0.25

Quarter of the way done, yay!!!

(OK, so maybe not if you think of residency as still being in school, but I had to tell myself when I was re-entering the education system that this was just a 4-year program).

I crammed last night, crammed this morning, took one more of those disheartening, yet not completely heartbreaking tests, and year one of med school was suddenly over.

Today I had lunch with some friends (and yes, beer), will attend a birthday party later on, and tomorrow I am en route to Vermont to run another one of those insanely long runs that darn Joe Henderson has me addicted to. I feel out of shape, but very happy that, despite it all, I am still in shape enough to do it (I think!).

And "despite it all" ought to encompass the cyclic patterns of cramming/beer drinking, the cutting up body parts, the shadowing of doctors, the pediatric physicals, the baby measuring, the liver palpating, the rewards of geriatrics, the despair of geriatrics, the new bike routes, the living in Main st, Rochester (where congregations of police cars happen with somewhat an alarming frequency), the new, precious friendships, and the teratomas (I learned this last night, most disgusting thing I've ever seen so far).

It's sure been a rollercoaster, especially the first few months (until I learned how to memorize shit, which apparently I had been successfully avoiding despite being a professional student). And although I feel almost as ignorant about the science behind medicine as I did last August, at least now I don't feel awkward asking about someone's sexual orientation, habits, drugs, depression, and all that stuff. Everyone seems to pick what they really wanna retain in Med School (the surgeons were uncannily good in Anatomy, for example). I have worked hard in my primary care clinical work, have had a blast with it, and have predictably done better than in any other of my classes. They tell med students that they will change their minds about 10 times about what specialty they want to go into before they actually make a decision. But perhaps 35 year-olds don't change their minds so much. Perhaps we are more aware of whether we're in it for the thrill of the ER, the dollar signs of Dermatology, or the relationship with the patients. For me, the later is obviously the winner, and although I could still change my mind, I am enjoying the ride for the moment, having fun with the art of medicine (versus the science of it, which yes, is interesting, but not quite as thrilling to me).

Gotta get some sleep before the festivities tonite. More later, I have great plans for this summer...

A toddler in medicine

My friend Aisha said some months ago that we were all like toddlers in medicine. That's how clutzy we are still with our tools, our interviewing skills, and our knowledge.

But it hit me cold yesterday how people expect me now to give them advice, be it fake patients or real ones at the doctors’ office. Both cases are un-scary in theory because, in the case of fake patients, they and I know that I really don’t know anything. And at the doctor’s office, the doctor is actually there, or follows me at some point to recheck my work.

Nonetheless this is frigging scary. That I, with my highly defective short term memory (make that short, medium, and long), with my profound ignorance of all things medical, shall give a piece of advice to a patient, just plain freaks me out. I realized this yesterday at the doctor’s office. I’ve been working with a pediatrician, and rather than have me follow her around, she semi-randomly picks 3, 4, or 5 patients and has me do their school physical. This was painfully shocking the first time, like when your dad throws you (you being a toddler) in the pool so you learn to float. Yes, floating is awesome once you figure it out. But struggling for air maybe isn't quite as cool. And that is definitely how I felt. "Sooo...you want me to go in there and ask them about school and nutrition, and check their heart and lungs? Err...right? Their reflexes too?" And panic, panic, panic (as I had had zero warning that I was going in by myself!). My face must have been hilarious. If my doc had more of a sense of humor and a little more than 8 seconds to spare, she might have laughed her ass off. But she didn't, and threw me in the room instead, mumbling something about a form. Turns out that I did check a heart, a pair of lungs, of ears, of eyes, of feet (after laying my patient down), and then I sat her back up to look at her tonsils, and then laid her back down to listen to her tummy, and then I made her walk and then I sat her back down to check her feet pulses and then I gave up and did not lay her back down to palpate her tummy. Yeah. Your doctor makes this look like she's doing 5 things when you get a physical bc she's so smooth and experienced. Get a cluzty first year med student to do it. It will look like the 20 things that she is actually doing, and the thing is that she still will have missed another 10 things that she was supposed to do. But hey, it was my first time in the water. Thankfully, there is a form that I found after I had done all this, and I was able to do a more normal interview, "how's your sleeping, any problems going to the bathroom, any changes at home, do you exercise, what are your mile splits, where did you get that awesome tattoo, oh yeah, do you have any concerns for the doctor today" (accurately implying that I am pretty much useless and all I do is relay the info to the doc). So at the end, I floated, not gracefully, not skillfully, but I did it. And after her throwing me in the water like this so many times, I have kinda gotten used to it. It's sure stressful and, albeit forceful, an extremely good way to learn.

Granted, the school physicals are usually uneventful and if there is anything that needs attention (lungs that snore, golf ball-sized tonsils, babies with fevers and runny noses), I will defer to the doctor. But they still ask me/tell me about their issues, and I still need to be able to hear that snore in that lung, or to note that perhaps the size of that tonsil is somewhat not ordinary. And this is what makes me uncomfortable, because I am still a toddler who knows so very little...

The patients I am least comfortable with are babies, so fragile, their ears so little for me to come in with my otoscope, their heads so mushy still. On Wed, I did the check up of a 4 month old and a 6 month old. The exams turned out to be easy, but talking to the mothers was fairly stressful. They need lots of education/advice, especially if it's their first baby, and I just don't know! Do you introduce one veggie at a time at 6 months? at 9? 30 oz of formula a day? 40? mix it with cereal? Do you introduce fruit at 8 months? Or is it goldfish? pizza? And OMG. What boosters do you need at 6 mo? at 9? at 3? There sure are a zillion vaccinations for their tiny little butts to take.

But I digress. The point is, that despite being a wreck every Wed morning (in anticipation of the afternoon at the clinic), I also have a little bit of fun. Because, after all, that is what I wanna do when I grow up.

Spring break!!

I am back!!
It's been a while, I know. Too much to study, too many miles to run, and well, life.
I've seen lots of patients since I posted last, gone for lots of runs, taken too many tests, drunk too much coffee and stayed up too late, too many nights, studying too many pathways. But today I get to enjoy the exhilarating hiatus of Spring break. Spring break. Med students (first and second years) get a Spring break. Do yall remember that? I had forgotten. What will I do with myself? Yea, I am smiling. What will I do with myself just sounds like an awesome thing to wonder, after not having a moment to spare in the last few weeks. Double workouts? A book a day? A movie a day? A beer a day? Two, THREE beers a day? And to think that in my previous life this was compatible with my occupation...(well, maybe just the workout/beer combo..)
So life is looking good. The sun has been out for the last week or so, and we are in the fifties now. I've run in shorts twice already, and although the weekend is going to be slimy and grey (maybe just to remind me of Oregon), I am really really really happy that the snow is melting. I do need to take my bike out one of these days...or it's going to hurt A LOT in September for the Iroman.

To wrap up the term, I could talk about the amazing (and terribly sad) experiences I've had with my geriatrics patients, I could talk about the night and day contrast between my Biochemistry class and my clinical experiences, or I could even talk some more about nutrition (yawn yawn, I know...).
Instead, I am just going to say that I am very very grateful to be sharing this experience with such an awesome group of people. As things go in med school, I end up spending about 12-14 hours a day with my classmates, more on the week of a test. And most is fun, but some days we have a bad day, and it just so happens that bad days are great to pull people together, and after only seven months in this very cold city, I feel very warm and un-lonely. I can go home and be quiet if I need quietness and silence, but there is certainly always somebody to listen to me rant, tell bad jokes, get coffee, or go for a beer when I need to. And it's only been seven months, and most of these people are more than 10 years younger than me. I certainly was not expecting to make good friends so soon. So yeah. Fifties out. 17 miles tomorrow. Party tonight. Beer. Still miss my friends, but I am very grateful of my new ones, and of life being so generous to me right now.

~e

Hope

This week, I met a patient who made me feel really good about medicine, and about being able to really make a difference. NS is almost 80, and has had problems with his heart for all his life (many of his family members died before turning 50 from heart disease). NS had had a quintuple-bypass surgery, and had lived happily after that for many years. He was a ski instructor, a tennis instructor, an English teacher, a Sunday School teacher...he even retired and went to teach in parts of the world where almost everyone is illiterate (and no, he had surprisingly not heard of Three Cups of Tea!). He is also obviously in love with his "new" wife of 20 years, and simply has a lot going on for him. But a few weeks back, he came in the hospital with shortness of breath, and as he was being tested had a stroke. His doctors gave him TWO DAYS to live.

Tough, right?

He was released from the hospital on a weekend, and somehow he was able to get a hold of his cardiologist. After talking on the phone, the cardiologist drove an hour to NS' house on his day off so they could chat. The next day, NS had surgery. And now it's four weeks later, and he is getting ready to go home.
His cardiologist just knew that he would be able to survive yet another operation on his fragile heart, as he had treated him for years. And thus risks were taken, and NS has now the face of that who has faced death, who has been given a terrible lottery ticket with those bad genes, but who has, at least for once, teased death away. This is my first patient that has come so so so close to it. And I don't think I'll forget the depth of his eyes, so heavy with wisdom.

And that right there is the power of medicine and the difference that one doctor can make. I honestly don't know what did the cardiologist know that the ER docs didn't. I don't care. I just know that thanks to a turn of luck, of right people at the right time, and of using and abusing our healthcare system, NS will live to teach his granddaughter how to ski, to read more books, and to inspire a few more people like me and like his Sunday School students.

So today, despite knowing a lot less about pyruvate carboxylase than I should, and despite missing teaching, I am very happy with my choice. Maybe one of these days I can actually help out. Make a difference on someone, on someones. That, right there, would be cool.

In the meantime, I just completed one of these cycles that go on in 1st year med school (and I just have a feeling this happens everywhere in the country). Test monday. Beers monday. Relaxed week. Today, movie and beer (and OMG have you watched The Single Man? I haven't watched such a good movie in a looooong time!!). Tomorrow, I learn to cross-country ski. And then there will be Monday, 2 weeks from our next test, and I will realize just how little do I know about the 100+ pages that our teachers have covered in lecture. Oh. Well.

~E

PS: Oh. And it's EIGHT Farenheit outside. How is a Spaniard supposed to cope???

More on Dr. Berk

Dr. Berk is coming back as full time CEO of the Medical center. What do you guess that a job like that takes? 50? 60 hours a week? This man is amazing!

http://www.urmc.rochester.edu/news/taubman/?id=2742

AND to continue with depressing stories, my patient yesterday had MS, diagnosed in his early 40's. Severely disabled practically since diagnosis, and acc to Dr. N, without much hope for him to get better (he practically can't walk and even if he could he has absolutely no energy). From lack of activity he is gaining weight. And weight gain and chronic lack of activity make an excellent recipe for shit to happen. So that was another very upsetting day at the Rehab unit. I wonder if I will get callous at some point. I don't know if I want to, though. Will I loose my humanity?

~e

Stroke and accidents

This week we've been focusing on life after a traumatic accident or after a stroke. One of the patients I saw (who I interviewed for almost 2 hours) had just had a stroke. She's thin, looks healthy, and walks (make that walked) around. But she is 85 and just lost her husband of 60 years (!!). Did that give her a stroke? Why did her body decide this particular moment to fail a little bit in its blood supplying job to the brain, rendering her leg and arm a dead weight?

"My" patient was upbeat and hopeful, given that she has a little mobility of some fingers. But after talking to the doctor I realized that this upbeatness is out of blissful ignorance, as she probably won't be able to walk again without a walker or go up her stairs--among other things.

I realize that 85 is a great age to make it in good health. She's lived a long life and she told me that she was "ready." It's the natural course of life, and it is a matter of time, and not of whether, that "mishaps" are going to cause our bodies to fail us like that. But I still have trouble accepting it. I guess it goes back to death and our coming and going in the world...maybe I haven't thought of that as much as I should. I am sure I will have plenty of opportunities to face death and the natural path of life in the next few years...

On the other side of things, the unnatural courses, we had a presentation by the Medical Center CEO, Dr. Berk. He had a biking accident in June that fucked up his C3 vertebra. And there went his ability to walk, grab things, control his bodily fluids, sign his name, wiggle his toes. Dr. Berk was not a CEO for no reason, and his talk was eloquent, matter-of-fact, and devoid of any self-pity. He simply took the turn too fast and skidded and went over his handlebars to break his neck upon landing. And as he was laying there, beginning to pant, he realized exactly what had happened, how high his break had to be for his diaphragm to be out. And he felt the sensation in his limbs leaving him, some of it without return, as he was laying there. Scary, huh?

He is back to work now and has a superduper chair that enables him to be a little taller than me if he presses a button, which I guess is good if you go to a lot of fundraisers where people tend to spill their drinks.

And sure, he still has an amazing job and a wonderful family and many things to go for him.

But he broke his neck. Not at age 85, but while still youngish. And even though he is gaining some sensation and some movement, he is now faced with a life very different from the one he had envisioned.

With this also I have issues (who doesn't!). And with the cases we were presented with right after the conference, like a teacher who had a skiing accident while in his 20's. Yep. Wheelchair for the rest of his life. Now happily married, happily employed as a 5th grade teacher. Looks happy and hipermegaenergetic. So why does it depress me?

I went on a ride today because it was over 30 degrees (most of the snow on the roads is gone) and because I am physically addicted to my bike. But as I was coming down new, unknown turns, I was sure slowing down more than usual.

The soberness of our week doesn't end up here. We've also been learning about all these genetic disorders that can be really messed up (and are more frequent than I ever thought). Just like last week we had patients with disabilities that were obviously living a full, satisfying life, we had a parent presentation this week of parents of children with disabilities that seem more overwhelmed than happy with their kids. And that might just be my impression.

Ahh. The weight of knowledge. Time for some Twilight (what!).

~e

Ice and First Patient

So the ice skating was fun. My first lap consisted of very tiny steps, and many of my classmates stopped to make sure I was allright, held my hand, and gave advice. There was no rail or wall, and most of these people have grown up skating. I was of course the Southern Spaniard from Oregon who hadn't been on a rink before. But at the end of the night, I was "skilled" enough to compete in dives, which is when you go as fast as you can and then dive on the ice, and whoever goes further with their body wins. I had a blast, obviously.

But to more serious things. Today I saw my first real patient, at a hospital. We were briefly briefed in what to do and there we went. My partner and I were given 90 minutes to obtain a history and perform an exam. I thought at first that 90 minutes was gonna be a looooooong time, given that the doctor I shadowed spent an average of...I don't know, 30 minutes, with each hospital patient.
But time went by superfast. She had many things to tell, she was very interesting, and she had many many medical problems. I only felt frustrated when she sought reassurance from us and we couldn't provide it. First, we don't know anything. And second, even if we did, the news might or might not be good. That's gonna be hard, ain't it?
But anyways. It was an awesome experience. In the midst of all the textbook stuff, it is so wonderful to be able to actually get a feel for medicine.

I'm gonna stay out of her story for many reasons, but I can tell you this: when I introduced myself, she said, "Oh, Esther, biblical!!," not knowing that everyone in Spain had to name their kids with names out of the Bible or fear being boiled in oil by their in-laws/parents/neighbors... So she later asked me what church do I go to. I was able to hide my chuckle. I wanna say it's been a couple of years since the last wedding (and thus the last time I went to church). Then she lectured me a little, that we have to care for our spiritual self. I got out by saying that I didn't need to care for my spiritual self at church, that I could do it elsewhere (I did not tell her that I did it in my once-a-week 15 minute yoga routine...).
But yeah. Good thing that I am going to go by Dr. CM. Otherwise this might get tricky...

Time for some Genetics...
~e