you have to complete your to-do list for your patient. This is also when you chart. For each of my patients I am required to put in a progress note or a full history of present illness note if it’s a new admit. As always, there is a very specific format for how things should be written. Again, the hardest part is the Assessment and Plan, in which you synthesize the facts into a problem list for each patient. For each of their main problems (let’s say 1. Chest pain, 2. Hypothyroid, 3. Low calcium levels) you develop a strategy of what you plan to do to treat them. During this time you may also get a new admit from the Emergency Department. If someone is getting admitted that will now be my new patient, I will go down to the ER and do my initial evaluation. I then have to come back and write a History of Present Illness note and talk with my resident about the orders we think are appropriate.

6 pm-8 pm: Depending on when you get your last admit you may be staying late to finish up. If your shift is ending at 5:30pm, the rules of the universe will guarantee a new admit at 5:20pm and you will be there til 7:30pm writing notes and orders. Despite these long hours the process is the most fun I’ve ever had in my life. Time flies by.

9 pm: Shower. Debate if I have the energy to do some practice questions (yes, we have a big final shelf exam at the end of the rotation) and typically decide it’s better to spend 45 minutes watching tv with my husband before I do it all over again.

So that’s my new life! I wake up each morning excited for the day to come. I don’t get a minute to myself. My day is constantly challenging me and making me feel like I have volumes of knowledge still missing but it is the happiest I have been in a very long time. Guess I made the right choice 🙂

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A Time Like Never Before

It’s been 33 days and 3,771 practice questions since I started my dedicated board studying. Although I spent the first two weeks in an emotional state of panic, I think I’ve finally relaxed enough to enjoy this unique opportunity. During no other time in my life will I have the chance to simply review medicine and put everything I know into neat little boxes. The first two years of medical school go by in a blur. The chaotic pace really doesn’t lend itself to digesting what you are putting in your brain. It’s just facts, facts, facts–how fast can you learn these facts? With tests nearly every week you are forced to move on to the next, losing the ability to compartmentalize information and put the pieces together that make up the human machine.

These last 33 days have been exhausting–but I am finally starting to put the pieces together. Connections that I totally missed the first time around are lighting up like a giant map that had once been drafted in pencil, now replaced by glittering fiber optics. Each day I am simply filling in details.

To be honest, the excitement of what is to come in the next two years (and the rest of my life really) is the only thing that is driving me. While studying things like the approach to cricothyrotomy (gotta go through the cricothyroid membrane) my mind wanders as I imagine my first emergency intubation in the ED. I go to bed unable to sleep not because I am nervous about the exam, but because I can’t wait to start my rotations. I lay awake thinking about my future patients and colleagues. Imagining all these scenarios I’ve waited my whole life for…

In terms of exam prep, I’ve noticed that tackling Step 1 is all about pattern recognition. Once you re-learn the material you start to figure out how questions on a particular topic are going to be asked. With limited time and 8 hours of questions, beating the exam becomes as much playing their game as it is about the knowledge. Of course, you have to know the material to recognize the pattern, but once you have that down, it is kind of fun every time you recognize a question.

One source of material that isn’t talked about much is “USLME Secrets.” I have found that book to be a really great resource after I finished reviewing a particular section as way to check myself, and review some of the “golden” USLME-loves-to-ask -these-types-of-questions.

My practice score is still about 10-15 points away from my “dream” score but I feel pretty good about getting there in the next 20 days. We shall see. Right now things are falling into place–of course, there is always the danger of forgetting what you’ve already covered, so I just have to make sure I am continually reviewing.

I am very fortunate to have a loving, supportive husband who gets me enough to know that the next 20 days are 14 hours of medicine, and maybe 1 hour of making sure our house is livable. I am so grateful that he’s there to encourage me and give me the freedom to just live and breathe medicine. I really owe him once this is all done, he’s basically had a shadow of a wife. Just one of the small sacrifices of the profession. I’ll be back in 20 days, I promise!


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Ugh, and other things I didn’t expect about Step 1 Studying

Here is a recap: I am exactly 12 days into my dedicated Step 1 Study schedule. The days are long and even lonelier. My mental status oscillates between stressed, tired and panic. I have tremendous anxiety about whether or not any of the studying I am doing is actually “sticking.” I wake up, start studying, and before I know it, it’s 4 or 5pm and I am wondering where has the day gone? Some days I forget about lunch. Other days my brain starts its own mini-revolt and I am forced to walk away from my desk and do something, anything other than what I have been doing for days. That’s when I run. Exercise seems to help.

Before I embarked on this task I thought to myself: hey, you’ve done really well throughout medical school, just relax, put in the work and everything will go fine. It can’t be as bad as everyone says. I would hear stories of 15 lb. weight loss, gray hair, ulcers and serious physical illness all from the process of studying and taking the Step 1 board exam. I never imagined that it actually is that bad. Sitting in a room for 12 hours a day, every day for 6 weeks, with nothing but practice questions and review material is agonizing torture. As positive as you try to remain a certain amount of self-doubt inevitably creeps in. Your mind wanders and begins to reflect on the sheer amount of material you need to know and you start getting a deep sinking feeling. Until you snap out of it and do another block of study questions. Yes, I am teetering on some edge.

I am taking my first full length practice exam (8 hours) on Saturday, so I guess I’ll see how the studying is going. At least if I am terribly on the wrong track with my methods I have time to re-group and adjust with enough time before the exam.

I like to end my blog posts with some wonderful revelation and advice. All I can say about where I am right now is that this process is the first time I have truly felt the sacrifice required of my profession. Maybe because all the other sacrifices were so spread out, a weekend lost here or there, a birthday celebration postponed. But right now as I am chained not just to studying, but the anxiety of it all, the process has made me feel very viscerally how hard it is to become a doctor. I know I’ll look back on this time and think, that was nothing, but being right in the middle of it, it feels–dare I say–like the hardest thing medical school has put before me.


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MS2 Year: My Medical Education Has Begun

MS2 year hit me like a swift punch in the gut. Usually, when you think of the first week of school, warm fuzzy thoughts of seeing your old friends, catching up on summer experiences, easing into things with a couple of “orientation” lectures come to mind. All of those nice back-to-school pleasantries were abruptly cut short by the reality of the situation. There is no “easing in” with medicine. Time is short and there are unthinkable quantities of medicine to be learned. Not to mention a national licensing exam (known as Step One), which looms like a dark ominous cloud over every lecture.

MS2 year is brief–our last classes end on March 12th and with that marks the completion of our “formal” didactic lectures. We will have ostensibly learned all we need to know to not only pass (almost everyone does that) but excel in the USLME Step One exam. Fast forward a few months of intense studying, a quick 8 hour exam, and we move on to the clinical wards for 2 years of hospital based rotations. But I am getting ahead of myself here…

To say that the last two weeks have been an adjustment would be an understatement. Although I immensely enjoyed my summer, the break from the grueling daily grind of being a medical student served to dampen some of my once sharp neuronal connections. The year began so abruptly, you’d think it had never ended. There was no hand-holding- let’s review everything you forgot from MS1 year-before we bombard you with new information. MS2 is REAL medicine. Microbiology (the bugs), pharmacology (the drugs) and pathology (the clinical presentation). All of the basic science details we learned last year are a given–you are expected to know how the immune system works–now here are the disorders!

This is of course why we are in medical school in the first place, but actually learning the medicine and everything that can go wrong with us, while at the same time remembering the foundational details of how we work is harder than it appears. With the basic science behind us, I am now learning about things I have never heard of–ever. Which puts my brain at a distinct disadvantage, since repetition is the key to learning. Compounding my stress is a seemingly endless list of resources, all of which are magically dubbed “essential.”

Between reading the bible of medicine (Robbins), watching someone explain that bible in an easily digestible way (Pathoma), filling in the gaps (Kaplan videos), reviewing the information on a flashcard (Firecracker) and doing practice questions to make sure I actually truly did understand the information (Robbins Review Questions and Question Banks)–there is very little time left to go to lecture, listen to a professor explain the same in a slightly different way, take notes, and then review. Not to mention this is all happening with the assumption that I remember the basics from MS1 year–a generally poor assumption. So, in a nutshell, MS2 year is a juggling act. You have to balance learning the essential information (“medicine”) with a savvy review of the foundational science information all that medicine is based on. Never forgetting that Step One is the end goal for this year, so you better be annotating First Aid with all those new and important details. No wonder I am overwhelmed. 

Have I found that perfect balance yet? No, far from it. But I am slowly seeing my brain change and adjust to the pace required for this year. Currently, I am studying and reviewing material from the time I get home from class, usually around 3pm until 11pm or midnight daily. I hope, as I get smarter about what study tools I use and my brain gets used to being asked to memorize and recall volumes of information, things will get easier. If not easier, at least at some point, the grueling medical school pace will be my new normal once again and it won’t feel so alarming to be studying 12 hours a day.  

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Out of Practice

All I can say about the past week is that MS1 year spoiled me. It made me soft. I am slightly embarrassed to admit this, but after spending a year attending classes, sitting at my comfortable desk, studying when I felt up to it, napping when I felt up to that too, I forgot what it’s like to work a full 9-10 hour day. I have not been this exhausted in years.

I have spent the last week as a full-time instructor for a Summer Surgery Program for high school students. The days are long. I wake up at 5:45 am and spend the majority of my day on my feet or speaking with students. The program is really fantastic, not just for the students, but also for me since we spend 4 hours each day observing surgeries in the OR. In the afternoon we have didactics for the students–as an instructor I’ve taught things like the history of surgery, anesthesia/pre-operative care and heart and lung anatomy.

The enthusiasm I see in these kids is really inspiring. Today I showed them an aortic aneurysm repair surgery and they were mesmerized, thrilled, practically jumping up and down after we walked out of the OR. It was wonderful to see that sparkle of ambition in their eyes. A future dream in the making. They reminded me of how excited I’ve been this year with each new milestone.

My day doesn’t end when theirs does. I am also working on an independent research project in the Emergency Department and since my IRB just got approved last week, I’ve been heading over there for 3-4 hours in the evening to get things off the ground. By the time the last student has been picked up by their parents I feel like I just want to melt into my couch and not get up until the next day–somehow I find the energy to wander into the ED instead.

The funny thing is, as soon as I am in there I forget all about how sore my feet are and how physically drained I am. In the past two weeks I’ve had some amazing experiences. On multiple occasions I have been mistaken for an MS4 after someone overheard my presentation to the attending, which is pretty much the best compliment you can get as a med student. I am definitely starting to feel pretty comfortable in interviewing patients and doing physical exams–but before I get too proud of myself, I should mention they only throw me the softball patients, as in, simple cases of stomach pain or kidney stones. Either way, I am learning a crazy amount and working my ass off.

Although my level of exhaustion this week was off the scale, one night I literally fell asleep with a fork in my hand on my couch (eek!), it’s been rewarding and one of the best weeks of the summer. Here’s to another 3 weeks of early mornings!


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