Archives

Just My Luck … With Graduations

If I am a black cloud in something, that something is graduation.  My gloomy graduation history dates back to 2006.  What are the chances that every landmark graduation ceremony in my education process elicits tears from the sky?  Count them, thrice – high school, undergraduate (Baccalaureate AND Commencement) and last week, medical school.

High School Days

Out of all my career graduations, this was the least I cared about; hence, I was the most okay with nearly missing it.  At that time, I was a girl of few needs:  1) go to an Ivy League college, or somewhere close enough to a prestigious brand, 2) be valedictorian, or settle for salutatorian and 3) get off Long Island.  I fulfilled about 1½ points on that list.  I was most bummed that I did not graduate in the top 2 of my class to attain the lofty title of valedictorian or salutatorian (I was ranked #3, with no Olympic bronze medal recognition for that achievement).  The gunner in me then forever held a grudge against the high school that cheated me of my accomplishments, especially since I clean-swept all the senior awards with the highest, nearly perfect grades in all my classes.  Connetquot was unfortunately still on a “quality points system” that year, as opposed to the more mainstream “weighted average system.”  I still remember Connetquot as the school that essentially dinged a student for trying to be well rounded by playing in the orchestra (a lowly level 4 course), while another student with less stellar grades who was able to take more advanced classes received more points and ranked higher.  It was also the school that held me back from taking more Advanced Placement (AP) classes early enough to count more before college applications went out.  Except for a few special teachers who nurtured my potential and vision for success, there was nothing memorable about the high school that tethered my wings to a wall.

Now you have a basic understanding of my residual bitterness and how I could careless about graduating high school?  Maybe I did not get into my top choice of colleges (Cornell) and yet, I was happy and looking forward to life and school in the city (NYU).  Let’s not forget, I was bouncing off Long Island after 18 years of suburban, if not rural, life.

Excellence My Ends

Excellence My Ends

The morning of graduation was cloudy, humid and rainy.  I looked out the window and heard the pitter-patter of rain … and rolled back to sleep.  I assumed the graduation ceremony was cancelled due to inclement weather.  Nope, it was on.  In haste, I rinsed my curls and threw on my white cap and gown and ran in 4-inch heels.  I was not the only idiot who thought there was no graduation, seeing girls and guys getting dropped off and running into the school.  And here were the beginnings of my tardy tendencies.

I rushed to find my spot on line, somewhere amongst the honor society gang.  Because I was late, I also lost the spot I had on stage, one I personally requested and squeezed from the principal to make something worthwhile out of being #3.

The graduation could not have been more of a drag. The only family spectator was my father; my mother and sister did not come, given how rushed the morning was.  My hair was frizzing from the humidity.  I was nervously looking up at the sky, believing it would shower at any moment’s strike.  What was I proud of?  Getting through with perfect grades and off the island?  My school failed me and perfect grades did not get me on stage where I belonged.  In a deviant way, I was glad that it was dark and gloomy, for I believed the heavens above saw it befitting to make the day miserable for Connetquot and it’s Class of 2006 Graduates.

Wow, I still sound bitter 8 years later …

NYU Memories

The little chunk of campus I experienced

The little chunk of campus I experienced

Every May in honor of NYU graduates, the Empire State Building lights up Violet!

Every May in honor of NYU graduates, the Empire State Building lights up Violet!

College epitomized my glory years.  It was a fresh environment with a much more intellectual and social crowd.  I was happier, the butterfly that emerged from a tight, suffocating cocoon and spread its wings to fly and discover the world.  Come on, I was going to school in the middle of Manhattan!!!  I had no campus, but that did not matter, because my fun-filled campus was uniquely all of NYC.  These were the years I spent finding myself, exploring the city, reconnecting with my Asian heritage and making awesome friends to last a lifetime.

Four years bounced by, and now I was part of NYU College of Arts & Science, Class of 2010.  My Baccalaureate Ceremony took place at the famous Radio City Music Hall.  Center stage and Magna Cum Laude.

While the ceremony was indoors, outside it was again, dreary and gray. There were a few sprinkles, but not significant enough to ruin my wonderful graduation day.

 ~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-

Commencement was a different situation, that fateful Wednesday in May at Yankee Stadium.  It was cold and horribly wet and more like May showers.  Ponchos and caps were passed out for barely enough coverage.  I was freezing in my violet gown that did nothing for insulation.  There I sat, for the next few hours, under a bright yellow umbrella ready to break or fly away, listening to Alec Baldwin and other VIP people give speeches about inspiration and success.  Where was the sunshine I so anticipated for my huge and memorable college graduation?  Apparently, it was playing hide-and-seek in the ultimate hiding spot and refusing to budge.

Okay, it was pretty cool to graduate at Yankee Stadium

Okay, it was pretty cool to graduate at Yankee Stadium

All the special people get FULL coverage from Mother Nature's wrath

All the special people get FULL coverage from Mother Nature’s wrath

President Sexton, meet Dr. Alec Baldwin, crowned Doc of Fine Arts in 2010

President Sexton, meet Dr. Alec Baldwin, crowned Doc of Fine Arts in 2010

What you giggly about Alec?

What you giggly about Alec?

Here are my previous blog entries back in May 2010:

End of a very Violet Era, Part 1

End of a very Violet Era, Part 2

Those days were less okay for rain to ruin, but I had another 4 years to gain graduation redemption, with medical school.

Freshly Minted MD

Fat chance.

The forecast for my medical school graduation on Thursday May 22, 2014 was just as glum as my luck with the last two cycles of graduation.  The morning started off bleak, but relatively dry.  Just as my fellow soon-to-be doctors assembled for the Class of 2014 photograph outside by the campus fountain, the droplets of rain started to pitter-patter.  Perfect timing.

At least the ceremony took place in the Staller Center for the Performing Arts, with a stable enough roof for coverage.

Fat chance again.  We had just finished the hooding process on stage, the ceremonial initiation into Doctordom.  Then something epically unprecedented happened:  the fire alarm went off in the middle of the Hippocratic Oath.  It did not cease to stop, in case it was a false alarm, so we all had to evacuate.  Into pouring rain.  Perfect timing, again.

On top of my day of unfortunate occurrences, my dear sister missed my graduation.  She rushed to take all her finals in order to catch a flight out from California in time for my once-in-a-lifetime graduation from medical school.  Except en route, unprecedented and unseasonal weather in Denver derailed her flight (and many other travelers with important, but less so, itineraries) into New York and in time for my special day.  Inclement weather in the form of wild tornadoes and shooting hailstorms was rarely seen in Denver, except on that one fateful Wednesday.  I was bummed my sister could not make it to my graduation, the one person who has put up with my shenanigans all these years, like stressing out and taking a marathon of final exams back to back just come home in time for me.  After the chaos that comes with flight cancellations and angry mobs of travelers, it took her a grand total of 24 hours and hopping through 5 cities before she touched down safely.  Now I’m beginning to wonder, would I just be a bad luck charm for her graduation next year?

~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-

Ray of Sunshine Despite being a black cloud given my dark history of graduations, finally a sliver of sunshine peeks through the gray clouds. My education has taken a grand total of 20 years (if you count kindergarten), but it has not stopped there.  Learning is a lifelong endeavor, an ever-changing process.  It has been an uphill trek, with each step building a foundation for the next higher step.

Elementary school was defined by the basics of the alphabet and arithmetic.  For me, it was also learning English as a second language.  If I put a brown paper bag over my head and spoke, I would sound like any young white girl off the streets.  You would not guess I was in ESL for 3 years.

The large chunk of time defined by middle and high school was all about mastering the SATs and AP exams to get into the best university personally possible.  Those were my hard-working, gunner days.

From college onwards, there was a gradual decline in my gunner ways.  I still worked my butt off for good grades, but I valued my youth and social life more.  There, I built a nice liberal arts foundation and fulfilled rigorous premedical requirements, and took too much time for retail therapy and bubble tea and culinary excursions.

And now, the last 4 years have been defined as my medical enlightenment saga, where the real beginnings develop for a young doctor-in-training.  From burying my brain in books and medical lingo to falling asleep in lectures almost on a daily basis to roaming the wards and chasing after residents who think you’re a pestilent ghost, medical school have nurtured fine memories.  I graduated at the tender age of 25; I have learned so much, and yet so little.  Just as there’s always wiggle room for dessert, there’s also room for personal and academic development.

Thank you to my family and friends for their love and support.  I have made some wonderful, intelligent, compassionate and talented friends who I am glad to call my dear physician colleagues.  Together, we will be friends to last a lifetime, forever connected by our beginnings at Stony Brook Medicine as we journey forward on a magic carpet ride into the world of medicine.

Haha, my Mama's donning a white coat!

Haha, my Mama’s donning a white coat!

Proud Mama and Papa at Graduation Din Din

Proud Mama and Papa at Graduation Din Din

(Gray) Graduation Day!!!

(Gray) Graduation Day!!!

Sister, Sister

Sister, Sister

Sister, Sister ... Take 2

Sister, Sister … Take 2

WORLD, prepare for some awesomely bad ass doctors coming your way! 

Congratulations to all 129 Graduates of Stony Brook School of Medicine, Class of 2014!!!

At the end of the alphabet, where the cool kids are

At the end of the alphabet, where the cool kids are

 

Still at the end of the alphabet

Still at the end of the alphabet

The obligatory, Connie Yu MD graduation selfie

The obligatory, Connie Yu MD graduation selfie

The Final Countdown

The Match, one of the most memorable moments of medical school and training.  A week filled with anticipation, agony and anxiety.  Beginning this past summer, applications for residency were prepared and sent to various programs around the country.  Interviews occurred from earliest in mid-October to the end of January.  For me, I had a very extensive and arduous interview trail, spanning that entire season.

Oddly enough, applying for residency is like searching and interviewing for a first job, except for a few minor deviations when it comes to the complicated world of medicine.

  1. So you go on 10 – 15 interviews for whatever specialty you choose.  You generate a rank list and so does every program.  Yes, you rank your potential employers.
  2. A computer determines your fate.  Yes, a computer takes nearly 30,000 lists by applicants plus lists by each program, multiplied by >30 specialties.  Applicants are essentially “matched” to one program based on their respective lists.  Prospective doctors are at the mercy of a technological beast, how mysterious right?
  3. There is no such thing as multiple job offers.  You will never know what program liked (or hated) you.  On February 26, the rank lists were finalized and sucked into a black hole.  Pixie dust and magic occurs soon after for 2 weeks … until March 17.

Did I Match? … Monday was a big day, where I learned whether or not I matched to a program.  At exactly 12:00PM (well, a little earlier than that on my phone), the big email came…

It's a Match!!!

It’s a Match!!!

Phew! What a relief!  The most optimistic four words I have ever been excited over!  Not that I doubted I was going to match, but I can’t help being a neurotic medical student!  Sunday night was the first night in nearly 25 years of my life I was an insomniac.  The catecholamines and endorphins on fire throughout my body kept me up and awake until 3AM.  Even unconsciously, I’ve been stressing about the Match.  This past weekend with my friends on a mini-hiking trip, I was talking in my sleep, asking “Hey, are you nervous?” So my friend responds, “About what?”  And I say, still asleep and with absolutely no recollection of this event, “About the Match of course!”  Clearly, I’ve been experiencing some turbulence deep down in my unconscious.

Luckily, I do not have to go through this week’s infamously named the Scramble, which has since changed to the Post-Match Supplemental Offer and Acceptance Program (SOAP).  This is where applicants who did not match search, apply and hopefully accept an open, unfilled spot in available specialties.  For those who do unfortunately, it’s highly stressful to try and nail a residency spot in 4 days time.

——————————————————–

What is bound to happen when you have thousands of medical students anxiously and impatiently awaiting their fate that has already been determined as of Monday?  Let’s see, we have brains and beauty, manual dexterity and technological sass … something is bound to happen.  And it did.

On Monday night, someone on Student Doctor Net forum posted a trick to seeing where people matched.  By going on the National Residency Match Program (NRMP) homepage, right clicking on the page and viewing the page source, there would have been fate, revealed.  Many students got wind of this underhanded trick, courtesy of poor programming and glitch in the system.  Maybe except Stony Brook, because our entire class is either taking a sub-internship or taking a course called Transition into Residency.  I was busy studying for a midterm the following day!  Well, I was distracted and perusing the SDN forum in Emergency Medicine to see what stupid drama was unfolding, which meant I was totally in the wrong forum!

I guess it was meant to be.  I enjoy surprises.  I look forward to the glorious moment I will be sharing with my friends, family and faculty come Friday.  Even if I had that choice, I would not want such a precious moment destroyed by curiosity, impatience and technology.  Match Day is a climactic time representing my hard work and accomplishments since kindergarten.  I have come so far since coloring in the lines and raising (and killing) a baby caterpillar.  Tomorrow will be an amazing day and I cannot wait to see where I will be for the next 3 or 4 years!

balloons

A Rite of Passage for All in Medicine

Medical students have the fortune of dealing with gore, germs, and gas.  It’s part of the unwritten law when we sign on to roam the wards in the beginning of 3rd year.

Now, I survived most of my clinical years without getting urinated on or blood squirted at.  I did have the grand luck of scrubbing into a gyn-oncology case involving a pelvic mass that was most likely metastatic ovarian cancer.  The surgery involved a massive tumor debulking with an exploratory laparotomy.  This woman had 11 liters of ascitic fluid in her belly due to metastatic disease.  All of that poured out and no suctioning could keep up with the overflow.  Of course, from my standpoint, I bore the brunt of this overflow when the suction failed me.

Flash forward to my 4th year now.  I’m on a trauma surgery elective.  There is a patient on the floor under the general surgery service who has a small bowel obstruction (SBO).  He hasn’t been passing gas (aka. farting) or making bowel movements.  Plus, he started vomiting again.  Clearly, he was obstructing.  The next step in management would be decompression via nasogastric placement and suction.  The nasogastric tube (NGT) is inserted through the nostril into the nasopharynx and oropharynx, and hopefully down the esophagus into the stomach.  The suctioning helps to decompress the bowel and allow the bowels to ‘untwist’ to relieve the obstruction.

I’ve placed one NGT before at the Peconic Bay ED.  It was painful seeing the patient gag, vomit and suffer.  Last month in the ED, I observed an NGT placement for a man with a high-grade SBO.  Even with the lidocaine anesthetic spray in the throat, the poor guy was gagging and swallowing really hard to push that tube down.  Simply witnessing an NGT placement makes ME hesitate, choke, grimace and tear!

Well, opportunity presented itself this week on trauma service.  Hey, I signed up for this elective to DO stuff, right?  A surgery resident was next to me.  The nurses attached the tubing to suction. I put on a pair of gloves and mercifully lubricated the NGT.  The bucket was strategically placed in front of the patient.  I looked at him, put my hands on his shoulder as I looked him in the eye and apologized profusely for what I was about to do.  By far, it is the most uncomfortable thing to witness and perform, but most certainly to experience first-hand, awake.

My resident assured me, “Make sure you keep going and do it quickly.” Okay, I braced myself, armed and ready to go.  Before I went for it, I said, “Sorry sir, it’s going to be a little uncomfortable, but I’ll make it quick.”  I lied.  It was not quick.  The tubing went in and struck the back of the nasopharynx.  It was plastic tubing, so I was banking on it to cooperate and just bend.  But the tube kept hitting a dead end!  I just needed to push it a little harder to get past the impediment.  In the meantime, my patient was gagging and tearing in discomfort.  My resident stepped in and pushed the tubing down like a pro.  This all happened in a matter of 5 seconds, which is not very long in layman times, but at the bedside, it felt much longer.  Boy was I tense, sweaty and wide-eyed.

Oh, and as he was lying in discomfort after getting a tube down his throat and I was at his bedside patting away his misery, he vomited smelly green fluid all over my left hand.  He missed the bucket and bulls-eyed my hand, and white Swatch.  I should have been smarter with my positioning and gowning.  I mean, my hand should not have been in the path of potential vomitus nor over the bucket.  Still, I did not leave his side and continued to reassure him that he was okay and the worst part was over.  Unless, he thought the worst part was vomiting on me ….

Swarovski Face FountainAfter I washed my hands (and watch), he apologized profusely.  I do not know if he was red from the embarrassment, the vomiting or the nasogastric experience.  The next few days on early morning rounds at the bedside, he continued to apologize for puking on me.  No matter how much I smiled, saying “It’s okay, really…,” he would greet me with, “I’m sorry again for what happened last time… really really sorry.”

Well, he was a very nice patient.  But I like to have a “lesson learned” tidbit at the end of an entry.  The next two nasogastric tubes I did on the floor were great successes, meaning no projectile action or embarrassing moments.  And those times, I armed myself with a blue gown for added protection.  Just in case …

No Brainer

One thing I learned from my neurology rotation thus far is that I must stop being so awkward in front of patients.  Here are some memorable moments, which are mostly humorous interactions that only point to how awkward of a medical student I still am, even as a ‘wizened’ 4th year!

mental trainingThe Mini Mental Status Examination:  Usually I start off the neurological evaluation with cognition.  I stumble with this part a great deal.  I feel like it’s a nonsensical Q&A session and the patient wonders why I’m asking silly questions about puppies and math and sticking out the tongue…

Is the patient awake, somnolent, lethargic, or comatose/unconscious?  If the patient is awake, how alert is he or she?  Well that’s tested with several components:  orientation to person (self), time (date, month, year) & place (hospital, city, state); registration (repeating 3 named objects, like “apple, dog, cup”); attention and/or calculation (spelling WORLD backwards or serial 7’s by counting back by 7s from 100); short-term recall (of the previously named objects); language (naming of 3 objects I point out on or around me); repetition; and complex commands, including obeying (“stick your tongue out”), reading (“close your eyes” and do as it says), writing (a full sentence, with subject and predicate to be fancy), and drawing (a complex figure of 2 overlapping pentagons to bring out the inner kindergartener).

So one day, my partner in neurology crime and I set off to do a consult on a patient evaluated for stroke vs. syncope vs. seizure.  He was under the trauma service for several days status post motor vehicle collision where he was amnesiac to the event. The problem?  He was pretty uncooperative.  And obese… and could care less what we were doing for him.  He was falling asleep during our encounter, basking beneath of the beaming rays of sunlight infiltrating his side of the room. Add to that, he was an Italian guy with a heavy mafia-man accent.

Now, I try my best to go through the mental status examination.  I think, I speak louder, I enunciate, I repeat.

I get to the attention and serial calculation section, which has always been a hiccup for me AND the elderly patient. Why me you ask?  Mostly dealing with the frustrated patient who stalls, scratches head and gives up.  Well, this elderly, big and burly, sleepy Italian guy with an accent was a unique one.  I asked him, “Okay sir, can you spell the word WATCH forwards for me?”  He furrowed his brows, gave me a dazed look, and stumbled like a wobbly toddler. He said, “What? … Uhhhh, [bumbles a bit]… blergh…”  Okay, so it was well established that he could not spell a word forwards.  What I did next was beyond my comprehension.  I looked at him again and commanded, “Now, spell WATCH backwards.”  What an epic fail?!!  Go ahead and laugh, I’m laughing at myself too.

stupid-momentsFast forward through the neurological exam to the cerebellar testing, with the same Italian patient. Typically for testing of cerebellar function, the primary center of balance and coordination, you do finger-to-nose, rapid alternating hand movements, or heel-to-shin.  I stand in front of him, face-to-face, with my finger held up in front of my face.  I asked him to do the following:  “Okay, use your finger and touch your nose, then my finger.  Back and forth like that… And I’ll be moving my finger.”  So he touched his nose, smiled a little, overshot my finger, and touched MY NOSE.  Startled like a buzzed monkey, I jerked and nearly fell over backwards.  He laughed, my friend laughed, and I probably turned tomato-red.

finger-touching-nose-of-babyThis was not the only time I was touched by a patient, literally. For general neurology consult in the ED this week for a patient with 2 day history of severe headaches associated with nausea and photophobia, who also happens to be a happy hunter (which classically points toward a viral meningitis picture, especially when the patient had similar symptoms and the stated diagnosis 20 years ago, but the ED physicians somehow failed to get a lumbar puncture and consider it in the differential diagnosis BEFORE calling neurology…)  Anyway, I was obtaining his history and asked him to point to the location of his headache.  Normally, patients would localize with their hands, on themselves.  Well now, this gentleman reached over the banister and up, busted into my Connie bubble, and palmed my head.  That’s right, he essentially gave me a big pat on the head as he was describing his headache.  We all found it pretty comedic moments later, when he realized he was supposed to point to his own head.  When I performed the routine finger-to-nose test to assess coordination, he, like the Italian guy, touched my nose and found it humorous.  This time, I was less caught off-guard and did not nearly fall back onto my rear end.  Man, do these patients enjoy ruffling my feathers for kicks and giggles. Oyyyy…  The embarrassing moments for me did not end there…

Same meningitis guy who palmed my head… during the mini-mental status exam, I asked him to follow some basic commands.  I said to him, “Okay sir, take your right finger and touch your left nose.”  Awkward silence, a confused expression on the patient’s face, finger immobilized in mid-air …. then a burst of laughter as my partner next to me cracked and nearly died.  I shook my head as I wanted to face palm myself right there.  What I meant to say was, “Take your right finger and touch your left ear” to gauge cross command comprehension and execution.  Instead, I made an idiotic blunder when I looked at the guy’s face, in particular his nose, the one nose, as I was anticipating and saying aloud the next step.

polar_face_palmOh the journeys of medicine… Can you believe I’m going to be an intern, released into the ripping wild in 8 months????  Triple ooyyyyyy….

Emergency Surprise!!!

It’s been a dilemma 9 months in the making:  Anesthesia versus Emergency Medicine.  Wow, that’s the amount of time for a full-term baby to pop out!  Am I ready to be “born,” to take the first baby steps towards being a doctor in the real world?

Since January, I have been straddling the fence between Anesthesiology and Emergency Medicine.  I did both mini-clerkships back-to-back in the middle of 3rd year, and loved both equally.  I was that eager medical student, chasing down blood draws and IV placements, clearing the rack of charts, driving the stretcher into the OR (albeit haphazardly, like your stereotypical Asian female driver) and jumping to intubate!

Anesthesia_CoffeeIn the past 9 months, I ended up picking anesthesiology and just running with it.  No looking back, no tripping and no regretting.  I even did an international trip to China with one an anesthesiology team from across America to raise awareness about epidural analgesia during delivery, a method of pain management so prevalent in the United States, but lacking in China.  A great trip to top off the end of 3rd year and solidify my path towards anesthesiology as the centerpiece of my personal statement.  Or so I thought…

anesthesiologist-copyNow, the BIG however… Call it a 6th sense or the devil versus angel sitting upon my shoulders.  I still felt fidgety about my choice, a constant nagging sensation in the deep cortices of my brain.  Why was I asking dozens of residents and anesthesiologists why and how they chose the field?  What are their career plans?  What does the future look like, as if a magic crystal ball exists in every operating room?

I had misgivings about the field, particularly with the uncertainties of Obamacare.  For instance, Obamacare calls for increased use of midlevel providers, such as physician assistants and nurse practitioners, to fulfill the need for primary care providers.  In essence, they are cheaper labor for less time (in terms of education and training).  Now, translate that to anesthesiology… certified nurse anesthetists (cRNAs) are infiltrating the field, citing they are as equally qualified as MD anesthesiologists to perform procedures, administer powerful medications and work independently. In roughly a dozen states, cRNAs can practice in the OR without physician supervision.  With all the head butting and increased competition, there is a growing expectation of physicians to pursue fellowship training in areas such as pain management, cardiothoracic surgery, pediatrics, obstetrics and regional anesthesia, to have that extra level of expertise, particularly in saturated areas of the country (think urban hubs, from East Coast to the West Coast).

anesthesiologyFrom my experience and extensive research sifting through blogs and articles, the future as an anesthesiologist is looking murky and potentially on the downslope.  People have tried dodging this question, but I have a good idea of the answer.  Reimbursements are going down.  MD anesthesiologists may be moving towards perioperative care, working in the clinic and optimizing patients for surgery.  They are also falling into a supervising role, where one physician oversees 4-5 rooms of residents (at an academic center) or nurse anesthetists (community or academic hospitals). The physician in charge pops into the room when 1) it’s time to intubate, 2) it’s time to extubate or 3) when complications arise.  Of course, more complicated patients will require a physician from beginning to end, attentive to the vital signs, medications, fluid input/output and actual surgery.

And I believe that’s what struck me the most:  potentially less patient contact and feeling less like a doctor.  Your interaction with the patient is 75% in the OR, when he or she is heavily medicated and asleep.  True, leading up to anesthetizing a patient, you are the person alleviating any anxiety and concerns, which is a powerful role anesthesiologists play.  At the same time, you are a floating manager, instead of the hands-on doctor who cares for the patient from beginning to end.  I need to talk, touch and think.  I need to be remembered, be the doctor.

Here is my top 5 list of reasons why I switched last minute… 1-2-3… Breathe!!!

1. I’m not a clinic person:  I shadowed for a morning in the perioperative clinic… and hated it. When I was in the pain clinic… it was utterly painful.  Yes, it’s lucrative, procedure-heavy and regular.  But hells-to-the-no when days drag on and you have to deal with potential opioid addicts and chronic pain patients who are only temporarily treated with steroid injections and never really cured.  There’s a belief floating out there that people who go into anesthesiology, but hate the operating room and love the moolah, end up in the pain clinic.  One of the basic foundations of anesthesia is analgesia, achieving pain relief.  If I could barely deal with the acute pain service and chronic pain clinic, how could I survive becoming an anesthesiologist for the rest of my life, without paining myself?

ME_496_LifeIsPainful22. I’m a cold person:  The operating room is always too cold.  Not even donning a scrub hat and mask helps me stay warm.  Or sitting at the head of the table, playing word games and occasionally peeping over the curtain at the surgeon’s stage, trying to stay warm beside the patient’s bear hugger-heater.

tumblr_mincti1suv1qzx52zo1_5003. I’m bored:  I need excitement in my life, and sitting in a cold OR and staring at the monitors does not cater to my thirst for adventure.

anesthesiology_or

Severe_Boredom__by_Bowserkills74. I’m a world traveler:  In my personal statement, I wrote about my trip to China and newfound motivation to become an anesthesiologist.  When the chairman of medicine critiqued it, he stated, “… I don’t see how global health fits in with your career choice in anesthesiology… there just aren’t many opportunities out there for you… and it’ll confuse your readers.”  And it clicked.  No matter how much I force it, anesthesiology was not meant to be.

around-the-world-153845. I’m a fashionista:  When you’re wearing hospital scrubs all day, hiding and suffocating behind a mask and stuffing your long black locks into a scrub cap, it’s hard to become a fabulous trendsetter.

cristina-greys.jpg?w=640——————————————————————

September rolls around, I start my sub-internship in Emergency Medicine.  I chose it because 1) my school requires every 4th year to complete a 4-week sub-internship to graduate and 2) I was potentially ruling it out.  Except… I ruled it in.  About 4 days into my sub-internship, I was a changed medical student.  Any bit of doubt and confusion dissipated and my mind was as clear as a fine spring day.  It took 4 weeks of anesthesiology to realize it was not for me and 4 days of emergency medicine to see how happy, excited and awake I was, no matter what hour or how nutritionally deprived my mind and body were.  Best diet regimen:  caffeine, water, adrenaline and some food.  I would bring in a homemade meal, Chinese veggies/chicken over rice or a simple sandwich, and it would take me hours to eat, one meal chunked into bite-sized portions over 2-4 hours.  Multitasking at my best.  Discipline made effortless.

Yummm... MRSA and VRE... Its 4pm the day before my birthday, the 1st meal of a long & fun day and its taking me hours to eat... Emergency medicine is the perfect diet and exercise regimen for a bikini body.

Yummm… MRSA and VRE… Its 4pm the day before my birthday, the 1st meal of a long & fun day and its taking me hours to eat… Emergency medicine is the perfect diet and exercise regimen for a bikini body.

So I flipped my future with a snap of my fingers.  In 2 short, but busy, weeks I had to start on a clean slate, shotgun and select programs, write a new personal statement exploring why I love emergency medicine, obtain new letters of recommendations and honor my current sub-internship with flying colors and comments.  Luckily, it only took me 1 solid day to draft a personal statement (versus a whole summer to get a single paragraph down for my anesthesiology essay).  The only thing I failed at was securing an away rotation this late in the game.  I threw my arms up in despair and crossed my fingers for the best.

Trauma-ER_Hospital_6510And what a fine month it has been, as I have never been this motivated and energetic about medicine and work thus far in life.  To be at the front lines as the “medical detective,” not knowing what surprises will come ramming through the door, is truly rewarding and exhilarating.  In a fun little series, called “Adventures in the ER,” I will have anecdotes from my month as a sub-intern and how learning from patients is the best medicine for any doctor.

Are You Afraid of the Dark?

The first day on my Radiology rotation, I walked into the pitch dark reading room and said, louder than I anticipated, “Oooooh… nap time!” Of course attending and resident physicians and other medical students were there.  They must have heard.  Even if I blushed, barely anyone would notice, because it’s just soooooo darn dark in that room!

Naturally, I enjoy my beauty sleep.  I have a wicked talent for sleeping anywhere, anytime, in any position and in any environment.  Whether there’s a Super Nova or a dark and stormy night, I will go to sleep.  Here is a glimpse of me taking a snooze in the library during first year of medical school… yeah, I work hard 😉

An Asian Sleeping in the Library...

An Asian Sleeping in the Library…

Now that you know my sleepy habits, I was bound for an uphill battle for the next two weeks.  Also not helping my situation of a potential fail, I was kick-starting the rotation jetlagged from China.  My circadian rhythm was flopped, so putting me in a dark room all morning was not conducive to keeping me alert and awake.

The other funny thing about this rotation was the fact that there were only 2 Asian girls on the rotation.  We consistently introduced ourselves as “4th year medical students on a 3rd year clerkship” because 1) there were 4th year medical students concurrently doing a Radiology elective who were going into the field and 2) we did not want to get taken seriously, making it semi-okay that we appeared clueless and zoned-out half the time. With an extensive history of being confused with other Asian girls, we were sure to be mixed up, especially with the rooms in total blackness except for an occasional glow from the computers.

My 2-week stint on Radiology gave me the best nap sessions all year.  I’d sit strategically behind the attending and resident physicians. The spinning boss chairs that I sat in made it all too comfortable to fall asleep in.  If the opportunity presented itself, I’d squeeze behind a door and play a couple of rounds of Candy Crush.  I’d turn over and check on my friend, who’d have a curtain of hair in front of her face like the Japanese Ring Girl, totally hiding out and snoozing.

I came awfully close to getting caught this one time.  We were in nuclear medicine with the course director, Dr. M.  As he’d be reviewing nuclear scans, such as PET scans and all that jazz, we would be attempting to pay attention to every detail and look at least half-interested, speaking he was THE director.  The room was glowing white.  I sat behind him.  Still jetlagged late last week, I was trapped in boredom.  Fighting to stay awake, I lost and fell asleep for a solid 2 minutes.  Luckily I did not snore, as I was mad tired.  My friend said to me later, “You were damn lucky he didn’t turn around!”  Whew, close call!

Other times, I’d either be in a resident presentation or lecture.  As you’d guess, I’d be fighting a losing battle, hyperextend my neck in my seat, and snooze away.  Since the lecture hall/conference rooms were very small, it was noticeable.  I made a record number of rejuvenating naps these past 2 weeks, minus a sore neck from all the hyperextension in my chair.

To end my blog on why I would fail to be a radiologist, I had the final exam this past Friday.  80 multiple choice questions on anything radiology … and I hit the snooze button during the exam.  Donned in scrubs, comfortable as ever, my friend and I both passed out during the exam.  Come on, we had 3 hours to take this exam we could care less about.  We were bound to take the elevator ride to Cloud 9!

Full Code… Full Throttle

Right now, I’m rotating through my Medicine clerkship, one of the most comprehensive and intellectually stimulating rotations of medical school.  And this Saturday, I experienced my first coding patient.  Who knew I’d participate in the hands-on resuscitation efforts of a dying woman, just like how you’d see it on TV?  Literally, HANDS-ON!!!

I was doing a weekend call on the telemetry floor, where patients come in with shortness of breath and/or chest pains and are on continuous cardiac monitoring. I was seated at the computer station, doing my notes so I could get out early.  Next thing I knew, people were running and huddling down the hall.  My partner and I wiggled ourselves into the commotion and found ourselves amidst a full code.

This 99 year old lady was in asystole – aka, “flatlined.” Her heart was not beating, she did not have a pulse. The way to resuscitate this poor lady was to do chest compressions to massage the heart back into electrical activity and IV vasopressors like epinephrine.  Residents and nurses were bunched around the bed, in this tiny room, shouting orders and poking the hell out of the patient’s veins and arteries.  Everything was flying by so quickly; it was utter mayhem.

Asystole-LARGE

As medical students, we were delegated one simple, yet essential, task within our limits of muscle power and intellect:  mad chest compressions.  We lined up to alternate every 2 minutes of chest compressions and to check the pulse.  I went first.  I ripped off my white coat and stethoscope.  Then I jumped on the bed, fists out, arms straight, and pumped the hell out of the patient’s rib cage.  This was the very first time I did live chest compressions on a human being; previous practice sessions were on plastic dummies, and boy was the live version a workout for my nonexistent biceps!

h0FFD9CE6

It was the longest 2 minutes I’ve experienced.  You are on top of the patient and pumping your arms with all your might and stamina.  You look to your right and you see the respiratory specialists working on the patient’s airway and oxygenation.  You look to your left and see the residents attempting to obtain arterial blood and femoral access.  You are rocking the patient like an earthquake, while other members of the medical team are intubating or sticking needles into vital vessels.  After my round of CPR, I was tachycardic and diaphoretic and very much fatigued.  Yet, it was the greatest feeling in the world, knowing you participated in the resuscitation efforts of a dying patient.  Even as a medical student, you can be useful in a life-death situation.

After almost 40-45 minutes, the patient got a pulse, got a heartbeat, got a stable blood pressure.  She was whisked away to the ICU.  Soon after settling in the room, she decompensated again.  Round 2 of CPR commenced and chaos broke loose again. Except this time, the residents in ICU took turns with compressions, and they did not last very long.  She was deemed a futile resuscitation, and family was offered to consider a DNR/DNI.  And the patient died that afternoon…

Indeed it was a crazy day.  It was also a sad day because a patient did not make it, despite the hard work and efforts of the medical team.  There’s the indescribable feeling of satisfaction, knowing you were a valuable member of the medical code team. As a medical student, when you feel like you belong somewhere, you feel wanted.  You feel good.  You are important, especially when it involves patient care.  And you could save a life…