Top 10 Study Spots

A list of the top 10 most interesting/unusual/weird places I have studied medicine (none include a desk):

10. At the summit of a ten mile hike (the EKG book fit nicely into my Camelbak).

9. In the middle seat of an airplane. Not too original except for the fact that the seatmates on either side were looking over my shoulder and commenting on the subject material. Topic: platelets. Window seat guy: "I'm on Plavix." Aisle seat guy: "What are platelets? Is that a disease?"

8. On a ski lift. But it was hard to turn the notecards with my ski gloves on. And even harder to stuff the notecards back in my pocket, get a pole in each hand, and scoot to the front of the seat in time for the lift to end.

7. In the bathtub. But the water made the ink run on the notecards.

6. On the toilet. (Sorry).

5. At the pool, both in a chaise lounge and on a floaty in the pool, but ran into same problem as #7.

4. In my kayak, floating in the middle of the back bay, toes dipped over either side into the water.

3. Sweet Tomatoes (a soup/salad buffet restaurant). If I came for a late lunch and studied long enough, I could dish up dinner before leaving!

2. On my cat. Not with my cat, on my cat. He made an excellent bookstand...the reading angle was perfect. And he didn't even seem to mind.

1. On a date. With my (very) patient husband.

The Day That Wrote Itself

There are days that it takes me a while to formulate what I want to write. I think about it while I run, feet in rhythmic movement, a moving meditation of words. Other days are easier; I sit down and words flow.

Today, this blog wrote itself.

I saw fifteen cardiology patients today. Here are eight of them:

Patient #1: Denial

Me: "Do you have trouble sleeping at night?"

Patient: "No. I've taken Xanax at night to sleep for years. I'm not addicted, just used to it."

Patient #2: The Generous Risk-taker

Doctor: "Your stress test and angiogram showed that four of your bypass grafts are blocked and your heart is severely damaged. You need to be very careful or you will need a heart transplant."

Patient (reeks of smoke): "Well, can I go up in a hot air balloon to 4000 feet?"

Doctor: "You really want to go up there and do a self-induced stress test in a basket 4000 feet up with no medical personnel to help you?"

Patient (thinking): "That's a good point. Would you like to come?"

Patient #3: The Medicaid Fraudster

Patient (with $400 purse, BMW keys, and 3 pack-per-day cigarette habit): "Doctor, I know my cholesterol is worse than before since I stopped taking my meds. I can't afford my medication and Medicaid doesn't cover it for me. I need a generic."

Doctor: "Oh?"

Patient: "Yeah. That reminds me, my boyfriend and I are buying a hot air balloon. Would you like to come for a ride sometime?"

*note: I do not know what is up with hot air balloons today. Apparently they are the thing to do for cardiac patients in Arizona.

Patient #4: The Undersharer

Patient: "I have chest pain."

Doctor: Asks all manner of questions related to chest pain symptoms

Patient (20 minutes later): "I work for a company that transports museum exhibits. A few weeks ago, I was at work and was pinned between a wall and a 1200 lb crate that rolled into my chest."

Me: "Is that when the chest pain started?"

Patient: "I think so."

Later X-Ray showed 4 broken ribs

Patient #5: Another Undersharer

Me (taking history): "Have you ever had any heart problems?"

Patient: "No."

Me: "Any murmurs, stents, valve replacements, high cholesterol, high blood pressure, or chest pain?"

Patient: "No."

Me: "Have you had any surgeries?"

Patient: "No."

Me: "Any problems with your lungs or breathing?"

Patient: "Well, I had pneumonia after my quadruple bypass three years ago."

WTF?

Patient #6: The Neurotic Oversharer

*contrast this to patients #s 4 and 5.

Patient: "Doctor, I know you told me to to worry about my myocardial bridge, but I am concerned."

Doctor: "The myocardial bridge is nothing to worry about. Your angiogram showed that it is not significantly occluding your coronary artery, and since it is a congenital condition, it will not get worse."

Patient: "Well, I've been looking into research to get it fixed. There are all kinds of new experimental procedures."

Doctor: "You don't need it fixed."

Patient: Produces 6 page, typed, single-spaced paper detailing his research on the subject, complete with references in parentheses and a works cited page.

Doctor: "This research is for bridges that cause artery blockages. You don't need any intervention. And, this experimental procedure is only done in New Zealand."

Patient: And while I'm here, I want to talk about my blood pressure."

Doctor: "O-kay..."

Patient: "It's just out of control. I take my medications, but every time I put my cuff on, I get so anxious and just watch the numbers creep up and up."

Doctor: "How often are you taking your blood pressure?"

Patient: "Roughly, um, (thinks)....maybe 25 times a day?"

Doctor: "I think you should do it just a few times a week, when you are relaxed and not stressed."

Patient: "I also think my blood pressure is causing me to have erectile dysfunction."

*note: by now I am zoning out and am as bored by the patient as you probably are at this point.

Doctor (later, to me): "That guy is really annoying. I think I'm going to fire him from my practice."

I don't blame him.

Patient #7: The Surgical Clearance Patient

Patient: "I need cardiac clearance for a surgery that I'm supposed to have on Thursday."

Doctor: "That's in two days! I'm not sure we can clear you that quickly, especially if you've had any heart problems in the past."

Patient: "Please, doc. I really need this surgery ASAP."

Doctor: "Well, what is it for?"

Patient: "It's with an ENT doctor."

Doctor: "For what?"

Patient: silent

Patient's wife: "Well, I bought him a nose hair trimmer for an early Valentine's gift. But he had so much darn hair that I guess it wrapped around the attachment and...."

Patient: "It's stuck up there."

Doctor: "What's stuck up where?"

Patient: "You know. The nose trimmer attachment. It's stuck way up there and I need the surgery to remove it."

Doctor: "We'll do your cardiac clearance as soon as possible."

Patient #8: The Med Student Abuser

Me: "Can I listen to your heart and lungs?"

Patient: "Sure. I'm all for helping students learn."

Me: "Sounds good." (Listens and then puts stethescope down on the exam table next to patient).

Patient: "So you're learning how to use this thing, huh?" Picks up stethescpe and whirls it around, just as I lean into check his pulses.

Stethescope bell hits me in the temple.

Me: "I'll just go get the doctor for you."

Ow.

10 Things

Here is a list of 10 things I wish I had known upon entering medical school:

10. Eat, sleep, shower, and poop when you can. Cuz you never know when the next time you can is.

9. It IS possible to have a life during medical school. Many of my friends were able to get married, have babies, adopt a dog....BUT...

8. Realize that medical school will not always allow you to spend time with them, or even to live with them.

7. Patients die. It's (probably) not your fault.

6. Sleep is not necessary to live; nor is it required to make life and death decisions.

5. You'll learn to study all the time. Examples include, but are not limited to: notes wrapped in a baggie in the shower, EKG book while at summit of ten mile hike, flash cards while at the DMV/hair salon/post office/public transit/red lights/bathroom/other "unavoidable delay."

4. Shoe requirements: 1) Really, really comfortable. 2) Blood/other body fluids wipe off easily.

3. You'll get sick. A lot.

2. Many days you'll wonder why you went into medicine. And then you meet a patient that reminds you that...

1. Medicine= love. Love your patients. Love yourself.

A Doctor's Christmas Dinner

I'm stuffed. Christmas dinner with my family, a happy time spending time with grandparents, cousins, aunt and uncles, and all the good Swedish food I remember having as a kid. It's bittersweet; I'm worried that next year I'll be an intern and won't get to be home for Christmas. It's my last year on an academic schedule, the last year that I can depend on someone to protect my time. And as I was thinking about being a doctor during Christmas, my mind drifted to the many foods I learned about in medical school. Not really foods exactly; doctors seem to like to name various pathologies after the dishes they abstractly resemble. So here is my idea of a Christmas dinner for doctors, a menu of pathology.

To drink:

Port-wine

Coffee-ground

Cafe-au-lait

Rice water

Appetizers:

Anchovy paste

bread and butter with red currant jelly

caseous (cheese) necrosis

Grape clusters

Olive sign

Main dish:

Pizza pie with onion skin

Hamburger sign

Millet

Dessert:

Red cherry

Strawberry tongue

sugar coated spleen

chocolate cyst

Apple core

Banana sign with nutmeg

Here is what we are really serving:

To drink:

Port-wine stain: hemangioblastoma

Coffee-grounds: upper GI bleed emesis

Cafe-au-lait spots: neurofibromatosis

Rice water: cholera diarrhea

Appetizers:

Anchovy paste liver: amebic liver abscess

bread and butter with red currant jelly: pericarditis, klebsiella pneumonia

caseous (cheese) necrosis: tuberculosis

Grape clusters: hydatidiform mole

Olive sign: pyloric stenosis

Main dish:

Pizza pie with onion skin: cytomegalovirus retinitis and hypertensive arteriosclerosis

Hamburger sign: uncovered vertebral articular facet

Millet: spread of tuberculosis

Dessert:

Red cherry: Tay-Sachs disease

Strawberry tongue: Kawasaki disease

Sugar coated spleen: chronic spleen serositis

Chocolate cyst: hemorrhagic ovarian cyst

Apple core: colon tumor

Banana sign with nutmeg: hypertrophic cardiomyopathy and alcoholic hepatitis

These are all signs and symptoms that are clinical language to describe the diseases mentioned. Doctors just seem to describe these clinical signs in terms of a better known entity: food. Everyone knows what bread on butter looks like. So when you see a heart with pericarditis, it's a frame of reference for something you see. But it is an unappetizing way to characterize disease.

My advice: don't have holiday dinner in the doctor's lounge.

It's Not Easy Being Green

No, I’m not talking about Kermit the Frog or even about the environment. I’m talking about medical school. Now that I am a few months from graduating (after nearly four years) I have decided that it’s never easy to be the "greenest" person in one’s profession with little knowledge and a lot of demands. The following account is really true; it is way too bizarre to have been made up.

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.

Month 42: Realize I am graduating in 6 months. Start reflecting on stories. Decide some are pretty funny, and almost certainly universal for medical students.

Month 43: Write them down. More to come.

Board and Restless

I switch my computer on, open up a webpage, stare at it blankly, and shut my laptop. I go unload the dishwasher, clean the catbox, and put away my shoes. I return to the computer, mindlessly opening it back up. With a frown, I shut it again. I open a book, then shut it. I stare at my dog. He stares back. I'm not sure what to do now.

I took my boards yesterday. I am so used to doing practice tests online, to using every spare moment to open a book and do a practice question, that I forgot what it's like to not do that. It's become a habit, a compulsion, to take free moments and turn them into study time. Now the test is over, but I feel no different than I was day before yesterday. I have to adjust to the new, test-free me. It's very disorienting.

I remember this sensation after I took my Step 1 board exams. I wandered around the house restlessly for a few days, turning my computer on and off, cleaning, hovering around my husband until he finally suggested that I go to the gym (a good idea). Eventually I settled down, into a new routine that didn't include 200 daily practice questions, each with a 2 paragraph question stem and answer choices a through j. But now I'm back to this post-board restlessness after Step 2. You think it would be relieving, to have the test over with. But with the test's completion, a significant effort in your life is over. And you are left with the residual habits and anxiety that have unknowingly become part of your daily routine, without anywhere to direct them.

I think anyone in intense academia can relate. I remember the end of my dad's dissertation, when he would dazedly relinquish the Apple Mac (high tech with a 7" screen) to a six year-old me to play Shuffle Puck and McGee. Even though he had a diploma on the wall and cap on the desk, it didn't feel right that he didn't need the computer anymore. Even to me, the house was strangely quiet without the sound of the dot-matrix printer. It had been my bedtime lullaby for as long as I could remember.

I imagine this will happen in the days following my Step 3 boards and written/oral specialty boards. Each time I'm a little more prepared for this strange inner restlessness. It's something that was new for me in medical school, yet another course in the unwritten curriculum. And on many levels it tests doctors in other ways than the questions. It asks you to devote your entire thought process to something, then leave it and be able to shift focus. The test demands all your effort, with no immediate result to show for it. It makes you think quickly, so you have time for every problem. It doesn't take excuses, only answers.

Such is the daily practice of medicine. And these lessons are probably even more valuable information than the actual questions asked.

Metamorphosis

I interviewed for medical school just about four years ago. It was my first (and only) interview, and I was desperate to get in after the long, somewhat traumatic, experience of the application process. My mom came with me, and she and my sister helped pick out my outfit. Pretty black skirt suit, pumps, white blouse, generic black briefcase, hair down, fingernails and toes painted a safe pale pink, eyeshadow carefully applied. I interviewed well, feeling like I needed to be everything they wanted. Want primary care docs? Family practice it is! Want someone bilingual? Yo Hablo! Rural, underserved medicine? Why, I wouldn't do anything different. Need someone taller? I can order heel lifts! I'll be just what you want and do anything it takes.

Everything was external to me, a force dictating my future that I had no control over. I wanted desperately to be a medical student, but didn't seem to know how to make admissions committees pay attention to me, see past my white skin and nontraditional science major and frustratingly low MCAT score to my strengths of empathy and love of medicine. My workouts during those months were hours of kickboxing, my muscles toned and body thin with the effort of trying to punch and kick myself out of this box of uncertainty and desperation.

Fast forward four years. I'm graduating from medical school in a few months, and on the interview trail for a residency position. In many respects, it's similar to applying to medical school. You prepare written statements, an online application, and visit for an interview. But for me, it was all different. I didn't fit into my old suit, my body no longer skinny from unhappy workouts stemming from a lack of contentment and control. I bought a skirt suit that skimmed my new curves, strong legs and hips from hours of happy, thoughtful running and hiking with my new dog and husband. The new suit, a dark gray with a collar that cascaded down in a gentle ruffle, felt to me to represent a little of my personality- polished, yet fun with some unexpected detail. My formerly nude nail polish was replaced by a cheerful pink plaid on my toes, peeking out from those same pumps, and my nondescript white blouse replaced by a bright blue top that turned my hair auburn and showed my personality a little bit more. The generic black briefcase wasn't there; I opted for my pink, blue, and tan patchwork Coach tote. I don't like wearing my hair down or eyeshadow, and this interview sported a dressy ponytail and clean eyes. I wasn't going into the interview as a blank slate, available to be designed into anything they wanted. I was going in dressed in things that I liked, knowing things I liked about the program and things I like about myself. The balance shifted between me needing to be a good fit for them to needing to be a good fit for each other.

So, it was a much happier interview than a few years ago. I've gained a little more style, power, knowledge, and a lot more confidence. The transformation from wanna-be student to almost-doctor was evident in these similar, but very different encounters. There's a change from a frozen, headache-inducing smile to an easy, genuine one. This is a happy metamorphosis, and one that I am proud of, for the health of both my patients and myself.

Strong Candidate!

Residency

I thought you became a doctor after graduating from medical school.

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!

Hopefully....somewhere....

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.

Life and Death

There are two givens about life. You are born, and you die. And medicine intersects these points. I prefer to be on the birth end of the graph. Being part of the process of a new life in this world is joyous and rewarding, and preferable to me over caring for the end. But obstetrics is the only specialty that traverses these two givens, that can unite them in a matter of minutes rather than years. We hear about life and death situations a lot, in terms of making a decision to save someone's life. But what if you have two lives to save?

Babies are born, and some babies die. It's terribly sad, but not unexpected. With what needs to happen for any baby to born healthy, it is truly a miracle that it ever happens. And it isn't surprising that sometimes things don't go right. More precarious is the balance of a healthy baby and unhealthy mama. I've only seen this a few times. One instance that sticks in my memory is of a young woman, twenty-five weeks pregnant, unconscious as an oscillating ventilator forced air into her swine flu-filled lungs. She couldn't get well with a parasite (baby) grabbing every extra molecule of oxygen she had. And so the decision became- do you deliver her for the possibility of saving this mom of a three year old, this wife and daughter, and risk a probable death of her baby? Do you watch her oxygen saturation decline in the presence of a happy, reactive fetal monitoring strip? Do you keep her alive for a few more weeks, using her body as a physiologic NICU incubator for her baby, and see what happens? This is what was opted for, and she was delivered two weeks later. Last I heard, her baby was doing well and she was newly pregnant again- a good ending for a tough call.

I saw another instance of this today. A young woman, exactly my age, came in to have her prenatal ultrasound. We looked at her uterus, measured her little boy, watched the happy flutter of his heart and his kicking feet. Swinging the ultrasound around for a cursory quick glance of a normal ovary revealed a large, nodular mass lined by enlarged lymph nodes. Most certainly an ovarian tumor, a highly malignant mass nestled against her growing child. Life and death, adjacent, growing silently together. Would this tumor be all this baby knew of his mother, both in the womb and growing up in her absence? Would the mother watch her baby's fluttering heart grow still as she underwent treatment in hopes of removing the cancer? Is there a chance of them both being okay, a chance for her existing daughter to keep her mother and gain a brother?

Medicine is imprecise, a collection of educated guesses from educated people, and that's the best you can do. And somewhere amid these calculated thoughts, there is a person. The nature of medicine is caring for fellow humans in times of difficulty, and it seems reasonable that the physician would grieve along with their patients. But they also need to learn to let go of the summation of patient pain to preserve themselves and their practice of medicine. It seems to be an unspoken competency in medical school, a skill untaught and hard-learned for most. A skill I am still learning, and expect to learn better in any field of medicine, especially obstetrics.

My First Baby

Here is the (long overdue) account of my first baby. Not one that I carried in my own body, but one that I cared for and delivered. The baby that changed my career as a doctor.

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.