A different world

Today was my first day working on labor & delivery. It was pretty darn insane. The laboring room is a large shared room where about 15-25 women wait to be completely ready to start pushing and give birth. While they wait, most lay completely naked, legs spread open, screaming in pain as others walk by ignoring them. Everyone at the hospital seems very used to the fact that women are screaming all the time and ignore it, some even laugh at a particularly vocal patient. At one point today, a woman was screaming so much so I went over to her to check to see if she was complete (ready to deliver). One of the residents stopped me and said, "Don't worry. Ignore her. She will learn we don't give preferential treatment for being loud and she will quiet down." I felt so awful that I had to ignore this woman who was shrieking in pain. It felt so wrong to let her deal with the pain by herself. In case I forgot to mention earlier, patients are not allowed to have visitors so they go through all of labor, delivery, and postpartum alone; they can't see anyone outside the hospital and no one can see their baby until they leave.

Another fantastic quote from today... a patient was just admitted from the emergency department in labor. It was her first time giving birth. She didn't want to lay down on her hospital plastic mattress because there were no sheets on it and it was dirty from someone else's blood. When she told the resident who tried to get her to lay down on the mattress so he could examine her, he laughed and said, "This is a public hospital stupid. We don't give everyone bed sheets. Lay down."

The lower level residents deliver the babies. The upper level residents wear white and therefore usually only stop by if needed. For the most part, we are on our own in the delivery. The goal of the residents in the delivery is to get the baby out as quickly as possible. If the woman is scared or isn't pushing "enough" , everyone in the room laughs at the patient and tells her to "stop dreaming and grow up." Some of the residents smack the patient on the forehead if they think she needs a "wakeup call" and needs to push more. If you are taking too long in the delivery, the senior resident comes by and says "This is taking too long. Cut her right now" (cut means cutting an episiotomy to make more room for the baby to come out). During one of my deliveries today, the baby was making good progress and was coming out just fine. This patient was young and this was her first delivery so she was scared and needed some coaching; she had only tried pushing 2 or 3 times. When the senior resident said the patient was taking too long, he told me to cut her. I hesitated, not just because I didn't have experience with episiotomies or not just because I thought that she didn't need to get cut (even though I don't think she did), but also because this woman did not receive any pain killers or analgesia of any kind before he wanted me to cut her. He pushed me aside, took the scissors and cut about 2 inches into this woman's perineum. Despite seeing many natural child births back home and all the births I see here are without analgesia so I had heard my share of screaming and pain, I had to look away from this patient when she started screaming. I have never ever in my life heard that kind of a scream. The resident gave her a large episiotomy and pulled the baby out without any consideration of pain relief, not even local analgesia. He walked away and the woman was left there alone, bleeding, still shocked by what had just occurred. She laid there alone, naked, with her legs still in the stirrups, bleeding because the resident had to go to another delivery and didn't have the time to stitch up her wound for another ten minutes. When I finished with the patient, I walked away and realized that my surgical mask was wet and that at some point during this episode I must have cried.

As I mentioned before, physicians here do not use ultrasound monitoring to hear the fetal heart beat; instead, they listen using their stethoscope. This is a technique that I am still working on. One of the residents teased me that I didn't know how to do anything here and asked how we could possibly monitor patients differently in the US. As I looked around the crowded room full of women in labor, windows open, with flies accumulating on the patients that were too exhausted to scurry them away... I didn't know where to begin describing the difference. I started telling this resident that where I trained, every patient was constantly monitored for contractions and fetal heart tones. I didn't even bother to describe that every patient had a private room or the other luxuries patients have in the US. I could tell that talking about constant ultarasound monitors, let alone central stations with computer access to these monitors was an entirely different world. I'm learning tons from my experience, some are positive experiences and some are negative experiences but all are great opportunities for learning. That said, I know that I will come away from my month here with an extreme gratitude for the medicine I have a privilege to practice back at home.

A great week

I finished off my first week at work. Today was a really awesome day. I felt like I knew what I was doing, felt pretty confident with my Spanish in the hospital and outside of it. Today everyone was celebrating the upcoming Valentine's Day. For about two hours, everyone kindof stopped working to enjoy food and spending time together at work. It seems corny but it was really cool! One of the attendings brought his guitar and everyone just sang, danced, and had fun! Everyone was having so much fun in our party in the emergency room that they decided to move the party to the labor floor (the big room with tons of hospital beds and naked pregnant women waiting for the doctor to be ready to deliver their baby). Although everyone in the party was having a good time, but I have to admit it was really a bit weird to be dancing, singing, laughing in a room where women were screaming in pain as they had natural child births! That said, it was really nice to feel included and see how different the dynamics between co-workers can be in a hospital at a different country.

I have a really good friend at the hospital who is a first year resident. She is a native Haitian, who moved here to the DR for medical school. Her husband is in the US trying to take the US medical exams and get into medicine in the US. And she is super patient and kind with my Spanish. We had tons of fun chatting today; it was only once I got home that I realized that talking to her was pretty effortless even though it was in Spanish! This must mean progress!!

Tomorrow morning I am leaving for an adventure! I am going to Samana, a peninsula north of the capital. The region is known for some of the world's best beaches, amazing nature scenes, and whale watching! I'm excited to be venturing out of the city! I can't wait to tell you all about it!

Rounds

"Rounds" are a way for a team of physicians to review patients and the day at hand. There are many different ways of "rounding" , some more formal than others. Most of the time in the US we have walking rounds where whoever is taking care of the patient updates the team with how the patient has been doing over the past 24 hrs. In general rounds are a way to exchange information as well as to learn from the patients. Rounds usually have a bit of hierarchy involved- the attendings are everyone's boss, senior ranking residents are responsible for the team, residents are responsible for their patients, medical students are responsible for staying alive. :)

Here in the DR, rounds are very structured and formal. Every morning, the residents that are post-call present to the entire hospital in a conference room. It took me awhile to realize this but everyone sits according to rank. The pre-interns sit in the back and wear beige scrubs, the interns are the next up in green scrubs, the upper level residents wear all white, and the attendings sit in the front row. The first few days, I sat in the back because I didn't want to get in anyone's way and because I feel pretty lowly in the scale of my medical training in general, let alone in Spanish. As a guest visitor, however, I get to skip up a few ranks and now sit in the second row from the front. It's pretty neat although the attendings see me more and try to engage me in debates for "my professional opinion" about the debate at hand from my experiences in the US and of course "what Williams says." Williams is considered a Bible for Obstetrics and it is really worshiped here. FYI Williams is written at UT Southwestern, one of our top programs we ranked!

Rounds at this hospital in the DR starts off with a prayer. One of the senior residents leads the prayer thanking God for the honor to serve this population, and prays for the safety of the residents and the patients; then, everyone joins in and recites the Our Father. One of the senior residents then lists off all the deliveries, complications, births, deaths, surgeries, procedures, number of blood units available today, etc. Next, the resident presents patients in the past 24 hrs that had complications or were particularly unique.

The volume here is like nothing I've ever heard about- at least 60 deliveries/day. One resident told me that this morning she delivered 36 babies this morning. WHAT?!! I have no idea what to expect next week when I work labor & delivery but have a feeling it will be challenging!

The severity of cases discussed here are equally insane. Everyday we talk about things that I've been told I would probably never see in my career- here it happens every day. It's really exciting to come home and read about things that I've never even thought could happen. I'm learning so much!

An awesome 24 hrs

Last night I met really neat people staying at my hostel. They are ecology graduate students that do field work throughout the DR. They spend months at a time exploring the huge uninhabited areas of the DR- they even travel with a donkey! I had such a blast learning about what they do- it's totally different job than anyone I've ever met. I've been here less than a week and have already met so many incredible people!

Since there were some guys in the group, I ventured out of my hostel after dark. We went to an authentic Dominican restaurant. The food was awesome and the company was wonderful. As lame as it sounds, making new friends every few days is really awesome. The restaurant had live music and dancing. I loved watching Dominicans dance- they are incredible! I even got to dance a bit. It was a blast!! Being here in the DR makes me feel so alive sometimes- the music, the people, gosh it is just awesome!

I went to work with a level of excitement- today would be better because I would be better prepared. I understood much more of the morning conference. The acuity of illness seen in this hospital is insane. As a quick example for any medical readers, a woman came to the ED pregnant with pre-eclampsia which turned out to be thyrotoxicosis which rapidly lead to congestive heart failure, C-section, ICU admission, and sadly death... all this happened within a matter of a few quick hours.

I felt brave today in the ED. I walked into the crowded waiting room and did my own triaging. I saw some really awesome patients. I understood them (for the most part) and they understood me (for the most part). I presented my patients in Spanish using all the right words I had written out the night before and admitted several to the hospital. All of this would be pretty easy standard stuff at home but I was just so darn proud that I could stay afloat today. As a result of the mini personal victories, the number of patients and the acuity of illness seemed less overwhelming.

I have a HUGE amount of respect and love for my co-workers in the hospital. They are incredibly patient and kind with me. More, absolutely everyone I have worked with has unheard of phenomenal clinical skills. I can't say this enough- they are AWESOME whether they are medical students, interns, or residents. For every pregnant patient, they use their stethoscopes to measure the fetal heart tones. How insanely awesome is that?! Clearly, it's a technique I'm still learning since back home I was pretty spoiled with using Doppler ultrasound on everyone (and used to be super proud of being able to hear the heartbeat easily).

So the past 24 hrs has been awesome. I'm still sweating tons, learning tons, and adjusting but today is the first time I'm excited to say I feel like I'm making progress. :)

No other words- insane.

Today was my first day working in the emergency department at the largest (and public!) hospital in the Caribbean. Every morning starts out with a morbidity and mortality reviewing what happened the day before. This morning, over 60 babies were delivered. The cases discussed were probably the most insane things I've ever heard about- a baby weighing 7500 g at birth, insane infections of the uterus. We just don't ever see these kinds of things in the US.

Everyone in the hospital is very friendly and welcoming. My Spanish is getting better- at least for today! I spent a lot of time with the residents today, learning how to describe patients in Spanish when presenting them to attendings. Although I have plenty of practice speaking to patients in Spanish, learning the medical lingo for describing them to other physicians was tons of new vocab. It was really tough!

The ED in the hospital is a large room with lots of "stalls" with patient beds. Women are told to enter their stall and take off their clothes; there they lay completely naked, alone, exposed on tables covered in garbage bags to keep them clean. The women that are allowed into the ED out of the small crowded waiting room of about 50 women are triaged, which means only the ones who are suffering most are seen. I've seen plenty of women who I thought were suffering in the US but I NEVER ever witness the agony of each patient who came to the hospital. These women literally come in because they are dying. I knew to expect a much different type of experience this month, but nothing can prepare you for the types of things I saw today.

Although I only worked 7am-12pm, it was the hardest day of my life. I walked out feeling sick, everything was a blur. As I pushed past the 50 or so people waiting for space to open up in the lobby to enter, a woman saw me and tried to give me her newborn baby to take with me. I walked home feeling completely exhausted and numb. At home, I couldn't do anything but lay down and try to sleep. I forced myself to wake up and eat lunch. Luckily, my hostel mother saw the exhaustion in my first day and gave me a cup of amazing Dominican coffee. I felt better soon and was motivated to read up on all the ill patients I saw today. Tomorrow will be another challenging day for sure, but I look forward to the challenges ahead of me.

Staying afloat

Today was my first day of work but it was more of an orientation day than work. I spent most of the morning waiting to figure out who I will be working with. As I tried to chat with peers, I was scared to learn just how different certain dialects of Spanish can be and how difficult it can be for me to understand them. Many of the people I met used slang and spoke rapidly… all which made me feel really uneasy about signing up to work here a month! I guess my biggest worry was that everyone here would think I was stupid or would ignore me. I’m used to feeling like a good student and was suddenly totally overwhelmed with the thought that I may be the dumbest person that they work with all year because my Spanish isn’t up to par and because I’m not used to their way of doing things.

Luckily, I met a really nice residency coordinator who answered all of my questions nicely even if I had to ask her to repeat things a few times so I could understand her. I was relieved to find out that nothing was lost in translation and that the residency coordinator here understands that I am just a medical student and that I don’t start my residency until the summer. Phew! She was very friendly and encouraged me to make the experience my own. I’m only required to be at the hospital from 7am until noon! Of course, they said I could stay longer and work as much as I want, but that would be up to me. It felt like a relief that they don’t seem to expect much out of me. I’m worried that I will disappoint everyone! This week I will be working in the emergency department of the women’s hospital. Next week I will be working the labor and delivery floor. After that the post-partum and then “we will see”.

I got a tour of the hospital today. Since it is so warm outside always, most of the hospital has tons of windows for “natural air conditioning”. The hospital is divided into large open wards where patients have no privacy and at times are sharing beds. Women sit bed next to bed naked, moaning, exposed. My first reaction was to look away in the hopes of providing decency. In the laboring room, women lay in their beds, waiting for their turn to deliver. Perhaps most shocking was the delivery rooms where women were on small tables completely naked but covered in blood, being operated on in a large common room. It was definitely something that I’ve never seen before.

I'm sure that I will have more stories to tell later in the week once I start working more. In the meantime, I'm trying not to be too hard on myself. There are times when I feel great being here and there are times when I'm not going to lie- it's a struggle. I started feeling really overwhelmed and tired at the end of the day today; I was frustrated with my Spanish and still struggling to run in the weather. I wanted to use the internet and feel like myself again but the internet went out. I felt so alone and wasn't sure how things were going to turn out. Luckily, as I went to the kitchen to get a snack, I met wonderful people my age and spent the rest of the night with new friends. Even more, I was super excited to find out the internet returned. Thank goodness!! So the day started out exciting, then I got frustrated with my running and my language skills, but ended well thanks to David's phone call, new friends, and internet access. I'm glad to report that I think that qualifies as staying afloat. :)

Hasta la proxima...

Tourist day!

I started off the day with a nice run along the ocean. I hate to complain because the scenery and sunshine was wonderful, but I had a hard time getting used to the heat and running without music (for safety reasons). I'm hoping tomorrow morning will be a better run. :) Even my running, something that has become a huge part of my routine and how I like to define who I have become, has to adapt to being abroad. Google maps pedometer, the way I usually track my distance for running, doesn't work in Santo Domingo so I'm just estimating how far I go with my watch. My Type A personality has lots of adapting to do!

I spent the rest of the day walking around the capital, exploring the historic colonial zone of Santo Domingo. The island of Hispanola was one of the places that Christopher Columbus landed and many of the original architecture from that era still exists in the downtown.

I took lots of pictures and hope to describe all the neat places I visited once I upload them on my computer. I haven't found my USB cable to upload pics yet because I haven't unpacked yet. I haven't unpacked yet because my hostel is run on "Dominican time." I was supposed to move today to my permanent room while I'm here but instead was told "Don't worry about it! It's Sunday! We will move you tomorrow." :)

I really enjoyed walking around the city without an itinerary, stopping to sit in the shade whenever I got too hot to read a book. I even noticed that since arriving here, I tend to walk slower. Maybe I have a laid-back persona somewhere in me after all!

One of the coolest things that I did today happened by accident. I walked into an academy of sciences that I thought was a kind of museum; honestly I mostly walked in because I was really hot and in need of some shade. Right away, someone greeted me and introduced me to a group of 20+ Dominicans who were meeting for an afternoon intellectual discussion about Freud. They were so excited to have me join them. Gosh, it was so darn cool to hear people talking about Freudism in Spanish!!

I hope to upload pics from my trip this week so I can talk more about the amazing places I visited today. In the meantime, I'm planning to study obstetrics a bit tonight. Tomorrow is my first day of work. Honestly, I have no idea what to expect. It's exciting but also a bit nerve-wracking to think about the huge volume of patients that are seen there and how little I know about what my responsibilities will include. Keep your fingers crossed for me tomorrow!

To all of you back in the US, I hope that you enjoy Superbowl Sunday! I miss the fun parties and yummy snacks... my favorite part of football. :)

Hasta pronto!

Day 1

I arrived safely in Santo Domingo- yipee! I already took tons of pictures but haven't found my USB cord to sync the pics; I will add them once I unpack.

I flew out of JFK early this morning. The people waiting with me for our flight were an incredibly diverse group- native Dominicans speaking quickly and loudly on their cell phones (who were they talking to at 4am?!), native Haitians anxious to return home through the DR for now until airports re-open in Haiti, and lots of energetic and enthusiastic volunteers traveling to Haiti to help with the relief efforts after the devastating earthquakes. The flight went by quickly, mostly due to some interesting people watching and a really lucky comfortable emergency exit seat.

My goals for today were simple- get a cell phone, call home, find a place to stay, be safe. I'm excited to report that all were accomplished easily! :)

My cell phone 1(809)423-4587. It's free for me to receive incoming calls. Please call! Otherwise, I have really incredible access to the internet (phew what would I do without it?!) and can usually be reached via gchat when I'm on my computer.

My hostel is awesome. It is a family-owned hostel who are super friendly and patient with my long-winded Spanish questions. We have a shared kitchen and dining room, lots of terraces... and best of all unlimited free wireless! Having unlimited access to the internet is a huge (and unexpected) bonus. I rely on the internet so much for staying in touch, looking up maps, planning running trails, etc and I didn't expect to have such great access so I couldn't be happier about it. My hostel is a bit more expensive that I had originally planned, but it feels so great to have such a nice safe place I can call home. I'm sticking to my mama's advice ("safety and peace of mind is priceless") and went for a place I can easily call home abroad.

My hostel is an a great part of Santo Domingo called Gazcue. Gazcue is a quiet quaint, tree-lined neighborhood. It has plenty of restaurants and shopping plazas within walking distance. Did I mention that I am <5 minute walk to the ocean?!! I'm also walking distance to the major touristy areas in case I miss being an American one day. :)

I took really awesome pictures today when I walked around my neighborhood. Did I mention that I walked along the ocean for a few hours today? How is that snow treating you, Cleveland??!

I also went to a grocery store today. It was a huge supermarket with tons of options- they even had soy milk! One of my pastimes back home is grocery shopping so I was really excited about my first supermarket in Santo Domingo! My favorite thing about the grocery store was how colorful and busy it was. I just loved that everyone was taking their time and that everything was kind of disorganized forcing you to walk up and down each aisle. I didn't have a grocery list in mind but decided to splurge on nutella ($7!!) and buy some smarter choices too (bread, butter, cottage cheese, pasta noodles, apples, granola bars). Don't worry mama, I will make better planned meals at the next trip. :)

So all in all, it was a hugely successful arrival to the DR! Ok so I may have accidentally been stupid when I decided to peel my apple ( to avoid washing the skin with local water that I'm not used to and could get sick from) with a wet knife; dangit. I really hope I don't get sick on my second day in Santo Domingo. Keep your fingers crossed that I have enough ciprofloxacin and metronidazole to get me through these mistakes!

Sending anyone who is reading this lots of love. :)

Bad at goodbyes!

I'm at an airport hotel near JFK tonight. My flight leaves for Santo Domingo early tomorrow morning. Thank you so much to Meredith, Nina, & Brent for the amazing voicemails and support! I am so lucky to have such wonderful thoughtful friends! I saved your voicemails so I can listen to them when I get homesick. :)

I've finally stopped crying... or at least I hope I have. First, some background. I am a huge sap. When I was 12 years old, my mom drove me to my first overnight camp- it was only 45 minutes away from our home and I was only going to be gone for 5 days. Both of us cried for a good 15 minutes. I guess for whatever reason I never grew out of this- I cry when I have to say goodbye or leave home. Now don't misunderstand me... I like to think of myself as super tough in most situations. When there is a crazy crash C-section, I am calling a code on a patient, etc I am completely calm in an almost eerie way. I guess this is what makes me crying today (and yesterday!) before my trip so humbling. As tough as I can be in clinical situations, I still am a homebody mama's girl who gets scared. I figure that there are a lot of new experiences waiting for me starting tomorrow- it's ok to be nervous about them even if I'm also still really excited about all these opportunities.

Plan for tomorrow: 4am arrival at JFK- yikes! Arrive in Santo Domingo at 1pm. Arrive in my new home for the next month. Get cell phone. Call home (s). ENJOY THE 81F sunshine!! This weekend, I hope to do some fun exploration of the colonial historic part of the capital. I will post pictures later in the weekend if all goes well.

So to all my friends I didn't call back before I left- I'm sorry. I just didn't want you to have to hear me being emotional, I knew it would pass. To David and Olive- I miss you guys so much already; please take good care of each other... and enjoy the snow! To my wonderful amazing parents, thank you for always taking such good care of me, giving me a huge hug and letting me cry it out, but encouraging me to be the strong person I know I can be, too.

Dominican Republic in February!

Hi everyone! Huge apologies for the lack of posts since May (yikes!!). So much has happened since I last wrote- I passed my licensing exams, I finished some tough rotations, applied for residency programs, interviewed at 21 hospitals across the country, enjoyed the holidays in Texas, and submitted our rank list for residency programs! Phew! And of course, there has been plenty of wedding planning going on, too!

Next up on my long to-do list this year is a trip abroad to the Dominican Republic! Back in college, a good friend of mine recommended that I read "Mountains Beyond Mountains" by Tracy Kidder. The book chronicles the life of Dr. Paul Farmer, an incredible physician who is an incredible advocate for social justice particularly in his work in Haiti. His organization, Partners in Health, has lead the recovery efforts after the tragic earthquakes that have devastated the country. The passion with which Dr. Farmer.

"But if you're asking my opinion, I would argue that a social justice approach should be central to medicine and utilized to be central to public health. This could be very simple: the well should take care of the sick. " - Dr. Paul Farmer

I think that my trip to Santo Domingo, Dominican Republic will provide a life-changing experience and I'm honored to be able to serve this population, as well as any Haitian refugees. I feel like my medical school experiences have really come full circle with this trip.

I will be working at maternity hospital boasting 25,000 deliveries a year!

Just so you know, the largest university hospital in the US boasts a "small" 15,000 deliveries a year. Yikes! It looks like I will have plenty of work waiting for me there! I'm really excited to immerse myself in the Spanish language and OBGYN in an underserved population of patients.

I apologize in advance for delays in responding to emails! I will post my phone number in the DR where I can be reached once I arrive in the DR. In the meantime, below is a link to the hostal that I will be staying.
http://hostalbellaepoca.com/eng/contacto.php
Street Cayetano Rodríguez #3, Gazcue.
Sto. Dgo., Dominican Republic
Phone 809.221.1271

Lucky lady :)

I am on my acting internship in OB this month. I'm loving it so far (more details later) but I wanted to post about my first day post-call. I came home today after a 30 hr shift at work. David was at home waiting for me. He understood what it meant when I said that my day was "fine." He understood that we would talk later and didn't take it personally that I was too exhausted to tell him that I missed him. After taking a glorious post-call 3hr nap, I woke up to find out that David had been busy with a special surprise. He went out and got some of my favorite things to indulge in after call- sloppy joes, my favorite beer, my favorite lemonade, scallops for a special dinner. Despite my lack of sleep, I couldn't help smiling and being excited to spend the rest of my day off with him! It meant so much to me that he understood what a rough night of call can feel like and that he gave me time to relax before I talked about my day. And the fact that he did this all while he is on his ENT AI makes me feel just that much more special. I feel so lucky to have such a caring, thoughtful, and understanding fiance! I think that we make a great team. :)

Goal for 25

I turned 25 this weekend. I was worried about turning 25. It sounds old, I guess. I can remember thinking 25 was really old. I guess it freaked me out because I thought that by 25 I would have a job, be living independently (sorry mom & dad), be married, have kids, etc. Instead, I'm still in school, I still shamelessly appreciate my parents driving Cleveland to get me a nice meal and stock my fridge, and have no money in sight for the next decade. Ouch. Instead of worrying about it too much, I tried to be pro-active and think about things that I wanted to do in the next 25 years. So here is my list:

1.) Be healthy & active. It's not easy to take good care of yourself when busy. I want to make sure I make my health my priority. I took a jump start on this goal- I ran a 10 mile race on my birthday morning and got my lifetime best time. :)
2.) Find a job. Get a good residency, work hard, train well, earn a living. Seems easy enough, right?
3.) Learn how to be a good wife. Get married next year, learn how to have a healthy marriage during residency and 80 hr work weeks, don't get too grouchy post-call, make time for each other.
4.) Pay back my parents, somehow. Take good care of them- it's my turn. Help them make each year their happiest & healthiest. Try not to lecture about health stuff too much.
5.) Have kids. There will never be enough money or enough time in my line of work.
6.) Do something for myself everyday. Running, reading, bath, cooking a fun recipe, walking Olive- whatever it is and whatever it becomes, I want to make sure I try to find time for being a healthy happy person
7.) Get back into yoga. It makes me stronger, healthier, happier.
8.) Start swimming again. Join a team.
9.) Keep in touch with friends. Friends from home, college, med school, and beyond- I have met so many wonderful people that I want to keep in my life wherever I go next. There are no excuses- phone/texting/twitter/facebook/email makes it so easy to say hello.
10.) Find a passion in medicine. Love what you do at work and be happy you are doing it everyday (or most days).

Soon to be GRINDLER MD!!!!!

In case you missed it out of all the craziness and excitement, David proposed and we are engaged to be married!!! The week that I got into Case for medical school I got a Chinese fortune cookie that said "there will be big changes but you will be happy." Boy was that fortune cookie right! Since starting medical school, I met David, we moved in together, we bought a dog, we remodeled our townhouse together, we learned how to become physicians, and best of all we are happy! I could not have planned a happier or more exciting three years of my life!

As we continue to move forward in our lives, we plan to get married in early May of 2010, graduate and officially become Grindler MDs in mid-May 2010, and start residency in July 2010! So many exciting things!

I'm working on a wedding website now to talk about how we met and our wedding plans. Contact me for the site!

Karma

On my neurology service I have seen many examples that life is just not fair. A woman in her 30s who had been trying to get pregnant for several years finally does, only to experience a seizure; we scan her head and find that she has metastatic lung cancer. She was a smoker when she was a teenager. Now she is faced with the decision to aggressively treat her cancer and live an extra few months or give her future child a chance even though it will mean that her child will never have a mother.

I have also seen an example of how sometimes the bad things that you have done to others can catch up with you. We had a world famous neurosurgeon on our neurology service as a patient this week. Neurosurgeons are notorious for bragging about the very worst residency lifestyle- on call overnight at the hospital every 2nd or 3rd night, bragging about working 120 hours a week, excited that they were only home for 8 total hours this week. The long years of sleep deprivation and the surgical culture bred throughout training makes many of these surgeons unpleasant to say the least. Our patient this week was a neurosurgeon who suffered a traumatic brain injury after driving intoxicated on his way to a surgical conference. Last week, he was doing life or death procedures on brains and making nurses/residents/students cry on a daily basis on the side. His life as a neurosurgeon was mean- he was well-known for being one of the meanest humiliating surgeons around. This week, he is a patient and is slowly starting to realize how humbling it really is. The patient maintained his bossy cruel demanding personality at first. As he realized the extend of his injury, the long road to rehabilitation ahead, and that he would never operate again despite those long years of training, he became a different man or at least tried to.

I met a neurosurgery resident this week and recognized the name. This neurosurgeon in training had paged me late on a Friday night after I had gone home to yell at me for an inconvenience that my staff physician had made. It was totally uncalled for (I was just a medical student, it wasn't my mistake, it wasn't a big deal) but I remember his name. After I met the patient-former neurosurgeon on our floor I thought of this resident again. Sure, he was tired and it wasn't fair that he was working so late... but how quickly it all can change and you can be at the mercy of your colleagues.

These experiences remind me- life isn't fair sometimes, but sometimes it is. I hope to work hard at being the best person I can be as well as the best physician- after all, they are not mutually exclusive.

A bad day

I'm finishing up my pediatrics rotation and feeling ready to reflect (and have a weekend off!). I have really surprised myself with how little emotion I feel when I'm working at the hospital. I always care about my patients but somehow it doesn't translate to an emotion. This changed when I started pediatrics- everything started to affect me. Before I describe today's bad day, I want to remember that there have been some really special moments in this rotation. I've witnessed and participated in more than 60 deliveries of an infant before starting peds- sure I thought it was awesome and special, but it wasn't until I was on the pediatrics side and when I was the person responsible for this seconds old new person that I realized how special it really was. And another patient I met in the hospital, an adorable 2 year old with some bad luck... I spent 2 weeks seeing her and when she was finally healthy enough to go home, her family left me a heartfelt note describing how much I helped them through a hard ordeal. I liked being able to appreciate how special those moments were.

Today was a day I wished that I could turn off my emotions and not let things affect me. One of my patients, a previously healthy 13 month old came to the hospital for a bad ear infection and today we had to tell the family that their only has a very severe form of leukemia. I overheard mom calling her parents saying, "Mom, pull over the car... are you pulled over? It's leukemia. It's bad. We are going to be the hospital for at least 6 months." I talked to dad who kept saying "He's all we have. Our lives revolve around him. He has to get through this." And after hearing all this, I learned from my attending that this form of leukemia has the most intense chemotherapy and very few kids are able to make it. Today would be a good day to be numb.

More sadness today- a 12 year old healthy child with complaints of diarrhea developed pancreatitis, then we diagnosed a severe inflammatory bowel disease, only to find that he had a cancer that no one in the history of medicine has survived; a baby born premature and with lots of complications is now 8 months old and ready to play but has had no visitors in the hospital so he just stares at the ceiling above his hospital crib; an 18 year old fighting cancer for several years, excited to go to prom this year, learning that her cancer is back and its back for good this time. Although I recognize that today is a particularly sad day, I can't but help thinking that this is too difficult to do everyday for the rest of my life. Although I am glad that I am not numb to sadness, I don't like that I come home and feel numb, so drained. It makes talking to friends and family difficult- how can I chat about what's new in my life when all I can think about are the experiences that have influenced my day? So basically, even though I've had some unbelievably positive experiences in peds, the few bads ones make me cross it off the list of career choices for me.

A gut feeling

On my surgery rotation, my energy and hard work was appreciated but I didn't quite feel like I fit in. When I asked my colleagues on general surgery what they thought I would be "when I grow up," I had several people tell me that I would undoubtedly love Obsterics and gynecology (OBGYN). I have always appreciated forming strong doctor-patient interactions in clinic, something that I really missed during rushed general surgery clinics where patients became a nuisance and their questions just slowed us down. I didn't just want more patient interaction, I wanted more meaningful interaction with my patients. That said, my love for surgery taught me that dedicating my life to clinic like a family practitioner wouldn't be enough for me. My colleagues noticed in me that I wanted to pursue a career in which I had the best chance at being a real practicing surgeon- a physician who is able to perform a surgery and really take care of them afterwards. They saw in me a future OBGYN. I wasn't sure about the idea because I hadn't done my OBGYN rotation at the time, but I was very excited to start.

It didn't take long for me to realize that my colleagues were right. In fact, on my first day of OBGYN I had the revelation: this is what I want to do with the rest of my life. Almost instantaneously, everything fit. I loved working with women. I loved the challenges of pelvic anatomy. I loved that all of the procedures performed in the operating room had significant meaning that I would have to follow up with important discussions with the patient. For example, I had a hard time getting excited about reducing a hernia on general surgery. What was the point in spending time with the patient afterwards? Instead, in OBGYN my patients were having emergency C-sections to rescue their babies or exploratory laparotomies to remove a suspected cancer followed by hysterectomies. I loved the importance and meaning of everything I did in the OR. I loved that afterwards, I got to really talk with my patients and help them understand what happened in the OR and why.

I have really enjoyed all of my clinical rotations. I have a passion, however, for OBGYN. This field makes me feel more alive. I am excited to go to work everyday with this field. This field makes me feel like it's all worth it. This field makes work seem easy again. Oh my goodness- I think I'm going to be an OBGYN!!!!!!!!!! :)

On death and dying

My experience in general surgery and trauma calls at night immersed me in a world with really sick people, some of which ended up dying. My first experience with death was overnight on trauma call. A man came in as a "cat 2 MVC + EtOH" meaning he was like most of our trauma patients at an inner city hospital- drunk, driving, and badly hurt. After securing his ABCs (airway, breathing, circulation), we saw his only obvious injury was a broken arm. He started becoming more agitated and it took almost 6 of us to hold him down so that we could finish our exam for injuries. A few moments later, we realized that he had no pulse and that his heart was no longer beating. I started chest compressions on him for what seemed like forever (in actuality about 3 minutes). As I was beating on his chest I couldn't help thinking that I was keeping him alive at that moment. I didn't expect the chest compressions to work- I had heard of the statistics that less than 10% of patients who receive CPR make it out of the hospital alive- but somehow miraculously he re-gained a pulse. He was brought back to life. We re-evaluated his injuries and discovered that he had an acute abdominal bleed. His blood pressures started dropping and we realized that he would need to go to surgery immediately to try and stop the bleeding. I helped transport him into the operating room. He lost his pulse again. We started chest compressions again but realized that stopping the bleeding, and not keeping his heart pumping was his best chance at life. Without much time for the usual sterile techniques and precautions, we essentially sliced into his abdomen and 3 L of blood gushed out of his abdomen, soaking us all. We quickly surveyed his injuries and realized that they were too severe to correct, he still had no pulse, and there was nothing we could do for him. He was pronounced dead a little after 20 minutes when I first met him. I helped sew up his abdominal incision and couldn't help myself from thinking that just 20 minutes ago, I was talking to this man, hating him for being so agitated so drunk so careless. Now, he was becoming cold and stiff as I finished up his sutures. Now, I realized that I had seen life leave a person's body for the first time.

After watching so many episodes of ER and other medical TV shows that dramatize what I did for the past 4 weeks, I can now appreciate why so few physicians watch them. The truth is, after crying after watching a patient die on TV, I had no emotional response to seeing my first patient die. I felt numb. I wanted to feel something. Instead, I went on to work up the next trauma that night and went on to the regular OR cases later that morning. I always thought that death and dying would really affect me and my ability to practice certain types of medicine. Instead, almost instinctively, I became numb to it all. Almost instinctively, I adapted the same coping mechanisms for dealing with death (dark humor, sarcasm, indifference) that I had promised I would never have. And despite the fact that I wish I could feel differently about my first patient's death, I realize that if I had let it get to me, I would have had a difficult time continuing to work and finishing this rotation. I'm not really proud of who I became over these past few weeks but I felt that I had to in order to get through all experiences that were thrown at me.

In the end, I witnessed 4 patients die on trauma call and I was responsible for withdrawing life support for one of them. It never become easier to witness death but I did stop searching for an emotional response. I hope that a few days from now, once I've caught up on my sleep, I can reflect on these patients and their deaths... and maybe even have a good cry to prove that I'm not numb after all.

Learning you can't help someone who doesn't want help

My first week of inpatient medicine was exciting and amazing. Patients came in very sick and one to two days later they were able to come home again. From my eyes, it looked as though patients were on the verge of death and were given another chance at life everyday in inpatient medicine. I found it so exciting that we were able to diagnosis a problem and fix it- what could be more gratifying than that?!

Unfortunately, at a metropolitan hospital, not every patient wants to get helped. In fact, we had several patients who left "AMA" against medical advice for one reason or another. One patient in particular really disturbed me when he left AMA. A patient came in for a life-threatening condition where his airways were closing up and he was unable to breath. Since he was so sick, he had to get a tube placed into his throat to breath for him. For several days, he was kept alive through the help of machines. On the 4th day, he woke up and extubated himself (a crazy painful ridiculous thing to do) and demanded to be discharged. He was brought to our floor to stabilize his other medical problems, try and figure out what caused his airways to close up in the first place, and to make sure that he was stable enough to go home. Within 5 minutes of arriving, he demanded to leave. I spoke with him to try and find out why he wanted to leave. I thought that if I tried hard enough, I could convince him to stay, I could be his advocate. Instead, after everyone on our team tried to reason with him he walked out. I felt really uncomfortable watching a man who I knew would not live much longer without medical help walk out, convinced he was doing the right thing for himself. He was so proud that he showed the doctors who was "boss." He loved making a scene. It was really painful for me to see that his need for another drink was leading him to a very soon early grave. He could not be reasoned with and everyone on the team shrugged him off. In the end, we cannot make a patient do anything. A patient has the right to make their own decisions, even if they are the wrong decision. Even so, it was really discomforting to know that the next time I saw this patient medicine would not be able to do much to help him. To me, it was my first experience watching a patient die.

Outpatient --> Inpatient

I completed my 2 month rotation in family medicine and outpatient clinics (TB, urology, cardiology, ENT, ID, ortho peds, rheumatology). Although my first week was overwhelming (wait I have to remember all the right questions to ask the patient, do the right physical exam techniques, remember my findings, write a note, present my findings to my attending, and carry a conversation with a patient I just met?!), I used the low-pressure outpatient clinics to stay positive and focus on doing better with each clinic. Each day I feel like I was able to improve on something or learn something new or really reach out to one patient... but each day I did that I was confronted with 1000s of things I still hadn't learned, the reality of how much better I could have done something, or thing I shouldn't have said. With each day I felt like it was one step forward and a 28479 steps backwards.

I met so many amazing patients in such a short time- one afternoon I had a patient who was an inmate, a middle-aged woman who never learned how to read, and a male to female transgendered patient. I felt privileged and even excited to be able to work with so many interesting patients, even though it was through considerable hardship in their life that they became "interesting patients." My outpatient experience was exciting everyday because everything was so new- I'm sure that migraines aren't thrilling for most practicing physicians but for me, it was such a thrill to have a patient who I wanted to help, read about how to help her, and recommend the appropriate treatment for her.

Although most days were exciting for me, I had a few days when I felt a tug of the negativity of medicine that so many of my classmates have warned me about. I worked with a patient who had many serious health problems and yet was always ready to blame someone else or something else for the poor care she took of herself. I was really discouraged to meet someone who didn't seem to be invested or even interested in their health. This woman's health problems were a reason for her to be concerned and to make life changes; instead, she did nothing and came to see a physician sparsely. As I talked to her about ways that she could improve her health I started feeling resentful for talking to this woman who clearly didn't seem to care about her health. I disliked this woman for her excuses, for her poor health habits, for her disdain of her own body. This woman was going to die very soon as a young woman with poor habits, and she totally did not seem to care when she was told this. I left clinic that day feeling deflated. I was disappointed in myself. I felt guilty for having a visceral emotional response to this woman. I felt guilty that I found being negative about patient interactions. After speaking with other students and physicians I learned that everyone gets a patient like this. The trait that I realized would be helpful in my future would be to learn that coping with situations and being able to move on from them. In my last week of clinic, I was able to see this patient again. She had started to make some positive changes that I was very eager to hear about but I still had a negative thought in the back of my mind questioning whether she would be able to maintain these positive changes.

I hope to keep all the valuable lessons I learned in my first 2 months in mind with my next rotations. Tomorrow is my first day of inpatient medicine- my first taste of the grueling hospital hours of medicine, my first experience with overnight calls, my first opportunity to work with very sick patients. I'm not sure what to expect with this new rotation. One thing that I know will be true throughout the next two months- I will always have much more learning to do.

Medicine hits home

My parents came in on Friday and we had an amazing time out at dinner. It was one of the best time's we have all had together here in Cleveland. This morning they were planning on leaving to drive to Canada. I made them breakfast and we were just milling about the house. I was running about the house and in passing quickly asked my dad how he was doing and didn't really pay attention to the answer. A few minutes later, I realized that my dad was unable to speak or move his L arm. In medicine, we learn to immediately assess patient mental status by asking three questions: who are you, where are you, and what year is it. Dad could not communicate with me and I could see the terror in his eyes as he struggled to realize that he could not talk. I instantly knew what was going on and all that I had learned about rushed past me- what tests he needed, chances of survival, etc. I brushed it all aside and pretended that nothing big was going on and that we were just going to the emergency room "just in case." On the drive over, I was freaking out in my head... I knew that my dad was having a stroke and that he needed to get to the hospital very soon in order to reverse the damage to his brain. As his daughter, I joked about Cleveland traffic and pretended that it was just another Saturday. In my head, I kept thinking of how terrifying it was to see aphasia (the inability to speak to others) in my father's eyes. In my head, I kept thinking how serious this may be.

Luckily, we live very close to the emergency room (<1.0 mile) and I know key words that will get you immediate attention at even the busiest hospitals (i.e. I'm a medical student here...he stopped being able to talk 5 minutes ago...). In the ER, I saw a team of physicians mill about him, doing the exams I was thinking of doing. I understood what was going on but I was torn as to what I should tell my mom. Should I tell her everything that I'm worried about with the risk of scaring her? Should I hide the worst scenario because it's not really likely and risk hiding a possible truth from her?

It's scary for me to realize that my parents are not as young as I always thought they were. It's even more frightening for me to think of my parents as patients.

Luckily, my father began improving within 10 minutes of his episode. He was able to move his hand again and slowly regained the ability to speak. This is a very good sign in medicine... if his symptoms resolve in under half an hour, it means that he didn't really have what is known as a "stroke" but a milder version of a similar situation. He is still at the hospital in the neurology observation until so that they can make sure that he continues to do well. He is doing very well- he has no residual physical effects from what happened. He is, however, having a lot of trouble dealing with what happened. He still is struggling to come to terms with why it happened to him and what it means about his age and his health. (FYI if you read this and are in contact with my dad please pretend you know nothing about this. He will tell people when he has come to terms with what happened and is ready to tell others about it.)

Despite all the medicine that helped me realize he needed to be seen in the ER and despite all the great care he received there, I can't help shake the feeling of a "hidden blessing." Dad wasn't supposed to come with my Mom to Cleveland. What if this had happened to him while he was alone at home with no one to tell him he needed to go to the hospital? What if this had happened on the drive from Chicago? What if he hadn't been able to come upstairs to try to talk to us for a second time? What if we didn't live as close to the hospital? I really hope that something like this never ever happens again. That said, I feel really lucky that I was here able to help my dad get the care he needed and I was there to make sure both of them understood what was happening with the physicians. I can't help thinking that despite my scientific training coaching me otherwise, everything really does happen for a reason. I just hope that that we can all use the reason behind this experience to help us all.