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My new idea of fun is spouting off random surgical instruments with a really serious facial expression.

“DeBakey. 3-0 monocryl. LigaSure.” (Try it; it’s all the rage.)

I can’t believe I’m saying (technically writing) this: I have officially finished my surgery rotation. If ever there was a time to reflect… From the very moment I first contemplated medical school, the surgery clerkship was the insurmountable challenge to be conquered. It seemed so contrary to my very nature: these goobers get up insanely(!) early to go stick sharp objects into people and tamper with their innards. If left to my own devices, I usually get up around noon. I tend to be incredibly cautious and will spend hours agonizing over something as innocuous as the wording of an email. Surgeons also kind of have this, uh, reputation. For not necessarily being the nicest people. Or something. Cough. I’ve literally been told that I’m too nice; I’ve been told to stop being nice. You see my concern? Anyway. Not only did I manage to survive despite all of the above, but I actually liked it. (And I was never late! Not once! VICTORY.)

 

I'm basically a cross between this...

I’m basically a cross between this…

...and this.

…and this.

 

 

 

 

 

 

 

I didn’t quite get the unequivocal epiphany I was hoping for. There were no angel choirs, no confetti showers, etc. Even so, I’m much more convinced that this is a path worth further pursuing. I feel like it’s both something I’m capable of and something I could truly enjoy. My plan is to use my first elective period in March to take a neurosurgery elective to really experience the field and hopefully (fingers crossed) be able to make a decision about whether or not that’s the road I want to take. Something else I’m considering at the moment in case that isn’t quite enough to convince me (and because I’m the worst ever at making decisions) is taking a year of leave to do research and have some time to get a little more clinical exposure and develop more confidence in my choice. I’m kind of a Nervous Nellie about this whole thing because I’ve already played the “get through an entire degree program and then decide you want to do something completely different” game. It was a great game, don’t get me wrong, but not much in the way of replay value.

In other news, I’ve remarked on here previously how I was a little bummed about my performance thus far in terms of grades. I’m oh-so-happy to announce that I’ve since received my grade in psychiatry and feel that my hard work and admittedly greater knowledge base in comparison to my prior rotations was reflected in the assessment I was given. (Subtext: while the system certainly isn’t perfect – how could it be given its inherently subjective nature – it’s not absolute shenanigans. Thank goodness.) I’m hoping with everything in me that this trend will continue for surgery. I definitely had my moments, but I feel like I did a pretty good job overall demonstrating that I was acquiring both knowledge and skills as I went along and working my patooshkies off. The anxiety-ridden waiting period has already commenced.

Pretty sure I made up that word. Here it is, represented in corgi form.

Pretty sure I made up that word. Here it is, represented in corgi form.

Neurology starts on Monday and I’ve already muttered at least 5 expletives provoked by the brachial plexus. (In my humble opinion, that means I’m doing it right.) Looking forward to polishing my neuro exam and, let’s be real, not waking up before 5:00 AM!

To stream or not to stream – that is the question.

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Lecture hall at 8:30 a.m.

The idea of attending lectures is becoming more and more of a thing of yesteryear with the advent of technology. Medical faculty often marvel at how rarely one takes notes by hand anymore or how textbooks are now often electronic. On any given lecture day, anywhere from 10 to 30 students are sitting in the lecture hall at 8:30 a.m. (generally less on snowy days or right before long holiday weekends like Labor Day).

UMMS affords students flexibility in deciding how they like to learn lecture material whether in class or online. All class lectures are recorded and are posted only minutes after the lecture, making it easy to watch lecture content from the comfort of one’s home, library, coffee shop, or even bed! Students even have access to prior year’s lectures, making it possible to watch all the lectures before the first day of school (for all the over-achievers out there). I will point out though that on several days of the week, we also have interactive group sessions usually in the afternoons that require attendance and are not recorded (doctoring, paths of excellence, patient presentations, small group discussions, initial clinical experiences).

While certain portions of the curriculum are mandatory attendance, lecture attendance is usually optional. As someone who both streams and attends lecture, there is something to be said for going to class. Here are a few things I like about it:

  • You get to see people in your class – with most of the classes being optional in the M2 year and with more individual standardized patient experiences for doctoring rather than whole group discussions, it is possible to be a complete hermit and go weeks without seeing classmates.
  • You are forced to watch and hear things at a normal speed – I have a tendency when streaming to want to watch videos at 1.4 or 2x faster only later realizing that I didn’t catch what was being said at all. For example, just last week we learned about PAH (pulmonary arterial hypertension) and PH (pulmonary hypertension), which sound surprisingly alike especially when watching at a faster speed. However, in class, I can just turn around and ask, “What did he just say?”
  • You get to laugh at the professor’s humorous remarks along with your class-going friends. Sequences later, you’ll reminisce and say “remember that time professor X said ...” These often just don’t translate as well when listening – especially when watching the video at 2x speeds. Some of my favorite recent comments by professors in class,
    • On lecturing: “More glad than usual to be here [lecturing]. I’ve bored myself to death over the last 24 hrs playing Angry Birds and watching South Park episodes after episodes after episodes”
    • On streamers: I’ve been talking this whole time to you on the recording. Now I learn that you are watching this like Sunday morning after the football game… So I’m going to stop speaking to you like you’re presently listening.”
    • On lecturing for the second hour in a row: “I’m tired of listening to myself so I’m going to get the enthusiasm up here. I’m going to be James Earl Jones, I’m going to be Jim Harbaugh…and we’re going to talk about … lungs.
  • You automatically block off time on your schedule for lectures. With there being so many events and cool things to do in medical school, it is often easy to delay watching lectures and become wrapped up with things like research, shadowing, or extracurricular and with quiz-free weekends, it becomes all the more important to keep up with the material. Going to lecture helps me from getting behind on content.

Nonetheless, I appreciate the flexibility of streaming too. On any given week, I will go to class half the time and stream the other half. Sometimes I even pick and choose which lectures I want to go to. I can’t seem to quite make up my mind on which I like more so, in the meantime, I will just enjoy the freedom of being able to choose!

Hello from the other side…

For now, my time at St Joe’s has ended. My inpatient rotation there ended about a week ago, and I am happy to have had the opportunity to work there. I was definitely nervous at first, because I was assigned to a Hem/Onc floor and I am notorious for crying (as in, I cry when I see someone else crying). Nevertheless, I was pleasantly surprised at how much I enjoyed working with both my team and my patients.

While there was definitely a fair share of tears (what, you want everything?), they were healing tears and gave me a better perspective of what a physician’s role should encompass. Not just prescribing medications and radiation treatments, but also providing emotional and empathetic treatment. Despite my apprehensions, I am grateful for the three weeks at St Joe’s, because my patients there have left a lasting impact on me, both professionally and personally.

In addition, I still was able to attend the inaugural Exercise and Sport Science Institute (ESSI) Symposium and learn more about UM’s exciting new institute funded both by the Office of Research and the Athletic Department. From hearing about new advancements in designing a better football helmet to learning about inertial measurement units and their application in improving your golf swing, I had a blast!

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Speaking of athletics, I also went to the unveiling of the new Nike basketball uniforms, with Jalen Rose and DJ Khaled, a few weeks ago. It’s crazy the amount of excitement Michigan Athletics is generating right now!

Tapas and Neutrophils

I had no intention of getting involved in research when I began my medical school journey, and I definitely had no plans to work on a project that would take me to an international conference in Barcelona. My short, one summer stint in a lab had been fine, but in med school I planned to play soccer, work on the leadership team at the UM Student-Run Free Clinic, and spend time with friends and family. That all changed when I met Dr. Kelly Walkovich.

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Presenting my research at the European Society of Immunodeficiencies Biennial Conference in Barcelona

We were in our M1 immunology course, and Dr. Walkovich was facilitating a patient presentation of a family whose child had SCID. I’ll always remember the intense buzz of euphoria that traveled from my forehead to my fingertips as I first fell in love with neutrophils, T cells, and cytokines. After the presentation, I contacted Dr. Walkovich, she immediately responded, and she invited me to shadow her at her Immuno-Hematology Clinic at Mott. At the clinic, I became hopelessly infatuated with the patient population, the providers, and the many different disease processes. At the end of clinic, Dr. Walkovich asked me if I would be interested in working on some research projects with her. I eagerly blurted “yes.”

We began with a project on the Duffy antigen receptor and its connection to benign ethnic neutropenia. I gave a 10-minute talk on our findings at the University of Michigan Immuno-Hematology Symposium in the spring, and a few days later Dr. Walkovich called and asked if I would like to go to Spain in the fall. I stammered incoherently for a few seconds before once again eagerly blurting “yes.”

A few weeks ago, I presented at the biennial meeting of the European Society of Immunodeficiencies in Barcelona, Spain. It was magical. I spent all week learning about advances in all kinds of immunodeficiencies, meeting like-minded people from all over the world, and listening to some of the best minds in immunology, hematology, and oncology. Plus, I was in Barcelona, one of my favorite places in the entire world. Jet lag never really even hit me because I was so excited to wake up, find my new friends, eat really good Spanish food, and feel those shivers of excitement every day in the plenary and breakout sessions.

The depth and breadth of opportunities here as well as the flexibility to do whatever sparks your interest whenever that spark happens to hit you never ceases to amaze me. I initially wrote off research because I never felt that zing of excitement early on in undergrad. But then one physician gave an inspiring lecture on a topic I was falling in love with, nurtured that interest, and rekindled a passion that eventually led to me gorging myself on knowledge (and tapas) at a conference in Europe. I love the accessibility of the faculty here, the way the school builds in the time and resources to do whatever you love, and how it allows med students to intentionally pursue whatever they love (even if it’s neutrophils). That is the Michigan difference!

M3.5?

Hello and happy fall! It’s actually starting to feel like fall now. The mornings are chilly, and the heat feels much less oppressive. I saw a few leaves changing colors, and there is apple cider everywhere. I love it so much. Fall also means that we’re halfway done with rotations. We had an intersession week three weeks ago that marked the halfway point. I can’t believe that the year is flying by so quickly, but I’m also very excited for what is to come next year.

On Saturdays, we wear maize.

On Saturdays, we wear maize.

I admit that it’s been an embarrassingly long time since I’ve posted an update. It turns out that being on the wards and studying for shelf exams is decently time consuming. However, I’ll try to bring things back up to speed.

Last time that I wrote, I was starting my surgery rotation. After the initial shock wore off, I really enjoyed surgery, despite the very long days. I learned how to sew and throw knots, and I touched a carotid artery. I learned anatomy much better than I learned it the first time around, and I saw the inside of a living, breathing person. These are amazing privileges, and I try to always remember that my training is also a privilege, especially on those 4am mornings.

Next up was family medicine. It was a rather short rotation at three weeks long, but I enjoyed every minute of it. I loved the variety throughout the day, as we saw everyone from children to senior citizens. The scope of family practice is astounding, and every day was different. I spent my time at the Chelsea clinic site, and it was a great experience. The public health part of me really enjoyed the focus on preventive medicine, and I just really enjoyed my time on family med.

After family med was another quick three-week rotation: neurology. We spent a week each on three different services, and I spent time on consults, inpatient, and pediatric neurology. The brain is an absolute black box, and it was great to learn a little piece of the mystery. I was a little scared of the rotation after our M2 neurology block, but it ended up being pretty great to see the things that we learned M2 year applied to patient care.

Now, I’m on obstetrics and gynecology, which we generally shorten to ob/gyn. In my three weeks on service, I’ve scrubbed into gyn surgeries, spent time in gyn onc clinic, spent time in ambulatory clinic helping with pre- and post-natal visits, and watched several births. Labor and delivery is the most emotional setting I’ve worked in so far. There is every kind of emotion, and I admit that watching parents cry joyful tears over seeing their babies for the first time made me a bit sniffly too. I have one more week on ob/gyn, and I am excited to see what it brings.

Quick break between surgeries... Bouffant caps are all the rage.

Quick break between surgeries… Bouffant caps are all the rage.

That was a whirlwind tour of the last couple months. I’ve been pushed and stretched in many ways, and I know there is only more of that to come. Despite the fact that there are good days and bad days, rotations that I like more and rotations that I like less, it is an incredible privilege to be able to learn in this setting. I want to take a moment to thank the patients who allow us to learn. I know that every patient I see has made a conscious choice to let a student see him or her, and I thank them for allowing me to speak to them, examine them, and learn. Hopefully one day, I’ll be able to make them proud.

There we have it. We’re halfway done with the core rotations of third year, and it’s October. For me, it seems like time is moving much too quickly. However, a lot has happened during the past few months. I’ve learned a lot (but definitely still have so much more to learn…), and I’ve started to figure out what I may be interested in doing as a specialty (and if nothing else, I have definitely crossed a thing or two off the list). It turns out that sometimes life is surprising, and sometimes the last thing you thought you’d ever do may be the one thing you can’t stop thinking about. I still have a few months to decide, but I’m definitely experiencing warm fuzzy feelings toward a certain specialty. We’ll see if it ends up being the one I choose.

However, I don’t have to make any decisions today, so for now, I’m going to enjoy the last bits of summer and the beginning of fall. I hope that you do the same. As always, thanks for reading, and until next time, spend some time outside and have some apple cider for me.

Chasing life in the ER

This week in doctoring, we talk about breaking bad news. How to tell someone that his or her loved one is dying or is dead. We hear heartbreaking stories from parents of dead children, of organ donors, and of heroes. Their sorrow seems so palpable and fresh despite the years that have passed that we can’t help but listen transfixed, rooted in their stories. On the other hand, we also hear uplifting tales from organ recipients, from doctors who are also patients, and from people whose lives have been saved and irrevocably changed. Never has the line between the finality of death and fragility of life seemed so close.

emergencyOn a Tuesday afternoon, the ER is packed. Our clinical reasoning elective mentor is busy with getting caught up as he is just starting his shift so we ask the attending signing off if there are any cases that would be good to visit. “There’s a burn patient coming in. You should definitely see that,” she tells us. I watch the bustle of the resuscitation bay of the main ER as paramedics cart the patient in.

I don’t know who he is, how old he is, or even what his name is. But his body is covered in burns. Even watching from afar, I see that his skin is an angry red, sloughing off in chunks. I’m no expert, but it looks bad. “His burn surface area is 45%, which we estimate using a 9 by 9 by 9 rule”, an off-duty attending explains to me. I can’t imagine what that must feel like. I hope he’s not awake I think to myself.

“We found him rolled up in a blanket and he was covered in burns,” the paramedic explains. “There was a bonfire outside. It smelled like kerosene.” The room is crowded with lots of people in multi-colored scrubs. Everyone is talking. Space is limited. Who is in charge I wonder? And even more people come in.

I watch the screens beep as the patient’s HR increases. The resident is intubating the patient to secure the airway. The screen then beeps with alarms and I feel as though time has stopped as the patient’s heart rate drops to asystole. The resident immediately starts chest compressions. It happens so quickly that I barely have time to blink. Someone else (maybe an attending?) switches over to do compressions too. Perhaps it is only then that I realize that death is a possibility. “We need more people to do chest compressions – med students.” All of a sudden, I am no longer just a spectator.

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Empty room in the ER

“I have a pulse,” the resident calls out before we can even find gloves, which are difficult to find when you actually need them. I don’t think I’ve ever been as relieved. He’ll be okay, won’t he?

It’s strange I know, but I always think of death occurring elsewhere. The patient with ovarian cancer or the patient with heart failure who is at the end of line treatments. Yes I’ve met them, but they’re alive when I see them you see.

Eventually I imagine I will have to face death and perhaps my own limitations. It is a frightening concept, but a very real and universal part of doctoring – or so I’m told. But, at least not today. I don’t know what his end outcome will be. No doubt his path to recovery will not be easy. Life and death are held in a delicate balance.

Nonetheless, he’s alive. And for that I’m thankful.

*** The details mentioned in this post have been modified to protect patient confidentiality.***