The White Coat Files

You can hold the heart

2012-02-12T23:39:00.001-06:00

7AM. Wake up. Snooze the alarm.
7:30. Get up. Breakfast. Start studying.
8:55. Text from the attending. Oh yeah, we're on call this weekend. Patient in the ER. Possible appendicitis.
9:15. Arrive at hospital. Start seeing patient. Agree with presumed diagnosis.
9:50. Attending arrives. We discuss. Post the case for the OR.
11:30. Finish surgery. Save this one for the record books. Got to staple the appendix and remove it. Didn't feel like a total idiot using laporoscopic instruments.
12PM. Lunch. Burger and fries. Ignore plaque build-up. Start laundry.
1PM. Get another call. Second patient needs an operation today. Change back into scrubs, head to hospital. Scrub. Learn. Repeat. (seriously, a third patient gets posted as we enter the OR for the 2nd case of the day.)

In the meantime, learn that a CT surgeon has a CABG (bipass) surgery for this evening. Ask to observe, permission granted.

6PM. Enter Heart Room. Team agrees that I'll probably be asked to scrub. Because they need someone to hold the heart while the grafting is sutured. I ask if they are serious. They insist they are.
6:30-10. Bear witness to a chest being opened, lungs and heart visualized, heart-lung machine set up, and vein grafts prepared. Watch as the heart slows and then stops with the administration of KCl and cold water. Let my hand be guided and shown where to hold so that the bipasses can be performed. Learn about the heart-lung machine. See the heart beat again on its own. Cringe as the wire and large needles bring the chest wall back together.
10:30. Finally leave the OR, my own heart pumping with adrenaline.

Being in medicine is a privilege and an honor. Was it only 2 years ago that I wrote this post about my first encounter with the heart?

55 more words*

2012-02-11T09:46:00.002-06:00

Things come in threes. Good, bad, in threes they come. I’drather the deaths of young women not be these threes.

One, blogger friend of a blogger I follow. Another, friend of a friend. And lastly, inevitably, a patient who's body is done.

Lesson? Say ‘I love you’ and pray ‘thank you’ every single day.

*I've adopted this study in fitting my experiences into 55 word snippets. You can find others here and here.

Women in Medicine

2012-02-04T08:24:00.000-06:00

This past week I joined a new service for surgery. It's another private practice group, who seems to mostly to elective surgeries to remove gallbladders and repair hernias. It's very relaxing after working my tail off in January.

So now I have time to read and study. And I'm trying to do just that. But wouldn't you know, in the Sabiston text on Surgery, there is a section on Women in Surgery in the History of Surgery part. And ALL of the women listed worked to become prominent OB/GYNs in the 1800s. And then I found the NIH's site Celebrating America's Women Physicians. Almost all of the women in my surgery text have pages on there: Dr. Anna Elizabeth Broomall, Dr. Emiline Horton Cleveland, and Dr. Mary Amanda Dixon Jones.

I do have a few months left before I really have to decide what directing my career takes after medical school. But I've been thinking about that A LOT lately. I'm enjoying being in the OR.... but. I don't think I want to be the 'come to the rescue' type surgeon in an emergency, nor the referral from someone's family doc. I don't think I want to set myself up for lots of LONG surgeries.

Becoming an OB/GYN is kind of at the top of my list right now. In theory, this field answers all of my desires for what I want my day-to-day life and life over the years to look like. I will get the personal and long lasting relationships with my patients like primary care docs. But I'll also get to share their most exciting (or heart-wrenching, I know) months and days leading up to and in the delivery room. And when they require surgical intervention for gynecological problems, I can answer 'I can do that for you.'

I'd be lying if I said I wasn't worried about the challenge of an OB/GYN residency (surgical sub-specialty after all) or what my hours might be like for years and years to come. Topics like birth control and sterilization are becoming more politicized by the day, and I have my faith, my conscious, and the needs of my patients to wrestle with. As much as I want to be an awesome doctor, I also want to be an awesome wife and mother, sister and daughter and friend.

But if I've learned anything in the past 9 months, it's that I'm tough, capable of hard work, and, given time and experience, believe I have it in me to be a great physician. Could OB/GYN be the field that makes me happy to get up and go to work and allows me to come home happy to my family? If that's the case, all the annoyances might fade into the background.

Cheers!

June 1894 graduating class of the New York Medical College and Hospital for Women.

Wednesday

2012-01-25T22:55:00.001-06:00

Forgive me if I ramble. I'm home after another 15+ hour day. Nothing particularly exceptional about it. Patients to see. Orders to be written. Chest X-Rays to follow up on. Surgeries to do. Learning something in each and every minute, but not all of it in the textbooks.

And yet. What does it really take to make a day exceptional?

Surgery is a unique field. The OR is no place for secrets or modesty. We see more of patients than anyone other than parents and lovers. And that's before we start cutting. We see and touch parts of patient's bodies that are theirs, yet they'll never see or touch them or know them. I'm constantly reminded that we're all made up of the same stuff- bones and muscles and nerves and vessels. Stuff that can be precociously delicate and fragile but also resilient and unrelenting in its sole purpose of staying alive.

As a part of the surgery team, I am invited to stand witness to the intimate undertakings in the OR. And I'm also privy to information that will impact patient's lives forever. I was wrong to think Heme/Onc holds all the cards for bad news delivery. I personally have been the first person to read and process pathology reports for new cancer diagnoses. I've seen our pre-op suspicions proven false only to be replaced by more serious post-op diagnoses.To see the fear of the unknown and the realization of mortality in the eyes of men 50 years my senior is nothing but humbling.

In my 4 weeks of General Surgery, I haven't shed a tear. Not over accidents with fire involving children. Not with careless and hazardous gun shot wound victims. Not when MY patients took a turn for the worse in front of my eyes in the OR and earned a spot in the ICU while I sat helplessly by. Until tonight.

Tonight I did my own evening rounds as I put my signed progress notes in the charts, having missed formal rounds earlier in the evening. It's been one of the best decisions of these last 4 weeks. In mere minutes, I connected with my patients in a way that is new and challenging and humbling and good. It was incredible to hear the words spilling out of my mouth as I explained the days events and tomorrow's plan to one patient. I spoke with more confidence and medical knowledge than I sometimes believe I possess. To look a man square in the face, eye to eye, and just be there with him as he explains the hurt of learning he has cancer. To hold their hands, to attempt a moment of peace amid the chaos. What incredibly good use of my time.

Slowly and surely I'm learning what it will mean for me to be a doctor, to be the kind of doctor I want to be and know I can be. Somebody must have been looking out for me, because it's absurd I knew at age 20 that this path into medicine would reward me tenfold for every ounce of effort I put forth.

And with that folks, I say goodnight.

Best Invention Ever

2012-01-24T22:09:00.000-06:00

Today was a relatively long day. Could be worse, but also could be better. I scrubbed on 2 cases and spent most of the rest of the day on my feet, too. Yes, I'm sore, but it's okay. Why, you ask?

BECAUSE I DISCOVERED COMPRESSION STOCKINGS.

I don't know where they've been all of my life, but I don them now with pride. Suddenly I realize that my 2nd grade teacher did not have weird old lady legs but did in fact possess then true wisdom about gravity and fluid retention and feeling good enough to come back to work tomorrow.

Naturally I ordered 2 more pairs immediately after I realized how much I liked the first. And I suggest you all do the same.

The End.

On life, death, and surgery

2012-01-15T19:03:00.000-06:00

We started orientation on Jan 3-4. So my 1st "real" day on Surgery was Jan 5, a Thursday. I worked the following weekend through Friday the 13th. A run down on my time thus far:

-120: in-house hospital hours in 9 days. I don't say this to brag, but to remind my future self that this happened and I survived, because I'm sure it won't be the last time.
-2: patient deaths. Talk about appreciating the onus of wielding a scalpel.
-1: GSW case. Wherein I developed a deep respect for my fellow medical staff. No matter what was said about the patient's drug and alcohol levels, decisions that led to a gun shot wound, or the patient's family's denial about the severity of the situation, everyone gave their all in the middle of the night to save the patient's life. Being a part of that is more humbling than I can convey on this blog.
-2: awesome residents who inspire me to be a great leader when the time comes for less experienced students/residents to look to me for direction.
-8: number of surgeries I scrubbed in on. It might be more, but I was having trouble remembering. Must document better next week! They included: burn cases, penile implant removal, leg amputations, gallbladder removals, small bowel obstruction, and the GSW.

I'm loving this rotation so far. I like the academic atmosphere and rounding as a team. I LOVE being able to scrub in on so many surgeries, even if most of the time I'm driving the camera on a laporoscopic case, it's better than being a human retractor or not being in the OR at all. 6 more weeks of fun!

Sixteen Hours

2012-01-10T22:17:00.001-06:00

My day.
5AM wake up call. Arrive in hospital by 5:30. See 4 patients, write notes, meet team at 6:55 for a census run-through. Reduce our case load from 7 to 4. In the OR by 8 to observe the 1st case. See a couple of patients in between cases. Sneak in a 5 minute lunch. Scrub in on a lap case that converts to open. Finish but stick around recovery. Help with last patient in afternoon clinic. Back to recovery, 2 sick patients there. Talk to families. Begin rounds at 7:30PM. See 15 patients, discuss cases and plans for tomorrow. Decide it's time to go home. Find out one of ours is in trouble in the cath lab. Code in progress. Watch the team in action bring him back. Review OR schedule for tomorrow. Climb into my car at 9:30PM. Home for nachos and cereal.

I am really loving this rotation. Even as a medical student, there is so much opportunity to see and touch and do. I like the quick pace. I like learning about management of surgical patients.

But man. Today was a long day. And not just long as in 'I have a lot to learn so I better stick around and figure it out.' No. Long as in 'we have some REALLY SICK PATIENTS we need to take care of.' Dedication is such an understatement about what I saw tonight- doctors and nurses and therapists all committed to the care of patients. I love my 'job.'

Twenty Twelve

2012-01-03T19:35:00.001-06:00

Do you ever get back home from vacation and wonder if it actually happened or was just a nice, restful dream? I sure do. I got back into BR late, late Sunday evening after a glorious 2 weeks off. I spent 10 days in Cincinnati, 5 in Connecticut, and enjoyed every minute.

Today I started my General Surgery rotation. Along with Internal Medicine, Surgery has a reputation of being physically demanding andtime consuming, but incredibly educational. Like so many milestones of medical school, I look ahead to the next 8 weeks with a mix of emotions. I'm worried about my lack of surgical knowledge, and worried that I've forgotten everything I've learned thus far this year. I don't know how I'll respond to the hierarchical atmosphere of the field. I'm eager to see if I like being in the OR, and taking care of surgical patients, and if the next 8 weeks will tip the scale in favor of OB/GYN, since gynecology is a surgical sub-specialty. By now I've grown accustomed to the massive amounts of knowledge we seem to acquire in a short amount of time, though it fills me with no less wonder or awe; the next 8 weeks holds much promise.

And so, dear reader, I leave you with some poignant words from Emily Dickinson:

Surgeons must be very careful

When they take the knife!

Underneath their fine incisions

Stirs the Culprit- Life!

Cheers!

Jefferson Medical College, c. 1900

Pondering

2011-12-11T13:55:00.001-06:00

I've finished 3 of 4 weeks of my hematology/oncology Ambulatory Medicine rotation. I really like this field. I like having a better understanding of a CBC* and the differential. I like learning about the mechanism of various chemotherpy drugs, because in my biochemist mind, they all make perfect sense. I enjoy learning about the epidemiology of cancer, who gets it and why.
Am I destined to be an oncologist? I'm not sure. Despite all of the things I mentioned already, I'm not sure if I want to be the one in charge of giving people chemotherapy. I understand the purpose, and appreciate that the most severe regiments are saved for those patients in search of a cure. Perhaps my sentiments are flavored by my youth, my naivety, my green-ness in this profession. I live in the world of textbook statistics, of textbook explanations of disease progression and patient prognosis. I'm painfully aware that real clinical experience is lacking, but not for lack of wanting it. How can I know when it's appropriate to offer hospice care and when it's worth going out on a limb? That patients living years beyond their diagnosis of small cell lung cancer with brain metastasis exist, that they laugh and smile and joke and don't give a hint of what's simmering beneath their skin? I can't. I haven't been around long enough.

And there's still the question of OB/GYN. I'm signed up for a Sub-I in Maternal Fetal Medicine in March, after all. And I was really drawn to the work the general OB/GYNs did when I was on my rotation this fall. Everyone and anyone seems to have the opinion that obstetricians have the worst lifestyle imaginable and are on call all the time. Granted, I didn't follow the same call schedule that all the attendings did. But being on call isn't like a residency-like call night when your butt is planted at the hospital. It may be like that. Or you might spend the whole evening at home. It really depends.

Anyway. I am REALLY putting a lot of faith into the impact my next rotation, surgery, will have on my career path. I've never painted myself a surgeon. I enjoy the OR, but I like my time with patients at the bedside or in clinic too much to be a genuine surgeon (aka someone who'd rather live in the OR). Maybe this attitude should dissuade me from even thinking about OB/GYN. I just feel like an OB/GYN gets to be a surgeon BUT ALSO so much more.

WHAT I DO KNOW NOW:
1. I want to have patient continuity. This generally translates into having an outpatient clinic office. I'm down with that.
2. But I also want to be consulted on or manage my own admitted patients. This means inpatient duties.
In my mind, 1+2 rule out becoming an ER doc or a hospitalist. Beyond that, who knows.

*CBC= complete blood count, including white blood cells, red blood cells, and platelets. The differential tells you what types of white blood cells make up your total number.

Still here

2011-11-28T21:08:00.001-06:00

The random thoughts rolling around in my head tonight:

-Thanksgiving break was awesome. Houston totally rocks. Thursday was filled with the trifecta of friends, food, and football. Spent time with the bf, and celebrated anniversary weekend with a date night at a steakhouse. Saw family that I hadn't seen since well before I could drive. Although I watched Notre Dame sturggle on the football field, I made some new friends while doing so.
-Now. Back to reality. Week 2 on my Hematology/Oncology Ambulatory month. Spent 12 hours at the hospital/office today. The right choice for learning a LOT? Yes. The right choice for having a lazy month? No. But all's well that end's well. And this month ends with NO EXAM and 2 WEEKS VACATION = winning.
-I kind of like this stuff. I think I could be a good oncologist. That means a fellowship and then very few procedures. Quite different than an OB/GYN residency and lots of procedures and surgeries and deliveries. Needless to say, I have much to think about.
-It's COLD HERE. Not like Midwest in November Cold. More like Hey it's Louisiana and only 1 week ago it was 80 degrees outside and now there will be a LOW OF 35. My car is going to be like hell frozen over tomorrow morning. Woe is me. The South has officially made me a wimp.
-It's nearly December of my third year of medical school. HOLY CRAP. If all goes according to plan, I'll be spending this time next year knocking the socks off all my interviewers at potential residency programs. Someone pinch me. This is all happening kind of quickly....
-November 28 is an awesome day. My birthday is in ONE MONTH. And it's officially 3 years from the day Ryan and I decided to be boyfriend and girlfriend.

And for the record, I have so much to be thankful for. My incredible and incredibly supportive family. My health and happiness. My wonderful boyfriend. More good friends than I deserve. The opportunity to be someone's doctor someday. Oh, and definitely the roommie's cat who believes my lap is his personal lounge chair- no objections here.

Love and hugs from a cold Louisiana apartment!

Life in a Day

2011-11-20T14:31:00.001-06:00

On Friday, I basically reverted back to being about 15 years old. Well maybe 16, since I was driving. I carpooled with a classmate to NOLA for an exam, we carpooled back. I hit up the library that afternoon because Michelle Au's THIS WON'T HURT A BIT was on hold for me. Then I babysat 2 awesome little boys. Because I need Christmas money to buy gifts for my family and friends. Yes, folks, I will be turning 25 next month. This is the life of a medical student.

After the boys went to bed, I found a truly awesome documentary film to watch on Netflix, called Life in a Day. You can apparently also watch the whole thing here on YouTube. People from over 180 countries broke out the video cameras on a single day, July 24, 2010. Over 4500 hours of film was compacted into 90 breathtaking minutes.

I laughed. I cried. And though I was sitting alone on a beanbag, I felt more connected to dozens and dozens of people I've never met. Obviously I would highly encourage you to watch.

My life in a day today? The gospel at mass was of my favorite passage, Matthew 25, when Jesus teaches on the lifestyle we must adopt in order to gain entrance to heaven. I've written about it before here. Three babies were baptized today, too, in a ceremony filled a little pomp and circumstance fitting for such an occasion. Little kids swarmed from all over the church when the time came to gather at the baptismal font, sitting close on the floor for a good seat. And after pouring water over their heads three times, the priest took each infant into his arms and carried them the length of the aisle, asking that we all join in welcoming our newest member of the church. I even teared up a little.

I'm spending the rest of the day baking in preparation for Thanksgiving. I'm making my tried and true apple pie, and attempting a new garlic pull-away bread. From the smells in my kitchen, I think it's shaping up to be a delicious meal. I am struck again, per usual, with awe and respect for the countless of generations of women who filled their days with these tasks. I've been at it for almost 4 hours and only have some dough in the fridge and a rising pan of bread to show for my efforts. This is time consuming work. Labor of love indeed.

In medicine-related news. I finished Neurology on Friday, and will be doing an Ambulatory Medicine rotation next for 4 weeks. I've chosen to spend it with a hematologist-oncologist, and hope to figure out if this might be my future field. If I have to be 100% honest though, I might be most pumped about the fact this rotation does NOT have a shelf exam at the end. No more tests till February! It's like Christmas came early.

Cheers!

Wisdom

2011-11-15T20:47:00.001-06:00

The past 7 months 'on the wards' have taught me many things. One of the most ubiquitous lessons is that of time. Time will turn the youngest most innocent babies into elderly adults, with wrinkles to match their experiences. Our time here on this earth is limited, and the time will come for all of us to breathe our last breath. Time heals all things, in one way or another. This begs me to reflect and consider how I'm using my time.

Today I met, as my fellow med student put it, a genuinely lovely patient. After meeting the minimum criteria as a patient in a teaching setting (demonstrating the progress of his disease and discussing his satisfaction with the current management plan), he went on to teach us about being human.

'Age quod agis': Latin, translating to 'Do what you are doing'

What does this mean to you? he posed the question.

I thought for a moment. Do what you are doing. If you're successful, you're not doing anything else. It means you're fully present. What an incredible gift to give another person- your full presence.

This highlights one of the lessons Sir William Osler impressed upon his students, and it is a goal I aspire to every day. With the cell phones, email, pagers, etc. it's not an inherently easy task. But I do believe we owe it to each other to try. Our patients deserve our full attention when we're in the exam room with them, just as our peers do on rounds and our families do at home. A challenge indeed.

It's rumored that people will forget what you said and did, but will always remember the way you made them feel. There are certain people in my life, with whom I've felt appreciated, valued, dearly loved, as a result of their undivided attention. I only hope that people will remember me in this same fashion.

Age quod agis. Do what you are doing.

In parting, our dear patient drew on another part of the world, the far east, to leave us with this: "With my heart, with my lips, and with my mind, I bless you and all you do."

Have I told you lately I love what I do?

Brain Atrophy

2011-11-07T18:36:00.000-06:00

image from here

Brain atrophy is a function of aging. You see it on the CT reports, whether the atrophy present is or isn't consistent with the patient's age.

At 24 (can't say that for too much longer.... yikes!) a scan of my brain should show absolutely no atrophy attributable to age. AND YET, I'm having this weird experience of being a clinical student during which I feel like I am forgetting EVERYTHING I have learned, losing all the skills I should have on lock. I hear drug names that are no longer foreign, but they might as well be. Function? Side effects? Hmmm, let me think really hard about that. Or pull out the Epocrates app on my phone. Write a consult note? Sure, do I have 60 minutes? This surely was not such a struggle 3 months ago.

I almost hesitated putting this post up. I don't blog anonymously, and must therefore work under the assumption that some future employer somewhere might at sometime read these words. Hello there! Apparently I'm not perfect. But I'm trying. I promise.

So what gives? Is this proof that if you don't use it you lose it? As in- 8 weeks on Internal Medicine was grueling but oh-so-educational, and lovely in it's repetition, but now that I have other tasks on the daily agenda, my brain has promptly misplaced all those lessons? If I were to find the silver lining here, which I like to do when I can, I'd argue that you have to give a little to get a little. I know I've sacrificed Step 1 pearls in order to make room for the knowledge of HOW TO DELIVER BABIES or TRULY APPRECIATING YOUR NURSES or HOW NOT TO GET SUED.

I'm also working on the assumption that 99% of what I'll need to know in practice I'll do over and over in residency, developing a muscle memory for not only my hands, but hopefully my mouth, brain, and heart. There, if not before, will this annoying pseudo-brain atrophy hopefully reverse.

Lose- lose?

2011-10-30T08:41:00.002-05:00

Last night I went to a Halloween party with some friends, and got on the topic of motherhood and careers. In the conversation were a stay-at-home mom, a medical student mom, and several childless medical students.

This topic has been written and blogged about to death, I know, but I felt compelled to add my two cents after our discussion last night.

Guilt seems to drive so much of the emotions. If you're at home with your child all day long, but want to get out and talk to real life adults or long for your own fulfilling job/hobby outside the home... you feel guilty for daring to want to spend this time away from your kid. If you're on the path to becoming a physician, and have to figure out how in the world to leave your baby at home so you can go to the hospital and learn how to take care of other people's babies, spouses, and parents... you feel guilty- will your little one ever understand the daily struggle, or will she somehow remember these early years with resentment? If you've held off on having kids for whatever reason up until this point, and, looking forward toward the rest of school and residency and an actual career as a doctor-what with it's 4 weeks max maternity leave- don't know when in the world that's going to happen, ... you feel guilty, for having the luxury to be so damn selfish at this inappropriate age, for the old-lady eggs that hopefully still will hold the potential for your children, for the time apart you know you'll have to deal with but can't imagine yet if ever you do get to call yourself Mommy. This seems like quite the lose-lose situation- you're damned if you do and damned if you don't.

Why?! According to Wiki, guilt is the state of being responsible for the commission of an offense; it is also a cognitive and emotional experience that occurs when a person realizes or believes- accurately or not- that he or she has violated a moral standard, and bears significant responsibility for that violation.

I can't imagine that any of us have committed an offense; no, rather, it is the delicate and complicated moral standard surrounding women's roles both inside and outside of the home that make us itch. Where does it come from? The stereotypical roles men and women have held throughout history served as complement, requiring a true team effort to successfully run the home and farm/shop/business, driving arranged marriages. Reasons for marriage shifted to love and sex, and it became more and more apparent that what used to be a man's job could easily be performed by a woman, and vice versa.

And yet. We still feel the pull in so many directions, striving to deliver on the years of being told we're smart and should do something with it for goodness sake, unable to deny the innate drive to carry a child and fulfill the reproductive potential that has been building up for just as long. Becoming Superwoman, impossible though we know it is, seems the only logical choice.

Perhaps we'd do ourselves and our fellow women a favor by considering what our definition of a successful woman looks like. Could we be so brave to absolve each other of our guilt? To celebrate our successes together and agree that the hardships do indeed exist in every arena of our lives, to share that burden and that joy- maybe then we'd shake some of this guilt we all manage to carry.

photo from here

Taking a leap

2011-10-29T08:16:00.003-05:00

A couple of days ago, we scheduled our rotations for Jan-June 2012. Geez louise the time flies. Anyway, I recently had the best idea ever to swap out my December Psych rotation for Ambulatory Medicine instead, hoping it would give me some direction on what kind of Sub-I I would want to do in May or June, because I'd have to know by January.

So we're doing our scheduling thing, and I totally re-work everything. Out flew the advice to just finish my cores, which would have meant Peds then Surgery, because there was a new spot open for Surg for Jan/Feb, and I have some aversion to waiting to do this one last. It wasn't as easy as flip-flopping Surg and Peds, though, because Peds for March/April was full. So Peds goes to May/June. I was left with the decision- hold off on a Sub-I at Tulane till July at the earliest, or take the plunge and do it earlier.

I wanted to do Psych in March and the Sub-I in April, but Psych is unavailable in March. And so I'm left with this:

Jan/Feb: Surgery
March: Sub-I at Tulane
April: Psych
May/June: Peds

Since the Sub-I was moved to March, I had to know now what department I wanted, and what service at that. So I took a leap of faith. I chose OB/GYN, Maternal-Fetal Medicine service. It seems like a good compromise, doing my Ambulatory month next and then this Sub-I early. If I love it, OB/GYN it is! If I don't I have plenty of time to re-work my schedule and get situated in something else, and I'll have a good experience on the books no matter what.

Someone please tell me I'm not crazy...

Trusting this leap of faith provides me somewhere to land!

photo from here

Best Yet

2011-10-26T17:38:00.000-05:00

Last night the eval for my OB/GYN rotation was released for me to view online. All of the different attendings I worked with filled out paper evals, and the clerkship director summarized them for my final eval.

It was my best yet.

I'm super excited that I seem to have an upward trend for third year. Here's crossing my fingers that my shelf exam grade is on par so that I can Honor this rotation!

And our hearts forever...

2011-10-25T07:35:00.001-05:00

Love thee Notre Dame!

This past weekend, ND played USC. The game started at 8PM, the first night game in our stadium in over 20 years. ALL (and I mean 99.9%) of my friends decided that THIS was the game we needed to attend sometime last fall. So like a kid who looks forward to the magic of Christmas around December 26, I've been looking forward to this weekend for about 365 days, give or take a few.

The day was perfect, up until the game started, and the Irish forgot how to play football...

Back to the day full of fall perfection. The weather was gorgeous, a cool crisp morning that really warmed up under the afternoon sun. The leaves displayed in all their red-orange-yellow glory. The golden dome outlined against a blue sky without a cloud in sight.

Starting Friday night, all of my guy friends, without discussing it beforehand, I assume, carried on quite the consistent greeting once they saw me: huge smile, arms wide, hug, and lift, up off the ground I went. Every single one. Talk about feeling the love.

There's also something incredible about seeing the people with whom you shared your "best" for years, even if it was for the first time in months or years. You pick up right where you left off, which makes you think you're still 22 and might grab dinner in the dining hall and crash in someone's room on campus before the game starts. But then you realize, time has passed, things have happened in the meantime.

You get to celebrate people's accomplishments with them, new job, new promotion, acceptance to school, PhD exams over, med school still rolling. You get to share in the joy of new relationships, engagements, and weddings. Hopefully you get to halve the sorrow of disappointment of life not going your way, losing a parent, or a relationship on hold. These are the people that have seen each other's best and worst, and love them to death all the same. This weekend was a family reunion.

So. We laughed, we cried. We walked till our toes were numb from cold or exhaustion. We parted, not with goodbyes, but with 'see you later's. And now begins the hopeful anticipation of next year's reunion at our home under the dome.

Is this a sign?

2011-10-20T18:22:00.000-05:00

This is the last week on my OB/GYN rotation. I'm pretty sad to leave it, because I've enjoyed pretty much every minute. I was able to see so many aspects of the field, from hospitalist ob/gyn doctors, private practice offices, and various specialties like maternal-fetal medicine, urogynecology, reproductive endocrinology, and gyn oncology.

Tomorrow is Friday, so that means it's shelf exam time. I fully understand why all the clinical students aim to finish their cores ASAP- these things really put a damper on the rotation....

ANYWAY. When I was in clinic last week, we saw a woman who is expecting twins; she scheduled a c-section for tomorrow at noon. Immediately I piped up, asking if I could come back and see the delivery after I finish my exam. And the doctor, amazing like she is, said yes, as did the patient. Every delivery that I saw and/or gowned and gloved and helped mommas meet their babies- it was just 1 baby at a time. But this one, twins!

SO. The point to this whole post is this: Tomorrow evening I will fly over 1000 miles to get back to Notre Dame, to see my boyfriend, SO MANY of my friends, and the stadium where dreams come true. I have been looking forward to this weekend for months and months. Seriously, we made hotel and flight arrangements when it was still over 100 degrees here with 100% humidity.

AND YET. The rush of adrenaline I just experienced had nothing to do with being Irish or loving football or dancing at the Backer with my complimentary long island iced tea in hand. No. It had everything to do with the fact that Dr. H just confirmed that the c-section is still on.

Am I destined to go into OB/GYN?

R U Up for a Challenge?

2011-10-10T19:18:00.000-05:00

Because I sure am!

I recently discovered the 'step n tone' classes at the local YMCA. I do much better with group classes than I do trying to keep up any kind of activity level on my own that will actually burn calories. So I LOVE this class. Almost an hour of nonstop moving, with the 2nd half all abs and gluts. There's usually a zumba class before this one, so if I get there early enough, I can do both.

The man who runs the class introduced the newest installment of "the challenge." He guarantees that participants will lose pounds and/or inches, and will gain endurance. In the past, people lost as little as 20 pounds and as much as 125.

So. Fully believing this will be as much of a mental challenge as a physical one, here's hoping I stick to this. I am ALL ABOUT losing pounds and/or inches. It's become necessary that I lose the med school weight. I mean, I'd love to lose the 'senior year of college' pounds, too, but I won't get too choosy....

Wish me luck!!!

areuupforachallenge.spruz.com

What if I can't choose?

2011-10-05T21:26:00.000-05:00

Okay, first of all, this is BLOG POST NUMBER 200. I never could have guessed when I started in the summer of 2009 that I'd still be going strong as a T3, staying in touch with family and friends across the country and world, sharing a bit of myself with my peers and new-found friends, and discovering common interests and struggles with fellow bloggers. In 2 weeks, I will be halfway through my third year and a mere 18 months from earning the MD behind my name. I only hope I've stuffed my brain with enough diagnostic and management knowledge, filled my heart with enough empathy and compassion, strengthened up my legs for long hours on my feet, and programmed my calendar to help keep my priorities in check.

Speaking of life come May 2013... 78 weeks from now. At the pace we're on now, that doesn't seem so far away. Before then (kind of much before then) I will need to choose a specialty. What field will I choose, or will one choose me?

I've been struggling with this lately because I really enjoyed my 8 weeks of Internal Medicine. I'm also really enjoying this OB/GYN rotation. I need someone in the medical field who isn't biased, just pushing for me to follow in their footsteps, someone who knows a lot about different residencies and the options that become available upon their completion. Someone who can look into their crystal ball and say, "Erin, THIS is what you're going to become."

So far. Pros for Internal Medicine:
I learned SO MUCH in 8 weeks. How much could I learn in 3 years?
I liked the academia-ish atmosphere present in our community hospitals. We pre-rounded. We did morning report. We rounded. We did lunch talks.
I enjoy being in the hospital.
This residency lends itself to some pretty cool fellowships. Say, Heme/Onc, intensive care, palliative care for starters.

Pros for OB/GYN.
I envy the long-term relationships these docs have with their patients. I want that.
I like the outpatient clinic. Which is conducive for building those relationships.
I like being in the hospital.
I like being in the OR. I want to know how to do more in there.
OB/Gyns seem to have this great mix of being a primary care provider, part time surgeon, and pseudo-internist.
Delivering babies is fun. MIRACLE OF LIFE. Have I said that before? Sorry if I have. But I hope I never cease to be amazed at the transformation of 1 egg and 1 sperm into MANY cells into an organism with organs that all work together. One minute you have 1 patient on the bed in front of you. And then there are 2.

And so. I just want to know how to schedule my life after Christmas break. I want to get my VSAS stuff together so I can do some rotations away. I want to be sure, come summer 2012, that I'm filling out the ERAS for the specialty that fits best with my interests, my gifts, and the lifestyle I think I want for the next 40 years.
IS THAT REALLY SO MUCH TO ASK?

Sigh. Not in panic mode. Promise. Just hoping it doesn't come to that....

Sigh

2011-09-30T13:22:00.004-05:00

There is something divine about spending the afternoon reading at home with the windows open and the warm (but not humid and too hot) breeze blowing in.

I think we might be over the worst of the Louisiana summer heat. No promises, I know. But weather like today's just makes me want to call all my classmates in sick from school and have a picnic at a park. We used to spend a lot of lazy Saturday or Sunday afternoons at the park when I was in high school. And not to mention the time on the quad at Notre Dame.

Those were the days.

In other news, all's well with the OB/GYN rotation. I split my time this week with a reproductive-endocrine doctor who does fertility medicine and overnight shifts at the ER (2nd one tonight). It's pretty amazing to see a human blastocyst up close and personal (under the microscope) before it's transferred to a patient's uterus for implantation, fingers crossed. And all I can say about tonight is, ladies who don't have a primary OB and are going into labor? I can't wait to help you this evening :)

Only 3 weeks left and then heading to brain related rotations- neurology and psychiatry!

Cheers!

Deep in the Heart of Texas

2011-09-25T17:05:00.001-05:00

Operation 'Surprise Ryan for his Birthday' was a success. Sadly on my way back to Louisiana now...

On Vaccines and Politics

2011-09-15T20:10:00.001-05:00

I want to start by acknowledging that I highly doubt that any of you, dear readers, visit this blog for political opining. For some crazy and inexplicable reason, an alarming number of you find my online pages by searching some combination of 'surviving medical school' because I ineptly titled a couple of posts as a T1 with those words. Though, two years later I'm still here, surviving indeed. But I digress.

As anyone following the race for Republican presidential candidate or tunes in to the news knows, there was recently a debate in which the HPV vaccine was discussed. In particular, Gov. Perry's attempt to mandate all 11 year old girls to receive the vaccine and his unfortunate monetary ties to the manufacturer of the vaccine. And later, what had to be word vomit coming out of Bachmann's mouth, as she suggested recipients of the vaccine may develop mental retardation as a result, since some lady told her that happened to her daughter. As she said, "I am not a doctor, I'm not a scientist, I'm not a physician. All I was doing was reporting what this woman told me last night at the debate."

Well. I'm not a physician either, but I will be soon, God willing. And I have this to say.

1. We live in fast paced world, connected across the globe by news and social media that can be updated in the blink of an eye. When you become a public figure, and one whose words are blasted everywhere at that, you have to assume a certain level of caution and responsibility for what you say. It's infuriating to me that, as a member of the field of medicine, I will have to deal with the aftermath of such off-the-cuff comments that SCARE PEOPLE away from making educated, rational, evidence based decisions regarding their health.

2. We already vaccinate against a disease that is sexually transmitted: Hepatitis B. We vaccinate infants at birth and then give 2 boosters within the first 18 months of life. While HepB can also be transmitted through other bodily fluids, having sex with multiple partners is a risk factor for contracting the disease.

Gardasil and Cervarix prevent dysplasia (changes in cell growth) caused by the strains of Human Papilloma Virus that are linked to cancers of the cervix, anus, vulva, penis, mouth, and throat with few to no side effects after tens of millions of doses adminstered.

In either case, immunizations against the viruses prevent serious and potentially fatal illnesses in the event that someone is exposed. But we live in a society where many parents like to pretend that their child will ever become sexually active, or may ever be exposed to a sexual partner who is infected with a transferable virus.

I hope people will realize the disservice we're doing to the next generation by denying them preventable medicine.

3. The cost of medicine is indeed rising. But as the old saying goes, an ounce of prevention is worth a pound of cure. The more we do to motivate people to develop healthy habits and to participate in preventative medicine, the less we'll have to pay for their costly, chronic illnesses down the line. This objective is ambitious, I know, and includes education, nutrition, exercise, and access to clean air and safe environments, just to name a few. But I see no reason not to soldier on.

And with that, I'll step down from my soap box.

Please ask your physician for medical advice, and refrain from taking it from a candidate seeking your vote.

55 words from the other end of the spectrum*

2011-09-13T20:11:00.000-05:00

It's 8AM. L&D team meeting starts. Two patients discussed, phone rings.

Mom is coming in. Fully dilated. Feeling pressure.

I follow the attending into an empty room and organized chaos ensues. Gloves on. Instruments ready.

Mom pushes once, twice, third time's the charm. Welcome to the world, baby girl.

It's now 8:15AM. Onward we march.

*During my Internal Medicine rotation, I was challenged to write about a recent meaningful moment in 55 words. This is what came to mind, the first patient's death I witnessed. It turns out that both life's endings and its beginnings are quite inspiring.

A Decade Later

2011-09-11T20:50:00.003-05:00

10 years ago, it was September 11, 2001, and I was a new freshman at Saint Ursula Academy. My first class of the morning was Algebra I.

The details of the day are pretty foggy, but I do remember that there was some kind of announcement made about halfway through that class made about the planes crashing into the Twin Towers in New York. I'm not sure if they cancelled classes, but I do think I stayed for the full day at school. The full extent of what was happening sunk in later around lunchtime. There were TVs out in the foyer outside of our gym, and people were sitting and standing with eyes glued to the screen as video footage of the attacks were shown and reporters tried to make sense of it all.

I'll never forget the group of Spanish exchange students who were huddled around each other crying. They had just arrived in the US, and had no idea what this meant about being here or getting home.

The rest of us tried to calculate how important P&G or GE headquarters were to international interests, and whether Cincinnati was at risk. Not many people had family or friends in New York, so we just watched and waited.

I knew at the time that it was the kind of event like JFK being shot or the men landing on the moon. Everyone knows where they were when they heard the news. I wish I had a better memory of that day. Maybe that's why I keep a blog now, to have a better record when my memory fails me.

Today I remember, as many have said, the worst and the best of humanity that we saw 10 years ago. There was incomprehensible evil. But unexpected and incredible goodness, too.

Money in Medicine

2011-09-09T17:20:00.000-05:00

I've been told over and over again that wanting to get rich is not the reason to go into medicine. You've gotta really love what you do every day to make the hardships worth it.

I saw this quote again today, and it seemed to reinforce that idea:

"You can only become truly accomplished at something you love. Don't make money your goal. Instead, pursue the things you love doing and do them so well that people can't take their eyes off you."
-Maya Angelou

Speaking of things you love, I LOVE being a third year student. I got to scrub in on a cesarian delivery today (SO COOL) and am also feeling pretty good about the 1st eval I got back from my Internal Medicine rotation:
"Erin will be an excellent student, resident, and physician if she continues to do what she is doing, trying to better herself every day."

This weekend is shaping up to be 100% fun and so I'm calling it: today is a very good day indeed.

Cheers from Tiger Country, but GO IRISH! Also: This baby knows what's up.

Babies and Mommas, Mommas and Babies

2011-09-04T20:56:00.000-05:00

I am 1 week into my OB/GYN rotation. After spending Monday and Tuesday in New Orleans for orientation (hello marsh fire smoke!) and Thursday with my longitudinal preceptor and in lecture, Wednesday and Friday were the only real days I spent in the clinic/hospital. But they were enough fun to make up for the other days!

I spent Wednesday with an attending who has been practicing here since before I was born, and for the past 2 years has done only gynecology, leaving (sadly) the long days and nights of obstetrics behind her. It was obvious that coming to work each day provided her the opportunity to see and catch up with women she's known forever, in addition to providing them medical care. As much as I enjoyed the time last rotation that was ALL inpatient, I'm once again thrown for a loop, wondering if I'd rather have the chance to develop such long lasting relationships with my patients.

Friday I was with another attending who does ob/gyn. I got to scrub in for the first time ever in the OR to observe/ very MINOR assist with a procedure. Then it was off to clinic all day, with trips back to the L&D floor to see one of his patients who was induced that morning. I got to perform a lot of exams myself, which was great. I'm discovering that a lot of muscle memory is needed to know what/where you're feeling things... We finished in the clinic around 4PM, so I went to the library to read until our lady on the floor was ready to push. That happened later, around 7.

Again, I scrubbed in and got all suited up (mask, foot covers, gown, gloves) and waited for Baby P to make herself known to the world. The patient pushed several times, and with a little vacuum assist, the baby's head was out. Immediately I became part of the action, as the attending guided my hands to turn the baby and ease her out. I held her as he clamped and cut the cord, and then we cleaned her off a bit for her first photos by Dad.

It was truly an exhilarating moment, and I feel so thankful to be invited into this intimate, memorable time as this family of 3 was established. And to think, I have 7 more weeks of this!

Up next- Assessment center, more ob/gyn and maternal-fetal medicine.

And later- RYAN VISITS THIS WEEKEND. And we're tailgating at LSU. Surely a good time will be had by all :)

And last but not least. I survived my first tropical storm (Lee) in the south. Lots of rain and wind but all is well.

Bedtime Reading

2011-09-01T21:50:00.001-05:00

I should have added this...
Call 1-800-255-2500 for your very own knot board today!

The view from the 22nd floor

2011-08-29T16:21:00.000-05:00

I'm back in Nawlins. And today is officially day one of my THIRD clerkship this year. Time for OB/GYN!

This is one of the rotations that requires me to come back for orientation. I really can't complain, though. I get the chance to see friends and fuel my love for this city. Absence truly makes the heart grow fonder.

Anyway. I spent a LOT of time in this building during my 1st and 2nd years of medical school, absolutely FILLING up 20 foot white boards with my biochemistry and physiology notes. Today those same concepts are repeated again on those white boards by new T1s and T2s. Life is a wonderful and cyclic thing.

I kind of miss medicine (as in the Internal Medicine clerkship) already. I have to review all kinds of anatomy and gyn issues that I haven't thought about in a while. The real fun begins on Wednesday when I start in the hospital back in BR. And let's be honest. In the next 8 weeks, I'm going to learn a lot. And I'm going to catch some babies. THE MIRACLE OF LIFE. I can't wait.

Cheers and love from the Big Easy!
Erin

Daily Joys

2011-08-24T14:57:00.001-05:00

"To each one of you the practice of medicine will be very much as you make it-

to one a worry, a care, a perpetual annoyance;

to another, a daily joy and a life of as much happiness and usefulness

as can well fall to the lot of man."

-Sir William Osler

Here's to being (almost) finished with the the medicine rotation. A daily joy indeed.

Don't Blink or You Might Miss It

2011-08-21T20:50:00.001-05:00

Another weekend has come and (nearly) gone. I use the term 'weekend' loosely here, since it technically refers to Saturday and Sunday, but is most lovingly considered to begin as soon as you clock out Friday till Sunday evening when you have to think about work again.

Unless you're on Medicine here. Then your weekend starts at 12 noon Saturday, if you're lucky, and later if you're not. Considering you spent almost 80 hours of the last 124 at the hospital, the 'To Do' list has reached epic proportions, and includes, most importantly, PREPARE FOR SHELF EXAM. So any fun 'To Do' items are shadowed by those that are necessary and those that involve studying.

And just like that, the 'weekend' is over and now it's time to get ready to for WEEK 8 of Medicine to begin tomorrow at the crack of dawn. Before dawn, if we're telling the truth here.

Okay. I'm not as bitter as I sound on here. But I start my OB/GYN rotation in 8 days and the best part of it might quite possibly be working only 2/8 Saturdays. Alleluia!

I am sad to be leaving the world of Internal Medicine though. There isn't really a problem they don't know what do with. And I've just hit my stride and feel pretty confident interviewing and examining and managing my patients. And my attendings have been nothing short of excellent. Let's just say the bar has been set high. For the remaining clerkships, you have your work set out for you.

What in the world am I going to do during residency when these crazy hours surely rear their ugly heads again....

Staying Late

2011-08-16T23:08:00.001-05:00

Part of our Internal Medicine curriculum involves staying late one night a week, til ~10PM. I think it's better than the Q4* call schedule my peers in New Orleans have, because I'll spend fewer late nights overall at the hospital. Their only upside? Having a post-call day in which you stay till noonish then go home and sleep. I'm not so lucky.

I stayed late tonight, and it really wasn't a big deal. We were just busy enough for me to have stuff to do without the team being overwhelmed. Win. I did a full H&P and even dictated my note, though I'm curious on the feedback I get back on it.

So when I rolled into my apartment after 17 hours away, I WISHED I was exhausted enough to just drop in bed and fall promply to sleep. But no. Apparently the excitement of the ER is too much, leaving me wide awake feeling like I could spend another few hours at the hospital.

This cannot be normal.

I'll pay for it tomorrow in, oh say, SIX HOURS when I need to get up and get ready for work. Until then, I'm sippin my Brooklyn Summer Ale and catching up on online reading. :)

Cheers!!

*Q4 call means that every 4th night you stay overnight (if you're a resident) or till ~11PM and then return at 5AM (if you're a student) to admit patients from the ER and to manage things on the floor as they happen. The hour restrictions have changed for 1st year residents (ie Interns) but this is how you ended up with people working more than 24 hours in a row. Because on a call day, you still come in around the regular time in the morning, do all your regular work all day, but then put in an extra "night shift" until the day crew comes in and you can sign off with them. Sounds like a real party if you ask me!

Living the American Dream

2011-08-12T20:35:00.001-05:00

Today I saw one of the Fam Med attendings walking the halls of the hospital. I asked how he was doing, and his response was, "living the American Dream."

I got to thinking about this...
Proof I've chosen the right field: my day consisted of:

-waking up at 5AM
-arriving to the hospital by 5:30AM
-seeing 2 patients in the ICU and being fairly well versed in what was going on with them
-having my presentation time change from 11:30AM to 2PM to 12PM to 1PM, and still delivering a coherent "Alcohol Withdrawal Seizures" talk
-performing my first rectal exam on an elderly patient who was actively passing stool during the exam (damn you kayexalate*!)
-writing up an H&P I feel really proud of
-learning a patient we admitted to Hospice passed away today
-coming home at 6:30 and eating a decadent dinner, ie grilled cheese sandwich
-taking the first stab at MKSAP questions while my neighbors head out for the night
-and later, hitting the sack only to do it all over again tomorrow, but in 1/2 day Saturday style....

and I STILL would call it a pretty good day. Just to think, generations have labored before me so that I could do exactly this today.

http://www.ellisisland.org/

*a liquid medicine administered to lower your serum potassium. this is accomplished by making you poop it all out....

Bittersweet

2011-08-07T19:52:00.000-05:00

Almost a year ago I found a great piece of wisdom from Michele Au and posted about it here.

I've been thinking some more about this lately. If I had to be completely honest, I am still very much trying to get Best Actor AND Best Supporting Actor. I don't feel that it's much of a challenge to let go of what's going on when I step into a patient's room to talk to them and perform my exam. I like seeing how they've been. I like talking to family members, even if the conversations are sad and tough.

However. We are on this push to do well. I don't want to be an average medical student, and I definitely don't want to be a mediocre doctor. I want to be an excellent physician. I want to have the bedside manner that leaves my colleagues and nurses and patients with only kind words on their lips when my name comes up in conversation. I want to have the diagnostic prowess that allows my patients to feel a sense of relief by giving their symptoms a name, by giving them weapons in the form of treatments and medications to fight back. And I want to be the kind of daughter and sister and friend and hopefully someday wife and mother who ensures that all the people who matter most know they are so loved.

I don't think my friends were lying when they said third year would be better than second year. I feel MUCH closer to being a doctor, which is exhilarating and terrifying all at the same time. The things I'm learning now WILL be useful for the rest of my career, in one way or another. Finally.

But to those whom much is given, much is expected. I feel the pinch now. There's much to learn, much to process, much to do. Too much. We are painfully aware that time spent doing anything other than reading or studying is time that could be spent reading or studying or sleeping.

We're called out. Called out on our mistakes, so that we don't repeat them. Called out on our ignorance, so that it can be rectified. Called out now, so that we aren't later. It takes a lot of guts to try to defend your decisions to people with years of experience on your mere weeks. That itself is tiresome.

It's easy to start to feel alone in this struggle, and so I try to remind myself that I have some amazing classmates here with me, walking the walk each and every day. I hope they know I'm here for them, too.

A meaningful moment in 55 words, no more, no less*

2011-08-04T18:46:00.002-05:00

CODE.

A seemingly innocuous word for chaos.

Ben's seen two, got to do chest compressions. Me? Zero.

When we get the page, I take off running after the doctor, heart racing from anticipation, not exertion.

I open the door to find quiet.

DNR. I raced to see her last agonal breaths.

Now, back to lunch....

*An exercise posed to us during a group session, part of our Thursday afternoon series

The Real Deal

2011-08-01T21:35:00.000-05:00

Sitting at a table with 4 attendings, 1 senior resident, 5 interns, 3 medical students, 2 externs, 1 pharmacist, and 4 pharmacy students.

This was how I started my day, how I started my 5th week of Internal Medicine as a T3.

And then I got to see 3 patients, the same amount as the interns on my team.

And I knew more answers to questions than I didn't know.

AM I REALLY GETTING THE HANG OF THIS?? KINDA SORTA??

Biggest lesson of the day? The more I learn now, the less my heart will pound when it's my turn in the hot seat giving morning report on the patients I admitted overnight on my first call night as an intern, in, oh, say, a mere 23ish months. It's amazing how motivating it is to NOT want to look like an idiot to people you respect...

Snapshot of a Great Day

2011-07-31T14:21:00.000-05:00

Saturday, June 30, 2011
5:30AM- alarm goes off and I wake up feeling surprisingly refreshed. maybe it's because I know today is the 1/2 way mark for my Medicine rotation.
5:45-5:52 out the door and make it to the hospital in record time. it's amazing how much the traffic disappears on the weekends.
6:15- finish talking with the night nurses for 4/5 of my patients. rocking and rolling today.
6:50- vitals and labs recorded on all patients, just enough time to go down to the doctor's dining room and grab cereal, milk, and OJ. breakfast of champions
7-7:25- morning report. significantly more relaxed with only the docs and students there.
7:30-10:00- see my patients, write progress notes, attempt to put in orders for meds and discharges
11:00- see a patient admitted overnight and get his HPI. sounds like atypical chest pain. print off his ECG and discuss with fellow students.
11:45- our attending confirms our diagnosis of unstable angina. smiles all around.
12:15PM- meet up for lunch with some other doctors, family members, and a new intern.
2:00- home. in a great mood. start some laundry, straighten up the apartment. watch good will hunting and relax.
4:18- find out Ryan is an uncle! wish I was closer to Connecticut to meet the brand new baby.
5:15- skype with the fam. miss the little puppies at home.
6- meet up with a friend to get take out food. we watch Harry Potter and the Deathly Hallows, Part 1.
8:45- walk down to the movie theater, grab tickets, and slip into seats just a moment before Harry Potter and the Deathly Hallows, Part 2 starts.
11- talk to my sister, explaining I loved the movie. she can't stand how it veers from the books. we decide taking a day or 2 and watching all 8 movies back to back must happen in our near future.
11:30-fall asleep pretty much as soon as my head hits the pillow, with the bliss that comes only from knowing you don't have to be at the hospital the next day...

The South

2011-07-29T21:27:00.002-05:00

People like to talk here. A LOT.

Yesterday I took advantage of some glorious morning and evening slivers of free time to drop off and pick up a couple of dresses at the dry cleaners. The drop off wasn't too bad, but picking up took a good 15 minutes. The woman at the checkout finds out that I'm a student at the hospital and assumes I'm in nursing school. I correct her to say medical school, and she assumes I'm at LSU. I correct her that I'm from Tulane, and it is at this moment that we become BEST FRIENDS. She TOO is a Tulane grad school alum. She too understands the undeserved judgement those of us in green receive in this gold and purple city. She too worked in the medical field for a while before burning out. She's worked at a teaching hospital and knows how IMPOSSIBLE it is to work among students of every variety and training residents. And OF COURSE she has an opinion on the status of health care in America, what fields are lacking female physicians in Baton Rouge, and the cultural disconnect between home grown patients and internally trained docs.

Whew.

I also got side tracked on my way out of the door at 6PM tonight with a tech (of some sort) who's in a business administration program and who thinks about going back to nursing or medical school to open her own medical business. This conversation was a little more fun and a lot less overwhelming.

OH! HOW COULD I FORGET?
The best comment I've gotten yet from a mom at the pediatric clinic:
"My baby just turned 1, and I'm wondering about the types of foods he can eat. My babysitter cooks everything from scratch, but just told me she's feeding him squirrel and rabbit meat. They killed a ram recently and he'll be getting that too. Oh, not to mention my father who wants to feed him frog legs...."

As of noon tomorrow, I'll be halfway done with Internal Medicine. How the time flies when you're having fun!!

A Haiku

2011-07-25T21:00:00.001-05:00

Medicine: clerkship
during which my sunglasses
become quite useless

Pseudo-Domestic

2011-07-24T21:27:00.001-05:00

There was a time when I considered myself a little housewifey. Albeit single, I couldn't deny the satisfaction I felt when I walked through a clean apartment, or indulged in a home made pie. To be honest, these feelings were also competing with extreme frustration over my lack of a dishwasher and the sense that someone else should be doing the cooking or cleaning once in a while.

Since I've been back in BR, I've completed 3 of 8 weeks on my Internal Medicine rotation. Anyone familiar with the satirical novel House of God will empathize with the fear and dread with which I approached this rotation. There is so much to know. There simply aren't enough hours in the day to eat and sleep properly and read and learn and actually see and take care of patients. Or there's JUST barely enough. One or the other.

Sundays have turned into my do laundry and go grocery shopping and clean the bathroom and take care of bills and empty the trash day. These things take some time. Since the hungry cat meowwwing outside my bedroom door serves as my Sunday alarm clock, I've scratched a few things off the list each week before lunchtime.

I guess the point of this post, really, is to say that, despite the canyon of student debt I'm digging myself into and the lack of a real social life and living so far away from the people I love most.... I am a million times more happy that I am going to be a doctor than I would be just running a home. I know a lot of women consider that their path, but I'm so thankful that I was born in the 1980's instead of the 1880's or 1780's, and that many courageous women forged the way so that I can pursue this passion.

First female physician in the US in 1849, graduating first in her class (she even lived in Cincinnati for a time!)

"The idea of winning a doctor's degree gradually assumed the aspect of a great moral struggle, and the moral fight possessed immense attraction for me."

NYT Gets it Right Again

2011-07-23T22:38:00.002-05:00

I have to share this article. The author really sums it up well.
Why would anyone choose to become a Doctor?

"The awe of discovering the human body. The honor of being trusted to give advice. The gratitude for helping someone through a difficult illness. These things never grow old."

Thanks to Fizzy for this flow chart to help figure out if med school is for you!

Life

2011-07-21T22:11:00.000-05:00

At the hospital, we're surrounded by illness. We see people at their worst. We sometimes glean bits and pieces of their journeys, develop the slightest appreciation for the baggage they carry. We sometimes see death win.

But we also can stand witness to the good. The family members that spend night after night sleeping on the hospital pull out bed. The nurse who goes the extra mile. The patient who chooses to be a teacher for us.

Maybe it's just growing older and wiser, but seeing what lies ahead, the good and the bad, the things within our control and the things that hit us like a ton of bricks, it's given me quite the perspective. Like the Savage in A Brave New World (which a patient's granddaughter happened to be reading BTW), I want them all. I claim it all. I want the love and the joy and the ecstasy and the passion and the peace, even if it comes as a package deal with sadness and pain and hunger and want.

I'm learning to embrace the human experience. It's not good or bad. No qualifier will do. It just is.

That (my inner rambling) being said, I do need to note the blessings several exchanges with friends new and old have been in my life lately. To connect with another, to see them just for a moment, genuine and vulnerable and beautiful as they are, and to allow them to see me that way too, is truly a gift. I'm so thankful for the opportunity to maintain my sanity amidst the chaos that is being a third year medical student.

And with that, I return to the world of hyperkalemia and the physical exam of the comatose patients....

Week 2 and Something New

2011-07-14T06:36:00.003-05:00

I will be totally honest. I expected there to be more to blog about once I started third year. Part of the problem is definitely wanting to respect and protect the privacy of the patients I see, but I think it's more than that. I read blogs by this doctor from Atlanta and this neurologist who has the craziest patients, and expect that I, too, will have these hilarious or inspirational experiences sometime in the 10-12 hours I'm at the hospital every day.

The truth is, I feel like I'm navigating an iceberg with a wet-suit on. Not only do I feel slightly less than equipped to handle the small chunk of knowledge that's expected of me, I am fully aware that there is SO MUCH MORE below the surface, and that sooner or later, hopefully once I've mapped out the terrain visible above water, I will have to take the plunge and explore what lies beneath.

image from here

I'm a little caught up in the details of remembering to check the IV pump for the rate and actually looking for cyanosis, and clubbing so that I can record no c/c/e under skin*, and doing these things every single time. I'm trying to figure out what abnormalities on review of systems are expected from an abnormal lab value, which is the only reason the patient came in, but certainly not the only thing going on medically.

I'm trying very hard to remember antibiotics. I am also terrible at this. So each time the attending turns to me and says "Erin, which cephalosporins have Pseudomonas coverage?" my face gets hot and my stomach sinks.

Occasionally there are glimpses of hope, signs that one day I might be able to do some of this by second nature.

Anyway, in other news, today is the day that we start our Longitudinal Preceptorships.
I was drawn to do this program in Baton Rouge in part because of this opportunity. We're paired with a physician and will spend a 1/2 day a week in clinic with them. Ideally, we will have a small cohort of patients that only get scheduled for appointments on Thursday mornings so that we can follow them. I requested a pediatrician, because I think Peds may be the last core clerkship that I do, and I'd like to get a taste of it before I have to think about scheduling aways and electives for 4th year. Hopefully this strategy works out.

Putting one step in front of the other,
Erin

*Much of notetaking is done by abbreviations and shortcuts. So, for a normal lung exam you might write CCTA B, or chest clear to auscltations bilaterally. For the skin no c/c/e means no cyanosis, clubbing or edema, or in plain English, no blue skin indicating poor oxygenation, no characteristic enlargement of the tips of fingers and toes, and no swelling.

Paradox

2011-07-07T20:43:00.001-05:00

I am tired. Not as tired as I could be, considering I have only myself to worry about, and made dinner for the week on Monday, etc. But just physically and mentally tired.

I am also happy. I like this rotation. No other week during medical school has made me feel more like a future doctor than this one. That even includes the long hours in gross anatomy lab- I guess at the time it felt like a Grand Adventure into a Career of Medicine. But in retrospect, although it was cool, it was also smelly and tedious and nothing like interacting with real live patients.

I feel like a lot of topics to write about float into my head, but usually have left to make room for things like DVT diagnosis and management or acute pancreatitis imaging by the time I am at a computer. That and the amount of "free" time I have to sit here is dwindling big time.

Mother Teresa said you should love until it hurts, because there can then be no more pain, just love. If I study till it hurts, will I become a Medicine rockstar? Here's hoping...

Love from the trenches,
Erin

Study date

2011-07-05T20:11:00.001-05:00

Taking care of my roommate's cat and beginning the step 2 question bank adventure.

Thoughts

2011-07-04T00:52:00.000-05:00

I flew back to Louisiana today. It's so hard to believe vacation actually happened when I return home and find it exactly as I left it. As I took off from Atlanta towards New Orleans, I had high expectations to see lots of fireworks. At first, there was nothing. Then, I kept noticing little bursts of light all over the place. Naturally, this thought crossed my mind: how cool is it that our eyes are totally wired to pick up and pay attention to movement? That's how I found all the mini firework shows. I'm every bit the nerd my sister and boyfriend believe me to be.

Apparently the keys on my computer and my sister's/mom's are really different. Let's just say typing was a bit of a struggle as I attempted to plug back into the world wide web tonight.

Tuesday I start my Internal Medicine rotation. It's guaranteed to be one of the most formative and memorable 8 weeks of med school. Let's hope tomorrow gives me enough time to mentally prepare...

As history can predict, these past few weeks were a vacation from school and also a vacation from blogging. Let's hope I find interesting things to write about in a HIPAA friendly way soon!

Apparently all the young professionals in my apartment complex are living up their independence with a late Sunday evening party outside my window. If I can catch a quieter moment, I think my exhaustion will win out and I can race toward deep stages of sleep. Wish me luck!

Cheers from Baton Rouge!

And PS- Thanks to those dedicated readers out there- you know who you are! And welcome to any newcomers- as I mentioned above, I hope to be more interesting than this....

A request for help for 2 teens orphaned in Joplin storms

2011-06-26T07:53:00.001-05:00

I received this letter via email because I'm in the New Orleans ND Alumni Club. Please read on, and if you feel so moved, help make a difference.

Dear Everyone:

I hope that this letter finds you in good health and enjoying your Summer. While we have
historically had a Club project each Christmas, a situation has arisen with which some of us with
the Club have decided to get involved. As I am sure you are aware, a devastating tornado struck
Joplin, Missouri on May 22, 2011, totally destroying thousands of homes, killing more than 100
people and devastating the lives of many. While events like this normally are merely news
events for a few days, those of us in the New Orleans area have a greater appreciation for the
long term impact that events like this can cause to the affected community. The Joplin storm has
hit closer to home for us, as one of our own was directly impacted. More particularly, JS,
a new attorney with our office and a 2010 graduate of Notre Dame Law School, is from
Joplin.

As we watched the nightly news in the days following the storm, JS saw family
friends being interviewed and discussing the tragedy of the devastating storm, as her own mother
remained sequestered in their family home, fortunately safe, but just blocks from the devastation.
As the days passed, and the news evolved, JS learned that a number of their family friends
had perished in the storm. Last week JS returned home for the first time to volunteer in the
recovery effort. While there, she witnessed first hand the severe impact the tornado had on their
community and returned with many heart wrenching stories. After discussing the situation with
her, the Club has decided to assist with the following particularly tragic situation.

A 16 year-old girl named Grace was out of town during the tornado. When she returned,
she was told that her parents and younger brother had died in their family home, which was
totally destroyed. Several days later, when attempting to go through the rubble of her family’s
home, she discovered her father’s cell phone, which was amazingly still operational. When she
listened to the voicemails left on the phone, she was shocked to hear a message from a hospital
in Springfield (70 miles away), saying that her 12 year old brother was receiving treatment there.
The shock of learning that her brother was alive after thinking he was dead for several days
was compounded when she learned that he had been paralyzed. This 12 year old boy remains
hospitalized, while undergoing treatment and surgeries for his spine and leg injuries. The details
of where and with whom Grace and her brother are going to live are still being worked on, as
they have no family in the area. Regardless of how that is ultimately resolved, Grace and her
younger brother will no doubt have considerable financial needs for their living expenses, his
medical expenses, not to mention college expenses, as their parents were not well off.

In a nutshell, what was formerly a cohesive family has now been reduced to two orphans,
a 16 year old girl trying to take care of her 12 year old, paralyzed brother. Although it pales in
comparison to their family tragedy, their family home and all of their possessions were lost in
the storm.

On behalf of the Club, we are coordinating a relief effort for this young girl and her
seriously injured younger brother. JS will be our direct link to the kids themselves to ensure
maximum benefit from the donations. Accordingly, we ask that you consider making a donation
to assist in this relief effort. We ask that your donations be made payable to the Notre Dame
Club of New Orleans as the relief effort will be through the Club; however, I ask that you
forward your checks to our office at the above referenced address
(NALLEY and DEW, SUITE 200, 2121 RIDGELAKE DRIVE, METAIRIE, LOUISIANA 70001)
as we will be coordinating that relief effort on behalf of the Club.

Should you have any questions or wish to get involved directly with further relief efforts
for these two children or others in the Joplin area, please do not hesitate to contact either JS
or me here at the office. As you know, the needs in that area are almost endless and we have a
direct conduit through JS to ensure maximum direct benefit from your contribution.

As always, I thank you in advance for your consideration and generosity should you
choose to assist in this effort.

Home Sweet Home

2011-06-17T13:40:00.000-05:00

I love vacation. I mean, that might sound really obvious. Who doesn't enjoy some time away from the regular routine. But when most of the people you love the most are a full day's drive away, vacation=spending time with them.

Last week I finished up my Family Medicine rotation. Each student on the block does a project that is patient-centered. I left that day truly inspired. After six weeks in a primary care setting, I am even more convinced that efficient, cost-saving, good primary care is the answer to many of the health care problems we have currently in this country. It makes me want to practice evidence based medicine, to have a solid reason backing my decision making. It makes me want to have the best staff on my side, with protocols in place to follow up with patients and not let them slip through the cracks. It makes me want to use cool technology like mapping disease prevelence alongside access to parks and fresh produce, or vaccine adherence and level of education.

Anyway, on that good note, I travelled to CT to see the boyfriend and his family. As always, the break went by entirely too quickly. We ate great seafood (hello Lobster Trap on Cape Cod and their baked scallops....), watched good hockey (Go Bruins!) and even got to sit on the beach in the sun. It's only been 24 hours, but I miss him and all of it so much already.

Last night I got in to the Cincinnati airport. Getting to hug my mom and my sister, see the new Cincinnati skyline, be greeted by 2 very excited puppies, and hug my dad? Priceless. I'll be home for 17 whole days, as my mom pointed out with a smile, thinking it sounds better than 2 weeks. I can't wait to soak in the family, friends, food you can only get here, and lovely June weather.

8 weeks of Internal Medicine awaits me in Baton Rouge on July 5. I'll be putting off thinking about that for as long as possible!

Last Day on Family Medicine

2011-06-07T13:43:00.000-05:00

Has it been six weeks already?! Considering my calendar says June, it must be true. I've finished my first clinical rotation. Or I will in the next ~48 hours, once I finish the exam and give a presentation on my project. Then it's 3 weeks of vacation bliss in CT and OH. YAY.

I had my final evaluation with my attending this afternoon, and she had really great things to say. Mostly along the lines of being very comfortable among patients. I know I need to keep reading/learning the pathology of different diseases and especially learn all the damn drugs (x2 names for generic vs brand name....). But she thinks I'll be able to hold my own among the interns starting Medicine in July. I can't wait!

I'll be spending the day reviewing Family Med cases to prepare for our exam. It's a new test, so I can't even ask any of the T4s what it was like.... Keeping my fingers crossed!

Hope you're keeping cool in this crazy heat! Cheers!

Still Here

2011-06-05T18:39:00.000-05:00

Haven't posted in a whole week, so I thought I'd assure any worriers that I'm still here and kicking....

I have only 2 days left on Family Medicine. I can't believe that my first clerkship has gone by so quickly. What's scary is that Internal Medicine looms in the distance, right after a nice 3 week vacation...

That's pretty much it for now. Back to studying- after a frozen yogurt break that is!

Cheers!

You Don't Have to do That!

2011-05-29T10:47:00.001-05:00

I found a church nearby that I really like. There's a school associated with the parish too, so the pews are filled with good Catholics of every age. I like seeing the little ones with bows in their pigtails and itty-bitty sandals on their feet.

The readings today were about Jesus leaving his followers with the Holy Spirit, promising that he'd not leave them orphans. By receiving the Spirit, Christ would always be among them.

In the homily, the priest told a story about a recent all-faculty luncheon, where one of the teachers burst out, "Father, you don't have to do that!" when he cleared her empty plate. "And you don't have to do that," he replied. She didn't have to be a teacher at a Catholic school. She didn't have to forego the extra salary to work there. We all have a LOT of things we don't have to do but we do anyway, out of love, out of faith.

"Allow yourself to be defined by doing what you don't have to do. Christ's presence will be so obvious."

I like that a lot. Whatever you believe or don't believe, I think it speaks volumes about character when you do things you don't have to do, without being asked, without a promise of a thank you. Just because you know it's right.

There are countless opportunities in medicine to do things we don't have to do. I hope I recognize them and do them anyway.

This Side of Medicine

2011-05-27T13:48:00.000-05:00

A few days ago I met his beautiful lady. The same lady he met over 60 years ago, knowing, in his heart, in that instant, that she was the lady he'd marry.

When the dementia started getting worse, he responded out of love, taking on the cooking, the cleaning. He indulged his beautiful lady's wish to prepare dinner one night, and consoled her when she stood at the counter, tears rolling down her face, claiming "I don't know what to do."

They moved here when it became too much, caring for himself and his beautiful lady. He feels like he's failed. I can't disagree more. I see an incredible example of unconditional love. I see a man who still shows up every day, just to see his beautiful lady dancing down the halls.

Picture from here

Exiting the world of hypotheticals

2011-05-24T19:04:00.002-05:00

It's starting. Recognizing not every patient fits into a vignette. Learning the ACTUAL next step in management: it's too easy to say you'll just send the patient to the ER for suspicion of stroke- will you let them drive themselves? see if a family member can take them? call an ambulance? This is the real stuff.

I've also been privy to a number of conversations concerning power of attorney. While the consensus remains that this stuff is important, let me speak from someone else's experience that the process gets WAY more complicated when your loved starts losing competence. The time to set the record straight is NOW. Even more so if the legal chain of next-of-kin aren't living or aren't your choice. You can download your state's advance directive form here.

On the other end of the spectrum, I feel I must comment on a bill that was passed by the Louisiana House committee that would essentially end abortions in the state. Several things worth noting:
-It was repeatedly stated by the author of the bill that its purpose was to challenge Roe v. Wade
-It violates the Hyde Amendment, necessitating the availability of abortion in the event of rape and incest. As a result, the state could lose $5 BILLION in Medicare funding.
-It criminalizes doctors for performing elective abortions, with a possible 15 year jail sentence
-The bill and its passing are largely political moves- on one hand, attempting to push pro-choice groups to filing suits, and on the other hand, supported by people who are nervous about getting reelected.

My personal stance? I think abortion should be legal yet unnecessary. Until we direct our attention on educating the youth in this country- with evidence based teaching methods on sex-ed that goes beyond abstinence-only lessons, until we make contraceptives more readily available, until we create an environment that supports new moms on many levels, I firmly believe safe and legal abortion must remain available.

And so we wait. Hopefully I'll be available the next time this is discussed at the capital. I'd love to express my opinion as a Catholic and as a future physician. While the author of the bill pulled a power move, directing voting members to consider that this bill, unlike many others they will vote on, may very well help them get in or keep them out of heaven, I disagree. I just can't imagine that I'll have to answer for someone else's choice (a man choosing to rape a woman, a couple choosing to express their love while not wanting children, a woman choosing what to do when she discovers she's pregnant). I do think I'll have to answer for how I served these people. It's my choice to see Jesus in them all.

All I Really Need to Know

2011-05-21T15:49:00.001-05:00

...about being a doctor I learned by teaching swim lessons.

1. Get down on your swimmer's level.
When you meet your 3 year old swimmer, that first impression can make or break the entire rest of the week. Standing and towering over the little guy prevents any kind of instant bonding or relationship-forming. You've got to get down, eye to eye, on their level.

Likewise, where a doctor goes after entering a patient's room is huge. Studies have shown, that, despite spending the same amount of time in a room, patients perceive that the doctors who sat down and talked them were there longer than those who remained standing. Eye to eye, demonstrating a genuine sense of concern allows for patient satisfaction and a greater chance for compliance and healing.

2. Don't ask a question you don't want to answer to.
You never ask if a swimmer wants to swim today, if they will jump in, or if can swim just one more lap. Language is key to a successful lesson. WE are going to swim today, you ARE going to jump in, one more lap, and you WILL be all done. Giving positive feedback is also absolutely imperative, building trust, confidence, and a sense of accomplishment.

In medicine, the twist is this: in a lot of ways, patients are responsible for their health. They choose what to eat, if they'll exercise, and how many exposure to risky things they'll risk. But I do believe that a sense of teamwork, bit of coaching, and the assurance that the patient is not alone in making progress and searching for a cure. And the impact of a little enthusiasm cannot be underestimated!

3. Know what you can do on your own, and when you're in over your head.
There is much to be said about the 1-on-1 swim lessons that the Swim Ministry offers. But when the screamer just won't stop screaming, or when your student thinks it's play time ALL the time, or you can't come up with another way to explain the S-pull, you've gotta pull in reinforcements- the wiser, more experienced staff that are there for just these occasions.

I don't think anything can or will ever replace the doctor-patient relationship. Built over time, based on mutual trust, this relationship is the foundation of medical care. But there are many other members of the team whose contributions cannot be overlooked. The nursing and administrative staff, the pharmacists, therapists (RT, OT, PT, etc), dietitians, and specialists each play a role. We need not work alone :)

Something Special

2011-05-19T07:35:00.001-05:00

Last night, there was a really nice reception at the home of this campus's dean and his wife- the new LEAD students, the T4 LEAD students that have put in a year here, the clerkship directors and other docs we work with, their spouses, and even a few kiddos were all in attendance.

This is exactly the kind of event I knew would take place here and that simply wouldn't had I stayed in NOLA. Being part of a small program means it's something special. It was great to have all those deserving of praise recognized. It was a wonderful opportunity to meet some of the attendings I'll work with over the next year, as well as a chance to enjoy each other's company outside the context of hospitals and work.

And despite being 1000 miles away from the Dome, despite being deeeeeep in the heart of Tiger Country, something else really cool happened. Those from my class that were in attendance were asked to stand up and share our hometown and alma mater. I won't say the cheers for Notre Dame were louder than those for LSU, but it was a close second :)

Swimmingly

2011-05-14T13:29:00.000-05:00

Life is pretty good here. I get to park in the physician's lot for free and eat in the physician's lounge for free. Apparently my white coat and nearly-all-access badge means I am one of those "Authorized Personnel" who gets into cool places in the hospital. Clinic starts at 8:30, I usually have at least an hour for lunch, and finish before 5.

Oh! You want to know about patients? I see a lot of them, too. Starting with Family Med seems to have been a solid decision. I see infants and kids (yes, leg up on Peds!), and pregnant women (yes, leg up on OB/GYN), and people who've had surgery or who need surgery, you get the picture.

I think I'm getting a little bit better at taking a good history or asking about the chief complaint. There's usually something I've left out, but the residents always catch me. I'd like to write more, but I'm waiting to see more patients so that I can kind of meld stories together and stay HIPAA kosher and make sure no one stumbles onto my blog and thinks, "OMG this is totally about ME and I never gave permission for it to be on the world wide web!!"

So until then, you can find me poolside, reading up on health literacy.

Cheers!

Déjà vu

2011-05-11T19:22:00.000-05:00

When I was in high school and toward the beginning of college, I worked as a server in a private, members-only club back home. The work wasn't too difficult (set a table properly, serve from the left, clear from the right, etc.) and the pay was great. Being that I was under 21, taking drink orders from people was kind of a nightmare. I'd go around a table, write down what I thought I'd heard, and return to the bar with requests for "cabanay" or "peeno nawar."

Since I've started my Family Medicine rotation, I often go in and interview patients without first having access to their past medical records or medication list. When I ask if they can tell me what medicines they are taking, I am eerily reminded of those days dressed like a penguin, promising to return with nectar of the gods. Donned in my white coat, however, everyone assumes I know exactly what they mean. So. Dye-tro-pan? It's ditropan. Micro-dent-in? It's macrodantin. Luckily the residents can translate....

Mom's Day

2011-05-08T15:48:00.001-05:00

photo from here

It's hard to celebrate Mother's Day when my mom and all my pseudo mothers (grandmas, aunts, cousins, and friends) are so far away! This time last year, my mom and sister were visiting me in New Orleans for a very special Girls Weekend. Even though I got to see them just a few weeks ago in SC, I wish they were here so we could cook and laugh and play cards and just be ourselves.

I tried out a new church today, and really liked it BTW, and of course it was 1st Communion weekend. The little ones decked out in flowered headpieces and ribbons and gloves- and let's not forget the seersucker suit on one little guy- were too cute. But it was during the Sign of Peace when I felt it, and saw it, stood witness to it. Love was tangible in that room. Families everywhere, hugs, kisses. Hands reached out across aisles. The song we always used to sing in Badin mass came to mind, "Peace I leave with you my friends, my friends, and I am with you till the end."

So to all the mommas I know- both here on earth and in heaven above, veteran mommies and mommies-to-be, my wish for you today (and every day): May the love I experienced today be always present in your lives. I'm sending it to you across the miles!

What they didn't tell me

2011-05-04T22:06:00.001-05:00

Much of the pre-clinical conversation on clinical life in medical school is kind of lofty and hypothetical and for the most part, positive and optimistic. I might have added the last two, being a 'glass is half full' kind of gal myself, but who knows. We talk about performing H&Ps (history and physicals), and even get a little bit of practice. They teach us to be thorough. They teach us about coming up with a differential, or list of possible diagnoses, and about using findings from the history, exam, labs, or procedures to narrow down the list to a winner.

What they don't mention? That in the real world, being a doctor is about constantly learning, teaching, helping others, and also making a living. You need to get paid. You need to not get sued. So. Charting on a patient has VERY MUCH to do with how you document what you saw, what you didn't see, what you're thinking, and why.

I hate to be living and one day working in a legal/social/political environment that requires me to perform my job in such a way that COVER YOUR ASS remains high on the priority list.

In other news. REAL LIFE THIRD YEAR SEEING PATIENTS STARTS TOMORROW. Stay tuned.

Who's Appy Now?

2011-05-03T19:53:00.000-05:00

Okay, confession, I like this title mostly because it's also the title of an ER episode where intern John Carter removes the appendix of resident Peter Benton... then displays it in a jar on the mantle above his fireplace. Anyway, I digress.

More importantly! Third year! Woo!

All I've done so far is sit through two out of three days of orientation. So, I'll have more to say after Thursday about Family Med.

I have, however, downloaded some seemingly awesome apps for my phone that I hope will be of use in the next six weeks. I'll share now :)

Epocrates. The must have pharm app.

Medscape. Which I'm told is as good as the Massachusetts manual.

Ob Wheel. To determine dates of conception and due dates based on last period. Since I'm doing my Fam Med with the BR General's Fam Med Residency program, I should see a little bit of everything.

Qx calculator. I used it today to assess the Framingham risk score, but it has MANY other functions.

AHRQ ePSS. This outlines which screening protocols are appropriate based on gender, age, and other risk factors, and lists them according to their graded recommendation, based on the strength of data.

I expect I may add to this last, especially if the driod market picks up some more that are exclusively available on the apple products as of now....

Off to do a computer case, and feel like a T3! Cheers!

Shopping

2011-04-30T10:47:00.000-05:00

Let me start by saying I am super pumped to be living a stone's throw away from Whole Foods. New apartment win!

Too bad my first shopping experience there to pick up just a couple of items for dinner included me knocking down a $20 bottle of wine with my purse as I sidestepped to avoid running into another green shopper.

I'm pretty sure my face was the same color as that merlot....

In other news! I'm 99% moved in (just gotta tackle the pile of miscellaneous papers and make sure my closet is organized) and LOVE it here. If you'd like my new mailing address or want to see pictures, let me know :)

Wow! Wednesday: 5

2011-04-27T19:51:00.000-05:00

1. I passed. Lord only knows why I was spared the 3-8 week rule on getting the Step 1 score back, but it came a mere 19 days after I slaved away at a computer for 8 hours. NEVER AGAIN. Until Step 2. Which I plan to rock after spending a year in the state capital. The cycle never ends....

2. Today has been the first full day in Baton Rouge. I. LOVE. IT. I'll post some pics of the awesome new apartment I get to call home once my roomie gets back in town and we finalize all the artwork and such.

3. I'm starting my first clerkship rotation next week. That is, technically on Thursday. Monday and Tuesday= orientation in NOLA and Wednesday= orientation in BR. More to come....

4. I had the most wonderful, fabulous, lovely time in Texas with Ryan over Easter weekend. He's apparently photophobic now so I won't have any pictures to share, but let it be said I still consider myself the luckiest girl to have had Marco point out Ryan as one of a few single guys at a party one night in August of 2008. Bring on another year of LA-TX traveling <3

Wow! Wednesday: 4

2011-04-20T09:26:00.000-05:00

I should have bought stock in the airline industry.... here I go again! This time, I'm headed to Texas to see the boyfriend and make the most of his 4 day Easter weekend vacation.

Wish me luck staying cool in the Valley!

Back Already?

2011-04-18T08:02:00.001-05:00

So the presentation went WAY better than I could have imagined. Basically this awesome resident who's working on the paper to be published prepped me and stuck around till the bitter end of the conference in order to help the audience soar from 12 people to 13....

Nevertheless, I hope it's not my last presentation at such a large meeting, and maybe next time, I'll skip most of the being nervous part and just focus on educating others on something "only I" really know about :)

So, later Wednesday night, into the wee hours of Thursday morning, I tried my hand at overnight flying. I figured it would save time and that we'd be able to make the most of our mother/daughter weekend in South Carolina. Well. The flight was full. There was a less than happy baby on board. I don't think I slept at all. Plus, switching time zones twice in two days meant I had NO idea which end was up, just that my eyes hurt. All's well that end's well, and I snuck in a looooooovely nap at my sister's place while she labored away in class like a good college student.

I am SO glad I finally flew my butt to SC! Katie came up to ND like once a semester it seemed like, yet it took me almost 2 years to step foot on her campus. It was gorgeous. No wonder she wanted to go there as soon as she saw it.... I got the full tourist treatment, got to see Katie's new house for next year which is practically on campus itself, and ate some gooooooood southern cookin'.

The best part, obviously, was all the relaxing time I got to spend with my family. Through all the endless days of Step 1 studying, I wished and prayed for days like these. Feeling like a normal person. Spending more than the 50 minutes of a Goljan lecture outside. Cooking. Laughing. Enjoying life.

And just like that, I'm already back in NOLA. Mission Finish Packing My House in the Next Two Days has commenced. Wish me luck!

Wow! Wednesday: 3

2011-04-13T07:51:00.001-05:00

I never anticipated my summer clinical research job would come to this. Sitting in a nice hotel lobby, donning a brand new professional dress, about to go to the AANS annual meeting. Yours truly is giving a short and sweet presentation later this afternoon.... Wish me luck!

T2 Thoughts

2011-04-10T10:45:00.001-05:00

Last night I went to the History of Medicine's annual banquet. It's been happening for many years (not sure exactly now many, oops for forgetting the program...) and has featured lots of impressive docs as the honored speaker. You can imagine how excited I was to hear Dr. M, who not so long ago enlightened me on Dr. William Osler, and who throughout the year led our clinical diagnosis elective. Missing out on the Medicine rotation here and missing working with him is on the short list of 'cons' about going to Baton Rouge.

Anyway, the other awesome part about last night was being out among real people! And even better, seeing med school friends whose company has been painfully absent these last weeks. One of the women at our table asked all of us what year we were in school, and I proudly responded "T3." With Step 1 behind me, I believe it's now official!

So, in honor of my newly granted wisdom and in an effort to avoid packing, I thought I'd share some thoughts on how to study for Pathology, Pharmacology, and Clinical Diagnosis- the three ongoing courses of second year. (Note- any fellow 2013-ers, PLEASE share any additional thoughts you might have!!)

May
So you're coming to the end of your first year, finally got a handle on what you need to do to pass, when they throw some 2nd year stuff at you before you've had summer vacation. You know, just for kicks. The 3 weeks of lectures and the exam on the last day of the year will have information for 4 courses: Immunology (the one that stands alone) and Pathology (aka Mechanisms of Disease), Pharmacology, and Clinical Diagnosis, all focusing on Inflammation.

The point of this block, as well as the Neoplasia block and any intro Microbiology, is to provide a foundation of concepts and to supply you with a language with which you can discuss how disease happens all over the body.

As the T1's I talked to last night already had heard through the grapevine, the most important part of this block in terms of grades is Immunology. It's a one and done course. If things don't go so well for path, pharm, or clinical diagnosis, you have the rest of the year to bring it up. That being said, it's always nice to have some cushion room, too, so don't completely blow it off either.

So. How to study?
For Immunology, you'll get a packet. Know it. Do the questions at the end of each section. Make it your best friend. I'd recommend flashcards for learning all the cytokines (IL-1, TNF-alpha, etc.) Pull out all your best tricks for memory aids to remember who does what. For example, I know IL-4 takes care of class switching from IgG to IgE because I think to myself "work 4 GE." It's not anything special but it works, especially because I used to confuse it with IL-5, who is key for activating eosinophils. And E is the 5th letter of the alphabet. So that cleared that up...

I wish I had more to say about the path/pharm/clinical diagnosis component of this block, but I was a lost puppy and kind of held on for dear life. In retrospect, I should have bought my medium Robbins at this point and started using it, but you live and learn. Maybe some smarter friends can help beef this out....

August
The first two weeks were by far the worst two weeks of medical school, pulling a photo finish for parts of Step-1 studying. Why? Welcome back from summer vacation! Let's have 25 lectures this week on stuff you've never ever heard of before. Ready, set, go. There was no sugarcoating it. There are LOTS of bacteria and viruses and fungi out there and even more drugs to treat the infections. My struggle with learning new languages (hello, this totally is a foreign language!) and having never taken a micro course before did NOT help.

What I did: Went to lecture, studied from the packets they gave us, read Clinical Microbiology Made Ridiculously Simple.
What I wish I would have done: Used First Aid more. The micro section is concise and to the point but gives a great foundation for organizing all the bugs. Spending two or three days with this section a month ago made me wish I had done it eight months ago. The Ridic Simple book was great, so I'm glad I used that, though.

Note: I think the curriculum is changing so that microbiology will be integrated into systems blocks instead of how we did it altogether in five weeks. Hopefully this will make it less painful!

September-March
The good stuff. THIS is when the tide begins to turn, and slowly you feel like you might be of some use to a sick person someday. First year is tough in helping you feel like a future doctor because no one comes in because everything is normal and they feel great. They come in because something is bothering them and now you'll start to learn how to identify what it is and how to make it better :)

It is around this point that I started getting VERY picky about who's lectures were worth attending, who I needed to listen to later on tegrity, and who could be ignored completely. The biggest change between what's happened before this point and what happens after? You need to learn a lot more than what is presented in lecture. So you might as well make the best use of your time. For me, that meant mostly studying at home.

Pathology
A laundry list of things, in my opinion, you must do. The order doesn't matter.
-Read the Robbins chapter(s) associated with the block. I usually took Day 1 to do this.
-Read the Goljan chapter(s) associated with the block. Day 2.
-Stay somewhat up on the lectures happening at school. Noteservice and tegrity all. the. way.
-Practice questions. Practice questions. Practice questions. And then more practice questions. This is how you learn it. I promise. Don't get upset if you get most of them wrong at first. As long as you're getting most of them right when it comes time to take the test, that's all that matters. What I learned over the course of the year is that a lot of choosing the right diagnosis comes down to knowing the little nuances that differentiate two similar diseases. And that doesn't come quickly.
Where do these questions come from? I thought you'd never ask!
Get the Robbins review
Go here: WebPath
Use your Q Bank (more on this later...)
If you get Goljan's book, you can register it online or w/e and he has some questions too
-Check out the OWL website for their outlines for each section
-Use First Aid. Know the graphs and charts and pictures. Use the memorization hints.
-Check out the images provided by school
-Listen to Goljan's audio lectures. I'd recommend doing this while cleaning your house or walking at the park. He's simply amazing, but it's easy to get distracted and do other things online while listening, so I just avoid that and listen while doing something else that requires little thought.
-BRS pathology is very concise and to the point. A good review.
-review any questions provided in the systems packet (ie tutorial questions)

Oh! The first thing you should do wit First Aid is take it to Kinko's, have them remove the binding and 3 hole punch it, and put it in a LARGE binder. Each block, I removed the system of interest out of First Aid so I didn't need to cart the whole thing around. Then at the end, if I had any extra useful information, I added into the binder.

I think that's mostly it with path. For each block, I felt fairly overwhelmed and kind of lost at the onset, but by the end of week 2, things seemed totally doable. Almost like clockwork, 2 days before each exam, I wished I could take it then and there then wait agonizingly for Friday to roll around.

NOTE: Friday exams will be the absolute best part of 2nd year. You get your weekends back!

Pharm
You need to know the mechanism of action, indications and contraindications for a drug, side effects, and any important drug interactions. This is all outlined well on PharmWiki.
PharmWiki will be your friend. Use it. Take the quizzes over and over till you get them all right.
Pharmcards (literally the name of the brand) would probably be a good idea. I got them late in the game to study for Step 1, but I'm glad I did.
Again, pull out any and all tricks for memorizing stuff about pharm. Chemo-man is awesome for heme/onc. Things like that.
Pharm can usually be crammed and passed, but the better you learn it the first time around the easier it will be come Step 1 study time.

Clinical Diagnosis
I went to all of these lectures, because there were almost ALL given by the amazing Dr. L. This should tell you something, since I basically admitted to totally giving up on lectures earlier in this post. She is definitely just that good. Take notes from her slides, and you'll be golden.
There's usually very few questions on each block exam from Clinical Diagnosis, but I always felt like what I learned was ALL going to be relevant for real life someday.

Miscellaneous
I found the noteservice subscription to be well worth the money. The people in my class did a great job, and I was able to keep up with any earth shattering information that the instructor found important but Robbins, Goljan, or First Aid did not.

C Thorpe Ray Clinical Problem Solving elective. Doooooooo it.

Q Banks
I got a 6 month subscription to USMLE World. I wish I had done it for 9 (is that even an option?!) or 12. If I could go back, I would have purchased it in May, used it for Immuno/Inflammation, and done all the anatomy, histo, physio, and biochem questions over the summer. It was hard to squeeze them in later.
Each block, I did pathology and pharm questions for that system. I pretty much used tutorial mode exclusively. Reading the full explanation is really important, because it's necessary to know why the wrong answers are wrong and the right answer is right.

A few friends and I also made a somewhat admirable though not entirely consistent effort to do concept mapping with questions too. This basically consisted of using a white board to outline on the left details from the question stem (demographics, past medical history, physical exam, labs) and important points about all the answer choices on the left. Ideally, you should be able to link up the most info from the left to the correct answer on the right. I also used to do this on my own. Like I said, rationalizing why a wrong answer is wrong helps you get to the right answer. (Note: Dr. Pelly will probably come back and give a presentation on this method, so if it doesn't make sense right now, don't worry.)

Final caveat. I don't mind admitting that based on my grades and where they fell around the average, I wasn't a total rockstar this year. Sometimes I beat the average, sometimes I didn't. The plan all along was to make sure I felt what I leaned was board-relevant, even if I didn't get all the details that were Tulane-relevant. Since I don't know my Step 1 score, or the final grades for this year, I can't verify that this all worked out in the end. It was certainly frustrating at times to feel like the grades I earned didn't reveal all that I had learned or how hard I worked. But the reality is, all anyone will see is a P on the transcript. So I moved on, and made sure to enjoy this city and enjoy time with family and friends. Life is too short.

AND. If you see anything on here that doesn't work for you, drop it and don't look back. Figuring out how you study best is part of the challenge, and no one knows you better than you do.

Whew. I just wrote a novel. If you made it to the end, your dedication alone will carry you through your second year!

Count it All Joy

2011-04-09T08:48:00.005-05:00

I got this email this morning from a longtime mentor and friend, who runs the Swim Ministry program back home, where I learned how to swim, learned how to teach, and learned how to pray. It was a sad summer indeed when I had to choose 'real' jobs paying real money instead of going to the pool.

Erin- I woke up this morning thinking of you and your exam. I trust this is a good indication. Blessings, Sam

James 1:2 Count it all joy, my brethren, when you meet various trials, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing.
James 1:5 If any of you lacks wisdom, let him ask God, who gives to all men (and women) generously and without reproaching, and it will be given him. But let him ask in faith, with no doubting, for he who doubts is like a wave of the sea that is driven and tossed by the wind. For that person must not suppose that a double-minded man, unstable in all his ways, will receive anything from the Lord.

I can't believe Step 1 is behind me. The last couple of days studying, and especially all day Friday, I just felt like I was on a train-going fast-and needed to simply hold on tight. I'm hoping it was one of those " 'When I looked back and saw only one set of footprints in the sand?' 'That's when I was carrying you' " kind of days.

Thank you, thank you, thank you to everyone who offered up a prayer on my behalf!

And so now? Packing, traveling, beaching, packing, traveling, beaching, moving, starting 3rd year. In that order. But I've got to find a little shopping time... I think I've earned some retail therapy!

Cheers!

Wow! Wednesday: 2

2011-04-06T07:41:00.001-05:00

This morning I woke up and my heart started pounding a little bit. Today will be my last full day of studying for Step 1. There's no specific body system or subject area to cover. Just an attempt to round up all the straggling details and shove them in my head and pray they stay there till at least 5PM Friday. At that point, you may see me hopping up and down on one foot with my head sideways like a little kid trying to get water out of their ears, letting some of this knowledge loose.

The T3s and T4s I know always said they knew the most when they took Step 1. Months later, had they been asked to sit for Step 1 again, they'd certainly do worse than their original score. Space taken up by details like which enzyme is deficient in Niemann-Pick Disease (sphingomyelinase) or what distinguishes gout from pseudogout (negative birefringence and uric acid crystals vs. positive birefringence and calcium pyrophosphate crystals) or why is folic acid necessary before you even try to get pregnant (hello neural tube defects, which would be said and done before you pee on a stick)-- all that space gets taken up by things like writing a solid note in a patients chart and learning the correct way to suture once you're past Step 1. I'm worried I don't know as much as they did, as much as I should. No one can answer that for me though.

If you asked me six months ago about Step 1, I would have told you I was terrified. There is just so. so. so. so. so much to know. Now, I'm still nervous, but I think I'll be able to control my bladder function just fine. After doing over 3000 questions (granted, some repeated) you start to get a feel for what they're asking. And usually I know right away whether it's something I can fish around in my brain for, or whether that detail has been left, lonely, on my desk.

Anyway, I can definitely use all the prayers I can get, so from 8AM-5PM Friday, please offer a quick one for me- just to stay calm, focused, and really show 'em what I know. And if you happen to be in the Big Easy, well then you should definitely join us for celebration and revelry Friday night....

Cheers!
Erin

Pinch Me

2011-04-01T12:05:00.000-05:00

I just confirmed my test because it is ONE WEEK AWAY.

Saint Luke, pray for me...

And no, this is not an April Fool's joke!

Wow! Wednesday: 1

2011-03-30T08:12:00.000-05:00

For the next few weeks, each hump day will serve as a mile stone of sorts.

This week? Today I take my last exam for the second year of medical school. I feel like I should pinch myself. I feel like I'm still that 16 year old with lofty dreams of becoming a neonatologist, blinked, and now I'm here. I still feel the cool AC in the Kaplan center as I sat during review courses as I prepared for the MCAT. I can see Notre Dame's stadium in front of me as I received the phone call from my mom that "a very important piece of mail had arrived today", and remember the elation of learning that Tulane wanted me as a part of their class of 2013.

The most overwhelming lesson I've learned? If you keep putting one foot in front of the other, Newton's 1st Law of Motion takes care of the rest. (Excuse me taking liberties with physics). But seriously. Any long and challenging process appears quite intimidating when trying to take it all in at once. But as it would turn out, medical school, measured day by day, is actually doable.

Of course, this all assumes that I pass pathology and pharmacology and clinical diagnosis, and that I pass Step 1, and that I'm actually allowed to call myself a T3 soon.

Stay tuned.

Not so Delicious Ambiguity

2011-03-28T09:03:00.000-05:00

Remember at the end of each school year, when the final bell rang, and you could pat yourself on the back for suddenly transforming to a student in the next grade? This was especially fun as a junior in high school, as the seniors finished and graduated before the rest of the school was finished. At my high school, the day after graduation was celebrated by the "new" senior class by meeting at a local park, donning senior t-shirts (class of '05 all the way!) decorating our cars, and subjecting everyone else at school to a loud and obnoxious parade. We had to make our presence known. A new class was in charge now.

Endings often are much less climatic than I anticipate. Walking out of the last final exam for some terrible class feels like it should be met with fireworks and balloons and music. But it's not. Just empty hallways and a dorm room needing to be cleared out ASAP. I imagine this is where the journey vs. the destination motivational quotes come from.

Anyway. This is technically our last week of 2nd year. We have shelf exams tomorrow and Wednesday, and then are left in limbo until May 2, when we will be summoned to begin our clinical years. Some of my friends have decided to take on the T3 title after Wednesday, since you can start third year without having taken Step 1. But since I'm taking that (awful, terrible, no good) test on the earlier side, I think I'll wait till then. I certainly don't want to jinx anything. And to be perfectly honest, I dont' think I could celebrate finishing all the coursework from the first half of medical school without having Step 1 behind me. It's not the entire reason for busting my butt for the past 2 years, but it's proof that I learned as much of that stuff as I could.

And just like every other transition to a new academic chapter, reaching the top of one mountain offers the view of the next one we must climb. Back to the end of the pack, the bottom of the totem pole. There's always so much more to learn.

Finally

2011-03-27T20:29:00.000-05:00

Your account information:
Expiration Date: Wednesday, April 27, 2011 04:29:06 PM EDT
Suspended Tests: 0
Completed Tests: 51
Unused Questions: 0%

So now I just have to re-do all the questions I got wrong until they are ALL CORRECT. Ha.

11 days, 12 hours, and counting

Goljan FTW

2011-03-24T16:21:00.000-05:00

"I don't even remember my own phone number, but I remember this: O157:H7. Forget your phone number. Learn this."

Many thanks, Dr. Goljan.

What's worse?

2011-03-23T09:41:00.000-05:00

I've been doing a LOT of practice questions. Like 100+ a day. If practice makes perfect, I want to be a pro at sitting my butt down and answering 50 questions at a time. Sigh.

Anyway. Sometimes when I'm reviewing the answers, I'll get frustrated that I knew the diagnosis but just missed the detail that was actually being tested. Other times I'm picking daisies in left field.

So is it worse to be this close or to be completely ignorant? Either way it's wrong....

Also-
Where will you fall on the REAL bell curve?

image credit

For all my teacher friends out there

2011-03-21T07:16:00.001-05:00

I know what you make.

http://www.youtube.com/watch?v=RxsOVK4syxU

A Haiku

2011-03-18T16:54:00.002-05:00

Oh UWorld Q-bank!

Random blocks of forty-six

make or break my day.

Fitting Title

2011-03-18T09:16:00.002-05:00

I needed this REMINDER today.

Matching

2011-03-18T07:21:00.002-05:00

All this Match Day hoopla is making me

1. kind of teary-eyed, having experienced the tip of the iceberg of hard work and investment that it takes to get to March of your 4th year of medical school, and, and totally empathizing with the emotional roller coaster

2. motivated to kick this party into high gear. THREE WEEKS and counting.

I think I can, I think I can, I think I can....

http://tulane.edu/news/newwave/031811_matchday.cfm

They tell me it gets better

2011-03-16T08:46:00.004-05:00

I feel like I am in my own version of Groundhog's Day. Each day is the same. Wake up, do questions, read, eat, read, go for a walk, more questions, more eating, pharm flashcards, bed.

I have to keep reminding myself that this Step-1 study time is finite. That I will not actually spend the rest of my days subject to the whim of UWorld's selection of randomized questions. That the diseases I read about affect real people with real families and real lives. That I will one day prescribe some of the 3483098403290935 (not an exaggeration) drugs I'm learning.

Until then, keeping my sanity with Graeter's ice cream PRN. I pretty much have the best family EVER who sent me 6 glorious pints, all with chocolate CHUNKS. Graeter's is proof God wants us to be happy.

These kids know what I'm talking about

GAP COUPON

2011-03-14T07:03:00.000-05:00

You probably have more time to go shopping than me. So use this coupon at the GAP and feel good about 5% going to Teach for America.

Give and Get is Here!: "Enjoy 30% off from March 17-20 at Gap, Banana Republic and Old Navy plus we'll make a 5% donation to a non-profit."

Paying it Forward

2011-03-13T13:26:00.005-05:00

I've talked about Dr. Paul Wright in my blog before. You can read about it HERE, HERE, and HERE. His message of compassion in medicine has left a lasting impression on me.

About a year ago, and then again in January, I shared the story of how I met Dr. Wright, and how his meeting Mother Teresa affected him, and as a result, me. This was part of an AMSA-sponsored program called Ted X Tulane, based on the Ted.com conferences and posted talks by really cool people on really cool stuff.

It would appear that the message of Mother Teresa and Dr. Paul have not stopped with me. Adam, a T1 presented a poster at the AMSA conference about all the Ted X Tulane talks that have occurred this year. Here's to many more inspiring stories being shared among the Tulane family! (And special thanks to Lexi for sending me the pictures!)

(speaking of Ted.com- this is an awesome video about how speech is formed. study break!)

Time for some Inspiration

2011-03-12T22:09:00.004-06:00

And Ms. Erin Duquette shared this great little piece tonight. Many thanks!

First, Do No Harm

2011-03-11T18:13:00.004-06:00

Check out this great piece from a fourth year medical student at the University of California.

excerpt:

I spend two years sitting in class learning about various -ologies, and then I take an eight-hour test, the national board exam, to prove that I've learned something. I leave the classroom, and I am finally allowed to see real patients, not just the actors in the fake clinic who get paid to pretend they have thyroid disease. I ask people probing, personal questions, and I listen as they talk about their devastating disease and lives. I try not to cry, because it feels unprofessional, and nobody wants a doctor who cries.

-Alison Block

Ummmm this is me in seven weeks and three days. Excitement + fear + anxiety + hope.

PS- Impulse purchase of the day? ER, Season 1 on iTunes. Maybe I'll learn something on my lunch breaks....

Day 1 (of 30)

2011-03-09T21:52:00.004-06:00

Swamp tour!

Today began my 30 day push till Step 1. A lot of people are taking 6 weeks to prepare, but word on the street is that's just barely too much. So I'll take my chances with 4 and enjoy 3 weeks off in April.

My family left this morning, and are still driving home. I just don't know why Cincinnati and New Orleans have to be so far apart!

See you on the other side, after jumping through this hoop called STEP 1!

Why I love New Orleans

2011-03-04T16:30:00.003-06:00

Because people turn abandoned houses into living art.

http://candychang.com/before-i-die-in-nola/

It's Here!

2011-03-04T14:57:00.003-06:00

Mardi Gras!!!!

I met a guy waiting for my po'boy, and he shared this link. You should read it too.

HOW TO WIN AT MARDI GRAS (<-- click here)

You will not be disappointed.

finished

2011-03-03T08:17:00.003-06:00

LAST BLOCK EXAM EVER IS OVER

Now, time to celebrate! Cheers!

A haiku

2011-03-01T15:13:00.007-06:00

the ginger ale, my

impulse purchase, shows how much

I am missing you

Back

2011-02-28T20:10:00.002-06:00

Back to the kitchen with no dishwasher (unless her name is Erin)

Back to the house with an entirely too noisy air conditioner

Back to being thissssss close to preferring lukewarm showers that require only a slight turn of the cold water handle

Back to the crazy home of Carnivale and Mardi Gras, filled with the promise of visitors and parades and beads

Back to being half a couple

Texas was great. But now I'm back. Step 1/D Day/ Judgment Day is 38 days away.

Chug, chug, chug.

No complaints here

2011-02-22T20:01:00.003-06:00

With Step 1 a mere 44 days away (not that I'm counting or anything) I can honestly say I'm quite content. When I started medical school, my goal was to maintain a healthy balance between academic life and personal life. I think my positive attitude at a time when medical school is trying its best to suck your soul is testament to my success.

I was inspired today at a talk given by an OB/GYN doctor from Virginia. His practice speaks volumes about the kind of medicine I hope to practice one day. Inclusive as opposed to exclusive. Hate the disease, love the patient. Practice good medicine. Follow your conscious, always. He fully supports anyone who lives out their ideology. Pro-choice? Fine, but offer all services to the best of your ability. Pro-life? Ok, but make sure you're loving the patient, never pitting her against her unborn child. He's pro-life but just as fed up with the movement, which I noted today was in disarray. What we don't have enough of, he said, was love. I hear what he's saying, and it's quite the challenge to truly sort out my thoughts. Your ACTIONS are what matter most. It will be nice to be given the opportunity to do and speak and have relationships with patients soon.

Tomorrow I go to Texas for a much needed mini vacation to see Ryan. He'll still have work, and I'll still have studying to do. But man, it will be nice just to be in the same place for a little while. Did I mention our planned trip for the beach?

When I get back, I will be mere days away from my LAST BLOCK EXAM EVER. Gotta let that one soak in. It's amazing how far you really can get by just putting one foot in front of the other.

HOW AWESOME is it to be able to have the windows open? It freaked me out at first (thinking I left the stove on or something) but the sounds of the cicadas are quite lovely.

Signing off from February's paradise.

I wish I was this cool when I was 5

2011-02-21T19:18:00.001-06:00

photo credit

Where you can find me

2011-02-21T15:06:00.003-06:00

I just scheduled the first 8 months of my T3 clerkships:

May-June: Family Medicine (6 weeks)

July-August: Internal Medicine (8 weeks)

September- October: OB/GYN (8 weeks)

November: Neurology (4 weeks)

December: Psychiatry (4 weeks)

Now, I've just got to get through the next couple of weeks of human behavior, MARDI GRAS, the worst four weeks of my life, and Step 1. Challenge accepted.

Love is the Answer

2011-02-20T11:04:00.003-06:00

The Lord said to Moses, "Speak to the whole Israelite community and tell them: Bo holy, for I, the Lord, your God, am holy. You shall not bear hatred for your brother or sister in your heart. Though you may have to reprove your fellow citizen, do not incur sin because of him. Take no revenge and cherish no grudge against any of your people. You shall love your neighbor as yourself. I am the Lord."

Leviticus 19:1-2, 17-18

Jesus said to his disciples:

"You have heard that it was said, An eye for an eye and a tooth for a tooth. But I say to you, offer no resistance to one who is evil. When someone strikes you on your right cheek, turn the other one as well. If anyone wants to go to law with you over your tunic, hand over your cloak as well. Should anyone press you into service for one mile, go for two miles. Five to the one who asks of you, and do not turn your back on one who wants to borrow.

"You have heard that it was said, You shall love your neighbor and hate your enemy. But I say to you, love your enemies and pray for those who persecute you, that you may be children of your heavenly Father, for He makes his sun rise on the bad and the good, and causes rain to fall on the just and the unjust. For if you love those who love you, what recompense will you have? Do not the tax collectors do the same? And if you greet your brothers only, what is unusual about that? Do not the pagans do the same? So be perfect, just as your heavenly Father is perfect.

Matthew 5:38-48

Today I'm really hoping that all my fellow Catholics in positions of great power and responsibility listened at church today.

Sources for yesterday's rant

2011-02-19T12:01:00.002-06:00

Top 10 Shocking Attacks from the GOP War on Women

(from MoveOn.org Political Action)

1. Republicans not only want to reduce women's access to abortion care, they're actually trying to redefine rape. After a major backlash, they promised to stop. But they haven't.

2. A state legislator in Georgia wants to change the legal term for victims of rape, stalking, and domestic violence to "accuser." But victims of other less gendered crimes, like burglary, would remain "victims."

3. In South Dakota, Republicans proposed a bill that could make it legal to murder a doctor who provides abortion care. (Yep, for real.)

4. Republicans want to cut nearly a billion dollars of food and other aid to low income pregnant women, mothers, babies, and kids.

5. In Congress, Republicans have proposed a bill that would let hospitals allow a woman to die rather than perform an abortion necessary to save her life.

6. Maryland Republicans ended all county money for a low-income kids' preschool program. Why? No need, they said. Women should really be home with their kids, not out working.

7. And at the federal level, Republicans want to cut that same program, Head Start, by $1 billion. That means over 200,000 kids could lose their spots in preschool.

8. Two-thirds of the elderly poor are women, and Republicans are taking aim at them, too. A spending bill would cut funding for employment services, meals, and housing for senior citizens.

9. Congress voted yesterday on a Republican amendment to cut all federal funding from Planned Parenthood health centers, one of the most trusted providers of basic health care and family planning in our country.

10. And if that wasn't enough, Republicans are pushing to eliminate all funds for the only federal family planning program. (For humans. But Republican Dan Burton has a bill tp provide contraception for wild horses. You can't make this stuff up.)

I just don't get it

2011-02-18T08:06:00.005-06:00

I haven't talked politics on here in a long time. But being in medical school has definitely changed my attitudes about lawmakers and their impact. I view the situation from my own world view (a woman, Catholic, future doctor,etc) but also try to understand the arguments I plain don't agree with.

I really don't get the Republican party. (Sorry to any family/friends I offend with this post- maybe I should have started with that....)

I understand the whole Dem vs Rep issue of big vs small government. That makes sense.

Why, then, are Republicans SO insistent on inserting themselves into women's reproductive rights? The statistics are out there, the numbers of unintended pregnancies are high (among whites, and higher still among blacks and Hispanics). I'm sure limited access to contraceptives doesn't explain the picture entirely, with religious beliefs and preference contributing to the figures, but I can't be persuaded that abstinence only education and denial of condoms or the pill to people who want it is in any way beneficial.

What I didn't understand growing up was that pro-choice, as the counterpart to pro-life, wasn't simply anti-life or pro-abortion. Because, unfortunately for those of a formative age, this language is utilized in an attempt to further the pro-life cause.

What I understand now is that at the heart of the pro-choice stance is the protection of the woman to make any choice she wants regarding her pregnancy. The choice to carry the pregnancy and keep the baby is respected. The choice to find an adoptive family is respected. The most difficult choice- and one I don't think ANY woman comes to without much thought and trepidation- choosing to have an abortion, is respected.

The point is, no one outside the woman and her partner should be making that decision.

So why do the proponents of small government advocate so strongly that this decision be made instead by the collective body, the lawmakers and citizens?! I just don't get it.

And then they add insult to injury.

Failing to address the root of the problem is as good as failing to address the problem, in my opinion. Why are there so many unintended pregnancies?

-Maybe (probably) people didn't receive proper sex education, explaining how babies are made and how contraceptives work. Abstinence education works for some, but without a strong family foundation or circle of friends supporting that decision, it's often unrealistic. So addressing this root= better sex ed, period.

-Maybe people don't know what contraceptive options are out there, or have access to them. This largely goes back to poor education, but also relates to proposed revisions of the health care reform, dictating what constitutes as preventative medicine. So addressing the root= increasing access to contraceptives.

Furthermore. I wasn't around before Roe v Wade. I can only imagine, then, the desperation and fear that led women to seek procedures from untrained, dirty, quack 'docs.' I can only imagine the heartache of the real docs admitting women into the hospital for botched abortions, or worse yet, filling out death certificates because of them. I don't want to experience that reality. The right argues that restrictions and added burdens to safe and legal abortions will significantly reduce the number of abortions taking place each year. I'm worried they are wrong.

One of my favorite teachers and role models taught me that when it comes to abortion, it doesn't have to be illegal for it to stop. If our youth was better educated and a family's values and expectations were clearly communicated, if sex wasn't so taboo, if, if, if... abortion could be legal but unnecessary.

If the topics of pregnancy and abortion aren't enough (and they are), consider that Dems can barely get a comment out before it's criticized by the loud mouth conservatives and their media support.

For example, Michele Obama pledged to increase support of breast feeding this month in attempts to address and reduce childhood obesity. Mind you- breast feeding was the ONLY option for nourishing infants until the last century; the human race seemed to have done pretty well with that. There are a lot of reasons women don't breast feed now- they're given formula information from manufacturers before they leave the hospital with their bundle of joy, it's a real challenge for the working mom if she has no pumping room (sitting in the bathroom stall to pump sounds like a real picnic), it's HARD to figure out the latching and positions and it's painful, and let's not forget scooping some powder into a bottle and adding water is easy.

Not every new mom wants to breast feed. It's her choice (see how we respect and protect that one?). But for those who want to but just need a little boost or support, kudos to Michelle Obama. And thanks to the IRS for the tax break if we buy pumps on a medical spending account.

SO. What's the big deal?

Republicans found several ways to spin this story.

1. Michelle Bachman lashed out, falsely accusing the US of being a 'nanny state' buying breast pumps for moms, figuring the hard left's answer to everything is government.

2. Sarah Palin credits the encouragement of breast feeding to not wanting to talk about the high price of milk. Sigh.

So let's see if I have it straight. The right would have us raise ignorant youths who will inevitably get pregnant, deny them a choice, deny them resources to affordable medical care (hello proposed Planned Parenthood cuts), and offer no help for those who WANT to provide the healthiest option of breast feeding.

It's well established that disadvantaged parents (ie young teens, poor, single moms) have a hell of a time improving their socioeconomic status- their kids grow up in poverty, struggle in school, and turn to crime and violence. This is no way to operate.

So.... Hmm. I don't have a good closing for this post. I'm too frustrated/disappointed/ confused. God help us.

Dream

2011-02-13T13:22:00.004-06:00

This morning I woke up in the middle of a crazy dream, the second in as many nights about future clerkships. I was on family medicine (I hope to do it first) but was among a bunch of medical students. We had a horrible first day, and the resident told us to return to the hospital at 3AM. I knew, even in my unconscious state, that that was ridiculous. And so I asked, several times, if she really meant 3AM, or was maybe thinking 6, 7, 8.... No. 3AM it was. Nearly in tears, I see this man running across a bridge (yeah- bridge in hospital- where was I? Seattle Grace?) and everyone is telling me, 'your boyfriend is here.' No, that's not him! And it wasn't him running. But when I turned to look, there was Ryan. And then I woke up. I always wake up when I'm getting to the good part.

In the other dream, I was on surgery. A bunch of other students were filling in to all go observe surgeries. I expected to be in the OR, maybe not scrubbed in, but at least among the action. Nope. Instead, we all walked into an arena, with like 10 ORs next to each other down below. The lucky/smart/on their game people got box seating or something directly above the ORs. Again, realizing how absurd this was, I searched for the person with the sign-in sheet so I could leave my John Hancock and get the hell out of there.

The good news?

I'm 100% confident that NONE of my future rotations in Baton Rouge will in any way resemble these dreams. As one friend pointed out yesterday, the whole year will be much more like a Sub-I (sub-internship, when one acts like an intern for all intents and purposes). Without residents or fellows to compete for procedures or cases with us, being expected to enter orders into the computers, etc, he's totally right.

Can I make it to May 2?

I think I can I think I can I think I can.....

On a Desert Island

2011-02-10T20:50:00.003-06:00

I'd need very few things.

Like an unending supply of orange spice tea. Lipton, please.

And a constant supply of Graeter's ice cream, any and all flavors with chocolate chips. With a cooler to store said stash, of course.

Finally, all five seasons of Friday Night Lights, with my own island-style movie projector.

SPF 50. Skin cancer would probably make the hot tea, cold ice cream, and best show of all time much less enjoyable.

Yeah, I'd be a very happy girl.

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Purgatory

2011-02-08T19:37:00.004-06:00

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A friend recently defined Purgatory as the spring semester of a second year medical student's education.

It seems incredibly fitting. We're locked into library cubicles, small coffee shop tables, and in home offices. There is no escaping. The books are piled high as reminders of all that we are responsible for, from the very first day of anatomy's gross dissection of the muscles of the back straight through to the last scheduled lecture on Spirituality and Creativity in the Human Behavior Block. And all that fell in between, when you try to consider it at once, becomes almost laughable it's so monstrous.

Judgement Day looms in the distance, under the guise of STEP 1. Our ability to memorize and comprehend and explain the complexities of the human body, and all it's glorious failures, will be tested, yes. But also our self discipline, our motivation, and above all else our will. We want to fight the good fight, we want to finish the race. And so we must keep the faith.

The prayer requests have officially begun.

Light the grotto candle. Add my name to the refrigerator list. Run the fingers over the rosary beads. Ask that I might succeed, if only it be God willing.

It's a Small World After All

2011-02-06T08:54:00.003-06:00

Friday night I went to prom. Med Prom that is. It's pretty much the prom most people wish they had in high school- free of charge with an open bar to grant all of your (no shots please) beverage wishes. Each year, the first year class is basically surprised with the responsibility of planning this massive party for the whole school and everyone's plus ones. I give the class of 2014 two thumbs up.

Since Ryan was stuck in Texas, I basically went to prom 'stag.' Being dateless had no affect on indulging my guilty pleasure of getting all dolled up. (This the girl who threw only 2 parties senior year at ND with her roommates- and make cocktail dresses and suits and ties required attire.....) I was super excited to don the dress and heels I snagged in my bargain shopping spree in BR last week.

So in going-stag style, I mingled around, chatting it up with all the T1s and T3s that I haven't seen in ages. Studying most days in your second bedroom turned office will do that to you. I love being surrounded by people at all stages of the medical school spectrum: I remember the days not so long ago when I was among the newest students, still figuring out each new subject but making plenty of time to love life; I envy the T3/T4 crowd, with so many milestones behind them, from Step 1 to the most challenging required clerkships. Lucky for me, Tulane is the kind of place where everyone is quick to help out their fellow (wo)man. So I left with some tips and general been-there-done-that I promise this too shall pass encouragement.

And since life, medicine, and New Orleans are ALWAYS full of surprises, I was thrilled to run into not one but two lovely ladies from my "life before medical school." The first, a girl from my college dorm who I haven't seen or talked to since before graduation. She's in St. Louis and doing well and made the absolute best company while patiently waiting our turn at the bar for drinks for what seemed like an eternity. The second was a girl from my high school class who's going on her 6th year in New Orleans. We've tried to touch base in the past, but have an even firmer resolve to hang out soon because TWO MORE '05 Ursula girls happen to be in this fine city presently.

It's a small, small world.

Can't argue with that

2011-01-31T18:04:00.004-06:00

Today when I got home, the 2 older boys who live next door were locked out and awaiting Mom or Dad to arrive with a key. A couple hours later, I heard them playing outside and went out (apron donned) to see if they had been outside this whole time.

No, Mom came back, they assured me.

Then, upon seeing the apron, You cooking?

I just finished dinner.

You eat by yourself?!?!

Well, I live by myself so yes, I eat by myself.

You should have friends or something.

They come over sometimes, but we can't do that all the time.

I really miss sitting down with my parents and sister for family dinners. Love and miss you guys!

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