Too much, but not enough

We all face moments when we ask ourselves, “could I have done more?”

In medicine, we fear this juncture, run from it, and do everything in our power to be able to pat ourselves on the back and say “we did everything we could.”

Then there are the times when we are faced with the more challenging question. What about when we are forced to wonder, “did we do too much?”

The moment when we are sitting in a quiet room with a weeping family searching for the words to explain why their beloved family member is dying after a procedure we insisted would prolong their life. Why the grandmother who was so delightfully infused with life just yesterday was now in multi-system organ failure, maxed out on pressors and neurologically devastated.

The family voices what we’re all thinking:

“I just wish we hadn’t done the operation.”

They would have died without the surgery. That’s what we tell ourselves. But looking around the room I see reflected in the eyes of my fellow team members a question echoing my own:

Did we just kill this woman?

But no one says it out loud. Not in the room with the family, not on the miserable walk back to the ICU to inform the team we are making our patient DNR and only providing comfort care.

If we had sent her home with this ticking time bomb in her chest would we have been morally responsible when that bomb had exploded? Wasn’t it our obligation to provide her with all of the interventions we had at our disposal?  Are we acquitted of this horrific outcome because our intentions were pure?

How is it that we did too much, and yet I still feel as if we didn’t do enough?

The phrase “the possible benefits outweigh the risks” means something different when you’re left explaining why the risk are the only thing present in the end.

Did we push too hard? Were we the scalpel-happy surgeons that we are assumed to be, operating on anything we can get our hands on? In all of our good intentions did we snatch the precious time this family had left?

I’m really asking.

 

 

 

 

To End on a Positive Note

If you’ve come into contact with me at some point in the last 8 weeks, I’m sure you know how I’ve felt about my pediatric rotation. To be fair, it never really had a chance. Coming off the amazing high that was surgery, peds had a lot to live up to. Not going to lie – it didn’t even come close.

However, instead of telling you all of the things that I loathed about this rotation, I’m taking the advice of a friend and mentor of mine and I am focusing on the positive. So here is a list of the things that I enjoyed over the last 8 weeks:

  • Outpatient pediatrics allowed me enough free time to work out twice a day, including long hikes to watch incredible sunsets.
  • My incredible team of Residents allowed me to ditch out on an afternoon of doing intake H&P’s so that I could scrub into my patient’s surgery, which turned out to be a fantastic example of the beauty of continuity of care.
  • I became unrealistically attached to two of the most amazing ladies I know (someday we’ll write a memoire together and it’ll be hilarious, just wait).
  • Being mistaken for an Attending or Resident on multiple occasions – frustrating for my senior resident, but helpful for getting morning report from the nurses.
  • Pediatrics gives you a few morning’s off to do some online modules – I was lucky enough to spend those mornings jumping in on surgical cases.
  • I got offered an away rotation at one of the top surgical programs on the west coast for the month of July.
  • I was able to take a spontaneous 18 hr trip to Vegas to attempt to see The Chainsmokers.
  • I once explained to an outpatient Attending that I liked surgery because I find that I thrive in an environment where I am spoken to like a dog.  To his credit, about 10 minutes later I hear from across the clinic “Tessa, Come!”
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The amazing Team D. Just another example of how fantastic people can make anything tolerable.

On the other hand, here are a couple experiences that describe my feelings for most of pediatrics:

  • While doing an intake physical exam on a 5 year old child around 9:30 pm on a Saturday night the child begins to scream “I don’t want to do this! I just want to go to bed.” to which I yelled back “Me too!”
  • On my last day on outpatient pediatrics I was struck in the head with a dinosaur shaped reflex hammer by a 7 year old child – a perfect analogy for my experience of outpatient pediatrics.

The good news is that other than 2 weeks of intense study for the USMLE Step 2, I will be spending the next 5 months in or around the Operating Room.

So check back with me after that, maybe by that time I’ll agree with the unbelievable rude resident I met in Las Vegas who told me that going into surgery is the worst decision I could ever make (spoiler alert: I have definitely made worse decisions).

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Night out in Las Vegas with these amazing women that fill my life with so much joy and substance.

Speaking of the reactions that I get from people who find out that I have chosen to apply for surgery,  these are some of my favorites:

  • “I loved surgery, I just couldn’t do that life style.”
  • “You must really not like sleep.”
  • “Your life is going to suck” (my personal favorite right there)

I’ve realized something after hearing these statements and experiencing a non-surgical lifestyle these last two months.

We all value different things according to the amount of  self-worth, enjoyment and meaning we gain from each respective item. When coming to choosing careers within medicine, people prioritize different aspects of the careers in accordance with these values. Some people really value having lots of free time to do other things that they enjoy. Other people really enjoy connecting deeply with others and require a setting where that is encouraged.

I have realized that a large part of why surgery makes sense for me is that I really value having a career in which I can tangibly see the difference I am making. In addition to this, when I work, I like to work hard. I’m a single minded and intense individual that thrives in an environment that challenges me. Being in a place of  work that utilizes my intensity allows me to be more relaxed in the rest of my life. Something that I noticed over these last 8 weeks, is that when I don’t have a place to channel this energy, it starts to manifest itself in the rest of my life in the form of anxiety.

Do I look forward to the “surgery lifestyle”…. not necessarily!

I do find that like most morning people, if I haven’t accomplished at least a substantial amount of things by 7 AM the day is just over. However, I don’t crave getting few hours of sleep, missing meals, and not going to the gym as often as I would like.

But the things is, these last 8 weeks of Pediatrics my lifestyle has been pretty sweet. Like I mentioned above, I worked out a ton, I hung out with amazing people, I took spontaneous trips – and yet the majority of the time I was a miserable and anxious wreck. The value I place on myself and the meaning I get from life is not directly related to my extracurricular activities. The peace that I am able to maintain within requires a safe space to send all the turmoil, and unfortunately a 9-5 clinic job just doesn’t do it for me.

Moving forwards, when I hear people’s opinions about me going into surgery, instead of getting into midnight arguments, I’m going to try and just smile and be thankful that those people found their passions and are living them out.

Our inner fires burn at various temperatures and ignite for different things. The more comfortable you get with your own flame, the more you can appreciate the inner power and drive of those around you. Being aware of what motivates you changes the conversation from one about getting the most competitive specialties, to finding the most compatible ones.

Thank goodness we’re all unique and that medicine has a place for us all!

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Fantastic views from Angel’s Rest in the Columbia River Gorge

In other news, that’s the end of my 3rd year of Medical School! It’s been a whirlwind journey, and one that has facilitated more growth than most years of my life combined (no, not physical growth. I’ve been this tall since I was 16. I swear). Through it all, here I stand – a terrifying step nearer to the ledge of responsibility that is becoming an Intern.

Thank you all for your support along the way. I’m ready for 4th year now.

xx

-T

The Switch

“Who are you?”

I’m walking next to the gurney, transporting the patient from the emergency department to the OR, when I hear this dreaded question. Rarely have I experienced a positive reaction from a patient when you explain that there is a medical student *gasp* scrubbing into their surgery, so I try my best to avoid disclosing that fact whenever possible.

“I’m Tessa,” I smile and keep walking.

“And you are a….”

I sigh, “I’m the medical student working with your surgical team.”

“Will you be there for my surgery?”

“Yep!” I attempt to stay upbeat despite it being 4 AM and I’d been working all night, “but don’t worry, the Attending will be doing everything, I’m just there to make sure they don’t do anything too crazy.”

He laughs, which surprises me. This man is supposed to be really sick, that’s why we were heading to the operating room in the first place.

We’d received the consult at around 3 AM, I had been sitting in the OR watching a rather laborious laparoscopic cholecystectomy that my fellow medical student had scrubbed in on, when the Intern had requested my help with this particular patient. He was a 55 year old man with cancer who had recently finished a course of chemotherapy and had presented with acute onset abdominal pain. Not super exciting on it’s own – but the CT scan peaked our interest.

“Free intra-peritoneal air” said the preliminary read. I remember trying to contain my excitement – this meant I was getting a surgery tonight.

When we approached his room I could see from outside the glass that this wasn’t looking good. His blood pressure reading 85/50 and heart rate in the 170’s, before we even entered the room the Intern sent me to call up to the OR to inform our Attending.

We started a fluid bolus, got a quick history and I started working on the H&P that would need to be done before we went to surgery. When our Senior resident and Attending arrived I followed them into the room. Even after the administration of 2 liters of normal saline his blood pressure had continued to drop to 75/40. I listened to their conversation while my eyes stayed pinned to the monitor, half expecting him to crash any moment.

“It looks like you may have perforated a part of your bowel.”

After allowing the patient a brief moment to finish the string of obscenities coming out of his mouth, the Attending continued:

“This can sometimes happen after undergoing chemotherapy, or it could be due to your malignancy itself. Either way, we’re going to need to take you to surgery to remove the damaged piece of your bowel.”

“What are the risks doc?”

“Well, you’re very sick. There are always risks to undergoing a procedure, but even more so with your co-morbidities. I have to be honest with you, the prognosis doesn’t look very good. This very well may kill you.”

He takes it in for a few seconds, “how long would I have? Weeks? Months?”

There was an uncomfortable air that settled over the room.

“No,” my Attending clarifies, “I mean that this could kill you tonight.”

I could see the flurry of emotions cross his face like a blizzard turning him a paler shade of white and I was struck that even a man carrying a terminal cancer diagnosis could be surprised by his mortality.

“Is there someone that we can call for you? Does anyone in your family know that you’re here?”

“There’s my daughter, but she doesn’t know I came. I’ve been in the hospital so much recently I figured she didn’t need to know.” He checked the clock, “It’s the middle of the night, I can’t call her now.”

The intern and I were left to consent him for the operation, and I was given strict instructions not to let him out of my sight. I took my post at his bedside as the operating room called for us to bring the patient upstairs.

“I do hope you get to learn something at least, since you have to be up in the middle of the night for this.” He’s smiling kindly at me and I reciprocate. He continues on, “Tessa is a very nice name, where is it from?”

“It’s Dutch,” I respond, prompting a conversation about Europe, his military service that took him to Germany and the bitterness the Dutch hold against the German soccer team. I ask him about what he did in the service and about his family. We arrive outside the main OR board and wait for anesthesia to arrive. He’s telling me about his daughter who he believed to be about my age. I don’t know when, but sometime along the ride up the elevator I had ended up holding his hand.

We’re silent for a moment and as I look at him I feel a sudden rush of emotion. There was something about him that personified my own father. The words my attending had spoken just a half hour before rang in my ears: this could kill you tonight. 

“You really should call your daughter.” I urge earnestly, “she would want to know.”

His eyes meet my own in a moment of shared desperation, he nods his head.

I help him get to his phone and wait, desperately trying to hold back the tears as I listen to this man leave his daughter a voicemail verbalizing the direness of his situation, his unconditional love, and how proud he was of her.

By the time he hung up, Anesthesia had arrived. I take hold of his hand again as we’re rolled back into the OR.

Normally, at this point I am assisting the nurses in getting the patient connected to the SCDs, correctly positioned, and grabbing my gloves and gown for the scrub tech. But this time I just stand there holding his hand, his unrelenting grip capturing me in place.

At this point my Attending comes and stands next to me. I wonder what he’s thinking of me – this useless medical student just standing there, being of no help to anyone. I fear he can see the tears welling in my eyes. We stand there in silence for what felt like years as the Anesthesiology Attending arrives and initiates the induction of anesthesia.

When he’s finally asleep, I let go of his hand and glance towards my Attending. He considers me for a minute, and I half expect him to kick me out of the OR and tell me to go get my emotions in check.

Instead, he simply nods and states, “I think we’re going to need some music for this one, don’t you?”

So we performed the operation while blasting Shakira and Enrique Iglesias.

This experience demonstrated to me the dichotomy of what it means to be a physician, and especially to be a surgeon. It’s a balancing act. We must be human, we must feel and connect deeply with our patients. We also must be able to turn it off, put our heads down and charge forward at the top of our game.  Both roles are required in providing complete patient care.

If I had been the lead surgeon, I never would have been able to be objective and thorough in that operation if I had spent the entire time worrying about the daughter who may not get to see her father again. But I also wouldn’t have been able to facilitate this man’s calm journey to the operation if I hadn’t embraced my humanity and made a connection.

So we have to develop the switch – the one that puts a pause on our humanity and turns on the well-oiled-machine that is the experienced surgeon. We turn on some 80’s rock, latin pop or EDM and fix the problem.

I think this is essential in nearly all areas of medicine – to have the ability to suspend our emotions and do what needs to be done. It’s healthy and it’s required.

But what happens if we forget to flip the switch back once the surgery is over or we’re finished running the code? When the outcome is bad, isn’t it just simpler to leave it off? We have more patients to take care of, more surgeries to do, more lives to save. So yes, it’s easier to remain disconnected. I’ve seen examples of that happening throughout this past year on the wards. But I’ve also been shown amazing demonstrations of courage, vulnerability and compassion when physicians have purposefully made the decision to flip the switch back, to embrace their humanity and with it, their humility.

On my pediatric rotation this last month an Attending of mine reminded me that sometimes I need to rein in my intensity to a level that my patients can handle. To read the room, take a step back, and make a connection before I rush into my plan for their care. I think that fits well with this concept, because in the same way as I consciously decide pump the brakes when it comes to my level of directness with my patients, it is also a conscious decision to lay down the suit of armor that is medicine and meet our patients and their families where they are.

I hope that moving on in my career that I can continue to remember the importance of this decision and fight against the lazy temptation of disconnection.

The First Cut

They say the first cut is the deepest. For me, this was definitely not the case.

It is a typical tuesday afternoon and I am preparing for my 3rd case of the day when the intern I am working with informs me that he needs to leave for clinic. It will be just me and the Attending for this next one.

I report to the OR, feeling a little nervous and not sure how this Attending will react to a 3rd year medical student being the only one around to help. I grab my gloves and am helping position the patient on the table when he arrives.

“Good afternoon Dr. Lamberton,” he chimes, “will you be helping me out on this one?”

“Yes sir, it looks like it’s just you and me today.” I brace myself for his response.

“Well that sounds just fine.” He smiles and motions for us to go scrub.

We re-enter the room and drape the patient in the usual fashion. I’ve never been to the ballet, but I have been to the operating room, and when you watch this choreographed dance, it feels pretty similar.

“Alright now Dr. Lamberton is going to read the time out.” my Attending’s voice thunders.

I look up from the suction I’m securing to the drape, surprised, and make my way to where the scrub nurse is holding the patient’s chart. My voice is only mildly shaking as I muster my most commanding tone.

“This is patient _________________, MRN ________________ born ___________________. Consented for a ___________________ under general anesthesia.”

I look to anesthesia and they take over, the rest of the team following in suit. I’m grinning behind my mask as I step back to my place across from my Attending. He nods to me with a fatherly-like approval. We work together to mark our incision site. The scrub tech hands me a lap-sponge in addition to my suction so I can keep the field dry for the Attending while he makes the incision.

“Please hand the scalpel to Dr. Lamberton.”

I drop the suction I’m gripping (almost off the sterile field) and try to maintain my calm as the scrub tech hands me the scalpel.

This is it, I’m thinking as I place the scalpel on the skin, This is my moment. I’m a surgeon now.

With all the concentration and focus pinned on the tip of the blade, I begin to carve my masterpiece. Commanding my hands not to shake as I bring the knife along the 5 cm of marker that directed where my incision would go. I reach the end of the line, removing the blade from the skin. I turn to hand the scalpel back to the scrub tech and as I’m preparing to state the words I had heard so many times before – my Attending clears his throat.

“Why don’t you try that again.”

I look down at my work of art only to discover, to my horror, that I had barely cut through the dermis. Sheepishly, I take another stab at it. I see my attending nodding his head slightly as he grabs the Bovie and continues the surgery.

My great moment wasn’t as graceful as I had dreamt it would be – but when are they ever? For me, some of the most influential moments in my life have been ones that occurred completely on accident. You can’t plan for moments of growth and progress, you can only capture the opportunity placed in front of you.

This story isn’t about me capturing a moment. While it’s certainly cool that I got to make the first cut (and a moment I won’t soon forget), the real amazing thing to me was the opportunity that was placed in front of my Attending that afternoon. He was burdened with the load of an inexperienced assistant, and instead of complaining or ignoring me and my tightly clenched suction, he elevated me to a position in which I did not belong and gave me the tools to inhabit such a place.

That’s the beauty in really teaching someone – it’s not about asking the hardest pimping questions or assigning the latest articles to read. Those are great tools in assessing someone’s preparedness and self-directed learning process, but to truly teach means lifting the student from where they were so that they can take in the view from where you are.

I was blessed with such a teacher that afternoon, and I hope that one day I can strive to be a surgeon who raises up those around me in the same way he did with me.

The Power of Love – Surgery Style

At MS3 orientation in July of 2016, they warned us about the “slump” in student moral that tends to occur around February of the 3rd year. When the pressure to perform and stress scheduling away electives, deciding on our final career choices, and getting letters of recommendation becomes just too much and we all crumble. Hearing this, I remember thinking to myself “I’ll be on surgery. What a disaster that will be.”

Little did I know that February and March would wind up being my favorite months of all of medical school and that surgery would be exactly what I needed.

I felt the slump starting in January – coming back from my great Australian adventure and landing in the purgatory of the neurology rotation. I had all the signs of a great depression on the horizon. My attitude starting surgery was pretty much “at least now I’ll be too busy to perseverate on how sad I am.”

And then I was hit by the semi-truck that is love and it appears my life will never be the same again.

As I realized that yesterday was the last time I will scrub into the O.R. for a few months, I spent a few minutes reminiscing on some of the revelations I’ve stumbled upon along my recent discovery that I want to be a surgeon:

  • The most dangerous thing about using Meth is that it seems to make you determined to climb ladders.
  • I have never met a group of people as enthralled with the fact that I am left handed as a team of surgeons.
  • Life tip: Don’t get a tattoo you would be embarrassed to have your surgeon see right before they cut you open.
  • I don’t belong on the anesthesia side of the curtain.
  • Nothing screams diagnosis in an exploratory laparotomy like finding a Foley catheter floating in the peritoneal cavity.
  • I’m happier working 14-hour-days on General Surgery than I was working 8-hour-days on Internal Medicine.
  • Lethal triad of death: hypothermia, coagulopathy, acidosis
  • I need to learn Spanish.
  • Food and sleep are not required.
  • The canal stitch is all about bar hopping.
  • Sometimes you suggest a plan, and spend the next 3 minutes hearing how explicitly wrong you are. Other times you’ll get handed the Bovie and told “if you want to take it out, go ahead and take it out.”
  • If you are forced to spend a day in clinic – surgery clinic is the place to be.
  • Surgery life is literally nothing like Grey’s Anatomy.
  • Apparently for Lent this year I decided to give up my dignity (ok, so maybe that part is slightly like Grey’s Anatomy).
  • A patient that leaves AMA because he hasn’t eaten in 12 hours sparks very little sympathy from a team who hasn’t eaten in longer than that.
  • When a General Surgery resident asks you why we’re giving Demeclocycline to a patient with hyponatremia – they’re pimping you. When an Orthopedic resident asks the same question – they genuinely want the answer 😉
  • Don’t drink coffee for the first time in a month right before you scrub in – your Attending will wonder why you’re shaking life a leaf while throwing an anchoring stitch.
  • There’s a real gift in having residents who invest time in teaching you. On the other hand, there is nothing more frustrating than someone who refuses to teach an eager student.
  • If you scrub into the wrong surgery – just go with it.

Perhaps the most important thing that I learned, is that I belong in the world of surgery and I can’t wait to continue pursuing this career.

But first I must conquer my final rotation of 3rd year – Pediatrics ( I can feel the depression setting in already).

xx

-T

The Storm

There’s a calm that comes before the storm.

*beep beep beep beep*

The trauma pager goes off and I feel it to my very core. A shot of norepinephrine through the system – a sympathetic response to the stress of what is to come.

The message reads “Level A trauma, ETA 20 min”.

“Crap, I never got to eat,” my chief resident mutters. If this trauma is anything like the last few days, we’ll be spending the next several hours in the OR, and food will be the last thing on our minds.

I nod sympathetically, suddenly very thankful for the tamale that I shoveled down a few minutes earlier. We stop by our call room and she inhales the salad she brought from home, and we’re moving again.

When we walk into the ED, all eyes are on us. People pay attention when the trauma surgeons enter – something must be about to go down.

From this point, each trauma goes about the same.

We meet up with the ED attending and residents outside of the room – the patient hasn’t arrived yet. Making small talk, we don our trauma gear: cheap blue gowns, hair nets, gloves, and protective masks that cover our mouth, nose, and eyes (you never know where blood will be going in a trauma).

In the moments before  the patient arrives, an eerie calm settles over the room filled with doctors, residents, nurses, respiratory therapists, and med students like me. We’re standing in a circle around the empty hospital bed, preparing  ourselves – knowing that literally anything could be coming through the doors.

It could be a meth addict who fell of a ladder. A hiker who slipped off a waterfall. An unrestrained MVC with the driver thrown 100 ft from the vehicle after going over a 150 ft cliff. A GSW to the chest, abdomen, or head. A man who fell out of a tree trying to rescue a cat. A kid who was stabbed in a road rage incident.

From in the hallway someone announces “make way” and we watch as the EMTs roll the patient into the room.

The thunder starts to roll.

The EMTs are giving report, and before the patient is even fully transferred to the hospital bed the nurses are searching for IV access. Vitals are being taken, both by hand and machine. The junior resident starts the primary assessment, calling out the ABCs (airway, breathing, circulation) and head to toe inventory of injuries. My senior resident is standing at the foot of the bed, taking it all into account, making the decision of when to escalate. We’ve called for the “black blood” and packed RBCs and FFP are running.

As they work, I’m writing it all down. As a medical student my job, second only to not getting in the way (the  golden rule for any trauma situation) is to take notes on everything happening. All the damage called out, questions asked to the patient, details about the incident – we’re going to need it all for our note, which must be completed before we can take the patient to the OR. That’s also my job.

The first few trauma’s I’m massively overwhelmed, but after a couple of times I learn to tune out the unimportant voices, and I begin to recognize the voices of my team amongst the crowd. By the end, I’m grabbing staplers, gaze, c-collars – anything my senior resident calls out for.

It’s time for a chest x-ray: the eye of the hurricane.

It’s our first step to analyzing the internal damage to the patient, and requires us all to take a few steps back (outside the room to be exact) and regroup.

During these moments our ACS team gathers together. Our chief tells us the imaging she wants to have done, and the junior goes to put in the orders. She turns to the attending and they decide if the patient is stable enough to go to CT, or if we need to go straight to the OR.

The x-ray is captured, and we walk back into the room to take a look at the result on the machine.

The eye has passed, and the winds howl once more.

From there, we’re either placing chest tubes or rolling the patient – time to see the damage on the other side and discover spinal tenderness and decreased rectal tone. This is where I end up with blood on my gloves and gown, rolling trauma victims is not a clean business.

We’re off to CT, and the whole trauma team accompanies the patient. My junior resident logs into the computer in the control room and I start writing the note, we only have about ten minutes until we know if we’re going straight from here to the operating room.

We watch with bated breath as the scans appear on the screens. None of us are radiologists, but years of looking at similar images has made our attending adept enough to see when something is wrong.

Some of the results are obvious enough for even me to see – a massively bleeding spleen, free fluid around the bladder, air under the diaphragm. Sometimes it’s subtle. Sometimes there’s nothing at all.

Sometimes they’re gone before we even get to the scanner, and we’ll never know why.

The dichotomy continues. We’re breathing a sigh of relief or we’re already on our way to the operating room. I’ve already finished the H&P, written a progress note and an updated H&P. If we’re heading up, it’s all about damage control. We plan the operation to get the most dire things finished before they become to unstable and we have to pack them – we’ll close after a few days of cooling off in the ICU.

On occasion we get to finish it all, surprised as we close the skin that our patient is still rock solid.

If we’re lucky, we haven’t gotten more trauma’s while we’ve been operating. When we’re not, the senior has run out to meet the next level A, with the attending not far behind and sometimes I am the only one of the surgical team in the room with the open patient for a few minutes until the back up attending arrives.

When we’re finished, it’s back to rounds. No chance to take a break or sitting down. We have lists of patients to manage, and we must be efficient.

For only one thing is certain in this business – another storm is coming.

 

 

Upon Traveling Alone

The first trip I did by myself was in June of 2016 after taking  the NBME Step 1 exam. There were plenty of reasons why I went traveling (#1 being the near continuous 2 years of studying in coffee shops leading up to the exam), but there were a several specific reasons why I felt the need to go alone.

The greatest of which was the fact that I wanted to prove to myself that I could.

Looking back over the years that I have been single, I have kept myself from doing a lot of things because I didn’t have anyone to do them with. I’m envious of people who have a built in travel and adventure partner in their spouse or significant other. I also have this pathological fear of showing up to things alone. I HATE it more than almost anything. So if I don’t have someone to go to a party, movie or even church with me, I probably won’t go.

Combine this with every single 20-something woman’s deep dark fear of ending up alone (insert me singing “On My Own” from Les Mis at the top of my lungs), and the bleakness of my situation brought me to a realization:

if I am always waiting around for someone to see the world with, I may never actually get to see it.

So I took matters into my own hands and I went out on my own.

In that limited time, I had moments where I absolutely hated being alone. I remember standing on the train platform in Berlin heading to Prague with tears in my eyes, and hearing them call out a train leaving for Amsterdam. I realized that I could be heading back to the safety and comfort of my mother and grandfather and I wouldn’t have to be alone for another second.

But then there were the rest of the moments, the moments where being alone was the most serene, existential experience that there is. The day before I was in that train station, I had walked through Berlin early in the morning while the rest of the city slept. I found myself standing at the base of the Brandenburg Gate completely alone. Chills shot through my entire body as I embraced the magnitude of the monument and the history that surrounded that place. I learned in that moment that feeling infinitesimal and insignificant in the course of time also has the ability to make you feel powerful and untouchable.

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So with that memory in mind, I got on the train to Prague. To this day I believe that was one of the best decisions I have ever made.

After that moment, I went on to meet people who were also out there on their own, and suddenly being together in our aloneness made us not feel so alone.

In the end, I loved it. I felt empowered and liberated! “I don’t need no man” (insert sassy finger waving).

So I decided to go again.

This trip was different in a lot of ways. One of which was that it was over Christmas: A holiday famously known for spending time with family, and I was leaving mine behind (not because I don’t love my family, but because it was literally the only 2 weeks I have off all year). Because of this, there were less solo travelers for me to meet and I experienced intermittent feelings of homesickness over the holiday.

In many ways I went though the same emotions as the first trip. There were moments that I LOVED it, and moments that I sat on park benches in near tears because I felt so lonely.

But this trip was also different, in that I learned a very different lesson from it.

What I learned on my first trip is that I CAN do it alone – what I learned in this one was that I don’t necessarily want to.

I think that’s a scary thing for women (or anyone) to say: I don’t want to be alone.

I’ve always seen that desire to be a point of weakness. Like if I want to be in a relationship that somehow makes me pathetic and desperate. Instead I should desire to be alone, and if I end up NOT alone – eh, I’ll be happy too.

But perhaps, admitting to yourself that you want a partner to do life with isn’t a weakness. Perhaps this honesty with yourself actually requires significant strength.

After my first trip I told everyone I saw that they MUST travel alone at some point. I certainly have not changed my mind of that. I believe that simply possessing the knowledge that you have the ability to do things on your own is priceless, even if you are in a relationship (besides I have learned so many other valuable lessons and grown in numerous ways from traveling alone, so I think it’s just generally a good idea).

Especially as women, we need experiences that bring out our inner Viking Warrior Princess. I don’t know if it does it for everyone, but traveling alone certainly channels mine 😉 I also find that I am more purely myself when I travel on my own and it bleeds into my life even after I have come back to reality. I am less likely do go along with things I don’t like or worry about what people will think of me if I disagree with them after I have been spending time channeling my Viking Warrior Princess self.

Yes, I can, and will, do life “on my own” if I have to. I will definitely not stop traveling or living my life just because I don’t have a significant other at the moment. But that doesn’t mean I have to DESIRE to always be “alone”.

I can be a strong, independent, powerful woman while also acknowledging the desire in my heart for a deeper connection and relationship.

I’m sure you all probably figured that out years ago, but what can I say – I’m a little delayed in the whole relationship area 😉

xx

-T

**disclaimer: I wrote most of this before I got o Sydney, where I met some INCREDIBLE people and enjoyed the comradery of fellow travelers leaving home for the holidays. It definitely changed the perception of my trip a bit from what’s above, but I still thought what I wrote was important, so I’m posting it anyways 😉

Feminine Charms

Sometimes I don’t like being a woman.

Don’t get me wrong, there are a lot of great things about it, and even while writing these words I feel a bit hypocritical as I am about to condemn part of a social institution that I also very much enjoy.

I don’t like being a woman, because I don’t like the fact that while I walked through the halls of the hospital yesterday I got catcalled twice (and before you ask me what I was wearing – let me tell you: Dress pants, blouse, white coat, ID badge, Stethoscope – I looked like a complete professional).

I don’t like being a woman because I can leave a yoga class looking like a total train wreck and still get harassed by 3 drunk men in the parking lot.

I don’t like being a women because apparently it gives my patients the right to comment on how “a pretty young thing like you can’t possibly be a doctor”.

I don’t like being a woman because I have been called “b****” or worse for not responding to complete strangers who have addressed me inappropriately while walking down the street.

I don’t like being a woman because I have been harassed by several men while getting off the elevator on my way into clinic and was immediately expected to blow it off, paste a smile on my face and endure 2 more hours of my following patients dropping subtle comments about my appearance.

These things (and many more like them) make me not like being a woman.

Of course, as I said earlier, there are definitely parts of this institution of appreciating women for how we look that I certainly enjoy. I can’t deny that I feel great when an attractive guy checks me out or does a double take when I’m walking by. I have definitely benefited from using my “feminine charms” to get things that I want (to be clear – I do NOT mean sleeping with my boss or ANYONE to get ahead, I simply mean that even I am not so socially awkward that I don’t know how to throw a flirtatious smile in the right direction or laugh at a dumb joke to make men around me feel good about themselves and want to help me).

I also cannot say that men don’t get harassed by us women, but I don’t think anyone can really argue that it is in the same magnitude or with the same intent that women encounter.

This intent, at least in the professional setting, is something that I recently had a conversation about with an attending of mine. We had been walking down the halls of the V.A. hospital (and all of you who have rotated through a V.A. now know why I am writing about this haha) when a man addressed us very informally and a gaze that certainly wasn’t appropriate in terms of a doctor-patient relationship. This sparked a discussion between us as to why it is that our patients seem to hit on us incessantly.

According to this attending, she believes that it has something to do with certain men being uncomfortable with women in a position of power over them. As if, even though I may be their physician and in a position of authority, they can still ‘put me in my place’ with a few words by reminding me “hey, you may be in charge, but you’re still a woman and because of that I will always have power.”

This may not be the reason for every patient of mine that compliments me (maybe some are just really nice and don’t understand social constructs. I don’t know their life) but I do think a lot of what this attending said has merit for we see it in widespread culture we well as in medicine.

A few weeks ago I was chatting with some fellow travelers at a hostel in Sydney, Australia. There was an international group of us discussing the major events that happened in 2016 – mainly, Brexit and the U.S. Election. I casually mentioned “I guess what we learned this year is that anyone can become President. Maybe I’ll be the next president.” To which one of my companions replied “well obviously you can’t Tessa, you’re a girl.”

I laughed.

I laughed because it wasn’t meant in a mean spirited way and in the context of our discussion (and knowing the personal views of who said it) it was pretty funny. But it also stung with an uncomfortable truth. I’m not saying necessarily that no woman who had run for this election would have won or that Hillary simply lost because she was a  woman.  But it’s also impossible to ignore the double standard given to women throughout our society.

How do we fix this? If you’ve read my blog before you know I don’t have the answer to this, because I rarely have any answers. What I do know, is that it certainly doesn’t help when children are raised with role models and authority figures that say things like “grab them by the p***y”. Obviously I can’t blame this whole thing on Donald Trump, misogyny was around long before him – but I can’t see how he is helping the situation.

When young men are raised in a country where it is ok to demean women who are seen as intimidating or powerful, using sexist language to put them in their place, how can we expect them to behave any other way? Simply the fact that saying such horrible things about women is excused away as “locker room talk” kind of points out the very depth of the roots of this issue.

I am realizing of late that I often perpetuate my own double standard that I hold for men. I sent a snapchat to some friends the other day with the caption saying “The struggle of trying to look good enough to get hit on by the residents but not my patients.” Of course I meant this as a joke, I try to be professional in the work environment… well, most of the time ;). So I can’t really stand here on my soap box condemning all men for hitting on me, cause sometimes I like it, and I see how it can be frustrating. Because how are you supposed to know if I will like it or not to try to flirt with me?

I don’t know what to tell you about in a social setting, except that if I express disinterest in speaking to you, that probably means I don’t want to talk to you (and the same goes for all women). There is also a super huge probability that we women aren’t hard of hearing or playing hard to get when we ignore someone catcalling us on the street. There’s an even larger probability that when we straight up say “leave me alone”that we legitimately mean it.

As far as in the medical setting, here’s a hard and fast rule: Don’t hit on your doctor, your nurse, respiratory therapist etc.

I don’t care how good looking we (or you) are, getting compliments about our physical appearance from patients is always inappropriate and unprofessional.

So, if you’re a woman reading this, join me in attempting to not hold men to different standards because of their physical appearance and in standing up for ourselves and our respect in our professional lives.

If you’re a man reading this, I already assume that you are probably not the men I am talking about here (I don’t know why I assume that, probably projecting or whatever) but I urge you to hold yourself, your friends, and your children accountable to respecting women in all areas of life, but ESPECIALLY as professionals. In this day and age, we can use all the help we can get.

xx

-T

Uncomfortable 

The idea of being comfortable makes me think of home, especially around the holidays. Sitting in front of the fire, drinking roiboos tea and eating a piece of dark chocolate while it rains/snows outside – I can’t think of a single place where I would be more comfortable.

This year, my holidays are pretty much the opposite of this. Instead of drinking tea and eating chocolate in the snow with my family, I’m sitting on various beaches in Australia.

Sounds horrible right? 😉 (Obviously I’m being fasceious here, it’s actually physically quite comfy and I’m incredibly fortunate to have the opportunity to travel)

It’s an incredible experience, it’s just not where I’m necessarily the most comfortable.

But just because something isn’t emotionally or physically comfortable doesn’t mean it’s not a good thing. In fact quit often I find the opposite to be true. This doesn’t mean that every uncomfortable situation you find yourself in is actually the best thing that has ever happened to you.

But I do find that there is unlimited benefit and potential in choosing to be uncomfortable.

I learned the value of “choosing discomfort” when I was a teenager. At age 14 I went on my first mission trip. It was a trip to Ecuador to spend 2 weeks building a church. Pretty standard. This trip was called the Ultimate Workout, and was unique in the fact that it was only for teenagers, and the entire point of it was to put you in a group of about 40 kids that you had never met before, and somehow survive and contribute to society (with adult supervision of course, well until a few years later when I, as a 17 year old, was in charge of one of these groups. That’s another story).

I remember the months leading up to that trip I was terrified. I wasn’t the most outgoing kid, and making new friends was hard for me. So the prospect of spending 2 weeks with a bunch of strangers was petrifying to me. I still don’t know what it was that got me on that plane – but in the end, I had the most fantastic 2 weeks and I ended up returning 3 more times the following summers.

I think the thing that kept me going back was that I realized that those moments where I was stretched far beyond my own comfort zone were what cultivated my greatest personal growth. I was forced to be creative and resourceful – so I was.

I’ve found this is often true in medicine as well. I’ve learned the most from situations through my training where I am thrown in the deep end and was expected to swim. I went to numerous suture labs, practiced at home on pieces of fruit, but I didn’t really learn to suture until the day in the operating room when the OB/GYN attending handed me the needle and said “close” (This reminds me, I need to practice my knot tying before surgery starts).

So what is the point? In the few weeks leading up to me leaving for Australia, I found myself excited but also remourseful that I wouldn’t be able to be “comfortable” for Christmas this year. I chose to adventure instead – a choice that often means leaving your comfort zone in the dust.

So while I do miss being home, I’m out looking to cultivate personal growth in areas that aren’t exercised during my days in the hospital (but also to have some fun before returning to my particular reality). I’m investing in myself, and sometimes that takes presidence over being comfortable.

My version of a “white christmas” this year on a beach in Adelaide, SA

Merry Christmas

Xx

-T

Psych, out!

Today I completed my 6 weeks of psych-ation, and boy was it sweet! While I will probably not miss the subject matter or the patients, I will definitely miss the schedule that allowed me to go to yoga 4-6 times per week, eat 3 meals a day,  and spend some quality time with my friends. In tradition of how I close every chapter of medical school – here is a few things I have learned over the last 6 weeks:

  • People crashing off Methamphetamine and PCP are NOT very pleasant to be around.
  • 80% (by my approximation) of patients hospitalized in psych hospitals have Borderline Personality Disorder.
  • Nothing intimidates you like having a patient with antisocial personality disorder posturing in the window of the resident room during rounds.
  • I have seen more fist fights on psych than all my other rotations combined
  • If you don’t have a relative with schizophrenia – you don’t have schizophrenia.
  • Don’t put your cat in the freezer.
  • Most psychiatrists operate on a scale between biological vs psychoanalysis in  terms of treatment. When a psychoanalyst heavy attending covers for a biological heavy attending over the weekend – it’s not pretty on Monday morning.
  • I don’t want to be the “bad guy” when it comes to patient care.

Probably the most impactful thing that I learned has to do with the concept of “dissociation”. Dissociation of something that well all do. It’s that thing that we do whenever we zone out while reading a book, going for a run, playing video games (for those that do that), or browsing social media. It’s something that we need, because it allows us those moments where we feel outside of our current situation. In moderation, it’s an essential thing and a healthy coping skill. When it starts to take over our lives and impede our social functioning – it becomes an addiction (and a really unhealthy coping skill because now you’re legit coping with nothing).

The point of this, is that I have been desperately in need of dissociation for the last few months. The overwhelming thing about medical school is that it tends to have the ability to consume all parts of my life, making distancing myself from it really challenging. Even my free weekends and evenings are shadowed by an overhanging cloud of anxiety.

So now that I am officially 1/2 done with my 3rd year of medical school(WHAT?! thats crazy! Let me just freak out for a second) it’s time for  me to embark on 2 weeks of “dissociation” from this medical school life. For the next 2 weeks I am not going to worry about picking a specialty, getting letters of recommendation, or deciding where to go after next year (these are the things all 3rd year medical students are currently having aneurysms over).

Goodbye Student Doctor Tessa – Hello Tessa, 24 year old girl traveling in Australia =)

Peace out, reality.