Mile 14020 + 2482.6: Main Street

Above: Americana at its best. The aluminum-sided diner on a business-lined Main Street. Red Robin Diner, Johnson City, NY.

BACK TO THE
BIG CITY LIFE.

... more on that in a bit.

My four weeks in February were my first four weeks ever in New York. And to many people, when I mentioned that I was in New York, the first thing they ever thought was "New York City." And I was like no, there's more to New York than NYC. But I can understand, with NYC's metro area being almost twice the size of Illinois as a state itself in terms of population, there can't be much more. But to me, a traveling Midwesterner, I had to explore the world of upstate NY for myself.

So after four-weeks in the flat-land of Decatur, I found myself in Johnson City, New York. It was quite a change, being amongst the hills of the Appalachians, but I found it quite enjoyable. A part of me wished I could ski, so I could go up and take advantage of the hills, but I'll be honest, the beauty of the area was just awe inspiring. It was my first time to the Northeast ever, but the hospitality of New York State made my stay quite memorable (not to mention having someone at church giving me a genuine hug before a week before I hit the road!). Binghamton was one of the cities that had a culture and identity of its own while combining a small-town feel into the variety of things to do in a bigger town.

However, I wasn't there to simply enjoy myself. I had an Internal Medicine Subinternship to accomplish. A new routine had to be learned, but I was pleased I got to work with two groups I had limited interactions with in my past: 1) U.S. medical students - I had some experience with them in OB, but not as closely as I did here. 2) Osteopathic medical students and residents. As for the latter, I took advantage of my four weeks, and got to watch what made them exactly "different."

And to be truthfully, during rounds and having discussions, there wasn't much different there. So I asked one of the residents that I worked with, "What makes osteopathic medicine, osteopathic?" And all of a sudden, I found myself doing a process called "rib raising" on a patient with a ventilator. The philosophy (and forgive me if I get it wrong me being an allopathic student) is to give more room for the lungs to breathe air by increasing the space between the scapula and the spine. A very cool thought. I saw other osteopathic manipulations that involved very fine finger dexterity and sensation that I could only see years of practice mastering. I really enjoyed I could learn something new over the last 4 weeks, as I don't think there's only one right way to master the art of medicine. Somehow we all have an approach that works, and as doctors, we stick to it.

But one thing that I noticed about my 8 weeks on the road, was the value of overnight call. Yes, I would end up tired and pooped after 24-30 hours on board, but then I would realized the value of staying up. To interview patients and get those History & Physicals of unique in-the-middle-of-the-night cases was amazing. I remember in both the ERs of Decatur and Binghamton, I'd stand there at 3 AM figuring out how I should attack the history of a patient. Perhaps it was the novelty or even the academic satisfaction of getting my brain to work at such an early time in the morning. I learned a lot during those hours in the morning, and that's something I'm thankful for.

Now, my drive has brought me to the world of Columbus, Ohio. Where I'm doing ICU. More on how this rotation has a different way of looking at patients in my next entry.

Mile 13624: Final Push

Above: Team "Kentucky Fried" takes one final shot. December 2010.

PUUSSHHH!!!!

Being on call has become a routine for me. Every fifth day during my rotation, my partner and I end up staying 24 hours at the hospital "on call" in the Labor & Delivery Ward. We're responsible for admitting patients in labor, writing their history & physicals and to observe / assist with deliveries. Sounds hectic, but yet over the 6 1/2 calls I have had over the last 6 weeks, there was none more busy than my final day. However, that doesn't mean that the night was tiring beyond measure, as I found the pace of this call exhilarating. I found myself in synchronization with three other nurses saying "push!" to get a mom to finish her delivery and even was treated to a "fourthmeal" along with the nursing staff underneath our attending doctor's tab.

I'll be honest, a quarter pound burger along with a frozen non-alcoholic lemonade sits pretty well when being on call.

However, even after not having busy calls, that night was our "test" to see how much we learned through the deliveries that we had over the calls in the past weeks. And that's something both my partner and I both noticed: we learned a lot simply by observation (and much more than we give our eyes credit for). With the help of our attendings and our past memory, we were able to position the baby's head on its exit from the vaginal canal, deliver placentas, and even coach the mom through her contractions.

I'll admit that it is really invigorating and exciting to do the coaching. I've always seen it on telemagazines and on TV shows, but when actually doing it, it feels quite different. Coaching seems to be one of the most important parts of delivery, as I see how good coaching can result in much more efficient pushing and quick delivery of the baby.

Okay... 10 seconds... Let's go!.... Come on back into it, take a deep breath, give me 10 more seconds... you can do it!

I really loved the OB portion of my rotation. There's always some type of joy associated with delivery, and it brings a type of doctoring where instead of dealing with something that holds back our own lives (the loss of health), OB most of the time brings happiness and its not just to the mother but to the baby's family. This was best seen midday, when one of the nurses yanked my partner and I out of the nursing station simply to do "rounds" consisting of delivering a muffin-top birthday cake and 2 glasses of "fake champagne" (aka sparkling grape juice) to each mom with a newborn that day and singing "Happy Birthday" to each new baby boy and girl. We did 9 newborns that day, and it felt very rewarding.

Even in a world where malpractice could be scary, I can definitely see the light that OBGYN doctors see that motivates them to do their work everyday.

---

Forgive me for not writing for the last month. I'll admit the hectic schedule of OB has held back my ability to stop and think and write. However, I was able to see a side of my OBGYN rotation that is more applicable to anyone in every field, and I'm thankful to have an attending that was inspirational as the one I had to show me it. More on that in the next entry.

Mile 12056: First On-Call

Above: Almost a perfect shot on my "adopted sister's" final night in town. Replace that lightbulb, Chicago! November 2010.

SOMETIMES THE UNEXPECTED
JUST HAPPENS.

This week, I began my OBGYN rotation at St. Anthony Hospital in Chicago, IL. There's a group of 10 students working what has been nomered as a q5 schedule. A typical stretch of days include clinic, surgery, more clinic, call, and post-call. Call and Post-Call add up together for a 24 hour time shift from 6:30 AM - 6:30 AM the next day.

And that's exactly what I just went through.

I'll admit that call does have its pros and cons. Let's start with the cons first, because I personally think they won't outweigh the pros. There's less sleep (and odd patterns of it) and an acquired horrible diet (100% fresh pure high-fructose corn syrup in my Crush Orange Soda to start off my day and a nurse offered me chili cheese fries for the night).

Then there's the pros that make call kinda cool: A nifty on-call room (with a comfy bed and a small flat-screen TV). My crush soda (along with the rest of my on-call meals) were taken care of with meal cards. Hanging out with a cool nursing, midwife, and medical staff when there was a long period of downtime. An awesome resident who took the downtime to teach us.

However, the big win of the night occurred early in the morning almost 24 hours after my first call, when my partner shot me a call on my cell phone that woke me out of my trance of sleep in the on-call room. "The doc's here, just wanted to let you know so you won't miss the delivery." So within 10 minutes I was upstairs. I had taken the patient's H&P earlier that night (looked like labor was going to move on smoothly), and hit the sack rather worried about not getting to see a birth that night.

And here I was scrubbed up with the doctor, and the whole experience just went by so quickly. For me as a new medical student, the novelty was definitely there and made every single moment from scrubbing up to catching the baby to waiting for the placenta to come out post-partum exciting. I was glad I had an attending who was willing to trust me to guide me throughout the process. It felt really awesome to participate in the joy with the family & parents that were there.

So here I am, typing up this entry after just ending my shift (a little of editing at home led to a later release). In a discussion I had with my partner in the elevator post-call, we came to an agreement saying that although call is so tiring, a call experience is very rewarding and very cool (although doing too many calls I think makes the novelty wear off). Both my partner and I delivered for the first time today. It totally takes technique and practice, but with the joy brought of making a new boy or girl make it into the world, to me, there can be nothing more motivating to perfect my delivery skills & knowledge as much as I can in the next 6 weeks.