Kid, you are very right

Conversation that just happened between one of the attendings I'm working with this year, her 3 year old, and me as we were trying to put away supplies from the papaya workshop she did:

kid: "I want to play with them!"
to kid: "these tools are for doctors"
me: "maybe one day you'll have your own set"
attending: "[physician activist] is going to be a doctor one day soon"
kid: "Why?"
attending: "because she's very smart"
kid: "runs away laughing out loud..."

Yep, sometime I too want to run away laughing when I realize that I'm going to be a doctor.

Time flies when you're [in med school]

At 10am this morning, by handing in my psych self exam, I officially completed my 3rd year of medical school.  I am now 3/4 of the way to my MD!

However, I am also officially taking a year off to do research next year, which means I'm on the 5 year medical school path.  So I guess I'm really just 3/5 of the way to my MD.  I'm really excited about the research I'll be doing and the city I'll be living in.  I'm a bit relived that I now have a little more time, and will have more exposure, before having to faithfully decide on obgyn.  Plus, it is allowing me to feel like I'm doing everything in my power to make up for my [first attempt] failed step 1 score.  I'll never actually know if it'll make a difference in my life path, but at the same time I can't imagine that it'll hurt anything! A year to re-learn spanish, exercise, sleep regular hours, travel, cook/eat healthy, socialize with friends, be close to family, ....  what is not to love?! 

I can't believe it has already been a year since I started on the wards!  A year since I wrote this post.  A year later, I still struggle with empathy, compassion, and time management.  While I still feel like I know nothing, I can also tell that I've become more proficient in presenting patients and writing progress notes.  I am better at answering questions.  I have learned to suture, catch a baby, drive a laproscopic camera, do complete neurological and psychological exams, and so much more.  I am also learning to forgive myself when I make a mistake, make an idiot out of myself, and when I have a visceral emotional response to my surroundings.  One year down on the wards and a life time to go.  Every day I spend with patients, I become more and more excited that this is my life!

And life marches on

Break-ups suck.
Trying to keep it together, so I don't look all teary like my psych patients, is hard.
Life keeps marching on.
Is this a clue that I'm supposed to give up my dreams of having a family to throw myself into medicine entirely?
On the upside, at least my roommate & friends are amazing.

More input, more confusion

I spoke with a long-time mentor who is an academic obgyn this morning.  She currently has a career that I imagine myself wanting for my future.  The gist of a long conversation is that she thinks I should seriously reconsider OB, and should opt instead for peds or family medicine.  She thinks my personality would do better in something truly primary care.  According to her, too many OB programs are malignant and for good reason.  She also stated that she would reconsider family for herself if she could do it all over again.

It's looking like a research year might be the only option.  Not necessarily to build up my CV, but to buy myself another year before having to make this decision.

Anxiety about next year

The uncertainty about next year is making me slightly ill.  I was hoping to know by now if I'll be taking a research year or going on to 4th year, but alas, nope.  Having not been offered a fellowship in the first round of selections, I get to keep waiting until all the spots are officially filled up.  Who knows how long this whole process will last...  It is so much worse than sitting by the phone for a date to call!

My peers are fervently filling out VSAS (visiting student application service) applications for audition rotations.  Rumor has it that spots fill up super fast and one must be very strategic about these things.  I haven't opened the email sent from my dean about registering for VSAS.  I have yet to figure out where I'd even want to do an audition rotation!

To make matters worse: my experience speaking at the conference of Friday, seeing where the 4th years matched, and a conversation between ob-headed peers and an OBGYN attending we greatly respect have me wondering if I should go into peds instead.  I LOVE obgyn.  I love everything about it and like what my life could look like.  I can do perinatal care, high risk OB, adolescent health, trans reproductive health, provide abortions, surgery, and the list goes on and on... But a lot of obgyn programs are malignant, conservative, and have seemingly unhappy residents.  I also worry that the all female environment will bring out the competitiveness in me.

I like peds a lot.  I can still do adolescent reproductive health, medical education, trans health, and public health based work.  I can maybe, probably, also provide abortions.  The pediatric community is all so happy, nice, and welcoming.  If I'm going to have my own family, peds will allow for a better balanced life.  Plus, I have many a connection that will help me get into a good peds residency.

Taking a year off would slow down the process a bit, but it will also slow down the process a bit.  Translation: I'll buy myself a little more time before making a decision.  I'll make more noteworthy connections in the obgyn world that should help me for residency.  However, I'll be 30 when I graduate medical school!!!  Yes, yes, I know that age is only a number.  But 30 is a really big number.  It'll also mean that I'll spend the next 2 years nomadicly as I move for the research year and then travel all around for 4th year.

Anyone have a crystal ball?

Match day 2012

Good luck 4th years!  Hoping that tomorrow brings only joyous news as you embark on the newest phase of the medical education adventure!  Crazy to think it is already your turn to match and our turn to be 4th years...  how quickly med school is flying by.  I'm so very excited to see where you all end up [and wise enough to avoid all hospitals come July].

(stolen for facebook)

Being an example

Today was consumed by neurology orientation.  I don't know how I used to sit through entire days of lectures for two whole years of med school (and all the years before that)!  But the endless day of lectures isn't the point. 

The point: don't volunteer to be an example.  The clerkship director asked for a volunteer to demonstrate a proper cranial nerve exam on.  No one was volunteering and so after what felt like hours, I finally raised my hand and took the seat front and center of all my peers.  In the process of doing a proper neuro exam on me she discovered that I likely have carpal tunnel syndrome to some extent or another.  Lovely.

I'm not surprised at all by her observation.  I've had off and on wrist pain for a long time thought it is usually when I've been over using them: knitting constantly, signing (ASL), and typing at odd angles such as when I worked as medical assistant.  Plus, she only found a defect in my left wrist (my non-dominant hand) and it was a really cursory haphazard exam. 

BUT carpal tunnel syndrome is one of my biggest fears as I prepare for a future in OB.  [Along with my fears of loosing my eye sight or limbs to years of chronic type I diabetes.]  So many older doctors I know have given up delivering babies or preforming intricate surgeries due to wrist problems.  Having a fear pointed out in front of a room full of classmates doesn't do much for one's self esteem.

Appearance (aka my mom was right)

Blow drying my hair and wearing makeup really does make a difference with the way patients interact with me.  I'm treated more like the 27 year old I am,and less like a high school student pretending to be an adult. This is especially true when I'm wearing scrubs.  However, while I can rally to add an extra 10 minutes to my morning ritual for makeup and hair, I'm pretty sure I wont be swapping my danskos out for high-heels anytime soon.

The ancient art of obstetrics

I've decided that I'm going to need to supplement my obstetrical education to include the usage of forceps, assisting mom to deliver in positions other than supine, vaginal breech deliveries, vaginal delivery of twins, and external version.  I'm sure there are a few other ancient tricks that would be good to learn too but I don't yet know what they are!

I can almost guarantee that I will not adequately learn these techniques in the US and that there very well may come a point in my career where these skills will mean the difference between life and death of a mom or baby.  I imagine that I'm going to have to spend some time abroad to learn these tricks!

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

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?

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.

Doctor x2?

I had an unexpectedly long conversation today with my old md/mph adviser. He is a man who has done amazing things in this world and who's opinion I greatly respect. He planted a seed: I should be going for a phd in health policy. He also told me that I don't need to do it now, but with the track I'm on, I should keep it in mind for the future. He basically gave me a huge complement, a very flattering charge.

Hmmm. The idea does sound appealing. Maybe one day I'll be a doctor, doctor? A MD, PhD, MPH? For now though, I really want to get out of the world and start practicing medicine. It is very much something I can think about when I have more experience under my belt.

Solicited advice

Before Thanksgiving last year one of our anatomy professors warned us that we were going to be treated differently by our families when we went home for break. He explained that between the turkey and the pumpkin pie, our families would likely be soliciting medical advice from us. He was right. Even if I can't answer their questions, I like being that person. I savor the roles of caretaker, hand-holder, medical translator, and reference librarian of primary medical literature. Having the knowledge and skills to be a support system is why I originally became an EMT and was part of the impetus to go to medical school.

Recently though, I've been confronted with a few different ways to handle those who offhandedly solicit medical advice from physician friends in social settings. Watching these encounters occur, I totally understand the perspective of both providers.

One answers all questions with "you should talk to your doctor about that", giving no specific answers other than to simply triage the urgency of the situation. Her perspective is that she doesn't have all the facts that their doctor will, and doesn't want to be put in a position of missing something or bearing bad news. She wants to keep boundaries between her personal life and her career.

The other views the ability to offer medical advice as her contribution to relationships. She knows that her schedule limits her ability to be part of the community: to go to shul, volunteer with the chessed committee (making meals for new families, the sick, and those in mourning), pick up carpool, and host holiday meals. So she compensates by constantly "being on call" to those in her community. In a way, she views sharing her skills and knowledge as her debt to society.

I wonder what my stance on friends soliciting medical advice will be. Of course, I actually need to know some medicine before this relevant, but i still find it interesting to think about. Will my career and family life be two separate entities or will they blur into each other? Will I get knocks on my door for emergency consultations during shabbos or will I actually choose to take a complete day of rest? Knowing my personality, I imagine I'll be more like the latter physician constantly there to support friends and family. I'm kind of curios to know other physicians choose to do. I think it is time to start asking my mentors.

career counseling

In the few months leading up to Step 1 (and 3rd year clinical rotations) there are a bunch of hurdles that my medical students makes all 2nd years run through. Besides learning the computer system, getting another TB test, taking an official standardized patient exam, etc., we also have to have a career counseling session. These sessions were billed as "a half an hour opportunity to sit down with a dean". We were sent a long form to fill out and bring to the session with us.

Turns out that the half an hour session about our future was really a nine minute psych consult. A glorified opportunity to make sure that we're not about to jump off the building nor totally oblivious to our quickly approaching destiny. He asked me how I was eating and sleeping, what my study plan is, and how I am feeling about it all. He then continued by giving me advice for 3rd year. His advice? Come in prepared, be nice to everyone, show that you care, don't slack on any of the rotations including the ones you aren't interested in. Do people not know this?! It seems so logical!

In other news, I am feeling totally unmotivated by our current academic block. Turns out that living a life of endocrinology pathology translates to complete study apathy. I really need to tap into my 20+ years of endocrinology experience, and soon.

Broken

I subscribe "Pulse", a weekly internet-based literary journal. Some of the pieces are so-so but others are absolutely wonderful; this week being one of the later. The story was titled "Broken" and tells of a pivotal moment all medical professional go through, the point where our idealistic nature gives way to jaded frustration. Besides being a good read, it hit close to home as the shifting mindset of budding physicians is something I've been thinking (and talking) about a lot recently.

Last week I had my first official meet up with my "first-year buddy" where I passed along a piece of advice I had been given by a doctor-friend. Before I began this doctor-friend told me that her biggest reget was not keeping a paper journal throughout her med school journey, as she knew she was profoundly changed, but lacked documentation of the evolution. I was already keeping a journal at the time (having started during the interview trail) but have used her words as motivation to keep up the practice. When I passed these words on to my buddy, she immediately asked what, if any, changes I had noticed so far? To which I responded with a simple "yes". It is not easy to express how an experience changes you. It is even harder to do when you don't view all these changes as positive. And harder still is to present this information in a way that it wont bias the experience of my first-year buddy.

While I have not yet "broken", what are some of the things that have changed over the past year? The top 3, or at least the 3 I feel like mentioning right now, are:
1) I have become more impatient with people and with bull shit. Because my time is overly structured and because I can't take a break from studying without feeling guilty, I find myself inpatient to anything or anyone that slows down my productivity.
2) My vocabulary has changed. I now use words like "acute", "lateral", and "pathological" in every day, non-medical, conversation. I also triage my conversations with friends in order to extract the most important information first. I blame this on being impatient .(see #1)
3) Having yet to see a really successful model of personal life for career driven physicians, I have been making peace with the idea of potentially not getting married and having children. (see previous entries with "family" labels)

I am sure that I will continue to change over the course of medical school and my career, and am hopefully that these changes will be chronicled in my paper journal and maybe also on this here blog. I sincerely hope that I never significantly change or break to the point of being driven away from medicine and the idealistic desire to do good in this world. If I do, I hope that I, like the author of the article, can find ways to be reminded of my goals and be made whole again.