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Scrubbing In

Time: 7am
Location: Labor and Delivery Floor
Attire: Scrubs and Danskos
Occassion: First day on OB/GYN Rotation

“Do you know how to scrub in?” asked the second-year resident, Dr. B, as we speed-walked through endless sets of double doors to the Delivery ORs. “We’ll do it together.”

We stood side-by-side at the huge silver sink basins, already wearing masks and hairnets, and began the ritual of scrubbing. First, we cleaned beneath each of our fingernails with a plastic pick. Then we opened packages of special scrub sponges filled with special soap. When we turned on the water by hitting a huge panel with our hips, a large clock above the faucets turned on, counting down from five minutes. 5:00. 4:59. 4:58. 4.57… Scrubbing is required to take the full five minutes. Scrubbing takes a directed sort of focus, the same feeling I get when I am running; the mind feels at once still and directed, and the rest of the world fades away. I focused on my fingers, imagining each of them as a box with four sides, and proceeded to scrub each side of each finger-box ten times. I did the same to the palm, the back of the hand, the wrist, and the arm all the way up to my elbow, then started on the other hand…

In a hospital world where everything always feels rushed, standing at the sink for a five full minutes, hearing only the water hitting the steel basin, is at once strange and calming. The trickiest part is rinsing: the water must not drip onto any part that you’ve already rinsed. Once you’ve rinsed, NOTHING can touch your skin. As I was finishing up, the clock reaching 0:00, my pinky brushed the string of a mask sitting on the shelf above the sink. I froze. Dr. B chuckled ruefully, “I’ll meet you in there,” she said, heading towards the OR as I reset the clock and began the entire scrubbing procedure again.

Towels and gowns, out and ready to go!

The second time I scrubbed successfully and backed into the OR, opening the huge doors with my back to protect my newly clean arms. The scrub nurse (in charge of all the logistics in the operating room) handed me a sterile towel, and then held up a sterile green gown for me to plunge my arms into, like a bathrobe going on backwards. The efficiency of the OR staff took me by surprise; the moment my arms entered my gown, a second nurse was at my back, tying the strings. Next, the scrub nurse helped me into my gloves. First the white pair, then the green pair over the top. This way, if the top glove broke, I’d notice the lighter color glove showing through.

I was ready.

The patient was already in the room, lying on the table with her huge belly sticking into the air. Dr. B stood on the patient’s right. The attending physician, Dr. V, stood directly opposite on the patient’s left, directing the show. I stood at Dr. B’s left elbow, my hips resting against the surgical table and my hands on the patient’s leg (protected under a sterile drape). Across from me, the scrub nurse positioned a huge tray of instruments – scissors, scalpels, forceps and towels. Dr. V positioned the huge lights overhead. Anesthesiologists stood by the patient’s head, busy with IVs. The atmosphere was calm, purposeful, and efficient. I stood stock still, afraid to get in the way, unable to diffuse the thought that I was close enough to mess things up badly if I bumped against Dr. B or knocked over the instrument tray.

Everyone’s focus honed in on the square of brightly lit, pregnant belly. With Dr. V’s guidance, Dr. B made the incision and exposed the surface of the uterus. Then Dr. V turned to me. “Kate, put your hand on the uterus and slide it up until you find the top.” I reached, heart beating faster. The dark red uterus was warm and smooth, stretched tight because of the baby inside. I slid my hand up into the abdomen between the skin and uterus, my eyes widening: the uterus was so big! And my hand was inside the body of a LIVING PATIENT! It was a surreal but wonderful feeling.

Dr. B continued the procedure, opening the uterus and breaking the amniotic fluid sac. Dr. V reached inside for the baby. Time stood still as she calmly pulled, spun, and wriggled the baby into the world, exposing a little bottom, two feet, two flexing arms, and finally a tiny face to the air for the first time. The baby scrunched up her face and started to cry, at that moment the most beautiful sound in the world because it meant that she was healthy and safe. As Dr. V carried the baby over to her mother’s arms (free to move behind the surgical drape), she cooed, “Happy birthday, we all love you, welcome, oh happy day! Born at 7:46am on a Monday.”

With a start, I realized that in my first hour on OB/GYN, I had scrubbed into a c-section delivery, touched the inside of a living, breathing woman, and seen a new life come into the world. Hundreds of thousands of babies are born every day – for mother nature birth is routine. But for me it was completely incredible. I scrubbed several more times that day, each time before another c-section, spending the five minutes of calm reflecting on what I was seeing. I might just become an OB/GYN. Oh happy day indeed.

Tired but happy at the end of the day!

From Launch Week and Beyond

Around a year ago, during Launch week of medical school, we were asked to write down a goal that we hoped to achieve within a year, and fill up the corresponding columns asking “what, so what, now what.” I immediately wrote down, “improve at public speaking.”

Public speaking has been a weakness of mine, as it has hindered me from pursuing many opportunities that although I was passionate about, I did not take on because they seemed very frightening. I have many research interests specifically regarding health care issues within the Arab American community. I know that I want to participate in conferences and conventions, present research findings, and engage in community outreach and educational events, but I also know that I am more nervous to stand in front of an audience than I am excited to present. However, I decided that with the start of medical school, it was time to further develop myself rather than hold myself back.

Within a few weeks of the school year, I submitted a research abstract about a project that I had worked on over the summer (topic: autism in the Arab world and the U.S.) to the Pediatrics Research Symposium. In my mind, I thought I was going to be giving a poster presentation and that I would at most have to talk to three people at a time. A few days later, I received an email congratulating me that my abstract was selected for an oral presentation. My heart was instantly racing. Instead of feeling excited, proud or happy, I felt extremely nervous. After a day of thinking, I replied to the email stating that I appreciated the opportunity but would prefer to opt out for a poster presentation instead. 

A few hours later, I received an email from my research mentor who basically asked, “are you crazy?” He said that this was a very rare opportunity/privilege for a student to be asked to give an oral presentation and that I should not turn it down. I recalled the goal that I had set for myself earlier on in Launch week and sent an email asking if I could revert to giving an oral presentation. The answer was yes.

Raising autism awareness at a Dearborn community event

But now I had to prepare for the presentation. I knew exactly what I wanted to say. I also was very passionate about my research project, and felt very knowledgeable and comfortable discussing it with my mirror. Even though I could give a great presentation in front of my reflection, I knew that did not at all mean I could do the same in front of a live audience. When presenting in public, my heart races, my breathing becomes labored, and my voice shakes. So I had an idea!

I decided to run around the house for three minutes to reproduce the physical changes that I feel when my name gets called up to give a presentation. Afterward, I stopped and tried to give my talk. At first my voice was shaking, just as it does when I am in front of an audience. I kept practicing the same scenario. I became much better at managing my breathing and speaking in a way that even when my heart was fully racing and I was out of breath, I was still able to speak fluently without letting my voice shake.

When the presentation day came, my name was called and my heart was racing, but much less than it did during my practice. I actually felt at ease giving the presentation and then, about a minute into it, I had the best epiphany: for once, I was more excited to be standing in front of an audience than nervous. I had set a goal for myself on day one of medical school, and since then, have made big strides towards achieving it.

Medicine with a family

Some of the green beans from our garden

Attending medical school in general can be a difficult process. As a non-traditional student with a wife and child, I have had to learn to navigate between my home life and school life.

Before starting school, I worked as a radiological engineer. Although it was a full-time job and I would be on call frequently, I was able to complete most of my work on-site so when I got home I was free to spend time with my family without any other obligations hanging over my head. Once I started school however, a dramatic shift occurred. I suddenly had classes that could last all day and then material that I needed to bring home and study.

When I first started school, I was hoping to find this perfect balance between the two, but I have found that there is no uniform balance between the two and every individual will have a different sense of balance. For me, I have learned during this year that if I choose to take my daughter to story time at the library on a Saturday morning, then I will be spending the rest of the weekend preparing for a quiz on Sunday.

Although it has been an adjustment, my family and I have come to enjoy the time we are all together and try to make the most of it. For example, my daughter was studying gardening at her school, so we created a garden at home. I built a small above-ground garden where we planted vegetables, fruit and some herbs. She has loved watching the vegetables grow and we are almost ready for our first harvest of green beans. This has been a great bonding experience for my entire family.

At a book signing in Toledo

This year I have been a dedicated lecture goer. I found that actually attending class worked best for my lifestyle. While this may not seem like the most effective use of time to some, it has worked well for me because it is a way create some separation between my home life and school life. This allows me to more efficiently divide up my time. When I am at school, I focus primarily on that and I try to do the same when I’m home.

One of the hardest things to manage is feeling isolated from a lot of the class. Because I do have a family, I must accept that my schedule will probably not be the same as most of my classmates. I often have to navigate doctor’s appointments for my daughter, who is doing pickup and drop off, and many other aspects that just come with being a parent. I have found it most helpful to study with some of my classmates who also have children and are trying to juggle parenting, marriage and being in medical school. Although it has been an arduous task at times, I have found that the balance between school and home life may not be ideal, but understanding that this is not forever helps to make the sacrifices easier and time spent with my family that much more enjoyable.

As I look back on my first year of medical school, it is hard to believe how far I have come but one thing that is certain is that I could not have made it this far without the support of my family.

Behind The Beat: Music, Movements and Medicine

Music has the power to heal, motivate movements and transcend time and space. Throughout history, music has been the global soundtrack for social change as artists have utilized their platforms to stand in solidarity with those on the front lines of justice.

The chilling chorus of “Strange Fruit’ by Billie Holliday, the soulful symphony of ‘A Change is Gonna Come’ by Sam Cooke, and healing harmonies of “We Are the World” by various famous artists of the 1980s provided monumental sounds that reflected the issues of the times. There are countless songs that have had a similar impact, captivating individuals decades after they were created. The enduring capability of allowing people in 2017 to understand the feeling of years past through song illustrates the art of music.

University of Michigan Medical School Match Day Party 2017

In my second year of medical school, I saw an advertisement for DJ lessons. Though my initial thought was that DJing would be an unconventional hobby for a medical student, I have never been one to prioritize conformity. One lesson turned into several sessions, which resulted in learning the art of matching beats per minute, scratching, and nurturing my own sound.

Within months, I procured my own turntables and speakers, and had my DJ debut with the help of my classmates. I was nervous for my first showcase as DJ Docta J, but the support of my classmates transformed my butterflies into confidence. Not only do DJs create a space for good vibes, they are in the unique position to help people de-stress and dive into whatever emotion the music brings out. There is nothing like experiencing a crowd’s reaction to a throwback jam that allows them to let go, dance and be fully and freely in the moment.

Music has the potential to cultivate celebration, hope and resistance. Affirmation was the gleeful shriek of an adolescent when they heard the beat from ‘Born This Way’ by Lady Gaga drop at a prom for LGBTQ youth in Ypsilanti, MI. Community was revered while playing Detroit-based artists at an event for Soulcially conscious entrepreneurs whose mission is to ensure that local businesses are included in the city’s rapidly changing economic landscape. Gender equality was embraced when playing ‘Who Run the World (Girls)’ by Beyonce at the University of Michigan Medical School Fall Ball with women representing more than half the room of future physicians. Learning how to DJ took time, patience and resources, but I am thankful for a creative release from medical school and feel blessed that my hobby creates an atmosphere of joy for other people.

Classmate’s Summer Jam July 2016

Through DJing I have been given the opportunity to witness and be a part of the power and sustainability of music as a social tool, while also being reminded of its significance on a more personal level. My grandmother grew up playing the piano in Marietta, GA when Black families were sharecroppers and music played a pivotal role in providing hope. My mother was a local college DJ as her work-study job at the historical Black college she attended, and my aunt took a leave of absence from college to play in the symphony orchestra in Guanajuato, Mexico. Music is in my blood.

Though my professional path led me to being the first physician in my family, music will always be the rate and rhythm that connects me to my roots and grounds me in something bigger than myself.

A Day on Pediatrics

5:15am, my alarm goes off. It’s the beginning of a new day. My M3 clerkships are beginning as well; I’m in the middle of my first rotation: pediatrics.* Today, my inpatient team is on “early call,” which means that we are responsible for taking over care of all the pediatric patients that were admitted overnight. We have to be in at 6am (a half hour earlier than usual) to hear about the patients from the night team. Being early call also means I can wear scrubs rather than dress clothes, so getting dressed is mercifully easy in my half-asleep state. I pack my lunch and head out into the fresh predawn air, walking past newly blooming flowers on my way to the hospital. The promise of beautiful spring day is all around.

Stopping for a selfie with Big Bird on my way in to Mott Children’s Hospital!

At the hospital the night team fills us in, and then it’s time to “preround” on my patients. Using the electronic medical record, I check on their vital signs and fluid balance overnight, read new lab and test results, and jot down my ideas for the coming day’s care plans. After this is done, I visit their rooms, ask how the night was, and perform a physical exam. Ideally, this is all done before 8am, when the medical students and residents have a morning lecture or conference. Even with only two patients, I am almost late. I have no idea how I’ll someday follow eight patients like the interns do!

At 9am, morning lecture is done and it’s time for rounds. Together with the attending physician, senior resident, interns, and sometimes nurses, dietitians, and social workers, we visit each room, talk about the condition of each patient, their plan for the day, and make sure to address any concerns the patient and their family may have. This can take a long time! When our team is full and caring for 22 patients, even if we spend just 10 minutes on each, rounds take almost four hours. I start off the discussion on my patients by reporting what I learned during my early-morning prerounds and stake a stab at their plan for the day (the interns do this for the other patients); the attending physician leads the discussion from there. The more you know about the patients and their conditions, the easier it is to stay engaged during such a long rounds, and I do my best to stay focused.

The afternoon is spent following through on the care plans decided during rounds: we talk to subspecialists (cardiologists, nephrologists, etc.), look at test results, see if new medications are making a patient feel better, and write notes that summarize each patient’s day in their medical record. I try to take a moment when things are calm in the team room to visit my patients again in the afternoon. I find that on my morning rounds I get to know the patients’ medical conditions, and during my afternoon rounds I get to know them a little better as people and families. In the afternoon people are more chatty, and I’m not in such a time crunch. My patients range from newborns to teenagers, in the hospital due to all sorts of things including asthma attacks, pneumonia, kidney infections, feeding difficulties, and constipation. Part of what I like about pediatrics, though, is that children’s bodies are very resilient and most of our patients go home in just a few days!

Soon it’s 4:30 or 5:30pm, and the team is finishing up for the day. The interns stay until 6pm to sign out to the night team, but the medical students usually leave before that as the day’s work is done. I walk home through the late afternoon sun and reflect on the day, happy I’ll have some time to run and cook dinner before studying for a few hours for the shelf (the exam at the end of each rotation). Before I know it, it will be 5:15am, and time to begin another day!

*I wrote this in March…clinical rotations have kept me busy enough that I’m only finishing the post now!

Sharing my story, and redefining success

During my M1 year, I’ve learned an enormous amount about biology and medicine, but I think I’ve learned the most from my classmates. It’s been an unbelievable experience. The class is full of people who have done interesting things, work hard, and thoroughly enjoy both life and medicine. Everyday, I learn something from a classmate through a story, their advice, or observing their interactions with peers and patients.

The running community I’ve built in Ann Arbor, after the Dexter to Ann Arbor Half Marathon. This group helps me stay grounded and be successful, and includes some of my best friends. From left: Noah, Sam, Jake, Paige, Jonathon (me!), and Luc.

With this in mind, I thought it was time to share a story of my past experiences, so I signed up for the Leadership curriculum’s “Story Series: Stepping outside my comfort zone.” These events are my favorite thing the medical school does. It’s a “Moth-style” story slam where medical students tell a story to teach their classmates in an informal setting.

I spent some time reflecting on what I’d learned by being a member of the Northwestern Club Cross Country and Track Teams as an undergraduate and decided to share this story. I joined the team my sophomore year even though I’d never run competitively before. I quickly realized I was the slowest on the team. This was hard for me because I had never been so bad at something compared to my peers for such a long period of time. I wasn’t sure if I wanted to stay on the team, or if the team wanted me.

However, as time passed and I got to know everyone, the team became my community. In fact, I realized that the team transformed my time at Northwestern and gave me some of my best friends. This experience helped me redefine what success meant to me. It wasn’t about winning races or being good at something, it was about finding a community, making friends, and being happy.

I’ve brought this new definition of success to Michigan with me. I still run almost every day, but I’m not really trying to race anymore. Instead, I’ve used running to build a community in Ann Arbor. I’ve met most of my best friends through running – there’s a group of eight other medical students I go running with almost every day. We talk about medical school, life, and plans for the weekend. We use running to relax and take a break from our studies. Though I may not be running at the same level I was, there’s no way I can think about the community running has given me here and say that I haven’t been successful in running.

Stepping up on stage to share this story was a tough thing to do. It’s easy to share our successes, but much more difficult to be vulnerable in front of the whole class. However, because I learn so much from my classmates, I decided to share. For medical students, I feel this story is important. We’re at the bottom of the hierarchy in the hospital – and we don’t know very much. So finding ways to persevere when things aren’t going well and find success in whatever form will continue to be incredibly important for our education.