Agape

Thank you for endless slices of German chocolate cake, and for proving that you really are never to old to jump on a trampoline.
Thank you for making Christmas magical, and for patiently letting my tiny hands remove and replace every single piece of silver tinsel my 6 year-old self could reach on your Christmas tree.
Thank you for proving that a smile really is the best accessory.
Thank you for teaching me how to climb trees, and for helping me hide the evidence of scraped knees and scuffed shoes.
Thank you for teaching me that love is selfless and can be given long after a person stops being able to receive it.

For these lessons, and so many more, I will always will be so thankful. Oh, how I will miss coming home to your hugs and our conversations spent holding hands and each other. Losing you will forever leave a hole in our family, one that we will do our best to fill with sweet memories and your legacy of love.

Out of the Woods

"Code Team, to the CT Scanner. Code Team, to the CT Scanner."

As the voice of the hospital operator echoed the familiar call to action, myself and one of the radiology residents jumped up from our chairs and dashed out of the resident reading room and across the hall to the CT scanner.

When a code is called in a hospital, organized chaos quickly follows. Within seconds, swarms of white coats pour through stair well doors. Nurses with crash carts run through halls. The urgency is palpable.

When myself and the radiology resident got to the patient, the code team was already there (I swear they can apparate) assessing the situation. An ICU patient sent for imaging had semi-consciously pulled out his ET tube and NG tube. He was now in the process of desatting as all of the oxygen molecules dissociated from their hemoglobin chaperones, with no new recruits coming from the lungs.

Last block I did an elective in radiology. Which means I was out of the medical trenches for the past few weeks, safely tucked away in dimly lit reading rooms aglow with the light of high definition monitors. While I am not considering a career in radiology, I did learn a lot and it was interesting to explore a field of medicine I have never really learned much about before. But whenever I toyed with the idea of not going into clinical medicine, something (like a code being called) reminded me which side of healthcare I want to play for.

Pulmonology and anesthesia soon showed up and the patient was reintubated. I sat back and watched intently as the emergent situation was quickly resolved. As we walked back into the reading room after the patient was stable, the radiology resident mumbled, "Man, I sure don't miss that." I smiled, realizing just how much I did.

Shiny and Bright

It's been one of those weeks where my to-do list seems endless and it's left me wishing there were more hours in the day night (for sweet, sweet sleep).  At this point in my life, it seems that there are medical students who know exactly what they want to be when they grow up. And then there are those of us running around in short white coats who still don't have a clue. I, for now, am solidly in the latter category.

In between studying and making pro and con lists for every medical specialty known to man, I remembered this quote a classmate and I used to always say to each other (usually at 2am in moments of exhausted exasperation, hunched over biochem notes):

One day, when I'm all grown up and all the unknowns that currently keep me up at night are known, I'm sure a part of me will miss the mystery of not yet knowing what will be. So for now, I'll make another cup of cocoa, start a new list, and try to be grateful for a future full of shiny and bright possibility. 

More than you know

During rounds I made a mental note to go back in and check on the patient. Something about the way our attending examined him without even saying hello rubbed me the wrong way. When I walked back in I introduced myself, went over and said hi to our patient, and then turned and began speaking with his grandmother, the primary caregiver.

I then began to listen to his heart, lungs and abdomen. I looked over at his grandmother while I palpated his belly, careful not to disturb the feeding tube protruding from his abdominal wall. She was smiling at me and at her grandson, with a look of relief across her face. I finished up my exam and shook her hand. While I was walking out she began explaining to me that she was concerned that his G-tube had a hole in it, but that it wasn't scheduled to be replaced for 5 more days. I told her I would speak with my resident and see what we could do.

The remainder of Mike's hospital course was uneventful. After some arm twisting/begging, I got interventional radiology to replace his G-tube and he went home on a course of antibiotics to kick the nasty respiratory infection that landed him in the hospital in the first place. As we were discharging him, his grandmother thanked me for taking such good care of her grandson and we joked about how he was quite the ladies man, since all the nurses loved him.

Truthfully, I get why my (very intelligent and seasoned) attending didn't bother to say hello to Mike every morning. The kid has cerebral palsy. He looks different, acts different and can't speak. And most physicians really just don't know exactly how to interact with severely disabled patients. But that's the thing, patients are people. And even severely disabled and nonverbal people have personalities and needs, they just can't communicate them in the same way most of us are able to. But I've learned, and am continuing to learn, that so much about medicine is more than what you know - anyone can look up facts and treatment plans on UptoDate and clinical judgement comes with time. At it's core, medicine is about showing people, and their families, that you care. It's about taking extra time to speak with a concerned parent about their sick child - even when the attending and resident have already explained the situation three times. It's making funny faces back when your stethoscope is cold and your patient makes a silly face. It's about calling other departments and stressing the fact that something for your patient needs to be done and no, it cannot wait.  And sometimes it's simply smiling at a patient even when you know they can't smile back.

Mouth to Mouth

Our COPD screening event at the local town mall was well underway. If you think people try to avoid that annoying guy at the random phone kiosk (seriously, has anyone ever bought a phone there? Ever?), then you should see 'em try to dodge a bunch of over enthusiastic medical students and residents in white coats. ;)

I had finished explaining to an older gentleman how the spirometer works and he had just taken a very deep breath and attempted to expel all of his air into the mouthpiece. He was red in the face, wheezing hard, and basically about to fall out of his chair at any moment.

Me: Sir, it's ok! Let's take a few deep breaths before you use the machine again. I don't want you to pass out! *Half jokingly*

Man: Are you kidding?! That's what I'm banking on! If I pass out, you have to give me mouth to mouth!!!

Me: Oh, yeah? That's a clever little plan. 

Man: You can't trust me, I'm a dirty old man, hah!

I continued with the screening test, to the soundtrack of the male residents' laughter. By the end of it, both my new friend and myself were red in the face - him from chronic lung disease, me from embarrassment.

Forget about kids, in my experience it's the OLD people who say the "darndest" things.

Happy Sunday, folks. :)

Metrics of Affection

Glancing over the patient list this morning, my eyes lingered on the bolded phrase "NbBoy X, Known Trisomy 21." My stomach sank as the possible complications of that diagnosis began running through my head.

A few minutes later, after we had discussed each patient with the residents, we began our morning rounds in the nursery to perform our newborn exams.

Walking into that patient's room I didn't really know what to expected. Disappointment? Sadness? Fear of caring for a child with disabilities? Whatever angst I was feeling quickly dissipated as we all piled into the room to a grandpa's happy and proud laugh. A dad grinning from ear to ear. And a mom gently holding her new baby, smiling that tired but completely content smile, as only new mom's can.

We spoke with the parents, wheeled over baby boy X in his crib and began examining him. Once we were done we wrapped him up snug and passed him back to mom, who was clearly already completely in love with her new baby.

Later that morning, when we were discussing patient plans, one of the interns asked if the parents were aware of the situation. My resident said yes, and that they had been informed a couple months ago. The two of them began tossing around the idea that maybe the parents were in denial or didn't fully understand the diagnosis.

And, while I am definitely new here, I don't think denial was it at all. Because watching the mom look into the eyes of her new son, I only saw one thing, and it was love.

Move over, Clement Clarke Moore

A call light flashing for a room with a 10cm dilated patient is pretty much the best thing that could ever happen on the labor and delivery floor. The nurses jump up, the midwife sets down her coffee, and the super-excited (but totally professional) medical student all rush down the hall, eagerly anticipating the birth of a fresh new little babe. Be still, my uterus.

I just finished up my Ob/Gyn rotation. Part of my rotation included two weeks on the Labor and Delivery floor which meant one thing: BABIES!!!  I've seen too many vaginal births to count, and was even allowed to "catch" a few babies myself. Because this rotation will forever hold a special place in my heart, I wanted to write something to commemorate my time with all the excited new mommas and (nervous as all get out) new daddies to-be. In lieu of another list (which we all know I love), I give you a poem...

“'Twas right after the call light flashed”

'Twas right after the call light flashed, when all through the floor

Not a person was sitting, waiting around was no more.

The nurse jumped up, right out of her chair

And the midwife, mid bite, set down her pear.

The medical student looked up, from her very dull text

And could only hope, she knew what was happening next.

The three of them rushed to the room down the hall,

When they walked in the daddy-to-be looked ready to bawl.

A look of determination swept across the mom’s face.

“Lets do this!” She said, “This baby won’t wait!”

Sterile gowns were tied, white gloves put on,

One last check was performed, that cervix was gone!

The midwife looked at momma, “You know what to do.”

“When the next contraction comes, you push right on through.”

A contraction spike began climbing, on the monitor screen

The poor woman turned red, and started to scream.

She gritted her teeth and moved that baby on down

Straight through the birth canal, until baby started to crown.

“Medical student c’mon! Put your hands right on mine.”

So I bent next to the midwife, and her hands I mimed.

“You can do it!” rang out, the nurse's loud cheer,

"Just one more push, she’s practically here!"

And sure enough, a head started poking through.

The miracle of life – with lots of other goo.

With all the strength she could muster, that momma pushed

When a head popped through, albeit kind of smooshed.

Then one shoulder came, and then one more

And finally a beautiful baby, met by no one before.

Up on momma’s tummy, new baby went

Momma smiled through teary eyes, her energy all spent.

The daddy carefully stayed at the head of the bed,

And bent down and kissed his new daughter’s head.

“You’ve done it,” we cheered. “You are such a champ!”

And I almost forgot, my scrub pants had gotten kind of damp.

The new momma glowed, and she thanked us all

“Baby girl 13:15!” was shouted down the hall.

And as another shift ended, on the L&D floor

That was awesome I thought, I’m ready for more!

I changed out of my gooey scrubs, and replayed it all

I smiled and thought, maybe I'll be an Ob/Gyn, after all.

~The End~

Hello, Darlin'

"Hello, Darlin'

Nice to see you.

It's been a long, long time..."

As Conway Twitty's voice rang out from the patient's buzzing cell phone, the very focused intern began inserting a catheter through the abdominal wall where it would drain almost 4 liters of fluid from Mr. X's very distended abdomen.

Just as the catheter tip was reaching our fluid filled money spot, I thought about all the other times that song may have been the soundtrack to moments in this patient's life. Driving a date to the movies. Playing to an empty house after his kids went off to college. Serenading him now when he goes to his favorite local diner for pie. And then I thought about this moment. The one we all found ourselves starring in. The setting: a quiet ICU. The supporting characters: a seasoned attending, a couple of nervous interns, and one third year medical student, trying desperately not to contaminate my sterile gloves. The leading role: a man in his early seventies, currently grappling with the harsh reality of decompensated heart failure.

I originally began this post during my last week of internal medicine. And while there were moments that I absolutely loved working on the floor, there were also many that left me disillusioned. There have been stories that I've wanted to share on this blog, but ultimately chose not to. Mostly because I felt that my writing was inadequate. But also because coming home after ten-plus hours surrounded by sickness, the last thing I wanted to do was write about it.

A lot of those posts, like this one, would start off with a person, their story eventually interrupted rudely by an illness. And that's where it would stop. Because as much as I tried I couldn't find a nice way to wrap it up. A final point or "Scrubs-like" realization to conclude those posts would elude me. It just wasn't there. And I guess that's what made those moments in the hospital, like the one above, so heavy. Those moments remained absent in my writing because they did not exist in real life. Sickness is cruel like that. It so rarely provides the luxury of a satisfactory conclusion.

It is the singular commonality I've found in all the really sick patients I've seen. That no matter how many pack years they've smoked, how severe their coronary artery disease is, or how much their cancer has metastasized, no one ever imagines the hospital is how or where they will end. And when they do find themselves in those moments, faced with the end of it all, it just doesn't seem to fit. Kind of like Conway Twitty in the ICU.

"Thank you, darlin'

May God bless you

And may each step you take

Bring you closer

To the things you seem to find."

Dear med school newbie...

A couple weeks ago I posted an open-ended letter to a future patient. A couple days ago one of my dear friends, who I've known forever, started medical school. I like the idea of writing to people I know, but writing to people I don't know is just so fun too. It's in that spirit I give some advice to the brand new med school newbies out there.

Dear med school newbie,

First off, congratulations! Not just for getting accepted to medical school, but for accomplishing the goals that mark that journey. The pre-requisites, and letters of recommendation, and community service projects alone are usually enough to scare the faint of heart from ever even thinking of applying to medical school. (Do I dare even mention the MCAT? Ok, I won't.) But not you, friend. You stuck it out. You figured out exactly how much caffeine precipitates palpitations and walked that fine line like an olympic gymnast. You passed organic chemistry - even if it was with a C. You volunteered your time and parts of yourself and hopefully along the way you realized that helping people is really one of the greatest things ever. Which only made your nerdy little heart chase after a career in medicine that much faster. Go you. :)

Right now I wish I could give you a hug and a high five through the internet (get with it, technology!) I also wish I could tell you that the hard part is over. That once you get that life changing letter cementing your white-coated dreams into reality you can take a breath and relax. (Ok, I guess on the actual day that letter arrives you can chill for a bit.) But if I said the rest of this crazy ride was all downhill after getting accepted, I would be a big fat liar. Which is generally something I try not to be. (People like you more and your scrubs fit better. :) )

The reality is that medical school is like a roller coaster. And some days -- like when you pass an exam you were sure you failed, or you manage not to make an ass out of yourself in front of a faculty member -- you are going to feel so confident and sure of your decision to practice medicine. But other days are going to be low. And the stress and workload and never ending list of things to know and study and review will be overwhelming. You may find yourself questioning this particular life choice and doubting your ability to do this whole med school thing.

I wish I had some advice on how to get through the tough days. All I can say is lean into the people who supported you this far. They're still there. Seek comfort and encouragement in your new med school friends - they're in the academic trenches with you! And remember why you wanted to become a doctor in the first place.  Set goals for yourself and chase after them, just like you did when you were still a puny "pre-med." Acknowledge and appreciate your strengths. Work on your weaknesses, but don't beat yourself up over them. And just a couple of med school myth busters for you: Every one struggles with something. No one "barely studies." And no person in a white coat, yes even your esteemed faculty members and attending physicians, will ever know it all.

It's also important to know that medical school is finite. It's not gonna last forever. And, even though I'm only 2 months into clinical rotations, they are so so so much better than the first 2 years. Because those years suck! There really is not use telling you they don't. But again, they only last 2 years. And then they're gone. So learn as much as you can. Say goodbye to the outside world (and your tan. Libraries generally don't have UV lights.), and work your tail off. Because one day you'll walk into a patient's room and lying before you on a hospital bed will be that random disease you read about manifested in a living, breathing person and you will be able to help them. Which is really what all of this med school stuff is about in the first place.

And, when all else fails, and on those days when you "literally can't even," remember PASS = MD/DO.

Now, go put your smarty pants on. We've got some studying to do. :)

Morgan

P.S. This week I really did walk into a room where a patient had one of those "random diseases" we're told as students we'll "hardly ever see." When you get a chance, check out neurofibromatosis. Gotta love those neurocutaneous disorders. :)

Time Machine

I looked down at my watch and felt a small surge of panic rise in my chest. 6:42am. 18 minutes until morning report. 18 minutes to talk to my patient and examine her before I had to be sitting in a conference room on the other side of the hospital.

Mrs. X, can you tell me how your night went?

Mrs. X, did you get some sleep?

Mrs. X, have you had any headaches? 

I began asking my usual battery of questions to a sleepy, semi confused elderly female patient. She interrupted me to say that she needed some water. I hurriedly explained that I would have the nurse bring some in once we were done.

6:47am. 13 minutes.

Any nausea?

Any vomiting?

Again, she asked me for some water.

"I know your throat is dry Mrs. X. We have you on NPO in case we need to do any procedures. I'll have the nurse get you a small cup of water as soon as we finish up here. "

6:51am. 9 minutes.

That time when I looked up from my watch, I noticed Mrs. X gently rubbing her throat, eyes closed. I stopped. I felt like someone had smacked me in the face. Here was an 88 year old female patient, a patient who I had been assigned to follow. A patient who looked remarkably like my grandmother. A patient who was sick and tired and scared. And she was asking me for water. Water.  And all I could focus on was getting the information I needed so I wouldn't make an ass out of my self in front of my attending. Here I was behaving exactly like the type of doctor I had sworn to never become.

I paused. Grabbed her hand and said that I was sorry she was so thirsty. I filled up her cup with a little bit of water (NPO is the worst) and patiently waited while she slowly took a few sips. After she was done I took the cup from her and started over.

I was 6 minutes late to morning report that morning. And I though I can't say that I didn't care -- the watchful eyes of my resident stung a little as I took my seat,  I was more grateful for a lesson learned.  I realized just how easy it is to give in to the endless demands placed on pretty much everyone working in a hospital. I also realized that the choice of giving in to the ever present tick-tock of an over-packed schedule, or taking the time to truly care for the living, breathing human being in front of me will always be just that -- a choice.

Realistically, as a third year medical student, my choices don't impact much right now. Mrs. X would have eventually gotten her water at 7:00am anyways when her nurse came in to administer morning meds. But one day, my choices will have more lasting consequences. And I want them to be positive ones.

Dear Future Patient...

Dear future patient,

First off, let me say that it will be a privilege to take care of you. There are a lot of folks in long white coats out there with a jumble of letters after their names, and I am honored that you will one day allow me the privilege of being your doctor. It's something that I am working very hard at, and will continue to do so for the rest of my career.

Because this relationship you and I will have, of patient and physician, is based on honesty, there is something you should know. I did not score exceptionally well on my licensing exams. In fact, like 50% of the other physicians out there, I did not even score in the top 50th percentile. So, if you're looking for that doc who knocked their licensing exams out of the park, I know several and I will get you their contact information and a referral, no charge. :)

You see, reading information out of a medical text book and regurgitating it onto a scantron is not my forte, and never has been. Those questions are two dimensional and more often than not, all they really test is a person's ability to recognize a word they've seen before and match it with another word they've seen before. The exams don't always test how well the examinee understands a concept, just how good they are at a matching game with really big science words. Your disease process, like you, is a multi-dimensional ever-changing entity. So when it comes time to treat you and tailor your care to the unique and complex individual you are, the ability to correctly pick "B" on a multiple choice test doesn't really seem all that helpful, don't you agree?

So, yes, knowing the science behind your ailments and injuries is the foundation of this thing we call medicine. And as I move forward in my training I will continue to learn and strengthen my understanding of the diseases that will one day bring you into my office. But, there is more to providing good quality patient centered care than high exam scores. For example...

While I'm learning about the various kinds of anemias and how they will make you feel like crap, I'm also learning to put you at ease when you tell me about what hurts. And while I need to know what neurological exams to perform if you present to me with stroke-like symptoms, I'm also learning to make asking questions about your bowel movements more funny and less awkward. Should you get admitted to the hospital for acute atrial fibrillation, I'm learning about the medications  I need to give you to make your heart stop racing like its chasing after the Sprint Cup. I am also learning how to keep you in the discussion and remember that you are the center of treatment, not your disease. When your concerned wife drags you into my office because you've been coughing up blood for the past week and have a history of unintentional weight loss, I'm learning how to explain the diagnostic exams I want to run to see if it is cancer in a way that empowers and not terrifies you. And one day, when you aren't really you anymore and your body is old and simply no longer capable of doing this "life thing," I am learning how to prepare the people you love and walk them through the difficult process of letting you go.

So no, I did not pass my board exams with flying rainbow colors. I passed them and moved on to learning how to practice medicine. I scored what I needed to so that I could continue to learn how take the very best care of you.  Because that has always been my goal - to be an amazing doctor, not an amazing test taker.

Thanks for letting me be honest with you, dear patient. It will still be a few years before we meet, and I promise until we do to continue to to bust my butt and learn the things I need to know to provide you with phenomenal care, the same kind of care I would wish for myself, and those that I love.

See you soon,
Future Dr. Day

P.S. Stop smoking, try to get 30 minutes of exercise at least three times a week, and don't be afraid of those leafy greens. :)

Lo siento

"Hey, have you ever heard of benzos causing GI bleeding?" I quietly asked one of the first year interns on my team during rounds this morning.

"No. Why?"

"Dr. X. just said patients on ativan are at high risk for GI bleeds."

"Are you sure he didn't say aspirin?"

"Yeah, he definitely said ativan."

"Hm. Yeah I've never heard of that. He really didn't say aspirin? He has a pretty thick accent. Maybe you misunderstood him."

"Oh no, I'm from AZ and am totally used to listening to people with thick accents," I said, half joking.

Full of third year confidence, I grabbed my phone and opened epocrates to check the adverse effects of ativan.

Later, during a lull in the morning activities, I mustered the courage to ask the attending about this baffling correlation between ativan and GI bleeds. He looked at me, puzzled and said, "no, aspirin. Aspirin causes GI bleeds."

Blank stare. Internal scream. Morgan, you arrogant ass.

"Oh. I must have misunderstood."

I caught a smile creep across the intern's face out of the the corner of my eye, just as our attending began pimping me on aspirin, and other drug classes, that are known to cause GI bleeds. Woo.

Happy Monday, folks! And, if you too were served a tasty slice of humble pie today, I hope you at least learned something from it. :)

Then Came the Morning

My flight had been postponed for the following morning and I was riding in a shuttle to some crappy hotel in Atlanta. In between small talk with the driver and an 18-year old newly enlisted soldier on his way to boot camp, I managed to catch bits of the talk radio program playing in the background. The speaker, an older man with a voice that could have given Morgan Freeman a run for his money, was speaking about the journeys this life takes us on. The quote that resonated with me, at that time just a med school hopeful fresh out of a medical school interview, was this:

"If we knew how hard the journey was going to be, we would never take the first step."

And I think most of us, regardless of what life paths we're cruising along, would agree with that statement. Because goals are great, and dreams are...well, fun to dream about. But when you're in the thick of things it can be easy to forget why you started in the first place.

Now that I have taken survived boards, the real "school" portion of my life has pretty much come to a close. No more entire days spent studying in the library. No more case reading lists and PBL exams and flash cards filled with "high yield" facts. There were times during these past two years when I doubted this path I worked so hard to get on. And from time to time, those words I randomly heard on a rainy night in Georgia, when I was exhausted and far from home, come back to me. And I am glad there was no way I could have known then what the first two years of medical school would hold for me.  Because I know now what I might not have believed then. That though stressful times would come, I would not only get through them, but be strengthened by them. And with every passing exam, I would grow more confident in myself as a future physician and as a person.

One week from today I officially start my third year in a hospital seeing patients every day. After two years of burying my head in books, I am so excited to be back among the living. And while I am sure there will be tough times in the next two years, for now I remain blissfully, and thankfully, unaware.

The Final Countdown

"No. When the sternocleidomastoid contracts, your head looks to the opposite side of the contracting muscle."

The EM intern stared incredulously at the GIANT man nurse (seriously, this guy was a huge dude) who was schooling him on neck anatomy. While Dr. Shaky-Hands (a nickname I secretly gave him after watching him butcher a central line) timidly tried to figure out the mysteries of the SCM, his attending walked by and barked an order at him, which sent him running, and that was that.

The entire interaction lasted all of 5 seconds. And because of it I will always remember that when the SCM contracts unilaterally, the head turns to the opposite side of the activated muscle. One tiny factoid I randomly learned years ago that still helps me on OMM/Anatomy questions.

One week from tomorrow I'll take the first of my two board exams. Which is kind of a big deal. Any medical student will tell you, starting with the very first day of medical school, everything is about boards. Boards boards boards. They determine a lot. What specialties you're competitive for, what residencies you have a shot at matching to, etc. Like I said, kind of a big deal. As you can imagine, this weekend I've been doing my best to keep the panic at bay.

I haven't studied enough! 

I should probably post-pone my exam... 

There is no way I know everything I need to know for this thing. 

I'm out of coffee. Nooooooo!!!

Earlier today, I had a practice question about the SCM, and was reminded that I have been preparing for this exam for years. I have studied enough. I am not going to post-pone my exam (not gonna lie, a pretty big factor in this decision is that I wouldn't get to go home and drink margaritas by my pool before I start rotations, but whatever). And no, I won't know everything I "need to know." There is simply too much.

But in the next seven days, in addition to making one last pass through First-Aid and replenishing my coffee supply, I am going to to trust that I know more than I think I know. And keep my fingers crossed for at least one question about the SCM. ;)

Two Truths

As of about 10:30 this morning I finished my second year of medical school. Woo! Though I still have to take boards (I hear they're kind of a big deal), next month I start clinical rotations. That means I'll be trading the library for a hospital and my sweat pants for scrubs. At this point, it seems almost too good to be true. If I had to spend another year confined to a library, I am 92% confident I would lose my mind.

Truthfully, it's difficult for me to believe that these didactic years are coming to a close. During the first week of school, one of our professors reminded us that the next two years were hellacious, but finite. And in twenty-two short months, they would be over. But somewhere between reading pathology and figuring out how exactly to do an H&P, it's easy to forget that this season of life is just that -- a season. So here I am now, weeks away from taking boards and wondering what life next year will look like. During the past two years I have learned a lot - about medicine and myself. And while I know there is still so much more to learn, I wanted to reflect on what I know to be true. So, this post does consist of a list (my favorite!) -- though it is a very short one. The two most important things I have learned this far in medical school are:

1. We must build each other up
2. Work hard and be kind

Now, before you freak out and wonder what kind of crazy medical school I go to, rest assured. I am plagued by pharmacology and pathology, the idiosyncrasies of renal physiology, and the never ending confusion of immunology just like every other under-slept and over caffeinated punk in a short white coat. And, yes, knowing your stuff and being able to answer questions correctly on exams (and ultimately figure out what is going on with your patients) is imperative. But I can learn all of that from a book. And what I don't fully understand on paper will eventually make sense on rotations once I see the pathology manifested in a living (hopefully) breathing human.

But those two things are what I have truly struggled with for the past twenty-two months. Reaching out to a classmate when it's obvious they're frustrated and stress. Refraining from class gossip about who failed what or messed up during a practical. Trying to finish that last chapter when its 1am and the words about renal pathology are swirling together so much that they are actually starting to look like glomeruli. Stopping by my favorite administrator's office to ask about her sick cat, when all I want to do is go home and study. These are the things that are really important. These are the things that aren't written on a syllabus.

There is a joke I once heard about a commencement speaker at some medical school graduation. During his speech he states that because of the ever-changing nature of medicine and advances in science, "unfortunately half of everything we taught you here is wrong. We just don't know which half." So while its guaranteed that some of what I have learned from a book will change twenty years from now, I am confident that those two life learning objectives will always be appropriate.

These past two years have been a crazy, awesome, stressful ride. And I am sure the next two will be no different. I hope that two years from now I'll have mastered both of my truths a little better. (I'll also be crazy freaking excited to graduate!!!)

So here's to being half way done with this ridiculous journey! And to anyone else who is mere days/weeks away from taking boards -- trust your preparation and believe that we got this!

The Ann Perkins to My Leslie Knope

When I was a pre-med undergrad, I never missed a chance to hear medical students speak about their experiences in medical school. One thing that they always mentioned was how important having a solid support system was. Now, as I enter into full blown board studying and am about to reach the most stressful part of a very academically (and emotionally) taxing 2 years, I get that sentiment more than ever. Most people just can't get through something as stressful as medical school alone. Lucky for me I have an awesome support system, captained by best, best friend Shannon (no, one best was not enough). Shannon is pretty much the coolest, most awesome, prettiest person ever. And she has got being a best friend on LOCK DOWN. For example, Shannon is who I call when...

I think I passed a test.
I think I failed a test.
I'm worried I broke my cat - this happened twice this week.
I can't sleep.
I don't know what to eat for lunch.
I can't remember a plot line in Friends.
I'm on the verge of baking cookies for a kind and handsome stranger and need to know if it's creepy.
I really, really, really need to analyze ever single minute of the Bachelor/ette.
I don't remember what things people who don't study all the time do.
I need to vent and/or cry.
I need her to look up the satisfaction ratings of a casserole dish when I'm at the store, ready to buy it.
I just did something stupid - this one happens a LOT.
I need her to help me pull off operation Mother's Day from across the country.
I'm bored.
I don't know how to set up my appleTV.
I don't know how to fix my appleTV.
I miss home.

If you're reading this and thinking, wow. This sounds like a lot of give, give give on Shannon's part, you're right. I definitely got the sweet end of this friendship deal. Though, I do send her cat selfies on a very regular basis. Like this one!

And this...

And this...I especially love the look of desperation in Jack's face in this last one. 

While it mega-blows that we live far apart, I am so lucky to have a friend who loves me always, encourages me constantly, and isn't afraid to tell me when I'm being a brat (pshh...like that ever happens).

Love you, buddy! 2,058 miles ain't got nothin' on us. :)

Here's Your Sign

As I walked down the steps of our lecture hall, the setting of all my academic battles for the past 2 years, I felt the stress melt away. I had just finished my last big exam of second year (before boards, anyway). I felt light. I felt free. (I felt tired, too. But mostly light/free.)

I smiled at my exam preceptor as I turned in the exam packet. I lightly tossed my scantron in the scantron box, watching nonchalantly as it floated down to join the others.

I walked back up the stairs, past all the poor schmucks who were still taking the test. As I left the lecture hall, I breathed a huge sigh of relief. I walked down the hallway, smiling at all the tough questions I knew I had gotten right.

Self, you are so smart.

Self, you worked so hard.

Self, you really are going to be a doctor!

Self, thwack. OUCH.

Apparently, I was so caught up in the bliss of a triumphant conclusion to PBL that as I was going outside, I hit myself. In the face. With a door.

I checked to make sure that no one saw what had just happened. And went home to take a seven hour nap. And ice my face.

So, if you've ever had an encounter with a medical student, and asked yourself, "how do they not fall down more?" It's because they're too busy hitting themselves in the face. With doors. :)

Flora

I've been trying to remember important moments that we shared while I was growing up.

I remember you leading me and Jonathan into the Cracker Barrel gift shop while we were on vacation and telling us we could pick out anything we wanted.

I remember you and Papa throwing a giant birthday party for all of the Arizona grand kids while we were in Disney World, to make up for all the parties you had missed.

I remember you asking me where I got my curly hair from and when I responded from my dad, you laughed and asked me who I thought had given him his curls.

The specific moments are blurred and slightly faded. And there aren't nearly enough of them, with us living on opposite sides of the country. But I will always remember how you made me feel - so cherished and so loved.

This past Saturday, I was reminded that I am not the only one who will remember you that way. Yours was a life spent loving and cherishing people. And, if I end up loving people even half as much as you managed to, I'll consider it a life well spent.

Livin' the Dream

I've been doing a decent job of not succumbing to the pre-board panic epidemic that is currently running through my class like wildfire. I am still showering regularly. Most of my meals don't come pre-packaged. And I am BUSTING through Parks and Rec (thanks Netflix). With all that being said, I have been having some pretty interesting dreams this semester. So I'm starting to think that maybe, just maybe, my subconcious is starting to feel the pressure. Here are a few examples...

I am studying in one of the study rooms at school. All of a sudden the room turns into a dungeon that is being guarded by a giant crocodile. Apparently this ROUS (reptile of unusual size) is invisible to everyone but me. Because I watch it eat everyone that tries to come and rescue me. Even Lorelei Gilmore. Who was bringing me coffee. Gah...

I am studying at school, in the same room as the above dream, when I feel something in my mouth. I spit out said object into my hand and its a tooth. So, I just toss it in the giant pile of my teeth that is already sitting on the table next to me, and continue studying path. No biggie...

I'm driving in the middle of Nowhere, USA when my truck breaks down. Have no fear, the creepy/persistent guy that had a crush on me in high school is there in an instant. Literally, out of nowhere. Ready to jump start my Tacoma and ask for my hand in marriage. Thanks, Jared. 

And the newest addition...

I'm working in the cadaver lab when I accidentally boil a human heart and lungs in a crockpot. Oops. Then I freak out because I have to tell my PI (principle investigator - real lab lingo, I promise) what I've done. (Note: I don't freak out that I have just boiled another human's heart. No, that's absurd.) I finally get up the courage to tell my mystery PI and walk into his office. Once inside I find Brad Pitt (the PI) who is nonchalantly cleaning his shiny black motorcycle in what appears to be an auto body shop. Once I tell him the news he laughs and says that happens all the time. Oh, and not to let anyone eat the heart and lungs. 

I've got to admit, my subconscious is pretty creative. Plus I don't mind sharing my REM sleep with Brad Pitt. White coats and motorcycles? Yes, please. ;)

Thankful

Whenever I'm feeling particularly sad/stressed/homesick or just generally cranky, I try to come up with things that I'm thankful for. I think Oprah may have recommend this - but honestly what doesn't she recommend? Regardless of whose genius idea it was initially, I've found that it's a sure-fire way of pulling me out of my funk and re-focusing myself on all of the awesome things in my life. And, since today marks exactly one month of my being a real adult (I've decided that "real" adult means paying for health insurance. Thanks, Obama), here is a list of 26 things that I am thankful for.

1. Spring. ALL of the snow outside my house has officially melted, people. ALL OF IT! Birds are chirping and everything. After five months of insanely cold frozenness, right now, spring is about as magical as a Disney Pixar movie.
2. Coffee. Aka, get-up-and-go juice. (And also, stay-awake-because-you-haven't-finished-reading-that-path-chapter juice.) 
3. My crazy supportive family. I would not be where I am, or who I am, today without their constant love and encouragement. 
4. My equally crazy supportive friends. We laugh, we cry, we eat a lot of frozen yogurt and spend too much money on Sonic fountain drinks. I'm pretty sure that's what love is. 
5. Electric blankets. They're like being wrapped in the best hug ever. And you don't have to worry about BO.
6. Being in medical school. It's the source of 96.4% of my stress, and I am still thankful to be here every day. (Admittedly, some days I'm more thankful than others.)
7. My cat. I have yet to lose a "cat-off," so I say with confidence, my cat is better than yours. ;) 
8. My local Dunkin Donuts coffee girl. She knows my voice, she knows my order, and she's the smiling face I see before spending all night in the library. You. Go. Girl. 
9. All Starbucks baristas everywhere. You spread joy and happiness. And even though you sometimes spell my name wrong (Megan, Morganne, Marie) I don't care and I will always forgive you. This might also be what love is. 
10. Volunteering at my local food bank. This is one of my favorite parts of the week. The people there are amazing and kind and I'll always be thankful to have known and served with them. 
11. Picmonic. This fun study tool is pretty much like watching cartoons. (Cartoons that are linked to high yield totally testable medical school topics, but cartoons nonetheless.)
12. The Pennsylvania Game Commission. This is random, and I'll spare you the details. But earlier this week they took care of a "situation" involving a mortally wounded deer and my backyard. 
13. The SheReadsTruth online community. If you're looking for a daily devotional, these ladies write awesome, God-infused, scripture-based plans and I absolutely love, love them. Please check them out! 
14. Non-school books. I repeat, books that do not have ANYTHING to do with medical school. Sometimes, I forget these even exist. This weekend I started reading "The Book of Unknown Americans." I am half way through it and loving it so far!
15. Pathoma. I speak for myself and almost every other medical student when I say, Team Sattar for Lifeeeeeee. 
16. AppleTV. Man oh man, has this little black box of wonders revolutionized the way I procrastinate. Just. Can't. Reach. The. Remote. Before the next episode starts. Oh, well. ;) 
17. Online shopping. Also known as the "if a girl finds a perfect dress, she'll need a light spring jacket and cute summer sandals to match" phenomenon. It's like the grown up equivalent to the life lessons learned in the childhood classic, "If you give a mouse a cookie." Only more expensive. 
18. Last minute road trips. My punk kid brother is visiting me this week and I love having him around. He'll be on the opposite side of the country this time next year (his first army post is in Alaska) so I'm soaking up all the brother-sister bonding time I can. 
19. My awesome local church. Nothing makes a place feel more like home than being able to go to "my church" every Sunday. 
20. Only one more PBL exam to go! This is almost too good to be true. The exams that have dictated so much of my life for the past two years are almost done. Woo-freakin-hoo!!! 
21. That I can call my dad any time for any reason. From banking advice to what to do when a bat invades my house (true story), he has always been my own personal "Mr. Fix It." And I'm pretty sure I have the greatest dad in the world. But I might be biased. 
22. The health of my family and friends. I spend the majority of my time learning about everything that can go wrong with the human body, which makes the fact that all the people I love dearly are healthy that much sweeter. 
23. I'm thankful for the people that read this silly blog. And who are STILL reading this post. It turned into quite a doozy, huh?
24. I'm thankful for my mom. She puts her heart and soul into teaching a bunch of bratty junior high students math. But from the stories she tells me, what she is really teaching them is that that they are important. That they matter. And that they each have gifts to offer this world. 
25. I'm thankful that home is only a plane ride away. 
26. I'm thankful for the cross. I'm in the middle of the SheReadsTruth lent study right now and am in awe of God's love for a fallen world and the sacrifice Jesus made to bring us Home. 

Guest Post

FALSE.

It's day two of my embargo with the outside world. Subzero temperatures mean one thing for this Arizona native - never leaving my house. I did venture out to get groceries this morning. Which only reinforced my desire to never be more than 7 feet away from by electric blanket. (I've named him Gus. I think it's serious.)

Anyways, about two months ago Ghabrielle asked me to be a guest writer on her blog, The Night Owl Chronicles. Ghabrielle is also a second year medical student, so I was super excited and very flattered that she asked me to write about my medical school journey so far - including the application process and my current preparation for board exams.

She just published the post earlier this week and I think it turned out really great! If you are interested in applying to medical school, especially a DO school, I encourage you to check it out here!

Alright gang, Gus and I are going to cuddle up and see what all the fuss is about with this "Birdman" movie. If you've seen it, let me know what you think!

Vingt-six

I'm turning 26 tomorrow. That feels so weird to type, because I don't feel 26. Not that I really know what that's supposed to feel like, but still. I always get a little nostalgic around my birthday. I think we all do. For me, it's like this built in milestone that screams, "Hey! Remember what you were like this time last year? And the year before? I wonder what you'll be up to next year? You should really just take this time to think about where you've been, where you are, and where you're going." Annoying, no? I totally agree.

I started an alternative birthday blog post that involved tears, second grade spelling tests, and frantic calls to my best friend. I'll spare you the details but the gist of it was pretty much that I, as a 26 year old, am still struggling with the same things I was at age 9. Second grade me had some pretty high expectations of herself. (According to my mom, this started early. Example: In kindergarten, if I was coloring a picture and "messed up," said paper was immediately crumpled up and thrown into the trash.) As it turns out, 26 year old me also has very high expectations.

On one hand, this motivates me to work really hard and push myself to always be better. I'm thankful for it because I'm not sure if I would be where I am without the constant internal pull to keep getting better. On the other, when I don't achieve said expectations, things get pretty ugly. (I am NOT a pretty crier.)

So this year for my birthday, on the recommendation of my super-smart best friend, I'm going to start telling myself a different story. One that isn't constantly plagued with comparing my success to other peoples'. Or wondering why my grades aren't better, or why I'm not in perfect shape, or why I'm still single. (Answers: med school is hard; med school is time all-consuming; see previous two.) Instead, I hope that it reads more along the lines of someone who is kind, works really hard, and loves Jesus.

Last night, this verse was on my heart. I love it because it reminds me that God is in control, and He has been from the very beginning. And no matter how messed up I sometimes feel, He loves me and has plans for my life, things that he designed me specifically to do. I just love that.

"For we are God's masterpiece. He has created us anew in Christ Jesus so we may do the good things he planned for us long ago." Ephesians 2:10 

Thanks for hearing my heart. I'm off to bed to dream about birthday cake. :)

Highs and Lows

There is a kid in my class at school who is famous for his greeting: "Hey, man! Alright, highs and lows!"

It's great because instead of the absent minded, "Hey, how's it going?"  -- where you don't really expect an honest answer before you move on with your life, the greeting I'm guilty of --  this greeting makes you think, and you get to hear what the other person is dealing with, the good and the bad.

So, here are the week's highs and lows.

Highs:

• I was volunteering at a local school science fair and got to hold a tarantula AND a spotted gecko! They reminded me of home and made me happy.
• I made some serious progress inderstanding some concepts that kept tripping me up in neuroanatomy. The irony of how difucult it is to cram facts about the human brain into my brain is not lost on me. 
• I bought a new nutribullet and have been drinking smoothies for days. I've even become one of those weirdos who adds kale. It looks disgustng, but tastes delcious!
• The Lone Bellow came out with a new album and it's awesome! I'm seeing them live in February and can't wait. 

Lows:

• It's still winter - brutally cold and icy. I am not a fan. 
• I had to pay for health insurance like a real adult. Does the government not get that the whole point of staying in school was to prolong the realities of being an adult? 
• We're less than two weeks out from our first big exam of the semester. Hello, sleepless nights. 

I'm thankful to be ending the week with my "highs" outnumbering my "lows." Hope you can say the same!

Evidence of Things Unseen

I've been back in the land of snow for all of five days. Yesterday, I was diagnosed, by a fellow classmate, with a bad case of acute homesickness, precipitated by seemingly endless snowfall. The first few days after visiting home are always tough. Mostly, because all of my recent memories and thoughts are about people and places I'm currently a country away from.

In the days leading up to winter break, we had a series of neurology lectures. At one point, our professor mentioned that memories are stored throughout the entire cortex of the brain. Meaning that while there is a single structure responsible for making new memories (the hippocampus), no such structure exists for memory storage. Rather, our memories are stored over the entire surface of our brains. So everything we are, everything we think, and believe and feel and dream, is literally surrounded by our memories. So. Cool.

So while the immediate post-departure sadness of leaving home is frustrating, there is something beautiful in knowing that even though I'm miles away from home, living on the wrong coast, buried in a foot and a half of snow, the primary organ that makes up "me" is blanketed with memories of the people and places I love.

While you read this, I hope that you're close to your loved ones (and places!). But, on this chilly winter night, if you find yourself far away from everything that makes you "you," take comfort in knowing that, in a way, everything you do and everything you are is wrapped up in moments passed. And, should you ever feel the need to take a trip down memory lane, your memories are quite actually on the surface of your mind, just waiting to be remembered.