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.