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!

Why I [think I] want to be a Neurosurgeon: reason #3

May I just say that I cannot wait for my Neurosurgery sub-I in July? I already have a plan in place for my week off before fourth year begins. Sit down a minute, dear reader, grab a hot cup (or cold, depending on which part of the world you are in) and let me tell you...
Firstly, I have a 10K run to do Sunday the 27th. Training for this has been pitiful, but if I have to walk part of it, then so be it...to think that two years ago I ran a half marathon in just (barely) under 2 hours, at about a 10 minute mile without stopping...it boggles the mind.
Second, I need to read through as much of the Neurosurgery bible as I can, focusing mainly on the chapters that one of the residents mentioned are high yield for the sub-I.
Third, I need to seriously get up to speed on my suturing and knot tying skillz. I have not tied a knot since - I cannot remember. I need to do this non-stop for hours on end, until I can tie perfect square knots, with my eyes closed, one handed, while suturing with the other hand. I will also attempt to perfect the much sought after left handed tie and perhaps achieve immortal-like status as a sub-I in the OR. This is going to be hard with a metacarpal fracture of the 1st finger, but it has to be done.
Fourth, I intend to get myself used to waking up at the crack of dawn and working out for half an hour. Just half an hour, please God? 'K, thanks.
Fifth, I intend to figure out a way that I can eat healthy despite being a sleep deprived, time crunched zombie. This means lots of healthy snacks that can be fit into my white coat or scrub pockets, a filling healthy breakfast to get me as far into the day as is possible and NO junk food. None!
That cup almost done? Come on, now - get yourself a second. You know you want one. Listen a while to my third reason about Neurosurgery. Here, have a seat.

Reason 3: the brain is awesome. When a human fetus is unable to gain the nutrients it requires in utero (for a myriad of reasons, e.g. maternal consumption of alcohol or drugs) and essentially becomes malnourished, it starts to cut back on growth of certain organs and body parts. The liver, usually one of the biggest organs in the human body becomes smaller, the lungs, the kidney and other organs are reduced in size in order to save precious nutrients. This process, however, does not apply to the brain. It continues to use just as much energy for growth as it normally does, at the expense of other vital organs. What mean this, you ask? Yes. The brain is THAT important. The brain makes you you. It guides your movement, creates your thoughts, controls your breathing so you don't have to, keeps your heart beating and protects you from harm. Basically, all other organs exist to keep the brain happy. Injury or insult to the brain comes with devastating consequences and half of Neurosurgery is a surgical emergency with crucial decisions that must be made by reflex. In a nutshell? Awesome. What better way to spend the rest of my life than training to heal and understand this elegant organ?

Today, we had a class meeting to discuss the residency application process - from good ol' ERAS to making sure you get good letters of recommendation. These meetings always invoke a mixture of feelings in me. Excitement, worry, fear, anticipation...it's all those and more. On July 1st, 2010, the online application, aka Electronic Residency Application Services will open for applicants to begin entering information. September 1st, 2010 residency programs will start accepting said information for applications. Scary. On top of that scariness, I have sub-I's back to back from July through September and then a required medicine rotation in October. When will I have the time to make sure my application is submitted in full and as early as possible?
In other news...
I fractured the metacarpal of my 1st finger (pinky) on my DOMINANT hand. Yup, just in time for my first Neurosurgery sub-I in July. My arm is gloriously wrapped up in a splint. This should be fun. (Please notice sarcasm here).
Hopefully, it heals enough to gun through tying knots in the OR with hand pain. Or maybe I'll come off like a trooper since I'll be suffering through 16+ hour days with a disability. Ugh, at least I know nothing worse could happen at this point...
...Oh, wait - I have to take the Pediatrics shelf exam next week Friday. I haven't even talked to the course director about the fact that I'm not supposed to be using my right hand. However, like studying for the boards many months ago,
I will take this
one day
at a time.
Goodnight!

Just a thought

I just got done with a four week Neurology rotation and began a two week public health rotation (read vacation) this Monday. After that, I will have six weeks of Pediatrics to go through and then third year will be over. How fabulous is that? Quite fabulous indeed, I say. After a 10 day break, the real fun begins with my first Neurosurgery sub-I in July. At this point you can interject with some syrupy sweet baby talk, "Who's an excited med student?" "Who's an excited med student?" To which I will point both my thumbs in a self-ward direction. "This girl".
I am scared, apprehensive and about ready to vomit with excitement. I want it to come NOW.

Why I [think I] want to be a Neurosurgeon: reason #2

The day that current 4th year medical students around the US found out about where they would spend the next 3+ years of their lives training during residency happened Thursday, March 18th, 2010. This epic day was excellent for one of my fourth year friends, who got her first choice in General Surgery and good for another one of my fourth year friends, who got her third choice in General Surgery also. Of course, since I am somewhat convinced that Neurosurgery is for me, I eagerly scanned the posted match list for people matching into Neurosurgery. It was both exciting and extremely frightening. These feelings sent me into a frenzy of setting-up-appointments-with-the-Neurosurgery-powers-that-be, in order to frankly assess whether or not I am a good enough candidate to 1)match ANYwhere...you best believe that I will take what I can get and 2)maybe/possibly/hopefully/please God match at my current top choice. One of these meetings happens on Friday. Another, hopefully, next week Tuesday. My resume has been updated and printed on paper watermarked, my goals put in fresh perspective and my fingers appropriately crossed. Which leads me to this post:

Reason 2: the specialized, very technical aspect of Neurosurgery is appealing to me. I enjoy working with my hands and spending time on tasks that require physical manipulation. It gives me an incredible sense of accomplishment and pride when I am able to complete said task, with the involvement of much elbow grease. For example, as an undergrad, I worked part time in one of my school's cafeterias. This job involved sorting plates, cups, cutlery and other dining hall paraphernalia off a rapidly moving conveyor belt, ridding them of the drink and food scraps they had left and placing them onto the car-wash-for-utensils that then cleaned them. At the start of the 4 hour shift, there would be the odd bowl of half eaten cereal and empty juice glass, but eventually, piles upon piles of plates and silverware would be jammed onto the belt. Although a very simplistic example of technical skill, I loved every moment of this job. The manual dexterity required to manipulate forks, knives, cups and glasses of all sizes, odd shaped bowls and plates, stack them together in like piles, remove all traces of solid material from their surfaces, place them into the dishwasher machine on steroids and do it incredibly fast - while hot steam billowed into my face and even more objects jetted in on the belt was insane. (In a very good way). Each shift, I would challenge myself to not drop a single utensil, or allow a plate to pass by unnoticed.
Exciting also, is the idea of being highly specialized in a field, performing complex procedures with meticulous attention to detail, over and over again until I am absolutely amazing at what I do. Could the satisfaction that comes from knowing you spent hours scrupulously dissecting away a tumor/placing screws for spinal fusion/establishing hemostasis with a job well done be greater? I think not.

Why I [think I] want to be a Neurosurgeon: reason #1

There are two fourth year medical students on the Psychiatry rotation with me, and, during the shuttle ride home from the hospital today, I was talking to one of these medical students about residency applications, rank lists and match day - this year to be held on March 18th. The conversation, being a good one, fraught with such expressions as "I can't believe it's happening" and "It's out of my hands now" and "Am I really going to be a doctor in 4 months?" got me thinking about my own impending doom/application process, which starts July 6th, on my first Neurosurgery sub-internship. And in the course of my soul searching and deep inner reflection, I decided I needed to put into words why I think I should spend the next 7 years AFTER medical school being sleep deprived and slaving away long hours in the hospital days into months.

Reason 1: Working hard makes me happy. Working extremely hard makes me even happier. This is not to say I do not appreciate a lazy day at home with naught but a book in hand. I do. I just don't feel the need to "have a life outside of Medicine", or "Maintain an active social life" or the many other good reasons that people quote when deciding on a lifestyle vs. (for lack of a better word) non-lifestyle specialty. I want to be consumed by my work. I want to wake up early, spend a substantial portion of my day working hard at what I love, and go home feeling fulfilled, because I brought it all to the table. Will this naive, idealistic and romanticized dream of an honest day's work change as I morph into yet another bitter, overworked and underpaid resident? Maybe. I hope not...but we will see.

Man on bike vs. traffic

On the highway on my way to psychiatry at Westchester hospital this morning, I saw a man on a professional racing bicycle riding furiously amongst the traffic. Was he riding furiously because he got onto the highway inadvertently and was in full scale panic mode because he couldn't get off? Or was he training for the next tour de France? Who knows. In any case...what happened next was pretty awesome in my (humble) opinion. As he was riding along on his merry way, an SUV, perhaps assuming it had the right of way (SUVs these days!), tried to cut him off and switch lanes. Without pause, the man on the bicycle held aloft his hand and struck the side of the SUV four times (yes, I was watching eagerly and counted). Sorry, buddy, I got this lane. I mean, I know you're in a vehicle that probably weighs about 30 times more than I do...and I'm just a guy on a bike right? But, come on now. I got this.
Which made me think - what sort of person thinks that this is acceptable behavior? What was going on in his mind? Does he have a mind? Etc. Pretty interesing. Especially now that I'm on psychiatry...food for thought, I tells ya. Food for thought.

This time will be different

This time will be different.
This time I have foil paper.
I put it on my head, it protects my brain.
Wrapped three times around
not twice-
three times. With the end tucked in at the middle.
It provides
maximum security this way.

They have attempted to enter my house three times now.
I know this because the silent alarm
that is hooked up to my medial temporal lobe
to my
corpus amygdaloideum
went off each time.
(they don't know I know).

I have TOP secrets.
Top security secrets that the government wants.
They put
surveillance cameras on my street
at the grocery store in my favorite coffee cup my wife is in on it too.

I am a lone warrior in a world gone mad.
The new delivery man making his rounds
has his eye on me.
The deli across the street
recently opened
with the fat free muffins
has a room full of spies
working nine to five
tapping my phone lines
HA! Joke's on them
I communicate via the mind.

Last year I developed a math equation
an equation of cataclysmic proportions
unlocking the secrets of time
this equation will
change the fabric of time and space
as we know it.
So you see. I have TOP secrets.
Top secrets that the government wants.

Men in long gray overcoats
and
blackened sunglasses
working for the CIA
for the FBI
hover on street corners
communicating over the private satellite links
they have installed in microchips
at the base of their brains.
They pretend to read newspapers
They hold long conversations with their mothers
but
the newspapers are upside down
and
they say the same thing in a loop
3 minutes 33 seconds.
(I timed it).

Trying to get past my defenses.
Might as well give up now.
Almost got me last week
when I ventured out for supplies
running low.
A lone warrior
in a world gone mad.
But
this time will be different.
This time I have foil paper.

Happiness is...

1. An early morning session of high intensity interval training.
2. A Stephen King novel, a hot cup of English Breakfast tea (two sugars - yes, sugar damnit - and milk), a rainy day.
3. A freshly opened, out of the package, new white coat.
4. Another desktop worthy picture of my nephew.
5. Volunteer neurosurgery call with the most amazing residents on earth.
6. A clean apartment.
7. Two hour conversations with my Mom about nothing.
8. A hard day's work and a shuttle ride home.
9. Nebert shenanigans.
10. A good night's sleep.