Best and Worst

Peds Surgery
Best: Procedures! There is something really gratifying about draining abscesses.
Worst: There were some really stressful times that I didn't necessarily feel comfortable about, luckily the nurse practitioner jumped in to save me.

Internal Medicine (Adult Medicine)
Best: I worked with some awesome residents. For some reason they trusted me. I got to run a code because I showed interest. Getting a hug from a patient on their discharge day who had previously been frustrated with her care and requested me to my senior IM resident, her family gave me hugs too.
Worst: Adults. Not feeling like I knew what I was doing. Long hours. So many drunks and drug overdoses.

Clinic
Best: Quote from my quarterly eval- "best intern ever". I get praised by my attendings every Wednesday that I'm there.
Worst: Some feelings of animosity directed toward me by some of the other residents at my clinic.

Work peeps
Best: Wine nights. Birthday party planning. Rocco's Tacos.
Worst: There aren't any. These people are awesome. One of our residents lost her dad last week and it was amazing to see how we all jumped in to support her.

Other
Best: Being so close to one of my best friends and helping her wedding plan. Random trips to the beach whenever I want. It's October and I'm in shorts and a t-shirt.
Worst: Always wish I had more time to spend with Lexie. Thank goodness for hour restrictions.

Florida Month 1

Well it has been about a month of this doctoring business. So far nobody has died on my watch. The perks of having to stay up all night and having to talk about consistency of a kid's bowel movements at 3am is that at least I am getting paid now. Yes, my life is that exciting.

I am currently on general outpatient peds. Lots and lots of well child visits. There is no shortage of newborn baby visits so lots of snuggling fresh little humans. There is also the freaking out when they aren't gaining weight or have turned yellow. All in all, it has been really good. So much so that it has me considering general peds as a backup plan which is pretty big because I was adamant that I would only do peds ED. I will be at this clinic for another full week and then once a week for the rest of my residency. They have had me generate a list of patients that they are going to try to schedule on my clinic day so I will get to watch this little babies grow up during my three years here.

My time to explore my new surroundings has been rather limited. This is the first weekend I have had off since I started. There is a complete lack of food in my house because of that which is making for a great diet. I also signed up to take my last set of general boards at the end of August. Can't wait to have that behind me. My very last month of general adult medicine is in September and after that it's the under 18 crowd from here on out.

Back to studying. Keep your fingers crossed no hurricanes head our way.

-Pasty Girl in the Land of Tan

The Cat

For over a week now, there is a grey and white cat that perches itself outside my front door and incessantly meows. I am not a cat person, never have been and this little beast is doing nothing to endear me to the genus. I'm not quite sure why it picked my house of all places to set up its nightly terrorizing. There is no food out that would draw it close, I definitely have not gone out to pet it, and it didn't get the hint when I tried to shoo the thing away. So a friend and I came to the conclusion that karma, Mother Nature, Buddha, God, Mohammad, or some being/force out there is trying to drop the clue of my impending cat lady status. And based off the last three guys I have dated, I may as well go adopt some more puppies cause that seems like a far better option than being attached to one of them for any length of time.

So guy #1, he was maybe my best lesson in why it isn't always a great idea to date a friend of a friend. There was no set up though. We met on a float trip and within hours of returning home, I had a friend request waiting along with a message from him. After a couple weeks, I finally broke down and agreed to go out on a date with him. For starters, the guy was probably in a no win situation as my expectations are more on the unachievable level but I didn't think he would crash and burn as badly as he did. He did get points because he drove 2 hrs just to take me out but that's about where the point earning stopped. During the first hour we were together, I learned in no certain order that he had gone to jail for a DUI and had to pay $25k in fines, that he "didn't feel bad for me because I got myself into this" when I was discussing having to do call right after a day shift which meant working for about 30 hrs, and the icing on the cake was that he may or may not have a kid but he didn't want to find out cause he didn't want to pay child support. I pondered whether my friends were playing a joke on me. I was half way convinced it was a ruse when I asked my friend about the potential kid and they knew nothing about it. Regretfully, I allowed my friends to convince me to continue seeing him beyond that first date but eventually came to my senses. The major problem with dating friends of your friend is that you have to see them at different events throughout the year. Can't wait for the awkwardness of this year's float trip.

Then there is the waiter who got my number when my "friend" (same one who decided this cat showing up was a sign I'm destined for cat ladiness) wrote it on a receipt. And besides the story about how things started, there wasn't a whole lot bad about guy #2. His only major fault was his lack of understanding and patience. My internal medicine rotation killed this relationship. When you have to be at the hospital at 4:30am and he gets off at 11pm, it doesn't allow for much time to see each other. It was a great lesson though that I can't trust my friends with paper and pens. This same friend decided to sign me up for an unknown number of dating websites for my 28th birthday but the funny thing about the present was that I didn't get to know about it until about three months later.

And to round it out, guy #3. He was a random encounter right before I left for audition rotations which meant we spent about four months communicating before we actually went out. It seemed promising but didn't live up to expectations. Prior to this date I had been sick for about a week and not able to stomach much. I ended up not being able to eat very much nor drink the bottle of wine that he insisted against my attempts to graciously decline. So he took it upon himself to drink the whole bottle of wine minus the 3-4 oz that were in my wine glass. He also ate all of the bread as he continued to drink and at the end of the night I nearly vomited after he decided to point out that he must have backwashed into his glass because of the remnants at the bottom. Okay piece of advice for potential backwashers, this is not something you draw attention to. You try to hide this and the embarrassment on your face so your date doesn't think you are totally disgusting. Through dinner it was becoming more evident that the wine was having an effect on him (the other option is that he just had horrible manners). He went from sitting square on to having to lean against the wall perpendicular to me. Our conversation was limited to sports and family. While I love talking about both of those topics, I was doing about 80% of the talking and he would interject with things like "my parents are going to love you" or his plans to teach me how to shoot a gun. I don't deal well when people try to push me to do things and there were already multiple times he struck that nerve. And I definitely get the instinct to turn and run when I get the clinger vibe. To end the night, he had to drive me home. My question regarding whether or not he wanted me to drive didn't go over so well and also distracted him enough to cause him to lose balance and trip off a curb. Looking back, I should have gotten a taxi though I'm not sure if we even have those in Jeff City. My knuckles were blanched the whole ride home as he almost took out a group of pedestrians and ran up on a sidewalk. There was definitely no second date and I regretted that he knew where I lived especially after I received some guilt tripping texts and the fact he was an ex-Marine. And my attending ripped into me about letting him drive me home after he had the whole bottle of wine. I now have the number for my own personal white Subaru taxi courtesy of Dr. A.

Hopefully the next won't be nearly as bad as #1 and #3 or my random checking of the dog adoption listings may turn into actual calling. But right now as I sit here watching Lexie trying to paw at a ball with another toy in her mouth, I love it being just us two. Definitely no cats are needed.

Student Doctor Status: Complete

48 hrs and 14 hrs until it is seriously official but I AM DONE!!!! I walked out of my very last rotation yesterday at 6pm. It was a very odd feeling knowing the next patient I see will be as Dr. Raney with no "student" attached to the front of the introduction. And I came home to celebrate by catching up on my Thursday night dramas and watching one of my favorite movies, The Last of the Mohicans, with Lexie curled up beside me. There was no crazy party or heavy drinking, just a latte in hand and a protein bar for dinner. It was a sign of how exhausting this process has been and now it is over. I have one set of generic boards to just pass (I don't even have to do well on them) and my peds boards in three years.

So here is where I thank everyone. There have been so many people standing beside me as I made this journey and I couldn't have done it without you all. And all the people that brought doubt into my life, thank you too. You only kept my fire burning and pushed me not to give up, to prove you wrong. e

O Ye of Little Faith

Call me a pessimist. I went in to Match day expecting the absolute worst and I prepared all the documents I would need to send to programs that had available spots. It was terrifying. I was also trying to do everything I could to keep it together for the sake of my roommate who was in a worse situation than I was with very few programs willing to support his visa process. In the end, I came out  feeling like a winner but had to suppress my joy and excitement while I attempted to help my roommate scramble for a spot.

The next three years are looking sunny and warm. I will be training in polo country, specifically West Palm Beach, FL (my #1 choice). It was my first choice program and I am so honored that I was one of their top choices. I had the privilege of rotating there in October, originally scheduled as a fun out-rotation to see if I actually liked peds ER as a potential career path and it was also close to one of my best friends so I could spend time with her. It was #3 on my original rank list prior to going on auditions. Even if West Virginia and Michigan had lived up to my expectations, Florida so far exceeded my list of program wants that it jumped to the top of the list. The group of residents were supportive and attendings respected them. There was an atmosphere supporting education but also allowing for you to have fun and have a life outside of the program. I looked at the third year residents who were at the end of their training and had nothing but respect for them along with a comfort that they had been well trained and were capable of competently practicing on their own.

At the end of the day on Monday, all four of us at the Jeff City site had contracts on the table. Two were going in to internal medicine in Michigan and Florida. My roommate scrambled in to a spot in Washington, D.C. Overall as a class, things went fairly well for those of us that did the DO Match. An AWESOME outcome- there were six people so far that have matched in to general surgery, all six are female. We have some bad ass chicks in our class. Next month will be the final match (MD) with the other portion of our class finding out what the future holds for them. Best of luck to all of them. Can't wait to celebrate with everyone at graduation in three short months.

Giant Ball of Stress

Well, we are nine days out from (residency) Match. I thought the whole process of applying to med school would be the most stressful hurdle in this whole adventure but boy was I wrong. This point far surpasses anything I have gone through thus far. It seems like there are too many things working against me. For one, there are more people graduating from med school this year than ever before. Couple that with fewer residency positions open, especially in pediatrics and the numbers don't add up. It is estimated that at least 500 of us won't even get in to a traditional rotating internship position (this is a back up for a lot of people if they don't match into their first choice).

And then there were the things that I could have controlled and let myself down. I am my own tough critic picking apart my application each day thinking if I had just studied that extra hour rather than watching Grey's Anatomy how much better I could have done. But it is too late to make corrections and there are no do overs. Lists for both students and programs were turned in last week. Nine more excruciating days of waiting.

My stress is effecting all aspects of my life. My sleep, eating, how I treat people, tolerance level, and especially my emotions. So I apologize to anyone that has been on the receiving end of me blowing them off or a nasty glare or awful comment. There have also been disappointments to add to all of that as well. Expectations that didn't hold up. Some with people I barely knew and I take responsibility in building them up to fail and others with those I count closest to me. I'm holding back a rant right now as I am still digesting the hurt feelings and trying to come to a place of understanding.

So to my fellow 4th years going through these painstaking following nine days till the DO match, best of luck and if I could provide you Xanax or Ativan, I would. To those waiting on the MD match in March, good luck as well and I hope those announcing their happy match news next week don't drive you over the edge.

105 days till graduation!!!!

Wrapping it up

It's been a while. A bunch has happened in the past four months so here is a quick synopsis of the highlights. I had three audition rotation spread out around the eastern half of the US which I spent many hours in my car venturing around.

September: I spent the month in Charleston, WV working in the Women's and Children's Hospital. I spent my first two weeks in the pediatric ICU with a bunch of kids that had the lovely enterovirus D68. This was also where I encountered my youngest victim of child abuse. It is a situation I have long feared and knew it was only a matter of time until I came face to face with a perpetrator but the scenario I had gone through in my head did not fully prepare me for how I would feel. The image of seeing a little four month old baby in a coma with electrodes connected to her head and an intubation tube sticking out of her mouth. Later seeing the images of her brain bleed and the damage to both of her retinas not knowing whether this little girl would ever return to baseline despite all our efforts was hard to deal with. After she was extubated, I spent hours working with her to correct her sucking reflex as she continued to choke on her spit and feedings and the fear was she would have to be reintubated. I will never know what happened to LP but I would have gladly taken that little peanut with me.
My last two weeks in West Virginia was spent on Infectious Disease service. I saw lots and lots of bone infections. My experience over the last two weeks was very different than my first two. I wasn't allowed to really do anything but observe and my initiative to come in early and round on patients on my own was not appreciated. This was a very tough time as it was the beginning of interview season and I was with the program director so I would overhear him talking to staff about offering people interviews. My last day, he shook my hand and wished me luck in my future...that was it. I never received an offer to come back and interview. It stung at the time but reflecting now, I would be very upset if I were to match to Charleston. The program didn't offer what I wanted and I don't think I would have thrived there.

October: Glorious October. I was able to spend it in warm, sunny West Palm Beach, FL. I was so excited just going in to this rotation as I would be spending it in the pediatric ER which is a potential goal for my career direction. And it didn't disappoint in the least. I saw some crazy diagnoses, worked with some of the best pediatricians I have encountered, and interacted with a fantastic group of residents. During my third week there, one of the physicians I worked with sent an email on my behalf to the head of the peds program, the overall residency director, and director of medicine of the hospital system recommending me as a future resident. This started the ball rolling which would have me moved to the pediatric floor of the hospital to take care of my own patients and by the end of the third week I was interviewing for a residency spot. I had been warned that the peds residency director was intense but he was like that with all interviewees and residents. Well I must have caught him on a really good day because I had a fantastic interview. I have talked with the assistant residency director since and had very positive feedback. I am crossing my fingers, toes, arms, and legs crossed (I have been instructed it is not safe to work or drive with my eyes crossed so for safety purposes, they will remain uncrossed).

November: I made the huge climate change up to Detroit to spend the month at Children's Hospital of Michigan. Holy cow is it a huge hospital. I was still trying to get my bearings at the end of week four.  We had a hefty patient load that never provided a reprieve. It was an insane month. I don't think I have ever worked so hard in my life. Short shifts were 11-13 hour days with night and long shifts being 14-16 hours. It was slightly different as I was working as a sub intern which meant I had all the responsibilities of a first year resident but I just had to get all my orders and prescriptions entered by my senior residents as I didn't have that capability. And it was freaking cold. There was a record cold streak that went through, the same one that dumped 6 feet of snow on Buffalo. It was the perfect timing for the heat to go out at my friend's house. This made having to stay at the hospital where there the inside temperature was above 60 degrees slightly more enjoyable. All the hours I was putting in didn't go unnoticed, at least by the senior residents I was working with. I received a great deal of praise from my attendings, chief residents, interns, 3rd year students, as well as patients. Unfortunately, this didn't result in an interview at this program. Of the two programs I did a rotation at, this was the most upsetting not to get an interview. I am still dwelling on it and remain frustrated. I don't think I could have done any more than I did while on the rotation so at least I have no regrets in that aspect.

December: I got the chance to return home for the month to do a rotation in physiatry. It has been so nice to be home and the rotation was so relaxed compared to what I had endured over the past three months. It was tough going from all my patients being under the age of 18 to rarely seeing anyone under the age of 50 who didn't have a work related injury with an open L&I claim. I had a hard time not resenting patients who came in complaining of 10 out of 10 pain who were able to walk in to the exam room and were able to smile during the history taking and denied having any disruption in their sleep when I had just come from caring for kids riddled with cancer in their bones who were unable to walk more than 10 steps. I definitely think I am going in the right direction as far as my preferred patient age bracket.

Residency outlook: I have finished up interviews and am currently putting my rank list together. I have been trying not to get too attached to a program going in to the last month before results come out but it has been very hard. My mind set starting out was that I would make the most out of wherever I ended up but coming out of rotations it is more apparent how important it is for it to be a mutual match. February 9th is when all will be revealed. The waiting is excruciating and I'm sure the next month will only be that much harder. Think warm happy thoughts.

Only 14 weeks left of rotations and less than 5 months till graduation.

In My Backyard

There are many things I love about my parents but there is a story that I am most proud of that exemplifies the type of people they are. It happened when I was little and though I was present, I didn't grasp what was going on until much later in life. It was a normal thing for us to hang out with my preschool teacher, Gloria and her family. We often took turns hosting dinner so going over to their house one particular night didn't strike me as weird or special. I loved Gloria. She was awesome. And even though her sons were older than me, they still put up with me. We ate dinner all together and then started watching a movie. The volume was up pretty loud and I think we had some Lincoln Logs we were playing with down on the floor. I didn't really notice that my parents slipped out of the house during this time but I do recall being told to stay in the living room which was at the back of the house. I learned later that my parents were standing outside, protecting Gloria and Willy's house from a group of KKK members who had been threatening them for weeks. We spent several nights at Gloria's for the next few weeks. This was Southern Missouri in the late 80s. Events like this were rather common unfortunately. This story highlights how I was brought up; to treat everyone as equal no matter their education, background, color, gender, or beliefs.

I bring this up to preface what I am about to delve into, to say I am not jumping on a side because it is "the white side" or "fighting for the minority". The lessons my parents taught me stuck and I see people as people, no separate categories because of the pigment of their skin. Bottom line, I want justice to take place with a non biased, thorough investigation of what went down on August 9th. I have attempted to refrain from posting anything on social media regarding my feelings about what has been going down less than two hours from me but my frustration has boiled over and is driving me nuts. So many people want to jump to it being strictly a race issue. I won't say that it didn't play a factor but that might not be the whole issue. What about this kid walking down the street in daylight caused the officer to feel the need to draw his weapon? Should the video of him robbing a convenient store come into play?

Let's start with Ferguson, MO. For the people back home, it is comparable to the south Lakewood and Parkland areas. It isn't as bad as East St. Louis but it's not a place you get ice cream and skip down the streets either. This is a place I lock my car doors if I have to drive through. I wouldn't stop for gas in this area and I have my phone charging in case I needed it. To be honest, I would drive out of my way to avoid going through that area all together. Why? I know several people who have been mugged or harassed in that area. Being short and unformidable, I opt to play it safe. Crime has been on the decline in the areas surrounding Ferguson but it's reputation persists for a reason.

A point I keep hearing on the news is that there are only three African American police officers on the 50+ member Ferguson Police Department. Yes, Ferguson is predominately an African American community but what about some other statistics. The Ferguson-Florissant area has a graduation rate of around 70% but close to 50% of fourth graders have below average reading abilities. These statistics make it less likely for kids from that area to go on to enroll in a police academy or college. The majority of the citizens are blue collar workers. There is also the negative connotation regarding cops that is ever present in the poorer communities which Ferguson most certainly is.

How about the witnesses? Somehow I was venture to bet that Brown's friend is pretty biased as most people's friends or family would be. As for the other witnesses that claim to have watched the shooting go down, what caused them to turn their attention to Brown and Wilson? Was it the sound of bullets or was it shouting that took place prior? Did they actually see the whole thing or just the final moments? And unfortunately, stemming from an embarrassing history with white people (yes, I have white guilt for the things my ancestors did prior to my existence), there is a tendency for the African American community to band together when one of their own falls. Need an example? How about OJ Simpson who is still defended to this day even after he wrote a book about how he might have carried out the murders. What I am simply trying to say is we may not have good unbiased witnesses to help answer the question of what happened leading up to the trigger being pulled.

Let's talk about the video. While this is just my take on what I saw in the video, I doubt anyone would try to argue that Brown was being friendly to the convenient store cashier. I would label him a bully and if I were in the cashier's shoes I would have felt threatened by the body language used. While he was unarmed, it does not take a knife, gun, or other weapon to be threatening or cause damage. He had none of those items as he robbed the convenient store but was able to use his force to terrify another human. This is in vast contrast to the angelic depiction I have heard his family try to portray.

Do I think it is fishy that we have yet to hear a description of the incident from the officer involved? Yes. Do I think things have been handled poorly? Most definitely. Do I think people are acting appropriately? An emphatic NO. There is no reason for the looting and destruction that we have seen in the week and a half since Brown's death. I have friends working in the hospitals around the area that have seen multiple injuries each night of the protests. These injuries have included stab and gunshot wounds to go along with the tear gas. At least 10 police officers have been taken to the hospital during this time. An eye for an eye is not a way to solve this.

Now we have another fatal shooting involving an officer. The environment that has been present around St. Louis for decades needs to be changed. It is going to take a lot for relations to be rebuilt. Trying to figure out the right way to move forward likely doesn't come with easy solutions. The first thing that needs to happen is to allow the investigation to be done before jumping to the conclusion that it is going to be corrupted. I want to believe in our justice system and I want others to have faith in it as well. I want citizens to have a sense of security and officers to feel safe while on the job. I want the media to stop stirring up further problems and stop giving camera time to the non-peaceful rioters and looters.

I want everyone to be safe and not have to worry about walking down the street. I want bullying to not be okay. I want race issues to be the only thing that is dead.

Cloud 9

Well, I'm officially in my fourth and final year of medical school. It's amazing how quickly it has flown by but at the same time I recall moments during first and second year that seemed to drag on. I finished up third year doing OB/Gyn in April and Peds in May. I loved almost all of my rotations this past year but these two really stuck out and were phenomenal.

My April rotation was back with the OB/Gyn I rotated with in September. Honestly, if I wasn't going to do Peds I would most likely go in to OB/Gyn. Like my September rotation, this one was full of some crazy unexpected twists and turns. I encountered one of those experiences that I definitely will never forget in my whole medical career. It was at the beginning of the month and I went to check on one of our ladies that had been in labor for about 13 hours. It was her first pregnancy so she was actually progressing quite well. I walked into the room to find the soon-to-be mom, her husband, a nurse, and a tech. She was in the final stages of labor and had started to push. As I was talking to the patient and asking her how she was feeling, her leg went numb and within a few minutes her left hand started to shake. My first thought was "oh s**t, this is going to be bad" but the nurse reassured the patient, husband, and me that she had been laboring so long her muscles were fatigued. Well...I was right. She went full on grand mal seizure. The nurse and tech ran out of the room to get help so you know, it was just me, a seizing lady, and her frantic husband. We did a C-section and had baby out within 8 minutes of her seizure. Long story short, the mom recovered, baby was fine and adorable, and it was the first time I was put in the real doctor shoes. It was amazingly scary but I learned a lot about myself. Most importantly, I didn't freeze in an emergency.

May was my favorite rotation of the entire year. It firmly cemented Peds is the right place for me. I was able to rotate with a different pediatrician who has been out of residency for two years. He took a lot of time to teach me things and give me pointers for residency. I encountered a little girl that absolutely stole my heart. She is 14 months old and has a rare heart condition called Scimitar syndrome. She has had 5-6 surgeries already in her short life and is scheduled to have her right lung removed in the next week. So much has happened in her short life yet she is so happy and full of life. Her little body wasn't constructed to take her past her third birthday most likely, but that little peanut made a huge impact on me and how she LIVES her life and there honestly hasn't been a single day since I was blessed to meet her three weeks ago that I haven't wondered how she is doing.

And then there was the past two days. The first two days of fourth year. They have been downright incredible. I am on internal medicine and lucked out that my attending has dismissed us to study for boards which I really need to do. Blessing. Yesterday I received an email from our Med Ed secretary wanting to pass along my most recent evaluation because she thought I needed to see the comments. It had me really nervous. Like sweaty palms, pitting out nervous. Evaluations from peds clerkships count as a whole lot for residency selection. Well I think my attending was way nicer than I deserved. He wrote many flattering things including "Very professional and polished like a senior resident despite only being a third year medical student." Awesome. And today, I received an email from the attending with a letter of recommendation for me and a note saying that because he hadn't done very many of these, he sent my letter to the pediatric residency director at Mizzou to have her look over it. She responded with an inquiry as to whether or not I would be applying to their program because she would love to interview me in the fall. Are you kidding me?!?!? Honestly, I had ruled out MD programs because I didn't feel competitive enough but this gave me hope. My dream program has always been Mizzou. I literally almost cried happy tears in our medical library while reading that. Even if nothing happens, it was an amazing confidence boost that is much appreciated before boards and starting the application process.

To top of the past couple awesome months, my mom's scans came back completely clear. We had been following some suspicious nodes that were lighting up on scans but they have completely resolved in the past 6 months. Her tumor marker levels were also in normal range so it was the best possible news.

Till next time.

Suggestions

1. Coming to a doctors appointment high is never cool...especially when there is a tiny critter feeding off whatever you put in to your body.

2. You do not need to go to the ER for nausea or for a UTI. These can all be managed in a clinic!

3. Antibiotics are for bacteria. Viruses are not bacteria.

4. Some amount of pain is normal. As my last attending liked to say "pain means you're alive".

5. There is no pill for the shortness of breath you are experiencing from the pack a day you are smoking and your obesity.

6. When you come in requesting a pap smear seven months after your last one, maybe you should rethink some of your choices.

7. You have no feeling in your feet? Yes, this concerns me. But when you let me know that you aren't compliant with your diabetes medications and are eating fast food for every meal don't be shocked when I'm not jumping out of my seat to figure out what the heck is going on.

8. STOP SMOKING!!!! We aren't just saying this cause we like the sound of our own voices (okay, some of us do).

Happenings

Planning for next year is in full swing. And it's terrifying! The thought of trying to pick the top three places I am interested in for residency is daunting. I have absolutely no idea how to even narrow the list down to three. They all kind of look the same when I do my pros and cons list. I don't think I am a huge city girl so I have kind of shuffled the Brooklyn sites at the bottom of the list and I'm not big into the GTLing so Jersey gets put down there too. The good/super stressful thing is that my match will be over in less than a year so this whole limbo thing will be over in twelve months.

I finished my pediatrics rotation last month and am on my second to the last required rotation of this year. In four months I will be done with all the remaining tests I have to take in medical school. Then it is just a year of clinicals and enjoying my last 11 months before graduation. Pretty nuts how close the end is getting.

As far as family goes, everything seems to be going well. Mom is still healing from her December surgery but everything is pretty on track and she is scheduled for her final surgery in May. I think she will be very happy to get that out of the way. Otherwise they are both kind of waiting to see where I match to before they decide where their next adventure will take place.

Things are always changing here in JC whether it be rotations, the people, weather, or what random expedition we find ourselves on. We have all been spending quite a bit of time together in hospital as well as out. We have had residency selection and completion of boards to celebrate and it is starting to set in that June is not that far away when some students and interns will be moving on to far away places. I have gotten to know some new people and been out in the awful dating scene. I like hanging out with my dog so much better.

Speaking of my dog, the little troublemaker has a heart condition. I ended up taking her to a veterinary cardiologist (who knew there was such a thing) and there is no structural defect but the electrical conduction is definitely jacked up. She got put on some old people medicine (a beta blocker) to help slow down her heart rate which was beating at 300 bpm (normal is around 100 bpm) and try to get her rhythm to be regular. Luckily, they did clear her to fly and the cardiologist said she wasn't restricted from any activities. I would have problem pet.

Happy Belated Valentine's Day! And Happy Presidents Day!

Another Year Down

Things are moving pretty fast around here. During the month of November I knocked out two short rotations: anesthesia and radiology. I'm currently manning the crazy people (or the ones that don't know where they're at) on psychiatry with only two weeks to go. This rotation has been pretty quiet. I am only allowed to really see the patients we are consulted on in the hospital since most of the patients seen in the clinic are employees at the hospital and don't want us in the room. So I mainly just sit around the library doing some online shopping and working on assignments my attending gives me. Of course on my birthday this would all get thrown out the window and become a super insane day. We had two code blues, two new consults, a degloving of a shin in the ER that required 22 stitches, and I was able to sit in on two kiddos with ADHD. And it culminated in me going home work on an article review which I had to give the next morning. The highlight of the whole day was when I poked my head out of the triage room in the ER to let the family know I was about to put the last stitch in and as I was closing the door I heard the daughter on the phone telling someone that "the doctor just let them know that she was about done with the stitches". I got "thank you doctor" from the patient and her kids when I was done too. The excitement of that is not lost on this girl.

I made the whirlwind trip back home for Thanksgiving and was able to see family I haven't seen for a whole year and meet new little ones. There was the traditional soccer game, noodle and Grandma Hill's roll making, and going in to Seattle for dessert and putting up the Christmas tree. This of course was followed by (successful!) Black Friday shopping to knock out all the cousins. It is always nice to spend time with family but with recent family stress, it was that much more important. There have been a great deal of changes at the hospital my mom works at with new management stepping in who are implementing a lot of changes. One of these changes is asking my mom to step down from the manager position she has held for the past five years. With hospitals on the West coast still recovering from the recession, there aren't many open positions in management and with the extensive neuropathy my mom has from chemo, she is fearful of taking a position back at the bedside. With her ongoing surveillance for cancer, there is also a lot of anxiety when it comes to losing insurance since she carries both of my parents' insurance. Needless to say, there is a lot of stress at home.

Hope everyone had a very Happy Thanksgiving and you are enjoying the holiday season!

The Ramblings of a Crazy Lady

The last couple months have been super busy. My surgery rotation last month took up a lot more of my time. One of our general surgeons left the hospital which meant we are down to two general surgeons and then of course it would be the perfect time for one of them to go on vacation....so it was just my attending on for half the month. There was not much sleeping being done in the month of October for me. Luckily the other student and resident I was one with were awesome and we all got along really well. Being that busy did mean we got to see some pretty cool stuff. All I have to say is there is a reason we suggest the preventative testing when we do and harp on it so much. Get your colonoscopies people!!!

Third year core rotations will be half way over after this Friday which means I should probably get going on setting up my schedule for next year along with my two electives for this year. I guess I should commit to which specialty I actually want to end up in too. I'm having far too much fun with everything which is making it that much harder to decide. Babies still draw me in and I find myself signing up to be with the anesthesiologist that is on OB while I'm on my anesthesiology short rotation  to get back into the delivery room. 

Along with all the school chaos, I opted to add more demands on my life by getting a puppy. Lexie is a 16 week lab/spaniel mix who is very energetic. She is totally a momma's girl and is pretty terrified of the most ridiculous things (the mop!!!). I adopted her from a shelter where she was born after some people tried to drown her mom and they discovered she was pregnant upon admission in to the kennel. She is a handful but completely worth it. And she will be getting her first introduction to WA come December. 

Lost

I guess I was pretty naive going in to this whole thing thinking my first loss was going to be an older person (for some reason I always pictured it being a little old man) probably with some chronic heart failure or COPD who knew there time was coming and was surrounded by their family. It never crossed my mind that my first loss as a med student would be on my OB rotation. Now there is a newborn baby girl and her two year old sister that will grow up without their mommy. My heart is truly aching for this family. I have gone over her chart and all my interactions with her multiple times but it doesn't change the fact that she is gone. It isn't a patient scenario anymore, I don't just get to walk away at the end of the day and brush it off because it was some made up case. This was my patient and though she showed no signs of there being anything wrong with her, all labs were clear, her BP had normalized, and her imaging came back negative it doesn't make this nagging feeling going away.

I keep trying to tell myself that we did everything we could. The CT we ordered was extra because my attending had a hunch that something wasn't right. So how do you explain it to her family? How do you look her husband in the eyes and tell him that he is going to have to raise these little girls on his own?

It seemed like a simple case. Open and shut. Maybe that is why this is so hard to digest. I have been feeling ridiculously nauseated since coming back from the hospital this afternoon. I almost broke down and cried in the grocery store. Maybe I will get used to losing patients eventually but I sure hope not. I don't want this to be something I am used to. I like people alive and healthy and able to play with their 2 year old daughters and snuggle their newborns. But unfortunately I have to look at this as a learning opportunity and vow to not let it happen to the next one (even though there was nothing really we could do which sucks even more).

Calling It

...time of death- 20:40 on 9/10/2013. I have learned this week that I am really good at self sabotaging. I am so focused on what I am doing right now that I push everything else far aside. I live with my pager being within a one foot radius at all times. I wake up in the middle of the night convinced I have slept through either my phone or pager going off and frantically check it only to find out I have no messages. And I LOVE it. I called things off with a perfectly nice guy this week partially because I was getting annoyed at going to St. Louis about every other weekend and missing any weekend deliveries.

My confidence in myself is rather low which is common for most students (rightfully so as we are still babies in this whole doctoring scheme) but there are instances when I suspect something but fail to speak up and it turns out I was actually on the right track. I had an instance of this today while being along side a girl as she worked through active labor. We kept getting her right at the doorstep of calling in Dr. C to do the delivery and that little baby would opt to regress back. I kept thinking "I believe that is what turtle sign actually looks like" but as it was just me, a nurse, and the girl's family, I opted to keep my mouth shut cause I have learned to not say any crazy terms in front of patients during intense moments (after 28 hrs of labor, we were at defcon 1). For the non-medically related people that read this, turtle sign is an indicator of the shoulders being positioned so they are too wide to fit through the pelvis. Oddly enough I read about this type of issue (aka shoulder dystocia) last night and knew the techniques for it but again I opted to not attempt them. Nursing staff has way too much faith in us students and assumes that we know what we are doing so I feel like if I had asked the nurse that was with me if the techniques would have been appropriate she would have agreed with me because of the doctor part in my student doctor title. Well it turns out my instincts were right and now I am kicking myself cause I might have helped speed up the delivery for this poor girl had I jumped in and done a simple maneuver.

The great things about this month:
1) My passion for what I get to do as a career has been restored. I am having such a blast even though I am working my butt off for this rotation. I come home exhausted and am so pleased about it. It is a good tired. I look forward to going to clinic each day and stare at my pager willing it to go off when I go home.

2) Some of the odd facts I know have come in handy for this rotation. My attending was so pleased with knowledge I had from watching a "True Life" episode on MTV back in college and being able to track down a treatment they used on the show. She has said multiple times that this is going to positively impact the lives of many of her patients and credits me. That is an amazing feeling.

3) Dude, I deliver babies. Like literally, I am the first person to ever hold new tiny humans.

4) Recovery phase from the past two years seems to be about complete. The three of us are all in a much better place with some fantastic/healthy changes about to happen. And there might be two furry additions to the fam in the very near future.

Rotation #2 Recap

This month was a lot bumpier than the last. I was on outpatient internal medicine with a physician that was hard for me to read. It seemed like I just couldn't do things right for her. When I asked for guidance on how I could improve, she claimed that she hadn't read over my charts yet. She was signing off on the dang things saying she had and she agreed with my assessments. I give up.

On a positive note, I was told I wasn't allowed to leave by multiple nurses, staff, and patients. I received many hugs from my residents in the nursing home. I was told by family members of the patients that I was appreciated because I took the time to explain things to them- this is something I always do, maybe equally for myself as it is for my patients. And in the end, I learned what not to do and how I don't want to be at the bedside.

This past month had the traditional Sunday dinners and movie nights. We went out to treat ourselves at our favorite restaurant in Jeff City (I think they are starting to recognize us there) and went to cancer fundraisers. It is safe to say we are enjoying ourselves.

So next up- OB/Gyn. I can honestly say I am so excited to start this rotation. Maybe it's because my last one didn't go so well or that there are kids involved but I'm remaining optimistic. I have also heard great things about the physician I'm with. She actually has a sense of humor...thank goodness!!!

Now if we could just fast forward through to Wednesday afternoon when this silly presentation that my last attending past off on me is over and done. Public speaking is not my thing.

Correction

As it turns out, I am on OUTPATIENT IM. Oops. I ended up going with the wrong attending on Monday and then with the correct one on Tuesday. Mondays, Wednesdays, and Thursdays are more relaxed with me just shadowing my attending and she will ask me questions while we are in with patients. Tuesdays and Fridays are a little more stressful as I go to the nursing home on my own where I have to do progress notes or work ups on patients by the time Dr. O gets there. I need to learn to be faster as I have yet to completely get through all my patients by the time she gets there. Rotations are definitely making me acutely aware of the massive amounts I still have to learn.

Month #2

Life has not slowed down at all. I always laughed it off when friends would tell me the last two years of med school would go super fast. They weren't lying. Thursday was my last day on my family med rotation and I was really sad to leave. In the past month, I have developed relationships with the staff and some of the frequent flyer patients at the clinic. I am honestly considering stopping by to say hi to one of the admitted patients that I rounded on last week. I would be lying if I didn't say I was more than a little stressed about my new rotation especially since I feel like my last one ruined me because it was so fantastic. 

Round 2 starts in the morning with internal medicine. On the service with me will be three residents so I will be the low man on the totem pole. And one of them happens to be our chief resident. Oh joy. I think it's safe to say that this rotation is going to take a whole lot more work than my family med stint. The physician starts off each morning with a little learning session where we start running down what we know about a chosen topic and then after a while he adds in missing details. So no matter how exhausted I am at the end of the day, I'm going to have to come home and put in some work for the next day rather than crashing. Bummer. But I should come out at the end having learned a bunch. 

Tomorrow we also add three more students into the mix from the Kansas City school. The four of us from Kirksville have gotten super duper close during the last month and I know a couple of people are feeling anxious about new people coming in and decreasing the access we have and whether or not they will fit in with us. Meh...I say the more the merrier. The past month we have enjoyed going on a float trip, dinner parties, exploring Jeff City, shopping adventures to the outlet mall, and going to the movies. It is slightly comical that that is what we have done in one month of third year cause that would have been a run down of a whole years events during second year. The freedom feels pretty great. 

More changes to update you on later. Just not quite yet though :)

Catching Up

These past couple of months have been pretty crazy. Classes finished at the beginning of May and since then, life has been a marathon. I was originally slated to take boards at the beginning of June but that didn't happen. I admittedly didn't deal with stress very well and pushed my date to July which snowballed other things I had planned during the time I assumed I would have off.

At the beginning of July, I braved going to Nebraska for my friend Karla's wedding. So incredibly happy for them (I totally cried at the ceremony). A group of KCOMers went and we had a blast having one last get together before we spread out across the country for rotations. On the way back, I picked up my mom from the airport and we made our way back to Kirksville to pack up the rest of my stuff.

In the event you weren't aware: I have a ton of stuff. Too much. We ended up taking two loads down. Thank goodness I only moved two hours away or else I would have been in big trouble. Any concern I had about not having enough stuff to fill my new place vanished pretty quickly.

With my garage overflowing with furniture and boxes and nothing but the beds set up in my house, mom and I headed back to Seattle for a couple days before going to Kauai. It wasn't exactly the vacation I envisioned but it was an escape. I stayed at our hotel studying while my parents ventured around the island. Surprisingly, I got a lot done. The day before we left was the only day I allowed myself to go out and explore but I was able to go to the beach where South Pacific was filmed (one of my favorite movies), saw some sea turtles, and enjoyed some time with my family.

After getting back, it was another week of studying and then off to take my board exam. I have the worst luck with testing centers. When I went to go take my MCAT way back when, the computer wouldn't recognize my fingerprints and they had to do it the old fashioned way which they hadn't done in over two years. I retested for the MCAT when I was in the master's program and they tried to tell me I wasn't registered to test for that day (thank goodness for smart phones). This time while I was being logged in, the whole Citrix system shut down and they couldn't log anyone in. They finally got it working again and eight hours later, I finished that beast but the system wasn't recognizing that I was done. There was a lot of anxiety over the past couple of weeks about whether or not there would be any other issues with my test.

Orientation for third year took place the day after I took boards. Probably not the best scheduling decision as I was super duper tired (and my hospital ID which I'm stuck with for the next two years shows it). While this was all going on, my wonderful momma came back to Missouri again to help me get unpacked. We were able to go see my aunt and her new house for the Fourth of July before my mom had to go back and it was time for me to start my first rotation in family medicine.

Rotations: I LOVE THIRD YEAR!!!! I know it has only been three weeks but I am having such a great time. The four of us from the 2015 class are getting along really well and we get together fairly often in our down time. Our hospital only has a family medicine residency and a traditional intern year so we have a lot of one-on-one time with attendings. The group of residents and interns are fantastic and are being so helpful. It is a little intimidating moving from the classroom to the hospital but everyone we have encountered has been patient and understanding. I have only had one instance that I felt the wrath of rapid fire questioning from a doc but I survived and was surprised at the end of it how much I actually knew.

My first rotation is in family medicine. I only have a week left since I have the next two days off and I'm getting rather sad that it is almost over. I have gotten along with the doctors and staff so well and could not have asked for a better welcome to clinicals. From the very first day I have been seeing patients on my own before the doctor goes in to make sure everything is correct. I'm still trying to get all the medications down (lord there are so many) and I am feeling a little rusty on my OMM skills but I'm hoping that will improve with time.

Life in Jeff City: Compared to Kirksville, I feel like I am living in a big city. I'm still getting used to having so many options for grocery stores and being able to stop on the way home to pick up random things I need from Target or Kohl's. Three of us went on a float trip the weekend after we started. We are really close to the Lake of the Ozarks and the rivers that branch from that. AND we actually have some time to enjoy it. I'm still getting used to seeing armadillos as roadkill (I really don't remember those ugly things being around when I was little). If the past three weeks are any indication of how the rest of this year is going to be then I can honestly say that the past two years were worth it in order to get to this point.

Life is going pretty fantastic right now in pretty much every aspect. Did I mention I passed boards??? :) Thanks everyone for your support and the care packages to keep me motivated.

The Big C

Be warned- I'm using my blog to vent. Last week, I saw an article about Kara Dioguardi and her decision to use surrogacy because she found out she was BRCA 2 positive and today Angelino Jolie comes out about her double mastectomy because she is BRCA 1 positive. Okay, this is coming from a med student who has had multiple lectures on the BRCA mutation, who tested negative, whose family is positive. That is my resume on this so take it or leave it.

Here is my fear: while I think it is great that these ladies can be open about what they went through, I predict there is going to be an uptick in the number of women who go to their doctors terrified that they have the same thing and will be requesting a test which their insurance doesn't cover/they can't afford. I have been through the testing. It isn't cheap. There is only one company that can do it since they somehow copyrighted the genes and it is $4000! And my great insurance (I'm not being sarcastic, it really is pretty good) only covered 10% of the cost.

Facts: BRCA mutations are pretty rare. Only 6% of breast cancers are attributed to either form of the mutation. Estimates are 1 in 300 to 1 in 800 are carriers of the mutation. THAT MEANS THAT NOT EVERYONE WITH THE MUTATION GETS BREAST CANCER!!!!! In genetics, this is referred to as penetrance. Yes, there is an increased risk. But should you base your life off of something you may or may not get in the future?

My mom found out she was BRCA positive over a year ago. She was fraught with worry about whether or not she had passed it to my sister or I. My sister was tested first and I finally gave in to put my mom's mind at ease. I did not want to be tested. I didn't want my decisions in life to be altered by something I may or may not have. After the results came in for both of us, there were conversations that included tears and remorse for what she had passed one of us. There was so much guilt on her part as she was dealing with treatment.

My mentor for my master's gave me a book that had a whole chapter on BRCA mutations. It discussed both sides of the argument of whether to find out or not. It was a very thought provoking read and I am thankful that my mentor passed it on to me. It didn't convince me otherwise, it actually strengthened why I didn't want to find out.

I posed this question to my mom: if she knew before she had had me that she had the mutation and there was a 50% chance she would pass it to me, would she have kept having kids as an option? The guilt she felt leads me to believe that she would have opted for adoption even though she claims she wouldn't have. That's a pretty huge life altering decision if you ask me. Not only for me (I'm pretty thankful she didn't know back then), but for her as well. And my dad, and my sister, and my whole family.

Genetics is a tough thing. The past two years of my life has been greatly affected by a single point mutation in the massive amount of genes we carry around. I have a huge suspicion that it attributed to the rift in my family. My mom's oncologist even tried to put a time limit on when things were supposed to happen if you had the mutation. No one can predict what the future holds, whether or not you have a mutation or not. So here is the moral to my story is- don't let a test determine your life choices. What will you miss out on if you do?