Sometimes, There are Just No Words

There has been radio silence on this blog lately. I’ve tried writing this post several times and just can’t seem to do it.

Surgery was a very rough rotation for my family. It wasn’t just the change in schedules because a normal day was 5am to 5pm for me, with call days being 5am on call day through at least 8am the following morning. When I was home, I was exhausted. Part of the required assignments was completion of online video modules; on more than one occasion, I literally fell asleep on top of my laptop doing the modules. That is just the nature of this particular rotation–it was exhausting, but the majority of the time I was still having fun, even if I didn’t see myself going into surgery.

There are just some things that you can’t prepare for. My strategy for the surgery rotation was to keep my head down, work hard, be helpful, and move on. I didn’t think I wanted to go into surgery, but I was looking forward to the experience and learning a lot.

On the night of Memorial Day, David got a phone call. From his mom. Which wasn’t exactly unheard of, but this time things were different. My father-in-law was diagnosed with small cell lung cancer in July, and he was going downhill fast. After a couple of hours of panic at the sudden change in status, the ventilator was withdrawn. With the diagnosis, we knew there wouldn’t be much time, but we were not prepared for this so soon. This happened after midnight and I was due to get up at 4am to be in the hospital before 5am to see my patients. I still went into work that day, because 1) short notice 2) there was nothing I could do for my family as we were all in shock and 3) I deal with grief better when I am busy. That was the first time I have ever thought that I really didn’t want to spend time in the hospital on a particular day, so it was quite unlike me.  I did let my clerkship leadership know, and they did let me take off a day to comfort my family and help with the arrangements. The funeral was on my post-call day, so I didn’t need any extra time off for that. I am not the type that likes to ask for help, or likes to have special arrangements made, but this was one time that it was nice to have supervisors that were understanding. The situation put me into a mental funk that I still don’t think I have recovered from, on top of still having some guilt for missing a day of work–I totally felt like a slacker even after I made up the time and assignments.

The most difficult part, though, was being home. My father-in-law was a good man, and I loved him, but I’ve only known him for 6 years. It was much harder for David, and I didn’t feel like I was doing a good job of comforting him when I spent so much time away. This is why I feel medicine is a tough profession for families–the perception is that time away is weakness (especially in surgery). Many people have asked me how I balance being a mom, wife, and med student. Most of the time, it’s not too bad, because I get to do so many of the things that I love on a daily basis. However, there are plenty of instances where I feel like I have stretched myself too thin. This was one situation where I definitely felt like there just wasn’t enough of me, or enough time, to go around.

There were a few other things that happened during my surgery rotation that were beyond my control, and that are beyond the scope of this post, but I have learned from them and moved on. This particular rotation was Murphy’s Law for me… everything bad that could have happened, did happen, and happened at the worst possible time. I haven’t really felt much like writing/blogging since, especially about this topic. After several weeks, I am just now getting back to feeling like I know what I’m doing again, and with that, comes the need to write.

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Recent News from Our Children’s Hospital

This past month, I’ve been on elective in our children’s hospital. I’ve spent a week each in heme/onc, wards, PICU and currently, ID. I love this hospital! I love all of the good we can do for children–which is why I think I’ve always wanted to be a pediatrician. Then this article was released this week:
Children’s Hospital Separates Conjoined Twins

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My surgery rotation was very rough, and not just because of the workload and studying. David and I really needed a break and some room to breathe afterward. We didn’t even tell anyone we were going, besides our babysitters, until we were at the airport. We’d talked about visiting Moab, Utah ever since the first epic road trip. We made that trip a reality over my vacation break (the week of my birthday!), and I’m so glad we did!

Landscape Arch
Delicate Arch
Double Arch

Canyonlands National Park

This time of year is the perfect time to go out west to explore the parks. Low-hanging clouds would kiss the mountains with fresh snow overnight, but during the day it was warm enough to go hiking without putting on too many layers. We also basically had most of the parks to ourselves. On the hike up to Delicate Arch, I don’t even think we saw a dozen other people. My goal was to sit in the stillness and quietness of nature, so it was perfect.

And then of course David indulged my nerdiness and we drove by Denver’s children’s hospital. I am so lucky to have him!

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It’s the Most Wonderful Time of the Year

Guess what, friends? I am wearing my wedding band again, there is nail polish covering up dirty nails, there is a smile on my face, I get to see my family again. What does that mean!?!

Surgery is over! The intensity of ‘working’ 80+ hour weeks, 28+ hour call days/nights… it’s over. It’s done. And somehow I survived with my sanity… more or less. More on that later.

Therefore, the series I’ve been doing on evaluating rotations for possible career choices will continue, hopefully sooner rather than later now that I have slightly more free time. And for those in the States, I hope you have had a very Happy Halloween! I’m so happy that it is now the most wonderful time of the year–the holidays have started and I get more time with family! This makes me so incredibly happy after everything we’ve been through lately.

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Rotation: Bone & Joint Infectious Disease (IM Subspecialty)

Name/Location of Clinical Rotation

Internal Medicine subspecialty (2 weeks)–Bone and Joint Infectious Disease

Typical Day:

I’d arrive around 7:30am after taking the Ladybug to daycare. I’d see a few patients, write my notes, and meet up with the team at 9am to round. Rounding would take a lot of time and we’d see a fair amount of patients. Afternoons were reserved for clinic on Tuesdays and Thursdays, and sometimes we’d see patients til 4:30-5pm or later. Other days, I’d get to leave for the day once all the work was done, sometimes as early as 2:30pm. Since I was on Infectious Disease, there were plenty of cultures being sent, so I got to go down to the microbiology lab to look at slides and have them read. I also really liked my team. Sometimes I’d get to go with the pharmacy students to presentations and journal clubs, and I even got to share some of my micro/immuno Step 1 mnemonics to help them as they studied, too. It was nice to teach for a bit, while also learning something new.

What did I like most about this specialty?

We actually got to see a lot of cool pathology. Burns and traumas were interspersed among our diabetic foot ulcers and pneumonias. I really liked working with the adults we saw on this service; they seemed to really like having a med student to talk to, so that was fun. (And then sometimes, on my way into the hospital, I would run into my patient outside, smoking, and I’d say, “Hey, I’m going to see you soon in your room, ok?” Sometimes that would work to get them back inside.) ;)

What did I like least about this specialty?

Sometimes I felt like the work was a bit too repetitive…. Vanc/Zosyn for everyone!  (Or at least, that’s how it felt some of the time.)

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I’m not really sure; we saw inpatients and we also had clinic, so I felt like I saw a good mix of patients.

Did my interests, values, skills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

Yes. This was another service where I felt like it was valuable for me to sit and talk to patients after my work was done. I enjoyed the patients, the learning, and getting to be useful.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

I’m thinking that I really want to work in a hospital long-term, so knowing that I could do that in this subspecialty felt like a “fit” for me.

What info do I still need?

I’d still like to get more experience with other rotations to give this one a fair comparison.

Has my perception of this specialty changed? If yes, how?

Around this time, I felt like I hit my stride with adult patients. I was learning to take better H&Ps on this service than on Cardiology (on Cardio, we basically just cared about heart/lung issues) where on this service, I got a lot more practice taking full histories (especially on clinic days with brand-new patients!). I’ve thought about Infectious Disease before (because chasing down rare illnesses like Ebola sounds like fun straight out of The Hot Zone, right?), so it was fun getting to actually see what it was like.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

I actually enjoyed this rotation more than I thought that I would, so it’s still on the radar for the future.

Right now, how interested am I in this specialty?

Maybe a 7. It’s still Internal Medicine, and I’m still excited to see other specialtes, but I can say that I definitely enjoyed my time here.

What information do I still need to evaluate this specialty? Any other comments or reflections?

As a part of this team, we got to work with a small group of pharmacists and pharmacy students, which I hadn’t seen used elsewhere, but made a great addition to the team. We also had clinic twice each week, once for the HIV clinic and one for the Bone and Joint clinic. Both were a lot of fun. I actually really liked getting to go to the clinics. I got to help out with interviewing the patients and performing physical exams, changing dressings, answering questions, reassuring worried patients, etc. (Have I mentioned that I really enjoyed clinic days?!)

Pro tip–keep a roll of tape with you, because you’ll be putting dressings on a lot of joints and it saves time. The attendings love you if you do this one small thing to be helpful–yay, efficiency!

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Rotation: Cardiology (Internal Medicine Subspecialty)

This is the first post of many this year that I’m using to evaluate the different third year core rotations every student gets to experience. I’m using the AAMC Careers in Medicine clinical rotation evaluation form to track what I thought about each rotation and elective during 3rd year as I figure out what specialty I’ll be applying to a year from now (!!!). Even though I am fairly certain I want to be a pediatrician, I still want to give each rotation a fair shot and experience as much of medicine as a whole as I can before I officially choose.

Name/Location of Clinical Rotation

Internal Medicine subspecialty: Cardiology (2 weeks) at the VA

What did I like most about this specialty?

I didn’t really know what to make of this specialty at first, since it was at the VA hospital (I’d never been there before) and it was my very first experience as a third year medical student. I was pretty bummed at the beginning because there was no possibility of seeing any kids on this rotation, but I was pleasantly surprised how well I fell into the team and taking care of this particular patient population. I really enjoyed working with this patients and seeing the pathologies in the realm of cardiology.

What did I like least about this specialty?

Honestly? No kiddos… Other than that? Not much, really. I liked listening for murmurs, checking out echo results, and observing catheterizations in the cath lab.

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I think so. We got a good mix of emergency cases and inpatient cases to keep me busy and on my toes. I found that I really liked working in the hospital enviornment, even though I didn’t get to see what outpatient, private practice cardiology looked like.

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

I really enjoyed getting to spend time with my patients and their families. Since we were at the VA, many of the patients would share their stories with me, which I loved. I really value that time getting to know my patients on a deeper level.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

I really like working in a hospital setting, so I don’t feel like being in private practice would have interested me as much, given what all I saw on the hospital floor.

What info do I still need?

Since this was my first two weeks of third year, I still think I need a lot more time exploring Internal Medicine as a whole before choosing it and then pursuing a fellowship… if I thought that was something I’d like to do in the future.

Has my perception of this specialty changed? If yes, how?

Yes–I didn’t think that I would enjoy it as much as I did, so I was really glad that I got put here for my first rotation.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

I definitely view this specialty/subspecialty more favorably now that I’ve gotten to see how things are done first hand. It also gave me a sense of how the physicians spent their time on the job and at home.

Right now, how interested am I in this specialty?

On a scale of 1-10, probably a 6. But I feel like I’m maybe downplaying how much I like it since I haven’t seen anything else to compare it to yet.

What information do I still need to evaluate this specialty? Any other comments or reflections?

Things I did not realize or other fun things we got to do: One day my classmates and I missed some of our weekly lectures because that morning we had someone come into the emergency department in the middle of having a massive myocardial infarction (heart attack) and we got to see him from admission to the cath lab and saw the placing of the stents to open up his coronary arteries. It was pretty amazing and exciting (and bonus–he lived!).

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So you may have noticed that for awhile, nearly all of my posts were about the dreaded Step 1 exam that second year medical students generally have to take (and pass) before continuing on to third year.

This year, all medical students on rotations were to have off on Wednesday, July 8th, because that was the day that Step 1 scores were released. If someone were to fail the exam, they would need to meet with Student Affairs to discuss their next steps. The administration wouldn’t want to “out” someone who failed by having them leave the wards in the middle of the workday, so we just had a free day.

The night before our scores were to come out, I told myself that I would have a great day, and to not check my phone for emails all the time–that everything was going to be just fine. Which was fine until 1am when I woke up in a panic thinking what if I failed? After that, sleeping well was no longer an option. I tried to reassure myself that it would all be ok, that I had passed every practice test that I had taken, that my personal value was not based on the score I received on this one exam. I avoided logging into my NBME site until around 8am.

And that’s when the madness started. I opened my laptop the same way I always do, but this time I was greeted with a gray screen featuring a file folder with a question mark on it. The first thing I did was to call my husband, since he knows all things Apple, and I was hoping he’d be able to tell me a quick fix to get my laptop back to normal on this super-important day. I tried all of his suggestions. Nothing worked. Rebooting/restarting/every tip and trick he could think of or find online simply did not work, and I was really in a state of panic. Of course it just HAD to be this day, this one important day that I’ve been waiting for for well over a year! 

At 10:59am, my phone dinged with an email that read (more or less): your score will be available at 11am. Since my laptop was kaput, I tried using my phone to access the system… Nope. Too much traffic on the site, nothing would load. I called the local Apple store to see about when I could schedule an appointment to have them fix whatever this glitch was. Unfortunately, the only appointments they had open were several days later, so I gave the local store a call and the manager said to bring it in anyway.

Thank goodness for AppleCare. They were able to fix my laptop the same day and it was free of charge and only cost me two trips to the east end. The panic of getting my score back faded as I realized just how much information I stored on my laptop that I didn’t have backed up to a secondary source… not just info for school but also my own projects and research.

After two trips to the nearest Apple store in one day, I had my laptop back and all of my data had been salvaged. When I finally got a chance to check out my Step 1 score, it felt so anti-climatic. I had passed. All of that worrying, all of that panic, was for naught. A year’s worth of worrying, studying, overthinking, etc…. and what I learned was, as my husband always tells me, no matter the outcome, it’ll be okay.

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Resources for M1

With so many medical schools starting classes within the next few weeks, I thought I’d reblog some tips I had for last year’s incoming MS1s before I publish some tips for MS2s. This is what worked best for me, after lots of trial and error; pick and choose what is best for you. I know med school is stressful and there will always be a gunner or two, but the goal of your training should be to become a competent physician, and not to ace every exam. Good luck to all the incoming first years!

We don’t technically have a book list or a website that lists the books, because most people don’t use them. I’d imagine that most schools are like that, at least for the first year. Our profs’ notes are generally pretty good, so even though they may say that some books are “required” in the syllabi, it’s not necessary to have them to do well in the courses.

With that being said, there were several books that I used in this past year that I thought were really helpful.

-Everyone will say to get a Netter’s Atlas. It’s pretty much the gold standard, but one of the authors is actually our main professor so if there’s something in Netter’s that you don’t understand, she’s an incredible resource.
-They recommend a Grant’s Dissector–don’t buy it. There will be a group copy in the anatomy lab, but it’s not especially helpful for studying in class, and I didn’t find it very useful for lab either, because your instructor for the day will tell you how to go about the dissection, which is usually a bit different from Grant’s.
-I cannot recommend Rohen’s Color Atlas of Anatomy enough. It’s a compilation of pictures from expert dissections so you can see the same structures from many perspectives. I hated staying long hours in the lab, so this source was invaluable.
BRS Anatomy was a great resource for practice questions; highly recommended.

I bought the High-Yield Embryo book and it was the only resource I needed besides the class notes.

-You’ll need a Sidman’s and Sidman’s at our school (one of our profs is also an author) which is a self-study workbook. Hold off on buying it though, since your MS2 mentor may give you theirs (I’m giving mine to my MS1).
-I used the High-Yield Neuroanatomy and that’s all I needed besides the notes.

Dr. K suggests Bates’ Guide to Physical Examination, which I’ve heard that most schools suggest, but I don’t think anyone used it. I didn’t.

-I don’t think many people bought/used an outside book, but I did. The one suggested by our profs was Ross and Pawlina’s Histology, and I thought it was really helpful. I did extremely well on the exams because I’d used more than just the slides provided in class, so I thought it was worth it. I only bought it in the beginning because I found it for dirt cheap on Amazon.

Biostats (Incorporated into ICM):
High Yield Biostats was definitely worth it since our biostats is a self-study model.

BRS Biochem for practice questions was helpful.

-Personally, this was the hardest class for me, so I felt like I needed a little extra help. I bought the Medical Physiology book they recommended and used it for practice questions and clarifying things I had a bit of trouble understanding.
BRS Physiology was also great for practice questions.
-PreTest Physiology was also great, but I borrowed a copy from the Student Affairs office.

I also had a copy of First Aid (came with my AMA membership for free) that I used to review before exams.

That is all that I can think of. Books aren’t really necessary (except for Anatomy), but I do think the books I used to supplement my lecture notes definitely helped me to succeed this year.

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The Correct Answers

“Have you ever seen….. ?”  NO

“Do you want to see…. / Do you want to do….” YES

Just do it! You’ll get to do and learn so much more if you stay open to all options. Even if you’re tired. Even if you’re bored. Even if you’ve seen/done whatever it is already. Even if it’s the end of a call day and all you really want to do it go home.

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Full Disclosure

I love being a mom in med school. It’s not easy. Lots of people have told me that they are proud of me for making all of these facets of my life work together so smoothly. But that’s not always the case…. far from it. So here’s my full disclosure.

Yesterday, our little Ladybug got sick at daycare. Kids get sick, not a big deal, right?

Since third year has started, I’ve had a really hard time balancing working + studying + “me” time + husband time + baby time + family time….. a really hard time. I’m behind in studying. I’m behind in UWorld questions. We still aren’t fully unpacked yet. I have a mountain of stuff to donate/sell/trash since we are downsizing (basically because I don’t want to move all of this stuff again when we move for residency). And no energy to do any of those things once I get home. It doesn’t help that we won’t have wifi until this coming weekend–and I wasn’t going to watch a 3 hour Tegrity over how to work AllScripts over my phone’s hotspot. All of these things have been weighing on me, even if I haven’t really been thinking about it.

Yesterday after getting out of my rotation, I really wanted to knock out some work and catch up a bit. So naturally, the Ladybug got sick. When we got home, we cuddled on the couch. And we watched Despicable Me 2 for the millionth time (it’s her favorite movie… she adores the Minions). My plans were derailed, I was disappointed that I couldn’t get much done, but everything was just fine.

Today we also had clinic after seeing our inpatients, so I got home a lot later than I usually have so far into this rotation. The Ladybug is still having belly issues so she is taking a nap. My first thought: I should study! My second thought: I could take a nap! My third thought: I could veg out and watch a movie and do whatever I want to do!

What really happens? A mix of things. Last night I held her while the movie played, and I read a few cases out of Case Files: Internal Medicine. Once she finally went to sleep, I spent the night in her room on the inflatable bed (not my favorite way to sleep, but she needed me and I wanted to be close)–I had no more energy to study, and I could barely keep my eyes open. We ran late this morning getting to daycare but I still managed to preround and be prepared for work rounds with my attending (who forgot to tell me we also had clinic this afternoon). She had a good day at daycare, didn’t eat much, and fell asleep on the way home.

Now, I am using my ten minutes of “me” time to write this blog post while I eat dinner. I hope to get a few cases knocked out before Ladybug’s nap is over, because I know she will want more cuddle time (totally fine by me!). I feel like a bad student because I am so far behind in my goals for studying and knocking out cases, but my daughter needed me and of course I was going to be there for her.

There are a lot of times where I feel like I’m not good at anything…. that I’m not a good mom, a good wife, med student, etc. It probably happens at least once a day. I still have not prepped freezer meals so I can enjoy family time when I get home. I still have yet to make it to the gym this week. Last year, I was almost sick over whether or not I should take a leave of absence for the first year of my daughter’s life because I didn’t think I could handle everything, all at once, and still be functional and sane. Personally, I feel like I would be a happier, better person/friend/wife/mom if I could get a 5 minute neck and foot rub every day. However, I am so glad that I didn’t postpone my education for a year, and I am ever so thankful that we decided to try for a family three years before we had originally thought. She’s made life so much fuller and richer in ways I had never expected–I really thought that when people told me how much babies change your life was just a bunch of blah, blah, blah…. but they were right. It isn’t always rosy, but most of the time it is pretty fun. I doubt myself all of the time. I don’t have my life put in order, not at all. But it’s a pretty happy life, even if I am behind in studying.

My ten minutes are up…. Back to working cases.

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