Endings and beginnings

So this is probably the best time to drop a word back in here. I finished my USMLE Step 1 test. I get my score back tomorrow. If I feel motivated, I might write a post or two about that experience. A quick summary on my second year of medical school and the end of preclerkships: I’m surprised how much I learned in so little time. But I’m even more impressed with what I don’t know because wow, you can really spend a lifetime learning medicine.

In two weeks, I will be hauling a pager, struggling with EPIC, furiously reading, and most scarily — taking care of patients. My first rotation is pediatrics. I am nervous for a few reasons. To start, it so happens that the hospital I am rotating at was exactly where I was hospitalized (and as a pediatric patient to boot!). I’m not quite sure how I will be handling that situation. Right now, I think I will be okay (by the way, my doctor is finally taking me off my last medication!), but who knows how I will feel when I see an equally sick child on the bed? And as excited as I am to finally “get to be a doctor” (not really as I am still a few years out from my MD), I can’t help but feel SO nervous. The immense responsibility of having someone else’s life in your hands… I mean, wow. One can say that at least I’m lucky to be starting on pediatrics since children are generally a more resistant folk (emphasis on generally), and the pediatricians are known to be incredibly supportive and great teachers. Our deans this week have been throwing at our face that from now on, our time is no longer our time, it is our patients’ time. And I’m okay with that. In fact, in a weird way I am looking forward to not having to think about myself and focus on someone else (that’s probably not psychologically healthy but I don’t care). I’m just worried… what if I can’t do enough? What if I mess up? What if I don’t know things?  It’s a little funny to me because I wrote about this exactly in one of my secondary essays when I was applying to medical school. The prompt was something to do with asking us what we thought our biggest challenge would be, and I said it was learning to accept that patient outcomes and healthcare in general are not entirely in our hands. I said back then that I hoped my colleagues and teachers would prepare me for this struggle, and I think I am better, for sure, but it will be a battle I will have to keep fighting. I hope I am good enough for my patients.

Smoking Cessation

I’ll be one of the first to admit that I tend to have absolutely no sympathy with smokers, judge them very harshly, and I’m just all around very rude and not understanding to them. I realized this was going to be a problem when I was shadowing in cardiothoracic surgery a few years ago because, well, there’s just a ton of patients I’ll get who will be smokers, and as their doctor, I can’t be nasty with them. So I always knew this would be difficult. Our first week in the pulm unit, we had a class on smoking cessation beginning with a patient presentation. I remember thinking that when they told us they’d bring in a smoker, I was very disgruntled, wondering what a smoker had to offer to a presentation when it’s really easy to find a smoker. What new information would this person provide?

Well, she was a quitter. And I guess that didn’t do much for me at first, but the more I listened to her talk, the more I realized how wrong I am/was about smokers. Granted, smoking is still terrible for your health. And you still should not start it. But I guess I always just approached the quitting part in a way that wasn’t conducive to anyone quitting at all, which makes me think back to a bunch of people I “defriended” because of their smoking habits. One of my classmates asked our patient what it feels like to try to quit, what a nicotine craving really is like, and she couldn’t really tell us except that she just wanted to smoke whenever she needed to cope with something stressful. I’m sure I’ve heard something like that before but this time my perspective changed. Maybe it’s because I’ve started to realize more of my own unhealthy coping mechanisms, but in that moment I suddenly felt a big burst of empathy for smokers (I know, I can’t believe I’m saying that too). It’s really hard when you’re in that moment to try to convince yourself out of your unhealthy habit — you know it’s irrational, you know it’s unhealthy, you know that in any other normal state of mind you wouldn’t want to do this, and yet you still do. I’ve struggled with my own demons for years, and it’s HARD. Even now, after seeing a psychiatrist and therapist, I still have my relapse days. And as we learned in psych, mine is based on neural circuits that I’ve ingrained since I was a child. So how different is that really from the smoker whose own neural pathway is also messed up, telling him/her to just get that burst of relief and calmness and happiness from the cigarette?

So I’m glad I actually had that interview in the end. Next week we’re supposed to practice motivational interviewing, something I was initially dreading because I didn’t think I could pull off acting sympathy. Well now I know I won’t have to because I really do get it, I think. And I’m glad that I’m learning more about what it feels like to be the patient (hah, as if I don’t have enough experience with that).

M2

Something happened in the past few weeks that finally made me realize that I’m actually about to be a doctor. I don’t know what it was; perhaps it was wrapping up the cardiovascular system, which happens to cover most of America’s healthcare problems in a compressed bursting-at-the-seams 4 week package. It could also be because we got our clerkship schedules for the coming year (I got plastics and ENT for my surgical subs, which I’m extremely happy and excited for!). It could be actually being able to read an EKG, knowing what treatments to give someone who’s going through a heart attack, being able to hear and identify a murmur. It could’ve been that I had to teach some of the lay public how to do the cranial nerve exam. Something happened, and it finally occurred to me that I really am not just a student going through the motions, but I’m actually almost a doctor. Wow.

Steve Jobs

Just about anyone I’ve spoken to knows that I was reading Steve Jobs by Walter Isaacson because I raved about the book to EVERYONE. I finally finished it last night. I was reading the Kindle version so it’s hard to approximate how much of the book was devoted to references toward the end (according to the %, it should be ~25%), but I was definitely reading the book non-stop for at least a week and it still took me that long to finish it. Regardless, I loved the book.

Disclaimer: I am NOT an Apple fan (I don’t own a single Apple product). I am not a techie person at all. And I definitely hate biographies. What honestly convinced me to read it was the insanely high # of positive reviews on Amazon and Goodreads and the fact that it was already loaded on my Kindle.

So you can assume that the fact that I loved this book says something either about the subject matter himself or about Isaacson’s writing style (gonna go with the latter since the main reason the book was great was due to its almost gripping/dramatic/cliff-hangery style). Some people think that this may all be some great marketing ploy, but Jobs never even got to read the book let alone make edits to it before it was published (the only part he played was in deciding the cover, which is hilariously quintessential Jobs). I think Isaacson did a brilliant job in gathering numerous resources to present an unbiased view of Jobs. I loved reading about how Apple and its products came to be, the development of Pixar, and Jobs’s way of managing a company and how he saw the future. I think all of it in itself was very inspiring. For example, I’d say here are some life lessons I picked up myself:

1) Do something you’re passionate in. Seriously. You’ll never achieve the same level of success if you’re just doing something for money — as was shown by Sculley’s leadership of Apple in addition to Microsoft’s downfall. As Jobs repeatedly mentioned in the book, he was trying to create a lasting legacy of a company and great products, not a profit. He also wanted a team of people who were equally passionate about the product, and as he said, when you put A players together, they like to play together to make great things.

2) The reality distortion field – if you think and believe and act like something will work, it will. Probably this follows point #1 in that when you really put your mind behind even the craziest ideas, you can make the impossible possible.

3) Focus. This goes back Apple’s rise to power, which was generated because Jobs realized that he had to focus on only a few products to make them excellent. I noticed that other companies are doing something similar now — for example, much to my chagrin Google decided to boot out Google Reader because they wanted to focus on other products (they also eliminated Wave, etc). I think we all know deep down that when you focus on a few things, you’re better, but it’s nice to get that refresher once in a while.

4) How you present yourself and behave is important. That includes Jobs’s strong eye contact, the way he could turn on charm when he wanted to (and equally turn it off to get you to beg for it back), the way he built his company and himself on design and simplicity and perfection and sophistication. It also includes some of his flaws. Be honest (like he was) but you don’t need to be nasty or rude to achieve your goals (as he learned later). Don’t abandon your family either. Take time for what’s important.

5) Take time for yourself. Maybe this wasn’t something Jobs was good at, but it’s definitely something I picked up as a lesson. He took walks all the time to think and discuss and tried to eat healthy foods (albeit to the point of crazy sometimes). And he admitted himself later that it was probably when he was taking on the role of CEO of Apple again plus running Pixar that he overworked and began to experience health problems. In America’s capitalist society we’re trained to be robots, keep pushing, be better than everyone else, sleep less, do more. But the thing is, we’re humans and unfortunately (as I also learned the hard way), eventually we get sick, and you HAVE to stop. If only we could all learn that lesson before it was too late.

I also noticed I have a weird connection with the guy. We love perfect things. We like white. We like clean. We like obsessing over fonts. It’s great! (however I prefer sharper edges and not rounded rectangles… and that’s why I don’t like iOS)

Personal updates — I know I’ve been MIA. Med school does that to you, I guess. I finished my first year. It was incredible. Long, stressful at times, but amazing and exactly what I wanted. I’m happy with where I am. I love my friends and my peoples and I’m enjoying exercise (!!!) and I love my kitty and I feel so calm and blissful. It’s great!

Perspective

I’ve been working on a database for my research project, and it involves pulling data out of medical records for cancer patients. Most of this is fairly mindless but a few things continually catch my eye. Like how I am jolted and feel slightly uncomfortable every time EPIC tells me I’m accessing the record of a deceased patient. Or when I see a particularly young patient.

Today I was most bothered by seeing how many patients had various events on my birthday (April 7, a rather nondescript date). The most distressing was when I saw a date of diagnosis that happened to be on my 18th birthday. Even though I should’ve been mainly happy that I was even well enough to be out of the hospital, celebrate my birthday with some friends, and be able to eat a cake, I was mainly upset because I had wanted the boy I was seeing at that time to come to my birthday party but he wasn’t able to. Yet somewhere out there, there was someone who was receiving his/her diagnosis of cancer and that s/he’d have to go through chemo and radiation. How upsetting that must’ve been for both the patient and the family. Here I was belaboring over my insignificant and ultimately short-lived relationship while someone else out there was probably getting among the worst news of his/her life. Way to put my problems in perspective.

Intro to Anatomy thoughts

Before we first went into anatomy, we were asked to describe our feelings for a word bubble. I chose “epinephrine”, probably because I’m a dork, but also because it was accurate — I wasn’t really just anxious/nervous/excited, I was a bit of both, and all I felt was my heart rate speeding up and slight sweating and just adrenaline. I wasn’t sure how to feel. In the past, I’ve shadowed many surgeries, and I was never nervous around operations on open bodies. Something about the fact that we’d be with dead bodies, however, made me feel… eerie? I didn’t know what to expect. All I knew was that I wasn’t alone in my feeling in the room.

As we changed into our scrubs, I felt the rush more. I frustratingly tried different combinations to get into our lab until I finally got in, and I was the first girl. The minute I saw the body bags, all I wanted to do was find my body. Immediately, I adjusted. I didn’t even notice a smell, although I’m sure there was one. When I found my body, the bag was partially cracked open, and it was all I could do to keep my hands away from the bag so I could open it all the way.

I wanted to wait until after our first true lab and dissection to see how I felt, and I suppose intuition always wins — I love it. Before the class, we watched a video about what it meant to donors, and many talked about how they wanted to be more beyond their deaths, how they wanted to keep teaching, etc. As desensitized as I am to the whole “OMG, there’s a dead body in front of me that I’m cutting into” feeling, I haven’t stopped forgetting what a gift it is for us to be able to have these cadavers. Even in my fury of excitement as we reflect muscles and palpate structures, I still think about how lucky I am that someone was so kind enough to donate her body to me to let me learn and further my education. I have never had any anatomy — I’m not even kidding. I never even had to memorize the bones or the muscles of the body when I was in elementary school. I’ve literally had no anatomy. So in addition to learning this whole new language of terminology, I’ve also had to learn about where things are, what they are, how they are, etc. I won’t lie, it’s been tough. I spend hours on the pre-lab readings hoping to identify as many things as I can on various forms of art/pictures. In the end, there’s nothing like learning from touching the muscle in my hand or feeling the bumps of the spinous processes. I’m so thankful to the donors in our program that they are able to help me learn anatomy.

One of the cooler things to me too is how everyone’s body is so different. My friend and I were discussing how something that you’d even think you’d take for granted, like the number of vertebra, can vary between human to human! What does that mean for evolution? Who knows. I think it’s fascinating that you can try to extract someone’s life and story from their body postmortem. My program doesn’t let us know about details of death (or life) until maybe later, so it’s truly all a mystery to me. But I know that even the basics we’ve seen already reveal much. For example, I now know that if I were a cadaver, I’d be a pretty boring dissection since I’m probably all bone and fat with very little muscle. That sucks. I really need to work out more. I may not have exciting skin lesions on me, but I have had enough sun exposure that I may have some macules worth checking out. Is my story cool? What would future students know about me? Here’s a girl who either goes outside a lot or is extremely sensitive to sunlight or doesn’t wear sunblock (middle is true). Here’s a girl who clearly avoids the gym (true). Here’s a girl who is really frail — why? What happened to her? (kidney failure) I just think that’s so great that you can guess at all these stories about someone.

I’ve so long wanted to donate my body to future patients that I never thought about another purpose for it. But as someone said in our video, what if your organs aren’t the best organs? (e.g. cancer/other diseases, you’re old, you’re missing some, etc.?) Is there any other way I could give back? Probably. I think it would be pretty great to donate my body to medical education if I couldn’t put it toward live patients. I’d hope that they would respect me as much as I respect my cadaver, but even so, I’d be dead, and the best I could hope for was that these future students would get something out of my body.

2013 Resolutions and the first steps!

The year I got into medical school (2011), something happened. I’ve been grappling with this issue ever since someone asked me once, what do you want AFTER medical school? And I didn’t have a good answer. After I got sick, even the thought of going to medical school seemed so far away and unlikely that that’s as far as I aspired, and I didn’t think about what I wanted after that. When I got my acceptance, the truth loomed over me — what next? What do I want now? It may also have just happened to coincide with the first year I’ve ever been independent, but when I was sitting down to make my 2012 resolutions, I was at a loss. What else did I really need?

So one of my resolutions ended up being the 20 books challenge, which I did complete, along with a few other resolutions that worked for me. I focused more on building myself as a person and culturing my hobbies.

This year was even harder to make resolutions, especially since I did so well with last year’s. But I finally scrounged around and made nine. I’ve actually finished 1/20 books for this year already, which I’m proud of. Here’s the one I will be talking about today as it’s a huge step for me! 3) Gain weight (5-10lbs) / start exercising. Seriously. (yes, I actually wrote it like that)

After the hospital experience, I lost so much weight. I don’t think I ever fully regained my muscle mass because I just haven’t been as diligent about working out compared to before (for example, when I used to swim). I mostly regained leg muscle because, really, it’s not like I can just not walk around or go up/down stairs. But working on my arms has been a lot harder, probably because I am lazy but also because it’s really hard to face just how weak I became. I don’t know where the 5-10lbs that I’m missing (compared to my base weight) went but I’m guessing it’s somewhere there. It’s been an uphill battle for me to regain my weight, but this year, I’m determined. I’m finally off of most of my medications, and this is the time.

Today I went to the school gym with my best girl friend here at school C. We were careful to eat lunch first upon her advice and one of my other “body builder type” friends’ advice. The gym was calming but filled with confusing machines. I’m so glad I had someone with me. She asked me what muscle groups I wanted to focus on, and I said arms and back. Arms because of what I said above, and back because I’m scared I’ll get osteoporosis. We started with back. OMG! First, I didn’t even know back muscles could ache or be tight. I guess I was just used to sitting and orienting my body in one way. I think the longest/hardest part was when we were trying to fix my form for something, and I learned how uncomfortable it was to arch my back after hours of sitting straight.

The arm weights were the worst. I truly learned how much I had lost. I think the strangest sensation was feeling the crackling down in my forearms every time I tried lifting something.

We finished off with a bit of cardio. I think in the future, I want to go swimming, although I heard rumors that the pool isn’t heated, which doesn’t sound pleasant given the current weather conditions. I also noticed the rowing machines, which I miss from my random crew conditioning days. Right now, I feel sore and light at the same time. I’m also still hungry even though I ate a whole meal after. If I’m to follow my diet, I’m supposed to eat whatever I want whenever, so I think I’m going to go grab some cookies and peanut butter. I weighed myself on the machine at the gym to gauge my baseline. Good luck to myself for this coming year!