Last week was my first week of Dermatology (and the start of my last rotation! Just three more weeks and I’m officially done with medical school!), and by the end of it, I couldn’t help but think of the movie “My Big Fat Greek Wedding,” because of how often patients were told to put vaseline on various bumps and rashes and ulcers. Vaseline and steroids, I guess, would be the two most common recommendations I’ve seen.
It’s been a fun, laid back rotation though! By the end of it I should be able to treat basic acne and eczema on my own, and tell people when they really should have that mole looked at.
If anyone has any ideas for how I can sleep better for the next 16 nights until Match Day, I’d love to hear it! Lists are in, and the only thing standing between me and knowing where I’m living for the next three to five years is, well, I’m not entirely sure why it takes three weeks, but it does.
I thought it’d improve, but tonight I went to bed later and woke up even earlier! It’s normal for me to have trouble sleeping a night or two before big change, but nearly three weeks away? Sigh. It feels like I’m on a surgery rotation, except I’m on a fairly light outpatient gynecology rotation.
4:41am is an unacceptable wake up time when my alarm goes off at 6am. I’m going to try going back to sleep. (I started this post last night and figured I might as well finish it while catching myself in the act).
(You’re going to have to put up with these countdown posts for a few more months. Sorry!)
It’s one hundred days till my graduation! What amazes me is not that it’s so close, but rather, how normal it seems that I’m going to be a doctor in three months. Four years ago, I still wasn’t even sure I was going to get into medical school; I hadn’t yet received my first of three acceptances. Once I did get in, I suffered from a touch of “Impostor’s Syndrome,” and was worried that I’d gotten in by accident, that I was going to struggle through medical school, and maybe not fail out, but that I would have taken up a spot that should have gone to some more deserving person.
The year during my application cycle, I read several medical student and resident blogs, and I strongly suspected that I was going to struggle with the first two years (I was a psychology major and only took a few biology class in college), but that I was going to thrive in my clinical years. At the same time, I worried that maybe I was going to start my third year clerkships and realize that actually, I hate this, and I’ve just wasted two years of studying and ~$120K to realize that.
The real attitude change happened after my pre-clinical years. Passing Step 1 (and not just passing, but actually doing okay), and then finishing third year, finally resulted in my feeling like Yes, I deserve to be here, and more importantly, Yes, I can build a satisfying career in medicine.
Third year was hard. I worked long hours, always felt like I needed to be studying more (and was usually right about that), and even though I was in the hospital all day, I often felt useless and confused about my role on the team. And every time I finally figured things out and bonded with my team, it was time to move on to a new rotation. And yet it was amazing in its own way. I got to help deliver babies, and sew and staple and glue people’s skin (and muscle, and connective tissue) back together. I got to drain fluid out of someone’s knee, and stick foley cathers up several urethras. I got to do a lot of things that I will either never do again, or will only do during my intern year. I’ve built the extensively broad foundation of medical knowledge that all doctors start off with, and soon I’m about to begin specializing in the field that I’ll be practicing in for many, many years to come.
I remember meeting fourth year medical students when I was a first year and being in awe. Even as a third year, fourth years seemed amazing. How did they know the answer to that question?! They’re only a year ahead of me; how is the knowledge gap so vast? Fourth years seemed so wise, knowing everything from the common causes of fever after surgery, to where to get the better free coffee in the hospital (like the 7th floor patient family lounge and the neurosurgery ICU).
And I have to admit, I do feel a lot more confident these days. I figure out my place on my teams much faster, and I know how I can help. I worked hard throughout third year, and that hard work culminated in an excellent, not just okay, Step 2 CK score, and good letters of recommendation that landed me interviews at several schools I would be very happy to match at.
I remember starting medical school and thinking about how proud of myself I’m going to feel on my graduation day, and yeah, I already do feel proud. Pride is often regarded as a bad thing, and it certainly can be, but right now I’m going to bask in this sense of accomplishment. My education has only just begun, but it has begun, and I’m glad it’s going to continue. Residency is going to be its own challenge, and it’s not going to be the happiest, most relaxed days of my life, but it’s going to be meaningful, and I feel like overall I like my life best when I’m really working toward something.
I went to a special grand rounds in the pediatrics department yesterday, and the topic was “My First Death.” It was a panel of five people, plus the doctor in charge of the pediatric palliative care service in the children’s hospital. Each of the five told a story of their first patient death in their current roles, and then the floor was open to questions, or for other people to share their experiences. I’m not an easy crier, but I admit I came close to tearing up at least once or twice.
The idea of my own death still terrifies and confuses me on some level, but at the same time I am very aware of the inevitability of death, and of the extended process both dying and grieving can become. It’s interesting to me how little we talk about death in the US. When I lived in Ghana, I was confronted with death more often, but these days I think if I wasn’t in medicine, it’d be fairly easy for me to only think about it on a very superficial level.
I feel a little self conscious sometimes when talking to people outside of my family and classmates, especially on my more bleak rotations. I feel like it’s inappropriate for me to share what I’ve been going through and thinking about, like finally writing up my advance directives and assigning at least one or two medical powers of attorney, or how interesting it is to see the variety of people who are the ones standing by someone during their most trying and difficult times (sometimes not even family or romantic partners, but people whose lives have become intertwined in unusual ways), or when the death or illness of a child precipitates the end of a marriage, was the divorce inevitable someday or would they have stayed together otherwise?
I worry that speaking my mind is being a Debbie Downer, that people don’t want to hear about these things. That the stories that I find almost uplifting in a bittersweet way, like the attending who told the fellow to stop CPR so that the baby could spend the last moments of its very brief life being held instead of being pounded upon, will simply be depressing.
What was my first death as a medical student, by the way? It depends on how you define it. Was it the patient in the Emergency Department that my resident wanted me to try CPR on (I don’t remember why exactly I didn’t “get a turn”) but who everyone was just waiting to pronounce dead? Or was it the patient I followed my entire four weeks on the general Internal Medicine rotation who we had nothing left to offer and were sending home with hospice? (Or the one I had for two days who we also had nothing left to offer and also sent home with hospice? He probably actually died first).
I’ve never had a patient die in front of me, but I’ve known quite a few patients, quite a few people, adults and children both, who either died soon after I met them, or who I know will die within another year or two.
I don’t have a specific point to this post. I think that mostly I’m wondering how much it’s okay for me to talk about these things, because they’re on my mind often, and dying, death, and grieving, are all a big part of living, as much as we really don’t want them to be.
I think that one of the reasons I’m taking this Pediatric Palliative Care rotation is because I don’t really know what to do when people, patients or their loved ones, are grieving. I don’t know how I’m supposed to talk to them. I don’t know yet when it’s okay to keep talking and when I should be quiet, I don’t know when I should leave or when I should stay. I know I won’t be able to learn all this in just four weeks, but it’s a start.
We, people, don’t talk much about grief. And when we do, it’s mostly in the context of death, not in the context of the ongoing loss that is associated with, for example, a severely ill loved one. Today I watched a young couple grieve after learning that their baby would be incapable of even the most minimal definition of meaningful life (severely under-developed brain), but as difficult as that was, it doesn’t compare to the numerous times I’ve been around parents caring for chronically, tragically ill and/or disabled children. They did not plan for this. Most people don’t ever think of the possibility of this becoming their life. And the available resources for assistance at home (or long term facilities where their children can live) are pitifully lacking. I know I see them at their worst, when their child has landed in the hospital, again, or when they have just learned of the enormity of their situation, but still, my heart breaks for them.
I’m hoping this rotation will give me some beginning insight for how to better interact with these families. It is not, never has been, enough to sympathize with them, if I don’t know how to show that I am thinking of them. That I am proud of them for doing what they can, for living each day, for still finding things to smile and laugh about with staff. Even if there isn’t anything I can to do fix, or even help their child, there has to be some way I can be someone who adds something, however small, to their life. And if there isn’t, then I want to do what I can to minimize my footprint, to not take anything away from them.
I don’t want these families to fall into the same category as “starving children in Africa.” I don’t want their place in my life, in my work, to be a simple reminder that there are people out there dealing with harsher realities of life than my mundane concerns. And I don’t want to minimize their lives to this one thing, however big and consuming it is, because they are more than the parents of a sick child, just like Africa is more than just a continent full of corruption and poverty.
It feels somewhat trite writing an entry about this, almost like I’m exploiting their situation to write a good blog post. But these families do affect me, and there are many I will never forget. Not all these memories are sad either; some are bittersweet, and some are actually downright pleasant.
The end is in sight! 60 days till my Match Day, and exactly 12 weeks left of rotations. Today I started Pediatric Palliative Care, then I have Special Topics in Reproductive Health, and then I end with Dermatology.
I still have Step 2 CS to take (mid-February, unless I find an earlier date that has opened up), and my Dermatology rotation has a small test at the end, but I’m essentially done with the more stressful parts of medical school (minus the match, which is a different kind of stress; it’s more just disorienting).
There’s two other medical students on my current rotation, and I hadn’t realized it, but I had missed being around my peers. I’ve been mostly on my own during my rotations this entire year, with just a few exceptions. It’s nice being able to commiserate about things like Step exams, and being behind on thank you emails, but it’s also nice for the shared joy aspect, because we’re all very excited about this Pediatric Palliative Care rotation (strange as that may seem).
Here’s to another exciting four weeks!
I’ve been looking forward to and wondering about this year ever since I realized it would be the year I graduate from medical school. So hello 2013! Welcome to existence! I’m going to try to savor each day, but don’t mind me as I continue to count down to my match day (73 days) and my graduation (136 days).
I don’t have any specific resolutions this year. I think I did a good job with 2012, especially given its rampant stressors, so my goal is to just keep doing life better. Keep trying to be more mindful by continuing to do things like culling my possessions, and re-adjusting that tricky work life balance problem. Eating better. Exercising. Reading more. Spending more time connecting with loved ones. The usual. :)
I hope this is a good year for all of you, dear readers, especially my fellow fourth years! I hope we all match in places that we’ll be pleased with.