The Lucky Ones

One weekend when I was in 8th grade, my parents decided to throw a garage sale.  My dad made a trip up to the park next to our house with a handful of fliers. He returned home with a white little puppy that we absolutely, under no circumstances, were going to keep.

Well, we kept her.

She was shy and smart and sweet. And, in no time, she filled a spot in our family we hadn't even known was empty. The way dogs do.

For the past eleven years she was a faithful companion and friend. She would play fetch for hours. Cover your face in slobbery kisses. And became the perfect afternoon poolside napping buddy. She was the first one by your side when you were sad. And could convince you, with big brown eyes, that you really didn't need that last bite.

Tomorrow marks one week since we had to say good-bye to Maddie. Few things resemble the selfless and constant love of a dog. And I am still so very sad that I have lost mine. Going home won't be the same without her wagging tail that never, in eleven years, failed to greet me at the door, no matter how long I'd been gone.

When most people hear the story of how we adopted Maddie, they usually say that she was one lucky puppy. But, as anyone who has rescued an animal before knows, we were always the lucky ones.

Merry Go 'Round

In second grade my teacher, Mrs. Kittleson, gave my class an assignment: write an instructive paragraph on making peanut butter and jelly sandwiches. She told us to be as specific and as detail oriented as we could, because the next day she would be reading and following our directions. I spent the full writing period carefully crafting, what I thought were, the most perfect peanut butter and jelly sandwich instructions of all time.

The next day, standing at the front of the class with the ingredients for the sandwich du jour, Mrs. Kittleson asked whose instructions she should follow first. I, being the overly confident, bright-eyed second grader that I was, shot my hand up straight in the air (Hermione Granger style) all too eager to be picked first. As I marched my recipe up to the front of the class, I looked back on my fellow classmates (the poor schmucks) because I just knew that my instructions were going to make the best peanut butter and jelly sandwich. Like, ever.

It wasn't until Mrs Kittleson opened up the jar of peanut butter and placed the entire lid-less jar onto a slice of bread, followed by the lid-less jar of jelly, that I realized I had left out a couple key pieces of information. Mrs. Kittleson was literally following our instructions and mine, and the rest of my class's, were found wanting. My teacher's creative way of improving our instructive writing styles came at the steep price of one 8-year old ego.

I was reminded of that story this past week. Thursday marked my first ever encounter with a real, non-standardized, honest-to-goodness patient. And the moment I remembered that I had omitted spreading the peanut butter onto the bread with a knife felt very similar to having my case presentation annihilated by the internal medicine attending. Multiplied by about 500, minus the smell of peanut butter.

I have learned many a lesson in humility since my second grade PB&J days, so I was not expecting to give the most perfect case presentation of all time. But, overall I thought the encounter had gone well and was excited to present my findings on a real patient to a real doctor in a real hospital. So, when Dr. Attending asked who wanted to go first, I volunteered. And then 25 minutes of this happened:

Student Dr. Day, don't you think it is important to figure out exactly why your patient was weak, instead of just assuming he had overdosed on his glucovan?

Student Dr. Day, don't you think obtaining peripheral pulses in an elderly diabetic patient with a history of systemic vascular disease and bilateral diabetic foot ulcers is pretty important?

Student Dr. Day, are you telling me that you did not palpate for the PMI and compromised your physical exam and because your patient was "upset?"

Student Dr. Day, list the classes of diabetes medications. Go.

As what I can only describe as the longest 25 minutes in my medical school career (and maybe even my life) dragged on, I felt more and more like a total failure. It wasn't until the H&P blitz was finally over, when Dr. Attending smiled at me and said nice job that it hit me. He was telling me to make a PB&J.

He did not expect me to know that I absolutely needed to figure out why an elderly patient was weak. (It's to rule out a stroke.)

He did not expect me to check the patient's peripheral pulses. (The patient already had foot ulcers, so blood flow is already compromised. But it still needs to be something I at least think of.)

He knew I wouldn't know how to react to a complicated case where the patient was emotionally and physically upset. (When a patient has upset themself to the point they are vomiting, as long as they are not dying, you can go always go back! Like, when the vomiting has stopped and the world is good again.)

He knew I wouldn't be able to completely list all of the classes of diabetes medications. (sulfonylureas, meglitinides, biguanides, incretins, thiazolidinediones - to name a few)

Dr. Attending did not expect me to effectively give a case presentation (or perform a thorough history and physical exam) any more than Mrs. Kittleson expected a room full of 8 year-olds to write exact instructions on making a sandwich. The point of the exercise was to show us how much more we still had to learn, and to let us experience a patient interaction in the real world, with a real sick person.

After all cases were presented (and inside tears cried), Dr. Attending told us that he hoped we enjoyed our patients, but even more importantly, he hoped our patients were able to enjoy us. He told us to work really hard at remembering why we wanted to go into medicine in the first place, and that he works with doctors every day who have forgotten just that. He told us that being a physician is the greatest job in the world and that eventually, we'll be able to help people and maybe even bring some joy into their lives.

And even though my patient (with dementia) probably forgot about the entire interaction about 7 minutes after I left, while I was shaking his hand and thanking him for his time, he looked up at me and told me that I was a nice person. So, in some very small way, maybe I already have.

The Horror

There comes a time in every medical student's life when they realize that something horrible has happened. There you are. Going about your day. Taking care of errands and minding your own business with a cheerful smile (and maybe a caffeine charged eye twitch) when it hits you. You have lost the ability to interact with your fellow man in a normal, non-school related, scenario. You my friend, are a social freak. Nice. 

While there have been subtle hints throughout the past year that this was happening, I refused to believe the seriousness of the matter until this past week while I was at the grocery store. 

There I was, with real pants on and everything, standing in line at the check out counter. I had finagled exactly 1.5 hours into my test-week study schedule to shower and restock my food supplies. I was on time and mishap free when the following scene occurred.

Lady in front of me finishes checking out, grabs her purchases, and exits the store. 

The elderly cashier, let's call her Grace, turns to me and smiles a warm smile. A smile filled with the hope and promise of a pleasant interaction with a freshly-showered, sane-looking, mid-twenties female. Notice the "sane-looking" part. You see, this story takes place on Monday. And I hadn't really been interacting with people for about five days at that point. Every day I had been holed up in my house, buried under my mountain of books, only speaking to my roommate and my cat (but mostly my cat). Needless to say, at this point, my social skills were a bit off. 

So, when Grace looked at me, smiled and extended her hand to take my shopper rewards card, my idiot hermit brain interpreted that as something different. And while I did hand her my rewards card (social cue accepted, appropriate response executed), I also began introducing myself as a second year medical student who was about to take Grace's medical history (social cue misinterpreted, abort ABORT).

I got half way through my name when I realized what I was doing. By that point poor, sweet Grace's face had morphed into a mixture of confusion and pity, with just a hint of fear. 

But don't worry, friends. I still have two and a half years left before I'm responsible for the health and well being of another human. 

*Though, I'd still make a mental note to steer clear of teaching hospitals come June of 2017. And also, for that matter, grocery stores. 

Holding On to Good

Today the first year class had their white coat ceremony. Which got me thinking about my white coat ceremony last year. My classmates and I joke that our school "hazes" their students by throwing them face first into anatomy, embryology, and histology courses for 12 weeks (not a lot of time), right at the start of school. So, by the time white coat rolled around last year, I was in the middle of the worst semester of my life (class wise) and all I wanted to do was cuddle up with my parents and listen to them tell me how special/smart/pretty I am. (Which happened. Thanks, mom and dad. :) )

As you might know, I am a huge fan of lists. (My very first post to this blog was a list.) They help me get my thoughts down, reflect on past experiences and take a look at how I'm feeling in general. So, here is a list of things I've learned/embraced since I donned my bright new white coat and stethoscope exactly one year ago.

• Family is most important.
• Good friends are very important. While I'm not sure if "hard to find" is how I'd put it, I do know that once you have them, investing in those friendships and having solid people by your side makes life so much better. 
• I will never know everything. And neither will anyone else in a white coat. 
• Medical school may force you to adjust expectations you have of yourself. And that's okay. 
• Few things are more valuable than good sleep. 
• A good cup of coffee is one of those things (see above).
• I like Taylor Swift. She makes me feel twenty-twooo--oo-ooo. (Sorry, I couldn't help myself.)
• Things seem much worse when the sun goes down and much better after sleep. 
• I HATE immunology. Cell warfare? Super cool! Until you have to learn. Every. Little. Detail. 
• I am a morning person. Surprise! (So weird to even type that out...)
• I am too old for all-nighters. Writing papers and staying up all night to study in college, totally doable. Staying up all night to study now? Yeah...not gonna happen. 
• Sometimes I stay home just to study with my cat. He's cuddly and I like it. Plus the coffee there is free. And endless. 
• I am living on the wrong coast. 
• If you don't sometimes question whether or not you made the right choice going into medicine, you're lying. 
• The human body is sometimes super cool, sometimes kinda gross, and usually a fun combination of both those things. 
• Be kind to people - regardless of how much sleep you've had, how stressed out you are, or how hungry you are. It's nice to be nice. 
• Going to Sheetz after 10pm for a food run will inevitably end in multiple trips to the bathroom. Not. Pleasant. 
• Pelvic examinations on a teaching mannequin and pelvic examinations on a real live female are the same, and also different. Which is neat. 
• Medical school has NOT ruined medical shows for me. I could still watch ER and Scrubs for days. 
• The only thing worse than over-caffeinating is under-caffeinating. And hey, those tremors and heart palpitations will diminish. Eventually. 
• Clinical faculty members can make or break your PBL sessions/practicals/life. For the love of all that is good and pure, get on their good side, and stay on it! 
• No, medicine is not fair and neither is medical school. Next. 
• Psalm 94:18-19 gives me peace before every big exam: When I said, "My foot is slipping," your love, O LORD, supported me. When anxiety was great within me, your consolation brought joy to my soul.
• Finally, to quote my (super smart) punk kid brother, "sometimes, you just have to embrace the suck." 

The Whole30

Saturday I took the evening off from studying and meal planned. Then I went into the city to shop for said planned meals at Whole Foods and Trader Joes. No, I am not dropping out of medical school to become a chef, though sometimes that is tempting. Folks, I am doing the Whole30!

I first heard about the Whole30 program when my awesome, super smart, and very pretty friend Shannon told me about it in a conversation that went a lot like this...

S: "We're doing the Whole30!"
Me: "Neat! What is that?"
S: "It's a diet that's kind of like Paleo, only more restrictuve."
Me: "Sounds great!"
After the phone conversation
Me: Yeah. Nooooope.

That was pretty much my first encounter with Whole30. I didn't ever think I'd be doing this. I love all things sweet, chocolate is my spirit animal, and I adore baking. But after hearing about Shannon's experience (read about her first Whole30 experience here, and she just finished her second, the stinker), I felt it would be good for me. Like most people, my relationship with food is not great. I could fill in the "I'm a ______ eater" with bored, stressed, happy, sad, tired, thirsty, etc. Which means that most of the time, when I do eat, it's not because I'm hungry. Which is supposed to be the point!

Whole30 attracted me because it is all about making good food choices with the intent of being good to your body. It's 30 days of clean eating. No sugar. No dairy. No grains. No legumes. And you're not allowed to step on the scale. It isn't some diet fad that tries to trick your body into losing weight by shoving over-processed and "fake" food into your face. I hate this type of dieting because besides eating garbage, it also pits you against your body. Which doesn't make any sense at all since most people "diet" to "get healthier."

Our bodies are AWESOME (I should know, I spend 92.7% of my time studying them!) and they're made to run best on good, nutritious food. So, I'm excited to see what mine feels like when I eat real food, the main rule of the Whole30 program. I have already done things I never thought I would do. For example, there is a jar of ghee in my pantry and I'm sipping on coffee with almond milk as I write this. (Also, I am in love with cashew butter. I think it could be serious.) Yesterday I was a little nervous/panicked worrying about whether I will actually be able to keep this up for 30 days. But mostly I'm looking forward to eating tasty food (I made Spicy Cashew Zoodles with Chicken last night and it was a-MAZING), resetting my "food attitude," and seeing how different I feel when I'm eating clean. While I was cooking yesteday (and reminding myself NOT to touch my roommate's emergency chocolate supply) I kept thinking of this quote:

So, here's to doing things we've never done and adventures of all kinds. Especially this one! If you want to learn more about the Whole30 Program click here!

Happy Monday!

"CHD"

Because I believe Wednesdays are THE worst, and because I love telling stories about my friends doing ridiculous and embarrassing things almost as much as I love telling those same stories about myself, here is a tale to lift your spirits on this here "Hump Day".

The following scene took place last Friday during one of my patient case study groups. To further set the stage, there are 8 second year medical students (myself included) and one facilitator, a clinical faculty member, sitting around a table. It also happened to be our first meeting of the new case block. Which means it was our first time with this facilitator. Hooray for first impressions.

Thirty minutes and one physical exam into our session, my good friend "H" was writing our list of differential diagnoses on the whiteboard. In his mid-Friday afternoon blur, he wrote "CHD," incorrectly merging the acronyms CHF (congestive heart failure) and CVD (cardiovascular disease). Our case facilitator, Dr. E, called him out and asked him what "CHD" meant. To which he promptly responded, "Sorry, I guess my hand is just used to the D."

Immediately my face turned bright red.  I tried my best to stifle the 8th grade boy laughter that was bubbling up and noticed a couple of my other group mates were clearly doing the same thing. All the while, H, having realized what he had just said turned around and sheepishly corrected his mistake while whispering, "Oh, dear God," into the board.

Despite my best attempts to remain professional, ultimately our facilitator realized something was up. When she asked me (at this point I was bright red, with tears streaming down my face) if I was ok, I croaked that I was fine and managed to regain my composure. For the remaining hour and a half, H and I couldn't look at each other. And no matter what I thought of (dying puppies, the world running out of chocolate, VEEP never returning to TV) I was still on the verge of cracking up.

It was. Just. That. FUNNY!!!

So, Happy Hump Day everyone! May your day be free of humiliating experiences. But if you do find yourself in a precarious situation, I hope you are able to become one with the inner prepubescent junior higher in all of us, and laugh inappropriately in front of your superior. :)

My Cat, the Dog

My first big exam of the semester is over! Which means I can get back to doing normal things, like sleeping, cleaning my house, and playing with my cat - who has been feeling very neglected with my non-stop studying the past two weeks. Just ask him.

A photographer blog I follow recently wrote a post "My Dog, The Cat." Which I related to (kind of) since I have a cat, who is really more of a dog.

Internet, meet Jack. A four year-old Blue Russian, known for knocking things off the counter, needing constant attention, and using my macbook as a his own personalized heated seat. It turns out, he is also quite the hunter, as I documented here. His full name is Jack Bristow, and yes, he is named after the Alias character, which is funny since I have never seen a single episode of that show. I adopted him from my good friend almost 2 years ago when Jack the Cat was having problems playing well with others. And by others, I mean my friend's new baby.

During the past two years he has moved with me across the country, kept me company on many a late night curled up next to (or on top of) various medical text books, and been subjected to thousands of snuggles. It's funny how attached we get to the animals in our lives and I am so thankful for the funny little one in mine. So, here's to Jack. The cat who turned my dog-loving self into a crazy cat lady.

See it for Yourself

My wise hair dresser once told me that life was all about perspective. While some of the things that man said were far fetched, Howard did hit the nail on the head (or the split ends with the scissors, as it were) with that one.

Earlier this week after a conversation with a friend who is starting the medical school interviewing process (So so so so so glad that is OVER), I was feeling a little blue. My friend has an interview at the school that I desperately wanted to attend, but after interviewing there, was not accepted. The chronological (and emotional) distance I've had since that gut wrenching email has helped. And I have faith that I am exactly where I am supposed to be right now. But giving her advice for her interview and answering her questions about when she could expect to hear back from Dream School was tough. Don't get me wrong, I love my friend and want amazing things to happen to her! It just brought back a lot of feelings I thought had long since been put to rest. But later this week, when I was studying about the differences between secretory diarrhea and bloody diarrhea (Ahhhh, microbiology), I had an epiphany.

Five years ago if you were to ask me what I wanted to do after college I would have told you that my dream was to to go to medical school and become a doctor. People frequently used to ask me where I wanted to go to school and I remember answering (I can still hear the younger and more fit me saying it right now): "I don't care where I go. I'll go wherever I get in." And that was the truth. When it came right down to it, my dream was not to go to a school, it was to become a doctor. And in less than three years (wait, what?!) I'll have two letters after my name that will allow me to do just that. Be a doctor. Practice medicine. Help people.

If I hadn't ended up at the school I am at now, I wouldn't have met the amazing people I'm lucky enough to have by my side on this crazy adventure that is medical school. I wouldn't have learned that I can live a more than four hours away from my dad. Or that I can (barely) survive snow. The thing is, sometimes when our dreams come true, they look different than what we had imagined. But that doesn't make them any less beautiful or perfect for us. And I hope that I can remember that the next time I lose my perspective.

AND, in case you haven't laughed yet today, Sage Howard gave me that advice while he was putting TWO INCH blonde streaks into my hair, as per my request. Eeeshk. Talk about perspective. ;)

When You Come Back Down

You were in sixth grade when you announced that you wanted to go to West Point. Dad had given you a book he had just read, The Long Gray Line, and for you, that was it. You read about a class that graduated in war times from an institution charged with educating some of our military's greatest leaders. An institution whose history department proudly claims, "the history we teach was created by those we taught." From that moment every baseball practice you went to, every accelerated math class you studied for, every trumpet solo you perfected, was all for one purpose: to get you into West Point.

Along the way, you turned into a pretty great kid. I remember when you called to tell me that you had done it. That John McCain had given you his primary nomination to the academy and you were finally going to be a part of that Long Gray Line.  Back then I didn't think it was possible for me to be any more proud of you than I already was. I was wrong. Since you started West Point three years ago you have learned a new language, won awards for leadership, and are ranked in the top ten percent of your class. You have traveled the world and passionately learned about cultures different than your own. You've competed in international military competitions and have trained with those blokes across the pond. You've learned about sacrifice and how to take care of people. And now you have a symbol of that hard work. Of that bond you share with your classmates, and those who have gone before you and will go after you.

What has always inspired me was your ability to create goals for yourself and work tirelessly, relentlessly, and fiercely until you achieve them. You don't stop until the job is done. And even then, you're on to the next one. I know I'm the older sister, so really this should be the other way around, but watching you go after your dreams, has given me the courage to chase my own.

At the age of eleven, you set a goal for yourself and in 271 days, you will accomplish that goal. It seems like a long time, and yet I know it will fly by. So I'm going to try and cherish those 271 days. During which you'll still be here and safe, unburdened by the difficult choices and tasks your future career will inevitably ask of you.

But when they are up and all of this becomes real, my prayers for you won't change much. I will pray for your safety. I will pray for your protection. I will pray for those you lead and for those who lead you. I will pray that you always know how very much you are loved; and that wherever you are, whatever you're doing, your family will be waiting to welcome you home.

Bats on Ice

You know that Beyoncé song, "Cigars on Ice?" According to the Beyoncé dictionary, because that's a thing, Cigars on Ice (n.) is defined as "the practice of drinking alcohol on the rocks while smoking cigars, two luxury status symbols at the same time." This post has absolutely nothing to do with that song, other than I had it stuck in my head while I was writing this post. And because this post tells the tale of how I put a bat on ice. Minor point. 

Monday morning, I was awoken by the following texts from my roommate:

I think a bat got inside our house and is outside our [bedroom] door. We're kinda trapped.
Jack saved us. 

I detected a hint of urgency/emotional trauma in her texts (I am a doctor in training, after all) so I decided to drag myself out of bed and head downstairs to investigate.

Apparently, when she woke up that morning, my roommate heard a commotion coming from our kitchen. When she opened her bedroom door, to her horror, she was greeted by a bat flying straight toward her face. As she slammed the door, she noticed my cat (Jack), deep in the throws of the hunt, leaping after our uninvited house guest. While she and her boyfriend were in her room trying to figure out what to do, Jack tracked down the bat and killed it. I at first found this part of the story difficult to believe, since normally Jack can't be bothered to kill stink bugs, let alone winged vermin. But I guess he realized his moment to achieve glory had finally arrived and he leapt for it. Pun intended.

I didn't think much of the whole incident. My dad is a retired game warden and growing up, I saw my fair share of dead things. Needless to say, my threshold for "ick" is pretty high. So, with the bat securely tied in a trash bag and in the basement awaiting garbage removal, I thought the story was pretty much over.

Incidentally, Jack had a check up appointment at the vet scheduled for Tuesday afternoon. While we were at the vet, I mentioned that he had killed a bat in my house the day before. One rabies booster later, we were on our way out of the office when the vet poked her head back in and told me that I might consider calling the Public Health Department so they could come pick up the bat and test it for rabies, just in case.

Once we got home, and after giving Jack the appropriate amount of treats earned for the thorough ear washing and shots he had bravely endured at the vet (9 treats, by my calculations), I dialed up the local public health department, for what I thought would be a brief call.

It was not a brief call.

Twenty minutes later, I was half way through filling out an incident report form with a lovely woman named Diane who needed to know how many people were in the home at the time of the bat incident, how old said residents were, what said residents cell phone numbers were, and whether or not said residents had:
Noticed any small bite marks on our person
Woken up in the middle of the night to a bat flying around the room
Felt a bat fly by our face
Touched the bat
Touched the carcass of a dead bat with bare hands
Touched anything the bat might have touched
Touched any bat feces
Seen a small child touch the bat
Seen a small child in a room with the bat

When Diane had extrapolated all of the pertinent information regarding the bat incident, I was told to wait for her supervisor to call me. Apparently, this was going straight to the top.

So, 4 minutes later, Supervisor Maureen called and pretty much repeated the same conversation I had with Diane minutes earlier. Except Maureen wanted me to take the bat to get tested for rabies. (For future reference, the public health department does not make house calls to pick up dead, potentially rabid wildlife.) Maureen then instructed me to put the bat in "coolants." When I asked her if she meant antifreeze, she was slightly exacerbated by my "silliness" because she meant ice. After I put the bat in coolants/ice, I was to put the bat in the refrigerator and label it to make sure no one would eat it (Welcome to "Pensiltucky," everyone) and bring it in to the Public Health Department first thing Wednesday morning.

I mentioned my threshold for ick was pretty high. This is also largely in part because I grew up in a family that hunts, so dead animals next to my frozen foods was not new territory. My roommate, however, was not used this particular method of storage. So the bat spent the night in the basement in a Tupperware dish on ice. Hence, bats on ice... 

This morning I woke up and took our furry deceased friend to the local Public Health Department Office where Diane and Nurse Dave were waiting for me. Our bat will be shipped to the lab today and hopefully we'll have the results tomorrow morning. Fingers crossed the bat is rabies free. 

As for the hero of our story, he is still walking around his castle (AKA my house) like a soldier home from Nam.

He is also getting used to his new anthem, nah nah nah nah nah nah nah nah Bat Cat. 

UPDATE: The Public Health Department called, and the bat tested negative for rabies. Hallelujah. 

Patch

I guess this wouldn't be a true "medical student blog" if I didn't mention a medical show/movie that inspired me. So, I'm gonna tear off the band aid and do it. Deep breaths, everyone. Here is how Grey's Anatomy changed my life...

KIDDING! Man. That would be terrible. Okay. For real now, I just finished watching Patch Adams. I know, I know. It's the epitome of cliche. But c'mon, gang. I can't NOT write about how much I love this movie. It's just the best. 

In the light of Robin William's death, my friends and I were talking about how much we loved his movies and how we wanted to watch one in memoriam of him. Since we're all bright eyed, bushy tailed, medical students who will finish our didactic training at the school year's end, it seemed fitting to watch a movie where Robin William's plays a man who breaks the typical white coated doctor mold of his era.  Cue Patch Adams. 

My favorite line of the move is this:

"You treat a disease, you win, you lose. You treat a person, I guarantee you, you'll win, no matter what the outcome."

It is undoubtedly one of the most often quoted lines of the entire film. But it encompasses such a vital component of practicing medicine. One that I hope all of us doctor wanna-be's remember when we are out next year seeing patients, and putting all of our hard earned book smarts to good use. 

I also hope that enema bulbs are still bright red. Because they sure do make terrific clown noses. 

The Distance

I have learned that the path to becoming a doctor is not linear. Which drives the Type A, OCD, perfectionist individuals attempting to do just that, a little crazy. The problem with learning almost everything there is to know about the human body, is that you're learning almost every little thing there is to know about the human body. Which means that for most of us, it's impossible to do in one pass. So instead of taking a linear path from point A to point B, it's more like you're running a path that twists and turns back onto itself. You're exposed to the same material different ways at different times. Each time you pick up a little more.

My school's curriculum is problem based, and instead of learning in lectures, we learn in small groups where we're presented with a case. Most of the time it feels a lot like House. With less snarkiness and condescension. (Usually.) Our cases consist of a "patient" presenting with various symptoms. Then we work through the case, getting patient histories, coming up with differential diagnoses and ordering lab work, etc. We finally get to a diagnosis and then we pick readings from our text books about whatever pathology or disease our patient had.

These cases used to take forever. Our first case we ever did, a pediatric case where the kiddo had trisomy 21, my group took four two hour sessions to work through. And that case was relatively straight forward. The reason it took so long was because we didn't know anything. We spent hours looking up what blood test and urinalysis results meant. Deciphering an abnormal physical exam from a normal physical exam. Trying to figure out exactly what we were looking at on imaging studies. Learning the difference between respiratory and metabolic acidosis and alkalosis and whether or not they were being compensated. It was tough.

Today, we got through a pretty complicated case - our patient ended up having HIV, fungal infections, herpatic lesions, exposure to tuberculosis and a host of other problems - in one hour. Now we know what to do. We know how to take a history. What we're looking for on a physical exam. What tests to order (most of the time). What a list of legitimate differential diagnoses looks like (pretty much).

If medical school was linear it would be easy to mark your progress. To check off the boxes of things you knew when you learned them and then give yourself a gold star for being super. But it's not. And sometimes, it's easy to forget how far you've come because you're focused on how much farther you've still got to go. But today as I overheard the first years arguing about what different lab tests meant, I felt happy and thankful to be doing what I am doing. And grateful for the reminder that while I've still got a lot to learn, it's less than it was a year ago.

There's Your Trouble

"So what's going to be your toughest class this semester?" 

It was a familiar question. My dad had asked me the same thing a couple days before asking my brother. The two of them launched into a discussion about electrical engineering (I think ?) and we continued our drive through the Arizona desert up to Payson. 

As my summer came to an end, most people asked me what I'd miss most about being home, or what I was most excited to get back to. But my dad asked what would be my biggest challenge. Not because he was trying to bum me out or kill my blissfully school-free summer buzz. But because that's how my dad deals with challenges. Head on. And that's how he is still teaching me to handle them. 

My dad is someone I can always count on. For support, for financial advice, for comedic relief. For everything and anything. He is the person I call when things are great. And he is the person I call when things aren't so great. And throughout my childhood (and early adulthood), he has taught me that challenges are just that. Challenges. Not impasses. Not impossibilities. But obstacles to overcome. I've learned that there is power in realizing what my faults and weaknesses are. By recognizing where I've stumbled before, I can catch myself before I fall next time. 

So, here I sit, on the eve of my first day as a second year medical student. I'm gonna trust my dad again on this one and tackle this beast head on, one day at a time. It's worked this far. :) 

Melancholia

If this post's title reminds you that you never got around to watching the film of the same name starring Kirsten Dunst and Alexander Skarsgard, please do yourself a solid and KEEP forgetting to watch that movie, because it blows. Seriously. Like, Pittsburgh-bar-hoppers-on-St. Patrick's-Day blows. But in a funny and weirdly unexpected way, of the movies I have seen recently, it has had the biggest impact on my life.

To spoil the movie's ending (Here I'm playing fast and loose with the word "spoil," as that would imply there was something good to be spoiled. Which there isn't.) the world ends. No joke. Kirsten Dunst and her annoyingly forgettable sister and her almost cute nephew are sitting in the grass, holding hands, hiding in a circle of sticks when the planet Melancholia crashes into earth and both of the planets implode. Boom. Game over. Once the movie was over, while I was mentally chiding myself for such a gargantuan waste of a Friday night, my friends who had also endured the movie were making comments that pretty much boiled down to a lot of, "Guys, that could seriously happen," "Now I'm not going to be able to sleep for days," and "That's honestly one of my biggest fears." And I couldn't relate to any of those remarks. Not a one.

Without much thinking, I responded in my head to their worries and woes of potential calamity with the simply reply, "That's not what has been planned for this earth. Since the beginning of time there has been a promise and story and it does not end in some stupid rogue planet crashing into this one."

Later when I was driving home that night I was struck by the realization that there was a disconnect between my beliefs and my life, and there had been for some time. This past year I got a little lost. And a few weeks before my first year of medical school ended, I figured out why. It's because I was sitting in the grass, surrounded by a circle of sticks, wanting it to be some special secret cave that would protect me from catastrophe (seriously, please don't watch this movie), all the while knowing that it wasn't enough.

We all have our own circle of sticks. Something that makes us feel safe and secure. My circle of sticks historically has been school. I hide in my books and busy schedule and list of never ending exams because it makes me feel safe and in control. And while I know what I believe, my life this past year has not really reflected that. The more lost I felt, the more sticks I added. I put my faith in things of this world, instead of putting my faith in Jesus. While I am grateful for school, and while it will get me to where I want to be career wise, it cannot be the thing I go to for security. It can't be where I place my faith, find my purpose or derive my identity. Reviewing the movie and comparing it up to my life made me realize  that my own ambitions and goals and dreams can't save me from the pressures of this life anymore than a circle of sticks could save Kirsten Dunst from the planet Melancholia.

So my challenge to myself this year is this: to not let school become the thing I believe in most. To place my faith in Christ alone and be filled with His joy that does not depend on the circumstances of my life.

And, to pick better movies to watch on my nights off. :)

Next to Me

I'm always thankful for the time we get to spend together. I know we don't see each other much now that I'm a country away. And I know I don't call you nearly as much as I should.

But when we are together, I'm always reminded (and humbled) by how much faith you have in me. It used to frustrate me because every time I called to tell you about some huge exam or whatever else was troubling me, you'd always immediately respond with a simple "You can do it" or "You'll get through it." I used to think that you just didn't understand whatever it was that I was going through. That it was easy for you to say that I'd get through it because there was no way you could comprehend how big "it" was. And maybe you didn't, and still won't. But I realized these past few days that it wouldn't matter to you anyway. Your response would still be the same. And it's because you have this awe inspiring, anxiety crushing faith in me. Which is something I'll never be able to thank you enough for. I can think of few gifts that matter more than the gift of a parent whole heartedly supporting their child. And that is what you have always given me.

I know our relationship hasn't always been sunshine and rainbows. We have had our fair share of highs and lows. But I've always known this to be true: that you have always and will always believe in me.

So thanks, mom. If every child had a parent who believed in them half as much as you have believed in me, the world would be a much more beautiful and loving place.

A year ago today

I am 19 days out from starting my second year of med school. This is both exciting and scary. I'm excited to get back into my school routine and see my friends. I'm also nervous about starting year 2 of an intense med school curriculum, which culminates (a little less than a year from now) with my first board exam, the dreaded "Step 1." Eeshk.

I keep flashing back to what life was like last year at this time. Exactly one year ago today, my dad and I left for Pennsylvania with my packed truck and U-haul trailer in tow. I was feeling pretty much the same way  I am now: excited and scared. Last year, the unknowns of the upcoming year were the source of my anxiety and excitement. This year it's the opposite. I know what this year will bring. I've done it once before.

This year will bring excitement and joy.
And frustration and stress.
I'll freak out.
I'll geek out.
I'll go for days getting barely any sleep.
I'll take post-exam marathon naps.
I'll be thankful for my PA family.
I'll miss my family and friends back home.
I'm going to make mistakes.
And then I'm going to make more mistakes.
I'm going to disappoint myself.
I'm going to be proud of something I've accomplished.
I'm going to look like an idiot in front of a faculty member/clinician.
I'm going to mess up case presentations.
I'm going to forget to ask a basic question in a patient interview.
My handwriting will become increasingly illegible.
I'm going to put my stethoscope on the wrong way.
There will be moments I think I made a mistake going to medical school.
There will be moments I know I am exactly where I'm meant to be.
I'll drink more caffeine in one day than the American Board of Cardiology recommends, times 8.
I'm going to feel like I know nothing.
I'm going to feel like passing boards is impossible.
I'm going to call my dad in tears.
I'm going study more than I ever thought possible.
I'm going to pass exams I think I've failed.
I'm going to get through it.

A wise friend told me that I need to make a list of everything I've done that seemed impossible before I did it. She told me to then hang it some place I'll see often to remind myself that difficult things always seem impossible before they're done. Getting through last year would definitely top that list. It was the most challenging thing I've ever done, for many reasons. But I got through it. And I look back at everything I learned from last year - both inside and outside the library. And I'm so thankful for each of the experiences I had and the valuable (sometimes painful) lessons I learned.

So, one year to the day after I started this crazy adventure, here's to another year full of ups and downs. :)