From Such Great Heights

We all have that Thing.

You know what I’m talking about – that one Thing about ourselves that we just can’t get over. That one Thing that more than anything else we would want to change if we could.

The Thing that our nasty little inside voice whispers to us about. If only you weren’t __________ then you would have that job. If only you didn’t have _________ then you wouldn’t be alone.

Maybe if I just changed ___________ then he would love me.

We all have that Thing.

Mine is my height.

At 6’1″ tall, I’d be considered a tall guy, but for a girl? It’s ginormous. And the thing about this Thing of mine is that it may be one of the few things about me that I absolutely, under no circumstances, can ever change.

No matter how much I wish, pray, hope, and dream – I will never be any shorter than I am.

But here’s the other thing about this Thing of mine – while I hate it, I also LOVE being tall (find that confusing? It’s cause I’m a girl, don’t worry about it).

I love that I can always see the stage at a concert. I love the fact that I draw attention when I enter a room. I like that I am an incredibly difficult person to intimidate (a VERY valuable trait as a female medical student), because it’s nearly impossible to look down on me. I love the fact that I feel comfortable traveling alone because I would be a super inconvenient person to kidnap!

Isn’t this so often true about our “things?” Even though there are a thousand reasons for why we want to change them, I bet you we can also come up with a thousand and a one reasons for why they are an important part of what makes us so incredibly unique and beautiful.

Of course, I do get tired of hearing “Wow you’re tall” from random people on the street, having to always wear flats (because people complain when I wear heels), and getting asked if I play volleyball. I get jealous of all the “girl squad” photos where are the girls are the same height. And yes, there is a part of me that full heartedly believes that I will end up alone because I am tall.

However, in the spirit of Thanksgiving this week – I am choosing to be thankful for this Thing of mine. And perhaps by not perseverating on all the things I hate, maybe I won’t have the energy to hate them anymore. What if we did that more? How much happier would we be if we stopped hating unchangeable things about ourselves?

So while I do get exasperated by the aforementioned items, today I am just thankful that I am tall enough to reach the top shelf where they store all the jeans in the extra, extra long sizes 😉

 

 

Internal Conflict

My first full 10 week rotation is finally complete – and man does it feel good! Internal medicine: it’s a physician’s “bread and butter,” where we as medical students learn how to manage both chronic and acute illness.

Or, thats what we’re supposed to be doing.

For me, internal medicine felt a lot more like a combination of speech and acting class, where we learn how to give a perfect presentation and act completely enthralled on rounds. However, as much as I struggled with certain aspects of this block, I did learn a few more interesting things:

  • Medical School is hard – it’s even harder when you go through your day feeling as if  all your effort is completely useless.
  • Patients can be both at risk for clotting and massive hemorrhage at the same time – good luck deciding whether or not they should be on anti platelet therapy
  • Ohio is not for me.
  • I dislike shadowing just as much now as I did when I was in undergrad.
  • You can be good at something and still hate every second of it.
  • No matter how good the circumstances of life, you can always find something to complain about (and vice versa), your experience of a situation has much more to do with your outlook than the situation itself.
  • I have a “great” personality.
  • I LOVE cardiology.
  • For many patients, the social work part of their case is often the most complicated
  • I have the capacity to be jealous of a catatonic schizophrenic.
  • Don’t try to put SCD’s on a bilateral above the knee amputee – the nurses will get VERY confused.
  • Rheumatology is a specialty for BOTH joints and autoimmune disease.
  • The best way to motivate people is to believe in them, its far more effective than threats. We’re much more scared by the prospect of disappointing you than angering you.

All in all, I am thrilled to be done with Internal Medicine, and totally psyched to be headed to psych-ation next!

15 minutes 

For his last seven days I was the first face he and his wife saw in the morning.

He was admitted for uncontrolled atrial fibrillation with rapid ventricular response. At 69 he was a man riddled with cancer. Stage IV pancreatic cancer that had metastasized by the time of diagnosis.

His case was complicated. He was fluid overloaded but intravascularly depleted. His Afib combined with his diastolic heart failure caused his heart to be unable to fill, resulting in hypotension. At the same time our meds to control his rhythm and rate tanked his BP. When we tried to get off some of the extra fluid from his lungs and legs he developed worsening AKI from volume depletion. We switched him to digoxin, but his kidney failure resulted in rapid development of supratheraputic levels and hyperkalemia. We started midodrine and sotalol, finally controlling his heart rate but throwing it the other direction with rates in the 30’s.

Every morning would start out the same way.

“How are you feeling today sir?”

“Fine ma’am, just tired.”

His severe back pain from the bony metastasis combined with orthopnea caused him to only be able to sleep sitting up in a chair with his head leaned forward over a table.

“Any chest pain, shortness of breath, nausea or vomiting?”

“No ma’am.”

Then I would listen to his heart (in its textbook irregular irregular rhythm) and lungs (diffuse wheezes bilaterally and crackles throughout) and examine his impressive 4+ bilateral pitting edema.

All in all, this took about 10 minutes. He wasn’t a very talkative man – probably due to his inability to breath – and his physical exam rarely varied.

On day 4 his right hand became edematous. That was the day my attending gave me a “gold star” for teasing out that he has a history of gout. Back on the prednisone he went – just when we had finished his taper from his last COPD exacerbation.

Next I would turn to his wife and spend the next 5 minutes having an identical conversation every day. I would inform her of the changes we made and what we were hoping they would accomplish. I stressed the complexity of his situation. Heart rate vs blood pressure, lungs vs kidneys.

“We’re stuck between a rock and a hard place” I found myself saying day after day.

We had run out of options. He had failed amiodarone when he was first admitted due to prolonged sinus pauses during conversion to sinus rhythm. Our last resort was to give him a pacemaker, then we could then load him up on amidarone and he could pause away all he liked.

The only catch was that in order to get the pacemaker, cardiology required he have a life expectancy of at least 6 months. So we talked to the oncologist, who is unable to give a prognosis without the patient completing the full round of chemotherapy. Only as long as the patient remained in uncontrolled atrial fibrillation he is not stable enough to get the chemotherapy.

It was a circular argument – the man could not live without the pacemaker, but he could only get the pacemaker if he was expected to live.

Finally, an agreement was made and he was sent down to get the pacemaker.

I come in the next morning excited that he will finally be turning the corner. I take a look at his morning labs and vitals and I’m shocked – they were horrible.

I look for the op note from cardiology, and I find that he never received the pacemaker. He was unable to lay flat as they were prepping him for the procedure, so it was aborted and he was transported to the ICU in acute respiratory distress.

I take a look at his chest x-ray: it’s catastrophic.

I read the notes from the ICU doc, the nephrologist, the cardiologist. I see a note from a palliative care consult.

Over the last week I had often wondered to myself when it would finally be the time to call palliative care and talk about hospice. Something about this family was shrouded in such optimistic denial that it never seemed like a good time to bring it up. This man fully believed that he would be able to get well enough to go back to work. I think we all wanted to believe that too.

I take a deep breath, and head to the ICU.

When I enter his room, I see him laying on his back for the first time. He’s on high flow oxygen through the nasal cannula, but his breathing sounds like he’s on the ventilator. He’s unresponsive and gurgling sounds escape as he struggles for air, using his accessory muscles of respiration.

I turn to his wife:

“A lot happened yesterday.”

“Yes, it did.”

We stand in silence for a moment, watching him gasping for air.

“I was really hoping he would be able to get the pacemaker.”

She nods “me too.”

We’re silent again.

“I saw that you met with the palliative care doctor yesterday, I’m sure that was difficult.”

She turns to look at me now “I’m going to tell the doctor today that we’re ready for comfort care.”

She’s crying, and I feel the tears welling up in my own eyes.

“I am so sorry, I was really pulling for him.”

She walks towards me with arms outstretched and wraps herself around my waist.

“You woke me up every morning. Thank you for being so kind.”

This man passed away later that afternoon.

There are a lot of emotions revolving around me when I think about this experience. He was my first patient to die. I have been present at codes before and have seen patients die, but this was the first one who was mine. It’s a unique and conflicting situation, mourning for and with people you barely know.

But it’s the words of this mans wife that continue to stick with me: “Thank you for being so kind.”

I’ve never consider myself to  necessarily be a “kind person.” When I say that the first thing that comes to mind is one of those girls who is all smiles and brakes for squirrels and refuses to kill spiders but transplants them outside their house instead. That’s really not me.

So what was this woman talking about?

Looking back, I can’t think of anything in particular I did that was all that kind. I didn’t bring them flowers or offer back massages. The only interaction I had with them was that 15 minutes  every morning. It wasn’t anything out of the ordinary, it’s part of my job as a medical student.

But maybe the true beauty of kindness is that it doesn’t have to be anything extraordinary. It doesn’t have to take hardly anything from us. Maybe it’s not all about big sacrifices or superficial statements. What if the kindness that counts is the type that you don’t even know you are giving, but that flows from compassion and genuine concern?

And what if this kindness is really the most important thing we can give as a healthcare provider?

In the end, it wasn’t our valiant efforts, medical knowledge, grand medications or extraordinary measures that she thanked me for. It wasn’t my flawless explanations of the pathophysiology of the disease process nor my ability to diagnose gout. It wasn’t my thorough progress notes.
It was my kindness.

So if kindness is so important, why is it that while I feel confident that my clinical knowledge, reasoning and skills will fully develop over my training – I feel a terrifying ache that I may lose this kindness by the end?

So for now, I just fight to remember those words. To remind myself that no matter how poor the outcome or how helpless we are medically – we can always be kind. And perhaps, that can make the greatest difference.

**Patient identifying information and diagnoses have been changed to protect patient identity**

Elephants

“We need to address the elephant in the room – which is your size.”

I gasp.

Surely I just heard incorrectly and the physician did not actually just say that to my patient.

I witnessed this encounter back during my first week of rotations as a third year medical student in an outpatient family medicine clinic. The office was almost completely empty that afternoon as most of the residents were in a meeting, and I was assigned to work with the one remaining resident and a covering attending (who shall remain nameless).

As I introduced myself to this attending, he informed me that he was a self-proclaimed nutrition expert and that he had recently written a book on that subject. Being the daughter of a dietician, I was excited. I liked being able to speak to patients about making positive lifestyle changes and I figured he would be a good example of how to implement such change.

Boy was I wrong.

The first patient that afternoon was an 85 year old women coming to establish care at this clinic. I go in to get a full history and talk with her about her long list of medical problems. She had all the usual stuff – diabetes, hypertension, chronic pain and a BMI of 33 (actually not all that impressive these days). I ask her about diet and exercise and she tells me that she has been unable to exercise for the last 10 years due to a car accident followed by chronic back and leg pain combined with severe osteoarthritis of her knees.

She was a very sweet lady who seemed genuinely interested in improving her health and quality of life as much as she could. She told me about how she used to be a runner and that she never had any of these problems before her accident.

So when I go out and give a brief story to the resident and attending before they head in to come up with the final plan for her, I am looking forward  to seeing how this attending can help such an eager patient to make some realistic, practical changes to improve her quality of life.

But as you can tell by what was basically the opening statement by this attending – that did not happen.

I understand that some physicians endorse a “tough love” approach with their patients, and I have seen it work really well when that physician has a good relationship with their patient. However this encounter had no resemblance of relationship building. This was no “come to Jesus” conversation. All that happened was three people of authority walking into a room and telling a woman everything that she is doing wrong – which believe me, she already knew.

When we forget to add the “love” part to the tough love conversation, all that ends up happening is shaming – and no one has ever been promoted to change by being shamed or made fun of by their physician.

I have no answers for how to make sure we maintain the love. For now, when I am tempted (which is several times daily) to forget to have compassion for my patients I remember the look on this poor woman’s face, take a deep breath, and try again.

Third Wives Club

I think I’ll probably end up being someone’s third wife.

This is a statement I make pretty often, always drawing a few chuckles from the people I’m with.

I figure my husband will get married for the first time in his early 20’s. Like so many people at this age, he will believe he wants is exactly what society tells him: 9-5 job, wife, kids, van etc. So he does all of these things, only to realize in a few years time that this isn’t actually what he wants at all, and divorce quickly follows. After this marriage he will swing to the polar opposite – the trophy wife. And while I have a pretty high opinion of myself, even I know that I am not trophy wife material, so obviously I can’t be wife #2. But as we all know, trophy wives aren’t exactly known for their stimulating conversation… so eventually he’ll get bored of that, and here comes divorce #2. By this point, he’ll be fed up of all the things he has been told he is supposed to want and realize “you know, Tessa’s pretty funny, and up for cool adventures, and not horrible to look at”… and we’ll live happily every after.

It’s a real life fairy tale isn’t it?

What this ridiculous theory stems from is an observation I have made that most people that I know want lives that follow along the same plot line (or slightly different versions of the same plot). Job, kids, BBQ’s, football etc.

Not that there is anything wrong with wanting these things, but as someone who doesn’t want pretty much any version of this typical story – I find myself wondering: can I be the only one out there who doesn’t fit the mold?

I don’t think that’s true.

I believe we all want different things. As varied as our personalities are, so are our hopes and dreams. While some do actually want kids and the suburbs and a van – I think there are just as many out there who don’t want that, but are conditioned to believe this is the ideal to strive for. That somehow, no matter how unappealing it may seem, achieving a life that looks like this will automatically make them happy.

We’re told as we grow up that our dreams have to fit within the confines of this generic story line. We are discouraged form pursuing anything unknown, scary or divergent. Instead of writing our own book, we fill in the blanks in the one provided for us.

Want to travel?  Take a year abroad during college so you can settle down right afterwards.

Want to be an artist? Well you better marry a rich business man so you can become a stay-at-home mom and paint for fun.

You don’t want kids? You’ll change your mind when you find the right person.

So we settle. We stop pursuing our passions and get an average job and surround ourselves with average people and give up our hobbies that we no longer have time for. We become complacent, and our complacency leads to boredom.

We all desire some kind of adventure, it just manifests itself differently. So when we force ourselves to fit into a mold designed for someone else we become complacent. So we  look for a spark in life in the only place we know how to – romance.

Our desire for danger, wonder and the unknown causes us to enter volatile, explosive relationships. I mean, what can be more adrenaline pumping than wearing a suicide vest and not knowing when it will go off?

I’ve been in relationships like this. I think back to a guy I dated in college – it was like standing on the edge of a cliff not knowing whether or not he would choose to push me off. When he decided not to – I was happier than I ever had been in my life. But when he finally did shove me over (and they always do) I found myself splattered over giant boulders on the bottom of a ravine. It’s the kind of heartbreak Taylor Swift writes songs about.

And when relationships that initially ignite our inner flame do last – eventually this “spark” fades, because no fire can burn forever. And when it does, we find ourselves back in this cookie-cutter life we’ve settled for. We are intrinsically unhappy. But we don’t blame our own dream deserting, goal abandoning selves – no, we blame our partner for not giving us the thrill we deserve (which is total BS).

So my question is – What if we did the opposite? What if we cultivated in ourselves a life of adventure, excitement and passion and found ourselves a steadfast partner to experience it with?

What if instead of following someone else’s plot line, we created our own story? One where the suspense had nothing to do with whether your significant other was going to leave you – and everything to do with the adventures you decided to go on together.

So you don’t want kids? Don’t have them. You want to travel? Go. Your dream adventure is driving a van full of kids to soccer practice from your house in the suburbs? Fantastic!

Passionately pursue your dreams with the gall of the wind and the strength of the river. Let your life be the roller coaster and your significant other your seat-buddy, riding the loop-d-loops hand in hand.

What if we stand by the cliff flying kites in a storm knowing that we will catch each other if one of us slips, instead of wondering when we will knock the other off the edge?

Personally, I believe that if more of us lived like this there would be less divorce, depression, and all around discontentment with life. And my friends – life is too precious and too short to not live the adventure that you deserve.

How it starts

In Berlin there stands a Holocaust memorial for the Jews killed during WWII. The memorial is a bleak site – a large square filled with gray slabs of concrete, like coffins.

Walking through this monument was a somber and unique experience. You start at the outside edge where the slabs  are only about a foot tall. As you begin walking through, the slabs begin to grow taller and the ground dips down, so that by the time you are in the middle the slabs are about 3x your height. You are completely surrounded by them.

As I was standing there, encircled by these walls of cement, I had this overwhelming feeling of: This is how it starts.

It doesn’t begin with the walls towering above you. It doesn’t begin with enslaving men, women and children in death camps. It doesn’t begin with a someone taking a gun into a school, movie theater, office building, or night club. It doesn’t begin with police officers executing someone or a sniper targeting officers at a rally. It doesn’t begin with a man driving a truck into a crowd of celebrating people or with planes flying into buildings.

It begins with hate.

A seed sometimes to small to even notice – but it grows. Hate and fear, leading to isolationism, accusations and degrading generalizations. The seed turns into a sprout, fed by the media (both mainstream and social) and political figures who believe that saying sexist, racist, homophobic things mean they are a “straight talker.” The sprout turns into a tree, and the tree into a forest. Suddenly, here we are with concrete coffins stacked high above our heads.

I remember when we learned about the holocaust in school, thinking: “how could anyone ever let this happen?” I get it now, for I see the mentality behind it in my Facebook friends, patients, and presidential candidates.

I have no grand ideas about the perfect laws to pass or policy to be made to make this all go away, and in truth I don’t think such a thing exists. Our only option is to turn our eyes inwards, recognizing our own fear and hatred and fight against it with everything we have. Reminding ourselves that not every muslim is out to destroy the western world, not every Christian is homophobic, not all black people are gangsters and not all police officers are violent racists.

As unrealistic as it is to believe that we can make everyone in the world suddenly decide to love each other  – I do believe with my whole heart that each person who decides to choose love over hate makes this world a little bit of a better place. Let’s be part of what keeps this world remaining beautiful, not what makes it ugly.

In the words of the comedian Jim Jeffries: “Hate doesn’t beat hate… it just makes more hate. The only thing that beats hate, is love.”

Let’s choose love my friends.

Continuing to care

“I can’t find the fetal heart tones.” The nurse states with a tone of underlying panic as she exits the patient room.

It’s around 7 am, and those of us working the night shift are getting ready for morning sign out before we can head home and get some much needed sleep after a crazy 14 hours shift.

“Tessa, go scan her” the resident nods towards the ultrasound machine and I cheerfully follow his command, rolling the ultrasound into the room of my patient.

She’s a young woman admitted the night before for preterm premature rupture of membranes (PPROM) at 21 weeks gestation. I’d seen her once before, a few weeks before in the L&D triage area right after she had found out she was pregnant. When I saw she was back in triage the night before I recognized her name immediately. I remembered really liking her and feeling an easy connection.

That night I was there  when we explained to her the options with a PPROM at 21 weeks – either we induce labor now to terminate the pregnancy (as a 21 week old is not medically viable), or we wait and hope to keep her pregnant and infection free until 23w5d when we can give steroids to try and mature baby’s lungs. We scanned her and saw cardiac activity but minimal fluid, and she made the decision to try and make it to 24 weeks (when the fetus is considered medically viable).

Throughout the night, whenever I had a spare moment I would stop by her room. I chatted with her and her mother about medical school. They asked me about the details on any of the cute residents and if it really was as much like grey’s anatomy as they imagined (I told them it totally is, except for the fact that everyone else is married and I still go home to my cat everyday. But other than that it’s basically the same 😉 ).

So as I haul the ultrasound into the room, waiting for it to turn on, I try and make cheerful smalltalk, seeing the terror in her eyes. I scanned, and I scanned, and I scanned. Again, trying to maintain a poker face as I didn’t want to be that medical student who told the patient their baby was dead when in reality I just don’t know how to use an US machine. But as I continued to scan, I found no cardiac activity.

I kept scanning.

I knew that I couldn’t tell her this, because while I was nearly 100% positive on the outcome, I am a medical student and I needed a resident to confirm the results. So I stood there, continuing to scan, planning how to strategically exit the room and grab a resident without alarming her. Thankfully, at that moment one of the day shift residents  came into the room. We looked at each other and she saw on my face that it wasn’t good.

“Are you having some trouble?” she asked carefully.

“Yea I am, would you mind  taking a look for me?”

She did, and found the same thing I had.

I remember as they told her the news, how her and her mother both looked repeatedly back to me. As if somehow the way I responded to this would dictate what came next.

I left that morning with a heavy heart. Just an hour before I had scrubbed into a cesarean section where the attending physician had complimented how good my subcuticular suturing looked (although it literally took me like 6 years to do it) and I had felt on top of the world.

That night as I arrived back at the hospital for another night shift, my patient was ready to deliver (they had induced her that morning after I left). I walked into the room before the rest of the doctors came in, wanting to know if it would be alright with them for me to be present in such a delicate situation.

As I walked in, my patient’s mother came and gave me a hug saying “I am so glad to see you.” I was moved at the importance of a familiar face in this devastating situation.

Continuity of care – it’s an aspect of medicine that we like to talk about, especially in the setting of primary care specialties. Basically, what it means is that you get to see the same patients for a long period of time. It literally translates (from medicine talk to english) as continuing to care (both physically and emotionally) for a patient.

As medical students, continuity of care is a phrase that we throw around when discussing why or why not we want to pick a certain specialty. People who require continuity and really enjoy having long relationships with their patients pick fields where this is possible – family medicine, OB/GYN, Pediatrics.

I struggle with continuity of care. Obviously I believe that having stability in your primary care is a good thing for patients – you won’t find a doctor or prospective doctor who disagrees with that. But I struggle  with whether having continuity of care is a good thing for me.

By continuing to care you patients, you are not just taking care of them – you are actually getting emotionally invested in their outcome. How wonderful that is when things go awesome! It’s great when you have helped a patient along from conception to birth. But when things go wrong, how do we deal with that?

I think one of my strengths (and my weaknesses) as a medical student is that I have the ability to throw myself 100% into what I do. When I am in the hospital, I am 100% there, all the time. This allows me to be involved and empathetic to my patients, and they feel that they are my whole focus – because in that moment, they are. The problem I face with this is that it requires that I have a career where when I go home, I can 100% go home. I don’t think I have the ability to compartmentalize my life if the specialty I go into doesn’t do it for me.

I am afraid that for the rest of my life I will constantly be “taking patients home with me”.

The story of the patient above is a perfect example of this. I became emotionally invested in her story, and I am glad that I did. I think that becoming connected to your patients is something that makes you more than a doctor – it makes you a human being.

My fear is that if I allow myself to continuously becoming connected, invested, and heart broken when things go wrong – that eventually I will lose my ability to connect and care at all.

OB/G-Whine

These last 6 weeks I’ve been in the wilderness (of the 3rd floor of the Loma Linda Med Center) being tempted by OB/GYN – and it’s kind of working for me!

This is  super surprising, as coming into medical school I always said “I don’t know what I want, but I know I DON’T  want OB/GYN”… In fact, I complained a lot about starting my OB rotation (hence the title OB/G-Whine, instead of OB/GYN – get it? I know. I’m hilarious, you can thank me later) but somehow, in the midst of some things I didn’t enjoy doing, I also found myself doing things that I LOVED and that made 14 hour shifts something I looked forward to doing and reluctant to leave.

I don’t know if I will end up doing OB/GYN, it’s entirely possible that the things I hate about it will beat out the things that I love. However, it is back on the table, making my future life decisions even more challenging than before.

The good news is that again I have learned some fun facts to share with you:

  • Babies are a lot like God in the fact that they really don’t care to follow any of your plans.
  • If you can see through, it you can cut through it.
  • “Out of all the risks a woman can take in her life, getting pregnant in the biggest one.” – Dr. Patton
  • Breast is best.
  • Hormonal pregnant women do surprisingly less yelling than I expected them to (referring to my fears mentioned in A Family Affair).
  • My back rubs can cure hyperemesis.
  • It’s pretty awkward when an attending physician stops operating in the middle of surgery to inform the entire OR team that you look just like Jennifer Lawrence.
  • Hummingbirds hibernate every night and have to warm-up in the morning before they can fly.
  • For those pro-life friends of mine: the best way to decrease the number of abortions is not by making abortion illegal, but by increasing the use of long acting reversible contraceptives (LARCs) such as IUDs.
  • Benign Gyn has the power to kick Cardiothoracic surgery out of the OR.
  • On L&D, some nights everything that can possibly go wrong will and you will have 13 people waiting to be seen by triage, and the next night there will be one delivery and no triage patients and you will spend the entire time watching videos of polar bears, Russian and Korean rappers, and cats getting shot out of trees with a fire hose.
  • If you meet resistance while pulling out the foley – don’t keep pulling.
  • When you tell a surgeon you’re ambidextrous and then tell them you probably aren’t going into a surgical specialty, they get pretty upset.

And while all of these facts are super duper fun to know, probably the most important thing I learned and that I particularly want people who are not in the medical field to understand, is this:

The process of pregnancy and child birth can go wrong so incredibly fast. Yes, women have been giving birth centuries before hospitals and physicians. But childbirth was also the #1 cause of death in women during that time. So to my friends out there that are pregnant or planning to get pregnant, please go see your OB. Get consistent prenatal care and have the discussions about the birth process with a physician. Let them help guide you in the decisions you make about how to bring your child into this world in the safest possible way for both you and your baby. 

I’ll get off my soap box now. But for reals, OB/GYN has been a blast. I’ll be missing these times as I walk around in endless circles on internal medicine.

FullSizeRender

Shout out to these fool’s for putting up with me for the last 6 weeks!

If you’re looking for some midnight entertainment – here are a few of my personal favorites for your viewing pleasure, compliments of a few slow shifts on night float:

Life hack: if you type in “Russian _______” (insert literally any noun or verb) on youtube, you will find some great entertainment!

 

The Pool

When it comes to the swimming pool of love, there are two types of people:

  1. The ones who dive in head first without having any idea of the depth of the pool, the temperature of the water, or the contents of what lays beneath the surface.
  2. The ones who stand on the edge, staring at the water trying to gauge it’s depth, tentatively sticking their toe in to identify the temperature, and possibly even peaking under the surface through some goggles to see the bottom before choosing whether or not to eventually wade into the pool.

Through the discussions I’ve had with friends on either end of the spectrum, I have come to realize that there are pros and cons with either aspect.

Obviously, if you talk to someone who is continually diving into this pool, they’ll tell you tale after tale of how they have dove into the shallow end and snapped their neck, leaving them in paralyzing heartbreak.

However, if you talk to someone continually on the sidelines, they’ll be the ones with stories of the “one who got away”… only they have about 15 of them, and none of them needed to be the one that got away except that they spend their entire afternoon (or like 6 years) trying to judge the worthiness of the pool and if the pool even wanted them to get in – and never actually got in the water.

I am most definitely the second type of person, which is kind of interesting because I tend to dive right in in every other aspect of life. Yet somehow when it comes to love and relationships, I am as timid as a fly. My best friend is someone who dives right in. She feels immensely for people and throws her heart right into the mixture, putting herself out there, which is something I am incredible envious of. We have often said that if you could combine us we would literally be perfect at relationships (unfortunately that’s not possible).

The biggest problem I have with the type of person that I am (and why I think the other types of people are superior to us) is that by never getting in the pool we eliminate all possibility of success. Yes, you may dive in and drown time and time again – until eventually you don’t, because thats how relationships work. They all end, until one of them doesn’t. On the other hand, if you never get in, you will die from heat stroke every time and eventually the water will dry up and you will have absolutely no chance.

All this preamble is pretty much just to say that I recently did something that constitutes jumping face first in to a body of murky water with absolutely no hint of depth, temperature, or content. To some, what I am doing seems ridiculous and stupid and reckless. However, as someone who is used to living their life on the sidelines in this respect – this is progress for me.

I’m tired of the regret that comes along with doing nothing. I have countless instances that end with literally nothing happening and me still wondering to this very day if it may have been something.

As the girl who has mastered the art of playing hard to get – and pretty much any other game of manipulation and power out there – vulnerably chasing after something is pretty much the scariest, healthiest decision I can make. Instead of never allowing myself the possibility of heartbreak because I never let my heart get invested, I’m going to invest full force.

So maybe theres basically a 90% chance that I am going to drown, but maybe death by water rather than by a scorching ball of fire will be a healthy change of pace.

Besides, no good story every began with “and then I did nothing”… and believe me folks, this story is going to be one for the books. Although my self-esteem is probably going to take a big hit, so I’ll tell you all about it when I’ve recovered – In about 15 years 😉

Demolition

There’s a George Ezra lyric that goes: “you may think that he’s a demolition expert when he’s finished with your self-esteem.”

I can’t think of a single better way to describe the process of medical school. You get  accepted and you feel AMAZING. I mean, medical school is very competitive to get into, and this means that you are pretty much a part of the top percent of people as far as intelligence goes (don’t mind me tooting my own horn over here).

Then you get here and you are reminded that even the top 5% has to have someone on the bottom. Nothing makes a smart kid feel stupid like being surrounded by a boat load of  smarter kids.

No matter how many exams you pass or OSCE’s you sail through, the next hurdle never fails to have you leaving feeling like the dumbest person on the face of the planet. Entering 3rd year of medical school steps up this game to a whole new level.

There’s this process known as “pimping” that is hard to explain in any other way than that it is the feeling of shear terror when an Attending physician turns to you and says something like “What is the mechanism of action of human placental lactogen in the context of gestational diabetes?” or when you’re in a surgery and the surgeon points to a small string like structure and asks “What vessel is this?” Usually followed by frozen silence, an attempted answer, and then a deep sigh of disappointment or if you’re really lucky, a verbal beatdown about how you should know this.

It’s horrifying. I’ve definitely had nightmares about some of these episodes after they happened.

However, I will forever remember everything about human placental lactogen because of the moment when I didn’t.

An attending physician friend of mine once said to me: We’re not cooking breakfast here.

How true is that. When we screw up – be it medical students, nurses, residents, or even the big bad attendings themselves – it doesn’t just result in burnt eggs or funny tasting pancakes. These are real lives we’re dealing with. People with families, stories, hobbies, hopes, fears, and dreams who entrust all these things on us.

So yes, if I don’t know the relationship of the uterine artery and the ureter, someone can die. If I show up in surgery without knowing the past medical and surgical history of a patient, someone can die. If I don’t understand that a diabetic experiencing hypoglycemic episodes in the late stages of pregnancy can be caused by uteroplacental insufficiency (resulting in decreased HPL production and decreased insulin resistance), someone can die.

Sometimes we medical students require reminders that despite everything we have learned, we don’t know nearly enough for this responsibility. There are moments when being yelled at for being unprepared is the correct outcome, because someday when we are the ones holding the scalpel there will be no one there to be prepared for us.

So maybe a little loss of self esteem isn’t the worst thing – at least not when the alternative is someone losing their life.