Thursday, January 11, 2018

Lifer


I am a learner with a student problem. I have been a student at UC Davis my entire adult life. A week before my 18th birthday I packed all of my worldly possessions into plastic tubs stacked neatly in the back of my mom’s minivan and drove to my dorm room here at UC Davis. I got out of the car, made my bed with extra long twin sheets and my whole life changed forever.

15 years later, I am about to become a five-time graduate of this institution. Being an Aggie has been one of my greatest and proudest achievements. To be able to learn and grow in a place where I feel loved and challenged is why I have never been able to part from Davis. The teachers and mentors I have met along the way—those who encouraged me and helped me, are the reasons I have been successful here.

Throughout my tenure I have completed over 1000 quarter units and the running total of my tuition bill could buy a rather large house in the Midwest. I love learning and I take my commitment to education seriously.

I ring in the New Year not in January with champagne and a count down to midnight, but every fall with fresh notebooks, pens and the crispy crackle of new book bindings.

I believe fervently that education is the great equalizer. I believe in the hope and the promise an education can bring.  And I have seen it. I have seen education change the lives of my friends and classmates. But we must remember that education only works in so much as we let it. A 2002 study from the US Department of Education found that disadvantaged children are often placed in low-resource schools, magnifying initial inequalities between them and their more advantaged peers before they have completed the first grade. If we are to be champions of life long learning, then we must make a commitment to prioritize and advocate for equitable and quality education from the start.

I’d like to tell you that being a professional student has always been wonderful and easy and joyful. But the truth is—like anything worth having in this life, its been hard and scary and I have known great failures and disasters along with my triumphs. Being a life long learner is not using a free afternoon to finish off a book you’ve been neglecting. But rather a commitment to forever trying things you are bad at, failing and a willingness to be humbled.

My recent venture in humility was during my anesthesia clerkship. The resident asked me to hand her the IV bag, and I was so excited that this was a task I felt that I could reasonably accomplish that I ripped the tubing off the bag and was promptly doused from head to toe in a liter of very cold saline. One of the many lessons I learned that day was that scrubs turn see through when they get wet.

To borrow from the adage in the Pixar film Ratatouille—‘anyone can cook,’—anyone can learn. Our brains are amazing, and adaptable and capable of way more than we think. By tolerating and dare I say, even searching for the edge of our comfort zone—where we learn and forget and learn again, get it wrong the first, and the second and if you’re a med student—the third time, until we finally get it right—that’s where the good stuff is.


And the best part is—it doesn’t matter what it is you’re learning about. With the internet and iphones, the world really is at our finger tips. So wherever you are in life, I hope you’ll join me in being a student. Let’s rev up out search engines, make mistakes and break in those book bindings. Pull up a chair. I’ll put the coffee on.

Saturday, December 16, 2017

The Lovely Bones


The foot bone’s connected to the shin bone. The shin bone’s connected to the knee bone. The knee bone’s connected to the thigh bone. The thigh bone’s connected to the hip bone.” –Dem Bones, JW Johnson, 1928.

For the last two weeks, I have been on an orthopedics rotation.

It wasn’t exactly my first choice to be honest. I usually enjoy being on the other side of the blue drape, but this elective fit my schedule so perfectly, I couldn’t pass it up.

Before I started, I sealed myself mind, body and spirit. You see, I had heard stories. Namely, my cousin who had aspirations of being an orthopod himself recounted getting shoved and having surgical instruments thrown at him whilst on his ortho rotation—ultimately choosing to go into internal medicine instead. Additionally there had been rumblings that ortho residents could be just a tad inappropriate, with reviews regarding their treatment of medical students decidedly negative. So when Monday came, I was ready. Ready that is to have a completely miserable time.

Ortho is one of the most male dominated specialties, both here at Davis and across the nation. According to the current listings on the Davis website, there is just one female ortho resident here. And if you give me the chance I will fly into a rage about the patriarchy and how women make better doctors (duh its science), but then I am reminded of the words of Dr. Berkowitz—the first woman to graduate from UC Davis, who said,

“if I had no male mentors, I would have no mentors at all.”

The ortho service was not where I expected to find mentors, let alone people interested in learning my name. I had so deeply ingrained the stereotypes of this specialty in my mind (sorry Max), that I am guilty of imparting the bias I was so ready to accuse others of. When meeting a woman ortho attending, who introduced herself to me and then said she was faculty, all while the green stripe on her badge was visible—I proceeded to ask her what year resident she was.

But luckily, most of the ortho residents and attendings I worked with are committed to promoting women in medicine and particularly in orthopedics. One of the attendings who is literally a foot and a half taller than I am—challenging stereotypes in his own right that white men can’t jump---is the last person I would expect to be an advocate for women’s health. But as it so happens menopausal women break bones, and often require the services of an orthopedist- meaning that these doctors find themselves as part of the care team for women. I was touched to see the level of commitment and advocacy these practitioners have to their patients. Something all specialities should strive for. 

I am grateful to have been included as part of the team, something which has never happened to me in an OR before. I was involved in all things, including holding a leg over my head for an Achilles release all the while trying to look relaxed. Noticing my arms were starting to shake the fellow used one hand to hoist the heel skyward, giving my shoulders a much needed rest.

Just pretend you’re at Crossfit,” he said. We both laugh.


And with that, maybe, just maybe, for two weeks…ortho was in my bones.

Thursday, December 14, 2017

Words with Friends


Greetings gentle reader! I hope you are well. Sorry for being away for so long. As you may have guessed I have been on the interview trail for anesthesia, and then came down with the worst cold in human history. But alas I survived and here I find myself in bed on a morning off, laptop on lap, New York Times open and coffee in hand. “Jewish Sunday” my friend Emily and I like to call it. With the colder weather, I hope you are finding your own warm and cozy spots these days, hopefully one spent surrounded by loved ones, whether they be of the human or four legged variety. As we gather for the holiday season, many traditions involve reminding ourselves that the light will return, whether its by lighting candles or untangling masses of LEDs on a string, or lighting a fire. But let us not forget we bring light into the world in other ways as well, with our words and with our actions.

As I (begrudgingly) listen to the news these days, I am reminded of how important it is that we not ignore the power of our voices. It starts with framing a situation or a problem so that we are moved to action. First we are changed, then we change the world. Dumbledore said it best, “words are in my not so humble opinion our most inexhaustible form of magic. Capable of both inflicting harm and of remedying it.” Sometimes we forget the magic inside of us, and the power our words have to create change.

When I’m having a low moment (or day, or week for that matter) I open a folder on my computer full of screen shots I have saved over my four years of medical school. There are only a handful or so, but they are of the kind words attendings and residents have written about me. The first in my collection was from an internal medicine doctor who was so kind to me during my first rotation of third year. He has even continued to help me even though I’m not going into IM. He didn’t need to write such kind and lovely things when in fact I am almost certain I was a fairly average medical student on service. But his gracious words have stayed with me since he wrote them. They have become more powerful and more impactful on my life than whatever final comments or grade I received for the rotation. And if I think about it, writing those words was not really that hard. It probably didn’t take him very long and yes he could have mentioned stuff for me to work on or whatever—but instead he gave a third year medical student the belief that she is going to make a good doctor. His words became something for me to live up to and for the first time really made me think about the choice we have to lift others up with our words, and how very little it costs us indeed.

There have been times since then when I’ve filled out evaluations of other people or responded to slightly annoying emails. Opportunities where my words could go either way. Let me tell you—the pull to type a curt email and use the most delightful of passive aggressive phrases, “per my last email,” is really strong sometimes, mostly when its early, mostly before coffee. But when my fingers hover above the keys, I ask myself WWJD or rather “what would Dr. Jones do.” I cannot tell you the kindness that man has shown me, mostly when I sent rather annoying emails or a time when he lead rounds on PSM and I found myself ever so slightly underprepared. People like him make me want to do better, to be better. And his graciousness and patience (Lord help me get some of that) add up to him becoming someone in my life who I know I can go to for help, someone who I regard as especially wise and humble and a role model. How did that happen? What magic is this? How do the words that we say change us so deeply.

I see it in other ways too. Like a great many, I fell in love with the play Hamilton, and a highlight of 2017 was getting to see it in Hollywood (and it was all I ever thought it would be). Living only a block and a half from the Pantages Theater in a fairly shitty part of town did end up having its perks. And while listening to the mixtape, I started to learn more about Miranda and how he wrote his most famous play. He was on vacation in Mexico and was reading Hamilton’s biography and decided to write a play about his life. It sounds crazy on the surface or like he had one too many pina coladas. But if inspiration strikes, don’t ignore it. Give in and see where it takes you. The words in your head are powerful beyond measure. And God love his friends and family who supported a rap musical about our first secretary of the treasury—those people are saints. Miranda has gone on to use his talents to raise money for Puerto Rico with his song Almost like Praying. How did he do that? The song is only 3 minutes long and yet has raised millions for people on an island the United States has forgotten. How do words move us so? He has also become one of my favorite people on Twitter (besides @KeyonRMitchell and @chicanobrother of course) and let me tell you for those not on Twitter—it can be a dark place these days, but Miranda has a way with precious few characters to impart strength and motivation to all who follow him—and to lead us to action with his words. You can learn more about his Toys for kids in Puerto Rico drive here, trust me your soul needs this right now. https://www.toysrus.com/toys4PuertoRico.

I have to be honest Gentle Reader, that most of the time I don’t feel very powerful. I wonder if the things I do and say really matter at all. Reading the news gives me the feeling we are on a high speed train going to hell and I wonder if I dare stick my baby toe out of the window to slow it down just a little. But then I look at all of the words that other people have told me and I hear their voices in my head and I feel the earth beneath my feet getting stronger and the tiny piece of the world I live in doesn’t feel so small. And the words and ideas in my head have more power and strength than I give them credit for. So my wish for you this holiday season is that we remember to turn on the light when things are most dark. May we use our words to move ourselves and others to action in creating a better and more equitable world. Together we light the way for each other. Together we find our way through the dark. 

And in the time it took you to read this, the world didn't change, but you did. Magic. 

Happy 2018. 

Sunday, October 8, 2017

GimmeSOMM

I think its no secret that I am partial to a glass of wine every now and then—in the most responsible and adult way of course. What pairs perfectly with wine you ask? Ahh yes….Netflix. While I was studying for Step 2 I would reward myself after a hard day of highlighting and question banking (it’s a verb okay) with a documentary. So one evening after a hard days graft, I stumbled on a rare gem of a film called SOMM. Its short for sommelier and it follows the journey of 5 young men (ugh I know, I know, patriarchy and things) on their journey to become Master Sommeliers. 

Not only was this film the fusion of my two life passions, wine and documentaries. It also looked a lot like studying for the boards. Because the master sommelier exam is hard. Like really hard. Like there are only 124 men and 25 women in North America (including Canada) that hold the title of master somm. The film details the arduous studying they have to go through, including pain stakingly drawing maps of the different wine appellations (btw there are over 350 in France alone), making flashcards and blind tasting wine after wine after wine in hopes that by look, smell and taste they will be able to correctly name grape varietal, country of origin, appellation, level of quality and vintage. Its pretty freaking magical to watch and I knew I had to find out more.

I looked up the Court of Master Sommeliers website and as luck would have it there was an introductory course taking place in San Francisco in 5 days time. Wine in one hand, credit card in the other I signed up. This is going to be magical. But then I was perusing the internet and reading other people’s accounts of the class and as it turns out they recommend you study ahead of time, because the test you have to take at the end of class is actually hard. Shit. More credit card, more wine, I ordered a wine book off of Amazon so I could read up.

Come Saturday at ‘its-too-early-for-wine o’clock’ I found myself in a gilded conference room at the Sir Francis Drake Hotel in Union Square with 80 other Somm hopefuls. We find our seats and the Master Sommeliers introduce themselves. I have the biggest fan girl moment at meeting (aka seeing from across the room) Reggie Narito—a master featured in the documentary Somm. A master from Australia stands up. “You’ll never guess what happened yesterday,” he says, “a customer said he liked full bodied wine like Pinot Noir.” The whole room erupts in laugher.

I’m so screwed.

What follows is a Q&A account of the next 48 hours, and my journey to sommelier.

1.     Is this all bullshit?
So the short answer to this question is yea, probably. And the long answer is…well, maybe. It does sort of feel like the emperors new clothes at first. Especially where the tasting is concerned. During the class we passed a microphone around the room so that each student—aka me and other 79 people now gripped with panic, could practice blind tasting. You say what the wine looks like, smells like, tastes like and then you take a stab at grape varietal, region of origin, vintage and quality of producer. You’re going to have to trust me that its stupid hard. The first guy to give the nose a go said everything he could think of. “Leather, gravel, spices, lemons, cherry, nutmeg.” You can’t just name off random things, but as it turns out, different wines do smell differently. Take for example my personal favorite the Sauvignon Blanc, it smells like green peppers, grass and grapefruits. There are some wines that smell like diesel fuel, others like flowers. The more you do it, the more you notice. A word to the wise—wine can smell like basically anything, but for the love of God do not say it smells like grapes. Now take a deep breathe and tell me you aren’t getting a wiff of fresh tennis balls ;)

2.     Surely the room is full of stuffy old white guys?

It probably used to be. The majority of somm’s are still white men, but as it turns out the tables are turning both with respect to gender and race. Women outnumbered men in my class. There was a great deal of diversity regarding race and age—as it turns out younger people are getting wise to just how lucrative wine can be. Each year the class of people passing the master somm exam becomes more diverse. The world of wine is being a more inclusive place. The Court of Master Sommeliers has a strict no discrimination policy and the times of men’s only clubs and smoking rooms has faded in exchange for a more diverse, younger, less white and decidedly more female crew. As it turns out, wine really is for everyone.


3.     Its just wine right?

Oh my God, I wish this class was just wine. In fact the purview of a sommelier covers spirits, sake, lager, ale, cider and cigars. Not to mention a sommelier must be well versed in all aspects of service and wine law. Wine law and wine production is conducted in 5 primary languages. I’m just going to venture a guess that you probably only speak one of them. Our class on the first day covered France and was taught half in English, half in French. Additionally wine laws, taxation, importation tariffs, labeling requirements, font size of the label, on and on, and in French no less. The importation of alcohol used to be grouped with tobacco and firearm importation, leading to the nickname ‘bullets, butts and booze.’

4.     How expensive is it?

Everyone except my Dad is allowed to keep reading. It was stupid expensive. Look away Dad, look away. The thing is that I signed up for the class while awaiting my step 2 scores, which I decided I had failed. I was going to need to find a back up career and pronto. They have a saying in wine, “how do you make a small fortune in the restaurant biz?” “Start with a large fortune.” The only way to make it as a Somm is to work for no money and be able to taste for free. Otherwise you have to be very very wealthy. At the very least compared to med school it’s a drop in the bucket.

5.     What can we learn from wine?

We rush though life these days. Constantly glued to our phones, demanding instant gratification. The monkey mind is always on. Additionally, working in the medical field we aren’t necessarily encouraged to take full advantage of all of our senses—particularly smell and taste. That’s probably a good thing where hospital life is concerned—I’ve done a lot of mouth breathing and having the nurses put peppermint oil on my surgical mask these days. But always forgoing smell and taste means that we are not fully experiencing the world. Taking the time to look at, smell and taste what is essentially a glass of fermented grape juice really can awaken our senses in all other aspects of our life. Savoring something instead of just horcking it down all the time can add a richness to our crazy, phone filled lives.

6.     What does it take to be a Master Somm?

I asked the only female master sommelier who taught our class this question. “How many seasons was Sex and the City,” she asked.  “Ummm….seven,” I reply. “Exactly,” she said. She went on to explain that she worked for seven solid years to not only study for the test, but to practice her blind tasting skills. She moved to Italy, she worked for next to no money in order to taste, even splitting tastings with a friend. The sacrifice it takes is definitely on par with medical school.

7.     Do you really lick rocks?

Yes.

8. What's on the test?

Yea....I can't tell you that. I was sworn to wine secrecy. But I can tell you that studying is most definitely necessary. Word to the wise, drinking wine and studying wine are decidedly different things. 


And at the end of a grueling 48 hours, 24 glasses of wine, 2 glasses of champagne, 518 pages of lecture notes and a 75 question test. You’re looking at the newest Introductory Sommelier.

Tuesday, June 20, 2017

How to be Good

“Make me good God. Make me good. But not yet.” – Nurse Jackie

The literal dividing line between anesthesia and surgery is a rather thin, sterile paper, blue drape. Anesthesiologists have kind of a thing about it actually. Everyone likes to secure the drape differently. I swear as long as I live, I'll never do it right. Even the most laid back resident has redone my perfectly secure drape. The art of drape folding is shockingly not something taught in medical school, so the first time I clamped down on the IV pole, cracking the plastic clamp and sending pieces of it flying precariously near the surgical field.

I’ve never seen that one before,” the resident said, quickly fixing my mistake-- and never trusting me with his sacred drape again.

Starting IVs is another thing they let the med student struggle with. The very first time an attending suggested I start one, my hands were shaking so badly I couldn’t even grab the needle from the drawer. He took one look at me, and then kindly suggested we "do this one together." Even when I did manage to get to the stage where you poke the skin, I was missing almost every one. Even in the SIM session we did. Every single stick on those stupid unrealistic plastic mannequin arms I was missing. They bleed food coloring. After a while even the saint like patience of the resident I was working with was growing thin.

You’re not looking at the catheter,” he said grabbing it out of my hands. 

I am looking,” I say back rather annoyed.

Not you’re not,” he insists, "watch me," he says sliding the needle effortlessly into a vein. 

We would do well to be a little more real about the learning curve regarding practical skills—especially cynical, impatient little busybody me. I don’t know how to fill a syringe with propofol without spilling it all over the place.  But because I spilled it, I now know how not to. You get good by being bad. How unfair.

Struggling and messing up is where the learning happens. Its important to try to run into situations where struggle might be possible, instead of avoiding them. For example, I tried every IV I had the opportunity to. And I missed a lot of them. But I am getting better. Well…at least I can grab the needle out of the cart…and I call that progress.

Intubation is another one of those skills that's semi-important on the patient’s not dying front. It can be tough, because getting the feel of the blade, the tongue, knowing what it is you’re supposed to see—that takes practice and it takes struggle. During one such attempt I looked up at the resident with those big “help me I’m stuck” eyes. “I’m just going to let you struggle,” he said like he had read my mind. Ugh. And struggle I have. 

I have found a million things I’m terrible at doing. A million more ways to mess stuff up. Umpteen questions I cannot answer, words that I do not understand. My facial expressions as of late alternate between raised eyebrows, nodding and my personal favorite—the blank stare.

But the more I try, the luckier I get. The days where I get both the IV and the intubation have increased in number. And that makes me feel good. And then the thought creeps into my head that maybe I’m actually good at this. Maybe I can actually master the art of drape clamping. And just when my step has a little swagger to it, the resident asks me to grab the IV for her. I pull the bag off of the tubing and am promptly doused from head to toe in a liter of saline. 


“Make me good God. Make me good. But not yet.”


Friday, June 9, 2017

23&us

It started like junk mail....

Hi, I just tested my DNA on 23andME and it says we are first cousins!?! Not sure who you are, but would like to find out more and see if this is in fact true. My name is David and I'm 36 years old. take care

I ignored it. Probably some guy in his mom’s basement sending weird messages to girls. Gross. I almost hit delete, but got distracted and just closed my computer instead, and promptly forgot about it.

A couple months later I signed into my 23&me account. And there he was…a stranger...in my gene pool. Who is this guy and why are we 12.5% related. And then I remembered the strange message from earlier. I decided to reply with facts about these tests being horribly inaccurate and who knows what they really tell us. And as I started typing I looked at the next closest related person to me…0.6% related, is my next “relative” on 23andme. 12.5% well that’s first cousins…and I knew I had to know more. Even if it was some guy in his mom’s basement.

Hi David, Yup-- this is super weird. I thought that I knew all of my first cousins because I have a fairly small family. Where do you live? -Fiona

Hi Fiona, I live in Canada just outside Toronto. I thought I knew all my first cousins as well, but now that I think of it, I do remember hearing a few years back that one of my Uncle's (who is now in his late 60's) got a girl pregnant in high school and she was "sent away" somewhere to have the baby. Not that I think that plays into this circumstance, but it just reminded me of the fact these things were kept hidden in the past!

Oh Jesus Christ. Is that baby me? Have my parents concocted some really convincing and elaborate story about having me? And also why then do I have my Dad’s forehead? Being some secret love child didn’t really appeal to me. Unless I’m a princess, then I’m game.

Our conversation went on over the coming weeks. Sometimes we just asked each other more about our lives, and sometimes we dived deep into the nitty gritty of our families. We imagined secret affairs and adoptions and immigration stories of all kinds.

Hi David,
My mom's parents do live in England, but they were displaced german jews and relocated from Germany after WWII. My dad's dad still lives in Scotland and he has three children, my dad, my Uncle Mark and my Aunt Kirsten. My uncle Mark actually lived in Toronto for a while.
-Fiona

Hi Fiona,
The only new thought that has crossed my mind today is that my maternal grandfather fought in WWI and would have been in Europe for a few years at that time. Does that somehow play into it? This is kind of exciting! take care, David

And just like that, we were both hooked. We looked up old newspapers and online archives trying to find a relative we might share. I was in full on detective mode. And David was right, this was kind of exciting. I only did 23&me for extra credit in a genetics class I took during college. The class was boring and I didn’t really find 23&me particularly interesting….until now that is.

And then one day, while lying in bed, trying to fall asleep. I knew. 

David lives in Toronto. The same city that my Uncle Mark went to grad school in. David and I share 12.5% of our genes. First cousins. First cousins share a set of grandparents. First cousins have parents who are siblings.

It became more and more clear to me—and perhaps you may have already figured it out—how we are related. But the thing was….David hadn’t.

How do you ask someone how sure they are about their mom and dad actually being genetically related to them? I just couldn’t do it. I stopped answering his messages.

While I was taking a break from our now 17 page long conversation thread. I called my Dad.

Does Mark have a son?” I asked him.  Because I think I’m talking to him and his name is David and he’s 36 and he lives in Toronto.”

I can’t remember exactly what it was my Dad said. But I’m guessing probably some explicative coupled with shock and an “are you sure” thrown in for good measure.

David kept sending me messages about his family. His British grandparents in WWII. His father’s family who have lived in Canada as far back as anyone can remember. On and on into marriages and births, the Great Depression, the Cold War. It was the most epic history lesson I have ever had.

I plied David with occasional messages back. I told him about a half uncle I have. The 4th child of my grandfather. I told him how much I love Canada and how attractive their Prime Minister is. And I asked him what he did for a living and about how high the snow drifts get in the middle of winter where he lives.

Hi Fiona,
I am an anesthesiologist. Maybe medicine is in our genes!-David

Anesthesia you say? In our genes indeed. And somehow him being a doctor made things a little easier. He knows how it works. He knows genes. He knows science. I tell him about school. He replies with “Don't worry it gets better after med school.”

Oh, he’s such a Canadian. And so so nice. So after much debate and a large glass of wine, I sent him a long and rather cryptic message suggesting that perhaps my Uncle Mark might be his father. He wrote back with a longer and more confusing message about how I might be the daughter of his uncle. I asked him about his forehead. My grandfather, my uncle, my dad and me…well we have a serious case of forehead going on. And I bet David had it too.

Hi Fiona,
Regarding my forehead I would say it is normal size.- David

I sent him my LinkedIn profile so he could see a picture of me. He wrote back…

 Hi Fiona,
Your forehead is not that big. David 

And then a few days went by…and I got this message.

Hi Fiona, Are you able to call me?

Oh God. He figured it out.

I called him from a friends house, excusing myself from the libations to talk to him in the stairwell of their condo. He had driven across the city to ask his mom about who is father was. And there in his mother’s living room on a freezing winter night in Canada, a 36 year old learned that his father was not a genetic relative, his sister—actually a half sister. His parents were unable to conceive children, so used a sperm bank. My Uncle Mark had been a donor.

The last message David and I exchanged on 23&me reads,

Hi Fiona, It was great to chat with you tonight. I guess the mystery is solved. We started off thinking about secret love affairs in the distant past, never in my wildest dreams did I think the true story would hit so close to home. take care, David


David and I still keep in touch with the occasional email. He was actually able to meet my Uncle Mark and my Dad at the wedding of my half Uncle. David has a loving family of his own, and his parents are still just as much mom and dad as they were before. And I guess if I’ve learned anything from this experience, apart from reaffirming my love of Canadians. Its that we are all related. We are all family. We're all cousins. David and I just like to think that now he has a bonus family. A slightly crazy, overbearing, large foreheaded bunch of British people who really don’t care what percentage of genes we happen to share.

Saturday, May 6, 2017

You're Everything that I Want


Hello Dears,

I hope you are well. I just got back from Hawaii (I know, I know, don’t hate me). I am just the right amount of hung over, sunburned and jetlagged, which if you ask me is the perfect frame of mind to provide you with some unsolicited advice. You’re welcome.

I would bet, that if you stood in front of graduating medical school classes and asked everyone to raise their hand if they thought 3rd year was the hardest year of medical school, I would guarantee that almost everyone would raise their hands—that yes, indeed 3rd year is the hardest year you will endure out of your time here.

This is why I had to go to Hawaii. My soul had to heal. Because it was one helluva year. During my vacation I had time to think about what information and advice would have been helpful for me to have before starting the year. I also visited a Seahorse sanctuary and saw baby seahorses, so there’s that.

The thing is that most people who have done even 1 rotation, really want to tell you about their personal experience. Myself included. Can you blame us? We survived—and we want to tell you about how we did it. The thing is I can almost promise you that you will have a different experience than anyone you talk to. That’s just life.

So I have compiled some helpful tidbits of wisdom, mostly devoid of my own personal experiences with the rotations (email me if you’re going to Redding, I have things to tell you). I hope these little nuggets will be helpful to you. They are the things I wish someone would have told me. And if you read no further, know this—you will make it through this year. I promise. We’re behind you, every step of the way.

1.     Don’t lie, but you probably will.
You’ve probably heard this one before. Like don’t say the patient’s potassium is 3.5 if you are only sure that its 3 point something. Seems reasonable right? But sometimes a resident will be like hey, “is she constipated?” And you’ll be like, “Um…no, don’t think so.” And then it will turn out that she is and blah blah, makes you look not very good. This kind of thing actually happens fairly often—just try to make sure the response that comes out of your mouth is, “I’m not sure,” or “Hmmmm….unclear.” or “I did not specifically ask her about that.” Its just better for everyone you know. So have some response always on the tip of your tongue that resembles I don’t know.

2.     You’ll never find anything or know where you are going.
You are going to be asked to grab things. And its completely unfair because likely you will have no idea where anything is, let alone the code to open the clean utility room. You ever used to watch the show Legends of the Hidden Temple? Used to be one of my favorites. Anyway if you didn’t experience Nickelodeon in the 90s, its basically kids running through a maze trying to find a statue—you see them rummage and fumble around trying to find this impossible-to-find thing quickly. That will be you. Go Team Barracuda! You’ll never find anything (at least not within the predetermined time limit). Honestly, best thing is to ask someone else—beg for help—usually works.
Okay I know I wouldn’t tell you about my own experience, but just this once. On the last day of third year, on the last day of my surgery rotation, we were in the OR and the attending looks at me and says, “find me a piece of blue foam.” Yea, sure buddy. That sounds readily available and easy to find. So I knelt down next to the supply cart, about to announce that I—once again—was unable to procure the needed item….when, there it was. A perfect piece of random blue foam sitting where it definitely should not have been. I grabbed it, still kneeling, and held it up to the surgical lights. The heavens opened and the Hallelujah chorus played. And that my friend will never happen to you.

3.     You want to be a doctor when you grow up, not a third year medical student. This one really should go without saying, but as you go through this year, remember that this is just temporary and not the state of being you will be in for the rest of your life. You will be in charge and make decisions and command other people. Being the bottom of the rung and constantly following behind other people—that won’t always be you. No one puts baby in a corner. Except you this year—sorry.

4.     Your white coat will not stay white. Whether you spill coffee on it, or perhaps have a very unfortunately incident with a blueberry yogurt, its just going to get gross. Try to get a spare one if you can. I still have no idea how to do that. Drying cleaning is your friend. Blueberry stains no matter how much bleach you use.

5.     You are never alone. I mean, at 4am pre-rounding on East 6—yes you may physically be alone, but we’re never far away. Lots of people are doing this with you. Get together and talk about what’s its been like. It feels so good. Use the doctoring check in time. Amazingly cathartic.

6.     Let yourself off the hook. Not everything and every interaction is going to go right. Trust me I wish it did, but it just isn’t going to. That’s okay. You’re human and you’re trying your best and that counts for a great deal of this year. Show up on time, have paper and pen (I refuse to carry those stupid folding clipboards because I pinched my hand in it once—never again), try to look interested or at least awake. Getting up early does sort of get easier—remember I said sort of. Warning: you will likely loose the ability to sleep in (at least temporarily). Try not to be the dick who wakes up your whole house, dog, significant other when they are trying to sleep like a normal person. Its rude. And you are now a morning person. Welcome.

7.     Drink hospital coffee with caution. You know usually its lukewarm. Like everyday for the last year it has been—the one time its piping hot you’ll burn your mouth. You’ve been warned.

8.     Some doors in the hospital you have the push to open them. Some doors in the hospital you have to pull to open. Good luck figuring out which is which.

9.     You are loved. You are so desperately and insanely loved and valued. And this year it may not often feel that way. Just because you are now a 3rd year does not change the fact that you are a good, loving, kind human being who should be shown respect and kindness. People may be mean or ignore you. That’s on them, not on you.

10. It doesn’t get easier or better, but it does get over. The same struggles I had during my first rotation, I had during my last. There are just truths about being a 3rd year that never change. I still struggle with feeling confident and knowing what I’m doing. And I still feel like I have lots to learn. But you’re going to do it all in spectacular fashion and at the end of it all you can drag yourself to Hawaii like half of my class did.

11. For God sake do not leave studying for the shelf until the last minute, you’ve been warned. These are good lectures for most of the rotations.http://som.uthscsa.edu/StudentAffairs/thirdyear.asp

12. You will do good things that help people that will never show up on your evaluations. Holding someone’s hand, making someone more comfortable, whatever it is-- you’ll do good in a million tiny hidden ways. Just because they are not seen or not documented does not mean they didn’t happen and it doesn’t make them less important or meaningful. I see you and you see you—that matters most, keep at it.

And if you lose your motivation I like to watch these, I find the intro oddly inspiring.
Go forth my brave warriors. The Class of 2018 is here if you need us, anytime, all the time.
Third year looks good on you.