3rd Year of Medical School.

Advertisements

Neurology.

  • How did I feel when I got home?

As my last rotation, the taste of fourth year right around the corner was always on my tongue. But I put my head down, kept myself busy, and confirmed three things: 1) Neurologists are badasses. 2) I feel something deeply powerful with stroke patients (go figure) 3) I love critical care. For my 2 weeks in the Neuro ICU, I was probably in the hospital for 95% of it – sleeping for a few hours in the call room until the next organ harvest operation, central line placement, or stroke page. I loved placing central lines, popping through the dura for my first lumbar puncture, or emergently rushing a patient to the OR – this chaos is my ebb and flow.

  • 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 was surprised to find how interested I was learning about neurology. I truly think neurology is the last frontier in medicine. There are still so many questions to be answered, so many diseases without treatment, and so much we still don’t know about that squishy pulsing thing in our skull. I loved the way neurology forces you to localize the pathology on-the-spot, and truly think your way through the diagnosis. But my lessons came from the most unexpected places as well- such as working with an expert in multiple sclerosis who opened my eyes about the extent of financial swindling with pharmaceutical companies. Then there was my Sharon. She was the equivalent of my Mr. Castillo on my vascular surgery rotation. A young woman with fire in her eyes and enough vibrance to light up a room. My intern and I, only saplings in our medical training, sat down with her husband and daughter to spread the cards of her critical situation. We consulted every service in the hospital trying to figure out what was wrong with her, but ultimately despite hundreds of labs, imaging, and biopsies, we didn’t have an answer for her husband’s hopeful eyes. She had been in the hospital for a week. That’s when I got the page. I remember how awful and bizarre it was talking to her- reassuring her – for those few seconds we had as she bled into her brain. I pretended like I wasn’t crying and refused to break her gaze, repeating,”Jim is coming, hold on okay? He’ll be here. Hang on.” Dozens of people flurried around us and the corner of her mouth gave her little smirk like she always did, right before her brain sagged beneath it’s fascial tent. With my third year wrapping to an end, I know that moment will be carried in a chunk of my heart forever. I will never forget that beautiful soul, or any of the amazing patients who shared their stories with me and let my unexperienced hands poke them at all hours of the night. I was lucky enough to honor every clerkship during my clinical year, and I can honestly say that staying interested in every aspect of medicine and taking complete ownership for my patients were not only the keys to my clinical learning, but also to helping me avoid burnout. I’ll admit- often my intrigue in neurology was usually only sparked if it directly related to the patients I was treating. But that little spark of intrigue is all it takes. So I run with it.

  • How much direct patient contact was there? 

So much. I loved the critical care aspect, and the slower pace of outpatient clinic and getting to actually spend time with patients.

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

Non-epileptiform seizures.

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

Yes, definitely – cerebrovascular disease. Our treatments for it still suck, though.

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

So easily. I feel pretty confident in saying now that this could be integrated into any specialty in medicine.

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

I’m not sure how to answer this, because I don’t feel like we currently do a very good job at either of these. But as I said, I think neurology is medicine’s last frontier. We just need someone to unravel it.

IMG_0171.jpg

 

A Priori.

An EMG test helps determine if muscle weakness is from nerve injury or muscle damage.

In resting muscle, it should be quiet.

In active muscle, it should fire rapidly like a machine gun.

Inhale. Needle in. Eyes down.

Waiting.

Then, we heard it.

Slowly, it emerged from the silence. That dreaded, faint signal beating from resting muscle.

Eyes closed.

Sinking.

He had been healthy a few months ago. But Amyotrophic Lateral Sclerosis had chewed away the nerves, leaving islands of muscle without any connection back to the body.

Despite losing all neuronal input, the muscles in our body keep searching for them.  Forever emitting a lost telegraph signal. Hoping.

Sit up.

Wiping.

Plaster smile.

After all, stranger

we’re only satellites

sending out signals

waiting for someone-

fucking anyone-

to receive us.

IMG_0174

 

 

 

PEDIATRICS.

Pediatrics.

  • How did I feel when I got home?

I felt more well-balanced. Although pediatrics was a steep learning curve for me (“Oh we don’t give cold syrup to kids this young?”), I really enjoyed the patients I was caring for every day. I didn’t mind staying late or waking up early, and I found a little more free time to balance my life outside the hospital with things that have been pushed aside with other clerkships. Outpatient peds clinic nearly converted me after a whole week getting spoiled with sleep and sauntering into the hospital at 9am. Almost.

  • 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?

Gahd, no. I mean, learning the basics of bronchiolitis and viral gastroenteritis will help me in any field I end up in. And hopefully, I can look a little less clueless when a stranger inevitably points to their kid and asks me what’s wrong with it. But in all honesty, I had to drag myself to study each night. I remember how eagerly I would go bouncing into a coffee shop to bury my head in a surgery textbook despite my exhaustion and spending all day in the OR, and it became increasingly apparent how different specialties truly pull at you. All in all, the kids were great – but asthma algorithms, growth charts, and counting wet diapers is not my jam.

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

I honestly love working with kids. Usually they are pretty healthy. Taking a social history is a breeze. They are pretty cute for the most part. And I feel like I’ve succeeded in life every time I finally get one to laugh at me. What I liked most of all about having pediatric patients was the absence of internal bias when treating them. There was never a lingering shadow of “metastatic cancer” or “2x CABG” weighing down our medical decision making. The kid is sick? Let’s treat them. I liked that.

  • How much direct patient contact was there? 

A lot. And I liked that. I miss interacting with patients and getting to hear their stories without having to hurry along to the next patient. And pediatrics was overall a slower pace with more time spent in patient interactions. “Tell me about how they first discovered your brain tumor.” “How were the first few weeks after bringing him home from the NICU?” “What do you want to be when you grow up?” I also really liked that physical exam plays such an important role in pediatrics. You see a bulging, red ear drum holding back a pocket of pus and prescribe some antibiotics – just like that. There were many times when a regular viral bronchiolitis turned out to actually be bacterial pneumonia after we noticed diminished breath sounds over a soggy pocket in their lung.

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

Everyone always says the downside of pediatrics is having to deal with the parents. I actually didn’t mind the parents. I didn’t really mind the boring diagnoses either, such as conjunctivitis or strep throat, because that meant I just got to spend more time playing with the patients since the diagnosis was covered. I guess the aspect I enjoyed the least was actually the medical team. I often felt annoyed with the smatterings of protocols for seemingly simple diagnoses, and the pompous gloat of the medical team as they tinkered with them, knowing that somewhere in the hospital other medical teams were pulling patients from the brink of death – unclogging arteries of the heart, suturing ruptured vessels, removing angry gallbladders.

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

Ultimately, yes. But not in a way that I see my own contribution to the world.

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

Very easily, I think. The youth is our future, isn’t it?

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

A little of both, I think. But at the end of the day, I definitely didn’t feel like I was ‘fixing’ much.

Evolving.

I remember asking myself, “How will I be different at the end of these 4 years?”

  • I usually groan when I have to wear my white coat, instead of eagerly slipping it on and beaming with pride like before ( I like my scrubs better).
  • I spend a lot less time focused on my make up, buying clothes, social media, and the curves of my body than I used to.
  • I find more happiness in things I used to take for granted, like having a day to sleep in, a free morning to eat brunch and read a book at my favorite cafe, a hushed conversation in the corner of a bar, patients who smile back at me, or a hot bath after a long day.
  • I have gone from knowing nothing, thinking I know everything, to knowing I know nothing.
  • I still love every minute of it.
  • I’ve realized that chest x-rays are useless.

Come float the river Styx.

It’s the feeling I get in right before they roll in. It’s the look in the surgeon’s eyes, standing at the head of the bed with arms crossed, calculating the seconds, the options, the outcomes. It’s having nothing else to live for outside the hospital except a sister with her own life. It’s the feeling in my chest after helping create a good death- saving one spirit from that painfully slow deflating of life in the corner of a nursing home. It’s the thrill of the running, bursting into the OR, metal clashing open on the table and the stillness right before the scalpel touches, eyes locking over masks, listening to your heart pound like a war drum against your rib cage. It’s the swinging on an emotional pendulum of extremism – it’s a fucking high and I’m a slave for it. An addiction that sprouted from young bones lying awake at night, nerves as tight as guitar strings, waiting for the screaming, the crashing. Honestly, it was Mr. Castillo. It was seeing him talk for the first time after we took him off the ventilator. It was seeing him walk out of the hospital, talking with his wife. It’s seeing his chart still empty since he left, knowing he’s still at home, still living a normal life. It’s the boulder that had been crushing my chest as I ran behind him, the gushing blood nearly audible as it filled his belly like a balloon from his ruptured aorta. Knowing he was going to die while also knowing I couldn’t take the pain again, I hadn’t healed from the last one yet. Until he didn’t.

And somehow, the pain was gone.

124