two things

Yesterday my housemate told me that I looked like I was really tired and stressed, to which I replied, "It's because I really am tired and stressed." It's been a really difficult past couple weeks in part due to my rotation schedule and figuring out what specialty I want to do. 

But there are two things that make me happy:

1. I'm going to be a doctor. What kind of doctor, I don't know, but a doctor with MD after my name. 

It's very like that I will finish medical school and get a residency position somewhere barring any disasters in the next 11 months. Of course there are programs that I think will better fit my goals and those are competitive. But so far I'm pretty sure I'm going to match somewhere. I feel that I have (almost) survived the brutality of third year because I have only 4 weeks left, even though it's going to be a miserable 4 weeks because I have q3 call for the next two weeks, then the shelf exam, and then moving out of Flint. 

2. I have friends and friends of friends who don't even know me at all who have offered me housing during my away rotations. This has been a huge source of stress removed. Thank you. 

Advice for recent college grads and me

I usually don't read advice letters to recent college grads because I'm not a recent college grad but mostly because I find them insipid drivel. But this from Jezebel spoke to me because I have been thinking a lot about what specialty of medicine to put down on my residency applications this September. 

I don't want to turn you into a misanthrope at such a tender age, but listen: most people do not have your best interests at heart. I now see that most of the idiots who told me I'd surely fail were projecting their own insecurities onto me.

I knew that all the people who told me that I should choose one of the ROAD* specialties weren't giving me good advice. Nobody has said that I would fail if I did any other specialty, but they have given me this look of pity, like I'm going to be miserable and disillusioned in a couple years time. (Radiology, Ophthalmology, Anesthesiology, Dermatology. These are very high paying specialties with comfortable work hours.)

When I think about the next few months: moving out of Flint and going to an away elective IN ONE WEEKEND, endless traveling for electives and residency interviews, graduating from med school, interviewing for residency, starting residency, having real responsibilities to keep people alive, I'm so overwhelmed! Then I felt better when I read this:

I've slowly gotten better at dealing with overwhelming responsibilities and terrifying experiences because I've been through similar overwhelming responsibilities and terrifying experiences before and I know I'll pull through. 

When I think back on the past few years, I have already so much that was overwhelming and terrifying, like pass Step 1, move to Flint, work with doctors, talk to real patients, navigate a hospital. That was all SO terrifying but I've made it to today. And that is a little bit reassuring. 

I don't want to wear a white coat.

When I was a second year medical student, I volunteered at a primary care clinic called Care Free. On my first day, I brought along my white coat and stethoscope like I did for every situations where I expected to see patients. I was working with an older medical student there who told me, "White coats are actively discouraged here," and had me set it down in the office for the rest of the afternoon I was there. I was a little confused at first but none of the other doctors, residents, or medical students there had white coats and I didn't want to look like an anomaly.

I think the non-medical public associate closely white coats and doctors. Even before my third year of medical school, I thought I would like wearing a white coat. 

Now that I am more familiar with the medical field, I hate white coats. I want to disassociate them from medicine. For me, the white coat represents an attitude to patients. It means that I'm really smart and important and you must talk to me. I'm more comfortable talking to patients when I'm not wearing my coat. 

This was actually one of the reasons I disliked my Internal Medicine rotation. Everyone wore white coats all the time. When we were rounding, I felt the residents, attendings, and students were ghosts huddled together and whispering. 

When I am I doctor, I will get some more freedom to decide the kind of practice I want. I'm sure that don't want to wear a white coat. 

To specialize

When I introduce myself as a student to patients, the more pleasant patients respond by asking what kind of doctor I plan to be. (There are much less pleasant ones too.) I say that I haven't decided yet.

One patient's family member told me, "Don't specialize."

I was so confused by this. I explained that the purpose of this year of medical school is to experience different specialties. He then explained that he thought I should do "general practice". I explained to him that family medicine is a specialty, so when I said that hadn't decided what to specialize in, I meant that family medicine was still on the table.

I was irritated because it was another example of the fact that family medicine is misunderstood. This was evident because this person didn't consider it a specialty. I see how people think that family docs are less "specialized" because they are see pediatric to geriatric patients. Most specialities are based on either patient population (e.g. pediatrics, OB/GYN, general internal medicine) or organ system (e.g. every field ending in -ology.)

Family physicians are specialists. They specialize in care for  all people with an emphasis understanding the patient's family and community. It saddens me that people don't think it's a skill to understand patients, to be engaged in the patient's community, to advise patients on lifestyle changes, to keep people healthy in the first place.

I also don't like it when people who don't know me at all think they should tell me what to do. I understand that probably they are trying to be nice since they're engaging me in conversation at all. This is better than complaining that they don't want to be seen by a student. But I don't think it's necessary for people to pinpoint what specialty I should do. I hate "advice" like that.

The best thing they could say to me also seems to be the most rare: 

I hope you find what makes you happy and good luck.

Future OB/GYN?

Before I started this rotation I thought that by the end of it I would have decided that I didn't want to specialize in OB/GYN. On the contrary, I haven't rule out this specialty. This fact really surprises me.

OB/GYN rotation ended almost two weeks ago. At that time, I jotted down some things I liked and disliked about the rotation.

Relevant medspeak:
obstetrics: branch of medicine that deals with pregnant women during pregnancy, delivery, and the postpartum period. 
gynecology: the branch of medicine that deals with diseases of the female reproductive organs. 

Likes:

• I'd be okay if I only saw female patients for the rest of my career. 
• I like asking people about their gynecologic history. Yup, this includes all the awkward questions we had to practice asking in pre-clinical years. 
• I like gynecologic surgeries. Some common ones I saw were ovarian cystectomy, dilation and curettage, salpingoophorectomy, hysterectomy, different types of tubal ligation, endometrial ablation, diagnostic laparascopy, salpingectomy for ectopic pregnancy. I think it's the coolest thing that I get to see the inside of someone's body. 
• I like doing a speculum exam and finding the cervix. 
• I like palpating uteruses.
• I like checking cervical dilation even though 80% of the time I can't find the internal os of the cervix. 
• OB/GYN residents are nice. But so far I haven't worked with any other residents so I'm not sure how they compare.
• Getting dirty in blood and amniotic fluid. 
• It's the medical application of my longstanding interest in reproductive health and reproductive rights. I've learned a lot more about reproductive medicine, which is someone I always wanted to learn about. I feel like I'm being true to my values and beliefs. I guess I'm still telling people to use birth control, just in a different setting. 

Dislikes:

• Ridiculous work schedule in residency and as an attending. What other physicians or working person would feel fortunate to have to work every fourth weekend and every fourth weeknight? Really, this is considered a cushy schedule for a full time OB/GYN.
• So... I kind of don't like obstetrics. I know this is half of OB/GYN... If I could do a residency that only consisted of gynecology, I would be ready to commit to that now. Unfortunately, it doesn't work like that. I could do a fellowship after an OB/GYN residency in an gynecologic field so that I'd pretty much only see gynecologic cases. But I'm not sure I'll have the energy to do a fellowship by the time I'm through one of the most difficult residencies so I can't make that decision right now. 

The typical patient on L&D

I have finished my clinical duties on OB/GYN rotation. This week we have exams and presentations. So I think this is a perfect time to procrastinate by blogging.

In preclinical years there were rare instances where we saw real patients in hospitals, not hired actors playing the part of patients. One time we were seeing patients on the pediatrics unit. A classmate of mine said something when addressing the parents of an infant that implied the parents were married. But they weren't married and the student felt really awkward.

Now that I've been at this hospital for about two months, the image I have of a typical parent is completely different. The typical obstetric patient at this urban safety-net hospital:
-Teenager or early 20s African American girl.
-The standard age to have a baby is in your late teens or early twenties. I'd say that most of the pregnant patients we see are between 16-22. This means that they're younger than I am. I'm a little bit taken back when I see a date of birth on the chart that's in the mid nineties. I remember the mid nineties! But now I'm not that surprised.
-The baby daddy (terminology is per patient) is minimally involved, if at all. At her delivery are usually her mother, her aunt. A few times I saw the baby daddy cry when the child was born and I was touched by that. But this is pretty rare.
A few days ago I saw a 28 year old patient who was pregnant for the first time. Reflexively I thought that she was old.

Then I saw a pregnant patient in her late thirties so by definition was AMA. Advanced maternal age: 35 years or older at the due date. I thought she was really old. She was starting to have grey hair.

First rotation!

An attending I worked with yesterday asked what specialty I wanted to do. I was honest and said that I wasn't sure. I probably won't decide until the end of my third year, which is as late as possible. He suggested that I write down notes from my rotations so that I can look back on them when making a decision on choosing a specialty.

That is a very good idea, I thought.

Also a couple friends inquired about my blog recently even though it had been on hiatus for months.

So I'm blogging again!

Quick recap:
I'm a third year student now. My first and current rotation is OB/GYN.
Passed USMLE Step 1!
My score was pretty good and I'm pretty happy with it. (Though I really wanted five more points. That's how it always is, isn't.) Good or bad, that uncertainty is over.

A doctor explained Bartholin's gland to a patient this way:
When you are about to eat delicious food, the glands in your cheek produce saliva to lubricate your mouth. Bartholin's glands have a similar function. When you have foreplay, these two gland on each side of the vagina that secrete fluid to lubricate.

I thought that that was a fitting analogy but I think about it every time my mouth waters.