I know the kind of doctor I want to be

When I think about all that I've done in the past few months I feel giddy like I'm in love. I'm currently in Chicago on an elective rotation. Before that I was in New York City for another elective. They were in family medicine and reproductive health.

It's wonderful because I'm learning all the things I want to know. During the last couple months I think I've better than the average 4th year student at placing a speculum and finding the cervix. I probably get it 9 times out of 10! Too bad I can't write "pretty good at finding the cervix" on my CV. I'd really like to. I'm proud of it.

It's wonderful because I feel I'm going to provide a really necessary service as a doctor. I had a patient thank me even though I really didn't do anything. I told her my name and, "I'm a student doctor working with Dr. So and So." Then I basically stood behind the doctor. But I feel very touched by this, more so than a lot of my other achievements because I think she really meant it.

It's wonderful because I'm meeting people like the kind I want to be, attendings, residents, and people who share and support my passions. They understand reproductive health and reproductive justice. They get it. They're really smart and down-to-earth.

Surprisingly, I've been treated better on my electives. Being treated like a person is something I believe all people deserve, even medical students. I hope it's because I know more medicine now because I do. I hope it's because I have better articulated what I want to do as a doctor because I have. I also hope it's because I've found "my tribe" because I have.

I will be applying to family medicine residencies that include training in family planning and a strong academic component. In the long run I'm hopeful that I will do all the things I care about: be a good full-spectrum primary care doctor for my patients and a proponent of this work via research or public health or advocacy.

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. 

8-year-old African American...

IT'S SICKLE CELL!

http://www.flickr.com/photos/snapeverything/4158509106/

A fellow classmate would blurt this out every time an clinical vignette featured an African-American patient. It become a joke that if there was a sick African-American man, woman, or child, that person had sickle cell disease before we even got to his or her symptoms. Every time we learn about diseases with an ethnic predisposition, sickle cell disease is always the prime example. While it is a fact that sickle cell trait and disease is more prevalent in people of African descent, it's troubling that sickle cell disease and thalassemia seem to be the only two diseases that people of African descent according to clinical vignettes we get in medical school. Caucasian patients are the default in most other clinical scenarios.

Oh every Jewish baby has Tay-Sachs.

Part 2 of 3: Ethical Issues during clerkships

One of our classes this semester is ethics. The first day of ethics class was a panel that all students were required to attend. There were a few third and fourth year students who shared with us some "ethical dilemmas" they faced during their clerkships. (Clerkships are rotations. You follow around a resident (usually), wake up at ridiculous hours, and get asked questions to which you don't know the answer.)

Basically three of the four stories had this moral:
Don't say anything if you think you're resident or attending is wrong or is just acting like a jerk. 

(The last one wasn't about the attending or resident being wrong or a jerk. It was about a teenage patient who feigned pain in order to be admitted and then her boyfriend tried to sneak onto the floor during the night or something. It was weird.)

Not on my watch

In my ethics class, we talk a lot about medical interventions and dying. It's pretty well-known that many medical intervention are overused. The patient's underlying condition won't improve, the treatment will decrease the quality of life in the time the patient has left, or the treatment won't relieve pain. Patient and families often feel that medical staff push interventionso on them that they don't actually want.

I generally believe that we should try to change this culture of excess intervention, respect the patient's wishes, known when to "let go". I think many students also agree to this principle.

But I can also understand doctors and medical staff who end up intervenening more than is necessary. I think it's because we all want to avoid death even though the hospital is full of death and dying. In a recent post in "A Cartoon Guide to Becoming a Doctor" talked about how doctors want to personally avoid patient death,  "Every time I cross covered the hospital as an intern, I would pray to get through the night without harming anyone." (Cross cover is when interns receives the patients from the day team and takes care of them through the night. It's problematic because the new doc doesn't know the patients well.)

I haven't experienced the death of a patient I had responsibility for but I know that it'll be a milestone experience. It'll be something I'll remember for a long time even if my medical decisions did not cause premature death. I'm not really looking forward to it either.

Docs don't want patients to die "on their watch" so they end up prolonging dying until the next shift takes responsibility for the patient, and the next after that...

"Research" or Glorified Microsoft Office suite operator

I'm doing research this summer. It's not any research. It's cancer research, which automatically makes people think it's important research. This means I'm getting paid by my medical school to work with a faculty mentor full time for seven weeks.

It's actually epidemiology research that's sort of related to cancer but not really. To most people, that sounds a lot less impressive than cancer research because they don't know what the hell epidemiology is about. (Wait, I don't know what epidemiology is...) It actually means that I wait around for my mentor to give me some numbers that I can make into a diagram, textbox, or table and put it in a powerpoint slide. My chief job responsibility is formatting a powerpoint slide that's to be a poster and writing the manuscript for a paper that I really don't understand.

I'll be getting a W-2 this year! This is the first paying job I've had since ... summer 2009? I had forgotten about the magic that is direct deposit.

Does anyone have experience carrying a large poster tube on the airplane? Please get in touch with me. I will have to do this in about a month's time.

The good news is that I felt a little less incompetent during my weekly meeting with my research mentor and Skype call with her collaborator, an epidemiologist at the University of South Carolina). Usually It was not because I contributed meaningfully to the discussion between my mentor and her collaborator because another (soon-to-be) second year student was there who seemed just as clueless as I was.

I've been reading a somewhat famous blogger on the med student blog circuit, Action Potential (http://apotential.wordpress.com/), who wrote about her summer research frustrations here. She's funny.

You might not believe it but I did learn how to do a complete physical exam

There's an order to conducting a physical exam. I took a class on it and passed the exam, which consisted of doing a physical exam on a classmate including memorizing the steps and performing them in the correct order.

You wouldn't know this if you had seem me at the weekend clinic where I volunteer.

What goes on in my head:
Me to patient: I'm going to conduct a physical exam on you.
OMFG WHAT'S FIRST??? OHHH I SEE EYES. OHH I SEE AN OPHTHALMOSCOPE AND OTOSCOPE ON THE WALL. WAIT. IS IT EYES FIRST OR NOSE FIRST??
Me: I'm going to look into your eyes now.
AHHH I CAN'T CLOSE MY RIGHT EYE WHILE KEEPING MY LEFT EYE OPEN...
OH SHIT. WHAT'S NEXT AFTER EYES AND EARS???

This went on until I went through the motions of enough components of the physical exam in no particular order until I thought maybe  the patient was fooled into thinking I gathered any useful information. (I didn't.)
  
When I left the exam room to report to the attending physician, I realized that I forgot to palpate lymph nodes. Oops.

Ridiculous mnemonics

Hey everyone! It's my revamped blog! I figured since medical school consumes my entire life now, I'll make this blog about medical school.

There are a lot of things to memorize in medical school so students and doctors come up with mnemonics to help remember them. However in my experience, some of them don't actually help you remember whatever it is you're supposed to remember. Furthermore, clinicians tend to publish papers introducing their mnemonic as if it's the greatest thing ever. This I find ridiculous.

HEADSSS is supposed to help pediatricians remember important questions to ask adolescents. However, all I could remember was that it was sort of like the word "head" but with some extra letters but I couldn't remember which letters, let alone what each stood for. I had to Google it when writing up this post.

HEADSSS:
H: home
E: education/employment
A: activities
D: drugs
S: sexuality
S: suicide/depression
S: safety

PPQRST has the honor of being the first ridiculous mnemonic I learned back when we were all bright-eyed first semester students. It's purpose is to help clinicians thorough assess a medical complaint. The problem is that we can't phrase the question to the patient the way the mnemonic is. We are supposed to ask questions simply and directly. Words like "palliative" and "provocative" are out so we have to remember to ask what makes the pain better and what makes it worse.

P: palliative factors
P: provocative factors
Q: quality of the pain
R: radiation
S: severity
T: temporal course
T: treatment

An internal medicine resident told me that for Step 2, PPQRST doesn't cut it because the student has to elicit a lot more specific information about the complaint. He has many more mnemonics for that. Yikes.

Feminist med students!

I have found my angrier med school feminist alter egos. You CAN be a feminist and in medical school! Well maybe not in medical school while being lectured to for four hours but I can still maintain a blog. There is hope yet in the world.

Their blog is here.

If only I could be so angry! Or actually, if only I could express my anger!

Oh no. No hope in the world. I have too much to study before Friday.

Budgeting time

I had a viola teacher in middle school who gave me the following rule about practicing my viola: You practice every day that you eat. He meant that if you were ill, and thus had no appetite and could not eat, you could take the day off.

At the time I never followed his advice, but these words came back to me this past week as I try to re-orient my lifestyle to the relentless pace of medical school. I'm still don't know how many leisure activities I can allow myself.

Should I take 1 hour go to DSW this weekend to buy boots? No. I'm trying a new line of thinking: If you find that you need something from the store, wait a week anyway. That goes for clothes, groceries, random stuff for the apartment. I hope it works.

All sorts of people -- faculty, administrators, fellow students, second-year students -- have been giving us advice about studying. But in the end, none of them are that helpful. A professor told us that we must study everyday. He specifically used football Saturday as an example of what we should not do. He said that we can't wake up early to tailgate in the morning, watch the game in the afternoon, go to the bar in the evening. Those days are gone! Oh wait, I never did those things in one day anyway. But for me it translated into checking facebook less and blogging less.

But some students say that it's not THAT bad. A second-year told me to take one night off a week. Don't study that night. But that confuses me somewhat too. Should I count Thursday night as my "break" night? I'm not studying much on Thursday anyway. On Thursday I already have class from 8am to 8pm, with an hour lunch break and breaks between classes of at most 15 minutes. I'm really just going home to get ready for bed. I feel a little cheated of my supposed free time if I count it as my "free night".

A fellow student, when asked about hobbies, replied that she reads every night before going to bed. I actually checked out a book from the library that I plan to read for 10 minutes everyday. This means I probably won't remember the beginning of East of Eden or The Unbearable Lightness of Being by the time I've reached the end. But I hope I can get some reading one this way.

I can't remember the last time 10pm or 10:30 was my cue to get ready for bed. I get up at 6:30am now and I need at least 7 hours of sleep to function at all the next day.

Lastly, I will make an effort to blog once a week. See you next week.

On the Eve of Medical School

I just uploaded onto facebook photos of my white coat ceremony that happened earlier today. After finishing uploading, I flipped through the photos. I seemed to me that that I looked older and more mature in those photos than the image I have of myself. Maybe it's the short hair, the smartly cut dress, or the (albeit short) white coat. Or maybe it's that in my mind, I know that it's the beginning of a formidable commitment.

Transitions

As popular and fun to read as travel writing is, it was never my intention for this blog to be a travelogue. I intend to update regularly but everyone in medical school tells me this will consume all my leisure time.

You may have noticed the new title of my blog. The end of my time in Denmark made me feel that that experience was fleeting, thus the previous title. But now I'm embarking on four years of medical school where the body is the subject of study. I think it also encompasses my interest in the body in society, in politics.

Today I had the first of a week-long medical school orientation. Immediately I was reminded of a similar experience, the orientation program for Aarhus University exchange students. The people I met my first day at Denmark Today, at the very first activity, became my friends for the rest of my time. So perhaps the same will happen now. We'll see.