Archive for the ‘medicine/medical school’ Category

Short White Coats and Goodbyes

May 23, 2011

It’s all over.  103 of my classmates and I graduated on Saturday.  Four years and a lot of blood and sweat (some of it ours) went into this project that culminated two days ago.  Now we are Doctors.

The ending of medical school has been a gradual process, starting many months ago such that when things were officially concluded on Saturday, there was no great sense of completion.  A lot of final good-byes had already been said by then, although at the time I don’t think many of us knew that those partings were to be our last.  Medical school has ended more with a peep than with a bang, with people spending their last days here with their families and their closest friends, rather than as together with the class as a whole.

I have always been a hopeless sentimentalist.  I am terrible at goodbyes and partings.  The endings of middle school, high school and even college were difficult for me as I faced the prospect of never seeing many of these faces again.  That is not to say that some have cropped up unexpectedly from time to time, but on the whole those final goodbyes always weigh heavily in my heart.

For many of us, these four years have been the hardest of our young lives.  We are leaving them behind for something else, and I think that a lot of us are ready to put them in the rear-view mirror.  A lot of challenges have been faced.  Some of them were surmounted, and some ran us over roughshod.  For me anyway, I look back at medical school as a mixed bag of successes, failures, and ambiguous endings.

I think now at the end a lot of us are happy to get those years behind us, and hurriedly consign them to the dusty annals of memory, ready to move forward to the next adventure that awaits us in residency.  Some of us have burned our short white coats, a symbol of the feelings some of us hold towards those days as medicals students.  But I have never been one to destroy pictures of past romances, and for the same reasons neither am I one who will burn his short white coat.

That coat and I have been through so much together.  It has carried my food, my books, my notes.  It has traveled up and down the hallways of hospitals, watched from the hooks in the trauma bay and the OR, borne witness to a lot of my triumphs and failures.  There are still marker stains from the pen I used to communicate with an intubated patient in the SICU.  Underneath that short white coat, I have grown into the person I am today.  For better or for worse.

It seems wrong to me to destroy that legacy.  I want to keep the coat with me, to remind me of how much I have been through.  Whether I like it or not, these four years are part of my life and it does no use to try and forsake it.  And in the same way, these people who walked across the stage on Saturday are perhaps not my best friends, but we have been through something together that we do not share with anyone else.  I imagine something like war buddies, we have had this shared experience which is very hard to describe to an outsider.  We may not be best friends, but we have been companions in this journey.  Walking this same road together for four years, you cannot help but form some bonds with your fellow travelers.

But this road has been hard, and I think many are happy to see it end.  Ready to move on to the next journey.  But for me the hopeless sentimentalist, I want to savor it a little longer.  I want to remember these people and these events that have shaped me.  I cannot say that these times have been an unbroken string of positive experiences.  But they have been intense times.  And they have been genuine.  I cherish these times and these people for that.  These times have changed me, and these people have both contributed to that change, as well as borne witness to it.  To walk away from that with little or no fanfare does not do the occasion justice.

I am going to miss you all.  I do not know when we might meet again, if ever.  But in these four years that we shared together, I want you all to know that you have changed me.  For better or for worse, I will carry these changes for the rest of my life.  And so I acknowledge you, Class of 2011, for being a part of not just the last four years, but of the rest of my life.

“It well may be
That we will never meet again
In this lifetime
So let me say before we part
So much of me
Is made of what I learned from you
You’ll be with me
Like a handprint on my heart.
And now whatever way our stories end
I know you have re-written mine
By being my friend…

Who can say if I’ve been changed for the better?
But because I knew you, I have been changed for good.”

– “For Good,” Wicked.

Waiting

March 9, 2011

I am about a week and a half into a two-week vacation.  And in the eternal paradox of writing and blogging, instead of my norm of having no time and plenty to write about, I now have plenty of time. . . but nothing to write.  But I shall do my best.

In 5 days I will learn if I matched, and in 8 I will learn to where.  I’d like to stay here if at all possible, and walking around the neighborhood I come across For Sale or For Rent signs, and think “Man, that would be nice to live there!”  But this thought is inevitably closely followed by “Shaddap!  Don’t think those things!  You have no idea where you’re headed, so don’t get your hopes up!”  I want to make plans for the future, but that impulse is brought up short.

In truth I’d like to stay, but I’d be pretty darn happy with just about any of the 4 or 5 places at the top of my list.  But the not knowing is difficult.  To pass the time I have rediscovered my passion for pleasure reading, and have burned through The Caine Mutiny and Snow Crash and have started back into the Harry Potter books in the space of about 3 weeks.  I’ve also dusted off some old video games, and revived an interest in high-yield cooking (ie stew) which I hope will serve me well in the coming years.

But inevitably the thoughts trickle in.  It’s exciting and scary, and my heart beats faster thinking about opening that envelope a week from tomorrow.  I’m going to be spending the next 5-7 years in wherever place the match algorithm has decided to send me, and I want to start learning about that place right now!  It’s a real exercise, to sit and savor this peaceful lull not knowing where I’m headed next.  But I imagine that’s not necessarily a bad thing.  If nothing else, it means I get to catch up a little bit on my reading 🙂

“Grant me the Serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.”

Starfish

February 21, 2011

At my high school graduation, one of our valedictorians (there were quite a few) told the 650 of us a story about starfish.  The way the story went is that there is a little girl walking down the beach.  Millions of starfish have washed up on the shore and are slowly drying out in the sun.  Realizing that they are all going to die, she runs up to the nearest ones and starts to hurl them back into the water.  An old lady sees her efforts and stops her.  She tells the girl that she’s being stupid, that she can’t possibly save them all.  The little girl looks up at the old lady and says “No I can’t, but I can save this one.”  She stoops down to pick up one more, and throws it into the sea.

Crazy as it is, that story has stuck with me all through my undergrad years, and played no small part in nudging me towards picking my current occupation.

But this brings me to a second story.

I am currently rooming with two first year medical students and a third year.  I have found I spend a fair amount of time in “discussions” with one of the first years regarding the, ah, nature of medicine.  Talking about how you are so busy, there are so many demands on your time, that it can wear you down.  And that you become kind of callous to the suffering.  But a few weeks ago my roommate went on a weekend medical mission to Mexico, where she saw a young girl with a heart defect that would kill her by adolescence without surgical intervention.  After coming back to the States my roomie spent a significant amount of time calling, emailing and cajoling anyone that might be willing to do the required surgery, getting so far as to get her medical records looked at by an American cardiothoracic surgeon and some charity groups.  Unfortunately it doesn’t look like anyone is willing to take the case.

But she tried to save this girl’s life.  I am nearly certain that I would not have done the same.  And so it gets me thinking back to the starfish and my motivations for getting into medicine.  Thinking on the importance of making small efforts towards small differences that may mean quite a bit to someone else.  There is really no conclusion here.  Just the thought that I’ve changed a bit since undergrad.  I got into this business to help people.  Sometimes perhaps that requires a little bearing in mind.

Another Christmas Post

December 25, 2010

Once again I find myself in the semi-dark, sitting at the dining room table in my family’s house looking out over the lights of [the city]. Got some Christmas music going on Pandora, hot apple cider and warm slippers on my feet. It’s a peaceful place, and as I am sure you have all grown accustomed to, one suited to reflection.

The biggest thing on my horizon these days is figuring out the rank-order for the surgery residency programs I’ve interviewed at. I plan to interview at about 15 programs and in my head there are more or less two criteria; how good is this program/how good a fit is this program, and how difficult is it to get home from there. The ordering of these priorities is rather conflicting me at the moment. On the one hand I want to get the best surgical training I can, and enjoy the company of the half-dozen or so people I will be spending the next 5 years with . . . but on the other hand I realize my grandparents are not getting any younger and neither are my parents for that matter. And a lot can happen in five years. And on top of that, something like 80% of residents end up starting their practice within 100 miles of where they did their residency and I kind of like [my city], and yes the people who live in it (or at least come back to visit from time to time).

I anticipate my surgical residency to go for 5 years (possibly as many as 6 or 7 depending on whether I take time off to do research), working 80 hours a week for 48-50 weeks a year. As residents we are supposed to have 24 hours off every 7 days, averaged out over a few weeks. So I won’t exactly be rolling in the free time, and taking a plane flight home when you gotta be back in 36 hours is tricky.

And so the dilemma. I am not sure yet how these conflicting priorities are going to pan out. And despite all this premeditation, where I end up may well be completely random, as The Match works its algorithm and sticks me where it will.

Anyway. A few years back (on Christmas Eve if I do recall correctly) I had an entry talking about how I feel like medical school has changed me. If nothing else, I feel like I complain a lot more than I used to. I have struggled with this, trying to find a balance between getting stuff off of my chest/venting, and just being a whiny person losing his perspective. I chose this path intentionally; there was no coercion, no trickery. I knew it would be a lot of work, and I knew it would be stressful. I knew it would test me, and teach me about myself. Returning to home, I feel kind of like I am looking at an old photograph, or reading an old journal entry. It’s kind of like a window into the past a little bit, as if all the other stuff that has happened in my life away from here hadn’t occurred. It’s almost like a gauge, a marker that throws into relief how much I’ve changed, now that I am back in a place that has remained mostly the same in the seven and a half years since I’ve really lived here.

I think it’s telling, that in this context I feel more grouchier, more tired, and cynical and world weary than I remember. I snap at my parents more than I used to. What I perceive as personality flaws are more nettlesome. I look at my old bookshelves and I realize I’d forgotten how much I used to read. But I also feel a sense of pride, of accomplishment maybe even bordering on hubris. I find I still enjoy walking, and the lights of the city, talking with my parents and playing video games with my sister. I enjoy seeing my old friends.

Truly, I don’t know where this all is going. I suppose I already feel a bit uprooted, while I process all the changes from med school. And I worry a bit about how much more untethered from my proverbial roots I will become if I wind up somewhere else. But we’ve only got one life to lead and it’s almost always too short for anyone’s liking. And so why constrain myself to a certain geographical area, when there is so many more places of the country to explore? And when I may even find a better experience farther away, rather than close to home? Well, I suppose that’s the dilemma.

Anyhow, I wish all of you a Merry Christmas, and all the best in the new year.

Vacation . . . Kind of.

October 18, 2010

Got back a few weeks ago from 3 months of “sub-internships.” They are classes/rotations in which you are theoretically supposed to act as an intern (1st year resident). It’s a good way to start learning how to be a good intern, a chance to get involved in the nitty gritty parts of taking care of patients, and an opportunity to visit other programs to show them just how awesome you are and how they should take you on as an intern next year. On the other hand, the 80 hour work-week, not exactly respected among most surgical programs anyway, doesn’t extend to students. Together with the programs more or less wanting to see what you’re made of, they make it a point to work you HARD. But it’s over, I don’t think I hurt my chances at those programs, and I have four weeks off.

Or at least I did have 4 weeks off until yesterday, when I got antsy and scheduled a (relatively) low key 2-week pathology class for myself. On the other hand, got to play soccer and frisbee last week, and I’ve started fencing again.  Enjoying spending hours at a time reading, and yes, the occasional video game. Life could be a lot worse now.

I’ve also started to get invites to interview for residency positions. Together with the sub-internships, they have kind of made the whole future life in surgery thing a lot more real. Plus, the idea that I won’t have more than a week off at a time for a long long time. I know you guys out there in the working world are already aware of it, but man, it’s a scary thought . . .

Medicine isn’t as fulfilling day to day as one might think. I had an interesting conversations with the first year medical students that share the house with me. The hospital is one huge layer-cake of human suffering, with scores of rooms on each floor containing a person or two having the worst (or if not THE worst, at least in the bottom 5) day of their life, in a building 14 stories tall. At the end of a 14 hour day you’re tired and beat, spending the day helping patients get better, or at least trying to keep them from getting worse. They’re all having a shitty time of it, and almost to a man (or wo-man) they could probably benefit from someone sitting down and hanging out with them for a few minutes. On Scrubs, they have scenes from time to time where JD or whomever sits down exhausted at the end of their day, at the bedside of a patient, props their legs up on the bed, and just hangs out with the patient. They shoot the shit, or they just both fall asleep, with the patient reassured that they’re not alone.

But leaving the hospital after that 14 hour day, struggling to keep your and your team’s (and thus your patients’) heads above water, you know you COULD take another 5 or 10 minutes out of your spare time to spend with a patient. But usually you don’t. Because you’re tired, and in a hospital of over 800 patients, you can’t help everyone. So you go home.

The young ‘uns charge into medical school looking forward to spending time with their patients, eager to heal, and failing that, at least provide comfort. But sadly, there are so many people that could use your time, you’re overwhelmed so fast. My first and second year, I learned the limit of my intellect, of how much I can cram into my head in a given amount of time. And in my third and fourth year I learned the limit of my compassion and energy, where you must draw a line between being with someone who is suffering, and taking time for yourself.

On the other hand, babies get born, people make recoveries, and there are some positives to be found if only one cares to look for them. So my goal for the rest of my 4th year here, in the waning months of my time in medical school, is to get better at finding those positives 🙂

Oh Surgery

June 22, 2010

After finishing my Emergency Medicine rotation a few weeks ago, I had a bit of a revelation that surgery is where I want to take my medical career.  EM was a lot of fun, don’t get me wrong.  But I always disliked how we never really fixed the sick patients.  If they were alright, we sent them home.  If they were really sick, we just held onto them until one of the in-hospital services could pick them up.  On my last day, there was a gentleman who was really very sick; he came in right at the turn of the shift, and so he had two shifts of EM docs working on him at the same time for almost an hour and a half to get him “stabilized.”  But then off he went to the MICU (medical intensive care unit), never to be seen or heard from again.  They paged a code to the MICU later that night, and one of the residents wondered aloud if that was our guy.  Who knows?  I found that aspect to be a little disappointing.

There are plenty of procedures in EM (I like procedures), and the shift-work lifestyle can be pretty awesome.  All the people I had the chance to work with were all very nice.  But you always give up your sick patients – you never really “fix” anyone, and the procedures are hurried, slap-together affairs because there are the other 20,000 patients out there waiting to be seen.  Plus there are the classic “emergency room specials,” the savory personalities that pervade every EM waiting room.

I appreciate that in surgery there is sort of a credo of personal responsibility.  Your incision, your patient.  And especially in critical care/SICU type work, the buck stops with you.  Patient goes from ER to the floor, and then if they’re too sick, they go from the floor to the ICU.  But once there, you gotta fix ’em.  No where else to put them.  And so they either get better . . . or they don’t.  :shrug:  That sort of mentality appeals to me.  I also love the feeling of cutting the sick right out of someone.  Peri-umbilical pain that turned into excruciating right lower quadrant pain a few hours ago?  Nausea, vomiting, fever?  Sounds like appendicitis to me.  Come on up to my OR and we’ll cut the sick right outta you!  And the mix of technical proficiency and medical knowledge.  Oh man.  Get excited just writing about it, lol.

So yeah.  It’s going to be surgery.  Get worried because of the hours, and the fact that I might end up like some of the people who come out of the process burnt out, angry shells of human beings.  But for the chance to do what they do . . . I think it’s worth the gamble.  We shall see.

In other news, I’ve been studying for the Step 2CK the last few weeks.  Kinda ready to get this over with, and move on to my SICU rotation in July.  oo rah!

Emergency Rotation II

May 2, 2010

Just coming off the night shift at the emergency department.  First time I’ve ever tried drinking Rockstar, and I’m not gonna lie, that is some powerful stuff.

Did chest compressions on an elderly man last night.  He was old, and so I am pretty sure it was his ribs I could feel breaking and crunching while I was jamming on his chest.  He was coded for about 15 minutes before the attending called it off.  Old man with cancer, and I guess this was his time.  Surreal stripping off my gloves and walking out of the resus room, diving back into the bustle of the emergency department after being part of an unsuccessful effort to save a person’s life.  The intern told me that I had done good chest compressions.

Put sutures into another man’s head just before I left this morning.  It took a long time; he was very patient and I was very clumsy.  He was grateful for my second class work and that surprised me.

I did not fall asleep once during this shift.  I am bad at finding pedal pulses.  I helped cut the clothes off of four separate people.

There is no good breakfast food at home right now.  So after the shift ended, I walked to the starbucks by my house.  For about 5 seconds I stood mute at the counter because I couldn’t remember what it was I wanted to order.  I ate a bagel and sipped my hot chocolate by a window.  Watched people come and go for a little bit, with their kids going to volleyball tournaments.

I got up, came home, sat down and wrote this, and now I am going to go to bed.

Emergency Rotation

May 1, 2010

Fourth year is officially here!  Last week on the night before my last shelf exam, I closed my textbook and it felt like a million pounds just fell off my shoulders.

Since then I have done a few shifts in the Emergency Dept as a 4th year, and it’s been a totally different experience.  A lot more autonomy.  Last night I got to suture a girl’s hand closed after she fell on some glass.  And I diagnosed a nursemaid’s elbow the attending had missed.

All in all it was an awesome shift, and it helped restore a few of the soul-points I think I had hemorrhaged over the last several months of my third year.

Labor and Delivery

April 9, 2010

Gonna try something new; instead of long posts, gonna just toss out some random stuff in brief.  Here goes.

Spending a month on the labor and delivery service.  Got to deliver a placenta, and had a resident guide me through delivering a baby (her hands on top of mine for the most part).  Scrubbing into c-sections.  Neat watching the little babies come to life when they pop out of mom’s vagina or uterus or what have you.

Flip side is a lot of babies that are too young to be “viable.”  The cut off here is about at 23 weeks of gestation; after that time, they will try but before, no effort is taken.  It’s a little bizarre being in on the discussions of whether or not to stave off pre-term labor a little bit longer, give steroids, etc or whether it is better to advise to throw in the towel.

One of the residents here delivered twins at 21 weeks.  At that age they are considered non-viable; they may come out with heartbeats and breathing, but there is no way they will survive.  And so the twins were delivered and taken from the room; I guess it is sort of the policy of the service to not let the parents see them until all signs of life have stopped.  I wasn’t there personally, but I can see how that can shake one up.  I’ve observed a few dilation and curettage/evacuations here for therapeutic purposes.  Reassembling the little bits of fetus after sucking them out through a tube to make sure you got them all is a bit of an unnerving experience.  Yesterday a family wanted to see their evacuated 14 week old fetus.  The resident did her best to sort of assemble the parts into a form resembling that of a human being so the family could see on the plastic lid of the pathology container.  Think what you wish about abortion as a social issue, but when you get down to it, it’s a pretty grisly process.

Anyway.  That’s my brief update!  Hopefully more to come in a similar manner.

Free Association Post!

February 7, 2010

It has been a while since I’ve last posted. I’m having a hard time pinning down specific things to talk about, so I figured I’d just let fly with the gestalt in my head.

I’ve been thinking about some of the memorable patients I’ve met over the course of the year. Single, earthy, elderly grandfather taking care of his two grandchildren. The girl who shot herself in the head, and the doctor who told her family. The really nice guy with inoperable pancreatic cancer. The other really nice guy who had the courage to joke about having his leg amputated. The sister and her mentally retarded brother who live together with her boyfriend, somehow making things work. The little girl with leukemia that we tried to send home for her birthday, but came back the next day to stay for four months. The man who lived in utter squalor at home with terminal cancer, that we kept in the hospital for two days against his will. The cancer patient who tried to leave AMA, trying to curse the doctors through his trach tube. The man who asked me when I’d be a doctor, and if he could be my patient. The woman that I tried to “give homework” to overcome her agorophobia by driving her son to school . . . and she succeeded. The 23 year old girl with a rare and terminal liver cancer. The little girl that we coded for two hours. The little boy with prune belly syndrome who smiled all the time.

I’ve been thinking a lot about surgery lately. About making it my career. I figure for some people, working 40 hours sucks because it’s just a job, and they spend another 40 hours chasing their hobbies and their passions. But if surgery is my job, my passion and my hobby. . . maybe that’s not so bad. I was told I was a low-average applicant, and I will need to do some solid work in the next six months or so if I want a shot at a good surgical residency in California. I am thinking that perhaps if I do surgery, I won’t necessarily get what I want, but maybe I will get what I need.

I have spent the last two Saturdays at the student run clinic I used to help direct. It’s amazing how far I’ve come since I was there a year and a half ago.  It’s kinda awesome realizing I have something to offer/something to teach.

My parents bought me this huge (for me) full size bed that I am luxuriating in each night.

I have started fencing again each Monday. It’s been so long, but the joy in that activity is still there. After practice this week, I went to dinner with some of the fencers afterwards. We all turned out to be grad students in one discipline or another. Was great to relax and be socially awkward in front of people who couldn’t care less.