The Good, The Bad, And The Facepalm, or, June/July: ER

Sorry!  I wrote this on time ages ago and then just never posted it.  I'll be catching up to the present over the next couple of weeks so expect drama, epiphany, and laffs!  And now, June and July:

For June and July, I was in a rural ER, working as a fourth-year student.  It was pretty flipping awesome.  Here are some highlights:

The Good:
- I did so much suturing.  I sewed every day.  Hands, arms, legs, faces; old people, tiny kids; everything from tacking gunshot wounds closed for the trip to the big city for surgery, to closing up messy lacerations from biking accidents.
- I learned an enormous amount about management.  Third year the focus is slightly more on honing your history-taking and diagnosis skills, so it was pretty invigorating to start really focusing on when to get a CT vs. an x-ray, when to admit vs. discharge, and some of the specifics of prescribing.
- I saw some decent trauma and a lot of drugs.  Interestingly enough, I was never on shift when any of the really serious stuff (stabbings and such) came through, but what I did see was plenty for a beginner like me.  I'll spare you the gory details, but man, people find a lot of awesome gruesome ways to mess up their hands.

The Bad:
-  Every doctor at this hospital worked 24 hour shifts.  I was allowed to choose my own hours, so I started out doing 12-hour shifts, then had to cut them down to 10-hours so I could study more for boards.  By the end of the month, though, I was routinely working 13-14 hour shifts as well as commuting 3 hours back home a couple of times a week.  It wears on you.
- I got run off the road in the middle of the night by a cow.  It was terrifying.  I'm so thankful I was able to avoid actually hitting that enormous thing, and thankful that when I ran off into the adjacent field I didn't hit something or flip or whatever and damage myself or my car.  Stupid cow.  When I told my coworkers the next day, they were horrified.  I guess people die from that.  Cows are HUGE.

The Facepalm:
- Sometime during the first month, a patient came in with a dislocated little finger.  I stood outside the room as my attending demonstrated on my hand the grip I would take and the vector of my force to put the joint back in place.  Sounds normal, right?


I almost passed out.

Joints are a definite weakness of mine.  Fluids, fractures, ears, feet - no problem.  But joints.  Joints fill me with a visceral dread so deep that apparently my body can't handle it, and I start to vasovagal.  I didn't even put the finger back in place.  I watched, nauseated and weak, as my attending did it for me.  I practically had vapors, for goodness' sake.  I still can't think too hard about it.

- You know how when you pick up a baby out of a carrier/ carseat, it's normal human impulse to lift the child way up above your head so they laugh and squeal?  It's fun and harmless and everyone enjoys it.  Unless you don't realise there's a metal lamp hanging above the childseat. I was mortified.  Mortified.  M-O-R-T-I-F-I-E-D.  I can't even tell you.  The mother was really nice about it, all, "Oh, babies are tough!  He's done way worse to himself so he'll be fine in three minutes!" but it took me a while to stop hyperventilating.  What if I knocked his brain about and he lost his ability to enjoy dense poetry before he can even appreciate what he had?  What if I slightly malformed his skull so he can't ever have a buzz cut because he'll look funny?  What if he grows up with a lamp phobia and never knows why?!  Horror!

I mean, I'm sure he's fine.

Conclusion:  Man, ER medicine is cool stuff.  I'm liking the blood and adrenaline, you guys.  And I actually like the small ER I was in, where I could personally keep track of all the patients in the department and know what was going on at all times.  It felt more like running things and less like being a little doctor cog in a big hospital machine, and part of the reason I wanted to be a doctor in the first place was to be in charge.  And once you get a certain distance outside the big cities, rural ERs see all of the trauma and sickness and craziness that the urban ones do.

Levelling Up - COMLEX

I am still alive.

I am studying for my board exam, which is in -checks desktop countdown- 11 days.

I am buried in lectures and notes and COMBANK questions.

I am still having my career crisis on a weekly basis.

I finished two months of ER a couple of weeks ago and have a half-written post about that, as well as a percolating one about my current month, OMM.  And if you don't know what OMM is, I will explain it to you.

In a minimum of 12 days.

Please understand that everything in my life is and has been on hold for about two months now.  This is the home stretch.  This fall is going to be a very exciting time and I can't wait to share it with you.  I just have to get there.  And that means going off the grid whilst preparing for this exam, and then lickety-split getting my residency application all put together and shined-up for those Judgy Judgersons, the residency directors and admissions people.

(I'm not serious, residency directors.  I'm sure you are all very nice.  Please let me into one of your programs.)

Anyway, I will leave you with this teasing snippet that I have only told my closest friends about so far but will expand upon in amusing fashion in my ER post: in July, I almost fainted from something really, really lame.

See you in two weeks.

So sweet, this surrender

If I could just get a little room to breathe... My exhaustion is at that point where it's a constant ache in my chest.  I can't seem to get a grip on my application for residency, or sorting out my elective rotations, or studying for boards.  It just feels like there is too much going on and all the deadlines are piled on top of another and I can't fix any of it because I'm working every day.  I have no idea what I'm doing.  Is there a most efficient way to do this?  Can I even get it all done?

I feel most worried about boards because I have to do well, and yet I can feel mediocrity creeping up on me again.  I don't remember pressing snooze for that extra half hour this morning but apparently I did, and I really needed that time for studying.  Or did I need sleep since my head feels stuffed with cotton?

I don't know.


Save me, God,
for the water has risen to my neck.
I have sunk in deep mud, and there is no footing;
I have come into deep waters,
and a flood sweeps over me.
I am weary from my crying;
my throat is parched.
My eyes fail, looking for my God.
But as for me, Lord,
my prayer to You is for a time of favor.
In Your abundant, faithful love, God,
answer me with Your sure salvation.
Rescue me from the miry mud; don’t let me sink.
Let me be rescued from those who hate me
and from the deep waters.
Don’t let the floodwaters sweep over me
or the deep swallow me up;
don’t let the Pit close its mouth over me.
Answer me, Lord,
for Your faithful love is good;
in keeping with Your great compassion,
turn to me. 


O God, you are my God;
    I earnestly search for you.
My soul thirsts for you;
    my whole body longs for you
in this parched and weary land
    where there is no water.
I have seen you in your sanctuary
    and gazed upon your power and glory.
Your unfailing love is better than life itself;
    how I praise you!
I will praise you as long as I live,
    lifting up my hands to you in prayer.
You satisfy me more than the richest feast.
    I will praise you with songs of joy.
I lie awake thinking of you,
   meditating on you through the night.


I am at rest in God alone;
my salvation comes from Him.
He alone is my rock and my salvation,
my stronghold; I will never be shaken.

Lord, please keep me righteous.

A few days ago, as I was leaving work, one of the paramedics shouted out, "And where do you think you're going?"  I responded, "To bed!  My shift is over!  You don't pay me enough to keep me here!"  She laughed and I went on my way.

As I walked into my room, though, I was feeling so unsettled I stopped dead in the doorway to ask myself what was wrong.  It took a bit of searching but I finally figured out it was that parting remark that so aggravated my conscience.  It's not that it was a particularly mean or rude response.  It fit the conversation.  The problem is that I didn't mean it.

I would say that if left to myself, it's fairly hard to get me mad or move me to cynicism when it comes to patients.  I don't get stressed out by high patient loads; I just start chugging away at the list.  I'm not likely to get dramatic about bad smells or low IQs or nasty feet.  I would say my professional demeanor is fairly warm and unruffled.  But if I have one flaw that I have struggled with consistently throughout medical school, it is that I am easily influenced by negativity specifically.  It's quite a weakness when you think about it. It means that when people around me are stressed, irritated, bitter, burnt out, or just being big bloody divas, I often get caught up in it even if that's not how I would feel if left to myself.  It's actually terrible.  I'm ashamed of it to the point that I almost didn't write this post. 

The night this happened, everyone else had spent the shift irritated with how busy the ER had been.  I'd been enjoying myself for the most part, but conversation centered around, "AGH why won't people stop coming in" and "Someone shoot me now" and "I can't wait to get out of here.  CAN'T WAIT."  I think I soaked that up and gave it right back, which is so dumb.  And it's even more dumb because I believe all of that was just crap.  Just talk.  The people I'm working with like their jobs, so why the pissed off chit-chat?

God is keeping me on this planet to be a light to others - to be a living example of the transformative power, the freedom and joy, of walking with Christ.  And yet, I struggle daily against what is essentially the pack mentality, emotional peer pressure, assimilation by the Borg.  And among medical people, the collective mindset is quite frankly poisonous.  It's critical, irritable, jaded, sarcastic almost to the point of viciousness, hardhearted, and unhappy.  It has dehumanizing them-vs.-us undertones, where patients are the opposing team.  Logically I get it; this is the underbelly of the mental pickiness necessary to be good at medicine and the distance we have to maintain so we can see sad/ traumatic things every day.  But that does not make it okay.

Another giant problem that arises in medicine concerns gossip.  I know everyone everywhere struggles with it.  But medicine is one of the few places I can think of besides police work where your work is directly concerned with people's dirty secrets (and also just their general dirtiness).  That means the line between sharing information and gossip is even thinner, and most medical personnel I've met don't even try to walk it because the information is so juicy.  Conversations segue straight from, "So her exam was pretty normal despite her insistence that she was in pain," to, "She was such a jerk to me!  And she smelled!  And did you see her teeth?  Ew!"  The issue is that pain, combativeness, malodorousness, and poor dentition can all be appropriate parts of a discussion regarding medical care, but they can all also be poisonous gossip that hurts not only the patient, but the gossiper.

I don't know exactly how to handle that yet.  In college I got pretty good at asking people to stop gossiping around me, but that was when I worked in retail, where it was blatantly obvious that we had no business discussing such things.  In medicine it can be difficult to pin people down, and as humans we will always get defensive when our sins are pointed out to us.  I wonder if it will be easier for me when I am a doctor and thus have some official and some unofficial authority; I've seen how often the doctor unconsciously sets the working atmosphere.  At the same time, though, I know that the Lord does not rely on earthly authority when it comes to people keeping each other righteous.  I technically have all the authority I need right now. 

I just need to let Christ make me bold about what is true.

Putting A Bow on Third Year

I'm on vacation this month.  It's pretty sweet.  I can tell it's been a proper vacation because I'm starting to miss work.  Seeing patients, having structure, using my brain... it will be nice to get back to it.  That said, I have almost two weeks left of time off, and I intend to enjoy them.

I was looking back over the posts I've made this last year and I realised, with a quick flash of guilt, that there are some key months I didn't write about.  In fact, there are some months I specifically said I'd write about that I then never wrote about.  Clearly, I am untrustworthy.  But to show you that I am capable of trying to make amends well after it matters, here is a quick rundown of The Months I Missed!

THE MONTHS I MISSED

September, family practice clinic: My attending worked like a dog.  And he had cancer.  Which meant I worked like a dog while he tried to work and often failed and sat in a chair with his head down, breathing deeply.  I was constantly worried about what would happen when he collapsed.   He gave a lot of steroid shots.  Pros: I got comfortable with autonomy and learned how to give knee injections.  Cons: none.  JUST KIDDING MY ATTENDING HAD CANCER.  You try watching a cancer patient work three jobs with a chemo pump on while he's almost too weak to stand and see what happens to your blood pressure.

(He's fine now.)

December, surgery: I know, I know.  How could I haven forgotten to write about surgery?  I don't really know, because it was a very post-worthy month, seeing as how I hate surgery and surgery hates me.  Not the people; they're just fine.  But the actual job.  Do you know how many times I almost collapsed during laparoscopic surgeries because I was falling asleep?  How many times people had to send me back to rescrub because I left my wedding ring on/ my hands were too high/ my hands were too low/ my elbows were touching my sides?  (Side note: my elbows were touching my sides.  Well, I promise not to rest my elbows on the surgical field, then - I mean, I was planning on it, but now that they're tainted and all.)

And then there's the wound care.  (Look up "chronic wound debridement" on an image search if you are brave and would like a visual.)  Keep in mind that I love abscesses and acute injuries.  I could lance infected wounds all day, go home smiling, and eat a casserole for dinner.  So.  When I tell you that cleaning/ debriding a chronic wound gives me uncontrollable full body shudders, it should give you an idea of how very much I should not do that job. I could go on, but hopefully I've already accomplished my mission and put you off your food and we can all stop thinking about this now.

Pros: I know without a doubt how to scrub in now, and they managed to beat the basics of sterile procedure into my brain.  Apparently that's important.  Cons: CHRONIC WOUNDS.  NEVER AGAIN.  Except probably again.  They're a difficult thing to avoid.  Also, I learned I am physically incapable of getting up before 0530.  I was late to work every day that month.  Every.  Day.


February, pulmonology: I got to see why people in internal medicine like to specialise.  It's because as a specialist you get time to stop and think while making boatloads of money, and you get to do procedures.  If I didn't think -oscopies were boring (from bronchi to bladders, if you have a tube or a space, we can stick a camera up/down/into it), and I didn't think 3 years of internal medicine residency would break me, I would consider specialising in something.  Seems like a nice life.  Pros: learning the basics of ventilator settings and a little ICU medicine.  Actually, learning period.  My attending this month wasn't the sweetest man, but he was a bloody good teacher, and that's more important.  He didn't load us down with scut work, so we could actually use our brains instead of tearing through paperwork as fast as possible to get it finished in time.  Cons: I'm really not built for a subspecialty.  If pulmonology is any indication, you learn about one small field in extremely thorough and technical detail, you use a lot of gadgets, and you avoid getting anywhere near chest compressions.  I'm a jack-of-all-trades, big-picture kind of lady.  Also a chest compressions kind of lady. I probably won't become an -ologist.

March, family practice: Family practice is nice.  We're all aware that I struggle with family medicine vs. emergency medicine, so the fact that I liked this month is no surprise.  I do know that clinic is a place where I struggle spiritually, because it's so easy to get lulled into the rhythm of paperwork, timed visits, and mild complaints.  I have trouble staying sensitive to what the Lord might ask His servant to do day-to-day.  I don't know.  It was a good month and a good way to cap off the year.

~~~

Overall, I loved third year.  I finally feel like I am being trained to be a doctor and it's thrilling.  That's probably a really naive-sounding thing to say, but guess what?  I'm not ashamed that my third year was awesome!  And I am deeply hopeful that fourth year will be similarly challenging and exasperating and bizarre and intense and fun.  Especially because my husband's back now.  Everything's better when he's home.

How I Learned To Stop Worrying And Love Kids For Short Periods Of Time, or, April: Pediatrics

I have a long and storied history of detesting children.  They are loud, messy, stubborn creatures whose apparent sole intent is to overwhelm you with snot, poop, and really loud screams.  For most of my life to date I have studiously avoided them and certainly have never understood why anyone would choose to spend time around them.  This year, the Lord decided to change that.

The first step was when my really good friends started having kids.  To be around my friends, I had to be around their (surely) loud, messy, poopy, screaming children.  And despite myself I realised... babies maybe are not always terrible to be around.  And they can be sort of cute.  At times.  And maybe they are cuddly when they're not crying.  And sometimes when you look into their big, trusting eyes, you see the future and blah blah blah they're nice, okay?

You can imagine how horrified I was to find out that I like babies.  But kids, I thought.  Certainly kids are still irritating and stressful and zero units of fun.  So it was with a certain amount of trepidation that I entered my last third year rotation.

My school gives students a mixture of outpatient and inpatient pediatrics, which is nice because it gives you greater exposure while still allowing you to get familiar with things like pediatric vital signs, lab values, most common diseases/ infections, etc.  And of course you see all ages.  So I had good opportunity to learn some things:

- Children get constipated a lot.  Like, a lot.  And they also get a lot of diarrhea.  Yet another similarity between elderly people and the very young: it's all about the poop.

- There is way too much asthma and obesity in our country.

- Pediatricians are vastly undercompensated given how hard they work and how valuable their services are.  And yet they're pretty cool people to be around.  Pediatricians like their jobs and like their patients, and now that I've seen both ends of that spectrum I know how much of a difference liking one's life makes to the kind of care patients receive.

- Sometimes, a toddler on sildenafil for his lungs is going to stare at you, slowly undo his diaper, and grab his penis. 

- FINE I ADMIT IT.  Kids are funny and fun.  And exhausting.  And they do scream and poop a lot, and sometimes cough RSV into your face.  Somehow this does not negate how fun they are.

The Lord showed me part of what all of this was for recently.  I have been praying about where to serve in my church, trying a few different areas and just feeling like God was closing doors in my face.  Youth?  No.  Bible study leader?  Not yet, at least.  Worship?  Surprisingly, no.  Finally I accepted what the Lord has been trying to tell me for a while but I didn't have the strength to acknowledge: for now at least, my way to help at church is with the little kids.  So I signed up.  And I love it, because kids are fun.

(And because their parents come and take them away at the end of the morning.)

The New Old Normal, or, Sometimes I Am Very Foolish

Okay so Matt is home.  And it's wonderful.  It's wonderful to see him, to wake up beside him, to have good conversations with a sane person face to face.  A deeper sense of peace has yet to settle in, though; I'm instead getting little fragments of the realisation that he doesn't have to leave again.  Like: I am working in the hospital this week, yet he will be here.  I associate the hospital with loneliness, but I don't have to anymore.  Maybe never again.  Or: I will have to continue to buy groceries for two people.  Or: I don't have to buy groceries by myself anymore!  Understanding that there is now a second person in my life is such a complex process that I can't even force it - it's all situational.  I can't have the thoughts about groceries before actually going and getting groceries and thinking, "What would Matt like?" and then feeling shock.

But whatever.  I dig it.

What I do not dig is giving up my space.  Yeah, I said it.  And I know that is totally selfish.  I'm working on it - it's only been a week! - and I'm not suggesting I deserve any sympathy.  But literally the only pleasure in living by myself the last year was having whatever schedule/ routine I wanted and always doing things my way.  Now I have to, like, share the Xbox.  And not turn on the closet light in the morning because that would throw light directly on Matt's face, and no one should wake up at 6 if they don't have to.  Or if Matt opens something in the kitchen in a way I wouldn't, then a short while later leaves a light on, then doesn't answer a phone call because he doesn't feel like it - crap like that is undeniably petty, but nevertheless frequently builds up to the point where I need to take a moment and consciously untense my shoulders.  I'm not used to noise.  I'm not used to dishes I haven't dirtied or a towel being wet before I try to use it.  I'm not used to asking someone else if they would like to do the thing I would like to do.  Amazing how I didn't even realise I was getting used to all of this, yet clearly I was.

I mean, I'm an idiot.  I'm being a total idiot when stuff like that gets to me.  I know.  And the majority of the time I look at him and am overwhelmed with gratitude to God that He brought Matt through the deployment and back home.  I have this sense that despite all the changes that I went through in the last year, my life was nevertheless mostly in a holding pattern, and now Matt and I can Get Back To It.  That's exhilarating.

I just have to relearn how to compromise.  And hopefully stop being addicted to chocolate.  But more on that later.

Wrong Place, Wrong Time, or, January: Internal Medicine

I think my month in Internal Medicine will be forever coloured by this last week - incidentally the last gasps of the rotation - starting with Saturday.

It had been a hard week with a high patient load, so I launched into my last weekend working the general floors with perhaps an overabundance of enthusiasm.  It was going to be a good day, I was going to see all my patients quickly and well, and things were going to present no problems.  It was 7am on a beautiful morning.

Cut to lunch, where I was trying to sip at a cup of soup that was too hot while talking to my husband, except the call kept getting dropped somewhere in the Atlantic or in space.  The morning, despite my resolve, had gone anything but smoothly.  It involved: patients being jerks, patients taking out their frustrations on me, patients telling me they hoped Jesus forgave me for what I was doing to them, etc.  Every visit had taken twice as much time as it should have.  There's something about people you are helping being mean to you, one after the other, for hours, that wears out a very particular part of you, and I was worn out.  But it was not my turn to stay late that day, and all I wanted to do was eat some calories and GO HOME.

So of course I was asked to stop eating and go and help one of the students from the other IM team do a history and physical down in the ER.  I stared at the asker blankly.  First of all, we have two internal medicine teams at my hospital, and they don't share work.  Ever.  I would go so far as to say that is the point.  Second of all, no one needs help on an H&P - it's a one-person job.  There's no way to speed it up or spread out the work. 

There was a moment of silent communication.  You know, the kind that isn't really socially appropriate.  My eyes said, you're really doing this to me?  And her eyes said, absolutely, and don't think you can finish eating, either, because I mean right now.  And my eyes said, you know I've had a bad day, right?  And her eyes said, I work in internal medicine so every day is a bad day and right now I need to spread the wealth; you'll do.*

Of course I said yes, dumped my soup, and went down to the ER.  She'd only given me the patient's first name (I'd forgotten to ask for more) so I couldn't find the patient.  Five minutes later my classmate walked up with the completed H&P and a text from his boss saying, Oh hey The Zoe doesn't have to help you anymore.

I went home posthaste.  Horrible hospital.  Horrible patients.  I dragged myself into work the next morning with zero units of motivation and zero units of hope.  Because I just knew it was going to be another bad day.

And I was totally right.  Well, I was wrong, but I was right; the patients were somewhat better, but that afternoon I came down with a rip-roaring GI virus.  I had vomiting and diarrhea every 10-15 minutes for eight hours, at which point I couldn't really walk very well and my friend rightly got scared and took me to the ER for IV fluids.  (That friend took care of me for two days straight.  I am so grateful.)

I think the virus is gone now.  But I had no idea that your body is weak and miscalibrated for days after something like that.  I don't remember Monday because I was sleeping the deep, wonderful sleep of phenergan.  Tuesday I miserably worked half a day, got sneered at by more terrible patients, gave up, and went home early to have a coma.  Today, the same (minus the terrible patients - I started a new rotation).

So whatever else I did or learned this month, all I can think of is the last five days.  And the last five days sucked. 

Lessons:
1. Living by yourself sucks!  Especially when you get sick.
2. Despite IM getting to see all the really cool diseases, I can't deal with seeing the same mean people every day and being forced to care about their bowel movements.  Thus, I am not an internal medicine doctor.
3. My prayer has changed over completely from, "Lord, help me love my patients" to "Lord, love my patients through me."  Because my love runs out too quickly, and despite my best intentions, it comes with strings.  Be nice to me.  Accept my help graciously.  Use deodorant sometimes because you live in a first world country and you are not that sick, you are just being lazy.  People need far more than I can give.  But the Lord's love is endless and perfect and patient.  How much better for everyone around me than the imperfect crumbs that I have.

Next up: pulmonology.  Whatever that is.



*This person is very nice, so probably it didn't go like this on her side.  And since she is an IM doctor she probably likes IM.  Probably she would tell you her eyes went, Please just help out for the common good.  And my eyes went, No, you're not on my team and I don't like helping people and also I hate you.  And her eyes went, I really don't want to have to force this on you but I have 3000 things to do so just do your job so I can do mine.  And my eyes went, I'm on the phone and don't want to do any more work and DON'T YOU SEE I HAVE SOUP.  And her eyes went, just do it and stop being a snotty medical student.  And my eyes went, fine but I'm not cleaning my room and you can't make me.

Again With The Future

Okay so this year has been pretty hard.  I submit evidence for your perusal:

• my husband was deployed to fight in Afghanistan
• I got pretty classic adjustment disorder after he left and almost quit school
• Step 1 board certification exam - enough said
• my husband got some injuries overseas, but not bad enough to send him home - I had to hear about these at work via Phone Calls that started with, "Hey, we need to talk now" instead of, "Do you have a second?"
• holidays by myself for the first time ever

I haven't said much (anything?) about my husband's deployment on here for several reasons.  The first is that deployment is difficult to talk about in a way that will reach others.  Unless you have experience with being in limited contact with your loved one for months at a time while he is (as far as you know) in mortal danger, you can't really know.  I didn't know.  The second is for what the military calls OPSEC - operational security.  You never know who's reading, and so the less information that is floating about, the better.  The third is quite simply that medicine is easy to talk about.  A year of solitary nights (broken by bouts of workaholism when the silence gets too overwhelming) is not.  He has been gone from my days this last year, yet he is inescapably present - an excruciating paradox.  I hate this limbo.  Anyway.  This year is finished and I don't mind.

Next year promises to teach me about uncertainty, which makes me itch.  I've never dealt much with uncertainty.  My whole life, I knew I wanted to be a doctor.  It was a vague plan that, as I got older, developed all the necessary steps. But I've completed all of those now.  Cue nausea.  I HAVE RUN OUT OF PLAN OH NOZ. 

Just like there's the quintessential first year conversation ("I'm so stressed I will never pass this test I hate my life") and a standard second year conversation ("I'm so stressed what are you doing for boards I hate my life"), there is one conversation that all third years have, constantly, until it's settled.  It revolves around what field to go into.  And for the first time I don't mind participating in the talk because we're finally talking about something constructive.  Sort of.

My dilemma is this: I want to do missions, possibly long-term.  But what field prepares me best for that?  The easiest answer is probably family practice - primary care, teaches you to deal with all types, good for developing relationships with people.  But.  The second tier of my problem is that modern suburban family practice makes me want to go back to retail while I frequently leave the ER singing.  So do I just do what I want?  Is that a good enough reason?  Here's why that last question is even worth asking: sometimes the Lord gives us honest desires as clues to what to do next; sometimes those desires are actually temptations (not from Him) and He asks us to walk away from them.  We have to wait for His guidance to be able to reliably tell the difference.

Six months ago this was not really a problem because I didn't need to make decisions yet, but my time cushion is running out because soon I need to start arranging my fourth year.  Fourth year for osteopathic students is mostly for audition rotations - you travel to the residency programs you really want to get into and rack up some face time.  Hopefully you impress the program with how smart and personable you are and help assure yourself of a spot there the next year.  Not to belabor my point, but I cannot start setting up audition rotations if I don't even know what field to look into. 

This is by no means a unique problem - I can list five classmates off the top of my head trying to make the same decisions - but I do think I have an edge.  Just because I don't know the plan doesn't mean my God doesn't have one.  And I know He will let me know, and I know it will be in enough time for me to make the right decisions.  I just get impatient sometimes.

Okay fine, I get impatient every day.  AT LEAST I'M HONEST.

Please Don't Mind The Echo, or, How I Got Into Medical School

So let's just get it out of the way that my second medical school acceptance call, for the school I now attend, was totally normal.  I was sitting on the couch playing video games with my husband when my phone rang.  I answered, the friendly admissions lady on the other end told me I'd been accepted, I thanked her profusely, and we hung up.  It was quite nice.

This is not about that phone call.  This is about my first med school acceptance call, and it involves one of the most private of places.  Let's start at the beginning.

The application process for medical school has several steps and takes about 6 months.  After taking the MCAT (which is its own 6-month ordeal) a student has to make it through primary and secondary applications, as well as a formal interview.  Using this body of information, the school makes a decision on who gets admitted to the incoming class.  The acceptance rate is below 15% at most medical schools.

I didn't have very good grades for the first 2 years of college, courtesy of balancing real life crap and school.  This meant when I talked to my premed counselor during my junior year, he sighed deeply and informed me that I wasn't a competitive applicant.  I let that pronouncement eat at me over the next year, even after doing well on the MCAT.  I tell you all of this so you will understand just how on edge I was during this process.  By the time I'd made it to the interview stage, I was practically vibrating with nerves.

Cut to November of my senior year.  I'd just had my first! ever! interview and was in that terrifying period just after: waiting for a response.  This particular afternoon I was hard at work in my college's histology lab, memorising slides with my fellow premeds, several of whom were also anxiously awaiting answers.  And like good premed seniors, we had our cell phones with us.  Always.  ALWAYS.  I would set my phone on the edge of the tub when I showered; otherwise it stayed in my pocket or my hand, where I would glance at it constantly.  It had been a week of this, and this day was no different. 

Until I had to pee.  Perhaps you see where this is headed.

I tossed my phone to one of my friends with strict instructions to answer for me if an unknown number called and tell them I would call back.  And I was still sitting on the toilet contemplating life when the main bathroom door slammed open and I heard my friend's half hysterical voice ring out.

"Zoe!  Someone called for you!  Where are you?  I'm bringing you the phone!"

"What?  Don't answer!  I can't talk to them right n-"

"No, no, it's too late, I already picked up, she wants to talk to you-"

"But - wait - "

It was indeed too late.  A hand shoved my phone unceremoniously under the stall door and shook it excitedly.  In a panic, I Kegel'd harder than any woman ever has in history, accepted my bloody phone, and squeaked, "He- hello?"

"Is this Zoe?"

"Yes, yes it is."  No.  Oh my goodness, no.  This cannot be happening.  Squeeze, Zoe.  Squeeze!

"Hi, this is Admissions Lady from The Medical School."

"Uh, ha, hi.  What can I do for you?"  Must talk less.  What if she hears the echo?  Oh, please, Lord, please don't let her notice an echo.  Please.

"I wanted to thank you for coming out to see our school, and I also wanted to let you know that we have decided to accept you into our school's incoming class."

Pause.

"Hello?  Zoe?"

I honestly don't remember what I said after that or how I got off the phone, because all I could focus on was that if I gave full rein to my relief and gratitude... well.  I really didn't need that poor lady on the phone to hear just how relieved I was.  I do know that I laughed uncontrollably for about five minutes afterwards.  As did both my mother and mother-in-law when I told them what happened.

There are some good lessons to be learned from this.
1. We often speak of God's perfect timing.  I would like to emphasize that He also has perfect comedic timing.
2.  Sometimes we will be blessed by having humility baked into a set of circumstances.  I can never talk about how I got into medical school without that story, and it is a beautiful demonstration of how little I actually control.

November: Obstetrics

My month of OB/Gyn is almost over.  It's been pretty good if quite slow at times.  I must admit, I'm just not a fan of speculum exams.  Not because they seem too private or anything (I don't think that's a problem most medical people have, ha), but... it's just... look, if I never have to smell trichomoniasis or BV again it'll be too soon, okay?  Okay.  And hysterectomies creep me out.  I think I've finally found the area of medicine that I can't depersonalise, and it's to do with female parts.  Like how guys often wince when they watch another man get kicked between the legs.  A future gynecologist I am decidedly not.

Fetal heart sounds are incredible, though.  Run a little ultrasound machine over the mother's tummy and there they are.  They make me smile every time.  And a baby's first cry?  It gives me shivers.  I didn't think I was someone who could be overwhelmed - even momentarily - by the bright miracle of birth, but I totally am, and I'm grateful.  I can see why a lot of people like this field.  The good parts are some of the best in all medicine, in my opinion. 

At any rate, I can deliver a baby now.  Have done twice.  The pushing and crowning part (as the baby's head passes through the birth canal) grosses me out a bit, but catching the baby, all warm and squirmy and new, is really gratifying.  Partly it's because I've always felt like there's a short list of quintessential doctor things.  It's a silly, arbitrary list but that doesn't change its visceral importance to me: sew up a cut, resuscitate someone, deliver a baby, listen to heart and lungs, give bad news.  I've done all but the last now.  It's sort of staggering to realise that.  I'm still a rank beginner, but the experience really is coming.

I am really, for real, in all seriousness, no joke, going to be a doctor one day.  And not one day off in the misty future.  I am going to be a doctor in a year and a half.

^____________^

In other news, I've put my finger on what's bothering me about liking emergency medicine so much.  It was my very first rotation, and I would have been happy to do anything (I think) as long as it wasn't more class.  And it was a great time.  What I need to help get some perspective is to find some things I don't like about the field.  It's worrying to have only positive things to say; usually that's a sign that you've lost your objectivity in that situation.  If, however, I had some negatives to consider, I would feel much more secure in my preferences.

Late night moment of doubt

Spending a week around people who are more married to their jobs than their are to their spouses has left me feeling lonely and wary of my career.  Four more months of this - four years in the long term.  Working and working in order to - what?  Work?  Seriously?

It's funny.  Being out doing "real medicine" is meant to remind you of your reasoning for putting yourself through the awfulness of the first two years of medical school.  But right now it just seems like a rat race.  Remind me; why am I doing this again?