So, apparently it is now the month of May, I have completed two months of Surgery and thus my third year of medical school, and it is now the beginning of my fourth and final year of medical school. These events provoke many questions–how/when did this all happen? Am I still alive? What has become of this blog for the past two months?
Posing with the Dune Buggy ride in Saugatuck, Michigan, where I spent a couple of days after finishing up M3 year. Would highly recommend wearing a seatbelt to future riders.
Hopefully I can get to at least some of these questions in the course of this long-delayed update, but first I just have to take a step back to say…Wow. It has been quite a year. This thought really hit home a couple weeks ago as I stood up in front of a panel of wide-eyed, brand new M3s during their orientation to address the elusive question of “How to be an M3.” It was mindboggling to realize that exactly one year ago, I had been sitting in that auditorium, fresh off my boards, about to begin my Obstetrics and Gynecology rotation without being 100% sure which part of this clerkship title meant the delivering of babies and which involved the rest of the aspects of taking care of women. Since that time, I have completed not only the OB/GYN rotation (and decoded the meaning of these words) but have also been an amateur psychiatrist, cardiologist, general internist, neurologist, family medicine-ist (unclear if this is a word, but it can be so for now), pediatrician, and surgeon for anywhere from 1 to 2 months at a time. I have, at times, slept less than I ever thought humanly possible, gone to bed earlier than I have since I was in third grade, awoken earlier than I believe most roosters begin to stir, eaten the majority of my meals in the hospital cafeteria, gotten to know the best call rooms and which ones to avoid at all costs, taken care of men, women, and children who have passed away, met patients I am certain I will never forget, and had many a moment that I would certainly like to forget. Dropping the code pager into the toilet on my first night on call would probably rank quite highly within this last category. As would my infamous spraying with a not-insignificant amount of blood of no less than three doctors while attempting to remove the placenta from a woman’s pelvis after a C-section. The anesthesiology resident involved in this case still heckles me for this each time I see him, but it has finally become funny rather than mortifying after a year. Well, almost.
Upon completing Pediatrics, I entered into a world of 4 AM wake-ups, 4-to-8 hours of standing at a time, lightning-fast rounds, intimate familiarity with retractors, and the reliance upon two hands (not my own, which were busy with the retractors) to remove cancer, relieve bowel obstructions, and perform other such incredible feats with such grace and speed that they seem to have a mind of their own. For me, it was comparable to watching a great field hockey player with superior stick handling skills at work: years and years of training resulting in knowing exactly what to do without having to so much as think about it.
This world of Surgery began for me in early March, when I started on the Endocrine Surgery service. The vast majority of our patients were having their thyroid or parathyroid glands removed, although I did get to see some adrenal gland (the glands that sit above the kidneys and produce lots of hormones) cases as well. I also got to see a ton of bread-and-butter General Surgery this month, including hemorrhoid removals, hernia repairs, and the removal of various lumps and bumps from very diverse parts of the human body. The endocrine cases were in many ways very satisfying, as they were relatively short procedures with small, subtle scars and, according to the patients I saw in clinic after their operations, almost immediate relief of the sometimes debilitating symptoms that these tiny (or, in the case of some of the gigantic thyroids, not-so-tiny) glands had bestowed upon them. I was surprised by how much medicine was involved in General Surgery: the discussions about patient diseases, diagnosis, and treatment were similar to those I had participated in during my Internal Medicine rotation, but they were much quicker, occurred earlier in the morning, and were followed by a full day in the Operating Room.
The necessity of knowing the pathophysiology, diagnosis, and management of the diseases we were treating surgically became particularly apparent inside the walls of the OR, where from the first incision some attending surgeons would ask me everything from, “What were this patient’s presenting symptoms?” to “What is the work-up for an adrenal mass found incidentally on MRI?” to “So Lauren, how exactly does the Bovie function?” I can tell you that the OR can be a warm place, between scrubs and gowns and masks and overhead lights–and it can quickly become a very hot place when you are asked a series of questions with the whole room listening while simultaneously trying to hold two retractors completely still.
Prior to starting my surgery rotation, I had completed all of the other M3 clerkships and was feeling pretty confident that I had started to figure out this much-talked about, much-anxiety producing M3 year. I would quickly learn, however, that surgery was a whole new ballgame. One of the biggest factors in this is the abrupt change in your schedule. I had gotten up early throughout the year (although “early” can mean very different things–on psychiatry, we were told never to come in earlier than 8 AM, and on medicine I would usually arrive at around 6 AM), but getting up earlier than 5 AM and going to sleep around 9 or 10 was definitely a shock to the system at first. More importantly, there was so little time between arriving home for a long day in the OR and needing to get to bed in preparation for the next day, and so many things to do in that period of time–i.e. make dinner, eat dinner, study for the oral and shelf exams, prepare for the next day’s cases, and, ideally, bathe–that exercise took a back seat for me. Or more like a position somewhere in the trunk of this metaphorical car. My uncle once told me something like, “Lauren, I’m not a doctor, but I do know that when you’re an athlete and you don’t work out, something in your brain–some chemicals or something–just aren’t right, and you just don’t feel like yourself.” I found this to be extremely true. I would only run once or twice a week, and my favorite pastimes like reading, playing guitar, seeing movies, seeing my friends, talking to my family, following sports teams, etc. were put aside.
So yes, these major changes in my schedule and exposure to this outside world were difficult to adapt to, and there was certainly a great deal of relief when my classmates and I put down our pencils from the Surgery Oral and Shelf Exams (which occurred on the same day–more on these events in another post) and were free for a week having then “graduated” from M3 year. On the other hand, there were definitely some unforgettable moments on this rotation. It is incredibly rewarding, for example, to see a patient to come in to the hospital in an extraordinary amount of pain and to take him to the OR, identify the bowel adhesions causing his pain, release or resect them, and then watch the small intestine go from a dismal blue to this bright pink color within seconds and, thereafter, see the patient’s condition improve rapidly. It is also a tremendous privilege to get to take care of extremely sick patients whose families entrust their loved one’s life to the surgery team. As I grew up witnessing firsthand through my father, surgeons are a remarkable group of people who sacrifice an extraordinary amount of time, sleep, and energy on a daily basis for many years in order to take care of the sickest of the sick. I also have to say that I have a whole new appreciation for my father and the training he went through to become a surgeon, all while still attending all of my embarrassing dance recitals, viola concerts (yes, I just admitted to that), and sports games. In addition, in seeing how hard the residents work, I can now appreciate how difficult it must have been for my mother to take care of me and my brother while getting through law school as my father completed a residency back when residents took call every other night and worked 120+ hours per week. As I have mentioned, I found it hard enough to maintain basic standards of hygiene and nutrition while getting through this year at times, and I really admire my classmates who have spouses and children and still made it through this challenging year.
I’m thinking that I’ve gone on long enough for now, and I promise to update soon about my adventures on my first rotation of M4 year¿Orthopaedic Surgery! Until then, enjoy the spring and, as always, I would love to answer any questions about Michigan, M3 year, the viola, or various other topics at lkehrlic@med.umich.edu.
Don’t miss the next Dose of Reality.
