You say Mudphud, I say Sucker

I'm old.

Like, really old. Seriously. I'm a third year medical student who is usually the same age as the youngest attendings. ATTENDINGS.

Brief side note: if you don't know the whole medical hierarchy, here's how it goes, in ascending order:
3rd year medical students
4th year medical students/acting interns (AIs)
Cockroaches
Interns (although in some services the interns are treated worse than the medical students, and in all services they work a lot harder)
Food service employees
Residents (ranked from 1st year to whatever the last year of that particular residency is, usually called the "senior resident")
Chief Resident (usually in the final year of residency, but sometimes it adds an extra year of residency to be chief resident)
Fellows (depending on if whatever you are doing is a fellowship)
Anyone who brings people good coffee
Attendings (have finished all of their training)
Friends of the Chief who want to see what medicine is like
Chief (head of the department)

Anyway. My point here is that I am usually being taught and generally bossed around by people who are up to seven years younger than me. Which is usually okay, other than all those whippersnappers making a racket, and sometimes I develop the strong urge to knit and put my hair up in a bun. So far they at least have the courtesy to act surprised upon learning my age, which is inevitably followed by the question: so what have you been up to (insinuated addition: "for all those years")?

There are two parts to this answer. Part one: I spent four pretty awesome years working in biopharmaceutical research, traveling, and having a total blast with tons of fantastic people after college. I needed the time to decide what to do with my life and although I sometimes wish I was four years younger now (then again, who doesn't??), I needed that time and I don't regret it one iota.
Part two: I spent four years as everyone's bitch getting a PhD which I now pray will pay off in some small way in the future and will not mean I have missed my chance to have kids or have a career which lasts for more than five years before retirement.

I know that sounds kinda bitter, and I don't really mean it that way exactly. It's just that I think a lot of us Mudphuds start feeling this way when we go back to 3rd year. We are all at least four or five years older, four or five years more jaded and tired and frustrated, and more importantly we have forgotten most of what we tried so hard to learn in the first few years of medical school. We finish our dissertations and show up to 3rd year like middle aged, haggard marathon runners staggering over the finish line, only to find another starting line, populated with these fresh-faced young people who have just gotten a full night's sleep and tons of carb loading. They just took their boards and it is all still fresh in their minds; they are still at an age where they can stay up all night and still remember where they live the next morning.

I haven't quite made up my mind about the abuse issue; that is, does having just gone through four to five years of consistent abuse make it easier to be abused for another three to five years, or is it better to go into it fresh? Maybe it is both, but speaking for myself, it isn't always easy to be treated like scum having just finished the scumfest of all scumfests. I know that medicine is a whole different field and basically everyone in the hospital, including the janitors, know more about medicine than I do, but come on! Didn't I just do this? As they say, it's déjà vu all over again.

Back to my original point. When I tell these younger bosses of mine that I have a PhD, most of them act impressed. They say really aggravating things, like, "Wow!" and "That's great!".

Is it? Is it really?

I dunno. I have been told over and over that I will be glad I did this, and in fact I do think I want to do clinical research, but right now, feeling old and behind and lost, I have to wonder.

And that's not even getting in to the thoughts I sometimes have about what I'd be doing with my six figures a year if I had gone straight into programming after college...

Pretend I didn't say that.

Finding words to say the worst

Today I met a completely disarming 6 year old girl. She was sweet and giggly, and very cute even though she lost all of her hair during her chemo and radiation. You could see how big her smile was even before she took off the mask she has to wear whenever she is out in the world, to keep her from getting sick. She has no immune system, you see--she, and her family, are waiting to see if the one she had transplanted into her is going to take.

She was referred to our clinic by her pediatric oncologist because they noticed that one of her eyes was occasionally drifting to the side, almost imperceptibly. My resident was concerned that they hadn't corrected this yet at the age of 6, because if you don't correct those sorts of disorders by age 7 they become almost impossible to fix. Even as he was telling me this I could tell there was something else he was worried about.

One of the worst things about being a doctor is knowing the bad signs. I knew as soon as I watched her pupil react to the swinging flashlight test that things were not okay, that they were a lot worse than we had at first feared. As we completed the eye exam, it was pretty clear that this little girl was blind in her right eye.

How do you tell her and her mother this? They did not come in today because they noticed something was wrong with her eye. They came in for a check up, and after her initial diagnosis, initial chemo and remission, then her relapse, more aggressive treatment, and bone marrow transplant, they thought things were just going to get easier from here. In fact, it was probably the radiation and chemotherapy that did it; the same things that probably saved her life took her right eye as payment.

As the resident went to call the referring doctor, the little girl's mom asked me what we thought. What was wrong? Why was it wrong? What was she seeing in that eye--were things fuzzy? Blurry?

I didn't know what to say. I thought she had seen that when we covered up her daughter's left eye, she couldn't see anything. I didn't know how to tell her she was blind in that eye--that she didn't see fuzzy things; she might--might--see a little light when you shined it right in that eye.

Luckily for me my resident came back, and he carefully explained everything, ending it by saying that the little girl could do whatever she wanted, that this would not hold her back in life at all. I added that just last week we did a check up on a physician who had been blind in one eye since birth. The mom didn't cry; she didn't really even look sad. She looked... the closest I can say is that she looked like a solider. She just put her arm around her daughter and said, "Okay."

And I find myself thinking about them tonight. Did the little girl understand what we were saying? Does she know that she won't ever see out of that eye again? Is her mom crying in her bed tonight?

I doubt it. They are much braver than I, and more thankful for everything they have. She has 20/20 vision in her left eye, and for now, that's enough.

Sweet dreams are made of this

Okay. The stress dreams have got to stop.

Just a sampling of the nightmares I've had in the past few weeks:

Dream One: I was operating with two residents, and we didn't really know what we were doing, and one of them made a mistake and the patient died, right there in my arms while I was trying to save her, and then the resident who killed her starting threatening that if I told anyone there would be big trouble... possibly another murder...

Dream Two: They tell me to do a procedure I have never done or even SEEN, one I don't really know how to do even in theory. But I have to do it, so I start by cutting into this fully conscious dude's scalp with a scalpel, and then I realize, horribly, that I didn't sterilize the area, and I'm not scrubbed in or even wearing gloves, so I try to play it cool but it's too late to use the betadine now, and one of the surgeons calls me over to tell me that I'm not cut out for medicine, that I'm a truly horrible student, not just because I just started cutting without any anesthetic or betadine or scrubbing but also because I keep scratching my leg, and even as she is telling me this I realize I'm scratching my damn leg, and they're telling me I'm no good, and the guy is bleeding, etc etc etc...

This is just a small sampling; there have been many, many other dreams (there are lots, since I've been having at least one, and usually several, per night). So what does it all mean?

It means that 3rd year is scary as hell. It's amazing, and great, and exhilarating, and definitely totally, completely terrifying. If you have never experienced it, the closest I can come to explaining it is to envision that you are on a jetliner, and all of the crew has passed out, and they grab you and plop you in front of the controls and say, "It's up to you to land this plane! The lives of you and everyone on it depend on you!" Then they slam the cockpit door and it's just you and the controls, the millions and millions of controls and blinking lights and switches with no labels. This analogy only works if you have never even set a toe inside a cockpit before.

Alright, enough of my melodrama. The irony in all of this is that they basically never ask you to do anything that matters (which, perhaps, makes it all the worse when you do it ineptly). I have to get some decent studying in since I spent most of yesterday reading the new Harry Potter book (it was AWESOME), and then get some sleep to prepare for my last week of reprieve before my general surgery month. Until then, may you dream of sunsets and waterfalls and butterfiles, none of which need a central line.

Two weeks down, six to go

So. Surgery.
What can you say?

I've had a fairly easy time so far, as surgery goes. The hours have been very reasonable (for surgery) and the people have been very nice (not just for surgery, but nice by any standard... with maybe one or two exceptions). I'm switching services now though, so things may get considerably more crazy.

So far I've seen some remarkable things. Today I saw a brain. It was just out there, with the skull about 60% removed. It pulsated with every heartbeat. I've seen surgeons drill holes through skulls and noses, bedsores that go to the bone, and tubes threaded through the tear ducts. I've smelled some smells I thought never could exist. I've put staples and stitches into people and taken them out, helped take and place skin grafts, and retracted for 34098213487.3 hours. So, now, at this one quarter-way point, what do I think of surgery?

In short, I have a great deal of respect for surgeons, and for the field of surgery. These people are cool cucumbers, and I salute them. They totally could have made it on the prairie.

From a medical student perspective, however, surgery is very challenging. They don't have much time to tell you what is going on, what you should be doing, etc. It's very scary, actually.

First of all, they engage in something called "pimping". Pimping is when they put you on the spot and ask you questions in front of a big group of people. Pimping is a very frightening experience, even when they are nice and don't really give you a hard time when you get the answers wrong. So far I have been really bad at this process. Even answers that I know fall right out of my head when they ask me in front of lots of other people, and most of the answers I didn't know in the first place.

Also, the OR is a very stressful place to be. It functions in a very regimented way, but that way varies depending on the people running the OR. Some are nice when you don't do things their way; others yell at you. It's hard to remember all the musts and mustn'ts.

Plus, sometimes you almost pass out. This happened to me. It was actually the first time I ever scrubbed in, on a breast reconstruction. I'm not 100% sure what happened, but I think it was a combo of sweating under hot lights and about 50 pounds of occlusive, non-breathing clothing, awkward posture, and the Bovie. The Bovie is an electrocautery device that they use to essentially burn through tissue and it emits all of this horrible smoke. It smells frickin' awful, especially when they are cutting through fat. Anyway I was about to pass out face down on the patient (not recommended) when I fessed up. They were nice as they told me to get out and get a drink of water. It was still embarrassing.

Anyway, there is more to my rambling, but for now I need to get some sleep. I will try to write some more random thoughts tomorrow. Until then, remember this: when they get out the Bovie, always ask for suction. You can suck up the smoke; it really cuts down on the passing out.

Ho. Lee. Lord.

Okay, people. I'm not sure what to write, because I can only think of maybe three people who would want to hear about the stuff I've seen in the past few days. I'm on surgery--plastics, to be exact--and let's just say we aren't just doing breast reductions and tummy tucks (abdominoplasty). I have seen one of each, however, and let me tell you what:
1. Do not ever have a breast reduction, even if your wabambas are the size of two dwarfs clinging to your chest.
2. If Weight Watchers wanted to become really effective, it would make all of its new clients watch a tummy tuck. Ask yourself: do I want that cupcake bad enough to have a whole Office Depot worth of staples in my body?

Anyway, plastics does lots of other things; hand surgeries, facial reconstructions after car accidents, skin grafts for burn patients, debridement of wounds, etc. My thoughts are as follows. First, do not ever get into a car accident. Second, never set yourself on fire. Third, don't get a giant wound.

I don't mean to be flippant; these surgeons are AMAZING, and the work they do is quite often miraculous. But seeing these patients and what they have to go through makes me thankful every second that I am not sick or injured.

Anyway, the hours haven't been awful. Sure, I'm getting up at the crack of dawn, but the patient load has been pretty light so we've been finishing pretty early. Of course, I pass out pretty early, and have been having to do a lot of reading; in fact, all I've done this week is work, drive, shower, study, and sleep. Occasionally, just to mix things up, I eat.

So far, I really like patient care, if I can get past my fear and confusion and frustration and ignorance and constantly being in the way and not knowing what I'm supposed to be doing or when or to whom. It is slowly getting better, though, and I'm definitely pretty excited to go in every morning, despite the fact that even God isn't up yet.

I need to go study, but I will leave you with this thought: did you know cheese slicers aren't just for cheese?

The early bird gets the nausea when she brushes her teeth

I've been pushing back my "wake up" time for the past few days so that today, the day before I start surgery, I got up at 5:30am. I'm guessing that, normally, I will have to get up no later than 5am, and probably earlier, depending on how short I can make my morning routine. I think that 4:45am will be a normal time, with the occasional 4am.

UGH.

That's one thing you can say for graduate school: there is hardly ever a reason why you would have to be in lab at a specific time, much less an early one. I mean, some people have lab meeting once a week in the morning, or journal club, but the earliest time for either of these things that I've ever heard is 8:30am. In fact, I had a journal club that was at 9am on Fridays, and I can't tell you how often I was late to that thing (or slept through it entirely).

I did go through a phase where I got in to lab at 7am or 7:30am because my husband was on pediatrics and would drop me off on his way to the hospital. Once I got used to that, it wasn't really that bad; in fact, I got to the point where I would basically wake up spontaneously most mornings. But, somehow, I don't see how that will happen for 4:45am.

What I can see happening is the following:
1. Nausea.
2. Self pity.
3. Occasionally dragging myself out of bed, slowly and painfully getting ready, and being about to leave the house, when my alarm goes off and I realize I am still in bed and it was all a dream and now I have to do it again.

But that's okay. I only have to do it for a couple of weeks, and then I get a two week break from ridiculous mornings when I switch to a service with less crappy hours. But after that, I have four weeks on another service which will start just as early, if not earlier.

So, six weeks. I can do this. Six weeks of getting up in the dark (but I can see the sun come up on my way to work!) and dry heaving when I brush my teeth (maybe I can lose a few pounds!) and being dressed and in the hospital a full three hours before I would normally even consider opening my eyes (but I get to wear scrubs sometimes, which is just like pajamas!!). As you can see, I'm trying to listen to that little, positive voice in my head, but at this hour, it doesn't always make a lot of sense (breakdancing chicken!).

I will try to post a short update after my first few days, but you might not hear from me for a little while. My schedule is packed with pushing my snooze button.