A little help

I had been yelled by one of the senior residents for not scrubbing in on surgeries I was repeatedly told by other residents to not scrub in on. During the middle of one surgery a nurse, who was worried my glasses would fall into a patient's open abdomen, taped my glasses to the middle of my forehead with a giant piece of surgical tape. And then I got kicked out of the OR because I didn't know the answers to the surgeon's questions. Needless to say, last Wednesday was rough. Walking out of the OR I could feel tears burning my eyes as I walked into the bathroom. After I had a good cry I went to the library to research the surgery I had just been asked to leave. I sat down at a computer, my face puffy and tear stained, closed my eyes and willed myself not to cry again. When I opened them, I saw that three of my med school buddies had pulled up chairs, literally surrounding me with friendly and understanding faces. They let me vent, made me laugh, and quickly pulled me out of the dark hole I was trying desperately not to sink into.

Last week was my first week of surgery. There were parts that were AMAZING (I seriously think I could just live in the OR), and as mentioned above, there were also some parts that were not so amazing. And it's in times like those that I'm unbelievably thankful for my med school friends. We run around the hospital, in short white coats, and every time we see one another, it's a relief. Because we know our battle buddies aren't going to pimp us, or ask us to drain anything gross, or yell at us for not doing something. Often our camaraderie manifests in dorky faces across the wards, goofy greetings as we pass each other in the stair wells, and sometimes simply being there when one of us is having a really rough day. But without these people, and those moments, I don't know how I would survive rotations. Because as I have found time and time again, those famous words ring true, "I get by with a little help from my friends."

Square One

I've been on surgery for all of two days now. And, while I absolutely love being in the OR, it can be intimidating to say the least. In and of itself, the OR is like a whole new world, with unspoken rules and sterile fields that cannot be broken. That, coupled with the vast amount of knowledge the surgical residents are able to rattle off at a moment's notice, is enough to make the most confident medical student break into a cold sweat. During the past two days I've been reminded of the (relatively) little amount of clinical knowledge I've mastered in my seven months in the hospital. While most of the time, I use this fact to motivate me, sometimes it has the opposite effect, and I can feel the realization of everything I have yet to learn weigh me down.

I experienced one of these moments yesterday morning. It was 5:07am and I was on my first ever surgical rounds. Myself, and the entire team of surgical residents were standing outside a patient's room when my fellow student and I found ourselves in the middle of a particularly bloody session of pimping (a style of questioning all medical students fear to our very core). While questions, that I did not know the answer to, were whizzing past me like bullets in a WWII period film, I remembered something a preceptor on my previous rotation told me about surviving medical training.

I was sitting across from her desk at the end of the day reviewing the cases we had seen. It was my final day working with her and we got to talking about medical school and its challenges. At the end of our conversation she gave me this final piece of advice:"Discover what you like about yourself. Hold on to that. And if you do, no one will be able to touch you. Promise me you'll do that?" 

Medical student, how do you repair a spigelian hernia?! As I was jolted back to reality by the quizzical stare of my senior resident, I could feel the heaviness already gathering in my chest. But then I made a choice. And, after taking a deep breath I calmly replied, "I don't know, but I'll look it up."

So c'mon 2016, bring it. :)

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. :)