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...

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