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.



Thursday, April 6, 2017

Your heart or mine?


Greetings Gentle Reader, 

If no one told you today, thank you for everything you do. Your hard work is appreciated and it gives me strength and joy to know that I live in a world with such wonderful people in it.

I also hope that you are treating yourself gently. God knows you deserve it.
***
I want to talk about people who throughout this year have treated you badly, who may have wronged you or ignored you, those people who only seem to remember your name when they need something or want to ask you ridic questions in front of large groups.

At some point this year, maybe this week, you were not treated with kindness and mercy and grace and humility, but with anger and frustration and fear and dare I say even malice.

I was recounting to my doctoring group this evening that emphatically these people should step on a lego. No doubt. Being anything less than gracious and kind and respectful to our fellow human beings isn’t how we should be treating each other, seeing how short human lives are n stuff. Ironic that in a hospital (a building which sees death on a daily basis) we should forget this fact. 

So after a frustrating day attempting to interact with the most type A-e-ist of type A people (who just want to break off the tip of the A and stab you in the eye with it), I was really having fun thinking about how karma will smite them and how I’d like to give them a piece of my mind (theoretically that is).

But then I got home, carrying a fresh bunch of daffodils Emilie got for me. I took a shower, I put on clean pajamas, I sang along to Tale as Old as Time and curled up in bed with a new book by my favorite author Anne Lamott (or St. Anne as I like to call her). I thumb through the first pages and it reads;

“Mercy means that we soften ever so slightly, so that we don’t have to condemn others for being total shits, although they may be that, (okay: are)….Kindness toward others and radical kindness to ourselves buy us a shot at a warm and generous heart, which is the greatest prize of all.”

Dammit. I’m so screwed. I don’t feel like being merciful or kind to people who make me and my friends feel bad. I’m just not that mature. And I doubt that these people will know or care that I have softened my heart towards them, or dare I say forgiven them for being wrong, for being rude, for being mean, for using their power to belittle instead of lift up, they were wrong and I want justice. Justice I say. 

As I type this, I am reminded of two things. #1. I have been so very undeserving of the mercy and forgivness others have granted me in my life. And so very grateful that I have crossed paths with lovely, kind people who say in spite of my mistakes, in spite of being rude and self-centered and lazy and dumb, that they still love me, still think I’m okay and the biggest gift of all is their forgivness and forget-y-ness of my messy interpretation of what it means to be human. Thanks.

Thing #2 I am reminded of an 83 year old real estate agent from Terre Haute, Indiana. Her name is Eva Mozes Kor, a survivor of medical experimentation in a concentration camp at the hands of Dr. Mengele—a Nazi doctor conducting “research” under the name of the Max Planck Institute. Eva lost her entire family during the Holocaust and was very nearly killed herself. Eva came into the public eye when she announced that she forgave Dr. Mengele for what he did to her and her family. She issued a written statement of forgiveness to the Planck Institute and was featured in a documentary about her choice entitled, “Forgiving Dr. Mengele.” (Netflix it, its amazing). Her decision to forgive shocked a lot of people and actually upset a great many in the Jewish community who believe that the Holocaust is unforgivable. I can’t disagree with them, but Eva explained that she decided to forgive Mengele for her benefit, not for his. You go girl.

Don’t worry, I’m not trying to compare WWII or Hitler to being treated like crap on a rotation. My point is, that if Eva can soften her heart against the war crimes and human rights abuses that were committed against her-- then I guess I can forgive the people that were mean and rude and ignored me. I guess I’ll work on it anyway, not for their benefit, but for my own.

So dearest fellow human beings--wherever you are--who have been rude and mean and unkind. I forgive you. I know you could have done better. We all can try to do a little better—even me. What do you say we chalk this one up to life eh? Our very precious, way too short, beautiful-in-spite-of-everything life.


My daffodils remind me that spring is coming. And my calendar reminds me that there are two weeks left in this rotation. And my heart…well it reminds me what love and forgiveness feel like.

I guess its starting to soften it just a little.




Friday, March 17, 2017

Fear and Loathing in French Camp


Hello My Beautiful Reader,

I hope you are well. I feel like we should just hug each other next time I see you. As you probably heard from my incessant whining and complaining- Steven and I are doing part of our surgery rotation in Stockton. We live in a shitty building with no hot water and there are spiders. Spiders. Ugh.

But it is important for me to tell you more about what this county hospital--built on an alpaca farm--on the outskirts of one of California’s most dangerous cities, is like.

Recently I bonded with Dean Henderson over the use of paper charts—something this hospital still uses. In the mornings, before rounds, the med students have to get there several hours early to run around and write down all of the vitals from the paper charts overnight for the residents—something Henderson himself remembers doing when he was in med school—like 30 years ago. I’m not bitter…not bitter at all. But paper charts are dangerous and they waste everyone’s time. I know EMR has its problems but its 2017 people. Get with the times. You cannot check medication interactions on paper and I can’t read your god damn handwriting.

Another absurdity that takes place here is the design of the hospital building itself. Let’s just say it puts the east wing of UCD to shame. There are two buildings, the newer part and then an older building called the towers- a medieval looking building made of stone bricks. Interestingly enough if you are standing on the third floor of the new building and then walk across the completely flat breezeway to the towers—you would find yourself on the 4th floor—without actually going up a floor. It’s a relic of how the floors were numbered and its super weird. Steven likes to tell me where to go in the hospital by using words like, “north”  and “south.” These words mean nothing to me Steven. Nothing.

Amidst this rather shitty building, with its shit system of patient record keeping and stupid layout, there are some really sick folks.

This morning when I was walking through the ER waiting room, the inscription of the Statue of Liberty came into my mind.

"Give me your tired, your poor, your huddled masses yearning to breathe free, the wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed to me, I lift my lamp beside the golden door!"

I know it sounds a little saccharine, but the people sitting in the ER waiting room, in Stockton at 4am—well they look pretty tempest tossed to me. The hospital is full of people whom society has forsaken and forgotten about. One of the features that was advertised to us at the start of our time in Stockton was that the pathologies of patients were “really good.” And of course by really good, they mean really bad. Disease so advanced we might only expect to see it in other, underdeveloped nations. And yet here they are, right in our own backyard. We see patients so in the grips of poverty or mental illness or drug use or victims of violence and tragedy of tremendous proportions.

We often visit the room of a recent trauma patient we saw. We peak our heads in and see family and friends visiting, leaving pictures and notes and whispering words of love and encouragement. We look up recent labs and imaging and physician notes—anything that might give us a glimmer of hope that things won’t end terribly for this family. Sometimes we glance in the direction of the room and shake our heads or ring our hands.

Stockton is a place of paradoxes. In spite of limping along with paper charts and poor design, this hospital catches our most vulnerable and for the many victims of violence in Stockton has often been the only thing between those people and death. Our trauma patient is getting good care. People who come to this hospital get help—although its often not nearly as much as we hoped. I think the woman who delivered her baby on the floor of the ER waiting room might attest to this. It’s a miracle-- but its messy and not anything like we thought it would be.

We only have a week left in French Camp, and while I can’t wait to get back to Davis, I am reluctantly grateful for my time here. While I will continue to fly into a rage about the copious amount of carpeting in the hospital (who does that?) and the fact that I spend my day tracking down charts, I have nothing but respect for the men and women who show up everyday to an imperfect building, with an imperfect system, in city rife with problems, to help people with no where else to go.


Thursday, March 9, 2017

Admit


I have often wondered what it feels like to be a patient in the hospital.

My personal experiences as a patient have been limited to the occasional clinic visit, having my wisdom teeth removed and a brief visit to the ED when I was 17, after cutting my foot open while backpacking in Point Reyes.

For all intents and purposes I stay securely and safely on the provider side of things. We get to keep our clothes on, we can for the most part eat what we like, drink what we like and unless you happen to be retracting in the OR for hours on end, we can use the bathroom when we want to.

Sure it can be a little uncomfortable and down right exhausting to be working in the hospital taking care of patients. I’ve started to refer to all the walking and rounding and standing we do as ‘slogging in my clogs,’ and I know you know the feeling. But when it comes to actually being a patient, no less one who is acutely ill, we don’t know the feeling—at least not most of us anyway. So we are left to imagine what it might be like.  

The other day I was helping an intern pack a horrendous and impossibly deep abscess and as we pulled miles of blood soaked curlex out of the wound I got to wondering what that must feel like. Vomit started to well up in the back of my mouth.

I don’t really want to be sick or hurt. Because who the hell does? But I do want to understand just a little bit better the loss of control patients must feel, the fear, the embarrassment and the sleepless noisy nights and rude early morning wake up calls.

Back in the day it used to be a fairly common practice to admit medical students to the hospital under a pseudonym and a fake (albeit mild) diagnosis, in order to allow them to experience the hospital as a patient. The Long Beach Medical Center still has a program like this—the only one left in the country started by an Australian Family Medicine physician, Dr. Stephen Brunton. You can read more about that program here. 

Programs like this one are insanely difficult to do. Hospital resources are stretched so thin these days, they aren’t about to waste them just so trainees can try on a hospital gown for the evening. But I maintain that the lessons the participants learn from a brief time in the hospital is immensely valuable. And if hospitals care about patient satisfaction the way they claim, then I’d like to see programs like this become common place.

So I started sending emails out to hospital CEOs and CMOs, ER directors and the like, asking if I could spend a night in their hospital. The answer was a swift and resounding absolutely not. Even the task of having the IT department create a fake EMR for me was too great a task for most hospitals to manage. Additionally, I think that hospitals also feared that real harm might come to me. And perhaps they are right to be concerned, after all medical mistakes result in thousands of deaths across the country each year.

For now, I have been attempting to experience patient life in other ways. For one, I tried patient coffee the other day. No—not the coffee in the cafeteria, but the brown liquid served up in miniscule Styrofoam cups. I don’t know what it was, but it sure as hell wasn’t coffee. I also let my friend Millie put me in an MRI machine for two and half hours to study my brain for her PhD. It was okay I guess, a little loud for my liking, but at least now I have confirmation that my headache isn’t a brain tumor. And finally, I am feebly attempting to live my life as a diabetic—a diagnosis I do not really have. I have tried to write down my carbs and test my blood sugar, but after bleeding like a stuck pig all over our kitchen after repeatedly stabbing my finger with a lancet I am taking a bit of a break. Because being diabetic sucks and I can’t do it.


I hope you never actually get to be a patient in the hospital. And unless we are actually facing illness or injury our experience will always be limited. But let’s challenge ourselves to experience more of what it might be like. Try laying on one of the gurneys to see how it feels. Let someone practice starting an IV on you so you can know how badly it hurts. Try on a Philadelphia collar (literally the most uncomfortable neck brace ever). 
And if in doubt about where to start to get to know hospital life, talk to your patients, ask them more, drink the coffee—I dare you.


Monday, February 6, 2017

Medical School: a fairytale


Once upon a time, there was a princess, who had decided to go on a long journey.

She had been told about what lay at the end of a long and winding path. It was all of the good things the princess had been wanting; happiness, joy, satisfaction, riches, success and the ability to cure the sick.

The princess prepared for the trip for many years. She had heard of others who had made the long journey and asked them what it was like. She read books about the road she was to travel along and slowly she gathered everything she needed to make the trek.

The princess knew that she was very lucky that the King and Queen were able to help her. For the path the princess chose had many trolls who lived under bridges who would demand payment for her to pass.

Finally, the princess set on her way. It was sunny and the although the road was cobble stoned and bumpy, when she stumbled, she always managed to catch herself. There were many other princes and princesses walking with her. And this helped the princess to not feel so alone, for she would have certainly been afraid without them.

As the path wore on, she grew tired. Some of the princes and princesses that had started on the journey weren’t with her anymore. Some walked slower, some walked faster and some had taken different roads altogether.

Along the way the princess was tested. Sometimes she had to stay up many nights in a row without sleeping. And other times she had to walk in the pouring rain and the blistering sun.

She met all sorts of creatures along the way. Some were kind and tried to help her. They would say nice things to her and encourage her to keep going. But others were mean and made her feel afraid. Sometimes a strange beast wearing all blue robes and a mask, would test the princess by making her stand very still for hours without eating or drinking or moving. The princess hated this creature the most.

But the princess kept walking. She walked uphill, and downhill. She walked on straight paths and narrow, twisted ones. Sometimes the path was paved with stone, and other times it was dirt. And sometimes it was mud.

One day, she came to a rope bridge lashed together between two high cliffs over a river. She wondered what would happen if she fell into the water. But she did not fall, for the other princes and princesses held her when she felt unsteady.

Finally, the path was straight again. It was sunny and warm and the road was paved with golden bricks.

“This is easy,” she thought. “I’m almost there.”

But then the path broke into six equal parts. The princess didn’t know which one to take.

She stood in the same spot for a year.

She asked the birds of the sky what the paths looked like from above and the fish in the stream what they looked like from below. But the princess wasn’t sure. The paths all looked different, but one didn’t look any better or worse than the other.

After a year of waiting, and asking every passing creature, the princess picked one. She still wasn’t sure she picked the right one. But the path she chose became hers. And it lead her to many of the things she was hoping to find, like happiness and love and joy and the ability to cure the sick.

The other princes and princesses chose their paths too. For some, their paths crossed a lot and some never did again.  The journey made them older, and gave them more grey hair and wrinkles. They were all less rich than they were before. And more tired. For they had faced monsters, and stayed up many nights in a row, and walked uphill and walked downhill, in the pouring rain and the blistering sun. But they found what they were looking for....and they all lived happily ever after.