Boo Ya, Anesthesia

As a 3rd year medical student, life and work can be demoralizing.  You are a perfectionist by nature; you dare not succumb to failure.  To you, failure could mean the inability to stick a vein, not being able to spit out the criteria and numbers for different stages of sepsis, or simply being … average.

Popping my bubble

It’s hard to admit, that I’m simply mediocre now.  I’m no longer the magna cum laude student, rockstar laboratory extraordinaire, artistic organic chemist on paper, or master calculus calculator.  I can excel on the hospital floors, writing the perfectly organized (and legible) SOAP progress notes and spending quality time talking to the patients, taking their histories, and doing a very thorough physical exam.  I can attain the perfect clinical grades and positive evaluations, on Surgery, Ob/Gyn, Pediatrics, Psychiatry, and Medicine.  And you know what pops my blissful bubble and leave me deflated like a breathless balloon?  That’s right, the dreaded shelf exam.  At Stony Brook, your final course grade practically depends on the final shelf exam.  Each rotation is very variable. In Ob/Gyn, the shelf exam is worth 10%, versus in Surgery, it’s a whopping 30% and the main determinant.  Heck worse, in Pediatrics, which I totally should have attained an Honors, the shelf exam is  not even factored in; it’s a mere qualifier! That means, no matter what your final tally is, if you don’t reach a certain percentile, say 50th percentile, you absolutely cannot get a High Pass!  And these shelf exams are long, stupid, and arbitrary, where you are compared to the whole nation of medical students taking the exam.  Many times, I learned more about patient presentations and management on the floors, and not from these stupid shelf exams.  If you are a good subject test taker, the odds of doing well are in your favor.

For me, I suck at taking tests.  I’m at a clear disadvantage already.  With each rotation, I go in with enthusiasm and determination; I come out slumped and slugged.  I cannot say I’m satisfied with my mediocre passes, because I know I could’ve achieved high passes and honors.

I did make one simply, yet playful promise to myself:  the first clerkship you get Honors is the field of your destiny.

Guess what?  It finally happened today!  Interestingly, the two fields I’ve been debating between happened to be the ones where I’ve attained the highest grades this year.  Both happen to be my elective clerkships, where, surprise, you don’t have shelf exams and heavily based on clinical experience!!

Time to Celebrate! All I wanted to do was top of a fine day with ddukboki, kimchi and rolled eggs, but it’s always the cork and my nonexistent biceps that defy me!

So destiny has spoken … ANESTHESIA it will be!  I did 2-weeks in January, and absolutely loved it.  I was very much involved in patient care, took initiative to do procedures and ask questions, and worked hard to study the basics of anesthesia.  Even after my 2 weeks, I was still attending the Wednesday morning Grand Rounds (I was not there simply for the morning coffee and muffins).  It is a specialized field with a set knowledge of physiology and pharmacology you apply to patients of all kinds, from young to old, sick and healthy.  You learn to take care of sick cardiac patients, see through the delivery of healthy babies and care of the mother, manage pain, and much more.  With so much diversity in patients and cases and opportunities to jump into emergencies, you become the master artist of resuscitation.  That’s what I realized I loved.  It feels mighty exhilarating to finally see the light at the end of the tunnel, the light that you can reach your potential and succeed, personally and academically.

Here’s a snippet of my clinical evaluations, which has also helped boost my self-confidence that I am making the right decision for myself, and not anyone else:

“Connie was enthusiastic and eager to learn about anesthesia.  She was a bright student.  She had excellent interpersonal skills.  She was engaging, inquisitive, and personable.  She was always behaved in a professional manner.  She was well prepared.  She was successful to perform careful endotracheal intubation  in the operating room. She also successfully mask ventilated patients in the OR , and place ivs. in the OR as well as oral airways, nasal airways, LMA, spinals and epidurals.  She also particpated in the pre-procedural time out.   She was a great team member-always helping out and was attentive to her patient.  she showed great enthusiasm in procedures and “hands on” patient care.  she was actively engaged in discussions of relevant clinical topics.”

Now popping my precious balloon

My mother has always been tough on me.  She wants me to enter a field where I can accumulate the moolah.  She wants me to do hematology/oncology.  Never has she supported me.  She’s been good at poking a needle into my blissful bubble and making me feel inadequate and terrible.  She’s good at pointing out my mistakes and saying, “See, you have a terrible memory… you can’t be a good doctor, let alone an anesthesiologist.” It hurts when I don’t have her support and confidence and she doesn’t listen to my interests.  Publishing compliments and gloating over my first Honors are not to boost my ego or show off; it’s to prove to my mother and myself, that I am capable of realizing and following my dreams.  I can be good with procedures because I’m not clumsy all the time.  I can be good with patients because I like to talk and comfort people.  I can be successful because I believe in myself.

Making a Difference

Today was a full day in Family Medicine. I go to Bethpage Primary Care with Dr. Arcati, who has been a holy preceptor. The entire office is absolutely spectacular; everyone’s just super nice. I love them and they love me =) Dr. Arcati usually previews me which of his patients are “cuckoo” if I go see them and surprisingly, several of his most “cuckoo” were on their better behavior whenever I was with him for the day. I guess that as a guest, I temper his patients down a couple of notches.  And many days, I get taken care of with lunches from the various pharmaceutical representatives – Mexican, Italian, pizza, salads, munchkins, you name it.  It’s a love/hate relationship with these drug companies; it’s hard to curse them when your mouth’s full of gourmet pizza =/

Most likely, I will not be making a career out of Family Medicine, but I want to maximize my experience nonetheless and enjoy it like a roller coaster ride. When I was on Surgery and Ob/Gyn, I looked forward to a break from daily 5am wake-up call. At the same time, Family Medicine every 2 weeks has been rather, disruptive, to the flow of a rotation. Take Pediatrics now. I’m enjoying this rotation and I look forward to my day. However, each day has been interrupted with lectures and lectures and lectures… stick in Family Medicine in my week of Pediatric Gastroenterology that is already stripped of a productive week, now I have close to nothing. Needless to say, I am not a fan of Stony Brook’s brand new Family Medicine longitudinal clerkship; it’s just plain intrusive.

Now, my complaints aside, I have been lucky with my Family Medicine site. Dr. Arcati makes me feel like I’m part of his family of workers. He lets me see patients with chief complaints, take histories, do physical exams, and formulate an assessment and plan. He also knows how much I love sticking people with needles, so I have the almighty privilege to draw blood and administer flu shots and make people happy and healthy.

People who come into the office have bread-and-butter cases:  fever, sore throat, congestion, cough, abdominal pain, etc… Simple. It’s the winter season; many people are succumbing to upper respiratory infections and asthma exacerbations. Nothing interesting.

Two weeks ago, I achieved a diagnostic milestone, times 2!  Neither of them were too shocking, so here are the stories. In the first case, a 60-something-year old woman comes in with a “lump on chest.” First thing I thought was, “Oh gosh, I have to do a breast exam…” It’s still awkward for me, as a female AND a medical student, even after doing breast exams and Pap smears not too long ago. I got her history and proceeded to exam the ‘lump.’ Okay, it wasn’t even on her breast; it was smack in the middle of the chest over the sternum. And when I palpated the mass, it was soft like fat tissue. Diagnosis?  Benign lipoma. Done.

Next case, a guy comes into the office with his girlfriend because he’s concerned about a “bump on the lip.”  Before I went in the room, I turned to the nurse, Rose, and we both nodded our head thinking it’s herpes.  So I enter the room and greet the couple. I take my history, and no surprisingly, stumble over sexual history. It’s been 2 years already, and I still can’t bear to bring up a real patient’s sex life.  With the girlfriend there, imagine how awkward THAT would be… Needless to say, I bumbled through without uttering anything remotely close to sex, though I was itching to do so because it’s relevant. I took a quick look at the guy’s red ‘bump on the lip’ and inside the mouth too. It did not look like a herpetic lesion (which is a very painful vesicle) or any serious skin infection. Diagnosis?  Pimple. Yes, a simple pimple.  I presented the case to Dr. Arcati, and I swore he laughed a little on the inside too. This guy comes in worried over a raging red bump on his lip, because we all make assumptions about what lesions on the lip mean… and in the end, it was a simple pimple. His treatment? It got popped. Oomph.

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Awkward lumps and bumps aside, today was a unique day. Amidst today’s many appointments of URIs and sickness, one patient came in presenting with “anxiety.”  I was sent in to talk to this young women, Foundations-style. For the first time since I started my clinical rotations, I was told I made a difference talking to a patient. I spent a good 15-20 minutes listening to her story:  30-something year old female has been experiencing headaches, crying, difficulty breathing like an “elephant on her chest,” and difficulty sleeping in the past several weeks. The root of her health complaints is coming from marital problems; she complains her husband has become more flat and unloving. They are seeing a marriage counselor to hopefully save the marriage. Her two children have picked up on the tension between the couple. In recent weeks, she has been affected by Hurricane Sandy with the power outage and some stress from work because of possible shifts in the business and lay-offs.  During my encounter with her, she started to break down and cry. This is the second time I’ve been left with a crying patient, and I’m not the best at comforting. Today, simply listening to her story and being supportive really helped her situation. I felt a sense of accomplishment as I told her she’s doing the right thing by seeking therapy.  But I also added that communication seems to be a key issue in recent years, and that needs to be resolved and maintained. Spending time with her husband when they’re not working or on weekends or with the kids is just as essential.  She is lucky to have support from family and friends; she’s doing a good job reaching out to her in-laws for advice and assistance. Most importantly, I told her simply, “Make sure to focus on yourself. You need to be healthy in order to have a healthy relationship with your family.”  She needed to relax and rest to be healthy and happy. And she took that advice to heart.

This is an aspect of medicine that is losing ground in the 21st century. Doctors do not have 30 minutes to be with a patient. I’m lucky to have worked with doctors who do spend adequate time with patients, but there are plenty out there who do not, at the expense of patients’ well-being. Today, I experienced the impact I made on patient by simply spending time talking to her. Dr. Arcati even said, “See? You really made a difference with her.” There is hope that patients will get the attention they deserve. You simply cannot let vulnerable people who can be helped to slip out of your hands. In every small way, even as a medical student, you can improve someone’s quality of life =)

Sharing the Joy of a Birthday

2012 – Year of the Dragon… Go Dragon Babies!!!

August 31, the big day of 2012 when I turned the almighty 24.  For the past 23 years, my birthday has not been that spectacular or worthy of shows like My Super Sweet Sixteen.  But his year’s birthday was like none other I’ve experienced yet.

I just started my Ob/Gyn rotation at Winthrop University Hospital this week. Lucky me, I kicked off my first week on Night Float, status post Surgery rotation and grueling shelf exam.  It was a rough transition. This entire week, I was floating on Labor and Delivery and seeing lots of babies come out of vaginas. I was fortunate to have a great intern, Cheryl, take me under her fledgling wings as we floated from triage to the ER to laboring rooms. For a change, I really felt like I was part of a team; she taught me well and I adapted to the field quickly. I took histories from women getting admitted for labor pains and put on my catcher’s mitt for the babies and placentas.  I was given the opportunity to help with the ER consults and observe vaginal exams. It was a productive and fun week because I enjoy performing procedures and just doing something, despite the long, tiring hours.

I showed up for sign-in at 5pm. At first, I had birds and stars spinning around my head from all the abbreviations rapidly tossed about.  I was in a complete whirlwind from how fast the residents were talking about patients and the squiggles on the computer commonly known as fetal heart tracings and how slow I was writing notes I could barely fathom. Thank God for Google for carrying me back from the sea of OB/Gyn lingo. From 6pm-6am, a full 12 hours, I would be attached to the intern’s hip as I traversed the floors and ER whenever she was beeped. Nights were slow and quiet, but when deliveries or emergencies happened, you had your hands full. And I liked it that way.

Early in the week, I was not adjusted to the night hours. I have a tendency require heavy doses of sleep, with bouts of narcoleptic moments by day; otherwise, I crank up the crank-o-meter. It was 5am and the floor was quiet. I was so sleepy and cold that I wrapped myself in a warm blanket like a burrito and plopped on the bed in the resident call room. Before I knew it, I curled up into fetal position and dozed off. Next moment, I shook awake and shuffled out of the room. Who knew that within 30 minutes, I would miss out on two births… TWO BIRTHS!!!  Two births I was waiting for ALL FREAKING NIGHT!! Gone in the minutes I drifted into the clouds… I learned a couple of lessons that morning:

1)    Do not venture into resident territory and sleep on their turf

2)    Do not sleep on your shift, especially as a medical student; I was not aboard a 24-hour shift and it just makes you look like a bum

3)    If you do feel sleepy, sit in a chair, turn your back to your audience, tilt your head down as if you’re concentrating on a paper, and then doze off. Just don’t fall off your chair, because that’ll make you look like a fool.

By 7am, I was a zombie by day.  It was odd, walking through the hospital as people drifted in to start their day and I was off to bed.  By day, I was sleeping in the tiny, boxy, and gray call room in the basement, designated just for the medical students.  You may ask, why the hell would you stay in this box when you could go across the street to your apartment and sleep under your own snuggly blankets? People did not get me, but here’s why.

1)    I’m Asian. I don’t sleep in my own bed unless I’m washed and clean.  I was so tired by 7am, I did not have the energy to shower. That was how sleepy I was. I would rather stay in the call room and sleep in a clean bed there than get my personal bed dirty. After all, I am working in a hospital…

2)    Even if I showered back at my apartment across the street, I did not want to wait for my hair to dry.  I did not have the energy to dig out my hair dryer and use it and I did not have the patience to let my hair dry naturally.  It’s an Asian thing:  you simply do not go to bed with your hair wet or else you’ll ‘catch a cold’ and have some negative energy about you. Honestly, I’ve broken that rule many times in the past, and you know what I did? I would sleep on my tummy, face buried in the pillow.  Times I did roll onto my back with my hair wet, I would end up with bad headaches.

In that gray box I slept in for a week, I did not know day from night, rain from sunshine. I would roll out of bed and gather my stuff to head back to my apartment and be blinded by the sun. Around 2-3 pm, I’d head back to take a refreshing shower, watch some TV, grab some food, and start my shift all over again. This schedule was set on repeat six times this week. Good thing it was only a week, because the residents do it for a month at a time.  Poor gals.

Let’s get to the highlight of my week.  How awesome is it to catch babies (and placentas) on your birthday?! How cool is it to say to the parents, “Dude, congratulations… your baby and I share the same special birthday. We’ll be forever connected!”  A once-in-a-lifetime opportunity to experience the joy of a new baby and a birthday spent on night float in the hospital.  Unfortunately, I missed the early hours just after midnight on Friday because I had to catch some sleep for my lectures. And of course, I missed most of the daytime because of lectures. Needless to say, I missed some births I was anticipating to happen since my Thursday night shift. It only left me 7 hours on Friday evening to physically catch a baby.

There were two families I made that special connection with.  One family, the Demartinos, were just plain awesome.  I met them on Wednesday night when Carol, a very sweet Filipino lady, was admitted for observation for high blood pressures.  Her 24-hour urine turned up positive for protein, which suggested preeclampsia. The baby was close to term and she was induced for labor.  Too bad I missed her C-section, since I followed her labor from beginning to end and had long chat sessions to occupy my time and their stay.  But I did manage to visit them on the maternity ward and say hello to their baby boy, Stefano. They were a pleasant couple with an adorable bundle of joy!  They were very excited to hear their son shared the same birthday as the medical student who followed them for the past 3 days.

The other family, the Connollys, were just as funny and incredible.  I met them in the beginning of the week for a labor check.  They were scheduled to come in Saturday (today) for an induction of labor. I did think I would be that memorable, but I was surprised they remembered me still today.  I also must add, my positive experience with them was partly due to their awesomely charming obstetrician, Dr. Lazarou.  I must admit, I had a crush on the doc; he had the hunky looks (it’s the Greekiness), the personality (chill, chatty, and charming), and the brains (he attended NYU, my alma mater, for a few years).  Anyway, Mrs. Connolly apparently told him over the phone that she met a very pleasant medical student and her birthday’s coming up on Friday, so he better be nice to me. Come the end of the week, both doctor and patient were still crystal clear who I was =D

Unfortunately, baby and me did not end up sharing a birthday; it was darn close.  It was the night of September 1, just a few hours after midnight, the Connollys welcomed a baby boy to the world, and I experienced the mirth with them and Dr. Lazarou. Baby boy and me were not birthday twins, but close enough!

There you go, the celebratory culmination of my otherwise tiring, tough week on nights! I met some amazing families and their babies, who will happen to be my birthday twins.  They won’t remember, but I certainly will.  When their parents tell them the story of how they came into the world, I will be forever tied in and a part of their family.