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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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