debt and burnout

These are two subjects that (almost) every medical student struggles with, but is afraid to talk about, even (or perhaps especially) with her med school classmates. I bring them up because I feel like both are topics that need to be addressed, and I would really like to get to the bottom of how we got here and what can we do about it now? I've chosen to link to two articles that specifically address these problems well, because I think they have a broader perspective than I could share.

Debt. Ugh. It's kind of the huge (more like gigantic) elephant in the closet, isn't it? I mean, I try to ignore it, I try to live my life in a conscientious way without stressing about money, but whenever I make a purchase over $5 - or even an unnecessary $3 purchase, like coffee - I think about how I am actually paying a significant amount of interest on that coffee or that toy for my cat. It is a constant burden that I would love to ignore but I would also be stupid to ignore - kind of a catch 22. I wanted to share this article about medical school debt and the path to becoming a doctor because 1) I don't have time to write something like this right now and 2) I think it's important to see the perspective of someone who has completed his training.

Note: I actually have no idea what this says... 

Burnout/mental health. Because I'm a person who has to talk about my feelings, profusely, to my friends, I feel lucky that sharing my struggles with depression and insecurity with my medical school friends has helped me to know I am not alone. I would be very surprised if I had a single friend who hasn't already dreamed about, let alone seriously considered, dropping out of medical school. This article  refers to a study that found that over half of medical students (I emphasize med students because this is really only the first half of our medical training) meet the criteria for burn out, and if anything, I would say this is an underestimation.

So how did we get here? What can we do about it now?

I think first we need to have physician voices willing to say that the burdens are too big and the stakes are too high. We need to have people willing to advocate for us and say that we need better loan options and better ways to fund medical education. I think it's mentally and financially healthier to have no debt and a smaller salary down the road, as is the case in many other nations.

I think it's important for medical schools not only to provide passive mental health care (ie where counseling is made somewhat available), but for medical schools and medical students to take an active role in prompting discussions about stress and burnout, and providing easily accessible options that aren't financially burdensome.

I don't have a perfect picture of what the solutions to these problems looks like, or how to get there. But the first step is just to bring them up.

change

Since I last posted, I finished my 4 week radiology clerkship and just finished the first two weeks of my neurology clerkship doing pediatric neurology, and let's just say my lack of posting can somewhat be blamed on the old adage, "When you don't have anything nice to say, don't say anything at all."

I think radiology is a fine specialty, but a really miserable rotation as a medical student. I had a radiology fellow say this to me, so I know I'm not alone in the feeling. Radiology as a medical student has been likened to be as interesting "as watching someone read." I honestly wished I liked it more - I actually really like the concept of radiology and anatomy, but we can just leave it at radiology is not the career for me.

So far, pediatric neurology was fairly depressing - dealing with death in children is not easy. Some day I will try to tell the story of the first (and so far, only) death I observed last summer, but I'm not quite ready to describe it yet. In addition, neurology just has many attributes that don't mesh well with me - I will attempt to write about this more later, but feel free to read my post from first year, cross one specialty off, in the meantime.

Anyway, what I really wanted to talk about is the third year of medical school in a more overall sense. Bear with me for another analogy:

Imagine you want to become a restaurant manager. You've already been to culinary school and know a ton about food. But in order to become a restauranteur, what you have to do is pay to rotate through different restaurants every two weeks. Every two weeks you are a waiter at a completely different restaurant - Mexican, Italian, American, French, etc, etc. And every week you are rated on your ability to be able to answer questions about the entire menu whenever the manager asks you, you are expected to work well with the other waiters and bus boys, you're expected to be friendly and accommodating to all the customers, work whatever hours you are assigned, and it's generally perceived that unless you use your own spare time to come up with unique additions to the menu, then you probably aren't very dedicated. There are some skills that you can carry from one week to the next - but in general, every two weeks you encounter a steep learning curve.

This sounds utterly ridiculous, right? A crazy, but maybe efficient way for you to become a good restaurant manager. But this truly is a comparable analogy to how we are trained during this year, substituting medical and procedural and physical exam knowledge and skills for the skills it takes to be an excellent waiter. On top of this, add a bunch of Type A personalities and feelings of guilt and failure about any imperfection and it's not surprising that articles like this are so unfortunately real.

With expectations and stakes so high, it is easy to forget that it is natural to struggle to excel at something when your work is constantly shifting. I find myself in the hospital sometimes longing for a "work home." Just a desk. A desk that is my place to sit, with people around it who will also be there tomorrow. I find myself jealous of the nurses who are just free to be good at their job and have plenty of time to do it. I find both of those emotions pretty strange, because a huge part of what appealed to me about becoming a doctor was avoiding a cubicle and being in a job where I could continue to grow and change. But it makes sense that in my constantly shifting world I would long for some continuity.

But where I find myself is when I embrace the change. Man, that sounds so freaking cheesy, and I'm sorry about that, but really... While part of me longs for the day when I can just be settled, I am forced to remind myself how exciting and dynamic my life is now. I am young and single and at the beginning of a career that could take me in a million directions - from operating on people to working abroad to starting a foundation to teaching students to researching cancer. I don't need to know the answers now. I don't need to be the expert now. This year, I have to cope with change. But I also get the opportunity to grow by being flexible and adaptable. I get to be open to being influenced by people. I get to just take it all in and work as hard as I can, and hope that along the way I grow closer to the person and doctor that I want to be.

concept: white coats

The idea for this new series has been brewing in my head for a while. Here's the crazy thing about medical school: not only are we expected to learn physiology, pathophysiology, common and uncommon presentations, diagnosis, and treatment of diseases, but we are also expected to learn an entire new culture. It continues to astound me how many there are, and in general how peculiar they are. I'll try to explain some of these cultural oddities in addition to continuing my normal posts.

So, white coats. If you haven't spent any time in a hospital, or maybe even if you have, you might not know that white coats are actually hierarchical symbols.

You see, medical students wear short white coats. Doctors wear long white coats. This distinction is probably hardly noticeable to patients, because who's really looking to see if the coat is to the doctor's hips or knees? But this whole message has gotten more confusing with the advent of other advanced practitioners. Nurse practitioners and physician assistants also have the distinct privilege of wearing white coats.

So now you can't just look at the length, you have to look at the badge. You should also take note of the badge for other purposes, like differentiating the *even more special* doctors. The division isn't just medical student vs. doctor - it's also residents (also called "house staff" because they literally used to live in the hospital) vs. fellows vs. attendings, who are all already doctors.

All this talk about white coats makes me want to rant about how medicine, an occupation where blood splatter is a relatively common occurrence, ended up with the white coat as its uniform. It's just so illogical. And also necessitates more laundry, which I hate, so yeah. This is probably where I should divulge some historical research about why there are white coats in medicine, but I usually get really bored when some old white dude tries to tell me why we do things a certain way because another old white dude thought of it, so you can google white coats if you're interested.

One really wonderful thing about white coats is that they can hold everything. At one point I've fit a small book, my stethoscope, 5 printed articles, a schedule, my cell phone, a pocket guide, three pens, a highlighter, a penlight, a small notebook, a roll of tape, a packet of tissues, my pager, and mints all in my white coat. It's like wearing a backpack! Except it does kind of start to pull on your neck after a while... but that's totally normal, right?

surgery: a summary

What did I love about surgery?

Cutting people open. Yeah, I definitely said that to freak you out. But, you know, if I'm super honest it's probably true in some weird way... and now I feel the need to say:

please-I'm-not-like-Dexter-I'm-really-a-normal-well-pretty-normal-person-who-just-thinks-surgery-is-cool-and-someone's-got-to-like-it-if-you-ever-need-surgery-right??? 

But really, whenever they let me do anything it is such a rush. There was this one attending on my last rotation that apparently has a reputation for not liking medical students very much. Let's call him Dr. Gruff. On my first day, he "pimped" me for about twenty minutes, quizzing me about anatomy and the treatment of ulcerative colitis and what I knew about the patient (which wasn't much because it was my first day and I didn't know what surgery I was going to until about 10 minutes before it happened). But apparently I did a good job, because the scrub nurse told me the next day that I actually answered his questions and sounded confident... which apparently not everyone does, I guess. I wouldn't have known I did well because basically the only sign was that Dr. Gruff stopped asking me questions. And sometimes this can be a sign that you're completely hopeless. Anyway, the point of this story is that this attending actually started to like me. Probably because we talked about playing Candy Crush one day when one of the nurses brought it up. :) (Thanks Mom for introducing me to that one...)

So anyway, the real point of the story is that one day I was in the pre-op area for one patient when this doctor taps me on the shoulder and asks me to help roll another patient back to the OR. I get there and help set the patient up, but I'm expecting the resident to show up at any time, and they always take precedence over us to scrub in on cases. Suddenly the attending is there scrubbing in and the resident is nowhere to be found so I think: well, I get to be first scrub! I grab gloves and scrub in on the pilonidal cyst excision.

It was so exciting. I got to make the incision and do a lot of bovie-ing (reference my initial post about surgery). Now let me explain a pilonidal cyst to you, so you can be shocked at my excitement: a pilodnidal cyst is a big mass that fat guys sometimes get right above their butt cracks. Yep. I got to help operate on someone's butt crack.

(I thought about putting a picture here - but then I googled it. For those of you brave enough to click on the link, it's actually a good representation. For those of you who are not brave, this is when you thank me.)

But then, but THEN, the most amazing thing happened. In the next surgery, we were almost done and getting ready to remove part of the bowel. There's a part where they clamp off the mesentery (the tissue layer with blood vessels that supply the bowel) and then tie it off. The fellow takes a tie, and Dr. Gruff says to me, "let Chelsea have a tie." It was THE MOST flattering thing that I'm pretty sure anyone said to me the whole rotation. I guess it's hard to explain, but that's the way surgeons think. The opportunity to DO something is the biggest reward someone could give you.

Anyway, that was a big tangent. And I hope if Dr. Gruff ever finds this he knows that the nickname is all in the name of fun and I really did enjoy working with him. Except for when he passed my level on Candy Crush.

What else do I like?

The pace. There's always something to do and you're always on your feet doing something. Maybe I won't like this when I'm 60 years old, but I really love it now.

Being able to concentrate on just one problem. This is an oversimplification, because surgeons do manage their patients and all their medical problems when they stay in the hospital after the surgery, but in reality surgeons get to focus on the problem they are trying to fix with surgery and leave most of the rest for the patient's primary care physician. I like this. I think this means I have more of a specialist mindset, but we shall see.

photo credit

Anatomy. It's just cool.

What don't I like?

The lifestyle. Aka the lack of lifestyle. I honestly didn't mind the hours as much as I was expecting to, but by the end of just eight weeks I felt pretty worn out. I didn't have time to do a ton of things outside of work, although I did continue going to my dance class and hanging out with friends and things. But the residents worked probably at least 2 hours longer than I did some days, plus all day on the weekends. It's just hard to imagine anything being worth working that many hours for 7ish years. And it's not like attending hours are that much better. I heard over and over, "only do surgery if it's the only thing you can love" (this was all from non-surgeons, though, so take that for what it's worth.

Sometimes, the people. I liked a lot of people I met, but I didn't meet very many people who I really, really admired. Who I just thought their personality was really similar to mine, or someone who I would aspire to be. I don't know if the mentality in surgery is changing, if it truly is becoming less hierarchical and paternal and God-complex-y, but I don't want to lose my compassion. I don't want to lose my desire to be a servant to others. I've been told don't fall into the trap of choosing a specialty based on a mentor you really admire, but I wonder if the converse is also true - maybe I shouldn't choose a specialty where I had trouble finding people who I greatly admired?

To end, an analogy:

Something I found really energizing about surgery was that it reminded me of dance. Surgery requires so much work and time and dedication that you have to be passionate about it. In surgery, you are expected to learn quickly and to take all corrections immediately and to remember them the next day (this, at least, was a philosophy I learned from my dance training that I applied to surgery and it served me well). Surgery is physical and requires muscle memory and a striving for perfection. It requires you to think on your feet. Even though you may be performing the exact same procedure, the patient's anatomy may be slightly different or you might accidentally nick a blood vessel and you have to adjust immediately. And there is definitely an art to surgery. I heard more than one surgeon say that you could have done the most beautiful surgery on the inside, but if the incision looks terrible the patient will think you are a bad surgeon. To be a great surgeon, you need to be a perfectionist who does amazing work in every single operation. It also helps when people like you. Malcolm Gladwell taught me that.

So this was quite a hodgepodge summary, and I refuse to jump to conclusions, but - surgery isn't crossed off the list quite yet. :)

surgery schedule

There are so many things to write about, I just need to get started blogging again. During the day when I'm bored during a surgery or something, I daydream about interesting moments and revelations that I want to share, but then I get home, make dinner and go to bed without sharing my epiphanies. So until they come back to me, I thought it might be of interest to share what a somewhat typical schedule on my new rotation, Colorectal Surgery, is like:

4:30 am Press the snooze button.
4:39 am Press the snooze button again.
4:48 am Freak out and jump out of bed.
5:06 am Try to shove some food in my bag, feed Gracie, get my scrubs and white coat on, remember my cell phone and pager and make it out the door by
5:15 am Walk to work.
5:30 am Go to the desk on the floor and start "skeletonizing" notes, which means filling out this three page form about every patient with their diagnosis, operation, physical exam areas (general, cardiovascular, respiratory, abdominal, extremities) and the assessment and plan. I usually do about 10 of these.
6:00 am Start "rounds" with the fellow or the chief resident. This is where we go to each patient room and ask questions, do a brief physical exam, and I furiously try to complete the note and write down the plan for the day. We also have to carry around a bag of dressing supplies and help change the dressings over patients' wounds.
7:00 am Round with the attending. I usually leave before this is over to try to get to the OR on time
7:20 am Go down to the pre-operative area and meet the patient and try to help the patient get back to surgery on time.
7:30 am With the anesthesiologist, take the first patient back to the room. I help the nurses and resident in any way I can to get the patient on the table and prepped.

This part varies a lot based on what type of surgeries I'm assigned to. Basically I scrub in the surgeries and help in any way the surgeons let me, such as suctioning, cutting sutures after they tie them, and other such things. In between surgeries I have about 15 minutes to meet the next patient, try to eat something and use the restroom. The motto of surgery is "eat when you can, pee when you can, sleep when you can." I also use this extensive period of time to read about the diseases that my patients have so that I can attempt to answer the questions I'm asked during the surgeries...

5:30-6:30 pm Finish up in the OR (the ORs actually use the time 17:30, which is also how the clocks were in France, and I kind of like this system because you don't have to write am and pm all the time. I digress...)
5:30 pm Go back to the floor and check in with the interns who have been there all day managing the patients. Do whatever they ask of you. When you want to go home, you're supposed to ask, "Is there anything else I can help you with?" and I'm typically disappointed when they say yes. :P I help write discharge summaries for patients that might be discharged the next day and do other sort of clerical type work that helps out my team, and then when they tell me to go, I ski-daddle!
6:30 pm Make dinner, usually eating a snack while it cooks because I'm so hungry by this point. Watch TV.
7:30 pm Study dutifully for an hour. Hah. If you believe me then you must not be in medical school.
9-10 pm Pass out.

The end! Sleep, eat and repeat.

roller coasters

Yesterday, after going in to work for rounds from 5am to 10am, I went to Six Flags with a group of my friends. It was a blast! We stayed until close at 10pm and ran all over the park. 

Not to brag, but I must say I was extremely impressed with my positive attitude which lasted ALL DAY. I almost had a breakdown and decided not to go right before we left - I was so tired and my stomach was hurting and they told me I had to put on a bathing suit and I was afraid of going and then ruining everyone else's day. But I ate lunch (food is magical sometimes!) and rallied and I'm so glad I did. 

So let's be real about some things. I am not a morning person. In my previous life, if I got less than 7.5 hours of sleep, I would be, you know, a b. Walking around all day at a theme park with people pushing and cutting in line and my feet hurting would just be a recipe for disaster - just ask my family. Add waking up at 4:30 am and working for 5 hours with only one cup of coffee on top of that? Finished. No more friends for Chelsea. 

But yesterday I was pleasant to be around! I suppose my friends may secretly disagree (how would I know?) but I personally was super proud of myself. Woot!

Endurance. Having a positive attitude and being helpful and pleasant to be around no matter how you feel inside. Refusing to complain. These are things I am learning this year. To be honest, I don't think these are necessarily things one inherently learns from medical school. They are qualities that are definitely desired in medical students, but you can make it through without them. But these are qualities that are important to me. I want to be a good addition to my team. I want to treat all patients well regardless of how they treat me. I want to be helpful and a hard worker and uncomplaining. And people are seeing it in me, and I am beginning to see it in myself. I just feel overall happier with my life. I feel like I'm contributing to something. 

Don't get the wrong impression though - I've already had some bad days. Times where I get switched out of surgeries I want to be scrubbed in on, times I get asked questions I should have looked up, times at the end of the day where I'm just so tired and we still have to round on 10 patients. ***Warning: Cheesiest analogy ever*** Being a med student really is like a roller coaster. Half the time you don't know what's going on, sometimes you feel so thrilled and accomplished and other times you feel devastated and disappointed. The only constant is an underlying anxiety that begs the question "what am I doing???" 

But my dramatically improved mood over the past weeks and the positive feedback/evaluations I've received so far encourage me that I won't regret this career choice. While the hours are long and the work is hard, I am beginning to believe again that I have chosen a career I will enjoy and continue to be passionate about. 

tired but happy

Wow this week has been a whirlwind. Surgery! I'm going to try to reflect on it through moments:

A chicken with its head cut off. This represents me during the first two days. Before this week I had never:

-pre-rounded on a patient
-written a progress note (also known as a SOAP note) on a patient
-"skeletonized" a note for my resident
-presented a patient on rounds
-scrubbed in on a surgery
-sutured real skin
-"Bovied" (I refer you to Wikipedia's explanation of electrosurgery...and if surgery doesn't gross you out, you could watch this tonsillectomy video...it actually isn't bloody and I feel like the only way to really understand is to watch. It's like a paint brush!)
-seen a surgical patient in clinic
-helped change wound dressings

Cancer. A poignant moment was being present when a woman was diagnosed with breast cancer. At least she was not surprised by her diagnosis. The mass on her breast was very obvious and had been present for some time because she was trying to avoid Western medicine. I really don't want to put any value judgments on this; while it is difficult for me to understand because it is a world in which I am now indoctrinated, I can also see the ways in which we often fail to make connections with patients and how a medical perspective is so alien to almost everyone, even highly educated people like this woman. It was really emotional to be present for a true life or death discussion with a vibrant woman who was making a clear, conscious effort to make the most out of her life and decide what was best for herself.

Surgery. Surgery. Surgery! It's so awe-inspiring to me. I get to work around 5:30 am and try to help write the notes and pre-round on my patient(s) before we round as a team (which means go to each patient's room and discuss their care and plan for the day) and then I start in the OR around 8am and go until around 5:30ish, then we round again on all our patients. I barely have time to eat peanut butter crackers in between surgeries but I don't even feel hungry most of the time - I try to remind myself to eat because I don't want to pass out or something. I remember yesterday I looked at the clock between surgeries and it was 3pm and I hadn't eaten anything since a small breakfast and I just thought "I guess I should eat even though I'm not really hungry..." My theory is that hunger just fades into the background when you're constantly moving around and helping out. My surgery rotation is my new weight loss plan. And I'm lucky that I'm on a service where I actually get to be involved in many of the surgeries so I'm rarely bored. And even after all this, I'm excited to be there. I'm excited to be intimately involved in this crazy thing that people trust us to do.

Anatomy = Beauty. The anatomy of a well dissected surgical field is just beautiful. I get that I'm kind of going into territory where my words maybe don't make much sense, but I just have to try to express it. It's just so amazing to see the inside of a body, how wonderfully crafted it all is.

Accomplishment. Maybe my residents are just super nice and are trying to make me feel good, but this week I feel like I succeeded at something. My resident yesterday told me I was a fast learner and I picked up how to help out with the notes and with the patients really quickly. He was impressed at how I was reading about my patients and about the surgeries and I was clearly trying to learn and to be helpful. Coming off last week where I just felt terribly mediocre and doubtful that I could ever stand out in a field of amazingly intelligent physicians, it was so nice to feel like I could be a sponge. I can contribute to the team and my hard work matters and I am where I'm supposed to be right now. My patients matter to me and I'm trying my best to be a humble servant to them.

Reality check. I'm realizing it's what I learn this year that will help form me into the physician I want to be. This is the only time in my life I will get exposure to a dozen different specialties and I want to learn as much as I can. My boards score may in part determine what I specialize in or where I go for residency, but it is what I do every day in the hospital during this year and every subsequent year that will make me into the doctor I want to become and will matter for all the future patients that I serve. I just met my new neighbor across the hall who is taking a gap year and when I told her I was a medical student, she said "wow!" It's so easy to forget that this sometimes painful reality used to be my big, seemingly-insurmountable dream.

This post was a lot more serious than I originally intended. Here's a picture of my cat, Gracie Lou Freebush, to make up for it:

Translation: "First Aid doesn't matter! I matter!"

anesthesiology

Let's see, what did I love about anesthesia?

Keurig Coffee. Hazelnut? Pecan Delight? Glazed Donut? Creme brulee? It's dessert and caffeination in 6oz amazingness! I've been told that department coffee machines should be the most important factor when deciding your specialty. Then again, I can guess why the anesthesiologists were giving me this advice. AND they even gave me time to drink it most days. A+.

Dancing. No, I did not dance in the OR while intubating someone. But I got to go out dancing two weekends in a row while on this rotation! Having a life? Honors. 

Procedures. Intubation, IVs, central lines (they actually let me try on the second one I scrubbed in on. I failed miserably. Apparently I wasn't poking "aggressively" enough into the huge vein in a person's neck. I know enough anatomy to know the big vein in your neck is kinda close to your brain...sorry I was a little frightened...), epidurals (I actually did one of these! And she didn't have a post-puncture headache the next day! Apparently I'm less afraid of spinal cords than veins. Success.)

Lunch. You actually get to eat when you're an anesthesiologist! A real 30 minute lunch! (Yes, you do detect a hint of sarcasm, but really, a 30 minute lunch of warm food is pretty amazing in the medical world... I assumed I would be eating nutrigrain bars and nuts for these 3 months on surgery) 

Patients being asleep. Sometimes, this was a huge sigh of relief. This isn't really about disliking interacting with people (although there were a few not-so-nice patients...) but more about how you can speak out loud about questions you have and medical problems that are going on without worrying about alarming the patient. One resident told me he liked being able to treat people immediately and seeing the results, compared to internal medicine where you often have to negotiate with patients and prescribe meds you think they will actually take - during surgery if a patient is hypotensive (has low blood pressure) then you just treat them. 

What did I dislike about anesthesia? 

Lack of continuity with patients. The two times I saw a patient after their surgery in this entire month is memorable to me. No one thinks of you as "their doctor." 

To be honest, lack of credit. I think anesthesiologists are often the person in the OR who is most concentrated on advocating for the patient and keeping them stable and comfortable. However, they are almost never recognized as having taken care of the patient at all, and surgeons were variably inconsiderate of the anesthesiologists. Some would let the anesthesiologist know when they were close to finishing the procedure, but most did not. After one surgical resident let us know he was readjusting the endotracheal tube, the attending actually chastised him, saying "You don't need to ask them permission! Just do it." My analogy is anesthesiologists are to surgery like sound technicians are to theatre. Without good sound, we could never have these huge performances with thousands of people in the audience. But unless there's some obvious blip in the sound, no one ever comments on that vital portion of the performance. Never have I walked out of a musical and said "Man, that sound quality was just so good!" Just like no patient has ever come out of surgery thinking, "Man, I'm so glad the anesthesiologist kept me comfortable that whole time!" We only notice when something goes wrong. 

Physics and Pharmacology. Not my cup of tea. Pretty important for anesthesia. That about sums it up. I would rate my interest level in these concepts at a "pass."

In sum, probably not my thing. But also something I don't think I would be unhappy doing. And now, on to Endocrine/Oncology Surgery. Which translates mostly into thyroid and breast surgeries. Which also translates into more work/longer hours, but I'm excited! I should get to suture and hopefully be more involved. I'm also excited to be working with the same team of people each day. Can't wait to see what coffee I get :)

highs and lows

Highs:

1) Seeing a lung transplant. It was awesome. I wish there were more creative words to describe seeing a person be given a new life, but it is just awe-inspiring. And I got to intubate him! There is an endotracheal tube (a "breathing tube") that has a double-lumen which you place so that you can inflate just one lung at a time. This man also felt like my first true patient. I got to see him the next day and he remembered who I was. Sometimes medicine, especially something like anesthesia where the patient is asleep most of the time, can seem so clinical and mechanical. It was exciting to feel connected to a patient as a person. 

2) Improving at something! Two weeks ago, I tried three different times in one day to intubate and I just couldn't do it. My positioning wasn't right, I couldn't get a good view, but I couldn't figure out what was going on. When I tried practicing on my own on a mannequin I accidentally intubated his esophagus (the tube to the stomach) and I couldn't even figure out what was wrong. But after practicing it a few times, I realized I'd been going too deep instead of curving forward. In the last two weeks I've now lost track of how many intubations I did because I got to do so many! I even intubated a 5 year-old this week. I've also gotten better at doing IVs (blood doesn't spill everywhere now... yay!) and helping draw up and administer medications. It's gratifying to see direct improvement, although it's also easy to concentrate solely on the many things I still struggle to do. There is so much to learn.

Low:

 

My boards score. I scored significantly lower than I wanted. Basically this means that I will have to work much harder if I want to go into a competitive specialty like dermatology, plastic surgery, radiology, ENT, etc and it may be more difficult for me to go to the locations I might want for residency. Working a lot harder is difficult to imagine when I already feel that I work pretty hard. I see other people who work much harder than I do, but I don't want their lives. I don't want to study constantly. I don't want to be so rigid and structured that I turn down invitations to hang out with people or forget to do something nice for someone else every once in a while. I want to have close friends and explore the city I live in and be involved in culture. 

I guess the lesson is, if we really push ourselves to do something difficult with our lives, most of us reach a point when we struggle to excel. I am now "average" in the pool of people I have placed myself in. It's difficult to accept. It's difficult not to question my life choices. It's difficult to work hard for two years and feel like you barely succeeded. It's easy to worry about the future when it seems that hard work and whatever intelligence you feel you have is not good enough anymore. I think I'm ready to be the big fish in a small pond again. Screw the big pond! I don't want to be a little fish anymore! I want to be a shark or something. I don't know where this analogy is taking me. I had a beer before I wrote this. I'm not liable. 

But to be serious for one more moment, a more important thing for me to concentrate on is the importance of placing my trust in God and not myself in this time. It is so easy for me to desire success when many things do come easily to me, things I constantly take for granted. And when my plans come crashing down, I become depressed because instead of putting my self worth in Jesus I have been placing my self worth in myself and my accomplishments. I believe God has a bigger plan than my small life, but that he also loves me so much that he also wants me to be happy within that plan. He wants my heart to be for him and I so hope that he uses this setback in my life to point me toward him. Please pray for me to continue to trust in him in this time and to believe that his plan is better, even though it's certainly not easier. 

Hopefully I will add more soon summarizing my experience with anesthesiology, probably more for me than for you, so that when I make that big decision at the end of the year about what I want to specialize in I will have something to look back on. And now I am just one 10 minute presentation away from Endocrine/Oncology Surgery!

weekend? I'm confused

Today I slept in until 8am (which feels very late after waking up at 5:30ish all week)! I laid in bed for a while playing candy crush on my phone, then I did yoga, took a shower, played candy crush again while watching 30Rock, walked a few blocks to my favorite coffee shop to buy coffee beans, and when I got back to my apartment it still wasn't even noon yet! Who are you weekend? Have we met before? You feel too much like vacation. I don't even know what to do with myself.

Ok, so I know my weekend activities aren't really what is interesting about my life, but the whole phenomenon of having a weekend is very strange to me. The first two years of medical school my weekends went something like this:

Wake up, study, eat, study, planned activity that usually involves eating so you feel less guilty for taking a break, study. Sleep, repeat.

I know, I'm exaggerating a little. I still occasionally participated in fun weekend-y activities like beer fests or brunch or going out every once in a while, but I really can't remember a Saturday where I woke up without an alarm and didn't have a huge amount of things on my to-do list. I feel like a real working person, even though I still can't quite nudge the nagging thoughts out of my head - "shouldn't you be studying Chelsea? I'm sure you should be doing something productive right now - like studying! Study!" I decided to ignore them for today - however, now I have no idea what to do with myself.

So enough about that. I'm sure you'd rather hear about my experience this week in the hospital. It's really difficult to use words sometimes after learning what often feels like a whole new language. As cliche as that is, it's happening to me! I have to think really hard not to use weird words or expressions that have already become commonplace.

On anesthesia I am assigned to a different service with a different resident every day, so my life is always changing. The only thing that doesn't seem to change are my aching feet. I'm so glad I started off on a "easy" rotation because working from 6:30am to 4pm this week exhausted me. Most of the time we are standing. Going from having to sit very still at a desk all day to standing all day wearing weird orthopedic shoes while being quizzed, trying to perform procedures that you have never done before, and constantly trying to be helpful and look interested when you have no idea what the hell you are doing is a whole new kind of crazy.

But it really is awesome. So far I've already placed 5 IVs (4 of them were asleep, but it still counts!), tried to intubate three times (maybe I'll be successful next week!), learned how to hook up EKG leads, learned a lot about medications, watched 3 epidural placements, gone to 8 lectures and held a scared patient's hand. I've been sprayed in the eyes with lidocaine (accidentally of course) and I've gotten maybe 30% of the questions that I've been asked right, so I feel stupid pretty consistently, but all my residents so far have been nice and genuinely interested in teaching me. The amount of knowledge I could gain is so vast, and even though I try to read about what I'll be doing the next day I'm mostly asked questions about things I've either never learned or learned and already forgotten. But I'm so happy I've finally reached this stage in my training. Even though the days are exhausting and I am certain there will be many harder days (and nights) in the coming year, I cannot wait to transform into a person who might actually someday deserve to be called doctor.

ending and beginning

Well, it has been 40 weeks since I last posted. Many things have happened since then, so here are some highlights:

 -   Took (and passed!) the equivalent of around 20 semester-long science classes.

 -   Took (and probably...hopefully...can't know soon enough if I passed) the longest and reportedly hardest of my boards exams, the infamous USMLE Step 1. (Yes, they can't just give us one exam, with a catchy name like "the bar" or something; we get to take 3 "baby" steps!) The actual test consisted of 8 hours of misery and over three hundred multi-choice and multi-media questions... To give you just a preview of what my studying looked like: I did over 2,000 practice questions and read the 400 page prep book approximately three times. I also watched about 70 hours of videos explaining pathology. In the last three weeks I was studying 8-10 hours per day and still didn't feel like I was accomplishing enough. Laying it out like I just did makes it seem like I did a lot - but believe me I am not being overly modest or something when I tell you that at least half my classmates studied much harder than I did. The importance of this score is that it basically determines your residency placement - either whether or not you can get a competitive residency or maybe if you would be able to get into the top programs in your specialty choice, even if it's not considered "competitive."

 -  After 19 years of dedicated classroom learning, I am leaving the classroom behind. Do you think my butt will start to look different?

 -  I am now going to live in the same location for two years in a row for the first time since going to college. Is this what growing up feels like? Sitting in air conditioning instead of moving boxes in 100 degree heat... If so, this adulthood thing is growing on me.

 -  My brother got married! I now have a new and wonderful sister-in-law. I am so happy they live in the same city as me so I get to hang out with non-medical students every once in a while. I would probably go insane if it wasn't for them and my weekly session watching Dance Moms with a good friend.

 -  I failed to blog... I guess my life just seemed insanely boring/depressing and I just didn't feel like blogging about my giant never-ending to-do list. But I am starting back up because now I get to do exciting things like: talk to people! walk around all day! do procedures! look things up that might actually help someone!

 -  I received a pager! I can't figure out how to use it and someone had to tell me that my pager number was on the back, but knowing how to work it doesn't matter right? I have a pager! Page me maybe...?

Well, if I haven't lost all my faithful readers (aka my family and a few friends when I bug you), hopefully you are in for a treat this year. I get to interact with people! While the hours will be long and there will still be plenty of tests and studying to keep me busy, I am finally getting to the part of my training that hopefully will make all this worth it!

Let me try to explain my schedule to you. I'm starting off with surgery! I will also be explaining things as I go along so hopefully this will make more sense later. Third year is the year where we're supposed to be exposed to the most things and make a decision about what specialty we would like to pursue.

• Surgery (12 weeks total) - big test called a "shelf" at the end
• Surgical subspecialty (4 weeks) - Anesthesia! (pretty excited because the hours are beautiful - I'll tell you more about it in a post soon)
• General Surgery (4 weeks) - Endocrine/Oncology
• Musculoskeletal (4 weeks) 
• "Wild Card" (12 weeks)
• Elective - Radiology
• Neurology
• Psychiatry
• OB/GYN (6 weeks) - shelf at the end
• Pediatrics (6 weeks) - shelf at the end
• Medicine (12 weeks total) - shelf at the end
• Cardiology
• Ambulatory (fancy word for "outpatient")
• General hospital floor

So I've packed the pockets of my white coat (which basically serves as hold-all/lunchbox/professional attire all at once) and I start my birth by fire tomorrow!