Hashing It Out

Maybe the day will come when I’m not giddy-excited about experiencing a “first”, but today was not that day.

Today I spent four hours with 3rd and 4th year medical students for their weekly didactic session. Living in a small town, I wasn’t sure what to expect. After all, small town means small hospital and small teaching program, so I tried to have “realistic expectations” not even knowing what that might mean.

At the same time, I was hugely honored by being asked to participate.

Four hours hashing through cases, asking and answering questions, participating in an intense brain-storming session coming up with differential diagnoses and treatment options, analyzing the diagnostic tests used, listening to some serious “constructive criticism” directed to those who presented cases. I realized I am beginning to actually know some stuff… a technical term for sure (ha!) but more-so an emotional experience when I realized I was participating in a discussion and understood the science and service of what was going on.

There are so many ‘bits’ to this journey that, taken together, will help mold me into someone called a physician. Some days are just “keep plugging away” days – the hours and hours of lectures and charts and pictures and pathways and diseases and treatments. Then there are the over-the-top days when I get to serve – when I can “practice” by being up close and personal with real patients with real problems and I have the chance to serve. The third part of this amazing journey is these unanticipated intense learning opportunities – chances to participate and grow on a level I never even knew possible.

For all the years – decades – that I’ve tried to imagine what it would really be like to do this, I never once came even close to imagining how wonderful it would be to be a medical student.

Wonder.

Full.

Full of wonder.

Best description ever.

 

Is Your Brain Bleeding Yet?

Today I thought about revising my ‘this isn’t hard’ statement… but no. Its not “hard” in the sense that its still not difficult to understand. But it is most definitely a ridiculously ginormous amount of information presented very fast.

Between Immunology (the body’s defense mechanism), Microbiology (bacteria and viruses) and Pharmacology (a seemingly endless array of drugs that treat bacterial, viral, and fungal infections), my classmates and I are now saying our brains are bleeding. Just a little joke to try to express the feelings of overwhelm as we begin yet another lecture with the announcement, “Okay, we’re going to speed up just a little, the last couple of lectures were really just the basics…”.

I spent a bit of time over the last few days with practice questions – those little vignettes that paint a picture, then ask a question with multiple choice responses to choose from. In one sense, the practice question exercise was encouraging – a bit of the volume of information is actually ‘sticking’ and I’m able to recall just enough to do what I call intelligently guess.

In another sense, it was a humbling experience. So much still that I do not know well.

So rather than simply sit here with my brain-bleeding joke and feel overwhelmed, I decided to change something.

Knowing how my brain works (taking pictures of information I know, then adding in details), I first drew a map. There really is a logical organization to the different categories of bacteria. Then I printed pictures of plates of the different bacteria that I’ll need to be able to recognize. Then I added lists of specific bacteria, then finally added in ‘matching’ drugs with their mechanisms of action and contraindications.

Whew! This now covers one whole wall in my living room… if you were to visit right now you’d be certain I’m headed for the loony bin! But now I’m confident I can continue adding information for the rest of the block – after all, we’re only two weeks in to an eight week course, which means tons of new bugs and drugs to add to my creatively wallpapered wall.

I will admit, at times my brain glazes over with paralyzing overload. But most often, I’m thrilled that I have this amazing opportunity and that I have the ability to actually learn this huge amount of information.

I think I’ll go do a bunch more practice questions, using my “wallpaper” as a tool to answer correctly. And thank goodness there’s only three more hours of lecture this week – which will allow all these bits to gel into long term memory before the next onslaught.

Journal Club

It was still dark outside as I hugged my steaming cup of coffee while driving a few blocks down nearly deserted streets. I’d been invited to participate in Journal Club this morning with 3rd and 4th year medical students from a different medical school, and I didn’t want to be late.

Anyone who knows me knows that I simply love science – and getting together with a group of other students to discuss a recently published research paper is truly my idea of the perfect way to begin the day. I had flashbacks of the three years I spent in a master’s program, attending Journal Club once a week and hashing through papers, working hard to stay on top of the ever changing face of scientific inquiry.

Walking into a nearly deserted building and finding the right conference room, I was nervous. I felt self-conscious a bit – after all, I’m invading their space, I’m a first year student at a school no one has ever heard of, and I was prepared to sit in a quiet corner and be a sponge.

And now, an hour later, I’ve decided to let go of my ‘issue’ of being self-conscious about other professional’s reaction to me, my school, my chosen path. Surrounded by 3rd and 4th year medical students, a few residents, a nurse practitioner, a Cardiologist, and a few Nephrologists (because of the subject matter of the paper we were discussing), I discovered kindred minds eager to learn and pick apart the latest information in order to provide the best service to patients. Predictably, there was revealed a vast difference between the narrow view of the published study and what happens in real life with real patients. Yet there were nuggets of wisdom gained from both the study and the discussion, and I eagerly look forward to the next meeting.

Chatting afterwards with a couple of 3rd year med students, I was reminded once again of what an amazing privilege it is to be at this school. For oh so many reasons, I am blessed beyond measure.

Now back to the books… learning all the details of strep and staph infections. Have I mentioned lately I love my life?!

Another First

Over the nine years that I applied to medical schools, I spent literally thousands of hours volunteering in clinics and hospital emergency departments. Those hours were variously spent cleaning counters, removing staples from medical records, emptying trash cans, and, if I was lucky, actually shadowing a few physicians.

I also had the privilege of spending a couple of years in a local hospital ICU working as a nursing assistant.

None of those many hours were anything like tonight.

Tonight, for the first time, I was officially working an ER shift with my physician mentor. Part of being a medical student at IUHS is the requirement to spend 20 hours monthly with my physician mentor – from day-one of being a student. Since my mentor works at a local emergency department (along with his mobile house-calls only practice as well as being medical director for a local college clinic), part of my monthly hours can be at the hospital. And it was nothing like what I expected.

The open-armed acceptance by other physicians and nursing staff. The mounds of charting (electronic med records) that takes so much time. Some truly belly-laugh-worthy ICD-10 codes, and beginning to get an understanding of how to chart for the hospital’s maximum reimbursement. Pizza in the break room. Crazy jokes and hilarious stories during down times.

The mind-blowing official invitation to join 3rd and 4th year medical students from a different medical school at their weekly didactic sessions and journal club meetings. Even though I’m just a first year student.

Analyzing EKG strips (not being able to get away with “I don’t know” but being led through what I do know to what I don’t yet). Comforting a little girl while she got stitches for a gash on her chin from slipping in the bathtub. Holding another amazingly brave little boy with a displaced supracondylar humerus fracture (a particularly nasty break in the bone just above the elbow) while he got an iv placed – and while with tears sparkling in his eyes he told me the story of how he’d been climbing way up in a tree and fell. Spending time helping people cope with their family member’s emergency.

Six hours spent in one of my all-time favorite places in the whole world.

Tonight, I am overwhelmed with gratitude. Not everyone gets to experience following their way-too-big dream from hopeless to fruition. Most give up way too soon, or don’t recognize and embrace the pivotal stepping stones as they occur. I’m right in the middle of my way-too-big dream coming true, and oh yes it is worth every setback, every heartache, every roadblock overcome, every study marathon and frustrating slammed door.

My house is about six blocks from the hospital, and as I write this I’m listening to a helicopter bringing in a patient – someone who needs care and will find it from the night shift. I find myself wishing I were still there, so I could learn more, experience more, serve more.

And I am reminded once again why I am on this journey.

Bugs

I’ve never taken a Microbiology course. So I was a little nervous about this block focused on Bacteria and Viruses – all those invisible critters that are essential for life or can create all sorts of nasty diseases.

Besides, I was kinda used to our Biochem prof and her amazing humor and ways of making a tough subject understandable and even fun to learn.

But oh my – have I mentioned lately how much I positively LOVE this school? IUHS has such an amazing array of professors who each bring their own personalities and gifts and I am blown away with how much I’m enjoying learning all the minutia that I always thought would be ‘hard’, but isn’t.

Or maybe I’m just in such a habit of preview, attend lecture, review, study for twelve hours every day that its just a matter of adding in more amazing information to what I already know.

This post doesn’t have any point except this: There can be such a sheer JOY in learning!

I had the opportunity to visit with my undergrad Biochem professor today for awhile. Had the chance to thank him for the solid foundation he provided almost ten years ago. Its important to say thank you. And he let me know how rarely he hears thanks.

Whatever your dream: pursue it.

Whoever has helped in your journey: thank them.

Wherever your path takes you: embrace the journey with JOY.

Imperfect Competence

Today was clinic day – spending time with my mentor Dr. J while we spend a few hours each week at one of the local college clinics. Migraines, yeast infections, PSVT (that’s a cool one – had to look it up) and post concussion syndrome meaning no more soccer for awhile. I still jump a little inside when Dr. J looks at me and says something like, What was the rule about when you can return to active sports following a concussion?  expecting me to explain to this student what has to happen before she’ll be cleared to return to active sports participation.

It was also class day. I had queued up the online lecture prior to leaving for clinic, then dashed back in the door one minute late, stuffed the headphones on my ears, and was instantly immersed in bacteria and viruses and (oh no not again!) biochemical pathways of metabolism.

During the ten minute break between lecture hours, I checked my school email.

And there it was. Subject line, “Block One Exam Grade and Status Report”.

That exam that I have been stressing over, worried about, just sure that I didn’t pass because there were far too many questions I had to guess on. Part of my brain went into hyper mode, analyzing the Subject line, wondering if that was a precursor to some elaborate email about what to do if you didn’t pass the final. Heart racing, I clicked and read…

PASS.

Not even “low pass”.

Truly, sitting here writing this, I’m not quite sure how that happened. There were  far too many questions I had to guess on.

My heart rate gradually slowed back to normal as I’ll admit I shed not a few tears. I flashed back on all the times in the last few months I’ve heard professors remind us that medical school exams will never try to trick us, but will most definitely constantly test our ability to evaluate a situation we’re not familiar with and apply the knowledge we do have in order to come up with the best reasonable response.

Maybe I need to reframe the way I look at this. Maybe I have to stop calling it “guessing”, let go of my ‘undergrad-style’ memorization expectation, and realize that while I cannot memorize everything, I can learn. I can apply what I do know. I can rely on all those hours of pouring over q-bank questions that asked about scenarios I’d never heard of and walked me through the process of understanding how to apply what I did know to what I did not.

I’m the type of person who has always needed to compete with myself for as close to flawless as possible in order to feel adequate. I’m discovering a whole new dimension to learning and application than I ever knew existed – based not on perfection, but on competence.

I have a feeling this is going to be an ongoing and amazing learning experience – not just about what information I can store in my brain. While I learn. And serve. And become.

The JOY Factor

Block One is in the past. A week of “downtime” is over (packed with an almost inhuman heap of amazing accomplishments). And Block Two is ramping up.

I’ll admit, I’ve been a bit trepidatious about going into Block Two. Its all about Microbiology, Virology and Pharmacology. Okay – a better way to say that is this: I’m nervous studying bacteria, viruses, and drugs. This is delving into subjects I’ve never taken a course in before so I’m back to that place of feeling inadequate without any academic foundation for what’s next.

Besides, I was kinda used to the intense and animated teaching style of our Biochem professor. Until today, I imagined that our Micro prof would be a stodgy old guy droning on about e.Coli and enhancers / repressors and blood typing and….. well, that was the beginning and end of what I thought it would be like.

And then there was today.

I hope that you, whoever is reading this, has at some point in your life had a conversation with someone who just overwhelmingly loves what they do, and has a real gift for infusing the discussion with JOY.

That’s the only way I can think of to describe what today was like.

A conversation (not a dry stodgy lecture).

With animated JOY.

About bacteria.

Just writing that makes me feel like giggling. And reminds me how important that JOY FACTOR is. I don’t ever want to wait until my life circumstance is all carefully arranged to justify joy. Today was a beautiful reminder of how I have the opportunity to choose JOY, no matter what is going on. No matter the subject. No matter the company. No matter of other areas of my life are challenging at the moment.

That JOY FACTOR. Wow. If it can transform a potentially dry subject (bacteria and viruses) into an animated interactive super cool conversation….. well, I’m going to be applying this in a few more areas of my life and watch the stress levels evaporate.

Funny how much energy I wasted in the last week worried about this. Liberating how fast the JOY FACTOR was contagious.

Grab hold and pass it on!

 

What Do You Think?

“Working” at the free clinic in my little town brings back so many memories!

This is the clinic I volunteered at way back when I first returned to college, not sure if I was cut out for the whole pre-med adventure.

Its also a clinic I’ve gone to as a patient at various times over the last decade.

As Dr. J and I breezed in yesterday for our shift, patients were lining up, some already waiting in exam rooms. Back aches, sore throats, medication refills, an arthritic knee that needed a steroid injection for a delightful elderly Spanish woman who spoke no English at all…

Then there was the patient I’ll call Ann (not her real name). Ann also spoke only Spanish. Although Dr. J (my mentor) is fluent, I speak very little (gotta work on that!). But I found myself following the gist of what Ann was describing. A petite woman, she was also a little strange – the sort of patient easily dismissed by medical folks who have better things to do than listen to a frumpy confused woman describe her aches and pains in a long rambling monologue.

Dr. J patiently listed, asked many questions, then looked up at me and said, “I just don’t know what’s wrong. Maybe nothing. Maybe something. Let’s get her to come back tomorrow for a blood draw – maybe that will give a clue about what’s going on.”

Standing in the tiny corner “doctor’s lounge” while Dr. J wrote up the lab slip, I mentally went back over what I had gotten from my limited understanding of Spanish, Ann’s body language and hand motions describing her discomfort. Suddenly Dr. J stopped what he was writing and looked up at me.

So, what do you think it is?

“Well, she’s got right flank pain. Belly pain. Feels just generally yucky. She’s wearing super tight pants, which she probably wouldn’t be doing if it were an intestinal issue. My first guess would be a urinary tract infection of some sort.”

But her pain is on the side, not the back. And she said she doesn’t have burning on urination. And she said its been going on for three weeks without a fever which just doesn’t fit a UTI.

“True. I just keep thinking, as a woman, the times I’ve had a UTI, it hasn’t been textbook. She’s a poor Spanish woman with no insurance, so she won’t quickly seek medical attention when she doesn’t feel well. She’s a little / a lot weird, so probably has some sort of mental health issues. Bottom line is, how cheap is a pee test just to rule out a UTI?”

Suddenly Dr. J jumped up and found a nurse. I need a quick urinalysis on Ann please.

Fifteen minutes and another patient later, the results were back.

Well look at that – definitely has a UTI. You were right – good work.

No time to enjoy the kudos as I followed Dr. J while he wrote a fast prescription and then off to see the next patient.

Later, though. Later, I thought about the experience of having an idea of what was wrong and being willing to express it to my mentor. Even though I’m a student and technically “don’t know much”, and I have no idea yet how to read that urinalysis to determined that Ann had a UTI. But I sure did enjoy that doctorish moment – and would have enjoyed the moment even if my idea had turned out not to be correct.

Poor patients. Confused patients. Whining or weird or argumentative patients. All the reasons I have always been drawn to working at this clinic that serves those no one else will see.

So much of why I pursue this path to becoming a physician.

 

What It Really Feels Like

Its Friday night.

The Biochem note cards are put away. I’ve logged out of the school lecture notes and recordings. Block Exams happened yesterday, and I actually slept for twelve hours last night.

I wasn’t going to write anything more until I got my grade report and could write a post something like, Yippee I passed!

But that’s not how this works.

Tonight is the emotional hangover after exams are done.

You see, I have this habit of JOY and HOPE. Its where I live. Its been carved into the cells of my body and soul over years and decades of tough life stuff that gave me a choice of either despair and mediocrity, or choosing to pursue my Big Dream while holding on to who I am with no compromise.

Even though that habit is powerful, it doesn’t negate the emotional hangover tonight. Thoughts of, What if I didn’t do well enough? What if I guessed wrong on the questions I wasn’t sure of? What was up with those questions about xyz that I truly can’t remember ever hearing about in a lecture or reading on a q-bank question? 

This isn’t an appeal for sympathy or support – lord knows I have heaps of support from some amazing people in my life. What it is, though, is a testament – a statement – about what medical school is really like.

Its frightening, at times. Its overwhelming, often. And here’s where it gets super important: How my professors and other school support people responded to my insecurity tonight is HUGE for me. Here’s what that looked like:

The very last bit of this “Block” was to submit an assignment through software called DxR Clinician. At IUHS we’re fortunate to have the creator of DxR, and it is a marvelous way to simulate patient care all the way from a new patient walks into your “clinic”, through history taking, physical exam, creating a differential diagnosis, and doing the details of documentation required. It can be overwhelming (at least it was for me), and I even got the diagnosis wrong but submitted the assignment anyway.

When I sent in the email, I wrote, “I worked very hard on this assignment, and got the diagnosis wrong in the end. I am confident that with more practice I’ll do better.”

And immediately I received the following email back. After hours. Actually quite late on the east coast where the response came from.

You are allowed and we encourage you to complete the case several times so you can learn from the feedback and get everything right! We give extra credit for completing multiple attempts as well. I promise it will get easier.

And I got a warm fuzzy feeling realizing that I’m at exactly the right place, with the most amazingly supportive faculty and staff.

Soon I’ll have that grade report. And I hope I passed finals. (Yes, that’s how I’m feeling tonight, so I’m not going to dress it up in goofiness or ‘I’m sure I passed’.) But in the meantime, I am confident I’m exactly where I need to be. Being human. Feeling insecure. And with folks actively encouraging me to keep going.

It feels very good.

 

I don’t…

Fourteen hours before a big-deal final exam, and I’m coming up for air for just a moment to jot down my list of “don’ts”… To me, this kinda defines how I live, placed in more than usual stark relief because of the journey I’ve chosen. These are all real. They’re all “me”.

I don’t complain about how hard this is.

I don’t second-guess my passion to be willing to take on the journey of becoming a physician.

I don’t live on caffeine.

I don’t get whacky out of balance in my life.

I don’t eat junk food.

I don’t skip class. Ever.

I don’t cram before exams. With my ‘normal’ day of 12 hours of studying, cramming would be pointless.

I don’t ever question that my particular med school is the absolute perfect ‘fit’ for me.

I don’t stop doing life just because I’m in med school.

I don’t compare myself to other students.

I don’t let go of my “life balance” stuff like exercise, reading for pleasure, play (dogs / kids / grandkids) and digging dandelions.

I don’t wait for a professor to tell me every detail of what I need to know. If I want a different explanation or more detail, I look it up (thanks Google).

I don’t tolerate or excuse me being crabby, or treating my family, friends, or colleagues with disrespect.

 

This is LIFE, not a sprint. And what an amazing adventure!