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Hello There, Fall

I think it can go without saying that it’s been a while since my last post. I promise that it has been a very busy time in the life of every M4. Since the last time I wrote, I completed several rotations, submitted my application for residency, and started interviewing!

Surprise Motley Crew reunion at the med school. I’m so grateful for these ladies!

The last time I wrote, I was on my ICU sub-internship. After that rotation, I spent most of July as a staff counselor of Camp Bold Eagle, the summer camp of the Hemophilia Foundation of Michigan. Camp Bold Eagle was amazing! I was a counselor and was able to spend the summer helping kiddos with bleeding disorders have a really fun summer camp experience. Even though interventions for hemophilia and von Willebrand’s disease have made huge leaps, it can be incredibly scary to live life knowing that you can have bleeds that can be life-threatening or damaging to joints. The goals of Camp Bold Eagle include giving kids with bleeding disorders a chance to just be kids at summer camp and also teaching campers how to transfuse their clotting factor, which is a huge step toward independence.

On the last night of each camp session, the campers who learn to successfully transfuse their factor are given the Butterfly Award, and it is a huge deal. Every year, Michigan medical students go to the camp to act as cabin counselors and also to learn a bit about providing first aid in a non-traditional setting. For the first time in my life (and probably only time), I provided boat-side first aid (while treading water in the middle of a lake, no less). There were two week-long sessions, and I spent one week with 6-7 year old boys and the second week with 11 year old girls. The weeks were very different experiences, and I loved them both.

Part of camp involves learning how to self-infuse factor. Counselors have the chance to learn how to self-infuse saline. It may have taken a couple tries…

In August, I was back in Ann Arbor for my General Medicine sub-internship. I had a really amazing experience. I loved the team of residents, and I saw a really good spread of medicine during the month. I also had a unique experience in that many of the “difficult” patients on our team happened to be a part of my census. Through my interactions with these patients, I learned how mental health can significantly affect health delivery and perception of patients, as well as how to have difficult end-of-life discussions. Overall, I had a really fantastic experience.

September brought my pediatric rheumatology rotation. I learned how to do a really good musculoskeletal exam, and I found rheum pathology really interesting. Peds rheum was really enjoyable and satisfying because many of the rheum diseases that affect kids can be medically managed with few lasting effects as compared to years ago when treatments were much less adequate. My next rotation was infectious disease, and I had a great time. I saw some really interesting cases, and I learned a lot about antibiotics and antibiotic stewardship. There is a lot of public health intertwined in infectious disease, so I had a fun time reaching back into my public health roots.

Definitely not the worst view to wake up to. One of the fun camp events was Polar Bear, where we ran into the cold lake every morning and dunked our heads under the water. Campers and counselors who participated every day were members of the Polar Bear Club (ahem, proud member).

September also brought the submission of ERAS, our residency application. Sometime over the summer, I decided on my specialty, and it turns out that my gut feeling was right all along. As soon as I stopped fighting myself, I knew that I had found the specialty that was perfect for me. When I met the residents on various rotations, I knew that I had found my people.

I had my first few interviews this week, and I’m so excited to see what this interview season holds for me. I’ll be checking in periodically from the trail, and I’m sure that I’ll be sharing my adventures. I know that there will be a lot of driving and flying involved, and I’m guessing that also means somehow learning how to pack light over the next couple months (still a work in progress).

Until next time, thanks for reading! I know I’m enjoying the fall weather and football season, and I hope that you are too!

Angelica is a fourth-year medical student at the University of Michigan Medical School. When she’s not on the wards, you can find her on a run around Ann Arbor or passionately discussing medicine and public health over tea.

Welcome to M4

It’s June apparently. The past three months have passed in a flash. It was still March the last time I wrote, and a lot has happened since then, including sub-internships, the last ever board exam that I had to take in medical school, and the arrival of some very spring-like weather. I can also officially say I’m an M4. Congratulations to this year’s graduates who have officially been MDs for a couple weeks now!

Furry study buddy

The beginning of April brought the beginning of my pediatrics sub-internship. The sub-internship is one of the much-anticipated rotations of 4th year. It’s a chance for us to act as interns, or first-year residents. We’re the first contact for our patients, and we have a significant role in their care. It’s a chance to stretch and enhance our clinical reasoning skills with much more responsibility than we ever experienced as M3s. As frightening as it initially was to get pages about patients (wait, is that my pager?), it eventually became part of the normal day. It was nice to be given a great deal of autonomy but to also know that there were multiple people checking everything I did. The team was also great and really treated me like one of the interns. For the first time, I truly felt as though I could call the patients that I cared for mine. It was overall an amazing experience.

May brought a very different kind of experience. I was able to take a quick trip to Chicago to see Hamilton and spend a weekend in Traverse City to attend a friend’s wedding. Then, I took most of the rest of the month to study for Step 2 CK, the last part of our national licensing exam that I had to take while in medical school. I have to admit that I had a difficult time transitioning back to hours of studying after spending most of the past year on the wards. I found myself longing to be back on the floors among patients. However, boards are a necessary evil, and that is that. Luckily, several of my best med school friends were also studying at the same time, and they were an incredible support system for the rough days. I also enjoyed studying with them because they kept me motivated, and we could help each other out with areas of struggle (this was especially helpful since we’re all interested in different fields and definitely have different strengths). The test itself involves a 9-hour day, so I left exhausted that evening. When we were done, we took a nice trip to the sandy Lake Michigan beaches and just enjoyed life for a bit—a much-needed mental break before our next rotation.

Step 2 studying is so much better than Step 1 studying!

Now, it’s June, and I’m back on the wards (yay!). I’m on my ICU rotation. I’m in my first week, and the learning curve is very steep (learning new terminology and seeing things that we’ve never seen before can be overwhelming). However, I am really enjoying the medicine. The patients are very complex and very sick, which can be difficult to deal with; at the same time, our goal is to give them the best chance at returning to as close to their normal lives as possible. I’m excited to see what the rest of the month brings.

In the meantime, I’m enjoying the nice weather and trying to spend as much time as possible outside. I spent last weekend out in the sun at a track meet (one part of my pre-med school life that I miss a lot). I’m also hoping that I’ll be able to make it to Top of the Park this year (Ann Arbor’s month-long summer festival including music, outdoor movies, and yoga to name a few of my favorite events).

As always, thanks for reading. Until next time, go out and enjoy something that makes you happy (preferably outside because the weather is perfect).

Loving our day at Lake Michigan!

Angelica is a fourth-year medical student at the University of Michigan Medical School. When she’s not on the wards, you can find her on a run around Ann Arbor or passionately discussing medicine and public health over tea.

Ten Things that the Third Year of Medical School has Taught Me

On February 17th, I took my last M3 shelf exam. I feel that I can finally believe it now that it’s written down. After 10 months and countless hours on the wards and studying, I can finally say that M3 year is over. It feels a little surreal to call myself an M4, but I can say that I’m definitely adjusting to the lifestyle (currently in a coffee shop with med school friends) and that I’m incredibly excited to do electives in my areas of interest. While it was a nice experience to get a little taste of everything, scheduling electives in my areas of interest feels like coming home in a way. While I am still trying to decide on a specialty, I can say with some certainty that my mindset is medical, not surgical, and this is the first step. I feel like I know what I want to do deep down, but I am still somewhat afraid to admit to myself and to others that I have found something that really feels right. I’ll be doing some soul searching over the next few months, but I can’t wait until the day that I can say that I’m committed to a specialty.

Since mid-February, I have taken the M4 Clinical Comprehensive Assessment (CCA) and the USMLE Step 2 CS, both of which are an assessment of clinical skills based on interactions with standardized patients. The CCA is essentially Michigan’s version of CS, and I took it about a week before heading to Chicago to take CS. Two of my friends and I took CS on the same day, so we were able to travel to Chicago together. It was nice having some company for the trip, and of course it was great to celebrate with them after.

Step 2 CS is over!!!

Now, I’m taking a class about medical education and effective teaching methods. It’s very important to me to become a good teacher so that as a resident and attending I’ll be able to effectively teach those less senior than me. It’s something that is really important to me. However, the course is also lighter than my usual workload, so I’ve had some time to think about the past year. It has kind of become a yearly tradition of mine to talk about a few lessons that the year has taught me, and I feel like it’s only right to keep that going. That said, here are 10 of the things that the third year of med school has taught me…

Be open.
I started med school thinking that I knew exactly which specialty that I would go into. Then, when I rotated on that specialty, I found myself somewhat unfulfilled (which brought on a nice bout of panic because I didn’t love the one thing that I was convinced that I would be doing forever). In all of my musings, my mind kept going back to two specialties in which I never thought that I would be interested, and I realized that these two specialties just felt right. If I have one piece of advice for people starting on the wards, it’s to be open. You never know what rotations will surprise you in both good and bad ways.

There is something to be learned from every rotation.
While you may not enjoy every rotation due to the subject matter, the personalities, etc., there is always something to learn from every specialty. I’ll use surgery as an example, since I’m fairly certain that I won’t be entering a surgical specialty. I actually really liked my surgery rotation (except for the 4 am mornings). Three of the most valuable skills that I learned during the rotation were how to run a really good subcutaneous stitch, how to tie knots that won’t fall out, and which indications warrant a surgical consult. There may come a time when I need to suture a superficial cut and tie some knots, and I feel like I can do that now. Also, I feel better about knowing when to call a surgical consult so as not to waste the surgeons’ time when surgery will likely not fix the problem. There is a lot to learn on every rotation if you’re just open and willing to learn.

There will be bad days.
Medicine is unique in that it is a career where you sometimes see patients in their most vulnerable states. People tell their doctors things that they don’t tell anyone else, and while this signifies a strong doctor-patient relationship, no one ever talks about the impact that this may have. Patients have told me some truly horrifying things, and more than once this year, I have questioned the goodness of humanity. While no match for the emotions and experiences of the patients, being exposed to their stories can also be incredibly difficult on medical professionals at every level of training. These are the times when I depended on my friends and colleagues to get me through the bad days. When we lean on each other, we make sure that everyone makes it. With the high rates of depression and suicide in medicine, it is incredibly important that we help others when they’re struggling and reach out to others when we’re the ones having a difficult time. Medicine doesn’t have to be as brutal as it has been in the past, and a huge part of that is being open and vulnerable with trusted colleagues. There will be bad days in medicine—the important thing is what we do about them.

These lovely ladies help me through the bad days as well as the good.

It’s okay to cry.
Full disclosure: I’m not really a crier. I have to be highly distressed or extremely angry to cry, but it definitely happened this year. I can also say with confidence that I’m not ashamed of it. I saw some truly traumatic and distressing situations this year, and therefore, I am not afraid to admit that these situations bothered me. I cried the first time that I saw a patient die and after a particularly distressing encounter with a patient (in the bathroom at the hospital, no less). It reminds me that I’m still a person, and that is something that I can be proud of.

Life goes on.
Two people that I love very much passed away unexpectedly while I was on rotations this year, and at the other end of the spectrum, several of my friends were married or had babies. Sometimes it can be easy to forget that there is a life outside of medicine and that it is continuing to go on whether we notice it or not. The world keeps spinning, the sun keeps rising, and if we forget to remember this, we miss out on life. Medical school is not the death of our old lives, but rather a continuation with a slightly different spin and a new (but not singular) priority. I admit that I’m very bad at this, but the events that happened this year made me reassess my priorities and remember that my life outside of med school was equally important to my life in it.

Lean on your people.
More than ever this year, I depended on the people in my life who support me. Not only did I rely on my family and friends, but this year, I also really relied on the people next to me in the trenches. There is something very special about the bonds that are formed during med school, and there is a lot to be said about those who understand exactly what you’re going through because they are also living it. This year, my support system kept me sane and focused when I lost sight of my goals. I can’t imagine having to do this without them—I’m quite sure that I couldn’t.

The Sisterhood, three years strong. I know I couldn’t do this without these brilliant and passionate people that I am so honored to call friends (though we’re basically family at this point).

The work/life imbalance is temporary.
As much as I try to have good work-life balance, I always feel like I never quite achieve it. Work always wins out for me, and I feel as if it has been particularly difficult to incorporate exercise and relaxation into my days this year. There have definitely been a couple of stretches where I didn’t exercise for several weeks straight, and I always felt awful afterwards. It is incredibly difficult to maintain balance on some of the more involved rotations, but I always tried to do one nice thing for myself on each day off (even if it was just sleeping past 4am—ahem, surgery rotation). One of the things that I’m looking forward to in the next year is having more free time to explore my interests outside of medicine. While some of the rotations will be intense this year (sub-internships), others are very outpatient-heavy and will allow lots of time for exercise and other extracurricular activities.

Celebrate the small victories.
Even though it sometimes feels as if the small victories are few and far between, it’s important to celebrate them when they do happen. Sometimes the small victories are a really positive and inspiring patient interaction where you feel as if you really helped make a difference for a patient. At other times, it’s a small victory to simply make it through the week when on a difficult rotation. There is much to be learned from small victories. In a training program that is years long, when at times it feels like there is no end in sight, the small victories can help get us through the dark times.

You will find your people.
I don’t mean the people who support you this time, though they are incredibly important, too. This time, I mean the field in which you belong, your future specialty. Shortly after meeting the residents in the two fields that I’m considering, I knew that they were my people. We shared a similar thought process and got really excited about the same things. They practiced medicine in the way that I had always dreamed I would. The fit was right, and there was absolutely no point in fighting it because I had found the fields where I would be happy. This year, I spent a lot of time trying to pick a specialty based on a list of pros and cons, but in the end, it was all about the feel. It was about the rotations that made me excited to come to the hospital before the sun was up every day. I found the places that I fit, and when it happened, I knew without question that I belonged. It’s a really fantastic feeling.

Despite it all, I can’t imagine doing anything else.
The intersection between medicine and public health is still my happy place. Even after all of the bad days, the angry rants, the tense moments, and the days spent questioning my life choices, I can’t imagine doing anything else but this. All it takes is a good patient interaction or an interviewee asking if I would still do this again to remind me that there is nothing else in the world that I would rather be doing. Even though there are lots of anxiety-provoking moments coming up in the next year (choosing a specialty, Step 2 CK, residency applications, residency interviews, the Match), I realize that I am living the dream that I’ve had since I was a child, and I wouldn’t trade that for anything in the world.

M4 life at its finest

It’s time to get back to work, I guess. This year has been a challenging one in many ways, but I am always amazed to see the growth that occurred in my peers and myself because of it. I can only hope that the next year brings as much growth and clarity as this one has.

As always, thanks for reading. Until next time, I’ll be enjoying the seemingly random warm and sunny days. I hope that you do, too.

Angelica is a fourth-year medical student at the University of Michigan Medical School. When she’s not on the wards, you can find her on a run around Ann Arbor or passionately discussing medicine and public health over tea.

Waking Up

On six out of seven days every week for the past few weeks, I woke up and headed to the VA (Veterans Affairs) hospital before the sun came up. I generally didn’t mind, though some mornings were harder than others. I arrived at the hospital, checked on the charts of the patients I was following, talked to their nurses about any overnight events, and went to see and examine the patients every morning. I then prepared for morning rounds, rounded with the team, and then worked on notes or other things that the patients needed. Then there were teaching sessions, tending to more patient needs, and making one final “tuck in” check on my patients before I left the hospital at the end of the day. This is the rhythm of Internal Medicine (IM). It has become my daily rhythm, and I love it.

Self-care winter break edition: mani/pedis and lunch

I admit that I had been feeling very burnt out prior to starting this rotation. The summer and fall were difficult for me, and it was one of those times where several events in my life made me stop and remember that I am a person, not just a medical student. I was hurting, but I pushed the feelings aside in my drive to be an excellent student. As I continued to push, I felt my compassion and empathy toward the patients I cared for slipping away. I hated how I felt, but I had no idea how to make it better.

This is the mood in which I began IM. I was trudging through a day early in the rotation when an intern (first-year resident) on the team made a simple request: provide him with one fun fact that was completely unrelated to medicine about each of the patients I was following. At first, I scoffed at the exercise. It was a simple task, but I was burnt out and cranky, so at the time, it seemed pointless. However, being the obedient med student that I am, I did what he requested and asked the patients questions about their lives outside of the hospital. I was transported down a rabbit hole into my patients’ lives. I learned of their struggles and successes, the things they enjoyed and their dreams. For the first time since the summer, I felt like I was coming alive again after sleepwalking through my days for so long. I was connecting with my patients, and I suddenly remembered all of the reasons why I decided to pursue medicine in the first place. I empathized with them in their struggles, and I also got to experience the small victories with them. I cared about them and was willing to fight for them. For the first time in a while, I felt like myself again, and I can’t thank that intern enough for a simple suggestion that completely changed my attitude and perspective.

Thus, I am happy to say once again that I feel very involved with the patients that I’ve been following at the VA. They have been an overwhelmingly pleasant group despite a variety of ailments and conditions. One of my favorites would greet me with a hearty “hello” every morning before we began our chat of how the night went and concerns for the new day. Usually these morning meetings are relatively brief, but this particular patient always liked to chat. The Type A part of me really wanted to be efficient, check in, and move on to see my other patients, but the human side of me always won over, and I spent many mornings chatting about anything and everything with this particular patient. These visits and my afternoon check-ins soon became one of the best parts of my day. Yes, I love the medicine, but this inpatient service has also provided me with the human element that I was missing.

Unlike residents or attendings, med students have pretty much infinite time because we follow far fewer patients than the residents and have much less responsibility. We are allowed and encouraged to get to know our patients better. Sometimes the things that we learn while talking to them help improve their care. Other times, getting to know the patients is simply for our benefit. They teach us about life, not just medicine. It’s a really beautiful thing.

When I started Internal Medicine, I was convinced that I would dislike it. I was wrong. I love the thought process of IM—it’s like the best form of mental gymnastics. I am pulling together every piece of medical knowledge I’ve learned and applying it. The attending, resident, and interns on my team pushed and challenged me in so many ways, and I love it. I really do. My brain feels like it’s going to explode every day, but in the best way possible. The medicine is amazing, the patients are wonderful, and this is what I always dreamed that medical school would be like. Also, the VA system itself allowed us to take more ownership of our patients and start to practice what it’s like to be an intern (interns and residents do not get nearly enough credit for the sheer amount of work that they do by the way).

I am happy to say that I am once again feeling well-adjusted. I was so excited to go to work every day and see my patients. I was excited to learn how to diagnose and treat them and to get to know them as people. I am compassionate and caring again. It’s amazing how one interaction can shake us to our cores and change our entire trajectory. I’m glad that happened to me because I really needed to be shaken awake. That said, burnout is real and is something that should not be taken lightly. It can harm patients, but it can also harm those in training, so if you have the chance, show a little kindness to the med students, interns, residents, fellows, and attendings you meet (I promise that they’re all working their tails off behind the scenes, and kind words or actions can alter the course of a day).

“Helping” me wrap presents. About 15 seconds later, both the bow and wrapping paper met an untimely demise.

Now, I have reached winter break. I am in the middle of three weeks off, and I am using the much-needed time off to recharge my batteries and reconnect with the people I care about. It has been a difficult year, but I am always optimistic for what the future brings. I have been pushed and stretched in many ways in the past year, and I feel like a different person because of it. This is how a future doctor is made, and I promise that it is quite the ride.

As always, thanks for reading. I hope that your holiday season is a wonderful one. See you in 2017.

Angelica is a fourth-year medical student at the University of Michigan Medical School. When she’s not on the wards, you can find her on a run around Ann Arbor or passionately discussing medicine and public health over tea.

Bump, Set, Spike

It snowed this week. I couldn’t believe it. I was at the Student-Run Free Clinic, and from the window, I saw snow falling to the ground. I’m still not entirely sure why this was surprising, as this is Michigan, and I have lived here my whole life. However, the day before, it was approximately 70 degrees and sunny, so I guess I’ll just chalk it up to that. Regardless, winter is coming, and it’s actually starting to feel like it.

Since the last time I wrote, I finished Ob/Gyn and Psychiatry. Both were really great experiences. For psychiatry, I was on the child and adolescent inpatient service and adult consult-liaison service. Both were really good experiences in different ways. On child and adolescent (CAP), I got to know the patients really well. Med students were allowed to join the patients for some activities like art therapy (coloring is amazingly calming) and conditioning (gym class!). My favorite of all was beach ball volleyball during conditioning—patients, staff, and the med students were all very competitive, and it made for a lot of fun (and some good-natured jabs at the med students). We also were able to dress up for Halloween (which the patients loved), which is yet another reason why working with the kiddos is always a fun experience. On the adult side, it was really interesting to act not only as a consult team but also as advocates for patients and intermediates between the patient and the medical teams (the liaison side).

It’s now the week of Thanksgiving, and we have the whole week off. Without clinical duties, I have no idea what to do (just kidding, I’m thoroughly enjoying my time off). Naturally, that means this week is a time to catch up on life and catch up with friends I haven’t seen in a while. I’ve been doing just that. My apartment is now sparkling, and I’ve met up with so many friends who I haven’t seen in quite some time. Right now, in fact, I’m at a local coffee shop enjoying a lavender latte and coworking with a friend (and taking sufficient breaks to talk about life, etc.).

On Monday, I start internal medicine, my last core rotation of M3 year. It is the longest of the rotations and will go all the way through the middle of February. However, in the middle of the rotation, we will have a 3-week winter break that I am very much looking forward to. After internal med, we will have the M4 Comprehensive Clinical Assessment (CCA), and then we have 2 months of electives in March and April before we start M4 year in May. It seems like time has gone by too quickly. I don’t feel ready to be an M4, but at the same time, I am very ready for all of the electives in my areas of interest. We’re starting to work on our schedules for next year, and I love my March and April electives. It feels good to have narrowed career choices down, and I am really excited for what is to come.

A lot has happened in the past month or so in my med school life and in the world as a whole. Good and bad things have happened, and there have been things that have made me happy as well as sad. In this season of thanksgiving, I can say that I am thankful for the family and friends who get me through it all. I couldn’t make it through the bad days without them, and they’re the first ones that I go to when I have something to celebrate. I am thankful for their ever-present love and compassion in a world that needs a lot more of both of those things.

Nothing is better than dinner with my favorites.

Nothing is better than dinner with my favorites.

That said, I’ll be enjoying the crispness in the air (which is a nice way of saying, “it’s actually really cold outside right now, but I’m trying to be optimistic”). If nothing else, it’s the best motivation to stay inside and study (or to make tea and coffee). As always, thanks for reading. Until next time, spend time with those you care about, be sure to find something that you’re thankful for, and try to spread a bit of love to the world and those around you.

Angelica is a fourth-year medical student at the University of Michigan Medical School. When she’s not on the wards, you can find her on a run around Ann Arbor or passionately discussing medicine and public health over tea.