Sarita Metzger (’15)
Glencoe, Trinidad and Tobago
Chemical Engineering, Princeton University
Netflix, Ice-cream and pondering a healthy lifestyle.
I own a mannequin with an interesting sense of style named Monica; she lives in my old bedroom in my parent's home.
- 9/1/14: Taking a Breath
- 7/27/14: Less Thinking, More Doing
- 7/24/14: Farewell D.C. … It's Been Real (Selfie Alert)
- 7/17/14: (Almost the) Weekend Musings 4
- 7/13/14: For the Kiddies
- 7/2/14: Hello Fourth Year
- 6/15/14: Happy Father’s Day
- 5/31/14: Weekend Musings 3
- 5/28/14: My pediatrics inpatient experience
- 5/21/14: Spring Break 2K14
- 5/19/14: Confessions of a Boring, Worry Wart, Introvert
- 5/9/14: I Told My Mother to Call Me Every Other Day…
- 4/9/14: “Did He Get Everything Out?”
- 4/9/14: “Real Doctors”
- 4/5/14: Weekend Musings 2
- 3/30/14: Do As I Say, Not As I Do
- 3/24/14: Weekend Musings 1
- 3/21/14: This Is Not About You
- 3/20/14: ...Would I Miss the Lecture Hall?
- 3/19/14: Breaking Sterility
- 3/12/14: Moaning and Still Undecided
Taking a Breath
I’m writing to you from Boston, on the brink of another rotation but today is Labor Day/a free day for me and I’m using it to catch my breath a little. This past month has been a whirlwind of witnessing the art of surgery, meeting some great faculty and residents, answering pimp questions (with an incorrect to correct ratio that I will let you guess) and agonizing over my personal statement. There was also a healthy (teehee) amount of sleep deprivation/caffeination, not bringing up my breakfast from nervousness during a Grand Rounds presentation and beautiful Florida weather (which I mostly enjoyed from inside the OR).
I am really grateful for the experience I just had. I learned so much about myself, what I can and cannot handle and about the profession I want to enter…I’ll get into that further in a future post but for now I’m writing because my baby sister told me to hurry up and post pictures of us at the Museum of Natural History…so bossy.
The weekend prior to my last elective, I wanted to get some continuous hours of preparatory reading in BUT it was going to be my last free weekend for a while and was my sister’s last full day with me so we went to the Butterfly and the Wolf to Woof exhibits.
Peace, Love and stay safe during your Labor Day celebrations,
Less Thinking, More Doing
Medical students occupy a very strange space, especially 4th year students. You navigate this uncomfortable space where you want to show initiative and interest and you genuinely want to learn, especially by doing…BUT you also risk coming across too aggressive or even more mortifying: annoying to the more senior team members. You risk getting/doing something very wrong even with the greatest of intentions. I understand that mistakes are bound to be made; they’re a critical part of the learning process, however when you feel like your 4th year is one long audition for residency, you tend to think of ‘mistakes’ in less understanding terms.
Maybe everyone doesn’t struggle with this, but I tend to have lengthy internal dialogues about everything: “should I ask the scrub tech for the scissors to cut now?” “What if I accidentally cut their knot?” (By the way, cutting a surgeon’s knot is one of my nightmares). “Should I ask to grab that retractor?” Mind you, these thoughts don’t paralyze me into inaction, I grab a mean retractor but as students we’re always analyzing our seniors’ response to us, asking for feedback and criticism to better ourselves…wait, I bet this is isn’t unique to just medical students, but you know what I mean.
I have these moments of hesitation because I have had mixed results: I’ve had residents say, “just grab the retractor if you want to, help is always appreciated”. Tried that, sometimes I’m met with a “thanks’, other times ‘nope, I’ll do it myself’ which invariably leads me to think “OMG, does the attending not like the way I retract!? How can I retract better?!”...I’m exaggerating…a little.
I’ve had others say “just ask” which is a much more natural approach for me (#TeamPolite) and I’ve been met with a “don’t ask, just take it…surgeons just DO” for every “sure, thanks for asking”. I’ve even had some “If I wanted you to take it, would have asked you to take it.”…always nice. I use all these words to say, it’s actually quite silly of me to take mental inventory like this. Since I’m dealing with multiple personalities, there’s probably no reliable algorithm…different strokes for different folks. (You know I enjoy a good cliché every now and then.)
As a student you are usually the least knowledgeable and experienced member of the team, BUT you still know SOME things, know how to do SOME things and you want to learn more, want to do more than just observe. Respect this and at the end of the day, no one can fault you for showing initiative, however small your gesture (as long as you’re not being obnoxious about it.) right?
Peace, Love and Overthinkers Unite,
Ps. Gearing up for my second away rotation, wish me luck friends.
Pps. I would have made the title “More savings, more doing” as I heard it in a Home Depot commercial, but it didn’t quite fit… although saving is good advice.
Farewell D.C. … It’s Been
Real (Selfie Alert)
My time in D.C. has come to an end even though I’m not much of a city person (much more of a suburb kinda gal), I had a wonderful time on my elective … learning so much, forging new relationships, repeating that I was from ‘Wright State’ not ‘Wayne State’ every so often.
I also fortunately had the opportunity to enjoy the company of family I had not seen in a while and old friends. Weekends were devoted to being a shameless tourist even though I’ve been to DC on numerous occasions:
Peace, Love and just a 7.5 hour drive between me and the BSOM,
Ps. I heard on the radio yesterday that “selfie” has been added to the dictionary. Hmmm.
(Almost the) Weekend Musings 4
Yesterday I had the opportunity to observe a robotic surgery that took a loooong time (by the end I had to decide which was more important: finding food or finding a bathroom) because the procedure itself was just a long one and partly because the attending working the case was still a bit new to robotics. Two fellows were scrubbed in with her who were a lot more familiar as they were more recently trained in the technology and I could see them providing her with direction and instruction even though she is several years their professional senior.
Afterward the attending said to me "there's no room for ego in this profession".
Peace, love and lifelong learning,
Ps. I chose to get food first
For the Kiddies
Right now I am doing an away rotation at a Children’s Hospital in Washington, DC and all I can say is: YES!!
This is a bit (maybe a little more than ‘a bit’) surprising to me because I never thought of myself as the kind of person that ‘loves kids’. In fact, during college I told my mother that I probably was not going to have any children of my own (I’m told many women go through this phase though). Of course most people like children, mini-people are adorable (mini-anything is adorable; so many kitten and puppy memes on the internet) but they also cry, require diaper changes and have a tendency to attract trouble like Magneto to iron nails (always and forever an X-men fan), but you know what I mean. There are definitely those people out there who can easily quiet a crying baby or make a shy toddler smile…and I find myself wanting more and more to be one of those people.
Honestly, I don’t know what happened, but I do know that I felt ‘it’ first on my obstetrics rotation. I had a fleeting thought: ‘goodness this creature is so cute, what if all my patients were like this?’ and you guys know I had a blast on that rotation. Pregnant woman are not half as frightening as I expected them to be.
Then I felt ‘it’ again during my pediatrics rotation. Nothing lit up my day like a well-visit with a talkative 7 year old, nothing made me reminisce fondly about my own teenage years like chatting with a 16 year old volleyball player about her future plans during a sports physical and nothing broke my heart more than a failure to thrive infant.
Whenever I talk with individuals who work with kids, they echo the same sentiment: “the kids are innocent and haven’t even had a chance to really live yet. They didn’t do anything wrong but bad things happen to them and they deserve our care”. This didn’t always sit well with me because even that 60-pack-year smoker with end stage lung cancer deserves our care but that aspect of innocence and length of time on this earth can really make one think.
I elected to do this Pediatric away rotation just for variety in my 4th year schedule, not necessarily because I was actively thinking about the children but I am SO glad I did.
I do not think General Pediatrics is for me, I have a feeling I will end up in the OR…but maybe working with the Pediatric population IS for me…maybe? Let’s stay tuned.
Peace, Love and figuring out your calling,
Hello Fourth Year
Last week Friday, I took my final shelf examination for my third year of medical school. As Murphy’s Law exists, I decided not to really exhale until I had received my Pediatric Shelf Exam passing results.
I really would like to sit here and write something that can tie my third year experience into a neat literary bow but that just seems like such a tall order right now: so many experiences to recount, so little creativity.
This past Monday we welcomed the former second year students to their clinical years at the Student Clinicians Ceremony and I had the privilege of saying a few words in recognition of one of the Interns I had the real pleasure of working with during my Pediatrics rotation for the resident Humanism and Excellence in Teaching Award. I’m just going to leave my little speech here, I think that will have to do as far as bow tying goes:
“Disclaimer: I’ve been known to be a little dramatic…I’ve tried to tone it down but apologies in advance.
I am very tempted to stand here and make mediocre puns about Dr. Shannon Golden’s name being golden and how she happens to also be that in both appearance and demeanor…but I will do my best to spare you.
I got to my very last third year rotation, Pediatrics and thought: YES, the kids and I are going to have so much fun…then I thought oooh, one month of sick kids in the hospital and another month of not so sick kids in the clinic, eh maybe they’re not going to have as much fun. Also, while third year is amazing and you have the privilege of taking care of people in one of their more vulnerable states, it can get to be quite difficult knowing that as a medical student, you are at the absolute bottom of the food chain and some team members see you only as the person lengthening their work day. I was definitely feeling this weight when I got to Peds. Then I met Dr. Golden at Dayton Children’s Hospital and it did not feel quite as heavy and I didn’t feel like as much of a burden.
In my experience, you come across three main types of residents: those that ignore students completely (and from a student perspective, sometimes flying under the radar is not a terrible thing), those that acknowledge your existence by asking you random questions here and there and enquiring if your note is finished 5 seconds after rounds had ended (spoiler alert: mine never was) and those that make an effort to make the student feel like an actual member of the treatment team and this is where Dr. Golden comes in. While sometimes during the year I felt like…an extra…just the medical student, in general, I’ve had the opportunity to work with some pretty great residents but rounding off the year with Dr. Golden was a treat. It was very new and strange to me when she would ask each of us which patients we wanted to see in the morning or suggest interesting cases based on the specialties we hoped to pursue…it was even stranger when before rounding but after we went to see said patient she sought US out to talk about OUR observations, OUR assessment and OUR plan. She was open to answering any questions and brainstorming WITH me and not just leaving me to fend for myself in front of the attending with a haphazard plan during rounds but even more importantly, not just telling me what to say during my presentation so that I didn’t embarrass myself in front of the attending, but I also, didn’t gain as much education-wise since the presentation wasn’t fully my own. Furthermore, she gave daily feedback whether it was on your note or your interaction with a patient, she let you know that you and your work were not unnoticed. Dr. Toussaint and Dr. Taylor, the clerkship directors kept talking to us about active learning and its merits and I can say that Dr. Golden definitely facilitated that on the wards...so much more fun than TBLs. Why was this such a big deal for me: first of all, I learned the hard way that some residents do not want to be bothered before rounds, spending time with the medical student is time not spent elsewhere (but students understand, residents are under extreme pressure and intern year seems scary) and secondly, I felt useful, to both the team and the patient.
All I’ve talked about thus far is how Dr. Golden treated me like I was a person but also it was refreshing to see her treat EVERYONE this way…consistently, not just medical students and not just at the caffeinated beginning of the day (to be fair, the Pediatrics day started a lot later than the Surgery and Obstetrics day so she had an advantage in the morning grumpiness department). She seemed to be such a pleasant light on the team, a light with difficult patients and a golden light (sorry, I really could not help it) with parents of difficult patients. She was a great example of what it means to be a conscientious resident physician and that’s why she deserves this…she deserves to know that we appreciate her. ”
In the end, Dr. Golden was not able to make it to the event so it was a little awkward. Additionally, I have a fear of public speaking so throughout the entire time on stage I suffered palpitations and wondered why I had volunteered to participate, but it’s good to push yourself out of your comfort zone from time to time, right? I am also avoiding photos since I don’t want to see pictures of myself looking scared while wearing red lipstick, something tells me that isn’t an attractive combination.
Peace, Love and one year closer,
Ps. I am going to be out of the Dayton area for a few weeks trying to rock out at an away rotation. Added bonus: my baby sister is in the country visiting from Trinidad, and my away rotation is in the same location as my other sister…three Metzger sisters reunited…and yes, you guessed it, it does feel so good.
Happy Fathers’ Day
What is my father doing right now? Probably relaxing at home watching the World Cup. (Unfortunately the Trinidad and Tobago team/Soca Warriors won’t be there but I have very pleasant memories of them qualifying in 2006…but I digress, this is supposed to be about my father.)
I would just like to thank that man for EVERYTHING he’s done for me: for being present in my and my sisters’ lives, we’re getting older…I’m almost at retirement age, but he continues to be involved (and no, not in a stifling ‘helicopter parent’ type of way…didn’t I say I was almost at retirement age?) I’m grateful for his ungrudging financial support all these years (tuition, yay!), for making an effort to visit regularly despite the distance between Trinidad and Dayton, Ohio…and of course so much more. I hope he knows that it is all and always will be greatly appreciated and respected.
Make sure to let your fathers and father figures (man or woman) know that you appreciate and recognize their role. Yes, we all know that we shouldn’t reserve our show of gratitude for just a single day of the year, but Fathers’ Day is a pretty nice reminder.
Peace and lots of LOVE,
Ps. He’s a little disappointed that none of his daughters are particularly skilled in the kitchen, however considering he’s skilled when it comes to a kitchen and a stovetop, we don’t need to be, right? And no one can poo poo my rice boiling and broccoli steaming talents…and I hear my sister makes a mean bean salad.
Weekend Musings 3
The “Great Divide” at the end of 2nd year really is a divide. You spend two years in the lecture hall with all of these people, you get to know them, you dissect the brachial plexus in anatomy lab together, you get owned by the autonomic nervous system TBL/quiz together, you stress about Step 1 together, you realize you’re all friends and then 3rd year you’re separated.
Some may be on the same rotation as you are but not the same site or the same team but at least you can say “what’s up?” once a week during Didactics. However, many are on completely different clerkships, or have ‘interesting’ weekend schedules...or are in a different group altogether with spring/fall breaks that don’t coincide with yours...you find yourself sending/receiving “what’s up?” texts while knowing a hurried text conversation could never be enough to catch up.
Then there are beautiful days like today…you have the weekend off and someone throws a surprise birthday party/cookout and you think, “hey, I miss these people”.
Peace, Love and Friends
My pediatrics inpatient experience
During orientation the clerkship director warned us that they expected some of us to get sick. I’m in the middle of my fourth week and I’m sick…again. Despite the hand washing and mask wearing, my immune system was just not ready; I write this post while coughing and sneezing. My senior resident asked me jokingly last night if I was allergic to them; in reply, I just sniffled and excused myself to go blow my nose. It’s difficult to mouth breathe and talk simultaneously.
While trying to listen to a little girl’s lungs, she told me my eyes reminded her of Lucy. Her mother later let me know that Lucy is her puppy…I’ve never seen a puppy with sparse eyebrows, snazzy winged eyeliner and eyelashes brought to you by Maybelline and M.A.C. but then again I have never met Lucy so who knows.
Terms like “cute little chunk-monster” are not uncommon and you will find yourself using them.
That high pitched baby-talk voice that adults adopt when around children is extremely difficult to avoid, I found myself doing it way too often.
If you don’t have a pen-light handy, you’re doing something very very wrong.
I was expecting runny noses but I never knew there was so much constipation in the pediatric population. Then again, I guess I wasn’t too big of a fan of fibre rich foods when I was that age either.
The Pediatrics rotation is like the Disney World of clerkships; everyone is so cheerful, there are lots bright colors, diapers, apple juice, singing and dancing. I think I mentioned before that tap dancing may not have been appropriate during my earlier rotations but I don’t think anyone would bat an eyelid if I broke out into some Broadway worthy choreography at the Children’s hospital…in fact last week, my team’s interns said that we the students could leave for the evening, but only after doing a dance…cha cha slide.
You will encounter obviously neglected babies, your heart will break.
Sometimes you will encounter a twenty-something year old patient in the children’s hospital. While interviewing them you have to keep in mind an awkward blend of your routine adult and pediatric history questions…you have to ask them about recreational drug use, safe sex practices and alcohol consumption…but you can’t forget to ask about their birth history.
Peace, Love and “will you let me take a quick listen to your belly? I want to see if I can hear what you had for lunch…oh my! Did you eat a racecar?”
Spring Break 2K14
Sigh. It went by so fast. Sometimes I forget it actually happened, then I remember the cost of my last minute plane ticket and just like that, the memories become crystal clear again.
Decided to hop a plane to DC to eat brunch (my absolute favorite meal of the day), visit my younger sister and to do some shadowing (in that precise order of importance)…also wanted to pay a visit to my grandmother for her 16th birthday. (There must be a math and biology genius out there willing to explain the fact that I am older than my grandmother.)
Saturday: My sister and I met up with some of my college amigos for brunch. I got a healthy dose of some of my favorite things: laughter and carbohydrates.
Later, my sister and I attempted to make a pasta dish and some salmon stew; I’d say we were quite successful. I discovered that I have a gift for chopping vegetables and washing greasy pots…critical life skills.
Monday: first day of my looooong (not nearly enough O’s) commute to/from the hospital…that train ride was for the birds.
I call this my “let me fake like this 5am train commute isn’t the worst thing ever” smile
The (insert adjective of your choice) view from my train window…
Tuesday: I was a guest at the hospital so they were nice enough to let me borrow some scrubs. (Everyone was so nice and welcoming to me that week, I really appreciated it since being a visitor can be overwhelming.) I asked as professionally as I could if I could take a selfie in the OR…and yes, there is definitely a professional way to ask to take a selfie.
Wednesday: Swung by (and by ‘swung’ I mean ‘spent a very long time on some Metro trains’) my grandmother’s place after shadowing to surprise her. Alright, so she knew I was coming but it makes for a better story if I say I surprised her. She gave me a beautiful necklace…I think in your not so old age, you forget how gift giving on birthdays work.
Thursday: I didn’t take any more OR selfies. My apologies
Friday: My sister and her boyfriend invited me to go see ‘Spiderman 2’ with them; the movie was alright. I’m really more of an ‘X-men’ kind of gal. I was starving before the movie so grabbed some Chinese food. They wouldn’t let me take my leftovers into the theatre…something about ‘establishment policy’. My fortune cookie said: “Take care not to become too attached to the unnecessary extras in this life”, oh the irony.
Saturday: Brunch, nom nom nom
Sunday: Digestive Diseases Week conference was in Chicago…our posters may or may not (the correct answer is MAY) have won posters of distinction. WOOT!! I didn’t have the presence of mind to take a picture of them while mounted nicely…or even take a picture with them; I only have a picture of them spread on the hotel room bed. The bed wasn’t made so I’m too ashamed to post that picture.
Finally sleep time: early to bed since orientation for Pediatrics rotation was the following day. I had very pleasant dreams about being back in Dayton, Ohio with access to my pickup truck and traffic free roads after a long week of riding the trains.
Peace, Love and not a restful week at all,
Ps. Many many thanks to my sister for being such a great host (despite taking me to dinner at that weird salad place.)
Confessions of a boring, worry wart, introvert
I tend to worry about everything and with applying to and waiting for responses from away rotations, thinking about my fourth year schedule and then there’s matching, which I am not going to stop wailing about any time soon, I might as well be giving out personal invites to wrinkles on behalf of my twenty-something face. How do all these med students out there stay motivated, not cranky and wrinkle free?
I am sure they are going to tell me things like their faith, friends, family…Facebook (teehee). Medical school can be terribly isolating, especially in the clinical years where you’re separated from the majority of your classmates so you have no idea what they’re up to unless they actively seek you out and vice versa. At this very moment, everyone I know could be at the best party of the century and if no one thinks to send me a text, I would never know, right? Even if you have a roommate and you guys are ‘besties fo’ lyfe’ you’re on different schedules. Unless both of you make an effort to say “hey what’s up?” once an eon, it’s very easy to just end up having the same address as that person instead and being real friends. You can imagine how much harder it is to keep in touch with people who don’t share a kitchen with you, who don’t live in the same apartment complex…or state…or country.
I like to think that every student laments at the disconnect from time to time. Sometimes you want someone to talk to, sometimes you want to talk about non-medical school things….but then, for myself, I realize I literally have nothing else to talk about…except maybe if I watch an episode of Scandal. But then I always watched it a day late because it came on past my bedtime and everyone has finished talking about Mellie and Olivia Pope’s hair by then. It’s hard out here for introverts who need to be in dreamland by 10 pm.
I find that it’s the little (some even downright tiny) things that act like pick me ups: like when a senior resident notorious for breathing fire introduces you to her patient as “my doctor in training” instead of not bothering to introduce you at all, as is her known usual, or when you get a whole four pimp questions right in a row (You’re a genius until they ask an epidemiology question…“Ummm, 5-10%?”) Or when your friend in Maryland who you haven’t spoken to in months calls out of the blue and says they thought of you randomly and you both indulge happy college memories that may or may not have actually been that happy at the time. Or when your baby sister sends you a random ridiculous ‘selfie’, when your neighbor invites you over for a much needed chat/vent session or even that sea green nail polish you rock on the weekends. (What? Trust me, it looks cool.)
Peace, Love and “she called me a future doctor” *squeals annoyingly with excitement*,
Ps. I’m only two weeks into my Pediatrics rotation and I am not one of those lucky people that gets through their inpatient month illness-free. Yay for rest and keeping hydrated.
Pps. Sick babies :(
I told my mother to call me every other day…
I am well aware I have not posted in almost a month. I recently had the OB/Gyn shelf examination (which was a lot more difficult than I thought it was going to be, so many sighs) then I went on Spring Break for a week and had a pretty packed schedule with limited internet access (You’re probably thinking: “limited Internet?! In what corner of the Amazon rainforest were you hiding?”) Most truthfully, it’s not other activities that kept me away, it is this mood I was/am in; I was hoping it would pass. I have been so overwhelmed of late with feelings of inadequacy and self doubt; my mantra seems to be “what if I don’t match?”
You know I try to keep things fairly light and fat free here so I didn’t want to write while in this mood but a good amigo reminded me that writing can be cathartic.
Whenever we get into funks like this (I say ‘we’ because I know I am not the only one with emo tendencies) it is extremely important to lean on positive people who support you. It could be your significant other, Mummy, Great Grandma Beatrice (neither of my grandmothers’ names are Beatrice), best friend Susie from kindergarten, ex boyfriend Bobby (or maybe not) or even a faculty member…someone you trust, someone who has your best interests at heart, someone to give you that pep talk reminding you why you came to medical school and why the medical profession is lucky to have you. It is so easy for us students to forget this sometimes, especially third years getting ready to deal with that tiny speed bump called “the match”.
A faculty member told me today “don’t waste your time worrying, just be concerned but keep moving.” It’s a bit lengthy but I’ll try to make that my new mantra.
Peace, Love and don’t worry (too much), be happy,
“Did he get everything out?”
Somehow, before this gynecology/oncology rotation, I had managed to avoid cancer patients. I’ve said ICUs are my least favorite place, well cancer is my least favorite diagnosis. (I suppose saying it is your favorite would be strange….even for the most soulless of human beings.)
Today is my final day of this service and I am glad that I had the exposure but I think two weeks was enough. I met so many women in various stages of their cancer journey. Let’s just say it would be hard for me to write a light, joking blog post about them.
Diagnosis: Dr. L spoke about the possibility of her having ovarian cancer and she just sat there, brown eyes unblinking, silent, flat affect; her husband cried. I sat there with my heart breaking wondering if it was ok to offer a man a box of tissues. Would that just embarrass him? Then I felt silly because if that were me, the last thing on my mind right now would be personal embarrassment, I would have a wife I needed to support emotionally.
Intra-op: “Her colon looks amazing, no mets at all. I was hoping I wouldn’t have to resect any of it”. I continued to retract and pondered his usage of the word ‘amazing’.
Post-op: “Did he get everything out?” eyes only half open, coming out of her anesthesia induced afternoon siesta. Nurse: “he said it was one of the best jobs he had ever done”. She smiled then reached for her head…I knew it was to make sure her purple knit cap was still there. My resident told me that after 7 cycles of chemotherapy, she was very self-conscious about her hair loss and allowed only the doctors to see her bare-headed. She stayed in the hospital for one week after her surgery, I remember writing in my “post-op day #7” note that I was concerned about her mood, she was not as talkative or cheerful as she usually was; no number of brightly colored balloons and flowers in a hospital room could change the fact that it’s still a hospital room and you receive scheduled pain medications…the stuff you can’t just waltz into CVS and buy on a whim. Even the strong willed, like this dear woman, have days where it is difficult to smile.
4 week follow up after surgery: “I would rather not use the term ‘cancer free’ but things are looking pretty good, surgery went well and you look great”. Then my resident recommended she go to a cancer treatment center for pelvic radiation and chemotherapy. Her response: “I really hate my body”. “Mom, please don’t say that” but her daughter could only look at the floor as she spoke. So many sighs. All I could do was give thanks that no one in the room had tried to make eye contact with me and think about my classmate who is interested in palliative care, a brave, brave man.
Peace, Love and cancer: fascinating and frightening,
I try to make sure I say “thank you for allowing me to participate in your care, I really appreciate it” to each patient, especially the very ill ones and more often than not I get an “of course, honey, that’s how you learn right?” Then I smile a little and do an internal tap dance...because an external one would be inappropriate in the hospital setting and I also don’t actually know how to tap dance.
Every once in a while you don’t get such an amenable patient though. My senior resident right now is in his fourth year of his OB/Gyn residency i.e. his final year before he becomes an attending himself. In the grand scheme of his career, what is a measly four years? Not a long time but at least long enough for him to learn how to do a lot-better-than-half-decent female pelvic physical exam. I mean, I am a third year medical student and even I can do a not-absolutely-terrible pelvic exam. Despite this, and the fact that he actually has an M.D., patients still say things to him like “I’d prefer to be seen by the real doctor”…oh the disrespect.
I can understand that pelvic exams can be a sensitive topic for women, especially when it comes to male physicians but I’ve seen this happen to female residents alike. I’ve also seen it on other rotations; I saw it happen to my senior resident and the intern on Internal Medicine…and you can only imagine how many times on Surgery, I saw my senior get slapped with a “…but YOU won’t be taking out my gall bladder right? It will be a real doctor, right?” I saw no less than 3 cholecystectomies every day for 2 months while on my general surgery rotation…this man was in his final/fifth year of his general surgery residency, probably bored of gall bladders.
Every time this happens, there is always an awkward silence between my residents and myself (more awkward than usual and I try not to make eye contact) where I’m thinking “wow, they just treated him like he was some kind of med student” and I know they’re thinking, “who do they think I am, some kind of med student?”
At the end of the day, patients are free to refuse care from anyone they please. I really do feel the residents’ frustration but if I was a patient, maybe I wouldn’t want someone I considered a rookie handling my care…or cutting me open and taking one of my organs out?
Peace, Love and ma’am, you’re at a teaching hospital,
Weekend Musings 2
This weekend I volunteered at a health fair, I haven’t volunteered at one for a long while since my weekends have not been my own for quite some time now **coughcoughWEEKENDCALLSCHEDULEcoughcough** First I worked at one of the BMI stations; I took care to break everything down into as simple terms as I could, I went through everything slowly and patiently (if this was an OSCE, I think I would have made Dr. Binder proud…maybe not, maybe that’s wishful thinking on my part.) I asked each patient what his or her personal concerns were, discussed realistic health goals and let them know that the road to a healthy lifestyle was a long marathon so I didn’t want anyone being discouraged if they didn’t have Adriana Lima’s physique by next week…or the week after that…or month after that for that matter.
Next I worked as a nutrition counselor. I let each patient come up with changes they could make in their life over the next few weeks and I reiterated that no change in the right direction was too small. (In retrospect, maybe 25 minutes with each patient at a health fair might have been too much but no one batted an eyelid at me. I promise that I am working on my time management issues). We discussed realistic and sustainable exercise plans, slowly making increasingly healthier choices day by day (no need to go off the fried chicken…cold turkey) and everyone’s favorite topic: portion size. Interestingly, several patients tried to convince me that two slices of bread was actually one serving and not two. They said that they were aware that the back of the bag said one slice was one serving but that was a mistake and companies didn’t want to pay to repackage their bread with the correct information. Where on earth were they getting this? Also, please don’t argue with patients. (That’s probably a sure way to fail an OSCE.)
Nearing the end of my shift, a clown walked into the room, not just any clown but Ronald McDonald. Sigh. Did anything I discussed with these people that day even matter?
Peace, Love and the infamous golden arches,
Ps. That didn’t stop me from taking a picture with him. After all, he is a celebrity.
Do As I Say, Not As I Do
On Family Medicine, my very first rotation, I remember lamenting to anyone that didn’t roll their eyes at me, that patients don’t bother to listen to your advice so why do they bother coming to the doctor at all. What’s the point of the physician even giving advice? Ok, you’re diabetic you are told over and over to eat better, work out, monitor your blood sugar, why don’t you? Do you WANT to die?
Oh to be young, self righteous and completely hypocritical.
I talk to strangers about exercise but the last time I had something even sort of resembling a regular exercise regimen (and by ‘regular’ I mean putting my running pants on more than twice a week; whether or not any sort of running was actually involved each time is a confession for another day) was at least 4 months ago. I drone about healthy eating and portion control; I eat fairly alright myself but the occasional slice of pie does find its way into my life and one of the reasons I want Summer to come is so I can feel less silly about eating ice-cream. Nevertheless, broccoli and I are good friends. Portion control is a completely different story. I can honestly say I live life as though it is one big buffet. What is portion control?
Then there are the body image issues. I know I am extremely sensitive to comments about my weight/appearance, I think MOST people are given the image conscious society we’ve createdit’s one thing for a young girl to endure her family commenting about her weight, it’s quite another to hear things like ‘overweight’, ‘BMI’ and ‘adipose tissue’ from a stranger in a white coat. (Yes, I am aware that some patients develop close relationships with their primary doctors so they’re no longer ‘strangers’ but don’t pretend you don’t get my point.)
My thinking has matured some since Family Medicine (a little less young and a little less self righteous) but now I have a new problem: I am told over and over not to “kill the patient with kindness” If I need to punch them in the back to check for costovertebral angle tenderness then so be it. (Kidding, kidding KIDDING, I promise I do not punch patientsor anyone for that matter. Violence is never the answer.) If they are obese, they need to be told so and counseled appropriately. If they smoke, they need to be told that they are actively killing themselves and offered alternatives on the journey to quitting, etc. etc. I get it, I really do. I know going to the doctor’s isn’t always the most pleasant experience for the patient (which is part of the reason why so many avoid the experience altogether. After all, who really needs to go to the doctor anyway? Physicians are just pill pushers who can’t shut up about the risk of cancer, right? Sigh. The things patients tell me.) Sometimes they need to be told things that are difficult to hear, we all do from time to time. I also know that part of the success in these ventures is the repetition; hearing something over and over contributes to a person’s motivation to change. However, it will never be ‘easy’ for me to talk to a 21 year old young woman about her weight, it will never be easy for me telling someone I recommend they stick themselves every day. I have seen patients cry at the mere mention of the word ‘Insulin’. I know if that ever happened to me, I would go through the stages of grieving and probably get stuck in the denial stage. Lifestyle changes are difficult for anyone who chooses to call herself/himself a member of the human race. (I suppose it would be difficult even for those who chose not to call themselves such.) Either way, let me never lose my patience and sensitivity.
Peace, Love and in solidarity with patients,
Weekend Musings 1
I had the pleasure of meeting a critical care doc yesterday. She mentioned that one of the reasons she went into critical care was because she found she had a gift for approaching end of life issues with her patients and their families. This led me to think about how the ICU is one of my least favorite places for that very reason and how physicians have one of the few professions where they can repeatedly have the privilege of being present for the last few moments of a fellow human being’s life, a privilege because the death of an individual is such an intimate thing. To me, this privilege goes hand in hand with the huge responsibility of preserving the dignity of their personhood while they are on their journey to death. One cannot help but think about how the execution of certain ‘heroic measures’ can diminish that dignity at times.
I hope I remember this during the hustle and bustle of the next code.
Peace, love and respect for the end of life,
March 21, 2014
“Good afternoon, Ms. Starflight. My name is Samantha Miller, and I am a student doctor working with Dr. Singh. I know you have answered so many questions in the past few hours, but do you mind if I ask you a few more?” Haha, ‘Starflight’, what an alias? How can these people be so uninhibited?..."
For more on this story, see: This Is Not About You, a piece posted by Sarita Metzger on in-Training, an online magazine for medical students.
…Would I Miss the Lecture Hall?
Can I be honest? I think most med students cannot wait until their third year…out of the lecture hall, interacting with patients. This is why we came to med school right? I was a little torn at the end of my second year. I really enjoyed my preclinical years; I loved what I was learning, I diagnosed myself with all sorts zebras. I didn’t have to get up that early in the morning. Best of all, I had autonomy: if I felt like going to lecture, I went. If I didn’t, I made sure to watch the recording later that day, no big deal. If I needed to get something done during business hours, no big deal. If I didn’t feel like using my Caribbean driving skills to drive to school in the snow, I didn’t, no big deal. I had time to do one billion and six extracurricular activities.
I felt like I would lose all autonomy my third year and just be trapped in the hospital all day. (‘Trapped’, my isn’t that a dramatic word?) Yes, seeing patients is beyond awesome, especially when they are real patients, not standardized patients mentally making a note of all the questions you forgot to ask while taking their history, but what if I had a mini emergency? I’d have to ask someone as humbly and politely as possible if I could leave and hope they didn’t think I was irresponsible….then write a bad evaluation for me…then I receive a bad grade. (The domino effect!)
First and second year I didn’t get yelled at for doing something wrong, I didn’t get pimp questions embarrassingly incorrect in front of a room full of people, I never had to wonder when I would be allowed to eat lunch, never had to feel like my weekend call schedule was oppressive…not to say that any of this actually happened to me this year or anything (saying that just made me sound defensive, didn’t it?)
In the first two years, my grades were based on how I did on quizzes and exams. I just studied my hardest and hoped for the best, whereas on rotation, part of my grade would be based on someone’s subjective impression of me. Sigh. I wish I could say I am the smartest cookie on the cookie sheet (or however the expression goes), so of course pimp questions are always a cakewalk. I am certainly not the most skilled; reasonably sure my surgery residents could not tell that I spent hours practicing suturing. (However, this one time a Plastic Surgery attending called me a ‘Young Jedi’…was not completely sure what that meant but it had to be positive right? And of course my chief resident wasn’t present to hear him call me that.) I’ve never been the best conversationalist. I mean, I only started watching CNN a few months ago so talking about world affairs was not my thing, I am not a sports enthusiast/I don’t understand the rules of football so I can’t talk about that and sometimes I feel like my sense of humor might be a little ‘off’ to people which makes for a lot of wonderfully awkward encounters…so how could I get random attendings and residents who spent varying (sometimes minimal) amounts of time with me to like me and think I was competent enough to deserve a decent evaluation? I suppose I could smile a lot and bring in baked goods…I have nice teeth, (see, this post wasn’t all self deprecation) no one would envy my baking ‘skills’ though.
Well, four and a half rotations in, I think I’m doing alright and despite my original fears and the occasional complaint (‘occasional’ is an understatement), I’m having a blast this year.
Peace, Love and it’s not as much of a jungle out there as I thought it was going to be,
Ps. And for all of you that don’t have any problems just cliquing with attendings, don’t be selfish, share your secrets.
Pps. I just registered for my Step 2 exam…anxiety mounting.
Ppps. CONGRATS TO ALL MY FOURTH YEAR HOMIES WHO FOUND OUT WHERE THEY MATCHED TODAY!!!
These past two and a half weeks of OB have taught me that I find vaginal births absolutely MAGICAL…I had never actually witnessed one before and I imagined the whole affair would just be gruesome and bloody. I suppose ‘magical’ and ‘gruesome’ don’t necessarily have to be mutually exclusive, but that’s not where I am going with this. Call me a sap (actually no, please don’t call me that), call me a traditionalist, but part of the magic for me is the aspect of love. I love it when the father of the baby, the baby’s grandmother, god-mother, great aunt Nellie etc. etc. are all in the room waiting for baby to enter the world. The love and support in the air is SO palpable and I find it absolutely amazing.
There was this Turkish lady who came to us in labor last week… all by her lonesome. She said her husband was at work, she wanted to surprise her mother so hadn’t even told her that she was heading to the hospital and her sister would be by the hospital later with some clean clothing and pizza. (She said pizza and I didn’t ask any more questions.) This woman was the one sweating, obviously in pain but trying to remain composed, refusing an epidural… like a STOIC ROCKSTAR and asking the resident if it was time for her to push yet. Then there was me, the lowly med student just feeling privileged enough to be in the room and trying not to be annoying/get in anyone’s way. SHE seemed perfectly ok with the situation so why did MY heart fall?
During the birth she reached out to me and I grabbed her hand with my gloved hand and told her to hold as tight as she needed. My gloves were dirty and the attending gave me a strange look. Yes, I know, I know. I know I broke sterility but I didn’t plan on touching anything draped in blue again, I moved out of my resident’s way and I felt like I did the right thing.
…Then I texted my father “OMG, I just saw someone give birth and it was GREAT!!” I imagined him smiling but thinking: I have such a cliché for a firstborn.
Peace, Love and just hold a hand,
Moaning and Still Undecided
My roommate has basically known since she crawled out of the womb (I am presently on my OB rotation so yes, babies crawling out of the womb is absolutely how babies are born) that Womens’ Health is for her. I haven’t been so fortunate. I am more than half way through my third year, only two more rotations left until I can call my self a fourth year, a little over a year in between me and my MD...and I still have NO idea what I want to do. Every time I think I’ve narrowed down the list or ruled something out, I have some experience or see something interesting and say to myself “hey, I think I can do this”. I used to call my parents every time I had one of these epiphanies, but I’ve had so many epiphanies now that even though we’re on the phone and I can hear them saying “oh, that’s great dear”, I know they’re thinking “so GI is the flavor of the week, huh? What will your calling be tomorrow?” In my defense, Gastroenterology has been the ‘flavor of the week’ for several weeks now, months in fact...but other strong contending flavors I have indulged include Urology and General Surgery…for a few days I was even thinking ENT...some months ago I thought “Plastics is it! I will do breast reconstructions for cancer patients!” Now that I am on my OB/Gyn rotation sometimes I catch myself thinking “pregnant ladies and pelvic exams aren’t so bad, I could do this.” My roommate would roll her eyes if I dared say that out loud.
Even though I think students should enter medical school with an open mind with respect to the various specialties, I would never ever wish being undecided in your third year of medial school on anyone…not even on Regina George or Angelica Pickles. (Please tell me you know who those young ladies are.)
The fourth years are matching soon. That is going to be me in a year; that means I am going to be applying to residency programs THIS year. Is your mind blown as much as mine yet? I remember first year wondering how was it that well adjusted human beings managed to survive the seemingly never ending histology course; I remember second year wondering how I would ever know what the Pathology lecturer was even talking about without that histology course under my belt…I even considered Pathology as a specialty, but I digress.
Most of my classmates are driving themselves in a frenzy over their fourth year schedules. All I hear is: “I want to do an Ortho away rotation here and here and there and there and everywhere…”, “Internal Medicine usually interviews at X time, so I am trying to get one of those months off to interview and I absolutely NEED a letter of rec from Dr. Y”, ”Ack! I have to take Neuro during block one but that’s when I wanted to take boards. When will I study for boards!” (It might have been me saying that last one.)
I think I want my fourth year schedule to fulfill that delicate balance of reflecting my interests in a particular specialty to residency programs while allowing me to dabble in some things that I may never have the opportunity to dabble in again…the epitome of wishful thinking. My schedule currently looks like a hodge podge, perfectly reflecting my indecision...the same goes for my CV *sigh*.
Several residents have told me that they didn’t figure out their passion until really late in the game. I’m still not sure if they’re just trying to be nice to make me feel better, they actually did survive this limbo or if they’re just saying whatever they think will make me stop moaning about it. (In all fairness, I only moan when someone asks me what I am thinking of going into; those who don’t ask are spared my moaning.)
I know part of this is me doubting myself and fearing I won’t match (*gasp* I hope I have not jinxed myself) and I know that this is not uncommon for students. I also know that some people apply to more than one specialty or they apply for transitional years to sort themselves out but I REALLY would like to avoid those options…but on the bright side, at least those are options.
Peace, Love and Indecision,
P.S. Today is my baby sister’s 19th birthday…she prefers you call it her second 18th birthday.