Dec 24, 2010
Dec 17, 2010
Month 1: A group of medical students listens to a robot simulation-patient with a heart murmur. It's the same murmur for every student. We must describe said murmur to teacher. Each student proceeds to listen to the patient with their brand new stethescope and echoes the previous student's assessment. In my anxiety and eagerness, I press my stethescope bell to his chest and repeat the same findings. Teacher points out stethescope is hung around my neck and not in my ears.
Month 3: We study anatomy of the lower extremity, and find a cadaver leg with painted toenails. Group of students abandons study and instead discusses whether the person the leg belonged to painted her toenails then died, or if sick student painted them postmortem. Argue about whether formaldehyde would act as nail polish remover or preserver. Never reach conclusion. I still kind of wonder about it.
Month 5: Study the thorax and abdomen. Work hard to learn muscles of chest wall and back. Anatomy professor (retired surgeon) points to a muscle and asks what it is. I blurt out "pec major! its pectoralis major!" He looks at me and says "that would be true...if he were laying on his BACK!" It was the trapezius (similar looking muscle, opposite side of body)! He took the opportunity, not unkindly, to remind us to first orient ourselves to the patient's position and anatomy in all visits and operations. Very sound advice indeed.
Month 10: School pays unfortunate woman to serve as a "standardized" patient for the purposes of us learning to do a well-woman exam. We take turns examining her breasts and learning to do a pelvic exam. As it turns out, opening the speculum is nearly impossible and requires at least three hands. Who knew?
Also Month 10: Same patient is exposed to little docs learning how to professionally communicate. A male classmate completes the breast exam, looks at her and says, "Your breasts feel great to me!" I think what he meant to say was, "Your breast exam is normal." It just came out wrong.
Month 13: I rotate through my first half day in clinic doing pediatrics. Secretly think newborns look like little aliens. Am horrified when little one cries when I touch him because my hands are so cold. I want to cry too.
Month 15: Man comes under my care after cardiac arrest. I ask how he was resuscitated. Wife cuts in and says she punched him in the chest, saying "You're not going to die on me, you son of a bitch!" The punch restarted his heart into sinus rhythm.
Month 16: Watch attending (physician) distract hospitalized patients and then eat food off of their trays.
Month 17: Watch a classmate diagnose twins based on fetal doppler tones. Laugh when attending tells him he did indeed find two heartbeats: Mom's and Baby's.
Month 21: Write out a prescription and attending signs it. Spend entire lunch staring at it, admiring my handwriting on prescription pad.
Month 24: Halfway through medical school, and still have to imagine myself sitting as the patient to know which side is their left and right.
Month 25: See infertility consult with attending. Assist with intrauterine insemination procedure. Attending approves my work by saying, "Between you and me, we should be able to get this lady pregnant."
Month 26: Greeted by new rotation attending: "Do you know how many millequivalents per hour to raise a hyponatremic patient's sodium level to prevent central pontine myelinolysis?" Um, no. I think I just forgot what sodium is.
Month 27: Greeted by new rotation attending: "Who the hell are you?"
Month 30: Greeted by new rotation attending: "The s*** has hit the fan!" Um, am I the s*** on your fan? Or is it something else? In any case, can I please, please run away?
Month 31: Realize between my tuition and my husband's salary (we work at the same place), we owe the health center eight thousand dollars for us to both work there full time.
Month 33: See patient with the back of my skirt tucked into my underwear.
Month 34: Do hernia exam on old, fat, hairy, bald man. He jovially warns me to be careful, don't get turned on. Realize, almost too late, that it is not professional to say "Ewwww!"
Month 35: Wear new dress. Attending asks if I am pregnant. Never wear dress again.
Month 36: Must get size medium scrubs from scrub machine at hospital as smalls do not fit over my hips. Mediums huge on bottom, even bigger on top. Curse misogynist freak that designed machine to only dispense atomic booger-colored men's scrubs in sets, not separates.
Also Month 36: Examine patient who has a toddler in tow. Toddler pulls on the drawstring of my too-big scrub pants while I am examining mother. Pants fall down. Complete examination in pink polka-dot panties.
Month 37: Eat at doctor's lounge with attending. Take last turkey sandwich. Attending gets ham, wants turkey. Takes my turkey sandwich. Opens both sandwiches. Removes cheese, changes his swiss for my cheddar. Proceeds to enjoy turkey and cheddar sandwich.
Month 38: Do rotation at a new hospital. Get slapped on the hand (literally) for harmless mistake. Watch another student get grabbed by the back of the scrubs and thrown across the OR. Fondly miss my sandwich-stealing attending.
Month 40: Almost seize with happiness when patient argues with reception that she wants to make her follow-up appointment with me instead of the real doctor.
Nov 14, 2010
Oct 8, 2010
Whoops. My bad.
I think a lot of people have this misconception. It turns out that while you graduate with a medical doctorate after four years, it's actually a sham. You can't practice anything. You have to go through a residency and become trained in a specific specialty, which can take anywhere from 3-7 additional years.
I just hit "submit" on my residency applications. It is a process akin to, but worse than, applying to medical school, with complicated essays, letters of recommendation, resume information, letters from the dean of your medical school, and lots of fees. Most people apply to between 15 and 50 programs. You put your applications in, hope for interviews, and then submit a list of your "rank" preferences of programs. The programs do the same for applicants, and a computer forms a "match" between students and programs. The Match results post the third thursday of March. If you don't match, you go into "The Scramble", which is the process of finding an open residency position and applying for that spot, and is as stressful and disorganized as it sounds.
I had a few programs that I was really interested in, and one in particular, but ended up submitting extra applications at the last minute, petrified that I would end up as an unwanted egg in the student scramble. Better to send more applications and get into less than my first choice than to end up thousands of miles from my husband in a specialty and program I didn't want to go to in the first place, is what I figured. So I made a list, checked it twice (thrice? Ten times?), made sure my information was not wrong but right...for each of the eighteen programs I selected. And finally hit the "submit" button with a relieved sigh.
And a happy smile crept into my heart and onto my face. It's really happening. I will be a doctor, a resident physician somewhere. A program will rank me because they want to train me, to have me to be one of their graduates. I will have a long white coat, instead of the short student coat I have now (which I thought was cool when I got it but now realize it only denotes me as an underling wanna-be doctor who doesn't actually know anything). This time next year, I will already be a few months into my residency. YAY! I'll be a resident!
Oh God. Self-doubt creeps in. The life of the medical student is wrought with emotional lability and doubt, and residency hunting season is the pinnacle of it. You compare yourself to others (how many interviews has she gotten already? Should I have submitted my application earlier? What is his class rank? Will my nice personality outrank that guy's jerk demeanor and high board score? Am I as helpful as she is? Do they care if I'm pretty?). You compare yourself to the expectation you have for yourself (Did I do as well as I thought I would? Will I match to one of my top choices? Did I do the application as well as possible? Am I as competitive as I hoped to be?). You worry about letting your friends and family down with a poor test score, low evaluation, or unmatched residency status, because they're the ones that believed in you all along, who thought you could be a good doctor even before you did.
Would anyone do it if they really knew? If they knew that the application to medical school, the acceptance to doctorhood was only the beginning? If they knew there wasn't one board exam but six, if they knew that medical school is only the first part in the process of becoming a doctor?
Would I do it again? Yeah. As stupid as that feels at the moment. It's probably a good thing that I didn't realize all of this at the time of my application and acceptance to medical school, because that only would have given me more to worry about. But ultimately it's a good thing, the path I want to be on. I love medicine. I just hope a program loves me back.
Sep 24, 2010
Sep 14, 2010
I thought I wanted to be a gastroenterologist. My background in clinical nutrition led me to an interest in the GI tract and how nutrients were absorbed and how nutrition affected health. Throughout my first two years of medical school I planned on become an internist and subspecializing.
And then I delivered this baby.
I was poised at the woman's vagina, easing the head, one shoulder, two shoulders, a body, and feet out of her body, clutching the newborn tightly against my too-big surgical gown. And my first, illogical, thought was "wow, this baby is really warm." Which was really stupid. Of course the baby was warm- he came out of a toasty uterus, insulated by his mother. But the first thought of a student doctor is often an expression of something that should be obvious, but just has not yet been experienced. It was a surprise to me when I first held him.
This has been kind of a funny story to friends, family, other patients, myself...I think in part because it illustrates that doctors start as children in medicine. We have these first experiences and have normal human reactions to them, instead of calculated medical answers. I think being a student gives you a unique perspective too, for your first delivery to coincide with a mother's first birth, where you share in the newness of this experience together. After that point, you are on unequal footing; the doctor and the patient, but as a student, you appreciate things along with the patient.
And I loved it. That feeling of cradling the warm, slippery baby and the happiness of laying the infant on his mother's belly was one of the greatest joys I had ever known, and ultimately changed my career in medicine.
Jul 26, 2010
Jul 23, 2010
Jul 11, 2010
May 25, 2010
- A young man so obese that the weight of his chest wall compressed his own lungs to where he couldn't properly oxygenate his blood. He needed a tracheostomy and a gastric tube and placement in a long-term care facility to lose enough weight to be weaned off of the trach.
- Two teenagers with multiple gunshot wounds to the chest following a gang fight.
- A Jehovah's Witness dying from complications of low hemoglobin post-surgery. She would walk out of the ICU if given a few units of blood, but instead will die within a day or so from heart failure from her steadily dropping hemoglobin.
- A patient with severe aortic stenosis who declined a valve replacement for years. Now she has consented to the surgery, but her heart is four times a normal size from the pressure exerted on it from the stenosed valve, which makes her a poor surgical candidate. Even if she were to survive the operation, her heart is too badly damaged to expect any change in prognosis.
- A young mother, brain-dead from an overdose of cocaine, meth, marijuana, and other drugs. She was brought in after crashing her car with her baby daughter in the backseat.
- A woman who wrote an alternative-medicine book on radiation poisoning, who failed to follow up with her doctor after he told her the treatment for her lung mass was radiation therapy. Now she is in the ICU with a lung completely filled with tumor and metastases to the liver and brain, causing intracranial bleeding. She didn't even want the CT scan that yielded that information. She died a few hours later, only 58 years old.
Apr 28, 2010
Apr 23, 2010
I grew up in Orange County, CA. Back in the 1980s, it lived up to its name. Every spring, my life was punctuated by the sweet smell of orange blossoms that heralded summer fun. By the time I was eight or so, that smell was gone, replaced by the smell of multimillion-dollar new construction. That orange scent always stayed with me though, bringing forth happy memories of my childhood.