Intern Year so Far

My first rotation of intern year was inpatient pulmonology. My very first day was on “short call”, meaning that I was on call til 9pm accepting admissions (and could stay til 11pm finishing up notes). Plus it was a weekend, which meant I was cross-covering two other services until handing off to the night team. I was terrified. I started out the morning by introducing myself to the nurses: “Hi, I’m Dr. Allie, and I’m a brand-new intern. I have no idea what I’m doing. Where are the stairs? Where can I find this room number? Where do I put my used isolation gowns?”

Pulmonology was really interesting. It took awhile, but I became more comfortable with taking care of common illnesses like asthma, bronchiolitis, and Cystic Fibrosis as a doctor, instead of a med student, or someone on the sidelines.

I wanted so badly to make a good first impression that I think what I actually did was more self-sabotage than anything else. Double-checking everything because I didn’t want to make a mistake made me slow. But, by asking questions I started to learn how to do things, got acquainted with our EMR system, and quickly fell into a routine.

Without a doubt, though, the best part so far has been getting to know my co-interns, senior residents, and the attendings here. I’ve made so many more friends and it feels like I have known them all much longer than the few months I’ve been here.

This was also my first month teaching med students as a resident. When you spend your days feeling like an idiot every single minute, it starts to feel like you have nothing to offer. As I started out in residency that first month, I felt like I was barely keeping afloat. After a couple of weeks, I was much more comfortable in my role, and began dedicating more time to guiding the med students. These were med students on their first-ever clinical rotation, and it didn’t take long to feel like, “actually, there IS something I can teach you!”

School may be out, but that doesn’t mean the learning (or re-learning) ends. I’m the type that learns through reading, and my med student habits have stuck with me, so I try to always carry something to read. Many of my days look like this:


There’s still time for fun. One thing I love about my program is their dedication to wellness. Once each block or so, my program sponsors Riley Rounds, fun outings for residents (and their families!). The first one was to an Indians baseball game, and the second was at a restaurant that also hosted games. One day in the lawn between hospitals they set up an inflatable obstacle course just for residents (plus Sno Cones)! We work hard but we definitely play harder!

So far, I am really enjoying residency, even when I feel like I’ve been an inadequate idiot all day. I’m slowly learning that it is ok to stick to my gut, speak with more confidence, and say NO. One of my interviewers last year said that “putting on the doctor pants” is a difficult thing to do, but if I chose a program that supported me in ways that I needed, it wouldn’t be as difficult as it could be. I’m only a few months in so far, but I am so glad I chose this program (and that they chose me)!

To see more frequent posts and snippets about my days as a pediatric intern, follow me on Instagram @pagingdrallie

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Long Time No See

The last time I posted, I had just found out that I matched into one of the programs on my Rank Order List for a residency in pediatrics, accomplishing a goal I’ve had since I was 14.


It has been such a long time since then, and I haven’t written about it. After Match Day, there was so much to do, and it felt like we had no time. It all went by so quickly.

We immediately went on the hunt for a house. On one Saturday, we toured 19 properties, put in an offer, and bought our first home.


My brother got married with my Ladybug as the flower girl:


I finished my final med school rotation in the NICU, which I absolutely loved.


We had to find a new daycare and it completely broke my heart to leave the one we’d used since the Ladybug was 8 weeks old.

I GRADUATED!


We took a family vacation to Key West, FL, Dry Tortugas National Park, and Savannah, GA.


We spent two weekends painting the house and moving in, with the help of the best family and friends.

Then the fun started. Mountains of paperwork and training and licensing and certifications before even starting orientation.

And now they call me Doctor. Paging Dr. Allie. It is real, and no longer a fantasy or far off in the future. It doesn’t feel like it at all. I’m currently on my second rotation, which means I have “survived” July of intern year, but not without rubbing one of the children’s hospital’s ladybugs for luck on my first day.

Frustration

My medical school is in a city at a boundary between two states. I live in the state opposite my school’s city. Because of this, there are lots of instances, especially in healthcare, where there are notable differences between the types of health services and execution of policies between the two states. I love my home state. I don’t agree with all of the laws and policies, but I love my home state. I don’t agree with all of the laws and policies of my school’s state either, but we have to function in a way that serves patients from both states well.

I am currently on child psychiatry and let me tell you… oh my goodness, the systemic problems are rampant. There isn’t a single child that we have had that hasn’t had at least one major problem/difficulty/delay in some form or another. These kids have some serious issues, and mostly not due to their own fault. It is so frustrating trying to get these kids the assistance they need when we repeatedly run into obstacle after obstacle. Psych is, by far, the singular specialty I have experienced that has this volume of barriers. It is unbelievably frustrating to have to hear each morning what new barriers we are waiting to overcome to give our patients the help they need.

To top things off, I overheard my attending this morning talking about the poor state of care patients from my state receive if they have the Medicaid my state offers. How my state is known for simply “not caring” about these people at all. That he is frustrated with his home state’s methodology for caring for patients, but that my home state is, despicably, even worse. It is enraging. I am so disappointed in my home state.

Disappointment isn’t enough. I want to do better for the people of my state, and every state, that has these sorts of issues. These issues are a systematic problem. There must be a way to fix these problems. That is not to say that the problems will be easy or fix, or that one particular group is responsible for the issues as a whole. As a medical student, I feel like not much that I do from day to day really matters, because at this point in my career my job is simply to learn so that I can be a great physician once I start practicing. I have a hard time accepting that I am not in a position that can make much change at this point. I have seen student-led groups reach amazing conclusions when they assemble for a common cause.

One person can’t do much alone. But if a group of passionate people with a cause work together to effect positive change…. THAT is what it is going to take to make these problems become less of a burden for the patients that depend upon the system to work for them. I want to start now. Not after I walk across the stage to get my diploma, not a decade later when I’m finally an attending, but now.

So, dear friends and readers…. how do we begin to tackle a systemic problem? How do we get those in power to care enough to be called to action? It is hard for me to see where all of the real obstacles are. These things, though, are immanently important.

HEART Article

I just have to share this article. It’s very well written, but totally heartbreaking. I can’t imagine being a parent and having to go through that with my child. It also shows that even if you’re a physician, when it’s your child, there are things you don’t know and need to turn to others for help.


http://www.nejm.org/doi/full/10.1056/NEJMp1312171

A Dream Realized

This is the beginning of a new adventure.

I was the kid who was excited to get home and check the mailbox to see if the latest issue of National Geographic had arrived.

The best week of the summer, for me, was Shark Week on the Discovery Channel.

I spent my summers chasing butterflies in the field behind our house, completely covered in chiggers, to put them in a bug box for observation while I looked up their Latin genus and species names.

I was the girl forever lost in a book.

Being the “smart kid” in a small town school is an occupational hazard. Classmates hate you when you are singled out as the “smart kid.” Teachers don’t seem to realize the damage they are doing when they praise some but not all. It makes me cringe when I see or hear it, because I know what the backlash is like as a kid.

Junior high and high school were no better. I’d say the fear of what my classmates would say or do to me was a major factor in my introverted personality that I still struggle with. Because, when an acquaintance in your class tells you to your face that he has always hated you because the teachers like you…. Well, I remember the smile that fell off my face, and I remember asking for independent study immediately after class, and spanned all four years. I withdrew within myself because I felt threatened. My senior year was the loneliest; I had one class, out of eight, with classmates.

High school was no place for me.

The teachers were wonderful, but they had to spend too much of their time babysitting certain kids to be any benefit to me. Independent study was a dream come true. I could work at my own pace to focus on my own goals. In my spare time, I edited copy for the yearbook and newsletter, as well as took on editorial positions with the literary magazine because writing was an escape for me. I would walk the hallways looking at the floor and making eye contact while talking to anyone was difficult if not painful. This is why I turned to writing; I can do it entirely on my own. I had been offered the opportunity to advance a year or two, but I declined for personal reasons. At the time, I thought that was the best decision.

Maybe I was wrong.

If I learned anything from these experiences, it was humility.

I am a very goal-oriented person. Once I made a goal chart out of colored construction paper– I would write out individual goals on paper squares and stick them to the board. Every time I achieved one, I’d take down the square and replace it with a new goal. Some were small (“understand calculus”), others a bit bigger (“graduate valedictorian”)… And some fairly lofty (“full ride to college”). Most if not all of these were achieved. I never told anyone about my goals, or my chart. I even hid the chart from my parents.

So what does that have to do with humility? When others–usually the adults, the teachers, at the time–would be happy and congratulate me, it made my life harder to live. (Of course, they never meant it that way.) When classmates and peers looked at me with glares intending for me to burst into flames, it’s impossible to be happy about my achievements. So instead, I’d keep my mouth shut. Silence seemed to be the better answer. I was known for being “quiet”, to a fault. To avoid the glares, I’d keep my nose in books.

College was such a huge relief.

Intelligence and achievement were celebrated. Talents were showcased. I was no longer an anomaly, an outlier. I could be happy in public. I could talk about the good things in my life.

But it is still hard to share my joys, even after all these years.

I know, for a fact, that there were people who giggled with joy when I didn’t get into med school the first time. I know that there are people who think I always have things “handed to me.” Because, of course, I haven’t earned anything through hard work or perseverance, right?

I am tired of hiding my joys because some people are either jealous or pessimistic, or whatever else.

Not much has changed, really. While I am not as introverted as I used to be, the people I connect with best at school are still the professors, even now. I have no idea how to explain that.

And, I am still keeping track of my goals.

For instance, today, a longtime dream came true.

My heart has been drawn to medical missions for as long as I can remember, but there has always been a barrier of some sort, either time or skills or money. Or all three.

One of the privileges of being a medical student is that you are encouraged to use your skills for the underserved. My school offers several opportunities for students to go abroad during the summer after MS1 to serve on medical missions. There was one in particular that I have had my eye on.

I’ve written before about Timmy Global Health. I love this organization and what it stands for–working with the Ministry of Health of the country to provide sustainable access to care for underserved populations. After dreaming for years to be a part of this organization, I was anxious for the opportunity to apply for one of the 20 spots to go to Ecuador next summer.

And then I heard how many of my classmates applied. For 20 spots, I heard rumors of 40, 50, or 60 applicants. So, I knew my dream may just remain a dream. But I applied anyway, prepped for the interview, and put it in God’s hands.

I cried tears of joy when I got the congratulatory email.

And of course, I wanted to share. I wanted to know who else in my class was going with me. I told my husband, my parents, and my closest friends. But at the same time, I was sad and didn’t want to share the news, because of how many people I knew were probably disappointed, and I didn’t want to rub my good fortune in their faces. Salt in the wound hurts all.

In this day and age, oversharing is the norm via Facebook, Twitter, whatever. We share what we ate for lunch (and where, with pictures, check-in’s, etc), vacations, how much work sucks… and my favorite (sarcasm), parents who share their children’s every bowel movement. It’s not just what we share, but how. The new term I overheard the other day was “the humblebrag”, bragging while trying and usually failing to sound humble. There have been so many articles and papers and blog posts about how these outlets for sharing hone our abilities to just post our “highlight reel” for the world to see, and so they are lies, mostly by omission. So, for instance, “I made this awesome dinner!” but leaving out the “I burnt it the first three times.” I’ve even read articles about how reading others’ highlight reels makes us feel depressed and inadequate. In my experience, it’s totally true! Someone else is having a great time doing X. I wish I was too. So I am immediately ungrateful for all the things in my life that are great, because I am falling into the trap of comparison. “Comparison is the thief of joy,” as the adage goes.

And so, I am sharing my good news anyway–I am so very excited that a dream is becoming reality, that a Bucket List item can be checked off next summer, that my head, hands, and heart can be used to help someone else. I hope that those not selected for this trip are selected for the other trips our school offers to Kenya, Brazil, or Thailand.

Ecuador. South America. The Amazon Basin. Galapagos. Straddling the Equator. Getting to use my Spanish skills. Actually using my newly-acquired clinical skills. New people to meet and communicate with. New problems to solve. So many new things to learn and experience on this adventure. I can’t wait!

But for now… back to studying the pelvis, the bane of my existence as a medical student.

Pimped

I need to quit saying that the week was killer, because the following week is always worse….

But, it’s over. Over, over, over. Thank you, God.

I really didn’t mind that my boss volunteered me for more work in another lab. It’s nice knowing that both PIs think I do quality work. But when T came to me with 18 fresh samples on the week we had scheduled 40 surgeries, I was not the happiest of campers.

It took me four hours just to homogenize the damn things. And that is only step 1. My boss walked in during the middle of my procedure, saw the obscene amount of tubes I had labeled (and probably noticed the displeased look on my face), and asked, “So… How many samples….?” When I said 18, all he could say was, “Oh. He didn’t tell me that. That’s ridiculous!”

It was a lot of work. I was frazzled. But, it got done, on time, with finesse.

And, all 40 surgeries, my most in one week to date, all went well.

That was in July, and that is what I miss now, two months into med school. I miss feeling like I can knock out anything with ease and have hard-and-fast evidence that I can rock a lab. I miss being in charge. I miss being able to learn real-world stuff that I can use immediately–and it’s not simply book-learnin’. I really, really miss a regular paycheck. I definitely miss my coworkers.

I checked our class calendar the other day to see what the spring semester looked like when it hit me that this is how it is now. It’s not going to get easier. It’s like being under a waterfall every day, it just keeps coming. And after the this year comes a harder second year. And then Boards. And then third year on the wards, being pimped in a different way. And then fourth year rotations and interviews and the submission of a rank list that will determine where I get my first job. And then intern year. And then more years of residency. And then maybe a fellowship–another 3 years. Maybe eventually I’ll be an attending.

It just keeps coming.

So today I found myself thinking how easy it would be to go back to the old job. I would still fit right in, I could still be that productive, I haven’t forgotten how to do everything in the lab yet. But I’d be giving up all of these new and exciting opportunities that come with having the basic tagline medical student. And I don’t think anyone could pry me away from medicine now.

In my “free time” (AKA when I am home and studying), I’ve had on marathons of Grey’s Anatomy. As much as I have enjoyed this show since high school, I love it even more now. Now, I understand things like “blue tet”, teratomas, esophageal varices, congenital diaphragmatic hernia, ascites from cirrhosis… the list goes on. And I LOVE it, being able to know not only what they mean but where they come from and why and how to fix them. I can only imagine how much more there is to learn and how much more I will understand once I learn it.

There is no going back now.

On Compassion in Medicine

After our exams this week, the last two days have been easy, with medical ethics-type lectures (which of course I totally geeked out to, especially since two of my favorite professors from grad school were guest lecturers), so compassion in medicine has been on my mind, and finally publishing this draft seemed appropriate. So here it is, tense left unchanged:

One of the blogs I read with some frequency (since I’m not in school yet and therefore still have what resembles a life and free time), is called “I’m 25 and My Boobs are Trying to Kill Me.” The author is a brave, witty life enthusiast who writes beautifully and sees the meaning in everyday life now that she is in remission from breast cancer. Having previously worked in breast cancer research, her story stuck with me because of how personal it was, in her own words as she was going through the experience of chemo. Her most recent post made me stop to think a bit about patient dignity.

You can read one of her latest posts here.

So, as a doctor, someday I’ll prescribe drugs or therapies in order to save someone, or at least bring his or her experience back to baseline. Most of the time when I do this, I will not have gone through it myself. I’ve never had cancer, so I don’t know what the experience of chemotherapy is like. Sure, I can read that I’d lose my hair and be nauseated with frequency, but I do not know what that experience is like firsthand. Reading this blog has guided my thinking about what patient care, and good patient care, really is. It’s not just good enough to nail down the diagnosis and prescribe the drug. In my mind, anyway, there needs to be something more.

She had her dignity. Her confidence. Those around her either destroyed it or built it up. How many of us take for granted those little things that make us feel like ourselves? She talks about how seeing the Gollum in the mirror when she expects a head full of long, brunette curls affects the way she views herself, and even more than that: she didn’t want other people to have memories of her as a bald woman. It speaks to how much she has lost her sense of self due to her illness. Realizing how the illness affects the person’s normal, day-to-day life outside of the clinic/hospital. It involves seeing them as a whole person. I am completely convinced that medical personal narratives can do wonders for patient peace of mind as well as give insight to physicians about how a patient can be better treated. Competently demonstrating compassion in a clinical setting is a complicated thing to do. What if one of her physicians would have asked her about how she felt now, in remission, even without her hair? Would she have felt better about her self (and herself) if the focus was put on how she was handling life outside the clinic, instead of her status as a cancer patient?

The term “holistic” gets thrown around a lot in the healthcare sphere these days. Whenever I read comments on how doctors think they treat patients holistically, I have to chuckle just a bit. Treating a patient as a whole person goes above and beyond calling a patient Mr./Ms. so-and-so instead of “the case of X in room 215.” I remember in grad school talking about caring for a person’s narrative in Narrative Ethics and Caring in The Ethics of Care. “Of course I see my patient as a whole person and not just a disease!” they say. Oh, really? We had cases on a regular basis… they would just roll in, endlessly. Many cases were brought to a bioethics committee’s attention, but more often than not, they never made it that far. There are plenty of opportunities for finding ways to change medicine that do not necessarily revolve around cost-containnment, new drugs, illness management, or the like. Establishing a relationship for the patient and physician is of the utmost importance, but many that I have encountered who plan on going into medicine seem to brush it off, which I feel is just incrediblely sad and a disservice to our future patients.

I think I just wrote a manifesto. It was not my intention, but that is where my mind wandered.

I hope I do not forget this as med school progresses.