So, I think I’ve decided to stop having some noble goal of cataloging useful information in this journal and will start using it as an actual journal. Not enough people read it to really matter, so off I go
Its 3, the night before we find out if we matched or not. I’m so nervous I can’t sleep and feel like I’m about to vomit. Rationally, I have no real reason to be afraid. I have 10 programs on my list, several of which have been courting me rather vociferously. Granted, they are not my top programs, but at least I have that on which to hold. The odds that I will not match are, I hope, pretty dang minuscule. Even so, the nagging doubts linger at this time of night.
Plus, this stupid P90X thing is absolutely destroying my back. I love it, and I’m taking it even more seriously than I thought I would, but it’s gotten to the point where I am taking 6-8 Advil a day just to keep my back pain in check. If it keeps getting worse I’m going to have to bite the bullet and go back to the doctor. All that to say this: the back pain isn’t helping me sleep either. But my arms, chest, and legs are sore in wonderful ways, so I’m going to keep up the program, in all its masochistic glory.
So, yeah. I’m scared. Hurdle #1 tomorrow, here’s to the next 4 days of elevated blood pressure.
The Interview Trail
December 19, 2008
My thought a couple months ago was to sit in my hotel room the night after each interview and record my thoughts on the program, as a way of helping me keep track of how I felt about it at the time. Well, it turns out I’m lazy and just plain old didn’t do it. In retrospect, however, it was probably for the best, as my opinions of each program I’ve been too has been so constantly molded and shaped by the subsequent interviews.
So, here I sit, 9 interviews down, and absolutely no idea what I want or need to do. I have my favorites right now (Portland, Denver, UTSW, and Cornell), but even that list is constantly changing. Its coming to a time where I have to decide what I really want out of life. There are two paths laid before me right now, and I don’t really know how to choose between. I have two primary goals on what I want out of residency: 1) to become a technically proficient and clinically competent surgeon, and 2) to land a fellowship which will allow me to do whatever I want with the rest of my life career-wise.
Now, these two goals don’t necessarily need to be mutually exclusive. In fact, I think any one of my top 4 programs right now will allow me to do both of those things, but there are definitely skews. For example, I will probably do a larger number of more varied cases at a place like Louisville or UTSW, and probably be a better surgeon at the end as a result of it. On the other hand, the fellowships that the residents land coming out of Cornell are among the best in the nation. Not to say that there aren’t great fellowships going to the other schools, there just seem to be more of them going to a place like Cornell.
And then, there are the intangibles, the most prominent of which are the personalities of the residents and the city itself. In the former category, UTSW and Cornell probably win, but it could just be happenstance that I connected with some of the guys there. In the latter, Portland and Denver stomp all over the other cities.
I’m tired. I’m tired of traveling, tired of the interview process, tired of not knowing where I’m going to spend the next 7 years of my life. It really is incredible the humiliation that we subject ourselves to on the path to becoming a doctor. I’m hemorrhaging money that I’m borrowing from someone else, paying someone for the “opportunity” to do some resident’s bitch work and paying to fly my happy ass around the country and paying for my hotel rooms only to show up at 6:45 in some time zone and try to sell myself. Screw this. Ok rant over. Its 3am, I have no idea why I’m awake, and I’m mad at everything
In a zen moment, I’m going to leave this post with a picture of why Portland is awesome
30 minutes away from the hospital...
Lack of Inspiration
October 20, 2008
I originally intended this journal to be a collection of stories that I picked up on the wards. I thought my days would be ripe with stories to tell. Stories of pain, heartache, inspiration, and joy. I am sad to sat that it simply didn’t happen.
I can’t say if it was my own lack of involvement in my patient’s lives, or that simply what happens around the hospital just isn’t all that interesting. All I know is that my moments of connection with patients were few and far between, and moments of inspiration were almost nonexistent.
It seems as though, unfortunately there are really only two kinds of patients (with the rare exception). They are either a) not all that sick, or b) so sick that they have lost the ability to effectively communicate. So, either way, establishing a real connection with a very sick patient is nearly impossible. Sure Ms. Smith who comes in to have her HCTZ refilled is a nice lady, but she’s not sick enough to make her interesting. And Mr. Jones with his end-stage pancreatic cancer is dying, but the drugs we are giving to keep him pain-free eliminate any chance at real communication.
And to top it all off, when the day ends, this turns into a job just like any other job. I come here, I get the things that I need to do done, and I go home. I pray that my M.O. will change once I am a physician and directly involved in the care of my patients, but I can say that while playing doctor as a med student (get ready for that post), I found it unbelievably hard to get really involved.
Studying Since Step 1
June 19, 2008
Since the second years are all in the throes of taking that infamous exam and I’m supposed to be studying for my pediatrics shelf exam, I thought I’d take a second to reflect on the studying (or lack thereof) I’ve done since June 17, 2007.
Quite honestly, I think I may have blown some kind of a study fuse while studying for the boards. Since that day last year, I think I’ve put in about 4 or 5 honest days of studying. I’m simply incapable of it any more. I find it tiring, boring, and simply useless. This has been proven by my scores on the various exams. Some I studied MUCH more for than others, yet my grades on most of them have been within 3 points of all the others.
So, here I sit, a book in front of me, doing anything but reading it. This is the last exam of third year, and I’m honestly a little bit terrified that I’m going to fail it. And yet, I’m not scared enough to really buckle down and study for it. Because I don’t give a flying crap about developmental milestones. I just don’t care enough to learn things in which I’m not interested anymore.
Pediatrics
June 13, 2008
As this is my second month of pediatrics, and its almost over, I’ll run down the highlights (for my own memory) of the first 7 weeks:
Dr. Cochran (If you haven’t worked with him, you don’t get it, and never will. If you have, smile quietly to yourself and remember your favorite times with him…)
Leaving the ER 4 times over the course of a 12 hour shift to get random things for Dr. Viets
“Acute Gastroenteritis” HA! 9.5/12 sucker.
Height: 5′10″ Weight: 275 Age: 9 freaking years old
Performing a Lumbar Puncture on a 8 moth old kid in status epilepticus.
The first time I was attracted to an attending.
H&P times a million
Being able to confidently tell people what I’m going into…without regrets.
Boredom on the Wardom
Harriet Lane
Having nothing to say to a crying mother watching her child die. Feeling bad about getting annoyed at how much time we spent in the patient’s room.
Feeling, for the first time this year, like one of my residents doesn’t like me.
Musical attendings.
Team Badass/Bad patients. Team Disaster.
Kairi
Landon
Anna Belle
I haven’t written anything here in a while. In fact, that last post was saved as a draft after I forgot to put it on here for almost a month. I’m gonna get back to this.
Decision
June 13, 2008
So, my mind is finally made up, I’m going into surgery. Am I going to stay there? Who knows. Going through a surgical internship, even if I decide its not for me, will provide a lot of options of other things I can do with my life.
If I was a betting man, however, my bet is that I’ll stick it out. I like the OR too much to do anything else with my life, I think. I like the whole philosophy of surgery, a get in-get it done-get out way of thinking that suits my ADD just fine.
Crisis
April 13, 2008
So, I thought I wanted to be a surgeon. I really, really though I did.
Then, I had a meeting with an interventional cardiologist that I met through family. He has what I want in life. Do I go through the horror of a medicine residency to get there?
Help!
I saw my first death a few days ago.
Going through medical school, of course, you see your share of dead bodies. Heck, I spent an entire semester in a large room filled with about 100 of them. Dead bodies are old news. This was the first time, however, I witnessed someone transition from being alive to being dead. It was strange, but in the complete opposite way that I expected. The oddity was in its complete nonchalance, even from me.
She came in with a ruptured thoracic aortic aneurysm, already a grim diagnosis. Most people don’t even make it to the hospital, and even then the majority of those that do don’t survive. Already under general anesthesia when I first saw her, she was never a real person to me, I suppose. They laid her on the table, turned her halfway on her side, and flayed her open. Dr. Safi works incredibly fast, and in under 5 minutes we had been through skin, fat, and fascia, cut out 2 ribs, incised the pleura, retracted the lung and found it…the 2-3cm hole in a tube that was about to kill this woman.
We operated for about 45 minutes. About 15 minutes in, the EEG went flat. Due to the massive infusion of IV fluids she was getting, she developed some problems with her potassium and her heart began to fibrillate. I’ll never forget how it looked. First, the heart was beating like any other heart, then it looked as if it were a bag filled up with small worms. It writhed and writhed, producing some crazy patterns on the EKG. Paddles were brought over to shock the heart back into a rhythm, only to have it begin to fibrillate again 2 or 3 beats later.
Both surgeons were sewing with alacrity, but it was (apparently) all in vain. Suddenly, without any warning, Dr. Safi threw his needle driver and pickups down, and shouted: “Case over! Call time of death.” Anesthesia was dissatisfied with this. “Give me 5 more minutes,” he asked Safi, who had already scrubbed out and was beginning to write. “Fine, fine” he replied. Dr. Estrera kept operating for a few minutes, then the anesthesiologist was satisfied. “Ok, case over. Time of death 10:15.”
And that was it. No trumpets, no grim reaper, no…nothing. Anesthesia was still keeping her body functioning for the moment, so there was no real change in her physiology. But she was, for medical purposes, alive one minute and dead the next. Over the course of the next few minutes, as anesthesia began to remove their supports and we began to close, I watched the heart begin to writhe slower and slower. We had closed up the cavity before it completely stopped. We closed the wound roughly, it was just going to be opened again by the coroner. Even after that, it wasn’t much different than dealing with a live anesthetized patient. We cleaned the blood off her chest, undid the drapes, and put blankets on her.
The only difference was, this time there was one covering her face.
