Mile 3187: Stand Up

Above: April 2010. Our wonderful crew & one of our attendings for the last two weeks.

GET UP... STAND UP...
STAND UP FOR YOUR RIGHT.
Bob Marley

I have something to admit. I'm a frequent second guesser. I know. It's a bad habit. I gotta quit... I'm working on it.

I'm coming up on the last day of these past two weeks. From my last entry you've seen I've had many firsts at the clinic we're working at. Our past Wednesday was one of the busiest we've seen, and at the end of the day we found ourselves sitting on those big fluffy couches, simply tired. Our attending (different from last time), comes in, pulls up a roller chair and starts to talk to us.

His words were quite simple, but they were encouraging. He said to us that our team (the one pictured above) pulled in quite a huge amount of patients for such a short time period, much more than previous teams he had worked with. We had worked efficiently and hard to accomplish a lot. Then he told us some good advice, advising us to start defending our decisions. I forgot his exact words, but from what I remember, it made lots of sense: the only way that us students will learn is if we take our own positions and defend them as well as we possibly can.

It comes down to a concept that I've been trying to work on all along: making medicine my own. There's a lot of data, opinions, and options out there in the medical field. But in order to learn, I need to interpret and make sure I can be competent in taking whatever is best and applying it to the decisions I make for my patients. Each patient that I'm put in charge of is my responsibility... if someone tells me or tries to do something that stands in the way of my approach to the patient, I need to be secure about my decisions. Otherwise, something might go wrong, just when the ability to control the situation slips out of my own hands.

So I need to stop second guessing. The physician's assistant (PA) that was working with us told me that she saw no reason for me to overthink, and to pick up that confidence to make solid decisions. With 2 more weeks in the rotation to go, I'll give that my best shot, with some motivation from her encouragement.

So, to Eric, Faith, Vanessa, Melissa, Veronica, and Shannon, thanks for being a great team. To our attendings at the clinic, Dr. S., Dr. G., and Dr. M., thanks for all your support to us. Finally, to the people at the shelter we serve, thanks for all your trust.

Mile 3166: Firsts

Above: May 2009. First time I ever popped an umbrella with Mary Poppins. I hope there'll be a second time.

THERE'S ALWAYS A FIRST
FOR EVERYTHING.

Last week was filled with a bunch of firsts. Here's five.

1. FIRST BLOOD DRAW.
Blood drawing can be intimidating for all the parties involved. On the patient end, seeing needles and blood is not exactly a pleasant sight. On the doctor end, it can be scary to not find a vein or take a wrong approach to inserting the needle, as both may cause discomfort to the patient. Adding both can lead to a stressful situation, but with the help of the patients in the chair, it made my experience much more inviting.

"If I can be the guinea pig and can handle being drawn blood from all of these sites, you can do it," one of the patients told me. I came out clean and was honest about telling the patient this was my first time. Tourniquet on. Search for vein. Spotted. Alcohol swab. Swished it around. Insert needle. Tube in. A flash of crimson blood entered the tube and it began to fill. I thank the patient in the chair for making my first try successful. I guess the first time isn't so bad with the right support.

2. FIRST FETAL OCCULT BLOOD TEST.
Okay, I'll skip the details, but we had to analyze for blood in a patient's stool to eliminate the possibility of any GI conditions. When our attending requested someone to do it, the hand that always gets me in trouble went up in the air. I soon was in to get the sample. This first showed to me that after the first time, its easy to get into the rhythm of things. Sometimes, exposure to the extreme is just what one needs to cross barriers.

3. FIRST PAP SMEAR ASSISTING.
I wanted to say "actual pap smear," but this was simply an assist. Getting a pap smear is intimidating for a male-doctor-in-training, for obvious reasons. But with the help of four other female doctors & nurses in the room, I was able to get through it. A complex process if done by self, but hopefully I'll be able to be in the hot seat with my awesome support team finally this week to try one.

4. FIRST TIME IN COUNSELING MODE.
I won't get too much into the story here, partially because of HIPAA and second because most of the situation occurred in Spanish (a lot more than Señor Fixity-Fix-It below). But I learned today that there are times that it is okay to step across the professional barrier, and not call someone by last name and to be honest about what's going on.

A lot did go over my head during the patient interaction, with some translated by an accompanying PA in the room. However, with even the little I knew, I went ahead, was honest, and told the patient, "No hablo mucho español, pero cree que eres un hombre/mujer fuerte. Puedes hacer todo,"* the reply of "Gracias" and a smile made me know that I connected with the patient when I needed to. I'm a sucker for emotional moments, but they're one of the most beautiful things about life.

*Translation: "I can't speak much Spanish, but I think that you are a strong man/woman. You can do everything."

5. FIRST BERRY & OREO ICE CREAM COMBO AT COLDSTONE CREAMERY.
One word: simply amazing. Okay, that's two, but that's how good it was... especially after enjoying the new movie release Kick-Ass.

And with all these firsts, I hope there will be seconds.

Shortie: Mile Zero

Above: My odometer start mark for my journey. Forgive the 0.1 on the trip counter - that was from the gas station. As for the seatbelt light - Contrary to the indicator, I do wear a seat belt regularly.

O' MEDICINE,
HERE IS WHAT I EXPECT O' THEE.

As I'm embarking on this second half of medical school, I've given great thought as hwo to approach the clinical side of medicine. I'm going to be expected to do things underneath objectives, rubrics, and my attending doctor's expectations. Well, I'm going to turn it around and put down here what my current expectations are for my next 2 years of medical school and residency. I understand that sometimes these expectations may not be met, but I want the best out of my education and want to be worked to my fullest potential.

Here they are (in short):
1. I want to be challenged (Please, no cakewalks!).
2. I want to experience the roller-coaster of emotions that doctors face day-to-day.
3. I want to interact with patients and staff first-hand.
4. I want to experience a variety of cases, from the most common to the most rare.
5. I want my experiences in medicine to be enjoyable.

Many of my following blog entries may deal with these expectations (and others I might come up with in the future too). And with that, the second half begins. My first stop for three weeks: Jackson Park Hospital in Chicago, Illinois for the first half of my Pediatrics Core rotation.

May the adventure continue... and start that odometer.

Shortie: Accumulating the Miles

Above: Summer 2009. my 2002 Ford Focus with 22500+ miles on it.

ROADS? WHERE WE'RE GOING...
WE DON'T NEED ROADS.

Wrong, Doc Brown. For my adventure we're going to need them, and lots of them.

Starting February 15th, you'll start to hear about some of my adventures on the wards. I'll be honest: I think its too cliche to measure an adventure by days, so I'm going to go out on a limb and do it in miles. You see, my Ford Focus is 7.5 years old and has been to many places and been through many things (inclusive of: high school prom, Walt Disney World, college, weddings, blizzards, and even into stupid potholes). However, even with all that, my car still just has over 22,500 miles on it (as I've been away from the U.S. for a while). So, to me, as much as this will be important for my car to get the miles, I see my clinical years as a rite of passage, as with each mile I get on my car, I'm a mile closer to getting my M.D. and hopefully my residency.

Most of my drives will be commuting, but there will be others which will be much more than that. So... Stay tuned. We'll get that odometer running soon.