Actually, the new academic year started 2 months ago, 2 modules ago. But it’s always a good time for a bulleted list!

#1: exercise and diet

• We are harpooned on a daily basis about the evils of obesity, how it is a risk factor for nearly every health problem — heart disease, cancers, pulm problems, even gynecomastia for men. The demands of school make it easy to slump into an inactive lifestyle. Lucky for me, I have these daily reminders from lecture instilling fear in my heart, and super health-conscious classmates to set an example. I would be bet that we have a much higher prevalence of triathlon athletes at Emory Med than in the general population. I, on the other hand…am not a good swimmer. Let’s just leave it at that. My goal is more modest (350 cal/day x 20 days/mo = 7000 cal/mo, @ 3500 cal/lb = 2 lbs/mo — see, we learn things)

#2: Get involved in research

• I feel that this is where you can make the most impact in the # of people you can help if you come up with something good. Learning about the history of insulin and Exenatide last module was pretty inspiring.  Ideally the research should have something to do with the field I decide to go into, but that is also a mystery. Module-wise, I liked GI and Endo. This year I am taking my elective in E.M. Also, I think it’s pretty cool when the Pathologist explains the autopsy on CSI… The real nuts and bolts will come down to rotations. I am definitely looking forward to seeing how things work in the real world.

#3: Save up for that tricked out stethoscope

• No, I have no C.O.I.’s , no secret deals with the stethoscope makers. What I do have earwax or something (perhaps a not-colorful-enough imagination), that make it difficult to hear soft sounds. Anyways, it would be nice to have one so I don’t miss out on the wards.

And finally…

#4: Design a line of professional clothing that is machine wash/tumble dry-friendly

• What is this hand wash cold, inside out, upside down, lay flat to dry nonsense? With all my recently acquired ‘clinical attire’, laundry has become complicated. And I should know–my people have been running laundromats in this country for centuries. Zing! Jokes aside, this is a serious problem.

Atlanta restaurant week back in August.

A large portion of my OB/GYN rotation was obviously spent with pregnant women, who spend a lot of time preparing for baby, either at the hospital, or at Babies R Us, or working, until baby becomes #1 priority. How anyone could assume that responsibility was and is beyond the understanding of my Y chromosome. What if you accidentally eat a tuna sandwich or forget your folate one day? What if your boss has a pretty, young, not pregnant thing ready to replace you if your well check takes too long? What if you trip on a pebble and fall on your tummy, your arms too slow and edematous to lessen the impact? The end product of the pregnant state, once emerged, serves to chronicle your performance during the most stressful 40 weeks of your life. And then you have to raise the thing. Ugh.

My mom, a 5 foot, 95 lb woman, proudly volunteered that I was born via vaginal delivery, 8 lbs 8 oz at 41.3 weeks. Although never spoken, the insinuation was that childbirth forever delegates women as the stronger gender. I realized that I was perfectly comfortable with this arrangement.

I waylaid my cynicism after I laid hands on a fresh, sterile, stinky newborn baby, simultaneously the ugliest and yet the cutest thing. A hundred billion have mostly turned out okay so far, largely devoid of input from men. So I hereby accept my responsibility of foot massages, back rubs, home cooked dinners, and, of course, adherence to ACOG guidelines in pregnant care.

1. Internal Medicine
2. Emergency Medicine
3. Pediatrics
4. Psychiatry
5. Dermatology
6. Family Medicine
X. Ob/Gyn
X. Anesthesiology
X. General Surgery
X. Radiology

Rise up this mornin’,
Smiled with the risin’ sun,
Three little birds
Pitch by my doorstep
Singin’ sweet songs
Of melodies pure and true,
Sayin’, “This is my message to you:”
Singin’: “Don’t worry about a thing, worry about a thing, oh!
Every little thing gonna be alright. Don’t worry!”

Some mornings, I need a little Bob Marley to get me going. Today was one of those mornings. I was tired and cranky and about to start a 13-hour nursery shift while on my pediatrics rotation. Then I saw Baby D, swaddled in hospital blankets and lying in his neonatal ICU (NICU) crib. I grinned widely to myself.

Mommy D had been my patient at the end of July when I was on the Labor & Delivery OB service. She was 25 years old, just a year younger than me, and she was pregnant with Baby #4. Of her 3 kids, she only had custody of one; she wasn’t even sure if she was going to keep Baby D.

Mommy D was addicted to crack cocaine.

It could have been the reason why her water ruptured prematurely at 30.2 weeks. And as a result Baby D was struggling in utero with almost no amniotic fluid to cushion him. On ultrasound, he wasn’t breathing or moving much. We tried to prolong Baby D’s delivery as long as possible, to give his lungs a chance to mature, but he was eventually welcomed into the world, albeit 2 months early.

Fast forward one month. Mommy D has not visited or called about Baby D in the NICU since she was discharged from the hospital. Baby D has periventricular leukomalacia and some calcifications of the brain (maybe due to a maternal TORCH infection). He may also have microcephaly and long-term neuro deficits. Essentially, Mommy D’s addiction has caused holes in Baby D’s brain. It was like one of those Saturday morning public service announcements – this is your brain on drugs – but in the flesh, in the form of this infant in my arms.

DFACS has been called and Baby D will probably be discharged to foster care once he’s stable and eating on his own. As I rocked him for almost an hour, holding him tight to my chest and humming a song, I couldn’t keep the tears back. What a sweet, sweet baby. With so many cards stacked against him already.

I’m going to listen to Whitney and my mentor on this one: Crack is whack. It ruins lives. It strips people of their futures. It kills hope.

So often, I’m plagued by the question: Is every little thing gonna be alright? I’d like to think so. But I know the truth is: not always.

So, I’ll make sure to hug Baby D extra tight tomorrow, even if it does cause tears to roll down my face.

I’ve been trying to remember every piece of this for the last month but time, as it often does, has managed to wipe many of the details away.  I suppose the best way to bring you back with me would be to tell you about the images that I still see when I close my eyes and think of my second day on surgery:  I can hear the cacophony of the bells, whistles, horns, and sirens of each monitor in the ICU room; I can see the heart monitor and watch as the normal rhythm changes suddenly to a pattern of tombstones racing across the screen; I can feel every muscle in my body tiring as I start my sixth round of chest compressions; I can pull my sneaker off of the floor and wonder why I was stuck to the ground for a moment, then realize that the linoleum is covered with blood;  I can hear fluid sloshing around in her lungs and underneath her skin as I pound on her chest; I can see the look of defeat in the eyes of everyone in the room when resuscitation efforts are called off; and I can still sense the stillness in the air of the room in the moments before it all started.

This patient came into the ER the night before for a problem that required immediate surgical intervention.  The surgery was long and reasonably complicated, but the patient was stable when she came out.  She ended up passing away approximately 12 hours after she returned from the operating room.  Within those twelve hours, her blood pressure readings were dangerously low.  Clinically, however, she did not appear as if her BP could possibly be as low as the machines were indicating, so hours were spent replacing cuffs, inserting new lines, and insisting that the blood pressure that we continued to read on the monitors was incorrect.  As it turned out, the blood pressure was being read correctly the entire time.  Every resident and attending racked their brains that afternoon, knowing that something just wasn’t right, but not prepared to second guess their treatment.  After all was said and done, three residents and I sat in the silent room, the patient’s cold body lying on the bed before us, wondering aloud if anything could have been done differently.  Everyone agreed, or perhaps was forced by defeat to agree, that every other path of management would have lead to the same outcome.

I know that this woman was eulogized by somebody, somewhere later that week.  If I know eulogies, much was made of the tragedy of this young woman’s death, but the universal consolation was that it was simply ‘her time’.  Some being greater than us had decided that her life on this earth was over.  Simple, really.  But as you enter the medical field, those consolations start to feel more and more empty.  Was it simply this woman’s time?  Or did your action, or lack of action, your judgment call, your mistake force the hands of the clock?

Welcome to the real part of medical school, kids.

Med school is hard, no joke.  There is always something you could be (and probably should be) doing to prepare for small group, to practice your clinical skills, to study for the ever-looming exam.  It is overwhelming sometimes, and if you’re not careful, you can forget that a world exists outside of the textbooks, articles, and anatomy objectives.

It was two weeks before our Skin, Muscles, Bones, and Joints exam, and I was already panicking.  Sure, two weeks might sound like a lot of time to prepare, but it’s surprisingly short when there is a blam (what we call a block exam) awaiting you at the end.  I had been hard at work all week, with the prospect of a visit from my husband Adam over the weekend to keep me going.  Adam hadn’t been having such a stellar week himself.  He’d been kept late at work every single day, trying to troubleshoot various problems that kept arising.  He was stressed out and frustrated.  Then came the really bad news.  Adam didn’t think he would be able to make it up to Atlanta after all.  I was disappointed, but I understood.  And after all, I had so much studying yet to do that we would have just hung around in the apartment while I crammed and Adam played solitaire.  It was probably best that I remain undistracted and concentrate on being super-productive.  These thoughts barely had time to form when Adam followed up his announcement with a question.  “Do you think you could come down this weekend instead?  No big deal if you can’t – I just thought I’d ask.”

My immediate instinct was to back out as quickly as possible.  “Let me think about it,” I said, knowing full well in my heart that it wasn’t going to work out.  But then I started thinking.  The thing is, knowing how busy I was planning to be that weekend, Adam would never have even asked me to drive eight hours round trip unless he really needed me to be there.  Shrugging, I said to myself, “It’s pass/fail,” and told him that I could make it.

Now, just in case Drs. Schwartz or Eley happen to be reading this, don’t worry – I took all my books down with me and studied there.  Still, I probably lost a point or two on the exam that I could otherwise have gotten.  In the end, though, it was worth it.  It’s that human connection to others that keeps us sane during our time here, because like I said, med school is hard.  Often you have to make time for those connections, because if you wait for the free time to just appear, you’ll be waiting a long time.  Yes, medical school is important.  But other things are important too.  That weekend down in Savannah, I felt lucky to be at a place like Emory where they also realize that.

Here I am with our dog Penny, whom I also enjoy spending time with.

Hello Loyal Readers,

I wanted to take a quick minute to post a reflection piece that I wrote recently about breaking bad news to patients.  As a student on any rotation, you will have to be the one to (or be part of a team that) must deliver bad news, and believe me when I tell you that it is one of the most difficult skills to master.  Some doctors go their entire careers without fully grasping the importance of the subtleties of this delicate patient interaction.  Fortunately for me, I was recently working with a young doctor who, in my opinion, is off to a great start…

Mr. S is a 60 year old African American male, a man who lives with his wife, and is close with his many children.  Mr. S was not my patient, so I did not follow his hospital stay at Emory very closely, but I did round with my resident on him the day that lab tests determined that he had metastatic pancreatic cancer.  When we arrived, Mr. S was downstairs getting an ultrasound done, but his wife and son were in the room.  I remember that they had been sleeping when we knocked—it had been a very long and emotionally draining hospital stay.  Although they had had no idea of the severity of Mr. S’s disease when they arrived a few days ago, the seed had been planted by their medical team that cancer was a very real possibility.
My resident and I knocked and entered the room, greeted the family and both took seats.   The four of us were clustered near the window, looking out on the fading spring sun.  After we made our introductions, my resident told the family what our tests had confirmed.  The family members simply nodded—they had been expecting this.  Their strength, as it appeared to me, was clearly fragile—hanging by a thread.  This made it all the more important that the remainder of this conversation was delivered in a way that respected the fact that the family’s emotional breaking point could occur at any moment.
I felt that my resident negotiated this beautifully.  His tone was always calm, and inviting of questions.  He gave a brief overview of the differences between palliative care and chemotherapy, discussed the merits and drawbacks of both in lay terms that did not condescend.  These are the things that any good doctor should do when delivering bad news.  What I believe was truly special, and what I believe I learned most about, was my residents knowledge of the times when words fail.  There were many breaks in this conversation where there would be no words.  Not because he had asked a difficult question or because anyone had broken out in tears.  It was, quite simply, because there are times in these difficult conversations when silence is more valuable, respectful, and encouraging than words.  My resident knew this, and perhaps more importantly, he did not fear it.  Sometimes we would sit with the family mid conversation for what seemed like an eternity to me, but turned out to only be about twenty seconds, and simply be present.  I felt that I could see the family members digest each piece of life-changing information piece by piece during these pauses.  They asked questions when they felt they needed to, and kept silent when they didn’t.   The entire conversation may have only taken 15 minutes, but I felt that each moment was well spent, and no word was wasted.

Stay tuned, kids.  My next post will chronicle my second (and significantly more epic) trip to Haiti!

We M2s are well into our rotation schedule for the year. Slowly but surely, we are eliminating career choices and gravitating toward others. I’m halfway through general surgery right now, and while I appreciate the work and am impressed by a surgeon’s work ethic, I’m not sure if I belong here. The service has been sending me hints:

1. Clinic is more fun than the OR
2. My resident said that the best advice from her residency advisor was to avoid surgery, unless she wanted to marry it and have hella babies with it
3. My fellow admitted that he couldn’t figure out how to get to Kroger without asking his wife
4. I got bile in my eye…during a laparoscopic operation.

But everyone is different! It behooves the undecided to ask questions and explore as much as possible. Join me, then, in my reckless pursuit of a life-defining career. I’ll try updating this list every few months and include new specialties that I’ve been exposed to.

1. Medicine: The default for the undecided leaves room for a later decision.
2. Pediatrics: I’m at Egleston right now, and I think kids — even sick ones — are more manageable than I previously thought. Plus, videogames at work.
3. Psychiatry: The “biopsychosocial” approach to mental health is an appealing challenge. Bonus points for people giving you the stink eye when you tell them your job.
X. everything else
X. Anesthesiology: The motto of anesthesiology is “vigilance.” Adherence to this principle is difficult when you have the distractability of a goldfish.
X. General Surgery: (see above)
X. Radiology: The lifestyle is great and the skills are respected, but the wandering spirit is not calmed by computer work.

Short update, so here is a comic (credit Michelle Au @ Scutmonkey):

I apologize for the extended absence, but once more the truth is back.  I believe that it has been nigh on four months since my last post.  I promise that I’ve been busy though!  Clearly we have a lot of ground to cover, so I will summarize my life since my last post in succinct bullet-points.  Prepare yourself—this will be a journey:

-    I took Step 1 of the NBME board exam on January 16th.  I know that other bloggers have mentioned this test and alluded to related anxiety/terror.  For those of you who don’t know, this is the first of many exams administered by the National Board of Medical Examiners that one must pass in order to become licensed to practice medicine.  It’s designed to evaluate everything that you’ve learned in the first two years of medical school.  People have been known to spend anywhere between four weeks to three months studying for this test, and the degree of sanity loss that you’ll witness among your classmates during this time is astounding.  Personally, I spent about five and a half weeks studying approximately eight to ten hours a day for six days out of each week.  Then I knocked it out in January so that I’d have six weeks of vacation.  If you have any questions about the experience of studying, feel free to contact me!

-    After the test I skipped town and headed up the coast to Washington DC.  I missed the inauguration by one day, but the spirit of merriment was still in full swing.  A few college friends and I met up for a mini-reunion, and we did our best to leave our mark on the nation’s capital.

-    I learned first-hand that parrots are the absolute worst possible pets.  Ever.  Did you know that in addition to learning how to imitate human sounds, they’re also very skilled at imitating alarm clocks and cell phone ringers?  In fact, they’re so good at these sounds that they often choose to share the full repertoire at the crack of dawn.  Seriously.  Own a goldfish.

-    My next stop was good old NYC, where I relaxed with my Mom, and saw some old friends.  Perhaps most importantly, I ate the best pizza that the world has to offer.  Every day.  Multiple times a day.  For two weeks straight.

-    Next stop:  Las Vegas for four nights.  We all know that what happens in Vegas is fated to remain in that heathen desert city, but I will give you one tiny sliver of a story.  Apparently, according to many Las Vegas residents, this guy:

plus this:

equals this much more famous guy:

And because of this mix-up, everyone was a winner.

-     The final excursion on my world tour was Costa Rica.  I flew into this country a city-dwelling, non-spanish speaking boy.  I returned a zip-lining, volcano-climbing, surfing, wildlife-loving, salsa dancing, occasionally-fluent-in-Spanish man.  I had a bunch of pictures that I’d been meaning to share with you, but unfortunately I lost them when I was robbed on a bus!  Ah well.  As one of my patients this week said, “Ain’t no time to look back, only forward”.  And as the Costa Ricans say, “Pura Vida!”

And now I’m back in Atlanta starting my clinical rotations!  Starting out with Internal Medicine at Grady has kept me quite busy, but I have a lot of thoughts on my experience thus far that I will definitely be sharing with you.

Until next time,

C-Q

To be honest, I thought the inpatient Psychiatry ward would sort of resemble “One Flew Over the Cuckoo’s Nest.” Alright, I didn’t really think that, but I did expect my experience on the ward to be much scarier than it has been thus far. It appears that psych patients, for the most part, are relatively gentle, despite their severe depression and hallucinatory psychoses. They are interesting people with intriguing stories and fascinating minds. No matter how many schizophrenic patients I encounter, I still find it hard to believe that people can “hear voices”, have full awareness that no one else can hear these voices and that the voices are only in their own heads, and yet the mind continues to produce these voices. Why does the mind insist on creating hallucinations when the patient knows they aren’t real? And why is there such a drastic difference in the insight patients possess? Some completely understand that they are psychotic, others resolutely believe that what they are hearing and seeing is real.

I didn’t think I’d be interested in Psychiatry, and I am not yet convinced that I am. Still, this is the only second clerkship I have done thus far, and I am entirely convinced that there is something to be gained from every moment I spend on the wards. Interacting with patients, learning the practice of medicine, pondering the depths of the human mind, examining my own response to hierarchy and stress and expectation- what could be more exciting…