Island Med Student

As long as I can remember I’ve been a “cryer.” I cry at SPCA commercials, ridiculously silly movies, and yes, even that one episode of Jeopardy. I never really thought that much about it until I worked with seriously ill people every day. I see tragically sad patient cases all the time. I’ve watched patients die and have dealt with a variety of very sad incidents. I’ve realized that my threshold for tears is set a bit lower than most of my peers. Try as I might, I’ve had to excuse myself out of patients’ rooms at times. As much as I try to separate myself from situations, I find it incredibly difficult to not cry at sad circumstances (for better or for worse).

From what I know about psychological theories, I can understand why my threshold for crying could be related to my upbringing. But it never seemed so real as is it did a few weeks ago. I was watching an incredibly silly, poorly made, Disney-esque movie involving some dogs. Really, it was not a reason for an adult to cry. It was just an infantile, fun-loving movie. But during one scene I felt the tears well up in my eyes. I tried to hold them back, but they poured down my face in rebellion. Then I looked around the room and saw my mother and sister crying as well. They had the same problem as me.

Call it nature. Call it nurture. Call it a ridiculous love for dogs. Call it what you might, but I realized at that moment that I came from an emotional gene pool.

I’ve thought about it many times since then. I know that the fact that I came from such a loving family has had a lot to do with the person I am. We express our emotions. We don’t hold back. We laugh out loud. We cry out loud. We bitch out loud. We YELL out loud! And that is something that I have always been proud of. Regardless of how many times it has made me look silly.

In addition, I came from a very “animal intense” and dog loving environment. I grew up on a farm, surrounded by many different types of animals. I have never not had a dog in my life. And for that I am grateful.

Tonight my mother sent me this “silly” email about “A Dog’s Purpose.” She warned me that it would make me cry. Well, it made me sob uncontrollably. And my sisters all replied saying the same. We share that same intense bond.

And I realized that I do try to live life like a dog, as the email encouraged. And I wouldn’t have it any other way. Below is the story. Cry, or don’t cry. Laugh or don’t laugh. But either way, I hope you enjoy it:

A Dog’s Purpose (from a 6-year-old):

As a veterinarian, I had been called to examine a ten-year-old Irish Wolfhound named Belker. The dog’s owners, Ron, his wife Lisa, and their little boy Shane, were all very attached to Belker, and they were hoping for a miracle.

I examined Belker and found he was dying of cancer. I told the family we couldn’t do anything for Belker, and offered to perform the euthanasia procedure for the old dog in their home.

As we made arrangements, Ron and Lisa told me they thought it would be good for six-year-old Shane to observe the procedure. They felt as though Shane might learn something from the experience.

The next day, I felt the familiar catch in my throat as Belker’s family surrounded him. Shane seemed so calm, petting the old dog for the last time, that I wondered if he understood what was going on. Within a few minutes, Belker slipped peacefully away.

The little boy seemed to accept Belker’s transition without any difficulty or confusion. We sat together for a while affer Belker’s death, wondering aloud about the sad fact that animal lives are shorter than human lives. Shane, who had been listening quietly, piped up, “I know why.” Startled, we all turned to him. What came out of his mouth next stunned me. I’d never heard a more comforting explanation. He said, “People are born so that they can learn how to live a good life …like loving everybody all the time and being nice, right?” The six-year-old continued, “Well, dogs already know how to do that, so they don’t have to stay as long.”

Live simply.
Love generously.
Care deeply.
Speak kindly.
Remember, if a dog was the teacher you would learn things like:
When loved ones come home, always run to greet them.
Never pass up the opportunity to go for a joyride.
Allow the experience of fresh air and the wind in your face to be pure ecstasy.
Take naps.
Stretch before rising.
Run, romp, and play daily.
Thrive on attention and let people touch you.
Avoid biting when a simple growl will do.
On warm days, stop to lie on your back in the grass.
On hot days, drink lots of water and lie under a shady tree.
When you’re happy, dance around and wag your entire body.
Delight in the simple joy of a long walk.
Be loyal.
Never pretend to be something you’re not.
If what you want lies buried, dig until you find it.
When someone is having a bad day, be silent, sit close by, and nuzzle them gently.
ENJOY EVERY MOMENT OF EVERY DAY!

Check out my post on Medscape to read a story about my patient who loves almonds.

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Have you ever noticed that sometimes the most emotional or worst days tend to be the ones where you learn the most? Well for me, that was true today. I had a particularly stressful day at the hospital. It was probably the combination of PMS, a huge patient load, and a longer than normal day.

When I was at the point that I was so tired that I had mentally “checked out” I got a text message from my partner Micah. He had accidentally broken the freon line in the refrigerator when attempting to defrost it, and the cookie jar fell into the dog bowl. Now, I know this isn’t the worst sequence of events that could happen to someone, but I was so already stressed out that it sent me over the edge. I started imagining Micah and my three doggies all lying dead on my apartment floor after having been exposed to the toxic fumes. I imagined having to call 911 and some sort of doggy 911 all at the same time. That, and my favorite cookies were now in the doggy bowls. If that weren’t enough, I imagined the already half-dead doggies consuming the chocolate cookies and dying from that as well. All while Micah lay dead on the floor already, without being able to save them.

Yes, I have somewhat of an overactive imagination. But everything together just sort of sent me into a mental downward spiral.

Then I met the last patient of the day. She was being dialyzed when I met her. Her health conditions sounded like a medical textbook: diabetes mellitus, hypertension, CAD, double above the knee amputations, asthma, AIDS, Hep C, s/p MI and CVA, CKD and ESRD on hemodialysis, metastatic colon CA, anasarca, SBP, pneumonia, and sepsis. She should have gone a long time ago, but she was still hanging on. I tried to talk to her but she just mumbled incomprehensibly. Eventually she asked me for some water. I asked my attending if I could give it to her even though she was NPO and on fluid restriction. I mean, yes she wasn’t supposed to have it. But at this point, did it really matter? Or would giving her a few sips of water to help with her cracked, dry lips and mouth be the humane thing to do? My attending agreed, and I raised her bed and put the cup of water to her lips. She thanked me.

Afterwards my mind went back to my dead partner, dead dogs, and broken fridge. As horrible as my day had been, compared to this poor lady, my life wasn’t all that bad.

It’s really all about perspective. One extraordinary thing about working in a hospital with incredibly sick folks is that it gives you perspective. Every day. And for that I am incredibly grateful.

Photo above is my new “fire escape refrigerator.” I guess 20 degree whether isn’t always a bad thing.

Check out my post on Medscape to read my “fake” new year’s resolutions.

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I’ve been thinking about this issue a lot lately. When I told everyone that I had decided to go to a Caribbean med school, some people thought I was crazy and said to me the “but you’re such a smart girl, why would you do that?” This post I wrote pretty much sums up my reply. But the gist is that prestige is not my goal.

Now I’m seriously considering a career in family medicine. When I told a doctor friend of mine he said, “but you’re such a smart girl, why would you do that?” I plan on writing a post to explain my thoughts on this, but I have a million reasons for wanting to pursue family medicine, and not a single one of them involves a desire for prestige.

I’ve been interviewing at different hospitals’ family medicine programs. Some of them are at more prestigious, university affiliated hospitals, and some of them are at financially challenged community hospitals. I’m finding myself drawn more to the community hospitals for many reasons that yet again I will write soon in a blog post. I told a friend of mine about this and she said, “but you’re such a smart girl, why would you do that?”

UGGHH! I just don’t get it. What difference does it make if I am the most brilliant girl on the planet?! I want to be an exceptional doctor. I want to provide excellent, compassionate care to anyone who needs it, and I’m particularly drawn to underserved populations. I just don’t understand why prestige is so important to people. I don’t care about winning a nobel prize or publishing a million articles in prestigious medical journals. I just want to be a great doctor and make the world a better place. The only opinions I really care about are my patients’. I want to give them the best and most compassionate care possible. And I doubt I’ll ever have a patient say, “but you’re such a smart girl, why would you do that?”

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

Check out my post on Medscape to read my thoughts on the meaning of life and the end of life.

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I just got home from my very last day of ob/gyn. I’m dreadfully tired. I’m sure all of you are sick of reading my endless posts about how fatigued I am from working long hours at the hospital. My apologies. But I write about my life, and the past 6 weeks of ob/gyn has involved many long hours of work.

I always promise to write about what I’ve learned during a rotation, but end up too tired to write very much. Instead of writing a nice list, with links and great information, I am going to once again make a very brief list of some “stuff learned” during my ob/gyn rotation. Here goes:

how to deliver a baby, when to induce labor, how to induce labor, how to perform a proper pelvic exam, how to work various speculums, how to do a pap smear, how to do a D&C, when to give antibiotics for women in labor, the beauty of birth, what trichomonas looks/smells like, how to measure fundal height, how to discriminate between the sounds of a placenta and baby, post-op orders for a c-section, the importance of wearing the big plastic booty covers during a c-section, how to perform an episiotomy, how to suture up a torn vagina, what drugs you can give to a pregnant woman, the importance of drinking water during pregnancy, how to perform a circumcision, how to catch a flying baby, the importance of asking the woman, not the father, about desiring pain medications, how to place an epidural, how to obtain cord blood, what pre-eclampsia looks like and how to manage/treat it, all about myomectomies, what bacterial vaginosis looks/smells like, what tests to perform during pregnancy, the importance of counseling on birth control, that some students need sensitivity training, how to read a fetal ultrasound, how to perform tubal ligations, how to differentiate between ectopic pregnancies and missed abortions, and much, much more…

I fell in love with my ob/gyn group. What a great group of people to work with. Unfortunately, med school is a crazy place where you spend crazy hours with a small group of folks for 6-12 weeks, and then start the whole process all over again. It’s kind of like prolonged speed dating, without the option to pick someone you like after it’s all over.

I had a wonderful last shift. 12 hours of labor and delivery, with no deliveries today, but a bunch of running around helping out with ob and gyn patients. At the end of the shift I ended up in a long, philosophical discussion with the head surgeon, a midwife, and another student. It was all inspired by the photos above. I was drawn to the view from one of the birthing rooms on the 12th floor of the hospital. When I arrived in the room, I found the surgeon and the midwife admiring the view as well. I snapped two photos and ended up in a 2-hour discussion with them. It’s funny and wonderful and beautiful how things bring people together. It makes me realize that there really are no coincidences. Life is a beautifully orchestrated sequence of events. And my last night of bringing new lives into this world ended with a bang. Just as it should.

Today has been interesting. I got up at 4:00 a.m, went to the hospital for ob/gyn rounds, checking up on patients, SOAP notes, etc. Then we had over 2 hours of lectures until 11:30. By the end of the lectures, I was almost dead. Because I hadn’t eaten all day, my blood sugar was probably around 4. Plus I was completely in need of sleep and the monotonous voice of the doctors did not serve to arouse me very well. Because of 3 very nice volunteers in my group, however, I was granted the rest of the day off!

I came home, gorged myself on food. And then stared at my laptop. I knew that I should probably take what little time I had (I had a doctor’s appointment in a few hours) to reply to emails, work on my emergency medicine personal statement, and research residency programs to apply to. But you know what? I decided not to!

Instead, I clipped my way-too-long-for-me fingernails, took a bubble bath and shaved my legs. Then, I put on my headphones and walked outside towards the nearest nail salon. I listened to “Sugar Sugar” by the Archies, and enjoyed the feeling of sunlight on my skin for the first time in what seems like decades. I read my Mindfulness book while getting a wonderful pedicure and relaxed on the table while getting my eyebrows “did.”

I just walked back home, listening to “Somewhere Over the Rainbow” by Israel Kamakawiwo’ole, while again enjoying the feeling of the fresh sunlight against my now shaven and beautifully plucked skin.

I am SO glad that I decided to do pamper myself, rather than work on anything related to med school. Sometimes, what you really need in life is to “Pour A Little Sugar on Me, Rainbow!”

Check out my post on Medscape about taking time to reconnect with the important things in life.

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Today might be the best day EVER!!

I took my USMLE Step 2 CS (clinical skills) test yesterday. It was SOO not that bad. All I really had to do was be myself, and treat patients like I normally would. I can say that there is a high likelihood that I passed. In fact, if I didn’t pass, I will be sorely confused. Actually, I even had one of my patients laughing even though they were supposed to be screaming in pain!

Just now, I sat down at my computer, getting ready to write the above paragraph, and I got that scary email from the ECFMG, “Your Score Report is Now Available.” Of course, I quit everything I was doing and hurriedly logged onto the site to download my report. Nothing else mattered at that point, but reading my freakin report! And then I finally opened the PDF, and…..I PASSED the USMLE STEP 2 CK (clinical knowledge)! And not only did I pass, but I did pretty okay. I think I could have done a heckofalot better if it had not been for the horrible pain that I was in that day, but at this point, I really don’t care!

So, what does this mean? Well, if I am correct (and I think the chances are good), I passed the USMLE Step 2 CS. I have now also passed the USMLE Step 1 and Step 2 CK. So, I have PASSED all the requirements to graduate and become an MD! Basically, I just need to finish up my rotations, and then I will be able to receive my diploma and make my doggies start calling me Dr. Campbell (okay, I doubt they actually will…but it would be cute).

I’m DONE!!!