Life and Death and and an Open Heart

About 24 hours ago the nation was rocked with news of the worst mass shooting in recent history, when a gunman opened fire on the Pulse nightclub in Orlando. Families didn’t know if their loved ones had survived the horror, and grief and rage and political posturing was rampant.

On the same day, I learned that a dear friend’s father passed away, quietly taking his last breath as he held his wife’s hand.

As a healthcare provider, I am confronted daily with life and death. Serving in a hospital setting means I get to see people at their worst, masks gone. Last night, I was struck by the wide divergence in how providers approach crisis and death. While news outlets scramble for the latest juicy morsel to boost their ratings, I get up close and personal with death.

Report from Provider A:

Ohhh you’re gonna love this one. He’s a frequent flyer, Done so many drugs I swear he’s got oatmeal for brains. I’m tough though – he knows better than to ask me for anything for withdrawals because he probably doesn’t want to hear the lecture any more. One of these days they’re going to pick him up dead. When you go in there, be ready for the stench – I swear he never takes a shower! Go on, go see him. We’re taking bets on which body part he’s going to say is in pain to try to get some narcotics. This is your brain on drugs hahaha…

Report from Provider B:

Shhhhh he’s finally sleeping. This patient is just 43 and had neck surgery a couple of days ago, then had a seizure during recovery and aspirated. Now he’s battling pneumonia and might not make it. Sometimes he’s oriented, most times he isn’t. He’ll get quite agitated but responds well to firm touch and gentle conversation. We’re medicating as much as we can to reduce his discomfort and anxiety without depressing respiration. We’ll be trying for a second IV site soon and will need your help with that – he doesn’t have many good veins.

What? Oh yes, his right side is affected from an old stroke. We think it was from excessive IV drug use. But he is such a resilient man – we’re hoping he pulls through. I’m so glad you’re here to help care for him.

So here’s a question for you. If you were the PARENT, which report would you hope was given about your son or daughter?

In the last week, I have held in my arms a woman dying of lung cancer (after smoking for 40+ years, she quit, but it was too late), a young adult who tried to kill herself by drinking antifreeze (it was touch-and-go, but she was discharged… determined to try again), and a man permanently disabled due to years of drug use. In each case, I watched providers struggle with how to handle the knowledge that each crisis was preventable, was a direct result of poor “lifestyle choices”, and that their care was pretty much useless in the long term.

Yet, I remain committed to hope. To joy. To gentle compassion. Even when – perhaps especially when – its the patient’s “fault” that they’re in a medical crisis.

I’m not naive. I’ve worked in some capacity in health care for a very long time. I’ve watched providers become jaded and angry. I’ve been witness to crass jokes as some attempt to use dark humor to guard their hearts.

Yet still, I remain committed to hope. To joy. To gentle compassion.

If you’re a provider, angry at the futility of your service, frustrated by a system that seems to use you up and ask for more, I invite you to explore the beauty of an open heart. Will it hurt more? Absolutely! But way back when you first decided to enter the field of health care, you CARED.

Find that.

Find the gentleness in your heart to reach out. Again. Even when you are certain it won’t make a difference.

Because even those who created their own crisis deserve compassionate care. And your heart will be better for feeling the pain, holding the dying, turning away from the jokes and anger and political posturing, and simply serving.

With an open heart.

Hiccups and Redirects

Being an adult medical student has its distinct advantages, and a few disadvantages as well I suppose. I’m an eternal optimist, so the downsides don’t really affect me much. But a friend asked me to address at least one of the downsides just to make sure folks know its not all sunshine and roses on this journey!

Probably the biggest downside so far has been having to take a leave of absence.

Most definitely not my favorite thing, having to write to my school and request a break. But since my school doesn’t offer federal financial aid or scholarships, I’m left solely responsible for tuition. Now don’t get me wrong, I am over-the-moon thrilled at the (relatively) low cost of tuition at my school. That said, its still high enough that one little life-hiccup can upset the fine balance of keeping up with payments while still being able to do things like buy groceries.

Sigh.

Being the optimist that I am, I took the break time to dive deeply into powerpoints, recorded lectures, and study aids. Its fascinating to me how much knowledge a brain can hold, and even without a deadline of upcoming exams I was able to spend daily hours in productive study. That Step One review book is becoming my best friend, and q-bank questions are my second ‘job’.

All that to say this: Regardless of what journey you’re on, if you’re passionate about the goal, don’t let anything sidetrack you or make you give up. Will it be hard? Absolutely. Will the journey include hiccups and re-directs and sometimes discouraging detours? Sure. Real life doesn’t offer a straight line from here to there.

But any goal worth having is worth working for, striving for, doggedly slogging through any mess for. As I continued studying and putting in clinical hours, I discovered that any sacrifice is worth it in the pursuit of this grand dream of mine.

Whatever you do, just don’t quit!!

Epic ER Firsts

This week has been epic in so many little ways. For starters, last weekend I spent about 20 hours training a group of folks (one of my income-generating ‘jobs’ that helps pay tuition). Then I moved – that major downsizing  wise move that will make focus on studying simpler but left me with aching muscles I forgot I had. Add in a few other life things and I’ve had a week of major sleep-deprivation.

Yet I just arrived home from my second ER shift of the week, feeling completely energized and just downright happy.

A couple of “firsts” merit mention.

Tuesday was a crazy-busy night in the ER. Was it a full moon or something? A woman with sky-high blood sugar who didn’t know she was diabetic. Drug addicts and anxiety attacks. A man who had been run over by a car (really!) and a probable stroke.

Then there was the young woman who thought she was pregnant, and complained of symptoms of a vaginal infection.

As I took up my usual stance in the corner, the nurse looked at me, looked at my mentor, and said, “How about the med student does the pelvic exam? You’ve gotta start somewhere right?”

I nearly hugged her. Then nearly had my own panic moment.

But its funny how years of being on the receiving end made it simple, especially with my mentor walking me through. There’s something magical and awe-inspiring to me about the human body, and about women’s bodies in particular. One human being growing inside of another – wow! I’ll never tire of this experience.

Fast forward to today. Another crazy-busy night in the ER with a steady stream of broken bones, chest pain, tummy bugs, and babies and elderly folks with health issues. It was nearly end of shift and my mentor was headed to the back to work on charting when Dr. U stopped me. “How are your suturing skills?”

Oh geez. Without even thinking I said, “I’ve never done it”.

And with his typical cheeky grin, he answered, “No time like the present!”

I was even more nervous as we walked into the exam room and Dr. U explained to the patient I’d be stitching him up. This young man had a few pretty deep gashes on his right hand from holding a glass when it broke, and was obviously quite uncomfortable.

Dr. U placed the first stitch and talked through each step, then handed the needle to me.

Eeek!

And, it was so much easier than I imagined it would be. Maybe because I’ve spent so many years hand sewing. Maybe because I paid such close attention to how Dr. U worked.

Stitches neatly placed, a fist-bump with Dr. U, and a super helpful diagram from my mentor Dr. J showing me how to determine the width and depth of needed stitches, and I’m hooked.

I will never tire of the variety, moments of intensity, even the mundane and downright annoying parts of working an ER. But this week, I catalog two more “firsts” that help solidify my dedication to becoming an emergency physician. I will never tire of doing “emergency” pelvic exams, placing stitches, cleaning wounds and splinting broken bones. I’ll also never tire of reassuring new moms and dads that their baby’s diaper rash is typical and easily treated, and calming the elderly patient who’s afraid of needed treatment and forgets my explanation before its complete.

Now, to sleep, and dream of growing up to be an emergency medicine doc one day. Tomorrow is a heavy study day, and I’m looking forward to it.

Its a Blue Baby!

Squeezed between intense study sessions, the very best part of my medical education continues to be the clinical hours spent learning and doing in the Emergency Department. Its not the adrenaline thing, although some folks insist that’s why I love ER. But what I truly embrace about it is the unpredictability, the chance to see something new constantly.

Last night was no different.

We were a little busy. Soon after my shift began, both docs suggested I go do an exam in Room Two where there was a baby brought in for “possible bruising”.

My heart beat faster – after all, its not often they send me in alone first and tell me to practice doing a full exam. At the same time, I was a little worried. Without even seeing the patient, my mind immediately skipped to possible abuse issues, playing through scenarios in my head and wondering why the docs chose this particular patient for me.

Determined to practice compassion while doing a thorough exam, I knocked on the door and introduced myself.

Hi, I’m Student Doctor J, I’ll be doing an exam and then my supervisor will need to come see you as well. So tell me what brings you in tonight…

Baby was dressed in just a diaper as dad tried to explain to me how he had been born with a little mark on his back, but it continued to spread. Now the marks covered baby’s back and went across both shoulders. Not a rash, not the sort of bruises I’d ever seen before. But marks that were kinda bluish. I continued to examine baby hoping I wasn’t missing something, and more convinced as I went along that this really wasn’t bruises and we didn’t need to be concerned about abuse.

I’d never seen anything like it.

Thorough exam complete on an otherwise healthy baby boy, and after learning that dad really wanted some simple blood test to tell him what this was and if his child would be okay, I went back to report what I knew.

Which wasn’t much. Often, when I see something for the first time, I feel completely tongue-tied trying to explain it and last night was no different. Then my attending and I got to do a little research to figure out what this was as he didn’t immediately know either (which perversely made me feel a little better).

Aha! Now I know what congenital dermal melanocytosis looks like! More prevalent among those from Asian (this baby) and African American decent, its an issue where melanocytes are trapped in the lower part of the dermal layer during embryonic development. Its harmless, and most often completely resolves by 3-5 years. And even if the marks remain throughout life, there’s no report of any adverse affect. Parents can be understandably worried when they see those funny looking blue marks, but clinicians need to be aware of the condition in order to avoid concerns about abuse.

Last night, between the inevitable colds and chest pain and panic attacks, I learned about a new condition that I’ll now always remember. And that little bit of researching and reassuring reminded me once again why I positively love medicine in general, and the ER in particular.

Now back to the books; its a Review day, and I’m getting an early start with the endless q-bank questions about glycogen storage diseases, pharm basics, and opportunistic infections. And I’m finding the joy in Review that comes from realizing I actually do remember details of what I first learned many months ago!

How Badly Do You Want It?

I remember being an undergrad and moving back home to save on expenses. Not exactly what I was expecting to be doing when in my 40s, that’s for sure! But I discovered I was willing to do what it took to do well in all those crazy pre-med classes I was completely unprepared for, and a great deal of that “doing well” simply required lots and lots of time. Living at home allowed me to focus exclusively on my studies.

Fast forward a few years, and I’m once again needing to make an adjustment. Sadly, the intervening years brought a house fire that completely destroyed my family’s home, so that’s no longer an option. So I’ve been snooping around looking for a much smaller place that will accommodate me, an adult child, and three German Shepherd dogs.

Its a dream-switch that is a bit uncomfortable actually. Rather than building always toward home ownership again (following divorce and life-stuff), in some ways I’m going backwards in order to go forwards.

Because I want medicine more than anything.

When you’re passionate about a goal, you’re willing to do absolutely whatever it takes. In my case, I have the amazing privilege of attending a medical school that doesn’t allow me to go into debt; that means I have a monthly payment on top of living expenses. So stress-reduction means limiting the expenses I can control by seriously downsizing. And quite honestly, once the decision was made, a whole heap of angst was lifted off my shoulders.

Do you have a thing you’re willing to pursue no matter what? Have you chosen to make sacrifices in the pursuit of that goal? I’m discovering that those sacrifices are nothing compared to the gift of being able to walk boldly forward, knowing that this is another big step in the right direction.

Now, back to the books!

Review or Reveille: My Secret to Staying Awake

Don’t laugh. I have a habit of getting really sleepy during review.

I’m not sure what that’s about, but I’ve been that way since undergrad.

Give me information that I previously tested on and ask me to review it, and for some reason my brain goes into twilight mode and I can hardly keep my eyes open.

In undergrad, it was manageable. After all, most of undergrad courses are fairly stand-alone. Even the bits of, for instance, General Chemistry that you need to retain and build on are manageable.

In med school that’s all turned catywonkus and it just doesn’t apply. EVERYTHING you learn has to be retained long-term. Well, at least through that all-important Step 1 exam – my be-all, end-all goal at this point.

Until recently, I’ve been stumped by how the heck to efficiently and effectively keep up with reviewing, regularly, without literally falling asleep. I was beginning to get frustrated. Then that frustration began turning into a fatalistic “ugh maybe I can’t do this” mentality (oh how fast I go there!) and I knew I had to come up with a solution.

Even though I’m in my 50s, my mother is one of my biggest fans and heads up my cheering section through this process. I never mentioned to her how I was struggling to stay awake during review sessions. But she messaged me the other day saying she had found me a gift.

A treadmill.

But not just any treadmill. This one has a handy-dandy shelf on it just perfect for my laptop.

Now, I walk while I review. Every day. Talk about the ideal “killing two birds with one stone” solution!

I’m no longer playing reveille during review sessions. I’m staying healthy. And coincidentally I’m retaining review information way better for going through it while I’m moving!

Challenge solved. Whew! I’ve even begun ‘attending’ live lectures while walking, going through flashcards and lecture notes – its amazing how much better this is!

Now back to the books – its time to review heart sounds. While walking.

49% Wouldn’t Do It Again

I was shocked quite frankly.

I suppose I shouldn’t be – after all, in every profession there are dissatisfied folks, those who discover that its not everything they imagined it might be. And I’ve certainly heard from docs who were indeed very unhappy.

According to a recent study in 2015, only 51% of physicians surveyed would still choose medicine as a career, down from 62% just four years earlier. Granted, this study was looking at one sub-set of medicine. But still…

51

Some would say its the fault of the current government. Or ever-declining reimbursements. Some would point at the ‘big business’ of medicine and decry how it has eclipsed any attempt at real service as the soul-destroying grind becomes overwhelming.

I remember about a decade ago when I hesitantly mentioned to a few doctor-friends that I was thinking of pursuing medicine, they all took great pains to tell me all the downsides. “Go into nursing, or become a PA”, they said. “Be a therapist if you want to heal people; become a scientist if you love studying Biology or the human body. Medicine is nothing like it used to be and I’d never do it again if I had the choice.”

I was curious, so I did a little snooping around.

A recent survey of over 95,000 nurses concluded that there was an alarming degree of job dissatisfaction and burnout in the profession.

MetLife’s annual teacher survey shows an “alarming” trend downward with only 39% of teachers satisfied with their jobs.

In fact, according to a job satisfaction survey that has been conducted annually for the last 30+ years, only 48% of Americans are satisfied with their jobs.

I suppose there are many different takeaways possible from this. Having lived as many decades as I have, I say, Bah Humbug to all the grousing about how unhappy any particular profession is – including medicine. The grass is no greener in any other job. The grind, unending documentation, onerous government regulations, stressful working conditions and limited autonomy – its everywhere!

And for all those who say they’d never go into medicine (or whatever profession) again… guess what? Its not the job! Its not the profession.

Teachers want to be doctors. Doctors want to be pilots. Cashiers wish they’d gone into Psychology and salespeople dream of finishing their MBA so they can have the corner office and make higher salaries. Those who never had the chance to get a higher education are certain they’d be happy if only they had, and those with multiple letters after their names fantasize about giving it all up and living on an island.

Just stop. We are more than our titles, bigger than the parts of us defined by who signs our paychecks. I’ve decided to completely ignore those who try to discourage someone’s dream based on their own “job dissatisfaction”.

Repeat after me:

I am strong. I am talented in these ways. I enjoy these parts of what I do, don’t enjoy these other parts, and can make peace with that. If I can’t make peace, I will make a change.

All that to say this: Yes, I’m aware that many of my colleagues had (or are having) highly stressful and even profoundly negative experiences during their medical education. I hear stories nearly every day from physicians who are deeply unhappy. Yet I remain convinced that its not the profession. PEOPLE are unhappy. In every profession.

I just happen to be overwhelmingly thrilled with every tiny speck of this journey I’ve embarked on. Every sleep-deprived study marathon. Each boring or hard to understand lecturer. Even meeting fellow professionals who seem rude or condescending or who don’t practice medicine the way I would. And including the not-at-all glamorous parts like ‘having to’ learn mounds of minutia that will be mostly obsolete by the time I’m in residency.

As long as we’re human, we get to take ourselves along into any profession.

Who I am is so much more.

 

Its NOT Hard

From being quite sure that my age would be a negative determinant of medical school success, to being willing to take any acceptance I could get, then moving to an intentional choice of which school is right for me – this has been an amazing journey. Through all the ups and downs I’d say the most powerful realization has been this: ITS NOT HARD!

As I write those three words, I’m well aware that there are students right now in classrooms, study cubicles, huddled in apartments and bleary-eyed in libraries – who are feeling the overwhelm of what’s been aptly called “drinking from a fire hose”. With the sheer volume of information presented during medical school, how the heck do I keep stating ITS NOT HARD?

Here’s the thing.

You have to completely  change the way you study. If you use the same study strategies you used to be very successful as an undergrad, you will fail in medical school.

That’s a pretty hefty statement to make, but I believe it with every brain cell I’ve used to “decode” medical school study strategies that actually work. With the sheer volume of information presented in medical school, its easy to get stuck in thinking that your primary ‘job’ is to memorize all those facts. To become a walking, talking encyclopedia of information.

Bottom line is that if you do that, you’ll absolutely fail to synthesize information in a way you can use to pass the med school exams and boards. The tests you’ll see in medical school are different than anything you’ve seen before, and that long list of facts you spend hours storing in your tired brain is just the beginning. In med school, its all about the story, the experience, using those facts as the foundation but going so much beyond facts to what they call “secondary and tertiary questions”.

If you spend your time simply memorizing facts, you’ll be shocked when you get to exams and realize you have no idea how to answer the questions – even though you’ve spent every waking moment studying.

Here’s what works.

  • Listen to the lectures – that’s just a recitation of facts. You do need those facts as a foundation.
  • Immediately begin composing “stories” – how might these facts come together with an actual clinical scenario.
  • Spend the bulk of your time studying clinical vignettes – ‘stories’ that present a case, then ask you to pull together those disparate facts into a cohesive whole. Use q-banks as your bible, read the questions aloud, and talk your way to a solution before you ever glance at solutions.
  • Judiciously make use of study aids such as flashcards and flowcharts.
  • Another absolutely priceless way to use the q-banks is to review why other answer choices are incorrect. Regardless of which software you’re using for review, they all provide an explanation of why a particular answer choice is correct or incorrect. Don’t simply scroll on by if you chose correctly – review why the other choices were not the best answer.

I’m daily blown away by how simple this really is, so long as I first get the factual foundation then spend time practicing incorporating all those facts into clinical scenarios. By faithfully putting in the time to study this way, you’ll find that medical school is not hard  – it simply requires you to learn a completely new way of studying!

Feeling overwhelmed? Feel like you’re drowning in a sea of information overload and can’t find a way to pull it all together? SecondChanceMentor offers a super cool service and we’d be glad to help you get back on track so you can actually enjoy this amazing learning experience!  Send us a message today and let us help you revise your learning style so you’re successful!

When Grief Hits Home

The medical profession is all about giving – serving those who are hurting and helping find medical solutions.

We’re not so good at receiving.

Yesterday morning I got a text message from my sister. My big sister is a doc herself and has been part of my ‘cheering section’ as I’ve pursued my own medical career. But this message hit me hard.

“I’m writing to tell you that Al passed away this morning.”

There’s nothing that can prepare you for such news. And while I feel like my sister holds half of my heart, I know that the sadness I feel is minuscule compared to hers. She found her true soul-mate late in life, and Al was one of those priceless men who treated my sister like a queen. Their life together was a beautiful testament to how wonderful a marriage is supposed to be. And my only thought was, I need to get to her. I need to help get our mother to her. We need to be together and wrap her up in our love and support.

As messages of condolences roll in, I’m watching how different folks deal with grief in another’s life. Some don’t say much but their “I’m with you” message is clear. Some offer prayers, some share a similar situation in their own lives. And some ask what they can do to help. With the help of friends, we set up a gofundme account to help us siblings and our mother travel so we can just be with. 

The most priceless messages we’ve received are those who say something like this:

Its okay to be sad. Its okay to cry. You don’t need to pretend you’re alright. I understand.

I hope I always remember this, as I continue to reach out to suffering patients. While there is a limit to medicine’s ability to ‘fix’ things, there is no limit to the power of compassion.

And often, just saying, “we’re with you” is enough.

Your contributions will be used to help us travel to be with my sis, and anything beyond travel costs will go to help with all those ‘little’ things for my sister. May blessings continue to flow into your life as you give, and receive, compassion.

The Others

I’m convinced that its never too early to begin establishing habits of acknowledging those “others” – the ones who so heavily contribute to student doctors and physicians being able to effectively do their jobs.

Last night, I spent late hours at my local hospital Emergency Department. It wasn’t exactly a busy night, but there was a steady stream of patients. The little boy with a croupy cough – not bad enough for admission, but I spent quite awhile reassuring his exhausted parents. The dad in the middle of a custody fight concerned about possible abuse to his 2 year old daughter. The confused young man high on ‘something’ and his mom who tried to cope…

As I watched the night play out, I paid attention to those “others”. Here’s a few of the lessons I learned.

  • Take time. In a busy setting like an emergency room, everyone is focused on doing their job. But I’m finding it so important to create time to interact with those “others”, even if just for a moment. The nurse who seemed relieved to share how her own son is doing with his medical challenges. The front desk folks who’s faces light up when I stop to ask them how their night is going. Don’t be so busy “doing your job” that you forget to take time.
  • Make eye contact. Its not enough to throw out a fast “how the heck are ya?” as you dash past the tech, or housekeeper, or student nurse. Stop walking for just a moment and make eye contact. Its important.
  • Say thank you. Last night I watched as patients were collected by Radiology for a fast CT scan, blood draws and X-rays quietly just “happened” after the doc checked that box in the EMR… Saying Thank You is huge. It doesn’t happen often enough. Its important.
  • Intentionally acknowledge people. Sure, often those “others” are just doing their jobs. And they’ll most often brush off your acknowledgement. Do it anyway.

It was after midnight when I finally said good bye to a mostly empty ER and walked out the door. I said good night to security and walked out into the drizzle – after all, I was parked close, under a light, and I didn’t feel any need of an escort. As I started up my car I looked out my rear view mirror and saw the security guy standing on the sidewalk. I hadn’t asked him to, but he had followed me out and was watching. Just to be sure.

I jumped out of my car and jogged back to where he was standing.

“Thank you,” I said, reaching out to shake his hand. “I didn’t think to ask you to watch, but I feel safer having you here.”

He acted a bit embarrassed actually as he dropped his eyes. “Just doing my job ma’am”. But I saw the smile lifting the corners of his mouth as I turned around to leave again.

Acknowledge people. Everyone. ALL are important.