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!

hide the crazy

Three weeks into second year, and already it is "exam time." I have three exams this coming week - Pharmacology, Intro to Pathology, and Ear/Nose/Throat (also known as Otolaryngology).

Things that have amused me about second year:
1) My friends like to bake to de-stress = lots of goodies for me lately
2) The first years think I know things. This makes me giggle on the inside.
3) I recently adopted two kittens, Gracie and Boo. Gracie had surgery for a patent ductus arteriosus before I adopted her - and I actually know what this is and how to treat it in human babies!
4) My friend and I started working out every day at 7am - jogging every other day, doing yoga the opposite days. I never knew that mornings could actually be enjoyable! Crazy. Also I love seeing people in workout clothes throughout the day, and rather than thinking "I should do that later" I now get to think "I already did that today!"
5) A guy in my class asked during the breast cancer lecture if there was breast tissue connecting the two breasts - now we all know who's never gone to second base...

Things that have not amused me about second year:
1) Lectures last all day long, and then, being a leader of Christian Medical Association and the OB/GYN Interest Group, in addition to having a life, means my master plan of just working every day until 6 or 7pm, like a normal person with a job, is not going to cut it this year.
2) One of my cats pooped in my laundry basket. I had to do emergency laundry at 1am when I got home from studying on a Friday night. Maybe adopting the kittens wasn't the best idea...
3) I realized dating during medical school is apparently really hard... and I kind of doubt it gets easier. I now reference Scrubs: Hide the Crazy
4) Grades. Remember when I complained last year about how I lacked motivation and just wished I could be graded? I take it all back, I'm a heinous liar.

Oh good. My pros outweigh my cons. Thank you to the boy in the front row of lecture.

second year

Ways in which my life will change tomorrow:

1) I will now rate everything in life by honors/high pass/pass/fail. And by life, I mean school, and by school I mean what will now be my life - the reasoning's a little circular. It's strange, going from a year of pass/fail back to being graded again, but I'm honestly kind of looking forward to it. I feel like an elementary school student who just wishes she could receive her "Music" and "PE" grades in letter grades instead of "superior" and... Hmm I don't remember what the other options were. "Excellent"? "Inferior"? "Tries hard but still can't sing/catch a ball"? 

2) I will cease complaining about being bored and commence complaining about having no time to be bored. 

3) I have to start calling myself a "second year medical student" which means admitting that I might know something about medicine. I'm a little scared.

4) I will be more well-rested (in theory) because our classes start 30 minutes later than first year! (I guess I could also just not go to class and get plenty of rest... but the theory is still a really nice thought.

Not sure what else will happen this year. But I'm about to go to orientation - maybe I will find out! 

summer

If nothing else, this summer has proved that I am an unfaithful blogger. So I will write a summary post here, and yet again promise to blog more often.

I spent this summer doing a "primary care preceptorship" which I prefer to call "Shadowing Version 2.0" or "Being a 3rd year with a good excuse not to know anything". For the past eight weeks I have mostly worked with a pediatric hospitalist, but I also spent a couple weeks at non-for-profit pediatric clinic. A pediatric hospitalist is a doctor who has done a pediatric residency who, instead of going into an office setting or specializing further, works in multiple different hospital settings. It is a relatively new specialty. I mostly spent time in the newborn nursery and the emergency room. I shadowed a number of different hospitalists and asked them all "what made you decide to be a hospitalist?" and the answers were always surprisingly similar - more flexible hours and you don't have to deal with the business side of medicine as much. Some doctors mentioned how they like dealing with the sicker kids but didn't necessarily want to specialize.

What I love about pediatricians, though, is that if you love kids, they will love you. I've always loved working with kids, and this summer has persuaded me that I would love doing pediatrics. You may be surprised to hear this, but kids smell way better than adults! In spite of the poop, pee and vomit, kids always seem to be cleaner. And their shampoo smells nicer. When I say adult, you may be thinking of yourself, and you may be saying "I shower every day!" Well, I hate to break it to you, but the few adults I met in the hospital over the past year did not smell very good. I'd take a poopy diaper over an adult who hasn't showered in a week any day.

I'm not set on it or anything - don't worry, I'm keeping my mind open! - but for most specialties, you can generally choose between adults or kids, and I definitely choose kids. Yay one choice down.

The other thing this summer did is give me hope. The first year of med school was hard for me. I didn't feel any passion for my classes. I struggled to create a life that kept me inspired and made me want to get out of bed in the morning. But this summer was wonderful - I loved being in the hospital, I loved working with the babies, I loved reading about diseases in between patients. I really loved wearing scrubs all the time. And I felt confident - I felt good about what I was doing. One of the highlights of my summer is the other day when my preceptor told another doctor that he thought I was operating on a third to fourth year level. It is really encouraging to know that while doing well on these stupid tests and paying attention in the classroom may be a struggle for me, I have the potential to be really good at what I will be doing for the rest of my life (after this year). I hope I can keep that in mind as I try to learn a terrifying amount of knowledge over the next ten months. I hope I can remember that the more I learn (and truly ingrain, rather than memorize in the short term for a test) the better I can serve my future patients.