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Life Medical School Medicine

I'm Back– Close Calls, Boards, and the Start of Third Year

My life looks very different now than what it did 5 weeks ago. And, 5 weeks before that, I was in another galaxy. I wouldn’t have thought it possible, but these last couple months have been more of a startling transition than going from college and a summer off to matriculating the first year of medical school. I will say though, this transition has brought much more enjoyable changes.
So let’s start back at the end of April/beginning of May during board exam preparations when I deleted every social media app and other time-sucking things from my life and moved in with my best med school friends; it simultaneously became a huge load off my back having awesome roommates and being in a more nurturing place at home, but then it got a whole lot more stressful because Macy and I needed to buckle down and study. Hard.
This was 6 weeks before my big test, and classes were already over to give us time to study for boards on our own. (Before I go on, for all you non-medical people- passing this test is crucial to moving onto your “clinical” years of medical school and an absolute necessity for getting the big D.O. after my name. Residency programs look at this test score and assess your worthiness, and if getting into medical school isn’t hard enough, I daresay this was about 437 times harder than anything I had to do to get in.) Anyway, I took a practice test that the school required we take to make sure we were ready to take the exam and pass it.
I was not at a passing score at that test, 5 weeks out from D-day. I’ve debated writing about it because it feels like a big deal to talk about scores. This test and the months of preparation leading up to it are such a big part of my life right now and no one shares their scores except with the closest of people. Still, I want to share at least some of my story for the same reasons- because it is such a big part of my life and I learned so much.
I was devastated about this practice test score for days. I curled up in my mom’s lap and cried. My dad bought me a Quiktrip pretzel and told me to take a step back and maybe talk to the school about pushing everything back a few months. I cried to an attending physician in his office- the medical school equivalent to calling your teacher “mom”. Still, I decided to buckle down and move forward as planned and the plan was to pass at all costs.
I knew balance was key and I needed to stay sane with breaks and hobbies, etc, but I also wasn’t stupid. I knew my “studying status quo” of cooking a nice dinner, running 4-6 miles 5 times a week and taking Netflix breaks- even without the social media- wasn’t going to cut it. With a very important deadline, some more sacrifices had to be made.
I think I ran a total of four times in that last month. I watched one 22 minute show at the end of my study days. I started drinking Ensure nutrition shakes for meals. I lost 20 pounds in the 6 months before my boards, which is not a healthy amount for me by the way. I gave my dog back to my mom for a number of weeks. I went to an 8-5 board review class and stayed. awake. for. the. whole. entire. week. I hit the books hard and cried and panicked and learned more than I have ever learned in my entire life. I was also very miserable and alone for the majority of every single day for those six weeks.
I took two more practice tests before my exam, and I surprised myself, getting significantly better each time. I didn’t really know what to expect as far as what kind of progress was possible that close to a test date, but I did it. As well as I was doing, my anxiety lurked in the shadows during every minute I wasn’t studying. I would go get dinner with Dru and inside my heart was pounding, saying “You’re going to fail because you didn’t bring your book with you.” In the shower every night, “You don’t deserve a break with scores this low.” Laying in bed, biting my lips until they bled, texting my family and anyone else that would listen to try to get any sort of 5 second reassurance where I didn’t feel like I was going to vomit my esophagus up into my mouth. The harder I studied, the more I feared I would not pass.
Being naturally high strung, having anxiety, and a having healthy dose of fierce test anxiety to boot, I fully expected to need a dart gun to feel calm on test day. The night before, I took a Benadryl and a melatonin at 6 PM just to cover my bases. I added an ice pack on my head and a heating pad on my feet for good measure. I was out by 7:30PM. I woke up that next day and grabbed my packed lunch and rode with Macy to the testing center as we were taking it on the same day. I felt like everything was going to be okay. I got low on time during the first four hours, and I had never needed extra time before. Still, I didn’t feel nauseous. Even during lunch, when my mind was able to wander,  I didn’t ever feel like it wasn’t going to be okay like I had been feeling for the past 6 weeks. Macy and I finished and went home- together, relieved, overwhelmed and exhausted- where my sweet boyfriend had cleaned my house and got me a couple precious happy gifts. Still, it would be another 6 weeks before I knew for sure I could take a breath.
In that 6 weeks I spent a lot of wonderful, mostly stress-free time with my family, roomies, and Dru. I learned Advanced Cardiac Life Support. Some of us went to the lake and saw lots of med school friends that we hadn’t really been able to let loose with really since orientation before first year. It was sweet, sweet relief to my tired, studied-out soul. Memories were made that I know I’ll cherish forever.
And then we started rotations. Possibly the most daily rewarding thing I’ve ever been privileged to be a part of. This useless noggin full of jumbled up, color-coded notes and random lectures finally has a use and can make heads or tails out of what’s actually wrong with my patients! (most of the time.) It is much easier to read medical things at night and on the weekends while being able to put a real patient’s face to the condition I need to learn more about.
I got my scores back last week and I was mostly pleased with the results. In my Type A hindsight, I like to think I could have done more and gotten an even better score by tweaking some of my preparation, but I do I know I did my best and really got a much needed confidence boost out of finding out that my best was good enough this time. Medical education can be extremely taxing in the self-doubt department and make you feel like you’re failing all around because it is so all-encompassing, all-consuming. This was not one of those times.
If you didn’t want to read the whole thing and scrolled down to the end here; I can really sum it all up by saying how extremely blessed I am to be in a career with these sorts ups and downs. Where the rewards are that much sweeter because of the trials. I can focus now on being the face-to-face, compassionate, knowledgable, doctor now that that pesky test is in my past; thank you Jesus.
I’m also lucky because of everyone that brought me meals (thanks, mom), sent me encouraging texts, cupcakes, edible arrangements, Starbucks, and hugs. My roommates really pulled together and helped me get through, while also studying and working really hard themselves. My family prayed for me and supported me emotionally and financially and recruited others to pray as well. My school faculty and classmates supported me and gave encouragement, resources, advice and kicks in the pants where needed. Dru loved me, taught me a lot of test material, and listened to me whine repeatedly; he did dishes, cooked meals and absolutely knocked his own test out of the park all at the same time.
I don’t remember where I read it or if it popped in my head or where I got it, but somewhere along the line, I told my family that I had a mantra for this seemingly insurmountable test. I started telling myself “You are overestimating the problem and underestimating yourself.” It sounds crazy at this point in my life that I would still be crippled at times with self-doubt and confidence when it comes to my ability to belong to this schooling and eventual career, but I do. Even after I got accepted to medical school, if you had asked me to look at a future hologram snapchat video of me seeing patients competently and happily coasting into the start of third year in July 2016, I would have said an incredulous, dumbfounded, “No, that can’t be me.”
It blows my mind, in the best of ways. 
 

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Health Medical School Medicine

Functional Anxiety

Hopefully by now you have learned not to expect much in the way of blog posts during the school year. It’s a rough time and nearly all relationships, hobbies, and other activities suffer in the thick of it.
I used to worry a lot about where the time went and fret over how little I had done in 3 hours or whatever. Now, I don’t have time for that. Anything that isn’t directly related to studying for my systems course- which right now is hematology- is immediately considered free time and I have promised myself to never regret how I spend my free time. If its free time and I want to sleep, I sleep. If I want to hold one of my babes, I try my hardest to get my sisters to let me hold them. Unfortunately sometimes OMM and DTP eat up my free time with their class requirement, and that is a quick way to get me really cranky.
“Hell Week 2.0” I think is now over. I remember one distinct week in first year that just raked me over the coals. We had back-to-back tests, Anatomy and something else awful like Embryology or something. On top of that, I was sick. I’m sure there was more to it than that, but I have PTSD and can’t remember.
This year’s worst week ever- just happened. I just had a lot going on; there were two tests and I had to do my first full history and physical on a standardized patient. This was all within 6 days but it didn’t fall on an exact calendar week so I had a weekend to study. That made it somewhat less traumatic than last year. Anyway its over and I survived. Somehow I always survive.
This “Hell Week” my sickness came after. A lot of my class and I are still fighting something viral. My nightstand is still cluttered with cough medicines and tissues but I am feeling much better. Sickness always comes with stress for me.
I think it is a part of the remnants left over from when I *cough* didn’t have it all together like I do now. Cough cough. I think all medical students are generally highly motivated, Type A’s who like organized outlines, but I take it to the extreme, and I always have. If I had time to write all my notes in perfect penmanship and white-out all errors, I swear I would.
When I was twelve I had a pack of 64 gel pens and I kid you not, they had to be put back in the box in rainbow order or I would lose it. 64 PENS. Some of us med students are more lax and some of us are more like me. I was WAYYY worse in college when the workload kept piling up and didn’t give me time to hole-punch all my papers into a color-coded, divider-laden binder and neatly outline each chapter of the assigned readings. Seriously. I really do have a problem.
Its called Generalized Anxiety Disorder.
I’ve written a version of this post several times; how I would tell cyberspace that I actually do have really bad anxiety; I could talk about how terrible mental illness is or how I think mental illness rates might be highest among medical students, but the truth is, I know very little about either of those things. All I know is what I’ve experienced.
And what I know from my experience is that I’m not really a victim of mental illness. I live a normal life. Anxiety doesn’t have its grasp on me and pull me under until I can’t breathe. There was a time when I might have said that it did, but honestly, I have a very blessed life, and always have. There were always people around me that knew me and supported me and didn’t let me get too far away before I was shown some perspective. I worried all my life. When I was little, I remember worrying a lot about my family dying, awkward moments, and getting sick when I was away from my mom. Now, pretty much all I worry about comes down to one thing: “Am I good enough?” Am I good enough at school, a good enough friend, am I going to be a good enough doctor, am I a good enough aunt, am I good enough to pass boards.
For the most part, though, its under control. I have functional anxiety. Enough anxiety to keep me working hard and not enough to keep me in bed, too scared of failing to do anything. I have had those days- though not in a long, long time. I call it functional anxiety and it’s livable.  My “anxiety” habits are things that happen to me involuntarily that I didn’t know were pathologic until college. I thought they were normal. I bet a lot of my classmates do the same things because stress does some crazy things.
Functional anxiety means my lower lip will always need chapstick. I bite and peel the skin off of that lip until it bleeds. It means I peel hangnails back, not out of boredom, but because I’m so twitchy. It means I can’t get through a single exam without wiping the sweat off my forehead. It means I have to pee right before a test and then I sit down to take the test and I have to pee again. It means I get really hot and sweaty when I am uncomfortable. It means I have to walk and take deep breaths when I’m really mad. It means I cannot keep my fingernails painted because I pick the polish off as soon as I’m alone with my thoughts.
These things are concealable. Most people wouldn’t know, and don’t know, that I am physically not able to listen as they quiz each other right before the exam because I am in my own head, taking deep breaths. It’s not something that they have to be conscious and courteous of, to spare me the agony of triggering my mental illness. I like that I have to deal with it. We all have our own adversity. It just so happens that mine is diagnosable- and also manageable. It’s my functional anxiety, and I’ll survive it. Just like I always do.
 

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Health Medicine Uncategorized

Lion Scratches

When I was 15 my legs were itchy. I couldn’t sleep. I writhed in agony, with no rash or bumps or any other symptoms. I went to my pediatrician, urgent cares when I couldn’t stand it, and even the emergency room once. No one could figure it out. I had a whole cabinet full of lotions and creams to numb and soothe. Eventually I got a referral to a dermatologist with a 2 month wait before her next appointment. When I finally saw her, she told me about another over-the-counter lotion and sent me away to come back in 2 weeks. Still no relief. When I went back she found a few goosebump sized bumps on the back of my thigh and she squeezed them until I cried to see what would come out. The best she could figure was that it was some sort of keratosis. She prescribed Triamcinolone acetonide cream- basically what I now know to be the steroid cream of choice for itchy skin. She didn’t just give me the little toothpaste sized tube either. She gave me a 1 lb. tub with two refills on it. I was instructed to rub it all over my legs and butt at night and anytime after I showered.
I followed the instructions; I got less itchy. And then it went away all together. I forgot all about the cream when I quit itching and then the itching would come back, so I used it again every night. The tubs of lotion lasted about six months and I used all of them, along with OTC CeraVe. With three tubs of triamcinolone, I did this for about 2 years. When I got to the end of my last thing of lotion, I went back to see the dermatologist. She gave me another refill and I left. Somewhere after this I started to get deep, purple striae on my legs. They were slight at first, then bigger and bigger. “Finally,” I naively thought, “I have a rash that she can see and get rid of!”
I got an appointment. She looked at my legs and frowned.
“Oh no,” she said, “I am so so sorry.”
She asked me how long I had been on triamcinolone.
“Almost three years,” I said, now age 18.
She asked me where I had been applying it, who prescribed it, how often I used it. These are all questions she should have known the answer to. She then explained to me how I slipped between the cracks for proper treatment. That steroid cream is only used to treat the symptoms for a short time and that I never should have used it that long without us searching for a solid diagnosis and treatment.
I had about six long, purple, shiny trenches on each leg.
Turns out that long term steroid use causes skin atrophy. Skin atrophy from steroids can look different on different people and even be more severe than what I have. Basically, I have skin atrophy much like what happens in stretch marks.
“I’m sorry pretty girl,” she said on my way out. “I like to keep my young girls with beautiful skin.”
I don’t know what happened. I don’t know if the refill number on my script got misread by the pharmacy. I don’t know if she was distracted and forgot to order me a follow-up appointment. Maybe my insurance wouldn’t pay for a biopsy and she forgot to revisit a solution. Maybe everything happened at once. I was ignorant and didn’t know to call and bother her office until a permanent solution was found.
I have since grown out of whatever caused me to itch, and I have never seen another doctor prescribe triamcinolone in excess. I now believe myself to have had keratosis pilaris– a relatively common and straightforward diagnosis. It doesn’t really matter what it was though. It won’t make the marks on my legs go away.
Mine is a cautionary tale of the power of medicine in both its healing and harming, and of the health care system’s shortcomings. Several things went terribly wrong in my care; placing the blame on her alone wouldn’t do anyone any good. It could be a lot worse. I still have my quality of life and no function was lost. I know others who get lost in the system aren’t always so lucky. Though there are steps the doctor could have taken to give me better care, I don’t blame her. I’ve seen her waiting room; I would forget some things too, with that many patients in a day. Having perspective from both patient and provider helps me to be more forgiving too.
The scars have since faded to a light pink, but they are still there- thin-skinned, ugly, and obvious whenever I wear shorts.
My nieces have all asked me about them at various ages. Their age doesn’t really matter because they are still too young to understand this medical mishap. Just the other day Addie asked me what happened when she was sitting in my lap. “Do you have an ow-ie?” The shock of the scars’ size was on her face, worried for me.
“It’s okay, they don’t hurt Addie. Some medicine did it to me.”
When I first got them, my older nieces asked me about them, I didn’t know how to explain it. I told them a bedtime story about how I happened upon a lion, and got scratched as I struggled to outrun and escape it. Then they started telling people their aunt got scratched by a lion.
I’ve seen articles where new mommies affectionately refer to their stretch marks as tiger stripes. Paying homage to their battle wounds from carrying a baby; owning them proudly instead of hiding them away. The scars remind them of the sacrifices they made to bring a life in this world. They will never forget why they are there. I haven’t brought any baby into the world, but my lion scratches still mean something to me. I won’t ever forget why they’re there, and though I’m still not fond of them, they remind me of how I fell between the cracks in an overworked, red-taped, short-on-time health care system- and how I, the patient, ultimately paid the price. Every time I look at them, they tell me never to let a patient of mine have the same kind of consequence in any form- cosmetic or otherwise.

Categories
Medical School Medicine

Second Semester Classes

I’m a little over 2 months deep in my second semester of medical school. I have finished my cardiovascular block, and am now a week into neurology/neuroanatomy. Its a doozy, but it’s nothing compared to last semester.
I got an email to talk about the classes I have, and I wanted to do it before Neuro gets too crazy, so here it is!
The second semester of medical school:
My school is in its second year of switching to systems-based learning and we officially start the systems in our second semester with cardiovascular. That basically means we go through every system in the body and cover everything that entails in about 6 weeks per system. We learn physiology, normal function, and review some anatomy, then we dive right into everything that can go wrong with it, what the symptoms are, the diagnostic tests you run, how to diagnose, and then finally the drugs to treat it.
The only thing is that there are so many different things going on now that I get a little overwhelmed. In addition to our systems block (which is the heaviest part of our lecture hours each week), we have Clinical Problem Solving, Clinical Skills Class and Lab, OMM Class and Lab, Developing the Physician, and now a Neuroanatomy Lab each week.
Clinical Problem Solving gives us a clinical case each week and is incorporated strongly into our systems courses. We learn to write SOAP notes and discuss diagnosis and treatment in small groups with a practicing physician. Easily my favorite time in class each week!
Clinical Skills teaches us how to perform physical exams, take histories, systems checks, auscultation, and other “real doctor” things. The lab that goes along with it also puts us with a practicing doc in the Tulsa area and we practice our skills on each other. Standardized patients (paid actors) come occasionally and we practice on them as well.
In OMM we have a lecture and lab each week. We practice our techniques on each other. We have officially finished muscle energy techniques and are moving into counterstrain.
Developing the Physician is a class where we are exposed to various issues in medicine. They are especially focusing us in on Geriatrics this semester and handling all the special controversies and humanity issues that that entails. A few weeks ago they gave us goggles that simulated going blind. Take that as you will. Nothing in the class is particularly hard, but there are due dates for papers, shadowing to do and small groups that always seem to be inconveniently timed with everything else going on.
All of these classes have their own exams too, which also don’t always line up well with the systems courses. For example, we are responsible for the dermatologic exam in Clinical Skills when we haven’t learned anything about the skin! Two tests in one week doesn’t happen a lot, but it always freaks me out a little bit because every little facet in medicine has SO MUCH material.
Neuro is just a little ridiculous. We have some really good professors this block but nothing is more complex than the dang spinal cord to me. How anything gets transmitted correctly in the body is beyond me. Still, being out of basic sciences, and learning the real medicine is such a wonderful milestone to have finally made it to. After all, its been a long road with science after science. Finding out that medicine is everything I wanted it to be is extremely satisfying.
There’s a little glimpse into my classes and how I’m learning.
Those of you who are in medical school, how does your school do it? Comment or message me!
Thanks for reading!

Categories
Blogging Medical School Medicine

Not for a Lack of Trying and Summer Plans

There are so many issues I want to talk about. Things I’m passionate about. In medicine and in life. Vaccines, mental illness and mood disorders, nutrition and exercise, pregnancy and childbirth, medical school admissions, preventative medicine, geriatrics, malpractice, thoughts on caring physicians, managing chronic illness, and of course this era of mistrusting our physicians and reliance on the internet. Big things are coming and happening and the future of medicine. I simply do not have the time to research and delve into these big issues and write the well-written pieces I know I can write while being true to my studies. The hard truth is, being the best physician I can in the future be means I need to give my all to the cardiovascular system right now. It means I can’t dive into those side issues I care so much about just yet because I need to know paroxysmal nocturnal dyspnea, bread and butter pericarditis, and Kerley B lines. I haven’t even had the spare thought-processing energy to figure out exactly where I stand on so many of these things. I sift through these thoughts in spare moments- spending time on my runs and in the shower deep in thought. When I’m done, I have a lot of little half-ideas and nothing really hashed out. Still, I write all my ideas in a note on my iPhone and save them for later. “Summer,” I promise myself. I’ll get down and dirty with these ideas this summer. It’s coming.
Also in the summer, a myriad of opportunities have come about since being in medical school- and I’ve been really blessed for that. I wasn’t really expecting it, since its so tough to find those good opportunities as an undergrad. Externships, research jobs, medical missions, vacations. I’m still sorting through it all right now, but I will be on at least one medical mission trip, being doing a summer rural health externship, possibly part time research. I’ll get some good shadowing time in too. Another big part is that I’m moving! Out of my parents house, and into one of my dad’s rent houses! I’m sort of sad, sort of excited. I’ll probably have roommates that are classmates and live WAYY closer to school so its mostly a good change. Anyway, I’ll keep you posted and thanks, as always, for reading!

Categories
Life Medical School Medicine

The Truth About Anatomy Lab

Before reading this post, please take time to review my disclaimer here.
If I had to pick a theme to encompass this semester thus far, the theme would be time. What time is it? What time do we have to be there? ? When can we stop studyingHow much time left on the exam? How long have we been studying? Where has the time gone? How much time is that meeting? Time, time, time. There’s never enough of it, but I’m always ready for whatever-it-is to be over.
Speaking of which, I have neither the time to write this, nor the amount of sleep I require, but I think I need to say it.
Simply because it bothers me so much, I feel like I have brought up the fact of having no time to reflect at least a couple times on this blog. Where it bothers me most though, is anatomy. I don’t have the time to be bothered though.
We were told to be grateful for the gifts of these donors’ bodies. We were told strict rules of how we would show that respect. (No cell phones in the lab, no pictures, be courteous, be mature, don’t take body parts, etc.) Some of us have even had cadaver labs before. Let me say this though, having now done both. Medical school cadaver lab anatomy is nothing like undergraduate cadaver lab anatomy. Do I feel more prepared having taken undergrad anatomy? Maybe I was more prepared on the first day of school, for words like “inferior” and “malleolus” to pop up. Maybe. I may remember some superficial muscles from anatomy 3 years ago. Rarely has this been true. I got my feet wet handling a dead body. Barely. (We shared two bodies with about 100 students.) Still, I don’t feel like I was prepared for the semester in store. Not really at all.
Some days it doesn’t bother me at all. I go in, do my work, chatting and laughing and focusing on the anatomy and other things and then I get out, and go get my dinner and go back to studying.
Some days I do not want to go in there. Not at all. Some days I just can’t find it in me to touch the bodies or talk or even think about anatomy. Because some days, it really just feels wrong. Honestly, I don’t even know how to deal with it. And even worse, I think a lot of people really aren’t dealing with it at all. It’s just become something we have to do.  We have to do it for a lot of reasons- because we have to learn it, and we were told to do it by our instructors; we’ve even been told that it’s a noble pursuit. Unfortunately, the severity of it gets ignored in the name of duty sometimes.
I feel like I’m doing something straight out of a concentration camp somedays and nobody has told me how to deal with it!
I’ll even go so far as to admit to ignoring the fact that they were humans at all. The smallest details sober me up though. I went to another group’s table and saw that their cadaver’s legs, (skin still on) were peeling like a sunburn. Something I don’t have to learn and not at all relevant to this anatomy unit, startled me and reminded me that her skin gets dry and flaky just like mine. We are humans. And one of us is cutting the other up.
I know how terribly fibrous and tedious it is to pluck through the connective tissue of the back of a human neck. I know the best technique to skin a human stomach- and leave the fat on- in less than an hour. I know the different texture of cutting through the human heart pericardium. I’ve heard the sound of a human tendon peeling off of bone, of a human sacrum being sawed through. Of flinging human fat into a bucket. I’ve had a neck ache from cutting on a human body for too long. I’ve wiped my forehead with the back of my glove, only to find that I’m wiping my forehead with the fatty “grease” of another human being. I’ve gone home with my cadaver’s armpit hair stuck to my shirt, found flecked bits of human tissue in my hair, in my scrub pockets, on my body. Each and every human body in that room has a distinct smell. We’ve made up names for them. Some nice, some not. The women’s hair on their heads is shaved. There is poop still in their intestines, though it doesn’t always stay there.
Are you catching my drift? I want to scream, “None of this is normal, or even OKAY!” Its not healing, its not easy; its ugly and its dehumanizing. These are opposites of what I’m trying to do here!!!
But for all the terrible, disgusting things I have beheld in that horrid lab that I hate with a passion, there is good. There is always good.
I have physically seen human organ cancers and surgical alterations and held a human gallstone, and a human ovary, and a human kidney in my hands. I have learned and traced and touched and owned the knowledge for myself what is in the human body. The depths and awe and intricacy and straight up crazy things it has to teach us. I felt the juicy, soft texture of a lung and looked inside a heart. I know the shape of each vertebrae and why its like that. I got elbows deep into the spinal cord and saw straight down a trachea into the lung. I’ve traced the ureter from its beginning in the bladder and out of the body. I follow the arteries to each and every place the hearts pump their blood- their sizes give away their importance. I’ve palpated a lymph node filled with disease and one that was healthy and smooth like a pinto bean. I’ve compared sizes of prostates to other bodies and looked at inflated bladders and black lungs and liver cancer.
We laugh and joke and play and gosh darn it, we get every last thing on our list done because its what we have to do and we are medical students.
If I choose to donate my body to a donor program I wonder what the students will say. What will they speculate about my life, my scars, my abnormalities. What will my body tell them? The truth is, a cadaver tells very little about what really mattered in their life. Would they have ever known or cared to know if their hepatic portal vein was much larger than normal? No.
Though I find it incredibly skewed that I know so much about my cadaver’s insides without knowing them personally, I know their anatomy- the health and diseased states of it. They’ve taught me a lot and I won’t let it go to waste. Cancer is ugly and surgeries leave gruesome scars. Palpation is a key tool I will always have in my hands. Variations are numerous- no body is the same. These are things they have taught me about patient care even though I wasn’t able to do anything but cut them.
They’ve taught me the depth and beauty and intricacy of the human body designed by God. They showed  me the beautiful mess that it is and allowed me to touch it and see it outside of a textbook. They’ve left me amazed, wowed, grossed out and “oh cool!”ed.
The truth about anatomy lab isn’t spoken about much. I certainly didn’t know what went on. A lot of it is unavoidable, and no one is completely innocent or at fault. It’s going to be messy and gruesome and uncomfortable. I think the point of it is to get the most education out of it that you can- both didactically and emotionally. Gratefulness, always. I now think donating my body would be a great sacrifice, one I am not sure I can stomach.
If anyone is asking me, though, I think it can be handled more gracefully by medical schools and medical students alike. My class isn’t particularly keen on mamby pamby feelings chats because we are so busy, but I think a candid briefing before anatomy starts and a debriefing after the semester would be helpful for us as future physicians. What we are called to do is heal and humanize and what anatomy lab is right now, is anything but.

Categories
Family Health Life Medicine

Empathy vs. Sympathy

I saw this video a long time ago and I remember showing it to my roommate and we just sat silently after watching it. I’m glad I was able to find it again. Its quick and easy to understand but she covers some deep things in it that I mull over in my head quite often.
I always get chills when she says “I know what its like down here and you’re not alone.” If only I was just able to convey that to people that I want to help. Its harder than it sounds.
[youtube https://www.youtube.com/watch?v=1Evwgu369Jw&w=560&h=315]
My relevant story for today isn’t really any thing compared to the pain and suffering some people go through, but I’m going to tell it anyway because it is what has got me to some realizations about helping people pain- both physically as a future physician, and emotionally with family and friends.
I had a bad sunburn recently. Mostly on my back. It was about two days old and I went running enough to soak my back and my shirt in sweat. It started itching in spots on my way home. Then it started burning. Then I took a warm shower. Then I got out and put some moisturizer on it. Through each of these steps it started burning worse, getting itchy all over. I’m not sure if I was done for from the moment I sweated salty chemicals onto raw skin or if I just kept making it worse, but by this time I was in a fit of excruciating pain and compulsive itching. Rolling on the floor, crying for my mom, rubbing it with my knuckles so that it wouldn’t sting worse from scratching. The only thing that took a little edge off was running the bathtub on cold over my back constantly. My parents were trying to talk me down gently and had to resort to holding back my arms, yelling “CALM DOWN” and watching me twitch and sob and cry.
It was awful. Truly I didn’t think I wanted to live much longer if I had not known it was just a temporary skin irritation. I thought of fibromyalgia and other chronic pain conditions. I thought of how scary it was to not know how much longer I was going to feel like that. To not know when or if I could sleep or eat or enjoy anything. I was begging to go to the ER to get a sedative.
The video popped in my head
“I know what its like down here and you’re not alone.”
I thought of how anyone was ever going to help me get rid of the pain. I was going through everything I knew to make it just a little better or tolerable so that I could sleep or distract myself from the itching til it went away. My mom was just as scared and helpless as I was. My dad was yelling unhelpful things like “SHH” and “Don’t touch it!”
After we thought of cool water and I was sitting with my back under the faucet, my mom just sat there with me as I calmed down and the burning got manageable. I don’t know if the house catching on fire could have gotten me out of the tub. I was scared to move for fear that the flood of relief would leave my body. My mom just sat there.  And for a bit, I was fine. My pain was not gone but I was comforted by the temporary relief I found and the fact that someone else was there, as if saying
“I don’t even know what to say; I can’t do anything to help you, but I’ll stay here with you and just be together.”
That’s what I hope to bring my patients if nothing else: Relief through connection.

Categories
Life Medical School Medicine Science

The-Burnout,-Doubt-Everything,-Find-Resolve-Again Cycle

Pre-meds take heart.
I ache for you. I really do.
I know how it is. I know you doubt your decision to become a doctor or PA constantly. I know that it comes at the worst times too. Right before a test.
I used to sit in the student union with my science classmates, staring at our textbooks. We watched the sun go down from the same spot almost every night. We ordered dinner in there; sipped coffee; ate entirely too many sour straws. We pretended to know how to explain the problems’ solutions to each other. We tried index cards, quizzing each other, making up games, and repeating the answers over and over. We tried writing it out multiple times and diagramming it, any creative way to make it easier on ourselves to learn.
During this ritual, one or all of us would end up with eyes glazed over, elbow resting on the book, face in hand. Or worse-  head down resting on the book staring off into the void.
Jenna would catch my eye and say “What?” as in “What are you thinking?” and I’d spout off our usual joke about wishing the information would just enter my brain through osmosis as I was laying on it.
Then- and stay with me here because our overloaded minds rarely make  sense. “I just…. I can’t… I mean… [sigh]. This is just really hard and I hate it and I’m tired and I can’t… I mean…. ugh… WHY?
Natural progression dictates the others around you join in on the moaning. Such begins a big discussion of every cruel assignment, poorly written test, where your grades are at, how bad/good your week is on workload, and a psychoanalysis of how to conquer every class and professor. It goes on and on.
Eventually I would realize that all the other study groups in the room are long gone. The moon is so high its not visible from the wall of windows anymore. Everything is closed. My roommate is probably fast asleep at home. I start gathering up my stuff realizing I’m not studying anymore tonight and sleep would better serve me. As soon as the backpack is slung around to my back, books out of sight, I feel immediately guilty that I have not studied enough.
I walk to my car slumped over, exhausted and sometimes genuinely depressed at another day of failure. Of not understanding. Of not making the grade. Of wanting to do something, anything other than how I spent my hours that day.
I get to my apartment, briefly stare into the kitchen and decide that making food would take too much energy even though I had apple rings and red diamond tea for dinner 8 hours ago. I get ready for bed literally beside my bed, the motions so familiar I don’t even turn the light on. Its simple really.
Take backpack off, set it on the floor beside my bed where I grab it first thing the next morning. Pull my bra out of my shirt, take my pants off. Plug in my phone. Get in bed. No makeup removal, no brushing teeth.
This, my friends, is the burn out.
I feel for you premeds because I know this trudgery well. It was my life for what felt like most nights of the last three years. I know how you feel even if you can’t say it.
What we are not able to articulate to our study buddies in the moment where you are pondering your life silently instead of actively studying- is how you aren’t sure if you want to actually do this. To be a doctor. You don’t know if you can do it all through undergrad and then add four more years. You don’t even know if you’ll pass physics and it keeps you up at night when you are so so tired. At the ripe age of 20, you are burnt out and you want to do something else. Please, God, anything else!! You just don’t have it in you anymore.
Believe me there are plenty of people that will tell you that you can go ahead and do something else. Many of your classmates will choose something else and you will secretly envy them. I did. They are probably the wise ones. The ones that will be able to go on a trip to Cabo with 3 other married couples when they’re 25 while you are still in school. Its a respectable and understandable choice. I wish I had been able to do something else.
Several times, though, in the middle of the “doubt everything” phase, I would consider my other options. “What else would I do?” I thought. “What do I really want to be doing?”
I didn’t have a single answer. In the moment there were plenty of things I would rather do: eat, stand outside, take a shower, make a phone call, break down and cry, stab a professor, eat again, sleep. But in the future? What did I want to be? A doctor. That was always the answer. I want to see patients. I want them to trust me, let me into their lives, mourn with them, appreciate their humanity, heal them, understand their health as a human being better than any other doctor they’ve ever had.
My rational mind then takes me to what I must do as a follow up. If being a doctor is all I want, and being a doctor requires medical school and medical school requires I pass this course. Then it follows that passing this course requires I study. So here I sit and here I will study. This is what you want to do. That’s all the resolve I need. It’s that simple.
In each burn out, you ultimately have to figure it out for yourself if medicine is still want you want to do, time after time. But I just want you to know that it happens, and it happens to everyone. Often. Questioning it isn’t a reason to quit. It not being what you want is a reason to quit. Because being a doctor is going to take a lot of work. Its probably going to take a lot out of you. You can do it, though, if its what you want to do. It’s going to be easier to handle all the work, when you realize that its not just something you have to do, in the end, you wouldn’t rather be doing anything else.
Also, go easy on yourself. It may be miserable to sit there studying; I know my group dreaded going in to study at the end of class each day, but being there is half the battle. And if you really wanted to be doing something else, you’d be out there doing it, not studying.
I know it sounds crazy but I actually miss those late nights with friends studying and talking and whining about our lives. I’m scared out of my pants for medical school to start! What if its worse than those terrible nights?! Now that is scary.
“It’s so strange how life works: you want something and you wait and wait [and work] and feel like its taking forever to come. Then it happens and it’s over and all you want to do is curl back up in that moment before things changed.” -Lauren Oliver
 

Categories
Family Friends Growing Up Health Life Medicine

Worry

I worry about big things, like about the future. I worry about small things, like about not finishing all the summer reading I wanted. I worried when I was 9 and had no legitimate concerns. I worry now when every decision feels so pertinent. I worry about serious things like the environment. I worry about stupid things like having white teeth.
I worry about my family. I worry for their health and happiness. I worry about about their worries. I worry about their sadness. I worry about their foot fungus. I worry about their flaky patches of skin. I worry about their backs, their diets, their sore throats. I worry about my sisters. I worry about depression returning, looming in the sky like a big thunderhead that just passed over us. I worry about my nieces. I worry for them because its so hard to be a girl. I worry because its so hard to grow up and grow up right. I worry because things go wrong. I worry for them because there are hurts I can’t hide from them. I worry that they will see my worry because I want them to know how blessed they are and I’m worried my worry will make them think otherwise. I worry about them when I start medical school. I worry that they’ll think I won’t have time for them.
I worry about my friends. I worry that I’ll disappoint them. I worry that they won’t get everything they want for their lives. I worry about the hurt they will have to endure if they don’t. I worry about love. I worry that I don’t have a clue. I worry that I won’t have time to have a family. I worry that I’m not good enough. I worry that I’m screwing up. I worry that things won’t work out even though I know they will.
I worry about medical school. I worry that I’ll flunk out. I worry that I won’t make friends or won’t have time to. I worry that I’m not cut out for it. I worry that I’ll be incompetent or embarrass myself. I worry that I won’t like it. That I won’t want to study. I worry that I’ll worry more than I already do. I worry that it won’t be everything I wanted it to be. I worry that I will have done all this for nothing. I worry that I’ve made my non-existent career more important than people.
I worry about cancer. I worry about diabetes. I worry about heart disease. I worry about death and disease. I worry about pregnant women. I worry about babies. I worry about obesity. I worry about families. I worry about women in more dire circumstances than I can even imagine. I worry about our nation’s healthcare system. I worry about mental illness. I worry about people who don’t know better. I worry about people that do know better. I worry about vaccines. I worry about abortion. I even worry about the overuse of antibacterial hand soap. I worry about the food we put in our mouths. I worry about business, ethics, medicine, politics, immigration, gender roles, and society because all these things play into our health. I worry that we won’t be able to fix it all. I worry that I won’t even be able to do my part.
I worry that the worries I have listed here don’t even scratch the surface of what I worry about. I worry that I won’t ever stop worrying. I worry that someday the burdens I have for people, the stress that I feel will shut me down into a deep dark place, like I’ve seen worry do to people before.
But most of all, I worry that someday I won’t worry about these things anymore.

Categories
Application Process Medical School Medicine

My Personal Statement

Caution: Post with heavy reading!
Since I have a lot of friends that just finished their junior year and are applying to medical school, I thought I would share my personal statement. If you’ve been applying then you already know the basic guidelines they give you and some of the more google-able tips you can find on what to put in it- and what not to.
For example:
About a page in length.
Highlight your good qualities. Duh.
Say what makes you unique.
Things like that.
But, the thing is. In all my searching, people rarely share them. I mean yeah, you can find a couple of examples, but I’m pretty sure they’re professionally written so as to be unrealistically bad, or “ideal scenario” good. Is mine perfect?  No. Is it real? Yes.
So here it is. The personal statement of a real, imperfect student that really really really wants to be a doctor. I didn’t have all the right connections, I didn’t have the perfect grades, I didn’t have a stellar internship working for the dean of the medical school. I’m an average student that worked my butt off, and never felt like I was going to get in. And now I did.
I wrote it myself, but like I said here, many many people proofread it for me. Just to have people read it and tell you different points of view on how it comes across is valuable, I think. You should see how many drafts of it that I have on my computer. It’s a little ridiculous.
 

“Dear Admissions Committee,

As I begin medical school, below is a letter I envision sharing with my patients when I begin my career.
 

To My Patients:

 

Thank you so much for trusting me as your physician. I want you to know the doctor who will be giving you excellent care for a number of years, I thought I would begin our relationship by giving you a brief look at how I ended up as your doctor.
You are an amazing being. It is almost hard to comprehend how many things had to go right for you to be conceived, born, and here in front of me today. My love of medicine began when my older sister became pregnant; I was just thirteen. I read all the pregnancy books, went to ultrasound appointments, and listened intently at her prenatal visits. Not only did I enjoy the learning aspect, I loved taking care of her while her husband was at work and she was on bed rest. We grew closer as a result of the caretaker role I filled. I shaved her legs, made sure she was consuming enough calories and gave her the medications she needed to avoid preterm labor.
Ever since I could write, I have kept a journal. If you were to read my journal, you would see my gratitude for sharing life with people and hearing their stories. I believe everyone has a story to tell. This, and the fact that I was raised to respect and help others, fits seamlessly with my interest in medicine, being that a doctor connects the story of a life in need with the hope of healing.
While on a mission trip to Mexico during two of my Spring Breaks, I helped build new houses in a small village. Our team gave the people there more suitable housing and spent time playing games with their children at a nightly carnival we hosted. Here, I learned how helping a community changes the lives of both those served and those serving. My lifelong commitments to learning, listening, and serving in the world around me have taught me how valuable people are, no matter their background, economic status, or level of education.
Firm in my resolve to become a doctor, I began volunteering at a free clinic in Tulsa sponsored by OU Medical School serving those with no health insurance. One of the clinic’s goals is to improve the health status of a part of the city that has relatively poor health and low income. I love seeing the patients at Bedlam Clinic- learning from the medical students, and getting to experience different procedures and tests each time. The exposure alone is an invaluable experience I will carry with me throughout my education and practice. Each day, I leave Bedlam with a smile on my face that does not go away for hours afterward. The thought of a future continuing to see and help patients, is a true delight for me. I cannot think of anything I would rather do than be your doctor.
As a biology student, a devoted aunt of five young girls, a runner, a research lab intern, a church member, an avid reader, and a volunteer, I am used to working hard. I enjoy being busy, and maintaining a rigorous but fun routine. I thrive on learning and working with my hands, body, and mind alongside all kinds of people. Best of all, I love this journey I am on. Trials and errors, ups and downs, knee injuries and finish lines- I have learned that I am capable of more than I thought possible. In running, as in life, I have learned that going the distance leads to a better, stronger me. Taking the hard way has never led me to failure, so I will continue to live and care for patients this way.
I offer my heartfelt sympathies regarding whatever ailment is bringing you in today. I promise you my best to assist you in getting well. From my shadowing experiences, I built bonds with great doctors who, in turn, allowed me to see their bonds with their patients at a family clinic. It touched me to be privileged enough to enter these rooms. Since patients seek their doctors when something is wrong, illnesses and problems become very personal in nature. I think just being examined by a doctor makes you vulnerable. Mothers, you might bring your kids in to see me, putting their care in my hands. Sons, you might bring your beloved elderly parent in about a concern you have. The responsibility of taking on this role for you and your loved ones is something I do not take lightly.
In my pursuit of loving people, positively impacting the world around me, and eagerly seeking to grow in medical knowledge, I am privileged to call myself the physician to the best patients in the world- you.”

 
You may notice I picked a slightly different approach. I was told by a couple people mentoring me, could be pretty risky. Instead of addressing it to the admissions committee, I addressed it like a letter to my future patients. I did this because I knew it would be easier to write to “them”- my patients- about why it is I became their doctor than it would be to convince an admission committee or interviewer of all the “great” things I had done to become the best student for their medical school. It isn’t about being a medical student after all- its about the doctor you become.
In the end, to make it stand alone, I told the reader (my interviewers) that I was writing it unconventionally and explained my intended audience.
I do think that the whole thing was a risk. But the risk paid off. Plus, I’m really proud of it because I’ve never seen one like it out there.
The doctors I shadowed all said they loved it and gave excellent criticisms that I took into account and changed a few things. But what I really like about it is that I ignored some of the advice I was given and left it the way I made it so that it stayed “me”. So feel free to ignore this post if it takes the “you” out of your personal statement.
I also gave it to my mom’s coworkers (public school administrators), my professors, an OU resident I met through an OU information session that became a mentor, as well as all of my letter writers for their opinions. Some liked it, some didn’t. The best compliment I ever got was someone telling me that they wanted me to be their doctor after reading it.
This was me.
Unknown
 
Source
Both interviewers at OSU complimented me on it, but the young resident told me that he received my file the night before and read through it. (OSU told me that this is the ideal to have their interviewers read over your file the night before they interview you, which I thought was really nice). He said he read it twice and then he read it to his wife and they both loved it. He said that if every doctor felt that way about their patients, it would change the health of the world.
I encourage you all to do something creative with it! As creative as one page with all your attitudes, accomplishments, and activities can get! Who knows, it may pay off!