Lazy patient

I think it’s interesting how when it comes to being lazy*, I choose to take my antidepressant over my immunosuppressant. I’ve been taking my immunosuppressant forever so you’d think that that one of all things would be the one I’d associate most with habit. And, you know, there’s also the part about how it’s the only thing keeping my kidneys from dying. But unless I’m on dialysis in the hospital, I can’t really see or feel my kidneys failing. At least not until it’s too late anyway. And I’m a tangible person; it’s a huge reason why I love surgery, because I like to experience my results. And when I don’t take my antidepressant, well, damn, I know. I know because suddenly things that should not bother me bother me again. I know because I’m self-conscious perhaps to a fault. I want to tear myself down because I’m never good enough. And I might brew on that for a while until I realize that I have indeed been lazy and I should really get back on yet antidepressant.

I’m probably one of the few “surgeon” types who’s so supportive of psych medications. I know most people shrug mental illnesses off as not real or something that is just a weakness we have to deal with. But I’ve felt the effects, and the fact that they feel as real — even more real — than something as physiologic as kidney disease should speak for itself.

*I know… This shouldn’t even be something that one can consider “lazy”. But I’m not perfect, I’m just as much a patient as the next, and yeah, I try but I’m not the most compliant. It was so much easier when I felt every little symptom. But now at I’ve been in remission for almost eight years…. Okay, You know what? I still don’t have any excuses. I should try to remember this whenever I’m on the other side of have bed.

Last rotation!

Amazingly, I’ve managed to not post here for almost all of third year. I think that speaks to the nature of this year vs. the other years of med school….

Finally had time to wash my white coat over the weekend, and this is what came out of it! Oops!

As I am currently on my last rotation (!!!), here are some things running through my mind as of late:

1) It really is tiring. – I don’t claim to be the most physically fit person ever, but I know even my running-every-day-and-I-love-crossfit classmates are pooped out. Last Sunday, I literally slept all day. The last time I did this was when I had swine flu in my first year of college, and then before then it was when I was still acutely ill! You really do get pushed to your physical limit, I think. Weeks/months of the minimal amount of sleep, eating at odd times (and sometimes not eating at all), working weird hours and thus messing up that circadian rhythm that I spent a year of my life researching, always having to be on your A-game… yep. Those things take a toll, for sure.

2) “Being a human” becomes harder and harder. – This is what I call any attempts a med student tries to be normal and assimilate into the “real world”. Prior to winter break, a bunch of us were at dinner and reflecting on how we all use medical jargon (and I wouldn’t even call it jargon) in our daily speak now. Just a few weeks ago, we were talking about how people can have benign vs. malignant personalities. I don’t think the #normal person speaks that way. I’ve also found it harder to communicate with my family about what I do and my non-med school friends (example: I’ve sent a ton of snapchats while dallying around in the OR waiting for room turnovers, and I get responses from “I hear you” [other med school friends] to “OMG I can’t believe you’re on your phone in the OR, that’s so not sterile!” [hon, not everything is sterile in the OR, and obviously I am not texting you if I am scrubbed in] to “why are you awake so early?”). I’ve also turned into one of those people I swore I would not become – people who only seem to be able to talk about medicine. *sigh*

3) I seriously can’t believe how fast time is flying. – Second years are asking me about Step 1 advice, which still feels like something that only happened a few months ago. In one year, I’ll be done with interviewing for my future job and career. In one year and a few months, I’ll know what I am doing with my life and where it’ll be. And soon after that, I’ll be “Dr LV”. And then… I’ll be making decisions that I have no qualification to make. I’ll somehow know all these things about proper dosage of medications, running a code, being able to talk to family because they’re requesting to speak to an MD, etc. I mentioned before that I thought that once I got into med school, it’d be like boarding a train that just keeps going without stops, and it feels truer every day. As much as I love what I’m doing, sometimes I do wonder if I’m missing out on something (esp. with #2). I keep finding all these books I wish I had time to read. I pin shamelessly all the places I wish I had time and money to go to (I’ve had to turn down family trips to so many places while in school that I want to cry). I just feel so YOUNG to almost be a doctor. It’s mind-boggling.

4) I’m so lucky I knew myself going into med school. – This is a lot harder for me to write about here since some of my friends might think I’m judging them. I’m not. I think everyone deserves to make their own choices. But third year especially has separated those that I think really got what medicine was and those who didn’t. Thankfully, most of them are in the former group, but I know of at least a few people who are now thinking that they may not even want to do residency after graduating because they don’t want to practice medicine at all. Or those who are willing to do so only because they have this humongous debt to pay off but actually derive no satisfaction in it. I find that all so sad, partially because I was very close to not being accepted into med school, and it’s hard for me to think that there are folks who were lucky enough to get in and then aren’t planning on actually being doctors anymore. I also feel sad for my classmates because they really did have to work their butts off to get here and then to find out that they aren’t happy with this choice… what a nightmare.

I’m so happy I picked the right thing for myself, though. I knew all the downsides of medicine going in, and even though I’ve realized more and more of them while being a third year, they’ve never deterred me from still loving what I do almost obsessively. Literally one of my friends just texted me, and I told him that I had a day off. He responded with: “What? A day off for you? On surgery??? Are you feeling okay?” I mean, I really live and breathe this stuff (read: I’ve lost two relationships with significant others that I thought could be my partner-in-crime-future-husband because I’ve loved/prioritized medicine more than them) so I guess his suggestion wasn’t THAT surprising. So yeah, it’s almost the end of the hardest year in med school, and I’m still getting that reaction, and I’m still taking extra hours just cause I feel so privileged I get to.

On that similar note, I also called it from day 1 what I was going to do with my life! I always knew I wanted to be a surgeon. I think initially, I was, like everyone else, drawn to the glamour of being The Surgeon, but even in my premed years I discovered real reasons why I liked surgery. And yet I still went into med school and especially third year trying to be open to other possibilities because (1) I didn’t want to be the person who was so narrow-minded and pissed everyone else off, and (2) I didn’t want to maybe pass up on something that could be my actual life’s passion. I’m really glad I did that because I really did enjoy my inpatient pediatric, EM, and cardiology rotations (in fact, cards made me really question the surgery path for a very long time). However, now that I am finally in my surgery block, it’s like coming home to your long lost lover. It just feels so right and makes me so happy. Yes, there are totally mean attendings. Yes, the hours suck. Yes, I’m tired and hungry all the time. But I love the OR. When I’m stressed, tired, sad, the only thing that can ALWAYS cheer me up is being in the operating room. I dig beautiful dissections. I love putting my hands on organs. I derive huge satisfaction by being in the right fascial plane. Blood bursting everywhere only excites me, not stresses me. Watching the surgeons sew is like watching magic. There’s only one place where you can literally hold a beating heart, feel the tremendous pressure of the cardiac output gushing against your hand as you block a hole in an artery, look and experience what makes humans Work. A patient was watching his laryngoscopy and said something along the lines of how gross the inner human body was. He asked how we all dealt with it. The attending and resident were like, oh, you get used to it. But I told him that I honestly thought that the inside of the human body is prettier than the outside. And it’s true. Because why would you ever want to look at the neck and not look instead at lovely vocal cords that are touching each other and vibrating perfectly to produce something as magical and precise as voice and language?

So anyway, yes, I’ll be going into surgery, I hope! A particular kind of surgery. ;) But I won’t reveal it here just yet. Let’s just say that if you read between the lines in my paragraph above, you could probably figure it out.

I still have a few more weeks of gen surg, but … fourth year, here we come!

The Catcher in the Rye by JD Salinger

I give this book a 2/5, and that might even just be generous. I know this is an American classic, and I think on some level I did enjoy reading it. But I absolutely despised Holden. I found him so whiny, narrow-minded, judgmental, and immature. I could not sympathize with him much at all. I wonder if I feel this way because now I am an “adult” (okay, sorry, I still don’t feel “grown-up” yet even though I am legally and developmentally) as opposed to a teenager reading the book (supposedly, a lot of adolescents identify with Holden’s angst). Perks of Being a Wallflower is commonly described as the modern version of Catcher, and I’m not surprised why. But I enjoyed Perks so much more. On some level it’s probably because I read it when I was younger and in the proper mindset. But I also think it’s because the main character in Perks was just not as annoying. Sure, he cried a lot and was a little oversensitive and clearly not socially adept, but I find that more excusable than someone who passes fast and harsh judgment on everyone they see.

I will say that one thing I liked about the book was the whole metaphor of the catcher in the rye and trying to catch children in their innocence and idyllic field before they fall off into the dark world of adulthood. As a third year medical student now, I feel even more separated from my youth because I’m finally “almost a doctor”. I finally almost have a full-time job, and not just a job but a career. My friends are getting married (!), my younger sister graduated college, and people around me are moving on and growing up. I might not be fighting it as much as Holden was, but it does make me feel sad, like time is passing on too fasts, and I’m not sure if I’m ready to step into that stage of my life yet. Like I always said with medical school and my initial fears the months before I started, I now feel like I’m on a train that’s just going to keep going without making stops anymore. I know I want to get to that end destination (I want it more than anything else in my life), but looking outside the window, I kind of wonder if I’m missing out on playing in those fields, and sometimes I want the train to stop just for a little while.

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!