High hopes

When I started this blog, I had a nagging feeling that I wouldn't be able to write very often. I drastically underestimated my lack of motivation. So, five months later, I have five months worth of stories and not one post. Hopefully, over the next few weeks I'll be able to get a few stories down, mainly for my sake. Sort of a debriefing of the last semester for myself. So here goes the first one.

It was my first day of rotations ever. I woke up extra early that morning. I wanted to make sure I had enough time to look professional, go over the directions to the room orientation was held in, and leave the house with plenty of time in case I got turned around in the maze that is the University hospital.
I found the room without any problem, but was nearly a half hour early, which meant sitting nervously waiting for orientation to begin. Finally two attending doctors showed up. They greeted us all and passed out thick green folders with our names on them. I opened mine and my stomach tightened into a knot. The first 8 pages were schedules broken down into days, each hour blocked off with a new task, meeting, or clinic to be at. There was no way I was going to be able to keep everything straight. I immediately pictured myself forgetting some meeting, being late to clinics, failing the rotation and dropping out of medical school with no way to pay back the debt I had already amassed. A little dramatic, but in the moment it all seemed possible.
Then I noticed my assignment for that week. I was to be in the Emergency Room, and I apparently had drawn the short straw; my first shift was from 4pm to midnight that night. That meant a full day of orientation, then an hour and a half break and then my responsibilities began. I had hoped to be eased in a little more gently, but there was nothing to be done. I showed up in front of the emergency room staff doors that only opened with a code. Not knowing it I awkwardly stood outside until someone came through the doors and I quickly snuck in.
I don't remember much about that first night, or even the second. There were lots of young kids in with colds and slight fevers, anxious mothers hovering over them, sure they were on death's door. We gave them a popsicle or cup of juice, went through the motions of listening to their heart and lungs, taking a quick peek in their ears and throats, then sent them home with a prescription for Tylenol. My third night, however, I had the first experience that made me feel like maybe, one day, I actually would be a doctor.
A young kid, maybe 13 years old, rushed in with his mother and younger brother, a bloody cloth pressed to his arm. I was the first on my team to see them, so I asked him to show me what had happened. He removed the cloth to show me a deep, angry gash across the soft part of his forearm. He had been playing in the park, his mother said, and had slipped and cut himself on a jagged piece of metal on a fence. My attending came in, took a look and said it would need stitches. He and I left the family to go ask the nurse to get the equipment we would need. My stomach started to churn. This could be my chance. I could speak up and ask if I could suture the kid, but I didn't have much confidence in my abilities, so the words kept getting stuck in my throat.
All of a sudden the attending turned to me and said, "you're going to stitch him up." It wasn't a question, it was what was going to happen. "Have you done it before?" he asked.
"On a pig's foot," I smiled back. He pulled me behind a curtain so the boy and his mother wouldn't see us. He showed me how to put on sterile gloves, how to hold the needle driver, then pushed me toward them. "Act like you know what you're doing," was all he said.
I approached them, attempting to smile reassuringly. Both the boy and his mom looked dubious. Maybe I shouldn't have shaved that day, maybe I wouldn't have looked so...fresh. The attending and I started washing the wound, trying to be as gentle as possible. Then he handed me a syringe full of anesthetic. I'd never given anesthetic before, I'd only seen others do it.
"OK, here we go! This will sting a little, but will be the worst part. You won't feel anything after this." Probably, I thought to myself. With a few corrections by the attending, we had him numbed up and the nurse handed me forceps and the suture. I thanked her, trying to sound more confident than I felt, and leaned over the boy's arm. It felt like everyone in the room was watching me, waiting for me to prove myself. I grabbed one side of the cut with the forceps and started to push the needle through.
Human skin was tougher than I thought. I pushed harder until all of a sudden it gave and the needle shot through. I looked up quickly, expecting the boy to pull away and start shrieking, but the anesthetic had done it's job and he hadn't felt a thing. After finishing the first stitch the attending watched me do a few more then patted me on the back and went to see another patient. With his vote of confidence I felt the muscles in my lower back relax a little, and I let out the breath I'd been holding for longer than I realized.
15 minutes later the wound was closed, 7 little stitches that while not perfect would do just fine. I cleaned up the arm and told the family they were good to go. I felt like I should give them all a hug or something, but I think that would have just been weird. They didn't know that what had just happened had me flying high for the whole next week, or that I'll remember them for the rest of my career, or that they gave me the experience that for the first time made me feel like all of the work I had done up until that point was actually worth it.

Giving bad news

Yesterday I experienced giving bad news to someone. Well, I practiced giving bad news is closer to the truth. As part of a practical exam, I had 15 minutes to tell a patient of mine that he had pancreatic cancer, and most likely had 6 months left to live. In reality, this is going to one of the most difficult aspects of my job. Watching someone come face to face with death and witness them process just what that means will be heartbreaking as well as an extraordinary privilege. Before I go and start sounding too noble, I should say what was most difficult about my encounter yesterday.
Sunday (the day before this test), Heather and I watched the latest episode of Modern Family. During it, Claire, the mom, had to tell her son that an old man he was friends with had died. As she was telling him, she couldn't stop smiling, and it became a recurring them through the episode. She called it a "coping mechanism." Well, later that evening I asked Heather to be my patient so I could practice giving bad news in a clear and sensitive. But when I started into it, I couldn't stop smiling! All I could think of was Claire.
Imagine hearing "you have 6 months to live" from someone fighting back a huge grin. That person would be a sick person. Then the panic set in. What if I smiled during my exam? I would surely get kicked out of medical school entirely.
So, yesterday morning, as I stood outside the exam room, waiting for the proctor to tell us our 15 minutes had begun, I prayed that I could just keep it together.
It went fine, no smiling or anything of that nature. And I also don't mean to make light of delivering bad news. Real life will be very difficult, but on an exam, with a standardized patient working on his acting skills, trying desperately to make himself cry, I'm proud to say I did not smile.

My Journal of Medicine

There are several prestigious journals of medicine, and they can be really intimidating when you're just starting out in medicine in general. First off, they're extremely boring. Very few pictures, lots of tables and graphs, and really complicated, foreign words like "xanthocromia."
Their importance, though, is in keeping doctors relevant. They publish the latest research, consensus, and expert opinions on treatments, procedures, etc., and in doing so, help medicine to always better itself.
The idea behind this blog is something similar. It's just for me. It's to keep me relevant, especially as I move through the different phases of my education. I want to document my thoughts, feelings, and experiences, because I know one day doing a physical exam will be second nature, interviewing patients will be like breathing, and formulating a differential diagnosis will be automatic. Right now those things are awkward, and my medical experience is relegated to books, flashcards, and a bunch of stomach-churning anxiety.
So I want to make sure that I write down my experiences somewhere, so that down the road, when these years are distant memories, I can remember where I came from, and maybe have something to pass down or share with someone else. 

For now, I have Step 1 (my first board exam) in a little over a month, and I can't think about anything else. The review book everyone uses, called First Aid, is 600 pages long. People say that if you have First Aid virtually memorized, you'll kill the test.
Yea, ok.
*sigh* It's going to be a long 4 weeks...