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. :)