Diving Deeper

When I was an undergrad, one of my pet peeves was the speed at which we would plow through subjects. It felt like we were skimming along on a speed boat, with the professor standing in the bow screaming out the names of what we were passing with instructions to “know that!”, whether we took the time to really understand it or not.

Memorize chemical formulas, memorize DNA structure and function, be able to describe the steps involved in a Biochemical reaction…

Then, in grad school, it was so refreshing to settle in to (mostly) really understand what we were studying, and I loved every moment of it.

Medical school is back to the speed boat in some ways. Just exponentially more speed boat trips and high volume of things we’re instructed to “know”.

So, I’m taking a couple of years out to DIVE DEEPER. I’m working on a PhD in Stem Cell Biology, one of the areas of medical science that I am deeply passionate about, especially when applied to neurological disorders and diseases. There is exciting research in the works that suggests that stem cell science may provide relief for those suffering from things like Parkinson’s Disease, Multiple Sclerosis, and spinal cord injuries.

Last night I spent hours reading – human stem cell science is absolutely fascinating, and I’m thrilled once again to step off the speed boat and settle in to learn a subject in depth.

Med school will be waiting for me – for now, this is an amazing experience. I might be in my 60s by the time I complete this process and have two “Doctor” titles after my name, but that’s okay. Ultimately, the study of medicine, and the study of cell science, is thrilling and energizing and both feed my need to focus on the good medicine can do, especially for neurological disorders.

Stay tuned for more steps I take on this grand adventure!

The Color of Courage

In the small town Emergency Department where I do my clinical hours, we see a lot of hurting people.

By definition, an emergency room is the go-to place for patients with lacerations, who just had a fender-bender on the icy streets and need an x-ray to make sure there’s no serious injury, or the endless stream of parents of kids with earaches and croupy coughs.

But there’s also the tougher cases. Not medically tough. But
emotionally tough.

The addicts hoping that their story this time will result in a prescription for narcotics. The person with mental health issues that we really don’t have a solution for. The homeless person who just really wishes they could get a warm shower and a safe place to sleep for a single night, but doesn’t have anything physically wrong to justify an admission.

Sometimes, its those emotionally tough cases where I learn the most. About the sort of doctor I choose to be. About how to listen with compassion. And even how to get along with medical professionals who have a very different view of respect than I do.

I’ll call him Sam. We were handed a thick stack of paperwork that showed all the different times Sam had been in area Emergency Departments in the last while. Four times in just the last month.

Sam is a heroin addict. And people like Sam seem to spark some of the most unprofessional attitudes I ever see in the field of medicine.

Sam was in pain. Sam thought he had a deep muscle abscess in his left shoulder, because it felt as awful as his right shoulder had felt recently when he’d required surgery to drain a seriously infected abscess caused by shooting drugs deep into  his muscles.

I watched as my mentor listened intensely, respectfully, while Sam explained where he hurt.  I watched him order tests, then go back and have a conversation with Sam about the results (thankfully not yet showing a deep infection).

Then I was amazed as Sam said, “So doc, can you prescribe xxx for me? I really want to kick. I really want to get clean. I’ve done it before, I know I relapsed, but I really want to do it right this time. Can you help me?”

And without a hint of judgment or condescension, my mentor immediately replied, “Yes, I can do that for you.”

Sure, Sam might not make it. He may change his mind ten minutes after he walks out of our Emergency Department. But for that moment, Sam was heard, he was treated with respect owed to every human being, and he was given hope.

And that’s just one of many reasons I love medicine, and is a picture of the sort of doctor I hope to be.

If you’re hurting, reach out. Some of us care. Deeply. And are willing to act.

If someone reaches out to you when they are hurting, hear them. Listen intently. And always offer hope.

 

A Chapter Book

Tonight I had the chance to spend several hours in one of my favorite places – the Emergency Department of my local hospital.

A dislocated kneecap (its a temporary thing and will be fine in time, go easy).

Putting staples in the back of a 9-year-old boy’s head (brave little kid, very nervous father, my first time holding the “staple gun” – funny how I always pictured a great big stapler and this thing is actually so small!)

Woman brought in by police officers who found her digging in the neighbor’s flower beds looking for her “stuff” (a little too much meth and a week without her psych meds, she’ll be fine after ‘catching up’ the meds and sleeping it off with a few warm blankets provided by a nurse who I’m convinced is one of the best nurses on the planet).

Then there was a man I’ll call Jack.

I was sitting beside my mentor while he caught up on charting when I heard the ER Director holler, “Is Student Doctor J still here?” 

“Come with me, I want you to feel this.”

I entered a room where an older gentleman sat in a chair wearing that oh-so-flattering hospital gown.

After quick introductions, the Director said, “Here, feel right here. Jack fell about 8 feet off a ladder. Tell me what you feel.”

I pulled aside Jack’s gown and immediately saw deep bruises where his back had hit something on the way down, and I felt him wince as my hand gently probed his right side. My fingers almost immediately found the “rice crispies” feel of subcutaneous emphysema – air trapped under the skin where it most definitely didn’t belong.

The Director towered over me, and with eyes dancing (he knows how much I love to learn / feel / experience new doctor-type things) asked, “Do you feel it? Tell me what it means.”

Yes, I feel it. There’s air under the skin. Perhaps a broken rib punctured his lung when Jack fell. We need to check the x-ray for fractures and the CT for a collapsed lung and be prepared to put in a chest tube if necessary.

Jack took in the information, asked a few questions, then a few more.

“I understand,” he said. “I just need to know what to expect. I’m so grateful my lung isn’t collapsed right now, and if it happens later I understand when to come back in. Now let me tell you why I’m not going to worry…”

And there followed a full 15 minutes of what I can only call masterful storytelling. Understand, 15 minutes is a long time in an ER. When I began to feel impatient, I’d remind myself, stay present! This is as much a part of doctoring as stapling a kid’s head wound or calling the Crisis Line for an overdose. 

Jack talked about spending his life in film – he was well past 80 after all, and had a rich history as a communications professor and a successful film director and loved stories. He talked of being married to his first wife for 52 years and watching her die of a rare cancer that followed the facial nerves. As he reached out to gently touch his second wife’s hand, he described the amazing experience of them finding each other after each losing a spouse, yet discovering a way to fully embrace their next chapter of living.chapter

Chapter.

Chapter books.

Jack said, “Everyone’s life is a chapter book. Not everyone knows how to let a chapter be read and finished so they can move on to the next. But the book, the story, is so much more than just one chapter!”

At 80+ years old, Jack looks and acts much younger than men twenty years his junior. His ribs and his lung will heal. His wife will gently support his recovery. And his ‘chapter book’ story will continue to inspire med students like me.

Thank you Jack.

 

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.