Surgery is not a spectator sport

Gosh, I have so much to write that I must think at least 10x a day, "Oh, I wish I could blog about that right now." But of course, nobody ever accused your third year of medical school of being boring and full of free time to blog. So I will have to satisfy myself with just one right now. I've been itching to write about my inpatient surgery rotation. I just finished two weeks on the colorectal surgery service. And -- it was fun! Actually fun! But -- I am exhausted! So exhausted!

I had the most incredible resident, Em, who gave me more responsibility and taught me more in two weeks than a textbook could have taught me in a year. She took me to lunch and had me practice my subcuticular stitches on a Starbucks banana. She stayed hours after she had to just to talk about patients and illnesses. She gave me rides to grand rounds. She let me do things in surgery and stepped out of the way. In short, she was amazing.

She understood that surgery is not a spectator sport. That once you are familiar with the excitement of being in the OR, it is supremely boring to stand at the back of the room and watch other people operate in a field you can't see, when they are speaking behind masks and it's difficult to decipher what they are saying. Knowing this, Em encouraged me to get my hands dirty. I got to see beautiful dissections of organs. I got to check a colon segment (removed) for cancer. I got to hold countless instruments for delicate procedures. I got to see the abdominal aorta pulsing and the shining dark brown lobes of the liver. How many people have held a pancreas? I am so lucky. Em advocated for me to the surgeons, getting them to let me scrub in, teaching me skills, and essentially pushing me to learn more about what it means to become a surgeon. It's tough. You wake up at 4:45 am if you are a resident. You rarely go to sleep before midnight. You do the math. But there they are, tireless and dedicated and liking their work, every day.

I don't know how I will ever thank her, but I know that when I am an intern (a first year doc post-MD), I will be kind to my medical students because of her. She made me think that you don't have to be a jerk to be a surgeon (and so did the rest of the team, who was pretty nice, in fact).

Oops, out of time. Drat.

Fatigue! Honestly come by.

Beginning your third year of medical school while moving out of your old apartment and changing your sleep cycle to an earlier one can be summarized by one word: exhausting. I am exhausted. But this has been one of the coolest things I've ever done, and I can honestly say for the first time I KNOW I made the right choice. I'm so glad I came to medical school.

I have seen patients by myself in a variety of clinics over the past few weeks, and B and I just moved 80% of what remained of my stuff out of my apartment this weekend and put much of it in storage. I have so much extra work to catch up on it's not even funny. And we won't be here next weekend because my cousin is getting married. But it's been amazing. B has sacrificed much of his vacation time in helping me, my mom, and my brother, who just had shoulder surgery. Let's just say there's a lot going on.

More after some sleep. But just wanted to write that I am still alive and kickin'. But not kickin' it.

The Unwritten Rules

One thing I'm learning is that on the wards, many, many people will let you just put your foot in it. This is not just other medical students who think they're competing with you -- doctors, nurses, staff will let you just make a mistake and then see how you react. This morning was my morning. My attending asked me to check my schedule and tell the patient when I'd be back. Simple, right? Nope. I didn't have my schedule (for the year, not this week) printed out and with me. That was mistake #1. I couldn't log on to the server because I had forgotten which account and password out of five new account/password combinations I was supposed to use. So it locked me out. That was mistake #2. So far, so good.

But the compounding mistake was asking another doctor to log in for me. Apparently that is a big, BIG no-no. But she didn't tell me that. The few other people sitting there didn't say anything. She was just silent, then asked, "Do you have an ID?" and I said yes, but I was locked out. Then she said, "hold on," and left, so I thought maybe she would help me. Meanwhile, I looked up the help number. When she came back, she said, "Are you still locked out?" and made it absolutely clear she was not going to do anything about it. Let me note that she didn't say anything along the lines of, "You know I'm not allowed to do that. Call that number on the screen." She was just silent, as was everyone else.

So at this point, I finally caught on and said, "I'll just call the hotline here." And I picked up my cell phone, spent the next 10 minutes on the phone, and got my schedule off the computer o' doom (it is not a coincidence that the server login screen resembles the Blue Screen of Death). By which time, of course, my patient had departed. I offered a dejected apology to my attending and then swallowed it like a big girl and kept seeing people (who in this case, were very adorable well babies, so this was frankly not too hard). But I lost a patient for my cohort and a chance to look like I actually had my act together.

Lesson learned: Never, never, never, never ask for help if there's a chance you can solve it without putting someone out. Because you are at the bottom of the ladder. Oh, and carry your schedule for the entire year, in case someone asks you what you're doing next July when your patients need shots. Third, always keep an eye out for the Unwritten Rules. The nurses know, just copy them. And never ask a doctor who isn't responsible for you for help. No teaching credit, no time. Oops, I forgot one: learn how to blend invisibly into an overcrowded room without getting in anyone's way or, God forbid, taking a chair (that one I knew: they all 'belong' to someone).

There but for the grace of God go I...

...where on earth have I been for the last month? Oof. That is truly the million-dollar question, but the answer is pretty much what you'd expect from a medical student in her last two months of her second/third year of a joint MD/MS program: studying. And finishing things. And starting things. With a touch of freaking out underlying it all.

Anyway, today I've got my typewriting skills back, because today was the day I PASSED the USMLE Step 1! Now, I didn't pass 'with flying colors' or streaks of glory or smears of superiority or any such thing. Oh, no. I passed by the very skin of my teeth -- which is not cool nor is it characteristic of my attitude towards exams. I usually like exams and do well at them. But that is another blog for another day. Today, I simply sigh a big sigh of relief. I passed. I passed. Thank the Lord above, I passed.

Which means: I can move forward with rotations. I don't have to call the nice patients in my longitudinal patient panel to tell them that no, I won't be seeing them at their appointments this year after all. I don't have to take time off to retake the test. I can graduate on time, hopefully, and some day be an actual doctor. I can actually enjoy myself (or try to) this year. I can start looking forward to the next set of exams. I can actually make friends with my new classmates/teammates/preceptors/attending doctors. And -- and this is the big and -- I can focus on learning medicine in all its nitty-gritty, terrible beauty.

And: I can help plan a wedding (yay x 1000), find a summer sublet, hang out with friends and B more, and be a less grouchy sister to my younger brother, who has moved home! Good times. Plus, my adorable and slightly plump, middle-aged Siamese cat will get more attention, not to mention my long-suffering parents. Today is honestly one of the most beautiful days I have ever seen. Fluffy white clouds, blue skies, sunshine, eucalyptus trees -- and a passing score.

A passing score, by the skin of my teeth. When I saw it, I felt my heart racing, the same feeling you get when you're hiking and you almost step off a cliff by mistake. Phew. And now, finally, I can say my classroom years have come to a close. I can finally let them go. And I'm mourning them, because I can't remember a time when I wasn't a student in a classroom whose job was to learn. And now I'm a student in the real world, an apprentice-student-doctor, being given real responsibility (with supervision) for real people with real problems who need actual help. The classroom of life.

So far, I'm on my third day of clinical rotations. I have seen two patients entirely on my own, many with my preceptors, and I have six patients who are "mine" -- I will follow them throughout the year and be at any of their appointments I can make it to. My rotation is a longitudinal one, which means I do ALL the core disciplines at once: family, internal, OB/GYN, pediatrics, psychiatry, neurology, surgery, etc. It's been AMAZING. It's been like a dream come true. And my preceptors have been really great teachers so far. And the patients, of course, are the entire point. That's the reason you wake up early (very early!) in the morning. Eventually, the goal is for me to have roughly 60 patients of my "own" for the year -- which is nothing when you realize that the average clinician carries about 1000 patients on a regular basis. But of course, we're just starting out.

I will be blogging more now -- so much to write about, so little time!

But I will never, ever forget, in exams or in life: There but for the grace of God go I.

It blows my mind.

It blows my mind that a healthy woman with NO prior health history, on NO medications, who had a baby 5 months ago, could spontaneously develop a dangerous liver abscess from a severe infection. This world is a crazy place.

Luckily, she will be okay. She was my last patient at the JMP! Which is another thing that blows my mind. I can't quite realize that three years have gone by. I am no longer that fresh-faced young person just starting anatomy. Three years older, and dubiously wiser, and slightly sadder, and definitely happier, all at the same time. I've learned a lot, and not all of it has been from a textbook.

1. It's good to be important, but it's more important to be good.
2. A sense of humor will preserve you.
3. Never scoff at love in any form.
4. Remember what it feels like to be sick. Everyone in the hospital feels like that times ten.
5. Be grateful. As often as possible.

That's all the sentimental nonsense I got for now. It's a mellow sunshiny afternoon here after days of rain, and our big clinical exam is tomorrow! I'm a little tired so I may take a quick nap before studying my physical exam stuff. We each get six patients: 20 min. for physical exam, 8 min. written exam, 7 min. feedback from each examiner. They grade you on above, at, or below competency, and there's some magical algorithm to tell them whether you've passed or not. Sigh.

Life is crazy right now. There is too much to remember. I miss B something fierce. I try not to dwell on the fact that I don't really get to see family, hang out with friends, catch up with old friends, or have lots of fun right now. But I'm probably contagious anyway, given this vague pro-dromal feeling, so perhaps it's a blessing in disguise.

I'm listening to The Great River from the LOTR soundtrack, which is beautiful. Wouldn't it be fun to be Howard Shore and compose all the music that went with that movie? Although maybe it would be more fun to be in the orchestra or the choir. Hmm. Either way, it's pretty fabulous stuff.

The Post Triumphant!!

I have an announcement to make! After 48 hours of incredibly hard work and very little sleep:

A new thesis comes into the world

To prevent the spread of germs (mine to you), visitors are very welcome after April 2nd.

We're Not Alone

And, as proof that others have felt this way since time began (or at least since the first world war):

Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.

Surely some revelation is at hand;
Surely the Second Coming is at hand.
The Second Coming! Hardly are those words out
When a vast image out of Spiritus Mundi
Troubles my sight: a waste of desert sand;
A shape with lion body and the head of a man,
A gaze blank and pitiless as the sun,
Is moving its slow thighs, while all about it
Wind shadows of the indignant desert birds.
The darkness drops again but now I know
That twenty centuries of stony sleep
Were vexed to nightmare by a rocking cradle,
And what rough beast, its hour come round at last,
Slouches towards Bethlehem to be born?

(Yeats, The Second Coming)