Reflections on Third Year

The past year has been one of unexpected and broad personal discovery, involving aspects of heartbreaking disappointment and sheer, unsurpassable joy.

Since July of last year, when I started third year, I’ve met amazing people, learned incredible things (including learning how much I don’t know) and been afforded unique opportunities.

I can confidently say that the third year of medical school was one of the most life-changing years of my life. Not only did I (finally) figure out what I want to be when I grow up, but I experienced breathtaking highs, gut-wrenching lows, unexpected humor, and a back door glimpse into a mysterious side of life…and death…that many never see.

Overall, I feel like this year, both personally and professionally, I’ve truly experienced an overwhelming breadth of humanity…and honestly, I never saw it coming.

I just wanted to thank y’all for making this journey with me. I have received so much advice, support, encouragement, and love from Mind On Med readers and through Twitter. I am continually thankful that I choose to share my experiences here – not only to give others a glimpse into this life, but so I can look back someday and remember how pivotal these years were in helping me become the physician I will eventually be.

I’m expecting that the next year will be an adventure in itself – two new babies (!!) who will hopefully keep cooking until December (oh, did you miss that – yah we aren’t getting another dog – no my friend, we met our four-legged & furry quota long ago), residency applications and interviews, Match Day in March, and all kinds of fourth year fun (hopefully involving significantly more DIY projects than third year). Thanks for sticking with me through the craziness!

Ok, I do believe that is enough mushiness for one year.

Here’s a few of the most viewed posts on Mind On Med from the past year:

Image: FreeDigitalPhotos.net | Ambro

Ob/Gyn Clerkship

I finished up my Ob/Gyn rotation at the end of December, right before we headed out for our awesome New Zealand adventure, and never got around to telling y’all about it…so here we go!

Obstetrics & Gynecology

This is a specialty that deals solely with all the amazing (and occasionally scary and not-so-amazing) things the female reproductive tract can do.

Obstetrics is derived from the latin word “obstare” which means “to stand by.” Obstetricians take care of women who are pregnant, trying to become pregnant, in the process of becoming un-pregnant or who have recently given birth. It’s a unique field in that it requires the physician take care of two patients who are literally joined together for a time.

Gynecology is the counterpart of the field of obstetrics and deals with normal physiology, as well as disease, of the female reproductive tract. It involves everything from surgery to clinical preventative care and encompasses a large array of normal and abnormal medicine.

The Clerkship

  • 8 Weeks: Rotations on Labor & Delivery, Night Float, Outpatient Obstetrics, Reproductive Endocrinology, Inpatient Gynecology, Outpatient Gynecology and Gynecological Oncology
  • Occasional lectures, practice clinical exams on Fridays
  • Night Float: A week on the L&D floor at night, 5:30pm – 7:30am. Includes attending births and delivering multiparous patients, as well as triaging patients who come in with obstetrical issues
  • Labor & Delivery: Basically identical to night float, but in the day-time hours
  • Outpatient: Straightforward obstetrics and gynecology clinics, including some time in ultrasound, high-risk Ob & general clinics
  • Reproductive Endocrinology: A field I enjoy immensely, helping women with fertility issues achieve & sustain pregnancy
  • Gynecological Oncology: Diagnosis & treatment of cancers of the female reproductive tract
  • Inpatient Gynecology: Benign surgical gynecology

Daily Life

  • Varies greatly depending on what week of the rotation we were on. Outpatient clinic is generally 8am – 5pm, while surgical specialties tended to have longer hours and Labor & Delivery/Night Float is a pretty set 12-ish hour day.

Ob/Gyn Clerkship Books

        

What I Like

  • The Patients: By & large the population in this field is young, healthy patients getting routine care…there are exceptions, but the “bread and butter” of Ob/Gyn is the young, healthy woman.
  • The Field: I don’t know why it didn’t strike me until I was in the midst of this rotation, but this area of medicine has always been my favorite intellectually. Studying for this rotation wasn’t studying for me, it was interesting. In anatomy pelvis & perineum was my best (and favorite) section, reproductive physiology was by far my favorite…and reproductive endocrinology could hold my attention for hours. I just find it interesting & exciting.
  • Variety: A little bit of clinic, a little bit of surgery, a little bit of boredom and a little bit of adrenaline…all around fun!
  • Happiness: Sure, when things are bad in Obstetrics they are really bad and usually involve a lot of sadness. However, this is one of the only fields of medicine that deals extensively with happiness. People are never excited to be in the hospital, but if they get to leave with a baby it definitely offers some consolation…much happier than being admitted for a ruptured aortic aneurysm or acute kidney failure or alcoholic liver cirrhosis.
  • Surgery: I thought I would hate everything about surgery…when I didn’t it threw me for a loop. Until this rotation I would say I was about 90% sure I was going into Pediatrics, because I seriously thought I would hate being in the OR. Now, I’m not sure.
  • Active: This field is a lot about doing – even in clinic. You’re always doing something, which helps keep me focused and maintain my attention…pap smears, biopsies, surgeries, deliveries, ultrasounds, etc. Lots of activity in Ob/Gyn.

What I Dislike

  • Family Friendliness: It’s no secret that surgical fields are less family friendly than non-surgical fields. However, this is rapidly changing with each graduating class of new physicians. I experienced no negativity towards women in Ob/Gyn who have a family, but it wasn’t as overtly supportive as some of the other rotations have been.
  • Hours: Unpredictable hours can be frustrating for planning the rest of your life.

Going into this rotation I knew I would love the Obstetrics part, I have a real interest in all things reproductive (hardy har, keep the jokes to yourself…this blog is family friendly…usually) and thus knew I would seriously enjoy the part of the rotation that dealt with Ob. So, why did I never really consider this a career option for myself? I figured I would hate the Gynecology & surgery part of it.

And…when I didn’t it threw a loop in my life plans. Now I’m not sure what I want to do with my life…

It’s like I can hear the time ticking away…things I need to get done that aren’t getting done…letters of recommendation, away rotations, personal statements. AH!

But, like my mom told me the other day – I guess it’s better to like two areas & not be able to choose one than to go through all of this and hate everything.

Team Discussion

Internal Medicine Clerkship

I started my Internal Medicine clerkship in July and my shelf exam will be on August 25th. Since I’m just over half-way done I figured it would be a good time to do a recap of the past few weeks.

Don't Put Hospital Pens In Your Mouth
image c/o of photostock

Internal Medicine

Internal Medicine is a specialty that primarily deals with diseases in adults. As our clerkship director put it, I-Med is basically everything minus pregnancy, kids and surgery. It’s a very broad specialty and not unlike family medicine in some ways, but quite different in that it specifically excludes obstetrics and pediatrics.

The Clerkship

  • 8 weeks – 6 on inpatient, 1 in clinic, 1 with an IM subspecialty (mine was Heme/Onc)
  • “Teams” consist of 1-2 medical students, an intern, resident and an attending.
  • Daily lectures, weekly “Grand Rounds” lunch meetings and various additional conferences
  • “Q4” Call, which means we’re on call every fourth day. Call for this rotation is 7am – 9pm and you’re required to be at the hospital that entire time, unless your resident tells you to go home. It’s a lot of call days, but we don’t have overnight call for this clerkship, so it’s not bad at all.

Daily Life

What time you get to the hospital and what time you leave highly depends on how your team operates, what your patient load is, how complicated your cases are and when your scheduled conferences/lectures fall in. This week we had one hour lectures at 7am and my team was rounding (this means discussing & seeing all the patients on our service as a full team) at 9am, so I didn’t have to be at the hospital until 6:40am or so to print out patient info, go to lecture at 7:00am and then see my patients. Some days we leave at 2pm or 3pm and some days we leave at 6pm or 7pm. On call days we leave at 9pm. It’s very random and different each day.

Twitter Questions

  • “How little sleep do you actually get?” I probably sleep about 6 hours per night, but I could honestly sleep more than that if I would be more disciplined about bed times.
  • “How much do you study now?” Not enough. This shelf exam is notoriously hard, so I should be studying more than I am, but it’s hard to come home and concentrate when you’ve been running around all day.
  • “What do you actually do?” Talk to patients, practice writing notes, pretend I can come up with diagnoses and treatment plans (they’re basically always wrong), practice history-taking and physical exam skills, help out the residents with paper work and other random stuff that makes their day a little easier, incorrectly answer questions my attending asks, fumble with BP cuffs despite knowing exactly how to take a blood pressure and doing it 10 times a day for the year I worked as an allergy tech, basically walk around looking and sounding goofy and out of place.
  • “What’s the scariest thing you’ve had to do on your own?” I really haven’t had to do anything scary on my own! My school did a great job preparing us to be third years by giving us ample opportunity for clinical experience during the first two. In this rotation we don’t do a lot of procedures, so it’s been pretty much without fear so far. I’ve gotten to assist with central line placements and bone marrow biopsies, though – that was lots of fun even though my job was pretty much limited to opening packages and tying sterile gowns.
  • “What books are you using?” Ah, good question.

Medicine Clerkship Books

  • Step-Up to Medicine: This is by far the most recommended book for this rotation. It’s a great overview, written in bullet-format (similar to First Aid). It’s a good review.
  • First Exposure Hospital Medicine: Our clerkship director issued copies of this book and the one below. They are pretty good – short chapters, quick overview and easy to read, but not enough a solo-resource for the shelf exam.
  • First Exposure Ambulatory Medicine: We had a quiz over this at the end of our clinic week. It’s a good, easy-to-read book, but like the other it’s probably not efficient enough for the shelf.
  • MKSAP For Students: I don’t actually own this one, but it comes highly recommended from a few 4th years. There’s a copy in our I-Med office, so maybe I’ll give it a looksy next week.
  • USMLE World Step 2 CK Q-Bank: There are over 1400 questions in Q-Bank that cover Internal Medicine. We just got access to Q-Bank on August 1st, so I havent used it much, but I think it will be helpful. The questions seem pretty tough.

What I Like

  • Instant Gratification: Inpatient allows for longitudinal care of hospitalized patients, so you get to see first-hand how treatments are helping (or not) over the course of a few days.
  • It’s Busy: There is always something to be done. I’d much rather be running around, busy and exhausted, than sitting around bored with nothing to do.
  • Skill: There’s a lot of diagnostic skill and brain power necessary for Internal Medicine. They are kind of like the physician investigators of the hospital…if someone isn’t sure what’s going on, they call the Medicine team. So far I’ve felt like every resident & attending I’ve been with has been a great diagnostician.
  • Complexity: Along those same lines there is a lot of variety and complexity in this field. It’s interesting to see people use little pieces from literally every part of their education – from Biochemistry to Fellowship training.
  • Opportunity: There are tons of fellowship opportunities in Internal Medicine – Cardio, Endocrine, Hematology, Oncology, GI, Infectious Disease, Pulmonology, Rheumatology, Nephrology and more. I absolutely loved my specialty week with the Heme/Onc team.
  • The People: I’ve really enjoyed the patients, house staff and physicians on this rotation.
Newborn
image c/o of arztsamui

What I Dislike

  • Something’s Missing: Kiddos. I really enjoy working with kids and Internal Medicine specifically excludes them.
  • Something Else Is Missing: While I’m getting to where I truly am enjoying this rotation (the first few weeks were rough), I don’t have that “feeling” people talk about getting when you’re doing what you should choose as your specialty. Internal Medicine doesn’t make me incredibly excited and I don’t feel like it’s something I’d be amazing at, but I also don’t hate it (anymore, like I said – first few weeks were rough…I think that was more the process of getting my role as a 3rd year nailed down). Who knows, though? I absolutely do not dread my days at all and I definitely enjoy what I’m doing most of the time. I just don’t know if this is “it,” so to say. Although, I seriously fell in love with Hematology/Oncology, so maybe it is.

Life As I Know It…

is about to drastically change.

My job is no longer simply learning about the basic science of disorders and regurgitating answers on exams…starting next week I get my first real taste of what a doctor does. 

My first clinical rotation is Internal Medicine and I am very excited to see the ins and outs of hospital work. I’m ready to get into the nitty gritty of what I came to medical school for in the first place – patient care. 

Original Photo Courtesy of Flickr Creative Commons user Plutor

A few things I need to tackle before next week:


  1. Clinic Clothes: The past two years I have mostly been able to get by with hole-ridden jeans, casual t-shirts, and Toms. Starting next week I will be dressing nice on an almost daily basis and it’s high time I hunt down a wardrobe that doesn’t make me feel like I’m playing dress-up in my mom’s church clothes every day. 
  2. Confidence:Confidence is a huge part of success – you’re entirely more likely to be taken seriously, to learn and to accomplish if you’re confident in your abilities to do so. I’m trying to stay cognizant of the fact that I’ve come a long way in the last two years and maintain an attitude of humbleness, while reminding myself that I am capable.
  3. Sleep Schedules: hate getting up early (I know…wrong profession), but it’s much easier when I’m doing it on a schedule. Some medical students claim to sleep 4 or 5 hours a night and well, that just won’t work for me. I need a reasonable amount of sleep or my brain literally feels like a fog machine…and we all know an 80’s dance party is no place to learn the art and science of doctoring.
  4. Time Management: As I discussed earlier my time is no longer my own and, as such, it is going to be absolutely pivotal for me to maintain schedules of time management in order to keep spending as much time as possible with my husband. I also want to make sure I have adequate study time and free-time to devote to my furry children and to this blog. I should probably also work towards devoting a little time to some form of …*gasp*…exercise (not that I want to or anything). So, scheduling and efficiency becomes my newest obsession.


And, because I have no witty or creative way to end this post, I’d like to put it out there that I was carded while buying a 5-Hour Energy yesterday. 


From this experience I learned two things:


  1. Must be 18 to buy energy drinks.
  2. I look somewhere in the vicinity of...”I just got my driver’s license!” years old. 

I know, everyone older than me is saying “you’ll appreciate it when you’re 50,” but people have been telling me that since I was driving myself to restaurants and still getting the “12 & Under” kid’s menus and it’s never made me feel better.


Right now all it does is make me think that I’ll be a 30-year old doctor pregnant with my first child and still getting the stank eye from old ladies for being pregnant before I can buy lottery tickets.

And, just so this is a completely random, how about you share some tips with me as I go into 3rd year? I’d love to hear your advice!



2nd Photo Courtesy of Flickr Creative Commons user rynosoft (attributed here due to Blogger formatting issues).

Trip To Betty Ford Institute In My Future

    I was three and she was 24 when we left – for years the alcohol and drugs precipitated the fighting, which brought on the feelings of guilt, which inevitably lead to more drinking. It was a vicious cycle that had to be broken and, no matter how much my he begged my mom not to leave with me, she knew we couldn’t stay.
    He’s a good man, my dad – a smart, hard-working, exceptionally talented man with a detrimental disease that makes people look at him differently when they find out. Two months after we left he checked himself into a rehab facility and, when they deemed him healthy enough to leave, he started taking me along to his weekly Alcoholics Anonymous meetings.
    I get my determination and persistence from my dad, an addict who has been clean and sober now for over 20 years.  I have a deep desire to be the doctor who knows addicts are real people who can be helped, a doctor who is compassionate to the struggles of those with substance-abuse issues and understands that addiction is a disease. One thing I don’t want – to be the doctor who passes over these patients as “drunks” or “druggies” who are passed the point of being helped. After all, there’s a good chance my dad wouldn’t have been around to walk me down the aisle two years ago had someone not believed that, when he finally hit rock bottom in 1989, he could still be helped.

I never got around to writing a post for my amazing Dad on Father’s Day, so I’ll talk about him a little here*. He has overcome so much for me and our family – fighting through the tough hand of addiction and trials he was dealt in his early 20’s, he managed to come out on the other side as an inspiring story of success. He truly is one of the most unfaltering and inspiring people I’ve ever known and I’m so lucky to call him “Dad.”


The fight he fought and the journey we travelled together inspired me to apply for an opportunity that promises to be life-changing – a week at the Betty Ford Institute during my Psychiatry rotation. A big-hearted donor, who fought addiction himself, sponsors four of our third-year students to spend time learning about addiction treatment at the world-renowned Betty Ford Institute during their Psychiatry rotations.


Along with @BChanMed and two others from our school I’ll be spending the last week of August submerged in addiction treatment. Although the other patients will know we are at the center for a learning experience and despite the fact that we will have lectures geared at treatment from a physician standpoint, a large part of our week will be active participation in the unique treatment program put forth by the center. We will learn the ins and outs of treatment by participating first hand in small group and counseling activities with other patients who struggle with various addictions.


The Betty Ford Center is the only US addiction rehab facility currently offering a program like this for medical students and I am so honored to be a part of the Summer Institute for Medical Students


First hand participation has been proven time and again to be pivotal in teaching us to be great physicians, but personal experience has taught me that physician-training in the area of addiction treatment is lacking, to say the least. It is not just those of us who choose Psychiatry as our specialty who will interact with people struggling with substance abuse or addiction – these are afflictions felt by patients from pediatrics to geriatrics and everywhere in between. I am so grateful to have this medical education opportunity and I hope that other programs will take note of the Betty Ford Institute’s revolutionary initiative and increase the number of medical students offered this opportunity by following suit to create similar programs. 

I anticipate a life-changing look into how professionals go about treating those who struggle with addiction and also help in teaching their family to be assets of rehabilitation. I am confident that I can take what I learn in my week at the center and translate that into compassion and understanding for the benefit of my future patients and I hope that this experience will enable me to be a better doctor, a better daughter and a better educator.


*My Step-Dad is also a huge influence in my life and if I were writing a post for Father’s Day he would most definitely be included. I’ve written a bit about him & organ donation advocacy here