Babies! part 2

Reading the Mothers in Medicine post  Ob/Gyn: Helping to expand families at the cost of your own? while continuing to think about my ticking biological clock, I can't help but wonder if I should simply choose career.  Rather than hoping and praying that I'll settle down and have a loving family, strong career, and house with a white picket fence; maybe I should just through all that energy spent fantasizing about my future completely and totally into medicine. 

Somehow, while studying for my surgery shelf exam today, I found myself googling images of gluten free vegan wedding cakes.  Not sure how I ended up there...  [No, I'm not getting married anytime soon.]  I've also spent a bit of time on ravelry looking at baby knitting patterns.  Those moments would probably [absolutely] be better spent doing an extra practice question or two.

It is still early enough that I can save myself from the inevitable future that dr. whoo? speaks of in her blog post; the always feeling like you're sacrificing one thing for the other that I've heard from so many other MD-moms.  Which is worse: delivering other people's babies while never having your own [and wanting them], or taking care of other people's sick kids while your own kids are left home to be raised by people who are not you? 

author's note: This post was written under the influence of high stress and sleep deprivation, 12 hours  prior to my surgery shelf exam, and while feeling guilty that tomorrow I drop my cat off at the kennel for winter break. He's going to hate me for it. Stress + guilt = a whiny post.  Sorry!

Babies!

It seems that all of my non-medical school friends are having babies!  [And since the girlfriend is sick of hearing about which friend just adopted and which just announced she's pregnant again, I'm sharing the news with you, dear blog-reader.]  I'm so excited for all my friends!  I'm also excited that there are lots of little babies I get to knit for, dress up, play with, take on adventures, and give back when I get overwhelmed.

Yet, at the same time, I can't help but feel my biological clock tic away while med school keeps on keeping on.  Tic. Tic. Tic.  I know, I know, it is so cliché.  Fears of approaching advanced maternal age while still being in residency are so yesterday.  My attending already called out this week for making a snarky comment in the OR regarding man's ability to father a child well into his AARP days....  Yet, as much as this bridge has been crossed by most other professional women that have come before me, I can't help but feel my uterus scream out in disdain as I draw ever-closer to the big 3-0.  

On the bright-side, lots of friends having babies now means I should have lots of readily available babysitters when [if] my turn ever roles around? Right?

The end of surgery

This week marks the end of surgery.  Well, at least the end of in-patient surgery.  I still have 2 weeks of out-patient surgery, gyn surgery, and possible surgery electives in my future.  This is good seeing as I actually really like being in the OR and think I'll miss it.  Regardless, I have an oral exam and a national shelf exam to take this week.  These exams will be the determining factor between honors, high pass, and pass, as I already know that my evaluations are solid.

I feel completely and totally unprepared for these 2 exams.  I'm pretty sure that I've never felt this unprepared for any exam in all of medical school.  Over the last 8 weeks I have learned how to stitch like a pro, how to spend long hours on my feet in the OR, and how to not mess with the pancrease.  Today I proved that I can use a bovie like a rock star and drive a camera with precision.  I'm pretty sure that I can even do a lap choly completely unassisted, assuming there was no gross anatomical variant or unexpected complication (ha!), and assuming someone would be stupid enough to let me try. 

However, over the last 8 weeks I have not learned how to verbalize surgical procedures, explain anatomy, articulate complications, or manage medically complex co-morbidities.  The medical team hospitialists do that for us.  I have done my best to stay on top of the reading and go through practice questions but I often find myself so exhausted at the end of the long day that I don't manage to retain what I'm studying.  Basically, surgery has prepared me to be a hamster on a wheel but not to take these exams.  How do other med students do it?  I'm feeling screwed.  And sleepy.

Pondering options

Instead of studying for the surgery shelf like I am supposed to be doing,  I'm starting to ponder my options for taking step 2.  My original thought was to do it in July.  However, I'm starting to think that it might be better for me to take it at the end of April. 
Advantages:
-I'll be done with it before I start stressing about moving for 4th year or my research year (which ever next year happens to be). 
-It'll give me at least 4.5 weeks off to study. 
-I'll be done with it before sub-I in May which is supposed to be intense!
Disadvantages:
-I wont have done psych yet.
-April is earlier than July, giving me less time to do questions prior.
-I'm speaking at a conference 4/13-15, in the middle of the 5 weeks of study time.
In the meantime, i should go back to studying for surgery & stop worrying about the future.

“Promise me if you find me like this that you’ll kill me.”

Read this article.  Read it NOW.  Then start having these conversations with your loved ones.  It is about time our society starts really, honestly, talking about end-of-life care.

And on a related note: my grandmother was moved back home with hospice care yesterday.  It still stinks to be treating others' as they confront death while my own family is facing it miles away without me there, but now I know they have a little more support. 

coffee

Holding a beating human heart > sleep!

Maybe I shouldn't throw pediatric cardiac surgery off the short list after all?  Something to think about when I'm not longer giddy and delirious on 3 hours of sleep.

surgery: day 37

2 preceptors down, 1 to go
Tonight I will hopefully watch organs being harvested!!!
Some moments in the OR are pretty dang cool
An oral exam and shelf exam approaching way sooner than I'm ready for
No motivation to study at all.  What so ever.
At least I made flash cards for the oral exam though
That's a start, right?
16  days until winter break!

Listen to your patients

"Listen to your patient, he is telling you the diagnosis" -Sir William Osler

Over my past 2.5 years of medical school, I have heard this quote over and over again.  It is mostly used in stressing the importance of taking a complete and detailed history.  It is used to say that the patient will relay the pathological signs as puzzle pieces, pieces that even a low level clinician can put together.  Think about the big wood toddler puzzles where there is no way a piece can be places in the right place.

My surgery attending, an old seasoned veteran surgeon, has recited this quote every time a patient comes in with mid-epigastric pain that radiates to the shoulder and is accompanied by years of "reflux" pain that is non-responsive to medication.  The patient may not use those exact words or explain it in text book order, but the patient is painting a clear picture of gallbladder issues.

I was recently reminded that listening to the patient can work the other way too.  Patients who come in with complex, in-congruent, complaints.  Patients who have pathology that clearly did not read the textbook.  These are the patients who are negative for every horse and most zebras, the patients who end up with diagnoses of exclusion.  The amazing part though?  We as providers approach the patient totally defeated, as if we have only apologies to offer, and they respond with complete affirmation and relief, as if they have known this to be true all along.  Their shoulders sink down, their spine uncurls, and they relax for the first time in a long time.  Then, when empowered, the patient begins to tell stories about why they expected this diagnosis long ago or how this diagnosis explains so many seemingly trivial signs they didn't mention before.

It amazes me how many different ways there are for a patient to tell you the diagnosis.  We just need to learn all the different, and subtle, ways to listen.

11 things I'm thankful for in 2011: MS3 edition

11. The PxDx app on my smart phone that lets me log actual patients on the go instead of having to make them up at the end of a rotation.
10. The MyFitnessPal smartphone app that is allowing me to not gain weight while living off crappy hospital food.
9. Protein bars & peanut butter packets for keeping my energy up when meals don't exist.
8. Big pockets in my white coat as I'm not sure how else I'd manage to keep my whole life on me at all times.  Seriously, my white coat may weight 20 pounds, but I can survive anything with it on!
7. Old handed down notes & advice.  Save time, save energy, learn from someone else's mistakes.
6. Finally being done with step 1!
5. Knowing exactly how many exams stand between me and the end of medical school: step 2, 4 shelf exams, and 1 departmental exam.
4. My immune system for keeping relatively healthy while expose it to every germ under the sun.
3. Nurses.  Particularly scrub nurses.  They repeatedly save my ass over and over again when I have no clue what I'm doing on the floor.
2. Family & friends that seem to understand why I don't have time to call them back.
1. My patients for being extraordinarily patient and generous with their time and bodies as a bright eyed and bushy tailed medical student learns from them.

What are you thankful for this Thanksgiving?

Becoming a statistic

Monday, 3 weeks into my surgery rotation, I became a statistic.  I stuck myself with a suture needle in the OR while attempting to close the patient.  There was a moment of silence in the OR.  The scrub nurse and my attending glared at my with wide eyes while their masks concealed their facial expressions.  Were they smirking?  Were they frowning?  The sound track of "shit! f#@k! Damn! I screwed everything up!" echoed in my head. 

As per the scrub nurse's orders, I placed the needle on a non-sterile field and pulled off my glove to have my hand inspected by the circulating nurse.  There, on the palm on my left hand was a small little speck of blood, signifying that I broke skin.  The circulating nurse's response was "shit!... well, I guess you need to go to the ER now."

What did I do?  I went to the sink and washed my hands with soap & water for a good long time.  I looked through the patient's medical chart weighing my options.  Then, in one of my less proud moments, I decided to forgo the OR in trade for going home.  I had been at work 11+ hours for the last 8 days.  I was exhausted, and embarrassed, and not wanting to make a stick of something with such a low risk. I didn't want to be put on HIV prophylaxis as I'm sure it'd screw up my diabetes big time.  There isn't anything that can be done for Hep C...  Plus, since being on surgery I've heard so many attendings tell war stories of being stuck and mocking the whole contact precaution protocol. 

"Researchers surveyed surgery residents at 17 medical centers and, of 699 respondents, 415 (or 59 percent) said they had sustained a needlestick injury as a medical student. Many said they were stuck more than once. Of the surgeons-in-training whose most recent needlestick occurred in medical school, nearly half of them did not report their injury to an employee health office, thereby avoiding an evaluation as to whether they needed treatment to prevent HIV or hepatitis C." -Medical Students Regularly Stuck By Needles, Often Fail To Report Injuries 

The story doesn't end there though.  I fixated on the needle stick, kept contemplating my decision, weighing my options.  I talked to my girlfriend, a few other medical students and a few residents whose opinions I trust.  Then, on wednesday, I made the mistake of mentioning the stick to my program site director & the surgery clerkship director.  That was it.  Wheels started turning leading me to employee health.  Phone calls were made.  Documents were filled out, papers were faxed, and emails were sent.  4 tubes of blood were drawn and plans were discussed to report back in 6 weeks, 3 months and 6 months.  


Nearly a week after the initial stick, I still feel like an idiot.  My dexterity is clumsy when it comes to using a needle driver, as was pointed out in my mid-block evaluation yesterday.  It did prove to be a lot of hoopla for a little event, a tiny tiny stick.  But you know what?  Wednesday night I went to bed with a clear conscious that I was doing the right thing.  Yesterday I breathed an even deeper sigh of relief in learning that I'm currently HIV and Hep C negative and Hep B immune.

View from the other side of the curtian

I got a call last night that my grandma was being taken to the hospital.  She had an acute change in mental status which prompted a blood draw from the visiting nurse which lead to a realization that she's significantly hyponatrimic (low sodium). 

When I went to bed last night, she was still being evaluated and stabilized in the ED.  Soon after I woke up, my mom called to ask how invasive central lines and arterial lines are.  She informed me that she's in the ICU, still lethargic, low serum sodium & high WBCs, and the doctors think this is all from a UTI.  She's maintaining her pressure relatively well on just simple fluids. 

While my 94 year old grandma has been DNR for a long time, there is no clear delineation on what falls into the resuscitate category.  There wasn't going to be any gastric tubes 5 years ago when a stroke meant she could no longer eat without aspirating, but then she was deemed confident enough to make that decision on her own and somehow that tube has kept her alive all this time.  So, the G-tube stays put.  My mom & uncle have decided that there is to be no intubation, no CPR, no trips to the OR.  But what about the gray area?  IV fluids, antibiotics, pressors, medication to stop an arrhythmia, etc...

So many times throughout 3rd year, I've heard physicians tell family members "if it was my mother/grandmother/sister/daughter I wouldn't want them to go through this, to suffer..." From the outsider's perspective, those conversations always seem relatively straight forward with a clinical decision based on the laws of probability.  From this perspective, it is much less straight forward.  She has already proven that she can overcome the impossible as she has been at death's door too many times to even count.  She's completely content with a dependent life, even if it one that I would never want for my self.  I'm realizing that making these decisions based on emotion and knowledge of the person is much more complex than making them clinically. 

Being the person the MY family turns to for medical advice is much more difficult than playing that role for others.  I'd like back to the other side of the looking glass now.

Adding to the short list?

Yesterday morning during surgery lecture we had a specialty talk on urology.  Guess what?  I found it fascinating!  It is a procedure biased specialty.  Procedures that often allow for significant improvement in the lives of some patients.  The doctor patient relationship can develop over long term care.  It involves reproductive and sexual health.  And, on top of it all, robotic surgeries?!!!  Yep, urology is now on my short list of potential career options. 

New short list:
-ob/gyn: general, MFM, gyn onc, adolescent
-peds: general, adolescent health, PICU, neuro, GI
-urology

A day of firsts

Today's been a day of firsts:
*my first time scrubbing into multiple consecutive surgeries, 3 to be exact.
*my first time using a scalpel on living human flesh.  Gross anatomy was the first time I had cut into other types of human flesh.  
*my first patient died, as in a patient I had followed from the very beginning of her hospital course to the very end.

Driving home I kept thinking about a comment a friend made to me when I started med school: "Keep a journal because medical school will change you.  You'll want to look back and see how." It is days like today when I realize how very right she was.

No on Mississippi Initiative 26 tomorrow

I'm a little afraid to see what tomorrow's election in Mississippi brings.  Why?  Rather than write up my own thoughts directly, I figured I'd compile a sort of meta analysis of what others are saying. 

        "Mississippi Initiative 26, the “personhood” amendment on the November 8th ballot, is not only dangerous for women’s health and lives—it is dangerous for our democracy. While not recognized as such, it is an openly theocratic endeavor. We should be talking about theocracy because this amendment is not just being fielded in Mississippi—it has been introduced in at least six other states, with more to come." -Carlton Veazey ('Personhood’ Agenda is Theocracy)
        "The term “fertilization” — which is sometimes considered synonymous with “conception” — could mean at least four different things: penetration of the egg by a sperm, assembly of the new embryonic genome, successful activation of that genome, and implantation of the embryo in the uterus. The first occurs immediately; the last occurs approximately two weeks after insemination (or, in the case of embryos created through in vitro fertilization that do not get implanted, never). Thus, on some reasonable readings of the amendment, certain forms of birth control, stem cell derivation and the destruction of embryos created through in vitro fertilization would seem impermissible, while on other equally reasonable readings they are not." -I. Glenn Cohen & Jonathan F. Will (Mississippi’s Ambiguous ‘Personhood’ Amendment)
        "...the amendment reaches so far beyond legal precedent and public opinion that even some abortion opponents — including the National Right to Life organization — are warning that it could harm efforts to overturn Roe. It's the legal equivalent of a poorly aimed grenade, one that could define as murder anything that results in the destruction of a fertilized egg or a zygote or an embryo."-Rogelio V. Solis (Editorial: Mississippi 'personhood' measure goes too far)
        "For all their sincerity and fervor, proponents of the personhood movement represent a small minority nationwide. In Gallup polls, support for a total abortion ban is almost exactly where it was in 1973 —at just over 20%, despite a rise in backing for limitations. Most people certainly don't want homicide charges brought against women who choose to have abortions or doctors who perform them." -Rogelio V. Solis (Editorial: Mississippi 'personhood' measure goes too far)
        "Many of us will vote against Initiative 26, believing it to exclude tragic conflicts in some life situations and to have unintended and unexplored consequences." -Reverend Hope Morgan Ward, Bishop of the Mississippi Conference of the United Methodist Church. (Thank you, Bishop Ward!)

If you're registered in Mississippi, please think carefully about the implications of your vote tomorrow.  Please, regardless of your political views, seriously consider voting no on this very destructive bill for the sake of women's lives, birth control, and fertility treatments.  History has shown that abortion wont stop on the basis of political decisions, but women's lives will be needlessly risked because of other people putting unnecessary barriers in front of competent health care.

Impostor syndrome

impostor

noun fraud, cheat, fake, impersonator, rogue, deceiver, sham, pretender, hypocrite, charlatan, quack, trickster, knave (archaic), phoney or phony (informal) He was an imposter who masqueraded as a doctor.

Collins Thesaurus of the English Language – Complete and Unabridged 2nd Edition. 2002 © HarperCollins Publishers 1995, 2002

Imposter syndrome is a common phenomenon among medical students.   A malignant idea that you aren't actually smart enough to be a medical student, don't have what it takes to be a doctor, and were just accepted to medical school because someone accidentally confused your file with someone else.  

I struggled a lot with impostor syndrome when I was struggling through gross anatomy my first year, and again when I was retaking step 1.  It currently seems that surgery is bringing on another flair up.  Left unchecked, it can be a crippling condition and self fulfilling prophecy.

The acute onset began during an M&M presentation I had to do on friday.  I stumbled over my words.  Unable to present an orderly case and lacking the clinical terminology I have been taught to use.  It was a fine presentation but very elementary in nature.  Sure, I'm a medical student, of course my presentations wont be as crafted as my superiors.  However, I was sub-par to my contempariers in presentation style.  This event coming on the heals of receiving my mediocre pediatric shelf exam score, and immediately prior to not knowing the answer to the ONLY question I was asked by my attending that day just left me feeling defeated. Acute events of impostor syndrome lead me into a tail spin of desperation: just skidding by on my rotations, not matching for residency, culminating in unemployment and failure. Destructive thinking.

Hopefully this week I'll prove my knowledge and abilities, both to my attendings and to myself.  I sure as hell could use a confidence boost right about now. 

"Grey's Anatomy" didn't lie

Surgery is chock full of drama.  Unfortunately, it isn't the fun sexy drama, but rather the drama that comes with clashing strong personalities.  My day is filled with strong egos and quirky neurocies attempting to co-exist in a high tension environment. 

I love the procedures.  I find the breadth of pathology that we treat on general surgery to be fascinating. I'm even okay with the slow pace and meticulous nature of the day to day.  However, the surgeon's personality?  After only 9 days, I'm already ready to shove a scalpel into my own eye.  The god complex is painful on a whole other level.  Plus, I'm finding that the answer to everything is always "cut it out" which doesn't fit neatly into my idea of being a comprehensive [primary care minded/preventive medicine based] medical provider. 

44 more days to go...

Surgery call math?

Tonight is my first night of call.  Well, first night of call as a doctor-type since I did it all the time as an EMT, but I digress... It is home call so it only half counts anyway. 

Call + surgery clerkship + Halloween night + stupid people = exciting learning?

Time will tell how this equation ends.

First real day of surgery

-Lasted 10.5 hours.  Of which, the majority were spent on my feet and 6 hours were spent in actual surgeries.
-I scrubbed into my first actual surgery and took my proper medical student place as a professional retractor.
-Due to the circumstances of said surgery, I had a lovely vaso-vagal episode in which I had to ask the scrub nurse for a stool so I didn't pass out or vomit on the patient.
-When sitting didn't prove to be enough, I broke scrub and excused myself briefly to re-compose myself.  I ended up being fine.  The rest of the team was fine with it.  Yep.  It turns out that I'm THAT medical student.  The one who nearly passes out & vomits in my first scrubbed surgery.
-I called my lovely girlfriend on my way home to strike a deal.  She's not allowed to break up with me during my surgery rotation, as I am sure that I will be a miserable and neglectful partner for the next 2 months.  Her response: "I bet we wont even talk enough to break up.  I'll have to do it over text message."  I do love her!
-My feet hurt.  A lot.  Disappointed my in well loved, and very old, danskos.  Here is to hoping that my body adjusts.
-Career hypothesis to date: surgery is looking like a no go.  OB/GYN is falling below peds due to the surgery component.

surgery: day 1 (orientation)

Yep, I'm already overwhelmed.  Can I go back to peds?  It is going to be a long 8 weeks!

PICU & peds neuro

My pediatric clerkship is quickly coming to an end, leaving me wondering if this is the specialty I'm destined for.  I've loved a lot of my experience so far.  While I have liked general out-patient peds, was surprisingly impressed by some of the other sub-specialties,  the PICU and neruo have been my favorite though.  It'll be interesting to see how my future evolves as I continue on into surgery, ob/gyn, neuro & family clerkships.  (OB being the clear front-runner when I started medical school.)

A recent NYT article on Dragon Parents was appropriately timed with my experience in the neuro clinic today.  "Conversations about which seizure medication is most effective or how to feed children who have trouble swallowing..." These parents are truly exceptional and have many things to teach the world.  Their hard-earned love, compassion, and understanding of daily blessings should serve as a lesson for all of us parents & future-parents.

HR 358 aka the "Protect Life Act"

And the madness concerning women's reproductive rights continues.  While Mississippi is leaving the debate of when life begins to their general pubic [initiative 26], which will have immediate determental effects including outlawing some types of birth control, the US House of Reps is also busy at work attempting to control my body and my choices.  Don't they have better things to do with their time and our money?!!!! 

I'm off to enjoy the first days of sukkot.  Hopefully the world wont go to complete hell in a hand basket while I'm gone.

Re-posting an RCRC action alert, the original can be found here:

STOP this Dangerous & Misleading Bill! Contact Your Representative Now!

Dear RCRC Advocate:
Congress is not listening to you! Instead of creating new jobs and helping our economy grow, they are attacking women's health in unprecedented ways!
HR 358 aka the "Protect Life Act" will be up for a vote on the House floor this week and you need to tell your Representative that you, as a person of faith, oppose this dangerous bill. It would ban abortion coverage in ALL insurance plans on the upcoming state exchanges, even if a woman uses her own private funds to pay for her insurance.
The "Protect Life Act" would also create a loophole in the Emergency Medical Treatment and Active Labor Act (EMTALA) that would allow hospitals to deny pregnant women stabilizing and life-saving treatments. It also expands already broad conscience protections for providers and entities who do not want to provide abortion services, without any regard for patient safety and protection or for those providers and entities who do want to provide abortion services.

HR 358 violates the hallowed promise of our nation to respect diverse religious views, so contact your Representative NOW and tell them to oppose this far-reaching and harmful bill!

Peace and blessings,

Reverend Dr. Carlton W. Veazey
President and CEO

10.11.11 in pictures

Happy national coming out day!  
(Not just as queer, but as a cowboy/girl ;-)) 

To quote a friend's facebook status: "happy national coming out day! i know this might come as a shocker to some of you, but i'm totally gay." 

And another: "Today is National Coming Out Day! If you would like to Come Out, or if you have already Come Out and would like to offer thanks, here is a lovely prayer written by Rabbi Rebecca Alpert: Nevarekh et Eyn HaHayyim asher natna lee haozmah lazet min hamezarim. Let us bless the source of life for giving me the courage to come out."

Happy 1 year anniversary of adopting Lulav!

Rejection

I had co-authored a JAMA letter to the editor recently.  Today we received a rejection.  I'm not overly surprised as it was a bit political for JAMA, but I am surprisingly disappointed that it was rejected.   Overall though,  I think I'm just moody and tired.  Trying to balance the month of high holiday while staying on top of my pediatric clerkship and preparing for the upcoming shelf exam has me WAY overwhelmed.  Right about now: being a medical students and being a Jew leaves me sleepy.

Repeating history

Due to a conversation today on state and federal healthcare spending, which quickly derailed into a conversation about all the issues with the federal budget, I've been thinking a lot about this whole "occupy wall street" thing.  John Stewart's "Parks and Demonstrations" shtick has fueled this thought process.  What if this is the real deal?  Could this be the start of something big?  A slowly growing revolution creating the change that is needed for sustainability and success?

It reminds me of all the stories I heard about the Vietnam era.   Stories of organized dissent, public protesting, empowerment of the younger generation.  These were stories I used to ask my parents to tell me over and over when I was little.  I always found myself a bit disappointed that they had such passive roles, envious of friends' whose parents were at UC Berkley and the such at the time.  They weren't the sit-in hippies or the draft dodging rebels.  They were just run of the mill 20-somethings, doing the best they could to stay on their feet, trying to progress their lives while barring witness to history evolving.

If this is the real deal, I imagine the conversation I will have with my future kid(s), G!d willing!
Kid: Mom, tell me about the wall street take over!
Me: Well, I was a 3rd year medical student at the time, busy on the wards and really out of touch with what was going on...

Very proud of this CLIPP case

We have to do standardized CLIPP (Computer-assisted Learning in Pediatrics Program) cases for our pediatric rotation.  I was very impressed by the case I did tonight as I've often found my medical education to be awkward on how to do a culturally appropriate and comprehensive sexual health interview.

I appreciate that they use an open question as an example instead of the simple, and awkward "do you sleep with men, women, or both?".  My actual replies to "do you sleep with men, women or both?" in the past have included "this week?" and "why are those my only two options?"  The other issue with being trained to use the both question, is how does the provider follow the response?  In the past when I, as a female, answer women, my doctor immediately and uncomfortably plowed forward without performing a comprehensive sexual exam.  She assumed that I sleep with women = she's a gold star lesbian, therefor she can not be as risk for pregnancy, STIs, sexual violence, and the many other things they should be screening for.  [PSA: STIs CAN be passed between female partners, and same-gender relationship violence DOES occur.] Basically, I believe the both question to be a stinky, outdated, question.   I also appreciate that they clearly explain the purpose of such questions in a way that [nearly] any medical student can understand.

The text below is taken directly from the case.  While not yet perfect, it is the best I've seen so far.  Good work CLIPP!  Way to educate medical students across the country!

"You thank Betsy for being comfortable with you enough to allow her to disclose her history of smoking and marijuana.
You now ask Betsy questions about possible sexual activity, "Are you going out with or dating anyone at the moment?" 
You ask Betsy if it's getting more serious, and have they been thinking of or had sex yet? You find out that she's never been sexually active. Of course, in your initial discussion you correctly did not inquire if she had a "boyfriend" or make an assumption about Betsy's preferred gender of her sexual partners.
Using gender neutral terms is very important in allowing sexual minority youth to feel comfortable with you.  If a teen is sexually active, asking “when you have sex, do you have it with girls, guys, or both” is very important.  Sexual minority youth suffer from society’s pervasive homophobia and often have more difficulties during adolescence than heterosexual youth.
Click here to link a power point presentation that discusses adolescent friendly health services and obtaining a comprehensive sexual history." 
Case 5 was written in August 11, 2002, by Kim Blake M.D., MRCP, FRCPC, Associate Professor of Pediatrics and Director, Pediatric Undergraduate Education, of Dalhousie University School of Medicine. The current case editor is Kirsten B. Hawkins, M.D., M.P.H., FAAP, Chief, Section of Adolescent Medicine, Assistant Professor of Pediatrics, Georgetown University School of Medicine. The section editor for the case is David Levine, M.D., Professor of Clinical Pediatrics, Morehouse School of Medicine.

Being picked up at shul

Nope, I wasn't picked up in the horribly awkward sense of being approached by the strangest, most socially inept, guy (or gal) in the room.  Or worse, by his mother.

I went to shul alone both days in the city that was most recently my home. I split my time between the conservative and the orthodox communities, revisiting my old haunts, and reconnecting with old friends. I didn't decide to travel for rosh hashana until I knew my schedule, leaving me little time to find housing and meal arrangements.  My solution?  I stayed with a non-jewish classmate. I accepted that I would be driving to holiday functions and back for the purpose of having a meaningful holiday.  I packed a box of cereal & refrigeration-free milk as a survival kit. 

It turned out that my survival strategies were unnecessary.  The holiday came filled with blessings beyond expectation.  Sitting in services the first morning, I was approached by the rebbitizin.  She asked if I had lunch plans & if not, would I like some?  I shrugged my shoulders and explained that I was intimidated to show up on someone's doorstep & then have them not be able to feed me.  Since being diagnosed with celiac disease I find myself very anxious at the prospect of last minute shabbos & holiday meals.  Knowing the anthropological song & dance of wanting to feed people who you invite into your home, and being acutely aware of all my food issues (gluten, kosher, semi-veggie, diabetic, etc.), I've evolved into more of an introvert as a way to avoid awkwardness.   Tangent aside, she replied "don't be silly! it'll be fine" and handed me a magical golden (er, green) ticket with a name on the front & directions to their house on their back.  The magic came in learning that the wife, the woman who prepared the marvelous lunch, happened to also be gluten free! Random coincidence = divine inspiration? = rosh hashana meal jackpot!

The rest of the holiday was more subtle, but equally blessed.  I prayed a lot.  I ate a lot.  I listened to and pondered a few really good dv'ra torah.  I spent a lot of time with old friends and people who I don't get to see nearly enough.  It felt like an ideal start to the new year.  May this year continue to be filled with unexpected blessings for all of us.  shana tova u'metukah!

A trash can full of egg shells

Tonight, while cooking, I decided that a trash can full of egg shells is a good indicator that a Jewish holiday is rounding the corner.  Tonight has been about studying peds, finishing abstract proposals, and sorting emails.  It also involved as making 3 apple cakes & 2 butternut squash kuggles.  I'm a bit overwhelmed at how full my calendar is for the next few weeks.  I'm also suddenly struck with the realization that my pediatric rotation is over halfway done and the shelf exam will be here SOON.  I have no doubt that my performance on this shelf exam will directly correlate to whether I simply pass the clerkship or I surpass it with a high pass or honors.  However, with the sweet smell of the new year coming from the oven and cooling on the counter tops, I'm feeling much more ready to celebrate the chagim.

l'shana tova umetukah!

Grumpy but still loving peds!

The past few days have been a bit of a mess.  Yesterday, I managed to literally make a mess.  I had the brilliant idea to change my insulin pump right before starting a new pediatric service.  Within 3 hours of getting to work, I was ketonic due to a kinked site.  I caught on early, changed my site, and sincerely hoped that I was in the clear so that I could stay at work.  Bad decision.  I should have just gone home.  The embarrassment of looking like I can't control my diabetes is far better than the embarrassment that came from vomiting acidic-ketone-filled loveliness all over the house-staff bathroom.  The wonderful pediatrician & NP?  They looked at me with sympathy (instead of with disgust) and sent me home for self care, as well as for a shower.

Then, today, while pre-rounding on the newborn well baby service I managed to royally upset a grandmother.  We had been taught by the resident yesterday that gloves were not necessary for a well baby exam as long as we wash our hands well and work in a specific order (mouth first, diaper last).  The grandma came out to inquire why I wasn't wearing gloves and so I apologized profusely.  I refrained from mentioning that the resident and attending had both done the same thing during the exam yesterday.  The grandmother made sure to make her frustration with me known to everyone on the service.  I hadn't met today's attending before, so when she showed up I introduced myself and immediately informed her of the situation.   Her amazingly calm response?  She rolled her eyes, said not to worry about it, told me a few anecdotal stories about how she's upset caregivers in her career, and did proper damage control. 

Lastly, I had the astute realization this afternoon that the chagim [Jewish holidays] are a week away.  I'm anxious about how to balance the holidays with clerkship responsibilities.  However, I'm on peds!  People are being really great about honoring excused absences and letting me travel to my second home for sukkot.  While I very much wish that more of the chagim could be spent with friends and family, observing the holy days in proper form, it could be so much worse [if I was on surgery].

the dark side of peds

Over the past few days I've increasingly been exposed to the dark, depressing, and horrid side of pediatric care.  Parents who abuse their children either directly or through neglect.  Caregivers who can't look up from texting long enough to answer my questions.  Parents who ask how soon they can go home with complete disregard to the fact that their child is sick enough to warrant being admitted to the hospital.  Caregivers who overtly, and horrifically, abuse their children. I want to scoop up all these children and protect them.  A tiny infant, a sweet little toddler, a loquacious mini person, all of them.  I want to wrap my arms around them and bring them into my home.  I want to be able to promise them that there is better out there, that they deserve to be loved and have the right to be a child. 

I seriously envisioned myself adopting the sweetest little 2 year old yesterday, a 2 year old that will be spending way too many days in the hospital for the horrors he has already experienced in his too short life.  I imagined myself sitting by his bed day in, day out, as he overcame this event and regained a childhood.  I had a vision of what my life might be like if I did take him home.  In that moment, a decision was made.  I will foster and/or adopt children at some point in my life.  There are way too many little ones, and not so little ones, that need safe and loving homes.  There are way too many horrible parents and caregivers out there and not nearly enough safe refuges. 

My heart hurts.  I'll never forget the signs of evil that draped this small child's body.  I hope I also don't forget the angles who took him in.  I'm seeing the good and the bad of the system.   Currently, it seems the bad is winning, and I'm quickly growing jaded.  My faith in humanity is becoming scared by the abuse case that never surmount to anything, with the child being placed back into an unhealthy environment because there is no where else to put him.  The parent who is unable to afford a necessary medication, even when it is on the cheap generic list, but is fully occupied by her very expensive phone.  The disengaged parent who is depriving their child of maximal growth and development through their lack of interaction.  The child that was abused in foster-care; the place that is supposed to be safe after experiencing neglect or abuse in their biological home.  How am I supposed to pick myself up from all of this?  How can I make a positive difference in this world with such a cruel reality?

Pretty colors highlight sad truth.

 Taken from http://www.remappingdebate.org/map-data-tool/growing-set-state-abortion-restrictions-visualized?page=0%2C0.

A very colorful, yet very humbling, chart was created by remappingdebate.org to provide visual imagery to the increase in abortion legislation.  Go to the website.  It has a lot of really good data on there about what bills have passed in which states, how many providers exist where, and more.  I find it so devastating to know that women's bodies are being this heavily regulated and that access to safe care is becoming exponentially harder to access right before our eyes.  I will NOT sit quietly and watch as women have to revert to coat hangers & back-alley butchers while conservative white men* get their way, forcing their morals on the rest of us and then leaving us to bear the brunt.  Abortions shouldn't have to be a common event but they do have to be safe, accessible, de-stigmatized, and offered without undo burden to all women.

* Yes, I am stereotyping.  But having sat in some of my local house of representative legislation sessions about when to define the start of life, I have seen that there is some truth behind the stereotype. 

Celiac Disease Awareness Day

I heard a rumor on a friend's facebook wall that today is celiac awareness day.  Like any educated person, I therefore felt it necessary to fact check before posting about it.  According to the almighty wikipedia: "A resolution was passed in the U. S. Senate, making September 13 National Celiac Disease Awareness Day. It is the birthday of Samuel Gee." Therefore, clearly, it is in fact national celiac disease awareness day.

Side note as to not embarrass my librarian friends: I promise you that my medical/scientific research is only partially based in facebook, google and the wikiworld.  I do occasionally also use peer reviewed journals for information and decision making. ;-)

In honor of this very special day, I present to you my recent escapades in gluten-free vegan goodness.  

 

Crepes! With chocolate-hazelnut filling.  We also made ones with daiya cheese. 

Peach blueberry birthday cake for the girlfriend.

Cake donuts! Next attempt will be a yeast version, deep fried &/or chocolate frosted- less healthy and more like what I remember.

Peds: day 15

I really like peds neuro.  Or at least, I really enjoyed my experience at the pediatric neurology clinic today.  It is totally humbling to realize how horribly wrong things can go (genetically, congenitally, maliciously and due to accidents) and involves a lot of guts to practice the unknown and unpredictable.  In one day I volleyed between heartbroken and optimistic, hitting on most emotions in between.    I watched one child have an infantile spasm, reassured a mother that her son could play football and could challenge the stigma of his diagnosis, and so much more.

I could imagine becoming a pediatric neurologist.  However, there is a distinct lack of a clear pathway to peds neuro.  It isn't like adolescents or peds cardio or something where you do a general pediatric residency and then do a specialty fellowship.  It isn't like peds surgery where you do a general surgery residency and then a pediatric fellowship.  Also, it isn't like peds psych which has the option of triple boarding, allowing for a single residency match. 

Heck, does anyone have a clear answer on how to become a pediatric neurologist with the least amount of relocating [of location/institution] possible?

3 questions

Today we had a lecture on MD compensation and productivity.  A very wise man, who is the business brains behind one very large local physician group, posed 3 questions to us.  He explained that he posses these same questions to doctors finishing residency and those early in their career.  If they can follow a path inline with their answers, he believes all else will fall into place.  I personally think these questions are good for anyone regardless of your professional track, so please feel free to answer in the comments section!

1) What are you good at?
2) What do you enjoy doing?
3) What do you feel called to do?

PSA for blogger users

I've tried responding to many of your post and it wont go through.  I was having the same problem on my blog and learned that it is due to the response setting style.  (I had googled the issue.) I guess it is an issue that blogger has been having.  You need to change your response setting so that it is in a pop up box or the such, anything other than the in text mode. 

(Solitary diner, I'm specifically looking at you!-  I want your polenta recipe!)

5th Annual Women Leaders in Medicine Awards and Reception

(taken from http://www.amsa.org/AMSA/Homepage/Events/Convention/WLIM.aspx, which is also where the application can be found.)

The submission deadline for nominations is Sept. 9, 2011 at 11:59 pm ET. 

Thank you for your interest!

The Women Leaders in Medicine awards were created by AMSA in 2007 to recognize women physicians and educators who serve as role models, teachers, highly accomplished professionals, and sources of inspiration for women and men who are currently in their medical training. These women deserve recognition for their accomplishments and dedication to fostering tomorrow’s women leaders in medicine.

We are currently accepting nominations for this year's WLIM awards. Medical and premedical students are encouraged to fill out our simple online form and tell us about an inspiring woman who has influenced the student's medical career.

Between four and six women are selected and invited to attend the AMSA National Convention in March to receive their award at a special reception. Many of our past awardees have considered their Women Leaders in Medicine award a truly meaningful honor because it comes directly from the voices of students. At AMSA, we hope to give back some recognition to these amazing women in addition to generating awareness about the importance of fostering leadership in medicine that promotes healthy change and equality in care and professional opportunity for women and men.

This year will be an extra special reception as we celebrate the fifth year of this inspiring event. We hope you will join us at AMSA's Annual Convention for the Annual Women Leaders in Medicine reception as we announce this year’s recipients!

My personal pep-squad

I recived a random gchat message from a random friend today:

"Are you ready to be my vaginacologist yet or WHAT?"

A simple, and lovely, reminder that there are people out there pulling for me to become a doctor.  I may decide not to be a ob/gyn, but finding out this week that I passed step 1, I am now much more confident that I will get through medical school with my degree [and hopefully my head still screwed on].  Thanks ya'll for supporting me through the annoyance of having to retake it. 

Now, if only I can get through the next 7 weeks of my pediatric clerkship without getting sick again...  I LOVE peds but I'm not such a fan of all the bugs the cute kids carry around.

Peds: day 5

I think I caught my first cold from the little buggers.  Either from them, or my roommate who has a pretty nasty cold/sinus infection that she caught during her OB/GYN orientation at the beginning of the week.   Between feeling like crap and closely watching the tropical storm over the gulf coast, I'm feeling pretty awful about this weekend.  I am supposed to be driving out to spend the weekend with my girlfriend when I get off call at 3 which I have been so excited about all week.  However, right now, I have no idea how I'm going to manage the drive when all I want to do is sleep.

Peds: day 3

We had our first 1-on-1 feedback sessions with our attending today.  Today being only the 3rd day I'm on his service!  It took 6 weeks (of a 8 week rotation) for me to get feedback on my internal medicine rotation.  Summary:  I still LOVE peds!

Peds: day 2

What I learned today is that cranky children can be soothed by continuing with their familiar routines.  A crying toddler while obtaining an H&P from his mother may be crying simply because he missed his breakfast, not necessarily because I'm in the room.  The same child was a blissed out cuddly monkey, patiently cooperating with this 3rd year medical student haphazardly conducting my first pediatric physical exam; all because I excused myself from the room so he could have breakfast before I proceeded.

A slightly older child required some teasing about having a dragon in his ear, and pretending to look in my ear, before he let me proceed with the otoscope.  There is lots of goofing around, taking time to explain things to parents and then again to the child on a level they understand, and time outs to clean up pee or vomit that were projected across the room.  It is all about the children when on peds: their schedules, their cooperation, their level of understanding.  So far, and not surprisingly, I LOVE it! 

What are your tricks for working with the little tykes in both in & out-patient settings?

Let us reinvision institutional norms instead of simple reform

"In 2000, the British psychologist James Reason wrote that medical systems are stacked like slices of Swiss cheese; there are holes in each system, but they don’t usually overlap. An exhausted intern writes the wrong dose of a drug, but an alert pharmacist or nurse catches the mistake. Every now and then, however, all the holes align, leading to a patient’s death or injury. "

This quote is from The Phantom Menace of Sleep-Deprived Doctors which was published in the NYT magazine earlier this month. I finally got around to reading it today.  (dearest gf: sorry for letting it sit in my inbox so long)  I also happened to stumble across this video today, which is an awesome visualization of a powerful speech given by Sir Ken Robinson.  Read then watch, or watch then read.  Let the two sources simmer together in your brain.

When watching the video all I could think about is how relevant the issue is to medical education.  The standardized testing, the individualization, the pacified boring lectures- yep, that sums up my last 2 years.  Sure, schools now are going all out to include group sessions, simulation centers, case-based education; butt it isn't enough.  Overall though, they are still working within the old system of education, still limited by the boxed in ideology of our forefathers.  There are schools, programs, that are drastically different such as the Program for Integrated Learning (PIL) at Drexel, but they are few and far between.

Looking at the article in collaboration with the video, it illuminates the undertone that drastic change is needed.  Passing new work hour regulations may be helpful but it is not actually addressing the underlying problem and is actually causing all new problems with hand off.  So now the powers that be need to formalize hand-offs, need to expand the length of residency programs so budding doctors can see all they need to, need to come up with night-time formal curriculum so that those on extended night float don't miss out... and the list goes on.  But will filling these holes really solve the problem?  Or will it just expose other holes that already exist in the system and create new ones?

I'm enamored by medical education. This interest fueled my decision to do my clinical years at my school's satellite site.  We're learning in a new model, one that involves more kinesthetic and team based learning, one that reads more like an apprenticeship than traditional 3rd year clinical rotations.  This out-pouching of our medical school also challenges us to be non-traditional, to think outside the box, and to come up with innovative revisions to the medical community in this city. 

From being at the satellite site, from watching the video, and reading the article, I'm inspired to think outside the box.  I hope that others are too and that we can collaborate to create tangible change in the future. I want to challenge more divergent thinking for those involved in medical education, that is if they (if we) can tap into our inner-kindergartner.

Old school

Ugh!  I find myself really frustrated with old school attendings who are sarcastic and rude to the nurses and office staff, snarky towards med students and residents because they believe us to be slackers, and then spend hours complaining about being a doctor.

A fable was told to us about how old school surgery residents would move into the call room of the hospital they worked at.  When asked why, the response was that they spent 1 day on and 1 day off.  And you know what?  They were extremely upset that they had to miss half the cases.

But you know what?  When I'm told by my clerkship director to leave at 2pm on Friday, and given the opportunity to go spend the weekend with my long-distance girlfriend and to get there before shabbos begins, that is exactly what I am going to do!  And I am not going to let these old school attendings make me feel guilty about it... (or at least try not to.)

Using religion to negotiate arbitrary borders: helpful or dangerous?

During my first year of medical school I went to a talk organized by our Jewish Medical Student Organization on the separation of conjoined twins.  The talk focused on the 1977 Pennsylvania case of thoraco-omphalopagus twins born to an Orthodox Jewish family.  These girls were born with a combined 6 chamber heart that would be incapable of sustaining their developing bodies.  The case brought up the ethical debate of whether it is acceptable to separate the twins in order to save a single life, knowing that the other would die in the process.  To sum of the full story, a unanimous decision was made on behalf of the medical team, rabbinical court, and American legal system that separation was justified.  It is truly a fascinating case though and worth the read.

I was recently reminded of this case when a friend, a classmate, brought my attention to the this week's New York Times Magazine cover story: the two-minus-one pregnancy.  Reading the article I realized that I have an arbitrary border placed between abortion and selective reductions.  I fully support a women's decision to abort a pregnancy, and believe that it is not my place to judge such decisions.  I believe that it is never an easy decision for any woman to make, it is never arrived at lightly, and that my role is provide supportive, quality health care to help her live her life in the way she chooses.  Yet, as confident as I am that I WILL provide abortions as part of my career, I can't imagine that I will be comfortable  providing selective reductions.  Or at least not comfortable performing the procedure when there is not a medical indication behind it.  Analytically, academically, I support a women's decision to reduce just as I support her decision to undergo an elective abortion but emotionally I feel very differently.  When distilling this discomfort down in discussion last night, I realized that it stems from my religious doctrine.  My understanding of Jewish text is that it is not for human's to decide whose life is of more value.  It is one thing when comparing the life of a living mother to the potential life of a fetus, but seems to be a totally different matter when weighing equal-ish [potential] lives against each other. 

I imagine this issue, and similar ones, will be revisited many times in my future.  I have no idea what choices I will make if actually put in such a position.  Yet, I imagine that these are the times I will turn to Jewish text.  These defining moments in my career will be when I seek rabbinic advice and reflect on the precedent set in ancient text.  However, I hope to be learned in the surrounding issues, comfortable in my own decisions, and cognoscente enough of my arbitrary borders that I will be able to support my patients regardless of where we both stand.  If there comes a point that I am not comfortable performing a procedure, I pledge to help bridge the gap.  I will refer them out to someone who can provide the comprehensive care and also to realistically help them access that care; much the same as I hope/expect from providers who refuse to provide abortion care.

Jokes for an extra 10 points

One of my friends swears that going into an exam laughing helps to boost your score.  He claims that reading a few jokes before going into step 1 added an extra 10 points to his score.  Being the supportive, wonderful, awesome person that he is, he sent me the following e-mail last night to read before the exam this morning.  Enjoy!

(I apologize that I don't have citations to give proper credit!)

Laughs worth at least 10 extra points!

 
Doctor: Nurse, how is that little girl doing who swallowed ten quarters last night?

Nurse: No change yet.

 
----

Doctor: Did you take the patient's temperature?

Nurse: No. Is it missing?

----

Doctor: Well, I have some bad news and some really bad news.
Man: Well, give me the really bad news first.
Doctor: You have cancer, and only 6 months to live.
Man: And the bad news?
Doctor: You have Alzheimer's disease.
Man: That's great. I was afraid I had cancer!

----

Patient: Doctor, I think I need glasses.
Teller: You certainly do! This is a bank.

----

“ Hello. Welcome to the Psychiatric Hotline…

If you are obsessive-compulsive, please press 1 repeatedly.

If you are co-dependent, please ask someone to press 2.

If you have multiple personalities, please press 3, 4, 5, and 6.

If you are paranoid-delusional, we know who you are and what you want. Just stay on the line so we can trace the call.

If you are schizophrenic, listen carefully and a little voice will tell you which number to press.

If you are manic-depressive, it doesn't matter which number you press. No one will answer.

If you are anxious, just start pressing numbers at random.

If you are phobic, don't press anything.

If you are anal retentive, please hold.”

----

The seven-year old girl told her mom, "A boy in my class asked me to play doctor."
"Oh, dear," the mother nervously sighed. "What happened, honey?"
"Nothing, he made me wait 45 minutes and then double-billed the insurance company."

----

A urologist’s license plate: 2 P C ME

----

Q: Why did the doctor tell the nurse to walk past the pill cupboard quietly?
A: So she wouldn't wake the sleeping pills!!!

----

The redneck dictionary of medical terms

Artery…………………………..The study of paintings.
Bacteria…………………………Back door to a cafeteria.
Barium………………………….What doctors do when patients die.
Benign………………………….What you be after you be eight
Cesarean Section…………….A neighborhood in Rome.
CTscan………………………….Searching for kitty.
Cauterize……………………….Made eye contact with her.
Colic…………………………….A sheep dog.
Coma……………………………A punctuation mark.
D & C……………………………Where Washington is.
Dilate……………………………To live long.
Enema…………………………..Not a friend.
Fester……………………………Quicker than someone else.
Fibula……………………………A small lie.
Genital…………………………..Non-Jewish person.
G.I.Series……………………….World Series of military baseball.
Hangnail…………………………What you hang your coat on.
Impotent…………………………Distinguished, well known.
Labor Pain……………………….Getting hurt at work.
Morbid……………………………A higher offer than I bid.
Nitrates………………………….Cheaper than day rates.
Node……………………………..I knew it.
Outpatient……………………….A person who has fainted.
Pap Smear………………………A fatherhood test.
Pelvis……………………………Second cousin to Elvis.
Post Operative…………………..A letter carrier.
Recovery Room…………………Place to do upholstery.
Rectum……………………………Darn near killed him.
Secretion…………………………Hiding something.
Seizure…………………………..Roman emperor.
Tablet……………………………A small table.
Terminal Illness…………………Getting sick at the airport.
Tumor…………………………….More than one.
Urine…………………………….Opposite of you’re out.
Varicose………………………….Near by / close by.

GOOD LUCK!!!

1st is the worst, 2nd is the best

(G!d willing!)  I will take any blessings the world has to throw at me in the next 30 or so hours.  Praying that 8 weeks on medicine clerkship followed by 6 weeks of full time studying plus a little bit of hypnotherapy and positive thinking will do the trick...

Now all I have to do is pass!  (After which, hopefully, this blog will become more interesting.)

Prolonging (step 1) agony

After doing very poorly on 2 practice tests taken over the past 3 days,  I'm beginning to think that there is no way I'll be ready to (re)take this exam a week from today.  I don't understand why my score is beginning to trend steeply downwards instead of maintaining stable or continuing to climb?!  I just want to be done with this all and back on the wards, back to what I came to medical school for in the first place; yet I also can't afford to fail again.

Brenner's army

Based off of The New Yorker article that came off this year, PBS put out this documentary on "doctor hotspots".   I propose we start Brenner's army: doing the research to find hotspots in our own cities and towns and implementing programs to change it.  It is about time we drastically change the way health care is accessed and better utilize our finite and precious resources!

Think there is any way that I can arrange a research year under Dr. Brenner next year?

I'm one of the 1700

"The fact that medicine is still compelling enough for 17,000 people each year to commit a decade or more of their life to training is inspirational."
From Dr. Danielle Ofri's article "Why Would Anyone Choose to Become a Doctor?" in the NYT.

Remember "O157:H7"

Increasingly often I seem to forget that I had a life before medical school.  Sure, I can recall my childhood, past experiences, and the different cities I lived in; but I forget the knowledge I acquired and the details of my other hobbies and interest.  A friend recently sent me an email asking about digital cameras which took me off guard.  My thought process consisted of: "Why is she asking me about cameras?!  Oh ya, I was a photography [and anthropology] major in undergrad.  I guess I should know something about this."  It took me days to respond, days to tap back into that old part of my brain and even still the response lacked finesse.  Talking about shutter speed, and apertures, and developing tricks used to be so second nature...

Dr. Goljan jokes that one should forget their own phone number in order to remember "O157:H7".  I'm beginning to think that it is a sarcastic joke, painfully illuminating what acquiring medical knowledge does to the rest of your brain.  Where does all that former knowledge go when it is replaced by pathophysiology and pharmacology?  Does previous knowledge come back when I reach residency? Post-residency &/or fellowship?  This [shiny pretty object] is your brain, this [deflated balloon/fried egg] is your brain on medical school...

Halfway mark

I'm halfway back to my normal life as a medical student: back to clinical rotations on the wards, back to activism and advocacy relating to women's health, back to national LGBT health organizing efforts, back to trying to publish the research I did last summer and possible starting on a new paper, back to completing my MPH requirements, back to not having enough hours in the day to work, study, eat, exercise and sleep.  Also, back to my cat and back to being within driving distance of a certain special someone. I couldn't be more excited!  The time can't go by quick enough.  I feel like a lazy sloth, wasting valuable time, simply sitting on my butt and cramming details into my head.

Last night I had a conference call for one of the national organizations with which I am involved.  I felt like I was letting my board down.  I was repetitively apologizing that between my medicine rotation and now dealing with personal issues (restudying for step 1) I haven't really done much of anything and that I wont be able to until after the middle of August.  They, my other board members, are nothing but encouraging and supportive.  They are other medical students, they get it.  I adore them [and am oh so very grateful for they way they are enhancing my med school experience].  But, I hate it!  These are issues I'm passionate about.  While I am sure I will continue to organize on issues of medical education and health equity throughout my life, I only have a year to serve in THIS position.  A year is not a long time to make significant strides and even less time when one has to solely concentrate on other things for a block of time during that year.

While I am so excited to get back to my normal, every day, chaotic life, I am also terrified.  This means I am halfway to retaking this stinking exam.  I feel like I've learned a lot and resolved some of my confusion in pharmacokenetics and pathophysology.  All of this studying has not been in vain.  This studying will also help me out later on the wards.  But my qbank scores are not really trending up.  Despite how much I study my score are staying pretty steady, right around where they peaked before I took the exam last time.  With every qbank set I do, I grow slightly more discouraged, fearing that step 1 will come out on top once again.  I plan on taking another NBME self assessment at the end of the week which hopefully (crossing fingers!) will show some growth and boost my confidence.

Spoke to soon

So, it turns that just because my state's government is on summer break doesn't mean that reproductive health battles aren't being fought in other areas of the US currently.

According to an article on change.org, "Medical students and residents at the University of Wisconsin pursuing OB/GYN studies may not be able to complete their training -- and the school faces the prospect of losing its residency accreditation for training doctors in this specialty. Why? Because medical students and residents are being banned from learning the abortion and miscarriage management techniques that save women’s lives. Anti-choice politicians in Wisconsin tacked on a provision to the governor’s budget bill stating that state funds cannot be used for abortion care."  Check out the link and sign the petition.

Also, the National Partnership for Women & Families' policy report today highlighted that "Rep. Cliff Stearns (R-Fla.), chair of the House Energy and Commerce Subcommittee on Oversight and Investigations, said the panel plans to investigate the Planned Parenthood Federation of America and "possibly" hold a hearing on the group's federal funding."  Really?!  With soooo much of a national debt to overcome, we're wasting chasing after PP.  Besides the fact that I strongly believe Planned Parenthood deserves every cent of federal funding they receive, blocking $70 million in funding is not going to make a dent in the amount that needs to be cut from the federal budget.  Dearest republican party conservatives, can you please just get over yourselves and actually spend time on things that matter, things that will actually improve the health and welfare of Americans' lives?

Being a lazy activist

I don't really have the time or energy right now to touch on current events in the way I'd like.  Due to step studying, I barely know what is going on in the world outside my window.  [Luckily, state congress is on summer break so access to reproductive health is not overtly being stripped away while I hide away inside.]  But, I wanted to lazily share a few recent [AMAZING] news articles, all of which happen to be from The New York Times. There was "First Study of Its Kind Shows Benefits of Providing Medical Insurance to Poor" published on July 7th.  There was an absolutely brilliant, and light-harted yet equally heavy piece,  "The Good Short Life With A.L.S." about how we face death in our society- really hitting on the need for open communication throughout one's life.  "New for Aspiring Doctors, the People Skills Test" takes a critical look at how medical students are screened in our country, and what some schools are doing in hopes of finding applicants with more people skills.  I personally hope that my own medical school would adopt such innovative interviewing methods.

Celiac

I was diagnosed with celiac disease in December 2005, over winter break of my senior year of college. My diagnosis was somewhat happen chance. Sure, I was extremely sick, but in totally non-traditional celiac diagnosis type of ways. I'll spare you the exact details. My home doctor laughed at the suggestion that I should be tested for it, but the physician at student health services who had no other idea what was going on, figured it was worth tacking on to the lab work. I came back positive to all 4 antibodies. I was then shuffled off to see a GI doc who confirmed my diagnosis and sent me on my merry [gluten free] way.

Working on the healthcare team at a diabetes camp, I had learned a lot about celiac disease in the summers prior to diagnosis. I knew I was at a high risk due to my strong family history of autoimmune diseases and my personal history of type 1 diabetes. I had suspected that it might be the culprit to my gradual onset of chronic woes and I was the one who suggested the test to the student health doc. I had done my research and was prepared for the results when I came back positive. I wont deny that going gluten free sucked, but emotionally, I rebounded to the news pretty quickly and I was soooooo ready to start feeling better.

When I was diagnosed, it was suggested that my immediate family members get tested. None of them did. Today, 5 1/2 years later, my mom saw a new osteoporosis specialist who screens for anti-gliadin antibodies as part of his comprehensive panel. Turns out that she has celiac disease too. She's 66 years old and totally asymptomatic. Antibodies don't lie. Okay, so sometimes antibodies are confused, but in her case it is a true positive diagnosis.

Watching her come to terms with the reality that she now needs to drastically change her diet is difficult. While she is willing to, she lacks the physical motivation of illness that I had. I imagine that it is also much harder to change your habits at 66 than it was at 21.

To my dismay, my endocrinologist does not screen all of his type 1 diabetic patients for celiac. So every time I have seen him since my diagnosis, I have brought in scholarly literature about the need to annually screen patients with related autoimmune disorders. He argues that it will make a difference in seemingly asymptomatic patients; that they will be unwilling to change their diets for a disease that is not causing acute distress. In lieu of today's events I both understand not wanting to turn someone's life upside down and also the need screen for conditions the patient is at high risk for. Had this doctor not screened, my mom would get to continue to naively live her life the way that she's accustomed, and at 66, who knows if untreated celiac would have left her with any serious term sequela. At the same time, I believe that it is out obligation as physicians/future physicians to supply our patients with all of the information regarding their health despite our personal belief about what they'll do with the knowledge. Example: we need to educate our hypertensive patients on smoking cessation and dietary changes, and the impact not making these changes might have, even if we know that they're going to simply walk out the door with a cigarette still in hand.

Am I just being naive though? Is my endocrinologist right in that we shouldn't screen for problems that aren't yet screaming to be found? Would my mom be better off not knowing that she has celiac disease?

Horrible, no good, very bad biochemistry

In medical school, it seems that biochemistry continues to kick my butt again and again. First there was the challenge of passing first year biochem. Then there was learning how to incorporate the biochemical pathways that I didn't really understand into pharmacology. Then there was re-learning all fine details again for step 1. And now, there is relearning it a AGAIN to retake step 1. No matter how many times I look over this stuff, how many times I draw out the pathways, how many mnemonics or songs I use, I can't seem to get a grasp on the damn subject!

I have no doubt that my inability to retain biochem is part of what did me in the first time with step 1, as I seemed to have a TON of biochemistry questions I didn't know the answers to while taking it. I spent my whole first week of studying this time picking my way through rapid review. I've also used BRS, First Aid, and Doctors in Training sources. No matter what I do though, none of it sticks. Maybe it is because I was a post-bac student with very minimal science exposure pre-medical school? Regardless of the reason, I'm starting to get a little nervous that my inability to retain this one subject is going to be my down fall yet again.

Anyone have magical advice of how to make sense of it all/retain the intricate details of pathways, rate limiting steps, and dysfunction resulting in disease?

Grand Rounds, Vol 7 Number 41: An Ode to Trainees

I was featured in this week's grand rounds: Grand Rounds, Vol 7 Number 41: An Ode to Trainee, hosted by A Cartoon Guide to Becoming a Doctor! I'm honored to be included and excited to see that my viewership has exponentially increased over the past few days. Hopefully I can entice some of you new (and old) readers to stick around as I continue on this crazy journey of activism and medical education.

So frustrating!

I took an NBME self assessment practice exam this morning, and got the exact same score as on the real step 1 that I took in April. Arg!!! So close to passing... yet not. Not even close to where I need to be. On the bright side, at least my score didn't go down and I still have 27 scheduled days of studying between now and my scheduled re-test date. Can I do this?

Life imitates art? Art imitates life?

A few of my classmates and I started a list of pop-culture movies with heavy pathological themes. We were trying to figure out how much of medical school curriculum could be learned through movies. Specifically movies with much more substantial lessons of disease processes, biochemistry, and/or real doctoring than what can be gleaned from Scrubs, ER and Gray's Anatomy. Here is the list so far. What other movies can you think of? (I am sure there are more!)

*Gross Anatomy (1989): "A smart first-year med student takes nothing seriously, except the pursuit of his Gross Anatomy (human dissection)..."
*Extraordinary Measures (2010): "A drama centered on the efforts of John and Aileen Crowley to find a researcher who might have a cure for their two children's rare genetic disorder."
*The Elephant Man (1980): "A Victorian surgeon rescues a heavily disfigured man who is mistreated while scraping a living as a side-show freak. "
*The Madness of King George (1994): "A meditation on power and the metaphor of the body of state, based on the real episode of dementia experienced by George III [now suspected a victim of porphyria, a blood disorder]."
*Lorenzo's Oil (1992): "A boy develops a disease so rare that nobody is working on a cure, so his father decides to learn all about it and tackle the problem himself."
*The Diving Bell and the Butterfly (2007): "The true story of Elle editor Jean-Dominique Bauby who suffers a stroke and has to live with an almost totally paralyzed body; only his left eye isn't paralyzed. "
*Love and Other Drugs (2010): "A woman suffering from Parkinson's befriends a drug rep working for Pfizer against 1990s Pittsburgh backdrop."
*Awakenings (1990): "The victims of an encephalitis epidemic many years ago have been catatonic ever since, but now a new drug offers the prospect of reviving them."
*Outbreak (1995): "Extreme measures are necessary to contain an epidemic of a deadly airborne virus. But how extreme, exactly?"
*And the Band Played On (TV 1993): "The story of the discovery of the AIDS epidemic and the political infighting of the scientific community hampering the early fight with it. "