My research year is absolutely flying by. I’ve accomplished so many things already: submitted two abstracts to a symposium and helped get a case study published, made major progress on my primary project using cerebrospinal fluid (details to come), learned how to do two different (rodent) surgical procedures and started work on developing a protocol for a third, and found (legit!) reasons to purchase an obscene number of scientific kits. I’ve also been having a positively fabulous time with my darling labmates – who loooooove being referred to as “darling,” I assure you – who are all pre-meds and seem to be convinced that I know things! I do my best to not prove them wrong. I mostly succeed. There have definitely been some bad days where science attacks with a vengeance and everything is the worst, but the vast majority of my experience has been awesome accompanied by awesome with a side of awesome.
Michigan Medicine team at RunTough for ChadTough event, including myself and aforementioned darlings in the center.
The primary project I’m working on that is truly “my baby” is the use of digital droplet PCR, or “fancy pants PCR” as I like to think of it, to detect cell-free tumor DNA in the cerebrospinal fluid (CSF). The idea is to be able to use something as simple as a lumbar puncture to characterize a brain tumor without having to do a biopsy (which, in the brain, is somewhat less than ideal.) Additionally, we’re hoping we can use this method to monitor response of brain tumors to treatment with serial lumbar punctures in addition to the usual serial imaging. We’re still in the way-early stages, but have successfully detected tumor DNA in CSF, woohoo! I’ve also learned how to design PCR assays myself, which is pretty sweet. There have been lots of roadblocks that we’re still working to overcome (free-floating tumor DNA is not exactly spewing forth like a fountain; the stuff is rare), but we’re definitely making our way forward.
I realize this still isn’t quite the most appealing thing you could imagine, but when the alternative is literal brain surgery…
I’m also helping out with our lab’s efforts to generate a mouse model of DIPG, a rare pediatric brain tumor that has a downright depressing prognosis. We’ve recently been successful in generating tumors in the correct region of the brain, the pons, but not with an ideal cell line (doesn’t very closely resemble the genetics of actual human DIPG.) We’re getting there! I had a teeny tiny bit of exposure to rodent surgery as an undergrad, but it’s wild to do these procedures now that I’ve been in on real-deal human surgery. Let’s just say I’ve become mildly spoiled from my prior experiences.
No gelfoam for hemostasis? UNACCEPTABLE.
In addition to my work in the lab, there have been multiple neurosurgery faculty members who have been kind enough to have me join them in clinic on a regular basis. It’s wonderful to not be totally removed from the clinical environment and to continue expanding my knowledge of the field I will be joining. I also regularly attend our brain tumor board on Friday mornings which is the ultimate nerdy good time. Faculty members from neuro-oncology, neurosurgery, radiation oncology, neuroradiology, and neuropathology (and I’m undoubtedly forgetting someone) all meet together to discuss the best path forward for patients with CNS tumors. I’ve already noticed fewer things going over my head (though there are certainly still plenty) than at the beginning of the year when I first started attending weekly. It’s amazing how you start picking up lingo just by hearing it frequently.
In summary, my only complaint is that the year is going by too quickly – AHHHHH!
TONS of things have happened since last I wrote, and I figure the easiest way to address them all (or at least the major stuff) is to do so in chronological order.
March: Neurosurgery. Neurosurgery was AWESOME. One of my primary goals in doing a neurosurgery elective was to determine whether or not I felt confident that was the field I wanted to pursue. Consider that goal thoroughly met. I was able to see a far wider variety of neurosurgical procedures than I’d previously been exposed to, and I enjoyed every single one of them. I was particularly worried that I wouldn’t like spine (especially since being able to even see anything as the med student involves both contorting oneself into extremely uncomfortable positions and a fair amount of luck). Turns out spinal surgery uses some of the coolest and most ingenious toys ever. Who came up with this stuff?! I often say that assembling furniture is like Legos for big kids; placing spine hardware is like those technical Lego kits (the ones with motors, lights, what have you) for big kids. I had a number of memorable conversations with several of the residents. They were wonderful about providing candid responses to questions, important things to consider about the field that aren’t necessarily obvious, and advice about how to set yourself up for success. The month also provided an opportunity for me to prove to myself that I could function on minimal sleep (though there’s, shall we say, room for improvement) and manage to keep myself together after witnessing some really tough situations. It was an all-around amazing experience.
April: Pathology. The fact that I was able to line up my neurosurgery and pathology electives back-to-back ended up working out perfectly. Pathology is what I initially envisioned myself most likely doing when I was first starting medical school. It’s, um… slightly different than neurosurgery. Just a smidge. Being able to transition directly from one to the other served to emphasize this difference and further bolstered my certainty that neurosurgery and I are in luuuuurve. That’s not to say that I didn’t enjoy pathology: quite the contrary! I got to see some really cool stuff and was pleasantly surprised at how often important foundational concepts came up in the midst of specialized pathology-specific knowledge. I was able to try my hand at following surgical specimens through the process of initial receipt from the OR, “grossing” (basically looking at and describing the tissue with the naked eye), and then examining slides of the tissue under the microscope. I also got to participate in autopsies, which was wild after having only seen the majority of the anatomy in preserved specimens in the anatomy lab. Spoiler: it looks different. Despite the fact that I’m now convinced that pathology is not where I’ll end up, I had a fabulous time and don’t doubt that my experience will serve me well in the future.
May: Step 2 Study Stupor. Not much excitement here. I dedicated the month to preparing to take both parts of Step 2: CK, or Clinical Knowledge, and CS, or Clinical Skills. CK is the standard multiple-choice, computer-based test. It’s essentially the same as Step 1, but with a more clinical focus. Lots of “what’s the next best step in management” questions. Still lots of anguish. CS is a series of encounters with standardized patients (actors who pretend to be patients) and a patient note following each encounter. It’s only offered in five places in the country and thus often necessitates a road trip. We’re fortunate enough to have a test center in Chicago, which is only about a 4-hour drive. I’m currently in the gut-wrenching waiting period that inevitably follows any of these exams until you find out how you did. I’m trying to pretend that it doesn’t matter. It’s not working.
June: RESEARCH YEAR!!! I officially started working in the lab this week after driving back from Chicago. Thus far, my time has mostly been spent getting situated: reading up on techniques I’ll be using, finishing up with required training to be a fully-fledged lab member, and becoming familiar with the work that everyone is doing. I won’t say any more on this now as this entry is already quite long, but I’ll leave you with the following proof of how hardcore my lab is:
We’re kind of a big deal.
I’m still more or less in a state of denial, but I’m at least peripherally aware that I’m done with my M3 clerkships. Like, completely done. Took the last exam, submitted all my evaluations, done. I even completed a clinical exam this week that has M4 in the title, as in M4s take this test. We’re having sessions about residency applications and there are constant references to doing things at an intern level. I legitimately have no idea how this happened. I don’t think the world around me can handle it, either: it was 65 degrees yesterday and today it’s snowing. Seems appropriate.
No, seriously. Not exaggerating.
Partly due to having to schedule the aforementioned M4 clinical exam for all of my classmates, we have a two-week period with lots of “free time.” In typical fashion, this “free time” is being used to get my life together and take care of all the things that have been blatantly ignored in light of clinical responsibilities. Among these things is submitting paperwork for my leave of absence because I finally managed to snag myself a research mentor, woohoo! I’ll be stepping out in May, taking the month to prepare for and take Step 2 (hooray for standardized tests; they never end), and then starting on my research in June. I’ll be working with a pediatric neuro-oncologist rather than a neurosurgeon as was my original plan, but I’m totally psyched.
I actually really enjoyed my pediatrics rotation. I, too, was shocked!
My work is going to be a delightful combination of basic and clinical, and I’m already scheming ways to creep around the department of neurosurgery on a regular basis (and by creep I obviously mean partake in meaningful experiences and not be at all awkward, ever.)
I’m also getting caught up on/trying to get back into a lot of work related to my involvement in curricular matters at the medical school. It’s been extremely difficult to stay involved with these sorts of activities when meetings are almost always in the middle of the day (and it’s not kosher to be peacing out all the time from clerkships.) I’m hopeful that I’ll be able to do much more this coming year, though I’m sad I missed out on such a critical time period for coordinating the curricular transitions that are still ongoing. Still plenty more to come with the first batch of students experiencing the abbreviated pre-clinical trunk and then jumping into clinical work roughly halfway through my research year. I’m excited to see how things go!
Speaking of being excited, I am so. stinkin’. excited. about starting electives in March. I’m going to experience the two fields I’m most interested in before I start my research year: neurosurgery and pathology (and yes I realize how ridiculous that combination is). Neurosurgery is up first and I’m trying to get myself ready for surgery hours again. I’m off to a great start: on Friday I slept through my alarm and got up at 1:30 PM (oops), and today I got up at 10:30 AM. Improvement! (I’m in deep trouble.)
I’ve also got plans with a friend to practice suturing, because I may or may not be kind of sort of (exceedingly) clumsy. Good times will be had by all.
I had a somewhat eye-opening experience yesterday. I had just gotten back into Ann Arbor the night before and, in typical fashion, already had the day booked solid with appointments, errands, visits, etc. A good chunk of those things were at the hospital, and so I found myself there despite not formally starting back to work until Monday. I initially felt kind of bummed to be back in all honesty. I wouldn’t go so far as to call myself “burned out,” but it really is exhausting having to be “on” all the time (at least for a closet introvert such as myself). The truth of the matter is that, as medical students, we’re constantly being evaluated by our superiors. At best, it can get a little old. At worst, it can drive you into a neurotic frenzy. I find myself somewhere in the middle ground between the two, perhaps a smidge closer to the frenzy end. Even so, simply being in the hospital felt more like coming home than it ever has. It felt like a reminder that all this grading hullabaloo is only temporary and worth enduring.
It ALMOST made me forget about the 2000 dollars I just spent registering for Step 2 examinations. Almost.
I’m getting ready to start the last of the M3 core rotations: Pediatrics. I’ve got a lot of things to mentally prepare myself for, such as catching every upper respiratory infection known to man, having the fact that I have no idea how babies work exposed in front of a bunch of experienced parents, not absolutely embarrassing myself should I run into someone in a Star Wars costume, and so on. It’s going to be rough.
omgomgomgomgomg (Play it cool, Stef, PLAY. IT. COOL.)
I am, however, very much looking forward to having an excuse to act like a total goober while on the job. (I’m building rapport with the patient, DUH.) I’m hoping to get some reticent tweenage boys and win them over with talk of video games. I’m also hoping that I’ll manage to finish out strong rather than succumbing to the finish line effect because wow is it difficult to focus when such a huge milestone is within reach.
Since I last wrote, I’ve decided that I definitely want to do a research year and I’m currently working on finding myself a lab. It sort of feels like a blast from the past, harkening back to my M1 experience trying to find an SBRP mentor for my summer research. Of course, this time the stakes are a wee bit higher. Aside from the obvious difference of duration, I’ve really got to be able to show something for my time (read: get published, preferably more than once) and I also need someone who is going to be ok with my schedule being a little flexible to allow for clinical exploration. It’s not exactly the easiest thing to ask: “Hi, I need you to get me into fancy journals and also let me do what I want. Kay thanks!” It’s also not ideal that the first chance I really had to sit down and start contacting people was over the holidays, when said people were likely off doing things other than obsessively checking their email. (I was playing video games AND obsessively checking my email.) Things worked out wonderfully in the case of my SBRP mentor; I just have to believe that it will happen again and keep plugging away!
“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 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.
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!