To sleep, perchance to, well, sleep

Today was my last clinical day of surgery; tomorrow is the surgery shelf exam. My feelings can be summarized by combining the traditional "zzzzzzzzzzz", indicating sleep or sleepiness, and the "ARRRGGGGGGGGGGGHHHHHHHHH" of fear/frustration, thusly forming the new compound expression:
zzzzzzzARRRGGGGGHHHHHHzzzzzzzzzz,
which is the rallying cry of 3rd year surgery clerkship students everywhere.

I was on call last night, and after two solid weeks of madness it really took a toll. I was able to leave the hospital early today but have found that I'm not doing very well with the last-minute studying. But I'm looking on the bright side: I'm too exhausted to panic.

I'm pretty sure I will be able to pass the shelf and therefore the rotation (knock on a forest full of wood). Unfortunately, though it is uncool to acknowledge that you are "gunning" for honors, these things do matter, especially if you are strongly considering a very competitive subspeciality, which I am. So, passing is not really enough. I'm trying to give myself a break since this is my first rotation back and I have, by careful calculation, ZERO knowledge of minor things such as, I dunno, ANY DRUGS AT ALL, but I can't allow myself to be complacent about being behind my classmates. I'm trying hard, but right now I'm not sure it is enough.

Also, much to my chagrin, I've found that osmosis learning does NOT occur after falling asleep on your book, which I have done more in the past few weeks than in the entirety of my life up until now. In addition, I have found that I've become stupider as the rotation wears on. I'm not sure if this is due to the previous "topping off" phenomenon I wrote about before, or the exhaustion, or hearing slightly different versions of "the next appropriate step of management" from three different books and ten different people, but it is definitely true.

In any case this will be over, for better or for worse, tomorrow before noon. I move on to family medicine next which will be AWESOME in terms of hours (closer to 9 to 5 than the 5 to 9 of surgery) but is a continuation of the brain-stuffing I've been attempting with mixed results. I am going to try to get caught up on my drugs (learning, not taking) and general medical knowledge, but also on remembing what my husband looks like. I miss him, a lot. Also I miss fun, and sleeping. And my dogs. And sleeping.

I am going to sign out before this becomes any more rambling... not surprising given that I wrote it more to have something to do other than study and not so much because I have something specific or interesting to say. My positive thought for the post is easy: tomorrow I'm done with surgery, considered by most to be the most difficult rotation of 3rd year. What have I learned?
1. Waking up any time after 5am is "sleeping in".
2. Caffeine can be your best friend, but use her wisely; she is a bitch-goddess who does not take either abandonment or abuse lightly.
3. Surgeons are crazy.
4. Papillary is the most common type of thyroid cancer.
5. I can't remember the fifth thing, 'cause my brain is full.

Okay, that's all for now. In closing, always rememzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

On second thought, no post today.

I was about to write a quick but scathing post about my horrific day and my generally abysmal outlook on the entirety of my medical education when I noticed my previous post. Let's just say that given my current state of mind I don't think anything I could write today would be in keeping with my new resolution, so I am going to take tonight to cool off and hopefully have a more reasonable outlook tomorrow.

Positive thought for the day: Today, despite persistent thoughts to the contrary, I did not harm myself or others. At least not physically.

To the best of my knowledge.

So far.

Super happy shiny fun time!

In flipping back through my previous posts, a subtle, yet persistent, theme emerged: bitching.

Yes, if I had to rename this blog, it would have to be called: "The Incessant and Unrelenting Bitchfest: A Tale of Two Degrees."

I'm sorry about that, for two main reasons. First--and you are never going to believe me about this one--I am basically a positive person. (I know! After reading my previous posts, it surprised me too!!) I'm not depressive, am only mildly moody (I like to think I experience the least possible amount of moodiness possible for a girl). I tend to be an optimistic, glass-half-full kind of person. And second, overall, I didn't hate graduate school, and third year medical school is basically awesome. Painful and terrifying and sad and really, really hard, but awesome.

So why so much bitching?

Honestly, I'm not 100% sure. I think a lot of it is that there are a whole lot of things about this career path that are extremely stressful, frustrating, challenging, etc. etc., and at some point my husband, family and friends get really sick of hearing about it, and tell me to knock it off, already! and I still have some venting to do, and, hey!, blog. Another part of it is that--and this is especially true of the grad school stuff--once you crawl out of a pit of despair, you want to put orange cones and CAUTION! tape and stuff around it, so other people don't fall into it, too. (Unless you are a certain person I am having to interact with a lot lately, in which case if you happen to fall into a pit with tigers and spikes and poisonous snakes I would laugh and laugh, and maybe throw rocks).

In any case I have resolved to try and always include something positive in every single one of my posts. Even if all I can manage is "Today I continue to successfully turn oxygen into carbon dioxide", my God, it'll be in there.

Currently, I am working on a list of "Everything you ever wanted to know about the surgical rotation, asked about, and were yelled at by a nurse." Expect it after I shake off my 30 hour shift. Until then, remember: fluffy bunnies are happy and cute!! Yay!

Ow... my brain

You know how there are signs at the gas station that tell you not to "top off" your tank? Well, I think I've topped off my brain.

It seems that no matter how much reading or studying I do there is actually MORE that I don't know. It's like when you are packing up your house and you spend two days putting stuff in boxes but somehow now there is still the same amount of stuff unpacked, so you pack more frantically, and now there is EVEN MORE STUFF UNPACKED THAN WHEN YOU STARTED PACKING AHHHHHHHHHHH.

Lately I don't know if I have any more boxes upstairs, if you know what I mean.

I have to admit, it's all pretty interesting. With as much studying as I've been doing, none of it has been nearly as painful as other stages of this process. Basically everything I'm trying to learn now is clinical, it's about taking care of people, and I really like that. Also, it's amazing actually seeing diseases and syndromes that somewhere along the line you convinced yourself existed only in books. It's amazing seeing how the new innovations in care over the last few years are actually being used to save people's lives, and seeing what new things are on the horizon.

I could go on and on, but I can feel details about primary hyperparathyroidism leaking out of my ears as I type, and I need that for tomorrow, when I'm on overnight call. Overnight call is often a prime time for pimping, because it is even funnier when medical students not only don't know the answer, but we cry. If you come up with any new innovations in brain drain plugs, definitely let me know, if I can remember why I needed it.

I don't know where time is, but it ain't on my side

Okay, this is going to be short. Why? Check out the title.

How in God's name to surgeons do this?!? It is NUTS. I mean, I haven't even had hours that were that bad and I feel like I'm barely scraping by. To be fair, I do have to do a whole truckload of reading and studying and other random busywork stuff when I'm not in the hospital, but still. Interns have it a lot worse, hour-wise. To give you a more specific idea of the hours I'm talking about, I have been spending 12-16 hours a day, an average of 6 days a week in the hospital. Then I need another 1-3 hours of studying time each day. My schedule has me working the next 13 days straight; then I get one day off, then work six more days. Then the exam. Included within those spans are two nights of all-night call where I could get five hours of sleep or zero sleep.

Also, I have to take the shelf test in less than three weeks, and that is freaking me out. The shelf test is a big, really hard, national exam you take at the end of each clinical clerkship--so, two weeks from Friday, I'll be taking the surgery shelf. Lots of people say it's the hardest one, but I don't listen to them. I listen to my brain, which is shrieking: AHHHHHHHH, we will never pass this exam!!!!!!!!!!!!!!!!!!


Okay, in any case, I have to go get some work done so I can get more than six hours of sleep tonight. Your final random thought: don't you think that Daniel Radcliffe always wears WAY too much blush in interviews?

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.