We are Dealing with People Here. . .

The other day I was attempting to fill my car with gas. It was extremely cold outside and the card reader wasn't working and I was getting increasingly angrier. Finally, after three attempts I went into the station. I was prepared with a, "What the Hell?" kind of response. I waited while one women counted out her drawer and another put in hers. A shift change. Awesome.

The lady greeted me with such kindness and explained that the satellite was frozen, and that's why it wasn't working. She chatted a bit about having worked there for 20 years. We talked briefly about how things had changed since she started. She told me that a few years ago she would have just climbed onto the roof herself and fixed the satellite, but that was no longer legal. They were waiting for the satellite company to come and fix it. She talked about how fortunate she was to have such good employees and that she liked talking to customers. I had completely forgotten to be pissed off. I finished filling the car and headed home.

I hadn't really thought about it, but we really don't talk to people anymore. In fact, I'm so awkward on the phone that I dread making or receiving phone calls. I prefer email and text messaging. Almost every business call I've made recently is automated.

What do we, as future physicians do with this kind of patient? How do we handle ourselves? Is anyone well-versed in small talk anymore? Are we too "chief complaint" driven? I will not further complicate the matter with a discussion of time, because that will get me full-circle back to my original emotion - anger.

We are not solitary creatures. We are not meant to be alone. In fact, those that spend their lives in solitude are rarely well-adjusted. So why have we created this way of living? Why are we in such a hurry? I have one theory - money. The faster we see patients, the more money we make. Stupid, huh? Our job is to heal people or make their transitions into death as smooth and comfortable as possible. How can we do that if we don't know how to communicate with one another? We live all over the country, on small plots of land, using the internet to avoid each other. This will not end well. I can't find the exact quote, but I believe it was Sir William Osler who said, "If you listen long enough, the patient will give you the diagnosis."

"Next."

(The image is artwork by Andy Goldsworthy)

A Perfectly Different Baby

Five down and two to go. Quarter five is now over. I didn't do too badly considering everything my little family has gone through in these last few months.

We knew when I got pregnant that I may not be able to carry her to term. We knew I might miscarry. When she was born five weeks early we were told she might have some brain damage due to her not receiving enough nutrition and possibly oxygen while I was pregnant. We knew she might have brain damage when her tiny four-pound body got bilirubin levels of twenty. We knew she might have cerebral palsy when she had sustained ankle clonus at two months. We knew she might have a seizure disorder. Now we are pretty sure she does not have cerebral palsy, but she might be autistic.

This all happened during fifth quarter. I did not fail even when I spent evenings playing with our Helena. I did not cry, because I love my daughter and will help her with whatever challenges she faces. Wasn't I even a little sad? Only occasionally, and then I am sad for her. I want Helena to enjoy her life and have every opportunity to thrive. She can do that even with a disability.

So does she have a disability? We don't know. The signs are there, but then again at nine weeks - Is she nine weeks old or developmentally only four, since she was born early? If she's only four weeks old she is nearly on schedule. We wait. We wait until she is six months old. That's a long wait.

My baby doesn't look at me. She doesn't smile much. She is very much in Helena's world. She loves music. She loves tummy-time. She loves to be tightly swaddled. She can stare at her grandma's quilt for hours. Is she disabled? I don't know. We wait.

People ask me - What can we do? I want you to look at my daughter. Hold her. Talk to her. You'll see - she's precious. She's perfect.

A New Baby, A Pile of Tests, and Contentment

We are well into 5th quarter, and it has definitely been a busy time. Four weeks ago I had our daughter - a full five weeks early! After much drama and a week-stay in the hospital, we all came home and are doing well. Needless to say I didn't study that week. At all. Nothing. I thought I was sunk academically. However, I took five exams the following week, got caught-up and am now doing fine. I couldn't just let myself fail. I've come too far to just give up. Thankfully I have the world's best husband who made it possible.

In two days we have our second neuroscience exam of this quarter. It's not that neuro is particularly difficult. In terms of understanding the material, it isn't too bad. What's extremely challenging is remembering all of the pathways and putting it all together with increasing piles of information to hopefully sort out, in the end, what is wrong with the patient. I'm a little worried.

A lot of people think that I am somehow super-human for having a baby in the middle of 5th quarter and not failing out. It's like all things in a person's life - whatever pile is before you, you must either sort it or clean it. ;)

And now, after much sleep-deprivation, I will go to bed and get up tomorrow and study all day. I will take mini-breaks to kiss and hold my baby girl and talk with my husband. Really, I have an almost perfect life.

Interesting aside - as one gets further into medical school it starts getting easier. The classes don't get easier, but one acquires some duck-like skills and allows things to just run off. You do what you have to do when you have to do it and yet still make time for what's important. That's the difference between first and second year.

Survival!

I cannot tell a lie - third quarter almost defeated me. It is also true that most of my classmates did well. I did not. In fact, I almost failed three courses. Yes, three. I managed to salvage everything from the wreckage, but it was absolutely the most stressful time in my life to date.

Most medical students don't fail - we fight and claw our way to the top or out of the hole. Unfortunately, I am not at the top of the pile. This makes it very difficult to see myself as a competent physician. Wait! This post is not about to deviate into the dark; do not fear. It is something I have had to contend with my entire life - I am not that intelligent. How did I possibly get into medical school? I'm above average, but that's about it.

You don't need me to point out to you all of the doctors of the world who could recite their lecture notes verbatim from all four years of medical school and yet they can't identify a disease in a real patient. The human body just doesn't like to play nice.

To future doctors - I urge you to remain interesting. If all you've ever wanted in your entire life is to be an otolaryngoloist, you're awfully myopic. There are all kinds of interesting things going on inside one's patients. I have three goals - one is ridiculously lofty and the other two are reasonable. I will not be upset if I don't make goal number one. I enjoy learning and people are fascinating. It's too bad some students can't find satisfaction in these things. Perhaps it is a mixed blessing that I have to struggle so much.

And now - I will continue to enjoy some break-time before preceptorship begins. I have never appreciated my free moments more than I do now. Medical school is kind of like being a POW - it's terrifying and sometimes unbelievably horrible, and then you're freed and it's unbelievable. The simplest things are so beautiful - like sleep and painting one's nails.

Medical Students are Crazy

There must be an anatomy test in 2 days, because I've found time to blog. I'm not going to lie - the intimate details of the nasopharynx do not interest me one bit. Learning the material for this test is like trying to convince a teenager to practice the cello for 2-1/2 hours everyday. Considering that I used to attempt this feat on a daily basis I know it is impossible. Since I am not currently passing anatomy, this is a problem. Step one - I've admitted I have a problem. Step two - continue with blog and ignore problem.

We had a tornado this week which not only uprooted several locals and students, but uprooted our schedule as well. The dreaded microbiology case presentations were cancelled. I felt guilty for being so grateful, but there you have it, I was ecstatic - especially since I've chosen sleep over study recently. I spent Thursday helping clean up felled trees and brush from a local town. It was great. I became a doctor to work with and help people. Reality - medical school has nothing to do with that goal. I take every opportunity that presents itself to work with people in the community so I don't lose sight of my goals and forget that I really do like people. Okay, most people.

A room full of medical students - it sounds like the start to a joke - in a way, it is. I enjoy watching us, myself included, in groups like this. It's like having 172 type-A bosses all standing around and trying to be polite. It's downright hilarious. We enjoy each other, because we understand the pain and joys of medical school, but we can barely stand each other, because we're all so similar. Some take charge no matter what, and others stand back and talk about them behind their backs. Some ace test after test and they're idiots. Some fail constantly, and they're going to be amazing doctors. I have no idea how the world works. I'm not going to lie - it's fun to watch.

So there you have it - medical students are nuts. We know this, we're just trying not to have that fact documented on paper. Whatever you do, don't let them know you're bipolar! Good luck boys and girls. Now get back to studying.

Medical School with a Baby

It has been quite awhile since my last post. Shame on me. Things really got interesting in second quarter, and third quarter is unrelenting. And then I found out, back in February that I'm pregnant. Mini-me was certainly planned, but not probable. I was not intended to have children, according to my doctors. Here I am, almost 17 weeks pregnant and at least so far, no signs of any problems.

I was waiting for some real inspiration for a post. Something uplifting and wholesome for future doctors. Something that will make the pre-meds very excited. Unfortunately I have had no such luck. It's not that I'm miserable, I'm not, but it's absolutely grueling, and sometimes that takes a toll on my usually positive self.

Balance. It's such a simple word, really. However, if one adds medical school and pregnancy to the equation the calculus becomes much more interesting. My pregnancy hasn't been too bad. I've been exhausted and quite sick, but nothing too major to report. Medicine of course does not care. It's not that my professors are callused and uncaring; they have been great. However, were I to put off a test on account of morning sickness, then I'd have to double-up studying for the next day's tests. Not an option. I dragged my sick and nauseated self to an anatomy final. I was sweating bullets trying not to hurl (chunder, vomit. . .). I managed and I even did all right on the exam, but it was pretty awful.

Balance. I cannot and will not spend all day and all night of everyday studying. The people who do that are machines, and not in a good way. People are not machines and algorithms do not always work. Creative thinking does have its place. I refuse to see people as merely a set of numbers. Those numbers are important, but if the doctor can't think beyond that - well then, you're going to have a problem.

Balance. What if I forget to listen? What if I'm so busy that I cannot really look? What am I then? I am that doctor that everyone complains about. The one who walks in the room and says without introduction to a cancer patient, "We're going to have to remove that finger." True story. It's unfortunate that every medical student (myself included) thinks that we're never going to get anywhere if we can't intelligently define LaPlace's Law. It's simply not true.

Balance. What does student Dr. Anne recommend? That you lay in bed for a few extra minutes every morning to take in the sounds. Look around at the trees. Have a good cry. Try to do better. We must do better.

The Physical Realm (not a medical musing)

Today I went shopping. I hate shopping, and especially for clothes. Partly it's the guilt that overwhelms me. Guilt that because I have poor control of my food choices and my drive to exercise is weak, I am somehow not a good person. Okay, gross overstatement, but every heavy woman knows about what I write. It is so hard to be a fit American. We have french fries available to us every 20 meters or so, mochas at every corner, and fantastically comfortable furniture begging to be sat upon, layed in, or lounged across. I do love exercising. I used to be a weightlifter. So what's the problem? As with all medical students - I hate doing anything halfway. So - why exercise for only an hour? I want a three-hour-a-day body-busting routine. 60 pounds ago and a lot more free time - I had that. It's depressing to go run for 30 minutes and lift a few weights.

I need to get over it. Being a fat doctor just doesn't look too good. Be honest - you'd trust a fit doctor over a fat one. I could never look a patient in the eye when I had to tell them to lose weight. It's awful! I need accountability! I need time!

Fear not - I will not make this a New Year's resolution. That's just bad luck. Mope. That is what I will do. Then maybe I'll find the strength to take the cliched bull by the horns and treadmill by the rails. . .