Medicine From The Trenches

Experiences from medical school, residency and beyond.

If I could change one thing in the lives of those around me…

I would ask them to stop comparing themselves to others. Don’t compare your grades, your scores, your running times or anything else to anyone except you. Strive to be the best you that you can be looking at the past for experience and to the future for achieving goals. In these days of social media, when everyone is busy scanning what others are doing on sites such as Instagram, Snapchat and Facebook, look only into the mirror and be content with the miraculous person that you see staring back at you.

Your wiles and abilities have enabled you to navigate your life so far. Your experiences can allow you to toss what doesn’t work and hold onto what does work. Your goals can give you a reason not to hit the “Snooze” button in the morning but they also give you a heading for progress. If you express gratitude for what you have learned/mastered and keep you eyes on your goals, there is little time for envy, jealousy and other negatives that can hinder your progress.

I always know that there will be others who are faster, richer, thinner, smarter and more beautiful that me. I applaud them, celebrate them but I am so grateful for being able to breathe air, run my race and figure out my “stuff” these days. I am healthy, happy and blissfully loving life as I touch my students and patients lives. In short, I connect with humanity and love every second of those connections as they come.

A great and free gift to all of us is the ability to look around and lend a helping hand to anyone in need. The greatest joys come from helping others without the expectation of receiving something in return. On any day and at any time, one can choose to change one’s thinking about any situation; reach out and just connect with those in need. In today’s world, the needs are great and dire.

So in the early days of this new year, look at yourself and be thankful/grateful while looking around to see who you might help at any moment. Wear a smile (cheap accessory) and savor every moment of life as they move by. These are free gifts!

3 January, 2017 Posted by | medical school, medicine | | 1 Comment

Time keeps moving and it’s is a blessing that it does keep moving.

In most places, we await the end of 2016 and the beginning of 2017. The passing of one year and the advent of another full of hope and promise for most of us. Still, nothing is new because time always keeps moving and everything changes often from one instant to the next. I have allowed this movement, this continuum to spur me to renew and reinvent myself without question.

This past year to my surprise, I embraced long distance running. My stress level dropped to nothing; my self-empowerment went to high levels. As I race along streets at 3AM, the only time I can get 1.5 hours of pure running into my crammed schedule, I do this movement for me and my sanity. I work on problems, I accept my world with joy and gratitude. This turns out to be a great way to get every day started and every challenge faced head on.

I will often mull some paper or new information as I tread along my winding path in my neighborhood near one the the Great Lakes in midwest United States. I can always hear the ebb and flow of the waves of the lake as I run along the beach; even if it’s too dark for me to see them. On a bright moonlit early morning, now long before sunrise on these shorter winter days, I love seeing my breath just in front of me.

Since I live in a suburban area, I seldom meet any automobiles in the early morning. If I meet anything, it’s a heard of deer grazing or a racoon crossing the empty street heading for the deep woods next to the lake. The deer ignore me but after spotting a coyote or two, I run with mace but still I run with emphasis and determination.

The thing about running, or even a brisk walk to begin your day, is that you can’t do these tasks for others. As a physician, my life and my practice has centered around being present to help my patients and students with solving their problems even if I ignore my concerns. With running, I do this for me and me alone; heady for non-self sacrifice. I think about me and how my middle-aged body runs faster and faster in the cold early morning darkness.

Daily running has a way of adding discipline into every aspect of one’s life. I eat healthy and clean because I know that high fat, high simple sugar foods will zap this burst of energy that running gives. I also forgive my occasional indulgence of beer on a non-practice evening because I have already run and exercised for the day. I also know that I am at my thinnest and lightest weight in my adult life; enjoying how well my clothes fit and how comfortable I am parking far from my destinations and hiking the extra distance.

The discipline that I have achieved with running, eating healthy and lifting a few weights has allowed me to keep a ready smile on my face and a song in my heart. I find that I simply enjoy interacting with my patients; joyful that I can help them feel better and meet the challenges of their worlds. This is some of the true magic of medicine that we keep learning, practicing and enjoying our art no matter where one is in the process. For many, just navigating the health care process is a source of added frustration and fear. Let your patients know that you are always the final common path for them as they place their health and trust in you; have their best interests in mind always.

As this year draws to a close, remind yourself of why you entered this profession and how fortunate you are to be able to help your fellow humans in any way small or large. Remind yourself that while this is a job for you, it’s often a change of life for your patients. Remind yourself that there is magic in empowering your patients; appreciating their fellowship and challenging yourself to be the best that you can be especially being authentic.

31 December, 2016 Posted by | life in medicine, medical school | | 1 Comment

We Do This

Last evening I was visiting with my classmates in one of the ministry classes that I am taking. As we moved through our discussion of our readings, my classmates nibbled on German Chocolate brownies that I had baked the morning before. I love to bake, therapy for this surgeon, as it is very nice to create something and watch other enjoy it. One of my mates produced a bottle of Benedictine with a supply of glassware; brownies and Benedictine!

One of our discussions in class centered around meeting Jesus. Quite an interesting discussion for a couple of physicians; two of us in the class. I related a story about one of my first patients that I treated as a medical student. This wonderful little patient was affectionately named “Ratso” by my supervising resident at the time. He was a patient in our Veterans Hospital coming in when his lung disease would get out of control.

“Doc, I was holding hands with Jesus”, he exclaimed to me as he began to respond to our treatments. He had been quite disoriented when his blood carbon dioxide level had achieved values that would be incompatible with life for most people. This patient not only had high levels, he turned the corner pretty quickly. “Yes, I will believe you saw Jesus”, I said to him as he clearly recognized me at last. I was seeing Jesus too.

So this is why I do this. For Ratso and the hundreds of others that I treat with care and love. Remember that what we do is like no other profession out there.

9 December, 2016 Posted by | medical school | , | Leave a comment

Some Thoughts for Those Starting Medical School this Month

As you get settled into your first-year coursework, I want to share some thoughts that come to mind:

  • Remember that you are fortunate to be on the doorstep of pursuing a magical profession. For everyone who achieves a seat in medical school, there are many who wish to be in your place. Honor them and remember them as you gather the knowledge that will make you a good physician.
  • Medicine is not easy, especially the study of the art of practice. There are many “all-or-none” tests along the way. There is a large volume of material to learn, master and apply to the practice of medicine and as such, you must make peace with that volume of material.
  • There are no “short-cuts”. This means that you have to make a concerted effort to be willing to take the long road. If you are looking for a short way around your work, medicine likely isn’t the profession for you. Get out early rather than later because medical school is expensive and quite unforgiving.
  • You are going to be working on people and not pathology. While pathology is interesting, always remember that the person with that pathology is loved by someone. Be willing to put yourself in the place of the patient or their loved one and treat them as you would wish to be treated.
  • Don’t believe what you hear but trust what you experience. Don’t go into any class or any rotation with preconceived notions of how it will be. Medicine is interesting and absorbing. Allow yourself to learn with a fresh approach and with fresh energy. While people who go before you will tell you horror stories about certain professors and certain subjects, it’s up to you to figure out and navigate them. You may be pleasantly surprised at how much you will enjoy this process.
  • Take some time to do something outside medicine at least once per week. Go to a movie, visit a museum or attend worship services. These outside activities keep your studies in perspective and keep your brain alive.
  • Keep yourself physically fit. Walk the stairs, take a 30-minute run daily and eat/sleep well. These physical activities will decrease stress and keep you healthy in the long run. Junk food, while quick, can make you overweight, sluggish and prone to picking up infections. Take time on weekends to prepare healthy (minimally processed) food and freeze it for ease during the week. You will save money, something that is always good.

Don’t forget to enjoy the process. Remember that you WANT to be here. Before you complain/gripe about something, try to figure out a couple of solutions or if the complaint/gripe is worth your time. If not, then focus on your studies and keep moving forward.

15 August, 2016 Posted by | first-year, medical school | , , | 1 Comment

Crisis Averted

I try to meet my challenges in academics, my religious studies, medical practice and physical conditioning as they come. Recently, my academic work, specifically my teaching style, came under sharp criticism (very negative) and increased scrutiny. Now, I don’t mind criticism and will listen with an ear for what might be worthwhile but none of what I faced was even worthwhile; directed as a personal attack upon me. This scrutiny forced me to question everything and forced me into a position of vulnerability that I couldn’t help. I was in a tailspin; looking for anything of validation.

Couple my largely “mental tailspin” with my loss of my friendship of one of my most valued friends. I had retreated back to a point of reliving the death of Gene and my almost catatonic reaction post. I was feeling most of the same types of issues that I faced when I thought my world had come to an end. These were feelings that I couldn’t control but now I have learned that I can feel them and use them to force me to meet challenges with renewed strength.

My spiritual challenges are there but with my renewed strength, I allow myself to serve and feel without apology. I make mistakes in performing my duties at the cathedral during Sunday mass but I learn from my mistakes and from my very generous mentors. I know that they question me but by questioning me, I am forced to question myself too.

My friend who has been quite generous in advising me in my academic work is back in my life which gives me renewed hope that I can learn more from him. I should have listened to him in the first place but my extreme fears would not allow me to benefit from his wisdom. I am blessed and grateful that he spends even two minutes with me and I appreciate all the wise counsel that he has shared with me.

I have watched him interact with his students, his infinite patience and critiques. His student population is more vulnerable and more difficult to teach but he is kind and had great insight into where each student lies in their learning. I learned patience and kindness from him. One day, I watched him answer questions as he walked with his students into the parking lot; surrounded by those who truly appreciated what he had to say. Whenever I see him, I know that I am in the presence of someone who is far greater than myself.

I headed off to interview for another academic job challenging in that I had to deliver a grand rounds presentation and interact with some of the greatest surgeons in this country. I more than passed that test; surprising myself with how wonderful it was to assist on cases that I haven’t performed in years. Sometimes a skills check with master surgeons is good for the soul too. It also helped that a couple of my former professors from residency affirmed that they were proud of how I have made my way in practice.

My physical conditioning continues to be a source of challenges and growth. My trainer balances weight training with running so that I will conquer the marathon distance and I will continue to enjoy vigorous good health. I am getting faster and stronger; finally seeing some of the definition that I sought but with a smaller muscle mass. I am enjoying my increased running mileage while meditating; keeping my head together. I observe the world as it moves past me.

My spiritual growth comes in the form of reaching inside myself for affirmation these days. I am alone with my thoughts and examine each one carefully. I am happy with my solitude, enjoying exploration of my creative side (not very creative at all) and some of the artistic resources in my city. The creative resources of our local artists, musicians and actors have brought a kind of renewal of spirit for me. I seek to interact with humanity and I am acquiring the tools to do so. In that acquisition of tools of spirit, I know that I am not alone and that I am quite happy with the spiritual state of my life.

I don’t focus on material objects much as they have always had little meaning for me. My connections with my patients, my students and my colleagues have been most important. I read the writings and poetry of my like-minded physician colleagues always surprised by the insight and the richness that they bring to my world. One in particular, posts a daily affirmation that moves my meditations quite often. I am truly blessed to know this extraordinary individual who gives so much to the world.

I know that happiness in life comes from the “good stuff” and I have the “good stuff” in abundance these days. My crisis of spirit is no longer a crisis but an acceptance that while I am not good enough for some people; not valued by most, I value and accept myself. I am made by my creator and I seek to be kind, generous and accepting of those around me; no longer a crisis.

30 July, 2016 Posted by | academics, life in medicine, practice of medicine | | 2 Comments

Getting Closer to the Start of Medical School!

This is a great post by a medical student. So much wisdom here.

Potential Doctor

As the start of medical school approaches, I can feel the excitement continuing to rise! This is going to be such an amazing journey! I know it will be very challenging and will stretch me in many ways. I am going to give it my very best effort, knowing that my family, friends and God’s strength will help to sustain me through the upcoming long journey!

Since my last medical school update, we have managed to get a lot done:

  • Take Basic Life Support class (CPR and AED): Done! Very useful course that I think everyone should learn!
  • Update immunizations: mostly completed. Pending 2 reports following a chicken-pox titre test and chest X-Ray. Two more tetanus shots will be done in August and February.
  • Financing my medical education: meet with the bank (done, credit-line approved!), apply for government financial aid (done, waiting for my application to be processed) and scholarships (done…

View original post 155 more words

29 July, 2016 Posted by | medical school | Leave a comment

In Today’s Climate…

Over the past couple of weeks, I have listened to the speeches at both political conventions along with the news reports of law enforcement officer killings/GSW injuries and civilian killings/injuries. Watching and reading new media reports have to be taken within the context of one’s experiences. My experiences have been as the daughter of immigrants, a biracial woman, a physician and a theological student. My heart breaks for those who are suffering and those who suffer. My oath, the Hippocratic Oath, that I swore many times as a medical student and now physician compels me to alleviate suffering wherever I find it.

The suffering may be physical or mental as many seek out our help in getting and keep them healthy. We, by our training, have to find, by any means necessary, a method of navigating the health care systems under which we practice as well as the political/social climate that we encounter. Sometimes that navigation can be as simple as a touch, a connection and sometimes that navigation involves working with every resource at our disposal to give the best care that we can achieve. My hope, my prayers, my experiences and my training have giving me insight.

I want to recount an experience that happened to me as a fourth-year medical student. I was returning home, driving a small red Mazda hatchback automobile, from a shift at one of the large city hospitals of my medical school affiliations. It was late at night, I was exhausted, ran out to my car in scrubs throwing my short white consultation jacket with hospital identification card and my stethoscope on the front seat along with my purse and overnight bag. As I drove through the rain-soaked city streets of this depressed neighborhood, I saw the reflection of police lights in my rearview mirror. I immediately pulled over to the side (I wasn’t speeding because of the weather) and stopped as required by law.

The police car pulled in behind me with two young officers getting out of the car quickly with their weapons drawn. For a split second, it took me in my exhaustion fog, I couldn’t believe that the weapons were aimed at me. I sat very still, keeping both of my hands on the steering wheel as one of the officers shined a flashlight on me; the other pointing his gun through the open window on the passenger side. “Get out of the car and put your hands on the roof.” one of them shouted.

I slowly opened the door, tears beginning to form in my eyes and shaking quickly overtaking me. I complied with his request stating the my identification and automobile registration were in my purse on the passenger side. I said that I was a medical student on my way home but the officer kept yelling at me to spread my legs and “shut up”. I couldn’t stop shaking (I even shake now as I remember how frightened I was). “This car is reported stolen,” he kept shouting in my ear. He began to pat me down. “This is a huge mistake,” I said in a shaky voice. “Please check my identification and look at my hospital cards,”I said.

It seemed like hours but in a few minutes, another police car pulled up with another older officer getting out. “What are you doing?” he asked. “We have the car and suspect in custody”. I was crying from fear and exhaustion. The officers immediately put their weapons back into their holsters as the other policeman said that I was free to go. I was so petrified that I couldn’t put the car in gear for a couple of seconds. I finally drove off slowly weeping uncontrollably.

What would have happened if one of those guns had discharged by accident? I would be dead by mistake. What would have happened if the other police car had not arrived? I would have been arrested most likely. It was a mistake but the first two policemen didn’t show any indication that they would check my identification. It was my first experience of being stopped by the police and not given the benefit of just being treated as a fellow human being.

As I read and hear of stories of any persons being stopped by the police, I still feel that fear from so long ago. I haven’t been stopped since then and I interact with police on a daily basis as I perform my job in surgery. Those interactions are always professional and quite polite but when I see their service weapons, I always remember that stop. I react to police officers through the lens of my experiences as I suspect all people do.

I have infinite respect for police officers as they have very difficult jobs under very dangerous circumstances. I have spent many hours with two detectives in the gang-violence division of my local police precinct learning about gang symbols and gang culture, rampant in the city that I practice in. I want to understand and stem this violence, treat its victims as they frequently end up in the trauma bay. Largely the street gangs in my city are involved in turf wars and drugs. The motorcycle gangs run in the suburbs dealing in drugs and human trafficking, another scourge of city and suburban living.

So today, I end up on the roof of my hospital, being thankful for my life and all I encounter in my practice of medicine/surgery. I always pray for insight, guidance and the ability to give the best to every patient/family member/loved one that I can give. I meditate during my distance runs, post-call in the bright sunshine of the early afternoons, as we are living in a climate of increased polarization by community leaders and populations today. I pray that I continue to live in the “gray areas” and not become jaded or polarized to the violence. I pray to continue to seek insight and solutions to the troubles of those I serve and treat; always remembering that the practice of medicine is my greatest privilege.

Yes, I swore that Hippocratic Oath as a medical student, as a graduate physician and I keep remembering it. I didn’t know back as a medical student, what I was swearing to but I know now, how difficult this profession can be. There are times of despair, depression for me as the hours tick past 30 and hope in humanity as I move thorough my theological studies. As the years have gone by, I am more of a “believer” and more spiritual than when I began this journey. I learn each day and I am grateful for the learning. When I look back, I would not change a single experience, even those that have frightened me.

 

29 July, 2016 Posted by | medical school, medicine, practice of medicine | | 2 Comments

Make Your Life Simple

As many are starting medical school, the most important task to master is getting your life under control. You are starting a journey of study that will absorb most of your waking hours in the next couple of years. Because of this, you have to take more than a few moments of time and figure out your basic needs. Starting medical school without taking a bit of life inventory is asking for problems that may cut into your precious study time. You have to figure out what you need and separate your absolute needs from the things that you want.

All of us who sit in that first lecture; open that first syllabus or textbook want to do well. We didn’t come to medical school to do poorly in our coursework. We seek out the wisdom of those who are a year in front of us and we start with the intention of “learning it all”. This drive for mastery comes largely from our premedical coursework where we always knew that in order to get into medical school, we had to have high grades and scholarship. Once in medical school, staying there and doing well becomes our next tasks as we adjust to the volume of information that will be presented in our pre-clinical coursework.

Making your life simple means that your living arrangements have to stable and comfortable. I largely used my apartment for showering, eating and sleeping. Much of my eating was done as I poured over my lecture notes and textbooks. I quickly found that doing much of my study at school was less distracting at first but I also found that heading off to bed early, getting up around 1AM and studying at home was also good for me. There were fewer interruptions from the phone and others as I was getting up when many were heading to bed.

My bed and bedroom were quiet, dark and restful. I refused to have any study materials in my bedroom; using my bed only for sleep. I also found that breaking my study time into 50-minute chunks worked well for me as I would often pace and recite my coursework, as a review, into a tape recorder so that I could listen to my study tapes on the subway as I made my way to class each day.

Making my life simple also meant that I bought my food for the week, on the weekends; making grocery shopping a break from studying. I had a great study group that like to meet on Saturday afternoon which meant that Saturday morning was great for food shopping. I also cleaned my house on that precious Saturday morning; getting rid of clutter that made me tired and less efficient.

Making my life simple meant that I planned each of my study sessions carefully. I made a list of what I needed to accomplish and marked off tasks as I completed them . Seeing those check marks gave my brain a sense of accomplishment that helped make the volume of material seem less intimidating. Still, I never felt completely ready for an exam but I always felt that I had a chance to do well because I studied for mastery (took no shortcuts during first and second year). “You can’t review what you haven’t learned in the first place.” was a favorite quote from one of my professors.

I always attended class prepared for the upcoming lecture by putting the previous lecture in perspective. This task helped me to see the “big picture” which can be neglected if one focuses solely on memorization. I sought understanding and perspective; organizing my studies around mastery rather than memorization.

If I have one regret in terms of my medical school work, it is that my physical conditioning suffered. As a graduate student, I was a middle-distance runner. My running helped manage stress and kept my weight down. I gained weight in medical school because the fastest foods were the ones that were unhealthy (high fat, high sugar). When I finally lost my medical school weight, it was my distance running that brought calm and organization to my life. Find a way to incorporate a minimum of 30 minutes of aerobic exercise in your schedule. Trust me, your grades will improve; your sleep will be more sound and efficient; your life will be simpler but more effective.

At the first sign of trouble, see your faculty instructors for help. They are the experts on the curriculum and should be your first and best resources if you need assistance. Your classmates are great but you should do a knowledge check with your instructor long before the exam comes up. Your instructor can also help you with organization should you become overwhelmed (very easy with the volume of material to master).

Finally, don’t forget family and friends. These people keep you sane but they can take up time if you don’t plan your interactions carefully. I often stated at the outset, “I have a couple of hours, let’s have a quick cup of coffee or breakfast”. I would set a timer on my watch so that I didn’t go overtime. It may seem rude but they adjusted to my general absence and helped my stay on task.

28 July, 2016 Posted by | academics, medical school | | 2 Comments

For Father’s Day

I want to share this post by a gifted physician, husband and father, Daniel C. Potts MD, who writes about his father. This post which can be found here: A Father’s Story is an honor to a father from a son who is a father. For me, this wonderful post reminded me of my father who was a physician and my first and best mentor. Please enjoy this post and honor your father on this upcoming Father’s Day.

17 June, 2016 Posted by | practice of medicine | | 2 Comments

Back to training for the marathon

If you have read my previous posts, you will know that I trained for my first marathon but was unable to complete the distance because of freak extreme conditions. In short, I had prepared for everything except cold and snow which fell and stopped me short of my 26.2-mile goal. I ended up with extreme hypothermia but determined to climb back into my training routine after an overseas trip.

This trip was one of my longest to date; required a 13-hour flight but worth every second the journey. I was transported to a land where I was very different from the crowds of people who live there. I found hills to run, markets and temples to explore but even better, I found connection with those who differ in culture from me. In short, the world became smaller for me but I became more aware of how similiar all human beings are. We are definitely brothers and sisters though we may look different, worship differently and have different professions/lives.

When I entered medicine, many years ago, I was determined to master the science that I knew I would need. Years later, I realize that the science is the tool that allows me to see the wonder of humanity. If I am going to take on the privledge of taking care of the health of those who trust me to have their best interests, then I must take on the connection of spirit with those who seek my care.

On my trip, I was able to explore markets and shops where those who sold herbs, used for thousands of years, explained how their medicines worked. I was able to tour modern surgical centers with those who explained how their medicine worked with equal pride and care. The simularities was the whether the physician was well-trained at some of the great universities or passing on the knowledge gleaned from previous ancestors, each took pride and care in the treatment of those who sought them out.

I also spend some time running the streets of the city that I visited. This city had hills that reminded me of San Francisco which enabled me to keep my training schedule. My marathon training is something that has allowed me to center my thoughts, improve and keep my physical conditioning and work out problems that might need careful consideration. I always allow my mind to go where it seems to want to lead my thoughts moving from something as simple as a song or careful consideration of other sides of a problem that might be present.

Long distance running is far from a chore but an exercise that can bring order to an otherwise chaotic life. As a middle-distance runner in university, I thought that the longer distances (more than 10 miles) would not be enjoyable but I have found a calmness and a serenity in covering those longer distances. I run for myself and for my selfish enjoyment. I have also discovered that with the longer distances, I can enjoy the microbrew beers that I have come to appreciate without thought of calorie intake or weight gain. For the first time in my life, I have to work to maintain my weight rather than weight loss. I am thinner than I have ever been in my life (adult or childhood).

With my marathon training and weight loss, I have found that people who haven’t seen me for six months or even six weeks, hardly recognize me. I remember one of my colleagues stating that he remembered my voice but didn’t recognize how thin I had become. For me, because I had always struggled with weight gain, especially when I am under stress, this new world of weight loss and thiness is uncharted territory. I should also that sleep has become more efficient and restful.  I use what I am learning about my new body to explore my new world. Running the streets of a foreign country was part of that new exploration.

Thus, as I move back into training for my first marathon, I have made it a point to focus on mental, spiritual and physical conditioning. I have also decided to add a healthy dose of weight training with my running. As I trained before, I find that I had lost a bit of muscle mass along with fat but now I need to see how I can work of being a more rounded and strong individual. I know that my physical conditioning is good and excellent for a person of my age but I want to be stronger, healthier and more mentally resilient.My training spilling over into every aspect of my life. This is the best marathon training that I can achieve.

30 May, 2016 Posted by | age, medical school | | 2 Comments