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.

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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!

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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…

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

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!

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

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.

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Liquid Dreams

With each day’s worth of musings, I get a clearer picture of what I want to do with my life:  Anesthesia.  What I will be doing for people will be what I do best myself:  Sleep.  Like putting together my morning cup of coffee to keep me moving like the Energizer bunny, I will become a master of the sleeping cocktail:  ease in the midazolam (oh the beauty of benzos!), breathe in a whole lotta oxygen (you know you like O2 when you go swimming), pump in the milky propofol (works like a charm!), spice up with some fine fine fentanyl (very strong opioid), jazz up with a little lidocaine (local anesthetic), top off the opening act with a pinch of vecuronium (muscle relaxant), and add a continuous whiff of sevoflurane (inhaled anesthetic), and your patient is in another universe.  Now you have a fully sleeping patient probably cruising halfway to Hawaii already.

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This past month and a half, I’ve been having long, constant pondering sessions on what I want to do for the next 30 plus years,  Emergency Medicine vs. Anesthesia.  Amidst my inner mental battles, I also have to figure out my 4th year schedule and away electives at prospective places I may wish to do residency.  But of course, both these plans hinder on me having a rock solid idea of what field I’m going into.  I run a daily list of pros and cons. I chat with residents and attending physicians day in and day out.  I consider lifestyle, because I need to eat/cook/sleep/watch dramas/read/exercise/vacation/yada yada … I also factor in the murky future for physicians and the general unknown world of health care we must accept, thanks to Obamacare.

Clearly, I’m in high stress mode these few months.  I have to make a career-changing decision, STAT.  In a couple of years time, I will have a job, albeit a five-digit figure, barely enough for life’s sustenance for the amount of work I’ll be scutting.

And you know what happens to me when my brain is on overdrive?  That’s right, I start having funky dreams.

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Last night, I had a dream I was in the operating room.  I was on the anesthesia side, behind the curtains with the fancy monitors and gadgets, gases, and medications.  One of the crucial intraoperative tasks of an anesthesiologist is to monitor vital signs … and input/output.  Input is how much fluids (or blood) is going into the patient, while output is measured by how much urine is coming out (and blood loss).  Typically, patients under general anesthesia have a Foley catheter to the bladder, and urine is collected and measured.  In the case the container fills up, the urine gets emptied out.  Usually you do not expect much urine because patients going in for surgery are kept NPO (no food or drink at least 8 hours before the operation). Except in my wet dreams…

FoleyIn my dreams, the patient on the table kept peeing out the Foley catheter, and I was mysteriously knighted the responsibility of emptying the containers under the table.  So much pee was flowing through the tube and container that I just could not keep up!  I was panicking, blubbering and shaking.  There were jugs and coolers filled with pee!!!  I was on my hands and knees under the sterile drapes trying to maintain pee control!  Where was the anesthesia resident to help me?!  Was the surgeon above the table yelling at how inept I was?  I heard nothing:  no surgeon cursing, no anesthesia to the rescue… Oddly enough, there was also no spillage and flooding onto the floor, or splashes to my face o.O   It was like the calm of a storm, the eye of a hurricane.  I turned back to the container in front of me, pushed down on the release button (like those spigots on the giant jugs you see for football games), and collected the continuously flowing pee…

And then I woke up before I could remotely make sense of this bizarre setting.

What a baffling dream?!  There was just a free-flowing fountain of pee coming out the Foley, rather benign now that I think about it.  Perhaps I have a subconscious fear of doing other people’s dirty work, such as cleaning up bodily excretions, which typically are left to the nurses, not the doctors anyway.  Perhaps I hate starting off at the bottom with the scutwork.  Who knows?!

What’s next to haunt my dreams, a patient going into anaphylaxis?  A patient waking up and popping up in the middle of surgery?  Laryngospasm during extubation (this actually happened a few weeks ago)?  What if I was the patient on the operating table and all of the above happened, plus more of the unthinkable? … {Shivers}

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Do I still want to Anesthesia?  Absolutely.  I loved my clinical experience, and would love it as a job I would want to wake up to every morning!  No bizarre dreams will deter the clear and solid path I have settled on.