alittleincite

[alittleincite]

Moving On

Oh boy, this has been a rough month. I broke up with my ex about a month ago, and I’ve been on a roller coaster of emotions and life crises. 

The synopsis: I was so happy to be in a relationship. It felt so good to love and be loved. I was learning so much from him, and he was extremely supportive of me and how to advance my career. Things were good when they were good, but there so many disagreements and misunderstandings. We did not communicate well with each other. We held different values, have different life goals, and spoke different love languages. I feel like he often listened to me and truly understood me, but in the end he would chose to do things his way and not compromise despite knowing where I was coming from or how I felt.

The ending: He hid something from me after we had just had a serious conversation about honesty, and I overreacted, felt disrespected and ignored, and broke up with him. I’ve learned that my emotions overcome and overtake me, causing me to act irrationally. (And I need to learn to reign these in for all future interactions.) After the waves of emotions subsided, I reached out to him, but alas that was the straw that broke the camel’s back for the two of us. He, too, was done with the relationship and did not think getting back together would be a good idea.

The stages of grief: I cycled through all stages of grief multiple times. I’m still going through them now though to muted extents as I am healing from the break-up. I was in denial for the first week. I thought he would come back to me and ask me to give him another chance, but alas this never happened and I came to realize we had really broken up. I hit the stage of bargaining and I hit it hard-- I groveled for us to get back together but he remained steadfast in his response: he did not want to re-enter the relationship right now; he told me he still loves me and cares for me deeply but we need to grow separately for now. (God, “right now”. And he refused to tell me he never wants to be in a relationship with me again. My poor heart and mind clung onto these precious little words and slivers of hope.) I entered the stage of depression more or less in front of him. We met up for a last talk and I cried in front of and with him. We comforted each other. I bawled my eyes out during a video chat with him several days later-- that was the last time I saw him and the last time I felt a connection with him. I became angry that he gave up on me and on us; angry for all the times he let me down; angry I let him “win”. And every once in a while, I would reach the glorious stage of acceptance, though it was fleeting and I would soon cycle through the other stages of grief again.

The aftermath: Some days are completely fine, and I understand that the break-up needed to happen and is for the better because we’re incompatible; I’m thankful it ended so I could pursue something better. On these good days, I’m filled with hope of finding someone who will make me happier and be a better fit for me as I return to the dating game. I’m filled with excitement of meeting new people, making connections, and learning new perspectives. And then some days like today are a lot harder, and I’m reminded of the loss of a close friend and potential life partner. Despite both verbalizing we would like to remain close friends, we stopped talking completely, and I miss him. Perhaps, he’s forcing distance because he knows I’m too emotional to be friends right now. Or maybe he is keeping his distance because he’s done with me and my baggage. I know I shouldn’t care but I can’t help but wonder and be miserable. I want to talk to him, but I know that will only prolong my healing so instead I feel sad about the void and loss of him from my life. To make things worse, striking out in the dating game (ie: not feeling compatible with someone, feeling like options are as notgood (bad me, why am I comparing!), being impatient with dating and just wanting to be in a relationship again (again bad me! I shouldn’t jump into anything too quickly)), sometimes makes me feel even lonelier.

The bigger picture: One of our first and biggest fights was about where we would like to end up. I wanted to stay in the area forever but he wanted the freedom to live wherever he wanted if/when opportunities arose. He didn’t understand the filial piety. This was earlier in our relationship and quite a dealbreaker for me, yet I came around to the idea and became open to moving with him anywhere in the world. A bit of a red flag was that he was not willing to compromise on this point and was waiting for me to come around and would otherwise end things. In retrospect, I always gave in to the way he wanted to do things and lost a little bit of myself and lost sight of my values/motivation and what really made me happy. He constantly questioned my career goals and made me think of other career opportunities-- to push myself I’m sure, but it also led me to feel a little unhappy with the career I was so satisfied with and proud of. After breaking up, I took a piece of the desire to live in a foreign country with me, and also continue to question what my next career move should be. Should I stay at my site? Should I stay in emergency medicine? These two things have caused me to spiral and “crisis” a bit. I have a sense of freedom and adventure and want to live elsewhere while considering what career trajectory to take. Combined, I want to quit my jobs and live abroad for a couple of months. I’m giving this more and more serious thought by the day/week. I’m telling many people of my plan to gather advice and opinions, and I really want to push myself to make that leap next year. We’ll see-- hopefully my OCD/type A/planner self doesn’t stop myself from stepping outside my comfort zone. I may have some big updates coming soon ;)

[alittleincite]

Snapshot of Life (April 2018)

Shame on me. It’s been over a year since my last post. I told myself I needed to make another post to capture my new grad/new PA-C experiences but I’ve let a whole year slip away without doing so. 

But here’s a snapshot of how much has drastically changed. I’ve been working in the emergency department for one-and-a-half years now. It’s been one year since I’ve transitioned into the Site Lead position. (Yes, I have this amazing mix of luck and talent. When I interviewed for an advanced provider opening in this emergency department, my boss told me they didn’t have a Lead Advanced Provider at the time and said the position is up for grabs. The little go-getter leader in me jumped at the opportunity, so I interviewed for the position of lead while also interviewing for a job at that site in general. Lucky me got both.) I also work per diem shifts in another emergency department for a different company.

A lot has changed since my last post. I’ve made worlds of progress. I went from hating my job, questioning my career choice, and have full-on panic attacks to being Site Lead and one of the fastest PAs at my full-time site and fully embracing and enjoying my job as an EMPA. I see more complicated patients and admit patients more frequently than I have when I was first starting out. I trained some of the new hires and found that I have enough expertise to do chart reviews and perform onboarding. I’ve gained a work family along the way from the knowledgeable and fun docs that take the time to teach me to the techs and nurses that I cannot do my job without. Just this week, I grabbed a beer with my medical director after a day full of meetings, kicked back with nurses/scribes/techs for an impromptu bbq, and celebrated a scribe’s birthday by bar hopping. I’m not going to pretend it’s all rainbows and unicorns-- there are tough days with complicated patients that make you question your ability as a provider or (many) days with rude patients who have unreasonable demands. But it comes with the job, and I love my job. 

Along with this, I’ve found a better work-life balance:

I was inspired by Marie Kondo’s book “The Life-Changing Magic of Tidying Up”, which my good friend sent to me as a surprise gift, to clean my room. Sounds rather trivial, but it’s quite the undertaking and it makes quite a difference in your life. I’ve gotten rid of bags and bags of clothes and jewelry which I haven’t worn in years. I donated stacks of old textbooks and thrown away an equally large stack of old notes and assignments. I’m still on this quest to create more order in my life in the form of my possessions, but it’s quite freeing to be able to get rid of things I’ve been holding onto for no good reason for far too long. It’s empowering to evaluate each object to decide whether or not it brings joy to you, and why or why not. 

I’m happily in a fairly-serious relationship with a boy that pushes me to be my best and supports me at my worst. When I first met him, I was infatuated by his intelligence and garbled to my friends that he has a beautiful mind. But while smart, he also has an artistic side. On one of first dates, we discussed the Walt Disney Museum and watched a video of three artists’ take on a tree. He takes beautiful photographs of even the most mundane things and creates technological 3d designs/art. And on top of all this, he loves to cook and is great at it. It blows my mind how he can be so good at everything. We’re 6 months in now, and I’ve grown to appreciate him beyond these relatively superficial things. Whether it’s stressors at work or most recently losing my wallet on the train, he’s there to troubleshoot and help me through it. He understands my shortcomings and tries to have us work through them together. Now, we’re not perfect and we have our fights and arguments every now and then, but I’m quite happy and hope that he’s just as happy with me as I am with him.  

That’s “it” for now. A lot has happened but it’s been a lot of good. I’d like to think that I’m living my best life. A life full of love, fulfillment, family, travelling, eating. I promise it won’t be another year until I post again. I’ve got too much to be thankful for and too much going on to let it go uncaptured through text. 

[alittleincite]

on some days, 16.

At work when people ask me how my day is going

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uptodate is my bible. almost as important as starbucks is in my life.

Everyday at work

[alittleincite]

New Grad PA-C

Alas, the much belated post. I’ve been meaning to write this for a while to capture my feelings while still fresh but have been so caught up with work and trying to maintain a sliver of my social life. Finally have a free moment, so here’s a recap of my first few weeks/months as a PA-C:

I thought PA school was hard. Then I started working. It’s a completely different kind of stress, and the amount of responsibility has increased exponentially. I’m 3 months in now, and in retrospect things have gotten slightly better but I still don’t feel comfortable or competent at work.

This is my first job out of school. As close to my dream job as I thought possible to achieve. It’s in my #1 choice of specialty (emergency medicine). I liked the docs when I interviewed and took a tour of the site. There are leadership opportunities (I also interviewed to be the lead Advanced Practitioner and got the position contingent on my clinical skills). And the cherry on top, it’s close enough to home so I could commute and finally plant myself back in the area after 4 years at my out-of-state undergrad and 2 years at my out-of-state grad school. It was everything I could ever want. 

My first days as an employee was to attend the annual partnership meeting for the new hire orientation before I even started shifts in the ED. God was this awkward. It was nice meeting docs and colleagues outside of work over dinner and drinks, but the cringe-worthy awkward moment was when my site won “Site of the Year” at the awards banquet and I didn’t know whether or not to go up with everyone to accept the award. I hadn’t even started working there yet and I surely didn’t deserve to be part of the recognition, but I awkwardly went up anyways and joined my site in accepting the award then for celebratory drinks which I sipped slowly so I wouldn’t leave a first impression as the girl with the brightest asian glow they’ve ever seen. UGH I still shudder thinking about how awkward this was.

I started my clinical work slow. Three shadow shifts following a doc around as he treated patients. I couldn’t participate at all, just observe. Then I had training shifts where I was paid 1/2 wage to be put on the schedule in the same shift slot as the doc who would be training me. What did training consist of? They let me see the patient, perform the physical exam, put in orders, and come up with the diagnosis and treatment plan. It was the whole deal. The entire patient encounter from start to finish. This was huge. I never did 100% of a patient encounter as a student. I rarely, if ever, put in orders. I rarely had to do the whole treatment plan and communicate this to the patient. This was an incredible amount of responsibility for me! A little liberating but mostly terrifying. This went on for 7 shifts before I was released to do solo shifts.

Solo shifts. Another level of increased responsibility. Another level of added anxiety. I was now being paid at my full wage to take up an entire PA/NP shift by myself. I was no longer an extra body on the schedule scheduled on top of another provider. I now had a scribe helping me type my encounters. I now had to do RME (rapid medical exams) as part of triage. So many new things thrown at me at once. I felt incredibly lost in RME as the first provider to lay eyes on the patient and put in orders before they went back to be treated by a final provider or to pick them up from triage (if straightforward and not requiring further work-up) and discharge them from there. This plus the pressure of trying to keep up with the speed of everything and trying not to slow the department down too much was so much to handle for little ol’ new grad me. Automatically forming a differential and knowing what orders to place was the greatest challenge for me in RME, and knowing whether the patients went to the acute side or express side was completely new to me-- I had no idea!?

People would ask me how working was, and I would answer honestly. “Terrible.” I was having an incredibly hard time. I cried after my second shift (and I had never cried in PA school, despite the 50+ exams we had during didactic year). It was so stressful-- soul-crushing even to realize how little you know and to have so much responsibility over another human and to feel so lost in this new job. One of my favorite things about emergency medicine became one of my greatest challenges-- you never know what to expect for your shift. People come in with different things all the time. Even if I were to study, it’s a hit or miss as to whether or not I would be able to apply that knowledge that day. And studying would be an ideal. There’s no time for that. My shifts are 9 hours long, which isn’t terrible, but I also commute 40 miles one-way, essentially spending 1.5 hours per day on driving. That plus the fact that I’m constantly catching up on charts for anywhere from 2-4 hours at home (because I’m very slow at coming up with my MDM (medical decision making)) makes my average work day 14 hours long. Work took up my life. It was emotionally and mentally exhausting. I hated it. 

Never had I questioned becoming a PA as much as I did those first few weeks. I wasn’t enjoying it. I didn’t want to do it anymore. I had worked tirelessly to get into PA school then worked even harder to graduate, but I didn’t even want it anymore. I woke up in the mornings dreading going to work. My heart would start racing as it got closer and closer to the start of my shift. I felt mixtures of sadness, anxiety, stress, and fear as I was driving to work. There was a period of 3-4 days where I woke up with miniature anxiety attacks in the mornings after having had a bad dream about work. 

I write all this in past tense but these feelings haven’t passed. Some days are better than others. I’m hanging in there. I’m still working. And I’m chugging through. It’s almost time for my shift now so I’m signing off for now but I’ll post again soon because there’s still so much to capture and reflect on.

Hang in there alittleincite PA-C. Don’t give up on something you’ve worked so hard for. You’re not a quitter, and now is definitely not the time to start.

[alittleincite]

Patience/Patients

First anecdote

Patient s/p CABG 2 months ago presented complaining of extreme fatigue even at rest.  Upon further questioning, I discover that he smokes cigarettes and does not exercise.  [Wow, it is SO obvious to me that his life would be 500x better through lifestyle changes.]  I skim through OSH records and see a typo that he had 12 siblings pass away from an MI.  I ask him about it but no that wasn’t a typo.  He had all 12 of his siblings pass away from an MI and he is s/p CABG and he continues to smoke and not exercise.  To top it all off, his wife-- also a smoker-- shared that her sister-- no surprise here, but also a smoker-- passed away from adenocarcinoma of the lung.   I understand cigarettes are addicting but does death staring you in the face not make you want to quit?  I did my part and educated them on the harms of smoking, but I knew my words were falling on deaf ears.  I was so frustrated with this encounter because no matter how much good we try to do, in the end, the patients must do their part to help themselves.  It makes me sad that no matter what we do and how badly we and they want it, we cannot heal everyone.  We can only have patience and not let this jade us.  We need to be patient so we can continue to help them.

Second anecdote

We spend two rotations (4 weeks each) on internal medicine, and I spent the first half in inpatient medicine at our main university hospital and had an amazing learning experience.  I was in an extremely smart and caring team, and my intern, SAR, and attendings were perfect provider role models.  I learned so much from them, the patients and their acute presentations, noon conferences and grand rounds, and from the hard hours I put in at the hospital and outside when I was research topics I had to present to the team.  I loved everything about this rotation and the hospital environment and was set on working in a hospital whether in emergency medicine or hospitalist/genmed,  This felt like my dream career.  With this realization, I emailed my advisor asking to switch my second half of internal medicine which was scheduled to be outpatient.  He said this wasn’t possible, so I asked the internal medicine program coordinator if I could stay on inpatient, but she said they were full as well.  Saddened by this, I reluctantly started my outpatient internal medicine rotation and hated it for multiple (legitimate!) reasons.  After my very first day, I called my advisor and listed the million reasons why this was not a good rotation and asked if there was any way I could switch to a hospitalist/genmed rotation.  He said no and tried to provide me with support to get through this rotation.  I felt cheated of the learning opportunities others were having from two inpatient rotations.  I felt cheated of the experience I need for my future job in the hospital.  I was salty and sour and grumpy about it all.

Fast forward a week later to today and I am so happy with this rotation.  I literally yelled to my attending yesterday that it was “the best day evarrrr!”  Yesterday, the office was extremely short-staffed so we had to room our own patients and take their vitals, aka cue that this was gonna be a poor learning day.  But it wasn’t!  I somehow managed to see more patients than I normally do; we finished on time; I had a free mocha frapuccino from a drug rep; and I went home with a delicious sweet potato pie from a patient and a handmade bar of soap from another patient.  To keep the good times rolling, today, a good half of the patients I saw today felt the need to tell my attending that they liked me very much/I was going to be a good doctor (--PA but I didn’t want to correct the patient when they sending compliments to my attending)/I was very thorough.  (I take the patient’s H&P by myself, orally present to her, then we see the patient together and go through assessment and plan with them.)  I wonder if my attending thinks I told the patients to tell her that.  How else would all these patients spontaneously feel the need to compliment me-- ugh, I’m so flattered.  The best compliment of all though was from a patient who is suffering from depression and anxiety since the passing of her daughter.  She was teary and crying as I took her history and went through SIGECAPs.  I offered advice and tried to be as compassionate as possible.  When I went back into the room with my attending, she told her that I was very good.  This meant so much to me, that I could help a patient going through such a rough patch like hers, that I could make a difference and emotionally connect with her during our encounter.

Patients.  This is what I do this for.  All the studying, it’s all for them.

Patience.  This is why I’m learning and loving.  I should never have given up on this rotation before I even gave it a chance.  Sure, I still feel cheated of an internal medicine rotation and feel like I’m getting extra primary care instead, but I can still take away so much from this.  Forever reminding myself that situations are only what you make of it.  The world is truly your oyster if only you have the right attitude.

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Two things prevent us from happiness; living in the past and observing others.

Unknown

easy solution: live in the present and stop comparing yourself to others.

[alittleincite]

2015

**Editing my last post because I distractedly wrote it while watching Grey’s**

So much happens in one year.   In this past year alone, I traveled to cities all over the United States multiple times and to 10 different countries– SF/Bay Area x3, San Diego x4, Boston x4, Atlanta x2, New York x2, Las Vegas, DC, Vermont, New Orleans, Asheville, Wilmington, Toronto, Paris, Brussels, Amsterdam, Prague, Budapest, Vienna, Berlin, Madrid, and Pamplona.  Travel aside, 2015 was a hectic years filled with achievements, growth, and self-discovery but not without stress, mistakes, and much room for improvement.

This was a year of wins and championships.  The Golden State Warriors won the NBA Championship and Duke Men’s Basketball won the NCAA Championship (hah! these are real highlights of my year).   I was awarded a $5000 scholarship, was selected to do a Global Health Elective, and was invited to participate in the applicant interview process for my PA Program.  I “won” by being the first and only student to have been placed at my Emergency Medicine rotation’s hospital.  This was by far my favorite rotation, setting, preceptor, and specialty, and I am thankful everyday to have been assigned this rotation because it is this rotation that led me to my (presumed) calling in Emergency Medicine.

This year, the way I view people transformed.  I’m learning slowly but surely to think about every person with kindness and empathy.  Every person has a story and a background, and they never warrant judgment.  It’s easy to judge someone on surface level details but the beautiful thing about medicine is that medicine does not judge.  Ideally, you treat a patient despite their background, history, or socioeconomic status.  Two stories from this past year highlight this for me: (1) one of our instructors shared with us a pivotal patient encounter with a drug-addicted prostitute.  The patient turned to prostitution to make money to support her two children.  She hated the prostitution but needed the money to support them, so she turned to drugs to cope with the shame.  In the end, resulting illnesses from the drugs and prostitution killed her, but her two children became very successful and well-educated individuals.  (2) the very first laceration I sutured was on a convict who was attacked in jail for supposedly snitching, which he denied.  He was an elderly male with long gaping wounds, clearly in discomfort/distress and upset that this happened to him.  I felt sympathetic, especially given his age.  It’s sad to think of old people in jail.  I was then told there’s a public directory of all criminals in the state listing what they were persecuted for.  The staff looked him up, and he had several pedophile acts among other crimes.  They were immediately disgusted and wished they didn’t have to treat him, but I didn’t feel this way.  I still felt sympathetic.  What happened to him was unfortunate, and despite his past, he did not deserve that attack.  To see anyone in such a vulnerable state is sad.  This newfound level of empathy and encounters with patients have led me to feel a greater sense of responsibility and love for my family.  Instead of seeing a visit with my grandparents as a chore, I see it as spending precious time with them while they can still maintain their health and to keep them company to thank them for everything they’ve done to pave the way for me.  I want to make sure I am always there for my family and to repay them for this wonderful and privileged life they have given me.  I’m lucky to be healthy and to be brought up to have the opportunity to chase my dreams, study medicine, and live such a joyous life.

This year has also blessed me with defining sorority milestones.   I was re-elected for another two year term on my sorority’s National Board and finally crossed the kids I’ve always wanted since I crossed and gained a charter little too.

And with the peaks and rainbows of this year, there were troughs as well.  PA school pushed me past my limits.  I think back to my didactic year and all I can think of is the daily grind of wake-lectures-study-sleep on the weekdays then wake-study-sleep on the weekends, low on the sleep portion/high on the study portion.  I struggled on my rotations and received feedback that I need to be more confident and proactive on every single evaluation I received– two areas I feel very uncomfortable with but two areas I want to work on for my new year’s resolution.  Looking back to my rotations I feel cheated of learning opportunities because my site didn’t allow me to do things other classmates had the chance to do (even when I mustered up the courage to ask!) and because I didn’t push myself hard enough.  It’s easier to take the day off to travel when your preceptor offers it  instead of asking to come in anyways on their day off to follow another preceptor.  It’s easier to wait for instruction instead of boldly ask for more responsibilities when I feel so lost and scared of hurting patients.  But take the easy way no more!  I am determined to be brave and proactive in my learning and to push past my unfortable-ness.

My other resolutions for 2016 are to be healthier (in both diet and exercise) and spend less time on social media.  I want to spend more time living life than trying to document it or yearn for other ppl’s lives and experiences.  So here’s to a new year and not-a-new-but-improved me.

[alittleincite]

This comic sums up my life so well.

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sometimes things are tough but look at this bun

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One Week in OBGYN

Every rotation is quite the roller coaster, especially this OBGYN rotation.  I never realized there are so many aspects and components to OBGYN.  I’m thankful my preceptor has set up a schedule so I get to experience from all angles.  

Day 1 and 2 [Clinic]: We saw many antepartums and a few gyn encounters.  While I was mostly observing (disappointing), I was able to help out by collecting GC/chlamydia and GBS swabs on a few patients in their third trimester, did Doppler for fetal heart sounds, and practiced measuring fundal height.  I even did a a few speculum exams and Pap smears!  Sadly, I’m still having a lot of trouble finding the elusive cervix.

Day 3 [Labor & Delivery]: The part every student looks forward, at least I am.  I want to be able to say I (helped) deliver a baby by the end of this rotation, but no dice on my first day of L&D.  We spent 9-3:30pm without much excitement on the delivery end.  Just rounded on postpartum mothers and discharged some, checked up on new admits with HTN, and saw two circumcisions!  I’ve been waiting to observe this since my pediatrics preceptor did not include us on his trips to the hospital and I was busy during the adult cases on my gensurg rotation.  Then we saw two decels in fetal heart rate, and my attending decided that the patient undergo C-section today.  So finally, although my shift ended at 6, the patient was brought to the OR at 5:30 for the C-section.  I had the opportunity the scrub in, stick my hand into the patient’s incision to feel her uterus, use the Bovie to remove a string of tissue, and massaged the uterus to deliver the placenta!  What a great way to end the day.

Day 4 and 5 [OR]: Didn’t scrub for the first case which was observing a hysteroscopy.  Scrubbed for the next two cases, did a bimanual pelvic exam, and inserted Foleys into these patients.  (Still have trouble finding the urethra as well.  Never realized how different they can look from patient to patient. No wonder everyone says female Foleys are harder than males.)  I got to manipulate the uterus during the surgeries and was supposed to remove the IUD in one of the cases, but the attending did it since the strings weren’t sticking out :/  The last case of the day was great for us students.  The patient was undergoing a vaginal hysterectomy for uterine fibroids.  What the ultrasound described as 6 fibroids turned out to be 50.  Yes, fifty fibroids.  The med student and I counted ourselves.  Her uterus was too enlarged to remove from the vagina so we had to debulk it fibroid by fibroid.  Since she had so many fibroids, we were given the opportunity to pull some off.  I even used the scissors to cut one off!  For my second day in the OR, I manned the ultrasound for a dilation and evacuation of an spontaneous abortion.  I wasn’t especially emotional but I felt a little odd as I watched a large suction evacuate endometrial tissue and “products of conception” into a strainer.  I also felt bad for the patient since this was her second SAb and she wants another child.  The next case was a robotic hysterectomy.  I got to practice my Foley, could not find the cervix on speculum exam, and then scrubbed out since i wouldn’t get to do anything else for the rest of the case.  Then for the last case of the day, another D&E, I arrived in time but the resident did not and was asked to scrub in and do the cervical part of the exam.  I was excited to have found the cervix on the first try and was going to get up off the stool so the attending could continue with the procedure but she then handed me the tenaculum and instructed me to take a bite on the anterior lip of the cervix and proceeded to hand me the local so I could perform a cervical block!!!!! She performed the cervical dilation and evacuation then let me feel the edges of the uterus with curette and perform hemostasis with pressure on the cervix.  This last procedure totally made my day and my week– heck, it’s one of the greatest highlights of all my rotations thus far.

Lasting feelings and thoughts from this week of OBGYN: Hearing fetal heart sounds at 12 week antepartum visits, seeing a tiny formed arm in the evacuated tissue of the D&E, mothers undergoing D&E not by choice but because their fetus had died or stopped developing inside their uterus, watching a C-section and seeing the hairy top of a head inside the uterus become a crying newborn baby within a few seconds of pulling it out.  There is so much life (and death) happening in OBGYN.  Seeing how early life forms makes me feel some type of way and really think about the moral debate of abortion.  I’ll leave it at that so I don’t get political, but hearing heart beats and seeing their little body parts in trimester one really makes you think.

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A Good Day in Surgery

These are hard to come by.  A true rarity.

The past two weeks have been a struggle for me to say the least.  I’m on my fourth rotation now, having done emergency medicine, pediatrics, and evidence-based medicine (basically a month to read papers and write a literature review on a topic of your choice).  I’d say I really only have one solid rotation of medicine under my belt since pediatrics was very laidback-- speaking of which, I need to post about this rotation sometime-- and EBM was not actual medicine but an in-depth journal club instead.  So this surgery rotation was quite the shock, especially coming off of EBM.

My preceptor told me to arrive to the hospital at 7:00 am, and I thought that was pretty early since it’s located 30 miles away from my apartment.  I rushed out the house on the first day and received a phone call from him at 6:20 am saying he has no cases that day so I should meet the residents at the hospital then go to clinic in the afternoon.  The residents gave me a brief rundown during the AM and I was a little disappointed I didn’t get to see any cases.  I carted off to clinic, a 15 minute drive away, to see patients in the PM.  I got to see the new patients and shadow him for post-ops and established patients.  First day done.  Simple enough right?

Quite the opposite.   Life is hectic, and I’m constantly doing things wrong. - I have to get to the hospital around 5:30 am to be ready for morning rounds at 6 am.   - This is my first time working in an inpatient setting, so I have no idea how to manage patients like this or even what to look for in a post-op check.   -  I keep floundering on my oral presentations during rounds because I’m missing information or missed a finding or don’t know how to manage a pt’s problem(s).  Also have zero experience doing rounds. - I forgot to ask pertinent questions in taking a history.   - This is my first time having access to EMR on a rotation and writing notes, so it takes me forever. - I’ve never used Epic before and needed step-by-step help to learn how to navigate basic functions.   - My “complex” suturing sucks.  Complete 180 from the praise I received for my simple interrupteds in the ED. - Worst of all, I’ve gotten yelled at and chastised by many scrub techs and doctors for doing something wrong.  Some scrub techs are super snippy, and my preceptor always has a condescending tone.  Their tones alone can and have ruined my entire day.   I feel like I can’t ask my preceptor questions because his responses make me feel stupid for not knowing.  I’m here to learn so why create such a hostile learning environment.   - Actually, even worse is that I don’t get to do much in the OR.  I’m observing most of the time and had to use every fiber of patience and self-control in my body to not act out during a 5 hour distal pancreatectomy with splenectomy because I was bored out of my mind staring at a screen of fatty connective tissue being resected.  My time could have been better used elsewhere, like studying for my EOR or brushing up on anatomy and concepts for future cases or even checking on patients on the floor but no, I was standing there staring at a procedure as my back and knees got progressively achy.  I’m especially frustrated because my classmates have gotten to do more on their rotations in small community hospitals where they are the only student, and it feels unfair that I am being cheated of that experience.  I had a genuine interest in surgery prior to this rotation and I can’t tell if surgery is not right for me or if I just hate this rotation.

Needless to say, these two weeks have really tried me and pushed me to my limits.  I’m trying to absorb large amounts of information all at once from useful clinical information to appropriate behaviors in the OR while trying to gain hands-on experience with suturing when given the rare chance to.  My routine has been: OR/rounds/clinic 10-15 hours per day, driving straight to the medical school to study, then sleeping 4-6 hours.  There have been two points where I felt so exhausted, I felt like I was at a breaking point.  A big ball of stress and emotions.

So these have been my past two weeks.  I’ve felt completely incompetent in every aspect possible.  But the title of this post is “A Good Day in Surgery” because I finally had one and I’m capitalizing on it now before I’m crushed down again.  Today: - Officially at the half way point of this rotation, I feel like I have most of scrubbing/sterility down as well as how cases run.  I’ve caught on to pre-procedure prep and am helping the nurses/surgeons set up and take down. - Felt like I did an adequate job on my presentation during rounds this morning. - I’m taking initiative of my learning and actively seeking opportunities.  Since I can’t get hands-on practice, I figured I might as well watch different surgeries that would be useful for my knowledge base and future rotations.  I introduced myself to a surgeon we don’t work with and asked to scrub in to his creation of an AV fistula and ventured off to scrub in with another surgeon in the afternoon.  I was the only student in these cases (no residents there, whoohoo!) so I was able to retract/suction/hold things and stay engaged.  These two surgeons were amicable and great teachers! - I cut sutures at the right length for my preceptor.  No condescension from him today!  Little thing but big win. - The intern I work with is really great at teaching and asked the surgeon if I could close three port incisions.  He walked me through perfecting a running subQ and gave me lots of pointers.  Frustrating since I was awful at it but very grateful for the practice.  He also gave me feedback since he’s rotating off and told me I’m eager to learn and improving! - There was an ED consult who I saw and wrote a note for then presented to the chief resident.  Only missed a few things from the H&P this time but vastly improved from my last consult.

Overall, today was a great day!  Lots of hands-on experience in the OR alongside wonderful teachers who are also easy to converse with, new approach to learning in this rotation, sensing improvement in my clinical skills and knowledge base, and getting the hang of things. Parting words from my chief: I may not get to do much in the OR but the more important thing is to learn how to manage pts (come up with a thorough assessment and plan, be able to present pertinent information precisely, etc) since these are skills that are necessary in all inpatient settings but I may not necessarily be doing surgery in the future (and PAs just assist in surgeries anyways).  He’s right, and that’s exactly what I’m going to do.

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Emergency Medicine

I never pictured myself doing something so important and acute as emergency medicine but I fell in love with it.  I can’t tell if it was from the excitement and newness of my very first rotation, if it was because I had the greatest teacher of a preceptor, or if it was because the patient population I served was ludicrously entertaining (think of a small town with a median income of $15,000/yr apparently known for its heroin, where vaginal discharge was GC/chlamydia unless proven otherwise), but I absolutely loved everything about it.

I looked forward to every single shift.  I was legitimately upset when I had to miss two half-shifts in the middle of the rotation due to a mix-up with my paperwork.  I even chose to skip the school welcome picnic and bar-hopping reunion to go in for one last shift because I enjoyed it so much and learned so much there.  Note, that last shift was AFTER my EOR exam and I am not one to skip social gatherings.  Sidenote, as if I was being “rewarded” for my dedication, there was a code that night and I had the chance to redeem myself and do chest compressions.  Much improved per my preceptor!  On top of all that, I even seriously considered changing my MICU elective to another emergency medicine one, but I decided against it because I should be exposed to more things and settings.

I waited til the start of my 2nd rotation to write this to see if I was just excited to be doing something new and to be on clinical rotations, but I think the interest for emergency medicine is real.  I am not as excited nor intrigued by rotation #2 in pediatrics, and I had wanted to grow up to be a pediatrician for a large part of my childhood and young adolescent life.  Funny how things never turn out how you think they would.

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