Thursday, September 18, 2014

The MD Countdown

I've had a countdown going on my iPad for a while now. I figure I'll share a screenshot now and then. 
Here's the first:


The exact date is an estimate based on previous graduations, but it gets the point across.

In 2016, I will be a doctor.

Time to keep studying...

Saturday, September 13, 2014

Time, Med School, and Life

Yesterday as I walked through the hallways of the hospital, I had a few moments of profound contemplation. Specifically, I pondered the volume of time my classmates and I are devoting to future careers as doctors.

Most of the time these past couple of years of med school, I have just ridden the waves of exams, studying, simulated patient encounters, exams, and real clinical experiences. I don't often think about how much time this is taking. Our lives are finite, but it's easy to stop paying attention to that fact, getting distracted by everything that's going on. When that happens, it's easy for the significance of each day to slip by unnoticed. I don't like that so much.

I'm now 29 years old. I started this blog when I was 25, a year after I got married, then went back to school to become a doctor. People mention all the time how long it takes to become a doctor, but most people don't really know what that means. It's a statement of commiseration, but it usually stops there. It's okay, because it's really hard to truly get it without living it.

For me, the time involved will be a little longer than most because I had to go back part-time after graduating college to get the credits needed for med school. So for me it's been:

- 4 years of undergrad the first time around (2003 - 2007)
- 3 years of school part-time, then the application year (2009 - 2012)
- 2.3 years of med school so far (2012 - 2014)

So, I'm 9.3 years in at the moment, with about 1.7 years left or so before the total of 11 years of post-high school education before I get my MD and start residency. With my most recent specialty choices in mind (more on that at another time - I'm loving Peds right now, even more than ObGyn, so everything's still way up in the air), I'll have another 3 or 4 years in residency.

That will make a total of 14 or 15 years of undergrad+graduate education by the time I can start working autonomously as a doctor. If you think that the average male my age these days will live to about 90 years, that's about 1/6th of my lifetime spent in school after high school.

That seems like a lot. Maybe it's not. But sometimes it really feels like a ton - especially when I'm surrounded by family and friends who are busy doing so much more with their lives during their 20s. Having or adopting kids, building careers, establishing themselves in communities, settling into houses, planning for their futures - all things we continue to put off until "after med school." Sigh.

All right, enough self reflection. I've been feeling behind in my book-learning for Peds recently, so today will largely be spent doing practice questions, reading, and maybe reviewing some drugs.

Enjoy your day today! If you're in Grand Rapids, enjoy the street fair in Eastown for me. It looked pretty cool as I drove past it to buy Hobbes more dog food this morning.

Thursday, August 28, 2014

Obstetrics and Gynecology - A Review


I need a break from studying for my ObGyn NBME Shelf exam (it's tomorrow morning), so I'm going to give a recap of the ObGyn clerkship. You might be surprised by what I have to say (or, if you're an Obstetrician, Gynecologist, or one of my classmates who just completed ObGyn with me, you might not), but to sum it up - it was awesome. Really cool stuff.

I wasn't expecting to like it nearly as much as I did. No, I haven't decided to go into ObGyn. Yes, I'm still pretty undecided on what I want to do with my life (Emergency? IM? Family? ObGyn? Surgery?). Luckily, experiences shall abound in the remainder of my third year of med school.

Okay. So ObGyn was an amazing experience - especially in comparison to M1 and M2. I mean, sitting still and learning in lectures, then sitting still and studying from books/notes/coursepacks is fun and all (I mean it - I actually enjoyed didactic learning!), but nothing really beats getting to be immersed in a real patient care environment. Especially when stuff's happing - and stuff HAPPENS in ObGyn. Most of the time. There were a few lulls (mostly on nights when half the people are trying to sleep thanks to their epidurals), but there was almost always something to talk about, something to see, or at the very least something you had just talked about or seen that you had to then go read more about.

One thing I learned was that vaginal lacerations give me the heeby-jeebies. What's the technical term for that? Oh yeah - The WILLIES. Everyone knows they happen more often than not, especially the first couple of times a woman delivers. It's not necessarily the reality of them - once they happen, they're just something to repair, no problem *dusts off hands as though he's the one doing the repair instead of the resident or attending*. Rather, it's the waiting, when you're not sure how extensive the laceration is going to be. The baby's head is crowning, straining the perineum, the bridge of the nose just barely peeking into the world... It's that moment, right before everything releases. That's the moment that causes the most tension within my chest, and it really takes some getting used to.

Suffice it to say that I really don't blame the mothers when they decline the offer of a mirror.

Keep in mind, I'm not a squeamish guy. My mom had to hold me back so I wouldn't get in the way when they were setting my younger brother's arm after he broke it when we were kids. When I was younger and got shots, they always had to ask me to keep my head back so they could see what they were doing. I was that enthralled. Anyway, I'm not squeamish, but I never thought I would enjoy the operating room as much as I did. For those that don't know, Gynecology is pretty much a surgical subspecialty. They do A LOT of surgery. Hysterectomies, oophorectomies, tubal ligations, exploratory laparoscopies for endometriosis, vaginal vault suspensions, urethral slings, dilatation and curettage, etc.

So yeah. I'm not 100% sold on ObGyn, but General Surgery might be on the table now - I liked the OR that much. Just not so sure right now about the lifestyle. We'll have to see how my surgery rotation goes in January. Wife really doesn't want me to pick ObGyn or Surgery because of the demanding lifestyle. In her words: "Just please don't. If you do, I'll support you. But please don't."

But back to my recap. I delivered 14 babies and participated in 12 Cesarean sections! I also assisted in 18 major and minor surgical procedures. I got to see robots being used in surgery. I practiced my knot tying and learned to close bellybuttons and low transverse abdominal incisions (skin only). I learned a lot from people, experiences, and books. And practice questions. I've done about 450 questions w/explanations (about 150 of which I've done a second time), and I have about 50 more to do tonight before I'm done. Just took a practice exam and passed, so I'm optimistic about tomorrow morning.

So what do I NOT want to forget? Here's a short list:

  1. How it felt to hand the first baby I had ever delivered to his/her parents, and to then see the looks of joy on their faces. How that look was repeated with every set of parents in every delivery.
  2. How hard the residents work! For everyone that thinks med school seems hard, just check back in two years. Then, if I'm anything like the amazing residents that I've been learning from the past two months, you'll see something truly impressive.
  3. The moral considerations I wrestled with surrounding the management of the most complicated cases, and the conclusions that each physician must come to for him/herself.
  4. Wondering in my head about which fathers will cry, get woozy, or do really well - and almost always being wrong.
  5. Seeing the doctors and everyone else work as an amazing, fluid machine when managing an emergency. I have so much respect for everyone in healthcare and what they do together for their patients.
  6. How much I enjoyed everything (minus waiting for vaginal lacerations to happen).
  7. The huge awe I now have for my mom and all the other moms out there, having glimpsed what they go through. And thus, the never-ending respect and gratitude I will one day have for Wife if she gives birth to any of my future gangly-limbed kids. Those will be some mad props.
That is all. Back to the practice questions. Wish me luck tomorrow!

Wednesday, July 30, 2014

Third Year = Awesome - An Update

An image of almost exactly the same setup as on my first day of ObGyn.
Original image from: http://www.lourdes.com/media/157961/daVinci_OR2.jpg
Yeah, yeah, I'm behind in posting. I have good reasons:

1. Exhaustion
2. Lack of free time
3. Exhaustion

I'm currently just over three weeks into my Obstetrics and Gynecology (ObGyn) rotation, and it's AWESOME. Crazy, crazy, exhausting hours, but very cool stuff. To help you understand the hours, I'll put it this way: I just finished day 3 of a 20-day stretch where I am scheduled at least 12 per day, every day. No weekends. No breaks. Let me break it down a bit more for you:

This week, I'm on from 5:30am - 6:00pm every day in Labor and Delivery (L&D). Yesterday I didn't get home till about 6:45pm because a patient started pushing right at the end of my shift. It was great though, because I GOT TO DELIVER HER CHILD. I'm keeping a running tally of deliveries - more about that once this clerkship is over. Anyway, this Friday I start at 5:30am and don't get home till Saturday morning at 7:30am. That's 26 hours straight, so I don't go back in until Sunday morning, when I work 7am-7pm (12 hours). Then Monday through Friday next week it's 5:30am - 5:30pm in Gynecologic Oncologic Surgery. That Saturday I'm back in L&D from 7am Saturday morning until 7am Sunday morning. After that, I'm on 5:30am - 5:30pm Monday - Friday in Maternal Fetal Medicine - all high risk patients. Then, I get a two-day weekend before a week of 14-hour night shifts from 5pm - 7am.

I want to reiterate - this is exhausting, but TONS of fun. I didn't expect to enjoy the ObGyn rotation half as much as I am. The moments when a couple's new baby is born is indescribable. It's awesome to see tough guys cry the first time they lay their eyes on a new son, or the look on a mom's face the first time she sees her baby. So fun to be part of all of that.

I've assisted on more than 20 different surgeries in the past weeks, even getting to throw My First Stitch. Who knew that ObGyn was half surgery?!? Definitely not me. My first day of the rotation, I was able to be in the room during a da Vinci robot surgery (see above image). While I wasn't operating (students don't operate), I was able to observe as the resident and attending worked. It was really cool how much they could do through just one small port through the umbilicus (bellybutton).

In most of the other surgeries, I've been able to actively assist the resident and attending. At this point, I think C-Sections might be my favorite, but I'm not sure. My week of ObGyn (lots of surgery) is still coming up, so we'll see if that changes. It's just really cool to have surgery start off nice and normal and then all of a sudden BOOM a BABY is coming out of the surgical site.

I have been almost constantly in awe of what modern medicine is capable of these past three weeks. It's insane what we are able to do with the aid of anesthesiology. A patient can be awake and talking to you one second, and then two minutes later surgery is underway and you're inside them, working to make them better... Many times throughout each day, I take a few seconds to pause and think about what I and the other doctors, nurses, and techs are doing, and I'm humbled. We are so privileged to have the abilities and education that we have, but we are so much more privileged to have such profound trust as that which is placed in us by our patients.

I still don't know what I want to do. I just know that I made the right choice in pursuing a career in medicine. Yes, there are often frustrating, embarrassing, uncomfortable, and really exhausting periods of time, but the good outweighs the bad, no question about it. I love taking care of people, and even though (as a med student) I'm not the focal point of the patient's care quite yet, I'm finally learning how to move into that role. Yes, I might be constantly on the verge of nodding off whenever I move to a quite room with some white noise. No, I don't get to play with Hobbes as much as I'd like. And extra-big YES, I might be missing Wife more than ever these days, with both of us working 12+ hours most days. But in the end, third year is leaps and bounds different from the first two years, and I'm love it. Granted, that might be because I haven't had to take an exam yet (and won't have to for another four weeks), but there you have it.

Third year is off to a great start.

Thursday, July 10, 2014

My First Stitch


Today, I put my first stitch into the skin of a human being. It may or may not have looked very like or unlike the above umbilicus. Sure, the attending may have quipped good-naturedly as I started the first knot, "Boy, I could have gone on Christmas vacation already" before laughing then just saying, "Hahaha - just kidding. I love med students." When I finished the knot he asked when I had learned to suture, and I said mostly last week, but that this was the first time I'd ever been able to assist in closing on a person, he said, "Oh really! Well, good job then."

My resident made me feel even better when she said, "And his first closing was deep in a bellybutton, not some straight, superficial incision like my first time."

Yes, third year is a lot of work. We moved from one surgery to another for eight hours straight with no room for a meal, and only time for one bathroom break toward the end of the day. I'm not sure if that is normal or not, but I am enjoying it nonetheless. I did let my blood sugar and hydration levels get too low today, though. Had a sharp, cracking headache all day that slowly built into a blinding, pounding migraine by the end of the day.

Now, I'm settling down to some nice, passive lectures to finish out the day. On the back burner is the case report that is due next Wednesday, along with the many chapters of reading that I haven't quite gotten to...

Ah well. There's always the weekend!

Wednesday, July 9, 2014

Step 1 - CHECK

These are the balloons that I would blow up and use to have a party if I had more time and didn't need to go to bed right now because
I have officially passed the first United States Medical Licensing Examination - Step 1!!!

While I won't be sharing my score, I will say that I'm very happy with it. Want the back story? Click here for My Step 1 Experience.

And now, I move on with 3rd year, which is turning out to be quite a bit more work than I expected.

Saturday, July 5, 2014

This Is The Part Where I Save The Day

When Wife and I were in Asheville on vacation, we stopped at a pretty cool bookstore called Malaprops. In this bookstore were some very cool shirts. Wife decided I should have two of them. The other (my favorite) I will share at a later date, I'm sure, but the below shirt is still pretty cool:


I haven't yet figured out Wife meant it as a joke or not. There's the obvious bookstore nerd theme of comic books and superheroes. Then there's the aspirational theme of me on my way to becoming a physician. I think it's safe to say that a lot of med students dream of using the skills that we're acquiring to one day save someone's life.

The thing is, today I may have done just that. Not really probably, but maybe a little bit possibly. Perhaps. Probably not.

I was out walking Hobbes for the second time today. On our walk, I'd tried out my new hospital Med Student badge on the parking structure at the hospital to see if it would work. It's ridiculous, but when the entrance gate swung up to admit the car I wasn't driving, I was thrilled.

So Hobbes and I are walking down the sidewalk back toward home, past some houses in the neighborhood, and I see this woman in her thirties walking with a little girl. The woman had a kite in her hand, and I thought maybe they were going to a nearby park to fly it. 

Suddenly, the woman starts jogging and letting the kite rise behind her. She lets it go up about 15 to 20 feet, right next to the elevated cable and telephone lines. Where we live, the lines go: cable (lowest) then telephone (middle) then electric (highest). The kite was getting higher as she got closer to me and picked up speed, and I could tell she was trying to get it as high as possible. It was making me nervous, thinking about the kit hitting the higher lines, so I casually said "Um, it might not be the best idea to fly that near the power lines. You could maybe get electrocuted?" 

She quickly slowed, letting the kite drop to the ground behind her. Her expression slowly changed into this dawning look of horror, and she said, "Oh. It probably wouldn't be the best to hit those would it?" I said, "Nope. Not the best idea." and just kept walking.

I don't know what would've happened if she'd hit the power lines. Best case scenario, the string would've been a sufficient insulator to not let her be zapped and she'd've just lost the kite to the tangle of string. I don't like to think of the worst case, but at least now we won't find out.

MS3 - Orientation - Day 4

Behold, the glory of my suturing technique (haha).
Special thanks to all the pork chops out there that used to ambulate on the above foot.
Your sacrifice did not go unnoticed.

Orientation week is a bit of a blur. We went on hospital tours, learned shorthand for writing prescriptions (after learning that we will likely be writing prescription and procedure orders for REAL patients, which will then be approved by a resident or attending before actually being carried out), and met our clerkship directors. We learned about the consequences of making mistakes and how to minimize them risk management, how to wash our hands (fourth time through that video? fifth?), and how to gown and glove using aseptic technique.

We learned about the software used to manage patients' Electronic Health Records (EHRs), how to get involved with research as well as our mandatory research projects this year, and how to fully utilize the university libraries in taking care of our patients.

We also once again learned about HIPAA (Health Insurance Portability and Accountability Act) - specifically how I will almost never be able to write about specific patients or their conditions on here. Even if I say nothing about their name, age, gender, etc., merely mentioning their condition may count as "identifying information." Particularly because I'm not *really* anonymous on here. I mean, my first name is in my comments, and my picture is all over the blog. It wouldn't be the hardest thing to identify me if you were a patient I'd seen. It's only one step further to realize that the patient I'm writing about is actually YOU. Nope, not a good idea. My patients' privacy is too important to me to compromise it just because the experience happens to be really interesting.

This in NO WAY means my blog will stagnate into a boring quagmire of mediocrity like the above paragraphs about orientation. No! I will still be able to write about things that I learn, procedures I see, and much of the other awesome stuff that goes into the transformation of a bookish MS2 into a slightly less bookish, more worldly MS3. You will probably just never see anything patient-related on here. Sorry.

Anyway, orientation week culminated in learning to tie specific knots used in surgery, then practicing those knots along with standard suturing technique on some dead pig feet. You see, pig skin is pretty much the closest thing to human skin - though it's still quite a bit tougher.

My first rotation in the hospitals will be Obstetrics and Gynecology (ObGyn), and I start the week off with Gynecology. I expected this to mostly be Pelvic Inflammatory Disease (PID) cases, pelvic exams, and various pelvic pathologies. I didn't think it would be very much surgery, but according to the rumor mill from the MS4s, that's not so much the case. Apparently I can expect a lot of time in surgery this first week, as there are a lot of hysterectomies seen in the Gyn side of the rotation.

I'm pretty interested in seeing anything and everything at this point. While the prospect of getting up each morning at 4:30am to begin rounding at 5:30am and not get home until 5:30pm is a bit daunting, the past couple weeks of vacation have left me feeling refreshed and rejuvenated. 

I'm still trying to not think about getting my Step 1 score back on Wednesday, as thinking about that seems to magically slow down time, but hopefully the business of the next few days will minimize that effect.

And so. I have today and tomorrow before clerkship-specific orientation on Monday, then full-swing rotations begin on Tuesday morning. I'm making the most of today - slept in (and I mean SLEPT IN - 10am yo!), made a killer bacon & egg breakfast, bought new shoes, grazed in the Apple store, walked Hobbes, transferred some photos, and now wrote this post. Now I may do some video editing from the NC Vacation, or I may chill on the porch and read. Who knows.

Anyway, wish me luck this week - especially on Step 1 Wednesday...

Monday, June 30, 2014

MS3 - Orientation - Day 1


Today saw the official beginning of Third Year. I'm (un)officially a third-year med student. Why the (un)? Because we don't actually get our Step 1 scores back until ~10 days from now, and we're not technically allowed to be MS3s until we pass that bugger.

However, barring disaster, I'm an MS3, as evidenced by the new (de-identified) hospital badge and pager. That's right folks - we still use pagers.

Granted, the practical rationale for pagers is pretty strong: cell signal = unreliable in big hospitals but pager function = good .: we use pagers. Pretty sure Wife already hates the idea of a pager. One more way in which med school trumps regular life. Case in point - the phrase "Your time is no longer your own" was used several times during today's orientation...

Speaking of which - Today's Orientation Schedule:

7:30am - Check-in and Continental Breakfast
7:45am-8:45am - Welcome and introduction to staff
8:45am - 9:00am - Intro to the building and operations by Security
9:00am - 10:00am - Professionalism. Apparently stuff gets REAL in Block III.
10:00am - 12:00pm - Fitting for respiratory suit masks for when we interact with quarantined patients.
12:00pm - 1:00pm - Full Hour LUNCH! PROVIDED = Yesssss.
1:00pm - 1:20pm - Pre-recorded Camtasia video by the Dean about being a virtuous physician. People be respectin' and we gotta be worthy of it, yo.
1:30pm - 3:30pm - Orientation Part 1, wherein we learned all the intricacies of the grading system and how important it is to never miss a day of clinical rotations. Suspension = My Eternal Fear.
3:30pm - 4:30pm - How To Properly Present The Patient You Just Evaluated.
4:30pm - 7:00pm - Block III BBQ and Surprisingly Fun Games with Prizes

In summary (because I just spent WAY too long on the North Carolina Vacation post, as was necessary to do it even half-justice), assuming all the material we covered was 100% necessary, it was an incredibly well-done day or orientation. We've got three more packed days planned for this week, wherein I will learn from the wisdom of the students 1 year ahead of me, meet my first clerkship director (Obstetrics & Gynecology!), tour some killer (figurative, people) hospitals, learn about "risk management" (which instantly makes me think of this clip of Ted from Scrubs - skip to 0:21), how to control infections (WASH YOUR HANDS), use new computer programs, suture people, and much, much more.

I'm going to try to put up a quick post each day about orientation, but I might just decide not to. We'll see how these next few days stack up against today.

Photos - Smoky Mountains Vacation - Asheville, North Carolina

Here's a super-quick, photo-heavy recap of our recent vacation to the Smoky Mountains in Asheville, North Carolina. I wish I could go into more detail, but I just got done with my first day of orientation for my 3rd year here at MSU CHM, and I'd like to write out a post about that tonight as well.

Here's how the vacation went following Step 1:

Monday, June 16th: 
      - Step 1 from 7:30am - 5:30pm (click here to read My Step 1 Experience)

Tuesday, June 17th: Driving
      - Drive to Asheville, North Carolina (12hr trip took 13.5hrs d/t traffic jams)

Wednesday, June 18th - Free Day #1
      - We hung around the Hummingbird Cabin, which was pretty much all ours in the middle of ~70+ acres of small mountains, streams, and trails. Went out to eat at 12 Bones Smokehouse - AMAZING. They're so good, they didn't even blink an eye when I jokingly told them we'd driven from Michigan just to eat there. They only laughed once Wife told them I was kidding. Afterward, we soaked in our hot tub and generally recovered from Step 1 and the drive.












Thursday, June 19th: Breakfast & The Biltmore
      - Ate books and read breakfast - oh wait... Nevermind - at the Early Girl Eatery. Highly recommended; awesome books food.
      - Visited the Biltmore Estate. Summed up in one phrase: The American Downton Abbey. Very literally. Couldn't take pictures or videos inside, but below you'll find some outdoor pictures, several of which are pretty cool panoramas.
      - Went hiking on the trails with Wife and Hobbes.





























Friday, June 20th - Sliding Rock and Waterfalls
      - Explored the beautiful Pisgah National Forest
      - Visited (and slid down) Sliding Rock. Tons of (cold) fun - luckily weather was hot that day. A video will eventually (once I get the time to make it) get posted, including lots of fun GoPro shots of us sliding down it.
      - Visited Looking Glass Falls - very cool. Sort of wish we'd had time to go swimming here.
      - Returned home to hike around with Hobbes, grill out, nap and enjoy the cabin.























Saturday, June 21st - Blue Ridge Parkway & Mt. Mitchell
      - Got lost finding the Blue Ridge Parkway. Met some interesting mountain people who were having a yard sale by the roadside when I stopped to ask directions. Before I could get out more than "Hi, I was wondering if you could-" all seven of them pointed in the same direction and in unison said, "That way." Apparently there was nothing in the other direction.
      - Found (after speaking with the communally-dubbed "Map Man" (and then getting lost again)) and drove around the Blue Ridge Parkway
      - Drove to the top of Mount Mitchell, the highest point East of the Mississippi River.











To explain the above photo, after walking the trail at this "scenic outlook" there were no Glassmine Falls currently falling. Hence the joking frowns. 



















Sunday, June 22nd - Free Day #2
      - Slept in, enjoyed reading around the cabin, cooked the best bacon I've ever eaten. Of course, I can't remember what kind it was...
      - Ate an absolutely FABULOUS late lunch at Tupelo Honey Cafe in downtown Asheville.
      - Walked around downtown, spent too much money on books at a local bookstore
      - Went back to the cabin and enjoyed relaxing one last evening before packing up. Below are some shots of the cabin itself, since I neglected to take them at the beginning of the trip:















Monday, June 23rd - Driving

All in all, it was the perfect post-Step-1 vacation. Many, many thanks to Wife for organizing and planning EVERYTHING while I was in the throes of Step 1 prep. She even worked three 12-hour shifts back-to-back the three days before we left on the trip. I'm still kind of confused as to how everything worked out, but never before has a vacation gone so smoothly. Well done, Wife.

Well done.

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