3rd Year of Medical School.

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Family Medicine

  • How did I feel when I got home?

Similar to the satisfaction of unfastening something too tight. I would race home from clinic and burst through the front door to be greeted by those two little chunks of sun.  I’d bask in the warmth and the light of those two small humans, soaking up their innocence and honesty and curiosity while they melted my heart like a stick of butter. It was like remembering what the sun felt like after a long and relentless winter. I slowly refueled my empty battery packs. I stroked their back a minute longer after they fell asleep. I squeezed them tighter before letting them go. I made silent wagers with the universe to pull in the reins for a few years, please stop them from growing so fast. Somehow, everything else on the rotation paled in comparison.

  • Did I feel excited to look up the illnesses and diseases in the patients I was caring for, or to study for the shelf exam? Was there diversity in the conditions being treated?

Absolutely. Family medicine is incredible in that sense – the breadth and diversity is as far-reaching as the eye can see. I ended up keeping a list of all the patients I wanted to go back to check their results, look up their weird symptom, or see if the specialist agreed with my diagnosis. I saw a woman with metastatic cancer who’s tumor had pushed it’s way through her abdominal wall – visibly protruding and angry for all the world to see. I saw a woman who was rapidly losing her ability to move her muscles, leaving some of the finest research hospitals in the country scratching their heads. I saw a woman with nagging pelvic pain after her appendectomy (she forgot to mention the stormy black and purple bruising spreading across her belly), who quickly re-visited the operating room. I saw where medicine heals and where medicine falls short. I saw the expansive gaps in our health care system in which we have plugged with glue and gum,  when it should have been gardened with diet, exercise, and mental health. I saw the incredible miracles that medicine can provide, tacking years of life onto patients knocking on death’s door. Overall, I loved finally being able to drink in the minutia of America’s ‘bread and butter’ diseases. Turns out, I still love medicine after all.

  • What were the main feelings I encountered while working with the patients? The medical team?

An overwhelming sense of belonging. I listened to patients spill their entire lives with me – their relapsing meth addiction, their embarrassing odor, their breaking marriage, their battle against their disease. They let me scrutinize their skin, push my hands on their belly, feel for lumps in their breasts, stick needles in their joints. They shared words of wisdom distilled from years of seeing the inner workings of the health care system. I didn’t feel frustrated with patients, as I had envisioned myself feeling while coaxing relapsing diabetics and narcotic shoppers. Instead, I felt the same connection that drove me into medicine in the first place – that same window into the human experience.

The medical team felt more like a true team than I have ever experienced. The medical assistants and I grew so close you’d think we’d all grown up on the same street. They helped me finally settle on a prom dresses, filled the clinic with treats for my birthday, covered my back when I slept through my alarm (granted, I slept until 1pm, for which their is no excuse other than my body had literally tried to enter hibernation). Then the incredible physician I had the fortune of working with – I had requested him specifically after I had cared for one of his patients with newly diagnosed mesothelioma (“I just moved here and my new doc picked up the cancer on my first visit!”). I filled a small notebook with observations and clinical pearls during my short time with him – but what impacted me most was seeing the way he interacted with patients. Upon entering the patient room, he would greet them with the same warmth of visiting family, and would quietly sit back, cross his arms, and listen. Sometimes patients would talk for nearly ten minutes, but he never interrupted. He simply listened, quietly nodding and observing. During the entire encounter, he spoke less than most physicians do during the first few minutes. And yet – he was able to narrow in on their diseases with unbelievable precision. He has caught more missed diagnoses than I can even describe. Nearly every patient I interviewed would tell me, without any prompting, how “I just went in for my annual physical” and “he thought he felt a lump/heard a murmur” or “he said he just didn’t have a good feeling about it” and BAM – they were diagnosed with cancer, underwent open heart surgery, or admitted to the hospital for a weird fungal infection. This happened every single day. He was the most remarkable influence on me – instead of dismissing symptoms as I had learned to over the past year, he actually listened to the symptoms I was dismissing and worked them up. During my short experience with him, we sent countless patients to the children’s hospital for bizarre illnesses I had read about in textbooks, to the operating room for “a little heartburn”, and we even sent a patient with newly diagnosed lung cancer on imaging to the cancer hospital for the first time. I can only hope to retain half of the wisdom he imparted on me, and even a sliver of his skill as a physician.

  • How much direct patient contact was there? 

So much. So, so much – and I couldn’t have been happier. Except if their had been a scalpel in my hand.

  • What were the humdrum aspects in the patient population or workflow that would have to be tolerated for the rest of your life?

Do-cu-men-ta-tion. And well child checks, ugh.

  • Does this specialty address one of the leading causes of death in the world?

YES. In every possible way. I think family medicine is ultimately the answer to most, if not all, of our health care problems. Unfortunately, I am too damn selfish to relinquish my time in the OR.

  • How easily can motivational impact be integrated into a career in this specialty?

SO EASILY. This seems so ridiculously obvious that I’m not even going to answer it.

  • Does this specialty focus on preventing problems or fixing problems?

Both. See prior statement.

 

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So do it. Decide. Is this the life you want to live? Is this the person you were meant to be? Can you be stronger? More compassionate?  Decide. Take a deep breath – your heart will try to lodge itself in your throat. Brace yourself. Here it comes – the headlong dive into the deep.

 

 

Psychiatry.

  • How did I feel when I got home?

I got a glimpse of what life was like before medical school again! Not only was I sleeping more than I have in the past 3 years, but life in general slowed down for me – I actually got ready in the morning, prepped tupperware lunches, and went snowboarding for the first time in years. I learned a lot about mental illness, addiction, and the biochemical imbalances that can push us off the deep end, and I know these problems really do permeate every field in medicine and I’m going to encounter them on a daily basis in my practice. I also realized that psychiatry offered a similar aspect that surgery did. There’s a saying I’ve heard that claims, “Those who don’t go into surgery end up going into psychiatry.” At first, I couldn’t wrap my mind around this. What could these two specialties possibly have in common? For weeks I tried to piece the two together and it wasn’t until a psychiatrist finally explained their similarity to me: both are extremely invasive, and both expose the taboo: the rawness of the human experience. Both fields throw the windows wide open, forcing you to stare inside the very essence of life.  Just like surgery, there were days that left me sitting stunned in my car – feeling awestruck by the beauty and the pain. But surgery’s twin sister was so drastically different in countless other ways. People walked slower. Talked slower. Smiled at each other in the hallways – instead of that look when you spot a surgical resident – like seeing a deer in headlights.

  • Did I feel excited to look up the illnesses and diseases in the patients I was caring for, or to study for the shelf exam? Was there diversity in the conditions being treated?

I tried my best to dive in and soak up everything I could, to learn the intricate details behind anti-depressants, opioid detoxification, socioeconomic factors impacting hospital care. But the truth is, I found myself feeling bored really quickly. For the majority of the time, the work felt passive: “How’s your mood today? Is the medication working? Should we try a different one?” There was definitely the few patients who were the exception to this  rule- and I was able to witness the enormous impact psychiatry can have in helping someone suffering from mental illness. But overall, I was constantly hungry for more. I kept finding myself turning back to surgery – looking up various topics in surgery, getting my name on more surgery papers than ever before, and sneaking back to the OR to close flaps or see traumas. I was grateful for the pause that psychiatry offered – a break in the grind, a chance to breathe – but in the end, I knew it was just that. A pause.

  • What were the main feelings I encountered while working with the patients? The medical team?

The medical team was AH-MAZING. My attendings became some of my absolute favorite people I’ve encountered in medical school so far, and honestly made me take a long, hard look at the stone cold personalities in surgery and truly come to terms with it. These attendings, in stark contrast, were overwhelmingly supportive and complementary, allowing me to take ownership of my patients, propose treatment plans, and write all of the notes. I’ll never forget the day the social worker was on the phone explaining members of the treatment team when she added, “and then Hailey, she’s the medical student on the team.” It sounds ridiculous, but being listed as a member of the team like that has not been a common occurrence (we’re not listed at the nurse’s station, on progress notes, in team meetings, etc). After all, it’s like you’re not really part of the team – you’re just a temporary transplant who only requires a formal introduction when standing face-to-face with the patient or about to put your gloved hand in their abdomen. But in psychiatry, I truly felt like I was fully embraced as part of the team.

As far as the patients I encountered, honestly a lot of my patients blended together in a blur of depression, anxiety, and detoxification. But then there were the select few who deeply impacted me and made me realize the fulfillment that psychiatry – in it’s finest moments – can offer. It was the young man presenting with his first psychotic break from schizophrenia, who became “my” patient – the patient I sat on the floor with and persuaded to agree with treatment, the patient who drew me a picture every day, the patient who left the hospital remarkably symptom-free with anti-psychotic flowing through his veins. It was my patient who stabbed himself in the chest in a suicide attempt, but miraculously missed every vital structure and left with only a handful of stitches. It was my pregnant patient withdrawing from heroin. It was my patient who, after hours of deep conversation, finally disclosed their suicide plan after discharge to me, and all of the ups and downs that followed: clever suicide attempts, riddles and games (“it’s all a game of chess”), and lastly, my letter (“checkmate”). In the end, psychiatry was both blissfully relaxing and an emotional whirlwind – with a tiny bit of crazy scattered in between.

  • How much direct patient contact was there? 

So much! I would say more than any other specialty. I loved getting to spend hours just talking with patients, hearing their stories, learning with them. I’m going to miss that.

  • What were the humdrum aspects in the patient population or workflow that would have to be tolerated for the rest of your life?

Borderline personality disorder and addictions. The former left me feeling absolutely emotionally drained. The latter left me feeling like there was nothing I could do and like I needed my own drink.

  • Does this specialty address one of the leading causes of death in the world?

Suicide is the second leading cause of death in young adults worldwide, so I guess it does in that sense. Otherwise, it probably does in many ways indirectly.

  • How easily can motivational impact be integrated into a career in this specialty?

SO EASILY! This was one of my favorite aspects of psychiatry! I loved feeling like I was helping to shift a patient’s path in life. I want to carry this with me. It’s easy to lose sight of this motivational potential with patients. I also loved the personalized descriptors used in the documentation of these patients and want to carry that with me as well – you never really see that in other specialties (like when my psych attending included “Appearance: well-groomed, eyelash extensions in place).

  • Does this specialty focus on preventing problems or fixing problems?

I would say fixing. But truthfully, I never felt like it did a great job at fixing them.

 

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When your favorite attending greets you with a present and pastries for your last day. 

Ob/Gyn.

Ob/Gyn.

  • How did I feel when I got home?

Ugh.

  • Did I feel excited to look up the illnesses and diseases in the patients I was caring for, or to study for the shelf exam? Was there diversity in the conditions being treated?

No. So many no’s.

  • What were the main feelings I encountered while working with the patients? The medical team?

“Why can’t they just push for a couple hours instead of us pushing more Ptocin to speed things along?”

“Why is the team doing a poll on whether Snape was Harry’s father or not?”

“Oh, look- another low transverse incision.”

“Oh, look- another shelf question about a pregnant woman with bleeding. Still no idea.”

  • How much direct patient contact was there? 

So much. Too much vagina.

  • What were the humdrum aspects in the patient population or workflow that would have to be tolerated for the rest of your life?

Oh dear god where do I begin.

  • Does this specialty address one of the leading causes of death in the world?

Probably.

  • How easily can motivational impact be integrated into a career in this specialty?

Meh.

  • Does this specialty focus on preventing problems or fixing problems?

Both, I guess. But truthfully, Ob/Gyn was like nails on a chalkboard to me. It was the first and only rotation I have disliked during medical school so far- and I’m okay with that. Maybe it’s my lack of personal experience with childbirth, differences in personalities with those who chose to pursue the specialty, or maybe a lack of a lot of exposure to newborns as I was growing up. Or, maybe, my soul spirit was in medicine in a past life and my allergy to Ob/Gyn stems from a deeply-rooted fire that spans through time and space. Whatever the reason may be, I am so blissfully okay with plopping Ob/Gyn onto the pile beside Radiology and Pathology of specialties I can safely cross off my list (and possibly burn later).

Ice Cream Sandwich Socks.

She was the most terrifying surgeon in the hospital.

In an age where white coats were to be worn only by men, she walked fiercely into medicine anyway. She took the sneers and barking from senior physicians but she held her chin held steady. Back then, medicine was not a woman’s game. With each step she climbed, she tacked on another piece of armor and she grew stronger. It toughened and polished her, and she was built into the indestructible surgeon she is famous for today.

I have watched chief resident’s fingers tremble beside her. I have watched fellow surgeons, renowned and respected in their own right, fall silent as she stepped into the room. Scrub nurses, usually bustling and preparing while chatting with the circulator,  stand alert with fingers poised and eyes glued her hands, anticipating her next move. Medical teams in the hospital, young doctors visiting from out of state, senior doctors trailing the end of their careers – they all know her name.

For weeks, we had stood shoulder-to-shoulder in silence as she performed many of the biggest surgeries known to medicine. The infamous Whipple procedure – a grueling 8 hour minimum- was her favorite. Her fingers seamlessly twirled around the surgical instruments, and I longingly watched as she carefully cut open the belly, clamped arteries, and unsheathed the pancreas. I stood perfectly still, often for over 10 hours, with my hands carefully planted on a corner of sterile draping. Others had warned me: “She prefers medical students to simply observe. Whatever you do – don’t grab anything.”

Yet something in me resonated with her. There was the smallest hint of a smile in the corners of her mouth under her mask when her eyes met mine. I recited my patient presentations I had spent hours memorizing for her clinic and could see a flash of approval in her stone cold expression before she spun on her heel to enter the patient’s room. Then one day, she handed me her suture. That day in the OR, I was taught the sacred ritual. She began to signal for me to cut her sutures with the slightest flicker of her fingers. One day, I nearly tripped over my own feet in shock as she stepped back from the operating table and silently waved for me to assist the chief resident in stapling the bowel in half.

She was like no one I have ever met. During my last day on her service, she unwrapped the ice cream sandwich socks I had bought for her and she squeezed the breath out of my ribcage. And I will never forget the words she told me:

“Hailey, you are a surgeon. I can see it in you. Do what you are.”

I remember you.

I remember you were embarrassed but you let me help you anyway. You joked that you could be my mother and I joked that I could just pick you up but you wouldn’t let me you wanted to do yourself you said you could do it you said. Every day you were weaker as you disappeared into the bed around you but your spirit never did, I remember that. You said you could do it and I was right behind you, watching your legs flail under you and your white knuckles on those bars and you scared me half to death so when your legs crumpled and you fell in my arms we both laid on the cold tile and you said it’s okay I’m okay and you laughed but we cried anyway. You wrote me a note and I still have it on my wall and I think about you all the time so when I heard his cold voice in our lecture say the disease that riddled your bones, I thought of you and your note and how you’re always right there.

And then you, I can’t forget you even though I knew nothing about you except that you were from Wyoming. I remember that because they said that’s where your children where and that someone came into your house with a baseball bat and that’s why your skull is caved in like that so they flew you here and found a fungus growing in your brain and I didn’t even know that was possible but then again I didn’t know anything about you. They unplugged you and left you and no one ever came for you, your children never came but your breath held on and all the nurses kept waiting, waiting for the room for the next patient but you kept holding on and I was so nervous to be alone with you because I didn’t know what to say god please help me so I washed your skin and moisturized the cracks in your lips and you had a tattoo on your wrist and I don’t know what it was or what it meant to you but you had a childhood and stories, so many stories, and I know you heard me because your eyelashes moved. Can you hear me? Everyone is here. Your children are here and telling you they love you, they love you so much, we’re here, we’re all here and its okay now. When I left you, you stopped waiting. Because the nurse went in and you were gone and they rolled you to the basement but no one ever came for you.

But for the life of me, I can’t remember what brought you. I remember your mother telling me you were an angel and how you would spend your weekends pulling weeds and helping people move but for the life of me I can’t remember what shattered your skull like that. They said the clear fluid dripping from your nose was from your brain and it wasn’t going to stop and there was silence and I listened to it drip, drip, drip, because your skull was like a broken eggshell and they couldn’t piece it back together, can’t you see. And even though I looked away, her voice has stayed with me anyway because I could hear her heart was breaking as the hallways echoed she can’t lose you, she won’t lose you, why won’t you DO SOMETHING doctor, but we can’t fix you we can’t fix you. So they left and she looked at me but this time I couldn’t look away yes I’ll stay with you yes I’ll pray with you and we cried in the dark and in the morning I left and so did you. But when I got home I still smelled like you and the water was so hot but I couldn’t get rid of you. I’m right behind you I knew nothing about you they never came for you we’re all here for you I can’t lose you we can’t fix you so the water dripped, dripped, dripped.

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