Week 2: starting to get real

This week was amazing. I'm becoming more comfortable everyday in the clinic but I'm also realizing how much more I need to learn everyday, so it ends up feeling like one big step forward, a tiny steps back. I'm trying not to feel overwhelmed and focusing on improving everyday.

One of my most memorable experiences this week (besides doing a female and male exam all by myself!) was in my family practice clinic when I got to speak with a patient on naloxone therapy. Naloxone therapy is a therapy for preventing deadly withdrawal to heroin addiction. As a medical student the greatest gift I have compared to any other point in my training is TIME. I had the time to really get to know this patient. I got to ask her more than the usual questions about fevers, chills, nausea, vomiting, diarrhea, constipation- I got to find out about this woman's life and how she became an addict. She shared her story with me and cried as she re-lived many of the decisions she wishes she could take back. As I told her I was proud of her for working so hard to get her life back on track, I realized that I was one of the first people to ever say something like that to her. It was with this patient that I remembered why medicine was so exciting to me in the first place- the real opportunity to impact and change a person's life.

My goal for the next few weeks is to remember to be excited and enthusiastic around the patients. I want the patients I work with to remember me as being excited to be able to work with them. Sometimes I'm focusing so much on asking all the right questions and doing the physical exam and remember it all to present to my attending that I forget that my main priority as a medical student is to know my patients better than anyone else around. This week I'm going to change that.

I also want to work on continuing to build confidence- even though I feel like I'm a long way away from being a real doctor, I need to start acting like one around my patients. I want to be more confident and self-assured around my patients this week.

1st week as "Student Dr.Grob"

One week done! It went by so fast! I am doing the next 4 months of rotations at an inner city hospital. It's really inner city... someone got shot in our hospital's parking lot during orientation; someone else got shot outside my family medicine clinic so we aren't allowed to go outside during lunch. I am doing a 4 week rotation through family medicine (Obsterics included!) in a Spanish-speaking clinic, rheumatology, pediatric orthopedics, and urology. So far, I LOVE IT!!!!

I especially like my family medicine clinic where I feel I have the most time to get to know my patients and decide on how to treat them. I have had a hard time learning how to balance listening to patients, writing notes in the computer, doing a physical exam, and figuring out what is the cause of their chief complaint and then how to treat it. It's a big jump from practicing talking to patients and doing a physical exam! I recognize that I have a lot of work to do but everyday I feel like I'm learning something and everyday I feel more comfortable tackling my daily responsibilities than the day before. That said, I know that some days will be harder than others. It's going to be hard not to take hard days personally.

This week I want to challenge myself to act like a real doctor and figure out the treatment for my patients (including drug doses!) before talking to my attendings. I also want to start studying more after coming home from the clinics. Overall, I hope to continue to have my daily focus on being positive and excited about this awesome experience.

In the meantime, it's really awesome to walk around with a pager... even though I haven't gotten any pages. :)

My major gripe so far: how heavy my white coat is stuffed with medical instruments, books, pocket books, cell phone, and PDA.

Learning how to be a doctor... starting tomorrow.

I start my clinical rotations tomorrow! For the next 4 months I will be doing rotations in outpatient clinics, family medicine, internal medicine, and surgery at a city hospital. I'm really excited to get started! I'm also a little nervous! Ok maybe more than a little nervous! I'm excited to get back to medicine and start applying my learning. I just hope that I can keep up with it all.

Before I get overwhelmed with working in the hospital (i.e. tomorrow), I want to set some goals for myself for the next few months.

First and foremost, I want to remember how to live a healthy balanced life. Physicians need to be able to set an example for health. I want to be proud of my health everyday. I hope to work out- even when I'm tired or grouchy after work- because I know that it will make me feel better. An adrenaline rush makes everything seem better. I need to use the time I have as a student to practice being a healthy physician. I hope to work out at least 4x/ week. Even on tough rotations.

The next few months will be challenging. I will be an inconvenience to all those around me (patients, nurses, attendings). My lack of clinical knowledge will get in the way of everyone. Everyone will know more than me. I don't want to take this personally. I want to use this time as an exciting opportunity to learn medicine. I'm not expected to know everything. I am expected, however, to be optimistic, enthusiastic, and energetic. When I inevitably make a mistake, I want to learn from it and immediately adapt. Dwelling on the mistake will hold me back.

I hope that I can remember that for many of my patients, I will be the main physician that they spend time with. I want to be alert, caring, and attentive to each and every patient I see every day.

Will I be able to do this?

Research block so far has been a nice break- working 8 to 4, having time to watch TV, call friends, work out, go on trips, no homework. Today I got a reality check- I received an email about scheduling my clerkships... and oh yeah they start next month. (!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)

I decided to start reading about what to expect in the next 2.5 years of clerkships. I read about my responsibilities and how much my life was going to change. I read about long hours, realizing your flaws, and never knowing enough. I realized that I have no idea how to summarize a patient's life and current condition in 30 secs to 3 minutes, depending on my rotation. I'm terrified, to say the least.

What if it's too much? How will I learn this all? How will I find time for myself? Who will I be after surviving this?

Most of my friends are finishing up their first rotations on the wards. They survived. And now that I realize just how stressful their day to day lives have been the past four months, I feel they deserve a badge of honor- for replying to my silly emails sent from a slow day, for finding the time to call me when they haven't slept more than 4 hours/night for the past month, for finding how to balance their crazy new life with their old one, seemingly effortlessly. I'm impressed. I just hope I can do the same.

In the meantime, after these realizations, I now have some SERIOUS incentive to get back to normal study habits!

So when do I become a real doctor, again?

Since taking my boards in March, I’ve been enjoying life on my four month research block. Although it’s been nice having a stress-free life and my biggest worry of the day is usually whether or not I should try a new recipe for dinner, it’s been tough adjusting to the fact that most of my friends are on clinicals. Everyone is learning so much and is actually DOING such cool things; I can’t help but feel jealous. I know I will get more than enough opportunities to do the same starting in July, but I still feel a little left behind. It certainly seems as though the last few weeks of my research block are going to have to be spent re-learning a lot of the medicine that I’ve forgotten already. This morning reminded me of just how much I have to review- and just how much longer it’s going to take for me to REALLY become a real physician.

I walk through the hospital to get to my research lab on mornings when it looks like it might rain. Today, as I zoned out and listened to the classical music in the skyway and smiled at the busy long white coats rushing past me, searching for a familiar face, a man stopped me and started screaming. As his screams echoed through the hallway, he grabbed onto me looking for help- all I could do was stand there. I froze, my mind went blank, and I just stood there asking him if he was ok. Luckily, long white coats from everywhere emerged and started calling for help. Now that the real help had arrived, I felt that I could walk away, but I knew that I hadn’t done my job. What should I have done? Who should I have called? How can you tell if his defibrillator really went off or if it was a psychiatric patient looking for some attention? Regardless of whether or not I could have really helped that patient in the skyway, my silence really concerned me. When am I going to be one of the people that responds to situations? When am I going to gain the courage to be the one helping people, not just another person asking if they are ok? When am I going to become a real doctor?

I DID IT!

I got my scores back. I did better than I ever imagined that I could. Finally, I can write with confidence: it’s over…I’m finally done with Step 1.

Since scores are released at midnight, I stayed up late to find my score. At 12:01am I saw that my score was up. Forcing myself to click on my score report and then scrolling down to see what my score was took so much. All the stress, all the hard work, all the sacrifices… all boiled down to this one score. When I finally saw my score, I couldn’t believe it. My eyes filled with tears and I actually started trembling. I had done better than I ever imagined that I could have done; I rocked the boards.

I called my parents first of course. I think that they were more excited than I was- I was still in shock about it all.

The next day was exhausting. Once I got my score back, this huge sense of relief swept over me. I was surprised by the physical reaction to finally being done. I came home after work and slept 3 hours on the couch. I think that after all these months of hard work, the stress and sense of impending doom were finally gone- it was a great feeling but an overwhelming one, too. I’m done. I’m finally done. :)

Step 1- done (kind of)

So I’ve survived- kind of. Five weeks of studying about 15 hours/day, without any days off plus all the studying for boards that I did when classes were still in session. It was really the last few weeks of studying that proved to me just how similar finishing my study plan and taking Step1 was to the race I ran back in September. In my race, the first few miles were a breeze. My last three miles were awful. I wanted to stop. In fact, I considered stopping the entire last three miles. Somehow, I was able to find the strength to get to that finish line. And somehow, after all that studying and after the countless times that I was convinced I would never be able to learn it all, somehow I woke up and it was test day and I knew that I had done the very best that I could have.

I haven’t received my score back yet even though many of my friends who took the exam earlier did (and did beyond amazing!). Since I don’t know how I did yet, I can’t really say if it was a “success” – however I end up defining what “success” really means on an exam like that. All I know is that I really gave it my all. I started early. I worked hard. I didn’t give up. I had more support and encouragement than I knew what to do with. What happened on test day is no longer in my hands. How I did compared to all the other medical students across the nation is something I can’t control. I just hope that regardless of how my score turns out, I can remember that I really did my best. It would be pretty awesome to get a great score though. :)

After the exam, I felt defeated. Many others (including David who rocked the exam) felt the same way. Very few people leave this test feeling great. I’ve just never left a test having absolutely no idea on how I did. It’s not a good feeling. I definitely didn’t feel like celebrating afterwards.

This silly test has been the culmination of 2 years of medical school. So much unneeded pressure has been put on this one exam. And you don’t really get a release from that pressure until you find out your score. There was a chance that I would find out my score today- I didn’t. A lot of friends that I ran into today, however, did. ALL of them did amazing. I’m so proud of them for doing so well but I’m so jealous of that feeling of release (and their awesome scores). I guess I have no choice right now, I just have to keep waiting until I find out my score, too.

Holding my breath in case it brings me good luck…

Last post before the big push of 2008

Today is the last day of winter "vacation"- a break where I spent more than half of it doing work! Tomorrow is the first official day of the biggest challenge of 2008- mastering head and neck anatomy, learning neuroanatomy, neuroscience, the brain, psychiatry, and orthopedics all in three weeks all while continuing to prep for my boards exam. And after my last exam on February 1st, it's 5 weeks of buckling down until Step 1 of my medical licensing examinations. This definitely won't be pretty.

Before the craziness starts, I just want to take some time to be corny and inspirational- hopefully time well spent because I think I'm going to need all the motivation and inspiration that I can get these next two months. Below is a list of a few things I hope to keep in mind during this big challenge.

• You can do this. You will do this. Look back at those workouts for training for the half marathon- they seem impossible even now after you finished the 13.1 mile race. You took it day by day then and made it to the finish line successfully- same is true for Step 1. If you have to, wear your medal from the race while you are studying. :)
• Take good care of yourself. Working out everyday will be a good break from studying. Plus it will keep you healthy, energetic, and less depressed. The gym is a great place to learn your drug flashcards when you are running. Swimming will help you clear your mind and re-focus. Keep it up!
• These exams are not about passing or memorizing details. These exams are about learning all the information that I can to provide a strong foundation for the kind of physician that I want to be. It is an honor to be studying to become a doctor- remember that you are learning to take better care of your future patients.
  
• Play with Olive.
  
• It's only two months. Work hard everyday and it will be over sooner than you think.
• Only say positive things. Do not complain or dwell on negativity. This will only get you down and bring your performance down.
  

On becoming a doctor

I have to admit that I was really nervous to re-read the essay I wrote two years ago to get into medical school; I was anxious to look back at who I was then and to see how (if?) I had changed. In my essay, I wrote about how swimming was an activity I always loved and traced how I began to first identify as an athlete. I also described the struggle it was for me to take a break from swimming as a result of an injury. Ultimately, it was the encouragement of my father (an Olympic athlete) that I found the strength to realize that taking care of myself was part of being an athlete as well as part of learning how to become a doctor.

My first year of medical school was the best year of my life- meeting new friends, living on my own, feeling successful, managing classes, balancing life, and even learning how to be a puppy mama in my spare time- it really couldn’t have been better. Second year hit me as a stark contrast: I felt like I was never doing enough, I always felt behind in classes, my life was unbalanced, the pressure of boards was crushing, and I wasn’t healthy. I became a jaded negative medical student, someone who I never wanted to be. I forgot why I was working so hard and if it was worth it but remembered that I had too many loans and had invested too much time to give up just yet. Ultimately, it were my clinical experiences this year that helped inspire me to shake out of it and remind me of who I was and who I am now determined to be.

Exhausted, grumpy, and disgruntled that my afternoon of studies was interrupted, I arrived at the children’s hospital in Cleveland for a shadowing experience in neonatology. When I saw my first tiny patients, everything changed. The innocence of the kids- how could I resist smiling, even it was for the first time in too long? After finishing the shadowing experience, I stayed a few hours extra to talk to residents and, of course, to play with my patients. This clinical experience changed me by showing me that not everything in life was negative and instantly re-focused me. I’m not sure if it was the cuteness of the patients that woke the real me or if it was finding a possible specialty that may be my calling, but it changed me. Despite how packed I thought my schedule was, I started doing extra shadowing experiences at the children’s hospital. I found an amazing mentor who showed me that not all attending physicians are jerks, that medicine could be fun, and that you can really care about your patients even if you haven’t slept in three days.

I learned more about the doctor that I hope to be during a communications workshop. In this workshop, we have actors as patients so that we can practice delivering bad news and other challenging communications skills that a medical student must learn. As I told my “patient” that she had a sexually transmitted disease, I could have stopped at describing the treatment for her disease. Instead of judging, I asked this patient if she felt safe and why she did not use protection. Although I had already met all the requirements for this workshop, I continued talking to this woman, trying to inspire her to take better care of herself. I found myself empowering this woman and giving her resources for how she could be more healthy and more safe. Even though this situation was not a real one, I realized some traits of the kind of physician that I hope to become. My experience at an all-women’s college made me aware of the challenges of gender; even more, it inspired me to become an advocate for women. I hope to use my experiences to empower women and encourage the best kind of health. I hope to treat more than the disease: I hope that I can help my patients self-actualize their potential as individual women.

I was able to see the full circle of medical care- patient, physician, family member, medical student- a few weeks ago when I went with my father to a doctor’s appointment. Before the physician arrived, I found myself asking the same questions and in the same rhythm that the physician did later on; maybe I was learning something about being a doctor after all. As the physician spoke with my father, I was impressed by how much information she was able to attain from her patient as well as by how much concern she was able to convey. I was able to ask questions that I knew my father would want to know the answers to and I was able to explain things to him again and to the rest of the family after the appointment. This doctor’s appointment with my father was one of the proudest moments I’ve had in medicine so far. I was so impressed that I was learning how to become a doctor; even more, I was impressed that what little I knew about medicine was useful and that it already allowed me to help my family.

It was clinical experiences like these that ultimately helped re-inspire me during a tough year and provide me with the motivation to continue working hard. I understand now more than I did before just how grueling being in medicine will be: my final weeks of block six and cramming neuroanatomy, head and neck anatomy, ortho, and boards review will not be easy; once block six is over, it will only become more challenging as I’m faced with reviewing for boards everyday for five weeks. Although the next few months will challenge me more than I have been before, I hope that seeing the big picture of the kind of physician I want to become will help me ultimately persevere and do my best. As I wrote several years ago and before I knew medicine, I am reminded of the passion with which I hope to become a physician: “My experience has given me an insight that will continue my interest in fitness and provide me with the resolve for a medical career: the ability to view changes as opportunities gained.”

Something more positive

Sorry for the last post- I was in a real exhausted funk! I called it quits and went to sleep earlier than usual. I woke up and felt sooo much better. Sure it's going to be hard work but something is telling me that this will be worth it.

My new goal- only positive thoughts and only positive things to say! I even changed my desktop pic on my computer to something silly to remind myself of staying positive. (This is the first image that pops up when you google image "positive"... hhahahahhahah).

A bit of negativity.

Me: "Mom I think I hate my life."
Mom: "Hunny you can't hate your life. You don't really have one."

After a grueling block 5 of relentless studying, I had 1.5 days off before getting thrown into my next block- the last block before I take the first part of the medical licensing exam. This block has a reputation of being the toughest one in medical school. Fall behind a day and you might as well do the year over, is the rumor. After only one week, I already feel overwhelmed, tired, and grumpy. For the first time really, I'm really starting to worry if I'm smart enough to get through medical school, let alone become a doctor. I'm really starting to doubt myself. Some classmates are managing to learn it all. Meanwhile, I'm so overwhelmed that I feel frozen in place. I study all the time but am worried that I'm not learning it well and convinced that despite my hard work, I'm not learning enough. What if I can't do this? What if I just am not tough enough to get through March?

I'm exhausted. I'm bitter. I'm filled with negativity. I know that I need to suck it up- each week is just going to get tougher. Residency will be tougher than anything I did in medical school. So what am I doing? If it's just going to keep getting harder, how do I know that it will be worth it and that I will be able to manage in the way that I want to? Today in a clinical rotation after class I was talking to an attending about a patient. Attendings are some of the most experienced physicians that can juggle it all effortlessly; despite this I looked into this physician's eyes and saw an exhaustion that I haven't even seen the likes of yet. If getting worse is almost a certainty, then how can I be motivated to get to what lies ahead?

Getting fancy with Olive

We like dressing up

Olive in her new dress- maybe not her favorite

Olive's boyfriend comes for a visit

Olive + Oscar = 2 friends for life (At least until food is involved)

Almost time for the holidays

A video from Christmas in Poland last year... sorry it took me so long to figure out how to post this online!

I did it!

I finished a half marathon!!! 13.1 miles!!!! Wo hoo!

My first 5-6 miles felt amazing- since I started towards the back I was passing people the entire time. It felt so good to learn that I was faster than someone! I felt very strong and even started thinking about training for another race. Unfortunately, mile 10 hit me... hard! I was so grateful that my family & David met me at this mile marker because I really needed a boost! David energized me and my Dad gave me such an encouraging and proud hi five! The last mile was definitely one of my most challenging to finish. At this point I was thinking, "What is wrong with walking? Why can't I just walk and enjoy the day?" My feet hurt, I was tired, other people were stopping... but somehow I crossed that finish line and boy did it feel amazing.

I still can't believe that I really did it. I've never been a runner before; in fact I'm pretty sure that I've hated it for most of my life. This time was different. With the goal of crossing that finish line, I pushed myself to run when I didn't feel like it and become an athlete again. In many ways, training for a half marathon was one of the most inspirational challenges I've had. It's easy to look at the 12 week training schedule and think that you can't do it- especially that one week when I ran about 30 miles! If you take things one day at a time, however, somehow you get through it. And on race day, even if you have some jitters, that training helps you cross the finish line. I think that I gained a lot of mental strength and discipline during these past 12 weeks. Even more, I think that I have some inspiration for the tough year that lays ahead. Studying for my medical board exam isn't going to be pretty. If I take a practice exam today, I will undoubtedly fail, just like I would if I tried to run 10 miles on day 1 of training. The point I have to keep in mind this year and the years to come is to be patient, have faith, and take things in long strides... eventually I will get there. Or at least I hope!

A huge part of why I crossed that finish line, was my support system. To all my friends who wished me luck. To all those volunteers who were cheering on race day. To David for not letting me take a day off. And most of all to my parents. To my parents, than you for encouraging me to take a day off when I was too tired and crabby but thank you for supporting me even when I didn't. Thank you for being there for me cheering me on just like all the hundreds of swim meets. Thank you for believing that I could cross that finish line. Thank you for being there for me on race day. I know that your support will carry me through these next tough months. Thank you.

10 miles- I DID IT!

I finished my first double-digit run today!!!!!!! To make it more impressive, I ran it in a monsoon! Within the first 2 minutes of my run it started raining and never let up; I'm pretty sure the last half of my run was the worse rain that Cleveland has seen in awhile. I made it home and looked like I had been doing water aerobics in my clothes! I think that if I can complete a 10-mile run in a monsoon, I have a good chance of doing a half-marathon in better weather. :)

This past week has definitely been my hardest in training, both physically and mentally. It's really challenging to find the time for these long runs with school work, let alone to find the energy to finish the runs! With only three more weeks until race day, however, I feel like I have too much invested in training to give up now, despite how utterly exhausted I am. I'll make a compromise- if I'm very tired tomorrow from my 10 mile run, maybe I'll skip my 5 mile recover run to take a nice long bubble bath instead. :)

Keeping my fingers crossed that I will make it to Sept 9th!

olive + poison control

I just got off the phone with doggy poison control. Olive will be ok. Things this little troublemaker has ingested in the past 2 months: loestrin, caulking, paint, 409 cleaner, lots of toilet paper, her own poop (ew!), among many other things besides her dog food. What a troublemaker!! Luckily, she's doing just fine.

In other dramatic Olive news, she had surgery on Friday: total hysterectomy, ingrown thumbnail removal, and baby tooth removal. Eek. Luckily, despite her attempts to poison herself, she's doing just fine.

A few pics of Olive- she's getting so big (from 4.45lbs in April to 10.8lbs in August!)








A better update is on its way eventually:
1.) The new house
2.) How the summer went
3.) 2nd year so far (I'm in my second week already!)

Half Marathon in September!!

It's official! I signed up for the Chicago Half Marathon on 9.09.2007. Now I am starting my 6th week of training- half way there! Overall, training has been great. I wanted to use this summer to get in shape. This summer is our last one ever so I figured that this would be a great time to start a 12 week training program. And more than the freedom of summer, I wanted to have the opportunity to prove myself as an athlete again. After 2 years+ of not being on a team, I wanted to feel the pride of training for something again. Plus I had something to prove- that I could be a real athlete this time around. Since developing asthma last year, I really struggled with keeping up a workout regime. How do you know if you are pushing too hard and that you will exacerbate your asthma if, after years of being a varsity athlete, you have learned to push through the pain? For the past year, I really struggled with finding a balance between taking care of myself and managing my asthma. I hope to find that balance somewhere among these 12 weeks. Although I'm still not sure if I will be able to cross the finish line in 6 weeks, I've already ran further than I ever have before and I'm already so proud. That said, it would be GREAT if I made it to the very end. Wish me luck!

If you want to learn more about the half, click here http://www.chicagohalfmarathon.com/

Catchup pics

A pictorial mini catch up on my life since exams:

Olive knew something exciting happened- we were done with school! A celebratory dance/karate moves.

Our first weekend after exams and we headed out of Cleveland to relax at home in Michigan with my parents. Olive found a new best friend along the way and David caught his first salmon.

Survived one thing and rounds (life) continues

Ultimately, I survived my emotional and overwhelming shadowing experience in the ICU. Things got easier by the end of the week, but not by much. I guess I'm so used to that feeling of achieving and it was really hard for me to be put in a situation where I felt so worthless and useless: everyone knew infinitely more than me about everything. Instead of being humbling, it was initially incredibly crushing. For one of the first times, I realized just how much work awaits me in all the years to come and just how much more difficult each year will be compared to now. For the first time, I had thoughts of doubt: would I ever be able to manage the long road ahead, am I tough enough, am I smart enough?

I survived, without quiting medicine just yet, and met with my boss. When I told him how overwhelmed I felt after the ICU and how much doubt it put in my mind about medicine he showed genuine concern: "Natalia, you should be excited by how much the team knew, not intimidated. You will be just as smart if not smarter than them when you get to their year. Remember, medicine is an exponential learning process. Every project seems like too much when you try to take it all on at once. Same thing with medicine. Just focus on excelling now and the later will fall into place until you are the kind of physician that you are proud of." I have a great boss.

I look forward to going to the ICU in my clinical years of medical school when I will know a lot more than I did last week. I'm not giving up on medicine just yet because who am I kidding- I love this stuff.

ICU at the Clinic

This week, in addition to working on my research project at the Cleveland Clinic, I will be doing rounds in the ICU with the physician that I work under. It's only been two days and so much has happened so far. Maybe I have so much to reflect on because I've been removed from medical school for a month, or maybe I'm just seeing things that I haven't seen before. Regardless, it's worth quite a bit of reflection!

I go on rounds in the ICU, where my physician is treated like a mafia boss. The rest of us are below him: fellows, residents, interns, PharmDs, and lastly me. Each day, rounds happen in the morning to fill in the big physician with what has happened since he last left (and everyone else stayed up all night handling). On my first day, I was filled with excitement. I was going to be part of a medical team! Finally what I had been dreaming of this whole year: applying my knowledge to real patients! We started with a very ill patient, especially ill even for the ICU. I started to feel really comfortable and dare I say confident in my knowledge as I answered some of the questions that the big physician asked the team. I started thinking, "Hey I can do this! I actually know some of this!" I started answering questions about Fick's law, West zones, oxygen consumption, and hypoxic vasoconstriction; woa look at me was what I was thinking. As the physician started asking more challenging questions (that I felt less confident about answering), the lower levels of the team (interns, me) started to notice that the patients blood pressure (normal 120/80) had precariously dropped to 50/20 and was dropping despite pharmacological intervention. To my surprise, no one in the team was really surprised by this. Someone made a passing comment about how there was nothing else to be done, and ROUNDS CONTINUED AS THIS PATIENT DIED. I didn't know what to do with myself. Should I pretend that it's not a big deal that I was watching this woman pass away? Should I try and fit in with the more experienced team members by continuing to answer questions? Even though there was nothing that could have been done for this woman, I still struggled with how little care there was for this fact. THIS WOMAN IS DYING AND NO ONE IS DOING ANYTHING. No one was even holding her hand as she passed away. She died minutes later, without her family, and without anyone except for the nurse to record her passing. Rounds continued, we joked about the patient who tried to overdose on Viagra, and no one mentioned what had happened. I started thinking, how does one ever get used to this. Even more, how do you ever get to a point, where this patient's death doesn't affect anything? More so, is this something that I WANT to achieve through my training? We also met a patient who was under comfort care life support, there was nothing else to do to help him, because he wanted to wait for his son to fly in from Europe to see him before passing away. This was presented by one of the physicians as a matter of fact: son arriving today at 6pm, per patients wishes. Is it so wrong that I started thinking about this man's life, the son when get got the news that he would have to fly into the US to say goodbye? Am I too sensitive?


I survived the first day of rounds and looked up as much as I could before the next morning for rounds. Overnight four of the patients we had seen passed away. I couldn't even remember what they looked like. No thought was really paid, just a brief mention, and we moved on to the new patients admitted to the ICU. Although I didn't see anyone pass away this morning, two codes were called. These physicians really are "ON" all the time, making diagnoses then rushing off in an attempt to revive a crashing patient. A patient passed away before rounds began. The patient's daughters saw my big physician doing rounds and came up to him. In front of the entire team, these grieving patients attacked him telling him to "get that fat stupid smile off his face" and that "he should be ashamed to call himself a doctor." My physician, my boss, the mentor for the entire team just stood there and took the verbal abuse from these women who had lost their mother. All he said was "please do not raise your voice in the ICU." Even though I recognize that these women were searching for a way to deal with their grief, albeit through placing inappropriate blame, I was really taken back. My boss, one of the most decorated physicians in one of the world's best hospitals was being told off in front of HIS team of students and he didn't do anything. I was so uncomfortable to watch this happen. Once the women were removed from the ICU, rounds continued as usual as if nothing had happened. I couldn't help but wonder, what kind of profession IS THIS? Where the most successful physicians who have dedicated decades of their life to their career still get insulted? It must have taken so much humility and profesisonalism for my boss to handle the situation the way that he did. And yet, I doubt I would be able to do the same, even after all the years of training to come!

Goodness! And I still have the rest of the week to go in the ICU! Keep your fingers crossed!