I'm just that awesome

I stride down halls with my [long] white coat flapping in the wind because I am badass. I answer trauma activations with "I got this" because I am that cool. I run codes in resuscitation room 1 with my eyes closed, a blindfold on, and one hand tied behind my back. I resect basilar tip aneurysms bedside. When Martin and Spetzler were looking at an MRI trying to grade an AVM, they called me. I know all the CPT codes, for all the procedures, all the time. Off the top of my head. I passed the Neurosurgery boards before I went to medical school. This 7 years of training? Just a formality - I have accepted the position of chair at Big Top Notch Academic Center of excellence, to commence the day after my graduation. When the chair at my program is away on vacation, who steps in? This girl. When there is an emergency in the OR, an unexpected turn of events, who do they consult? You got it, this girl. Why? I'm just that awesome.

Mens sana incorpore sano

Since it's almost the New Year, I've decided to get all mainstream and whip up some resolutions. All the cool people do this, right? Right.
Six months of internship has been good, bad, exciting, aggravating and fulfilling all at once. I go from being completely out of my depth to striding into patient's rooms, cool as a cucumber and ready to kick some General Surgery butt. Overall, the stress levels on a scale from 1 to 10, with 1 being "I could do this with one hand and my eyes closed", and 10 being "Somebody stab me now. In the eyeballs, and make it quick", range from 3 to 8. Basically, I need to figure out a way to relieve stress, get down with some R and R and generally, not turn into that bitter, angry and jaded surgical resident I used to hate when I was a medical student.
There are setbacks to this:
The administrative/paper work/scut crap I have to do in order to get things done, that is, Care For My Patients, is just atrocious. Does there seriously have to be a form for everything? Do they seriously have to be placed at opposite ends of the hospital? And whose job is it to stock those things anyway?! Grr! But, I digress.
And...well, I can't think of anything else right now...but I tell you, there are setbacks!
I went from working out 6 days a week and eating like a champ on my Neurology rotation to not working out for the entire month I was on Vascular Surgery and shoving down chocolate chip muffins and regular sodas like they were umm...candy. (They were, basically). This month, I am on Plastic Surgery and have been somewhat better - a grand total of 4 trips to the gym during a three week period and some concern about how many grams of sugar enter my insides.
But, like I said, New Year, new resoulutions, yes? Yes. Listen:
I decided to hop onto the Weight Watcher's bandwagon. It can't hurt to have killer abs, glutes you can debride a sacral pressure ulcer with AND be a Neurosurgeon, can it? I agree.
In order to reward myself, I plan on using my last week of vacation sometime in May or June and jetting off to an exotic land of white sand, gorgeous beaches and unending Pina Coladas. May it be so.

In other news, I start work in the Neuro Intensive Care Unit on New Years day, which is AWESOME! Enough with this General Surgery ish.

Happy Birthday deadrocketcow

Two-Seven: I'm a big girl now.

1 month done, 83 to go

I survived one month of general surgery trauma and have now moved onto my Neurology rotation, which is going to be three months of pure bliss. Only having to be at the hospital at 7am, and leaving at 4pm, with two days off a week does wonders for the soul. On top of that, I might actually have the time to learn something. Top 5 goals for the month of August (in no particular order):

1. Actually use the gym membership I purchased...at least 3 times a week
2. Get this car buying process over with
3. Furniture, anyone?
4. Register, study for, and take Step 3 (the evil never stops)
5. Make it through 6 chapters of Blumenfeld

If I can do those things, I will be a happy somebody*

*Read Baking Cakes in Kigali for the origin of that quaint expression

Please accept my apologies

If I don't return your call until next week. If you send me an email and I never reply. Instead, I text you three days later. I'm busy, I'm tired and I am stressed - I don't hate you. Yet.
In other words, it's not you, it's residency. On June 21st, I took the bus to my new hospital/home for the next 7 years and started Basic Life Support training. This is a course that incoming interns need to complete before they can be set loose on all the unsuspecting patients in the hospital. How to do CPR, what to do if a person collapses in front of you...good stuff you'd like your doctor to know, right? Health care workers (that's me!) need to get re-certified in this every two years. The course I had during medical school was three years ago - and long forgotten - and so it began. On the 22nd, I had Advanced Cardiac Life Support training, which is, well...advanced. I had to pass a test and practical the next day, so I was memorizing and punching my head that night. Then I had orientation, and more orientation and even more orientation. Fast forward a week and it was Friday, July 1st, the first day that three other interns (Emergency medicine guy, other Neurosurgery intern/guy and General surgery guy) and I had to take care of our 40 or so patients on the general surgery trauma service (I am doing a general surgery rotation this month). Basically, the day was probably, the worst day of my life.
The pressure from my seniors to get things done, the desire not to look like a complete idiot, the necessity of having to keep your cool, be diplomatic and not tell that nurse who keeps paging you about patient X's bowel movements to just leave you alone...added to the stress of not knowing where things are/how to do them/what the protocol is and getting lost in the maze of buildings is almost unbearable.
I worked literally, non-stop on Friday from 3:20am (I got up at 2:15am) to about 8:30pm at night. I did not eat, I did not drink and for the last four hours I continued my work with a full, pressed bladder. Very exciting. I never thought I would ever think to myself - I really, really NEED some coffee right now...but I did. On day 1.
I am told things will get better.
On another note, one of the general surgery seniors on my team ought to do stand up. This is what he told me:
Senior: "Hey deadrocketcow, what do you call a talking, breathing, neurosurgery patient?"
Me: "Umm, I don't know..?"
Senior: "Pre-op"
Me: "______"
The joke being, since Neurosurgery is fraught with complications and is generally, a high risk specialty, the only talking, breathing patient you would see on the Neurosurgery service hasn't had their surgery yet.
Today is my one day off (I get one a week) and I feel so much better because of it. I have slept 8 hours instead of 5. I have had a good breakfast instead of no breakfast and I am even being brave - I might work out! I guess this is my life for the next seven years. God help me.

Deadrocketcow, MD

I graduated from medical school today, and I can say officially, that I am a doctor. It was a day like any other, but one that I most probably will never forget. My mom, brother, sister, aunt, uncle, cousin and N came and made it even more special. Next stop: residency.

Step 2, you are getting in the way of my relaxation

I have postponed taking Step 2 twice, I think, because my brain was broken. It's currently on the mend, which is good, because I am going to take Step 2 next Friday. Or else.
Four years of undergrad and 3.5 years of medical school culminated in my applying for a residency in Neurosurgery and my matching. I will be leaving New York to go to [Mid-western state] in about a month. Now that that horrid business is over, and I am over my disappointment in not getting my first choice (almost over it, almost...), I am starting to get excited about finally pursuing the career I have dreamed about since time immemorial. I am looking forward to meeting my new co-intern, resident and attending family and exploring the hospital. Before that, I have to learn how to drive, find a place to live and move all my belongings.
For now, it's back to First Aid for the USMLE Step 2 CK and USMLE World.

I matched

Interesting quote

[T]rue gender equality is actually perceived as inequality. A group that is made up of 50% women is perceived as being mostly women. A situation that is perfectly equal between men and women is perceived as being biased in favor of women.

And if you don’t believe me, you’ve never been a married woman who kept her family name. I have had students hold that up as proof of my “sexism.” My own brother told me that he could never marry a woman who kept her name because “everyone would know who ruled that relationship.” Perfect equality – my husband keeps his name and I keep mine – is held as a statement of superiority on my part.


[Lucy, When Worlds Collide: Fandom and Male Privilege.]

There is no going back now

How to like it

A new favorite:

These are the first days of fall. The wind
at evening smells of roads still to be traveled,
while the sound of leaves blowing across the lawns
is like an unsettled feeling in the blood,
the desire to get in a car and just keep driving.
A man and a dog descend their front steps.
The dog says, Let's go downtown and get crazy drunk.
Let's tip over all the trash cans we can find.
This is how dogs deal with the prospect of change.
But in his sense of the season, the man is struck
by the oppressiveness of his past, how his memories
which were shifting and fluid have grown more solid
until it seems he can see remembered faces
caught up among the dark places in the trees.
The dog says, Let's pick up some girls and just
rip off their clothes. Let's dig holes everywhere.
Above his house, the man notices wisps of cloud
crossing the face of the moon. Like in a movie,
he says to himself, a movie about a person
leaving on a journey. He looks down the street
to the hills outside of town and finds the cut
where the road heads north. He thinks of driving
on that road and the dusty smell of the car
heater, which hasn't been used since last winter.
The dog says, Let's go down to the diner and sniff
people's legs. Let's stuff ourselves on burgers.
In the man's mind, the road is empty and dark.
Pine trees press down to the edge of the shoulder,
where the eyes of animals, fixed in his headlights,
shine like small cautions against the night.
Sometimes a passing truck makes his whole car shake.
The dog says, Let's go to sleep. Let's lie down
by the fire and put our tails over our noses.
But the man wants to drive all night, crossing
one state line after another, and never stop
until the sun creeps into his rearview mirror.
Then he'll pull over and rest awhile before
starting again, and at dusk he'll crest a hill
and there, filling a valley, will be the lights
of a city entirely new to him.
But the dog says, Let's just go back inside.
Let's not do anything tonight. So they
walk back up the sidewalk to the front steps.
How is it possible to want so many things
and still want nothing. The man wants to sleep
and wants to hit his head again and again
against a wall. Why is it all so difficult?
But the dog says, Let's go make a sandwich.
Let's make the tallest sandwich anyone's ever seen.
And that's what they do and that's where the man's
wife finds him, staring into the refrigerator
as if into the place where the answers are kept-
the ones telling why you get up in the morning
and how it is possible to sleep at night,
answers to what comes next and how to like it.

-Stephen Dobyns

The power of Good bye

When I was a third year medical student, on my Neurology rotation, I met a young man, about 34 years old, who had been referred to our hospital for further management of his disease. Basically, the hospital that he had just spent four days in getting his diagnosis was not equipped to fully handle his disease and had sent him to a hospital that could. I remember this patient encounter particularly because of how powerless I felt and how I had to "lie" to the patient (and his family's face).
This patient had not been acting like his usual self over the past two months, and without getting into too much identifying information, he had changed from a quiet, soft-spoken man to one who was forgetful, inattentive at work and given to anger outbursts. A CT done at the first hospital revealed a huge mass (read tumor) infiltrating most of his frontal lobes. The frontal lobes are parts of the brain that are responsible for so called executive function: the ability to know when actions are socially acceptable, to understand the consequences of one's behavior, etc. The CT explained why this young man had been exhibiting such bizarre behavior.
I was on call that night and it was my duty to see new patients that had been accepted onto our service and assist the overnight resident in making a plan. After a look at an MRI which had been ordered, a discussion about how this mass was most certainly a GBM (pretty much the worst kind of brain cancer you can get) and the fact that this young man would probably not live beyond the next two years (WITH aggressive treatment), I was dispatched to this young man's room, Neurological tools in hand, with the task to take a "history and physical".
In the room, the young man was sitting on the hospital bed, hair disheveled, but looking composed. His father, his father's brother and his father's brother's wife were sitting at the foot of the bed. I introduced myself, explaining that I was a third year medical student and that while the "real doctor" would be in shortly to see their son/nephew/nephew-in-law, I was here to expedite the whole process by making everyone's life easier and getting this routine stuff out of the way.
I did not realize it then, but I know now I was apologizing for what essentially I came to medical school to do: to learn how to interact with patients, gain pertinent information from their story and physical exam and work towards treatment. I knew this young man was so very sick, that his family must be upset in a way that I could not fully appreciate and yet here I was, learning off their pain. I felt like an intellectual vampire. Most importantly, I felt like a fraud. The family thought I was a contributing member of the team (and you can argue this all the way to the bank that I was, but we shall agree to disagree, for now) and that I was there to help them. In my mind, I was there because it was a required clinical rotation and a part of my curriculum.
Nonetheless, I did what I was there to do. Because I was learning, and because I like to explain things as I do them, it took me about an hour and a half to complete this patient encounter. To compare, on the practical exam I just took January 12th, that uses standardized patients, or patient actors, we are given 15 minutes to gain the same information. Through this 90 minutes, I tried to be professional: calm, methodical, friendly. I included the family in the conversation when I could and asked social questions also - who were they, where were they from, what did they do? I also told them about me - my goals, my background. I cannot remember if I attempted humor, but I think I may have, because at some point, there was laughter. Looking back I am ashamed to think that I was insensitive enough to joke, but I can only assume that I had assessed the situation and decided it was appropriate.
After all this was done, I knew it was time to lie - without lying. To withhold information.
"Is my son/nephew/nephew-in-law going to die soon?"
"Until we get more definitive tests I can't really say" (Yes, probably)
"Why is this happening? Is it genetic?"
"There is some research that shows certain types of tumors run in families. It's hard to say at this point if this is the case, because we are not sure what type of tumor this is" (I don't know, I don't know...I'm only a medical student. I'm...sorry)
"What happens next?"
"The next step is to take a sample of the tumor and perform laboratory tests on it to determine what kind of tumor it is"
"You mean he's going to have brain surgery?!"
"Yes. I know this is difficult. However, the surgeons here do this sort of procedure all the time and your son/nephew/nephew-in-law is in good hands" (Please don't let me say anything wrong, please God, make them stop asking me all these questions, I'm only a medical student!)
And so on.
When I felt I had answered all their questions, I turned to leave. The young man's uncle indicated that he wanted to talk to me outside. I felt afraid and flattered. Did I say something wrong? What is he going to ask me outside? Will I not know and look as stupid as I feel? And also: he wants to talk to me outside? Me? That means he must value my opinion. He actually thinks I'm a professional.
It turned out he wanted to talk more into detail about his nephew's bizarre behavior and what it meant. I was able to answer some questions and for those I could not, I said I would find out.
Over the next week I saw this patient and his family everyday. I listened, I answered their questions. I helped as much as I could. As I was wrapping up my rotation that week, I felt I had to say bye, but I could not. I felt more like an intellectual vampire than ever. I felt they would be angry with me. That they had opened themselves up to me so much and only for me to leave - on to my next rotation - the next week. I could not bring myself to explain that I would be leaving. Friday came and I had still not said bye. I had two competing thoughts all day. Tell them! They deserve to know. Don't tell them! How can you just leave like this?
In the end the decision was made for me. I had to leave for lecture and I had not said bye.
I often think about this young man and his family. I think about them and I feel guilty. I feel guilty because even though I was able to build such strong rapport and advocate for them, ultimately I let them down. I betrayed their trust. I wonder what they thought when the little medical student they could talk to for hours on end, because no one else had the time, about their suffering, their pain...just did not show up the next morning. Did they feel hurt? Confused? Angry? I imagine this must be the case. I wonder often also, where they are now, what they are doing and how he is doing with his disease. I wonder and I regret.

Reflection

I took my Step 2 CS exam January 12th. This served as chance to reflect on how much I have learned in medical school. I remember getting ready to start third year and memorizing the physical exam and the questions in the history. I thought to myself there was no way I could ever remember each maneuver or remember each part of the history and do it in a manner that pretended to be close to efficient.
Turns out, I did.
I studied about a week for this test (can you say pass/fail?) and only practiced doing a physical once - because even though I have not done much more than a Neuro exam for the past 6 months, once I started, it came back to me easily, flowing out my brain and into my hands like warm syrup on a buttered pancake. I was mostly concerned about making sure if a standardized patient started leading me down the path of HIV/STI's I remembered to ask about safe sex practice...or if another suddenly started coughing uncontrollably, I would offer a tissue, and remember to check for blood in said tissue. All the while coming up with a differential for hemoptysis, which is to say, coughing up blood.
I think I passed. But I'll find out for sure in six - ten weeks.
The next hurdle is Step 2 CK which I have rescheduled to March 28th. I am amazed at how different my state of mind is for this exam compared to Step 1. Perhaps, because I don't feel the fate of a residency position/my career/my happiness/my whole life as I know it rests entirely on this exam as it (sorta) did on Step 1. I have applied, I have interviewed, and hey - by the time I take the exam I will already have matched (or not matched). So take that, residency!
All in a day's work.

Things are back to normal

There are 66 days until Match day. I am almost done interviewing - I have two more and then interviews will be yesterday's headlines. Thinking about the email I will receive on March 14th (the Monday before the match) saying whether or not I have matched, makes me ill now. How will I be on the 13th? *Shudder*
Fourth year is winding down now with rotations such as "the research elective", Primary Care and ethics, where a late day is 6pm, and waking up early, is...well, non-existent. At this rate, residency will be a rude shock. If I match. A ha! Ha. Ha...excuse me while I go cry quietly in the corner.
I feel better now.
I have my Step 2 CS exam Wednesday and thank God it is pass/fail. Really, I just want to get it over with. Surely, I am empathetic and compassionate? Surely, I can ask [fake] patients the right questions in the right tone of voice with just the right amount of eye contact? In any case, this is just another one of those trials that medical school is full of, proving that I am worthy of the future M.D. after my name. Deadrocketcow, M.D. Nice, eh?
You know it.

Happy Birthday (to yours truly)

I turned 26 today.

Long time no post

I am in Houston, Texas, where I have been for the past 3 weeks and 4 days and where I will be for the next 2 weeks and 4 days. What am I doing, you ask? A required medicine "Sub-I". I put Sub-I in quotations because this is not the traditional Sub-I taken during the fourth year of medical school to explore a residency choice. This is something that has been created by my school to torture me. I jest. My school only considers one thing a Sub-I - this required month long Medicine (or Pediatrics) rotation taken during fourth year. This effectively places all my "traditional Sub-I's" in the category of electives - which means I can only receive pass/fail grades on the grueling three months I spent living and breathing Neurosurgery...but that's OK, right? Right?! Right...
...it is most certainly NOT OK. But, moving on...
I decided to come to Houston for my rotation, because this is where the slackers go, and after three months of Neurosurgery, I am definitely a slacker. Also, my sister and the cutest/most adorable/bestest nephew in the world live here, so I get to see them on weekends. Which, is the highlight of my week - yeah, not even the intricacies of high blood pressure and ACE inhibitor management can compare. Unless, of course, said high blood pressure causes a sub-arachnoid hemorrhage via an aneurysm. I'm kidding!! Have three months of Neurosurgery turned me into a cynical, self-absorbed, arrogant Neurosurgeon-to-be-medical student? Perhaps. Which reminds me...
This morning, the medical team that I am on were gathered to round before the attending, who loves to tell humorous stories encountered in his career as a Hematologist. On the way to the punchline on one of his stories, he mentioned casually some attributes about different specialists.
"Nephrologists tend to be very careful, precise people. They do things in a calculated manner."
"Orthopedic surgeons are only interested in driving their cars when they get done in the hospital."
"And Neurosurgeons, well, they are some of the nastiest people around."
Which, the entire team thought was extremely laugh out loud funny, seeing as that is my specialty of choice. He didn't know I am applying into that, which I guess, makes it alright.
A good thing came out of my being in Houston - I have two residency interviews scheduled here before I leave, which makes at least two plane tickets less of an expense during this whole interview season business.
This is my last week at the hospital though, and I get to spend even more time with my sister, nephew and brother-in-law. Awesome!

Status Post Sub-I #1

One Neurosurgery sub-I down, two more to go. I start my second sub-I tomorrow morning at the luxurious hour of 7am. While I am not as frantically excited as I was on that first day one month ago (since I have a fair estimation of what to expect), I am looking forward to exposure to a completely different program than my home institution. I have heard that this next program is as similar to my home program as an apple is to an orange, so this should be interesting. After jumping through the hurdles of obtaining I.D, getting access to the scrub machine and learning everyone's name...I have to learn how to navigate a system that is completely foreign to me and do it fast - a sub-I who does not know how to get things done fast is as good as no sub-I at all. In other words, more hurdles. Another concerning thing is - what will the other sub-I's be like? After a month with the most likable and easy going fellow you could ask for, getting stabbed in the back at every second will take some getting used to. Because the Neurosurgery sub-I is cut throat - every sub-I for him/herself, eat or be eaten...you get the point.
And of course, by the time I am just getting good at figuring things out over there, the month will be over.

Here's to a new month of Neurosurgery.

10 signs you are sleep deprived on your Sub-I

1. You spend a substantial portion of your day dreaming about how nice it will be to ease into some warm sheets at day's end and scheming how to get the maximum number of hours (start undressing in the elevator, eat dinner with right hand, brush teeth with left...).
2. You have thought about looking online for the possibility of injectable caffeine shots.
3. You have mastered the art of the 30 second power nap - standing up.
4. You have mastered the art of the 30 second power nap, standing up - with your eyes half open.
5. When walking into conference, you dawdle at the door, so there won't be any seats left - because if you sit, you will fall asleep.
6. You have pinched yourself to stay awake.
7. You know all the good places in the hospital to take a quick 15 minute nap (that couch on the dark end of the visitor's lounge, that abandoned stretcher on floor nine...).
8. You've been timing your coffees in order to keep blood levels of caffeine constant, with a gradual decline towards sleeping hours.
9. You've thought to yourself "If I don't sleep for 15 minutes NOW or at least have some caffeine, I will truly die. I will just konk out right here on the floor."
10. You would rather be hungry from 4am to 2pm so you can have that extra half hour of sleep.

Week One (or how I resolved what I want to spend the rest of my life doing)

I made it through the first week of my sub-I and my first 30 hour overnight call. So far, I am having an incredible experience - each day gets better than the day before. I can now declare that from not being able to sleep that night before my first day, waking up early and being dressed and ready to go 40 minutes before time, to loving every minute of being in the operating room, scrubbed in on the most amazing cases, to sleeping only 3 hours on Friday night, yet staying awake all through Saturday and into Sunday morning constantly on my feet, I am 100% sure that Neurosurgery is the perfect fit for me. Each moment of the day is an occasion to learn something new about Neurosurgery and surgical management, from the pathology behind various illnesses to communication, efficiency and multitasking skills necessary to be a great physician.
Even more fabulous is how wonderful the residents are, from the chief (who is letting me do more and more in the OR as I prove myself) to the interns (who are always ready to answer my questions, no matter how silly, no matter how small, offering advice on the application process).
I have been loving each task given to me, even though the residents will preface them with an apology for giving me "scut". I don't know if they believe me when I say I don't think it IS scut and that even if it were, I would be happy to do it.
All in all, I am having the best time of my medical school experience. Ever. Now on to my second week...

Tomorrow

I start my first Neurosurgery sub-I tomorrow morning at 5:30am. I feel horribly unprepared and horribly excited. Wish me luck!